Decadal increase in vessel interactions by a scavenging pelagic seabird across the North Atlantic.

Fisheries waste is used by many seabirds as a supplementary source of food,1 but interacting with fishing vessels to obtain this resource puts birds at risk of entanglement in fishing gear and mortality.2 As a result, bycatch is one of the leading contributors to seabird decline worldwide,3 and this risk may increase over time as birds increasingly associate fishing vessels with food. Light-level geolocators mounted on seabirds can detect light emitted from vessels at night year-round.4 We used a 16-year time series of geolocator data from 296 northern fulmars (Fulmarus glacialis) breeding at temperate and arctic colonies to investigate trends of nocturnal vessel interactions in this scavenging pelagic seabird. Vessel attendance has progressively increased over the study period despite no corresponding increase in the number of vessels or availability of discards over the same time frame. Fulmars are highly mobile generalist surface feeders,5 so this may signal a reduction in available prey biomass in the upper water column, leading to increased reliance on anthropogenic food subsidies6 and increased risk of bycatch mortality in already threatened seabird populations. Individuals were consistent in the extent to which they interacted with vessels, as shown in other species,7 suggesting that population-level increases may be due to a higher proportion of fulmars following vessels rather than changes at an individual level. Higher encounter rates were correlated with lower time spent foraging and a geographically restricted overwintering distribution, suggesting an energetic advantage for these scavenging strategists compared with foraging for natural prey.

Validating the use of intrinsic markers in body feathers to identify inter-individual differences in non-breeding areas of northern fulmars.

Many wildlife studies use chemical analyses to explore spatio-temporal variation in diet, migratory patterns and contaminant exposure. Intrinsic markers are particularly valuable for studying non-breeding marine predators, when direct methods of investigation are rarely feasible. However, any inferences regarding foraging ecology are dependent upon the time scale over which tissues such as feathers are formed. In this study, we validate the use of body feathers for studying non-breeding foraging patterns in a pelagic seabird, the northern fulmar. Analysis of carcasses of successfully breeding adult fulmars indicated that body feathers moulted between September and March, whereas analyses of carcasses and activity patterns suggested that wing feather and tail feather moult occurred during more restricted periods (September to October and September to January, respectively). By randomly sampling relevant body feathers, average values for individual birds were shown to be consistent. We also integrated chemical analyses of body feather with geolocation tracking data to demonstrate that analyses of δ13C and δ15N values successfully assigned 88 % of birds to one of two broad wintering regions used by breeding adult fulmars from a Scottish study colony. These data provide strong support for the use of body feathers as a tool for exploring non-breeding foraging patterns and diet in wide-ranging, pelagic seabirds.

Direct care nurses on the shared governance journey towards positive patient outcomes.

AIMS AND OBJECTIVES: To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing. BACKGROUND: Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions. DESIGN: This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes. METHOD: Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change. CONCLUSIONS: Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted. RELEVANCE TO CLINICAL PRACTICE: This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care.

Evidence of improved quality of life with pediatric palliative care.

Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life.

Is self-administration of subcutaneous immunoglobulin therapy safe in a home care setting?

Clinical practice based on best evidence can help ensure that patients receive safe and appropriate care from nurses. Members of a nursing inquiry council at a pediatric-based organization addressed the issue of patient-administered immunoglobulin therapy in the home care setting through conducting an evidence-based practice (EBP) project. Following the steps of EBP, an EBP change was implemented that allowed families the option of immunoglobulin therapy administration by the patient (or a caregiver) or a home healthcare nurse. Outcomes measured indicated that self-administration positively impacted patient and family satisfaction and posed no additional safety risks.