Why do nurses not escalate patient care when EWS indicates to do so?

Abstract Introduction Early warning scores are used worldwide as a tool to aid identification of acutely unwell patients by nursing staff. They do this by giving a patient a numerical score based upon physiological parameters. Literature review Early warning scores have been found useful in many settings and can bring about improvements in patient outcomes (for example mortality or admission to intensive care). Audit data shows that the rate of escalation is low. Aims To gain understanding of why nurses do not use early warning escalation systems appropriately and to investigate barriers to the use of EWS. Methods 14 nurses took part in semi-structured interviews. These nurses were of different bands and experience levels (including auxiliary nurses). Results and Discussion 3 main themes were brought out in the data: the gap between the theory and reality of the tool; the use of the tool being dependent upon the experience of the nurse and lack of belief in the specificity and sensitivity of the tool. Nurses often found that escalation was difficult due to lack of confidence, inability to reach staff to escalate to or other members of staff not believing in the tool. With increased experience, use of the tool decreased as nurses became more reliant upon their own knowledge and intuition. Regarding the sensitivity and specificity of the tool, nurses found that they often escalated patients who did not score high enough to trigger the system, and consequently found it difficult to be taken seriously. They also found that some patients with chronic diseases would trigger the system, but felt there was no need for this. Conclusions The use of the tool is important to improve patient outcomes. The knowledge of barriers to using the tool can be made useful in implementing change in practise

Why do nurses not escalate patient care when EWS indicates to do so?

Abstract Introduction Early warning scores are used worldwide as a tool to aid identification of acutely unwell patients by nursing staff. They do this by giving a patient a numerical score based upon physiological parameters. Literature review Early warning scores have been found useful in many settings and can bring about improvements in patient outcomes (for example mortality or admission to intensive care). Audit data shows that the rate of escalation is low. Aims To gain understanding of why nurses do not use early warning escalation systems appropriately and to investigate barriers to the use of EWS. Methods 14 nurses took part in semi-structured interviews. These nurses were of different bands and experience levels (including auxiliary nurses). Results and Discussion 3 main themes were brought out in the data: the gap between the theory and reality of the tool; the use of the tool being dependent upon the experience of the nurse and lack of belief in the specificity and sensitivity of the tool. Nurses often found that escalation was difficult due to lack of confidence, inability to reach staff to escalate to or other members of staff not believing in the tool. With increased experience, use of the tool decreased as nurses became more reliant upon their own knowledge and intuition. Regarding the sensitivity and specificity of the tool, nurses found that they often escalated patients who did not score high enough to trigger the system, and consequently found it difficult to be taken seriously. They also found that some patients with chronic diseases would trigger the system, but felt there was no need for this. Conclusions The use of the tool is important to improve patient outcomes. The knowledge of barriers to using the tool can be made useful in implementing change in practise

Estrogenic effects on a protandrous hermaphroditic species: Amphiprion percula

Estrogen concentrations are increased in aquatic environments due to the addition of pharmaceutical drugs (i.e. birth control) through runoff water. This manipulates maturation of sexes within many species that inhabit aquatic enviornments, including fresh and marine habitats. Amphiprion percula exhibit a hierarchal system behavioral pattern, which determines the social status of individuals within a group. Multiple clown anemonefish, A. percula were studied via a controlled environment and hierarchal succession was observed under estrogenic additions. From this study, data on sex change of a hermaphroditic protandrous species was observed under the influence of three concentrations of natural estrogen. Based on sex changes and aggression observed by A. percula, it is suggested that estrogen introduced to an aquatic system through external means, influences female-like characteristic within the species. Implications of estrogen entering marine environments through run-off water, may induce the same qualities and allow for a decrease of Amphiprion spp. overall because of the protandrousity of wild population

How Participatory Practice can Help to Strengthen the Role of Volunteering in Sustainable Development: An Organisational Perspective

The post?2015 development debates highlight that the experience of the poorest and most marginalised is one of exclusion due to power inequalities and discrimination. The Valuing Volunteering study demonstrated that volunteering has the potential to challenge power imbalances and strengthen ownership over change for individuals who are traditionally excluded from decision?making processes. However, this article also explores some of the barriers to this approach, such as paternalistic models of volunteering that seek to present the volunteer as the ‘silver bullet'; or the pressure to respond to the top?down agendas of governments and donors that are not aligned with the needs on the ground. The article will look at how participatory practice – reviewing existing mechanisms within VSO programmes as well as some new approaches trialled through the Valuing Volunteering research – can help to overcome some of these barriers and the opportunities and challenges of embedding participatory approaches within an international organisation

Predictors of Swallowing Outcomes in Patients with Combat-Injury Related Dysphagia

Background: Traumatic injuries, such as those from combat-related activities, can lead to complicated clinical presentations that may include dysphagia. Methods: This retrospective observational database study captured dysphagia-related information for 215 US military service members admitted to the first stateside military treatment facility after sustaining combat-related or combat-like traumatic injuries. A multidimensional relational database was developed to document the nature, course, and management for dysphagia in this unique population and to explore variables predictive of swallowing recovery using Bayesian statistical modeling and inferential statistical methods. Results: Bayesian statistical modeling revealed the importance of maxillofacial fractures and soft tissue loss as primary predictors of poor swallowing outcomes. The presence of traumatic brain injury (TBI), though common, did not further complicate dysphagia outcomes. A more detailed examination and rating of videofluoroscopic swallow studies from a subset of 161 participants supported greater impairment for participants with maxillofacial trauma and no apparent relationship between having sustained a TBI and swallow functioning. Conclusion: These analyses revealed that maxillofacial trauma is a stronger indicator than TBI of dysphagia severity and slower or incomplete recovery following combat-related injuries. Level of evidence: Therapeutic/Care Management study, level IV

Project Wise Latina

Latinas remain “critically understudied” (Garcia-Reid, 2007) and extant models of their development are inadequate to the task of explaining their unique cultural, familial, and ethnic identity processes (Denner & Guzman, 2006) and the importance of disaggregating ethno-cultural groups within the Spanish-speaking community (Umana-Taylor, et al. 2001; 2002;)is obscured. The National Women’s Law Center and MALDEF (2009) outlined several community and research initiatives to improve the social, educational, and employment outcomes of Latinas. Many of these are already inform the Adelante Chicas program that is the focus of our study. Intersectionality studies of gender (Shields, 2008), ethnic identity research (Quintana & Vera, 1999) and social capital studies of Latinas’ well-being (Garcia-Reid, 2007) afford a new lens with which to choose measurements of ethnic identity and to apply a feminist action-research analysis of qualitative and quantitative analyses we present. Programs that foster the acquisition, maintenance, and expansion of these resources are increasingly recommended and preferred by advocacy groups (NWLC & MALDEF, 2009). Data gathered for this study include program attendance and evaluation of its benefits by the girls; school engagement/attendance; academic outcomes; focus group narratives on experiences of prejudice, family obligations, and academic aspirations. Study design included comparisons of 8-18 year old girls enrolled (N=156): persisters vs. non-persisters on academic measures, attendance, and engagement. Results indicated that the majority of girls were Mexican-American ancestry, most were US born. Persisters’ GPAs were higher than non-persisters. Attendance at school was high overall (94-96%) and teacher comments were mostly positive. Academic outcomes were affected by proficiency testing. Academic aspirations were high for the adolescent cohort (pediatrician, etc.) but girls reported experiences of prejudice in schools, and their desire for more academic resources. Family obligations were coded for themes of ambivalence, preparation, or “immigrant struggle” narratives girls internalized. Overall, girls rated the program positively with age cohorts varying in benefits it provided to them. All cohorts noted the social-emotional support it provided. Fifth and sixth graders were most likely to focus on “confidence and motivation” it provided. Results are discussed in terms of effects of “high stakes testing” and cultural needs on girls’ academic aspirations and outcomes

Archeota, Spring/Summer 2023

Archeota is a platform for SJSU iSchool students to contribute to the archival conversation. It is written BY students, FOR students. It provides substantive content on archival concerns and issues and promotes professional development in the field of archival studies. Archeota upholds the core values of the archival profession. Contents: The Center for Sacramento History: A Reflection on the Importance of Internships By Sabrina Gunn Preservation Through Computer Games: Fighting Censorship by Using Minecraft By Taliyah Shaver Meet the New 2023-2024 Archeota and SAASC Team Farewell to Our Spring 2023 Graduates: Interviews With SAA Student Chapter Leaders The Sidedoor Podcast: The Smithsonian’s History and Science Communication Success Story By Beth Gonzalez Oregon\u27s Hops and Brewing Archive: Interview with Tiah Edmuson-Morton By Laura Dowell The Lowcountry Digital History Initiative: Adding Lost Voices to the History of Charleston, South Carolina By Katie Burns Summer Reading Recommendations Oral Histories, Photographs, and Metadata: An Internship at the Tom and Ethel Bradley Center By Cybele Garcia Kohel SJSU SAA Student Chapter 2023-2024 Team SJSU SAA Student Chapter Events AY 2023-2024https://scholarworks.sjsu.edu/saasc_archeota/1017/thumbnail.jp

Taste Manipulation and Swallowing Mechanics in Trauma-Related Sensory-Based Dysphagia

Purpose: This study explored the effects of highconcentration taste manipulation trials on swallow function in persons with sensory-based dysphagia. Method: Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensorybased dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/ aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7%wt/vol citric acid in 40% wt/vol barium suspension), and sweet–sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants. Results: Friedman’s tests for the 3 stimuli revealed significantly (p \u3c .05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p ≤ .0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet–sour and, to a lesser extent, sour than for unflavored boluses. Conclusion: Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation

2010 Ruby Yearbook

A digitized copy of the 2010 Ruby, the Ursinus College yearbook.https://digitalcommons.ursinus.edu/ruby/1113/thumbnail.jp