Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: a systematic review

Background nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective to evaluate the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. Design this is a systematic review Data sources Online databases including Academic Search Complete, Medline, Health Policy reference Centre, EMBASE, Psychinfo, CINAHL and the Cochran Library were searched to identify relevant publications in English published between 2001 and April 2018. Studies included evaluated an intervention to increase retention or reduce turnover and used turnover or retention figures as a measure. Review methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were quality-assessed using the Joanna Briggs Institute Critical Appraisal tools for Quasi Experimental and Randomised Controlled Trials. Retention/turnover data were used to guide the comparison between studies and appropriate measures of central tendency and dispersion were calculated and presented, based on the normality of the data. Results A total of 11, 656 papers were identified, of which 53 were eligible studies. A wide variety of interventions and components within those interventions were identified to improve nurse retention. Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. Conclusions Methodological issues impacted on the extent to which conclusions could be drawn, even though a large number of studies were identified. Future research should focus on standardising the reporting of interventions and outcome measures used to evaluate these interventions and carrying out further research with rigorous methodology. Clinical practice areas are recommended to assess their current interventions against the identified criteria to guide development of their effectiveness. Evaluations of cost-effectiveness are considered an important next step to maximise return on investment

Volcanic smog and cardiometabolic health: Hawaiian hypertension?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149349/1/jch13500.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149349/2/jch13500_am.pd

A Comparison of Risk Exposure in Aquaculture and Agricultural Businesses

Agriculture and aquaculture have common features associated with their biological nature affecting risk exposure of the businesses. The aim of this paper is to compare risk exposure in salmon farming and agricultural enterprises in Norway by using an implicit error component model to examine the risk structure of yields, prices and economic returns at the farm level. Results indicate a higher farm-level year-to-year variability in yields, prices and economic returns in salmon farming than in agricultural enterprises. The variability in livestock enterprises was generally lower than for crop enterprises. Return on assets was highest in salmon farming with an average annual return of 9.2%. All of the agricultural farm types exhibited a negative average return on assets on average. Stochastic dominance tests of the distribution of economic returns from aquaculture and agricultural farm types showed salmon farming to be the most risk efficient alternative and salmon farming was most attractive from an investor’s perspective.Risk analysis, variability, Norway, Risk and Uncertainty,

Preparing the sexual health workforce to deliver integrated services: is education the answer? A qualitative study exploring the impact of sexual health education on developing integrated policy and practice.

This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky’s account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed. In order to achieve the United Nations’ goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success. Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health

Sexual Health Education: an evaluation of the Northumbria Integrated Sexual Health Education (NISHE) Workforce Development Package delivered by UWE, Bristol

Background: Sexual health and wellbeing is a central focus of public health policy and service development in England (Department of Health (DH) 2013a, 2013b, Public Health England (PHE) 2015). Historically, services in the UK have been delivered through Family Planning clinics for contraceptive services or Genito-Urinary (GUM) clinics for sexual health issues. Current NHS Service Specifications for sexual health services emphasise an integrated service, delivered by a single health professional (DH 2013b), which has significant implications for the sexual health workforce. Within the South West, there was a disparity of sexual health education provision with little emphasis on the practical competence element. In order to equip sexual health nurses with the appropriate knowledge and skills to deliver an integrated sexual health service, the University of the West of England (UWE) entered a formal agreement with a partner university who had developed an educational package. UWE commenced delivery of two new sexual health modules in September 2013, incorporating both a newly developed classroom delivered Foundations of Sexual Health module and an established Integrated Sexual Health Education module which incorporated a practice placement, mentor support and blended learning approaches to deliver the theory element. This package had previously been successfully delivered in the North of England (McNall and Kain 2010). Aims This research, conducted between 2013 and 2015, explored the transferability of the model to the South West region and the degree to which the educational delivery met service demands in relation to integrated sexual health provision. Research Methodology: Data were collected using quantitative and qualitative methods, specifically longitudinal baseline and follow-up survey data from students (n=49) using two validated self-efficacy scales, focus groups with students (n=22) and semi-structured interviews with students (n=7) and strategic managers (n=6). Quantitative analysis of questionnaire data was conducted on baseline and follow-up data using SPSS version 2.2. The data exploring self-efficacy were analysed using Wilcoxon tests and Friedman’s tests. Descriptive statistics and frequencies were used to examine the characteristics of the study population. Qualitative analysis was conducted through thematic analysis and constant comparative methods (Braun and Clarke 2006). Key Findings: The results indicated that students who undertook the modules demonstrated significant increases in self-efficacy when using the evidence base in sexual health practice and when communicating in difficult situations. The highest percentage point increase in self-efficacy occurred when the students completed both modules rather than one in isolation. Service manager and student expectation regarding the instructional immediacy and technological specification of the e-learning package were not always met but the electronic mode of delivery was praised for its flexibility, especially important given the large geographical spread of students. Service managers and students were aware of the move to integrated service delivery but were often frustrated by structural restraints that impeded innovation and practice development, such as fragmented commissioning arrangements or lack of collocated services. Although these restraints limited the impact that new learning could have on the service that was offered to patients, there was some evidence that the students were using their professional autonomy to manipulate the system, in line with Lipsky’s (1980) concept of street level bureaucracy. Recommendations: Consideration should be given to the balance of e-learning and face-to-face contact within modules, to enhance instructional immediacy and increase student satisfaction. E-learning packages should be reviewed to meet student expectation by incorporating interactive technology and opportunities for collaborative learning. In addition, where service delivery is in a state of flux, modules should incorporate elements of leadership development to enable practitioners to initiate and manage change in practice

Acute Blood Pressure Responses in Healthy Adults During Controlled Air Pollution Exposures

Exposure to air pollution has been shown to cause arterial vasoconstriction and alter autonomic balance. Because these biologic responses may influence systemic hemodynamics, we investigated the effect of air pollution on blood pressure (BP). Responses during 2-hr exposures to concentrated ambient fine particles (particulate matter < 2.5 μm in aerodynamic diameter; PM(2.5)) plus ozone (CAP+O(3)) were compared with those of particle-free air (PFA) in 23 normotensive, non-smoking healthy adults. Mean concentrations of PM(2.5) were 147 ± 27 versus 2 ± 2 μg/m(3), respectively, and those of O(3) were 121 ± 3 versus 8 ± 5 ppb, respectively (p < 0.0001 for both). A significant increase in diastolic BP (DBP) was observed at 2 hr of CAP+O(3) [median change, 6 mm Hg (9.3%); binomial 95% confidence interval (CI), 0 to 11; p = 0.013, Wilcoxon signed rank test] above the 0-hr value. This increase was significantly different (p = 0.017, unadjusted for basal BP) from the small 2-hr change during PFA (median change, 1 mm Hg; 95% CI, −2 to 4; p = 0.24). This prompted further investigation of the CAP+O(3) response, which showed a strong association between the 2-hr change in DBP (and mean arterial pressure) and the concentration of the organic carbon fraction of PM(2.5) (r = 0.53, p < 0.01; r = 0.56, p < 0.01, respectively) but not with total PM(2.5) mass (r ≤ 0.25, p ≥ 0.27). These findings suggest that exposure to environmentally relevant concentrations of PM(2.5) and O(3) rapidly increases DBP. The magnitude of BP change is associated with the PM(2.5) carbon content. Exposure to vehicular traffic may provide a common link between our observations and previous studies in which traffic exposure was identified as a potential risk factor for cardiovascular disease

TORCH: A Cherenkov Based Time-of-Flight Detector

TORCH is a novel high-precision time-of-flight detector suitable for large area applications and covering the momentum range up to 10 GeV/c. The concept uses Cherenkov photons produced in a fused silica radiator which are propagated to focussing optics coupled to fast photodetectors. For this purpose, custom MCP-PMTs are being produced in collaboration with industrial partners. The development is divided into three phases. Phase 1 addresses the lifetime requirements for TORCH, Phase 2 will customize the MCP-PMT granularity and Phase 3 will deliver prototypes that meet the TORCH requirements. Phase 1 devices have been successfully delivered and initial tests show stable gain performance for integrated anode current &gt;5 C/cm2 and a single photon time resolution of ≤ 30 ps. Initial simulations indicate the single photon timing resolution of the TORCH detector will be ∼70 ps

Trigger point manual therapy for the treatment of chronic non-cancer pain in adults

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effectiveness of trigger point manual therapy for treating chronic non-cancer pain in adults