Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic.

BACKGROUND: Staff working in long-term care (LTC) homes during COVID-19 frequently reported a lack of communication, collaboration, and teamwork, all of which are associated with staff dissatisfaction, health concerns, lack of support and moral distress. Our study introduced regular huddles to support LTC staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to evaluate the process of huddle implementation and to examine differences in outcomes between categories of staff (direct care staff, allied care and support staff, and management) who attended huddles and those who did not. METHODS: All staff and management at one LTC home (< 150 beds) in Ontario, Canada were included in this pre-experimental design study. The process evaluation used a huddle observation tool and focused on the dose (duration, frequency) and fidelity (NP's adherence to the huddle guide) of implementation. The staff attending and non-attending huddles were compared on outcomes measured at post-test: job satisfaction, physical and mental health, perception of support received, and levels of moral distress. The outcomes were assessed with validated measures and compared between categories of staff using Bayesian models. RESULTS: A total of 42 staff enrolled in the study (20 attending and 22 non-attending huddles). Forty-eight huddles were implemented by the NP over 15 weeks and lasted 15 min on average. Huddles were most commonly attended by direct care staff, followed by allied care/support, and management staff. All huddles adhered to the huddle guide as designed by the research team. Topics most often addressed during the huddles were related to resident care (46%) and staff well-being (34%). Differences were found between staff attending and non-attending huddles: direct care staff attending huddles reported lower levels of overall moral distress, and allied care and support staff attending huddles perceived higher levels of support from the NP. CONCLUSIONS: NP-led huddles in LTC homes may positively influence staff outcomes. The process evaluation provided some understanding of why the huddles may have been beneficial: the NP addressed resident care issues which were important to staff, encouraged a collaborative approach to solving issues on the unit, and discussed their well-being. TRIAL REGISTRATION NUMBER: NCT05387213, registered on 24/05/2022.

The effects of an interprofessional patient-centered communication intervention for patients with communication disorders.

PURPOSE OF THE STUDY: This small scale study examined the influence of an interprofessional (IP) evidence based patient-centered communication intervention (PCCI), delivered by trained nurses in collaboration with Speech Language Pathologists, on patient outcomes in an active stroke rehabilitation setting. DESIGN AND METHODS: The setting constraints imposed the use of a single-group pretest and post-test design to determine the influence of the intervention on patient outcomes. Validated tools measured patient quality of life (QOL), depressive symptoms and satisfaction with care. RESULTS: Patients (n=34) showed improvement in all outcomes from pretest to post-test, including quality of life, geriatric depressive symptoms, and satisfaction with care. IMPLICATIONS: The findings indicate that a comprehensive person-centered communication intervention has the potential to enhance patient outcomes at discharge. Challenges to implementing and evaluating evidence-based interventions in practice are highlighted.

Cross-cultural validation and psychometric testing of the supportive supervisory scale in Spanish.

BACKGROUND: Supervisory effectiveness in long-term care facilities has been identified a key factor in staff satisfaction and quality of care. Determining its utility in Spanish speaking countries will assist with understanding different cultural and health service contexts. OBJECTIVES: To develop and psychometrically test the Supervisory Support Scale in Spanish. The Spanish version of the Supportive Supervisory Scale could be useful for cross-cultural comparisons of supervisory support, which is a key factor to improving work relationships in long-term care facilities. METHODS: Validation was carried out with 405 participants in 37 long-term care facilities. One-way analysis of variance was the test of significance performed to examine the differences among the facilities and Pearson product-moment correlations were used to assess construct validation of the scale. The mean and standard deviation were calculated for each supervisory score in each facility. Structural equation modelling was used to confirm the dimensions of the scale. RESULTS: The item-to-item correlations were positive, ranging from 0.44 to 0.78, indicating good reliability of the scale. The coefficient alpha for the total scale was 0.96. The 15-item had mean item scores which ranged from 2.89 to 3.96 (SD = 1.01-1.26). Standardised factor loadings ranged within a narrow range: 0.75-0.86 for the 'respecting uniqueness' latent variable and 0.76-0.88 for the 'being reliable' latent variable. Construct validity was demonstrated as measure was positively associated with job satisfaction (r = 0.412, p < 0.0001) and was negatively correlated with HCAs' stress and burden. CONCLUSION: The two-factor solution identified in the original scale that highlighted two key attributes of the supervisor; being reliable and respecting uniqueness, was also demonstrated in the Spanish Supervisory Support Scale as there was a moderate fit of the model. IMPLICATIONS FOR PRACTICE: The Spanish version of the Supportive Supervisory Scale could be useful for cross-cultural comparisons of supervisory support in nursing facilities which is a key factor to improving staff relationships and care in nursing facilities.

Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes.

Background and Objectives: To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods: Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results: Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications: These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.

Partitioning the transplant site effect in reciprocal transplant experiments with Impatiens capensis and Impatiens pallida.

Modified reciprocal transplant experiments were conducted with the annual plant species Impatients capensis and I. pallida to partition the influence of environment on fitness into two components; that of (1) conspecific neighbours occupying each transplant site, and (2) the abiotic and biotic features of each site exclusive of the conspecific neighbours. In the within-species reciprocal transplant series, differences in survivorship and fruit production by cleistogamous flowers were attributable primarily to the effect of conspecific neighbours. In addition, plants surrounded by neighbours from the site of origin produced significantly more fruit from chasmogamous flowers compared with plants surrounded by neighbours from the alien site. In the between-species reciprocal transplant series, one transplant site was consistently associated with greater survivorship and fruit production regardless of the identity of neighbouring plants. The results suggest that different aspects of the environment in these reciprocal transplant experiments (conspecific neighbours, other species, physical factors) determine fitness in different situations.

Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea.

STUDY OBJECTIVES: Questionnaires have been validated as screening tools in adult populations at risk for obstructive sleep apnea (OSA). Portable monitors (PM) have gained acceptance for confirmation of OSA in some patients with a high pretest probability of the disorder. We evaluated the combined diagnostic utility of 3 validated questionnaires and a Level III PM in the diagnosis and exclusion of OSA, as compared with in-laboratory polysomnography (PSG) derived apnea hypopnea index (AHI). METHODS: Consecutive patients referred to the Sleep Disorders Clinic completed 3 testing components: (1) 3 questionnaires (Berlin, STOP-Bang, and Sleep Apnea Clinical Score [SACS]); (2) Level III at-home PM (MediByte) study; and (3) Level I in-laboratory PSG. The utility of individual questionnaires, the Level III device alone, and the combination of questionnaires and the Level III device were compared with the PSG. RESULTS: One hundred twenty-eight patients participated in the study (84M, 44F), mean ± SD age 50 ± 12.3years, BMI 31 ± 6.6 kg/m(2). At a PSG threshold AHI = 10, the PM derived respiratory disturbance index (RDI) had a sensitivity and specificity of 79% and 86%, respectively. The sensitivity and specificity for the other screening tools were: Berlin 88%, 25%; STOP-Bang 90%, 25%; SACS 33%, 75%. The sensitivity and specificity at a PSG AHI = 15 were: PM 77%, 95%; Berlin 91%, 28%; STOP-Bang 93%, 28%; SACS 35%, 78%. CONCLUSIONS: Questionnaires alone, possibly given a reliance on sleepiness as a symptom, cannot reliably rule out the presence of OSA. Objective physiological measurement is critical for the diagnosis and exclusion of OSA.

Validation of the MediByte® type 3 portable monitor compared with polysomnography for screening of obstructive sleep apnea.

BACKGROUND: Portable monitors are increasingly being used as a diagnostic screening tool for obstructive sleep apnea (OSA), and in-laboratory validation of these devices with polysomnography (PSG) is required. OBJECTIVE: To assess the reliability of the MediByte (Braebon Medical Corporation, Canada) type 3 screening device compared with overnight PSG. METHODS: To cover a range of OSA severity, a consecutive series of patients wore the screening device while simultaneously undergoing PSG. Data acquired from the screener and PSG were blinded and scored separately. The number of apneas and hypopneas per hour were calculated using recording time (respiratory disturbance index [RDI]) for the MediByte device, and sleep time (apnea-hypopnea index [AHI]) for PSG. RESULTS: Data from 73 patients with a mean age of 53 years and body mass index of 32.2 kg/m2 showed high measurement association between the RDI and AHI, with a Pearson correlation of 0.92, accounting for 85% of the variance. Based on Bland-Altman measurement agreement, the mean difference between the RDI and AHI (-5.9±11.2 events/h) indicated screener under-reporting. For an AHI of greater than 15 events/h, the sensitivity and specificity of the screener was 80% and 97%, respectively; for an AHI of greater than 30 events/h, the positive predictive value was 100%, while the negative predictive value was 88%. CONCLUSION: The MediByte device accurately identified patients without OSA and had a high sensitivity for moderate-to-severe OSA.

PATTERN OF PHENOTYPIC VIABILITY AND FECUNDITY SELECTION IN A NATURAL POPULATION OF IMPATIENS PALLIDA.

Estimates of viability and fecundity selection of 13 phenotypic characters for 1,536 individuals of Impatiens pallida growing in 24 locations within a single natural population were compared. Directional viability selection of cotyledon area, day of initial leaf production, number of leaves, and stem length was detected throughout this population. Directional fecundity selection of cotyledon area, day of initial flower production, number of leaves present on day of initial flower production, stem length on day of initial flower production, number of leaves, and stem length was also detected. Phenotypic selection of these characters was strong in some cases, and the strength of selection was significantly heterogeneous among locations. For several of the characters, directional phenotypic selection within the population was significantly positive in some locations and significantly negative in others separated by only a few meters. Fecundity selection was stronger than viability selection for some characters, implying that fecundity selection was at least as important as viability selection within this population. Soil moisture levels and light intensities played a larger role than soil nutrient levels in determining the patterns of both viability and fecundity selection, and differences in directional viability selection were more strongly related to environmental variation than were differences in fecundity selection. The pattern of phenotypic selection could not be reliably inferred from the patterns of mortality and reproduction alone.

VARIATION IN MALE REPRODUCTIVE INVESTMENT AND MALE REPRODUCTIVE SUCCESS IN WHITE SPRUCE.

An experimental population composed of ramets of white spruce clones was studied to determine the influence of different levels of clonal male reproductive investment on clonal male reproductive success, where the male reproductive success of different clones in the population was defined as the proportion of the seed crop sired by each clone. We present a multilocus estimation procedure which provides unbiased estimates of the proportion of seed sired by each parental genotypic class from pollen gamete frequency data, whenever gametic segregation frequencies are known. Significant linear and quadratic components were found for the relationship between the number of male cones produced and the estimated proportion of the seed crop sired. A clone that produced an exceptionally large number of male cones, however, did not have the greatest male reproductive success. In general, the results support an assumption made in theoretical models of selection on mating system modifiers regarding the relationship between male investment and male reproductive success. They also support the hypothesis that male reproductive success in wind-pollinated species continues to increase substantially with increasing male reproductive investment.