TeamSTEPPS: A Foundation for Shared Governance in a High-Risk Obstetrical/Neonatal Service Line

Abstract Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety. Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A). Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through the implementation of a shared governance model. Shared governance, consistently recognized in the literature to positively affect nurse engagement and level organizational hierarchies, gives voice to RNs and increases RN involvement in decision making, impacting their practice and their work environment. As the project evolved, so too did it’s aim. Patient safety was a critical driver for the modification of the project. The revision laid a critical foundation for the future of shared governance by improving teamwork and communication among nurses, management, and providers using TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). Measures: The TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) provided insight into the department’s culture and guidance for the development of the curriculum. The questionnaire is comprised of 39 questions, including three demographic questions and one free-text question. The T-TPQ employs a Likert scale, with anchors ranging from strongly agree to strongly disagree (see Appendix B). The goal for the project was to train 95% of the team in TeamSTEPPS to improve communication and teamwork, as evidenced by a 5% increase in strongly agree and agree responses on the post-training T-TPQ. See Appendix C for a breakdown of the targeted team by role. Results: There were 166 respondents for the pre-training T-TPQ survey (see Appendix D). The TeamSTEPPS training goal was to train 95% of team members; the goal was met with 94.5% of team members trained. Of those trained, 90.5% completed the post-training course evaluation. Before implementation, less than 40% of participants scored their knowledge of TeamSTEPPS as very good or excellent, after implementation, 85% scored their post-training knowledge as very good or excellent. Overall, there was a 40% increase in excellent and very good responses. The plan to complete post-implementation T-TPQ six months after implementation was delayed due to a leadership decision to wait until People Pulse results were received. As such, the post-implementation T-TPQ data will not be available until the end of the first quarter of 2019. Conclusions: While the post-implementation survey data are not available, there are indications of the project’s success. The post-training evaluations indicated the training significantly improved the knowledge level of participants (see Appendix E). Additionally, activities in the department aimed at sustaining the use of the TeamSTEPPS tools and strategies are evident six months post-training and have been embedded in department processes, including critical events debriefings; there is also evidence of ongoing commitment with the development and regular engagement of the steering committee and charter

Communication and Social Influences on Foraging in Bats

Using social information can be an efficient way to respond to changing situations or to learn skills. Other benefits of foraging in a group, such as social facilitation, have also been reported. Furthermore, individuals foraging near conspecifics may use acoustic communication to mediate interactions. Many bat species (Order Chiroptera) are gregarious, and many tropical frugivorous bats rely on seasonally-abundant foods such that following conspecifics to a food source could benefit "followers" without harming "leaders." Animal-eating bats do not typically share food, but information obtained from experienced foragers could help facilitate development of prey acquisition skills in young bats. Additionally, communicative vocalizations serving various social functions have been reported in diverse bat species. Despite the opportunities for social learning and information transfer that many bats experience, few studies have attempted to determine if these phenomena occur in bats. Similarly, despite research on echolocation and some communicative calls, the context and function of social calls emitted by flying, foraging bats have received relatively little study. In this dissertation, I examine interactions between individuals in a foraging context and the impact of these interactions on the individuals' behavior. Specifically, I used pairs of big brown bats (Eptesicus fuscus) to test whether insectivorous bats can acquire a new foraging skill via social learning and what social cues might facilitate learning. I then describe the context of and attribute function to social calls emitted by bats in pairs. Finally, I examine the effects of social context on the foraging behavior of the frugivorous short-tailed fruit bat (Carollia perspicillata) presented with a food-finding task. My results provide the first evidence of the role of social learning (via attention to feeding buzzes and interaction with experienced individuals) in the development of foraging skills in young insectivorous bats. I also report a repertoire of social calls produced by foraging big brown bats and present evidence that males use social calls to defend food and increase their foraging success. Finally, I present evidence that social facilitation increases foraging performance in short-tailed fruit bats. These findings contribute to our knowledge of the social aspects of foraging in group-living animals

Programas internacionais de capacitação em pesquisa para enfermeiros no estudo do fenómeno das drogas na América Latina: desafios e perspectivas

The First International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas is a result of a partnership between the Inter-American Drug Abuse Control Commission (CICAD) of the Organization of American States (OAS) and the Faculty of Nursing in the University of Alberta, with financial support from the Government of Canada. The program was divided into two parts. The first part of the program was held at the University of Alberta in Edmonton, Alberta, Canada. It involved capacity-building in research methodologies at the Faculty of Nursing, which lead to the preparation of four multi-centric research proposals for drug demand reduction in the home countries of the eleven participants in the program. The second part of the program was related to the implementation of multi-centric research proposals in seven countries in Latin America and in Canada. This program presented expertise in research methodology to members of Latin American Schools of Nursing and introduced Latin American expertise to members of a Canadian Faculty of Nursing. The International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas has fostered the kind of inter-cultural respect and mutual appreciation necessary to confront the global health problem of the abuse of both licit and illicit drugs.El Primer Programa Internacional de Capacitación en Investigación para Enfermeros en el Estudio del Fenómeno de las Drogas en las Américas resultó de una colaboración entre la Comisión Interamericana para el Control del Abuso de Drogas (CICAD) de la Organización de los Estados Americanos (OEA) y la Facultad de Enfermería en la Universidad de Alberta, con apoyo financiero del Gobierno de Canadá. El programa fue dividido en dos partes. La primera parte del programa se organizó en la Universidad de Alberta en Edmonton, Alberta, Canadá. Abarcó la capacitación en metodologías de investigación en la Facultad de Enfermería, que llevó a la preparación de cuatro propuestas de investigación multicéntrica con vistas a la reducción de la demanda de drogas en los países de origen de los once participantes en el programa. La segunda parte del programa estaba relacionada a la implementación de propuestas de investigación multicéntrica en siete países de América Latina y en Canadá. Este programa presentó conocimientos especializados en metodologías de investigación a miembros de Escuelas de Enfermería latinoamericanas e introdujo los conocimientos especializados latinoamericanos a miembros de una Facultad de Enfermería canadiense. El Programa Internacional de Capacitación en Investigación para Enfermeros en el Estudio del Fenómeno de las Drogas en las Américas estimuló el tipo de respecto intercultural y apreciación mutua necesario para confrontar el problema de salud global del abuso de drogas lícitas e ilícitas.O Primeiro Programa Internacional de Capacitação para Enfermeiros no Estudo do Fenômeno das Drogas nas Américas é resultado de uma parceria entre a Comissão Interamericana para o Controle do Abuso das Drogas (CICAD) da Organização dos Estados Americanos (OEA) e a Faculdade de Enfermagem da Universidade de Alberta, com apoio financeiro do Governo do Canadá. O programa foi dividido em duas partes. A primeira parte do programa foi realizada na Universidade de Alberta em Edmonton, Alberta, Canadá. Compreendeu a capacitação em metodologias de pesquisa na Faculdade de Enfermagem, que levou à preparação de quatro propostas de pesquisas multicêntricas para a redução da demanda de drogas nos países de origem dos onze participantes no programa. A segunda parte do programa estava relacionada à implementação de propostas de pesquisa multicêntricas em sete países da América Latina e no Canadá. Este programa apresentou expertise em metodologias de pesquisa a membros de Escolas de Enfermagem latino-americanas e introduziu expertise latino-americana a membros de uma Faculdade de Enfermagem canadense. O Primeiro Programa Internacional de Capacitação para Enfermeiros no Estudo do Fenômeno das Drogas nas Américas estimulou o tipo de respeito intercultural e apreço mútuo necessário para confrontar o problema de saúde global do abuso das drogas lícitas e ilícitas

What is the research experience of young scientists in South Africa?

The results of an online survey - the SAYAS Survey of Young Scientists that involved the participation of 1021 postgraduate students and postdoctoral fellows from tertiary institutions in South Africa - were released in a report launched in November 2013. In this commentary we highlight some of the key findings from the report: The Research Experience of Young Scientists in South Africa.

Effects of sachet water consumption on exposure to microbe-contaminated drinking water: household survey evidence from Ghana

There remain few nationally representative studies of drinking water quality at the point of consumption in developing countries. This study aimed to examine factors associated with E. coli contamination in Ghana. It drew on a nationally representative household survey, the 2012?2013 Living Standards Survey 6, which incorporated a novel water quality module. E. coli contamination in 3096 point-of-consumption samples was examined using multinomial regression. Surface water use was the strongest risk factor for high E. coli contamination (relative risk ratio (RRR) = 32.3, p < 0.001), whilst packaged (sachet or bottled) water use had the greatest protective effect (RRR = 0.06, p < 0.001), compared to water piped to premises. E. coli contamination followed plausible patterns with digit preference (tendency to report values ending in zero) in bacteria counts. The analysis suggests packaged drinking water use provides some protection against point-of-consumption E. coli contamination and may therefore benefit public health. It also suggests viable water quality data can be collected alongside household surveys, but field protocols require further revision

Cool temperate rainforest in the Pilot Wilderness area, Kosciuszko National Park, New South Wales: Distribution, composition and impact of the 2003 fires

Although the distribution and composition of cool temperate rainforest in eastern Australia may be regarded as well documented, the recent discovery of cool temperate rainforest stands dominated by Atherosperma moschatum in the Pilot Wilderness area of Kosciuszko National Park shows that our knowledge is still incomplete. The additional discovery of 10 plant species previously unrecorded for the park including large specimens of Elaeocarpus holopetalus highlights the fact that although the flora and vegetation of the alpine and subalpine tracts of Kosciuszko National Park are relatively well studied, the remainder of the park is by comparison understudied and under sampled. Although not actively protected or managed, these cool temperate rainforest stands appear to have been little affected by the 2003 fires in the Australian Alps, with only 2 stands out of 25 showing any fire incursion. However, whether the direct effects of climate change or the indirect effects of human reaction to climate change poses the greatest threat to the continued existence of these stands is an open question. The aim of this short communication is to: a) examine the distribution and composition of these newly discovered stands of cool temperate rainforest and b) to briefly describe the impact of the 2003 fires on this restricted vegetation type

Archiving the Scientific Legacy of Dr. Alec Costin

Alec Costin is one of Australia’s foremost ecologists, internationally respected for his pioneering work into the soils, hydrology and vegetation of the Australian alpine regions. Advisor to governments and their agencies, he was instrumental in the conservation of the Australian Alps. Alec’s field notes, data sheets and Kodachrome slides, a record of the Alps in the 1950s and 60s, are important historically and provide an important resource to interpret change in vegetation and landscapes in the Australian Alps. The University of Melbourne, funded by the Australian Alps National Parks, will catalogue and archive these materials, so future generations of scientists and historians can easily gain access to them