Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

General properties of electrochemical capacitors

The use of capacitors for electrical energy storage actually predates the invention of the battery. Alessandro Volta is attributed with the invention of the battery in 1800, where he first describes a battery as an assembly of plates of two different materials (such as copper and zinc) placed in an alternating stack and separated by paper soaked in brine or vinegar [1]. Accordingly, this device was referred to as Volta’s pile and formed the basis of subsequent revolutionary research and discoveries on the chemical origin of electricity. Before the advent of Volta’s pile, however, eighteenth century researchers relied on the use of Leyden jars as a source of electrical energy. Built in the mid-1700s at the University of Leyden in Holland, a Leyden jar is an early capacitor consisting of a glass jar coated inside and outside with a thin layer of silver foil [2, 3]. With the outer foil being grounded, the inner foil could be charged with an electrostatic generator, or a source of static electricity, and could produce a strong electrical discharge from a small and comparatively simple device.

The motivational benefits of specific versus general optimism

This study addresses the question whether a specific, work-related form of optimistic thinking has motivational consequences in terms of work engagement above and beyond general optimism over time. A specific form of optimistic thinking is focus on opportunities. Focus on opportunities is a future-oriented belief that describes how many plans, goals, and possibilities people expect to have in their future at work. Based on a cross-lagged panel design with a two-year time lag and data from a sample of 124 German business owners, results of structural equation modeling showed that focus on opportunities positively predicted changes in work engagement over time, even when controlling for general optimism. This finding supports propositions of social cognition and self-regulation theories that emphasize the importance of a specific form of optimism that has motivating potential by referring to future work goals and opportunities

Elementary particles, general relativity and f-mesons

Abstract is not available.

Paraxial Maxwell beams: transformation by general linear optical systems

Extending the work of earlier papers on the relativistic-front description of paraxial optics and the formulation of Fourier optics for vector waves consistent with the Maxwell equations, we generalize the Jones calculus of axial plane waves to describe the action of the most general linear optical system on paraxial Maxwell fields. Several examples are worked out, and in each case it is shown that the formalism leads to physically correct results. The importance of retaining the small components of the field vectors along the axis of the system for a consistent description is emphasized.

spin Precession of a Charged Particle in a Magnetic Field Including the Effects of General Relativity

Abstract is not available.

Crystal Physics, Diffraction, Theoretical and General Crystallography

A formula has been derived for the mean-square error in the phases of crystal reflections determined through the multiwavelength anomalous scattering method. The error is written in terms of a simple function of the positions in the complex plane of the 'centres' corresponding to the different wavelengths. For the case of three centres, the mean-square error is inversely proportional to the area of the triangle formed by them. The theoretical values are in good agreement with those obtained by earlier workers from computer simulations. The present method makes it easier to optimize the number and the actual wavelengths to be employed in the multiwavelength method. The maximum benefits of this method are expected in experiments employing synchrotron radiation or neutrons.

Explanations of the general sketches of settlements on the Chonhar peninsula

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Proportion of Jews to general population of the European provinces of Russia

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Receipts and Bills of K. K. S. I.--General and unspecified

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A note on synthesis of the general, two-degree-of-freedom linkage

A graphical method is presented for synthesis of the general, seven-link, two-degree-of-freedom plane linkage to generate functions of two variables. The method is based on point position reduction and permits synthesis of the linkage to satisfy upto six arbitrarily selected precision positions.

An approximate mathematical procedure for the determination of characteristic parameters for a general case in three dimensional photoelasticity

In cases whazo zotatLon of the seoondazy pztncipal 8tzo,ae axes along tha light path ,exists, it is always poaeible to detezmlna two dizactions along which plane-polazlaad light ,antazlng the model ,amerCe8 as plene-pela~l,aed light fzom the model. Puzth,az the nat zstazdatton Pot any light path is dlff,azant Prom the lntsgtatad zetazd,ation Pat the l£ght path nogZsctlng the ePfsct or z,atation.