Comparison of Nurse Staffing Based on Changes in Unit-level Workload Associated with Patient Churn

Aim This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Background Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Method(s) Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Result Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Conclusion Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Implications for nursing management Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements

Undergraduate Nursing Students’ Attitudes Toward Mental Health Nursing

Objectives: The purpose of this study was to describe undergraduate nursing students’ attitudes toward mental health nursing and how these attitudes influenced their professional career choices in mental health nursing. Design: A descriptive, online survey was utilized to examine students’ perceptions of mental health nursing. A total of 229 junior and senior nursing students were recruited from eight nursing colleges in Midwestern United States to participate in this survey. Results: Students of different ages, genders, ethnicities, and nursing programs did not report significantly different perceptions of: (a) knowledge of mental illness; (b) negative stereotypes; (c) interest in mental health nursing as a future career; and (d), and beliefs that psychiatric nurses provide a valuable contribution to consumers and the community. Negative stereotypes were significantly different between students who had mental health nursing preparation either in class (p = 0.0147) or in clinical practice (p = 0.0018) and students who had not. There were significant differences in anxiety about mental illness between students who had classes on mental health nursing (p = .0005), clinical experience (p = 0.0035), and work experience in the mental health field (p = 0.0012). Significant differences in an interest in a future career in mental health nursing emerged between students with and without prior mental health experience and between students with and without an interest in an externship program with p-values of 0.0012 and \u3c 0.0001, respectively. Conclusions: The more exposure that students have to mental health nursing through clinical experiences, theory classes, and previous work in the field, the more prepared they feel about caring for persons with mental health issues

Initial stage of the 2D-3D transition of a strained SiGe layer on a pit-patterned Si(001) template

We investigate the initial stage of the 2D-3D transition of strained Ge layers deposited on pit-patterned Si(001) templates. Within the pits, which assume the shape of inverted, truncated pyramids after optimized growth of a Si buffer layer, the Ge wetting layer develops a complex morphology consisting exclusively of {105} and (001) facets. These results are attributed to a strain-driven step-meandering instability on the facetted side-walls of the pits, and a step-bunching instability at the sharp concave intersections of these facets. Although both instabilities are strain-driven, their coexistence becomes mainly possible by the geometrical restrictions in the pits. It is shown that the morphological transformation of the pit surface into low-energy facets has strong influence on the preferential nucleation of Ge islands at the flat bottom of the pits.Comment: 19 pages, 7 figure

A Model for Hospital Discharge Preparation: From Case Management to Care Transition

There has been a proliferation of initiatives to improve discharge processes and outcomes for the transition from hospital to home and community-based care. Operationalization of these processes has varied widely as hospitals have customized discharge care into innovative roles and functions. This article presents a model for conceptualizing the components of hospital discharge preparation to ensure attention to the full range of processes needed for a comprehensive strategy for hospital discharge

An Online Educational Program Improves Pediatric Oncology Nurses’ Knowledge, Attitudes, and Spiritual Care Competence

This study evaluated the potential impact of an online spiritual care educational program on pediatric nurses’ attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. It was hypothesized that the intervention would increase nurses’ positive attitudes toward and knowledge of spiritual care and increase nurses’ level of perceived spiritual care competence. A positive correlation was expected between change in nurses’ perceived attitudes toward and knowledge of spiritual care and change in nurses’ perceived spiritual care competence. A prospective, longitudinal design was employed, and analyses included one-way repeated-measures analysis of variance, linear regression, and partial correlation. Statistically significant differences were found in nurses’ attitudes toward and knowledge of spiritual care and nurses’ perceived spiritual care competence. There was a positive relationship between change scores in nurses’ attitudes toward and knowledge of spiritual care and nurses’ spiritual care competence. Online spiritual care educational programs may exert a lasting impact on nurses’ attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. Additional studies are required to evaluate the direct effects of educational interventions patient outcomes

Databases for Researching Athletic Training Literature

Searching the athletic training literature can be confusing and overwhelming with many possible databases for locating relevant peer-reviewed scholarship. Finding evidence-based literature from respected publications is helpful in clinical decision-making for athletic training practitioners. This column details recommended databases and search tips to help students, staff, clinicians, and faculty in the field of athletic training find the literature they need to help make evidence-based decisions and to stay current with the published literature. Databases discussed include Cochrane, PubMed, SPORTDiscus, CINAHL, PEDro, Sports Medicine, and Education Index (formerly Physical Education Index), and Google Scholar

Academic Libraries and Athletic Training: Research Preferences of Athletic Training Students

To ensure academic standards are met for athletic training curriculums, it is essential that librarians and faculty understand student research habits and information literacy instruction preferences. This article provides results from a survey of undergraduate athletic training students conducted at two universities. Athletic training students prefer information literacy instruction at the beginning of the semester. When seeking research assistance, students ask their classmates first, followed by friends and Google. Most students spend up to 60 minutes researching online before seeking assistance and prefer in-person communication for assistance from the library followed by email

Individual Nurse Productivity in Preparing Patients for Discharge Is Associated with Patient Likelihood of 30-Day Return to Hospital

Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P\u3c0.001) and an ED visit (−0.29 absolute percentage points, P=0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes

Relaxin Activates Peroxisome Proliferator-activated Receptor ƴ (PPAR\u3csub\u3eƴ\u3c/sub\u3e) through a Pathway Involving PPAR \u3csub\u3eƴ\u3c/sub\u3e Coactivator 1α (PGC1α)

Background: Relaxin activates peroxisome proliferator-activated receptorƴ (PPARƴ) by an unknown PPARƴ ligandindependent mechanism. Results: Expression of PPARƴ coactivator 1α (PGC1α) was increased by relaxin through distinct signaling pathways. Conclusion: The mechanism for relaxin regulation of PPARƴ is through increased PGC1α levels. Significance: Discovery of new targets of relaxin signaling may provide further understanding of its pleiotropic effects

Role of Quantum Confinement in Luminescence Efficiency of Group IV Nanostructures

Experimental results obtained previously for the photoluminescence efficiency (PL$_{eff}$) of Ge quantum dots (QDs) are theoretically studied. A $\log$-$\log$ plot of PL$_{eff}$ versus QD diameter ($D$) resulted in an identical slope for each Ge QD sample only when $E_{G}\sim (D^2+D)^{-1}$. We identified that above $D\approx$ 6.2 nm: $E_{G}\sim D^{-1}$ due to a changing effective mass (EM), while below $D\approx$ 4.6 nm: $E_{G}\sim D^{-2}$ due to electron/ hole confinement. We propose that as the QD size is initially reduced, the EM is reduced, which increases the Bohr radius and interface scattering until eventually pure quantum confinement effects dominate at small $D$