The quality of clinician and student quality improvement reports: An analysis of 8 years of submissions.

INTRODUCTION: Many papers reporting on QI projects are not publishable for a variety of reasons. We compared manuscripts submitted as QI reports between June 2014 and June 2016 (prior to publication of the revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) with papers submitted to the American Journal of Nursing between July 2016 and December 2022). The aim was to evaluate any changes in the quality of manuscripts and identify problems that led to rejection; we also compared the quality of students with non-student submissions. METHODS: We conducted a non-randomized descriptive study to evaluate 349 papers submitted as QI project reports between June 2014 and December 2022 using screening templates based on the SQUIRE 2.0 checklist and findings of the INANE Working Group on Student Papers. RESULTS: Manuscripts designated as QI reports accepted for publication increased from 4% during 2014-2016 (T1) to 14% during 2016-2022 (T2); one student submission was accepted. There was a slight decrease in submissions designated as QI that were not QI: 36% of student submissions during T1 and 31% of student submissions during T2. Among clinician submissions, 44% in T1 designated as QI reports were not QI versus 31% submitted during T2. There was a decrease in student submissions that followed the SQUIRE guidelines (36% during T1 to 24% during T2). CONCLUSIONS: Findings demonstrate that by following the SQUIRE 2.0 guidelines, authors submit more complete manuscripts with fewer missing components. However, there are still misconceptions about what constitutes QI versus research and how to report QI initiatives. After comparing the findings from both periods, it is noteworthy that there is essentially the same level of inaccuracy and lack of acceptable manuscripts. CLINICAL RELEVANCE: Sharing findings from QI activities through presentations and publications is a vital way of helping spread the learnings from these projects and improve health care for a wider audience. Clinicians, academicians, and students must understand the elements of the SQUIRE guidelines and ensure that this framework is used for both designing and submitting QI projects for publication.

Model analysis of post-fire management and potential reburn fire behavior.

Recent trends in wildfire area burned have been characterized by large patches with high densities of standing dead trees, well outside of historical range of variability in many areas and presenting forest managers with difficult decisions regarding post-fire management. Post-fire tree harvesting, commonly called salvage logging, is a controversial management tactic that is often undertaken to recoup economic loss and, more recently, also to reduce future fuel hazard, especially when coupled with surface fuel reduction. It is unclear, however, whether the reductions in future fuels translate to meaningful changes to reburn fire behavior, particularly in the context of potentially detrimental effects of harvest on other ecosystem services. We used observed post-fire snag structure in four high severity burn scars located in the Western United States that had variable post-fire snag basal area (13.3-63.9 mg ha-2) to initialize a simulation study of future coarse and fine woody fuel hazard and associated reburn fire behavior and effects. We compared untreated controls to intensive and intermediate intensity harvest treatments, both simulated and actual. All treatments showed some number of years of extreme fire behavior during which flame lengths exceeded thresholds associated with wildfire resistance to control, implying that future fuel reductions achieved by the treatments did not translate to conditions conducive for effective reburn fire management. Harvested stands had less severe soil fire effects (soil heating and smoldering duration) than untreated controls, explained by lower predicted peak coarse woody fuels (CWD) in the harvested stands. At higher pre-treatment snag basal area, harvested stands better maintained CWD within the range desired to maintain ecosystem functions such as nutrient cycling and wildlife habitat. These simulation results indicate that, even with reduced fuel hazard, salvage treatments may still be associated with severe fire behavior for some time after wildfire, but achieved reductions in coarse woody fuels may also reduce some soil fire effects. Tradeoffs in the effects of post-fire harvest must be considered carefully in the context of forest regeneration, local conditions that govern salvage methods, snag fall and decomposition, and associated potential reburn fire effects.

Consistent spatial scaling of high-severity wildfire can inform expected future patterns of burn severity.

Increasing wildfire activity in forests worldwide has driven urgency in understanding current and future fire regimes. Spatial patterns of area burned at high severity strongly shape forest resilience and constitute a key dimension of fire regimes, yet remain difficult to predict. To characterize the range of burn severity patterns expected within contemporary fire regimes, we quantified scaling relationships relating fire size to patterns of burn severity. Using 1615 fires occurring across the Northwest United States between 1985 and 2020, we evaluated scaling relationships within fire regimes and tested whether relationships vary across space and time. Patterns of high-severity fire demonstrate consistent scaling behaviour; as fire size increases, high-severity patches consistently increase in size and homogeneity. Scaling relationships did not differ substantially across space or time at the scales considered here, suggesting that as fire-size distributions potentially shift, stationarity in patch-size scaling can be used to infer future patterns of burn severity.

Fuel treatment effectiveness in the context of landform, vegetation, and large, wind-driven wildfires.

Large wildfires (>50,000 ha) are becoming increasingly common in semiarid landscapes of the western United States. Although fuel reduction treatments are used to mitigate potential wildfire effects, they can be overwhelmed in wind-driven wildfire events with extreme fire behavior. We evaluated drivers of fire severity and fuel treatment effectiveness in the 2014 Carlton Complex, a record-setting complex of wildfires in north-central Washington State. Across varied topography, vegetation, and distinct fire progressions, we used a combination of simultaneous autoregression (SAR) and random forest (RF) approaches to model drivers of fire severity and evaluated how fuel treatments mitigated fire severity. Predictor variables included fuel treatment type, time since treatment, topographic indices, vegetation and fuels, and weather summarized by progression interval. We found that the two spatial regression methods are generally complementary and are instructive as a combined approach for landscape analyses of fire severity. Simultaneous autoregression improves upon traditional linear models by incorporating information about neighboring pixel burn severity, which avoids type I errors in coefficient estimates and incorrect inferences. Random forest modeling provides a flexible modeling environment capable of capturing complex interactions and nonlinearities while still accounting for spatial autocorrelation through the use of spatially explicit predictor variables. All treatment areas burned with higher proportions of moderate and high-severity fire during early fire progressions, but thin and underburn, underburn only, and past wildfires were more effective than thin-only and thin and pile burn treatments. Treatment units had much greater percentages of unburned and low severity area in later progressions that burned under milder fire weather conditions, and differences between treatments were less pronounced. Our results provide evidence that strategic placement of fuels reduction treatments can effectively reduce localized fire spread and severity even under severe fire weather. During wind-driven fire spread progressions, fuel treatments that were located on leeward slopes tended to have lower fire severity than treatments located on windward slopes. As fire and fuels managers evaluate options for increasing landscape resilience to future climate change and wildfires, strategic placement of fuel treatments may be guided by retrospective studies of past large wildfire events.

Nursing Journal Policies on Disclosure and Management of Conflicts of Interest.

PURPOSE: Concerns about conflicts of interest (COIs) in research and health care are well known, but recent reports of authors failing to disclose potential COIs in journal articles threatens the integrity of the scholarly literature. While many nursing journals have published editorials on this topic, review of nursing journal policies on and experiences with COIs has not been reported. The purposes of this study were to examine the extent to which nursing journals have COI policies and require disclosures by authors, peer reviewers, editorial board members, and editors who have a role in journal content decisions. DESIGN: This cohort study addressed top-ranked nursing journal policies about and experiences with COIs in scholarly publications. METHODS: An analysis of COI policies in the instructions for authors of 118 journals listed in the nursing category of Clarivate Analytics Journal Citation Reports was completed in 2019. An electronic survey of the editors was also conducted to determine their awareness and experience with COI policies for their journals. Characteristics of the journals and policies were assessed. Information on polices about COIs for editors and peer reviewers were also reviewed. A content analysis of the policies included assessment of best practices and gaps in requirements. FINDINGS: For the journal policy assessment, 116 journals that publish only in the English language were eligible. The majority (n = 113; 97.4%) of journals had a statement on COI policies for authors, but only 42 (36.2%) had statements for peer reviewers and only 37 (31.9%) had statements for editors. A total of 117 journal editors were sent the survey. One declined to participate, leaving a total of 116 eligible editors; 82 (70.6%) responded and 34 did not respond. Sixty-seven (81.7%) of the 82 editors indicated that their journal had a policy about COIs for authors. Seventy-four editors (63.7%) responded to the question about their journal having a policy about COIs for peer reviewers and editors. Thirty-three (44.5%) of the respondents indicated their journal had a COI policy for peer reviewers, and 29 (39.1%) stated they had a policy for editors. Few editors (n = 7; 9%) indicated that they had encountered problems pertaining to author COIs. CONCLUSIONS: Findings from this study may help promote ethical publication practices through comprehensive policies on disclosure and management of nursing journal authors, peer reviewers, and editors. CLINICAL RELEVANCE: Declarations of potential conflicts of interest promote transparency and allows the consumer of research to take that into consideration when considering the findings of a study.

Executive Summary: Transforming Moral Distress into Moral Resilience in Nursing.

To examine practices for addressing moral distress, a collaborative project was developed by the Johns Hopkins Berman Institute of Bioethics, the Johns Hopkins School of Nursing, the American Journal of Nursing, and the Journal of Christian Nursing, along with the American Association of Critical-Care Nurses and the American Nurses Association. Its purpose was to identify strategies that individuals and systems can use to mitigate the detrimental effects of moral distress and foster moral resilience. On August 11 and 12, 2016, an invitational symposium, State of the Science: Transforming Moral Distress into Moral Resilience in Nursing, was held at the Johns Hopkins School of Nursing in Baltimore, Maryland. Forty-five nurse clinicians, researchers, ethicists, organization representatives, and other stakeholders took part. The result of the symposium was group consensus on recommendations for addressing moral distress and building moral resilience in four areas: practice, education, research, and policy. Participants and the organizations represented were energized and committed to moving this agenda forward. The full report is available online at http://journals.lww.com/ajnonline/Pages/Moral-Distress-Supplement.aspx.

Fuel treatments and landform modify landscape patterns of burn severity in an extreme fire event.

Under a rapidly warming climate, a critical management issue in semiarid forests of western North America is how to increase forest resilience to wildfire. We evaluated relationships between fuel reduction treatments and burn severity in the 2006 Tripod Complex fires, which burned over 70,000 ha of mixed-conifer forests in the North Cascades range of Washington State and involved 387 past harvest and fuel treatment units. A secondary objective was to investigate other drivers of burn severity including landform, weather, vegetation characteristics, and a recent mountain pine beetle outbreak. We used sequential autoregression (SAR) to evaluate drivers of burn severity, represented by the relative differenced Normalized Burn Ratio index, in two study areas that are centered on early progressions of the wildfire complex. Significant predictor variables include treatment type, landform (elevation), fire weather (minimum relative humidity and maximum temperature), and vegetation characteristics, including canopy closure, cover type, and mountain pine beetle attack. Recent mountain pine beetle damage was a statistically significant predictor variable with red and mixed classes of beetle attack associated with higher burn severity. Treatment age and size were only weakly correlated with burn severity and may be partly explained by the lack of treatments older than 30 years and the low rates of fuel succession in these semiarid forests. Even during extreme weather, fuel conditions and landform strongly influenced patterns of burn severity. Fuel treatments that included recent prescribed burning of surface fuels were particularly effective at mitigating burn severity. Although surface and canopy fuel treatments are unlikely to substantially reduce the area burned in regional fire years, recent research, including this study, suggests that they can be an effective management strategy for increasing forest landscape resilience to wildfires.

Honorary and ghost authorship in nursing publications.

PURPOSE: The purposes of this study were to (a) assess the prevalence of articles with honorary authors and ghost authors in 10 leading peer-reviewed nursing journals between 2010 to 2012; (b) compare the results to prevalence reported by authors of articles published in high-impact medical journals; and (c) assess the experiences of editors in the International Academy of Nursing Editors with honorary and guest authorship. METHODS: Corresponding authors of articles published in 10 nursing journals between 2010 and 2012 were invited to complete an online survey about the contributions of coauthors to see if the International Committee of Medical Journal Editors () criteria for authorship were met. Additionally, members of the International Academy of Nursing Editors were invited to complete an online survey about their experiences in identifying honorary or ghost authors in articles submitted for publication. FINDINGS: The prevalence of articles published in 10 nursing journals with honorary authors was 42%, and the prevalence of ghost authorship was 27.6%. This is a greater prevalence than what has been reported among medical journals. Qualitative data yielded five themes: lack of awareness around the rules for authorship; acknowledged need for debate, discussion, and promotion of ethical practice; knowingly tolerating, and sometimes deliberately promoting, transgressions in practice; power relations and expectations; and avoiding scrutiny. Among the 60 respondents to the editor survey, 22 (36.7%) reported identifying honorary authors and 13 (21.7%) reported ghost authors among papers submitted to their publications. CONCLUSIONS: Inappropriate authorship is a significant problem among scholarly nursing publications. RELEVANCE: If nursing scholarship is to maintain integrity and be considered trustworthy, and if publications are to be a factor in professional advancement, editors, nursing leaders, and faculty need to disseminate and adhere to ethical authorship practices.

The Top Nursing News Story of 2022: Acute Care Workforce Under Stress.

Weak institutional support hampers nursing's recovery from COVID.

Beyond Onboarding: Retaining Staff by Supporting Professional Growth.

Onboarding new nurses is but one role of nurse professional development practitioners during this nursing shortage; those in staff development need to develop strategies that will help retain experienced nurses. This article reviews recent reports on acute care staffing and focuses on nurse involvement in quality improvement initiatives and reporting as a means for engaging experienced staff.

Activism Is an Essential Nursing Role.

ABSTRACT: Nursing has a long history of activism, yet nurses are often heard to express their dislike of "politics" and their desire to stay away from the tense and contentious situations associated with political activism. Nurses, however, have a fundamental duty to advocate on behalf of their patients and communities. In this article, the authors discuss the rationale for and roots of political activism in nursing, the values that shape it, and the importance of nursing's stance on policies related to the health and well-being of those they serve. The authors also present exemplars of political activism and approaches nurses can use to address the pressing health care challenges of our time.

How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature.

BACKGROUND: Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context. OBJECTIVES: This study sought to quantify this lack of research by: (1) identifying and describing the primary health care EMR literature; and (2) comparing the Canadian and international primary healthcare EMR literature on the basis of content and publication levels. METHODS: Seven bibliographic databases were searched using primary health care and EMR keywords. Publication abstracts were reviewed and categorised. First author affiliation was used to identify country of origin. Proportions of Canadian- and non-Canadian-authored publications were compared using Fisher's exact test. For countries having 10 or more primary healthcare EMR publications, publications per 10 000 researchers were calculated. RESULTS: After exclusions, 750 publications were identified. More than one-third used primary healthcare EMRs as a study data source. Twenty-two (3%) were Canadian-authored. There were significantly different publication levels in three categories between Canadian- and non-Canadian-authored publications. Based on publications per researchers, the Netherlands ranked first, while Canada ranked eighth of nine countries with 10 or more publications. CONCLUSIONS: A relatively small body of literature focused on EMRs in primary health care exists; publications by Canadian authors were low. This study highlights the need to develop a strong evidence base to support the effective implementation and use of EMRs in Canadian primary health care.

Making It Through March.

After a bleak winter, the hopefulness of spring is just around the corner.

End Notes.

An editor-in-chief steps down, with gratitude.

2021: A Year of Hope and Heartbreak.

Optimism that the pandemic would be over was short lived.

History Is What We Make It.

And we need to make it one we're proud of.

Assessment of uncertainty in functional-structural plant models.

BACKGROUND AND AIMS: Constructing functional-structural plant models (FSPMs) is a valuable method for examining how physiology and morphology interact in determining plant processes. However, such models always have uncertainty concerned with whether model components have been selected and represented effectively, with the number of model outputs simulated and with the quality of data used in assessment. We provide a procedure for defining uncertainty of an FSPM and how this uncertainty can be reduced. METHODS: An important characteristic of FSPMs is that typically they calculate many variables. These can be variables that the model is designed to predict and also variables that give indications of how the model functions. Together these variables are used as criteria in a method of multi-criteria assessment. Expected ranges are defined and an evolutionary computation algorithm searches for model parameters that achieve criteria within these ranges. Typically, different combinations of model parameter values provide solutions achieving different combinations of variables within their specified ranges. We show how these solutions define a Pareto Frontier that can inform about the functioning of the model. KEY RESULTS: The method of multi-criteria assessment is applied to development of BRANCHPRO, an FSPM for foliage reiteration on old-growth branches of Pseudotsuga menziesii. A geometric model utilizing probabilities for bud growth is developed into a causal explanation for the pattern of reiteration found on these branches and how this pattern may contribute to the longevity of this species. CONCLUSIONS: FSPMs should be assessed by their ability to simulate multiple criteria simultaneously. When different combinations of parameter values achieve different groups of assessment criteria effectively a Pareto Frontier can be calculated and used to define the sources of model uncertainty.

Building Trust.

Nurses can help change the course of the COVID-19 pandemic.

2020: A Year of Let Down and Loss.

Looking forward to a fresh start.