SHARED TEAM EXPERIENCES AND TEAM EFFECTIVENESS: UNPACKING THE CONTINGENT EFFECTS OF ENTRAINED RHYTHMS AND TASK CHARACTERISTICS

This study explores the conditions under which shared team task-specific (STTS) experiences in crew-based arrangements may negatively influence team effectiveness.We suggest that the entrained rhythms featured in social entrainment theory act as a dual-edged sword with the potential to generate complacency detriments in addition to the commonly cited synchronization benefits. We argue that the manifestation and influence of the countervailing forces (i.e., synchronization and complacency) on the STTS experience—team effectiveness relationship will depend on salient task characteristics (i.e., frequency and difficulty). More specifically, frequently performed tasks create conditions for complacency tomanifest (generating an inverted-U shaped relationship between STTS experience—team efficiency), whereas infrequently performed tasks do not (generating a positive, linear relationship). We further this distinction by layering on task difficulty that, we posit, acts to amplify the respective negative and positive consequences. Analyses of archival data from 8,236 surgeries performed over one year at a large hospital located in the southwestern region of the United States were consistent with our hypotheses and 30 semi-structured interviews with operating room personnel added richness and precision to our theory. Ancillary analyses on patient post-surgery recovery rate yielded additional insights. Implications and future directions are discussed

Child Pain Matters: A Training Protocol for General Nursing Staff in an Infusion Center on Procedural Anxiety in Pediatric Patients with Crohn\u27s Disease and Ulcerative Colitis.

Procedural anxiety is a broad concept that encompasses fear, distress, and pain. Anxiety is the most critical factor affecting pain perception. There is a growing body of literature suggesting that early pain might have long-term consequences. There is also research evidence that has linked inadequately managed pain in the pediatric population to negative behavioral and physiological consequences later in life. Pediatric patients with inflammatory bowel disease (IBD) refers to Crohn’s disease and Ulcerative Colitis. These chronic conditions often require multiple and repeated medical procedures that may cause pediatric patients to experience procedural anxiety. Needle related procedures are any procedures involving the use of needles for medical purposes such as immunization, venipuncture, IV insertions, intramuscular, or subcutaneous injections. The literature and relevant theories are discussed. A proposed training protocol for nursing staff in an infusion center is presented and this author created resource handouts for nurses, parents, and caregivers. A social narrative written by this author is presented. Also included are distraction card easel prototypes developed by this author to be used as a distraction technique to reduce procedural anxiety. An illustrative case study is presented to show the application of psychological interventions in reducing procedural anxiety. The future utility of the protocol, adapting to individual differences, and future directions are discussed. Keywords: Procedural anxiety, pediatric, Inflammatory Bowel Disease (IBD), social narrative, distraction, needle related procedures, comfort positions, procedural support

Awakenings: An Equine Assisted Learning Research Project

Objective. The purpose of this pilot study was to determine if and how the Awakenings Equine Assisted Learning program was effective at improving the professionalism, confidence, communication skills and adaptability of students preparing for careers as Anesthesiologist Assistants. Background. Equine Assisted Learning (EAL) is a rapidly growing experiential model that utilizes horses to enhance participants\u27 awareness of their own non-verbal language, communication styles, projection of self-confidence and competence, and problem-solving abilities (Chandler, 2012; Green, 2012, 2013; Kane, 2012; Trotter, 2012). Methods. As a part of their regular educational and clinical rotations, first year students in the Anesthesiologist Assistant (AA) program participated in a 6- week training that included weekly, 2 -hour Equine Assisted Learning (EAL) sessions. Each session, the AA students participated in a 2- hour experiential equine assisted activity, specifically designed to address a certain target area necessary for their development as professionals in this field. The participants completed a pre and post assessment with 93 items that measured development as they relate to the EAL sessions. Results. The data was analyzed using t-tests, exploratory factor analysis, and qualitative self-reports. Confidence, empathy, awareness, and communication were the most significant factors. Conclusion. The qualitative data reinforced the quantitative findings that showed significant improvement in the objective factors as a result of the EAL sessions

Biomedical Signal Analysis of the Brain and Systemic Physiology

Near-infrared spectroscopy (NIRS) is a non-invasive and easy-to-use diagnostic technique that enables real-time tissue oxygenation measurements applied in various contexts and for different purposes. Continuous monitoring with NIRS of brain oxygenation, for example, in neonatal intensive care units (NICUs), is essential to prevent lifelong disabilities in newborns. Moreover, NIRS can be applied to observe brain activity associated with hemodynamic changes in blood flow due to neurovascular coupling. In the latter case, NIRS contributes to studying cognitive processes allowing to conduct experiments in natural and socially interactive contexts of everyday life. However, it is essential to measure systemic physiology and NIRS signals concurrently. The combination of brain and body signals enables to build sophisticated systems that, for example, reduce the false alarms that occur in NICUs. Furthermore, since fNIRS signals are influenced by systemic physiology, it is essential to understand how the latter impacts brain signals in functional studies. There is an interesting brain body coupling that has rarely been investigated yet. To take full advantage of these brain and body data, the aim of this thesis was to develop novel approaches to analyze these biosignals to extract the information and identify new patterns, to solve different research or clinical questions. For this the development of new methodological approaches and sophisticated data analysis is necessary, because often the identification of these patterns is challenging or not possible with traditional methods. In such cases, automatic machine learning (ML) techniques are beneficial. The first contribution of this work was to assess the known systemic physiology augmented (f)NIRS approach for clinical use and in everyday life. Based on physiological and NIRS signals of preterm infants, an ML-based classification system has been realized, able to reduce the false alarms in NICUs by providing a high sensitivity rate. In addition, the SPA-fNIRS approach was further applied in adults during a breathing task. The second contribution of this work was the advancement of the classical fNIRS hyperscanning method by adding systemic physiology measures. For this, new biosignal analyses in the time-frequency domain have been developed and tested in a simple nonverbal synchrony task between pairs of subjects. Furthermore, based on SPA-fNIRS hyperscanning data, another ML-based system was created, which is able distinguish familiar and unfamiliar pairs with high accuracy. This approach enables to determine the strength of social bonds in a wide range of social interaction contexts. In conclusion, we were the first group to perform a SPA-fNIRS hyperscanning study capturing changes in cerebral oxygenation and hemodynamics as well as systemic physiology in two subjects simultaneously. We applied new biosignals analysis methods enabling new insights into the study of social interactions. This work opens the door to many future inter-subjects fNIRS studies with the benefit of assessing the brain-to-brain, the brain-to-body, and body-to-body coupling between pairs of subjects

Proceeding: 3rd Java International Nursing Conference 2015 “Harmony of Caring and Healing Inquiry for Holistic Nursing Practice; Enhancing Quality of Care”, Semarang, 20-21 August 2015

This is the proceeding of the 3rd Java International Nursing Conference 2015 organized by School of Nursing, Faculty of Medicine, Diponegoro University, in collaboration with STIKES Kendal. The conference was held on 20-21 August 2015 in Semarang, Indonesia. The conference aims to enable educators, students, practitioners and researchers from nursing, medicine, midwifery and other health sciences to disseminate and discuss evidence of nursing education, research, and practices to improve the quality of care. This conference also provides participants opportunities to develop their professional networks, learn from other colleagues and meet leading personalities in nursing and health sciences. The 3rd JINC 2015 was comprised of keynote lectures and concurrent submitted oral presentations and poster sessions. The following themes have been chosen to be the focus of the conference: (a) Multicenter Science: Physiology, Biology, Chemistry, etc. in Holistic Nursing Practice, (b) Complementary Therapy in Nursing and Complementary, Alternative Medicine: Alternative Medicine (Herbal Medicine), Complementary Therapy (Cupping, Acupuncture, Yoga, Aromatherapy, Music Therapy, etc.), (c) Application of Inter-professional Collaboration and Education: Education Development in Holistic Nursing, Competencies of Holistic Nursing, Learning Methods and Assessments, and (d) Application of Holistic Nursing: Leadership & Management, Entrepreneurship in Holistic Nursing, Application of Holistic Nursing in Clinical and Community Settings

The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME).

Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. A cluster-randomized trial was conducted from 2010-13 in Tororo, a high malaria transmission setting. Twenty public health centers were randomized in a 1:1 ratio to intervention or control. The intervention included training in health center management, fever case management with mRDTs, and patient-centered services; plus provision of mRDTs and artemether-lumefantrine (AL) when stocks ran low. Three rounds of Interviews were conducted with caregivers of children under five years of age as they exited health centers (N = 1400); reference mRDTs were done in children with fever (N = 1336). Health worker perspectives on mRDTs were elicited through semi-structured questionnaires (N = 49) and in-depth interviews (N = 10). The primary outcome was inappropriate treatment of malaria, defined as the proportion of febrile children who were not treated according to guidelines based on the reference mRDT. There was no difference in inappropriate treatment of malaria between the intervention and control arms (24.0% versus 29.7%, adjusted risk ratio 0.81 95\% CI: 0.56, 1.17 p = 0.24). Most children (76.0\%) tested positive by reference mRDT, but many were not prescribed AL (22.5\% intervention versus 25.9\% control, p = 0.53). Inappropriate treatment of children testing negative by reference mRDT with AL was also common (31.3\% invention vs 42.4\% control, p = 0.29). Health workers appreciated mRDTs but felt that integrating testing into practice was challenging given constraints on time and infrastructure. The PRIME intervention did not have the desired impact on inappropriate treatment of malaria for children under five. In this high transmission setting, use of mRDTs did not lead to the reductions in antimalarial prescribing seen elsewhere. Broader investment in health systems, including infrastructure and staffing, will be required to improve fever case management

Organización y desincronización de los ritmos circadianos en enfermeras y matronas italianas: actividades sociales y laborales

INTRODUCTION: Biological rhythms are present in all living organisms. The circadian rhythm (from the latin circa dies), with a duration of approximately 24 hours, is the most commonly studied in human beings. Biological rhythms are characterized by multiple molecular mechanisms aiming at synchronization and adaptation of organism to the temporal variations of environment. The circadian individual preference (chronotype) represents the phenotypic manifestation of such a complex mechanism, in many behavioral and daily living aspects. As far the late 70’s of the last century, Horne and Ostberg identified individual differences in circadian attitudes and defined different chronotypes by means of a self-assessed questionnaires with a defined score. Belonging to a defined chronotype seems to have an impact on everydays activities including working. On the other hand, the biological circadian rhythms could be disrupted by everydays activities leading to desynchronization. It has been reported two main types of desynchronization: fast (jet lag) and slow (shift work). Recently, also tlso the change due to Daylight Saving Time (DST) has been identified as a desynchronizing condition with possible negative impact on health. Thus, the starting hypothesis of this doctoral thesis is that social and working activities and chronotype may be closely related, and desynchronization, eg, shift work and DST, should be taken into consideration in Italian midwives. OBJECTIVES: General To determine the effect of chronotype and desynchronization of circadian rhythms (shift work and DST) on social and working activities in Italian midwives. Specific - To assess individual circadian preferences, effects on sleep, and quality of life perceived by midwives. - To determine the effect of the chronotype on social and working activities. - To evaluate the association between the biannual DST and labor activity. - To determine the effect of shift work and the time change on social and work activities. MATERIAL AND METHODS: Two approaches were used: a) Observational study: by the use of validated questionnaires administered through social networks, registered midwives belonging to the Italian Board of Nursing of Midwifery were investigated during 2019. The variables evaluated were individual circadian preference, work shift, working experience, fear of medication errors and sociodemographic, such as age and educational level. A cluster analysis was carried out to know the association between variables. b) Retrospective case-control study using administrative databases: the certificates of attendance at birth generated during the period 2016-2018 in the Region of Emilia-Romagna of Italy were considered. The number of spontaneous deliveries two weeks before (control) and after DST (cases) were analyzed. Further variables, such as gestational age, type of delivery, delivery time, newborn’s weight, Apgar test 5 minutes after delivery, and the use of analgesia during delivery, were evaluated. Univariate and multivariate analyses (logistic regression analysis) were carried out. RESULTS: In the first part of the work, 401 midwives (98.8% women) were enrolled. The mean age was 38.5 }10.1 years and the most common chronotypes were intermediate (50.3%) and moderately morning (39%). Nearly fifty percent of cases self-perceived risk of medication error “at least once”. Perception of risk of medication error was associated with midwifes aged between 31-35 years, undergoing shift work, with a working experience between 6-10 years, and having an intermediate chronotype. In the second study, 7415 spontaneous deliveries were evaluated, the mean age of the women was 31.4 } 10.1 years, and gestational age 39.3 } 1.4 weeks. No significant differences were found between the number of deliveries before and after DST. There were no significant differences for the mode of delivery, gestational age and the number of spontaneous deliveries. Gestational time, newborn weight, Apgar test 5 minutes after delivery, and use of analgesia did not show statistical significance as well. Mother’s age was the only variable found to be independently associated with delivery during the two weeks after DST. CONCLUSIONS The chronotype and shift work in Italian midwives influence professional self-perception, specifically the perception of risk of medication error. Younger midwives, with lower working experience, engaged in shift work and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Morning hours seem to represent highest risk frame for female healthcare workers and shift work is not always aligned with individual circadian preference. Thus, some suggested practical applications could include, for example, assessment of individual chronotype and sleep attitude in healthcare personnel, specific training programs, and intervention strategies, such as time-scheduled naps during night-shifts. As for the potential rhythm disruption operated by DST, the present study did not find any differences in the number of deliveries in the weeks following time shifts. This finding is in agreement with previous data obtained at quite different conditions of latitude, climate, and light exposure. It is possible that the multihormonal etiology of labor may explain this phenomenon. Further studies extended to different latitudes and ethnicities, could be very useful to verify the possibility of a generalization.INTRODUCCIÓN: Los ritmos biológicos están presentes en todos los organismos vivos. El ritmo circadiano (del latín circa dies), con una duración aproximada de 24 horas, es el más estudiado en seres humanos. Los ritmos biológicos se caracterizan por múltiples mecanismos moleculares que se encargan de la sincronización y adaptación del organismo a las variaciones temporales del entorno. La preferencia individual circadiana (cronotipo) representa la manifestación fenotípica, de un mecanismo tan complejo, en muchos aspectos conductuales y de la vida diaria. Ya a finales de la década de los 70 del siglo pasado, Horne y Ostberg identificaron diferencias individuales en las actitudes circadianas y definieron diferentes cronotipos mediante cuestionarios autoevaluados con una puntuación definida. La pertenencia a un cronotipo definido parece tener un impacto en las actividades cotidianas, incluido el trabajo. Por otro lado, los ritmos circadianos biológicos podrían verse interrumpidos por las actividades cotidianas que conducen a la desincronización. Se ha informado de dos tipos principales de desincronización: rápida (jet lag) y lenta (trabajo por turnos). Recientemente, también se ha identificado el cambio debido al horario de verano o Daylight Saving Time (DST) como una condición desincronizante con posible impacto negativo en la salud. Por tanto, la hipótesis de partida de la presente tesis doctoral es que las actividades sociales y laborales y el cronotipo pueden estar estrechamente relacionados, y la desincronización, por ejemplo, el trabajo por turnos y el horario de verano, debe tenerse en cuenta en las matronas italianas. OBJETIVOS: General: Determinar el efecto del cronotipo y la desincronización de los ritmos circadianos (trabajo por turnos y DST) sobre las actividades sociales y laborales de las matronas italianas. Específicos: - Evaluar las preferencias circadianas individuales, los efectos sobre el sueño y la calidad de vida percibida por las parteras. - Determinar el efecto del cronotipo en las actividades sociales y laborales. - Evaluar la asociación entre DST y la actividad laboral. - Determinar el efecto del trabajo por turnos y DST en las actividades sociolaborales. MATERIAL Y MÉTODOS: Se emplearon dos enfoques: a) Estudio observacional empleando cuestionarios validados a través de redes sociales, durante el año 2019. Los sujetos de estudios fueron matronas colegiadas en la Italian Board of Nursing and Midwifery. Las variables estudiadas fueron la preferencia circadiana individual, así como datos laborales (turno de trabajo, experiencia laboral, presencia de errores de medicación) y sociodemográficos (edad, nivel de estudios, sexo). Se llevo a cabo un análisis por clúster para conocer la asociación entre variables. b) Estudio caso-control retrospectivo empleando bases de datos administrativas, concretamente los certificados de asistencia al parto generados durante el periodo 2016-2018 en la Región de Emilia- Romagna, Italia. Se analizo el número de partos espontáneos 2 semanas antes (control) y después del DST (casos). También se analizaron otras variables secundarias como la edad gestacional, tipo de parto, tiempo de parto, peso del recién nacido, test de Apgar a los 5 minutos del parto y el uso de analgesia durante el parto. Se llevo a cabo un análisis univariante y multivariante (análisis de regresión logística). RESULTADOS: En la primera parte del trabajo, participaron 401 matronas (98,8% mujeres), con una edad media de 38,5 }10,1 años y siendo los cronotipos más comunes los intermedios (50.3 %) y moderadamente matutinos (39%). El 48.1% de los casos auto percibían que habían tenido “al menos una vez” riesgo de error de medicación. La percepción de riesgo de error de medicación se asoció con profesionales con una edad entre 31-35 años, que trabajaban a turnos, con una experiencia laboral entre 6-10 años, y un cronotipo intermedio. Por otra parte, en el segundo enfoque, se evaluaron 7415 partos espontáneos, siendo la edad media de las mujeres de 31,4 }10,1 años, con una edad gestacinal de 39,3 }1,4 semanas y siendo el 64,7% italianas. No se encontraron diferencias significativas entre el número de partos antes y después del DST. No hubo diferencias significativas para el modo de parto, edad gestacional y el número de partos espontáneos. El tiempo gestacional, peso del recién nacido, test de Apgar a os 5 minutos del parto y uso de analgesia tampoco mostraron una significación estadística. La única variable que se asociaba independientemente con el parto durante las dos semanas posteriores al DST fue la edad de la madre. CONCLUSIONES: El cronotipo y el trabajo a turnos en las matronas italianas influyen en el ámbito laboral, concretamente en la percepción de riesgo de error de medicación. Las matronas más jóvenes, con menor experiencia laboral, que realizan trabajo por turnos y pertenecen a un cronotipo intermedio, parecen tener un mayor riesgo potencial de error de medicación. Las horas de la mañana parecen representar el periodo de mayor riesgo para las trabajadoras de la salud y el trabajo por turnos no siempre está alineado con la preferencia circadiana individual. Por tanto, algunas aplicaciones prácticas sugeridas podrían incluir, por ejemplo, la evaluación del cronotipo individual y patrón del sueño en el personal sanitario, programas de formación específicos y estrategias de intervención, como las siestas programadas durante los turnos de noche. En cuanto a la posible alteración del ritmo operada por DST, no se encontraron diferencias en el número de partos en las semanas posteriores al cambio de hora. Este hallazgo está de acuerdo con datos anteriores obtenidos en condiciones bastante diferentes de latitud, clima y exposición a la luz. Es posible que la etiología multihormonal del trabajo de parto pueda explicar este fenómeno. Otros estudios extendidos a diferentes latitudes y etnias podrían ser útiles para la generalización de los hallazgos encontrados

Internal representation in nurse education: Imagery and identity

The main aim of this thesis was to examine internal representation in the context of nurse education using two main output variables - namely imagery and identity. The initial basic argument for the thesis was that procedures to facilitate the acquisition of psychomotor skills that have been developed in sports science could fruitfully be applied to the development of skills in other areas, such as nurse education. Study one approached this through the use of an imagery training programme - PETTIER (Holmes & Collins, 2001) on an undergraduate nursing curriculum. PETTIER served as the independent variable with the dependent variable - performance - being measured through Obje&tive Structured Clinical Examinations (OSCEs). Unexpected results revealed no significant differences between the control and experimental groups, with the control group actually performing better overall. Given this, the explicit choice was made to pursue investigation into the other plausible factors affecting behaviour, in order to explicate and underpin the results obtained. Study two investigated students' perceptions of and preparation for the OSCEs using a skills training questionnaire. Results revealed common concerns, specifically related to skills practice. Furthermore these concerned the amount of practice time provided; the practice environment; and the amount of support and training during teaching. In light of these findings, study three pursued a contrasting and comparative investigation from the professionals' perspective on the curriculum. This specifically examined perceptions of the assessment structure and expectations within the curriculum; the content of the curriculum; levels of support and provision for training; and the application of theory and practice. This aimed to identify any coherent or conflicting views between the students' receiving the curriculum and the staff delivering the curriculum. Results revealed coherency in the professional view that theory and practice were equally as important for nurse education. However, students commonly perceived practice as the most important aspect. Also, some students often struggled to apply theory to practice and vice versa. In light of this it became apparent that students may in fact identify differently with the content of the curriculum. Therefore, appraisal of the content may have different significance for students and affect behaviour differently both internally and/or externally. Study four investigated this using Identity Structure Analysis (ISA)/lpseus (Weinreich & Saunderson, 2003).This explored how students applied themselves to the various aspects of nursing in the contexts of healthcare and broader affiliations, and how these fitted into students' broader sense of identity. It also looked at typologies within nursing and whether identity fitted into three distinct categories depending on construals. Study five followed this up using two individual case studies. The purpose of this was to encapsulate meaning behind individual construals and typologies and explicate the findings of ISA/lpseus and the implications for nurse education. Results found that construals are grounded in experiences which can affect development, behaviour and identity towards nursing and the broader affiliations in individuals' lives. In conclusion identity in nursing should be investigated further in order to provide stronger evidence in regards to typologies and how these may be influencing students' behaviour and development in nurse education. Such research could have important implications for the future of nurse education and be a positive step towards future curriculum revisions