Acute care nurses' attitudes, behaviours and perceived barriers towards discharge risk screening and discharge planning

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.Background: Patient safety and economic imperatives have made discharge planning for patients in acute care increasingly important in the last two decades. Indeed patients have more complex health care needs, shorter lengths of stay and longer recovery times. Discharge planning therefore must start early in the patient’s admission to ensure there is enough time to manage each patient’s discharge appropriately. Nurses have a pivotal role in discharge planning and early assessment for discharge. However, few studies have measured nurses’ compliance with elements of discharge planning or their attitudes towards discharge planning. Aim: The aim of this research was to identify nurses’ discharge planning behaviours, in particular compliance with discharge risk screening (DRS) policy, their attitudes towards discharge planning and the factors influencing their behaviours. Methods: A cross sectional descriptive design was used comprising two components, the first of which was an audit of one hundred patients’ medical records for DRS compliance. The second component was a self-report survey, which was in part informed by the audit results, of 94% of nurses who worked in the setting. Results: Nurses’ compliance with DRS, as observed in the audit and self-report survey, was low (between 24.2% and 33%). Patients admitted with a medical diagnosis (OR = .1 95% Confidence Interval .03 - .37) or surgical diagnosis (OR = .13 95% CI .03 - .06) were significantly less likely to have their DRS completed than patients with a respiratory diagnosis and there was a trend for patients admitted on weekdays to be less likely to have DRS completed (OR = .31, 95% I .08 – 1.2). Nurses had an overall positive attitude to the DRS and discharge planning and their screening was mostly accurate. Furthermore, nurses who complied with DRS policy had a more positive attitude (mean 37.14, SD 3.6) than those who did not (mean 34.77, SD 4.2) (P = .03) and were more likely to start discharge planning early. Nurses identified that the major barriers to DRS and discharge planning were the busyness of the ward on weekdays and patient characteristics. These factors hindered compliance with the DRS policy and discharge planning. Other findings suggest that nurses’ discharge planning knowledge and behaviours were inconsistent, that they were uncertain of their role, and the relationship between medical officers and nurses may have influenced their behaviours. Conclusion: This study determined that nurses do not often comply with DRS policy and therefore starting discharge planning early is hampered. The study suggests that there is a link between nurses’ attitudes, DRS compliance and starting discharge planning early. The implications for nurses’ practice include the need to develop clear guidelines, criteria or processes for discharge planning, which incorporate agreed upon roles for all members of the multidisciplinary team, in particular the nurses’ role. There is also a need to investigate a systematic, methodical approach to discharge planning that includes early screening, using the DRS and involvement of nurses in the development of guidelines and implementation of the systematic approach. Further investigation of nurses’ attitudes toward the DRS and discharge planning is recommended, as this was the only nurse characteristic in this study that was found to be linked to their behaviours

Families of strictly pseudoconvex domains and peak functions

We prove that given a family $(G_t)$ of strictly pseudoconvex domains varying in $\mathcal{C}^2$ topology on domains, there exists a continuously varying family of peak functions $h_{t,\zeta}$ for all $G_t$ at every $\zeta\in\partial G_t.

Abstract basins of attraction

Abstract basins appear naturally in different areas of several complex variables. In this survey we want to describe three different topics in which they play an important role, leading to interesting open problems

Understanding team, interpersonal and situational factors is essential for routine communication with patients in the emergency department (ED): A scoping literature review and formation of the ‘T.IP.S’ conceptual framework

Introduction Most patient–provider communication skills frameworks focus on interpersonal behaviours within the context of a single consultation. In contrast, Emergency Department (ED) patient encounters consist of many new interactions with different professionals over a short time period. Additionally, ED care often occurs in a chaotic, unpredictable, and overcrowded environment. While these factors are recognised to present a major challenge to effective patient–provider communication in the ED, there is no accepted framework to guide how professionals or teams should approach and optimise communication with patients in the ED. Objectives This review aims to identify the current literature relating to routine patient provider communication processes in the ED and synthesise a new framework to enhance understanding of routine patient-provider communication processes in the ED. Methods Searches of Scopus, Medline, EMBASE and CINAHL were conducted to identify literature written between 2000 and 2016 using the terms ((communication OR consultation OR health literacy) AND (patient) AND (emergency medicine OR emergency department)). Results Fifty-five relevant articles were selected for final inclusion. A qualitative synthesis was conducted and content interpreted as either facilitating factors or obstacles to routine ED communication were coded and grouped into three overarching themes. These were Team, Interpersonal and Situational factors, which together form the basis of the proposed T.IP.S framework. Conclusion T.IP.S is the first framework for patient-provider communication specific to the ED setting. The T.IP.S framework may be utilised to evaluate communication strengths and vulnerabilities, identify training requirements professionals, and ultimately improve patient experience and outcomes in the ED

How do field of view and resolution affect the information content of panoramic scenes for visual navigation? A computational investigation

The visual systems of animals have to provide information to guide behaviour and the informational requirements of an animal’s behavioural repertoire are often reflected in its sensory system. For insects, this is often evident in the optical array of the compound eye. One behaviour that insects share with many animals is the use of learnt visual information for navigation. As ants are expert visual navigators it may be that their vision is optimised for navigation. Here we take a computational approach in asking how the details of the optical array influence the informational content of scenes used in simple view matching strategies for orientation. We find that robust orientation is best achieved with low-resolution visual information and a large field of view, similar to the optical properties seen for many ant species. A lower resolution allows for a trade-off between specificity and generalisation for stored views. Additionally, our simulations show that orientation performance increases if different portions of the visual field are considered as discrete visual sensors, each giving an independent directional estimate. This suggests that ants might benefit by processing information from their two eyes independently

Ethical issues in the use of in-depth interviews: literature review and discussion

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

BackgroundPatient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both quantitative and qualitative approaches can be used to evaluate patient experience in the emergency department (ED), the latter is well aligned to develop a detailed understanding of features influencing the lived experience of ED patients. This study aimed to systematically review the literature of qualitative studies to identify determinants of adult patient experience in the ED.MethodsA Preferred Reporting Items for Systematic review and Meta-Analysis compliant systematic review was conducted using PubMed, CINAHL, EMBASE, BNI and bibliography searches to identify qualitative studies exploring patient experiences in ED published in English between 1997 and 2018. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Descriptive text and quotations relating to patient experience were extracted from included studies and a meta-synthesis conducted using thematic analysis.ResultsA total of 625 records were screened from which 40 studies underwent full review and 22 were included. Results were coded by two researchers (BG and JML). Meta-synthesis identified 198 discrete units of analysis which were clustered around five analytical themes. These were based on the perceived ‘needs’ of patients visiting the ED and were defined as communication, emotional, competent care, physical/environmental and waiting needs. Findings were translated into a conceptual model for optimising patient experience in the ED.ConclusionThis meta-synthesis provides a framework for understanding the determinants of patient experience in the ED. The resulting conceptual model and recommendations may have the potential to directly inform practice and improve the patient experience.</jats:sec

Golgin45-Syntaxin5 Interaction Contributes to Structural Integrity of the Golgi Stack

The unique stacked morphology of the Golgi apparatus had been a topic of intense investigation among the cell biologists over the years. We had previously shown that the two Golgin tethers (GM130 and Golgin45) could, to a large degree, functionally substitute for GRASP-type Golgi stacking proteins to sustain normal Golgi morphology and function in GRASP65/55-double depleted HeLa cells. However, compared to well-studied GM130, the exact role of Golgin45 in Golgi structure remains poorly understood. In this study, we aimed to further characterize the functional role of Golgin45 in Golgi structure and identified Golgin45 as a novel Syntaxin5-binding protein. Based primarily on a sequence homology between Golgin45 and GM130, we found that a leucine zipper-like motif in the central coiled-coil region of Golgin45 appears to serve as a Syntaxin5 binding domain. Mutagenesis study of this conserved domain in Golgin45 showed that a point mutation (D171A) can abrogate the interaction between Golgin45 and Syntaxin5 in pull-down assays using recombinant proteins, whereas this mutant Golgin45 binding to Rab2-GTP was unaffected in vitro. Strikingly, exogenous expression of this Syntaxin5 binding deficient mutant (D171A) of Golgin45 in HeLa cells resulted in frequent intercisternal fusion among neighboring Golgi cisterna, as readily observed by EM and EM tomography. Further, double depletion of the two Syntaxin5-binding Golgin tethers also led to significant intercisternal fusion, while double depletion of GRASP65/55 didn’t lead to this phenotype. These results suggest that certain tether-SNARE interaction within Golgi stack may play a role in inhibiting intercisternal fusion among neighboring cisternae, thereby contributing to structural integrity of the Golgi stack

Identification of Acoustic Emission Sources by Pattern Recognition Techniques

Computer pattern recognition has been used to identify and separate acoustic emission (AE) signals that are similar in appearance but are due to different sources. Simulated joint specimens were tested in the laboratory in which a fatigue crack was grown from the edge of a central loading pin hole. The hardened steel loading pin produced fretting AE by its contact with the 7075 T651 aluminum plate specimens during cyclic loading. The fatigue crack produced AE due to crack growth and to crack face rubbing during load cycling. The AE signals detected at two transducers mounted on opposite sides of the loading pin hole, at 2 in. and 4 in. from the fatigue crack, were digitally recorded at a 5 MHz digitization rate. The waveform features that were extracted from these AE signals and used in the pattern recognition were derived from the frequency spectral content of the waveforms. Better than 90% separation of crack growth from crack face rubbing was achieved using frequency features of the waveforms from either transducer separately. Better than 95% separation of fretting from crack growth or crack face rubbing, separately or combined, was achieved using the ratios of the spectral energies detected at the two transducers