Emerging Frontline Leaders' Voices in Response to COVID-19 Crisis.

BACKGROUND: The COVID-19 pandemic has significantly affected healthcare institutions, introducing new challenges for nurse leaders and their colleagues. However, little is known about how the pandemic has specifically affected the lives of these leaders and what methods and strategies they are using to overcome pandemic-related challenges. OBJECTIVES: The aim of this study was to examine the effect of the 2019 pandemic on emerging healthcare leaders and highlight methods and strategies they used to overcome pandemic-related challenges. METHODS: The participants in this study represent a diverse group of interprofessional healthcare faculty enrolled in a transformational leadership course (Paths to Leadership) when the pandemic first appeared. Three months into the pandemic, the leadership cohort was invited to participate in this qualitative study, exploring four questions: Q1: How have you transformed your working styles in response to the pandemic? Q2: How have you adjusted your personal life in response to the pandemic? Q3: How have you used leadership skills learned from Paths to Leadership during the pandemic? Q4: What lessons have you learned from the pandemic? Participant narratives were analyzed by a team of nurse researchers using conventional qualitative content analysis. RESULTS: Themes for Q1 (working styles) included shifted from face-to-face to telework, faced novel disease and decisions, worked more from home, and challenged to maintain contact with professional peers and team. Themes for Q2 (personal life) included accommodate adults working and children learning from home, looked for and found the positive, and continue to struggle. Themes for Q3 (leadership skills) included reflective practice, listening, holding, and reframing. Finally, themes for Q4 (pandemic lessons) included leadership, human connection, be prepared, taking care of ourselves, and connecting with nature. DISCUSSION: The 2019 pandemic brought hardships and opportunities to faculty members enrolled in an interprofessional transformational leadership course. In conjunction with this course, the pandemic provided a unique opportunity for participants to apply newly acquired relationship building, positive organizational psychology, and reframing skills during a time of crisis. Nursing leaders, whose educational offerings may be immediately "put to the test," may find our lessons learned helpful as they develop strategies to cope with unanticipated future challenges.

The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents.

OBJECTIVE: Associations between dysphonia and paradoxical vocal fold motion (PVFM) have been previously reported in adults, but it is unclear whether similar associations exist for adolescents. The goals of this study were to identify the prevalence and severity of voice disorders in adolescent patients with PVFM, identify differences between those with and without clinician-identified dysphonia, and investigate what factors were associated with voice handicap in this population. METHODS: A retrospective review of eligible adolescent patients diagnosed with PVFM over a 1-year period at a single institution was undertaken. Data collected from the medical record included demographic background, medical history and workup, patient- and family-reported symptoms, and findings from the laryngeal examination. The presence or absence of clinician-diagnosed dysphonia was used to subdivide the sample for analysis. RESULTS: Forty-eight patients with PVFM were included. The sample was primarily female (73%) with a median age of 15 years. Few patients had voice complaints (5%), but clinician-diagnosed dysphonia was common (52%) and ranged from mild to moderate. Vocal hyperfunction was frequently observed (55%), but anatomic abnormalities associated with dysphonia were rare (6%). Adolescents with dysphonia were significantly older, more likely to have vocal hyperfunction on laryngoscopy, and more likely to return for therapy than those without dysphonia. No notable differences existed in the number of behavioral therapy sessions or in the likelihood of completing treatment between the two groups. The majority of participants (79%) had at least one "confounding factor" (i.e., were currently taking a medication for asthma, allergies, or reflux, or had a laryngeal abnormality) but this did not differ significantly between those with and without dysphonia. A minority of individuals (28%) had abnormal scores on the Voice Handicap Index (VHI). Age was positively correlated with dysphonia severity but no other significant associations were observed. CONCLUSION: Although voice complaints are rare, dysphonia among adolescents with PVFM is common and can occur in the absence of laryngeal abnormalities and medical comorbidities, typically as a result of vocal hyperfunction. Dysphonia does not appear to be a barrier to PVFM treatment and may be a useful target in therapy.

Factors that influence transition to advanced roles by RN to BSN nurses, in three selected hospitals of Central-Uganda.

BACKGROUND: Despite the global rise in the number of nurses upgrading from Registered Nursing (RN) to a Bachelor of Science in Nursing (BSN), studies have indicated that successful role transition is difficult once the nurses return to their previous workplaces. Guided by the Transitional Theory, this study investigates the factors that influence the transition from basic to advanced roles among RN to BSN nurses in Uganda, Africa. METHODS: This study employed a descriptive correlational design. Using convenience sampling, fifty-one (51) RN to BSN nurses completed the semi-structured questionnaires. RESULTS: All the study participants (100%) described themselves as having transitioned from RN to BSN role. In bivariate linear regression, personal factors that were found to predict successful role transition included holding a managerial role, being aware and prepared for the role transition, and positive role transition experiences. Role transition motivators that predicted successful role transition included: job promotion, internal desire for self-development, and career development. One community factor - that is the support of doctors/physicians during the RN to BSN transition - predicted unsuccessful role transition. Societal factors deterring successful role transition included lack of support from other colleagues and the perception that BSN learning was not applicable to the RN clinical setting. In multivariate linear regression, only sub-scales of personal factors such as advanced skills mastery and positive personal experiences predicted successful role transition. CONCLUSION: The study suggests that personal factors influence successful role transition more than external factors.

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults.

OBJECTIVE: Paradoxical vocal fold motion (PVFM) is responsive to behavioral therapy, often resulting in a remission of symptoms, but little is known about whether treatment is beneficial with regard to PVFM-associated psychological symptoms or functional limitations. The goal of the study was to identify patient perceptions of the impact of treatment for PVFM and characteristics associated with treatment outcomes. METHODS: A survey was conducted of all adults who had received at least 1 session of treatment for PVFM in our outpatient clinic over a 2-year period. RESULTS: The 39 participants ranged in age from 18 to 82 and had received a median of 3 treatment sessions. At a median follow-up of 10 months following treatment, respondents reported improvements in a wide range of areas, including sports and leisure, daily activities, and social participation. The majority reported improvements in feelings of anxiety, helplessness, and control. Poorer outcomes were associated with more severe voice symptoms, fewer treatment sessions, and needing oral steroids for asthma control. CONCLUSION: There was a reduction in a wide range of activity limitations after treatment. Feelings of control were strongly associated with positive outcomes. The therapy appeared to be equally effective for adults with exercise-induced and environmental variants of PVFM.

Septuplet placenta: a case report.

OBJECTIVE: On November 19, 1997, 7 liveborn infants (4 boys and 3 girls) were delivered by cesarean delivery at 30.5 weeks gestational age. The pregnancy was the result of artificial induction of ovulation. STUDY DESIGN: The septuplet placenta was evaluated with a standard and systematic procedure for placentas of multiple births that revealed a septamnionic, septchorionic architecture with 5 fused and 2 unfused placentas. RESULTS: Each of the 7 umbilical cords contained 3 vessels. Two cords were velamentous; the remaining 5 cords were inserted eccentrically. The ratio of combined birth weights of the 7 infants to total placental weight (7.52:1) correlated with normograms of singleton and twin gestations. CONCLUSION: This ratio and additional calculations were used for comparison and for additional clinicopathologic correlations.