Heart Nursing Care Model

The role of the hematology ambulatory registered nurse (HARN) is currently disorganized at a large Midwestern clinic. Cumently the HARN is responsible for telephone care, lab results, prescription refills, patient education, submitting forms, and helping patients with miscellaneous items. The HARN is pulled in several directions throughout the day. With healthcare reimbursement changing, there is a growing need for HARNs to be utilized to one\u27s fullest potential and licensure. The purpose of this project is to create a new model of nursing care, which will further enhance the HARN role. Jean Watson\u27s Philosophy and Science of Caring provides a framework for this project. Four of Watson\u27s Caritas Processes are utilized in this project to explicate the HARN role and responsibilities. Healing, caring, and presence are key concepts incorporated in the creation of the Heart Nursing Care Model for the HARN. The Heart Nursing Care Model will help enhance the HARN role by utilizing the RN the fullest licensure, help decrease disorganization to the workday, and increase RN satisfaction. Implementation of the Heart Nursing Care Model will require leadership and evaluation from staff. Measuring patient, provider, and nurse satisfaction is important to evaluate prior to as well as after implementation of the Heart Nursing Care Model into nursing practic

Spatiotemporal studies of black spruce forest soils and implications for the fate of C

Post-fire storage of carbon (C) in organic-soil horizons was measured in one Canadian and three Alaskan chronosequences in black spruce forests, together spanning stand ages of nearly 200 yrs. We used a simple mass balance model to derive estimates of inputs, losses, and accumulation rates of C on timescales of years to centuries. The model performed well for the surface and total organic soil layers and presented questions for resolving the dynamics of deeper organic soils. C accumulation in all study areas is on the order of 20–40 gC/m2/yr for stand ages up to ∼200 yrs. Much larger fluxes, both positive and negative, are detected using incremental changes in soil C stocks and by other studies using eddy covariance methods for CO2. This difference suggests that over the course of stand replacement, about 80% of all net primary production (NPP) is returned to the atmosphere within a fire cycle, while about 20% of NPP enters the organic soil layers and becomes available for stabilization or loss via decomposition, leaching, or combustion. Shifts toward more frequent and more severe burning and degradation of deep organic horizons would likely result in an acceleration of the carbon cycle, with greater CO2 emissions from these systems overall

Predicting Smoking Behaviour Among Pregnant Smokers Using the Reasons Model and Self-Determination Theory

The dangerous health effects of smoking during pregnancy and during the postpartum period are well-established, yet a significant proportion of pregnant women continue to smoke despite being aware of the health risks and wanting to quit. While many risks factors for continued smoking or relapse have been identified, these factors are largely demographic and difficult to change. The purpose of the present study was to identify and measure the psychological factors that predict smoking cessation intentions and behaviours among pregnant women, during pregnancy and the postpartum period, who are either currently smoking or have recently quit. Pregnant smokers (N= 56) were asked to complete a series of questionnaires designed to access their reasoning at the three levels outlined by the Reasons Model and their feelings of autonomy and competence, and partner support in quitting smoking as indicated by Self-Determination Theory. Participants were also asked to complete a number of other questionnaires and a short, semi-structured interview to assess other factors potentially related to smoking behaviour. Participants were then re-contacted twice after their baby was born, at approximately two months and four months postpartum. At both times, participants were asked to again complete the questionnaire package and a short semi-structured interview. It was hypothesized that Reasons Model and Self-Determination Theory would predict both current and future intentions to quit smoking, and smoking behaviour, respectively. It was also hypothesized that those with direct experience with quitting smoking or reducing their smoking behaviour during pregnancy and postpartum (multigravida) would be more accurate in predicting their intentions to quit smoking and smoking behaviour than would those who were pregnant for the first time (primagravida). The results indicated some support for the ability of the two models to predict intentions to quit and smoking behaviour, though was limited by the small sample size. Further, level of direct experience emerged as a significant factor in participants’ ability to predict their intentions and behaviour regarding smoking. The current study suggests that both the Reasons Model and Self-Determination Theory are important tools for assessing and developing interventions for helping women to make positive changes in their smoking behaviour during pregnancy and postpartum

The changing body work of abortion: a qualitative study of the experiences of health professionals

‘Body work’ has emerged at the nexus of sociologies of work and bodies as a means of conceptualising work focusing on the bodies of others. This article utilises this analytical tool in the context of contemporary abortion work. Abortion provision in Britain has seen significant change in the last 25 years, paralleling developments in medical methods, and the option for women under nine weeks' gestation to complete the abortion at home. These shifts raise questions around how abortion work is experienced by those who do it. We apply the conceptual lens of body work to data drawn from in-depth interviews with 37 health professionals involved in abortion provision, to draw out the character, constraints and challenges of contemporary abortion work. We explore three key themes: the instrumental role of emotional labour in facilitating body work; the temporality of abortion work; and bodily proximity, co-presence and changes in provision. By drawing on the conceptual frame of body work, we illuminate the dynamics of contemporary abortion work in Britain and, by introducing the idea of ‘body work-by-proxy’, highlight ways in which this context can be used to expand the conceptual boundaries of body work

Pre-adolescent children’s experiences of receiving diabetes-related support from friends and peers: a qualitative study

BackgroundWhile pre�adolescent children with type 1 diabetes receive most support from their parents/caregivers, others also contribute to their care. This study explored pre�adolescent children's experiences of receiving diabetes�related support from friends and peers. The objective was to identify how children could be better supported by their friends and peers to undertake diabetes self�management.MethodsIn�depth interviews with 24 children (aged 9�12 years) with type 1 diabetes. Data were analysed using an inductive, thematic approach.ResultsChildren gave mixed accounts of their experiences of speaking to their school/class about diabetes with some indicating that this had resulted in unwanted attention. Most individuals reported that other children had a limited understanding of diabetes and sometimes acted in insensitive ways or said things they found upsetting. Virtually all children described having a small number of close friends who were interested in learning about diabetes and provided them with support. These friends provided support in three overlapping ways, as �monitors and prompters,� �helpers� and �normalizers.� While some children described benefiting from meeting peers with type 1 diabetes, most indicated that they would prefer to develop friendships based on shared interests rather than a common disease status.Discussion and conclusionsFriends and peers provide several kinds of support to pre�adolescent children with diabetes. Health professionals could consider ways to assist small friendship groups to undertake monitoring and prompting, helping and normalizing roles. Parents, schools and health professionals could explore ways to normalize self�management practices to better support children with diabetes in school settings.</p

Effect of permafrost thaw on CO2 and CH4 exchange in a western Alaska peatland chronosequence

Permafrost soils store over half of global soil carbon (C), and northern frozen peatlands store about 10% of global permafrost C. With thaw, inundation of high latitude lowland peatlands typically increases the surface-atmosphere flux of methane (CH4), a potent greenhouse gas. To examine the effects of lowland permafrost thaw over millennial timescales, we measured carbon dioxide (CO2) and CH4 exchange along sites that constitute a ~1000 yr thaw chronosequence of thermokarst collapse bogs and adjacent fen locations at Innoko Flats Wildlife Refuge in western Alaska. Peak CH4 exchange in July (123 ± 71 mg CH4–C m−2 d−1) was observed in features that have been thawed for 30 to 70 (\u3c100) yr, where soils were warmer than at more recently thawed sites (14 to 21 yr; emitting 1.37 ± 0.67 mg CH4–C m−2 d−1 in July) and had shallower water tables than at older sites (200 to 1400 yr; emitting 6.55 ± 2.23 mg CH4–C m−2 d−1 in July). Carbon lost via CH4 efflux during the growing season at these intermediate age sites was 8% of uptake by net ecosystem exchange. Our results provide evidence that CH4 emissions following lowland permafrost thaw are enhanced over decadal time scales, but limited over millennia. Over larger spatial scales, adjacent fen systems may contribute sustained CH4 emission, CO2 uptake, and DOC export. We argue that over timescales of decades to centuries, thaw features in high-latitude lowland peatlands, particularly those developed on poorly drained mineral substrates, are a key locus of elevated CH4 emission to the atmosphere that must be considered for a complete understanding of high latitude CH4 dynamics

Protect high seas biodiversity

The high seas—marine areas beyond national jurisdiction (1)—cover nearly half of Earth’s surface (2). The high seas support our planet in countless ways, from regulating the climate, to feeding millions of people, to supporting industries that contribute billions of dollars to the global economy (3). Even so, less than 1% of the high seas are fully protected (4), and the current patchwork of management and lack of oversight leaves them vulnerable to abuse. In 2017, the United Nations resolved to develop an international treaty for the conservation and sustainable use of the high seas. Negotiations are set to end this year. We must ensure that the forthcoming framework conserves high-seas biodiversity and promotes sustainable and equitable use

Women’s responses to changes in U.S. preventive task force’s mammography screening guidelines: results of focus groups with ethnically diverse women

Background: The 2009 U.S. Preventive Services Task Force (USPSTF) changed mammography guidelines to recommend routine biennial screening starting at age 50. This study describes women’s awareness of, attitudes toward, and intention to comply with these new guidelines. Methods: Women ages 40–50 years old were recruited from the Boston area to participate in focus groups (k = 8; n = 77). Groups were segmented by race/ethnicity (Caucasian = 39%; African American = 35%; Latina = 26%), audio-taped, and transcribed. Thematic content analysis was used. Results: Participants were largely unaware of the revised guidelines and suspicious that it was a cost-savings measure by insurers and/or providers. Most did not intend to comply with the change, viewing screening as obligatory. Few felt prepared to participate in shared decision-making or advocate for their preferences with respect to screening. Conclusions: Communication about the rationale for mammography guideline changes has left many women unconvinced about potential disadvantages or limitations of screening. Since further guideline changes are likely to occur with advances in technology and science, it is important to help women become informed consumers of health information and active participants in shared decision-making with providers. Additional research is needed to determine the impact of the USPSTF change on women’s screening behaviors and on breast cancer outcomes

Physical activity self-management interventions for adults with spinal cord injury: Part 2 – Exploring the generalizability of findings from research to practice

Despite the benefits associated with regular participation in physical activity, individuals with spinal cord injury (SCI) remain insufficiently active. The ability to self-manage participation may increase physical activity levels, but only if self-management interventions can be implemented in the ‘real world’. The purpose of this review was to examine the degree to which authors of published studies of LTPA self-management interventions for individuals with SCI have reported on factors that could increase the likelihood of translating this research into practice. A systematic search of five databases was conducted, yielding 33 eligible studies representing 31 interventions. Each intervention was assessed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and the PRECIS-2 (PRagmatic-Explanatory Continuum Indicator Summary) tool. The most commonly reported RE-AIM dimensions were Effectiveness (51.0% of interventions) and Reach (18.5%), followed by Implementation (14.2%), Maintenance (13.8%), and Adoption (4.0%). Overall, interventions were scored as primarily explanatory in five of the nine PRECIS-2 domains (recruitment, primary analysis, organization, flexibility [delivery], follow-up) and primarily pragmatic in one domain (setting). These findings suggest that while some LTPA self-management interventions for individuals with SCI are intended to be translated to real world settings, limited information is available to understand the degree to which this has been accomplished. Enhanced reporting of factors that could increase the likelihood of translating these interventions into practice is recommended