A concurrent mixed-method study exploring the experiences of interprofessional collaboration among Canadian midwives and obstetricians.

AIM: This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. DESIGN: A concurrent mixed-methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. METHOD: Eighteen RMs across Canada completed a demographic survey and the Midwifery-Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery-Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi-structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. RESULTS: The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife-physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician-midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter-Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. CONCLUSION: This study provides support for the Midwifery-Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. IMPLICATIONS: The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. REPORTING METHOD: The authors adhered to Consolidated criteria for reporting qualitative research (COREQ).

Cardiogenic Shock: An Overview.

Cardiogenic shock (CS) is a complex and dreadful condition for which effective treatments remain unclear. The concerningly high mortality rate of CS emphasizes a need for developing effective therapies to reduce its mortality and reverse its detrimental course. This article aims to provide an updated and evidence-based review of the pathophysiology of CS and the related pharmacotherapeutics with a special focus on vasoactive and inotropic agents.

Hypertensive Emergencies: Common Presentations and Pharmacological Interventions.

Depending on end-organ involvement, hypertensive crisis is classified as hypertensive urgency or hypertensive emergency. The recognition of a hypertensive crisis will lead to the adequate reduction of blood pressure to ameliorate the incidence of end-organ damage. Hypertensive crises result from dysfunction in the renin-angiotensin-aldosterone system and damage to the vascular bed. They occur commonly in the emergency department setting and can lead to increased mortality rates if not treated. Registered nurses play a vital role in assessing patients and administering medications during hypertensive crises. This article will outline the assessment strategies that registered nurses should implement in critical care units while patients are receiving antihypertensive drugs. We will also underscore the significance of monitoring specific laboratory values to mitigate the potential side effects of these drugs and exclude them when contraindicated.

A mnemonic for managing acute exacerbations of chronic obstructive pulmonary disease.

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory disorders in the world. Pharmacologic management of an acute exacerbation of COPD can be guided by the mnemonic ABC, for Antibiotics and anticholinergics, Beta2 adrenergic agonists, and Combination therapies and corticosteroids.

Syncope in the Emergency Department: A Guide for Clinicians.

Syncope is a common presenting symptom to emergency departments, but its evaluation and initial management can be challenging for ED practitioners and particularly urgent in the presence of high-risk features that increase the likelihood of cardiac etiology. Even after thorough clinical evaluation, syncope may remain unexplained. In such instances, practitioners' clinical judgment and risk assessments are critical to guide further management. In this article, evidence-informed strategies are outlined to approach the diagnosis of syncope and provide an overview of syncope clinical decision rules and shared decision-making. By incorporating risk stratification and shared decision-making into syncope care, practitioners can more confidently engage patients and families in disposition decisions to organize appropriate outpatient and follow-up care, observation, or admission.

Delirium in Emergency Departments: Is it Recognized?

BACKGROUND: Delirium is a complex neurocognitive manifestation of an underlying medical or surgical abnormality such as substance abuse, infection, sepsis, or organ failure. A recognized risk factor for delirium is advanced age (age >65 years). The projected demographic changes over the next 2 decades suggest that the number of aging adults will grow dramatically, and emergency nurses will see an increasing number of older patients manifesting the wide range of neuropsychiatric symptoms associated with delirium. METHOD: An examination of 5 commonly used delirium assessment tools was undertaken specific to clinical features, use, scoring, findings, advantages, and disadvantages. FINDINGS: Numerous factors contribute to the lack of effective delirium recognition. However, emergency nurses, with educational support, can successfully use the delirium assessment tools to recognize delirium. CONCLUSION: Emergency nurses face challenges in recognizing delirium. One key challenge for many of these nurses is the appropriate use of assessment tools suitable for the ED setting.

The Story of a Broken Heart: Takotsubo Cardiomyopathy.

Licensed independent practitioners in emergency clinical practice are tasked with differentiating acute cardiac presentations. Despite its similarity in clinical presentation to acute coronary syndrome, Takotsubo cardiomyopathy is a unique cardiac disorder characterized by a stress-induced ballooning of the myocardium. Also known as the broken heart syndrome, Takotsubo cardiomyopathy most frequently occurs after an overwhelming emotional or physical stressor. The subsequent impaired contractility of the heart places the patient at risk of complications, including acute heart failure, cardiogenic shock, thromboembolism, arrhythmias, and left ventricular outflow obstruction. Takotsubo cardiomyopathy is similar in presentation to other cardiac disorders; therefore, clinicians in emergency settings must be efficient and effective in their diagnosis of this disorder on the basis of its distinct criteria. The current article uses most recent evidence to describe the etiology, pathophysiology, diagnosis, and recommended treatment for Takotsubo cardiomyopathy to support licensed independent practitioners in emergency departments in improving patient outcomes and reducing morbidity.

Gut feeling: A grounded theory study to identify clinical educators' reasoning processes in putting students on a learning contract.

AIM: To develop a substantive theoretical explanation that makes sense of the decision-making process that clinical instructors use to place students on a learning contract. BACKGROUND: Clinical instructors are challenged with the task of objectively evaluating students using subjective tools such as anecdotal notes, diaries, unstructured observations and verbal feedback from other nurses. Clinical instructors' assessment decisions have a considerable impact on a variety of key stakeholders, not least of all students. DESIGN: Grounded theory method and its heuristic tools including the logic of constant comparison, continuous memoing and theoretical sampling to serve conceptualisation were used in the process of data collection and analysis. METHODS: Seventeen individual semi-structured interviews with clinical instructors in one university in Western Canada were conducted between May 2016-May 2017. Data were analysed using open, axial and selective coding consistent with grounded theory methodology. The study was checked for the Standards for Reporting Qualitative Research (SRQR) criteria (See Appendix S1). FINDINGS: Three subcategories, "brewing trouble," "unpacking thinking" and "benchmarking" led to the study's substantive theoretical explanation. "Gut feeling" demonstrates how clinical instructors reason in their decision-making process to place a student on a learning contract. CONCLUSION: Placing a student on a learning contract is impacted by personal, professional and institutional variables that together shift the process of evaluation towards subjectivity, thus influencing students' competency. A system-level approach, focusing on positive change through implementing innovative assessment strategies, such as using a smart phone application, is needed to provide some degree of consistency and objectivity. RELEVANCE TO CLINICAL PRACTICE: Making visible the objective assessments currently being done by clinical instructors has the potential to change organisational standards, which in turn impact patient and clinical outcomes.

Spontaneous Coronary Artery Dissection: A Comprehensive Overview.

Spontaneous coronary artery dissection is an underdiagnosed cause of acute coronary syndrome that primarily impacts young women. Spontaneous coronary artery dissection as a cause of acute coronary syndrome is not rare and should not be overlooked. Spontaneous coronary artery dissection should be considered on the list of differential diagnosis of any chest pain occurring in young women with few typical risk factors. The purposes of this article are to broaden the understanding and increase awareness of spontaneous coronary artery dissection, specifically its diagnosis and clinical outcomes.

Aortic Regurgitation: Review of Current Management.

ABSTRACT: Aortic regurgitation (AR) is a valvular disease characterized by retrograde blood flow from the aorta to the left ventricle. Various etiologies result in either an acute or chronic clinical presentation of AR and affect the severity of disease progression. Acute AR is a medical emergency caused by sudden increases in left ventricular volume. Immediate surgical intervention, vasoactive agents, and antibiotics are crucial for management. Chronic AR progresses gradually, leading to heart failure symptoms due to left ventricular remodeling. Diagnoses of both acute and chronic AR rely on electrocardiography, chest radiographs, and echocardiography. Cardiac magnetic resonance imaging may be incorporated in chronic AR diagnosis. Medical management of chronic AR aims to control hypertension and delay left ventricular dysfunction. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially calcium-channel blockers are recommended for chronic AR. ß-Blockers are cautioned against because of their potential negative effects. This article emphasizes the importance of early diagnosis and prompt surgical intervention in AR. This review provides a comprehensive overview of the pathophysiology and clinical manifestations of acute and chronic AR and a medication regimen for treating chronic AR in the adult population.

Systemic lupus erythematosus: An approach to pharmacologic interventions.

ABSTRACT: Drug therapy for patients with systemic lupus erythematosus (SLE) aims to decrease symptom severity. Pharmacologic interventions are divided into four categories: antimalarials, glucocorticoids (GCs), immunosuppressants (ISs), and biological agents. Hydroxychloroquine, the most commonly used antimalarial treatment for this disease, is a mainstay in treating all patients with SLE. The multitude of adverse reactions of GCs has led clinicians to minimize their dosages or discontinue them whenever possible. To speed up the discontinuation or minimization of GCs, ISs are used for their steroid-sparing properties. Furthermore, certain ISs such as cyclophosphamide are recommended as maintenance agents to prevent flares and reduce the reoccurrence and severity of the disease state. Biological agents are recommended when other treatment options have failed due to intolerance or inefficacy. This article presents pharmacologic approaches for managing SLE in patients based on clinical practice guidelines and data from randomized controlled trials.

Scaffolding safety in nursing simulation: A grounded theory.

BACKGROUND: Simulation-based learning is a teaching technique that allows learners to apply theoretical knowledge to enhance patient safety. Despite limited evidence about the relationship between simulation and patient safety outcomes, nursing programs continue using simulation to improve student competencies. PURPOSE: To explore the processes driving the actions of nursing students while providing care for a rapidly deteriorating patient during a simulation-based experience. METHOD: Following the constructivist grounded theory method, the study recruited 32 undergraduate nursing students to explore their experiences during simulation-based experiences. Data were collected using semi-structured interviews over 12 months. Interviews were recorded, transcribed and analyzed using constant comparison and simultaneous data collection, coding, and analysis. RESULTS: Two theoretical categories emerged from the data to explain the processes driving the students' actions during simulation-based experiences: Nurturing and contextualizing safety. The themes revolved around a core category of "Scaffolding Safety" in simulation. CONCLUSION: Simulation facilitators can use the findings to build effective and targeted simulation scenarios. Scaffolding safety steers students' thinking and contextualizes patients' safety. It can be utilized as a lens to guide students and assist them with transferring skills from simulation to the clinical practice setting. Nurse educators should consider deliberately integrating the concepts of scaffolding safety into simulation-based experiences to connect theory and practice.

Postexposure prophylaxis (PEP) of HIV among adults.

ABSTRACT: In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. Understanding the life cycle of HIV is of paramount importance in streamlining treatment regimens in exposed individuals. ART is a complex combination of drugs targeting different stages of the virus's life cycle within the host. NPs play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed.

Facilitators and barriers to the transition from registered nurse to nurse practitioner in Canada.

BACKGROUND: Understanding factors that affect integration of NPs is likely to address barriers and provide reform strategies that shape a cost-effective, sustainable, accessible, and efficient health care system. There are a limited number of current and high-quality studies examining the transition process of registered nurses (RNs) to nurse practitioners (NPs), especially in Canada. PURPOSE: To explore the experiences of RNs transitioning to NPs in Canada. METHODOLOGY: Thematic analysis of audio-recorded semi-structured interviews was conducted to explore the experiences of 17 RNs as they transitioned to NPs. A purposive sampling of 17 participants was completed in 2022. RESULTS: Six main themes emerged from analysis of 17 interviews. The content of themes varied according to NPs' years of experience and the NP school they attended. CONCLUSIONS: Peer support and mentorship programs were facilitators in the transition from RN to NP. Conversely, shortcomings in education, financial stressors, and the lack of NP role definition were seen as barriers. Legislation and regulations supportive of NPs, diverse and comprehensive education, and improved availability of mentorship programs may strengthen transition facilitators and help NPs overcome related barriers. IMPLICATIONS: Legislation and regulations supportive of the NP role are needed, focusing on defining the NP role and establishing an independent and consistent remuneration structure for NPs. A more in-depth and diversified educational curriculum is needed, with increased support from faculty and educators and continual encouragement of initiation and perpetuation of peer support. A mentorship program is beneficial to reduce transition shock from the role of the RN to the NP.

HPV vaccination for prevention of head and neck cancer among men.

ABSTRACT: The incidence of human papillomavirus (HPV)-associated head and neck cancer (HNC) has been rapidly increasing in developed countries, with HPV-associated HNC now accounting for 70% of all HNC cases. An increased incidence has been noted particularly among males. The disparities in HPV vaccine uptake rates and the increasing number of individuals with HPV-associated HNC suggest a lack of public awareness of both HPV sequelae and prevention options. This review highlights the importance of prophylactic HPV vaccination for preventing HPV-associated HNC, particularly in males. Current evidence substantiates the need for gender-neutral HPV vaccination programs and reinforces the recommendations made by the CDC. This article raises awareness of the association between HPV and HNC as well as the effectiveness of HPV vaccination in HNC prevention.

Final-Year Nursing Students' Experiences During the COVID-19 Pandemic: A Scoping Review.

BACKGROUND: The transitional experience from final-year nursing students (FYNS) to newly graduated RNs (NGRN) challenges individuals' professional and personal identities. Multiple studies have documented the experiences of FYNS graduating in the pandemic, but no studies have synthesized the findings. METHOD: This scoping review examined the barriers and facilitators FYNS experience as they transitioned to become NGRN during the coronavirus disease 2019 (COVID-19) pandemic. Databases were searched for relevant articles, and articles published in peer-reviewed journals between 2019 and 2021 that focused on the support of FYNS in clinical settings in North America, Europe, and Australia were included. RESULTS: Three themes were identified: emotional turmoil and coping, clinical competence and readiness for practice, and teaching strategies. CONCLUSION: This review revealed important insight on how the pandemic affected FYNS' transition to practice and identified gaps in the literature for future research. [J Nurs Educ. 2023;62(1):6-11.].

Pharmacotherapeutics for dyslipidemia management.

ABSTRACT: Effective management of dyslipidemia is of paramount importance to prevent cardiovascular (CV) complications. Using current clinical practice guidelines is recommended to correct lipid levels and prevent further pathologic processes. This article presents an overview of treatment options for patients with dyslipidemia and CV disease, with a special focus on the following drug classes: HMG-CoA reductase inhibitors (also called statins), cholesterol absorption inhibitors (ezetimibe), bile acid sequestrants, fibrates, icosapent ethyl, and PCSK9 inhibitors.

Systemic barriers and facilitators to the transition of registered nurse to nurse practitioner in Canada: A scoping review.

BACKGROUND: The scope of practice of nurse practitioners (NPs) is expanding, and an increasing number of registered nurses (RNs) are advancing their careers to become NPs. Nurse practitioners are prepared to improve access to high-quality care and enhance care standards. The barriers and facilitators in the transition of RNs to NPs have been seldom studied in the Canadian context. OBJECTIVE: To conduct a scoping review to identify systemic barriers and facilitators affecting Canadian RN experience in transitioning to independent practice as NPs. DATA SOURCES: Four electronic databases were searched for primary studies, and several search engines were used to retrieve gray literature. Keywords included NP, transition, novice, Canada, barriers, obstacles, facilitators, and their variations. Eligible studies are those published from the inception of each respective database to 2021. CONCLUSIONS: Four research studies and one report in the gray literature were located. Three themes were identified from the literature review, including inconsistencies in education and the need for mentors, need for legislation supportive of NP practice, and inconsistent remuneration structures for NPs. IMPLICATIONS FOR PRACTICE: Addressing systemic barriers and employing systemic facilitators are likely to facilitate the transition of RNs to NPs. The lack of primary evidence to explore the factors that affect the transition process from an RN to an NP in Canada indicates that further research must be done. Findings from the future research are likely to furnish a better understanding of the transition process so that the integration of new NPs into the health care system can be achieved efficiently.

CHEST: Mnemonic approach to manage pulmonary embolism.

ABSTRACT: Acute pulmonary embolism is a challenging and potentially fatal disease that requires prompt assessment and precise management. Due to the lack of specific symptoms, NPs need to know how to identify a pulmonary embolism to manage it safely. This article discusses risk factors, initial approach, and diagnosis of acute pulmonary embolism using pretest probability and risk stratification tools. A mnemonic is proposed to guide medical management.