White Paper: Building a Continuum of End of Life Care in Whatcom County: Train All Clinicians in Palliative Care

Despite the increase in focus and attention on palliative care services in Whatcom County, significant gaps in palliative care knowledge and skills exist among clinicians throughout the care continuum in Whatcom County. It is widely recognized that palliative care improves quality of life for patients with advanced illness and their families, reduces costs, and advances the Triple Aim. The recommendations provided in this report support the collective recognition that all clinicians caring for patients with serious illness, irrespective of practice discipline, background, or setting, require competency and skill in palliative care. All clinicians (including but not limited to doctors, nurses, social workers, chaplains, complementary care providers, and CNAs) in our region must have core knowledge, skills, and attitudes to provide palliative care in our community, including advance care planning conversation training, pain and symptom management, and strategies to participate in multi-disciplinary palliative care processes

Structural diversity and decomposition functions of volcanic soils at different stages of development

During a volcanic eruption, the extrusion of lava onto surfaces destroys biological activity creating virgin land surfaces. Through time this new land will be subject to soil formation and colonisation under relatively similar climatic conditions and parent materials. Soils formed from volcanic deposits present a unique opportunity to study microbial community development. Soils at different developmental stages and differing in vegetation cover were selected from four locations on the slopes of Mount Etna, Sicily. Three main research objectives were determined in order to test the hypothesis that the microbial communities from soils at later stages of development would have a greater biomass, be more diverse, be more efficient at utilising carbon sources and recover from an environmental disturbance at a greater rate. A field experiment was conducted to ascertain the long term in situ catabolic abilities of the microbial communities in each soil and to establish the effects of litter mixing on decomposition rate. Litter bags containing either Genista aetnensis (Etnean Broom), Pinus nigra (Corsican Pine) or a mixture of the two were buried at each of the sites and their decomposition monitored over a 2.5 year period. PLFA diversity, community composition and function was assessed for each of the soils. The soils were also subject to a disturbance and the recovery of key community parameters was monitored over a six month period in order to establish each soil community’s resistance and resilience to disturbance. A laboratory experiment was conducted in order to investigate functional diversity and decomposition functions of each soil community using a range of simple and complex substrates. The relationship between PLFA diversity and functional diversity was also investigated. No correlation was found between soil C and N contents, microbial biomass or soil respiration and soil developmental stage and there was no detectable difference in litter bag mass loss between the soil types. No non- additive effects were noted in mixed litters. The more developed soil had a greater PLFA diversity and PLFA biomass however the more developed soil was not more resistant or resilient to disturbance. Developed soils showed greater catabolic diversity compared with less developed soils broadly correlating with PLFA diversity. Despite increased PLFA diversity and functional diversity in the more developed soils, residue decomposition in situ was unaffected. Reduced PLFA diversity and community complexity did not result in reduced function. Soils at different developmental stages had similar catabolic responses and were able to degrade simple and complex substrates to a similar degree. Microbial diversity in soil has the potential to be very high thus resulting in a high rate of functional redundancy i.e. many species within the same community which have the same functional role. It is possible that only a few key functional groups present within the soil community contribute to the main decomposition function within the soil and were able to maintain function during perturbation. Both Etna soils had similar PLFA’s present in similar concentrations and these groups in general were maintained during disturbance. This suggests that total microbial community diversity may not be as important to community function as the presence of key functional groups

Controlled Postpartum-Newborn Simulation With Objective Evaluation Exchanged for Clinical Learning

Background: Simulation is a widely used teaching strategy. A paucity of evidence exist about evaluating acquisition of formal knowledge gained from simulation participation. This study compared practicing simulated assessments in the CSLC to practice in the clinical setting plus simulation, high/low level of student performance, and evaluated performance. Study variables were assessment, intervention, and critical thinking. Methods: Non-equivalent comparison group, post-test only quasi-experimental. 80 undergraduate nursing students individually demonstrated assessments while trained observer scored performance. Students provided written response to 7 questions before debriefing. T-tests, ANOVA, and MANOVA compared scores between the two groups. An outlier analysis operationalized high /low student performance. 92 points on both simulations equated to competent performance; lower scores required remediation. Results: No significant differences between the two groups on three study variables. A significant correlation found between postpartum and newborn psychomotor skills in high and low performing students. Average simulation performance score was 83 points. Conclusion: Well-designed simulation can be exchanged for learning in clinical, identify underperforming students, and evaluate performance qualit

Advancing the Future of Nursing: A Report by the Building Academic Geriatric Nursing

In the United States, the number of older adults will double during the next 25 years (United States Census Bureau, 2008). This dramatic demographic shift is changing the landscape of health care practice as more people live longer with multiple chronic conditions. To better prepare nurses to care for this future population, the John A. Hartford Foundation partnered with the American Academy of Nursing in 2000 to launch the Building Academic Geriatric Nursing Capacity (BAGNC) program. Since that time, 251 scholarships and fellowships have been awarded to nurses to advance geriatric nursing education, research, and practice. In 2009, the BAGNC nurse scholars and fellows formed an alumni organization to expand and continue their leadership development through peer networking and mentored policy initiatives. The BAGNC Alumni organization represents an elite set of new leaders in gerontological nursing to advance geriatric nursing education, research, and practice (Fagin, 2012). To this end, at the 2011 Council for Advancement of Nursing Science\u27s Special Topics Meeting, the BAGNC Alumni presented their ongoing and completed projects that relate to the Institute of Medicine (2011) (IOM) report The Future of Nursing: Leading Change, Advancing Health. Summaries of the individual presentations from this panel addressed the four key IOM messages and are presented in this article to highlight the action of these scholars and fellows

Imperial Matchmaker: The Involvement of the Roman Emperor in the Arrangement of Marriages between Client Kings

This thesis demonstrates that the emperor Augustus (27 BC to AD 14) did encourage and instigate marriage-alliances between the families of Roman client kings, as suggested by the sources. Analysis of the marriage-alliances formed before Augustus' reign reveals a number of characteristics that did not apply to many of the marriage-alliances formed during Augustus' reign and beyond. New or modified characteristics have assisted in the determination of which marriage-alliances were arranged by the emperor. Furthermore, this thesis also assesses the possible aims that compelled Augustus to arrange or encourage these marriages, how this policy complied with the emperor's other beliefs and policies regarding marriage in general, and whether his policy was continued by his successors. Finally the repercussions and problems that arose from binding the client kings together through intermarriage are examined and the policy assessed in terms of success or failure. The study of Augustus' policy of intermarriage between client kings also illuminates the nature and role of client kings within the framework of the principate and shed further light on their relationship with the emperor

Development and Implementation of a Peer Mentoring Program for Early Career Gerontological Faculty: Mentoring Early Career Gerontological Faculty

In conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), the Hartford Gerontological Nursing Leaders (HGNL) developed and executed a program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of the HGNL. The purpose of this article is to describe key strategies used to develop and execute the mentoring program and to present the formative and summative program evaluation

The utility of qualitative approaches in the investigation of the relationship between substance misuse and crime

The aim of this thesis was to examine the relationship between substance misuse and crime. Whilst extensive research exists in this area, there remains a paucity of research utilising qualitative methodology. A narrative review demonstrates the complex nature of the drug/crime relationship and provides an argument for the use of narrative in examining the aetiology of a complex relationship. This relationship is further examined in Chapter 3, where Interpretative Phenomenological Analysis (IPA) was used to analyse the narratives of 6 participants. The use of substances contributed to various types of offences for these participants as well as being apparent in the literature appertaining to sexual offending. Chapter 4 examines an intervention conducted with an alcoholic sex offender in treatment at a community drug and alcohol service. The intervention described enabled the client to identify pertinent risk factors (i.e. alcohol misuse) of recidivism without relinquishing his stance of ‘categorical denial’. A critique of the Substance Abuse Subtle Screening Inventory 3 (SASSI-3) is provided in Chapter 5. Examination of psychometric properties suggests that the SASSI-3’s validity is questionable raising concern regarding its appropriate application. The author concludes that this thesis will enhance current understanding of the relationship between substance misuse and crime

Keynote: Care for the Whole Person: Improving Quality of Life Beyond Biopsychosocial Approaches to Palliative Care

Casey Shillam, PhD, MSN, RN, is the Dean of the School of Nursing at the University of Portland. She was the founding Director of Western Washington University’s RN-BSN Nursing Program. Casey serves on the Health Policy Advisory Council for the American Association of Colleges of Nursing Washington, DC, and was selected for the American Association of Colleges of Nursing Leadership for Academic Nursing Program (LANP) and Robert Wood Johnson Foundation Executive Nurse Fellow program. This opening session will set the stage for the conference by providing an overview of important aspects of palliative care outside of traditional medical approaches to care. Particular focus is placed on differentiating between religiosity and spirituality and the importance of supporting spiritual and cultural preferences in palliative care. On completion of this session, participants should be able to: 1. Describe the impact of providing spiritual care on the biopsychosocial model of palliative care; 2. Distinguish between religiosity and spirituality; 3. Explore different dimensions of spiritual care in palliative care; 4. Develop a strategy for incorporating spiritual care into current practices