A human factors approach to evaluate predicators of acute care nurse occupational fatigue.

Nurses function at the point of care and assume a significant role in intercepting errors. They work in a mentally and physically demanding profession that is comprised of shift-work, subjecting nurses to considerable fatigue. Yet, few studies constructed a comprehensive model that integrates personal and occupational factors to explore their relationship with various types of fatigue (acute, chronic, physical, mental, and total). Here, we examine this type of comprehensive fatigue-model, in a report that represents one aim of a larger, mixed-methods study. The study sample comprised of 1137 registered nurses working in eight hospitals in a Midwestern state. Nurses reported higher levels of acute and total fatigue than chronic and physical fatigue. Staffing and resource adequacy, exercise, and sleep were among the strongest predictors. Since fatigue is a multi-faceted construct, a comprehensive fatigue-management strategy that targets both day and night-shift nurses is the optimal way to manage nurse fatigue.

Esophageal obstruction caused by mediastinal histoplasmosis: beneficial results of operation.

A patient presented with progressive dysphagia and chest pain. Radiologic investigation showed extrinsic compression of the esophagus by enlarged, calcified, mediastinal lymph nodes. Immunologic studies suggested that this was due to previous histoplasmosis, currently inactive. The nodes were excised at thoracotomy, with complete relief of symptoms. Operative management was most appropriate because of the apparent inactivity of the infection, the severity and progressive nature of the symptoms, and the possible prophylaxis of mediastinal fibrosis, a well-documented complication of histoplasmosis.

Cholinergic responsiveness of intestinal muscle in the pregnant guinea pig.

Clinical observations and limited animal experiments have suggested that gastrointestinal motility is suppressed during pregnancy. We therefore compared isometric contractions of colon and ileal circular muscle in response to carbachol (10(-8) to 10(-4) M). Data was analyzed by comparing mean maximal tension, dose-response curves, and EC50 values for tissue from the two groups of animals. Circular muscle from proximal colon, distal colon, and ileum in pregnant animals developed less tension in response to carbachol than did tissue from non-pregnant controls. Dose-response curves in the pregnant groups were depressed, when compared with non-pregnant groups, at concentrations of 10(-6) M and greater. Sensitivity of the muscle to cholinergic stimulation, as measured by EC50 values, was similar in the ileum and proximal colon but increased slightly (p less than 0.05), by a factor of approximately 2, for distal colonic muscle from pregnant animals. Assuming that circular muscle contractions are primarily responsible for mixing and propulsion in the gut, this reduction in responsiveness to excitatory cholinergic stimulation is consistent with the concept of pregnancy-related suppression of gastrointestinal motility.

Evaluation of advanced cardiac life support written examinations.

OBJECTIVE: To examine the quality of 2 advanced cardiac life support written examinations and the relationship between demographic variables and test performance. DESIGN: Descriptive. SETTING: Advanced cardiac life support courses held at 4 midwestern hospitals, one outpatient surgery center, and one community college. SUBJECTS: Nonprobability sample of 367 participants. OUTCOME MEASURE: Two versions of the American Heart Association advanced cardiac life support written examinations. RESULTS: Reliability coefficients of test A and test B were 0.45 and 0.54, respectively. Discrimination and difficulty indices calculated on both tests revealed that test B questions were more difficult, with better discriminators. Prior experience, sex of participant, and profession were identified as factors influencing test performance. CONCLUSION: Although test B surpassed the performance of test A, both examinations were problematic. Additional investigation and refinement of the advanced cardiac life support tests are warranted.

The similarities and differences of endometritis and pelvic inflammatory disease.

Pelvic inflammatory disease, a common gynecologic problem with an estimated 1 million cases annually, results in serious sequelae. Endometritis, a common obstetric problem occurring in more than 15% of all pregnancies, is the leading cause of maternal mortality. Risk factors are numerous. Diagnosis is not always definitive and relies heavily on the clinical judgment of the practitioner. Prompt initiation of empiric treatment regimens, close monitoring of the client, and client education result in positive health outcomes.

Caregiving and care receiving among a technologically dependent heart failure population.

This descriptive study investigated health-related quality of life (HRQOL) and caregiving/care receiving among 20 end stage heart failure patients receiving community-based inotropic infusions and among their 18 family caregivers. The analysis revealed that care recipients perceived considerable impairment from their disease process and poor HRQOL despite the use of inotropic infusions. Perceived powerlessness was identified as a predictor of the recipients' mental health status, while caregiver esteem adversely affected recipient HRQOL. Although insufficient preparation to care and caregiving tasks significantly contributed to the negative aspects of care provision. the esteem and mental health of the caregiver significantly enhanced HRQOL among caregivers.

Nurse consultant and professional liability.

The expanded role of nurse consultant brings greater responsibility and risk of professional liability in a litigious society. The nurse consultant needs to be aware of the elements that constitute malpractice and be able to plan for the management of risks involved. When purchasing a liability policy, the nurse consultant must consider the practice setting, types of policies, components of the policy, cost, and means to obtain adequate coverage. Other strategies for protection include proper use of the consultant process, client communication, and individualized client contracts. A well-written contract serves as a legal document to delineate responsibilities and outcomes, provide a professional image, and protect against possible negative developments.

Role of registered nurses in error prevention, discovery and correction.

BACKGROUND: Registered nurses have a vital role in discovering and correcting medical error. OBJECTIVE: To describe the type and frequency of errors detected by American critical care nurses, and to ascertain who made the errors discovered by study participants. METHODS: Daily logbooks were used to collect information about errors discovered by a random sample of 502 critical care nurses during a 28-day period. RESULTS: Although the majority of errors discovered and corrected by critical care nurses involved medications (163/367), procedural errors were common (n = 115). Charting and transcription errors were less frequently discovered. The errors discovered by participants were attributed to a wide variety of staff members including nurses, doctors, pharmacists, technicians and unit secretaries. CONCLUSIONS: Given the importance of nurses in maintaining patient safety, future studies should identify factors that enhance their effectiveness to prevent, intercept and correct healthcare errors.

Gallstone disease and pancreatitis in pregnancy.

Controversy exists over whether pregnancy is a risk factor for gallstone formation; however, changes in hepatobiliary function do occur during pregnancy to create a lithogenic environment; these changes include gallbladder stasis and secretion of bile with increased amounts of cholesterol and decreased amounts of chenodeoxycholic acid. In women with existing gallstones, pregnancy may bring out symptoms, including pain and even acute cholecystitis. This may be more common during the postpartum period than during pregnancy itself; however, the overall occurrence of symptomatic biliary disease in association with pregnancy is low. The effects of pregnancy, if any, on pancreatic exocrine function are undefined. Acute pancreatitis can occur during pregnancy but does not appear to do so with either increased or, alternatively, decreased frequency. The concept of pancreatitis caused by pregnancy per se is not valid, although in susceptible women with lipid disorders, hypertriglyceridemia can occur and serve as an etiologic factor. Gallstones are a common cause of pancreatitis, but in contrast to nonpregnant women, alcohol is unusual as a cause. Although the presentation of both acute cholecystitis and acute pancreatitis may be similar to that in the nonpregnant state, the differential diagnosis of both these disorders is expanded because of unique pregnancy-related conditions and the shift of abdominal viscera by the enlarging uterus. The diagnosis is clinical and supported with conventional laboratory studies and ultrasound; management is supportive and in most patients successful. Cholecystectomy is seldom necessary during pregnancy, either for acute cholecystitis or gallstone pancreatitis, but can be safely performed if necessary after the first trimester. Endoscopic papillotomy and stone removal for choledocholithiasis are possible during pregnancy and may be the treatment of choice for this unusual condition. Specific enteral or parenteral nutrition may be necessary in women with pancreatitis associated with hypertriglyceridemia.

Perceived needs of parents of critically ill children.

PURPOSE: To identify the needs of parents of critically ill hospitalized children as perceived by the parents and critical care nurses, and to identify any differences between the two groups. DESIGN: Descriptive, comparative. SETTING: Pediatric intensive care unit (PICU) in a Midwestern hospital. PARTICIPANTS: A nonprobability convenience sample of parents or primary caregivers of critically ill children (n = 21) and pediatric critical care nurses (n = 17). OUTCOME MEASURES: Critical Care Family Needs Inventory modified for pediatrics and demographic questionnaires. RESULTS: Information, assurance, and proximity to the critically ill child were identified as priority needs of the PCGs in this study. Significant differences on specific needs were identified between PCG/nurse matched pairs; however, no significant differences were found in total scores between the two groups by a two-tailed paired t test. CONCLUSIONS: This study supports the need to investigate interventions to better address parental needs of critically ill children. By consistent identification, prioritization, and incorporation of parental needs into the plan of care, nurses can assist the parents in the recognition and fulfillment of needs that have less perceived importance. Research-based interventions will facilitate improved parental adaptation to their child's critical hospitalization.

Correlation of contractions and transit in rat small intestine.

A single strain gauge was implanted chronically in the proximal jejunum of the rat to record contractions. FAsted pentobarbital-anesthetized animals received glucagon, caerulein, or isotonic saline control infusions intravenously while contractions were recorded. In control animals, the distribution of contractions in time showed clusters, with peaks at intervals of 14.24 +/-5.6 (SD) min. Glucagon produced dose-related inhibition of contractions. Caerulein at two lower doses produced a more uniform distribution of contractions in time; a higher dose caused inhibition. In other fasted rats, an isotopically labeled bolus was given through a chronically implanted duodenal cathether, and its distribution along the small intestine was examined in animals receiving the same doses of glucagon, caerulein, and saline. Glucagon caused a dose-related delay in transit. Those doses of caerulein that produced a uniform distribution of contractions accelerated transit; the dose that inhibited contractions delayed transit. Doses of glucagon and caerulein known to affect both motility and transit did not significantly affect water movement. The fasted rat resembles the fasted go in respect to the temporal distributions of jejunal contractions at a single point. Both quantitative and qualitative changes in contractions induce changes in transit.

Influence of the interdigestive myoelectric complex on enteric flora in the rat.

This study was designed to define the role of the interdigestive myoelectric complex in small intestinal bacteriostasis. In rats, six monopolar electrodes were surgically sewn to the small intestine at equal intervals. One week later myoelectric activity was recorded. Under different experimental conditions, segments of duodenum and ileum were cultured quantitatively, both aerobically and anaerobically. Five groups of 6 electrode-equipped animals each were studied after an overnight fast: rats in which (a) the interdigestive myoelectric complex was present, (b) the interdigestive myoelectric complex was disrupted for 6 h using morphine sulfate, (c) the interdigestive myoelectric complex was disrupted for 15 h using morphine sulfate, (d) the interdigestive myoelectric complex was disrupted for 15 h using phenylephrine, and (e) the interdigestive myoelectric complex returned after 15 h of morphine sulfate effect. In control rats and during baseline records before drug administration in the other four groups, the interdigestive myoelectric complex was present. Activity fronts cycled at regular intervals in the proximal small intestine and moved aborally. Activity fronts disappeared following both morphine and phenylephrine, with varying degrees of inhibition of spike activity. Titers of microorganisms increased after 6 h, becoming statistically significant at 15 h; this effect was seen with both drugs. However, titers were similar to controls in groups 5. These results show that the interdigestive myoelectric complex is an important regulator at bacterial growth in the small intestine.

Evaluation of esophageal diseases.

The diagnosis of esophageal disease can be made by history alone in 80 percent of patients. Primary symptoms include dysphagia, odynophagia, heartburn and central chest pain. Although these symptoms may overlap, one esophageal symptom often predominates. This observation and an understanding of the available diagnostic tests enable the clinician to develop an algorithmic approach to the diagnosis of esophageal diseases.

Esophageal adenocarcinoma in a patient with surgically treated achalasia.

Although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia, esophageal adenocarcinoma has been considered rare in this condition. We report a patient with long-standing achalasia in whom adenocarcinoma of the esophagus occurred many years after Heller esophagomyotomy, presumably related to Barrett's esophagus complicating gastro-esophageal reflux disease.