Emergency department arrival times in Florida heart failure patients utilizing Fisher-Rao curve registration: A descriptive population-based study.

BACKGROUND: Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions. OBJECTIVE: Describe the arrival time distribution of HF patients presenting to the ED. METHOD: The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools. RESULTS: HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas. CONCLUSIONS: The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED.

Option generation in the treatment of unstable patients: An experienced-novice comparison study.

There are a dearth of studies that quantitatively measure nurses' appreciation of stimuli and the subsequent generation of options in practice environments. The purpose of this paper was to provide an examination of nurses' ability to solve problems while quantifying the stimuli upon which they focus during patient care activities. The study used a quantitative descriptive method that gathered performance data from a simulated task environment using multi-angle video and audio. These videos were coded and transcripts of all of the actions that occurred in the scenario and the verbal reports of the participants were compiled. The results revealed a pattern of superiority of the experienced exemplar group. Novice actions were characterized by difficulty in following common protocols, inconsistencies in their evaluative approaches, and a pattern of omissions of key actions. The study provides support for the deliberate practice-based programs designed to facilitate higher-level performance in novices.

Demographic, Social Support, and Community Differences in Predictors of African-American and White Men Receiving Prostate Cancer Screening in the United States.

OBJECTIVE: To examine demographic, social support, and community factors from a national dataset that influence African-American (AA) and White men to receive prostate cancer screening (PCS) via the Digital Rectal Exam (DRE) or Prostate Specific Antigen Test (PSA). DESIGN AND SAMPLE: A cross-sectional secondary analysis from the National Health and Nutrition Examination Survey (NHANES) provided the sample of AA (N = 377) and White (N = 971) men over the age of 40 years. Regression analysis with confidence intervals was utilized to examine the factors associated with AA and White men receiving PCS. The Social Ecological Model provided the theoretical framework. MEASURES: Questionnaires from the NHANES dataset provided data for this study. RESULTS: Age, education, and access to health care was associated with AA and White men receiving the DRE. Income and church attendance was only associated with White men receiving the DRE. Only White men had an association of income with receiving the PSA test and only AA men had an association of marital status with receiving the PSA test. CONCLUSIONS: Cultural evaluations of PCS behaviors among AA men are necessary to decrease the health disparity of prostate cancer among the AA population.

The Effect of Relationship Characteristics on HIV Risk Behaviors and Prevention Strategies in Young Gay and Bisexual Men.

We examined whether relationship status, relationship ideation, and sexual agreements affected HIV/sexually transmitted disease (STD) prevention strategies and high-risk behaviors in young men who have sex with men (MSM). Using an online survey, we found that partnered MSM more commonly used condoms with casual partners and knew the reported HIV status of all their partners, compared to single MSM (p < .05). Men scoring high in relationship exclusivity reported higher condom use with casual partners compared to men scoring lower (p < .05). Of partnered MSM, 58% reported a sexual agreement. MSM reporting restricted sexual agreements more commonly used condoms during oral and anal intercourse with their main partners and casual partners compared to MSM reporting unrestricted sexual agreements. The data suggest that relationship status should be considered by health care providers when counseling MSM and that behavioral interventions should target sexual agreements as a mechanism to reduce HIV/STD transmission.

A study of HIV positive undocumented African migrants' access to health services in the UK.

Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrant's efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health-related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim. The purpose of this paper is to examine the basic social processes that characterize efforts to gain access to health services among HIV positive undocumented African migrants to the UK. The most recent estimates indicate that there are a total of 618,000 migrants who lack legal status within the UK. Other studies have placed the number of undocumented migrants within the UK in the range of 525,000-950,000. More than 442,000 are thought to dwell in the London metropolitan area. Even in cases where African migrants enter the UK legally, they often face considerable difficulty in their quest to gain legal employment due to barriers inherent to the system that grants work permits. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority.

Identifying core nursing sensitive outcomes associated with the most frequently used North American Nursing Diagnosis Association-International nursing diagnoses for patients with cerebrovascular disease in Korea.

The purpose of this study was to identify the core nursing sensitive outcomes according to the most frequently used five North American Nursing Diagnosis Association-International for patients with cerebrovascular disease using the Nursing Outcomes Classification (NOC). A cross-sectional survey design was used. First, nursing problems were identified through 78 charts review, and then linkages between each of nursing problems and nursing sensitive outcomes were established and validated by an expert group for questionnaires. Second, 80 nurses working in the neurosurgical intensive care unit and neurosurgery departments of five Korean hospitals were asked to evaluate how important each outcome is and how often each outcome used to evaluate patient outcomes using 5-point Likert scale. Although there were some differences in the core outcomes identified for each of the nursing problem, consciousness, cognitive orientation, neurologic status and communication were considered the most critical nursing sensitive outcomes for patients suffering cerebrovascular disease. Core nursing sensitive outcomes of patients suffering cerebrovascular disease using NOC were identified to measure the effectiveness of nursing care.

Information and communication technology: students' health education in 1st- to 6th-grade South Korea elementary schools.

BACKGROUND: The purposes of this study were to (1) identify school nurses' awareness of information and communication technology (ICT) use in students' health education and (2) explore the barriers or reasons for the adoption of ICT in school nursing practice, while (3) presenting strategies to speed ICT diffusion and dissemination into practice. METHODS: For data collection, 209 primary school nurses in K province of Korea were selected and e-mailed the questionnaires. Collected data were analyzed as frequency, percentages, and chi-square tests. RESULTS: The major reasons to adopt ICT were increasing school nurses' confidence in providing health education and improving teaching methods using diverse multimedia. The major barriers to utilization of ICT were lack of time for preparation of educational materials, lack of software availability, and lack of computer skills of school nurses and students. Several strategies were suggested to speed the diffusion of ICT into students' health education, such as integrating a health education course into regular curriculum. CONCLUSIONS: It is important to identify barriers and reasons for adoption of ICT in school nursing. In addition, strategies should be emphasized that result in more rapid diffusion of these technologies in school nursing practice.

A theoretical framework for simulation in nursing: answering Schiavenato's call.

The aim of this article was to provide a response that supports and extends Schiavenato's call for a theoretically guided approach to simulation use in nursing education.We propose that a theoretical framework for simulation In nursing must first include, as a basis, a theoretical understanding of human performance and how it is enhanced.This understanding will, in turn, allow theorists to provide a framework regarding the utility, application, and design of the training environment, including internal and external validity. The expert performance approach, a technique that recently has been termed Expert-Performance-based Training (ExPerT), is introduced as a guiding frame work for addressing these training needs. We also describe how the theory of deliberate practice within the framework of ExPerT can be useful for developing effective training methods in health care domains and highlight examples of how deliberate practice has been successfully applied to the training of psychomotor and cognitive skills.

Nurses' immediate response to the fall of a hospitalized patient: a comparison of actions and cognitions of experienced and novice nurses.

BACKGROUND: Falls represent a significant threat to patient safety for hospitalized patients throughout the world. Little is known, however, regarding nurses' immediate responses to the discovery of a fallen patient. OBJECTIVES: The objective of this study was to perform an experimental examination of experienced and novice nurses' reaction to the discovery of a fallen patient who has sustained a closed head injury. DESIGN: The study was based upon the expert performance approach, which utilizes a mixed methods approach to determining performance characteristics of individuals performing in a variety of domains. SETTING: The study was accomplished using a simulated task environment developed specifically for research concerning the performance of health professionals. PARTICIPANTS: The study included 12 experienced and 10 novice nurses, all of whom were currently employed in critical care settings. METHODS: The study used directly observed performance, which was quantified through the use of direct coding of clinical behaviors and the analysis of verbal reports of thought. RESULTS: The data indicate that experienced participants were not only more likely to call for help but that they were more likely to precede this action by checking for responsiveness, and then, after calling for help, establish the effectiveness of the patient's airway, breathing and circulation. These data confirmed that experienced participants were more likely to engage in the appropriate sequence of actions when faced with this unexpected and highly stressful situation. CONCLUSIONS: Novice nurses' superficial assessment of the situation and subsequent failure to react properly implied an overall pattern of superior performance by the experienced nurses. The results indicated that, compared with novice nurses, experienced nurses are more likely to initiate standard treatment protocols in situations such as the one reported in this study.

Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory.

Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.

Identification and comparison of interventions performed by Korean school nurses and U.S. school nurses using the Nursing Interventions Classification (NIC).

The purpose of the study was to identify Nursing Interventions Classification (NIC) interventions performed by Korean school nurses. The Korean data were then compared to U.S. data from other studies in order to identify differences and similarities between Korean and U.S. school nurse practice. Of the 542 available NIC interventions, 180 were selected as the basis of a questionnaire designed to quantify key aspects of school nursing practice. The data were collected from 131 school nurses working in Korea. The results indicated that Korean school nurses focused on classifications from the Physiological Basic domain. Comparisons to previously reported U.S. data reflect that U.S. school nurses focus primarily on the Behavioral domain. The data reflect important differences between the practice characteristics of Korean and U.S. school nurses. Further, the data support the utility of NICs in quantifying the practice characteristics of school nurses in Korea.

An exploration of the relationship between knowledge and performance-related variables in high-fidelity simulation: designing instruction that promotes expertise in practice.

Increasingly, high-fidelity patient simulation (HFPS) is becoming essential to nursing education. Much remains unknown about how classroom learning is connected to student decision-making in simulation scenarios and the degree to which transference takes place between the classroom setting and actual practice. The present study was part of a larger pilot study aimed at determining the relationship between nursing students' clinical ability to prioritize their actions and the associated cognitions and physiologic outcomes of care using HFPS. In an effort to better explain the knowledge base being used by nursing students in HFPS, the investigators explored the relationship between common measures of knowledge and performance-related variables. Findings are discussed within the context of the expert performance approach and concepts from cognitive psychology, such as cognitive architecture, cognitive load, memory, and transference.

Cognitions and clinical performance: a comparison of high and low performing baccalaureate nursing students.

Studies to date have employed a variety of methods to elucidate the cognitive processes that underlie nursing actions in clinical situations. Most studies relied on clinical case scenarios rather than actual patient care situations, and did not supplement cognitive measures with quantitative measures of performance or physiologic outcomes of care. The present study employed a quasi-experimental design to describe and compare the verbal report data of baccalaureate nursing students who were assigned to high and low performing groups based on their ability to alter the physiological trajectory of the patient in a simulated task environment. Low performing participants observed many irrelevant cues and failed to perform vital actions in lieu of extraneous actions that were not directly related to the patient's condition. Higher performing students were better able to recognize salient symptoms suggestive of deterioration in the patient's condition and were more expeditious intervening to improve the patient's physiological status.

A study of the relationship of nursing interventions and cognitions to the physiologic outcomes of care in a simulated task environment.

This study, based on the Expert Performance Approach, examined the clinical nursing performance of participants who were introduced into a simulated task environment requiring them to administer care to a client experiencing an exacerbation of Congestive Heart Failure. This was undertaken to identify cognitive and physiologic variables that differentiate performance levels among participants. Data on participant actions and verbal reports were coded to characterize their relationship with physiologic responses of the Human Patient Simulator. The results demonstrated that physiologic responses to nursing interventions reflect a reliable pattern that can be used to differentiate performance levels.

Cognitions associated with nurse performance: a comparison of concurrent and retrospective verbal reports of nurse performance in a simulated task environment.

BACKGROUND: Cognitions represent the computations associated with human thought processes. Verbal protocols offer a method by which to record these processes. While concurrent and retrospective verbal reporting of cognitions have been used extensively within nursing and other domains, the use of this methodology in nursing has been characterized by inconsistencies in its application. OBJECTIVES: The primary objective of this study was to describe and compare the content of concurrent and retrospective verbal reports provided by nurses during and after administering care in a simulated task environment. DESIGN: The study utilized a laboratory based quasi-experimental research design. SETTING: The study was based in a simulation laboratory designed specifically for use in studies designed to measure nursing performance. The laboratory integrated extensive instrumentation that facilitated the comprehensive audio and video recording of participant actions. PARTICIPANTS: The participants (N=15) were recruited from a College of Nursing at a large university in the Southeastern United States. METHODS: Research participants were asked to admit a patient experiencing an acute exacerbation of congestive heart failure in a simulated task environment, during which they were required to prioritize and provide care. Participants were trained in the method for providing verbal reports of thoughts, and concurrent and retrospective report data were collected during and after the simulation exercise. The data were then coded for the purposes of descriptive analysis. RESULTS: The results indicated that the concurrent verbal reports provide a more complete representation of the cognitions of research participants providing care in a simulated task environment. However, the results reflect that additional unique data is present in the retrospective reports, exclusive of the concurrent reports. CONCLUSIONS: The findings support the utility of concurrent and retrospective verbal reports as a method of gathering data in studies that address nursing performance in a clinical context.

The relationship between knowledge and clinical performance in novice and experienced critical care nurses.

PURPOSE: The purpose of this study was to measure directly the knowledge and performance of novice and experienced critical care nurses in a simulated task environment. METHODS: Nurses were required to control the physiologic deterioration of patients with respiratory compromise in 4 scenarios and were also tested on their knowledge of the constructs present in the scenarios. RESULTS: The results indicate that experienced nurses possessed highly superior knowledge when compared with novice nurses (P < .001). The results further demonstrated a lack of reliable differences in actual clinical performance when nurses were considered solely on the basis of their term of experience. Group differences in performance were demonstrated only when nurses who had achieved board certification in critical care nursing were compared with the remaining participants. CONCLUSION: The results demonstrate the lack of linkage between knowledge and clinical performance, which calls into question the supposition by many in nursing that knowledge and performance are inextricably linked.

Down low sex, older African American women, and HIV infection.

The phenomenon of down low sex, wherein men involved in monogamous relationships with women seek extrarelationship sexual relations with men, has gained recognition in recent years. This study addressed the issue of down low sex in a group of African American women whose long-term sexual partners had become infected with HIV during extramarital sexual encounters with men. A grounded theory methodology was used to explore the experiences of 11 women in individual interviews that were sensitive to the intimate nature of their experiences. Themes shown in the data focused on (a) being betrayed and losing trust; (b) reflecting upon the features of the past relationship; (c) seeking the positive aspects of the past relationship; (d) being ashamed before God, community, and family; and (e) assuming the caregiver role and sharing the burden of illness. The study identified the strong influence of positive long-term relationships on life decisions of women following a diagnosis of HIV, despite the extrarelationship sexual activities of their partners.

A community health nursing approach to the problem of antibiotic over-prescribing.

Antibiotic resistance due to over-prescribing is a critical problem for society. The purpose of this study was to examine the effect of a nurse-led quality-assurance-based program designed to decrease inappropriate antibiotic prescribing rates in patients suffering from viral upper respiratory tract infections. The study was based in a network of community health centers in the Southeastern United States. A quasi-experimental design based upon pre- and postintervention measurement via chart reviews was utilized in the study. Both the pre- and postintervention chart reviews revealed high levels of inappropriate prescribing. Following intervention, no gross decrease in prescribing rates was noted. Qualitative differences were noted postintervention that included increased rates of prescriptions for delayed antibiotic therapy and decreased rates of reflexive prescription writing for farmers. Additionally, the results reflected the decreased use of broad-spectrum antibiotics after the intervention. Although the study utilized a limited sample, it shows promise for the use of quality assurance approaches in moderating inappropriate prescribing practices.

Expert performance in nursing: reviewing research on expertise in nursing within the framework of the expert-performance approach.

Traditionally, studies on expertise have used social criteria to identify highly respected and experienced individuals and examined how these experts differ from less-experienced individuals. Our article reviews research on nursing expertise during the last decades from the perspective of the expert-performance approach, which focuses on reproducibly superior performance in everyday life. Our review proposes explanations for repeated failures to find reliably superior performance for nurses with longer professional experience. The article concludes with an outline of how the expert-performance approach can be applied to the study of nursing expertise where the focus is on measurement and analysis of superior nursing performance.

Mon2, a relative of large Arf exchange factors, recruits Dop1 to the Golgi apparatus.

The protein Mon2 is distantly related to the guanine nucleotide exchange factors (GEFs) that activate Arf1 on Golgi membranes. However, unlike these "large" Arf GEFs, Mon2 lacks the Sec7 domain that catalyzes nucleotide exchange on Arf1. Here we report that yeast Mon2 shares extensive homology with the noncatalytic parts of both the BIG and Golgi brefeldin A resistance factor subfamilies of Arf GEFs and is located to the trans-Golgi. Moreover, we find that Mon2 forms a complex with Dop1, a large cytoplasmic protein conserved in evolution from humans to protozoa. Deletion of Mon2 results in mislocalization of Dop1 from the Golgi and defects in cycling between endosomes and the Golgi. However, unlike Mon2, Dop1 is essential for yeast viability. A conditional allele of Dop1 shows that loss of Dop1 activity not only affects endosome to Golgi transport but also causes a severe perturbation of the organization of the endoplasmic reticulum. Thus, it appears that Dop1 plays a widespread role in membrane organization, and Mon2 acts as a scaffold to recruit the Golgi-localized pool of Dop1.