Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: a systematic review

Background nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective to evaluate the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. Design this is a systematic review Data sources Online databases including Academic Search Complete, Medline, Health Policy reference Centre, EMBASE, Psychinfo, CINAHL and the Cochran Library were searched to identify relevant publications in English published between 2001 and April 2018. Studies included evaluated an intervention to increase retention or reduce turnover and used turnover or retention figures as a measure. Review methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were quality-assessed using the Joanna Briggs Institute Critical Appraisal tools for Quasi Experimental and Randomised Controlled Trials. Retention/turnover data were used to guide the comparison between studies and appropriate measures of central tendency and dispersion were calculated and presented, based on the normality of the data. Results A total of 11, 656 papers were identified, of which 53 were eligible studies. A wide variety of interventions and components within those interventions were identified to improve nurse retention. Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. Conclusions Methodological issues impacted on the extent to which conclusions could be drawn, even though a large number of studies were identified. Future research should focus on standardising the reporting of interventions and outcome measures used to evaluate these interventions and carrying out further research with rigorous methodology. Clinical practice areas are recommended to assess their current interventions against the identified criteria to guide development of their effectiveness. Evaluations of cost-effectiveness are considered an important next step to maximise return on investment

Coping With Stress: Dispositional Coping Strategies of Project Managers

This study explores the relationship between project management practices, control appraisals and dispositional coping strategies used by project managers when dealing with stressful situations. Seventy-one project managers from a global sample participated by completing a web-based questionnaire. Results support the hypotheses that project managers apply more Active Coping and Planning strategies when dealing with stressful situations and that the level of maturity of the organisational practices is related to an increased use of Planning coping strategies. Findings and limitations are discussed

Does simulation enhance nurses' ability to assess deteriorating patients?

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care

Sample size: How many is enough?

Sample size is an element of research design that significantly affects the validity and clinical relevance of the findings identified in research studies. Factors that influence sample size include the effect size, or difference expected between groups or time points, the homogeneity of the study participants, the risk of error that investigators consider acceptable and the rate of participant attrition expected during the study. Appropriate planning in regard to each of these elements optimises the likelihood of finding an important result that is both clinically and statistically meaningful

An Application of GIS Techniques to Assess the Risk of Disturbance of Archaeological Sites by Mass Movement and Marine Flooding in Auyuittuq National Park Reserve, Nunavut

Coastal regions within Auyuittuq National Park Reserve (ANPR) are sensitive to mass movement processes and threatened by flooding in response to sea level rise. These processes pose a risk to culturally significant archaeological sites within ANPR. Sites at risk of disturbance need to be identified and protected to conserve valuable archaeological resources. Since the costs of identifying and monitoring sites at risk in remote areas are substantial, modern technologies such as Geographic Information Systems (GIS) can be used to create a more rapid and cost-effective means to monitor coastal environments and manage coastal resources. This study examines the application of GIS technology to assess the risk of disturbance of 44 coastal archaeological sites by mass movement and marine flooding within ANPR. Data on surficial materials and slope angles are combined in an overlay analysis to assess terrain sensitivity to mass movement. The output from this analysis is a coarse regional assessment of mass movement potential as it relates to the strength of materials on slopes. The overall risk of disturbance for archaeological sites within ANPR is assessed by combining the risk of mass movement and the risk of marine flooding. Twenty-eight sites within ANPR are identified as being at considerable risk to disturbance: these sites are located largely on glaciomarine sediments at moderate or high slope angles and are at substantial risk to flooding (less than two metres above sea level).Application des techniques SIG dans l’évaluation du risque de perturbation des sites archéologiques par les mouvements de masse et les inondations marines dans la réserve du parc national de Auyuittuq, Nunavut. Les côtes de la réserve du parc national de Auyuittuq sont sensibles aux mouvements de masse et sont affectées par la montée du niveau marin. Ceci constitue un risque pour les sites archéologiques de grande valeur culturelle. De tels sites doivent être identifiés et protégés afin de préserver les ressources archéologiques. Parce que les coûts d’identification et de suivi des sites à risque dans les régions éloignées sont substantiels, les technologies modernes peu coûteuses dont les Systèmes d’Information Géographique (SIG) peuvent être utilisées pour le suivi des environnements côtiers et la gestion des ressources côtières. Cette étude porte sur l’application d’un SIG pour évaluer le risque de perturbation par les mouvements de masse et les inondations de 44 sites archéologiques côtiers dans la réserve du parc national de Auyuittuq. Les données concernant les matériaux de surface et l’angle des pentes sont combinées dans une analyse d’évaluation de la sensibilité du terrain aux mouvements de masse. Le résultat de cette analyse consiste en une estimation régionale d’ensemble du potentiel de mouvement de masse en fonction de la résistance du matériel sur les pentes. Le risque global de perturbation des sites archéologiques de la réserve a été évalué à partir de la combinaison des risques de mouvements de masse et d’inondation marine. Vingt-huit sites présentent un risque considérable de perturbation puisqu’ils occupent des sédiments glaciomarins à pente modérée à élevée, à moins de deux mètres au-dessus du niveau de la mer

Study protocol: Intensive care anxiety and emotional recovery (Icare) - A prospective study

Background Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown. Purpose The Intensive Care Anxiety and Emotional Recovery (ICARe) study protocol proposes the development of a statistical model to determine the relationship between state anxiety during ICU stay and symptoms of anxiety, depression and PTSD at three occasions; after ICU discharge but prior to hospital discharge and at the third and sixth months post ICU discharge. Methods Prospective study including adult patients admitted to the ICU of a tertiary metropolitan Australian hospital for ≥24 h who are able to: (1) communicate verbally or nonverbally; (2) understand English and (3) open their eyes spontaneously or in response to voice to respond to the Faces Anxiety Scale (state anxiety assessment). One hundred and seventy patients will be assessed for their levels of state anxiety during their ICU stay to achieve a sample size of about 104 patients six months after discharge. The outcomes of the ICARe study will include symptoms of anxiety, depression and PTSD assessed by standardised questionnaires widely used in intensive care research. Demographic, clinical, and social support information will also be collected. Results The projected sample size will provide sufficient power to evaluate the association between state anxiety and adverse emotional outcomes, as well as a variety of variables that will be entered into a multivariate regression analysis. Conclusion This study will provide new evidence to improve care during critical illness and reduce adverse outcomes during recovery with the potential to decrease unnecessary suffering, promote comfort and improve long-term recovery

High Resolution Millimeter-Wave Mapping of Linearly Polarized Dust Emission: Magnetic Field Structure in Orion

We present 1.3 and 3.3 mm polarization maps of Orion-KL obtained with the BIMA array at approximately 4 arcsec resolution. Thermal emission from magnetically aligned dust grains produces the polarization. Along the Orion ``ridge'' the polarization position angle varies smoothly from about 10 degrees to 40 degrees, in agreement with previous lower resolution maps. In a small region south of the Orion ``hot core,'' however, the position angle changes by 90 degrees. This abrupt change in polarization direction is not necessarily the signpost of a twisted magnetic field. Rather, in this localized region processes other than the usual Davis-Greenstein mechanism might align the dust grains with their long axes parallel with the field, orthogonal to their normal orientation.Comment: AAS preprint:14 pages, 2 figures (3mm.eps and 1mm.eps); requires aaspp4.sty To be published in Astrophysical Journal Letter