Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-of-Life

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care-based training, with the overarching goal of promoting holistic patient care, especially for patients approaching the end of life. The literature review encompasses a threefold examination of spiritual care practice from diverse perspectives, including those of nurses, patients, and chaplains. The focus is on identifying barriers to spiritual care nursing practice, understanding the impacts of spiritual care on patients\u27 well-being (or the lack thereof), exploring nurses\u27 perceptions regarding their capacity to provide spiritual care, and evaluating the effectiveness of spiritual training sessions. Building upon these insights, a quasi-experimental study has been designed to assess the effects of spiritual care training on improving nurse competency and enhancing holistic patient care. The findings from this research have the potential to contribute to the development of targeted interventions and training programs that address the specific spiritual care needs of ICU nurses, ultimately enhancing the quality of care provided to patients, particularly those nearing the end of life

Bathtub and Unimodal Hazard Flexibility Classification of Parametric Lifetime Distributions

There are a number of bathtub and unimodal hazard shape parametric lifetime distributions available in the literature. Therefore, it is important to classify these distributions based on their hazard flexibility to facilitate their use in applications. For this purpose we use the Total Time on Test (TTT) transform plot with two different criteria: I. measure the slope at the inflection point on the scaled TTT transform curve; II. measure the slope at selected points from the constant hazard line on the scaled TTT transform curve. We confine our research to classify the flexibility of Weibull extensions and generalizations and also select one-shape and two-shape parameter lifetime distributions to exemplify the two criteria process

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-of-Life

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care based training, with the overarching goal of promoting holistic patient care, especially for patients approaching the end of life. The literature review encompasses a threefold examination of spiritual care practice from diverse perspectives, including those of nurses, patients, and chaplains. The focus is on identifying barriers to spiritual care nursing practice, understanding the impacts of spiritual care on patients\u27 well-being (or the lack thereof), exploring nurses\u27 perceptions regarding their capacity to provide spiritual care, and evaluating the effectiveness of spiritual training sessions. Building upon these insights, a quasi-experimental study has been designed to assess the effects of spiritual care training on improving nurse competency and enhancing holistic patient care. The findings from this research have the potential to contribute to the development of targeted interventions and training programs that address the specific spiritual care needs of ICU nurses, ultimately enhancing the quality of care provided to patients, particularly those nearing the end of life.https://scholar.dominican.edu/nursing-student-research-posters/1067/thumbnail.jp

How to control if even experts are not sure: Robust fuzzy control

In real life, the degrees of certainty that correspond to one of the same expert can differ drastically, and fuzzy control algorithms translate these different degrees of uncertainty into different control strategies. In such situations, it is reasonable to choose a fuzzy control methodology that is the least vulnerable to this kind of uncertainty. It is shown that this 'robustness' demand leads to min and max for &- and V-operations, to 1-x for negation, and to centroid as a defuzzification procedure

Effects of pay transparency on application intentions through justice perceptions and organizational attractiveness

In the current investigation, we test the proposition that applicants make inferences about how an organization treats its employees based on its pay transparency policy. Specifically, we tested a serial mediation model in which pay transparency positively influences applicants’ intentions to apply to a job opening through increased fairness perceptions and organizational attractiveness. We randomly assigned participants to a condition in which they read the profile of a company that implements pay transparency versus a condition in which the company had a policy of pay secrecy. The participants were invited to imagine themselves on the job market and then indicate: (a) the extent to which they felt the company treats its employees fairly, (b) their attraction to the company, and (c) their intent to apply to a position in the company. Results were consistent with the proposed mediation, suggesting that an organization’s pay transparency policy may signal to applicants the extent to which the company values equity and justice. We conclude with some concrete strategies for attracting qualified applicants based on these findings and suggest avenues for future research

Comorbidities only account for a small proportion of excess mortality after fracture: A record linkage study of individual fracture types

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality. Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality. Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable fraction calculated for each level of risk exposure. Results: During 1,490,651 person-years, women and men experienced 7,571 and 4,571 fractures and 7,064 deaths and 11,078 deaths, respectively. In addition to hip and vertebral fractures, pelvis, humerus, clavicle, rib, proximal tibia/fibula, elbow and distal forearm fractures in both sexes, and ankle fractures in men, were associated with increased multivariable adjusted mortality hazard ratios ranging from 1.3 to 3.4. Co-morbidity independently added to mortality such that a woman with a humeral fracture and one co-morbidity had a similarly reduced 5 year survival to that of a woman with a hip fracture and no co-morbidities. Population mortality attributable to any fracture without co-morbidity was 9.2% in women and 5.3% in men. Conclusion: All proximal non-hip, non-vertebral fractures in women and men were associated with increased mortality risk. Co-existent co-morbidities independently further increased mortality. Population attributable risk for mortality for fracture was similar to cardiovascular disease and diabetes, highlighting their importance and potential benefit for early intervention and treatment

Incorporating a clinical pharmacist in an outpatient palliative care team

Title: Incorporating a clinical pharmacist in an outpatient palliative care team Crystal Rim, PharmD; Sharon Leigh, PharmD, BCPS; Linda De Sitter MD, MPH; Mary Grant, ANP; Dana Nguyen, PharmD Palliative care is a growing field in medicine that focuses on delivering care that improves quality of life for patients with serious illnesses. Often, the goals of palliative care differ from traditional goals of medicine. Currently, there is limited data demonstrating the integration of pharmacists in the palliative care setting. The purpose of this quality improvement is to evaluate the clinical pharmacist’s role within an outpatient palliative care team when performing medication reconciliation and review. Medication review includes de-prescribing high-risk medications and optimizing medications in symptom management. Between January and February 2020, the clinical pharmacist interviewed patients referred to the outpatient palliative care service through three different methods: telehealth, pharmacy consult and telephone. The clinical pharmacist provided recommendations to the outpatient palliative care nurse practitioner and primary care provider for medication optimization, symptom management and de-prescribing based on STOPPFrail and Beers Criteria. Data from 19 patients were analyzed. One patient was excluded from analysis due to death. Five patients were interviewed through telehealth. Two patients were directly consulted for pharmacist review by the outpatient palliative care nurse practitioner. Seven patients were interviewed through telephone, of which 4 patients were referred to hospice following palliative care consult. Of 19 patients, 64 total recommendations (29 medication discontinuation, 30 medication optimization, 5 symptom management) were made. Six recommendations were accepted by the provider (3 medication discontinuation, 3 medication optimization). The average time spent on chart review for each patient was 1.5 hours. Pharmacist involvement in outpatient palliative care may be valuable. However, many barriers to providing meaningful interventions were identified in this study. While telehealth provided the convenience to the patient and caregivers, utilization was limited due to lack of standardization of technology. Telephone interviews allowed proper medication reconciliation prior to the palliative care visit, but non-medication related issues may be prioritized after the visit. Finally, pharmacy consult from palliative care nurse practitioners allowed more efficiency, but it did not allow formal pharmacist integration in the outpatient palliative care team. Further studies quantifying the pharmacist role in outpatient palliative care are warranted.https://digitalcommons.psjhealth.org/pharmacy_PGY1mn/1000/thumbnail.jp

A Population-Based Study of Peyronie's Disease: Prevalence and Treatment Patterns in the United States

Purpose. To estimate the US prevalence of Peyronie's disease (PD) from patient-reported data and to identify diagnosis and treatment patterns. Methods. 11,420 US males ≥18 years old completed a brief web-based survey regarding the presence of PD, past treatments, and penile symptoms (Phase 1). Phase 1 respondents with PD diagnosis, history of treatment, or PD-related symptoms then completed a disease-specific survey (Phase 2). Results. Estimated prevalence of PD ranged from 0.5% (diagnosis of PD) to 13% (diagnosis, treatment, or penile symptoms). Thirty-six percent of Phase 2 participants reported that penile symptoms interfered with sexual activities. Of participants who sought treatment for penile symptoms (n = 128), 73% initially saw a primary care physician, 74% did not receive treatment from their first doctor, and 92% were not diagnosed with PD. Conclusions. PD may be underdiagnosed/undertreated in the US. Improved awareness is needed of PD symptoms and treatment options among health care professionals

Laparoscopic Gastrojejunostomy for the Treatment of Gastric Outlet Obstruction

These authors found that laparoscopic gastrojejunostomy for the management of gastric outlet obstruction can be performed with good outcomes and acceptable complication rates

Noninvasive imaging of focal atherosclerotic lesions using fluorescence molecular tomography

Insights into the etiology of stroke and myocardial infarction suggest that rupture of unstable atherosclerotic plaque is the precipitating event. Clinicians lack tools to detect lesion instability early enough to intervene, and are often left to manage patients empirically, or worse, after plaque rupture. Noninvasive imaging of the molecular events signaling prerupture plaque progression has the potential to reduce the morbidity and mortality associated with myocardial infarction and stroke by allowing early intervention. Here, we demonstrate proof-of-principle in vivo molecular imaging of C-type natriuretic peptide receptor in focal atherosclerotic lesions in the femoral arteries of New Zealand white rabbits using a custom built fiber-based, fluorescence molecular tomography (FMT) system. Longitudinal imaging showed changes in the fluorescence signal intensity as the plaque progressed in the air-desiccated vessel compared to the uninjured vessel, which was validated by ex vivo tissue studies. In summary, we demonstrate the potential of FMT for noninvasive detection of molecular events leading to unstable lesions heralding plaque rupture