Increasing Knowledge and Comfort Levels of ICU Nurses in Goals of Care Discussions Through Palliative Care Education

Critical care nurses are tasked with treating patients during the most complex times, typically beginning with aggressive treatment measures and in many cases, transitioning to end-of-life care. According to the literature review, critical care nurses report they frequently provide care that they feel is futile and palliative care resources are underutilized in the intensive care unit. They also report limited education/training and comfort in understanding their role in goals of care conversations and end-of-life care despite their vital role in providing direct patient care. The goal of this project was to implement an education program using the IMPACT-ICU toolkit to ultimately increase intensive care nurses’ knowledge, comfortability, and involvement in goals of care discussions. All critical care nurses (n=25) on a neuroscience intensive care unit at a local community hospital were given a pre-and post-intervention survey to voluntarily complete. As well, all were required to complete the required education webinar via AACN consisting of information from the IMPACT-ICU toolkit. Results of the completed surveys revealed the educational intervention was effective in educating the bedside intensive care nurse role on identifying their role in prognosis, goals of care, and palliative care discussions. Overall, critical care nurses in the target community reported an increase in their ability to identify their role in prognosis, goals of care, and palliative care discussions

Cognitive and Occupationally-based Assessments in Acute Care: For Individuals with Acquired Brain Injury

The student researchers collaborated with Marcy Boschee, OTR/L, an occupational therapist practicing in the acute care unit at St. Joseph\u27s Medical Center in Tacoma, WA to investigate two clinical questions: [1] “What evidence is there for the effectiveness of the Montreal Cognitive Assessment (MoCA) in predicting functional cognitive impairment of patients 18-years-old and older in acute care who have sustained an ABI?” and [2] “Which occupationally-based cognitive assessments, feasible to use in the acute care setting, are most effective at predicting functional impairment in patients 18-years-old and older with mild to severe ABI?” A systematic review was conducted and 29 articles were included. The AOTA levels and the Research Pyramid of categorization were used to determine rigor. The findings indicated that the MoCA is not sensitive enough, nor sufficient, in detecting no or mild cognitive impairment. It is therefore recommended that when the MoCA indicates no cognitive impairment, the OT practitioner should administer an occupationally-based cognitive assessment to fully assess the client’s executive functioning abilities. The student researchers analyzed the findings and developed an occupationally-based assessment matrix, supplemented by a decision flowchart. These and the research itself were presented to Marcy and her colleagues in the acute rehabilitation unit at St. Joseph’s Medical Center. In order to best support the implementation of the new information into clinical practice, specific knowledge translation products and activities were offered. The effectiveness of the knowledge translation process was measured through several methods. These included extensive revision processes, post in-service surveys and corresponding analysis, as well as a structured consultation (e.g. follow-up questions) for our collaborating clinician following the in-service itself. It is recommended that St. Joseph’s Medical Center purchase an occupationally-based assessment, as outlined in the assessment matrix, to improve their ability to adequately and effectively assess mild cognitive impairment

Hurricane Evacuation Research: A Systematic Review

Public health agencies play a large role in research initiatives to gain a better understanding of human response during hurricanes. This research is critical to allow public health agencies and their partners in emergency management to develop and implement educational initiatives, communications plans and evacuation strategies to safeguard human life in times of natural disaster. While research has identified several primary factors that impact one’s decision to evacuate there is still a gap in understanding exactly how social factors impact evacuation decisions. A systematic review of the literature was carried out to gain better understanding of the level of knowledge about how and which social factors influence evacuation decisions. All of the research presented in this literature review was specifically designed to examine evacuation behavior, however in all studies, understanding the impact of social capital was secondary. This review indicates that three things should be considered when developing evacuation planning and intervention; these are: a set of specific major themes, social factors and research limitations and knowledge gaps. While much progress has been made in this area, additional targeted research is needed to truly understand how social factors coupled with known factors such as perception of risk, source of information, personal evacuation plans, prior hurricane experience, length of residence, lack of transportation, and sense of place interact to form the basis of one’s decision to evacuate during a hurricane. Having this greater understanding may allow agencies and officials to design and implement education and intervention strategies based on specific demographic, social, and physical attributes of the population and their surroundings that will improve evacuation efficiency and overall outcomes, including a reduction in death and injuries, improved household planning and preparation and higher evacuation rates during these critical emergency situations.Master of Public Healt

Housing Stability, Evictions, and Subsidized Rental Properties: Evidence from Metro Atlanta

Evictions cause substantial harm to lower-income families. The effects range from homelessness to job loss, school turnover, and deteriorating health. Previously evicted tenants can be pushed down-market and forced to accept substandard housing. Housing subsidy might be expected to reduce eviction rates and provide greater stability. However, little systematic research has examined the eviction rates of subsidized, affordable rental properties and compared them to nonsubsidized, market-rate properties. We examine eviction filings for multifamily rental buildings in five-county metropolitan Atlanta, using a data set of eviction filings, property characteristics, and ownership information. We identify the subset of buildings that are subsidized and distinguish between senior and nonsenior properties. We find that senior, subsidized multifamily properties have substantially lower eviction rates than market-rate properties. A senior-subsidized multifamily rental building is expected to have an annual eviction rate that is 10.7 percentage points below a nonsenior, market-rate property; this result is significant p \u3c 0.01, and compares to a mean eviction filing rate of 16.3 percent (16.3 evictions per 100 rental units). On the other hand, a nonsenior-subsidized building is expected to have an eviction rate that is 1.4 percentage points lower than a nonsenior, market-rate building; this result is not statistically significant. It is important to note that we do not have data on the economic characteristics of tenants, and that may account for some of the relatively high eviction rates of the nonsenior-affordable properties. We discuss implications of these findings for further research and housing policy and practice

Clinical Focus Program: Enhancing the Transition of Senior Nursing Students to Independent Practice

The Clinical Focus Program was designed to prepare senior nursing students for the transition to practice in the hospital setting. Through a series of 1:1 precepted clinical experiences, the students developed a broad base of clinical competencies and self-confidence in their nursing skills. Hospitals experienced reduced costs related to orientation and recruitment of new graduate nurses. The program also was valuable in building a network of collegiality and scholarship between education and practice environments. According to the National Center for Health Workforce Analysis, the supply of nurses will be 29% less than what is needed by the year 2020, based on a projected increase in demand of 40% and only a 6% increase in supply. One of many factors contributing to this shortage is nurses leaving nursing. Between 1996 and 2000, the number of nurses leaving the profession grew to almost 500,000. Although little is known about this population as a whole, 30% to 54% of new graduate nurses change jobs or leave nursing during their first year of practice for reasons that include feeling inadequately prepared for the fast-paced acute care setting, caring for high-acuity patients, and lacking a supportive work environment. Improving the transition from student to professional nurse might reduce these stressors and increase satisfaction, ultimately resulting in fewer nurses leaving the profession. This is supported by a recent report on the American nursing shortage published by the Robert Wood Johnson Foundation, in which one of the chief areas identified as needing improvement was in preparing students adequately for the reality of work as a professional nurse. One way to facilitate the transition from student to practicing nurse may be to provide additional clinical experiences for senior nursing students. Clinical experiences are rich learning opportunities for working with patients with clinical entities about which students may have only read or studied theoretically. Specifically, mentored clinical experiences before graduation are extremely valuable. Such programs bridge the gap between the idealism of nursing education and the reality of the workplace. Students begin to identify with the professional role and to think and perform like nurses. Providing mentored clinical experiences requires academic and service leaders to share the responsibility of creating these opportunities. This article describes the development, implementation, and first-year outcomes of the Clinical Focus Program (CFP), a partnership between the University of Wisconsin-Oshkosh College of Nursing (UWO) and 2 tertiary care institutions, ThedaCare (TC) and Children\u27s Hospital of Wisconsin-Fox Valley (CHW-FV). The driving force behind the program was the Wisconsin Nursing Redesign Consortium, a collaborative partnership of academic and service organizations formed to address the nursing shortage within the state of Wisconsin. At a conference sponsored by this consortium in 2002, nursing professionals across the state were invited to form service and academic partnerships and submit proposals for projects that would address the growing demand for professional nurses. The CFP was one of these pilot projects

Cooperative Automation Supporting Pilot-Dispatch Negotiation of Enroute Trajectory Change Requests

The advent of advanced technologies in communication, navigation, and surveillance is enabling more integration between the aircraft and the ground systems in managing air traffic operations. As a result, automation has evolved to provide the flight crew, air traffic controllers, and traffic flow managers with capabilities for collaborating on information access, analysis, and decision making. In this paper, we investigate different cooperative schemes between these agents, supported by automation, in managing dynamic trajectory changes while the flight is en route to improve flight and system performance. The analysis was conducted using an abstract cognitive tasking framework to identify trajectory change tasks independently from the agent performing them. Cooperation schemes were then derived by assessing different levels of cooperation on each task between the air and ground agents and their automation. The assessment was based on which automation-supported agent is more capable of performing the task and the expected benefit mechanisms that result from cooperating. The cooperation schemes were compared based on a qualitative, but objective, assessment of the benefits expected from cooperation

Amazon.com: Offering Everything from A to Z

Amazon’s focus on customer service has led to an impressive record of growth and profitability. However, late in 2012, the company posted a quarterly loss. This asks whether the company may be sacrificing profits in the interest of growing rapidly. It also explores the incredibly competitive environment Amazon faces