Health Care Initiative to Evaluate the Impact of a Nurse Practitioner Led Community Wound Care Service on Emergency Department Utilization

Nurse Practitioners (NP) diagnose and treat wounds and wound-related conditions based on their advanced scope of practice. An NP with graduate-level wound care education (NP(W)) gains additional knowledge and clinical experience to provide comprehensive wound care. This research aimed to explore community patients’ access to wound care in Southwestern Ontario (Canada). A quality improvement project was initiated utilizing stakeholder feedback to develop and implement a 12-week pilot NP(W)-Led community-based wound care service; the NP(W) wound care practices, clinical outcomes, and adverse events were described. One hundred twelve participants attended the service over 117 visits. The NP(W) services included prescribing and administering medications, providing treatments, ordering laboratory and diagnostic tests, sending referrals, and consultations. Patient experience was captured via a mail-in survey of the Generic Short Patient Experiences Questionnaire. There were 49 completed questionnaires from the NP NP(W)-Led service. Respondents reported confidence in the NP(W) skills and satisfaction with the overall care. Chart audits were conducted on 2066 charts to examine emergency department (ED) utilization before, during, and post-implementation of the NP(W)-Led wound care service. The most common reason for going to the ED was at the ED providers’ request, followed by being sent by a community nurse. There was a statistical difference between the total visits and visits for wound care at two points. Results from this small pilot study suggested a high-level patient satisfaction and noted decreased ED visits during the time the clinic was open. Keywords: Nurse practitioner, NP, wounds, wound care, community, emergency department, patient experience, quality improvement projec

Wound management provided by advanced practice nurses: a scoping review protocol.

OBJECTIVE: The objective of this review is to examine the current state of the literature regarding wound care provided by advanced practice nurses globally. Specifically, this review will examine the similarities and differences in the wound care practice of advanced practice nurses, including nurse practitioners, clinical nurse specialists, and advanced practice registered nurses. INTRODUCTION: Advanced practice nurses have graduate education and advanced scope of practice. The addition of advanced wound care training provides unique opportunities for advanced practice nurses to provide wound care. INCLUSION CRITERIA: This review will consider advanced practice nurses who are nurse practitioners or registered nurses with graduate education and advanced training (certification/education) in wound care. The wound care can be provided independently or as a part of a team, in any setting. METHODS: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. The databases searched will include MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of Systematic Reviews, and Scopus. To reflect changes in advanced practice nursing scope of practice, searches will be limited to articles published from 2011. Articles in languages other than English will be translated. Titles and abstracts will be independently reviewed by two reviewers, and relevant sources will be retrieved in full and reviewed. Any disagreements will be resolved through discussion or with an additional reviewer. The similarities and differences in wound care practice (type of wound, practice setting, treatments) will be extracted using a data extraction tool. Any modifications will be detailed in the scoping review. Extracted data will be presented in a descriptive format

Physical assessment skills taught in nursing curricula: a scoping review.

OBJECTIVE: This scoping review sought to establish the current state of knowledge regarding physical assessment skills taught globally in undergraduate nursing curricula. Explicitly, the review aimed to determine which skills are being taught via curricula and which skills are performed by students in clinical placements, as well as what physical assessment skills are being used by registered nurses in practice. INTRODUCTION: Nursing programs are expected to teach the physical assessment skills required for entry-level registered nurses to practice competently. The discrepancy lies in determining which skills are essential to teach entry-level nurses and which are unessential. INCLUSION CRITERIA: Studies that examined physical assessment skills taught to students in any undergraduate registered nursing program or used by registered nurses in practice were considered. Physical assessments included all techniques or skills taught in any year of a university or college teaching global registered nursing curricula. METHODS: Databases searched included MEDLINE (Ovid), CINAHL Complete (EBSCO), Scopus, and Cochrane Central Register of Controlled Trials (Ovid). Sources of unpublished studies included ProQuest Dissertations and Theses Global, OpenGrey, Open Access Theses and Dissertations, and Google Scholar. Studies published in English between January 2008 and November 2019 were included. Two independent reviewers screened titles and abstracts. Studies meeting the inclusion criteria were imported into the Covidence systematic review manager. Extracted data were presented in a descriptive format, including characteristics of included studies and relevant key findings. RESULTS: Thirteen records were extracted for synthesis: one integrated review, one author reflection, one mixed methods study, and 10 quantitative studies. The sources represented a global context: the United States, New Zealand, Turkey, Australia, Norway, Korea, Italy, and one of unknown origin. Three studies examined physical assessment skills routinely taught in global nursing curricula. Three studies explored physical assessment skills routinely used by students during nursing programs. Seven studies examined which physical assessment skills were routinely performed by registered nurses in practice. In the studies, there were 98 to 122 physical assessment skills taught in global nursing programs. However, only 33 skills were routinely taught in curricula, and of those, only 20 were the same across all studies (core skills). Students in nursing programs routinely performed 30 physical assessment skills, and six of the 30 skills were the same across all studies (core skills). Of the six core skills routinely performed by students, five were also routinely taught in nursing curricula in the included studies. Registered nurses routinely performed 39 physical assessment skills, and 11 skills were the same across all studies (core skills). Ten of the physical assessment skills taught in curricula were routinely performed by registered nurses in practice. CONCLUSION: This scoping review provides insight into physical assessment skills taught in nursing curricula and used by registered nurses in practice. This knowledge is essential for curriculum revisions and planning as it provides insight on how to best meet the needs of future nursing students

Physical Assessment Skills Used by Registered Nurses

Background: Nurses work in a wide variety of settings. Therefore, it is essential for nursing educators to continually evaluate and adapt nursing programs to ensure that the curricula prepare students to practice in a variety of health care settings. In this study, we sought to determine which skills were routinely used by registered nurses and to examine whether the cumulative number of practice settings influenced the number, and type, of physical assessments used. Methods: An electronic or a paper survey was distributed to registered nurses who worked as nursing clinical instructors at a mid-sized university in this cross-sectional study. Measures of frequency and central tendency described participant characteristics and physical assessment skills. A Kruskal-Wallis test was used to investigate an association between the number of practice settings and physical assessment skills used. Results: Forty-nine surveys were completed (59.8% return rate), with 47 surveys used for inferential statistics. Practice settings ranged from one to six, with a median of two employment areas. Medical-surgical was the most common setting (65.3%). Respondents identified 25 physical assessment skills as being performed routinely in their clinical practice; 11 skills were routinely performed by 80% of respondents. The median number of core skills routinely performed in clinical practice was not statistically significant (x2 = 4.03; p = .25). Conclusion:  Academic and clinical nursing educators, policymakers, and nursing managers can use this study’s findings to supplement decision-making concerning nursing employment and continuing education opportunities. Résumé Contexte : Les infirmières sont appelées à travailler dans des milieux de soins très différents. Il est donc essentiel que les formatrices en sciences infirmières évaluent et modifient sur une base régulière les programmes d’études afin d’assurer que ceux-ci préparent les étudiantes à pratiquer dans divers milieux de soins de santé. Dans cette étude, nous avons cherché à cerner les habiletés auxquelles les infirmières font couramment appel et à déterminer si le nombre total de milieux de pratique influence le nombre et le type d’habiletés d’évaluation physique utilisées. Moyens : Dans le cadre de cette étude transversale, un sondage électronique ou papier a été remis aux infirmières qui travaillaient comme formatrices cliniques dans une université de taille moyenne. Les mesures de fréquence et de tendance centrale ont permis de décrire les caractéristiques des participantes et les habilités d’évaluation de la santé physique. Un test de Kruskal-Wallis a permis d’étudier le lien entre le nombre de milieux de pratique d’une infirmière et les habilités d’évaluation physique qu’elle utilise. Résultats : Au total, 49 formulaires furent remplis (taux de réponse de 59,8 %) et 47 d’entre eux furent utilisés à des fins de statistiques. Le nombre de milieux de pratique variait d’un à six, avec une médiane de deux secteurs d’emploi. Le milieu de pratique le plus répandu était celui de la médecine-chirurgie (65,3 %). Les répondantes ont indiqué qu’elles faisaient couramment appel à 25 habiletés d’évaluation physique dans leur pratique clinique; 11 de ces habiletés étaient pratiquées sur une base régulière par 80 % des répondantes. Le nombre médian d’habiletés essentielles couramment mises à profit en pratique clinique n’était pas statistiquement significatif (x2 = 4.03; p = .25). Conclusion :  Les formatrices en milieux universitaires et cliniques, les décideurs politiques et les infirmières gestionnaires peuvent se servir des résultats de cette étude pour étayer leurs décisions concernant les activités de développement professionnel en cours d’emploi pour les infirmières

Physical assessment skills in nursing curricula: A scoping review protocol

Review objective:This review seeks to establish the current state of knowledge regarding physical assessment skills taught in nursing programs globally. It aims to explore the literature on physical assessment skills taught in nursing curricula globally, skills used by nurses in practice, skills used by students, and core physical assessment skills that are important to teach nursing students

Chemical abundances of late-type pre-main sequence stars in the σ\sigma-Orionis cluster

The young $\sigma$-Orionis cluster is an important location for understanding the formation and evolution of stars, brown dwarfs, and planetary-mass objects. Its metallicity, although being a fundamental parameter, has not been well determined yet. We present the first determination of the metallicity of nine young late-type stars in $\sigma$-Orionis. Using the optical and near-infrared broadband photometry available in the literature we derive the effective temperatures for these nine cluster stars, which lie in the interval 4300--6500 K (1--3 \Msuno). These parameters are employed to compute a grid of synthetic spectra based on the code MOOG and Kurucz model atmospheres. We employ a $\chi^2$-minimization procedure to derive the stellar surface gravity and atmospheric abundances of Al, Ca, Si, Fe, Ni and Li, using multi-object optical spectroscopy taken with WYFFOS+AF2 at at the William Herschel Telescope ($\lambda/\delta\lambda\sim7500$). The average metallicity of the $\sigma$-Orionis cluster is [Fe/H] $= -0.02\pm0.09\pm0.13$ (random and systematic errors). The abundances of the other elements, except lithium, seem to be consistent with solar values. Lithium abundances are in agreement with the "cosmic" $^7$Li abundance, except for two stars which show a $\log \epsilon(\mathrm{Li})$ in the range 3.6--3.7 (although almost consistent within the error bars). There are also other two stars with $\log \epsilon(\mathrm{Li})\sim 2.75$. We derived an average radial velocity of the $\sigma$-Orionis cluster of $28\pm4$km/s. The $\sigma$-Orionis metallicity is roughly solar.Comment: Accepted for publication in Astronomy and Astrophysic

FLAMES spectroscopy of low-mass stars in the young clusters sigma Ori and lambda Ori

Aims. We performed a detailed membership selection and studied the accretion properties of low-mass stars in the two apparently very similar young (1-10 Myr) clusters sigma Ori and lambda Ori. Methods. We observed 98 and 49 low-mass (0.2-1.0 M_sun) stars in sigma Ori and lambda Ori respectively, using the multi-object optical spectrograph FLAMES at the VLT, with the high-resolution (R=17,000) HR15N grating (6470-6790 AA). We used radial velocities, Li and Halpha to establish cluster membership and Halpha and other optical emission lines to analyze the accretion properties of members. Results. We identified 65 and 45 members of the sigma Ori and lambda Ori clusters, respectively and discovered 16 new candidate binary systems. We also measured rotational broadening for 20 stars and estimated the mass accretion rates in 25 stars of the sigma Ori cluster, finding values between 10^-11 and 10^-7.7 M_sun yr^-1 and in 4 stars of the lambda Ori cluster, finding values between 10^-11 and 10^-10.1 M_sun yr-1. Comparing our results with the infrared photometry obtained by the Spitzer satellite, we find that the fraction of stars with disks and the fraction of active disks is larger in the sigma Ori cluster (52+-9% and 78+-16%) than in lambda Ori (28+-8% and 40+-20%) Conclusions. The different disk and accretion properties of the two clusters could be due either to the effect of the high-mass stars and the supernova explosion in the lambda Ori cluster or to different ages of the cluster populations. Further observations are required to draw a definitive conclusion.Comment: 14 pages, 9 figures, 9 tables, accepted for publications in A&

UBVRIz Light Curves of 51 Type II Supernovae

We present a compilation of UBV RIz light curves of 51 type II supernovae discovered during the course of four different surveys during 1986 to 2003: the Cerro Tololo Supernova Survey, the Calan/Tololo Supernova Program (C&T), the Supernova Optical and Infrared Survey (SOIRS), and the Carnegie Type II Supernova Survey (CATS). The photometry is based on template-subtracted images to eliminate any potential host galaxy light contamination, and calibrated from foreground stars. This work presents these photometric data, studies the color evolution using different bands, and explores the relation between the magnitude at maximum brightness and the brightness decline parameter (s) from maximum light through the end of the recombination phase. This parameter is found to be shallower for redder bands and appears to have the best correlation in the B band. In addition, it also correlates with the plateau duration, being thus shorter (longer) for larger (smaller) s values.Comment: 110 pages, 9 Figures, 6 Tables, accepted in A

The Galactic O-Star Spectroscopic Survey. I. Classification System and Bright Northern Stars in the Blue-Violet at R~2500

We present the first installment of a massive spectroscopic survey of Galactic O stars, based on new, high signal-to-noise ratio, R~2500 digital observations from both hemispheres selected from the Galactic O-Star Catalog of Ma\'iz Apell\'aniz et al. (2004) and Sota et al. (2008). The spectral classification system is rediscussed and a new atlas is presented, which supersedes previous versions. Extensive sequences of exceptional objects are given, including types Ofc, ON/OC, Onfp, Of?p, Oe, and double-lined spectroscopic binaries. The remaining normal spectra bring this first sample to 184 stars, which is close to complete to B=8 and north of delta = -20 and includes all of the northern objects in Ma\'iz Apell\'aniz et al. (2004) that are still classified as O stars. The systematic and random accuracies of these classifications are substantially higher than previously attainable, because of the quality, quantity, and homogeneity of the data and analysis procedures. These results will enhance subsequent investigations in Galactic astronomy and stellar astrophysics. In the future we will publish the rest of the survey, beginning with a second paper that will include most of the southern stars in Ma\'iz Apell\'aniz et al. (2004).Comment: Accepted for publication in ApJS. 73 pages and 20 figures. Figure 19 is shown at a degraded resolution due to arXiv limitations. If interested in the high-resolution version, please contact the autho