ABSTRACT
BACKGROUNDS: Moral distress significantly affects pediatric ICU nurses, leading to nurse burnout, increased turnover and reducing patient care quality. Despite its importance, there's a notable gap in knowledge on how to manage it effectively. AIMS: This review aimed to systematically identify and analyze coping strategies and interventions targeting moral distress among pediatric nurses in ICU, uncovering research gap and future studies directions. METHODS: A scoping review was conducted followed framework by Levac, Colquhoun, and O'Brien and Arksey and O'Malley. Searches were performed in 11 electrical databases, like PubMed and China Biology Medicine disc, within a timeframe of the database construction to November 2023, and performed literature screening and data extraction. RESULTS: Sixteen articles were ultimately included. Coping strategies adopted by pediatric ICUs nurses can be categorized into adaptive and maladaptive strategies, with the latter including passive acceptance, taking leave, and drinking, while the former involve pursuing interests outside of work, reflection and philosophizing, and communication. Nine articles described and evaluated the effectiveness of interventions for moral distress, categorizing them into individual and institutional levels. Individual-level interventions include Interprofessional Perspective-Taking, the PICU Resiliency Bundle, Ethics Education/Skills, and the Center for Caring. Institutional-level interventions encompasses Comprehensive Care Round, Goals of Care Conversations, Pediatric Ethics and Communication Excellence Rounds, Nursing Ethics Council, and Medical Ethical Decision-Making, though not all were effective in alleviating moral distress. CONCLUSIONS: Nurses often use self-adjustment strategies for moral distress, institutional ethical support focusing on enhancing nurses' moral resilience, promoting reflective thinking and improving communication remains crucial. Various interventions for moral distress are currently available, but nurse engagement is low and their effectiveness remained to be verified. Future studies should explore what aids or hinders these interventions. There's also a need for large, multicenter trials and ongoing evaluations to create effective support systems for pediatric ICU nurses.
ABSTRACT
In this study, density function theory (DFT) is employed to compute Raman spectra of 40 important Perfluoroalkyl substances (PFASs) as listed in Draft Method 1633 by U.S. Environmental Protection Agent. A systematic comparison of their spectral features is conducted, and Raman peaks and vibrational modes are identified. The Raman spectral regions for the main chemical bonds (such as C-C, CF2 & CF3, O-H) and main functional groups (such as -COOH, -SO3H, -C2H4SO3H, and -SO2NH2) are identified and compared. The impacts of branching location in isomer, molecular chain length, and functional groups on the Raman spectra are analyzed. Particularly, the isomers of PFOA alter the peak locations slightly in wavenumber regions of 200 - 800 and 1000 - 1400 cm-1, while for PFOS, spectral features in the 230 - 360, 470 - 680, and 1030 - 1290 cm-1 regions exhibit significant difference. The carbon chain length can significantly increase the number of Raman peaks, while different functional groups give significantly different peak locations. To facilitate differentiation, a spectral database is constructed by introducing controlled noise into the DFT-computed Raman spectra. Subsequently, two chemometric techniques, principal component analysis (PCA) and t-distributed stochastic neighbor embedding (t-SNE), are applied to effectively distinguish among these spectra, both for 40 PFAS compounds and the isomers. The findings demonstrate the promising potential of combining Raman spectroscopy with advanced spectral analysis methods to discriminate between distinct PFAS compounds, holding significant implications for improved PFAS detection and characterization methodologies.
