Bridges and Barriers: Patients\u27 Perceptions of the Discharge Process Including Multidisciplinary Rounds on a Trauma Unit

Discharge planning is a complex process and ideally begins early in the patient stay. Despite evidence about the importance of discharge readiness, there is limited literature about the patient\u27s view during this transition. The goal of this study was to explore patient perspectives about the discharge process, including multidisciplinary rounds. Multidisciplinary rounding is a process where care providers from various specialties meet to communicate, coordinate patient care, make decisions, and manage responsibilities. The theme found was “bridges and barriers to discharge.” Participants identified timelines and tasks, communication, social support, and motivation as helpful and medical setbacks, insurance limitations, and infrequent communication as hindrances to the discharge. Future research is recommended examining efficacy of various discharge models and examination of communication and support throughout hospitalization

Sea Urchin Recruitment: Effect of Substrate Selection on Juvenile Distribution

Intertidal field observations have shown that juvenile purple sea urchins Strongylocentwtus purpuratus are found in higher densities near adults . The same is true for subtidal populations of juvenile red sea urchins 5. franciscanus. These distribution patterns could be influenced by any of three elements: substrate selection, early juvenile mortality or juvenile migration. Using laboratory-reared larvae, we conducted experiments designed to gauge the effect of substrate selection on juvenile distributions of these two sea urchin species. In both laboratory and field experiments, larval sea urchins showed no enhanced settlement in the presence of adults or adult-associated substrates. These results imply that early juvenile mortality or migration provide the greater influence on juvenile distributions

Impacts of Climate Change on Livestock Systems: What We Know and What We Don’t Know

Climate changes and the associated increases in atmospheric carbon dioxide concentration are just two of many possible future drivers of change in grassland systems and whilst there are significant uncertainties around these, they are probably more effectively characterised than many other drivers. The challenge for grasslands systems research is not so much trying to precisely predict future climate in the face of unresolvable uncertainty but rather to work with decision-makers to enhance their decisions for a range of possible climates, build their capacity to make sound risk-based and informed decisions and increase the array of options available for adaptation. There are many adaptations possible to address key climate impacts such as increased heat stress, altered pests and disease risk, vegetation change, increased risk of soil degradation and changes in forage quantity, quality and the variability of these. Many of these adaptations are extensions of existing best management practice. However, it is important to explore adaptations that are beyond incremental change to existing systems to be inclusive of more substantial systems change and even transformational changes. There is a need also to consider adaptations beyond the farm scale including in relation to value chains, institutional change and policy development. It is these areas in particular where there are likely to be increasing demands for research

Moral Distress in Critical Care Nursing: The State of the Science

Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended

Near-infrared spectroscopy can detect brain activity during a color-word matching Stroop task in an event-related design

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