Clumped isotopes reveal relationship between mussel growth and river discharge.

Freshwater mussels preserve valuable information about hydrology, climate, and population dynamics, but developing seasonal chronologies can be problematic. Using clumped isotope thermometry, we produced high-resolution reconstructions of modern and historic (~ 1900) temperatures and δ18Owater from mussel shells collected from an impounded river, the Brazos in Texas, before and after damming. We also performed high-resolution growth band analyses to investigate relationships between mussel growth rate, rainfall, and seasonal temperature. Reconstructed δ18Owater and temperature vary little between the modern (3R5) and historic shell (H3R). However, a positive relationship between reconstructed δ18Owater and growth rate in H3R indicates that aside from diminished growth in winter, precipitation and flow rate are the strongest controls on mussel growth in both modern and pre-dam times. Overall, our results demonstrate (1) the impact, both positive and negative, of environmental factors such as flow alteration and temperature on mussel growth and (2) the potential for clumped isotopes in freshwater mussels as a paleohydrology and paleoclimate proxies in terrestrial environments.

SMART Oncology Nursing: Literacy, Goals, Coaching, and Empowerment.

PROBLEM STATEMENT: This study assesses the effect of a nurse-designed SMART educational intervention on goal attainment, patient empowerment, and satisfaction. DESIGN: A mixed-methods study design was used. DATA SOURCES: 68 adults with cancer were recruited from an oncology research center and randomized to the immediate or waitlist control group. Empowerment was measured using the Patient Empowerment Scale, and health literacy was measured using the Cancer Health Literacy Test. ANALYSIS: Measures were completed by the immediate group at enrollment and by the waitlist control group after an eight-week waiting period to establish an updated baseline. Participants received four learning modules on goal setting and coaching to facilitate learning and activation of knowledge. Visit data were collected by nurses based on participants' written and oral responses. FINDINGS: Goal attainment ranged from 67% to 100%. Patient empowerment scores were high at baseline and throughout. No significant differences were noted among the groups on goal attainment, empowerment, or satisfaction. IMPLICATIONS FOR NURSING: RNs can deliver a SMART educational intervention using a universal health literacy approach to support adults with cancer in creating symptom management strategies and attaining self-care goals.

Holistic Nursing in Practice: Mindfulness-Based Yoga as an Intervention to Manage Stress and Burnout.

PURPOSE: Effects of a mindfulness-based (MB) yoga practice on stress, burnout, and indicators of well-being among nurses and health care professionals (HCPs). DESIGN: A randomized controlled trial, 80 HCPs assigned to either MB yoga intervention or control group. METHOD: The MB yoga intervention group (n = 41) attended weekly yoga classes and practiced yoga independently. The control group (n = 39) did not receive the yoga intervention. Study participants completed pre- and postintervention questionnaires, instruments included (a) Perceived Stress Scale; (b) Maslach Burnout Inventory; (c) Vitality subscale of the Medical Outcomes Study Short Form-36; (d) Global Sleep Quality item, (e) Mindfulness Awareness Survey, and (f) subscale of the Brief Serenity Scale. Diurnal salivary cortisol and blood pressure were assessed pre and postintervention. RESULTS: Significant improvements (p < .01) noted in MB yoga compared with control for self-reported factors, including stress (Perceived Stress Scale), burnout (Maslach Burnout Inventory), vitality (Medical Outcomes Study Short Form-36), sleep (GSQ), serenity/inner haven (IH), and mindfulness (Mindfulness Awareness Survey). Diurnal cortisol slopes and blood pressure were not significantly improved. CONCLUSION: The MB yoga intervention had a statistically significant effect on the health and well-being of nurses and HCPs, most specifically for measures of stress; perceived stress, burnout, vitality, sleep quality, serenity, and mindfulness.

Nurses' Experiences of "Being Swamped" in the Clinical Setting and Association with Adherence to AWHONN Nurse Staffing Guidelines.

PURPOSE: Being swamped is defined as "when you are so overwhelmed with what is occurring that you are unable to focus on the most important thing." The purpose of this study was to explore the experience of being swamped in the clinical setting among nurses who are members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the relationship of the level of being swamped to adherence to the nurse staffing guidelines. STUDY DESIGN AND METHODS: A 25-item survey was sent to ~21,000 AWHONN members by email in the Fall of 2018. It was completed by 1,198 members, representing 49 states and the District of Columbia. Questions explored timing and causes of being swamped, its effect on health care team members and patients, what helps when a nurse feels swamped, and nurses' reports of their hospital following the AWHONN nurse staffing guidelines. RESULTS: Twenty-eight percent of nurses reported being swamped daily or multiple times per day. Situations that contribute to being swamped include assignments that are too heavy, interruptions, critical patient situations, and mistakes made by others that nurses are expected to catch and fix. Teamwork and someone stepping in to help without being asked were identified as most helpful when a nurse feels swamped. Nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of being swamped as compared with those in hospitals that followed the guidelines some of the time, or rarely (p < 0.001). CLINICAL IMPLICATIONS: Being swamped is a common phenomenon among AWHONN members responding to the survey. The reported incidence of being swamped daily is significantly associated with the extent to which hospitals follow the AWHONN nurse staffing guidelines. Nurse leaders, hospital administrators, and staff nurses must work together to identify and initiate timely, feasible nurse staffing solutions that support the safety of patients and nurses.

A collaborative approach to building the capacity for research and evidence-based practice in community hospitals.

The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care.