Building a Leadership Culture for Environmental Health in a Nurse-Led Clinic

Climate change is the biggest global health threat of the 21st century (Costello et al., 2009). Temperature shifts caused by greenhouse gases have negative health impacts such as worsening of chronic diseases and increases in vector-borne diseases (American Public Health Association, 2016), which nurses are ethically responsible to address (American Nurses Association, 2015). At an interdisciplinary nurse-led clinic, staff were not prepared to assist patients in building resiliency related to the health impacts of climate change or to implement environmental sustainability in their workplace. Based on principles of partnership-based healthcare (Eisler & Potter, 2014), this project included Climate Conversations - sharing stories, values, and knowledge about climate change – (Minnesota Interfaith Power & Light, 2010) and evidence-based transformational leadership. The Nurses’ Environmental Awareness Tool (Schenk et al., 2015) was used to survey staff before and after they participated in behavioral interventions to incorporate environmental sustainability at their workplace. Compared to baseline, staffs’ knowledge of environmental sustainability increased significantly (p

Assessing the State of Comprehensive Medication Management in a Sample of Primary Care Clinics

OverviewComprehensive medication management (CMM) is an important tool to address medication-related morbidity and mortality and reduce health care costs. Medication therapy problems (MTPs) are a significant and costly barrier to improving patient outcomes1 and with more than half of all Americans taking at least one prescription drug,2 the need to manage and optimize patients’ medications is greater than ever. This report examines select practice and practitioner characteristics of the primary care clinics that participated in the research project, Enhancing Performance in Primary Care Medical Practice through Implementation of Comprehensive Medication Management. To be eligible to participate, sites had to have: established relationships with care team providers, a way of electronically identifying patients most in need of CMM, reporting processes in place for CMM data, read/write access in the electronic medical record, and an established CMM practice or a commitment to providing CMM. Because of these inclusion criteria, most participating clinics had CMM services in place for several years and were mature in their design and delivery of services. Site characteristics around the following areas were assessed: pharmacist and clinic demographics, delivery of pharmacy services, collaboration, billing and payment for CMM, and measuring CMM outcomes. The results of this report shed light on how CMM is being delivered in a sample of established CMM practices and therefore may provide benefit to those practitioners interested in building their own CMM practice.   Article Type: Original Researc

Association of Burnout With Primary Care Clinician Perception of Team-Based Scheduling Support

Introduction: Primary care clinician burnout is pervasive and detrimental. How components of teamwork and clinic culture might contribute to burnout remains unsettled. Objective: To examine associations between primary care clinician perceptions of specific components of teamwork and of organizational culture, and perceived stress and burnout. Methods: Cross-sectional survey study of primary care clinicians from 5 county health system clinics. Measures: Perceptions of teamwork related to coordination of care, and clinic provision of chronic disease self-management support; values alignment and workplace equity; and demographics. Data Analysis: Descriptive statistics and Spearman’s correlations to examine associations, controlling for clinic and examining response variability by clinic. Results: Of 72 clinicians, 64% were female and 32% non-white. About 56% had worked at least 4 years and half worked 5 to 6 half days/week or more in their clinic. Clinicians who reported having someone on the clinician’s care team routinely schedule follow-up appointments for patients with complex chronic illnesses reported lower stress and burnout. Those who perceived greater values alignment with their clinic and greater personal and employee equitable treatment had lower stress and burnout. Conclusions: Teamwork among clinicians and non-clinical staff, a component of teamwork that is not well-considered in current literature, could be an important piece of the puzzle to decrease the persistent and challenging issue of stress and burnout among primary care clinicians

Data for Control of the third dimension in copper-based square-lattice antiferromagnets

Using a mixed-ligand synthetic scheme, we create a family of quasi-two-dimensional antiferromagnets, namely, [Cu(HF2)(pyz)2]ClO4 [pyz = pyrazine], [CuL2(pyz)2](ClO4)2 [L = pyO = pyridine-N-oxide and 4-phpy-O = 4-phenylpyridine-N-oxide. These materials are shown to possess equivalent two-dimensional [Cu(pyz)2]2+ nearly square layers, but exhibit interlayer spacings that vary from 6.5713 to 16.777 Å, as dictated by the axial ligands. We present the structural and magnetic properties of this family as determined via x-ray diffraction, electron-spin resonance, pulsed- and quasistatic-field magnetometry and muon-spin rotation, and compare them to those of the prototypical two-dimensional magnetic polymer Cu(pyz)2(ClO4)2. We find that, within the limits of the experimental error, the two-dimensional, intralayer exchange coupling in our family of materials remains largely unaffected by the axial ligand substitution, while the observed magnetic ordering temperature (1.91 K for the material with the HF2 axial ligand, 1.70 K for the pyO and 1.63 K for the 4-phpy-O) decreases slowly with increasing layer separation. Despite the structural motifs common to this family and Cu(pyz)2(ClO4)2, the latter has significantly stronger two-dimensional exchange interactions and hence a higher ordering temperature. We discuss these results, as well as the mechanisms that might drive the long-range order in these materials, in terms of departures from the ideal S=1/2 two-dimensional square-lattice Heisenberg antiferromagnet. In particular, we find that both spin-exchange anisotropy in the intralayer interaction and interlayer couplings (exchange, dipolar, or both) are needed to account for the observed ordering temperatures, with the intralayer anisotropy becoming more important as the layers are pulled further apart