Monthly variation of unfinished nursing care at the US Army burn center

Unfinished nursing care (UNC) is a problem of time scarcity and has been classified as an error of underuse. More than half of hospital nurses (52-98%) report leaving at least one element of care unfinished due to time scarcity. Relationships between UNC, nursing staff supply, and working conditions were identified in previous cross sectional studies at civilian hospitals; no studies occurred in the burn care or military environments. The purpose of this study was to identify the prevalence and patterns of UNC in relation to variations in nursing staff supply and working conditions at the US Army Burn Center. Registered nurses and licensed vocational nurses working at the 40-bed burn center were asked to complete a 50-item, paper survey once a month for six months. Administrative data related to nursing staff supply and working conditions (e.g., supply/demand ratio, patient turnover, and overtime paid) were collected. Descriptive statistics and multilevel modeling were used in the analysis. The mean response rate for the survey was 44.9% (n = 36-50). Cronbach’s alpha was .96-.98. Each month, 85.7%-100% of all nurses reported leaving at least one element of care unfinished. The mean composite score on the Perceived Implicit Rationing of Nursing Care instrument was 1.69-2.27. Elements of care most frequently left unfinished were: documentation of care, emotional support, and reviewing interdisciplinary documentation to inform nursing care. Elements of care least frequently left unfinished were: the provision of enteral/parenteral nutrition, monitoring patient safety, and having important conversations with staff, family, or the patient. Only nursing care hours provided by float staff significantly predicted nurse estimates of UNC, [beta] = .008, p < .05, R² = .021. These results indicated that the prevalence and patterns of UNC were consistent with findings in previous studies of UNC. This was first study to describe variations in UNC over time and the first to measure UNC in the burn and military environments. Implications for practice, policy, education, and research were discussed.Nursin

Molecular Simulations Studies of the Effect of Ligand Architecture on DNA Binding

In this paper we use atomistic molecular dynamics simulations to study the structural reasons underlying the DNA binding efficacy of several polyamine-aminoglycoside compounds. We calculate the free energy of binding to DNA and conformational entropy loss upon binding for spermine-aminoglycoside compounds and dilysine-aminoglycoside compounds. We also calculate the structural features of the ligands and DNA before and after binding through the radius of gyration, the width of the ligand, the end-to-end distance of the grafts, the center-of-mass distance between the DNA and the ligand, and the distance between the ligands' amine groups and the DNA's phosphate groups. In order to understand the trends in DNA binding efficacy of spermine-aminoglycoside and dilysine-aminoglycoside compounds, we compare results from polyamine-aminoglycoside systems with ungrafted polyamines (spermine and dilysine) to isolate the effects of grafting spermine and dilysine to an aminoglycoside compound on binding behavior. First, we find that grafting spermine to an aminoglycoside compound improves binding efficiency to DNA over spermine alone in agreement with the experimental results of DNA binding. We discover that the improved binding is due to a decrease in the rate of the grafts unbinding from the DNA. We also find the spermine-aminoglycoside compounds bound to DNA with a greater efficacy than the dilysine-aminoglycoside compounds. Spermine is a longer, unbranched molecule which is more flexible and adept at optimizing its binding location on the DNA strand

The association between nurse staffing and omissions in nursing care: A systematic review.

AIMS: To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. BACKGROUND: Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. DESIGN: Systematic review. DATA SOURCES: We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. REVIEW METHODS: Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. RESULTS: Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. CONCLUSIONS: Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated