Global Citizens - Global Jet Setters? The Relation Between Global Identity, Sufficiency Orientation, Travelling, and a Socio-Ecological Transformation of the Mobility System.

Global crises such as the climate crisis require fast concerted action, but individual and structural barriers prevent a socio-ecological transformation in crucial areas such as the mobility sector. An identification with people all over the world (i.e., global identity) and an openness toward less consumption (i.e., sufficiency orientation) may represent psychological drivers of a socio-ecological transformation. We examined the compatibility of both concepts as well as their relation to people's support of a decarbonised mobility system and their flight mobility behaviour - a CO2-intensive behaviour that may be particularly difficult to refrain from for globally identified people, but less so for sufficiency-oriented people. In an online study conducted in Germany (N = 317), we found that global identity and sufficiency orientation were positively related. Both were negatively related to past flight-related CO2 emissions and positively related to refraining from flying and the support of decarbonised mobility policies. Accounting for both showed that sufficiency orientation in particular was related to fewer flight-related CO2 emissions and refraining from flying. Furthermore, we examined people's travel experiences. While global identity was unrelated to the frequency and duration of international travelling, it was positively related to the frequency and quality of contact with local people met on journeys. An experimental variation of whether participants first answered questions on global identity or on travel experiences revealed that remembering past international travelling led to higher reported levels of global identity. Taken together, global identity seems to profit from in-depth international contact with people, but can be decoupled from resource-intensive travel behaviour. Globally identified and sufficiency-oriented people may support a socio-ecological transformation. Our results indicate a compatibility of global identity and sufficiency orientation. Experimental and longitudinal research should examine causal links to foster our understanding of the conditions under which both can be strengthened.

Hospitalized Older Adults With Established Delirium: Recognition, Documentation, and Reporting.

Delirium, a life-threatening complication for hospitalized older adults associated with adverse outcomes, is often underrecognized and underreported. The purpose of the current study was to analyze delirium documentation for hospitalized older adults. Charts of 34 patients, aged 71 and older with documented delirium and referral to a Hospital Elder Life Program, were reviewed. With the exception of International Classification of Diseases-9 coding, delirium was only mentioned in 12 (35.3%) charts, although descriptors potentially indicative of delirium were usually recorded. Of these, the most frequently recorded were confusion (94.1%), mental status change (70.6%), and disorientation (61.8%). When nurses charted delirium descriptors, only 5.9% of their notes included physician referral. Physician responses were to order diagnostic tests and medications, usually antipsychotic or benzodiazepine agents. Of 28 patients requiring transfer to another facility after discharge, delirium was mentioned in only one transfer note. Commonly used delirium descriptors can be used for the development of natural language processing tools for clinical decision support. [Journal of Gerontological Nursing, 43(3), 32-40.].

Intent to stay: a pilot study of baccalaureate nurses and hospital nursing.

Hospitals want to hire baccalaureate nurses. Even if there were sufficient numbers of baccalaureate nurses to fill hospital vacancies, however, it is unclear how long these nurses stay at the "bedside." Until the profession can ascertain how many baccalaureate nurses stay in hospital nursing, simply preparing enough of them will not suffice. Because no published studies were identified that examined either how long baccalaureate nurses stay in hospital nursing or these nurses' reasons for leaving hospital nursing, we undertook a pilot study of our own baccalaureate graduates. Specifically, this comparative descriptive pilot study examined baccalaureate nurses' average number of years in hospital nursing and their reasons for leaving or intending to leave hospital nursing. Three hundred ninety graduates responded. Forty percent had left hospital nursing after an average of 6.4 years, with a median of 5 years. Just over 56% were still practicing hospital nursing, and of these, 81.8% were staff RNs, 26.9% of whom intended to leave hospital nursing in the next 3-5 years. Nurses who intended to leave were less satisfied in their jobs (P < .0001) than those who did not intend to leave. They were also more likely to disagree that RNs played a participatory role in hospital affairs (P = .048), that there were adequate staffing and resources (P = .041), and that RN-physician relationships were collegial (P = .048). The most frequent reasons for intent to leave were the following: to advance education or to take new positions (43%), stress/burnout, long hours, and lack of administrative support/respect (21%, respectively). Only 17% cited poor pay/benefits as a reason for intent to leave. Respondents who had already left hospital nursing cited similar reasons. Dissatisfaction with the practice environment results in baccalaureate nurses leaving hospital nursing at a time when there is a critical shortage of nurses in all practice settings, but especially hospitals. Considering the accumulating evidence of superior patient outcomes in hospitals well staffed by baccalaureate nurses, it is critical to identify and implement solutions to ensure that adequate numbers of experienced, baccalaureate nurses stay at the bedside.

Sociodemographic variables predicting poor post-discharge outcomes for hospitalized elders with heart failure.

Elders with heart failure are at high risk for poor postdischarge outcomes such as rehospitalizations, emergency department use, and unscheduled physician visits. This study was conducted to determine if sociodemographic characteristics would aid in identifying high-risk individuals.

Variables predictive of poor postdischarge outcomes for hospitalized elders in heart failure.

Heart failure (HF) affects more than one million older Americans. As the population ages, the incidence of HF will increase. The purpose of this study was to identify variables that profile elders hospitalized with HF who are at high risk for poor postdischarge outcomes. A total of 103 patients were enrolled in the study. A low serum sodium and a fair or poor self-reported health status predicted all-cause readmission. A low serum sodium predicted HF-related readmissions. Four or more HF symptoms and index admission to an urban hospital predicted physician office visits. Admission to a community hospital predicted emergency department visits, and the number of coexisting medical conditions indicated an increased risk for an emergency department visit. The findings indicate that it is possible to profile hospitalized elders with HF who are at risk for poor postdischarge outcomes.