28 research outputs found
Intercom 1995 November 27
No full textCampus Campaign Exceeds Goal, UT Tyler, TJC Music Groups to Perform, Repertory Plays Scheduled in December, Graduate Students Author AmeriCorps Grant, In The Spotlight, Alphi Chi Names Outstanding Faculty, Personnel Update, Service Recognition, Christmas Holiday Schedule
Survey of Nurses' Experiences Applying The Joint Commission's Medication Management Titration Standards
No full textFull author list omitted for brevity. For the full list of authors, see article.BACKGROUND: Critical care nurses titrate continuous infusions of medications to achieve clinical end points. In 2017, The Joint Commission (TJC) placed restrictions on titration practice, decreasing nurses' autonomous decision-making. OBJECTIVES: To describe the practice and perceptions of nurses regarding the 2017 TJC accreditation/regulatory standards for titration of continuous medication infusions. METHODS: A survey of nurses' experiences titrating continuous medication infusions was developed, validated, and distributed electronically to members of the American Association of Critical-Care Nurses. RESULTS: The content validity index for the survey was 1.0 for relevance and 0.95 for clarity. A total of 781 nurses completed the survey; 625 (80%) perceived titration standards to cause delays in patient care, and 726 (93%) experienced moral distress (mean [SD], 4.97 [2.67]; scale, 0-10). Among respondents, 33% could not comply with titration orders, 68% reported suboptimal care resulting from pressure to comply with orders, 70% deviated from orders to meet patient needs, and 84% requested revised orders to ensure compliance. Suboptimal care and delays in care significantly and strongly (regression coefficients > /=0.69) predicted moral distress. CONCLUSIONS: Critical care nurses perceive TJC medication titration standards to adversely impact patient care and contribute to moral distress. The improved 2020 updates to the standards do not address delays and inability to comply with orders, leading to moral distress. Advocacy is indicated in order to mitigate unintended consequences of TJC medication management titration standards
Turkish Journal of Chemistry’nin Bibliyometrik Analizi
No full texthis article dealing with the bibliometric analysis of 861 articles published between the years 1995-2007 of Turkish Journal of Chemistry which has been indexed by the Social Science Citation Index and Chemical Abstract since 1995. The following research questions have been discussed: Who are the most productive author? What is the relationship between the authors? What is the trend towards multiple authorships in TJC? What are the institutional affiliations of authors? Does the distribution of authors fit Bradford’s, Lotka’s and Price’s Law and 80/20 Rule? Which types of sources get cited more often in articles? Which journals are the most cited? According to cited journals what are the core journals in chemistry? With regard to impact factor, what is the place of TJC in JCR and SCI?
The most productive authors are Sakıp Ali and İhsan Çalış. Distribution of authors does not fit Bradford’s, Lotka’s and Price’s Law and 80/20 Rule, but distirbution of citations fit Bradford and 80/20 Rule. Contributors affiliated with Hacettepe University, Ankara University, and Ataturk University. Journals received %82 of all citations in the TJC. Turkish Journal of Chemistry, Journal of the American Chemical Society, Phytochemistry and Journal of Organic Chemistry were the most frequently cited journals. Number of references made to TJC has been growing consistently since 1996
Twitter Journal Club
No full textCuratorial note from Digital Pedagogy in the Humanities: Laura Gogia started Twitter Journal Club (originally #tjc15) while she was a graduate student; people agree to read an article together at a designated time period and live tweet as they go (occasionally with the author responding on Twitter). A hashtag on Twitter allows anyone to observe at any time and jump in whenever they like; they do not need to be part of the community, nor does using a hashtag make them part of the community if they do not wish to use it regularly. Discussion can be synchronous, planned or spontaneous, or asynchronous over an extended time period. Participation does not require membership in a community, but helps build a PLN, as Shelly Terrell explains (Rheingold). This artifact serves as both a model and a tutorial. See this article by Gogia and Warren in Hybrid Pedagogy for the backstory behind #TJC
DNP Final Report: TeamSTEPPS for Nursing Students
No full textThe purpose of this paper is to discuss the DNP project, which focused on improving communication skills for associate degree nursing students. The background and significance of this problem was identified, a systematic review of the literature was completed, and TeamSTEPPS, based on the body of evidence, was implemented in a clinical immersion setting. The project objectives were to implement communication techniques, using TeamSTEPPS, as recommended from the body of evidence. The anticipated outcomes were that nursing students would have increased confidence in asking questions in the clinical setting, reduced fear of communicating, and improved patient safety. A review of the literature supported the use of TeamSTEPPS for nursing students to improve communication skills (AHRQ, 2018). Failures of communication, including miscommunication during hand-offs, contribute to two of every three of the most serious events reported to The Joint Commission (TJC) sentinel events (Starmer et al., 2014). These findings led to the focus of this author\u27s clinical question: Do xi nursing students lack the ability to confidently communicate and ask questions for safe patient care? The project design was a clinical immersion of TeamSTEPPS for fourth-semester nursing students for one clinical semester with pre-and post-survey. Results included student reports of feeling decreased fear in asking questions in the clinical setting after the TeamSTEPPS communication clinical immersion project. Sustainability, limitations, and conclusions were reviewed, and a recommendation was offered to include TeamSTEPPS in the pre-licensure nursing curriculums. DNP impact and encapsulation of experience summary were offered
Improving pain reassessment and documentation in the emergency room
No full textPurpose: The Quality Improvement initiative targeted increased pain reassessment and documentation frequency among adult ER patients aged 18 and above, facilitated by ED RNs. During the TJS/CMS survey spanning 2020-2022, this site demonstrated insufficient pain assessment and documentation compliance.
Methodology: The study spanned four weeks and incorporated a multifaceted approach to intervention. The interventions included comprehensive in-service training for ED staff, a review and revision of the pain management policy documentation, implementation of hard stops within the medical record system to prompt pain assessment, the introduction of timed intervals for pain reassessment, and the incorporation of visual aid reminder tools to reinforce assessment practices. Data abstraction encompassed pain assessment and documentation rates, particularly focusing on the frequency and accuracy of pain reassessment among the specified patient population. The pre-implementation data served as a baseline, while post-implementation data allowed for an evaluation of the effectiveness of the interventions in improving pain assessment compliance.
Results: The study findings indicated a notable increase in the frequency of pain assessments among patients following the implementation of the pain assessment education program. Statistical analyses, including chi-square tests and two-sample t-tests, were conducted to examine outcome differences between the pre- and post-intervention groups. Pain assessments were conducted more frequently at post-med in the post-sample group, accounting for 55.7% of the time, compared to 26.7% in the pre-sample group. Furthermore, there was compelling evidence suggesting that the pain education program led to a greater reduction in patients' pain levels.
Implications for Practice: The project findings recommended a comprehensive approach to enhance RN compliance with pain assessment and documentation in the Emergency Department (ED). Strategies involved implementing monthly pain champion announcements, integrating the organization's pain policy and TJC/CMS orientation for new RNs, adopting more frequent chest pain reassessments, conducting regular pain audits involving charge nurses and Emergency Management personnel, and considering a future upgrade to the EPIC MAR with color-coded prompts. These measures aimed to cultivate a culture of vigilance toward pain assessment protocols, potentially improving patient care quality and aligning with regulatory standards in the Emergency Department.D.N.P.Includes bibliographical reference
Utilization of a suicide screening tool to increase suicide screening in adults in the emergency department
No full textPurpose of Project: Depression is a common and treatable illness characterized by cognitive and physical dysfunction (Centers for Disease Control and Prevention [CDC], 2018). It is a leading cause of disability and may potentially lead to suicide (Friedrich, 2017). Unfortunately, depression seems to remain a stigma, which can possibly lead to poor prognosis. Thus, according to the U.S. Preventative Services Task Force (USPSF), it is strongly recommended that screening for depression and suicide be enabled, especially in those facilities who possess the appropriate resources (2016). Facilities available may include physician offices, clinics, urgent care centers, and emergency departments (EDs). Unfortunately, not all facilities routinely screen for depression. Several EDs lack the proper tools necessary to promptly identify those at risk for depression and suicide (The Joint Commission [TJC], 2016). This may be due to a variety of issues including inadequate regulations, outdated policies, insufficient staff training, and poor integration with other health settings in the community (Agency for Healthcare Research and Quality [AHRQ], 2016). To address this issue, it is vital to ensure health care providers in the emergency room are actively screening all individuals for mental health illness, specifically depression and suicide. The purpose of this study is to foster increased awareness and early detection of depression and suicide risk.
Methodology: This project was a quality improvement study that used a quasi-experimental approach, involving prospective and retrospective chart-review data. Data was collected and analyzed to determine the effectiveness of the implemented suicide screening tool in association with prompt detection, diagnosis, treatment, and appropriate referrals. Behavioral health stigma was also evaluated among ED nurses using pre and post surveys to determine the relationship between nursing perception of suicide and effective screening.
Results: Nurse Survey Findings - After implementation of the suicide screening tool in the Monmouth county ED, SOSS survey scores remained the same. Both the pre- and post- survey scores illustrated a neutral level of stigma against suicide. Thus, nurses’ views of those who commit suicide may not have been influenced despite education and practice change. In comparison, the Middlesex county ED had a statistically significant difference in results between the pre- and post- survey. This may indicate that stigma levels decreased among nurses after education and reinforcement of the importance of effectively utilizing the suicide screening tool. Patient Findings - At the Monmouth county ED, before the implementation of the PSS-3 tool, only 10% of patients were screened for suicide. Of the 191 patients, five who had a chief complaint other than a psychiatric problem received a consultation. With the newly implemented screening tool, there was a 40% increase in psychiatric consults and a 58% increase in admission for further evaluation and treatment. At the Middlesex county ED, 93% of patients were screened retrospectively. However, only two patients received a psychiatric consult, and both had a chief complaint of “suicide”. After education, screening increased by 3%. Not only were more patients screened, psychiatric referrals and admissions doubled.
Implications for Practice:
Clinical Practice - The emergency room proves to be an ideal setting for diagnosing and treating mental health disorders as well as suicide. Screening should be done no matter the chief complaint.
Healthcare Policy - This study follows the suggestions published by The Joint Commission (Sentinel Alert Event 56) that steps be put in place to detect suicide ideation.
Quality and Safety - Prevention and screening have the potential to greatly reduce suicide rates, promoting quality care.
Education - One of the most successful prevention strategies involves programs that educate health care professionals. This study displayed that with education nurses were more aware and motivated to effectively screen for suicide.
Economic Implications - This project is an economically low-cost intervention in the ED.DNPIncludes bibliographical reference
Evolution of microgastropods (Ellobioidea, Carychiidae): integrating taxonomic, phylogenetic and evolutionary hypotheses
No full textBACKGROUND: Current biodiversity patterns are considered largely the result of past climatic and tectonic changes. In an integrative approach, we combine taxonomic and phylogenetic hypotheses to analyze temporal and geographic diversification of epigean (Carychium) and subterranean (Zospeum) evolutionary lineages in Carychiidae (Eupulmonata, Ellobioidea). We explicitly test three hypotheses: 1) morphospecies encompass unrecognized evolutionary lineages, 2) limited dispersal results in a close genetic relationship of geographical proximally distributed taxa and 3) major climatic and tectonic events had an impact on lineage diversification within Carychiidae.
RESULTS: Initial morphospecies assignments were investigated by different molecular delimitation approaches (threshold, ABGD, GMYC and SP). Despite a conservative delimitation strategy, carychiid morphospecies comprise a great number of unrecognized evolutionary lineages. We attribute this phenomenon to historic underestimation of morphological stasis and phenotypic variability amongst lineages. The first molecular phylogenetic hypothesis for the Carychiidae (based on COI, 16S and H3) reveals Carychium and Zospeum to be reciprocally monophyletic. Geographical proximally distributed lineages are often closely related. The temporal diversification of Carychiidae is best described by a constant rate model of diversification. The evolution of Carychiidae is characterized by relatively few (long distance) colonization events. We find support for an Asian origin of Carychium. Zospeum may have arrived in Europe before extant members of Carychium. Distantly related Carychium clades inhabit a wide spectrum of the available bioclimatic niche and demonstrate considerable niche overlap.
CONCLUSIONS: Carychiid taxonomy is in dire need of revision. An inferred wide distribution and variable phenotype suggest underestimated diversity in Zospeum. Several Carychium morphospecies are results of past taxonomic lumping. By collecting populations at their type locality, molecular investigations are able to link historic morphospecies assignments to their respective evolutionary lineage. We propose that rare founder populations initially colonized a continent or cave system. Subsequent passive dispersal into adjacent areas led to in situ pan-continental or mountain range diversifications. Major environmental changes did not influence carychiid diversification. However, certain molecular delimitation methods indicated a recent decrease in diversification rate. We attribute this decrease to protracted speciation
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Dual-baseline search for active-to-sterile neutrino oscillations in NOvA
No full textWe report a search for neutrino oscillations to sterile neutrinos under a model with three active and one sterile neutrinos (3+1model). This analysis uses the NOvA detectors exposed to the NuMI beam, running in neutrino mode. The data exposure,13.6×1020protons on target, doubles that previously analyzed by NOvA, and the analysis is the first to usecharged-current interactions in conjunction with neutral-current interactions. Neutrino samples in the near and far detectors are fitted simultaneously, enabling the search to be carried out over aΔ241range extending 2 (3) orders of magnitude above (below)1 eV2. NOvA finds no evidence for active-to-sterile neutrino oscillations under the3+1model at 90% confidence level. New limits are reported in multiple regions of parameter space, excluding some regions currently allowed by IceCube at 90% confidence level. We additionally set the most stringent limits for anomalousappearance forΔ241≤3 eV2.</p
Provider Adherence to Practice Guidelines in Overcoming Hypothermia in the Postoperative Period
No full textBackground: The implementation of a standardized warming protocol aims to prevent hypothermia in the postoperative period. Hypothermia in the postoperative period can result in inadvertent adverse outcomes for patients undergoing surgical procedures. In 2011, The Joint Commission (TJC) and Center for Medicare and Medicaid (CMS) issued the Surgical Care Improvement Project (SCIP) Inf-10 guidelines, known as the body temperature management guidelines, to decrease morbidity and mortality in surgical patients undergoing general anesthesia. These guidelines recommend using an active warming system, such as the 3MTM Bair Hugger TM System to warm patients intraoperatively.
Review of Literature: Randomized control trials (RCTs) and meta-analysis were included as part of the literature review with the use of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Collaboration and Medline databases.
Purpose: In this study, the research aims to evaluate the effectiveness of preventing hypothermia in a hospital that adopted the evidence-based body temperature management guidelines.
Methods: The author retrospectively analyzed a total of 243 medical records, which included 158 paper medical records and 85 electronic medical records using the hospital’s information management system. As part of the study, two groups, each consisting of 50 patient medical records meeting inclusion criteria, were analyzed. A total of 108 paper medical records and 85 electronic medical records were excluded from the study for not meeting criteria.
Results: Patients were randomized and divided into two groups. Group A (n=50) consisting of patients who did not receive active warming in 2010, and Group B (n=50) consisting of patients who received the active warming intervention in 2020. Group B revealed a mean body temperature that was 0.1° Celsius higher than Group A. At the end of surgery, Group A demonstrated nearly a 15% higher incidence of hypothermia when compared to Group B. Descriptive statistics were analyzed using an independent sample t-test, assuming unequal variance for the two groups. There was a statistically significant difference between the two groups (P \u3c 0.028). The study’s results support the use of forced air warming (FAW) in the intraoperative period as an effective way of preventing postoperative hypothermia in the Post Anesthesia Care Unit (PACU).
Implications/Conclusion: This study assessed the effectiveness of SCIP Inf-10 guidelines in preventing hypothermia in patients undergoing surgical procedures. Prior to 2011, there were no recommendations issued by TJC or CMS to actively warm patients. Active warming, as characterized by the 3MTM Bair Hugger TM System warming system has been shown to be decrease morbidity and mortality, surgical site infections and other complications. Group B, which consisted of patients having undergone surgical procedures in 2020, were actively warmed and experienced a 0% incidence of hypothermia. Group A, which consisted of patients having undergone surgery before the release of SCIP Inf-10 guidelines, experienced nearly a 15% incidence of hypothermia. It is reasonable to conclude that the utilization of body temperature management guidelines is effective in preventing hypothermia in patients undergoing surgical procedures
