Nursing Faculty Connecting with Students: A Heideggerian Hermenteutical Study

This study sought to gain an insight into the phenomenon of nursing faculty members connecting with students. Caring has been espoused as a key component of nursing education for many decades. In the last 10 years the terms caring and connecting are commonly found associated with each other, and yet there is no clear definition of connecting. It is important to understand a phenomenon from the point of view of those who are experiencing it. Therefore, a study which asked nursing educators to tell stories of the times they had connected with students was undertaken. Ten nurse educators in the Southern California area provided the stories for this study. Heideggerian hermeneutic phenomenology provided the philosophical background for this study and the interpretation of the stories. Interaction with the stories of the nursing faculty led to the identification of constitutive themes of the stories. The participants sought connections with students as an outgrowth of their core belief about how to interact with people. Connecting often brought with it an increase in the depth of knowledge about the other, a desire to spent time with the other, and a greater acceptance of the other. If the teacher and the student held similar values the probability of connecting increased. Connecting occurred on both the emotive/personal level and on an intellectual level. Intellectual connecting provided an increase in the energy, that was missing when there was no connection. Intellectual connecting made teaching more fun and faculty members enjoyed the increased energy level. However, connecting also uses the faculty member\u27s time and energy and connecting is sometimes hindered by the lack of one of these resources. Faculty members often experienced the inability to form a connection with students. Differing values were one of the major impediments to forming a connection. Preconceptions held by the teacher, the student, or both, were also identified as things that hindered connecting. In order to understand the stories of the nursing faculty participant, one must be cognizant of their language. Language provided pictures of connecting and not connecting, feelings associated with connecting and not connecting, and descriptions of what connecting meant to the participant. The stories of the nursing faculty provided the groundwork to begin to understand the relationship between caring and connecting. There are many questions left unanswered, but the faculty members provided a starting point for understanding what it means to connect with students

Interaction between polar molecules subject to a far-off-resonant optical field: Entangled dipoles up- or down-holding each other

We show that the electric dipole-dipole interaction between a pair of polar molecules undergoes an all-out transformation when superimposed by a far-off resonant optical field. The combined interaction potential becomes tunable by variation of wavelength, polarization and intensity of the optical field and its dependence on the intermolecular separation exhibits a crossover from an inverse-power to an oscillating behavior. The ability thereby offered to control molecular interactions opens up avenues toward the creation and manipulation of novel phases of ultracold polar gases among whose characteristics is a long-range entanglement of the dipoles' mutual orientation. We devised an accurate analytic model of such optical-field-dressed dipole-dipole interaction potentials, which enables a straightforward access to the optical-field parameters required for the design of intermolecular interactions in the laboratory.Comment: 11 pages, 6 figures, 1 table. arXiv admin note: substantial text overlap with arXiv:1104.104

Rural Readmissions in the Palliative Care Vacuum

Palliative care consultation is associated with reduced health care costs and improved quality of life while reducing length of stay. Small rural hospitals lack the depth of multidisciplinary resources to provide inpatient palliative care consult services. The purpose of this research was to assess the need for palliative care service in rural hospitals, while examining for a difference in hospital readmission rates in hospitals lacking palliative consult services. Data were obtained from the Pennsylvania Health Cost Containment Counsel including 3 hospitals with palliative programs and 3 without. Inclusion criteria were admissions for a patient carrying a diagnosis appropriate for palliative consultation between the last quarter of 2014 and 2015. There were 1394 index patients admitted to 3 rural hospitals lacking a palliative consult program. There was a higher rate of readmissions at the nonpalliative hospitals, 71.6% versus 55.1% (P \u3c .001). Data suggest there is a need for palliative telemedicine services to meet needs in rural hospitals. Palliative care consultation is associated with a more positive patient and family assessment of quality of life in the setting of complex life-limiting illness, while also improving the informed selection of health care choices that reduce the cost of care being provided.1-3 The Center for Advancing Palliative Care identifies palliative care as a multidisciplinary team including nursing, which is beneficial to patients and families facing serious illness.4 This includes, but is not limited to, illnesses such as cancer, cardiac disease, chronic obstructive pulmonary disease, and Alzheimer disease. Palliative consultation is associated with shorter intensive care unit (ICU) length of stay without altering mortality rates or disposition from the ICU.3 Palliative care services are becoming increasingly available in hospitals in urban centers or facilities with a bed capacity of greater than 200. Smaller, more rural hospitals, however, often lack the depth of multidisciplinary resources to provide an inpatient palliative care service.4 There is potential for palliative telemedicine services to reduce the burden to patient and families, as well as cost to the health care system. The extent of the rural disparity has not been fully explored and represents a significant gap in our knowledge. This research is designed to assess the need for palliative care consultation across a group of 6 hospitals utilizing readmission data in the population appropriate for palliative consultation. Population data were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes for all adult patients with diagnoses appropriate for palliative involvement. Data were obtained from Pennsylvania Health Cost Containment Counsel (PHC4). Three of the selected hospitals have an established palliative care program, and 3 hospitals do not. A correlational analysis of readmission rates was performed between these groups of hospitals in this patient population

The Future of Healthcare Delivery: IPE/IPP Audiology and Nursing Student/Faculty Collaboration to Deliver Hearing Aids to Vulnerable Adults via Telehealth

A multi-departmental, two-city initiative to provide hearing aid service via a telepractice approach was developed whereby nursing and auditory students with supervisory faculty used AV conferencing for training and interaction with referred patients. Located in two cities, 21 nursing and 15 doctoral level audiology students met virtually, and students received teleaudiology education and practicum with interprofessional education and practice components. Nursing students in one city and a supervising faculty in another city could interact with providers and patients in both cities to provide hearing care. The teleaudiology project delivered hearing health care services, including fitting of digital mini hearing aids, to 181 patients over 29 months of the project. During that time period, 205 total patients were referred to the teleaudiology clinic. Over 90% of these patients, as assessed by either patient teleaudiology clinic visits or telephone follow-up, successfully wore their hearing aids. Students administered selected published surveys related to patient outcomes both pre and post fitting. Patients reported significant hearing handicap reduction and were very satisfied with the teleaudiology mode of digital hearing aid and hearing health care service delivery. The experience provided interprofessional pre-service exposure to cutting edge technology and an innovative delivery system for future members of the healthcare workforce

Malaria incidence in Limpopo Province, South Africa, 1998–2007

<p>Abstract</p> <p>Background</p> <p>Malaria is endemic in the low-altitude areas of the northern and eastern parts of South Africa with seasonal transmission. The aim of this descriptive study is to give an overview of the malaria incidence and mortality in Limpopo Province for the seasons 1998–1999 to 2006–2007 and to detect trends over time and place.</p> <p>Methods</p> <p>Routinely collected data on diagnosed malaria cases and deaths were available through the provincial malaria information system. In order to calculate incidence rates, population estimates (by sex, age and district) were obtained from Statistics South Africa. The Chi squared test for trend was used to detect temporal trends in malaria incidence over the seasons, and a trend in case fatality rate (CFR) by age group. The Chi squared test was used to calculate differences in incidence rate and CFR between both sexes and in incidence by age group.</p> <p>Results</p> <p>In total, 58,768 cases of malaria were reported, including 628 deaths. The mean incidence rate was 124.5 per 100,000 person-years and the mean CFR 1.1% per season. There was a decreasing trend in the incidence rate over time (p < 0.001), from 173.0 in 1998–1999 to 50.9 in 2006–2007. The CFR was fairly stable over the whole period. The mean incidence rate in males was higher than in females (145.8 versus 105.6; p < 0.001); the CFR (1.1%) was similar for both sexes. The incidence rate was lowest in 0–4 year olds (78.3), it peaked at the ages of 35–39 years (172.8), and decreased with age from 40 years (to 84.4 for those ≥ 60 years). The CFR increased with increasing age (to 3.8% for those ≥ 60 years). The incidence rate varied widely between districts; it was highest in Vhembe (328.2) and lowest in Sekhukhune (5.5).</p> <p>Conclusion</p> <p>Information from this study may serve as baseline data to determine the course and distribution of malaria in Limpopo province over time. In the study period there was a decreasing trend in the incidence rate. Furthermore, the study addresses the need for better data over a range of epidemic-prone settings.</p

Modulation of emotional appraisal by false physiological feedback during fMRI

BACKGROUND James and Lange proposed that emotions are the perception of physiological reactions. Two-level theories of emotion extend this model to suggest that cognitive interpretations of physiological changes shape self-reported emotions. Correspondingly false physiological feedback of evoked or tonic bodily responses can alter emotional attributions. Moreover, anxiety states are proposed to arise from detection of mismatch between actual and anticipated states of physiological arousal. However, the neural underpinnings of these phenomena previously have not been examined. METHODOLOGY/PRINCIPAL FINDINGS We undertook a functional brain imaging (fMRI) experiment to investigate how both primary and second-order levels of physiological (viscerosensory) representation impact on the processing of external emotional cues. 12 participants were scanned while judging face stimuli during both exercise and non-exercise conditions in the context of true and false auditory feedback of tonic heart rate. We observed that the perceived emotional intensity/salience of neutral faces was enhanced by false feedback of increased heart rate. Regional changes in neural activity corresponding to this behavioural interaction were observed within included right anterior insula, bilateral mid insula, and amygdala. In addition, right anterior insula activity was enhanced during by asynchronous relative to synchronous cardiac feedback even with no change in perceived or actual heart rate suggesting this region serves as a comparator to detect physiological mismatches. Finally, BOLD activity within right anterior insula and amygdala predicted the corresponding changes in perceived intensity ratings at both a group and an individual level. CONCLUSIONS/SIGNIFICANCE Our findings identify the neural substrates supporting behavioural effects of false physiological feedback, and highlight mechanisms that underlie subjective anxiety states, including the importance of the right anterior insula in guiding second-order "cognitive" representations of bodily arousal state

Modulation of emotional appraisal by false physiological feedback during fMRI

BACKGROUND James and Lange proposed that emotions are the perception of physiological reactions. Two-level theories of emotion extend this model to suggest that cognitive interpretations of physiological changes shape self-reported emotions. Correspondingly false physiological feedback of evoked or tonic bodily responses can alter emotional attributions. Moreover, anxiety states are proposed to arise from detection of mismatch between actual and anticipated states of physiological arousal. However, the neural underpinnings of these phenomena previously have not been examined. METHODOLOGY/PRINCIPAL FINDINGS We undertook a functional brain imaging (fMRI) experiment to investigate how both primary and second-order levels of physiological (viscerosensory) representation impact on the processing of external emotional cues. 12 participants were scanned while judging face stimuli during both exercise and non-exercise conditions in the context of true and false auditory feedback of tonic heart rate. We observed that the perceived emotional intensity/salience of neutral faces was enhanced by false feedback of increased heart rate. Regional changes in neural activity corresponding to this behavioural interaction were observed within included right anterior insula, bilateral mid insula, and amygdala. In addition, right anterior insula activity was enhanced during by asynchronous relative to synchronous cardiac feedback even with no change in perceived or actual heart rate suggesting this region serves as a comparator to detect physiological mismatches. Finally, BOLD activity within right anterior insula and amygdala predicted the corresponding changes in perceived intensity ratings at both a group and an individual level. CONCLUSIONS/SIGNIFICANCE Our findings identify the neural substrates supporting behavioural effects of false physiological feedback, and highlight mechanisms that underlie subjective anxiety states, including the importance of the right anterior insula in guiding second-order "cognitive" representations of bodily arousal state

A prospective cohort study assessing clinical referral management & workforce allocation within a UK regional medical genetics service

Abstract Ensuring patient access to genomic information in the face of increasing demand requires clinicians to develop innovative ways of working. This paper presents the first empirical prospective observational cohort study of UK multi-disciplinary genetic service delivery. It describes and explores collaborative working practices including the utilisation and role of clinical geneticists and non-medical genetic counsellors. Six hundred and fifty new patients referred to a regional genetics service were tracked through 850 clinical contacts until discharge. Referral decisions regarding allocation of lead health professional assigned to the case were monitored, including the use of initial clinical contact guidelines. Significant differences were found in the cases led by genetic counsellors and those led by clinical geneticists. Around a sixth, 16.8% (109/650) of referrals were dealt with by a letter back to the referrer or re-directed to another service provider and 14.8% (80/541) of the remaining patients chose not to schedule an appointment. Of the remaining 461 patients, genetic counsellors were allocated as lead health professional for 46.2% (213/461). A further 61 patients did not attend. Of those who did, 86% (345/400) were discharged after one or two appointments. Genetic counsellors contributed to 95% (784/825) of total patient contacts. They provided 93.7% (395/432) of initial contacts and 26.8% (106/395) of patients were discharged at that point. The information from this study informed a planned service re-design. More research is needed to assess the effectiveness and efficiency of different models of collaborative multi-disciplinary working within genetics services. Keywords (MeSH terms) Genetic Services, Genetic Counseling, Interdisciplinary Communication, Cohort Studies, Delivery of Healthcare, Referral and Consultation

Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort

Aims/hypothesis: We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control. Methods: This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log10 ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA1c, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable. Results: At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3], p=0.001), higher mean IFCC HbA1c (HR 1.03 [1.01, 1.04], p=0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89], p=0.01) were independently associated with 3DR risk. Conclusions/interpretation: High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies