Pseudoclitoromegaly from acute T-cell lymphoblastic leukemia.

A 7-year-old girl presented with painful genital enlargement, which was first believed to be clitoromegaly of hormonal origin. However, on the physical exam the clitoris was not visible and the prepuce and labia minora were enlarged and tender. Magnetic resonance imaging demonstrated an infiltrative abnormal signal with restricted diffusion involving the enlarged clitoris and adjacent soft tissues of the prepuce and labia minora, confirming a nonhormonal infiltrative malignancy. The same abnormal signal was present in enlarged inguinal lymph nodes, the kidneys, and an anterior mediastinal mass. The pathologic diagnosis was T-cell acute lymphoblastic leukemia.

The experiences of new graduate nurses hired and retained in adult intensive care units.

BACKGROUND: It is a common practice that new graduate Registered Nurses are hired into adult intensive care units as initial entry into practise. There exists a practice readiness gap between nursing curricula and actual clinical practise expectations at adult intensive care settings; this has led to negative consequences and subsequent nurse turnover, a concern nationwide. Nonetheless, some new graduate nurses survived their initial transition and continue to practise in adult settings. The purpose of this study was to explore the experiences of nurses who were hired into adult intensive care as a new graduate and survived their transition from novice to competent, starting the third year of practise. METHODOLOGY: The study used the hermeneutic phenomenology research approach. FINDINGS: Data analysis revealed the overall meaning of the experience: coming to terms with being comfortable with being uncomfortable. The six themes associated with being comfortable with being uncomfortable were: confidence and uncertainty, gaining experiences and forever learning, intuitive knowing and intuition, difficult and stressful, being courageous and assertive, and the team and support people. CONCLUSION: New graduate nurses can survive to become competent adult intensive care nurses. This study reveals the need to promote exposure to a variety of clinical situations early, to promote resilience and self-care, and to foster unit teamwork and mentoring to ensure successful transition and overall retention of new nurses hired into in adult intensive care.

Developing professional competence among critical care nurses: An integrative review of literature.

BACKGROUND: Professional competence is the ability to base clinical decisions on prior experiences with particular clinical situations. METHODS: An integrative review of the literature using the methodology of Whittemore and Knafl. The guiding question was: What is the extent and nature of the published literature on intensive care nurses developing professional competence? RESULTS: This review analysed 21 peer-reviewed articles obtained from electronic databases. The three main domains of professional competence were managing situations, decision-making and teamwork. Three instruments, the Critical Care Competency Assessment instrument, the Self-Assessment Competence Tool, and the Intensive and Critical Care Nursing Competence Scale (intensive care unit), measure professional and/or clinical competence. Demographic factors are experience, education, age, figure tow near here certification status, gender and location. CONCLUSION: Perception of self-competence, seeing beyond the technical aspects of care to the patient, and perceptions of and bonding with intensive care patients and their families are other facets of professional competence that warrant further study.

Competency-based training for PMH nurse generalists: inpatient intervention and prevention of suicide.

Suicide is the tenth leading cause of death in the United States. Approximately 90,000 psychiatric mental health (PMH) nurse generalists work in hospitals in the United States, mostly on inpatient psychiatric units where the most acutely suicidal patients are hospitalized. Although competencies have been developed for mental health clinicians in assessing and managing suicide risk, there are no standard competencies for PMH nurse generalists. Widely accepted nursing practices do not meet suicide-specific standards of care or evidence-based criteria. Although both the Commission on Collegiate Nursing Education Essentials for Baccalaureate Education and the Quality and Safety Education for Nurses competencies stress the necessity for comprehensive assessment, safe clinical practices, patient-centered care, evidence-based interventions, and interprofessional communication and collaboration, there are no specific requirements for suicide prevention training in educational and clinical programs. The American Psychiatric Nurses Association has an opportunity to provide leadership in developing, implementing, and evaluating competency-based training for nurses and partner with the national effort to increase the competencies in suicide prevention in the behavioral health workforce.

Supporting a psychiatric hospital culture of safety.

BACKGROUND: Concerns for patient safety have risen to the forefront of health care, including mental health care. Safe patient care depends, to a large extent, on high functioning teams, yet team training is lacking in basic professional training programs. To address the need for team training, one psychiatric hospital adopted the Team Strategies and Tools to Enhance Performance and Patient Safety program (TeamSTEPPS). OBJECTIVES: To describe the implementation of TeamSTEPPS throughout the organization and to describe the differences in team attributes prior to and following implementation of TeamSTEPPS. DESIGN: Quality improvement project using a pre-post survey design. RESULTS: TeamSTEPPS was successfully implemented, and changes in all team attributes trended in a positive direction with 5 of 7 subscales reaching significance (p ≤ .01). CONCLUSIONS: TeamSTEPPS provided a practical approach for our hospital to systematically weave safety throughout the culture and improve team functioning and other attributes of highly effective teams.

Relocating the Menninger Hospital: a nursing perspective.

The move of the Menninger Hospital represented a special challenge to the direct care nursing staff. As the efforts to implement an effective translocation of the clinical services moved forward, the goal included an effective transfer of the long-established therapeutic community and practices of Menninger into the new setting. This article reviews the challenges, processes, and problems in achieving that goal.

The cultural adjustment and mental health of Japanese immigrant youth.

Interviews were conducted with eight Japanese immigrant youth about their experiences with respect to adjusting to life in the United States, dealing with discrimination, and coping with cultural challenges. They were also questioned about their mental health and family and peer relations. Results indicate that participants managed to maintain bicultural identities and to cope with the problems that they encountered. Nevertheless, they experienced the following difficulties: racism and prejudice, language barriers, and conflict regarding identity and values. In terms of coping, participants mostly relied on friends for support; only one had sought the help of a professional counselor. The implications of the findings are discussed in terms of working with immigrant youth from Japan.