Application at the Bedside: Moving from Knowing How to Knowing Why in Nursing

The nursing field is beginning to emerge as a profession with curricula that emphasis nursing as a discipline distinguished from a medically dominated paradigm. This changing focus places emphasis on professional competence upon graduation and entry into practice to foster fitness for purpose within an environment of continuously changing expectations of the nurse by society. Despite a growing body of research on transition into practice, a gap exists as to when this transition occurs and how this finding may influence educational preparation of nurses. This qualitative, exploratory study examined nurses’ perceptions of their transformation from novice to professional practitioner by examining a pivotal moment in their practice that affected their self-reported professional competence, Twenty-five nurses who had worked in a hospital setting between 2 and 5 years were interviewed. The primary research question sought to address whether a common thread became apparent after conducting interviews that may have implications for nurse educators to enhance or change their curriculum. Analysis of the interviews was conducted utilizing a constructivist approach. The data collected were analyzed using ATLAS.ti, Using participants’ words that described people, settings, themes and ideas that appeared in the data, coding was done acknowledging that some codes were based on the research questions and the initial review of the data. A common theme emerged from analysis that respondents felt that what they were taught in school was not valid in real life. Nurse educators need to re-envision their social responsibility and interrogate the traditional principles that have guided the curricula to prepare and train nurses’ for the holistic welfare of all individuals in society. This is necessary to meet the needs of a changing social structure within the nursing profession and society as a whole

“NOT My Issue!!!”: Teaching the Interpersonal Conflict Course

Students who enroll in communication courses to improve their conflict management abilities should be provided with both an understanding of, and skills pertaining to, interpersonal conflict across diverse contexts. In this article, we offer pedagogical guidance for teaching the Interpersonal Conflict course. With an emphasis on building communication skills usable in a variety of real-life situations and settings, this article includes discussion of necessary foundational concepts and applied content areas, sample application assignments, and relevant considerations for those teaching the course

Whose Fault is It? Externalizing Academic Responsibilities is Associated With Lower GPA

A core tenet of Bandura’s (1986) Social Cognitive Theory is that cognitive factors motivate human behavior. For instance, believing that earning high grades will result in a desirable job will motivate one to earn higher grades. Here, we suggest that externalizing the responsibility of one’s college education are more likely to struggle academically. As part of a larger study, college students (N = 396) from three universities reported their externalized academic responsibility (Chowning & Campbell, 2009), self-esteem (Rosenberg, 1985), narcissism (Gentile et al. 2013), and GPA. It was hypothesized that externalized academic responsibility would be negatively associated with GPA. In an exploratory follow-up analysis, we examined whether narcissism or self-esteem moderated this association. There was a negative correlation between externalized academic responsibility and GPA (r = -.37,

Public attitudes toward the use of force and presidential crisis responses

This dissertation explores the role of public opinion in U.S. presidential decisions to employ various alternatives in response to an international crisis. Presidents may choose from a range of force alternatives, including non-force alternatives, troop mobilizations, air strikes or ground assaults. Using the Poliheuristic Theory, I argue that public attitudes toward the use of force in a given crisis play a key role in the decision making process leading to such choices. The direction and intensity of public opinion is driven by a relative value assessment by which the public determines whether the benefits of a use of force are worth the costs. Presidents are aware of this relative value assessment and rule out crisis responses that are likely to violate the public's preferences in the first stage of the decision making process. In the second stage, presidents choose among the remaining alternatives by weighing the relative merits of each with respect to military and international-strategic implications. To test hypotheses following from this theoretical argument, I employ two methodological approaches. The first is statistical analysis. I develop a new data set of presidential crisis response choices and expand an existing data set on U.S. public attitudes toward the use of force, from 1949 to 2001. Using two extant data collections identifying international crises, I conduct Ordered Logit analyses, which produce results that are largely supportive of the hypotheses. The second methodological approach is the case study method. I conduct two detailed case studies of decisions to use force in Bosnia (1995) and Afghanistan (2001). These analyses are also supportive of the theoretical argument. I conclude that presidents are largely responsive to public opinion in the selection of crisis responses

Repetibilidade dos pesos e ganho de peso do nascimento a desmama de bezerros da raça Nelore.

Repetibilidade do ganho de peso ao nascimento e a desmama

An evaluation of three processing methods and the effect of reduced culture times for faster direct identification of pathogens from BacT/ALERT blood cultures by MALDI-TOF MS

Matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) is a fast and reliable method for the identification of bacteria from agar media. Direct identification from positive blood cultures should decrease the time to obtaining the result. In this study, three different processing methods for the rapid direct identification of bacteria from positive blood culture bottles were compared. In total, 101 positive aerobe BacT/ALERT bottles were included in this study. Aliquots from all bottles were used for three bacterial processing methods, i.e. the commercially available Bruker’s MALDI Sepsityper kit, the commercially available Molzym’s MolYsis Basic5 kit and a centrifugation/washing method. In addition, the best method was used to evaluate the possibility of MALDI application after a reduced incubation time of 7 h of Staphylococcus aureus- and Escherichia coli-spiked (1,000, 100 and 10 colony-forming units [CFU]) aerobe BacT/ALERT blood cultures. Sixty-six (65%), 51 (50.5%) and 79 (78%) bottles were identified correctly at the species level when the centrifugation/washing method, MolYsis Basic 5 and Sepsityper were used, respectively. Incorrect identification was obtained in 35 (35%), 50 (49.5%) and 22 (22%) bottles, respectively. Gram-positive cocci were correctly identified in 33/52 (64%) of the cases. However, Gram-negative rods showed a correct identification in 45/47 (96%) of all bottles when the Sepsityper kit was used. Seven hours of pre-incubation of S. aureus- and E. coli-spiked aerobe BacT/ALERT blood cultures never resulted in reliable identification with MALDI-TOF MS. Sepsityper is superior for the direct identification of microorganisms from aerobe BacT/ALERT bottles. Gram-negative pathogens show better results compared to Gram-positive bacteria. Reduced incubation followed by MALDI-TOF MS did not result in faster reliable identification

Atrial fibrillation management strategies in routine clinical practice: insights from the International RealiseAF Survey

Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients' clinical characteristics, AF control, and symptom burden.RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit.Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p = II.In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved

Benign anal lesions, inflammatory bowel disease and risk for high-risk human papillomavirus-positive and -negative anal carcinoma.

A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 population controls. Anal cancer specimens (n = 388) were tested for HPV by the polymerase chain reaction. Excluding the 5 years immediately before diagnosis, men, but not women, with anal cancer reported a history of haemorrhoids [multivariate odds ratio (OR) 1.8; 95% confidence interval (CI) 1.04-3.2] and unspecific anal irritation (OR 4.5; CI 2.3-8.7) significantly more often than controls. Women with anal cancer did not report a history of benign anal lesions other than anal abscess to any greater extent than controls, but they had used anal suppositories more often (OR 1.5; CI 1.1-2.0). Patients with hrHPV in anal cancer tissue (84%) and those without (16%) reported similar histories of most benign anal lesions, but anal fissure or fistula was more common among hrHPV-positive cases. Ulcerative colitis and Crohn's disease, reported by <1% of study participants, were not associated with anal cancer risk. The higher proportion of hrHPV-positive anal cancers among case patients with anal fissure or fistula suggests that such mucosal lesions may provide direct viral access to basal epithelial layers. Since risk associations with benign anal lesions in men may be confounded by unreported sexual behaviour, and since risk associations in women were generally negative, it seems unlikely that benign anal lesions act as promoters in hrHPV-associated anal carcinogenesis. Moreover, benign anal lesions appear not to be linked to an alternative, hrHPV-unassociated causal pathway to anal cancer. Ulcerative colitis and Crohn's disease were not supported as causal factors for anal cancer

Analysis of MHC class I and II expression in relation to presence of HPV genotypes in premalignant and malignant cervical lesions.

Cervical intraepithelial neoplasia (CIN) grades I to III lesions (n = 94) and squamous cell carcinomas of the uterine cervix (n = 27) were analysed for MHC class I and II expression and presence of HPV genotypes. MHC class I and II expression was studied by immunohistochemistry and HPV typing was performed by general primer- and type-specific primer mediated PCR (GP/TS PCR). Both techniques were performed on paraffin embedded tissue sections. Results show disturbed MHC class I heavy chain expression in CIN I to CIN III, as well as in cervical carcinomas. Upregulated MHC class II expression on dysplastic epithelial cells was also found in the different CIN groups and carcinomas. Prevalence of HPV genotypes increased with the severity of the lesion, mainly due to the contribution of the HPV types 16 and 18. No correlation could be established between the presence of specific HPV genotypes and any MHC expression pattern in the different CIN groups or cervical carcinomas. In some cases these data were confirmed by RNA in situ hybridisation showing HPV 16 E7 transcripts in the same dysplastic/neoplastic cells from which MHC status was determined. The results indicate that local differences may exist in the type of cellular immune response to HPV induced lesions