Essential nursing care of the critically ill patient

This chapter is about essential nursing care. Because it is often referred to as basic nursing, nurses may not always perceive it as deserving of priority. Yet, how well patients are cared for has a direct effect on their sense of wellbeing and their recovery. ‘Interventional patient hygiene’ is a systematic, evidence-based approach to nursing actions designed to improve patient outcomes using a framework of hygiene, catheter care, skin care, mobility and oral care.1 This chapter focuses on the physical care, infection control, preventative therapies and transport of critically ill patients. The first two areas are closely linked: poor-quality physical care increases the risk of infection. The final areas are essential features of critical care nursing.

Perioperative Nursing

This chapter introduces the beginning perioperative nurse to the key concepts and principles informing perioperative practice within Australasia. It describes the patient care roles of the nurse as well as the perioperative context and culture that inform the delivery of care during the surgical patient's journey. Aspects of the regulatory environment are examined, such as advocacy, accountability, delegation and scope of practice. In addition, the chapter explores the role of professional associations and highlights the importance of practice standards for perioperative nursing. The role of evidence-based practice (EBP) is also acknowledged. As this dynamic nursing speciality continues to evolve, the chapter concludes with a discussion of emerging advanced-practice roles for perioperative nurses.

Boosting morale and improving performance in the nursing setting

AIM AND BACKGROUND: While the importance of morale is well researched in the nursing literature, strategies and interventions are not so prolific. The complexities of interpersonal relationships within the clinical domain, and the critical issues faced by nurses on a daily basis, indicate that morale, job satisfaction and motivation are essential components in improving workplace efficiency, output and communication amongst staff. Drawing on educational, organizational and psychological literature, this paper argues that the ability to inspire morale in staff is a fundamental indicator of sound leadership and managerial characteristics. EVALUATION AND KEY ISSUES: Four practical concepts that could be implemented in the clinical setting are proposed. These include: role preparation for managers, understanding internal and external motivation, fostering internal motivation in nursing staff, and the importance of attitude when investing in relationships.

Can active learning principles be applied to the bioscience assessments of nursing students? A review of the literature

- Objectives To explore if active learning principles be applied to nursing bioscience assessments and will this influence student perception of confidence in applying theory to practice? - Design and Data Sources A review of the literature utilising searches of various databases including CINAHL, PUBMED, Google Scholar and Mosby's Journal Index. - Methods The literature search identified research from twenty-six original articles, two electronic books, one published book and one conference proceedings paper. - Results Bioscience has been identified as an area that nurses struggle to learn in tertiary institutions and then apply to clinical practice. A number of problems have been identified and explored that may contribute to this poor understanding and retention. University academics need to be knowledgeable of innovative teaching and assessing modalities that focus on enhancing student learning and address the integration issues associated with the theory practice gap. Increased bioscience education is associated with improved patient outcomes therefore by addressing this “bioscience problem” and improving the integration of bioscience in clinical practice there will subsequently be an improvement in health care outcomes. - Conclusion From the literature several themes were identified. First there are many problems with teaching nursing students bioscience education. These include class sizes, motivation, concentration, delivery mode, lecturer perspectives, student's previous knowledge, anxiety, and a lack of confidence. Among these influences the type of assessment employed by the educator has not been explored or identified as a contributor to student learning specifically in nursing bioscience instruction. Second that educating could be achieved more effectively if active learning principles were applied and the needs and expectations of the student were met. Lastly, assessment influences student retention and the student experience and as such assessment should be congruent with the subject content, align with the learning objectives and be used as a stimulus tool for learning.

Work Stress in the Nursing Profession : An Evaluation of Organizational Causal Attribution

The goal of this study was to examine the role of organizational causal attribution in understanding the relation of work stressors (work-role overload, excessive role responsibility, and unpleasant physical environment) and personal resources (social support and cognitive coping) to such organizational-attitudinal outcomes as work engagement, turnover intention, and organizational identification. In some analyses, cognitive coping was also treated as an organizational outcome. Causal attribution was conceptualized in terms of four dimensions: internality-externality, attributing the cause of one’s successes and failures to oneself, as opposed to external factors, stability (thinking that the cause of one’s successes and failures is stable over time), globality (perceiving the cause to be operative on many areas of one’s life), and controllability (believing that one can control the causes of one’s successes and failures). Several hypotheses were derived from Karasek’s (1989) Job Demands–Control (JD-C) model and from the Job Demands–Resources (JD-R) model (Demerouti, Bakker, Nachreiner & Schaufeli, 2001). Based on the JD-C model, a number of moderation effects were predicted, stating that the strength of the association of work stressors with the outcome variables (e.g. turnover intentions) varies as a function of the causal attribution; for example, unpleasant work environment is more strongly associated with turnover intention among those with an external locus of causality than among those with an internal locuse of causality. From the JD-R model, a number of hypotheses on the mediation model were derived. They were based on two processes posited by the model: an energy-draining process in which work stressors along with a mediating effect of causal attribution for failures deplete the nurses’ energy, leading to turnover intention, and a motivational process in which personal resources along with a mediating effect of causal attribution for successes foster the nurses’ engagement in their work, leading to higher organizational identification and to decreased intention to leave the nursing job. For instance, it was expected that the relationship between work stressors and turnover intention could be explained (mediated) by a tendency to attribute one’s work failures to stable causes. The data were collected from among Finnish hospital nurses using e-questionnaires. Overall 934 nurses responded the questionnaires. Work stressors and personal resources were measured by five scales derived from the Occupational Stress Inventory-Revised (Osipow, 1998). Causal attribution was measured using the Occupational Attributional Style Questionnaire (Furnham, 2004). Work engagement was assessed through the Utrecht Work Engagement Scale (Schaufeli & al., 2002), turnover intention by the Van Veldhoven & Meijman (1994) scale, and organizational identification by the Mael & Ashforth (1992) measure. The results provided support for the function of causal attribution in the overall work stress process. Findings related to the moderation model can be divided into three main findings. First, external locus of causality along with job level moderated the relationship between work overload and cognitive coping. Hence, this interaction was evidenced only among nurses in non-supervisory positions. Second, external locus of causality and job level together moderated the relationship between physical environment and turnover intention. An opposite pattern of interaction was found for this interaction: among nurses, externality exacerbated the effect of perceived unpleasantness of the physical environment on turnover intention, whereas among supervisors internality produced the same effect. Third, job level also disclosed a moderation effect for controllability attribution over the relationship between physical environment and cognitive coping. Findings related to the mediation model for the energetic process indicated that the partial model in which work stressors have also a direct effect on turnover intention fitted the data better. In the mediation model for the motivational process, an intermediate mediation effect in which the effects of personal resources on turnover intention went through two mediators (e.g., causal dimensions and organizational identification) fitted the data better. All dimensions of causal attribution appeared to follow a somewhat unique pattern of mediation effect not only for energetic but also for motivational processes. Overall findings on mediation models partly supported the two simultaneous underlying processes proposed by the JD-R model. While in the energetic process the dimension of externality mediated the relationship between stressors and turnover partially, all the dimensions of causal attribution appeared to entail significant mediator effects in the motivational process. The general findings supported the moderation effect and the mediation effect of causal attribution in the work stress process. The study contributes to several research traditions, including the interaction approach, the JD-C, and the JD-R models. However, many potential functions of organizational causal attribution are yet to be evaluated by relevant academic and organizational research. Keywords: organizational causal attribution, optimistic / pessimistic attributional style, work stressors, organisational stress process, stressors in nursing profession, hospital nursing, JD-R model, personal resources, turnover intention, work engagement, organizational identification.

Le Grand Tour Du reste de l’Europe jusqu’à la Laponie – et retour

Rencontre entre le Sud et le Nord Depuis des siècles, les pays méditerranéens ont entretenu des relations actives avec le Nord de l’Europe. Les regions du Nord ont été conquises et converties, manipulées et colonisées, mais aussi intégrées dans les réseaux commerciaux, scientifi ques, culturels et touristiques. Les voyageurs du Sud de l’Europe ont peu à peu découvert les regions plurielles du Nord de la Finlande, de la Suède, de la Norvège et de la presqu’île de Kola. L’attraction focntionnait aussi dans l’autre sens. Pour les gens du Nord, scientifi ques ou artistes, le Sud de l’Europe constituait une destination aussi exotique aue la Laponie pour ceux du Sud. Dans ce recueil, nous proposons dix points de vue sur ces échanges et réseaux entre la Sud et le Nord. Le premier chapitre présente Tornio, connue très tôt comme la porte de la Laponie, les premières relations scientifi ques entre le Nord et le Sud, ainsi que les exhibitions de Samis dans les métropoles européennes. Le deuxième chapitre propose une analyse des experiences et des impressions de voyageurs italiens, espagnols et français. Le dernier chapitre est consacré aux voyages d’artistes et écrivains fi nlandais en France, principalement à Paris. Ces rencontres entre le Sud et le Nord qui participèrent à la remise en cause, la relativisation et la construction des identities nationals et ethniques, permirent aussi de créer une conscience européenne commune.

Approximate linear time ML decoding on tail-biting trellises in two rounds

A linear time approximate maximum likelihood decoding algorithm on tail-biting trellises is presented, that requires exactly two rounds on the trellis. This is an adaptation of an algorithm proposed earlier with the advantage that it reduces the time complexity from O(m log m) to O(m) where m is the number of nodes in the tail-biting trellis. A necessary condition for the output of the algorithm to differ from the output of the ideal ML decoder is deduced and simulation results on an AWGN channel using tail-biting trellises for two rate 1/2 convolutional codes with memory 4 and 6 respectively, are reported.

Importance of meridional circulation i flux transport dynamo: the possibility of a maunder-like grand minimum

Meridional circulation is an important ingredient in flux transport dynamo models. We have studied its importance on the period, the amplitude of the solar cycle, and also in producing Maunder-like grand minima in these models. First, we model the periods of the last 23 sunspot cycles by varying the meridional circulation speed. If the dynamo is in a diffusion-dominated regime, then we find that most of the cycle amplitudes also get modeled up to some extent when we model the periods. Next, we propose that at the beginning of the Maunder minimum the amplitude of meridional circulation dropped to a low value and then after a few years it increased again. Several independent studies also favor this assumption. With this assumption, a diffusion-dominated dynamo is able to reproduce many important features of the Maunder minimum remarkably well. If the dynamo is in a diffusion-dominated regime, then a slower meridional circulation means that the poloidal field gets more time to diffuse during its transport through the convection zone, making the dynamo weaker. This consequence helps to model both the cycle amplitudes and the Maunder-like minima. We, however, fail to reproduce these results if the dynamo is in an advection-dominated regime.

Hydrogen Storage Capacity of Carbon-Foams: Grand Canonical Monte Carlo Simulations

Hydrogen storage in the three-dimensional carbon foams is analyzed using classical grand canonical Monte Carlo simulations. The calculated storage capacities of the foams meet the material-based DOE targets and are comparable to the capacities of a bundle of well-separated similar diameter open nanotubes. The pore sizes in the foams are optimized for the best hydrogen uptake. The capacity depends sensitively on the C-H-2 interaction potential, and therefore, the results are presented for its ``weak'' and ``strong'' choices, to offer the lower and upper bounds for the expected capacities. Furthermore, quantum effects on the effective C-H-2 as well as H-2-H-2 interaction potentials are considered. We find that the quantum effects noticeably change the adsorption properties of foams and must be accounted for even at room temperature.

Dynamo models of grand minima

Since a universally accepted dynamo model of grand minima does not exist at the present time, we concentrate on the physical processes which may be behind the grand minima. After summarizing the relevant observational data, we make the point that, while the usual sources of irregularities of solar cycles may be sufficient to cause a grand minimum, the solar dynamo has to operate somewhat differently from the normal to bring the Sun out of the grand minimum. We then consider three possible sources of irregularities in the solar dynamo: (i) nonlinear effects; (ii) fluctuations in the poloidal field generation process; (iii) fluctuations in the meridional circulation. We conclude that (i) is unlikely to be the cause behind grand minima, but a combination of (ii) and (iii) may cause them. If fluctuations make the poloidal field fall much below the average or make the meridional circulation significantly weaker, then the Sun may be pushed into a grand minimum.