Self-Management of Unpleasant Auditory Hallucinations: A Tested Practice Model

Individuals who experience auditory hallucinations (AH) frequently report hearing unpleasant voices saying disturbing things to them, making derogatory remarks about them, or commanding them to do something, including harming themselves or someone else. The Self-Management of Unpleasant Auditory Hallucinations Practice Model was developed to help psychiatric-mental health nurses in both inpatient and outpatient settings implement evidence-based nursing care for voice hearers who are distressed by unpleasant voices. The model\u27s utility extends to nursing education, administration, and research. The model is comprised of three parts: (a) Assessment of Voice Hearer\u27s Experience, (b) Nursing Interventions, and (c) Voice Hearer\u27s Expected Positive Outcomes. These three parts of the model describe nursing assessments conducted with an interview guide and two self-report tools, nursing interventions that teach strategies to manage unpleasant AH in a 10-session course or individually, and evaluation of voice hearer outcomes with two self-report tools

Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"

Background: Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods: Process evaluation of an action research project (2003-2007) guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC). A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results: The overall ACIC score improved from 1.45 (limited support) at the start of the study to 5.5 (basic support) at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion: Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care delivery in a primary care system with limited structure. The study succeeded in achieving a considerable improvement of the overall support for diabetes patients but further improvement requires a shift towards system thinking among policy makers. Currently primary care providers lack the opportunities to take up full responsibility for chronic care

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

‘Oh you pretty thing!’: How David Bowie ‘unlocked everybody’s inner queen’ in spite of the music press

The 1967 Sexual Offence Act decriminalised homosexual acts between men allowing gay men to discuss their sexuality in public. Few prominent popular musicians came-out until 1972 when David Bowie claimed that he was bisexual in an interview with Melody Maker. Music papers and Bowie had substantial cultural power: Bowie was a rising star and music papers recruited journalists who discussed and perpetuated social change. The subsequent conversation, however, reinforced negative stereotypes in constructing the queer subject and tried to safeguard commercial concerns due to the assumption that the market for popular music avoided queer music. This undermined arguments that associate permissive legislation with a permissive media and society, but, to some, representation alone empowered people and destabilised preconceptions about queer identity.Published versio

Nurses' Perspectives on Handoff Practices That Promote Patient Safety

Effective handoff communication is critical in promoting patient safety. At change of shift, nurses exchange patient information, but little is known about nursing handoff practices and patient safety. The purpose of this research was to examine nurses' perspectives on handoff practices that promote patient safety and to identify conditions and processes that pose risks for patient care.This grounded theory study was conducted in two medical-surgical units in an urban academic institution with a purposive sample of 21 nurses using semistructured interviews and 87 ethnographic observations. Data were collected and analyzed simultaneously using constant comparison and positional mapping.Nurses maintained patient safety during handoffs by painting a full picture of patients so that oncoming nurses were well-prepared with information to prioritize assessments and detect changes in a patient's condition. Processes that promoted painting a full picture were organizing information, asking and answering questions skillfully, and engaging in respectful dialogue. Conditions that facilitated painting a full picture were respect, trust, time, private space, and face-to-face oral communication. Interpersonal tensions, lack of time, interruptions, and noise often hindered nurses' practices and jeopardized patient safety. Nurses' perceptions of the effectiveness of handoffs often depended on the position of the nurse in the handoff as either the oncoming or offgoing nurse.Quality handoff information depended on an offgoing nurse arriving at handoff with a grasp of their patients. To acquire a grasp, nurses gathered and synthesized information throughout their shift. As nurses did so, they were actively constructing the story of the patient. Processes that facilitated constructing the story were receiving good handoff reports, assessing the patient, cueing in, and writing it down. While constructing the story, nurses were prioritizing assessments and detecting patient changes. Poor handoff reports, staffing constraints, and unpredictable patient flow challenged nurses in constructing the story. Nurses may arrive at the handoff with a poor grasp posing risks for patients.Future research interventions need to consider the position of the nurse in the handoff. Research comparing handoff practices in units with good and poor clinical environments is needed

Nurses' Perspectives on Handoff Practices That Promote Patient Safety

Effective handoff communication is critical in promoting patient safety. At change of shift, nurses exchange patient information, but little is known about nursing handoff practices and patient safety. The purpose of this research was to examine nurses' perspectives on handoff practices that promote patient safety and to identify conditions and processes that pose risks for patient care.This grounded theory study was conducted in two medical-surgical units in an urban academic institution with a purposive sample of 21 nurses using semistructured interviews and 87 ethnographic observations. Data were collected and analyzed simultaneously using constant comparison and positional mapping.Nurses maintained patient safety during handoffs by painting a full picture of patients so that oncoming nurses were well-prepared with information to prioritize assessments and detect changes in a patient's condition. Processes that promoted painting a full picture were organizing information, asking and answering questions skillfully, and engaging in respectful dialogue. Conditions that facilitated painting a full picture were respect, trust, time, private space, and face-to-face oral communication. Interpersonal tensions, lack of time, interruptions, and noise often hindered nurses' practices and jeopardized patient safety. Nurses' perceptions of the effectiveness of handoffs often depended on the position of the nurse in the handoff as either the oncoming or offgoing nurse.Quality handoff information depended on an offgoing nurse arriving at handoff with a grasp of their patients. To acquire a grasp, nurses gathered and synthesized information throughout their shift. As nurses did so, they were actively constructing the story of the patient. Processes that facilitated constructing the story were receiving good handoff reports, assessing the patient, cueing in, and writing it down. While constructing the story, nurses were prioritizing assessments and detecting patient changes. Poor handoff reports, staffing constraints, and unpredictable patient flow challenged nurses in constructing the story. Nurses may arrive at the handoff with a poor grasp posing risks for patients.Future research interventions need to consider the position of the nurse in the handoff. Research comparing handoff practices in units with good and poor clinical environments is needed

Handoffs and Patient Safety

Effective handoff communication is critical for patient safety. Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. The purpose of this qualitative study was to examine medical-surgical nurses' (n = 21) perspectives about processes that promote and hinder patient safety intra-shift and during handoff. Results indicated that offgoing nurses' ability to grasp the story intra-shift was essential to convey the full picture during handoff. When oncoming nurses understood the picture being conveyed at the handoff, nurses jointly painted a full picture. Arriving and leaving the handoff with this level of information promoted patient safety. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Improvement efforts need to target the different processes involved in grasping the story and painting a full picture. Future research needs to examine handoff practices and outcomes on units with good and poor practice environments