The utilization of midazolam as a pharmacologic adjunct to endotracheal intubation by paramedics.

OBJECTIVE: Pharmacologic agents have been used in the prehospital setting for facilitating endotracheal intubation (ETI). The purpose of this study was to determine the utility of intravenous midazolam for prehospital patients who require pharmacologic relaxation to facilitate ETI. METHODS: Data were reviewed retrospectively using paramedic charts from an eight-month period for a three-county state EMS system. RESULTS: There were 26,133 paramedic dispatches during the study period. Six hundred eighty-three ETIs were attempted, including 72 midazolam-facilitated intubations (MFIs). The most common indications for MFI were "clenched teeth," "gag," and "combativeness." Successful MFI was achieved in 45 of 72 cases (62.5%). Midazolam-facilitated intubation was less successful for trauma patients (41.2%) than for medical patients (69.1 %) (p = 0.04). Of the 58 failed conventional ETIs that occurred during the study period, 25 (43.1%) were identified as having one or more indications for the use of MFI. Although the use of intravenous midazolam was effective in facilitating ETI, a high MFI failure rate (37.5%) was noted. CONCLUSION: Although it is of limited efficacy, MFI is underutilized and should be considered by medical direction as a pharmacologic adjunct to ETI in selected field patients.

Motivation and job satisfaction of deans of schools of nursing.

Factors influencing the job satisfaction of deans of schools of nursing were analyzed using the motivational theory of expectancy. A questionnaire was sent to 595 deans/directors of baccalaureate and higher degree schools of nursing accredited by the National League for Nursing. The three part questionnaire consisted of (1) Demographic data, (2) Motivation and Reward Scales, and (3) The Job Description Index. Significant relationships were found within each job satisfaction variable (P less than or equal to .05). The most significant and numerous relationships were found within the variable of pay or salary. Deans who had long tenure in their administrative positions and were associated with large universities and schools of nursing were also found to be statistically significant (P less than or equal to .05). A direct relationship between the scores on the Motivation and Reward Scale and the scores on the Job Description Index was supported. The individual and collective facets of job satisfaction were positively and significantly correlated (P less than or equal to .05) with motivation, providing support for the theoretical framework that proposes an interdependent relationship. Additional findings from regression analyses suggested that motivation is a significant predictor of job satisfaction.