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Does the Use of Positive End Expiratory Pressure (PEEP) During Surgery Decrease Respiratory Complications Twenty-Four Hours Post Operative?
Get PDFGeneral anesthesia can lead to pulmonary compromise during surgery. Nurse anesthetists in the operating room are responsible for minimizing pulmonary complications while managing ventilation through mechanical ventilation. Positive end-expiratory pressure (PEEP) can be used to improve oxygenation, prevent airway collapse and facilitate expansion of alveoli during each breath. Yet the use of PEEP varies among clinicians, as supported by the literature. The goal of this systematic review was to evaluate the impact of PEEP intra-operatively on selected respiratory outcomes. The research question was: Does the use of positive end expiratory pressure (PEEP) during surgery decrease respiratory complications 24 hours post-operative? This review was guided by the Preferred Reporting Items for Systematic Review (PRISMA) flow diagram and checklist. Within study quality was assessed with The Critical Appraisal Skills Programme (CASP) Randomised Controlled Trials Checklist and Popay’s guidelines were followed for a narrative cross study synthesis. Seven studies were included in this systematic review. Results demonstrated less impaired gas exchange with higher PEEP and overall respiratory compliance was greater in subjects who were managed with PEEP. Most PEEP groups demonstrated less pulmonary infiltrates post operatively as well as less atelectasis and pleural effusions. Using PEEP intra-operatively generated higher oxygen saturation post-operatively and fewer patients who received PEEP needed 100% oxygen in the recovery unit. This review yielded evidence related to the intraoperative use of PEEP that nurse anesthetists may use to guide their anesthesia practice
Increasing Staff Nurse Knowledge Related to Organ and Tissue Donation: A Quality Improvement Project
Get PDFInitially viewed as doubtful and plagued with uncertainty, the process of organ/tissue transplantation has proved to be one of the most successful medical breakthroughs of modern medicine. From the initial documented success of organ/tissue donation and subsequent transplantation, the need for organ/tissue donation exceeds the available resources. Many individuals are aware of the need for organ/tissue donation for life-saving transplantation but do not take the necessary steps to become a donor or share that desire with family and/or loved ones. There are no national programs or efforts in place for standardized nursing education about organ/tissue donation and transplantation. The purpose of this quality improvement project was to increase nurses’ knowledge of the New England Organ Bank (NEOB) guidelines for organ and tissue donation. The project design was a pre-test, an educational program, and post-test. Twenty-two nurses completed the pre-test component (N=22, 63%) and fourteen nurses completed the post-test (N=14, 40%). Results indicated nurses had better overall better knowledge of organ donation then specifically tissue donation. Nursing staff demonstrated increased knowledge of NEOB guidelines and the nurse’s role in timely reporting after the educational program on organ donation with improved post-test over pre-test scores. Future replication of education related to NEOB guidelines for donation of organs and tissues and nurse responsibility for timely reporting should increase emphasis on the area of tissue donation. A need based assessment to determine specific areas of deficit may aid in promoting positive outcomes in future replication
Can\u27t Hurt, Might Help: Examining the Spillover Effects from Purposefully Adopting a New Pro-Environmental Behavior
Get PDFThis field experiment investigated whether purposefully adopting a new pro-environmental behavior (e.g., unplugging appliances, reusing shopping bags) led to positive spillover by altering people’s subsequent pro-environmental behaviors and political attitudes. Participants (N = 125) recruited through community organizations were randomly assigned to either adopt a new pro-environmental behavior of their choice for three weeks, or were not invited to do so. Behavior adoption increased participants’ likelihood of contacting their Senator about climate change, but had little direct spillover effect on other individual pro-environmental behaviors, their likelihood of making household-wide changes, the political importance they placed on climate-related issues, or their support for emissions-reducing policies. Behavior adoption increased sense of environmental responsibility among some participants, leading to indirect positive effects on purchasing organic/local produce and policy support. Overall, observed positive spillover effects were limited and relatively small. There was little indication that behavior adoption led to any meaningful negative spillover effects
First Births: A Review of the United States Primary Cesarean Section Rate And Recommendations for Further Study
Get PDFThe cesarean section (CS) rate has increased exponentially worldwide over the past twenty years, and today it is the “most common major surgical procedure in the United States” (Boyle et al., 2013). CS is associated with increased morbidity and mortality for both mothers and newborns, and lowering the national CS rate has become a national health concern (American College of Obstetricians and Gynecologists, 2014). Once a woman has her first CS (the primary CS), it is very likely that all of her subsequent deliveries will also be by CS. Thus, preventing primary CS is critical for reducing the overall CS rate (ACOG, 2014). This paper explores factors contributing to the elevated CS rate, and specifically examines the diagnosis of labor dystocia. The nurse’s role in promoting normal birth and preventing CS is also outlined. Lastly, emerging programs intended to address the elevated CS rate are discussed
Commencement Program 2016
Get PDFThis commencement program is for baccalaureate and advanced degrees.https://digitalcommons.ric.edu/commencement_programs/1128/thumbnail.jp
Diversity as Opportunity: Insights from 600 Million Years of AHR Evolution
Get PDFThe aryl hydrocarbon receptor (AHR) was for many years of interest only to pharmacologists and toxicologists. However, this protein has fundamental roles in biology that are being revealed through studies in diverse animal species. The AHR is an ancient protein. AHR homologs exist in most major groups of modern bilaterian animals, including deuterostomes (chordates, hemichordates, echinoderms) and the two major clades of protostome invertebrates [ecdysozoans (e.g. arthropods and nematodes) and lophotrochozoans (e.g. molluscs and annelids)]. AHR homologs also have been identified in cnidarians such as the sea anemone Nematostella and in the genome of Trichoplax, a placozoan. Bilaterians, cnidarians, and placozoans form the clade Eumetazoa, whose last common ancestor lived approximately 600 million years ago (MYA). The presence of AHR homologs in modern representatives of all these groups indicates that the original eumetazoan animal possessed an AHR homolog. Studies in invertebrates and vertebrates reveal parallel functions of AHR in the development andfunction of sensory neural systems, suggesting that these may be ancestral roles. Vertebrate animals are characterized by the expansion and diversification of AHRs, via gene and genome duplications, from the ancestral protoAHR into at least five classes of AHR-like proteins: AHR, AHR1, AHR2, AHR3, and AHRR. The evolution of multiple AHRs in vertebrates coincided with the acquisition of high-affinity binding of halogenated and polynuclear aromatic hydrocarbons and the emergence of adaptive functions involving regulation of xenobiotic-metabolizing enzymes and roles in adaptive immunity. The existence of multiple AHRs may have facilitated subfunction partitioning and specialization of specific AHR types in some taxa. Additional research in diverse model and non-model species will continue to enrich our understanding of AHR and its pleiotropic roles in biology and toxicology
On the Micropolitics and Edges of Survival in a Technocapital Sacrifice Zone
Get PDFThis article explores the industrial sacrifice zone of Endicott, New York, which in 1924 became the birthplace of International Business Machines Corporation and quickly established itself as an industrial launching pad for the production and innovation of modern computing technologies. Drawing on ethnographic research and taking a micropolitical ecology approach, I consider industrial decay and community corrosion key agents for understanding the sedimentary record of neoliberal “technocapitalism” [Suarez-Villa, Luis. 2009. Technocapitalism: A Critical Perspective on Technological Innovation and Corporatism. Philadelphia, PA: Temple University Press]. In particular, I explore here how the flip-side of local narratives of deindustrialization and economic sacrifice are other narratives of coping and navigating community decline. These local sacrifice zone narratives, I argue, expose key dimensions of surviving corporate neoliberal and technocapital sacrifice
Exploring Nurses\u27 Attitudes About the Value of a Hospital Based Medical Futility Policy
Get PDFNurses are responsible for providing care for patients and following through with a physician’s orders, however, it is not always easy to do. Certain cases are more difficult than others, especially those involving end-of-life care versus continuing with life-sustaining measures. It is not an easy decision for families or patients to make, but sometimes these life-sustaining interventions can do more harm than good, causing much distress among caregivers (Burns & Truog, 2007). Some cases have become hallmark cases like that of Terri Schiavo, a woman who was in a persistent vegetative state from 1990 to 2005 while her parents and husband fought between keeping her alive or letting her go peacefully (Quill, 2005). Another difficult case in 2007 involved a toddler, Emilio Gonzales, whose mother fought for more time with her child rather than removing the ventilator (Cohen, 2007).
Defining futility and its role in healthcare has been an ongoing issue since the 1980s. For the purpose of this research paper, futility is defined as “treatment or clinical interventions that are not likely to result in benefit to the patient or produce the expected outcome” (Terra & Powell, 2012, p. 103). Nurses can suffer from moral distress when they are obligated to provide life-sustaining interventions to patients that have a small chance of benefiting from them. Nurses may experience less frustration and moral distress if hospitals implement a futility policy that provides guidance in these difficult cases. The purpose of this study is to explore nurses\u27 attitudes regarding a hospital-based medical futility policy
The Miracle Worker: The Use of Historical Research in Theatrical Design
Get PDFThis paper chronicles the research, creative process, and design choices behind the costumes I created for the Rhode Island College production of the play, The Miracle Worker, by William Gibson. It is the culmination of my Individualized Master of Arts Program at Rhode Island College.
The program I created focused on the intersection of historiographical procedure with theatrical design practices to create a final design based on a scholarly synthesis of research. My aim was to create a design that was both historically accurate to Boston and Alabama in the 1890s, as well as fulfilling all of the principles necessary for an effective theatrical design. The challenges involved in this project besides strength of design were time management, budget constraints, and the creation of garments that appeared period-appropriate while also functioning in the logistics of live theatre
Educating Oncology Nurses with Simulation: A Chemotherapy Spill
Get PDFThe purpose of the QI project was to determine if the use of a simulated chemotherapy spill increased the competencies and confidence of oncology nurses employed on an inpatient chemotherapy unit. An educational QI design was utilized including a confidential voluntary pre and post intervention survey. The simulations were held on a 25 bed oncology unit. Twenty-nine RNs participated. The simulation objective was to locate and follow the current hospital policy, the MSDS for the particular drug and clean up the simulated spill based on the current policy. Twelve simulations were conducted. Only 20.6% of RNs had been previously exposed to a chemotherapy spill. More than half of RNs felt the simulation resembled real life and all felt that the simulation very much or somewhat prepared them to handle a chemotherapy spill. The results of the comparable questions were all statistically significant (P = \u3c0.001) and suggest that the simulation did increase the nurses’ awareness of and comfort in locating the current hospital policy and MSDS. RN’s reported increased knowledge of the contents within a chemotherapy spill kit and an increase in feeling prepared to deal with a spill in the future. An unintentional finding revealed omissions and discrepancies in the current policy. Future research to include larger cohorts in multiple oncology settings is needed to support educating nurses with simulation. Simulation may also be useful in creating, reviewing and revising policies