Nurses’ experiences and understanding of workplace violence in a trauma and emergency department in South Africa

Violence in South African society has reached epidemic levels and has permeated the walls of the workplace. The aim of the study was to gain a deeper understanding of how nurses experience and understand workplace violence perpetrated by patients, and to make recommendations to reduce this type of violence. A qualitative, exploratory and descriptive study was conducted to explore the experiences and coping mechanisms of nurses regarding workplace violence. The purposive sample comprised eight nurses working in the Trauma and Emergency Department in the Western Cape, South Africa. Thematic analysis was done of the semi-structured interviews. Four main themes and 10 categories were identified. Nurses are experiencing physical threats, verbal abuse and psychological and imminent violence on a regular basis. They tend to ‘normalise’ abusive patient behaviour because of the perception that workplace abuse ‘comes with the territory’, which resulted in under-reporting. However, perpetrators received compromised care by being avoided, ignored or given only minimal nursing care. Coping mechanisms ranged from using colleagues as sounding boards, helping out with duties, taking a smoke break and using friends and family to get it ‘off their chest’. The tolerance of non-physical violence and the absence of policies to deal with the violence, contribute to under-reporting.Department of HE and Training approved lis

Shaping Health Policy for Low-Income Populations: An Assessment of Public Comments in a New Medicaid Waiver Process

Since the Supreme Court decided that the Affordable Care Act\u27s (ACA) Medicaid expansion is optional for the states, several have obtained federal approval to use Section 1115 waivers to expand Medicaid while changing its coverage and benefits design. There has long been concern that policy making for Medicaid populations may lack meaningful engagement with low-income constituents, and therefore the ACA established a new process under which the public can submit comments on pending Medicaid waiver applications. We analyzed 291 comment letters submitted to federal regulators pertaining to Medicaid Section 1115 waiver applications in the first five states to seek such waivers: Arkansas, Indiana, Iowa, Michigan, and Pennsylvania. We found that individual citizens, including those who identified as Medicaid-eligible, submitted a sizable majority of the comment letters. Comment letters tended to mention controversial provisions of the waivers and reflected the competing political rhetoric of “personal responsibility” versus “vulnerable populations.” Despite the fact that the federal government seemed likely to approve the waiver applications, we found robust public engagement, reflecting the salience of the issue of Medicaid expansion under the ACA. Our findings are consistent with the argument that Medicaid is a program of growing centrality in US health politics

Acute and Chronic Effects of Green Oat (Avena sativa) Extract on Cognitive Function and Mood during a Laboratory Stressor in Healthy Adults: A Randomised, Double-Blind, Placebo-Controlled Study in Healthy Humans

Green oat (Avena sativa) extracts contain several groups of potentially psychoactive phytochemicals. Previous research has demonstrated improvements in cognitive function following a single dose of these extracts, but not following chronic supplementation. Additionally, whilst green oat extracts contain phytochemicals that may improve mood or protect against stress, for instance species-specific triterpene saponins, to date this possibility has not been examined. The current study investigated the effects of a single dose and four weeks of administration of a novel, Avena sativa herbal extract (cognitaven®) on cognitive function and mood, and changes in psychological state during a laboratory stressor. The study adopted a dose-ranging, double-blind, randomised, parallel groups design in which 132 healthy males and females (35 to 65 years) received either 430 mg, 860 mg, 1290 mg green oat extract or placebo for 29 days. Assessments of cognitive function, mood and changes in psychological state during a laboratory stressor (Observed Multitasking Stressor) were undertaken pre-dose and at 2 h and 4 h post-dose on the first (Day 1) and last days (Day 29) of supplementation. The results showed that both a single dose of 1290 mg and, to a greater extent, supplementation for four weeks with both 430 mg and 1290 mg green oat extract resulted in significantly improved performance on a computerised version of the Corsi Blocks working memory task and a multitasking task (verbal serial subtractions and computerised tracking) in comparison to placebo. After four weeks, the highest dose also decreased the physiological response to the stressor in terms of electrodermal activity. There were no treatment-related effects on mood. These results confirm the acute cognitive effects of Avena sativa extracts and are the first to demonstrate that chronic supplementation can benefit cognitive function and modulate the physiological response to a stressor

Diurnal rhythm of plasma EPA and DHA in healthy adults

Knowledge of the diurnal variation in circulating omega-3 polyunsaturated fatty acids (n-3 PUFAs) may be an important consideration for the development of dosing protocols designed to optimise tissue delivery of these fatty acids. The objective of the current study was to examine the variation in plasma concentrations of eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3) over a 24-h period in healthy adults under eating and sleeping conditions generally approximate to a free-living environment. Twenty-one healthy participants aged 25–44 years took part in a single laboratory visit encompassing an overnight stay. EPA and DHA were measured in plasma samples collected every two hours from 22:00 until 22:00 the following day, with all meals being provided at conventional times. Cosinor analysis was used to estimate the diurnal variation in each fatty acid from pooled data across all participants. A significant diurnal variation in the pooled plasma concentrations of both fatty acids was detected. However, evidence of distinct rhythmicity was strongest for DHA. The timing of the peak concentration of DHA was 17:43 with a corresponding nadir at 05:43. In comparison, the observed acrophase for EPA was delayed by three hours, occurring at 20:41, with a nadir at 08:41. This is the first time that the diurnal variation in these important bioactive fatty acids has been described in a sample of healthy adults following a normal pattern of eating and sleeping. In the absence of any dietary intake of EPA and DHA, circulating levels of these fatty acids fall during the overnight period and reach their lowest point in the morning. Consumption of n-3 PUFAs at night time, which counteracts this pattern, may have functional significance

Le stress et le décrochage scolaire, un lien négligé ou négligeable? : une étude sur l'impact du stress social sur la performance scolaire, l'impulsivité et la prise de risque en fonction du niveau de risque de décrochage scolaire

Plusieurs outils mesurent le niveau de risque de décrochage scolaire grâce à l’évaluation de certains facteurs de risque connus, comme le niveau de performance scolaire et les difficultés d’ordre comportemental. De hauts niveaux d’impulsivité et de prise de risque peuvent d’ailleurs prédire des difficultés de comportement. Mais qu’en est-il du stress? Le stress comme facteur de risque a été discuté dans certaines études sur le décrochage scolaire, mais son impact sur les performances scolaires, l’impulsivité et la prise de risque n’a jamais été mesuré en lien avec le niveau de risque de décrochage scolaire. Cette étude propose d’évaluer l'impact du stress social sur la performance scolaire, l'impulsivité et la prise de risque et de le mettre en lien avec le niveau de risque de décrochage scolaire. L'hypothèse veut que plus le niveau de risque de décrochage scolaire est élevé, plus le stress social aura un impact négatif sur nos mesures. 37 adultes de 15 à 20 ans, sans diplôme, ont été rencontrés. Après la caractérisation et l'évaluation du niveau de risque de décrochage scolaire, les participants ont réalisé des tâches de performance scolaire, d’impulsivité et de prise de risque avant et après une situation de stress, le Trier Social Stress Test (TSST). Des échantillons de cortisol salivaire ont montré que le TSST n'a pas provoqué un stress assez significatif pour tester notre hypothèse. Les données indiquent cependant un lien significatif entre le niveau de risque de décrochage scolaire et l'impulsivité. De plus, les données liées à la prise de risque apportent un questionnement intéressant sur ses liens avec l'impulsivité. Nous ne pouvons conclure que plus le niveau de risque de décrochage scolaire est élevé, plus le stress a un impact négatif important. Toutefois, nos données supportent le lien entre l'impulsivité cognitive et le niveau de risque de décrochage scolaire.Dropping out of school can seriously affect employment possibilities and social integration. There are tools to investigate and measure the level of risk of dropping out. Academic performances and behaviour problems are well documented risk factors. Impulsivity and risk taking can lead to problematic behaviour. Certain studies have looked into the impact of stress on the dropping out process, but its impact on academic performances, impulsivity and risk taking has never been evaluated directly with the risk level of dropping out. Objective and hypothesis : The objective of this study is to evaluate the impact of stress on academic performances, impulsivity and risk taking and to measure the relation of this impact with the risk level of dropping out of school. The hypothesis is that higher the risk level, higher the negative impact stress will have on our measures of academic performance, impulsivity and risk taking. Method : 37 young adults between 15 and 20 years old with no diploma took part in the study. After measuring the risk level of dropping out, a full characterization was made followed by academic performance, impulsivity and risk taking tasks before and after a social stress condition, the Trier Social Stress Test (TSST). Results : Our salivary cortisol samples show that the TSST did not produce a significant change in levels of stress to adequately test our hypothesis. Our results show a significant interaction between impulsivity and the risk level of dropping out. Furthermore, the relation between risk taking and impulsivity in our results is interesting Conclusion : The objective of this project could not be adequately tested since the stress condition didn't produce a significant stress reaction, as measured by salivary cortisol. The level of risk of dropping out was significantly correlated with impulsivity, but not risk taking, nor academic performances

Themes in Health Care Culture: Application of Cultural Transformation Theory

Key aspects of culture change include familiarizing oneself with how relationships are structured and encouraging an awareness of how people relate to one another on a domination/partnership continuum (Eisler & Potter, 2014). In 2013, 200 nurse leaders were asked to rate their own cultures on a continuum of domination to partnership based on Eisler’s Cultural Transformation Theory (1987). Of those nurse leaders, 37.5% rated their organizations as being closer to a domination culture than a partnership culture. These findings prompted the development and delivery of a webinar series that applied Cultural Transformation Theory to healthcare culture. The attendees noted an overall change in self-rating of their healthcare culture as they learned about domination and partnership culture. This shift in rating could indicate Cultural Transformation Theory’s usefulness in understanding healthcare culture, and in identifying domination and partnership relationships. In discussions during the webinar three themes emerged: 1) Healthcare culture inclines toward domination and this has an impact on patients, 2) Leadership impacts organizational culture, and 3) Leaders are unaware of domination tendencies within their own cultures. Further discussion is needed to identify strategies that support cultural changes, ultimately leading to improvements in safety, quality, and patient experience within healthcare

The Acute and Chronic Cognitive and Cerebral Blood-Flow Effects of Nepalese Pepper (Zanthoxylum armatum DC.) Extract—A Randomized, Double-Blind, Placebo-Controlled Study in Healthy Humans

Background: Zanthoxylum armatum DC. (ZA) is a traditional Asian culinary spice and medicinal compound, which is rich in monoterpenes and hydroxy α-sanshool. Mechanistic interactions with the monoamine, cholinergic and cannabinoid neurotransmission systems, as well as transient receptor potential (TRP) and potassium ion channels, may predispose ZA to modulate human brain function. Objectives: To investigate the effects of a single dose and 56-days supplementation with a lipid extract of ZA on cognitive function, mood and cerebral blood-flow (CBF) parameters in the pre-frontal cortex during cognitive task performance. Design: Double-blind, randomized, parallel groups study with N = 82 healthy males and females between the ages of 30 and 55 years. Assessments were undertaken pre-dose and at 1, 3 and 5 hours post-dose on the first (Day 1) and last (Day 56) days of supplementation. Results: A single dose of ZA (Day 1) resulted in acute improvements on a ‘Speed of Attention’ factor and the Rapid Visual Information Processing (RVIP) task, in comparison to placebo. However, following ZA participants were less accurate on the name-to-face recall task. After 56 days of ZA consumption (Day 56), speed was enhanced on a global ‘Speed of Performance’ measure, comprising data from all of the timed tasks in the computerized battery. Participants also completed more correct Serial 3s Subtractions at the 3 hours assessment and were less mentally fatigued throughout the day than participants consuming placebo. These effects were complemented on both Day 1 and Day 56 by modulation of CBF parameters, as assessed by Near Infrared Spectroscopy (NIRS). The primary finding here was a reduced hemodynamic response during the RVIP task. Conclusion: ZA improves aspects of cognitive performance, in particular the speed of performing tasks, in healthy humans and results in concomitant reductions in hemodynamic responses in the frontal cortex during task performance. The findings suggest an increase in neural efficiency following ZA

Improving Communication between Doctors and Parents after Newborn Screening

Background: Newborn screening (NBS) enables early treatment, and some consider it a natural vehicle for genetic screening. Bioethicists argue for caution since families of infants with carrier status can develop psychosocial complications. This paper describes the methods and feasibility of Wisconsin’s statewide project for quality improvement of communication and psychosocial outcomes after NBS. Methods: When NBS identifies carrier status for cystic fibrosis or sickle cell, we contact primary care providers (PCPs), answer questions, and invite them to rehearse informing the parents. Three months later, we telephone the parents, assess knowledge and psychosocial outcomes, provide counseling, and assist with self-referral to further resources. Afterward, evaluation surveys are provided to the parents, to be returned anonymously. Results: Birthing facilities provided accurate PCP names for 73% of 817 infants meeting inclusion criteria; we identified PCPs for 21% more. We reached 47.3% of PCPs in time to invite a rehearsal; 60% of these accepted. We successfully called 50.2% of eligible parents; 61% recalled a PCP explanation, and 48.5% evaluated the explanation favorably. Evaluations by parents with limited health literacy were less favorable. Conclusion: It is feasible to follow parents for psychosocial outcomes after NBS. Preliminary data about communication is mixed, but further data will describe psychosocial outcomes and investigate outcomes’ associations with communication