Shaping nursing profession regulation through history - a systematic review.

AIM: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. BACKGROUND: An in-depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. INTRODUCTION: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio-contextual circumstances upon which governments made regulatory changes. METHODS: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and an inductive thematic approach for synthesis. RESULTS: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. DISCUSSION: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. CONCLUSION: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. IMPLICATION FOR NURSING AND HEALTH POLICY: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally.

Multistate licensure: opportunities for nurses to practice in new ways.

The first state board of nursing came into being in 1903. It was not until about 1980, however, that the last state passed legislation mandating licensure for all RNs. Traditionally, RNs had been licensed to practice only within their state licensure and were required to be re-licensed for every other state in which they wished to practice. This article examines multistate licensure and how this practice will open up wider opportunities for today's registered nurses.

Outsourcing: a managerial competency for the 21st century.

The widespread application of outsourcing has been fueled by the changing nature of the work contract between employers and employees. The large-scale corporate downsizing that began in the late 1980s inspired a trend away from employer loyalty. This fact, coupled with today's tight labor market, has created a "guerrilla" work force comprised of deal-hungry professionals conditioned to signing bonuses, stock options, and higher-than-scale salaries.

Quality wound care equals cost-effective wound care: a clinical model.

The cost of wound care frequently is defined as the cost of materials and labor, ignoring the effect of both variables on outcome. As a result, money-saving measures actually may increase cost while reducing the quality of care. Definitions and tools to enable professionals to understand, evaluate, and compare the cost-effectiveness of wound care practices and treatment modalities are given.

Measuring competencies of temporary staff.

Strategic staffing requires an understanding of a new model, what Charles Handy has named the "Shamrock Organizational Model," in which you have three equally valuable groups of staff a minimal core of full-time staff; a short-term contingency workforce; and a supplemental workforce for long-range temporary staffing needs. Ensuring the competency of all three is a nontransferable, although shared, responsibility of both the hospital and the supplemental staffing company.

Quality wound care equals cost-effective wound care: a clinical model.

The cost of wound care is often defined as the cost of materials and labor, ignoring the effect of both variables on outcome. As a result, money-saving measures may actually increase cost while reducing the quality of care. Definitions and tools to enable professionals to understand, evaluate and compare the cost-effectiveness of wound care practices and treatment modalities are given.

Fluorescent image tracking velocimetry of the Nimbus AxiPump.

High shear rates and extended residence times causing hemolysis and platelet activation can develop in an assist pump or cannula when inferior flow conditions exist. The high volume output of a miniature axial flow pump presents challenges in avoiding these adverse conditions. To assess the hemodynamics within the continuous flow Nimbus Axi-Pump, vector flow fields inside a translucent inflow cannula and a modified 12 mm AxiPump were mapped. Fluorescent image tracking velocimetry was used to track the motion of neutrally buoyant fluorescent particles (30 microns) using pulsed laser light, high resolution video cameras, and computer image analysis. An acrylic pump housing and cannula were integrated into a mock circulatory loop filled with a Newtonian, optically clear blood analog fluid. The flow parameters were controlled to yield known, physiologic loading conditions, including varying degrees of pulsatility. Cannula flow visualization results exhibited critical recirculation patterns at the bend. These results will be used to further optimize the design of the inflow. Particle impact was seen at the pump inlet in the inducer region of the rotor. Very good attachment of flow from the rotor to stator was observed when the pump operated at normal operating speeds. Intermittent regurgitant flow fields were evident in the presence of increased pulsatility and low pump speed. These results have lead to improvements in impeller design and speed control criteria to avoid potential deleterious flows.

Mast cells retain their responsiveness upon continuous and repetitive exposure to antigen.

To assess the effects of prolonged and repetitive exposure of antigen on mast cells (MC) we utilized our co-culture system in which rat peritoneal MC are kept viable and functionally active on 3T3 fibroblasts. MC were presensitized with IgE anti-dinitrophenyl-human serum albumin (anti-DNP-HSA), activated with the relevant antigen (DNP-HSA) (69.4% histamine release) and incubated for 7 days in medium alone or medium containing the antigen with or without Ca2+ ions. During the prolonged incubation MC released only small amounts of histamine (20-26 ng/plate/day) under all the different culture conditions. Moreover, these MC were not activated after each medium replacement with fresh antigen. When activated MC cultured in medium containing antigen and Ca2+ were presensitized prior to a second challenge performed on days 1, 2, 5 and 7, they released 35-45% histamine but were still partially desensitized compared to initially challenged MC. Immunofluorescence studies demonstrated that the MC unresponsiveness to a second challenge could be partially attributed to lack of membrane-associated IgE antibodies. Repetitive activation (four times) of MC at daily intervals did not abrogate their releasing capacity although the intracellular histamine content was diminished. When repetitive activation was performed 2 and 4 hr after the first challenge, a more intense MC refractoriness was observed (release of 17.3% and 21.1% histamine respectively versus 67.7%). It is suggested that MC activation occurs even after continuous exposure to antigen and that MC can respond to repetitive immunological stimulation.

Optimal management of a ventricular assist system. Contribution of flow visualization studies.

The Novacor (Baxter Novacor, Oakland, CA) Left Ventricular Assist System (LVAS) incorporates a versatile microprocessor based controller that permits a variety of operating modes. These include internally triggered automatic synchronous counterpulsation, electrocardiogram triggered synchronous operation, and full to empty or fixed rate asynchronous operation. The aim of this pilot study was to determine the extent to which washing of the blood contacting surfaces of the pump may be optimized by suitable choice of operating mode. Visualization of flow fields adjacent to surfaces in confined areas requires small, neutrally buoyant tracer particles for feature extraction. A novel technique using fluorescent tracer particles (100 microns), an argon laser, and a low pass optical filter has been developed for this purpose. Particle motion was tracked from video images and calculations were made of velocity. Flow visualization was performed under conditions that simulated clinically observed hemodynamic conditions, typical of the immediate post-implant period. At a given LVAS output, fluid speed in the vicinity of the inflow valve tended to increase at higher LVAS beat rates (and consequently lower LVAS stroke volumes). This and future work may well be useful in selecting the optimum modes of LVAS operation as a function of the hemodynamic status of the patient.

Respiratory dialysis. A new concept in pulmonary support.

Use of a new intravenous oxygenator made of hollow fiber membranes arranged around a centrally positioned balloon is reported. In vitro studies using fluorescent image tracking velocimetry and gas exchange analysis demonstrated enhanced convective mixing with balloon pulsations and augmented gas flux (100% increase in pO2) compared with the device in its static configuration. In vivo observations confirmed a greater than 50% increase in O2 flux with balloon activation. Those parameters that produce radial flow and convective mixing in vitro enhance gas flux in vivo, thus confirming the efforts to exceed the fluid limit translate into improved gas exchange.

Automated analysis of multiple-pulse particle image velocimetry data.

An application of multiple-pulse particle image velocimetry to the study of particle motion in a two-phase flow through a cylindrical tube bank is described. An algorithm is developed that automatically analyzes the digital, multiply exposed pictures of this flow and determines the particle trajectories, using a linear particle image tracking method. From these trajectories particle velocities as well as points of impact and angles of incidence and rebound for particles that collide with the cylinder surfaces are determined. This algorithm is sufficiently rapid that data can be collected and analyzed contemporaneously.

Nursing: the hospital's competitive edge.

The health care marketplace is becoming increasingly competitive. The hospital has a built-in marketing force with the nursing department, because nurses are in constant, direct contact with the customer. Nursing must identify the case mix profile of the community and focus the hospital product lines to meet community needs. The nursing department should decentralize, change, measure, and innovate the staff mix needed to operationalize these product lines. The development of nursing practice standards for the case mix will help to identify the staff mix needed and create systems to efficiently manage the product lines. Nursing management must become aware of cross-subsidization and downward skill substitution of nursing personnel. Nursing information systems must generate quality reports that invoke cost consciousness on the part of nursing staff. Quality assurance programs must become unit based and complete with frequent audits to correlate length of stay with nursing quality. Correlations must be determined between nursing productivity and case mix to determine the hospital's niche in the marketplace. The transformation of health care into a competitive business industry has created many opportunities for nursing. The health care industry's incentives for efficiency along with the decreasing demand for inpatient hospital services will be the forces driving health care toward a competitive marketplace. The hospital's nursing department should be strategically positioned to become accountable for increasing market share and enhancing quality patient outcomes. The focus has shifted from the theoretical to the tactical, which is a step in the right direction, particularly for nursing. Nursing, if strategically positioned, will not only thrive but will also excel in this chaotic environment by capturing the opportunities and being innovative.

DRGs: a new era for health care.

The DRG system classifies patients according to their resource consumption, based on their medical diagnosis. It was originally developed at Yale University and later studied in New Jersey. This resulted in its implementation as a pricing system. It incorporates the clinical and financial information, through the use of the patient record, resulting in the generation of information for managers to use in making decisions to run their operations. Although it began as the Medicare prospective pricing system for acute inpatient settings, it has extended to other third party payers and beyond the hospital. The changes and challenges that this new system has brought about has presented numerous opportunities for nursing.

Comparability of skin temperatures from three sites on the hand.

Skin temperature from three recording sites (web dorsum and two digital sites) on one hand were compared over a 30-minute period during which room temperature was raised from 66 degrees to 80 degrees F causing skin temperatures to range from 78.5 degrees to 92.3 degrees F. The web dorsum remained significantly warmer than either digital site at the lowest skin temperatures; no significant inter-site differences were seen as skin temperature gradually increased. These findings imply that none of the three sites is more advantageous than the others when recording hand temperature values around or above 85 degrees F. However, at the lower levels of skin temperature, there is a "floor" below which the web dorsum is no longer a sensitive indicator. More generally, basic data of this type provide a necessary but often absent foundation for routine practice of clinical biofeedback.