Perceived Needs and Coping Resources of Newly Hired Nurses in Transition

Newly hired nurses who do not transition well often leave their first nursing position or nursing prematurely, at great cost to themselves, the profession, the hiring organization and patients. The purpose of this secondary analysis study was to better understand the experience of new graduate nurses (NGNs) and experienced nurses as each group transitions to a new setting in nursing practice and the contribution the preceptor role plays in that transition. Schlossberg\u27s Transition Theory was the framework that guided the study. The original data were collected from 118 newly hired nurses who were predominantly female and Caucasian with the majority being under the age of 30 years and having less than one-year experience. The data available for secondary analysis were collected at three, six and twelve months after the date of hire and included all transcripts from structured debriefing sessions offered at the conclusion of educational offerings that were a part of an extended orientation program. Analytic coding and word count methods were used in the data analysis. Themes were identified and Schlossberg\u27s transition theory was mapped to the themes. Themes that were identified indicate that both groups of nurses rely on Institutional Support for transition. Institutional Support comes in the form of a Human Connection (preceptor, leadership, staff and others and a go to person) and a Process Approach (orientation and consistency). Both groups of nurses have a Sense of Self and a Self-Awareness that allows the nurse to articulate: What I Need, What I Know and Don\u27t Know and What\u27s Real, and Fear. Major findings suggest that preceptors are critical early in the transition of newly hired nurses but a different type of support is needed later on. Experienced nurses want a tailored orientation that takes into consideration prior knowledge and skill. Findings also suggest that newly hired nurses in transition continue to look for support beyond the first year of the transition. Hospitals should consider implementing transition to practice programs that support the newly hired nurse throughout the first year of transition and should also consider a mentorship program of support after the first year of transition. Hospitals need to recognize and acknowledge the experience and skill of the experienced nurse in transition and provide tailored orientation for those individuals. Educational programs need to acknowledge that the transition of new graduate nurses is difficult and design a capstone-nursing course to prepare the graduating nursing student for transition to professional practice. Further research should focus on the transition needs of the experienced nurse, and what type of additional support all nurses need following the first year of transition

National park research fellowships increase capacity and creativity in responding to climate change

The challenges posed by climate change in national parks and other protected areas demand creative approaches, new ideas, and experiments that are beyond the capacity of any single park or agency staff. Research fellowships provide a critical way that the National Park Service (NPS) and its partners can address the agency’s needs to address climate change adaptation challenges. At least 30 such programs support stewardship-relevant science in national parks. Some national programs and initiatives at Acadia National Park in Maine, Rocky Mountain National Park in Colorado, and Sequoia and Kings Canyon National Parks in California serve as examples of how researchers in these programs are informing restoration, relocation, vegetation and fire management, and resource protection activities; documenting change that has already occurred; providing baseline data on biodiversity; and conducting novel experiments. Successful fellowship programs have strong engagement of resource managers, emphasize communication with management and public audiences, and incorporate ongoing support and evaluation. As a result of these successes, NPS and partners are working to expand and strengthen the sustainability and effectiveness of research grants and fellowships

Maine’s Climate Yesterday, Today, and Tomorrow

Recent evidence suggests that climate change is occurring at an accelerated rate as a result of human-induced greenhouse gas emissions and associated pollutants. Based on a recently completed study, the authors describe the changes Maine’s climate is likely to undergo over the next century. They suggest that while reduction of greenhouse gases is crucial, Maine needs to be prepared to adapt to the impact that our already changing climate will have on various ecosystems and economic sectors within the stat

Transition of Experienced and New Graduate Nurses to a Pediatric Hospital

This study reports on the 3-, 6-, 12-, and 18-month outcomes of 118 newly hired registered nurses (RNs) who completed a 12-month transition-to-practice program at a pediatric hospital. Experienced RNs (n = 42) and new graduate RNs (n = 76) showed improved organization, prioritization, communication, and leadership skills over time. The experienced RNs reported better communication and leadership skills than the new graduate nurses. Results inform transition program development for both new and experienced nurses. The American Association of Colleges of Nursing (2012) predicts that, without a multifaceted approach, a national nursing shortage will occur by 2020. Many nurses leave their first position and sometimes the profession within the first year of employment (Baxter, 2010; Welding, 2011). Retaining nurses is a vital component of any approach to averting a nursing shortage. In an attempt to retain nurses, healthcare institutions often provide a transition-to-practice (TTP) or nurse residency program for new graduate nurses (NGN) entering the profession. The Institute of Medicine (2011) in its Future of Nursing report also recommends a transition program for nurses moving to a new specialty or to advanced practice roles. Completing a NGN transition program is associated with a decrease in nurse attrition by as much as 80% (Halfer, Graf, & Sullivan, 2008; Rush, Adamack, Gordon, Lilly, & Janke, 2013; Spector et al., 2015). This reported decrease has led to organizational interest in transition programs to improve retention. The goals of residency programs for the NGN have ranged from increasing new nurse confidence and competence, to increasing satisfaction and retention (Fink, Krugman, Casey, & Goode, 2008; Goode, Lynn, McElroy, Bednash, & Murray, 2013; Institute of Medicine, 2011; Spector et al., 2015). Although literature supports the effectiveness of transition programs for the NGN (Fink et al., 2008; Goode et al., 2013; Spector et al., 2015), there is little evidence on the experienced nurse’s transition to a new specialty practice. Furthermore, most transition programs do not report outcomes beyond the first 12 months of employment. Thus, the purpose of this study is to evaluate nurse stressors and supports during and after a 12-month transition-to-employment program for both new and experienced nurses transitioning to a pediatric practice

Keeping 21st Century Paleontology Grounded: Quantitative Genetic Analyses and Ancestral State Reconstruction Re-Emphasize the Essentiality of Fossils

Advances in genetics and developmental biology are revealing the relationship between genotype and dental phenotype (G:P), providing new approaches for how paleontologists assess dental variation in the fossil record. Our aim was to understand how the method of trait definition influences the ability to reconstruct phylogenetic relationships and evolutionary history in the Cercopithecidae, the Linnaean Family of monkeys currently living in Africa and Asia. We compared the two-dimensional assessment of molar size (calculated as the mesiodistal length of the crown multiplied by the buccolingual breadth) to a trait that reflects developmental influences on molar development (the inhibitory cascade, IC) and two traits that reflect the genetic architecture of postcanine tooth size variation (defined through quantitative genetic analyses: MMC and PMM). All traits were significantly influenced by the additive effects of genes and had similarly high heritability estimates. The proportion of covariate effects was greater for two-dimensional size compared to the G:P-defined traits. IC and MMC both showed evidence of selection, suggesting that they result from the same genetic architecture. When compared to the fossil record, Ancestral State Reconstruction using extant taxa consistently underestimated MMC and PMM values, highlighting the necessity of fossil data for understanding evolutionary patterns in these traits. Given that G:P-defined dental traits may provide insight to biological mechanisms that reach far beyond the dentition, this new approach to fossil morphology has the potential to open an entirely new window onto extinct paleobiologies. Without the fossil record, we would not be able to grasp the full range of variation in those biological mechanisms that have existed throughout evolution. View Full-Tex

Lessons Learned: Newly Hired Nurses\u27 Perspectives on Transition into Practice

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes

Dopaminergic Modulation of Medial Prefrontal Cortex Deactivation in Parkinson Depression

Parkinson\u27s disease (PD) is associated with emotional abnormalities. Dopaminergic medications ameliorate Parkinsonian motor symptoms, but less is known regarding the impact of dopaminergic agents on affective processing, particularly in depressed PD (dPD) patients. The aim of this study was to examine the effects of dopaminergic pharmacotherapy on brain activation to emotional stimuli in depressed versus nondepressed Parkinson disease (ndPD) patients. Participants included 18 ndPD patients (11 men, 7 women) and 10 dPD patients (7 men, 3 women). Patients viewed photographs of emotional faces during functional MRI. Scans were performed while the patient was taking anti-Parkinson medication and the day after medication had been temporarily discontinued. Results indicate that dopaminergic medications have opposite effects in the prefrontal cortex depending upon depression status. DPD patients show greater deactivation in the ventromedial prefrontal cortex (VMPFC) on dopaminergic medications than off, while ndPD patients show greater deactivation in this region off drugs. The VMPFC is in the default-mode network (DMN). DMN activity is negatively correlated with activity in brain systems used for external visual attention. Thus dopaminergic medications may promote increased attention to external visual stimuli among dPD patients but impede normal suppression of DMN activity during external stimulation among ndPD patients

Dopaminergic Modulation of Memory and Affective Processing in Parkinson Depression

Depression is common in Parkinson\u27s disease and is associated with cognitive impairment. Dopaminergic medications are effective in treating the motor symptoms of Parkinson\u27s disease; however, little is known regarding the effects of dopaminergic pharmacotherapy on cognitive function in depressed Parkinson patients. This study examines the neuropsychological effects of dopaminergic pharmacotherapy in Parkinsonian depression. We compared cognitive function in depressed and non-depressed Parkinson patients at two time-points: following overnight withdrawal and after the usual morning regimen of dopaminergic medications. A total of 28 non-demented, right-handed patients with mild to moderate idiopathic Parkinson\u27s disease participated. Ten of these patients were depressed according to DSM IV criteria. Results revealed a statistically significant interaction between depression and medication status on three measures of verbal memory and a facial affect naming task. In all cases, depressed Parkinson\u27s patients performed significantly more poorly while on dopaminergic medication than while off. The opposite pattern emerged for the non-depressed Parkinson\u27s group. The administration of dopaminergic medication to depressed Parkinson patients may carry unintended risks

Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers

Context Lung cancer is one of the most common cancers affecting both men and women and is associated with high symptom burden and psychological distress. Lung cancer patients’ family caregivers also show high rates of distress. However, few interventions have been tested to alleviate significant problems of this population. Objectives This study examined the preliminary efficacy of telephone-based symptom management (TSM) for symptomatic lung cancer patients and their family caregivers. Methods Symptomatic lung cancer patients and caregivers (N=106 dyads) were randomly assigned to 4 sessions of TSM consisting of cognitive-behavioral and emotion-focused therapy or an education/support condition. Patients completed measures of physical and psychological symptoms, self-efficacy for managing symptoms, and perceived social constraints from the caregiver; caregivers completed measures of psychological symptoms, self-efficacy for helping the patient manage symptoms and managing their own emotions, perceived social constraints from the patient, and caregiving burden. Results No significant group differences were found for all patient outcomes and caregiver self-efficacy for helping the patient manage symptoms and caregiving burden at 2 and 6-weeks post-intervention. Small effects in favor of TSM were found regarding caregiver self-efficacy for managing their own emotions and perceived social constraints from the patient. Study outcomes did not significantly change over time in either group. Conclusion Findings suggest that our brief telephone-based psychosocial intervention is not efficacious for symptomatic lung cancer patients and their family caregivers. Next steps include examining specific intervention components in relation to study outcomes, mechanisms of change, and differing intervention doses and modalities