10 Years Later : The Impact of the Affordable Care Act on Prevention and Public Health in North Carolina.

The passage of the Affordable Care Act had a great impact on the landscape of public health programming and clinical preventive care in North Carolina. Large funding measures have supported community-based prevention efforts and led to policy, systems, and environmental changes to support a healthier population.

Celluloid zombies: A research study of nurses in zombie-focused feature films.

AIM: To explore how nurses, who are the principal character of zombie-focused feature films are portrayed. DESIGN: A mixed methods study with a quantitative exploration of 44,000 feature film synopsis and additional online material for films made between 1900 and 2018 was used. Zombie-focused films (485) were reviewed for their genre, county, year of production, and plot-lines. Ten zombie films featuring nurses in key roles were analysed via an interpretive, qualitative thematic analysis. The study was undertaken between May 2018 - November 2018. METHOD: A quantitative review of film synopses and relevant movie specific web sites or key literature for the word, 'zombie' and/or 'zombie nurse' and an interpretive, qualitative thematic analysis of nurse specific zombie films. RESULTS: Most of the 485 zombie-focused films located were produced or co-produced in the USA. Only 115 zombie-focused feature films were identified with health professionals, of these, 27 films featured nurses, 10 with nurses in the main role. Nurses were portrayed as romantic, sexualized, caring, self-sacrificial and strong or evil, however, the over-arching representation of nurses in zombie films was tied to the depravity from which zombie sub-culture is based. CONCLUSION: Few zombie films feature nurses in the main role. However, the negative, violent and deprived nature of this genre offers a poor reflection on nursing. IMPACT: How nurses are portrayed in films is important because it influences how the public, patients, and nurses themselves view their profession and role. Understanding the way nurses are portrayed may help professional bodies to better prepare recruitment material.

Clinical leadership and rural and remote practice: A qualitative study.

AIM: To explore how clinical leadership is perceived by nurses in rural and remote areas of New South Wales, Australia. BACKGROUND: There are few empirical studies aimed at understanding clinical leadership from a rural and remote perspective. METHODS: A qualitative approach, based on interpretive phenomenology, used thematic analysis of recorded and transcribed interviews. Ethical approval was secured, 56 interviews were undertaken, across 14 different rural and remote health facilities, with nurses across the spectrum of practice. RESULTS: Thematic analysis led to five themes and findings that support an understanding of clinical leadership from a rural and remote context. Clinical leaders were seen to considerably impact on the initiation of change and quality of care. They also faced barriers if the health facility was poorly staffed, lacked support and if the community were strongly co-dependent. CONCLUSION: In rural and remote areas, clinical leadership is evident to support change, innovation and care quality. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should be aware that staff shortages and challenges to staff retention or the initiation of change are affected by poor clinical leadership. This paper suggests that managers who facilitate clinical leadership are better able to support professional education and greater efficiencies in the delivery of quality health care.

Negative behaviours in health care: Prevalence and strategies.

AIM: To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre. BACKGROUND: Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes. METHODS: A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours. RESULTS: The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ2  = 5.65, p < 0.017), observation of LA and VA (χ2  = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ2  = 9.03, p < 0.003) were identified. CONCLUSIONS: Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression. IMPLICATIONS FOR NURSING MANAGEMENT: Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required.

Clinical leadership and nursing explored: A literature search.

AIMS AND OBJECTIVES: To explore what we know of the concept of clinical leadership and what the term means. Clues to the definition of clinical leadership, the attributes of effective and less effective clinical leaders, models of clinical leadership and the barriers that hinder clinical leadership development were explored. BACKGROUND: While nursing leadership and healthcare leadership are terms that have been evident in nursing and health industry literature for many decades, clinical leadership is a relatively new term and is may still be misunderstood. DESIGN: A search was undertaken of formal and informal literature using a library database and a range of search engines for the words "clinical leadership" and "clinical leadership in nursing." In each case, the full search parameters were employed with searches between 1974-2016. Full-text articles were requested, and English was the preferred language. RESULTS: In total, 3,259 publications were located through seven database search tools, although these included a large number of duplications. Following further informal searches and removing irrelevant material, 27 research or literature review focused papers were retained that included 17 qualitative studies, one quantitative study, one mixed method study, one Delphi study and two that compared other research studies. As well, five literature reviews were retained in the synthesis. The data synthesis resulted five categories: definitions of clinical leadership, characteristics most likely or least associated with clinical leadership, models applied to clinical leadership and limits to clinical leadership development. CONCLUSION: Clinical leaders are recognised for having their values and beliefs parallel their actions and interventions. They are found across the spectrum of health organisations, often at the highest level for clinical interaction, but not commonly at the highest management level in a ward or unit team and they are seen in all clinical environments. RELEVANCE TO CLINICAL PRACTICE: Clinical Leadership and an understanding on how clinical leaders contribute to the health service is central to the application of values-based practice and how clinical leaders impact on innovation, change and making care better.

The male of the species: a profile of men in nursing.

AIM: To establish a profile of men in nursing in Western Australia and explore the perception of men in nursing from the perspective of male and female nurses. BACKGROUND: A project team, including some of the current authors, produced a YouTube video and DVD about men in nursing which led to further enquiry on this topic. DESIGN: The study employed a non-experimental, comparative, descriptive research design focused on a quantitative methodology, using an online survey in early 2014. METHOD: A convenience sample incorporated registered and enrolled nurses and midwives in Western Australia. FINDINGS: The range of data included demographic information and the respondents' perceptions of men in nursing were collected. Findings indicated that the main reasons for choosing a career in nursing or midwifery were similar for both genders. Common mis-perceptions of men in nursing included: most male nurses are gay; men are not suited to nursing and men are less caring and compassionate than women. Suggestions to promote nursing to men included: nurses are highly skilled professionals; there is the potential to make a difference for patients; nursing offers stable employment, professional diversity and opportunities for team work. There is a diminished awareness of opportunities for men in nursing and negative stereotypes related to men in nursing persist. CONCLUSION: The study produced recommendations which included: using the right message to target the recruitment for men and promoting a more realistic understanding of the profile and perception of men in nursing.

Twelve possible strategies for enhancing interprofessional socialisation in higher education: Findings from an interpretive phenomenological study.

The aim of this study was to investigate the interprofessional socialisation experiences of health professional educators (HPEs) across five health science faculties in Perth, Australia. Evidence supported the importance of educators teaching and learning together, although there was minimal evidence with regard to the type of support HPEs received or required in order to socialise interprofessionally within higher education. Interview participants comprised 26 HPEs from various health-related professions across Western Australia. An interpretive phenomenological framework was used to discover the phenomena of interprofessional socialisation. The examination of the data was undertaken via qualitative content analysis with the aid of NVivo 10 software. Content coding led to the development of categories, sub-categories, and then themes. Five themes were identified; however, only one of these themes, "interprofessional socialisation strategies within higher education," is explored within this article. Based on the data within this theme, 12 possible socialisation strategies (formal and informal) were identified for HPEs, which could be implemented within health science faculties, taking into account the organisation's culture and strategic intent towards interprofessional collaboration and education.

Do patients with young onset Alzheimer's disease deteriorate faster than those with late onset Alzheimer's disease? A review of the literature.

BACKGROUND: Young onset Alzheimer's disease (YOAD; onset before 65 years of age) is thought to have a more rapid course and increased rate of progression compared to late onset Alzheimer's disease (LOAD). This assumption appears partly due to important clinical, structural, neuropathological, and neurochemical differences suggesting YOAD is a separate entity to LOAD. The aim in this review was to systematically identify and examine appropriate studies comparing rate of cognitive decline between patients with YOAD and patients with LOAD. METHODS: A computer-based literature search was initially undertaken, followed by citation tracking and search of related papers. Primary research studies specifically focused on the rate of cognitive decline between people with YOAD and LOAD were included. Studies were described, critically analyzed, presented, and discussed in the review. RESULTS: Four studies were included, of which three were longitudinal and one was a case-control study. Three of the included studies found a faster rate of decline in patients with YOAD, and one found no difference in rate of decline between the two groups. CONCLUSIONS: The findings of the review are mixed and conflicting, and limited by the heterogeneity of the included studies. There is a need for future research to design systematic studies that include sufficient sample sizes and follow-up periods, and control for possible confounding factors such as education level, baseline cognitive impairment, and vascular risk factors. This will help to validate the findings so far and improve our understanding of the rate of cognitive decline in people with YOAD and LOAD.

A Systematic Review on the Role of Wildlife as Carriers and Spreaders of Campylobacter spp.

Campylobacter spp. are important zoonotic pathogens and can cause one of the main bacterial diarrheal diseases worldwide. Research in the context of infection arising from transmission from other humans and other vertebrates has been extensive. A large fraction of these investigations has focused on domestic animals; however, there are also a number of publications which either totally, or at least in part, consider the role of wild or feral animals as carriers or spreaders of Campylobacter spp. Here, we carry out a systematic review to explore the role played by wild vertebrates as sources of Campylobacter spp. with a compilation of prevalence data for more than 150 species including reptiles, mammals and birds. We found that numerous vertebrate species can act as carriers of Campylobacter species, but we also found that some host specificity may exist, reducing the risk of spread from wildlife to domestic animals or humans.

Writing exceptional (specific, student and criterion-focused) rubrics for nursing studies.

Effective assessment of nurses in higher education is dependent on the interpretation and demonstration of learning outcomes by students and educators/academics. Rubrics can effectively communicate unit learning outcomes to students and may contribute towards the academic rigour of nursing courses, when assessment criteria are articulated clearly and consistently to both students and educators/academics. This paper aims to describe the different types and uses of rubrics, as well as outline the steps required to develop exceptional rubrics whilst using the literature as a basis for suggestions. Well written rubrics can facilitate consistency of marking across a student cohort, which may result in decreased student anxiety regarding assessment expectations, uniformity of assessment style and layout and may ensure that educators/academics across a teaching team are interpreting assessment criteria, consistently. Exceptional rubrics can empower students to success in academic assessments.

The HEIPS framework: Scaffolding interprofessional education starts with health professional educators.

The link between interprofessional collaboration and interprofessional education has been at the centre of discourse for some time. To understand some of the challenges of interprofessional collaboration, a research study was undertaken. The study investigated the interprofessional socialisation experiences of health professional educators, across five higher education faculties in Perth, Western Australia (WA). An interpretive phenomenological framework was utilised to explore the phenomena of interprofessional socialisation. Twenty-six professional educators were interviewed from a variety of health-related disciplines and qualitative content analysis was undertaken with the aid of NVivo 10 software. Examination of the data discovered a range of barriers that were potentially preventing professionals from working together effectively, within education. Overcoming some of these obstacles were identified, such as, professional language, organizational support, time and workload and the proximity of professionals. The research also recommended a framework that would support health educators. Currently, there are conceptual frameworks that guide the professional and interprofessional socialisation of healthcare graduates within education. Whereas, there is very little guidance or frameworks to support professional educators interprofessional experiences. The heath educators' interprofessional socialisation (HEIPS) framework is presented within this paper, and is a four-step process to encourage the interprofessional socialisation of educators within universities.

Rate of Cognitive Decline in Alzheimer's Disease Stratified by Age.

BACKGROUND: There is only limited information available about the effect of age on course of cognitive decline in patients with onset of Alzheimer's disease (AD) over the age of 64 years. OBJECTIVE: We compared the rate of, and factors affecting, cognitive decline in patients with AD aged < 65 years (young-onset AD), 65-74 years (middle-onset AD), and ≥75 years (late-onset AD). METHOD: The study used longitudinal data from the Essex Memory Clinic which included a total of 305 participants; 56 had YOAD, 73 had MOAD, and 176 had LOAD. The rate of cognitive decline was measured using scores from the Mini-Mental State Examination (MMSE), and the data were examined using multilevel models analysis. RESULTS: There was evidence of a difference in cognitive decline across the age groups with the YOAD group declining 2.8 MMSE points per year, those with MOAD declined 2.0 MMSE points per year, and the LOAD group declined 1.4 MMSE points per year. CONCLUSIONS: Patients with LOAD have a better prognosis than YOAD and MOAD. However, even between the MOAD and LOAD groups, age is a significant predictor of cognitive decline, with older patients having a more benign course.

Ethical issues and clinical expertise at the end of life.

Oncology care has changed markedly in the past decade. With new therapies, patients are experienced in living with life-threatening illness and believe in the abilities of science and the health care system to find new therapies. Changes in the treatment paradigm have altered oncology nursing practice. The integration of newer targeted therapies with their specific side-effect profiles also has changed end-of-life care. Strategies used to manage patients during the active treatment phase of illness can inform and improve nursing practice when active care has been set aside. Evidence-based practice provides a guide to identify, critically appraise, and use evidence to solve clinical problems.

How local health departments work towards health equity.

BACKGROUND: Health inequities are exacerbated when health promotion programs and resources do not reach selected populations. Local health departments (LHDs)1 have the potential to address health equity via engaging priority populations in their work. However, we do not have an understanding of what local agencies are doing on this front. METHODS: In the summer of 2016, we collaborated with informants from thirteen LHDs across North Carolina. Via semi-structured interviews, the research team asked informants about their LHD's understanding of health equity and engaging priority populations in program planning, implementation, and evaluation. FINDINGS: All informants discussed that a key function of their LHD was to improve the health of all residents. LHDs with a more comprehensive understanding of health equity engaged members of priority populations in their organizations' efforts to a greater extent than LHDs with a more limited understanding. Additionally, while all LHDs identified similar barriers to engaging priority populations, LHDs that identified facilitators more comprehensively engaged members of the priority population in program planning, implementation, and evaluation. CONCLUSIONS: LHDs are ideally situated between the research and practice worlds to address health equity locally. To promote this work, we should ensure LHDs hold an understanding of health equity, have the means to realize facilitators of health equity work, and recognize the complex context in which health equity work exists.

Lateral Violence in Nursing Survey: Instrument Development and Validation.

An examination of the psychometric properties of the Lateral Violence in Nursing Survey (LVNS), an instrument previously developed to measure the perceived incidence and severity of lateral violence (LV) in the nursing workplace, was carried out. Conceptual clustering and principal components analysis were used with survey responses from 663 registered nurses and ancillary nursing staff in a southeastern tertiary care medical center. Where appropriate, Cronbach's alpha (α) evaluated internal consistency. The prevalence/severity of lateral violence items constitute two distinct subscales (LV by self and others) with Cronbach's alpha of 0.74 and 0.86, respectively. The items asking about potential causes of LV are unidimensional and internally consistent (alpha = 0.77) but there is no conceptually coherent theme underlying the various causes. Respondents rating a potential LV cause as "major" scored higher on both prevalence/severity subscales than those rating it a "minor" cause or not a cause. Subsets of items on the LVNS are internally reliable, supporting construct validity. Revisions of the original LVNS instrument will improve its use in future work.

Assessing Preliminary Impact of the North Carolina Community Transformation Grant Project Farmers' Market Initiatives Among Rural Residents.

OBJECTIVE: Using the Social Determinants of Health as the study's theoretical underpinning, the authors examined the impact of the North Carolina Community Transformation Grant Project farmers' market initiatives on changes in awareness and use of farmers' markets, and fruit and vegetable consumption. METHODS: During the farmers' market season, the researchers conducted a random digit-dial telephone survey among residents in 3 rural North Carolina counties to examine changes in farmers' market awareness, shopping, and fruit and vegetable consumption. They examined change over 1 year using t tests, chi-square tests, and propensity score matching. RESULTS: In 1 county there were increases in farmers' market shopping and fruit and vegetable consumption, and in 1 county there were decreases in farmers' market shopping and fruit and vegetable consumption. CONCLUSIONS AND IMPLICATIONS: The impact of farmers' market initiatives may be affected by county-specific socioeconomic contexts.

Experience with an adult alcohol withdrawal syndrome practice guideline in internal medicine patients.

STUDY OBJECTIVE: To standardize treatment of alcohol withdrawal syndrome (AWS) in internal medicine patients using an adult AWS practice guideline with a symptom-triggered management approach. DESIGN: Prospective interventional (pilot group) and retrospective (control group). SETTING: University teaching hospital. PATIENTS: Thirty-two internal medicine patients identified as being at risk for AWS and treated according to the AWS practice guideline who were compared with 49 internal medicine patients managed with nonstandardized approaches. INTERVENTION: Patients in the pilot group were assessed using the AWS type indicator. They received lorazepam, clonidine, or haloperidol, based on AWS type indicator assessment and adult AWS practice guideline criteria. MEASUREMENTS AND MAIN RESULTS: Data collected and analyzed were drugs administered to control AWS symptoms, use of sitters and physical restraints, length of hospital stay, and discharge from hospital receiving tapered drug therapy. Pilot patients received 46.6% less benzodiazepine (p=0.001), 20% more clonidine (p=0.01), and 18.2% more haloperidol (p=0.002) than control patients. No drug therapy was required in 19% of pilot patients compared with 2% of controls (p=0.01). Significantly more control (71.4%) than pilot patients (18.8%) were discharged with tapered benzodiazepine therapy (p

Impact of an alcohol withdrawal syndrome practice guideline on surgical patient outcomes.

STUDY OBJECTIVE: To standardize treatment of alcohol withdrawal syndrome (AWS) in surgical patients using an AWS practice guideline with a symptom-triggered approach. DESIGN: Prospective interventional (pilot group) and retrospective (comparison group). SETTING: University teaching hospital. PATIENTS: Thirty-eight trauma, orthopedic, and general surgery patients identified at risk for AWS in the pilot group, and 34 patients who were managed using nonstandardized approaches. INTERVENTIONS: At-risk patients in the pilot group were assessed using the AWS Type Indicator. They received lorazepam, clonidine, or haloperidol, based on AWS Type Indicator assessment and AWS practice guideline criteria. MEASUREMENTS AND MAIN RESULTS: A standardized symptom-triggered approach to managing AWS was expected to decrease the use of benzodiazepines, avoid undertreatment of adrenergic hyperactivity and delirium, decrease the need for sitters and physical restraints, and reduce hospital length of stay. Pilot patients received a mean of 23 mg less benzodiazepine (p=0.01), 0.1 mg more clonidine (p=0.01), and 20 mg less haloperidol (p=0.06) than comparison patients. Pilot patients also required significantly fewer sitter hours (p=0.04) and hours of restraint use (p=0.09) than comparison patients. No significant differences were found between groups for length of stay (p=0.77). CONCLUSIONS: This pilot project suggests that trauma, orthopedic, and general surgery patients at risk for AWS can be safely and effectively managed with a standardized, symptom-triggered approach. Moreover, this approach decreased the amounts of benzodiazepines and haloperidol administered to patients at risk for AWS.