Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience

The objective of this study is to examine the incidence of reported stress due to mistreatment by patients toward clinicians and the role of mistreatment from patients along with organizational factors in clinician distress. A survey of clinicians was conducted at a large academic medical center, resulting in a final analytic sample of 1,682 physicians, nurses, advanced practice providers and clinical support staff. Nurses reported the greatest incidence of mistreatment by patients as a major stressor (18.69%), followed by Advanced Practice Providers (11.26%), Clinical Support Staff (10.36%), and Physicians (7.69%). Logistic regression analysis was conducted to determine the relationship of individual- and organization-level characteristics with the odds of reporting mistreatment from patients as a major stressor. Overall findings indicate that nurses and those who work in the ER and ambulatory or outpatient clinics were more likely to be stressed from mistreatment by patients than other clinicians. Stress due to mistreatment by patients was also associated with higher Well-Being Index (WBI) distress scores, rapid changes in workflows or policies, ongoing care of COVID-19 patients, under-staffing, and low perceived organizational support. Gender or sexual minorities (not identifying as male or female) and younger (18-34 years of age) healthcare workers were also more likely to experience stress from mistreatment by patients. Individual resilience was not statistically significantly associated with reported stress from mistreatment by patients. Organizations must examine expectations for patient and visitor behavior in tandem with service standards for clinicians toward patients. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

UBC-Nepal Expedition: Acute alterations in sympathetic nervous activity do not influence brachial artery endothelial function at sea-level and high-altitude.

Evidence indicates that increases in sympathetic nervous activity (SNA), and acclimatization to high-altitude (HA), may reduce endothelial function as assessed by brachial artery flow-mediated dilatation (FMD); however, it is unclear whether such changes in FMD are due to direct vascular constraint, or consequential altered hemodynamics (e.g. shear stress) associated with increased SNA as a consequence of exposure to HA. We hypothesized that: 1) at rest, SNA would be elevated and FMD would be reduced at HA compared to sea-level (SL); and 2) at SL and HA, FMD would be reduced when SNA was acutely increased, and elevated when SNA was acutely decreased. Using a novel, randomized experimental design, brachial artery FMD was assessed at SL (344m) and HA (5050m) in 14 participants during mild lower-body negative pressure (LBNP; -10 mmHg) and lower-body positive pressure (LBPP; +10 mmHg). Blood pressure (finger photoplethysmography), heart rate (electrodcardiogram), oxygen saturation (pulse oximetry), and brachial artery blood flow and shear rate (Duplex ultrasound) were recorded during LBNP, control, and LBPP trials. Muscle SNA was recorded (via microneurography) in a subset of participants (n=5). Our findings were: 1) at rest, SNA was elevated (P<0.01), and absolute FMD was reduced (P=0.024), but relative FMD remained unaltered (P=0.061), at HA compared to SL, and 2) despite significantly altering SNA with LBNP (+60.3±25.5%) and LBPP (-37.2±12.7%) (P<0.01), FMD was unaltered at SL (P=0.448), and HA (P=0.537). These data indicate that acute and mild changes in SNA do not directly influence brachial artery FMD at SL or HA

Examining the Relationship between Community Orientation and Hospital Financial Performance

A community orientation strategy may be a socially responsible way for hospitals to simultaneously improve financial performance and community health, in accordance with the Affordable Care Act. Using data from the AHA Annual Survey, AHRF, and CMS Cost Reports, this study examined the association between hospital community orientation and three measures of financial performance, and whether that relationship differs for some types of hospitals. The analysis revealed that hospital community orientation was positively associated with total margin and that not-for-profit hospitals engaging in higher levels of community orientation experienced lower operating margins, on average, relative to for-profit hospital

UBC-Nepal Expedition: Acute alterations in sympathetic nervous activity do not influence brachial artery endothelial function at sea-level and high-altitude.

Evidence indicates that increases in sympathetic nervous activity (SNA), and acclimatization to high-altitude (HA), may reduce endothelial function as assessed by brachial artery flow-mediated dilatation (FMD); however, it is unclear whether such changes in FMD are due to direct vascular constraint, or consequential altered hemodynamics (e.g. shear stress) associated with increased SNA as a consequence of exposure to HA. We hypothesized that: 1) at rest, SNA would be elevated and FMD would be reduced at HA compared to sea-level (SL); and 2) at SL and HA, FMD would be reduced when SNA was acutely increased, and elevated when SNA was acutely decreased. Using a novel, randomized experimental design, brachial artery FMD was assessed at SL (344m) and HA (5050m) in 14 participants during mild lower-body negative pressure (LBNP; -10 mmHg) and lower-body positive pressure (LBPP; +10 mmHg). Blood pressure (finger photoplethysmography), heart rate (electrodcardiogram), oxygen saturation (pulse oximetry), and brachial artery blood flow and shear rate (Duplex ultrasound) were recorded during LBNP, control, and LBPP trials. Muscle SNA was recorded (via microneurography) in a subset of participants (n=5). Our findings were: 1) at rest, SNA was elevated (P<0.01), and absolute FMD was reduced (P=0.024), but relative FMD remained unaltered (P=0.061), at HA compared to SL, and 2) despite significantly altering SNA with LBNP (+60.3±25.5%) and LBPP (-37.2±12.7%) (P<0.01), FMD was unaltered at SL (P=0.448), and HA (P=0.537). These data indicate that acute and mild changes in SNA do not directly influence brachial artery FMD at SL or HA

Evidence of a North Atlantic right whale calf (Eubalaena glacialis) born in northeastern U.S. waters

Author Posting. © The Author(s), 2008. This is the author's version of the work. It is posted here by permission of John Wiley & Sons for personal use, not for redistribution. The definitive version was published in Marine Mammal Science 25 (2009): 462-477, doi:10.1111/j.1748-7692.2008.00261.x.The general temporal and geographical patterns of North Atlantic right whale (Eubalaena glacialis) calving events have been clarified during the last quarter century of research (Kraus and Rolland 2007). Right whales give birth to a single calf every three to five years after a twelve- to thirteen-month gestation period (Best 1994; Kraus and Hatch 2001). Most calves are born between December and March in the coastal waters of the southeastern U.S., the only known calving ground for this species (Kraus et al. 2007; Winn et al. 1986). Although historical whaling records suggest that there were once two winter calving grounds, one off the southeastern U.S. and the other off northwestern Africa, it appears that only the former is still used today (Notarbartolo di Sciara et al. 1998; Reeves and Mitchell 1986; 1988). In the late winter, right whales leave the calving grounds and migrate to their foraging grounds off the northeastern U.S. and Canadian Maritimes. North Atlantic right whales can be found in Cape Cod and Massachusetts Bays throughout the late winter and early spring (Hamilton and Mayo 1990; Mayo and Marx 1990; Schevill et al. 1986), in the Great South Channel during mid-spring to early summer (Kenney et al. 1995), and in the Bay of Fundy (Kraus et al. 1982) and on the Scotian Shelf (Mitchell et al. 1986; Stone et al. 1988) during the summer and fall. Some individuals (mostly pregnant females and juveniles) return to the calving grounds off the southeastern U.S. in December and January, but the location of the rest of the population during those months is currently unknown (although recent evidence suggests that right whales are present in the Gulf of Maine and on the Scotian Shelf throughout the winter (Mellinger et al. 2007; T. Cole pers comm. ; S. Van Parijs pers comm. )

Development and Testing of the Quality Improvement Self-efficacy Inventory

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses’ ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses’ knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies