Implementing a Nursing Professional Model to Improve Staff Nurse Engagement and Teamwork

Problem: Several studies have examined the role of the nurse and reveal that job-related stress, defined as an overload of high acuity patients, physical and emotional demands of the job, and lack of autonomy, may impact engagement and teamwork (Garrosa et al., 2010). Evidence suggests a direct correlation between high levels of staff engagement and teamwork improves quality outcomes for the organization. Therefore, it is imperative that we measure staff engagement and teamwork on our nursing units to ensure that quality indicators are met and that as an organization we provide safe patient care. Context: The purpose of this Doctor of Nursing Program (DNP) evidence-based change of practice project was to apply the elements of a professional practice model on a 48-bed medical-surgical-telemetry unit at a medium sized (225 licensed beds) tertiary medical center to measure the effect on nurse engagement and teamwork. The main stakeholders in this project were nursing administration, the unit management team, and staff nurses working on the interventional unit. The unit was chosen due to several indicators: decline in staff morale, lack of perceived teamwork amongst the staff, and the exodus of key staff members due to the demands of the role. Interventions: Using a pre-test, post-test design, nursing staff on the telemetry unit were enculturated with a professional practice model (known as the Voice of Nursing [VON]) along with its six core values and defined lean principles. Interventions consisted of a workshop, post workshop meetings, development of a visual board, and enhancement of an existing unit-based team known as Creating Lasting Change (CLC) to drive change on the unit. Measures: Measures chosen to study the intervention’s processes and outcomes targeted: a) nurse knowledge regarding the VON professional practice model, b) staff engagement, c) intent to stay with the organization, d) culture of teamwork, and e) improvement in the quality metric of patient falls. Results:The findings after implementing a professional practice model compared to pre-study findings are as follows: Nurses had a clearer understanding of the professional practice model (increased by 33%) Improved engagement on the interventional unit (improved by 4%) Intent to stay within the organization (increased by 11%) An improved culture of teamwork (improved by 9%) Decreased falls from a total of 4 to zero during the last three months of the project (June-August 2018) Conclusion: The purpose of implementing and enculturating the elements of a professional practice model demonstrated the intent to get to the hearts and minds of nurses and create an environment in which nurses are engaged, and a culture of teamwork exists. An engaged work force helps encapsulate a safe, efficient, and effective environment for not only the nurse but for their patients

Home-based Education Increases Knowledge, Communication and Living Donor Kidney Transplantations

__Abstract__ A focus group approach was used to disclose transplant candidates’ view on patient-tailored interventions that could target modifiable hurdles to LDKT. A majority would appreciate an home-based educational intervention (chapter 2). Solving knowledge insufficiencies regarding the various renal replacement therapies would be one of the main goals. Additionally, patients would welcome a discussion on living donation with members of their social network. Such interventions would also be potentially effective in addressing other psychosocial hurdles to LDKT within patients’ social network. Patients report that a non-persuasive approach is appreciated since health care professionals will intrude families’ comfort zone (chapter 2). Yet, if the discussion on LDKT is not initiated by those present during the home-intervention, the educator should address the issue in a non-persuasive manner. The way in which the subject of living donation is addressed warrants cultural sensitivity. For instance, cultures in which modesty is a strongly valued tradition an indirect communication style is more appropriate (chapter 3). An indirect communication style would for example be: “Which aspects of the education on renal replacement therapies have drawn your attention specifically?” A more direct style would be: “Has someone in this room ever considered to be a living kidney donor?” Educators should try to tailor the education and the communication style on a case-by-case basis. Therefore, acquiring knowledge on the family values and norms is needed in order to receive optimal family engagement. In addition to a tailored and non-persuasive home-based educational intervention, patients and members of the social network who do not speak the language of the educator would value an independent interpreter. Besides these subtle (communication style) and obvious (use of an interpreter) differences, no further qualitative or quantitative evidence was found for cultural differences in factors hampering the access to LDKT. Neither did patients report on other conditions that need attention before implementing an home-based education. This thesis and other literature show that knowledge is repeatedly found as one of the important factors for promoting the access to LDKT. Yet, prior to the manuscript in chapter 6 no validated and standardized tests on knowledge among renal patients regarding kidney disease and all treatment options existed. Therefore, part of this thesis was devoted to the development and testing of the psychometric properties of a questionnaire that assesses patients’ knowledge on kidney disease and renal replacement therapies. That effort resulted in a 21-item list with two stable dimensions containing items on ‘Dialysis and Transplantation’ (11 items) and ‘Living Donation’ (10 items). Such a thorough questionnaire enables reliable testing of patient’s knowledge on kidney disease and treatment options. Therefore, this questionnaire was used to test potential changes in knowledge due to the home-based intervention. Chapter 7 present the development and protocol of the tested home-based intervention. Patients and their family/friends who received the home-based intervention had two home visits in addition to the regular hospital information. The first home with only the patient was intended to get an idea of patient’s family and culture. The patient could then invite family and friends for the second home visit (the educational intervention). The aim of the educational intervention was to provide information on kidney disease, dialysis, kidney transplantation and living donation. Central to the intervention was promoting the communication on the different treatment options between the patient and members from his/her social network. For this communication techniques from multisystem therapy were used. This therapy systematically considers the stability of relations and ensures that the conversation takes place within a framework of respect for individual feelings and autonomy. For this the quality system of multisystemic therapy was applied which involves structural supervision and anonymous/independent quality checks. Results of this home-based educational intervention show favorable effects (chapter 8). The patient and family/friends show a significant improvement in their knowledge and an improvement in their communication regarding the various treatment options. Moreover, analyses showed that the home-based intervention results in a fivefold increase in the number of potential donors tissue typed and actual living donations. Given the success and the limited side-effects of this approach implementation in other transplant centers is strongly recommended for transplant candidates without a living donor. Further research on the generalizability of the intervention and the cost-effectiveness is warranted

Identifying intimate partner violence in different ethnic groups in primary care - a systematic review and secondary data analysis

PhDBackground Intimate partner violence (IPV), including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that can identify women from different ethnic groups experiencing IPV who present in clinical settings are a prerequisite for an appropriate response from health services to this substantial public health problem. Aim: To examine the evidence for the validity of questions trying to identify IPV in different ethnic groups and to determine whether their validity varies between ethnic groups. Methods Design: A systematic review and the secondary data analysis of a cross-sectional survey of four questions (HARK) identifying IPV in a primary care sample. Main outcome measures: Systematic review - for each set of index questions identified, diagnostic accuracy indices, correlation coefficients, reliability measures, validity evidence based on response processes and test content were analysed and interpreted. Secondary data analysis - diagnostic indices for IPV and its dimensions in three ethnic groups were calculated for the four HARK questions combined and for the individual HARK questions. 4 Results Systematic review – there is no evidence of questions valid for identifying IPV in specific ethnic groups, including white groups. Secondary data analysis - the optimal HARK cut off score of ≥ 1 was unaffected by the participants‟ ethnicity. The diagnostic indices generated using the HARK cut off of ≥ 1 remained at a high level, in all three ethnic groups. There were no significant ethnic differences in the diagnostic indices of the four combined and individual HARK questions‟ ability at identifying either IPV or its dimensions. Conclusion From the systematic review and secondary data analysis, there is no evidence that questions‟ validity for identifying IPV varies significantly between different ethnic groups. The secondary data analysis does provide evidence that four questions (the HARK) can identify IPV in self-classified UK census categories of African- Caribbean, south Asian, and white groups

Coordinated neuronal ensembles in primary auditory cortical columns.

The synchronous activity of groups of neurons is increasingly thought to be important in cortical information processing and transmission. However, most studies of processing in the primary auditory cortex (AI) have viewed neurons as independent filters; little is known about how coordinated AI neuronal activity is expressed throughout cortical columns and how it might enhance the processing of auditory information. To address this, we recorded from populations of neurons in AI cortical columns of anesthetized rats and, using dimensionality reduction techniques, identified multiple coordinated neuronal ensembles (cNEs), which are groups of neurons with reliable synchronous activity. We show that cNEs reflect local network configurations with enhanced information encoding properties that cannot be accounted for by stimulus-driven synchronization alone. Furthermore, similar cNEs were identified in both spontaneous and evoked activity, indicating that columnar cNEs are stable functional constructs that may represent principal units of information processing in AI

Systemic organisational knowledge management: an action research study in a high-performance sport institute

Knowledge management (KM) is increasingly gaining significance in the academic and professional realms as a source of organisational competitive advantage. However, despite the promise of competitive advantage, knowledge management initiatives can sometimes be unsuccessful. Historically, the discipline of knowledge management has multidisciplinary roots in various organisational sciences. Added to that, there exist multiple definitions and perspectives in the field, all influencing the way in which knowledge management is implemented in organisations. Further, the organisational context in turn plays a key role in outlining the knowledge management strategy. As such, there is a lack of a standard framework for knowledge management implementation, adding to the dilemma of how organisations plan and implement knowledge management.The knowledge management literature points to the need for an integrated effort for knowledge management implementation, embracing the complexity inherent in the field marked by the interconnectedness of multiple critical success factors, networks of knowledge and the critical role of knowledge management in facilitating competitive advantage. Knowledge audits have been cited as the critical first step in the design and implementation of knowledge management practice. However, the current knowledge audit methodologies in the literature predominantly adopt a systematic, snapshot and fragmented approach to inquiry conducted by external consultants in order to recommend and design independent knowledge management solutions. This appears to be at odds with the need for an integrated effort for knowledge management implementation.This research contributes to the knowledge audit literature by rethinking the audit methodology. A knowledge management review methodology is proposed emphasising a systemic and iterative approach to inquiry, facilitated by the embeddedness of the researcher in the context. The study contributes by arguing that knowledge management practice that is systemically embedded across the organisation is more likely to be sustainable and resilient to changes in the context and provide continuous competitive advantage. The knowledge management review methodology draws from an interaction of three action research approaches, insider action research, systemic action research and critical participatory action research, to contribute to theoretical understanding and practice of knowledge audits.The research is conducted in a high-performance sport institute where the researcher was embedded as an employee. The case study organisation is further recognised as a knowledge intensive firm and a public-sector organisation, with specialised and esoteric knowledge that interacts in multilinear ways to facilitate the attainment of the organisation’s strategic objectives. As such, the case study organisation presents a unique opportunity to conduct and review the methodology for informing their knowledge management practice. The iterative and systemic approach to inquiry, facilitated by the interaction between the three action research approaches, was instrumental in simultaneously enhancing the learning across the organisation and facilitating systemic organisational knowledge management.The research further positions itself amongst the ongoing debates on the future of the discipline of knowledge management, emphasising true systemic integration of knowledge management practice in the organisational context, functions and objectives for sustained competitive advantage.</div

Effect of elicitors on physiomorphological and biochemical parameters of Indian mustard (Brassica juncea) and rapeseed (B. napus)

The present investigation was aimed to assess the effect of different concentrations of elicitors viz., salicylic acid (SA) and benzothiadiazole (BTH) on physiomorphological and biochemical parameters of Brassica juncea and B. napus cultivars. The field experiment was conducted during 2012-13 at Punjab Agricultural University, Ludhiana, India. Four different treatments of elicitors and a fungicide treatment were given to 10 week old plants up to four consecutive weeks. Content of total soluble protein, free amino acids, total sugars and reducing sugars ofleaves of both B. juncea and B. napus were evaluated after each spray. The content of total soluble protein increased, whereas the contents of free amino acids, total sugars and reducing sugars decreased in all the treatments after each spray. Among all the treatments, the combinations of elicitors, i.e., BTH (3 ppm) + SA (33 ppm) and BTH (7 ppm) + SA (17 ppm) exhibited maximum contents of total soluble protein, free amino acids, total sugars and reducing sugars than control in both the cultivars. These treatments were more pronounced in increasing plant height, internodal distance and number of pods per plant in both the cultivars. Our results suggest that the combinations of elicitors act synergistically to promote growth and metabolic activities in B. juncea and B. napus cultivars leading to the induction and regulation of disease resistance

Environmental management system auditing within Australasian companies

Reviews the literature on environmental management auditing, and surveys 132 ISO 14001 certified organizations in Australia and in New Zealand. Identifies the main reason for internal environmental audit, and the most frequent actions that result from the audit process, such as formation of a preventive plan. Looks at review procedures by top management, and the frequency of audit. Reveals the length of time an audit takes and the method of documentation adopted, by different industries. Notes six major findings and recommends sharing the findings of audits with employees and&nbsp; suppliers so that improvements can be identified and implemented.<br /

Analysis of Multi-Activation Layers in Neural Network Architectures

A common practice for developing a Neural Network architecture is to build models in which each layer has a single activation function that is applied to all nodes uniformly. This paper explores the effects of using multiple different activation functions per layer of a neural network to analyze the effects of the architectures’ ability to generalize datasets. This approach could allow neural networks to better generalize complex data providing better performances than networks with uniform activation functions. The approach was tested on a fully connected neural network and compared to traditional models, an identical network with uniform activations, and an identical network with a different activation function for each layer. The models are tested on several problem types and datasets and analyzed to compare the performance and training time