Emergency care nurses' self-reported clinical competence before and after postgraduate education - a cross-sectional study.

Changing prerequisites in healthcare leads to the increased complexity of nursing. Since there are no regulations on re-validation of competencies for emergency nurses in Sweden there is sparse knowledge on how nurses develop competencies after registration as nurses (RN). AIM: To describe self-reported professional competence after postgraduate education among RNs in emergency care settings. METHOD: A cross-sectional design and STROBE guidelines were used. The short version of the Nurse Professional Competence Scale was used for data collection and the data were collected before and after postgraduate education, descriptive and comparative statistic was used for analysis. RESULTS: 62 (71%) students participated in the first data collection and an independent group of 31 (48%) students participated in the second data collection. The results showed generally good competencies before entering education and significantly improved competencies after education were found in areas of working independently and reviewing literature for evidence-based nursing Conclusion: The competencies were assessed as very good after education. Evaluating nurses' competencies supports educators in developing education to ensure the need for knowledge in emergency care. To ensure required competencies among emergency care nurses there is a need to regulate additional training and re-validation of emergency nurses' competencies.

Maternal mental health and adverse birth outcomes.

Recent research in economics emphasizes the role of in utero conditions for the health endowment at birth and in early childhood and for social as well as economic outcomes in later life. This paper analyzes the relation between maternal mental health during pregnancy and birth outcomes of the child. In particular, we analyze the relationship between maternal mental health during pregnancy and the probability of giving birth preterm (PT), having a newborn at low birth weight (LBW) or being small for gestational age (SGA). Based on large population-representative data from the German Socio-Economic Panel (SOEP) and cohort data from the National Educational Panel Study (NEPS), we present extensive descriptive evidence on the relationship between maternal mental health and preterm birth by carrying out OLS estimates controlling for a wide range of socioeconomic characteristics. In addition, we apply matching estimators and mother fixed effects models, which bring us closer toward a causal interpretation of estimates. In summary, the results uniformly provide evidence that poor maternal mental health is a risk factor for preterm birth and low birth weight in offspring. In contrast, we find no evidence for an relationship between maternal mental health and small for gestational age at birth.

Barriers in achieving patient participation in the critical care unit.

OBJECTIVES: Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. Therefore, this study aims to identify barriers to patient participation in the critical care unit, as identified by critical care nurses. DESIGN AND SETTINGS: Qualitative data were collected in four focus group interviews with 17 nurses from two separate hospitals. The interviews were analyzed using qualitative content analysis. FINDINGS: The results show three main categories: nurse's attitude toward caring, the organization of the critical care unit and the patient's health condition. CONCLUSION: Barriers for patient participation in the ICU were found and this lead to a power imbalance between patient and nurse. In contrast to other care settings, this imbalance could be a consequence of the critical care organization and its degree of highly specialized care. The clinical application of our results is that these barriers should be considered when implementing patient participation in such a highly technological care situation as a critical care unit.

Quality of patient care in the critical care unit in relation to nurse patient ratio: A descriptive study.

BACKGROUND: Intensive care is one of the most resource-intensive forms of medical care due to severely ill patients that are cared for in units with high staffing levels. Nursing's impact on the health of patients has shown that the number of nurses per patient and nurse education effects patient outcome. However, there are a lack of studies investigating highly specialised nurses in intensive care and their relation to patient outcome. METHOD: This is a retrospective study of critical care registry data (all patients >15 years) in general critical care units at seven university hospitals. RESULTS: Patient care and complications in relation to nurse/patient ratio showed that unplanned extubations occurred in 3-5.7% of cases. A difference between hospital patients' length of time on ventilation was found with the hospitals with the least amount of patients and with 0.5-0.6 specialist-nurse/patient a longer time on ventilation was noted. The length of ICU stay showed differences between the hospitals and nurse/patient ratios, with higher nurse/patient ratio with the longer length of ICU stay. CONCLUSION: Despite similarities between hospitals in relation to SAPS III on admission to critical care, there was a difference in nurse/patient ratios ranging from 1:1 to 0.5:1 and mean time on both invasive and noninvasive ventilation.

Actions to improve documented pain assessment in adult patients with injury to the upper extremities at the Emergency Department - A cross-sectional study.

BACKGROUND: Pain is one of the most common symptoms in the Emergency Department (ED) and is the cause of more than half of the visits to the ED. Several attempts to improve pain management have been done by using, for example, standards/guidelines and education. To our knowledge no one has investigated if and how different actions over a longitudinal period affect the frequency of pain documentation in the ED. Therefore the aim of this study was to describe the frequency of documented pain assessments in the ED. METHOD: A cross-sectional study during 2006-2012 was conducted. The care of patients with wrist/arm fractures or soft tissue injuries on upper extremities was evaluated. RESULT: Despite various actions our result shows that mandatory pain assessment in the patient's computerized medical record was the only successful intervention to improve the frequencies of documentation of pain assessment during care in the ED. During the study period, no documentation of reassessment of pain was found despite the fact that all patients received pain medication. CONCLUSION: To succeed in increasing the frequency of documented pain assessment, mandatory pain rating is a successful action. However, the re-evaluation of documented pain assessment was nonexisting.

Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study.

Pain management is described to be insufficient for patients suffering from a hip fracture, and the management for this vulnerable group of patients may be challenging due to their medical history (multiple comorbidities) and polypharmacy. Previous research has mainly focused on fast tracks aiming to reduce time to surgery. But the research on how pain management is handled for these patients in the prehospital context has been sparse. Therefore, the purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture. A descriptive and qualitative design with Critical Incident Technique was used for collecting data. Moreover, a qualitative content analysis was used for analysing the collected data. Twenty-two participants communicated their experiences and 51 incidents were analysed. The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to individualize the pain relief for patients with a suspected hip fracture through a variety of interventions.

Preference for pasture versus freestall housing by dairy cattle when stall availability indoors is reduced.

Providing cattle with access to pasture has been shown to yield benefits, including access to more space, fewer agonistic interactions, better air quality, and the ability to perform a greater range of normal behaviors. Preference for pasture appears to depend on several parameters, including weather conditions and availability of shade. The primary aim of this study was to evaluate the preference for pasture versus inside a freestall barn with variable stocking densities at the stalls. We also investigated the effect of temperature-humidity index (THI) and precipitation on this preference. Overall, cows spent on average 13.7±2.6 h/d (mean ± SD) on pasture (ranging from 7.2 to 18.0 h/d across days); at night (between 2000 and 0600 h) cows spent the majority of their time (78.5±27.8%) on pasture. Stall availability had no effect on time spent outside, but time spent on pasture decreased with increasing THI during the day and declined during nights with more rainfall. Stall usage changed depending on stall availability; standing with 2 and 4 feet in the stall and lying time indoors decreased with decreasing stall availability. Indoor lying time also increased with higher THI and more precipitation. In conclusion, cows preferred to be outside at night; they were much more likely to remain indoors during the day, even when overstocked.

Management and classification of children with head injury.

BACKGROUND: Traumatic brain injury is the most common cause of morbidity and mortality during childhood. AIM: This study was conducted to describe the primary management and classification of children admitted to the emergency department for head trauma. SERIES: All children (0-15 years) with a history of head injury who were admitted to the outpatient emergency department at a single paediatric trauma centre in the Stockholm region during 1 month were included. RESULTS: There were 242 children (137 girls and 105 boys; mean age 5.3+/-4.4 years) who fulfilled the inclusion criteria. Based on the Scandinavian Head Injury Classification, 73% were classified as minimal, 17% mild and 2% moderate head injury. This classification seemed to be more accurately reflective than the ICD-10-based classification in the management of the children with head trauma.