Stress and Coping in Nurse Managers: A Qualitative Description

Indiana University-Purdue University Indianapolis (IUPUI)Objective: This study provided a qualitative description of stress and coping as perceived by today's nurse manager incumbents. Background: The healthcare work environment as a source of overwork and stress has been implicated in today's nursing shortage. Nurse managers play a pivotal role in creating work environments for staff nurses, but little is known about the nature of nurse manager work. Methods: This qualitative descriptive study determined what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at three U.S. acute care hospitals participated in the study. Participants completed a demographic questionnaire and a 14-question interview incorporating components of the Critical Decision Method. Content analysis was completed and themes identified. Results: Difficult situations reported included feeling pressure to perform, interpersonal conflicts associated with organizational communication deficits, and issues of human resources and staffing. Nurse managers utilized a combination of emotion-focused and problem-focused coping strategies. When comparing novice nurse managers (3 years or less in role) with experienced nurse managers (greater than 3 years in role), the novices used predominantly emotion-focused coping strategies, a narrow repertoire of self-care strategies, and experienced negative psychological, physiological, and functional outcomes related to their coping efforts. Experienced nurse managers working as co-managers demonstrated mostly problem-focused coping strategies, a broad repertoire of self-care strategies, and reported no negative health outcomes. The study produced a cognitive model in the form of 10 questions that guide nurse manager decision-making related to stressful situations. The study generated four themes amenable to intervention. Conclusions: Performance expectations for nurse managers in acute care hospitals have increased since the 1990's making the role requirements unrealistic. Rising expectations increase nurse manager stress perceptions, making coping more difficult, and potentially harming nurse manager and work environment well-being. Findings from this study suggest that to address stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual factors as well as organizational culture, supportive structures, and systems that facilitate the role

Supersoft X-ray sources in M31: II. ROSAT-detected supersoft sources in the ROSAT, Chandra and XMM eras

We have performed Chandra observations during the past 3 years of 5 of the M31 supersoft X-ray sources (SSS) discovered with ROSAT. Surprisingly, only one of these sources has been detected, despite a predicted detection of about 20-80 counts. This has motivated a thorough check of the ROSAT M31 survey I data, including a relaxation of the hardness ratio requirement used to select SSS. This increases the number of SSS identified in survey I by 7. We then carried out a comparison with the ROSAT M31 survey II dataset which had hitherto not been explicitly investigated for SSS. We find that most of the ROSAT survey I sources are not detected, and only two new SSS are identified. The low detection rate in the ROSAT survey II and our Chandra observations implies that the variability time scale of SSS is a few months. If the majority of these sources are close-binary SSS with shell hydrogen burning, it further implies that half of these sources predominantly experience large mass transfer rates.Comment: accepted for publ. in ApJ; 2 ps-figures; high-quality figures available at http://www.mpe.mpg.de/~jcg/publis.htm

Development of a Humid Climate Definition

The role of humidity in indoor air quality has become of increasing concern in recent years. High indoor humidities can result in microbial growth on building surfaces, resulting in poor indoor air quality, as well as damage to the building and its contents. In addition to the IAQ impacts, high indoor humidity can cause occupant discomfort. The public review draft of ASHRAE Standard 62-1989R included requirements for installation of dehumidification controls in buildings with mechanical cooling located in humid climates. The draft standard included a definition of humid climate: where, during the warmest six consecutive months of a typical year, the wetbulb temperature is 19°C (67°F) or higher for 3500 hours or more, or 23°C (73°F) or higher for 1750 hours or more. This definition is that used in the 1993 ASHRAE Handbook of Fundamentals to define the humid climate region. The only areas in the continental United States which meet these criteria are close to the Gulf coast, all of Florida, and along the Atlantic coast as far north as southern North Carolina While it is clear that buildings in this humid climate region need to be carefully designed with regard to humidity control, it is also clear that buildings in other areas have an equal need for humidity control. The work described in this paper examines a number of potential indicators of "humid climate" and correlates them with the prevalence of indoor humidity problems in three building types. The FSEC 2.3 energy simulation computer program (Kerestecioglu et al. 1989) was used to simulate the three building types, using weather from 10 cities in the southeastern U.S. The FSEC software was selected because it is capable of accurately modeling moisture transfer within the building space and the dehumidification performance of cooling coils at part-load conditions, and predicting resulting humidity levels. The buildings modeled were a retail store (similar to a K-Mart or Wal-Mart), a large office building, and a fast food restaurant. Existing building models were employed for this study with ventilation rates in accordance with ASHRAE Standard 62-1989. The HVAC systems used were typical for these building types, without any special humidity control measures. The selected indicators of humidity problems are the number of hours per year with space humidity above 60% RH and the number of occupied hours with space humidity above 60% RH. TMY2 weather data (NREL 1995) for 10 cities was used for the annual building energy simulations. TMY2 data was also used to calculate a number of potential humid climate parameters for the same 10 cities. These included: the number of hours and the wetbulb-degree hours above 3 different wetbulb temperatures, the number of hours and grain-hours above 4 different humidity ratios, and the sensible, latent and total Ventilation Load Index (VLI). The VLI is the load (latent, sensible or total) generated by bringing one cfm of outdoor air to space neutral conditions over the course of one year (Hamman, et al. 1997). The ability of each climate parameter to predict indoor humidity problems was analyzed and compared. Implications of using the selected parameters to define a humid climate will be discusse

Case Study of an Innovative HVAC System with Integral Dehumidifier

In most applications, heating, ventilating, and air conditioning (HVAC) equipment is controlled to maintain an indoor dry-bulb set point temperature. Moisture removal by the HVAC system is considered to be an operational byproduct. During summer months, the operation of the HVAC system is usually sufficient to meet both the sensible and latent cooling loads. However, during other times of the year when sensible loads are reduced, the moisture load can be significantly higher than the available moisture removal capacity of the air conditioning system. This can lead to elevated indoor relative humidity levels and an uncomfortable indoor environment. In many cases, designers, engineers and building occupants combat high indoor relative humidity and associated comfort problems with the use of additional dehumidification equipment for both commercial and residential applications. The use of extra dehumidification equipment can be expensive in terms of first cost and annual operating costs. First costs associated with this type of equipment may include additional electrical circuits, condensate drainage, and additional air distribution systems. The loss of usable floor area, localized noise, and zonal “hotspots” can also be considered a cost penalty. As an alternative to using separate equipment for meeting both the sensible and latent components of a building’s cooling load, off-the- shelf products were used to construct a self-contained air handler. The air handler is controlled using a low-cost thermostat and humidistat. The dehumidification element of the system is completely independent from the air conditioner and works nearly the same as conventional dehumidification equipment. At times, both the dehumidification equipment and the air conditioner operate in unison when the need arises. The use of dehumidification equipment integrated with a conventional AC system provides a unique solution for moisture control applications. This paper describes the development and testing of this integrated equipment. Although this technology is not new, the integration of a dehumidification system with a standard air conditioner is an innovative strategy that can be used to address moisture control in buildings. This new HVAC configuration would provide a low-cost solution for building owners and a more comfortable indoor environment for building occupants

Efectos de la salinidad sobre la gravedad específica y la viabilidad de huevos de una carpa norteamericana (Ciprinidae)

The influence of salinity on survival, specific gravity, and size of eggs of the endangered Hybognathus amarus (Rio Grande silvery minnow) was studied to provide insight into factors affecting their potential dispersal and fate. Under low salinity conditions egg specific gravity declined significantly in the first hour after spawning as the perivitelline space of the egg filled with water. Egg specific gravity achieved a minimum value approximately 1 h post-spawning and remained approximately constant until hatching, which occurred near 48 h post-spawning at 20°C. Specific gravity of the egg depended on the salinity of the water surrounding the egg: hardened eggs changed rapidly in diameter and specific gravity when exposed to water of higher salinity. Size and specific gravity of H. amarus eggs also differed when the eggs were incubated in different groundwater sources. Experiments indicated that calcium chloride saline solution had a greater effect on egg specific gravity and size than did solutions of sodium or potassium chlorides. Survival of H. amarus eggs declined sharply at salinity greater than 3 (practical salinity units, PSU) and was only 5% at a salinity of 8. Habitat restoration to benefit H. amarus should consider the salinity of habitats in which eggs incubate.El efecto de la salinidad sobre la supervivencia, gravedad específica y talla de los huevos del ciprínido puesto en peligro de extinción, Hybognathus amarus, fue estudiado para proporcionar información sobre los factores que afectan la dispersión y el destino de los huevos. Bajo condiciones de salinidad baja la gravedad específica del huevo disminuyó de forma significativa durante la primera hora después de la puesta, a medida que el espacio del perivitelino del huevo se fue llenando de agua. la gravedad específica del huevo alcanzó un valor mínimo 1 hora después de la puesta y quedó aproximadamente constante hasta eclosión, que ocurrió alrededor de 48 horas tras la puesta a 20˚C. la gravedad específica del huevo dependió de la salinidad del agua que le rodeaba. los huevos con corion endurecido cambiaron rápidamente en diámetro y gravedad específica cuando fueron expuestos a agua de salinidad más alta. El tamaño y la gravedad específica de los huevos de H. amarus también se diferenciaron cuando los huevos fueron incubados en diferentes fuentes de agua subterránea. Los experimentos indicaron que la solución salina del cloruro de calcio tuvo un mayor efecto sobre la gravedad específica del huevo que las soluciones de los cloruros del sodio o del potasio. Expuestos a soluciones de salinidad de más de 3 (PsU), la supervivencia de los huevos de H. amarus disminuyó claramente, bajando a sólo el 5% en la solución de 8. la restauración del hábitat con el objetivo de beneficiar a H. amarus debe considerar la salinidad de los hábitats en los cuales el huevo incuba

Patient experience in an interprofessional collaborative practice for underserved patients with heart failure

Heart failure is a complex chronic condition that results in multiple patient visits throughout the care continuum. Patient experience has associations with clinical outcomes. The purpose of this study was to examine patient experience among the underserved in a specialized interprofessional collaborative practice heart failure clinic. This prospective study utilized both qualitative and quantitative data to describe the patient experience within an interprofessional collaborative practice. Data were collected from patient experience surveys in 1128 patients seen in the Heart Failure Transitional Care Services for Adults (HRTSA) clinic between January 1, 2018, and December 31, 2021. Interprofessional collaborative practice surveys were completed by clinic staff members. When examining relationships associated with patient experience, we found three significant associations. Being single was negatively associated with patient experience. When examining IPCP and patient experience, overall interprofessional collaborative practice alignment [t(237)=2.00, p=.046 ] and the team’s alignment of mission, vision and purpose [t(254)=1.99, p=.047] were positively related to patients’ care satisfaction. Interprofessional collaborative practice team alignment can positively impact patient experience in underserved patients with heart failure. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Scattering and Iron Fluorescence Revealed During Absorption Dips in Circinus X-1

We show that dramatic spectral evolution associated with dips occurring near phase zero in RXTE observations of Cir X-1 is well-fit by variable and at times heavy absorption (N_H > 10^24 cm^-2) of a bright component, plus an underlying faint component which is not attenuated by the variable column and whose flux is ~10% of that of the unabsorbed bright component. A prominent Fe emission line at ~6.5 keV is evident during the dips. The absolute line flux outside the dips is similar to that during the dips, indicating that the line is associated with the faint component. These results are consistent with a model in which the bright component is radiation received directly from a compact source while the faint component may be attributed to scattered radiation. Our results are also generally consistent with those of Brandt et al., who found that a partial- covering model could explain ASCA spectra of a low-to-high transition in Cir X-1. The relative brightness of the two components in our model requires a column density of ~2*10^23 cm^-2 if the faint component is due to Thomson scattering in material that mostly surrounds the source. We find that illumination of such a scattering cloud by the observed direct component would produce an Fe K-alpha fluorescence flux that is in rough agreement with the flux of the observed emission line. We also conclude that if the scattering medium is not highly ionized, our line of sight to the compact source does not pass through it. Finally, we discuss simple pictures of the absorbers responsible for the dips themselves.Comment: Accepted for publication in The Astrophysical Journal (23 pages, including 11 figures

A Catalog of Transient X-ray Sources in M31

From October 1999 to August 2002, 45 transient X-ray sources were detected in M31 by Chandra and XMM-Newton. We have performed spectral analysis of all XMM-Newton and Chandra ACIS detections of these sources, as well as flux measurements of Chandra HRC detections. The result is absorption-corrected X-ray lightcurves for these sources covering this 2.8 year period, along with spectral parameters for several epochs of the outbursts of most of the transient sources. We supply a catalog of the locations, outburst dates, peak observed luminosities, decay time estimates, and spectral properties of the transient sources, and we discuss similarities with Galactic X-ray novae. Duty cycle estimates are possible for 8 of the transients and range from 40% to 2%; upper limits to the duty cycles are estimated for an additional 15 transients and cover a similar range. We find 5 transients which have rapid decay times and may be ultra-compact X-ray binaries. Spectra of three of the transients suggest they may be faint Galactic foreground sources. If even one is a foreground source, this suggests a surface density of faint transient X-ray sources of >~1 deg$^{-2}$.Comment: 63 pages, 22 figures, 3 tables, accepted for publication in Ap