How nursing care is expressed among nurse anaesthetists in the perioperative context: A meta-ethnographic synthesis

Aim To develop a conceptual framework describing nursing care from the anaesthesia nurse's perspective in the perioperative context. Background Surgical patients find themselves in a vulnerable situation in need of advanced treatment and care. Nurse anaesthetists have a central role in reducing harm and enhance patient safety, in which person-centred care has been identified as a key component. However, they are challenged by productivity and efficiency demands leading to a potential risk to patient safety. Design Noblit and Hare's interpretative meta-ethnography, directed by the eMERGe reporting guidance. Methods A comprehensive systematic search of nine databases without year limitation. Fifteen studies published between 2002 and 2021 were found eligible for inclusion. Quality appraisal was performed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Results Four themes were identified: being vigilant to keep safe from harm, strengthening patients' confidence, expressing courage to act and speak up, and endorsing team collaboration to achieve best practice. The themes were synthesised into the metaphor, ‘Continuously assessing and acting according to the patients' needs in a holistic perspective’. A conceptual framework was developed, illustrating the interconnection between the different nursing expressions, as the nurse anaesthetists seek to care for the patient as a whole person. Conclusions Nurse anaesthetists aim to deliver holistic nursing care. Nursing care is expressed at two levels, foregrounding and backgrounding anaesthetic nursing, in line with the philosophy of person-centred care. Nursing care in anaesthesia is a matter of how and why it is performed, expressed in attitudes toward the recipients of care. Relevance to clinical practice The framework may be used to inform educational programs and clinical practice in nurse anaesthesia and to promote person-centred care as a shared value across all levels involved in perioperative patient care. No patient or public contribution Data were retrieved from already published literature.publishedVersio

From threat to control – nurse anesthetists’ experiences of being redeployed or assigned new tasks during the Covid-19 pandemic in Norway

Bakgrunn: I mars 2020 erklærte Verdens helseorganisasjon utbruddet av covid-19 som en global pandemi. Anestesisykepleiere har blant annet spesialkompetanse innen luftveishåndtering, og ble raskt flyttet til frontlinjen blant annet ved intensivavdelingene for å ivareta håndteringen av smittede pasienter. Hensikt: Hensikten med denne studien var å få en dypere forståelse for anestesisykepleiernes erfaringer med midlertidig å bli omplassert fra en anestesiavdeling og/eller å få tildelt andre arbeidsoppgaver under covid-19-pandemien i Norge. Metode: Det er anvendt en kvalitativ metode med eksplorerende design og induktiv tilnærmelse. Datainnsamling ble gjort via individuelle dybdeintervju av seks anestesisykepleiere ved et universitetssykehus i Norge. Dataanalysen ble utført ved hjelp av kvalitativ innholdsanalyse. Resultat: Dataanalysen resulterte i ett overordnet tema: Fra trussel til kontroll, og fire kategorier: Å stå i front i ukjent terreng; Sammen er vi sterke; Moralsk plikt til å bidra; Med ledelsen i ryggen. Hver kategori ble også utdypet med sub-kategorier. Konklusjon: Innledningsvis var omplasseringen forbundet med usikkerhet, engstelse og uforutsigbarhet, samtidig som anestesisykepleierne opplevde en sterk moralsk plikt til å bidra i front. Etter hvert ble følelsene erstattet med yrkesstolthet, opplevelsen av å være en ressurs, ny læring og opplevelsen av kontroll. Ledelsen har et særlig ansvar for at det er tilstrekkelig personale, tilrettelegge for medvirkning, opplæring og kompensasjonsordninger ved eventuell lignende situasjon i fremtiden.publishedVersio

Modelling abrupt glacial North Atlantic freshening: Rates of change and their implications for Heinrich events

The abrupt delivery of large amounts of freshwater to the North Atlantic in the form of water or icebergs has been thought to lead to significant climate change, including abrupt slowing of the Atlantic Ocean meridional overturning circulation. In this paper we examine intermediate complexity coupled modelling evidence to estimate the rates of change, and recovery, in oceanic climate that would be expected for such events occurring during glacial times from likely sources around the North Atlantic and Arctic periphery. We show that rates of climate change are slower for events with a European or Arctic origin. Palaeoceanographic data are presented to consider, through the model results, the origin and likely strength of major ice-rafting, or Heinrich, events during the last glacial period. We suggest that Heinrich events H1-H3 are likely to have had a significant contribution from an Arctic source as well as Hudson Strait, leading to the observed climate change. In the case of H1 and H2, we hypothesise that this secondary input is from a Laurentide Arctic source, but the dominant iceberg release for H3 is hypothesised to derive from the northern Fennoscandian Ice Sheet, rather than Hudson Strait. Earlier Heinrich events are suggested to be predominantly Hudson Strait in origin, with H6 having the lowest climate impact, and hence iceberg flux, but H4 having a climate signal of geographically variable length. We hypothesise that this is linked to a combination of climate-affecting events occurring around the globe at this time, and not just of Laurentide origin. (C) 2010 Elsevier B.V. All rights reserved

A comparison between early presentation of dementia with Lewy Bodies, Alzheimer's disease and Parkinson's disease: evidence from routine primary care and UK Biobank data

OBJECTIVE: To simultaneously contrast prediagnostic clinical characteristics of individuals with a final diagnosis of dementia with Lewy Bodies, Parkinson's disease, Alzheimer's disease compared to controls without neurodegenerative disorders. METHODS: Using the longitudinal THIN database in the UK, we tested the association of each neurodegenerative disorder with a selected list of symptoms and broad families of treatments, and compared the associations between disorders to detect disease-specific effects. We replicated the main findings in the UK Biobank. RESULTS: We used data of 28,222 patients with PD, 20,214 with AD, 4,682 with DLB and 20,214 controls. All neurodegenerative disorders were significantly associated with the presence of multiple clinical characteristics before their diagnosis including sleep disorders, falls, psychiatric symptoms and autonomic dysfunctions. When comparing DLB patients with patients with PD and AD patients, falls, psychiatric symptoms and autonomic dysfunction were all more strongly associated with DLB in the five years preceding the first neurodegenerative diagnosis. The use of statins was lower in patients who developed PD and higher in patients who developed DLB compared to AD. In PD patients, the use of statins was associated with the development of dementia in the five years following PD diagnosis. INTERPRETATION: Prediagnostic presentations of falls, psychiatric symptoms and autonomic dysfunctions were more strongly associated with DLB than PD and AD. This study also suggests that whilst several associations with medications are similar in neurodegenerative disorders, statin usage is negatively associated with Parkinson's Disease but positively with DLB and AD as well as development of dementia in PD

Warm Atlantic surface water inflow to the Nordic seas 34–10 calibrated ka B.P.

Author Posting. © American Geophysical Union, 2008. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 23 (2008): PA1201, doi:10.1029/2007PA001453.A number of short-lasting warm periods (interstadials) interrupted the otherwise cold climate of the last glacial period. These events are supposedly linked to the inflow of the warm Atlantic surface water to the Nordic seas. However, previous investigations of planktonic foraminifera from the Nordic seas have not been able to resolve any significant difference between the interstadials and intervening cold stadials, as the faunas are continuously dominated by the polar species Neogloboquadrina pachyderma s. Here we examine the planktonic foraminifera assemblages from a high-resolution core, LINK17, taken at 1500 m water depth off northern Scotland below the warmest part of the inflowing Atlantic water. The core comprises the time period 34–10 calibrated ka B.P., the coldest period of the last glaciation and the deglaciation. The results reveal a hitherto unknown faunistic variability indicating significant fluctuations in both surface water inflow and in summer sea surface temperatures. During the interstadials, relatively warm Atlantic surface water (4–7°C) flowed north into the eastern Norwegian Sea. During the stadials and Heinrich events the surface inflow stopped and the temperatures in the study area dropped to <2°C. The Last Glacial Maximum was nearly as warm as the interstadials, but the inflow was much more unstable. The data reveal two previously unrecognized warming events each lasting more than 1600 years and preceding Heinrich events HE3 and HE2, respectively. By destabilizing the ice sheets on the shelves the warmings may have played a crucial role for the development of Heinrich events HE2 and HE3.The study of LINK17 was financed by UNIS as a part of the ESF-EuroClimate Program Resolution (grant 04-ECLIM-FP33)

Geochemical response of the mid-depth Northeast Atlantic Ocean to freshwater input during Heinrich events 1 to 4

PublishedArticleHeinrich events are intervals of rapid iceberg-sourced freshwater release to the high latitude North Atlantic Ocean that punctuate late Pleistocene glacials. Delivery of fresh water to the main North Atlantic sites of deep water formation during Heinrich events may result in major disruption to the Atlantic Meridional Overturning Circulation (AMOC), however, the simple concept of an AMOC shutdown in response to each freshwater input has recently been shown to be overly simplistic. Here we present a new multi-proxy dataset spanning the last 41,000 years that resolves four Heinrich events at a classic mid-depth North Atlantic drill site, employing four independent geochemical tracers of water mass properties: boron/calcium, carbon and oxygen isotopes in foraminiferal calcite and neodymium isotopes in multiple substrates. We also report rare earth element distributions to investigate the fidelity by which neodymium isotopes record changes in water mass distribution in the northeast North Atlantic. Our data reveal distinct geochemical signatures for each Heinrich event, suggesting that the sites of fresh water delivery and/or rates of input played at least as important a role as the stage of the glacial cycle in which the fresh water was released. At no time during the last 41 kyr was the mid-depth northeast North Atlantic dominantly ventilated by southern-sourced water. Instead, we document persistent ventilation by Glacial North Atlantic Intermediate Water (GNAIW), albeit with variable properties signifying changes in supply from multiple contributing northern sources.This research used samples provided by the Integrated Ocean Drilling (Discovery) Program IODP, which is sponsored by the US National Science Foundation and participating countries under management of Joint Oceanographic Institutions, Inc. We thank Walter Hale and Alex Wülbers for help with sampling, Kirsty Crocket for providing additional samples and Matt Cooper, Andy Milton, Mike Bolshaw and Dave Spanner for analytical support. Heiko Pälike, David Thornalley and Rachel Mills are thanked for productive discussions and comments on earlier versions of this work. We also thank three anonymous reviewers for their constructive feedback, which greatly improved the manuscript. Funding for this project was provided by NERC studentships to A.J.C. (grant NE/D005728/2) and T.B.C. (NE/I528626/1), with additional funding support from a Royal Society Wolfson Research Merit Award and NERC grants NE/F00141X/1 and NE/I006168/1 to P.A.W. and NE/D00876X/2 to G.L.F

Middle to Late Devensian glaciation of north-east Scotland: implications for the north-eastern quadrant of the last British-Irish ice sheet

We present a review of over 175 years of research into the Middle to Late Devensian (Weichselian) glaciation of north-east Scotland based crucially on both its lithostratigraphic and geomorphic records. The location of the region, and surrounding seabed, makes this unusually detailed record significant for deciphering the former interactions and dynamics of Scottish and Scandinavian ice within the North Sea Basin (NSB), which continue to be controversial. A twelve-stage event stratigraphy is proposed based on a parsimonious interpretation of stratigraphic relationships, till lithology and regional clast fabrics, striae, subglacial bedforms, ice-marginal features and published geochronometry at critical sites. The record of regional glaciation supports converging evidence that the north-eastern quadrant of the last British and Irish Ice Sheet (BIIS) reached its maximum spatial extent in the late Middle- to early Late Devensian and later re-expanded following widespread internal glacial reorganisations, marine transgression and partial retreat from the central NSB. Retreat was interrupted by several glacial readvances of limited extent. Field-captured data helps identify important events that are not clearly resolved from remote sensing alone, particularly regarding growth phases of the last glaciation