Examining the Impact of Organizational Support on the Secondary Traumatic Stress of Mental Health Professionals Exposed to Workplace Violence.

Mental health professionals are at a heightened risk of secondary traumatic stress (STS) due to the higher prevalence of trauma-exposed individuals seeking clinical help compared to the general population. The aims of this study were as follows: (1) to explore the association between exposure to workplace violence (WPV) and secondary traumatic stress, and the potential mitigating effects of organizational support and (2) to examine how the workplace setting (inpatient vs outpatient) affects the experience of STS. The study was cross-sectional. Over 58 days, survey data was collected from mental health professionals working in both inpatient and outpatient settings. A total of 2,549 professionals responded. The overall prevalence of STS across settings was 87%. The highest reported secondary traumatic stress levels were among nurse practitioners/APRNs (49.29%), followed by nurses (47.94%) and psychiatrists (46.85%). Levels of STS occurred at slightly higher levels among professionals in outpatient settings (48.39%) than those in inpatient settings (45.11%). Increased exposure to WPV correlated with higher levels of STS, while higher levels of perceived organizational support (POS) had a moderating effect on STS levels. This study suggests that STS is a significant phenomenon and that mental health professionals are at risk for developing the condition. Organizational support can play a role in mitigating the effects of WPV and STS. Interventions aimed at improving organizational support and building psychological resilience may help reduce the prevalence of STS among this population.

Evaluation of an unfolding obstetric experience simulation in an undergraduate nursing program.

BACKGROUND: Clinical practice for pre-licensure nurses in obstetrics widely varies and many sites do not consistently present opportunities to meet course objectives or manage complex obstetric nursing care. To address this problem at our institution, we designed a large-scale obstetric simulation using recommendations for best practice in simulation design criteria. We designed an unfolding, obstetric simulation that allowed students repeated opportunities for deliberate practice after micro-debriefing. METHOD: A convenience sample of junior level nursing students (n = 53) participated in a pre/post design evaluation to measure achievement of communication skills based on student perception of obstetric nursing self-efficacy and their ability to transfer those skills to a similar scenario. RESULTS: Scores for obstetric self-efficacy were significantly improved. Pre-simulation (M = 40.78), Time 1 (M = 61.0) and Time 2 (M = 69.27), F (2, 159), =112.12, p = .00. A significant difference was found (t (52) = -7.839, p = .000) when comparing the mean pre and posttest clinical accuracy and completion scores for SBAR forms (n = 53). CONCLUSION: Our unfolding, obstetric simulation was effective in helping our students demonstrate the achievement of course objectives through improved obstetric self-efficacy scores and scores for shift to shift communication.

Evaluating the Usability of a Second-Generation Virtual Reality Game for Refreshing Sterile Urinary Catheterization Skills.

BACKGROUND: Virtual reality (VR) allows risk- and anxiety-free practice, mediated by consistent objective feedback. PURPOSE: This study evaluated the usability of a VR game system for sterile catheterization practice. Participant enjoyment, engagement, likelihood to practice, and comfort using VR are reported. METHODS: Thirty-one students and faculty tested a VR game using Oculus Rift devised to allow practice of placing a urinary catheter in a virtual patient. Data were collected via an electronic survey using the System Usability Survey (SUS) and a User Reaction Survey (URS). RESULTS: The SUS score was 64.03. Seventy-five percent of participants rated the game as positive overall on the URS. Left-handed players had more difficulty playing the game. Players with prescription glasses could not comfortably place the Oculus Rift over their glasses to play. CONCLUSIONS: The VR game shows promise for refreshing sterile catheterization skills.

Reliability and Validity of NCLEX-RN© State Pass Rate Standards.

AIM: The aim of the study was to determine whether state NCLEX-RN pass rate standards for nursing education programs are valid and reliable. BACKGROUND: Nursing education programs must meet minimum NCLEX-RN pass rate standards imposed on them by state regulatory bodies. The standards suggest validity and reliability issues. METHOD: To compute descriptive statistics and reliability coefficients to evaluate state pass rate standards, the study used a database of statutes and regulations that establish pass rate standards and a database of NCLEX-RN pass rates for 2,157 nursing programs in 45 states for 2010 to 2016. RESULTS: There is substantial variation in state pass rate standards. Nursing education program pass rates are not stable over time, suggesting there may be problems with reliability and validity. CONCLUSION: State nursing boards should consider revising pass rate standards to make them more consistent and improve the reliability of pass rate violation determinations.

The accuracy of state NCLEX-RN© passing standards for nursing programs.

BACKGROUND: Nursing education programs in every state must meet specified NCLEX pass rate standards in order to maintain licensure and accreditation. These standards are a source of great anxiety for educators and students. There is wide variety of pass rate standards among the states. In addition, individual nursing program pass rates vary substantially from one year to the next. OBJECTIVES: Pass rate variation suggests the need for scrutiny of the accuracy of applying state pass rates as a standard for evaluating nursing education program. This study considers the implications of such variation. DESIGN: The study computes 95% confidence intervals for nursing program pass rates from 2010 to 2014 to determine whether programs that failed to meet pass rate standards may have done so by accident and whether programs that met pass rate standards may have done so by accident. DATA: The study data includes statutes and regulations that establish pass rate standards and NCLEX pass rates for 1792 nursing programs reflected in reports provided by state nursing boards. FINDINGS: Almost 20% of nursing education programs violated the state pass rate standard at least once between 2010 and 2014. Among the programs that failed to meet pass rate standards, 28.4% had a 95% confidence interval that extended above the pass rate standard. A determination that these programs did not meet pass rate standards could well be erroneous. Approximately 17.4% of programs that met pass rate standards had confidence intervals that went below the pass rate standard. A finding that these programs complied with state pass rate standards might also be erroneous. CONCLUSIONS: Application of confidence intervals to nursing program pass rates suggests that use of pass rate standards to evaluate nursing program quality may not be appropriate. This suggests the need to rethink application of state pass rate standards when evaluating nursing education programs.

Paraplegia in a chiropractic patient secondary to atraumatic dural arteriovenous fistula with perimedullary hypertension: case report.

Intracranial dural arteriovenous fistulas are abnormal communications between higher-pressure arterial circulation and lower-pressure venous circulation. This abnormal communication can result in important and frequently misdiagnosed neurological abnormalities.A case of rapid onset paraplegia following cervical chiropractic manipulation is reviewed. The patient's generalized spinal cord edema, lower extremity paraplegia and upper extremity weakness, were initially believed to be a complication of the cervical spinal manipulation that had occurred earlier on the day of admission. Subsequent diagnostic testing determined the patient suffered from impaired circulation of the cervical spinal cord produced by a Type V intracranial arteriovenous fistula and resultant venous hypertension in the pontomesencephalic and anterior spinal veins.The clinical and imaging findings of an intracranial dural arteriovenous fistula with pontomesencephalic venous congestion and paraplegia are reviewed.This case report emphasizes the importance of thorough and serial diagnostic imaging in the presence of sudden onset paraplegia and the potential for error when concluding atypical neurological presentations are the result of therapeutic misadventure.

Biphasic synovial sarcoma in the cervical spine: Case report.

Synovial sarcoma is a rare malignant neoplasm of soft tissue that typically arising near large joints of the upper and lower extremities in young adult males. Only 3% of these neoplasms have been found to arise in the head and neck region. To our knowledge, there are limited reports in the literature of this neoplasm in the cervical spine.A case of biphasic synovial sarcoma of the cervical spine is reviewed. A 29 year-old male presented with pain on the left side of the cervical spine. Physical examination revealed a global loss of cervical motion and large, palpable mass in the left paravertebral area. The long-delayed Magnetic Resonance (MR) scan revealed a soft tissue mass measuring 8.3 centimeters (cm) × 5.7 cm that was surgically removed. A malignant biphasic synovial sarcoma was diagnosed on pathologic examination.The clinical and imaging findings of an atypically located synovial sarcoma are reviewed. This case report emphasizes the consequences of a limited differential diagnosis, prolonged treatment and the failure to perform timely diagnostic imaging in the presence of a paraspinal mass.

The attrition rate of licensed chiropractors in California: an exploratory ecological investigation of time-trend data.

BACKGROUND: The authors hypothesized the attrition rate of licensed chiropractors in California has gradually increased over the past several decades. "Attrition" as determined for this study is defined as a loss of legal authority to practice chiropractic for any reason during the first 10 years after the license was issued. The percentage of license attrition after 10 years was determined for each group of graduates licensed in California each year between 1970 and 1998. The cost of tuition, the increase in the supply of licensed chiropractors and the ratio of licensed chiropractors to California residents were examined as possible influences on the rate of license attrition. METHODS: The attrition rate was determined by a retrospective analysis of license status data obtained from the California Department of Consumer Affairs. Other variables were determined from US Bureau of Census data, survey data from the American Chiropractic Association and catalogs from a US chiropractic college. RESULTS: The 10-year attrition rate rose from 10% for those graduates licensed in 1970 to a peak of 27.8% in 1991. The 10-year attrition rate has since remained between 20-25% for the doctors licensed between 1992-1998. CONCLUSIONS: Available evidence supports the hypothesis that the attrition rate for licensed chiropractors in the first 10 years of practice has risen in the past several decades.

Using insulin pump therapy in poorly controlled type 2 diabetes.

PURPOSE: The purpose of this pilot/feasibility study was to evaluate the use of insulin regimens among individuals with poorly controlled type 2 diabetes. In addition, a secondary aim was to build the body of evidence regarding the use of insulin pumps in patients with type 2 diabetes. METHODS: The setting was a suburban private endocrinology practice. Patients were a convenience sample of 15 adults, aged 40 to 64 years with poorly controlled type 2 diabetes, as defined by a hemoglobin A1C (A1C) of 8% or higher when continuous subcutaneous insulin infusion (CSII) was initiated. Baseline, 3-month, 6-month, and 1-year A1C, body mass index (BMI), basal and bolus insulin use, and number of office visits were collected through medical record review. Descriptive, independent, and paired t tests were used to evaluate data. RESULTS: A significant reduction in basal insulin use was found. Significant reductions in A1Cs were found at 3 months, 6 months, and 1 year. A significant increase in BMI was noted. CONCLUSIONS: Results indicated improvement in glycemic control with CSII for some patients with an associated increase in BMI. Reduction of basal insulin use was significant and, for some, cost effective using CSII. Current policies regarding CSII use in patients with type 2 diabetes need to be re-evaluated.

Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians.

OBJECTIVE: To determine categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians in California. METHODS: Retrospective reviews of publicly available data from the California Board of Chiropractic Examiners. RESULTS: The DC disciplinary categories, in descending order, were fraud (44%), sexual boundary issues (22%), other offenses (13%), abuse of alcohol or drugs (10%), negligence or incompetence (6%), poor supervision (2%), and mental impairment (.3%). CONCLUSIONS: The professions differ in the major reasons for disciplinary actions. Two thirds (67%) of the doctors of chiropractic were disciplined for fraud and sexual boundary issues, compared with 59% for negligence and substance misuse for medical physicians. Additional study in each profession may reveal methods to identify causes and possible intervention for those who are at high risk.