Content Analysis Of Applied Learning From High FIdelity Patient Simulation Orientation to Critical Care

The Institute of Medicine (IOM) reported that over 98,000 deaths occur in hospitals from medical errors in the United States. In a follow-up IOM report, it was noted that nurses have a direct impact on patient morbidity and mortality and are often the last line of defense for patient safety. The challenge for nurse educators in hospitals is to ensure that as newly licensed nurses enter the workforce, orientation outcomes reflect acquisition of knowledge and skills, which are applied in practice. When newly licensed registered nurses are hired into critical care units, this puts them in a position where they have to learn basic competencies as well as the specialized practice of critical care. One teaching strategy adopted in acute care hospitals is use of high fidelity patient simulation as a way to address the competency gap of these nurses and improve patient safety and outcomes. However, little is known about the practice application of the skills and knowledge used by nurses who complete such orientation. This qualitative exploratory study analyzed newly licensed nurses\u27 description of knowledge and skills used in critical care practice following critical care orientation using high fidelity patient simulation. Data collection consisted of individual, semi-structured, guided interviews based on the Nursing Education Simulation Framework. A sample of 8 registered nurses participated in the interview and completion of a demographic questionnaire. Content analysis was performed using Krippendorf technique. The 8 themes that emerged are consistent with previous research studies that point to the steep learning curve faced by newly licensed nurses in critical care. Implications for nursing practice include expanding high fidelity simulation to specialty practice, developing interdisciplinary orientation and to proactively address the continued experience of culture shock

The business of death: a qualitative study of financial concerns of widowed older women

BACKGROUND: The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women’s experiences in the period soon after their husbands’ death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life. METHODS: This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis. RESULTS: Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband’s death. CONCLUSIONS: Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models

Caught in the H inact : Crystal Structure and Spectroscopy Reveal a Sulfur Bound to the Active Site of an O2_2‐stable State of [FeFe] Hydrogenase

[FeFe] hydrogenases are the most active H$_2$ converting catalysts in nature, but their extreme oxygen sensitivity limits their use in technological applications. The [FeFe] hydrogenases from sulfate reducing bacteria can be purified in an O$_2$‐stable state called Hinact. To date, the structure and mechanism of formation of Hinact remain unknown. Our 1.65 Å crystal structure of this state reveals a sulfur ligand bound to the open coordination site. Furthermore, in‐depth spectroscopic characterization by X‐ray absorption spectroscopy (XAS), nuclear resonance vibrational spectroscopy (NRVS), resonance Raman (RR) spectroscopy and infrared (IR) spectroscopy, together with hybrid quantum mechanical and molecular mechanical (QM/MM) calculations, provide detailed chemical insight into the Hinact state and its mechanism of formation. This may facilitate the design of O$_2$‐stable hydrogenases and molecular catalysts

After the Gap Analysis: Education and Practice Changes to Prepare Nurses of the Future

AIM: The purpose of the study was to describe the Connecticut Nursing Collaborative-Action Coalition’s work in identifying and addressing gaps between nursing education and practice based on the Institute of Medicine’s Future of Nursing report. BACKGROUND: Massachusetts Nurse of the Future (NOF) Competencies highlight the knowledge, skills, and attitudes/behaviors required for professional nurses. Integrating these concepts into the educational system will prepare the nursing workforce to respond to current/future health care needs and population health issues. METHOD: Education and practice partners in four regions conducted a gap analysis of the education to practice transition for new graduate nurses using NOF as a framework for assessment. RESULTS: Gaps in competencies were similar across regions. However, each organization uniquely addressed curricular gaps to best prepare nurses of the future. CONCLUSION: Curriculum improvements will provide students the advantage of being prepared for the rapid changes happening in health care

Epidermal growth factor receptor expression in laryngeal cancer predicts the effect of hypoxia modification as an additive to accelerated radiotherapy in a randomised controlled trial

<p>Accelerated radiotherapy (AR) improves the poor prognosis associated with epidermal growth factor receptor (EGFR) overexpression frequently seen in head and neck carcinomas. Combining AR with carbogen and nicotinamide (ARCON) counteracts enhanced tumour cell proliferation-and hypoxia-related radioresistance. The purpose of this study was to investigate if EGFR expression levels are associated with response to ARCON in patients with carcinoma of the larynx.</p><p>Patients (N = 272) with advanced stage larynx carcinoma were randomised between AR alone and ARCON. Paraffin-embedded biopsies from these patients were processed for immunohistochemical staining of EGFR. EGFR fraction was quantitated by automated image analysis and related to clinical outcome.</p><p>A large variation was observed in EGFR fraction between tumours with expression levels ranging from 0 to 0.93 (median fraction 0.4). No difference in 5-year locoregional control was found between low and high EGFR expressing tumours in the AR arm (69% versus 75%), which is in line with the established effect of AR in EGFR overexpressing tumours. There was, however, a significant association in the ARCON arm: patients with low EGFR levels had a better 5-year locoregional control (88% versus 72% p = 0.02) and disease-specific survival (92% versus 77% p = 0.01). ARCON improved locoregional control relative to AR only in patients with low EGFR expression (hazard ratio (HR) 0.34 p = 0.009).</p><p>In conclusion, only in tumours with a low EGFR fraction, adding hypoxia modification to AR has an additive beneficial effect on outcome. EGFR expression is a predictive biomarker for the selection of patients that will or will not respond to ARCON. (C) 2013 Elsevier Ltd. All rights reserved.</p>