Recognize, Repair, and Resolve: Understanding Ruptures within the Therapeutic Alliance

The therapeutic alliance, or the relationship between the therapist and patient, has been a popular research topic and is believed to play an important role in therapy, but what happens when the bond is broken and trust cannot be established? Unresolved ruptures are associated with deterioration in the alliance and may lead to poor outcome or patient dropout (Safran & Kraus, 2014). In order to recognize that a rupture has occurred, seven themed rupture markers are provided, six interventions are suggested to repair the rupture, and ten strategies are identified to assist clinicians resolve the rupture. To evaluate the understanding of mental health practitioners, an anonymous survey was distributed. Clinicians were asked to rate the frequency of observing when rupture markers have occurred within the relationship, the utilization of interventions to repair the rupture, and strategies to resolve the rupture. It was found that a relationship was determined between years of experience of the clinician and noticing compliance on the part of the client and with years of experience and linking the event to similar relational issues in a client\u27s life. Additionally, it was determined that the recognize stage of the rupture process was identified more frequently than the later stages of repairing and resolving the rupture according to matching responses of the quantitative and qualitative questions. Strengths of this study include a sample in which 44% of respondents indicated they had 16 years of experience or more in mental health and the use of a mixed-method design. Limitations include sample size, survey instrument, and lack of funding

Recognize, Repair, and Resolve: Understanding Ruptures within the Therapeutic Alliance

The therapeutic alliance, or the relationship between the therapist and patient, has been a popular research topic and is believed to play an important role in therapy, but what happens when the bond is broken and trust cannot be established? Unresolved ruptures are associated with deterioration in the alliance and may lead to poor outcome or patient dropout (Safran & Kraus, 2014). In order to recognize that a rupture has occurred, seven themed rupture markers are provided, six interventions are suggested to repair the rupture, and ten strategies are indentified to assist clinicians resolve the rupture. To evaluate the understanding of mental health practitioners, an anonymous survey was distributed. Clinicians were asked to rate the frequency of observing when rupture markers have occurred within the relationship, the utilization of interventions to repair the rupture, and strategies to resolve the rupture. It was found that a relationship was determined between years of experience of the clinician and noticing compliance on the part of the client and with years of experience and linking the event to similar relational issues in a client‘s life. Additionally, it was determined that the recognize stage of the rupture process was identified more frequently than the later stages of repairing and resolving the rupture according to matching responses of the quantitative and qualitative questions. Strengths of this study include a sample in which 44% of respondents indicated they had 16 years of experience or more in mental health and the use of a mixed-method design. Limitations include sample size, survey instrument, and lack of funding

Development of key performance indicators of capital market-oriented entities in the Prime Standard since the introduction of DRS 20

This paper examines the performance indicators of 168 Prime Standard entities since the introduction of DRS 20, focusing on the core question of how the use of performance indicators has changed over time. For this purpose, we compare the published key performance indicators from various companies in different years to point out existing differences. Furthermore, we examine which KPIs are changed most often and how frequently businesses adjust their performance indicators. The companies examined are differentiated according to size and sector

Examensklausur ZR Silberhochzeitsreise mit Hindernissen

Die reiserechtliche Klausur wurde aus Anlass einiger neuer Entscheidungen des BGH im Wintersemester 2010/11 im Examensklausurenkurs der Friedrich-Schiller-Universität Jena angeboten. Gegenstand sind zum einen klassische Standardprobleme der Haftung des Reiseveranstalters (Reisevertrag als Vertrag zugunsten Dritter bei Familienangehörigen, vertragliche und deliktische Haftung des Reiseveranstalters, Abgrenzung Eigen- und Fremdleistung, Schadensersatz für nutzlos aufgewendete Urlaubszeit), zum anderen insbesondere Probleme betreffend die Wahrung der Ausschlussfrist des § 651 g BGB

ICU Made 4 U: Critical Care Education for Novice Nurses

Background: The novel Coronavirus 2019 (COVID 19) pandemic had a large impact on education in the healthcare setting. At Henry Ford Jackson Hospital (HFJH), due to staffing constraints and emergent clinical needs, nurses hired during the COVID 19 pandemic did not complete standard critical care orientation after March 2020. During yearly learning needs assessments, nurses identified opportunities for enhanced education regarding the management of critically ill patients. Staff Development Educators and Clinical Nurse Specialists (CNSs) within the acuity adaptable units identified a gap in knowledge regarding critical care concepts. At HFJH, acuity adaptable units house critical care patients on the Medical Universal Bed unit and the Surgical Universal Bed unit. Aim: The aim of this quality improvement project was to increase novice nurses’ knowledge of critical care concepts while increasing confidence implementing advanced nursing skills within the patient population. Methods: The Staff Development Educators and CNSs proposed an education program to the nursing leadership and gained support for mandatory attendance. Content was formulated based on input from the interprofessional critical care team and feedback from the nursing learning needs assessments. Nurses caring for the critical care population hired or transferred after March 2020 were required to complete the program. Nurses were given the opportunity to complete and pass a standardized test (score of 80% or higher) in lieu of attending the educational sessions. Three, four-hour sessions were created and included didactic content, simulation with case scenarios, and interactive teaching methods with equipment specific to the intensive care setting. A pre-test was administered prior to content presentation and the post test was administered at the end of the third session. Nurses completed an evaluation for each didactic content presentation and received continuing education credit. Findings: The average score for pre-test was 70.7%. The average post test score was 77.3%. Demonstrating a 6.6% increase following intervention. The results of this quality improvement project indicated that formalized, didactic and simulation education opportunities enhanced the knowledge of critical care concepts for novice nurses. Nurses completed an evaluation for each didactic session with positive feedback and suggestions for additional content. Implications: Nurses with critical care experience opted to participate in the program to enhance their personal growth and knowledge. Based on the pre and post test results, gastrointestinal and parenteral content will be added to future sessions. Tailored education, with a focus on simulation and hands on content, showed to improve nurses understanding of advanced critical care concepts. These didactic, simulation, and hands on learning sessions will be integrated into the onboarding orientation for nurses caring for the critical care population.https://scholarlycommons.henryford.com/nursresconf2023/1004/thumbnail.jp

Ractopamine HCl improved cardiac hypertrophy but not poor growth, metabolic inefficiency, or greater white blood cells associated with heat stress in concentrate-fed lambs

Heat stress decreases livestock performance and well-being (Hahn, 1999; Nienaber and Hahn, 2007), causes metabolic dysfunction that decreases growth efficiency (O’Brien et al., 2010), and alters cardiovascular function (Crandall et al., 2008). Each year, heat stress costs the livestock industry up to $2.5 billion (St-Pierre et al., 2003). Ractopamine HCl acts as a nutrient repartitioning agent (Beermann, 2002); classified as a β adrenergic agonist (βAA), it shares pharmacological properties with adrenaline (Beermann, 2002). βAA increase muscle mass and decreases fat deposition through unknown mechanisms (Beermann, 2002). In feedlot cattle, they increase growth efficiency and improve carcass yield and merit (Scramlin et al., 2010; Buntyn et al., 2017), which increases profit and allows more meat to be produced from fewer animals. However, because βAA act via a stress system, it is unclear how the products affect animals under stress conditions. β1AA and β2AA can also cause tachycardia, heart palpitations, and arrhythmias (Sears, 2002). We hypothesize that β1AA combined with heat stress may overstimulate the adrenergic system, resulting is metabolic dysfunction and decreased performance. Sheep are a common model for cattle, and thus, the objective of this study was to determine the impact of ractopamine HCl on health and cardiovascular parameters, growth, and metabolic efficiency in feeder lambs

Evaluation of Vascular Control Mechanisms Utilizing Video Microscopy of Isolated Resistance Arteries of Rats

This protocol describes the use of in vitro television microscopy to evaluate vascular function in isolated cerebral resistance arteries (and other vessels), and describes techniques for evaluating tissue perfusion using Laser Doppler Flowmetry (LDF) and microvessel density utilizing fluorescently labeled Griffonia simplicifolia (GS1) lectin. Current methods for studying isolated resistance arteries at transmural pressures encountered in vivo and in the absence of parenchymal cell influences provide a critical link between in vivo studies and information gained from molecular reductionist approaches that provide limited insight into integrative responses at the whole animal level. LDF and techniques to selectively identify arterioles and capillaries with fluorescently-labeled GS1 lectin provide practical solutions to enable investigators to extend the knowledge gained from studies of isolated resistance arteries. This paper describes the application of these techniques to gain fundamental knowledge of vascular physiology and pathology in the rat as a general experimental model, and in a variety of specialized genetically engineered designer rat strains that can provide important insight into the influence of specific genes on important vascular phenotypes. Utilizing these valuable experimental approaches in rat strains developed by selective breeding strategies and new technologies for producing gene knockout models in the rat, will expand the rigor of scientific premises developed in knockout mouse models and extend that knowledge to a more relevant animal model, with a well understood physiological background and suitability for physiological studies because of its larger size