Enhancing Nurses\u27 Pain Reassessment and Documentation Using Clinical Decision Support: A Quality Improvement Project in Acute Care

Purpose: The project aimed to educate medical-surgical registered nurses (RNs) on using the clinical decision support (CDS) tools to complete pain reassessment and documentation. Objectives were to increase pain reassessment compliance, identify perceived pain reassessment barriers, and change current pain reassessment and documentation behaviors. Background: Nurses are responsible for assessing, reassessing, and managing patients’ pain. Quality pain reassessment and documentation are essential to effective pain management. Methods: Participants were accrued via convenience sampling in addition to inclusion and exclusion criteria. The Plan-Do-Check-Act (PDCA) Cycle was used to guide the pilot project conducted in one medical-surgical unit. Implementation interventions: asynchronous computer-based learning module with step-by-step instruction and demonstration on how to use the CDS tools, dissemination of tip sheets to reinforce learning module content, unit rounding, and distribution of information on the importance of pain reassessment and documentation. Participants were also invited to complete an electronic questionnaire to evaluate demographics and perceived pain reassessment barriers. Results: 18 participants completed the project. The educational intervention had a small effect on the participants’ pain reassessment compliance one-week post-intervention. By the second post-intervention week, compliance dipped and regressed to baseline. The primary barriers contributing to participants’ pain reassessment compliance rates were time constraints, competing patient care priorities, heavy workload, inadequate staffing, and forgetfulness. Conclusion: The project results suggest that an educational intervention focused on CDS tools could improve nurses’ pain reassessment and documentation compliance and behaviors

The effects of inlet turbulence and rotor/stator interactions on the aerodynamics and heat transfer of a large-scale rotating turbine model. Volume 2: Heat transfer data tabulation. 15 percent axial spacing

A combined experimental and analytical program was conducted to examine the effects of inlet turbulence on airfoil heat transfer. The experimental portion of the study was conducted in a large-scale (approx 5X engine), ambient temperature, rotating turbine model configured in both single stage and stage-and-a-half arrangements. Heat transfer measurements were obtained using low-conductivity airfoils with miniature thermcouples welded to a thin, electrically heated surface skin. Heat transfer data were acquired for various combinations of low or high inlet turbulence intensity, flow coefficient, first-stator/rotor axial spacing, Reynolds number and relative circumferential position of the first and second stators. Aerodynamic measurements obtained as part of the program include distributions of the mean and fluctuating velocities at the turbine inlet and, for each airfoil row, midspan airfoil surface pressures and circumferential distributions of the downstream steady state pressures and fluctuating velocities. Analytical results include airfoil heat transfer predictions produced using existing 2-D boundary layer computation schemes and an examination of solutions of the unsteady boundary layer equations. The results are reported in four separate volumes, of which this is Volume 2: Heat Transfer Data Tabulation; 15 Percent Axial Spacing

The effects of inlet turbulence and rotor/stator interactions on the aerodynamics and heat transfer of a large-scale rotating turbine model. Volume 3: Heat transfer data tabulation 65 percent axial spacing

This is Volume 3 - Heat Transfer Data Tabulation (65 percent Axial Spacing) of a combined experimental and analytical program which was conducted to examine the effects of inlet turbulence on airfoil heat transfer. The experimental portion of the study was conducted in a large-scale (approximately 5X engine), ambient temperature, rotating turbine model configured in both single stage and stage-and-a-half arrangements. Heat transfer measurements were obtained using low-conductivity airfoils with miniature thermocouples welded to a thin, electrically heated surface skin. Heat transfer data were acquired for various combinations of low or high inlet turbulence intensity, flow coefficient, first-stator/rotor axial spacing, Reynolds number and relative circumferential position of the first and second stators

Axial compressor middle stage secondary flow study

This report describes an experimental investigation of the secondary flow within and aft of an axial compressor model with thick endwall boundary layers. The objective of the study was to obtain detailed aerodynamic and trace gas concentration traverse data aft of a well documented isolated rotor for the ultimate purpose of improving the design phases of compressor development based on an improved physical understanding of secondary flow. It was determined from the flow visualization, aerodynamic, and trace gas concentration results that the relative unloading of the midspan region of the airfoil inhibitied a fullspan separation at high loading preventing the massive radial displacement of the hub corner stall to the tip. Radial distribution of high and low total pressure fluid influenced the magnitude of the spanwise distribution of loss, such that, there was a general decreases in loss near the hub to the extent that for the least loaded case a negative loss (increase in total pressure) was observed. The ability to determine the spanwise distribution of blockage was demonstrated. Large blockage was present in the endwall regions due to the corner stall and tip leakage with little blockage in the core flow region. Hub blockage was found to increase rapidly with loading

The effects of inlet turbulence and rotor/stator interactions on the aerodynamics and heat transfer of a large-scale rotating turbine model. Part 4: Aerodynamic data tabulation

A combined experimental and analytical program was conducted to examine the effects of inlet turbulence and airfoil heat transfer. The experimental portion of the study was conducted in a large-scale (approx. 5X engine), ambient temperature, rotating turbine model configured in both single-stage and stage-and-a-half arrangements. Heat transfer measurements were obtained using low-conductivity airfoils with miniature thermocouples welded to a thin, electrically heated surface skin. Heat transfer data were acquired for various combinations of low or high inlet turbulence intensity, flow coefficient, first stator-rotor axial spacing, Reynolds number and relative circumferential position of the first and second stators. Aerodynamic measurements obtained include distributions of the mean and fluctuating velocities at the turbine inlet and, for each airfoil row, midspan airfoil surface pressures and circumferential distributions of the downstream steady state pressures and fluctuating velocities. Results include airfoil heat transfer predictions produced using existing 2-D boundary layer computation schemes and an examination of solutions of the unsteady boundary layer equations

Humanization through Action Research as Methodology

The purpose of this action research study was to critically examine the use of action research as a mechanism to enhance graduate students’ development as emerging qualitative researchers. Although action research has been recognized as an effective means of transforming teaching practices, studies examining its use among graduate students learning to become qualitative researchers are lacking. Participants profiled in this study include two graduate students and one teacher educator. The context of the study was a graduate level course on action research where all three participants identified starting points, employed distinct action strategies, engaged in sustained, critical reflection, and developed metaphors representing their living educational theories of their practice. Results from this study indicate that each participant gained a deeper self-awareness and understanding of enacting qualitative research and furthermore, recognized action research as a powerful humanizing agent

Engineering and Engineering Education as Spiritual Vocations

Spirituality and engineering (education) are often kept in separate compartments in our lives. They may slip out occasionally for conversations during ethics classes or service learning projects, but speaking -- and living -- our spiritual/religious values as engineers and engineering educators/researchers is still uneasy territory for many. The spirit of free inquiry and reflection that permeates the liberal arts urges us to integrate our spirituality into the human and natural worlds we inhabit. How do we bring such thinking into the technical realms?In this session, we will describe our personal journeys toward engineering education and how we actively and reflectively integrate our core values and spiritual/religious beliefs and practices into unexpected aspects of our work as engineers, engineering educators, and engineering education researchers. Each facilitator comes from a different faith tradition and technical background. Mel is an open source software hacker rediscovering feminist Catholicism. Julia is a Quaker-Buddhist with a degree in Chemical engineering who worked as a energy consultant for two years. And Cole is a Christian with a degree in industrial engineering who spent over ten years as a minister

Pantoea agglomerans bacteremia: A rare case of spontaneous human infection by a plant pathogen in an immunocompromised host.

Introduction: Pantoea agglomerans is a Gram negative ubiquitous bacteria commonly isolated from plant surfaces, seeds, fruits and animal/human feces usually introduced to human by ingestion of infected fruits/vegetables, thorn pricks and gastrointestinal translocation in lack of stomach acidity. However, the pathogen can also cause opportunistic human infection especially when the immune system is impaired. The aim of this case report is to investigate clinical features in a patient with P. agglomerans bacteremia and bring attention the opportunistic infection by this rare bacteria. Case presentation: We present a case of 57 year old caucasian lady with past medical history of Chronic Obstructive Pulmonary Disease, Atrial fibrillation, Immunoglobulin (IgG) deficiency, recurrent pneumonia, urine infection, oral/vaginal candidiasis, Gastro-esophageal reflux disease who presents with one week history of increased shortness of breath, chest tightness and productive cough without fever/chills. She also had high INR of 4.7 (target 2-3) despite taking normal dose of warfarin. She denies plant exposure. Her vitals were stable, saturation maintained with oxygen supplementation. Chest exam revealed very poor air entry bilaterally suggesting exacerbation of COPD. Oral thrush was present. Recent IgG level within last 6 months was low. Blood culture grew Pantoea agglomerans, pan-sensitive to most of the antibiotics. Chest X ray, CT scan abdomen and urine studies could not localize the source of infection. She was treated with Ceftriaxone, INR normalized to therapeutic range and she improved to baseline after 10 days of treatment. Discussion and conclusion: P. agglomerans is a rare cause of bacteremia which usually presents as fever, chills and general toxicity, however could also present as a cause of exacerbation of chronic diseases. Spontaneous infection can occur in a immunocompromised host, however the pathogen is of low virulence. The link between upper GI symptoms along with antacid receipt and spontaneous P. agglomerans infection could be possible, however needs further study. Hence, P. agglomerans should be considered one of the possible cause of spontaneous bacteremia in a immunocompromised host