The development of an intervention to improve the safety of community care nurses while driving and a qualitative investigation of its preliminary effects

This paper details the development of, and perceived role and effectiveness of an innovative intervention designed to ultimately improve the safety of a group of community care (CC) nurses while driving. Recruiting participants from an Australian CC nursing car fleet, qualitative responses from a series of open-ended questions were obtained from drivers (n = 36), supervisors (n = 22), and managers (n = 6). The findings supported the effectiveness of the intervention in reducing self-reported speeding and promoting greater insight into one’s behaviour on the road. This research has important practical implications in that it highlights the value of developing an intervention based on a sound theoretical framework and which is aligned with the needs and beliefs of personnel within a particular organisation

A Comparative Effectiveness Study of Continuous Positive Airway Pressure (CPAP) Related Skin Breakdown when using Different Nasal Interfaces in the Extremely Low Birth Weight (ELBW) Neonate

Nasal continuous positive airway pressure (CPAP) is reportedly superior to mechanical ventilation in the neonatal population by reducing bronchopulmonary dysplasia (BPD). The neonate is vulnerable to injury secondary to immature physiological systems and skin structures and the current CPAP devices place constant pressure on nares, nasal septum and forehead, increasing injury risk. Through the framework of comparative effectiveness research an examination of nasal interfaces currently used during neonatal CPAP was conducted in an effort to provide scientifically supported recommendations and improve clinical outcomes. The primary aim of this study was to determine differences in the frequency, severity and specific types of nasal injuries described when comparing different nasal CPAP interfaces (prongs/mask/rotation) used in the treatment of neonatal respiratory distress syndrome (RDS). A secondary aim of the study was to identify risk factors that may be associated with skin breakdown during nasal CPAP administration. A three group prospective randomized experimental design was used to study78 neonates \u3c1500 grams receiving nasal CPAP using the same delivery system. The subjects were randomized into three groups: 1) continuous nasal prong group, 2) continuous nasal mask group, or 3) alternating mask/prongs group. Serial data collection included: demographic, biophysical measures and the Neonatal Skin Condition Scale (NSCS). This study demonstrated a significant difference in the frequency and severity of skin injury when utilizing a method of rotating mask and prong nasal interfaces during neonatal CPAP therapy; a useful clinical recommendation. Specific nursing care implications related to study findings include; choosing a device for best fit for infant (face shape and infant size); positioning of the CPAP device; developmental position of the infant; and focused skin assessment with rapid intervention. Standardized care including skin barriers, clinical expertise of nursing and respiratory therapy, and skin care management are strategies that warrant additional research

Implementing a Frequent Neonatal Resuscitation Program Educational Refresher Course to Improve Nursing Knowledge

It is estimated that 10% of newborns require assistance breathing at birth (American Heart Association [AHA], 2020). Successful neonatal resuscitation depends on critical actions that occur promptly to increase the chances of survival (AHA, 2020). Researchers have revealed the knowledge and skill retained from the neonatal resuscitation program (NRP) begin declining as early as three months after completing the program (Smith, Gilcreast & Pierce, 2016). The purpose of this evidence-based project was to implement a review of NRP education every three months to improve nurses’ confidence when performing neonatal resuscitation. A validated Self-Efficacy 14-item Scale (SES-14) was used to measure nurses’ confidence specific to NRP skills before and after the educational intervention. The Evidence-based Practice Improvement Model and Lewin’s Change Model provided the framework for the development, planning, and implementation of this project. The aim of this project was 80% of neonatal nurses at Erlanger Children\u27s Hospital who received the educational refresher course on neonatal resuscitation will have improved scores on the post-test by retaining knowledge and gaining confidence in neonatal resuscitation after three months. Eighteen (n =18) individuals participated, with eight (n= 8) completing the Self-Efficacy survey at more than one interval. Data analysis demonstrated test scores increased from the pre-educational survey to the post-educational survey. Nine of the survey questions were found to be statistically significant in increasing confidence scores after education

Mindfulness-Based Educational Module for Nurses Caring for Pediatric Mental Health Patients

BACKGROUND: Emergency pediatric nurses have the added stress of not only caring for medical patients but must also care for patients experiencing mental health issues. Many nurses feel unprepared to care for this specialized patient population. To bridge this gap, mindfulness-based interventions (MBIs) have been shown to provide nurses with the skills needed to care for mental health patients. This same concept can be applied to pediatric patients. Pediatric-focused mindfulness-based techniques can be used to help pediatric patients manage their symptoms. LOCAL PROBLEM: The setting for this project was an urban pediatric emergency department in East Tennessee. At the state and national level, there is a lack of available inpatient psychiatric beds for children requiring higher level of care. This has contributed to longer lengths of stay for patients holding in pediatric emergency departments. The purpose of this evidence-based practice project was for pediatric emergency room nurses to participate in a computer-based educational module that teaches implementing pediatric-focused MBIs in a pediatric setting. METHODS: The Johns Hopkins Evidence-Based Practice Model and Lewin’s 3-Step Change Theory were used to guide this project’s development, plan, and intervention implementation. Pre-module, immediate post-module, and 1-month post-module self-reports were measured with the use of the C-Scale Confidence Tool. INTERVENTIONS: To best determine the impact of this intervention, nurse confidence was measured using the C-Scale Confidence tool. Nurses’ self-reports before and after the intervention were collected to see if there was an improvement in their confidence in caring for pediatric mental health patients. RESULTS: Nurses\u27 self-reports showed an increase in nursing confidence after the implementation of a mindfulness-based educational module. Self-report nursing confidence scores increased from mean confidence of 3.18 to 4.13 (pre-module compared to the 1-month follow-up evaluation). CONCLUSIONS: Use of a mindfulness-based educational module resulted in a significant increase in nursing confidence when caring for pediatric mental health patients

Habitat use by the golden-cheeked warbler in Texas

Understanding species-habitat relationships is fundamental to the conservation of a species. This is especially important when the species is considered endangered. The Golden-cheeked Warbler is a habitat specialist that breeds only in oak-juniper woodlands (considered a climax forest) of central Texas. The warbler was listed as endangered under the federal Endangered Species Act primarily because of habitat loss and fragmentation. Conservation measures include the preservation of existing habitat and attempts to manage and enhance areas that once supported the warbler to return to the climax oak-juniper woodlands. My objectives were (1) to quantify the vegetation structure and species composition by vegetation volume of occupied warbler habitat across the breeding range in Texas and (2) to quantify the habitat use by the warbler in categories of behavior, substrate, height, and tree species. Instantaneous, focal animal behavioral observations were collected for three breeding seasons at six sites across the range of the warbler. Warbler behavior and microhabitat use were compared to availability of vegetation volume by height class and tree species. I found that Goldencheeked Warbler habitat varied by vegetation volume, canopy height and tree species among all sites. The warbler preferred twigs and foliage and the upper two height classes of the habitat structure for all behaviors. Tree species use did not match availability at any sites. The one consistent species result was the warbler used Ashe juniper significantly less than it occurred at all sites. Other major species were used disproportionately to the species occurrence at each site. Some tree species were used more often than they occur in the habitat while others species were used less than they occur in the habitat. Preferences for height class and tree species use were not significantly influenced by vegetation volume. Some other factor not measured such as prey availability may be the cause. Because warbler habitat characteristics and use vary across the range, any efforts to manipulate vegetation to become habitat must consider regional characteristics of Golden-cheeked warbler habitat

Reducing Burnout in Nursing: Implementation of a Mindfulness-Based Intervention

Objective: To decrease nursing burnout in a rural hospital setting. Background: Burnout increases the rate of turnover, lowers patient satisfaction scores, and increases costs. An estimated 15.6% of nurses are experiencing burnout at an annual cost of 9 billion dollars for hospitals. Local Problem: A rural hospital in Tennessee without a burnout reduction program available to staff. Methods: The Iowa Model Revised was utilized to implement a mindfulness-based stress reduction program. Invention/Measurements: The Palouse mindfulness-based stress reduction program was utilized for this evidence-based practice project. The online course spans eight weeks and includes videos, reading materials, and worksheets. The program takes approximately 50 hours to complete. The Copenhagen Burnout Inventory measured burnout pre-implementation and post-implementation. Results: Paired t-tests were performed to compare pre-implementation burnout and post-implementation burnout. Participants had a statistically significant improvement in burnout in all three areas measured by the Copenhagen Burnout Inventory: personal (p=.014), work related (p=.024), and client related (p=.008). Nine participants completed the pre-implementation and post-implementation surveys. Of those nine, 66% completed at least half of the content in the program. Conclusion: The use of a mindfulness-based stress reduction program resulted in a statistically significant decrease in burnout amongst nurses in this setting

What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

OBJECTIVE: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. DESIGN: Qualitative method of focus groups. SETTING/PARTICIPANTS: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. METHOD: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. MAIN FINDINGS: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. CONCLUSION: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting

INSTRUCTIONAL RELATIONSHIPS AND PREDICTORS FOR EIGHTH GRADE STUDENT ACADEMIC ACHIEVEMENT AS MEASURED BY THE NORTH CAROLINA END OF GRADE COMPREHENSIVE READING SCORES TO THE NUMBER OF VISUAL ARTS CLASSES COMPLETED DURING MIDDLE SCHOOL

The purpose of the researcher was to test for any significant relationships existing among the physical number of visual arts courses completed by 8th grade students during the middle school years to the actual academic performance as measured by the 2012-2013 North Caroling End of Grade (EOG) examination, specifically the Reading Comprehensive component. Scale scores from 125 students’ unnamed, archival files from a school in a district in the southern Piedmont of North Carolina were selected for the study. Student files were chosen using systematic sampling from a middle school which was representative of the population in the school system. The researcher analyzed data using a hierarchical multiple regression model in which the researcher first entered gender, sex, and socioeconomic status into the regression model to control for any effects on the number of years of art courses completed. The researcher determined that the results of the hierarchical regression analysis were not supportive of the research hypothesis. Beta coefficients for the predictive number of visual art courses completed, B = -.10, SE B = .65, ß = -.01, t = -.16, p = .88 lacked any predictive value to the core academic area of reading as had been believed by art and reading teachers for decades, at least as was discovered in this study. Some factors beyond the control of the researcher could cause some concern such as changing data systems and changing to a new version of the North Carolina End of Grade examination. Perhaps of most interest to all teachers is the need to check the whys in the justification of any one area as being so inclusive in the overall implementation of the Common Core Standards. Ease of personalization that art courses can offer to all students is just one idea. Perhaps legislatures and school boards members should commission studies to find other advantages or disadvantages

Development of an evaluation device to accompany a self-instructional program on the teaching of generalizations and cyclic individual testing and revision of the program

The purposes of this study were to develop an evaluation device to accompany a self-instructional program on the teaching of generalizations and to administer the same program to individual subjects for the purpose of revising the program. The evaluation device was based on the objectives of the program, "Teaching Home Economics Students to Generalize Their Learnings", by Dr. Hildegarde Johnson. Test situations constructed were similar to situations in the program in which the subject was guided to plan and make decisions consistent with current ideas about how students learn to generalize. Two tests, one to be used as a pre-test and the other as a post-test, were developed using parallel structure. The tests were sent to five universities where 156 students, who were majoring in home economics education and enrolled in a home economics methods course, responded to the evaluation device. Each test was scored using an answer key. The answer key was developed based on the responses of three members of the home economics education staff at the University of North Carolina at Greensboro. Each staff member had responded to the program. A Kuder- Richardson test of reliability and an item analyses were computed for the device