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Background
Leadership competency is required throughout nursing. Students have difficulty understanding leadership as integral to education and practice. A consistent framework for nursing leadership education, strong scholarship and an evidence base are limited.Purpose
To establish an integrated leadership development model for prelicensure nursing students that recognizes leadership as a fundamental skill for nursing practice and promotes development of nursing leadership education scholarship.Method
Summarizing definitions of nursing leadership, conceptualizing leadership development capacity through reviewing trends, and synthesizing existing leadership theories through directed content analysis.Discussion
Nine leadership skills form the organizing structure for the Nursing Leadership Development Model. Leadership identity development is supported via dimensions of knowing, doing, being and context.Conclusion
The Nursing Leadership Development Model is a conceptual map offering a structure to facilitate leadership development within prelicensure nursing students, promoting student ability to internalize leadership capacity and apply leadership skills upon entry to practice. 相似文献3.
Beth E. Burbach Leeza A. Struwe Lufei Young Marlene Z. Cohen 《Journal of Professional Nursing》2019,35(1):44-50
Background
Simulation plays a vital role in nursing education, however, modifiable factors influencing students' simulation performance have not been sufficiently examined. The purpose of this study was examine relationships among anxiety, self-efficacy, nursing knowledge, and performance during simulation.Methods
The study used a mixed-methods design. Anxiety, self-efficacy, academic achievement, and performance during simulation were measured quantitatively; correlations between key variables were calculated. Qualitative data were collected during post-simulation debriefing and triangulated to inform quantitative findings.Results
Significant relationships were identified between knowledge of nursing care and simulation performance. Student qualitative reports of heightened anxiety and lack of confidence and uncertainty contrasted from quantitative measures. Potential reasons for this finding were explored.Conclusions
The relationship between knowledge of nursing care and simulation performance supports the effectiveness of simulation as a means to evaluate the application of knowledge in a clinical laboratory setting. Further research is needed to explain the complex relationships between anxiety, self-efficacy, and performance during simulation. 相似文献4.
Martín Otero-Agra Antonio Rodríguez-Núñez Ezequiel Rey Cristian Abelairas-Gómez Iker Besada-Saavedra Ana Pilar Antón-Ogando Sergio López-García José Luis Martín-Conty Roberto Barcala-Furelos 《The American journal of emergency medicine》2019,37(1):100-108
Objective
To evaluate the biomechanical aspects involved in Cardiopulmonary Resuscitation's compression depth by children.Methods
A randomized crossover study with 196 children between 9 and 14?years-old was conducted. The children performed four CPR hands-only tests of 1?min in four different heights (floor, 5?cm, 10?cm, and 15?cm). Anthropometric, angulation and quality of CPR variables were registered during the tests.Results
CPR quality was sub-optimal in all tests. Tests with the simulated victim placed on the floor had the best compression quality. Children that made deeper compressions had significantly higher values in all anthropometric variables. Analysis gives more discriminatory power to the anthropometric variables than angulation variables on compression depth.Conclusion
Chest compression depth obtained by children depends more on their anthropometric characteristics than on their body position. The approximate age to perform compressions with an acceptable quality is 12?years-old. The use of steps increased arm angle, getting it closer to 90° but did not increase quality CPR when compared with performance on the floor. 相似文献5.
Background
Violence is a large concern for mental health professionals: 90% of physicians and nurses working in mental health areas have been subject to violence from patients. Approximately 80% of violent acts from patients are directed toward nurses.Objective
The purpose of this integrative literature review was to identify violence risk–assessment screening tools that could be used in acute care mental health settings.Design
The Stetler model of evidence-based practice guided the literature search, in which 8 violence risk–assessment tools were identified, 4 of which were used for further examination.Results
The Brøset Violence Checklist and Violence Risk Screening-10 provided the best assessment for violence in the acute care mental health setting.Conclusions
Using a violence risk assessment screening tool helps identify patients at risk for violence allowing for quick intervention to prevent violent episodes. 相似文献6.
Sandra Cristina Pillon Kelly Graziani Giacchero Vedana Jessica Adrielle Teixeira Leonardo Afonso dos Santos Roberto Molina de Souza Alessandra Diehl Goolam Hussein Rassool Adriana Inocenti Miasso 《Archives of Psychiatric Nursing》2019,33(1):70-76
Aim
To investigate the prevalence of depressive symptoms, psychological problems, suicidal behaviour and their associations in substance users in treatment.Methods
A cross-sectional study, with 307 substance users in an out-patient treatment facility, was undertaken. Socio-demographic data, psychoactive substances used, depressive symptoms, and suicide information were obtained.Results
70% of participants were depressed; of those, 8.1% were either under the influence of drugs or in withdrawal. Suicidal ideation was found to be present in those who had anxiety, were nervous, had depressive symptoms, or were under drug influence or in withdrawal.Conclusion
It is important to identify potential suicidal risk factors and implement the management of these conditions in substance users. 相似文献7.
Mollie E. Aleshire Alexandra Dampier Leslie Woltenberg 《Journal of Professional Nursing》2019,35(1):37-43
Background
Nursing students' attitudes related to health care teams in the context of interprofessional education (IPE) and the impact of these attitudes on IPE and future practice are not fully understood.Purpose
The current study assesses baccalaureate nursing students' attitudes toward health care teams and evaluates if these attitudes have changed after completion of a nursing course focusing on health care systems from an interprofessional perspective.Method
A convenience sample of 116 undergraduate nursing students in a required interprofessionally-focused course was invited to participate. The Attitudes Toward Health Care Teams Scale Quality of Care subscale (ATHCT-QC) and Team Understanding Scale (TUS) were employed via a pretest-posttest design. Paired samples t-tests were conducted to compare mean scores.Results
Ninety-five respondents (81.8%) voluntarily participated at the beginning and conclusion of the course.Conclusions
There were no significant differences between pretest-posttest attitudes toward interprofessional health care teams. Nurse educators must create and evaluate innovative IPE interventions to enhance students' preparedness to be effective interprofessional health care team members. 相似文献8.
Georges Ambaraghassi Claire Béliveau Annie-Claude Labbé Christian Lavallée 《Diagnostic microbiology and infectious disease》2019,93(2):136-139
Objective
In an era of rising healthcare expenditures, it is critical to find ways to decrease cost. The objective of this study is to evaluate the number of repeated tests and the associated cost savings in a university-affiliated hospital.Methods
The following 7 microbiology analysis were assessed for nonrepeat testing: HCV antibody, HBV core antibody, CMV IgG, rubella IgG, Treponema pallidum antibodies, Clostridioides difficile toxin detection, and vancomycin-resistant enterococci PCR. Presence of a prior positive result leads to the cancellation of subsequent orders.Results
Percentages of not repeated test ranged from 0.1% to 21.4%. Rubella IgG had the highest proportion of unnecessary repeat testing. Total cost savings were estimated at $33,627 for 2016.Conclusion
Unnecessary repeated microbiologic test can account for a non-negligible part of total volume test. Use of an automated software to detect unnecessary repeated microbiologic test through laboratory information system can generate important savings. 相似文献9.
Martina Beckman Matthew C. Washam Barbara DeBurger David B. Haslam Joshua D. Courter Heidi Andersen Joshua K. Schaffzin Michael J. Tchou Andrea Ankrum Joel Mortensen 《Diagnostic microbiology and infectious disease》2019,93(3):191-195
Background
Targeted antimicrobial therapy can reduce morbidity in patients with sepsis. Molecular methodologies used in the clinical laboratory can provide information about infectious agents faster than traditional culture methods. Using molecular information to make clinical decisions more quickly has been shown to improve patient outcomes, and reduce length of stay and healthcare cost in adults. Its effect on pediatric care is less well described.Methods
Blood cultures growing Gram-positive cocci or Gram-positive bacilli on Gram stain were evaluated by molecular and traditional methodologies. Results from the molecular platform, Luminex Verigene® Blood Culture – Gram-positive Panel (BC-GP) were compared to results from standard culture and susceptibility testing (Vitek? MS, Vitek?, E-test®). Overall statistical agreement is evaluated.Results
1231 positive pediatric blood cultures grew single isolates detectable by the BC-GP panel. 899 were correctly identified to species, 282 to genus, 50 isolates were not detected. All organisms detected by BC-GP that grew in single isolate cultures were identified as the same organism by Vitek? MS with the exception of 7 organisms.112 cultures were found to have polymicrobial growth of Gram-positive organisms. Excellent overall agreement was noted for antimicrobial resistance markers with only 5 samples displaying discordant results.Discussion
In general, clinicians can use the identification and antimicrobial resistance marker data gained from Luminex Verigene® BC-GP with confidence to alter empiric coverage. Rare instances of disagreement with traditional culture data led to maintaining the empiric clinical approach and did not result in patient harm. 相似文献10.
Early diffusion-weighted imaging and outcome prediction of comatose survivors after suicidal hanging
Dong Won Choi Suk Woo Lee Seong-Hae Jeong Jung Soo Park Hoon Kim 《The American journal of emergency medicine》2019,37(1):5-11
Purpose
Early outcome prediction after suicidal hanging is challenging in comatose survivors. We analysed the early patterns of brain diffusion-weighted magnetic resonance imaging (DWI) abnormalities in comatose survivors after suicidal hanging.Methods
After suicidal hanging, 18 comatose survivors were prospectively evaluated from January 2013 to December 2016. DWI was performed within 3?h after hanging in comatose survivors. We evaluated Utstein style variables and analysed abnormal spatial profile of signal intensity on DWI, brain apparent diffusion coefficient (ADC) values, and qualitative DWI scores to predict neurological outcomes.Results
All hanging associated cardiac arrest (CA) patients demonstrated bad neurological outcomes; 80% of non-CA comatose patients experienced good neurological outcomes. In hanging survivors with CA, cortical grey matter structures and deep grey nuclei exhibited profound ADC reductions and high DWI scores within 3?h after hanging, which was associated with diffuse anoxic brain damage with poor cerebral performance categories scores. CA comatose survivors had significantly lower ADC values and higher DWI scores compared to non-CA comatose survivors in the cortex and deep grey nuclei.Conclusion
Although the presence of CA is the most important clinical prognosticator in hanging-associated comatose survivors, HSI abnormalities and low ADC values in the cortex and deep grey nuclei on DWI performed within 3?h after hanging are well-correlated with unfavourable outcomes regardless of therapeutic hypothermia. Therefore, early DWI may increase the sensitivity of poor outcome prediction and may be an effective combinatorial screening method when available prognostic variables are not reliable or conclusive. 相似文献11.
David C. Mackenzie Aftab M. Azad Vicki E. Noble Andrew S. Liteplo 《The American journal of emergency medicine》2019,37(1):123-126
Objective
We sought to determine test performance characteristics of emergency physician ultrasound for the identification of gastric contents.Methods
Subjects were randomized to fast for at least 10?h or to consume food and water. A sonologist blinded to the patient's status performed an ultrasound of the stomach 10?min after randomization and oral intake, if applicable. The sonologist recorded their interpretation of the study using three sonographic windows. Subsequently 2 emergency physicians reviewed images of each study and provided an interpretation of the examination. Test performance characteristics and inter-rater agreement were calculated.Results
45 gastric ultrasounds were performed. The sonologist had excellent sensitivity (92%; 95% CI 73%–99%) and specificity (85%; 95% CI 62%–92%). Expert review demonstrated excellent sensitivity but lower specificity. Inter-rater agreement was very good (κ?=?0.64, 95%CI 0.5–0.78).Conclusion
Emergency physician sonologists were sensitive but less specific at detecting stomach contents using gastric ultrasound. 相似文献12.
Josh Greenstein Devjani Das Josie Acuna Monica Kapoor Cara Brown Abbas Husain Brendan Lally Barry Hahn 《The American journal of emergency medicine》2019,37(2):313-316
Background
In the emergency department, rib fractures are a common finding in patients who sustain chest trauma. Rib fractures may be a sign of significant, underlying pathology, especially in the elderly patients where rib fractures are associated with significant morbidity and mortality. To date, no studies have evaluated the ability of ultrasound to detect rib fractures using cadaver models and subsequently use this model as a teaching tool.Objectives
The purpose of this study was to determine if it is possible to generate rib fractures on cadaver models which could be accurately identified using ultrasound.Methods
This was a cross-sectional study performed during one session at a cadaver lab. A single hemithorax from four adult cadavers were used as models. Single rib fractures on each of rib five through eight were created. Four subjects, blinded to the normal versus fractured ribs, were asked to identify the presence of a fracture on each rib.Results
A total of 8 of 16 potential ribs had fractured induced by study staff. Mean accuracy was 55% for all subjects. The overall sensitivity and specificity for detecting rib fractures was 50% (CI: 31.89–68.11) and 59.38% (CI: 35.69–73.55) respectively. The overall PPV and NPV was 55.17% and 54.29% respectively.Conclusions
In this pilot study, subjects were not able to detect induced rib fractures using ultrasound on cadaver models. The use of this model as a teaching tool in the detection of rib fractures requires further investigation. 相似文献13.
Background
Liaison psychiatry nurses in Emergency Departments assess and plan onward treatment for individuals, often following self-harm or suicide attempts. These nurses are at high risk of occupational stress. Reflective practice groups may be beneficial, but there is currently no research evaluating this.Aim
We explored nurses' experiences of attending psychology-led reflective practice groups.Method
Thematic analysis of semi-structured interviews with 13 nurses was undertaken.Results
Four themes emerged from the data: (i) Sharing and learning; participants discussed how the group provided a platform to share common experiences, express emotions and learn from each other. (ii) Grounding and perspective; participants said the group encouraged reflection on the impact of their work, with a sense of valuing their skills and the difference they make. (iii) Space; participants spoke about the group being a protected, structured and safe space. (iv) Relationships; participants said the group allowed them to support each other and have conversations in a sensitive and non-threatening way. Discussions in the group increased some participants' confidence and self-esteem.Discussion
Some nurses perceive a range of benefits from participating in reflective practice groups.Implications for practice
For some mental health nurses reflective practice groups are an acceptable and valued intervention which may reduce burnout. 相似文献14.
Background
Within nursing education research, protection of students as human subjects must be the highest priority. This protection can be provided via student anonymity. A subject-generated identification code, comprised of responses to a series of questions, can link data across time points while protecting student anonymity.Method
Two studies, focused on palliative care education, used a subject-generated identification code to link student data across multiple time points. Refinements to the code were made between studies to further enhance anonymity and response consistency.Results
The subject-generated identification code fostered linking of student responses across three time points in study one and two time points in study two.Conclusion
There are many benefits to utilizing a subject-generated identification code in nursing education studies. Researchers must consider the need for a data management expert and balancing transposition errors and the power to differentiate between responses. 相似文献15.
Amelia Nelson Gregory Kelly Richard Byyny Catherine Dionne Candice Preslaski Kevin Kaucher 《The American journal of emergency medicine》2019,37(2):344-348
Introduction
Acute ischemic stroke is a leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.Objective
This review evaluates literature and utility of tenecteplase for treatment of acute ischemic stroke.Discussion
Tenecteplase is modified, third generation fibrinolytic with greater specificity for fibrin bound clots. Current data in acute myocardial infarction suggest decreased bleeding events compared to alteplase. Multiple trials have investigated superiority of tenecteplase compared to tPA for treatment of acute ischemic stroke. Current guidelines designate tenecteplase as an alternative treatment for mild acute ischemic stroke patients based on recent literature.Conclusion
Recent emerging literature and limited recommendation guidance from governing medical societies leave many emergency medicine providers to weigh benefit versus risk of fibrinolytic therapy and tenecteplase's place in therapy. This review evaluates the available literature regarding tenecteplase and its utility in the treatment of acute ischemic stroke patients. 相似文献16.
Objectives
This study examined the incidence of symptomatological post-traumatic stress disorder (PTSD) in bereaved Tibetan adolescents 3?years after the 2010 Yushu earthquake, then to identify possible and relational risk factors of PTSD by a cross-sectional study.Methods
A total of 867 bereaved Tibetan adolescents seriously impacted by the 2010 earthquake were investigated. Symptomatological PTSD was evaluated by the PTSD Checklist–Civilian Version. And coping styles were evaluated by the Coping Styles Scale. Exposure of trauma to the 2010 Yushu earthquake was evaluated by a checklist about earthquake containing sociodemographic variables.Results
3?years after the Yushu earthquake, 24.4% of the bereaved Tibetan adolescents had symptomatological PTSD. The results also indicated that coping styles and disaster-related experiences after the 2010 earthquake were connected with PTSD among survivors. When the 2010 earthquake struck, those having symptomatological PTSD were more probably to be buried/injured/amputated, and to witness burial/injury/death, and to have property damage. An individual who adopted positive coping skill was probably to have less symptomatological PTSD.Conclusions
The results showed that the existence of PTSD in bereaved Tibetan adolescents in the Yushu earthquake was very prevailing after 3?years. Effective psychological rescue work should be carried out, especially targeting bereaved Tibetan adolescents with more severe PTSD. 相似文献17.
Background
Schizophrenia is a chronic mental illness that affects the client, family, and community. Nurses are educated to use the nurse-patient relationship to provide health education and collaborative health decision-making. However, challenges abound for nurses and clients with schizophrenia to effectively utilize the relationship to reach these goals.Problem
There is a lack of evidence-based information to assist nurses to meet the challenges of building effective therapeutic relationships with clients for whom schizophrenia hinders health education and decision-making.Purpose
To examine current research findings on factors that influence therapeutic relationships in psychiatric treatment settings as an initial effort to provide empirically based guidance for psychiatric nurses who seek to better use the relationship to work with the client toward health-related goals.Method
This integrative review of the literature follows Whittemore and Knafl's (2015) method, analyzes 15 studies from multiple databases between the years 2006–2017, and assesses the rigor of each.Findings
Numerous methods are used to assess therapeutic relationships. Few studies included nurses. Provider perception of client symptoms can negatively affect provider assessment of quality of relationship; no such association was found on the part of clients. Providers and clients prioritize client needs differently, with providers influenced by treatment setting demands, but provider-training programs can have a beneficial effect on their relationships.Conclusion
Nurses and nurse educators can use the findings to guide assessment of how perceptions and priorities influence relationships. Findings also provide the foundation for further study of nurses' perceptions of therapeutic relationship, in progress, to yield more detailed information on what nurses and educators need to strengthen therapeutic relationships. 相似文献18.
Brian W. Gilbert Joel B. Huffman Joe Slechta Christine Porter John M. Gallagher 《The American journal of emergency medicine》2019,37(2):294-297
Objective
The objective of this study was to evaluate a new multidisciplinary process in which intravenous alteplase (tPA) waste, used for acute ischemic stroke (AIS), was salvaged in an attempt to maximize cost effectiveness without impacting door-to-needle (DTN) administration times.Design
This was a retrospective cohort between May 2017 and February 2018. The primary endpoint evaluated for this study was the total tPA salvaged and total cost savings in U.S. dollars. Secondary endpoints evaluated included overall DTN time in minutes.Setting
Emergency department of a primary stroke center.Patients
A convenience sample of sequential adult (>18?years) patients who received tPA in the ED for AIS were included for analysis.Interventions
New stroke process which involved bedside mixing of tPA and salvaging of excess waste in the main central pharmacy.Measurements and main results
A total of 50 patients were included in the final analysis. There were 25 patients included in the new process and old process groups respectively. A total of 605?mg of alteplase was salvaged from 25 patients in the new process group which was associated with an estimated cost savings of over $120,000 annually. Patients in the new process group had statistically faster average (52?min vs. 60?min; p?=?0.01) and median (50?min vs. 58?min; p?=?0.03) DTN administration times.Conclusion
Preliminary data, in this pilot study, utilizing a multidisciplinary model for tPA administration led to significant cost savings of tPA and decreases in overall DTN administration times. 相似文献19.
Gloria McKee-Lopez Leslie Robbins Elias Provencio-Vasquez Hector Olvera 《Journal of Professional Nursing》2019,35(2):112-119
Background
Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood.Purpose
To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression.Methods
211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout.Results
The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males.Conclusion
Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services. 相似文献20.
Jenna Garlock Leborah Lee Michaelia Cucci Lawrence A. Frazee Chanda Mullen 《The American journal of emergency medicine》2019,37(5):884-889