Exploring rural Nurses' preparedness and post-resuscitation experiences. An ethnographic study.

AIM: The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post-resuscitation period. DESIGN: An ethnographic study across two small rural hospital sites in New South Wales, Australia. METHODS: Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis. RESULTS: The first key theme-'Sense of Preparedness'-included three subthemes: 'Gaining experience', 'Issues with training and education' and 'Lack of warning'. The second key theme 'Aftermath' comprised two subthemes: 'Getting on with it' and 'Making sense of the resus'. CONCLUSION: This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse's experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care. IMPACT: Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment. REPORTING METHOD: Reporting complied with COREQ criteria for qualitative research. NO PATIENT OR PUBLIC CONTRIBUTION: This study explored the experiences of rural nurses. No patient data were collected.

Examining the roles of rural nurses in resuscitation care: An ethnographic study.

INTRODUCTION: Rural nurses play a vital role in the provision of resuscitation care, as first responders and often the sole healthcare professionals delivering timely interventions with greater role autonomy and extended scope of practice. Whilst there is a developing body of literature describing the 'generalist' roles of rural nurses when providing care in acute care settings, little is known about the roles rural nurses assume during a resuscitation. AIM: The aim of this study was to explore the role/s that rural nurses enact when delivering resuscitative care to their rural community. DESIGN/METHODS: An ethnographic methodology was used across two rural hospital sites in Australia, involving non-participant observation and interviews. RESULTS: Reflexive thematic analysis led to three themes that described the resuscitative roles of rural nurses: Senior and junior nurse, formal and informal leadership roles, multiple roles. CONCLUSION: This study has placed a spotlight on rural nurse's capacity to be adaptive in a dynamic and highly variable resuscitative environment. Building leadership capacity should be a rural nursing workforce strategy, aimed at supporting the unique roles that rural nurses undertake when working with various external teams during resuscitations.

Observing resuscitative practice. A novice researcher's experience of obtaining ethics approval.

Undertaking research involving vulnerable groups, such as those requiring resuscitation involves careful analysis during the ethical review process. When a person lacks the capacity to make an informed choice about their participation in a research study, a waiver of consent offers an alternative. This paper is based on a doctoral research study using ethnography to explore the resuscitative practices and experiences of rural nurses through observation and interviews. This paper aims to explore the ethical issues raised by the Human Research Ethics Committee relating to consent of vulnerable patients requiring resuscitation within a rural context. In particular, the challenges of addressing risk (privacy) vs benefit (public) associated with a waiver of consent. This paper will consider why the rural context should be championed during the ethical review process, when decisions about public benefit are being deliberated. Utilising a communitarianism approach that advocates for greater rural representation during the ethical review processes will ensure that rural research involving vulnerable groups can be addressed safely and benefit not only the experiences and practices of rural nurses but also the wider rural communities they serve.

Plant-inspired multi-stimuli and multi-temporal morphing composites.

Plants are inspiring models for adaptive, morphing systems. In addition to their shape complexity, they can respond to multiple stimuli and exhibit both fast and slow motion. We attempt to recreate these capabilities in synthetic structures, proposing a fabrication and design scheme for multi-stimuli and multi-temporal responsive plant-inspired composites. We leverage a hierarchical, spatially tailored microstructural and compositional scheme to enable both fast morphing through bistability and slow morphing through diffusion processes. The composites consisted of a hydrogel layer made of gelatine and an architected particle-reinforced epoxy bilayer. Using magnetic fields to achieve spatially distributed orientations of magnetically responsive platelets in each epoxy layer, complex bilayer architectural patterns in various geometries were realised. This feature enabled the study of plant-inspired complex designs,viafinite element analysis and experiments. We present the design and fabrication strategy utilizing the material properties of the composites. The deformations and temporal responses of the resulting composites are analysed using digital image correlation. Finally, we model and experimentally demonstrate plant-inspired composite shells whose stable shapes closely mimic those of the Venus flytrap, while maintaining the multi-stimuli and multi-temporal responses of the materials. The key to achieving this is to tune the local in-plane orientations of the reinforcing particles in the bilayer shapes, to induce distributed in-plane mechanical properties and shrinkage. How these particles should be distributed is determined using finite element modelling. The work presented in this study can be applied to autonomous applications such as robotic systems.

Voices from the 'resus room': An integrative review of the resuscitation experiences of nurses.

BACKGROUND: Nurses are often the first responders to resuscitations. Understanding their experiences of resuscitation will highlight the resuscitative context nurses work within and identify the conditions that support or hamper their delivery of safe and effective resuscitative care. AIM: The aim of this integrative review is to develop an understanding of nurses' experience of resuscitation, to gain knowledge of their challenges and identify gaps in evidence. DESIGN: Integrative review. METHODS: The electronic databases CINAHL, MEDLINE, Scopus and Web of Science were systematically searched from 2000-2021. Methodological quality of the papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was used to guide and report the integrative review. RESULTS: Eleven articles met criteria for review. Four themes arose from the literature that addressed nurses experiences of resuscitation: Chaos (external/internal), ethical dilemmas, clinical confidence and need for support. CONCLUSION: Nurses' experiences of resuscitation are multifaceted. Addressing the challenges that nurses experience during resuscitation will help ensure that nurses' are supported in their professional growth and personal well-being. Relevance to clinical practice and research: Building nursing leadership capacity within resuscitations is an area of clinical practice/research that is gaining traction as a valid solution to address the challenges nurses experience during resuscitations. Whilst the barriers to debriefing requires a greater level of consideration within the workplace.

What are we optimizing for in autism screening? Examination of algorithmic changes in the M-CHAT.

The present study objectives were to examine the performance of the new M-CHAT-R algorithm to the original M-CHAT algorithm. The main purpose was to examine if the algorithmic changes increase identification of children later diagnosed with ASD, and to examine if there is a trade-off when changing algorithms. We included 54,463 screened cases from the Norwegian Mother and Child Cohort Study. Children were screened using the 23 items of the M-CHAT at 18 months. Further, the performance of the M-CHAT-R algorithm was compared to the M-CHAT algorithm on the 23-items. In total, 337 individuals were later diagnosed with ASD. Using M-CHAT-R algorithm decreased the number of correctly identified ASD children by 12 compared to M-CHAT, with no children with ASD screening negative on the M-CHAT criteria subsequently screening positive utilizing the M-CHAT-R algorithm. A nonparametric McNemar's test determined a statistically significant difference in identifying ASD utilizing the M-CHAT-R algorithm. The present study examined the application of 20-item MCHAT-R scoring criterion to the 23-item MCHAT. We found that this resulted in decreased sensitivity and increased specificity for identifying children with ASD, which is a trade-off that needs further investigation in terms of cost-effectiveness. However, further research is needed to optimize screening for ASD in the early developmental period to increase identification of false negatives.

Students' perceptions of belonging in the School of Nursing at a regional university in Australia.

BACKGROUND: Attrition in pre-registration nursing degrees is a global issue. Students' perceptions of belonging is a factor that influences attrition. OBJECTIVE: The objective of this study was to evaluate students' perception of belonging to a School of Nursing, as well as their intention to complete the pre-registration Bachelor of Nursing (BN) program following implementation of the Initiatives for Retention (IR) intervention. DESIGN: A prospective cross-sectional survey of student nurses was undertaken using an online questionnaire. SETTING: A large regional university in Australia. PARTICIPANTS: Pre-registration nursing students. METHODS: Perceptions of Belonging were evaluated using the 24-item Belonging questionnaire comprising three subscales. Data were analysed using SPSS version 25. Pearson's correlation, Student's t-tests and one way ANOVA were used to assess associations and differences in belonging scores and student demographics, study status and participation in the Initiatives for Retention (IR) intervention. RESULTS: A total of 201 students responded to the voluntary questionnaire. The mean score for overall Belonging was 70.5 (maximum obtainable 96), mean Scores for University affiliation, University support and acceptance, and staff relations with students were 34.7, 24.1 and 11.8 respectively. Female students, those who were studying at the university for less than a year and those who participated in the IR intervention activities reported significantly higher University Belonging scores compared to their contemporaries. Logistic regression revealed that students studying the BN course for more than 3 years (OR: 0.43 95% CI 0.20-0.93, p = 0.031), and those employed (OR: 0.435, 95% CI 0.16-0.16, p = 0.022) were significant predictors of not attending the IR sessions. There were no significant differences in overall University Belonging scores based on other demographic characteristics and, study status. The majority of the students (84%) stated that they plan to continue and complete the BN program. CONCLUSIONS: Measures designed to develop student involvement may positively contribute a successful relationship between the institution and the student, increasing the students' sense of belonging and decreasing attrition among student nurses. PRACTICE IMPLICATIONS: Initiatives for Retention (IR) facilitate a greater sense of belonging in nursing students hence Schools of Nursing should consider embedding such strategies.

Dome-Patterned Metamaterial Sheets.

The properties of conventional materials result from the arrangement of and the interaction between atoms at the nanoscale. Metamaterials have shifted this paradigm by offering property control through structural design at the mesoscale, thus broadening the design space beyond the limits of traditional materials. A family of mechanical metamaterials consisting of soft sheets featuring a patterned array of reconfigurable bistable domes is reported here. The domes in this metamaterial architecture can be reversibly inverted at the local scale to generate programmable multistable shapes and tunable mechanical responses at the global scale. By 3D printing a robotic gripper with energy-storing skin and a structure that can memorize and compute spatially-distributed mechanical signals, it is shown that these metamaterials are an attractive platform for novel mechanologic concepts and open new design opportunities for structures used in robotics, architecture, and biomedical applications.

Auditory Processing of Speech and Tones in Children With Tuberous Sclerosis Complex.

Individuals with Tuberous Sclerosis Complex (TSC) have atypical white matter integrity and neural connectivity in the brain, including language pathways. To explore functional activity associated with auditory and language processing in individuals with TSC, we used electroencephalography (EEG) to examine basic auditory correlates of detection (P1, N2, N4) and discrimination (mismatch negativity, MMN) of speech and non-speech stimuli for children with TSC and age- and sex-matched typically developing (TD) children. Children with TSC (TSC group) and without TSC (typically developing, TD group) participated in an auditory MMN paradigm containing two blocks of vowels (/a/and/u/) and two blocks of tones (800 Hz and 400 Hz). Continuous EEG data were collected. Multivariate pattern analysis (MVPA) was used to explore functional specificity of neural auditory processing. Speech-specific P1, N2, and N4 waveform components of the auditory evoked potential (AEP) were compared, and the mismatch response was calculated for both speech and tones. MVPA showed that the TD group, but not the TSC group, demonstrated above-chance pairwise decoding between speech and tones. The AEP component analysis suggested that while the TD group had an increased P1 amplitude in response to vowels compared to tones, the TSC group did not show this enhanced response to vowels. Additionally, the TD group had a greater N2 amplitude in response to vowels, but not tones, compared to the TSC group. The TSC group also demonstrated a longer N4 latency to vowels compared to tones, which was not seen in the TD group. No group differences were observed in the MMN response. In this study we identified features of the auditory response to speech sounds, but not acoustically matched tones, which differentiate children with TSC from TD children.

CDKL5 deficiency disorder: Relationship between genotype, epilepsy, cortical visual impairment, and development.

OBJECTIVE: The cyclin-dependent kinase like 5 (CDKL5) gene is a known cause of early onset developmental and epileptic encephalopathy, also known as CDKL5 deficiency disorder (CDD). We sought to (1) provide a description of seizure types in patients with CDD, (2) provide an assessment of the frequency of seizure-free periods and cortical visual impairment (CVI), (3) correlate these features with genotype and gender, and (4) correlate these features with developmental milestones. METHODS: This is a cohort study of patients with CDD. Phenotypic features were explored and correlated with gene variant grouping and gender. A developmental score was created based on achieving seven primary milestones. Phenotypic variables were correlated with the developmental score to explore markers of better developmental outcomes. Multivariate linear regression was used to account for age at last visit. RESULTS: Ninety-two patients with CDD were seen during the enrollment period. Eighteen were male (19%); median age at last visit was 5 years (interquartile range = 2.0-11.0). Eighty-one percent of patients developed epileptic spasms, but only 47% of those also had hypsarrhythmia. Previously described hypermotor-tonic-spasms sequence was seen in only 24% of patients, but 56% of patients had seizures with multiple phases (often tonic and spasms). Forty-three percent of patients experienced a seizure-free period ranging from 1 to >12 months, but only 6% were still seizure-free at the last visit. CVI was present in 75% of all CDD patients. None of these features was associated with genotype group or gender. CVI was correlated with reduced milestone achievement after adjusting for age at last visit and a history of hypsarrhythmia. SIGNIFICANCE: The most common seizure types in CDD are epileptic spasms (often without hypsarrhythmia) and tonic seizures that may cluster together. CVI is a common feature in CDD and is correlated with achieving fewer milestones.

Designing Integrated Courses in an RN-to-BSN Program.

Three faculty members and an instructional designer collaborated to develop and implement first-term courses in a newly revised RN-to-bachelor of science in nursing curriculum. The ADDIE model served as the organizing framework for course development. Student assessment was approached in a novel manner, using integrated assignments that spanned each course. Students were able to demonstrate that objectives for all three courses were met, while synthesizing and applying their newly gained knowledge and skills. J Contin Educ Nurs. 2017;48(8):369-372.

Antibiotic non-susceptibility among Streptococcus pneumoniae and Haemophilus influenzae isolates identified in African cohorts: a meta-analysis of three decades of published studies.

Management of community-acquired pneumonia caused by Streptococcus pneumoniae and Haemophilus influenzae type B (Hib) can be complicated by emerging antimicrobial non-susceptibility. We conducted a meta-analysis to examine the antibiotic susceptibility of community-acquired invasive infections with S. pneumoniae and Hib in Africa from 1978 to 2011. With the notable exceptions of widespread trimethoprim/sulfamethoxazole (SXT) and tetracycline non-susceptibility, the majority of pneumococci remain susceptible to ampicillin/amoxicillin. However, 23.8% of pneumococcal meningitis isolates are non-susceptible to penicillin. Similarly, Hib isolates show non-susceptibility to SXT, tetracycline, erythromycin and chloramphenicol. ß-Lactamase production among Hib isolates is increasing, a new observation for Africa, but is mitigated somewhat by Hib vaccination scale-up. In summary, pneumococcal susceptibility to amoxicillin remains high throughout Africa, and amoxicillin can be effectively and safely used as first-line treatment for childhood pneumonia. Data support first-line treatment of bacterial meningitis with ceftriaxone or cefotaxime.

Treatment length and outcomes among adolescents: a secondary data analysis.

BACKGROUND: Adaptations to evidence-based substance abuse treatment programs may impact their effectiveness. A qualitative study of MET/CBT-5 implementation in community agencies treating adolescents found that the majority of the agencies made adaptations and that the most frequent adaptation was to provide more than five treatment sessions. METHODS: Baseline and outcome data from SAMHSA's Effective Adolescent Treatment demonstration were analyzed to assess associations between length of treatment, client characteristics, and outcomes at three months. RESULTS: Adolescents who received more or less than the protocol length of 5 sessions were less likely to be discharged to the community than those who received the 5 session protocol. Those who received more than five sessions were more likely to have higher severity scores at intake but almost 50% of those with more than five sessions had low intake severity scores. Clients who received less than five sessions tended to have lower severity scores than clients who received more than five sessions. CONCLUSIONS: Length of treatment tended to vary by site rather than severity of substance problems or frequency of use. There was no significant improvement of substance abuse problems or decrease in frequency of use with longer treatment. Implementation of the MET/CBT-5 component of the Cannabis Youth Treatment trial in the EAT project illustrates the difficulty of adherence to an evidence based protocol in the field.

Adolescent substance abuse treatment: Organizational change and quality of care.

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives.

Implementation of MET/CBT 5 for adolescents.

Implementation of effective substance abuse treatment programs in community settings is a high priority. The selection of a proven cost-effective model is a first step; however, difficulty arises when the model is imported into a community setting. The Center on Substance Abuse Treatment selected a brief substance abuse treatment program for adolescents, the MET/CBT-5 program, determined to be the most cost-effective protocol in the Cannabis Youth Treatment trial, for implementation in two cohorts of Effective Adolescent Treatment grantees. A qualitative investigation of the protocol implementation with nine sites in the second cohort chronicled adaptations made by grantees and prospects for sustainability. The study found that agencies introduced adaptations without seeming to be aware of potential effects on validity. In most sites, sessions were lengthened or added to accommodate individual client needs, address barriers to client participation, and provide consistency with current norms of treatment. Implications for fidelity of future implementation projects are addressed.

Process improvement needs in substance abuse treatment: admissions walk-through results.

Researchers have questioned whether the addiction treatment infrastructure will be able to deliver high-quality care to the large numbers of people in need. In this context, the Robert Wood Johnson Foundation and the Center for Substance Abuse Treatment created a nationwide network to improve access and retention in treatment. Applicant agencies described results of an admission process walk-through. This qualitative study used narrative text from 327 applications to the Robert Wood Johnson Foundation, focusing on admissions-related problems. We developed and applied a coding scheme and then extracted themes from code-derived text. Primary themes described problems reported during treatment admissions: poor staff engagement with clients; burdensome procedures and processes; difficulties with addressing the clients' complex lives and needs; and infrastructure problems. Subthemes elucidated specific process-related problems. Although the findings from our analyses are descriptive and exploratory, they suggest the value of walk-through exercises for program assessment and program-level factors that may affect treatment access and retention.