Comparisons of self-ratings on managerial competencies,research capability,time management,executive power,workload and work stress among nurse administrators

Aims To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Background Although NAs require multifaceted managerial competencies, research related to NAs’ managerial competencies is limited. Method A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. Results All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. Conclusion The present study provides recommendations for future administrative training programmes to increase NAs’ managerial competency in fulfilling their management roles and functions. Implications for Nursing Management The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.     

Effects of Procainamide and Lidocaine on Defibrillation Energy Requirements in Patients Receiving Implantable Cardioverter Defibrillator Devices

Effects of Procainamide and Lidocaine on Defibrillation. intntduction: In acute canine studies, lidocaine. but not prucainamidc, increases defibrillation energy requirements. We evaluated the effects of lidocaine or procainamide on defihrillation energy requirements in 27 patients undergoing intraoperative testing fur implantable cardioverter dcfibrillator device placement.
Methods and Results: Patients were tested off antiarrhythmic drugs and again following either lidocaine (200 to 250 mg loading and 3 mg/min maintenance infusions) or procainamide (1 gm loading and 3 to 4 mg/min maintenance infusions). The defibrillation testing protocol consisted of initial testing at 15 J, followed by higher or lower energies to determine the lowest energy producing three consecutive successful defibrillations. Overall, the mean defibrillation energy increased from 14 ± 5 J to 18 ± 7 J during lidocaine (plasma concentration 5.1 ± 1.6 μ/mL; P < 0.02) but were similar at baseline (12 ± 5 J) and during procainamide infusion (13 ± 6 J) (plasma concentration: procainamide 10.7 ± 7.2 μ/rnl.; N-acetyl procainamide 1.0 ± 0.4 μ/niL). A positive linear correlation was found between lidocaine plasma concentration and percent change in defibrillation energy (lidocaine: r = 0.61; P = 0.01). Procainamide raised the defibrillation energy in three patients, two with supra therapeutic plasma concentrations. The increase in defibrillation energy equaled or exceeded 25 J in four patients after lidocaine and in one patient after procainamide.
Conclusion: The data suggest that at high plasma concentrations, lidocaine and procainamide adversely affect defibrillation energy requirements consistent with an adverse, concentration-dependent effect of sodium channel blockade on defibrillation energy requirements in patients.     

Dobutamine stress echocardiography compared with dipyridamole thallium-201 single-photon emission computed tomography in detecting coronary artery disease

To compare the diagnostic value of dobutamine stress echocardiographywith dipyridamole thallium-201 single-photon emission computedtomography (SPECT) in detecting coronary artery disease (CAD),we performed both tests on 54 patients who also underwent coronaryarteriography. Dobutamine was infused at an incremental regimenof 5,10,20,30 and 40 µg. kg^-1. min^-1. Dipyridamole wasinfused at a rate of 0.14 mg. kg^-1. min^-1 over 4 min. Dobutaminestress echocardiography detected 40 (93%) and SPECT 42 (98%,P=ns) of the 43 patients with significant CAD, defined as (greaterthan or equal) 50% diameter stenosis. The specificity was 73%(8 of 11) for both tests. The sensitivity for detecting individualcoronary artery stenosis with dobutamine stress echocardiographywas 81% (30 of 37) for the left anterior descending artery,75% (24 of 32) for the right coronary artery, and 61% (17 of28) for the left circumflex artery. For SPECT it was 89%, 97%(P>0.05 vs dobutamine stress echocardiography) and 75%, respectively. Among the 97 stenotic coronary arteries, 17 had mild to moderatestenosis (50%-69% diameter stenosis) and 80 had severe stenosis($$70% diameter stenosis). With dobutamine stress echocardiography,53% of the arteries with mild to moderate stenosis were identifiedvs 78% of those with severe stenosis (P<0.05). With SPECT,the sensitivity was 82% (14 of 17) in mild to moderate stenosisand 89% (71 of 80) in severe stenosis (P=ns). No major sideeffects occurred during either test. Thus, both dobutamine stressand SPECT are highly sensitive for detection and localizationof CAD. However, the sensitivity of dobutamine stress is affectedby the level of stenosis severity.