Local interaction Strategies and Capacity for Better Care in Nursing Homes: A Multiple Case Study

To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff. Methods: We conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases. Results: Participants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these 'local interaction strategies'. We categorized these two sets of local interaction strategies as the 'common pattern' and the 'positive pattern' and summarize the results in two models of local interaction. Conclusions: The findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.National Institutes of Health 2 R01NR003178-04A2Claude A. Pepper Older American's Independence Center AG-11268Paul A. Beeson Award NIA AG024787VA Health Services Research and Development EDU 08-417John A. Hartford Building Academic Geriatric Nursing Claire M. Fagin FellowshipBusiness Administratio

Compassion Fatigue: An Application of the Concept to Informal Caregivers of Family Members with Dementia

Introduction. Compassion fatigue is a concept used with increasing frequency in the nursing literature. The objective of this paper is to identify common themes across the literature and to apply these themes, and an existing model of compassion fatigue, to informal caregivers for family members with dementia. Findings. Caregivers for family members with dementia may be at risk for developing compassion fatigue. The model of compassion fatigue provides an informative framework for understanding compassion fatigue in the informal caregiver population. Limitations of the model when applied to this population were identified as traumatic memories and the emotional relationship between parent and child, suggesting areas for future research. Conclusions. Research is needed to better understand the impact of compassion fatigue on informal caregivers through qualitative interviews, to identify informal caregivers at risk for compassion fatigue, and to provide an empirical basis for developing nursing interventions for caregivers experiencing compassion fatigue

Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature

The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research

Nonlocal effects in high energy charged particle beams

Within the framework of the thermal wave model, an investigation is made of the longitudinal dynamics of high energy charged particle beams. The model includes the self-consistent interaction between the beam and its surroundings in terms of a nonlinear coupling impedance, and when resistive as well as reactive parts are included, the evolution equation becomes a generalised nonlinear Schroedinger equation including a nonlocal nonlinear term. The consequences of the resistive part on the propagation of particle bunches are examined using analytical as well as numerical methods.Comment: 6 pages, 6 figures, uses RevTeX

Market incentives for shark fisheries

Fishers tend to prioritize landings of the most valuable product to better utilize vessel capacity. This may lead to discards of catches that are economically undesirable or legally prohibited. The high-value of shark fins and the low-value of shark carcasses has traditionally led to an example of that practice, known as finning. Brazil is an important player in the trade for non-fin shark products. The recent increase in shark meat trade is associated with increased imports of shark meat in Brazil. This increase may be a consequence of stricter finning regulations that has created incentives for full utilization of sharks and exposed the resource to a new source of demand. Thus, sharks overexploitation may increase, even if demand for fins weakens over time. This paper investigates the shark meat market development in Brazil over the last decades using demand and cointegration analysis, with a focus on before and after implementation of finning restrictions in 1998. Results indicate that shark meat is not a new market in Brazil, but an old one driven by a particular interest from local consumers. The decline in domestic shark meat landings, increasing demand for seafood, and the commoditization of shark meat have facilitated import growth. Additionally, domestic prices seem to influence imports most likely because Brazil is an important player as a shark meat consumer. This means that even with the global shark fin market weakening, the Brazilian demand for shark meat is likely to contribute to the overexploitation of sharks in poorly managed fisheries.publishedVersio

An EXAFS study of rare-earth phosphate glasses in the vicinity of the metaphosphate composition

A study of rare-earth phosphate glasses, in the vicinity of the metaphosphate composition, has been undertaken at different temperatures using the extended X-ray absorption fine structure (EXAFS) facility at the Synchrotron Radiation Source, Daresbury Laboratory, UK. The metaphosphate-like glasses examined contained the rare-earth elements La, Sm. Eu and Gd as R3+ ions. The experiments were carried out at room temperature, 145 and 79 K. The data show that the first shell surrounding rare-earth ions contains only oxygen atoms at a mean distance of similar to 2.2-2.4 Angstrom. The 'Iantfianide contraction' is clearly observed, i.e., the R-O distance decreases with increasing atomic number. The observed R(-O) coordination numbers are in the range 5-7. A second correlation shell was found associated with phosphorus atoms around the central rare-earth atom (similar to 3.5 Angstrom), and another rare-earth:oxygen correlation was also identified (similar to 4 Angstrom). Static disorder dominates the Debye-Waller term, but thermal disorder is not negligible. Within the accuracy of the EXAFS data, no significant structural variations were observed over the temperature range studied. We conclude that the anomalous bulk properties are associated with either subtle structural features or primarily due to rare-earth ion Interactions

Non-invasive methods of identifying and tracking wild squid

The ability to identify individual free-living animals in the field is an important method for studying their behavior. Apart from invasive external or internal tags, which may cause injury or abnormal behavior, most cephalopods cannot be tagged, as their skin is too soft and delicate for tag retention. Additionally, cephalopods remove many types of tags. However, body markings have been successfully used as a non invasive method to identify individuals of many different species of animals, including whale sharks, grey whales, seals, and zebras. We developed methods to sex and individually identify Caribbean reef squid, Sepiotheuthis sepioidea. Males showed distinct bright dots on their fins on a Basic Brown background and have a light line at the fin edge while the females had a gradual transition from Brown to Pale towards the edge of their fins without showing distinct fin-dots or lines. In the field we used four characters to distinguish individual S. sepioidea from each other – sex, relative size to each other, scars, and patterns of light-colored dots on their mantles and fins. These dot patterns are individually unique and constant in location through time. Observations in the field were backed up by an image database using illustrations and photography

Non-invasive methods of identifying and tracking wild squid

The ability to identify individual free-living animals in the field is an important method for studying their behavior. Apart from invasive external or internal tags, which may cause injury or abnormal behavior, most cephalopods cannot be tagged, as their skin is too soft and delicate for tag retention. Additionally, cephalopods remove many types of tags. However, body markings have been successfully used as a non invasive method to identify individuals of many different species of animals, including whale sharks, grey whales, seals, and zebras. We developed methods to sex and individually identify Caribbean reef squid, Sepiotheuthis sepioidea. Males showed distinct bright dots on their fins on a Basic Brown background and have a light line at the fin edge while the females had a gradual transition from Brown to Pale towards the edge of their fins without showing distinct fin-dots or lines. In the field we used four characters to distinguish individual S. sepioidea from each other – sex, relative size to each other, scars, and patterns of light-colored dots on their mantles and fins. These dot patterns are individually unique and constant in location through time. Observations in the field were backed up by an image database using illustrations and photography