Relationships of Secondary Traumatic Stress and Self-efficacy Among Obstetric Nurses Caring for Patients and Families with Perinatal Loss

Background The labor and delivery unit is a place where new life begins, and families are made. Perinatal loss is a traumatic event for families and those that provide care to expectant families. In providing care to patients and families experiencing perinatal loss, nurses are at risk for secondary traumatic stress, which could be harmful to their physical and emotional state leading to compassion fatigue and burnout. Perinatal loss represents a stressful and emotionally demanding event for healthcare professionals, as they must deal with the additional burden of managing their own emotions while caring for the patients. Self-efficacy is a factor that can help to ease secondary traumatic symptoms. Limited research has been done to explore relationships on secondary traumatic stress, the ability to cope and quality of life of obstetric nurses caring for patients, and families experiencing perinatal loss. Purpose The purpose of this study was to explore relationships between Secondary Traumatic Stress (STS), Secondary Trauma Self-Efficacy (STSE), and Professional Quality of Life (ProQOL) of obstetric nurses in caring for patients and families with perinatal loss. This study also describes what nurses state help them cope and feel supported when caring for patients experiencing perinatal loss. The relationship between obstetric nurses’ descriptive characteristics, secondary traumatic stress, self-efficacy and quality of life were explored to correlate any definitive characteristic to decreasing secondary traumatic stress symptoms, increased secondary trauma self-efficacy, decreasing compassion fatigue and increasing compassion satisfaction. Methods This study employed a quantitative descriptive correlational design with an additional qualitative component. The Secondary Traumatic Stress Scale (STSS), Secondary Trauma SelfEfficacy Scale (STSE), Professional Quality of Life Scale (ProQOL) were used to measure secondary traumatic stress, the ability to cope, compassion satisfaction, and burnout among obstetric nurses caring for patients and families experiencing perinatal loss. Inferential statistics were used to show relationships between obstetric nurses’ demographic characteristics, secondary traumatic stress, secondary trauma self-efficacy and professional quality of life. Concurrent qualitative and quantitative data collection were conducted by incorporating three open-ended questions at the end of the three instrument scales. The qualitative data were analyzed to explore the content and identify what in the participants words provided information to support and expand the quantitative findings. Results Study participants included a national sample of registered nurses who identified as obstetric nurses with experience in caring for patients and families who have had a perinatal loss. There were 1178 participants in this study of which more than half responded to each openended question. The results for this population of obstetric nurses in this study demonstrated positive findings such as higher percentages having less STS (on either the STSS or ProQOL STS), less Burnout, higher ability to cope and higher Compassion Satisfaction when exploring relationships with some demographic variables of age, having taken a perinatal bereavement course, being a parent, religious or spiritual beliefs, and the ability to share work related perinatal loss experiences. A negative correlation was shown between the ability to cope and secondary traumatic stress (r=-.484, n=1104, p Summary and Recommendations Through this research, identification of what affects nurses’ ability to cope with perinatal loss as well as what supports are impactful can inform policy and practice recommendations to best support care practices for obstetric nurses. Implications for nursing practice include supporting protocols, formal perinatal bereavement programs, certification in an obstetric specialty, religious or spiritual coping mechanisms, creating safe areas for debriefing and mentoring newer obstetric nurses caring for patients and families experiencing a perinatal loss. Further research is recommended to assist in policy development or changes to provide operational support for obstetric nurses. Further investigation on debriefs and other interventions need to be developed to help obstetric nurses deal with the effects of secondary traumatic stress during perinatal loss to further support what helps nurses cope during these events

Analysen des SR-Proteins Npl3 in der Translation und Charakterisierung von SR-Domänen-vermittelten Protein-Interaktionen von Npl3

Im Gegensatz zu vielzelligen Organismen existieren in Saccharomyces cerevisiae nur drei SR-Proteine. Diese fungieren als pendelnde Adapterproteine im nukleo-zytoplasmatischen Transport von mRNAs. Ein wichtiger Vertreter ist Npl3, welches auch mit aktiv translatierten mRNPs (messenger ribonucleoproteins) assoziiert ist. In der vorliegenden Arbeit wurde untersucht, ob Npl3 neben der Funktion des mRNA-Exports in das Zytoplasma in weiteren Prozessen eine Bedeutung hat. So konnte dazu beigetragen werden Npl3 als Prä-60S-Exportfaktor zu identifizieren. Außerdem konnte nachgewiesen werden, daß Npl3 über den Export und die zytoplasmatische Reifung hinaus mit dem Rpl10-haltigen 60S-Partikel assoziiert. Somit besitzt Npl3 das Potential über die Bindung an translationskompetente 60S-Untereinheiten die Translation zu beeinflussen. Tatsächlich konnte die vorliegende Studie eine verringerte Translationseffizienz in Hefezellen als Folge einer Verkürzung der SR-Domäne von Npl3 zeigen. Dagegen stellten sich der mRNA- und der Prä-60S-Export aus dem Zellkern sowie die zytoplasmatische Reifung des 60S-Partikels unbeeinträchtigt dar. Zusätzlich wiesen die Ergebnisse darauf hin, daß eine generelle Methylierung bzw. die Phosphorylierungsstelle an Position 411 in der SR-Domäne von Npl3 nicht essentiell für die Translation ist. Vielmehr bedingt die Verkürzung der SR-Domäne eine gestörte Bindung von Npl3 an das translationskompetente 60S-Partikel und daraus folgernd eine Störung der Monosomenformation in der Translationsinitiation. Dieser Defekt in der Monosomenbildung beruht auf einer ineffizienten Bindung von 60S-Partikeln an mRNA-rekrutierte 43S-Initiationskomplexe. Verschiedene Suppressionsexperimente und genetische Analysen in dieser Arbeit legen eine Rolle von Npl3 in Prozessen nahe, die mit den Funktionen von Rpl10 und Fun12 assoziiert sind. Des weiteren konnte eine Homomer-Bildung von Npl3-Molekülen nachgewiesen werden, welche vom N-terminalen Bereich der SR-Domäne abhängig ist. Zusätzlich demonstrierten Ko-Immunopräzipitations- und Immunfluoreszenz-Experimente, daß dieser Domänenbereich von Npl3 im Wesentlichen auch für die Bindung des Zellkernimportrezeptors Mtr10 entscheidend ist. Weitere Ergebnisse deuteten darauf hin, daß sich die Homomer-Bildung von Npl3 positiv auf die Translationsinitiation auswirkt. Demnach kann vorliegende Arbeit Npl3, und insbesondere seiner SR-Domäne, eine essentielle Aufgabe für die Translation zuweisen und lässt dabei auf eine Funktion von Npl3 im Prozess der Monosomenbildung während der Translationinitiation, wie auch im letzten zytoplasmatischen Reifeschritt des Prä-60S-Partikels schließen

Klinische Evaluation eines Verfahrens zur Autofluoreszenz-unterstützten Diagnostik von potentiell malignen Veränderungen der Mundschleimhaut

Die Funktionsweise des VELscopes basiert auf der natürlichen Gewebefluoreszenz der Schleimhaut. Das VELscope emittiert blaues Licht mit einer Wellenlänge von 400-460 nm auf die Oberfläche der Mundschleimhaut. In maligne verändertem Gewebe ändert sich durch Absorption und Streuung das Fluoreszenzverhalten. Für den Behandler wird dies durch eine Abschwächung des grünen Lichtes und damit einer dunkel bis schwarz erscheinenden Schleimhaut im VELscope-Verfahren sichtbar gemacht. Es wurden 133 Patienten der Sprechstunde für potentiell maligne Veränderungen der Sektion für klinische und experimentelle Orale Medizin der Universitätszahnmedizin Leipzig untersucht. Das VELscope-Gerät zeigt bei der Erkennung eines Plattenepithelkarzinoms eine Sensitivität von 100 % und eine Spezifität von 76 %. Für die Erkennung einer Leukoplakie liegen Werte von 54 % für die Sensitivität und 77 % für die Spezifität vor. Die Sensitivität für potentiell maligne Veränderungen liegt bei 77 % und die Spezifität bei 87 %. Die Ergebnisse für die Erkennung einer Dysplasie sind 79 % für die Sensitivität und 33 % für die Spezifität bei einer Gesamtzahl von 35 festgestellten Dysplasien. Die nicht unerhebliche Anzahl falsch-positiver VELscope-Befunde und die damit verbundenen niedrigen Werte für die Spezifität wurden nicht nur in vorliegender Arbeit belegt und kritisiert .Besonders erythematöse und ulzerierende Läsionen gehen mit einem erhöhten Fluoreszenzverlust einher. Das große Defizit der Methode ist die niedrige Spezifität und schwierige Interpretation, die zu einer erhöhten Rate von unnötigen Überweisungen und somit zu vermeidbarem Stress für den Patienten und erhöhten finanziellen Kosten führen würde.:Inhaltsverzeichnis Abkürzungsverzeichnis ................................................................................. III 1 Einführung ............................................................................................... 1 1.1 Mundschleimhauterkrankungen ........................................................ 2 1.1.1 Orale Epitheliale Dysplasie ......................................................... 2 1.1.2 Potentiell maligne Veränderungen .............................................. 4 1.1.3 Orales Plattenepithelkarzinom .................................................. 14 1.2 Diagnostik zur Früherkennung von Karzinomen ............................. 19 1.2.1 Palpation und Inspektion .......................................................... 19 1.2.2 Zytologische Untersuchung ...................................................... 20 1.2.3 Chirurgische Biopsie ................................................................. 23 1.2.4 Weitere diagnostische Möglichkeiten ....................................... 24 1.3 Autofluoreszenz .............................................................................. 27 1.3.1 VELscope- Funktionsweise ...................................................... 27 1.3.2 Diaskopie .................................................................................. 30 2 Ziele der Studie ...................................................................................... 31 3 Materialien und Methoden ..................................................................... 32 3.1 Patientenkollektiv ............................................................................ 32 3.2 Durchführung der Studie ................................................................. 32 3.3 Beurteilungsverfahren ..................................................................... 34 3.4 Auswertung ..................................................................................... 37 4 Ergebnisse ............................................................................................. 40 4.1 Patientendaten ................................................................................ 40 4.2 Klinische Befunde und Diagnosen .................................................. 41 4.3 VELscope-Befunde ......................................................................... 43 4.4 Biopsie-Entnahmestellen ................................................................ 45 4.5 Diagnostische Treffsicherheit .......................................................... 46 4.5.1 Positiver und negativer prädiktiver Wert ................................... 49 4.6 Ergebnisse auf Lokalisationen bezogen .......................................... 50 5 Diskussion ............................................................................................. 54 5.1 Bewertung der Fluoreszenzbefunde hinsichtlich des Patientenkollektivs .................................................................................... 55 5.2 Bewertung und Vergleich der Fluoreszenzbefunde ......................... 56 5.3 Bewertung unterschiedlicher Mundschleimhautveränderungen mittels Autofluoreszenz ........................................................................................ 60 5.4 Bewertung unterschiedlicher Lokalisationen mittels Autofluoreszenz . ........................................................................................................ 62 5.5 Bewertung der Quantifizierung der Fluoreszenzbefunde ................ 63 5.6 Bewertung der Methodik ................................................................. 66 5.7 Autofluoreszenzdiagnostik im Vergleich mit anderen Methoden zur Früherkennung von Mundkrebs ................................................................ 71 6 Zusammenfassung der Arbeit ................................................................ 76 7 Literaturverzeichnis ................................................................................ 80 8 Anlagen ................................................................................................. 96 8.1 Ergebnisse für Lokalisationen für b) und c) ..................................... 96 8.2 Kreuztabellen .................................................................................. 99 8.3 Aufklärungsbogen für Patienten .................................................... 100 8.4 Dokumentationsbogen .................................................................. 102 9 Selbstständigkeitserklärung ................................................................. 103 10 Danksagung ..................................................................................... 104 11 Lebenslauf ........................................................................................ 10

Two Examples of Circular Motion for Introductory Courses in Relativity

The circular twin paradox and Thomas Precession are presented in a way that makes both accessible to students in introductory relativity courses. Both are discussed by examining what happens during travel around a polygon and then in the limit as the polygon tends to a circle. Since relativistic predictions based on these examples can be verified in experiments with macroscopic objects such as atomic clocks and the gyroscopes on Gravity Probe B, they are particularly convincing to introductory students.Comment: Accepted by the American Journal of Physics This version includes revision

The shape and dynamics of a heliotropic dusty ringlet in the Cassini Division

The so-called "Charming Ringlet" (R/2006 S3) is a low-optical-depth, dusty ringlet located in the Laplace gap in the Cassini Division. This ringlet is particularly interesting because its radial position varies systematically with longitude relative to the Sun in such a way that the ringlet's geometric center appears to be displaced away from Saturn's center in a direction roughly toward the Sun. In other words, the ringlet is always found at greater distances from the planet's center at longitudes near the sub-solar longitude than it is at longitudes near Saturn's shadow. This "heliotropic" behavior indicates that the dynamics of the particles in this ring are being influenced by solar radiation pressure. In order to investigate this phenomenon, which has been predicted theoretically but has never been observed this clearly, we analyze multiple image sequences of this ringlet obtained by Cassini in order to constrain its shape and orientation. These data can be fit reasonably well with a model in which both the eccentricity and the inclination of the ringlet have "forced" components (that maintain a fixed orientation relative to the Sun) as well as "free" components (that drift around the planet at steady rates determined by Saturn's oblateness). While the magnitude of the forced eccentricity is roughly consistent with theoretical expectations for radiation pressure acting on 10-to-100-micron-wide icy grains, the existence of significant free eccentricities and inclinations poses a significant challenge for models of low-optical-depth dusty rings.Comment: 31 pages, 6 figures, accepted for publication in Icarus. Slight edits made to match various proof correction

Membrane Potentials, Synaptic Responses, Neuronal Circuitry, Neuromodulation and Muscle Histology Using the Crayfish: Student Laboratory Exercises

The purpose of this report is to help develop an understanding of the effects caused by ion gradients across a biological membrane. Two aspects that influence a cell\u27s membrane potential and which we address in these experiments are: (1) Ion concentration of K+ on the outside of the membrane, and (2) the permeability of the membrane to specific ions. The crayfish abdominal extensor muscles are in groupings with some being tonic (slow) and others phasic (fast) in their biochemical and physiological phenotypes, as well as in their structure; the motor neurons that innervate these muscles are correspondingly different in functional characteristics. We use these muscles as well as the superficial, tonic abdominal flexor muscle to demonstrate properties in synaptic transmission. In addition, we introduce a sensory-CNS-motor neuron-muscle circuit to demonstrate the effect of cuticular sensory stimulation as well as the influence of neuromodulators on certain aspects of the circuit. With the techniques obtained in this exercise, one can begin to answer many questions remaining in other experimental preparations as well as in physiological applications related to medicine and health. We have demonstrated the usefulness of model invertebrate preparations to address fundamental questions pertinent to all animals

The ideal gas as an urn model: derivation of the entropy formula

The approach of an ideal gas to equilibrium is simulated through a generalization of the Ehrenfest ball-and-box model. In the present model, the interior of each box is discretized, {\it i.e.}, balls/particles live in cells whose occupation can be either multiple or single. Moreover, particles occasionally undergo random, but elastic, collisions between each other and against the container walls. I show, both analitically and numerically, that the number and energy of particles in a given box eventually evolve to an equilibrium distribution $W$ which, depending on cell occupations, is binomial or hypergeometric in the particle number and beta-like in the energy. Furthermore, the long-run probability density of particle velocities is Maxwellian, whereas the Boltzmann entropy $\ln W$ exactly reproduces the ideal-gas entropy. Besides its own interest, this exercise is also relevant for pedagogical purposes since it provides, although in a simple case, an explicit probabilistic foundation for the ergodic hypothesis and for the maximum-entropy principle of thermodynamics. For this reason, its discussion can profitably be included in a graduate course on statistical mechanics.Comment: 17 pages, 3 figure

Scale-invariance in gravity and implications for the cosmological constant

Recently a scale invariant theory of gravity was constructed by imposing a conformal symmetry on general relativity. The imposition of this symmetry changed the configuration space from superspace - the space of all Riemannian 3-metrics modulo diffeomorphisms - to conformal superspace - the space of all Riemannian 3-metrics modulo diffeomorphisms and conformal transformations. However, despite numerous attractive features, the theory suffers from at least one major problem: the volume of the universe is no longer a dynamical variable. In attempting to resolve this problem a new theory is found which has several surprising and atractive features from both quantisation and cosmological perspectives. Furthermore, it is an extremely restrictive theory and thus may provide testable predictions quickly and easily. One particularly interesting feature of the theory is the resolution of the cosmological constant problem.Comment: Replaced with final version: minor changes to text; references adde