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

Volatile hydrocarbons inhibit methanogenic crude oil degradation

Methanogenic degradation of crude oil in subsurface sediments occurs slowly, but without the need for exogenous electron acceptors, is sustained for long periods and has enormous economic and environmental consequences. Here we show that volatile hydrocarbons are inhibitory to methanogenic oil biodegradation by comparing degradation of an artificially weathered crude oil with volatile hydrocarbons removed, with the same oil that was not weathered. Volatile hydrocarbons (nC5-nC10, methylcyclohexane, benzene, toluene, and xylenes) were quantified in the headspace of microcosms. Aliphatic (n-alkanes nC12-nC34) and aromatic hydrocarbons (4-methylbiphenyl, 3-methylbiphenyl, 2-methylnaphthalene, 1-methylnaphthalene) were quantified in the total hydrocarbon fraction extracted from the microcosms. 16S rRNA genes from key microorganisms known to play an important role in methanogenic alkane degradation (Smithella and Methanomicrobiales) were quantified by quantitative PCR. Methane production from degradation of weathered oil in microcosms was rapid (1.1 ± 0.1 μmol CH4/g sediment/day) with stoichiometric yields consistent with degradation of heavier n-alkanes (nC12-nC34). For non-weathered oil, degradation rates in microcosms were significantly lower (0.4 ± 0.3 μmol CH4/g sediment/day). This indicated that volatile hydrocarbons present in the non-weathered oil inhibit, but do not completely halt, methanogenic alkane biodegradation. These findings are significant with respect to rates of biodegradation of crude oils with abundant volatile hydrocarbons in anoxic, sulphate-depleted subsurface environments, such as contaminated marine sediments which have been entrained below the sulfate-reduction zone, as well as crude oil biodegradation in petroleum reservoirs and contaminated aquifers

Impact of birth weight and gender on early postnatal hypothalamic energy balance regulatory gene expression in the young lamb

Peer reviewedPreprin

3D Reconstruction of the Density Field: An SVD Approach to Weak Lensing Tomography

We present a new method for constructing three-dimensional mass maps from gravitational lensing shear data. We solve the lensing inversion problem using truncation of singular values (within the context of generalized least squares estimation) without a priori assumptions about the statistical nature of the signal. This singular value framework allows a quantitative comparison between different filtering methods: we evaluate our method beside the previously explored Wiener filter approaches. Our method yields near-optimal angular resolution of the lensing reconstruction and allows cluster sized halos to be de-blended robustly. It allows for mass reconstructions which are 2-3 orders-of-magnitude faster than the Wiener filter approach; in particular, we estimate that an all-sky reconstruction with arcminute resolution could be performed on a time-scale of hours. We find however that linear, non-parametric reconstructions have a fundamental limitation in the resolution achieved in the redshift direction.Comment: 11 pages, 6 figures. Accepted for publication in Ap

Using the Plan-Do-Study-Act cycle to manage interruptions during nursing team leader handover in the intensive care unit: Quality improvement project

Introduction: Intensive care unit (ICU) nursing team leader (TL) handover is a process that is at risk for miscommunication, compromising patient safety. Interruptions during this process have the potential to increase miscommunication. Bedside handover and use of a structured handover tool are two strategies advocated internationally to improve safety of handover. Study objectives: This quality improvement project employed the Plan-Do-Study-Act (PDSA) cycle to improve handover processes during nursing TL handover, including to reduce interruptions post-implementation of a multidimensional strategy. Methods: The project was conducted in a 21-bed adult medical/surgical ICU, at a tertiary referral hospital, in Queensland, Australia. All TLs were invited to participate, with consent provided to observe and record process details of handover. Baseline data indicated that TLs experienced frequent interruptions during handover. An audit of the source and reason interruptions occurred informed the development of an intervention that included education sessions focussed on safe handover practices, hands on training using an evidence-based electronic minimum dataset to discuss patient information and the relocation of handovers from the central ICU desk to the bedside. Data were analysed using descriptive statistics (median, IQR, frequency and percentages). Results: Handovers during the baseline period (n = 40) were conducted at the central desk and attracted 64 interruptions, equivalent to one interruption every 23 min. After implementation of the improvement strategy (n = 49 handovers), 52 interruptions occurred at the bedside, equivalent to one interruption every 29 min. During both the baseline period and post-intervention nurses were the main source to interrupt handovers to exchange greetings with the TL and to discuss patient and organisational updates. Conclusion: The PDSA provided a structure to understand the problem, develop an improvement strategy and inform future work to effectively manage interruptions during nursing TL handover

Implementation and evaluation of an electronic minimum dataset for nursing team leader handover in the intensive care: An interventional study

Introduction: Miscommunication during handover has been linked to adverse patient events and is an international priority. There is widespread use of clinical information systems in intensive care units (ICU) however, evidence-based electronic handover tools are limited. Study objectives: The aim was to implement and evaluate an evidence-based electronic minimum dataset (eMDS) for ICU nursing team leader (TL) shift-to-shift handover using the Knowledge-to-Action (KTA) framework. Methods: The study was conducted in a 21-bed medical/surgical ICU, at a Queensland tertiary referral hospital. Consenting nurses involved in TL handover were recruited. Four phases of the KTA (barriers and facilitators, tailored interventions, monitor knowledge use and evaluate outcomes) guided the research. Pre-implementation, the barriers and facilitators to eMDS use were assessed via a survey; three months post-implementation a practice audit and survey identified uptake and TL perceptions of the eMDS. Results are summarised using descriptive statistics. Results: On the pre-implementation survey (n = 39) nurses identified a time-consuming tool that contained too much information as the most common barrier and a user-friendly tool that saved time and contained relevant information as the most common facilitator. Findings informed strategies employed (education, champions, reminders, ad-hoc audit and feedback) to implement the eMDS. Post-implementation, audit results showed 42 of 49 (86%) TLs used the eMDS for handover and communication of patient plans increased. Key eMDS items were absent and additional documentation was required alongside the eMDS. Survey findings identified benefits to eMDS use such as patient content, suitability for short-stay patients, decreased time updating and printing the tool. But, almost half the participants found the eMDS contained irrelevant information, reported difficulties navigating and locating specific information and important content was missing. Conclusion: Adequate infrastructure is required to facilitate eMDS use. The design needs to flexible, modifiable, seamless to navigate and contain content that promotes succinct and informative handovers