Influence of topography and moisture and nutrient availability on green alder function on the low arctic tundra, NT

The Arctic has warmed by at least 3°C over the past 50 years and this rapid warming is expected to continue. Climate warming is driving the proliferation of shrubs across the tundra biome with implications for energy balance, climate, hydrology, nutrient cycling, and biodiversity. Changes in tundra plant water use attributable to shrub expansion are predicted to increase evapotranspirative water loss which may amplify local warming and reduce run-off. However, little is known about the extent to which shrubs will enhance evapotranspirative water loss in these systems. Direct measures of shrub water use are needed to accurately predict evapotranspiration rates and the associated hydrological and energetic impacts. In addition, it is crucial that we understand the abiotic factors that drive shrub distribution and physiological function to forecast further changes in tundra ecosystem function. Shrubs are expanding in areas that have a higher potential of accumulating moisture, such as drainage channels and hill slopes. Shrub expansion may be limited by variation in water and nutrient availability across topographic gradients. Nevertheless, the associations between shrub function and abiotic limitations remain understudied. To address these knowledge gaps, we measured sap flow, stem water potential, and a range of functional traits of green alder (Alnus viridis) shrubs and quantified water and nutrient availability in shrub patches on the low arctic tundra of the Northwest Territories. Frost table depth was a significant negative driver of sap flow and underlies decreased surface water availability with thaw. This was further supported through significantly lower stem water potential values as the growing season progressed. Shrubs in upslope locations had significantly lower water potentials relative to shrubs in downslope locations, demonstrating topographic variation in shrub water status. Shrubs in channels and at the tops of patch slopes significantly differed in leaf functional traits representing leaf investment, productivity, and water use efficiency. Channel shrubs reflected traits associated with higher resource availability and productivity whereas shrubs at the tops of patches reflected the opposite. This work provides insight into the abiotic drivers of tall shrub water use and productivity, both of which will be essential for predicting ecosystem function

Educating Oncology Nurse Practitioners to Provide Basic Palliative Care

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology and the National Comprehensive Cancer Network. With an advanced education and scope of practice, a holistic orientation, and an evidence-base that substantiates their provision of safe and effective care, nurse practitioners (NPs) are well positioned to improve access to palliative care; yet, many NPs lack basic knowledge of palliative care and do not have competencies to provide such care. Objectives: This project aimed to measure differences in NPs’ knowledge of basic palliative care concepts and their self-rated self-competence in the provision of its care before and after a formal education program. Methods: This study used a one-group pre-post test design and valid and reliable instruments to measure the effects of an education intervention on NPs’ knowledge of basic palliative care and self-reported self-competence. The content for the education intervention, which was drawn from the End of Life Nursing Education Consortium’s (ELNEC) Advanced Practice Registered Nurse (APRN) curriculum, was delivered in one 8-hour program. The sample included NPs who practiced in the regional network sites of a National Cancer Institute designated comprehensive cancer center. Statistical differences were tested using paired t-tests, and a Wilcoxon Signed Ranks test. Results: A total of 37 NPs participated in the program. Knowledge, as measured by the ELNEC KAT increased from a mean of 89.03 to a mean of 90.49. Paired samples t tests revealed a statistically significant difference between the mean pre and mean post-test scores (t =-2.165, df =36, p= .037). Self-reported self-competence as measured by the PCNSC increased from a mean of 3.21 to a mean of 4.10. Paired samples t tests revealed that the difference between the mean pre and mean post PCNSC score was statistically significant (t =-9.202, df =36, p= .001). Conclusion: A one-day course based upon the ELNEC APRN clinical modules was effective in improving both knowledge, and self-competence of basic palliative care among oncology NPs

The Perspectives of the Woman/Nurse/Executive Working in the Managed Care Environment of Southern California

The purpose of this study was to explore the perspectives of the woman/nurse/executive working in the managed care environment of Southern California. This research was extremely timely because (a) Southern California leads the nation in managed care market penetration, (b) changes in health care financing have resulted in a prolific expansion of nurse executive responsibilities, and (c) nurse executive experiences regarding increased responsibilities have not been researched. Role expansion impacts both male and female nurse executives, but female nurse executives must confront the dilemma of functioning in administrative domains which have been largely dominated by men. Knowledge about their experiences is vital to the future of the nursing profession and to the health care delivery system. This study blended feminist ideology with grounded theory. Seventeen woman/nurse/executive participants from mostly hospital settings were interviewed. Using primarily the dimensional analysis approach to grounded theory, the metaphor of a managed care battlefield became the study context. A typology of participants was discovered, consisting of four consecutive groups: (a) the Unsung Heroines, (b) the Engineers, (c) the Team Leaders, and (d) the Champions. Participants of each group made different ethical decisions about their most important responsibilities and leadership actions, resulting in a different professional identity, or battlefield position, for each group. The typology represented a continuum, ranging from the Unsung Heroines, who exhibited the strongest nursing identity and the least degree of organizational influence, to the Champions, who exhibited the weakest nursing identity but the greatest degree of organizational influence. The most important implications from this study involve nursing education, nursing research, and healthcare policy. Nursing education needs to be revamped to adequately prepare nurses for the expanding nurse executive roles. Additional research which explores the personal and professional value shifts involved in shaping these new roles is necessary. Finally, nurses must value feminist perspectives and become more involved in making healthcare policies which protect the essence of professional nursing practice