Method of calculating nursing workload based on individualised patient care

This thesis describes a method of calculating nursing workload based upon individualised patient care, a concept which is supported by the International Council of Nurses. An aid to this practice is the nursing care plan, the use and iñtroduction of which into a group of Scottish hospitals is described. Nursing care plans provide a description of the care which nurses prescribe and can be used as a source from which to determine the nursing care elements of the workload.A formula was developed and is presented for the calculation of the nursing workload based on the amount of time required for Planned Activities and the average percentage of time spent in Planned Activities. This formula incorporates time for Unplanned Activities. The methods of determining the time and percentage of time in Planned Activities are described. The major method used was non -participant observation.The formula was originally tested by the researcher on one medical ward where subsequently the nursing staff participated in the recording and collection of workload data.The system was extended to two other medical wards where the nursing staff also participated in the operation of the system for a period of six months.The information produced by this system has a variety of management uses which are discussed

Portraits of Adolescents As They Navigate the Competitive, College-Going, and Affluent Culture

A growing body of literature has documented the elevated rates of anxiety, depression, and substance use in adolescents who live in upper-middle class communities. The competitive college preparation and admissions process is seen as a contributor to student stress. This study endeavored to gain understanding of the lived experience of adolescents in upper-middle class communities as they navigate the competitive, achievement-oriented, and college-going culture. Using Sara Lawrence-Lightfoot’s portraiture method, the participants’ narratives illuminated the ways these students accepted, struggled with, challenged, and resisted dominant cultural messages that were transmitted to them through their experiences as they prepared for college. The analysis of the four portraits elucidated several themes to suggest that these participants experienced a loss of voice as they endeavored to conform to the standards of behavior promoted by community and the college process. Additionally, the participants narrated a clear set of values that they were encouraged to embody, values that are traditionally associated with patriarchal and capitalist cultures. The insights gained from the participants’ portraits have implications for practice and future research

Neurosteroid Influences on Sensitivity to Ethanol

This review will highlight a variety of mechanisms by which neurosteroids affect sensitivity to ethanol, including physiological states associated with activity of the hypothalamic–pituitary–adrenal (HPA) and hypothalamic–pituitary–gonadal (HPG) axes, and the effects of chronic exposure to ethanol, in addition to behavioral implications. To date, γ-aminobutyric acid (GABAA) receptor mechanisms are a major focus of the modulation of ethanol effects by neuroactive steroids. While NMDA receptor mechanisms are gaining prominence in the literature, these complex data would be best discussed separately. Accordingly, GABAA receptor mechanisms are emphasized in this review with brief mention of some NMDA receptor mechanisms to point out contrasting neuroactive steroid pharmacology. Overall, the data suggest that neurosteroids are virtually ubiquitous modulators of inhibitory neurotransmission. Neurosteroids appear to affect sensitivity to ethanol in specific brain regions and, consequently, specific behavioral tests, possibly related to the efficacy and potency of ethanol to potentiate the release of GABA and increase neurosteroid concentrations. Although direct interaction of ethanol and neuroactive steroids at common receptor binding sites has been suggested in some studies, this proposition is still controversial. It is currently difficult to assign a specific mechanism by which neuroactive steroids could modulate the effects of ethanol in particular behavioral tasks

Smoking as an early risk factor for problematic parenting practices

Parenting among those who use non-illicit and more common drugs such as cigarettes remains an understudied area for investigation. Secondary data analyses were performed in 2015 on a prospective study with parent and twin data available on n=3,009 individual members of female twin pairs born between July 1975 and June 1985 identified from Missouri-state birth records. Maternal smoking when the twins were 3+ years of age remained a significant predictor of offspring report of childhood sexual abuse (OR, 1.40; 95% CI, 1.02-1.92) after controlling for key covariates. Given limited public health resources, mothers who smoke during child's preschool years may be targeted for tailored parenting intervention

Infusing shame resilience into the counseling curriculum to support client conceptualization and student wellness

Shame is a silent epidemic that influences the health of our clients and the counselors who serve them. Using the tenets of phenomenology, researchers explored the experiences of students participating in a counseling course created to infuse shame resilience into the curriculum. Results and implications for future research are included

Building a Resilient Coast. Climate Variability and Coastal Community Resilience: Developing and Testing a National Model of State-based Outreach

The Maine Sea Grant College Program, in partnership with the Oregon Sea Grant College Program, conducted a two-year NOAA-funded project: 1) to explore how climate variability and coastal hazards may be affecting our coastal regions and how these relate to coastal development in the two states; 2) to encourage and facilitate collaboration among and between decision makers and coastal property owners to determine and implement appropriate responses to climate variability on short and longer timescales; 3) to discover the barriers that targeted audiences in the states have to taking action to either prepare for or mitigate the effects of climate variability; and 4) to develop educational and informational materials and strategies concerning these issues. The ultimate goal of the project is to move behavior toward decisive action that results in coastal communities that are more resilient to climate variability at all scales. In Maine, two groups were targeted with these strategies and materials: coastal property owners (CPOs); and municipal elected and appointed officials, including local and regional planning agency personnel. For the purposes of this report, “coastal hazards” include shoreline erosion, sea-level rise, higher tides, increased storm severity, and coastal flooding. This technical report covers only the Maine component of the project

THYMUS-DERIVED LYMPHOCYTES PRODUCE AN IMMUNOLOGICALLY SPECIFIC MACROPHAGEARMING FACTOR

Spleen cells from mice immunized with an allogeneic tumor when cultured with the specific tumor cells release into the supernatant a specific macrophage-arming factor(s) (SMAF) which binds nonspecifically to macrophages from both mice and rats and renders these cytotoxic to the specific tumor cells. SMAF also binds in an immunologically specific way to the target cells. SMAF-treated target cells grow normally in the absence of macrophages but are killed in the presence of normal macrophages. Thymus-derived cells are necessary for the production of SMAF since (a) after treatment with anti-θ serum immune spleen cells fail to release SMAF; (b) spleen cells from immunized T cell-deprived mice (thymectomized as adults followed by whole body irradiation and restored with bone marrow) fail to produce SMAF on stimulation with the specific target cells. While SMAF has the properties of a cytophilic antibody, it does not belong to one of the established classes of immunoglobulin since high activity is found after column separation in a fraction having a molecular weight between 50,000–60,000 daltons

Alternative Splicing of AMPA Subunits in Prefrontal Cortical Fields of Cynomolgus Monkeys Following Chronic Ethanol Self-Administration

Functional impairment of the orbital and medial prefrontal cortex underlies deficits in executive control that characterize addictive disorders, including alcohol addiction. Previous studies indicate that alcohol alters glutamate neurotransmission and one substrate of these effects may be through the reconfiguration of the subunits constituting ionotropic glutamate receptor (iGluR) complexes. Glutamatergic transmission is integral to cortico-cortical and cortico-subcortical communication and alcohol-induced changes in the abundance of the receptor subunits and/or their splice variants may result in critical functional impairments of prefrontal cortex in alcohol dependence. To this end, the effects of chronic ethanol self-administration on glutamate receptor ionotropic AMPA (GRIA) subunit variant and kainate (GRIK) subunit mRNA expression were studied in the orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC) of male cynomolgus monkeys. In DLPFC, total AMPA splice variant expression and total kainate receptor subunit expression were significantly decreased in alcohol drinking monkeys. Expression levels of GRIA3 flip and flop and GRIA4 flop mRNAs in this region were positively correlated with daily ethanol intake and blood ethanol concentrations (BEC) averaged over the 6 months prior to necropsy. In OFC, AMPA subunit splice variant expression was reduced in the alcohol treated group. GRIA2 flop mRNA levels in this region were positively correlated with daily ethanol intake and BEC averaged over the 6 months prior to necropsy. Results from these studies provide further evidence of transcriptional regulation of iGluR subunits in the primate brain following chronic alcohol self-administration. Additional studies examining the cellular localization of such effects in the framework of primate prefrontal cortical circuitry are warranted

Trauma in Veterans with Substance Use Disorder: Similar Treatment Need among Urban and Rural Residents

Purpose: The objective of this study is to determine whether rural residence is associated with trauma exposure or posttraumatic stress disorder symptoms among military veterans seeking treatment for substance use disorder (SUD) through the Department of Veterans Affairs (VA). Delivering mental health services to veterans in rural areas is a challenge, so identifying differences in the causes and outcomes of trauma exposure would assist in effectively targeting service delivery. Methods: Veterans (N = 196) entering SUD treatment at 3 Midwestern VA treatment centers were designated as either urban or rural, based on rural-urban commuting area (RUCA) codes. The veterans completed the Life Events Checklist, the Posttraumatic Stress Disorder Checklist, and the Addiction Severity Index’s psychiatric status subscale. Hypothesized relationships between rural-urban residence and both trauma exposure and symptomology were tested using independent samples t tests, chi-square tests, and ordinary least squares regression. Findings: The range of traumatic experiences was similar between rural and urban veterans, and rural-urban residence was not significantly associated with the overall array of traumas experienced or the symptom measures’ overall scores or subscores. Of 17 possible traumatic lifetime experiences, rural veterans differed from urban veterans on only 2, reporting significantly lower rates of transportation accidents and unwanted sexual experiences. Conclusions: In both the causes of trauma and the need for treatment, veterans residing in rural areas differ little from their urban counterparts