Journey to the Bedside: A Quality Improvement Project to Implement Bedside Report Utilizing Watson\u27s Theory of Human Caring

A 134 bed hospital in a rural community had a continuous struggle to meet defined goals on the hospital consumer assessment of healthcare providers and systems survey (HCAHPS). The hospital’s medical unit consistently performed lower in the communication with nurses HCAHPS domain than other nursing departments in the organizations. Between 2015 and 2017 the overall communication with nurse’s score in the HCAHPS domain of the medical unit ranged between 74-79%. Nursing staff were task oriented, focusing on the next task to be done instead of the current moment and interaction with the patient. A literature review revealed that consistent themes involving patient communication, nurse satisfaction, intensity of patient illnesses, and hospital marketability all have an impact on HCAHPS. Patient perceptions of care and interactions with nurses emerged as the most dominant theme found in the evidence demonstrating this as an important focus of the intervention to address the indicated problem. Many best practices were recognized in the literature as having a positive impact on patient satisfaction, however bedside reporting addressed all of the critical elements of the nurse patient relationship. An analysis of the literature review showed supportive evidence that bedside reporting would have a positive impact on the communication with nurse’s domain in HCAHPS. A bedside report intervention implemented utilizing the participatory model and guided by caring science produced key findings which demonstrated positive outcomes for patients, staff, and the organization. The participatory model allowed the bedside report process to be designed based on frontline staff members’ knowledge of the actual unit workflow. The early identification of potential barriers by the bedside report team also allowed for the team members to participate and lead staff engagement initiatives based on caring science. The Communication with Nurses domain in HCAHPS indicated an overall positive increase from 70.9% to 89.0% of patient indicating the top score of “always”. Data from the key question within the Communication with Nurses Domain in HCAHPS Nurses listened carefully to you indicated an increase from 68.3% to 85% of patients indicating the top score of “always” and data from the question Nurses explained things in ways you understand indicated an increase from 63.9% to 81.3% of patients selecting the top score of “always” According to the Watson Caritas Patient Survey Tool results, patients perceived that staff always met their needs with caring kindness over 90% of the time (n=103). A Staff Perception of Bedside Report survey (n=60) designed by the project leader indicated that staff perceived the bedside report process created a caring encounter between nursing and improved communication between staff and patients. Managing interruptions and patient needs during the bedside report were found to be important for successful implementation and workflow. The use of participatory model and a caring science concepts and a structured timeline allowed for staff collaboration, staff preparation, successful implementation, staff engagement, and plans for sustainability

Derivatization of Free Glycans for Glycan Sensor and Glyco-Functionalization Applications

Glycans, especially, cell surface glycans acting as receptors, are involved in a wide range of biological processes. Analysis of the cell surface glycans provides a basis for understanding the molecular mechanism of glycan-mediated biological process. The present method can be applied in derivatizing sugars from natural sources for glycan sensor and glyco-functionalization applications.https://engagedscholarship.csuohio.edu/u_poster_2012/1021/thumbnail.jp

Saving and Sustaining Community History One Block at a Time: A Case Study on the Marian Cheek Jackson Center and the Convergence of Public History, Community Informatics, and Digital Archives

Intertwining public memory, community archives, and technology, St. Joseph's C.M.E Church, the University of North Carolina's Southern Oral History Program (SOHP), and the Marian Cheek Jackson Center for Saving and Making History documented the legacy of the minority and working class voices within the Northside and Pine Knoll neighborhoods in Chapel Hill, North Carolina. Having preserved hundreds of oral interviews with a social justice orientation, the narratives were transformed into a physical and digital archive. This paper uses a case study approach to explore the Jackson Center's ethnographic framework and survey methodology used to entice community participation and examines 1) The application of oral and public history to document marginalized communities that may be underrepresented in traditional archival repositories 2) The definition of community archives 3) The role of Community Informatics in galvanizing support for the digital archives and 4) The implications of archival custody and the future for wider use.Master of Science in Library Scienc

Impact of Race on Housing in Low-Income Rural Areas in Oklahoma

The study is concerned with the analysis of the im~act of race on housing. The specific objectives of this study are to examine the relationship between race and housing (location, tenure, structural quality, and space) while controlling for the influence of income, family size and sex, age and education of the household head and to examine the relationship between family and housingcharacteristics as these characteristics influence a family's desire to change present housing.Housing, Design and Consumer Resource

Takagi–Sugeno Fuzzy Modeling of Skin Permeability

The skin is a major exposure route for many potentially toxic chemicals. It is, therefore, important to be able to predict the permeability of compounds through skin under a variety of conditions. Available skin permeability databases are often limited in scope and not conducive to developing effective models. This sparseness and ambiguity of available data prompted the use of fuzzy set theory to model and predict skin permeability. Using a previously published database containing 140 compounds, a rule-based Takagi–Sugeno fuzzy model is shown to predict skin permeability of compounds using octanol-water partition coefficient, molecular weight, and temperature as inputs. Model performance was estimated using a cross-validation approach. In addition, 10 data points were removed prior to model development for additional testing with new data. The fuzzy model is compared to a regression model for the same inputs using both R2 and root mean square error measures. The quality of the fuzzy model is also compared with previously published models. The statistical analysis demonstrates that the fuzzy model performs better than the regression model with identical data and validation protocols. The prediction quality for this model is similar to others that were published. The fuzzy model provides insights on the relationships between lipophilicity, molecular weight, and temperature on percutaneous penetration. This model can be used as a tool for rapid determination of initial estimates of skin permeability

Takagi–Sugeno Fuzzy Modeling of Skin Permeability

The skin is a major exposure route for many potentially toxic chemicals. It is, therefore, important to be able to predict the permeability of compounds through skin under a variety of conditions. Available skin permeability databases are often limited in scope and not conducive to developing effective models. This sparseness and ambiguity of available data prompted the use of fuzzy set theory to model and predict skin permeability. Using a previously published database containing 140 compounds, a rule-based Takagi–Sugeno fuzzy model is shown to predict skin permeability of compounds using octanol-water partition coefficient, molecular weight, and temperature as inputs. Model performance was estimated using a cross-validation approach. In addition, 10 data points were removed prior to model development for additional testing with new data. The fuzzy model is compared to a regression model for the same inputs using both R2 and root mean square error measures. The quality of the fuzzy model is also compared with previously published models. The statistical analysis demonstrates that the fuzzy model performs better than the regression model with identical data and validation protocols. The prediction quality for this model is similar to others that were published. The fuzzy model provides insights on the relationships between lipophilicity, molecular weight, and temperature on percutaneous penetration. This model can be used as a tool for rapid determination of initial estimates of skin permeability

Photoreceptor Outer Segment-like Structures in Long-Term 3D Retinas from Human Pluripotent Stem Cells.

The retinal degenerative diseases, which together constitute a leading cause of hereditary blindness worldwide, are largely untreatable. Development of reliable methods to culture complex retinal tissues from human pluripotent stem cells (hPSCs) could offer a means to study human retinal development, provide a platform to investigate the mechanisms of retinal degeneration and screen for neuroprotective compounds, and provide the basis for cell-based therapeutic strategies. In this study, we describe an in vitro method by which hPSCs can be differentiated into 3D retinas with at least some important features reminiscent of a mature retina, including exuberant outgrowth of outer segment-like structures and synaptic ribbons, photoreceptor neurotransmitter expression, and membrane conductances and synaptic vesicle release properties consistent with possible photoreceptor synaptic function. The advanced outer segment-like structures reported here support the notion that 3D retina cups could serve as a model for studying mature photoreceptor development and allow for more robust modeling of retinal degenerative disease in vitro

Risk of colon cancer in hereditary non-polyposis colorectal cancer patients as predicted by fuzzy modeling: Influence of smoking

AIM: To investigate whether a fuzzy logic model could predict colorectal cancer (CRC) risk engendered by smoking in hereditary non-polyposis colorectal cancer (HNPCC) patients. METHODS: Three hundred and forty HNPCC mismatch repair (MMR) mutation carriers from the Creighton University Hereditary Cancer Institute Registry were selected for modeling. Age-dependent curves were generated to elucidate the joint effects between gene mutation (hMLH1 or hMSH2), gender, and smoking status on the probability of developing CRC. RESULTS: Smoking significantly increased CRC risk in male hMSH2 mutation carriers (P \u3c 0.05). hMLH1 mutations augmented CRC risk relative to hMSH2 mutation carriers for males (P \u3c 0.05). Males had a significantly higher risk of CRC than females for hMLH1 non smokers (P \u3c 0.05), hMLH1 smokers (P \u3c 0.1) and hMSH2 smokers (P \u3c 0.1). Smoking promoted CRC in a dose-dependent manner in hMSH2 in males (P \u3c 0.05). Females with hMSH2 mutations and both sexes with the hMLH1 groups only demonstrated a smoking effect after an extensive smoking history (P \u3c 0.05). CONCLUSION: CRC promotion by smoking in HNPCC patients is dependent on gene mutation, gender and age. These data demonstrate that fuzzy modeling may enable formulation of clinical risk scores, thereby allowing individualization of CRC prevention strategies

Evaluation of a College-Community Approach to Developing Multi-level Primary Health Care-Population Health Promotion Practicums for Nursing Students

Background: An important objective of Canadian nursing degree programs is to educate students about the principles of primary health care (PHC) and population health promotion (PHP). This mandate is challenged by the lack of full scope PHP practice experiences within the Canadian health care system. Nursing education programs have thus increasingly developed innovative practicums outside of the formal health sector, yet limited formal evaluations have been conducted to evaluate these practicums. In addressing this need, faculty within a Bachelor of Science in Nursing (BSN) program at a Canadian urban college evaluated a fourth year practicum in multi-level PHP practice from the perspective of faculty, students, alumni and agency partners. Method: Within a participatory action research framework, a formal evaluation of this practicum was conducted to gather qualitative feedback. 36 participants took part in 20-minute group discussions at the final seminar or via an online survey. Thematic analysis was used to analyze the transcripts and survey responses. Findings: Current students reported three main areas of learning, including a deeper critical awareness of the context of health experiences, the nature of multi-level PHP practice and leadership. Importantly, this included a greater understanding of the nature of working at community and policy advocacy levels to promote healthy public policy. Participants also identified key elements of the administration of this practicum in order to support student learning. Conclusion: Evaluation findings emphasize the importance of continuing to situate PHP practicums within non-health based sites to enable nursing students to experience the full scope of PHP practice. These practicums need to include some projects that focus on community organizing and policy advocacy in order to support learning about multi-level PHP practice. It is also important for faculty to advocate for health system transformation guided by a primary health care model. Résumé : Contexte : Un objectif important des programmes universitaires Canadiens en sciences infirmières est d’enseigner aux étudiants les principes des soins de première ligne (SPL)) et de promotion de la santé de la population (PSP). Ce mandat représente un défi en raison du manque d’expériences de pleine étendue de la pratique en PSP dans le système canadien de soins de santé. Ainsi, les programmes de formation en sciences infirmières élaborent de plus en plus des stages novateurs à l’extérieur du secteur officiel de la santé. Toutefois peu d’évaluations formelles ont été réalisées pour évaluer ces stages. Pour répondre à ce besoin, les professeurs d’un programme de baccalauréat en sciences infirmières d’un collège universitaire é d’un centre urbain canadien ont évalué un stage pratique multiniveaux de quatrième année en PSP du point de vue de professeurs, d’étudiants, de diplômés et d’organismes partenaires. Méthode : Dans le cadre d’une recherche participative, une évaluation formelle de ce stage a été réalisée dans le but de recueillir des commentaires qualitatifs. Au total, 36 participants ont pris part à des discussions de groupe de 20 minutes lors du dernier séminaire ou ont répondu à un sondage en ligne. Par la suite, une analyse thématique a été effectuée pour analyser les données transcrites et les réponses au sondage. Résultats : Les étudiants actuels ont mentionné trois principaux domaines d’apprentissage, c\u27est-à-dire une meilleure prise de conscience critique du contexte relatif aux expériences de santé, la nature de la pratique multiniveaux de PSP et le leadership. Il importe de noter qu’il a aussi été question d’une meilleure compréhension de la nature du travail dans la communauté et des niveaux de sensibilisation stratégique nécessaires pour promouvoir des politiques éclairées en matière de santé publique. Les participants ont également identifié des éléments critiques à l’apprentissage en ce qui concerne l’organisation du stage. Conclusion : Les résultats d’évaluation font ressortir l’importance de continuer à placer des stages de PSP à l’extérieur des sites de soins de santé pour que les étudiants en sciences infirmières puissent faire l\u27expérience de la pleine étendue de la pratique en PSP. Ces stages doivent inclure certains projets portant sur l’organisation communautaire et la sensibilisation stratégique afin de soutenir l’apprentissage de la pratique multiniveaux en PSP. Il est également important que les professeurs recommandent une transformation du système de santé d’après un modèle de soins de première ligne