Scaling Up: Bringing the Transitional Care Model Into the Mainstream

Describes features of an innovative care management intervention to facilitate elderly, chronically ill patients' transitions among providers and settings; the adopting organization; and the external environment that affect its translation into practice

Influence of the Z\u27cation site on the B-02 and B-08 band lengths in tourmaline group minerals

Tourmaline group minerals are commonly assigned chemical formulae and identified based on normalization of chemical analyses. Difficulty in measuring the lighter elements as well as the valence state of iron can lead to uncertainty when differentiating tourmaline species. For this reason, there has been a significant amount of work investigating methods to identify tourmaline species aside from normalization assumptions. Most research to date has focused on variations and site-ordering at the X-, Y- , and Z- sites. Of all the sites in the tourmaline crystal structure, however, the only site that seems to remain chemically static is the B–site, as it is only known to host boron. Clark et. al. (2008) found that B-O2 and B-O8 bond lengths in the BO3 triangle are inversely related. Further, variation in the bond lengths is directly related to the chemistry at the other cation sites. Statistical analysis by forward stepwise linear regression showed the cation site which showed the best correlation was the Z’–site, which can be occupied by a variety of cations. The reasons for this correlation are still unclear. I am investigating why the chemical variations of the Z’–site have such a strong influence on the geometry of the BO3 triangle and how the weaker octahedral bonds can influence the stereochemistry of the B–site in the first place. Preliminary results suggest it may be related to the valence of the Z cation. Additionally, as the Z and Z’ are the same site, we are examining how the difference in positioning in the crystal lattice can result in such a pronounced variation on the influence each bond has on the BO3 triangle

Medical Migration to the U.S.: Trends and Impact

The United States is in the midst of a prolonged nursing shortage, one that could reach a deficit of 800,000 registered nurses (RNs) by 2020. Increasingly, foreign-trained nurses are migrating to the U.S., particularly from low-income countries, seeking higher wages and a higher standard of living. Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. This Issue Brief analyzes trends in medical migration, and explores its short and long-term effects on the health care workforce in the U.S. and in developing countries

Cause for Concern: Nurses’ Reports of Hospital Care in Five Countries

According to most experts, the U.S. faces a growing shortage of registered nurses, threatening the quality of care hospitals can provide. In the setting of nurse shortages and simultaneous concern about patient safety, nurses’ job satisfaction and their assessment of quality of care become critical. This Issue Brief highlights a crossnational survey that describes nurses’ perceptions of their hospital work environment, and identifies core problems in work design and workforce management in five countries

The Effect of Laser Scan Strategy on Distortion and Residual Stresses of Arches Made With Selective Laser Melting

The NASA Marshall Space Flight Center (MSFC) is developing Additive Manufacturing (AM) - both in-space AM for on-demand parts, tools, or structures, and on-earth AM for rapid, reduced-cost, small volume production of complex space-flight hardware. Selective Laser Melting (SLM) is an on-earth AM technology that MSFC is using to build Alloy 718 rocket engine components. An understanding of the SLM-718 material properties is required to design, build, and qualify these components for space flight. Residual stresses and are of particular interest for this AM process, since SLM is a series of approximately 100 micron-wide welds, where highly non-linear heating and cooling, severe thermal gradients and repeated thermal cycling can result in high residual stresses within the component. These stresses may cause degraded material properties, and warp or distort the geometry of the SLM component. The distortions can render the component out-of-tolerance when inspected, and even interrupt or halt the build process if the warped material prevents the SLM machine from operating properly. The component must be scrapped and re-designed, which is time consuming and costly. If residual stresses are better understood, and can be predicted, these effects can be mitigated early in the component's design. the compressive residual stresses in the z-direction were highest in the chess sample, followed by island then continuous. This may be due to the binding nature of the segment

Organization and Outcomes of Inpatient AIDS Care

The establishment of AIDS hospitals and AIDS units within hospitals has been controversial. Unlike other specialty care, AIDS care arrangements were initially developed as much to segregate AIDS patients from other patients and staff as to provide the best possible care. Ten years after many of these units opened, little evidence was available about whether the benefits of aggregating AIDS patients outweighed the potential hazards of segregating people from the mainstream of hospital care. This Issue Brief describes a national study to determine how different organizational settings affect the outcomes of inpatient AIDS care

Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research.

AIM: This paper revisits the published evidence relating to how nurse staffing levels impact on patient, nurse and service outcomes and considers the implications of this body of research for nurse managers in their quest to determine optimum nursing numbers. BACKGROUND: Within the context of the recognized global nursing shortage and particular local pressures within international health services, questions of appropriate nurse staffing levels and skill mix are once again becoming increasingly important. It would seem that the determination of optimum nurse staffing levels and skill mix is a central issue in relation to health service governance, service user involvement, as well as in the recruitment, retention and well-being of nursing staff across the service sectors. METHODS: A review of published evidence was carried out, applying key principles of the systematic method, in order to facilitate the identification of current factors and issues in nurse staffing levels research. The review did not seek to address a specific research question. The search covered 10 years from 1998 to 2008 and identified more than 500 relevant papers, giving a wide international perspective. KEY ISSUES: The majority of research in the field relates to the acute service sector and there are considerable similarities in issues that transcend international boundaries. Much of the research focuses on the impact on patients and nurses of 'poor' nurse staffing levels. More recent studies have explored the impact of nurse staffing levels on the service organization itself. However, while there may be an association between models of nurse staffing and outcomes, there is insufficient evidence to establish a causal relationship between these factors. In this context it is perhaps time to reconsider how nursing outcomes are defined and measured. IMPLICATIONS FOR NURSING MANAGEMENT AND CONCLUSION: Nurse managers, commissioners of services and workforce planners need to be cognisant of key issues and analyses in the consideration of nurse staffing levels. Not least of these is the need for a healthy degree of caution regarding the supposed objectivity, scientific basis, or evidence base, for rational calculation of optimum nurse staffing levels

What impact does nursing care left undone have on patient outcomes? Review of the literature

AIMS AND OBJECTIVES: Systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes. BACKGROUND: A considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear. DESIGN: Systematic review. METHODS: We searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses' aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review. RESULTS: Fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged. CONCLUSIONS: The review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self-reported data. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care, more research that uses objective staffing and outcome measures is required. RELEVANCE TO CLINICAL PRACTICE: Although nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, readmissions and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses' reports of missed care and consider routine monitoring as a quality and safety indicator

Hospital nurse practice environments and outcomes for surgical oncology patients

OBJECTIVE: To examine the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery. DATA SOURCES: Secondary analysis of cancer registry, inpatient claims, administrative and nurse survey data collected in Pennsylvania for 1998-1999. STUDY DESIGN: Nurse staffing (patient to nurse ratio), educational preparation (proportion of nurses holding at least a bachelor's degree), and the practice environment (Practice Environment Scale of the Nursing Work Index) were calculated from a survey of nurses and aggregated to the hospital level. Logistic regression models predicted the odds of 30-day mortality, complications, and failure to rescue (death following a complication). PRINCIPAL FINDINGS: Unadjusted death, complication, and failure to rescue rates were 3.4, 35.7, and 9.3 percent, respectively. Nurse staffing and educational preparation of registered nurses were significantly associated with patient outcomes. After adjusting for patient and hospital characteristics, patients in hospitals with poor nurse practice environments had significantly increased odds of death (odds ratio, 1.37; 95 percent confidence interval, 1.07-1.76) and of failure to rescue (odds ratio, 1.48; 95 percent confidence interval, 1.07-2.03). Receipt of care in National Cancer Institute-designated cancer centers significantly decreased the odds of death, which can be explained partly by better nurse practice environments. CONCLUSIONS: This study is one of the first to examine the predictive validity of the National Quality Forum's endorsed measure of the nurse practice environment. Improvements in the quality of nurse practice environments could reduce adverse outcomes for hospitalized surgical oncology patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94127/1/Hospital nurse practice environments and outcomes for surgical oncology patients.pd