Effect of Coulomb scattering on low-pressure high-density electronegative discharges.

For electronegative plasmas with low gas pressure and high ion densities, we expect Coulomb collisions between positive and negative ions to dominate over collisions between ions and neutrals. We incorporated Nanbu's cumulative small-angle collision method [K. Nanbu, Phys. Rev. E, 55, 4642 (1997)] into our one-dimensional three-velocity-component particle-in-cell code PDP1 in order to study the effect of Coulomb collisions on low pressure high density electronegative discharges. Nanbu's method treats a succession of small-angle binary collisions as a single binary collision with a large scattering angle, which is far faster than treating each individual small-angle collision. We find that Coulomb collisions between positive and negative ions in low-pressure high-density electronegative discharges significantly modify the negative ion flux, density, and kinetic energy profiles.

Adult patients looking at their burn injuries for the first time.

A total of 222 burn nurses from 30 burn centers completed a questionnaire about how and when a burn patient looks at their burn wound for the first time. The registered nurse is most frequently with the patient when the patient sees the wound for the first time (n = 187; 84%). Looking at the wound is not usually a planned event, and it is not documented in the patient record. Nurses use verbal and nonverbal patient cues to determine when it is appropriate for the patient to look initially at the wound and combine this initial look with an opportunity to teach wound healing. The patient asks the nurse for an opinion about the way the wound looks (n = 181; 81.5%). The nurse uses silence, presence-of-self, and gentle encouragement with the patient while remaining positive and honest. Respondents reported that the patient wants the truth but also needs reassurance and some degree of optimism when viewing the wound for the first time.

Pain and anxiety with burn dressing changes: patient self-report.

Pain and anxiety are integral parts of burn dressing care. Descriptions of pain and anxiety from the patients' perspectives enhance our understanding of their experiences. This descriptive study measured relationships between self-reported pain and anxiety. Twenty-four patients who had an uncomplicated flame or scald wound reported scores immediately before, immediately after, and 1/2 hour after dressing changes. Results indicated that pain and anxiety increased until day 4. Pain correlated with anxiety. Self-report scores showed that pain and anxiety are perceived by patients in a similar manner. Self-report scores are of great value because they indicate the degree of relief achieved with medication. Through the descriptive study, we found that the pain score immediately after dressing changes was greater than 3 on all study days. This finding indicates a need to further examine the way pain is managed with dressing changes.

Developing a teaching video on mechanical ventilation weaning to facilitate effective nursing research.

This article describes the process of developing a teaching video associated with conducting a nursing research study and directed at educating critical care staff nurses about the process of successfully weaning patients from mechanical ventilation. Techniques on developing the script and filming and editing the video are presented. The results of this process included staff empowerment and a teaching video used by 10 hospitals in a multi-site research project.

Preparing staff for opening of a new ventilator unit in long-term care.

1. The desired outcome of providing a safe environment for the resident on a mechanical ventilator was realized through an educational program that focused on knowledge and skill competency. 2. The program content included a didactic lecture, skills demonstration and competency evaluation through use of a mannequin with a tracheostomy tube on a mechanical ventilator to simulate life-like situations. 3. Staff without long-term care experience require additional learning opportunities addressing the specialized needs of the long-term care resident and family.

Outcomes of a pneumonia critical path.

Research outcomes of a pneumonia critical path for 73 patients in a metropolitan New York City hospital were analyzed. The positive outcomes included a decreased length of stay, decreased hospital charges, and improved multidisciplinary documentation.

Preventing complications in severe exfoliative skin diseases.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome Type II are both exfoliative skin diseases with complications similar to burn patients. The critical care nurse's responsibility is to recognize the disease processes early and assure aggressive nursing care is provided to prevent the serious respiratory, gastrointestinal, sepsis, renal, and pain complications.

Conflict with less distress: promoting team effectiveness.

As nurses increasingly turn to teamwork as a viable option for accomplishing a myriad of duties and responsibilities, they are discovering that teamwork can also be a source of conflict and stress. This article suggests that conflict is both inevitable and necessary within a team. A model of conflict is presented that aims not at reducing conflict, but at making it less distressing and thus more effective. The authors trace the influence of pre-conflict conditions and perspective-taking on conflict and ultimately team effectiveness. Finally, to apply the conflict model to practice, two examples are presented demonstrating both an ineffective and an effective use of conflict.

Use of midazolam--an alternative for controlled sedation.

Midazolam hydrochloride (midazolam) is a short-acting central nervous system depressant that allows controlled sedation of the patient after open-heart surgery. Use of an intravenous (IV) loading dose induces sleep rapidly, and can be supplemented by a titratable infusion to allow variations in the sleep-wake cycle. A loading dose of 0.1 mg/kg is given slowly IV. A continuous infusion with the dose based on mcg/kg calculation allows the nurse to titrate the infusion based on the desired therapeutic response.

A comparison of a new graduated estrogen formulation with three constant-dosed oral contraceptives.

Four-hundred-twenty-six women, aged 18 to 36, completed a four-cycle comparative, randomized, single-blind (observer blind), multicenter study of a new graduated estrogen formulation with three constant-dosed combination oral contraceptives containing the same synthetic steroid compounds. The products studied were Loestrin 1/20, Loestrin 1.5/30, Norlestrin 1/50, and a new graduated estrogen product, Estrostep. A total of 1,850 cycles were completed and analyzed for efficacy, side effects, metabolic changes, and cycle control. Four pregnancies occurred during the course of the study. None of the pregnancies occurred in the group receiving Estrostep. The new formulation produced the lowest rate of breakthrough bleeding (BTB) compared with the other three products. All four combination oral contraceptives resulted in an increase in high-density lipoprotein cholesterol (HDL-C). The levels of HDL-C were greatest with Estrostep.