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

Synthesis, structure and pyrolysis of stabilised phosphonium ylides containing saturated oxygen heterocycles

yesA range of twelve stabilised phosphonium ylides containing tetrahydrofuran, tetrahydropyran or 2,2- dimethyl-1,3-dioxolane rings have been prepared and fully characterised, including one X-ray structure determination of each type. The X-ray structures confirm the PvC and CvO functions to be syn and all the compounds undergo thermal extrusion of Ph3PO to give the corresponding alkynes. In some cases there is also competing loss of Ph3P to give different carbene-derived products and evidence has been obtained for the generation of 2-phenyloxete in this way. Raising the pyrolysis temperature leads in several cases to new secondary reactions of the alkyne products involving a sequence of alkyne to vinylidene isomerisation, intramolecular CH insertion, and retro Diels Alder reaction

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

Assessing cardiovascular status: a guide for acute nurses

Many patients admitted to acute care areas of a hospital experience cardiovascular compromise due to conditions such as acute myocardial infarction (AMI), acute coronary syndrome or exacerbations of chronic heart failure. Additionally, patients can experience cardiovascular collapse due to bleeding or cardiac arrhythmias postoperatively. As a consequence, nurses in acute care settings need to be competent in assessing the cardiovascular status of adult patients. The authors provide a framework for assessing the cardiovascular status of patients in acute care settings using the determinants of cardiac output. They provide a brief review of the determinants of cardiac output before discussing both the aims of cardiovascular assessment and how to perform, such an assessment. (non- author abstract)<br /

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

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