Renewing the Nursing Culture: Sustaining the Professional Community of Practice Through the Role of the Preceptor.

Culture is the driving frame within which all human action takes form. This article explores the elements and characteristics of culture and applies them to the nursing professional community of practice. As it drills down to the work in the cultural context, it argues for the central role of the preceptor in evidencing the influence of culture. For onboarding nurses and the nursing community, the preceptor becomes the carrier of culture, demonstrating the impact of culture in a way that exhibits its influence and impact on nursing practice and patient care.

An Interventional Response Phenotyping Study in Chronic Low Back Pain: Protocol for a Mechanistic Randomized Controlled Trial.

Evidence-based treatments for chronic low back pain (cLBP) typically work well in only a fraction of patients, and at present there is little guidance regarding what treatment should be used in which patients. Our central hypothesis is that an interventional response phenotyping study can identify individuals with different underlying mechanisms for their pain who thus respond differentially to evidence-based treatments for cLBP. Thus, we will conduct a randomized controlled Sequential, Multiple Assessment, Randomized Trial (SMART) design study in cLBP with the following three aims. Aim 1: Perform an interventional response phenotyping study in a cohort of cLBP patients (n = 400), who will receive a sequence of interventions known to be effective in cLBP. For 4 weeks, all cLBP participants will receive a web-based pain self-management program as part of a run-in period, then individuals who report no or minimal improvement will be randomized to: a) mindfulness-based stress reduction, b) physical therapy and exercise, c) acupressure self-management, and d) duloxetine. After 8 weeks, individuals who remain symptomatic will be re-randomized to a different treatment for an additional 8 weeks. Using those data, we will identify the subsets of participants that respond to each treatment. In Aim 2, we will show that currently available, clinically derived measures, can predict differential responsiveness to the treatments. In Aim 3, a subset of participants will receive deeper phenotyping (n = 160), to identify new experimental measures that predict differential responsiveness to the treatments, as well as to infer mechanisms of action. Deep phenotyping will include functional neuroimaging, quantitative sensory testing, measures of inflammation, and measures of autonomic tone.

The Power of the Frame: Systems Transformation Framework for Health Care Leaders.

Health care leaders are responsible for oversight of multiple and competing change interventions. These interventions regularly fail to achieve the desired outcomes and/or sustainable results. This often occurs because of the mental models and approaches that are used to plan, design, implement, and evaluate the system. These do not account for inherent characteristics that determine the system's likely ability to innovate while maintaining operational effectiveness. Theories exist on how to assess a system's readiness to change, but the definitions, constructs, and assessments are diverse and often look at facets of systems in isolation. The Systems Transformation Framework prescriptively defines and characterizes system domains on the basis of complex adaptive systems theory so that domains can be assessed in tandem. As a result, strengths and challenges to implementation are recognized before implementation begins. The Systems Transformation Framework defines 8 major domains: vision, leadership, organizational culture, organizational behavior, organizational structure, performance measurements, internal learning, and external learning. Each domain has principles that are critical for creating the conditions that lead to successful organizational adaptation and change. The Systems Transformation Framework can serve as a guide for health care leaders at all levels of the organization to (1) create environments that are change ready and (2) plan, design, implement, and evaluate change within complex adaptive systems.

Development of a professional nursing framework: the journey toward nursing excellence.

To achieve Magnet recognition designation, an organization must demonstrate a framework for nursing practice. However, successfully incorporating and sustaining frameworks and theories into practice are not easy undertakings. The authors describe how leaders and staff in a healthcare system created and implemented a conceptual framework for nursing practice to guide nursing practice for the system.

Managing the complexity of a systemwide electronic medical record design and implementation: lessons for nurse leaders.

Nurse executives are critical to the successful planning, implementation, and adoption of technology to support the workflow and documentation needs of nurses and other end users. Informed by key principles of complexity theory, the enormous task of broad-based implementation of a standardized electronic medical record can be accomplished through the thoughtful development of flexible structures and change management principles that promote intelligent decision making and adoption by key stakeholders.

Innovation cycle for small- and large-scale change.

In today's complex healthcare systems, transformation requires 2 major efforts: (1) a fundamental changes in the underlying beliefs and assumptions that perpetuate the current system and (2) a fundamental redesign of the multiplicity of diverse and complex subsystems that result in unpredictable aggregate behavior and outcomes. Through an Intelligent Complex Adaptive System framework combined with an innovation process a transformation process and cycle was created for a large healthcare system that resulted in both small- and large-scale changes. This process not only challenges the underlying beliefs and assumptions but also creates new possibilities and prototypes for care delivery through a change-management process that is inclusive and honors the contributions of the entire team.

Mood matters: a national survey on attitudes to depression.

BACKGROUND: Depression is the leading contributor to the burden of disease worldwide. Stigma and negative attitudes to depression can act as barriers to treatment and to social inclusion. Understanding attitudes to depression and treatment has implications for individual outcomes and societal mental health. AIMS: To explore public attitudes to, and management of depression, including lifestyle factors, medication, and psychotherapy. METHODS: A nationally representative online population survey of Irish adults was conducted by RED C. RESULTS: Nine hundred ninety-one people completed the survey. The majority thought that depression was a medical illness (90%), was different to sadness or stress (89%), and that awareness of depression was increasing (89%), while stigma was reducing (69%). Self-reported lifetime depression rates were high and were significantly higher in younger people (18-34 yrs) (63% vs 55%, p = 0.017), and in urban areas (60% vs 44%, p < 0.0001). Younger people were less likely to contact their GP (46% vs 61%, p = 0.034) and reported more stigma around antidepressants (ADTs) compared to older people (> 55 years) (74% vs 58%, p < 0.0001). There were negative attitudes to ADTs and a preference for talking therapies and lifestyle changes. Males were more likely to hold negative attitudes to ADTs. CONCLUSIONS: Stigma around depression is reducing and public awareness is improving. However, the very high self-reported lifetime rates of depression may reflect milder forms or emotional/psychological distress, rather than clinical depression. Negative attitudes and stigma towards ADTs remains high. A collaborative, sustained effort is required to advance public appreciation of mood and its management, across the severity spectrum, in tandem with destigmatising the targeted use of ADTs.

Acquired Aurotrichia ("Gilding Syndrome") of Miniature Schnauzers.

Abstract- Eighteen miniature schnauzers which developed a hair coat color change from normal to a golden color are reported. Average age of onset was 2.5 years, with no discernable sex predilection. The discoloration was not associated with endocrine dysfunction or other health problems. Eight of the dogs shared common ancestors. Fifty-five per cent of the dogs regrew their grey hair coats within two years. Résumé- Dix huit Schnauzer nains ayant présente une modification de la couleur de la robe de normal à fauve sont dérits. L'âge moyen d'apparition était de deux ans et demi, sans prédisposition sexuelle. La discoloration n'était pas associée à une dysendocrinie ni tout autre maladie. Huit de ces chiens avaient des ancètres communs. Cinquante cinq pourcent des animaux ont retrouvé un pelage gfis normal au bout de deux ans. Zusammenfassung- Es wird über achtzehn Zwergschnauzer berichtet, deren Fellfarbe sich in einen goldenen Farbton veränderte. Das durchschnittliche Alter bei Beginn der Veränderung waren 2,5 Jahre, eine Geschlechtsprädisposition lag nicht vor. Die Farbveränderung stand nicht im Zusammenhang mit endokrinen Funktionsstörungen oder anderen Gesundheitsproblemen. Acht der Hunde wiesen gemeinsame Vorfahren auf. Bei fünfundfünfzig Prozent der Hunde wuchsen innerhalb von zwei Jahren die grauen Haare nach. Resumen En el présente artículo se estudian diecioncho schnauzers miniatura, los cuales desarrollaron un color dorado del pelo de la capa. La media de edad de aparcición fue de 2.5 años, sin evidente predilección por el sexo. La decoloració no se asoció con malfunción endocrina u otros problemas de salud. Ocho de los perros tenían progenitores en común. Cincuenta y cinco por ciento prensentó crecimiento de pelo gris característico de su capa en un periodo de 2 años.