Integrating Disaster Management Into Curricula: A Successful Collaboration With Community Partners.

ABSTRACT: Millions of people are killed annually in disasters, and even more are injured, displaced, and in need of emergency assistance. Communities continue to need nurses who can respond effectively during times of disaster. A one-credit course was developed to provide a collaborative and engaging approach to prepare students for disaster and mass casualty situations. Student evaluation responses regarding all segments of the course indicate satisfaction and quality learning. The course prepared and qualified students to volunteer for a community service organization and provide community-based care.

Long Term Participation Outcomes for Severe Acquired Brain Injury in Childhood - An Expanded Scoping Review.

Introduction: Participation in childhood Acquired Brain Injury (ABI) lacks clarity in definition and determinants influencing long-term outcome. This paper aims to investigate and identify the factors that impact long-term outcomes, and prioritize the measures that focus on and endorse children, young people, and their family's concept of participation.Methods: A scoping review was carried out using research literature and non-research data sources including data review, child/family interviews, and expert consultation.Results: Six peer-reviewed papers sourced. Families reported that participation for the whole family is important and recovers in a non-linear manner after rehabilitation. Experts agreed the priority and complexity of participation following severe ABI.Conclusion: Review highlights that regaining participation through the attendance at, and the engagement in life situations, for children after severe ABI, is important, complex and is affected by many factors.Future research requires a flexible approach to understand participation and inform future targeted interventions.

A patient-centered approach to tapering opioids.

Simply treating opioid addiction isn't enough. Instead, reposition your patient's singular circumstances and needs at the center of efforts to end use of these agents.

Health promotion for young people with profound and multiple learning disabilities.

Research confirms that children and young people with severe learning disabilities do not have the same level of access to high-quality care, health education and health promotion activities as children and young people without disabilities. This article discusses a quality improvement, action research project to investigate alternative approaches to health promotion that enhance the health and well-being of children and young people with complex neurodisabilities. The project involved assessment of school records and completion by staff of an eight-question survey. It found that the proactive approach of school nurses in raising awareness and understanding through questioning was positively received, and reinforced how meaningful and relevant information could be delivered to these young people. The project also had unexpected benefits, including more integrated team working, increased knowledge, greater awareness and understanding of the importance of health promotion participation, and student satisfaction.

Paediatric Rehabilitation Ingredients Measure: a new tool for identifying paediatric neurorehabilitation content.

AIM: To develop an instrument (Paediatric Rehabilitation Ingredients Measure [PRISM]) for quantitative estimation of contents of interdisciplinary neurorehabilitation for use in studies of relationships between rehabilitation treatment delivered and severity-adjusted outcomes after acquired brain injury (ABI). METHOD: The measure was developed using an ingredients-mediators-outcomes model consistent with the International Classification of Functioning, Disability and Health, a literature review, and other current initiatives in the development of rehabilitation treatment taxonomies, with item codevelopment in workshops with rehabilitation professionals. Interrater reliability was assessed in inpatient and residential paediatric rehabilitation settings. RESULTS: Although sometimes an initially unfamiliar perspective on rehabilitation practice, PRISM's acceptability amongst professionals was excellent. Internal consistency of scores was sometimes an issue for users unfamiliar with the tool; however, this improved with practice and interrater reliability (assessed by Kendall's W) was good. The tool was felt to have particular value in facilitating interdisciplinary communication and working. Modifications to the design of the tool have improved internal consistency. INTERPRETATION: PRISM supports identification of the 'active ingredients' of an interdisciplinary rehabilitation package and facilitates interdisciplinary communication. It also has potential as a research tool examining relationships between rehabilitation delivered and severity-adjusted outcomes observed after paediatric ABI. WHAT THIS PAPER ADDS: Identifying contribution of rehabilitation to outcomes after acquired brain injury requires quantification of rehabilitation 'dose' and 'content'. Previous approaches to 'parsing' of rehabilitation dose and content may have overemphasized one-to-one sessions with therapists. We present a novel, holistic tool for identification of ingredients of an interdisciplinary rehabilitation package. It supports interdisciplinary communication and has potential as a research tool.

The effect of toothpicks containing flavoring and flavoring plus jambu extract (spilanthol) to promote salivation in patients -diagnosed with opioid-induced dry mouth (xerostomia).

OBJECTIVE: To determine if the use of toothpicks infused with flavoring and flavoring plus the food additive spilanthol (Xerosticks™) improve saliva flow in people with opioid-induced dry mouth. DESIGN: Time series, nonrandomized, double-blind within-subject design. SETTING: Private practice/academic multidisciplinary pain and palliative care clinic. PARTICIPANTS: Ten subjects with opioid-induced dry mouth were recruited, and all finished the study. METHODS: Salivary flow and pH were measured consecutively at baseline, following use of a mango-flavored toothpick, and again after use of a mango-flavored toothpick infused with spilanthol. Salivary flow rates and saliva pH were compared between flavored and baseline, between flavored + spilanthol and baseline, and between the flavored and flavored + spilanthol. Mouthfeel of each toothpick was assessed using the Bluestone Mouthfeel Questionnaire. OUTCOMES: The primary measure was salivary flow, and the secondary measures were salivary pH and mouthfeel. RESULTS: Saliva flow increased 440 percent over baseline with use of a flavored toothpick and 628 percent over baseline with similarly flavored toothpicks infused with spilanthol, and these differences are significant (p = 0.00002). Saliva pH increased with both toothpicks (p = 0.04). The addition of spilanthol produced a greater increase in salivary flow (p = 0.05) compared to control toothpicks with flavoring alone. Furthermore, addition of spilanthol improved the "mouthfeel" of the toothpick (p = 0.00001). CONCLUSIONS: Toothpicks infused with either flavoring or flavoring plus spilanthol are likely to be an effective remedy for opioid-induced dry mouth. Addition of spilanthol may improve effectiveness over flavoring alone and may be better ac-cepted because spilanthol appears to improve mouthfeel.

What are scoping studies? A review of the nursing literature.

BACKGROUND: Scoping studies are increasingly undertaken as distinct activities. The interpretation, methodology and expectations of scoping are highly variable. This suggests that conceptually, scoping is a poorly defined ambiguous term. The distinction between scoping as an integral preliminary process in the development of a research proposal or a formative, methodologically rigorous activity in its own right has not been extensively examined. AIMS: The aim of this review is to explore the nature and status of scoping studies within the nursing literature and develop a working definition to ensure consistency in the future use of scoping as a research related activity. DESIGN: This paper follows an interpretative scoping review methodology. DATA SOURCES: An explicit systematic search strategy included literary and web-based key word searches and advice from key researchers. Electronic sources included bibliographic and national research register databases and a general browser. RESULTS: The scoping studies varied widely in terms of intent, procedural and methodological rigor. An atheoretical stance was common although explicit conceptual clarification and development of a topic was limited. Four different levels of inquiry ranging from preliminary descriptive surveys to more substantive conceptual approaches were conceptualised. These levels reflected differing dimensional distinctions in which some activities constitute research whereas in others the scoping activities appear to fall outside the remit of research. Reconnaissance emerges as a common synthesising construct to explain the purpose of scoping. CONCLUSIONS: Scoping studies in relation to nursing are embryonic and continue to evolve. Its main strengths lie in its ability to extract the essence of a diverse body of evidence giving it meaning and significance that is both developmental and intellectually creative. As with other approaches to research and evidence synthesis a more standardized approach is required.

A comparison of telehealth and face-to-face presentation for school professionals supporting students with chronic illness.

We compared the perceptions of school professionals who received education about students with chronic illness by videoconference (VC) or by face-to-face (FTF) presentation. Forty-five different one-hour presentations were provided by a paediatric educator to a total of 1389 subjects - 919 viewed FTF presentations and 417 viewed VC presentations. Subjects completed a 10-item survey to assess satisfaction and other perceptions, such as access and convenience of the sessions, on a 5-point Likert scale. The results for the two different modalities were compared using analysis of variance. Participants at the FTF presentations (mean 4.6, SD = 0.6) and VC presentations (mean 4.3, SD = 0.7) indicated that they were very satisfied with the instruction they received. The FTF participants were significantly more satisfied than the VC participants (P < 0.001). Similarly, comfort with the sessions, perceived preparedness, convenience and other items were also highly rated in both groups, although the FTF group rated many of these perceptions significantly higher. Regression analysis showed that the comfort level with the presentations was a predictor of satisfaction, suggesting that people might not be familiar enough with VC sessions to be comfortable and satisfied with this delivery mechanism. Nonetheless, VC delivery appears to be a viable alternative when FTF is not possible, particularly in rural areas.

Nurse prescribing: national data analysis.

Kathy Davis and Vari Drennan summarise the results of an investigation into the prescribing behaviours of community-based nurses and GPs, using prescribing in constipation as a case study (Davis and Drennan, 2007).

'Nurse entrepreneurs' a case of government rhetoric?

INTRODUCTION: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. METHODS: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. RESULTS: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. CONCLUSION: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine.

Entrepreneurial nurses and midwives in the United Kingdom: an integrative review.

AIM: This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. BACKGROUND: Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. METHODS: Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$''social enterprise$''mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. RESULTS: Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. CONCLUSION: Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.

Evaluating nurse prescribing behaviour using constipation as a case study.

Non-medical nurse prescribing in the UK continues to evolve with new legislative frameworks. Studies evaluating patterns of prescribing by nurses remain scarce. This secondary data analysis of national prescribing data investigated the prescribing behaviours of community-based nurses and general practitioners (GPs), using constipation as a case study. Currently, 37 683 registered nurses, midwives and health visitors are qualified to independently prescribe in the UK; however, only 16.6% of nurses prescribed items for constipation. Prescribing practices differed between nurses employed by primary care trusts (PCTs) and general practice, between nurses and GPs, and across regions. PCT-employed nurses undertook 83% of nurse prescribing although activity increased steadily among general practice-employed nurses. Pharmacological treatment choices differed between nurses and GPs. Over 60% of all nurses predominantly prescribed from one class of laxative compared with a wider range prescribed by GPs. The extent, impact and outcomes of medical prescribing need further study.

Overlapping anal sphincter repair and anterior levatorplasty: effect of patient's age and duration of follow-up.

BACKGROUND AND AIMS: Anal sphincter repair can improve function in patients with faecal incontinence but it is unclear which benefit and its long-term efficacy has been questioned. This study aims to assess the functional outcome of a single surgeon series of overlapping anal sphincter repairs with anterior levatorplasty. METHOD: A retrospective study of 66 patients' case notes and anorectal physiology combined with an interview to assess their current continence and associated quality of life after surgery. RESULTS: Sixty-six female patients, mean age 62.8 years, mean follow-up 45.2 months, were assessed. Functional improvement in continence was seen in 77.1% of patients, which mirrored their subjective rating of surgery (62.7%--good/excellent). Continence grading scores improved from a mean (SD) 9.71 (4.82) pre-surgery to 5.55 (4.11) post-surgery. There was no statistical difference in functional results when stratified by age (<63 years or > or =63 years) or by follow-up [long-term (43-78 months) vs short-term (14-42 months)]. Post-surgical physiology data were not statistically improved compared to pre-surgery. CONCLUSIONS: Overlapping anal sphincter repair with anterior levatorplasty is an effective treatment for faecal incontinence. Patient age does not correlate with outcome, and symptoms do not deteriorate over time. Anorectal physiology results don't predict for symptomatic improvement in patients with faecal incontinence.

Posterior pelvic floor compartment disorders.

Posterior pelvic floor compartment disorders generally refer to functional anorectal disturbances that by definition are symptom-based rather than anatomical defect-based and have a significant impact on quality of life. Symptoms attributed to the posterior compartment are often non-specific and associated with structural, neuromuscular and functional defects giving rise to symptoms of prolapse, pelvic pressure, faecal incontinence, stool trapping and constipation. They may range from mild to incapacitating and occur in varying combinations. While symptoms of constipation and incontinence may conceptually represent the opposing extremes of normal anorectal function, the dynamic interrelationships between the different pathophysiological mechanisms involved in the development of these disorders suggest a more complex explanation. Faecal continence and defecation are dependent on several neurological and anatomical factors that involve coordinated physiological processes, including intestinal transit and absorption, colonic transit, rectal compliance, anorectal sensation and continence mechanism. However, it is well recognized that pelvic floor symptoms originating from one compartment do not imply absent pathology in another compartment. Furthermore, symptoms associated with one disorder (such as constipation related to functional obstructed defecation) can be causative in the sequential development of other pelvic floor disorders, such as a urogenital prolapse syndrome, that may further exacerbate symptoms. In addition, it has been found that treatment that corrects one problem may improve, worsen or even predispose to other symptoms from another compartment. Consequently, while the concept of global pelvic floor dysfunction has emerged, the traditional single speciality referral and evaluation of pelvic floor problems continues to foster potentially segregated management strategies that can overlook the relevance of concomitant symptomatology. The evaluation and treatment of posterior pelvic compartment disorders needs to assume an individualized but multidisciplinary therapeutic approach. Given the variation in surgical approaches described to correct anatomical integrity of posterior pelvic compartment deficits, the consensus on optimal management has yet to be achieved. Therefore, it is critical that outcome measures following surgery are clearly defined. Treatment is to a great extent dictated to by functional severity and the impact that symptoms have on quality of life. Long-term follow-up should ensure that the potential for complications is minimized and satisfactory bowel, bladder and sexual function is maintained.

The effect of composition (art or music) on the self-concept of hospitalized children.

The purpose of the present study was to determine the effect of composition (art or music) on the self-concept of hospitalized children. The music composition was created using the program Making More Music. The art composition was a drawing using standard medium. The Piers-Harris Children's Self-Concept Scale was used to measure self-concept. When examining subjects as one group, a significant difference from pre- to posttest for the Total score indicated an improved self-concept. Further analyses on each of the 6 categories indicated no significant differences. The art composition group had a significant difference from pre- to posttest for the Total score and for Popularity (POP). Although not significant, scores increased from pre- to posttest for Behavioral Adjustment (BEH), Physical Appearance (PHY), Freedom from Anxiety (FRE), and Happiness and Satisfaction (HAP). The music composition group had no significant difference from pre- to posttest for the Total score but a significant difference from pre- to posttest on Intellectual and School Status (INT) and Physical Appearance (PRY). Although not significant, scores increased from pre- to posttest for TOT, BEH, and HAP. There was a significant difference between the groups on 2 categories that indicated an improved self-concept for the music group under Intellectual and School Status and for the art group under Popularity.

The effects of aging on moisture-enhanced pork loins.

The effects of preinjection aging time on pork loins injected with a salt/phosphate/lactate solution were investigated. Ninety-six fresh pork loins, in two replicates, were divided into two treatments. Loins in the first treatment were injected to 13% of loin weight at 1 day post-slaughter with a brine containing 2.17% salt/3.04% phosphate/20.8% lactate. The second group was injected with the same brine 4 days after slaughter. Color and Warner-Bratzler shear (WBS) force were measured immediately, 7 and 14 days after injection. Purge was measured 8 and 15 days postmortem. Western blots to measure troponin-T degradation were performed on samples from the two loins that resulted in the lowest shear force, and from the two loins that resulted in the highest shear force, as measured by Warner-Bratzler shear. The two loins with the most purge loss and the two loins with the least purge loss were also analyzed by Western blots for desmin degradation. The L(∗) and b(∗) color values were higher (P<0.05) and purge was greater (P<0.05) for loins injected 1 day postmortem than for loins injected 4 days postmortem. Western blots demonstrated that injection did not affect protein degradation. Therefore, differences between individual animals that affect protein degradation remain important regardless of injection treatment.