Geographic Access to Early Pregnancy Loss Management.

Early pregnancy loss (EPL) is common, but patients face barriers to the most effective medication (mifepristone followed by misoprostol) and procedural (uterine aspiration) management options. This cross-sectional geospatial analysis evaluated access in New Mexico to mifepristone and misoprostol and uterine aspiration in emergency departments (comprehensive) and to uterine aspiration anywhere in a hospital (aspiration) for EPL. Access was defined as a 60-minute car commute. We collected data from hospital key informants and public databases and performed logistical regression to evaluate associations between access and rurality, area deprivation, race, and ethnicity. Thirty-five of 42 (83.3%) hospitals responded between October 2020 and August 2021. Two hospitals (5.7%) provided comprehensive management; 24 (68.6%) provided aspiration. Rural and higher deprivation areas had statistically significantly lower adjusted odds ratios for comprehensive management (0.03-0.07 and 0.3-0.4, respectively) and aspiration (0.03-0.06 and 0.1-0.3, respectively) access. Mifepristone and uterine aspiration implementation would address disparate access to EPL treatment.

Psychiatric Nursing Workforce Survey: Results and Implications.

OBJECTIVE: The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics. METHODS: An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce. RESULTS: Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance. CONCLUSIONS: Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

Professional Dilemmas Experienced by Pharmacy Graduates in the United Kingdom When Transitioning to Practice.

Objective. For many pharmacy students in the United Kingdom there are few opportunities during undergraduate education to learn, or be exposed to, different ways of dealing with ethical and professional dilemmas in real life practice. This study aimed to explore the experiences of graduates during their pre-registration year and early practice (up to two years post-qualification) on their perceived preparedness to make professional decisions when faced with problems or dilemmas once in practice.Method. Semi-structured interviews were undertaken with preregistration trainees and early careers pharmacists (up to two years qualified). Interviews were transcribed verbatim and analyzed thematically using the Framework Approach.Results. Eighteen interviews (nine preregistration trainees and nine qualified pharmacists) were conducted. Four key themes emerged: continued learning in practice, exposure to role-modelling, moral courage, and stress and moral distress.Conclusion. This study found that preregistration trainees and early career pharmacists perceive a need to be challenged and to receive further support and positive role-modelling to help them continue to develop their ethical and professional decision-making skills in the practice setting. The level and quality of support reported was variable, and there was a reliance on informal networks of peer support in many cases. This study suggests a need to raise awareness among preregistration tutors (preceptors) and line managers (supervisors) to improve and increase support in this area.

Pharmacy graduates' perceived impact of long-term undergraduate use of an ethical decision-support tool on their early practice.

INTRODUCTION: Values-based practice is an important concept within healthcare decision-making that sits alongside evidence-based practice. Values Exchange (Vx) (http://www.vxcommunity.com) is an online tool that supports the development of ethical and professional decision-making skills through values transparency. The aim of this research was to explore the perceived impact of long-term use of the tool during undergraduate study on pharmacy graduates' early practice. METHODS: Alumni in their pre-registration year or up to two years qualified were invited to participate via a question at the end of a survey, with additional students invited prospectively during an undergraduate lecture. All had completed three cases per year on Vx during the four-year master of pharmacy course. Semi-structured interviews were audio-recorded and transcribed verbatim, and framework analysis was applied. Ethical approval was obtained. RESULTS: A total of 18 interviews (nine pharmacists and nine pre-registration tutees) were conducted between May 2015 and March 2016. Thirteen participants were female, 13 were based in community pharmacy, and 10 were Caucasian. Interviews ranged from 50 min to 2 hours. Three themes emerged from the data: (1) the Vx learning environment, (2) learning and reflection, and (3) potential enhancements for learning. Participants perceived Vx to be an effective teaching tool supporting the development of skills necessary to exercise professional judgement in pharmacy practice. CONCLUSIONS: Vx appears to be a worthy addition to the armoury of teaching methods necessary to support future pharmacists in their preparedness to deal with ethical and professional dilemmas in practice.

Psychological issues affecting patients living with a stoma.

Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.

Students views of an online ethical decision-support tool.

BACKGROUND AND PURPOSE: Ethical reasoning is a key skill that must be developed during the undergraduate pharmacy course to prepare students for ethical decision-making in future practice as pharmacy professionals. In this initial study, we sought and documented the views of pharmacy students at a United Kingdom (UK) university on the use of Values Exchange™ (Vx), an online ethical decision-support tool. EDUCATIONAL ACTIVITY AND SETTING: Students deliberated on up to three ethical case scenarios every academic year using the tool. A preliminary study using a qualitative methodology was conducted with students nearing the end of their third-year of study to explore their views of the tool. Two focus groups were used to collect the data. Discussions were digitally recorded, anonymised and transcribed verbatim. Data was analysed using the five-stage framework approach. FINDINGS: Four main themes emerged from the data: students felt that Values Exchange™ enabled them to gain a wider perspective on ethical issues; it promoted reflection; it helped to prepare them for future practice; students liked the online environment. DISCUSSION: Vx prompted students to deliberate on many facets of a case, enabled them to consider and challenge the views of their peers, facilitated reflection and promoted greater honesty in responses and inclusivity, all supporting the development of moral reasoning skills. SUMMARY: Vx supports the process of ethical decision-making, encouraging a deep approach to learning within a safe virtual environment. Students believed Vx to be an effective tool for developing ethical reasoning skills in preparation for practice.

American Psychiatric Nurses Association-Transitions in Practice Certificate Program: Bridging the Knowledge Gap in Caring for Psychiatric Patients Within the General Nursing Workforce.

The purpose of this article is to publicize an important new Web-based educational program. Recognizing the growing gap in psychiatric-mental health knowledge and the need to better prepare new graduates and nurses transitioning from other service lines into psychiatric inpatient nursing settings, the American Psychiatric Nurses Association developed a 15-hour, modularized curriculum to provide foundational psychiatric-mental health knowledge. This modularized curriculum, called American Psychiatric Nurses Association Transitions in Practice (ATP) focuses on the knowledge and skills to insure the success of nurses new to psychiatric-mental health nursing settings and to improve the overall care for persons with mental health and substance use disorders. The ATP program is also proving to be useful content for nurses in emergency departments, hospitals, and other health settings to improve their care of patients with psychiatric and mental health needs. A summary of the program modules and a toolkit with suggested measures for nurses, patients, and agency outcomes is described. Feedback from participants completing the ATP program within the first 6 months is overwhelmingly positive and holds promise for widespread application across a variety of health care settings.

Evidence for promotion of nontenured faculty.

An increasing number of faculty members are choosing the nontenured path in academia. These faculty members bring expertise in teaching that must be recognized and valued. With the shortage of nurse educators, procedures to attract and retain these faculty members are needed. To address this problem, guidelines for promotion of nontenured faculty were developed. The authors describe the development process and the final criteria for promotion.

The status of the world's land and marine mammals: diversity, threat, and knowledge.

Knowledge of mammalian diversity is still surprisingly disparate, both regionally and taxonomically. Here, we present a comprehensive assessment of the conservation status and distribution of the world's mammals. Data, compiled by 1700+ experts, cover all 5487 species, including marine mammals. Global macroecological patterns are very different for land and marine species but suggest common mechanisms driving diversity and endemism across systems. Compared with land species, threat levels are higher among marine mammals, driven by different processes (accidental mortality and pollution, rather than habitat loss), and are spatially distinct (peaking in northern oceans, rather than in Southeast Asia). Marine mammals are also disproportionately poorly known. These data are made freely available to support further scientific developments and conservation action.

Use of electronic monitoring in clinical nursing research.

In the past decade, the introduction of electronic monitoring systems for monitoring medication adherence has contributed to the dialog about what works and what does not work in monitoring adherence. The purpose of this article is to describe the use of the Medication Event Monitoring System (MEMS) in a study of patients receiving isoniazid for latent tuberculosis infection. Three case examples from the study illustrate the data that are obtained from the electronic device compared to self-reports and point to the disparities that may occur in electronic monitoring. The strengths and limitations of using the MEMS and ethical issues in utilizing this technology are discussed. Nurses need to be aware of these challenges when using electronic measuring devices to monitor medication adherence in clinical nursing practice and research.

Demographics, psychiatric diagnoses, and other characteristics of North American Deaf and hard-of-hearing inpatients.

This study examined demographic and clinical data from a specialty deaf inpatient unit so as to better understand characteristics of severely and chronically mentally ill deaf people. The study compares deaf and hearing psychiatric inpatients on demographic variables, psychiatric discharge diagnoses, a language assessment measure, a cognitive ability measure, and a measure of psychosocial functioning and risk of harm to self and others. Overall, findings indicate a broader range of diagnoses than in past studies with posttraumatic stress disorder being the most common diagnosis. Compared with hearing patients in the same hospital, deaf patients were less likely to be diagnosed with a psychotic or substance abuse disorder and more likely to be diagnosed with a mood, anxiety, personality, or developmental disorder. Psychosocial functioning of the deaf patients was generally similar to hearing psychiatric patients. Deaf patients presented significantly higher risks than hearing patients in areas of self-harm and risk of sexual offending. Cognitive scores show that both the deaf and hearing inpatient population is skewed toward persons who are lower functioning. An additional surprising finding was that 75% of deaf individuals fell into the nonfluent range of communication in American Sign Language.

Psychological, sexual and cultural issues for patients with a stoma.

Patients undergoing stoma surgery will more readily adapt to their new body image and way of life if they receive professional and voluntary input from the ostomy agencies such as the British Colostomy Association, from the preoperative stage through to rehabilitation and their return to the community. Nursing has moved away from mechanistic, task-oriented care to holistic care and, apart from the physical changes that a stoma will cause, there are other areas to be considered to improve the patient's quality of life after surgery. Patients undergoing stoma surgery experience a profound threat to their sense of physical integrity and self-concept with the change of body image in relation to bodily functions. Sexuality is an integral part of the whole person and is a highly complex phenomenon. Many patients find it difficult to discuss their sexual feelings, especially after a body image change and the nurse should be able to help patients identify and adapt to alterations in sexual self-concept. Cultural background plays an important part in patients' lives, including their beliefs, whether personal or religious, their perceptions of recovery, behaviour and concepts of and attitude towards the disease process. Nurses must combine sound, general information with open, respectful questions to the patient or family and be committed to responding flexibly and constructively. This article describes some of the potential problems that may be faced by patients after stoma surgery and increased knowledge of these areas will allow nurses to improve patient care and satisfaction.

Parents with colorectal cancer: 'What do I tell the children?'.

Whatever the age of the child, there is no easy way for a parent to explain serious, life-threatening illness. For children to hear that their parent is ill is devastating, especially if the parent has cancer and needs a permanent colostomy. The diagnosis of cancer can produce feelings of fear, confusion and uncertainty in patients and their close relatives. How difficult does this then become for the child battling to understand long medical words, alien hospital environments and an ill parent? The social taboos that surround body matter elimination are legion and therefore the surgical outcome of having a permanent stoma changes the individual's body image perception long-term. The two case studies presented in this article highlight this problem as well as the lack of suitable available literature.

Treating peristomal skin problems in the community.

Adaptation to life with a stoma depends to a large extent on the health of the peristomal skin. This area of skin can become damaged in various ways, and the resulting discomfort or pain can make the use of a stoma appliance difficult. Problems such as these can be one of the major factors facing a community nurse in her/his care of the stoma patient. If the community nurse is able to recognize and correct these problems, this will enable the patient to carry on with a normal and productive life. Failure to correct stoma-related problems can have significant negative effects on patients' psychosocial well-being. This article discusses the causes and management of the commonest stoma-related skin problems.