Factors affecting emergency department length of stay of patients admitted to telemetry and critical care units

The purpose of this study was to determine the emergency department (ED) length of stay (LOS) of patients admitted to inpatient telemetry and critical care units and to identify the factors that contribute to a prolonged ED LOS. It also examined whether there was a difference in ED LOS between clients evaluated by an ED physician, an Advanced Registered Nurse Practitioner (ARNP) or a Physician's Assistant (PA).^ A data collection tool was devised and used to record data obtained by retrospectively reviewing 110 charts of patients from this sample. The mean ED LOS was 286.75 minutes. Multiple factors were recorded as affecting the ED LOS of this sample, including: age, diagnosis, consultations, multiple radiographs, pending admission orders, nurse unable to call report/busy, relatives at bedside, observation or stabilization necessary, bed not ready and infusion in progress. No significant difference in ED LOS was noted between subjects initially evaluated by a physician, an ARNP or a PA. ^

Adding concurrent data transfer to transport layer

In recent years, the internet has grown exponentially, and become more complex. This increased complexity potentially introduces more network-level instability. But for any end-to-end internet connection, maintaining the connection's throughput and reliability at a certain level is very important. This is because it can directly affect the connection's normal operation. Therefore, a challenging research task is to improve a network's connection performance by optimizing its throughput and reliability. This dissertation proposed an efficient and reliable transport layer protocol (called concurrent TCP (cTCP)), an extension of the current TCP protocol, to optimize end-to-end connection throughput and enhance end-to-end connection fault tolerance. The proposed cTCP protocol could aggregate multiple paths' bandwidth by supporting concurrent data transfer (CDT) on a single connection. Here concurrent data transfer was defined as the concurrent transfer of data from local hosts to foreign hosts via two or more end-to-end paths. An RTT-Based CDT mechanism, which was based on a path's RTT (Round Trip Time) to optimize CDT performance, was developed for the proposed cTCP protocol. This mechanism primarily included an RTT-Based load distribution and path management scheme, which was used to optimize connections' throughput and reliability. A congestion control and retransmission policy based on RTT was also provided. According to experiment results, under different network conditions, our RTT-Based CDT mechanism could acquire good CDT performance. Finally a CWND-Based CDT mechanism, which was based on a path's CWND (Congestion Window), to optimize CDT performance was introduced. This mechanism primarily included: a CWND-Based load allocation scheme, which assigned corresponding data to paths based on their CWND to achieve aggregate bandwidth; a CWND-Based path management, which was used to optimize connections' fault tolerance; and a congestion control and retransmission management policy, which was similar to regular TCP in its separate path handling. According to corresponding experiment results, this mechanism could acquire near-optimal CDT performance under different network conditions.

Nursing case management : a new perspective to caring for patients with hip fracture

Nursing Case Management has motivated nurses to examine the effects of care provided to patients, and to devise means of improving this care. The success of this nursing care delivery model is well documented among a variety of acute and chronically ill patients. Utilizing nonparametric ANOVA for comparison of two means, this study investigates the outcome of the implementation of a nursingcase management model on an orthopedic unit of a local hospital. A convenience sample (N=149) of hip-fracture patients for two separate eight months charting periods were used. The first period was pre-case management and the second period was after the implementation of nursing managed care on the unit. Results suggested that nursing case management was effective in reducing the total length of hospital stay and post-operative days significantly.

A study of state and trait anxiety and perceived causes of anxiety identified by licensed practical nurses returning to an associate degree nursing program

The purpose of this study was to identify the state and trait anxiety and the perceived causes of anxiety in licensed practical nurses (LPNs) returning to an associate degree nursing program in order to become registered nurses (RNs). The subjects for this study were 98 students enrolled in a transitional LPN/RN associate degree nursing program in two community colleges in the state of Florida. The State-Trait Anxiety Inventory (STAI) developed by Spielberger (1983), was used as the measuring instrument for this study.^ In addition, a Q-sort technique was used to obtain information from the subjects regarding perceived causes of anxiety. Anxiety causes for the Q-sort cards used in the study were developed from the themes identified by a sample of LPN/RN students in a pilot study. The state and trait anxiety levels were obtained using the STAI for college students scoring key and scales. Descriptive statistics were used to determine the state and trait anxiety of the students. Correlational statistics were used to determine if relationships existed between the state and trait anxiety levels and perceived causes of anxiety identified by LPN students returning to an associate degree nursing program.^ The analysis of the Q-sort was performed by computing the means, standard deviations, and frequencies of each cause. The mean trait anxiety level of the students was 57.56, $SD=29.69.$ The mean state anxiety level of the students was 68.21, $SD=25.78.$ Higher percentile scores of trait anxiety were associated with higher ranks of the Q-sort category, "failing out of the program," $\rm r\sb{s}=.27,\ p=.008.$ Implications for future nursing research and application of the findings to nursing education are presented. ^

Nurses' spiritual well-being: Its influence on attitudes and level of practice in providing spiritual care

The purpose of this study was to examine the relationship between the spiritual well-being of nurses and its influence on their attitudes toward providing spiritual care to patients. Two research instruments and a demographic data form were used for the survey. Using a descriptive design, tbe Spiritual Well-Being Scale, the Health Professional's Spiritual Role Scale, and the demographic data form were administered to 100 registered nurses from a large South Florida teaching hospital. The findings indicated a significantly positive correlation between the overall Spiritual Well-Being Scale and the Health Professional's Spiritual Role Scale (r = 0.52; p =.005). Significant differences were found between correlation of nurses' levels of spiritual well-being and all sociodemographic factors except for the three Age Groups and for religious affiliations. Findings have implications for how nurses should be trained in meeting patients total needs. ^