Perceptions of Nurses after the First Year of Practice: Expectations and Reality

Background: The nursing profession is facing a critical shortage stemming from retirement of experienced nurses, increasing healthcare needs of an older population, and more inclusive healthcare coverage. Newly licensed nurses (NLNs) have been the long-term plan to fill the gap. Despite the support from nurse residency programs (NRPs), many of these graduate nurses are leaving their first position. This turnover of nurses is detrimental to the nursing shortage, and financially burdensome for health care systems. Purpose: Two aims were explored: 1) to better understand the perceptions of newly licensed nurses after the first year of practice about their expectations and the actual reality of working as a nurse; and 2) to describe the perceived influences in the transition of newly licensed nurses into practice within an acute care setting. Methods: Using a medically focused, ethnographic approach semi-structured interviews were conducted with purposive sampling of 15 NLNs who had just completed a NRP. Transcribed interviews were coded using Atlas ti. V8. Data content was analyzed and once redundancy was reached relevant themes were identified through content analysis from exemplars. Findings: Perceptions of the NLN experience of being a nurse was that it was overwhelming and hard. Interpretive descriptive analysis of their perception of transition showed that nursing school provided them with a foundation but clinical experiences were not realistic to their real life practice. Four concepts to the reality of being a nurse emerged from the data; “Unexpected patient care experiences”; “More responsibility than expected”; “Difficulty with patient coordination and time management”; “Living the nursing lifestyle”. Success depended on NLNs receiving additional education and sufficient support. Conclusion: NLNs enter practice not prepared for the role of the real nurse. Strong academic preparation, an NRP, and time and support from experienced nurses is necessary for NLNs to become confident in navigating the physical, mental and emotional requirements of caring for acutely ill patients

Contemporary Natural History and Management of Nonobstructive Hypertrophic Cardiomyopathy

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No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography

Background: Young mothers face mental health challenges during and after pregnancy including increased rates of depression compared to older mothers. While the prevention of teenage pregnancy in countries such as the United States and the United Kingdom has been a focus for policy and research in recent decades, the need to understand young women’s own experiences has been highlighted. The aim of this meta-ethnography was to examine young women’s perceptions of their mental health and wellbeing during and after pregnancy to provide new understandings of those experiences. Methods: A systematic review and meta-ethnographic synthesis of qualitative research was conducted. Seven databases were systematically searched and forward and backward searching conducted. Papers were included if they were from Organisation for Economic Co-operation and Development countries and explored mental health and wellbeing experiences of young mothers (age under 20 in pregnancy; under 25 at time of research) as a primary research question – or where evidence about mental health and wellbeing from participants was foregrounded. Nineteen papers were identified and the Critical Appraisal Skills Programme checklist for qualitative research used to appraise the evidence. Following the seven-step process of meta-ethnography, key constructs were examined within each study and then translated into one another. Results: Seven translated themes were identified forming a new line of argument wherein mental health and wellbeing was analysed as relating to individual bodily experiences; tied into past and present relationships; underpinned by economic insecurity and entangled with feelings of societal surveillance. There were ‘no straight lines’ in young women’s experiences, which were more complex than dominant narratives around overcoming adversity suggest. Conclusions: The synthesis concludes that health and social care professionals need to reflect on the operation of power and stigma in young women’s lives and its impact on wellbeing. It adds to understanding of young women’s mental health and wellbeing during and after pregnancy as located in physical and structural factors rather than individual capacities alone

Agricultural Biotechnology's Complementary Intellectual Assets

We formulate and test a hypothesis to explain the dramatic restructuring experienced recently by the plant breeding and seed industry. The reorganization can be explained in part by the desire to exploit complementarities between intellectual assets needed to create genetically modified organisms. This hypothesis is tested using data on agricultural biotechnology patents, notices for field tests of genetically modified organisms, and firm characteristics. The presence of complementarities is identified with a positive covariance in the unexplained variation of asset holdings. Results indicate that coordination of complementary assets have increased under the consolidation of the industry

Toxic Diatom Aldehydes Affect Defence Gene Networks in Sea Urchins.

Marine organisms possess a series of cellular strategies to counteract the negative effects of toxic compounds, including the massive reorganization of gene expression networks. Here we report the modulated dose-dependent response of activated genes by diatom polyunsaturated aldehydes (PUAs) in the sea urchin Paracentrotus lividus. PUAs are secondary metabolites deriving from the oxidation of fatty acids, inducing deleterious effects on the reproduction and development of planktonic and benthic organisms that feed on these unicellular algae and with anti-cancer activity. Our previous results showed that PUAs target several genes, implicated in different functional processes in this sea urchin. Using interactomic Ingenuity Pathway Analysis we now show that the genes targeted by PUAs are correlated with four HUB genes, NF-κB, p53, δ-2-catenin and HIF1A, which have not been previously reported for P. lividus. We propose a working model describing hypothetical pathways potentially involved in toxic aldehyde stress response in sea urchins. This represents the first report on gene networks affected by PUAs, opening new perspectives in understanding the cellular mechanisms underlying the response of benthic organisms to diatom exposure

Benefit of enactment over oral repetition of verbal instruction does not require additional working memory during encoding

For this research, we used a dual-task approach to investigate the involvement of working memory in following written instructions. In two experiments, participants read instructions to perform a series of actions on objects and then recalled the instructions either by spoken repetition or performance of the action sequence. Participants engaged in concurrent articulatory suppression, backward-counting, and spatial-tapping tasks during the presentation of the instructions, in order to disrupt the phonological-loop, central-executive, and visuospatial-sketchpad components of working memory, respectively. Recall accuracy was substantially disrupted by all three concurrent tasks, indicating that encoding and retaining verbal instructions depends on multiple components of working memory. The accuracy of recalling the instructions was greater when the actions were performed than when the instructions were repeated, and this advantage was unaffected by the concurrent tasks, suggesting that the benefit of enactment over oral repetition does not cost additional working memory resource

Sharing Meta-Information to Guide Cooperative Search among Heterogeneous Reusable Agents

A reusable agent is a self-contained computational system that implements some specific expertise and that can be embedded into diverse applications requiring that expertise. Systems composed of heterogeneous reusable agents are potentially highly adaptable, maintainable, and affordable, assuming that integration issues such as information sharing, coordination, and conflict management can be effectively addressed. In this article, we investigate the effectiveness of sharing meta-level search information to improve system performance, specifically with respect to how sharing affects the quality of solutions and the runtime efficiency of a reusable-agent system. We first give a formal description of shareable meta-information in systems where agents have private knowledge and databases and where agents are specifically intended to be reusable. We then present experimental results from a mechanical design system for steam condensers that demonstrate performance improvements related to ..

Understanding the Role of Negotiation in Distributed Search Among Heterogeneous Agents

In our research, we explore the role of negotiation for conflict resolution in distributed search among heterogeneous and reusable agents. We present negotiated search, an algorithm that explicitly recognizes and exploits conflict to direct search activity across a set of agents. In negotiated search, loosely coupled agents interleave the tasks of 1) local search for a solution to some subproblem; 2) integration of local subproblem solutions into a shared solution; 3) information exchange to define and refine the shared search space of the agents; and 4) assessment and reassessment of emerging solutions. Negotiated search is applicable to diverse application areas and problem-solving environments. It requires only basic search operators and allows maximum flexibility in the distribution of those operators. These qualities make the algorithm particularly appropriate for the integration of heterogeneous agents into application systems. The algorithm is implemented in a multi-agent framew..