Engaging Nursing Staff in Research: The Clinical Nurse Specialist Role in an Academic-Clinical Partnership

Purpose: The purpose of this article is to describe the processes of exploring and implementing an academic-clinical study, engaging nursing staff in research, and maintaining their enthusiasm within the context of an academic-clinical research partnership. Description: The core competencies of the clinical nurse specialist (CNS) role address evidence-based practice, quality improvement, and research. Studies and exemplars of the CNS role in the literature illustrate expert practitioner and facilitator of evidence-based practice, but less attention is given to methods used by the CNS to engage staff in clinical research. Outcome: The CNS was successful in obtaining staff engagement in the research project from exploration through sustainment. Conclusion: Collaborative research between academic and clinical partners enhances the educational and professional environment for students and clinicians, promotes evidence-based practice, and from this project may promote Veteran and family-centered care. The CNS played a key role in engaging and sustaining staff commitment, which contributed to the success of this study

Elk summer-autumn habitat selection in the Clearwater Basin of north-central Idaho

Since the 1960\u27s, Rocky Mountain elk (Cervus elaphus nelsoni) populations have declined steadily in the Clearwater Basin in north-central Idaho. The Clearwater Basin Collaborative (CBC) was formed with the goal of restoring healthy elk populations to the Clearwater Basin. They initiated this study by collaring 53 cow elk from four distinct areas. I analyzed elk detection and GIS-based habitat data from June 15-September 15 2014 to address one of the CBC\u27s objectives: identifying elk habitat use responses on summer-autumn range. Ground-truth surveys are necessary to verify satellite-derived data are analogous to actual vegetation components. I used a proportion analysis to compare satellite derived cover type and forest cover to the true on-the-ground cover type and forest cover classification. All habitats had over 85% accuracy in the cover type validation analysis and 84% in the percent forest cover validation analysis. To assess the summer-autumn habitat selection of elk I used a new modeling approach with a use-availability design, the Synoptic model, to assess the importance of topography (valley and midslope), forage emergence and senescence (NDVI and NDVI*forest), the type of habitat (shrub, forested, or herbaceous), and forest cover (high and low) to elk habitat selection. The relative variable importance of habitat variables in descending order was: forest, valley, shrub, lowcover, NDVI and NDVI*forest, midslope, and highcover. I used a MANOVA to test for overall differences in mean habitat selection coefficients among populations. MANOVA results showed there was no significant difference in habitat selection among populations. Then, I examined how distribution patterns related to habitat variables by calculating a habitat suitability index (HSI) for each of the four populations. Overall, elk showed a positive relationship with shrub and forest, and a negative relationship with valleys and high cover in the four populations. The results of this study indicated that elk select for a juxtaposition of both forage and cover, and used high to moderate elevations during the summer. The CBC has attributed declines in the Clearwater Basin elk populations to the loss of early-seral shrub habitat and subsequent limiting effects of summer-autumn nutrition. Based on this analysis, elk populations would be enhanced by converting areas of contiguous forest cover to a diversity of seral communities, particularly early-seral shrubs with adjacent forest stands. These results will help us recognize resources important for elk conservation or habitat improvement, and inform ongoing research in identifying elk nutritional status and population responses on summer-autumn range --Leaf iv

Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty

Objectives To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. Design Mixed-method, pre–post quasi-experimental design. Setting A Midwest Veterans Affairs Medical Center and a nonprofit health system. Participants Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. Intervention Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult\u27s hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. Measurements Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult\u27s hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. Results Family caregivers’ knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult\u27s hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult\u27s surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. Conclusion Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group

Examining Addiction Treatment Facilities: An Observational Study from the Perspective of Medical Students

At the Institute for Research, Education, and Training in Addictions (IRETA), medical students are selected nationwide to learn about addiction and interact with patients undergoing treatment. It is well known that most medical schools do not provide significant training in addiction, and part of IRETA\u27s goal is to remedy this need. In this study, medical students took observational field notes during site visits to various addiction treatment facilities. The data consisted of a comparison of treatment programs, as well as the results of motivational interviewing of patients. A thematic analysis was then conducted by the three students and the IRETA Education Director. The data was coded into five themes essential to the doctor-patient relationship specific to these experiences with patients suffering from substance abuse. The Alcohol and Alcohol Problems and Perceptions Questionnaire (AAPPQ) and the Drug and Drug Problems and Perceptions Questionnaire (DDPPQ) were used as well. From the results, it was found that in categories of Role Support, Therapeutic Commitment, and Role Security, medical students were significantly more comfortable in treating patients with substance abuse. The themes found from compiled data included: Communication, Support, Environment, Empathy, and Physician Education. These themes are useful in educating medical students and professionals alike about the needs of patients suffering from addiction, and the most efficacious way to provide treatment

Hyper‐eosinophilia in granular acute B‐cell lymphoblastic leukemia with myeloid antigen expression

Acute lymphoblastic leukemia with eosinophilia (ALLEo) is a rare but a distinctive clinical entity. Clinical features of idiopathic hyper‐eosinophilic syndrome (HES) can be seen in patients with ALLEo. We report a 10‐year‐old girl, in whom HES was initially suspected but further investigation confirmed the diagnosis of acute B‐cell lymphoblastic leukemia with myeloid antigen expression. Clinical response to chemotherapy was excellent with achievement of complete remission for 4 years. Serum interleukin‐3 and ‐5 were elevated at presentation and normalized with disappearance of eosinophilia after induction therapy, supporting the reactive nature of eosinophilia in ALLEo. Hematologic malignancy should be considered in patients with hyper‐eosinophilia, before attributing it to HES.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92438/1/j.1442-200X.2011.03471.x.pd

Biological and economic feasibility of pruning and excising white pines for blister rust control

White pine plantations which were established in 1968 on 88 acres of the Palouse Ranger District, Clearwater National Forest, were treated by pruning and canker excision to remove lethal white pine blister rust cankers. The success rate 15 months after treatment was 98 percent for pruning and 81 percent for excisions. Future growth and development of the stands were projected using a stand growth model. Economic analysis based upon these projections yielded positive benefit/cost ratios for both pruning alone and pruning with canker excision

Monitoring root disease mortality : establishment report

Two thousand and thirty-nine trees on 213 plots are being monitored yearly for root disease infection and mortality. Three compartments on the Fernan Ranger District of the Idaho Panhandle National Forests are the site of the project. Relationships between factors such as species, aspect, slope, elevation, habitat type, stand appearance on aerial photography, plot root disease severity ratings, and measured volume losses due to root disease mortality are being evaluated. Effective means of judging past and future losses in root disease-affected stands are sought