A New Color-Magnitude Diagram for Palomar 11

We present new photometry for the Galactic thick disk globular cluster Palomar 11 extending well past the main sequence turn-off in the V and I bands. This photometry shows noticeable red giant and subgiant branches. The difference in magnitude between the red horizontal branch (red clump) and the subgiant branch is used to determine that Palomar 11 has an age of 10.4+/-0.5 Gyr. The red clump is used to derive a distance d_\sun=14.3+/-0.4 kpc, and a mean cluster reddening of E(V-I)=0.40+/-0.03. There is differential reddening across the cluster, of order \delta E(V-I)~0.07. The colour magnitude diagram of Palomar 11 is virtually identically to that of the thick disk globular cluster NGC 5927, implying that these two clusters have a similar age and metallicity. Palomar 11 has a slightly redder red giant branch than 47 Tuc, implying that Palomar 11 is 0.15 dex more metal-rich, or 1 Gyr older than 47 Tuc. Ca II triplet observations (Rutledge et al. 1997) favour the hypothesis that Palomar 11 is the same age as 47 Tuc, but slightly more metal-rich.Comment: to appear in AJ (19 pages, 4 B&W figures, 1 colour figure

Implementation of an evidence-based practice nursing handover tool in intensive care using the knowledge-to-action framework

Background Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, s tandardised handover tools for nursing team leader s in intensive care are limited. Aims The study aim was to implement and evaluate an evidence- based electronic minimum dataset for nursing team leader shift -to-shift handover in the intensive care unit using the k nowledge- to-action framework. Methods This study was conducted in a 21- bed medical/surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in team leader handover were recruited. Three phases of the knowledge- to-action framework (select, tailor and implement interventions, monitor knowledge use and evaluate outcomes ) guided the implementation and evaluation process. A post -implementation practice audit and survey were carried out to determine nursing team leader use and perceptions of the electronic minimum dataset three months after implementation. Results are presented using descriptive statistics ( median, IQR, frequency and percentage) . Results Overall (86%, n=49) , team leader s used the electronic minimum dataset for handover and communication regarding patient plan increased . K ey content items however were absent from handovers and additional documentation was required alongside the minimum dataset to conduct handover. Of the team leader s surveyed (n=35), those receiving handover perceived the electronic minimum dataset more Page 4 of 24 positive ly than team leader s giving handover (n=35) . Benefits to using the electronic minimum dataset included the pat ient content (48%), suitability for short -stay patients (16%), decreased time updating (12%) and print ing the tool (12%) . Almost half of the participants however, found the minimum dataset contained irrelevant information, reported difficulties navigating and locating relevant information and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface. Linking evidence to action Prior to developing and implementing electronic handover tools , adequate infrastructure is required to support knowledge translation and ensure clinician and organisational needs are met

The influence of personal characteristics on perioperative nurses' perceived competence: Implications for workforce planning

Objective: To examine the influence of personal characteristics on perioperative nurses' perceived competence. Design: A cross-sectional survey design was used. Setting: A census of 3,209 operating room nurses who were members of the Australian College of Operating Room Nurses across all Australian states and territories was invited to participate. Primary Outcome Measure: The Perceived Perioperative Competence Scale-Revised, a 40-item survey consisting of six subscales measuring the dimensions of perioperative competence was used. Results: A total of 1,044 usable surveys were analysed representing 32.5% of the accessible population. Across the six subscales, demographic predictors accounted for 5% to 33% of the variance in nurses' perceived perioperative competence. Conclusions: These results may inform workforce planning initiatives designed to address the needs of this diverse specialty group. Efforts to retain older nurses need to be centered on redesigning workplaces, increased remuneration and professional recognition, and integrating technology to promote efficiency and safety. Workforce planning should include strategies such as creating academic partnerships with universities, to provide perioperative nurses access to specialty education and advanced skills programs

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

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

© 2017 Australian College of Critical Care Nurses Ltd. Introduction: There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. Objectives: The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. Methods: The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. Results and discussion: A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. Conclusion: Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for 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

Self-care after traumatic injury and the use of the therapeutic self care scale in trauma populations

Aims: To report a correlational study of the relationship between gender, age, severity of injury, length of hospital stay and self-care behaviour in patients with traumatic injuries. Background: This study may provide a foundation for targeted nursing intervention and education programmes to help patients better recover from their injury, which is a fundamental aspect of nursing. Design: A longitudinal cohort study. Method: This study of patients hospitalized for traumatic injury was conducted from May 2006–November 2007. The Therapeutic Self Care Scale along with demographic and clinical data, were completed at 3 and 6 months after hospital discharge. Using data from the 3-month survey, the validity and reliability of the scale was calculated. Multiple regression was used to identify predictors of self-care at 3 and 6 months. Finding: Participants (n = 125) completed the questionnaire at 3 months and 103 participants completed it at 6 months. Self-care was high on both occasions and high self-care at 3 months was related to high self-care at 6 months. Older participants reported higher self-care at 3 months compared with younger patients. Factor analysis of the scale revealed three clear components; taking medication, recognition and managing symptoms and managing changes in health conditions, which explained a total of 59·8% of the variance. The 10-item revised scale was reliable. Conclusion: The findings indicate that self-care remains fairly high and stable in the first 6 months after trauma. The revised Therapeutic Self Care Scale was valid and reliable in the trauma population

Health status after traumatic injury

BACKGROUND: This study explored the relationships between health-related quality of life and postacute factors such as patients’ perceived access to information and support, perceptions of illness and ability to provide self-care after traumatic injury. METHODS: Adults (18 years or older) admitted to hospital for ≥24 hours for the acute treatment of trauma in two hospitals in Queensland, Australia, were enrolled in a prospective cohort study. Questionnaires completed at hospital discharge and 3 months and 6 months incorporated the following: demographic data; psychological factors (Revised Illness Perception Questionnaire, Information, Autonomy and Support Scale, and Therapeutic Self-Care Scale); and outcome data (medical short form-36). Data on injury and hospital stay were obtained from health care records and the Queensland Trauma Registry. RESULTS: One hundred ninety-four patients with a median Injury Severity Score 9 (interquartile range, 5–14) were enrolled, with 125 (64%) completing questionnaires at 6 months. More than half the cohort reported symptoms of pain, fatigue, stiff joints, sleep difficulties, and loss of strength. All subscale scores on the short form-36 were below Australian norms 6 months after injury. Predictors of poor physical health included older age, lower extremity injury, and increased perceived consequences of their injuries, whereas predictors of poor mental health included younger age, female gender, and lower perceived control over their environment. CONCLUSIONS: Patients with minor to moderate injury based on anatomic injury scoring systems have ongoing challenges with recovery including problematic symptoms and low quality of life. Interventions aimed toward assisting recovery should not be limited to trauma patients with major injury. LEVEL OF EVIDENCE: Prognostic study, level III

Developing a minimum dataset for nursing team leader handover in the intensive care unit: A focus group study

Background Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. Objectives The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. Methods This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages. Results Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (Name, age, days in intensive care), Situation (Diagnosis, surgical procedure), Background (Significant event(s), management of significant event(s)) and Recommendations (Patient plan for next shift,tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (Admissions to ICU, staffing/skill mix, theatre cases) and patients (Infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient. Conclusions The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific information to maintain continuity of care and patient safety across shift changes

Direct measurement of the 14N(p,g)15O S-factor

We have measured the 14N(p,g)15O excitation function for energies in the range E_p = 155--524 keV. Fits of these data using R-matrix theory yield a value for the S-factor at zero energy of 1.64(17) keV b, which is significantly smaller than the result of a previous direct measurement. The corresponding reduction in the stellar reaction rate for 14N(p,g)15O has a number of interesting consequences, including an impact on estimates for the age of the Galaxy derived from globular clusters.Comment: 5 pages, 3 figures, submitted to Phys. Rev. Let