An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries.

OBJECTIVE: An interprofessional team known as the Tracheostomy Steering Committee (TSC) was established to prevent tracheotomy-related pressure injuries (TRPIs) and standardize practice for tracheostomy insertion and care of patients with tracheostomies. In addition to reducing the number TRPIs, the TSC sought establish an escalation process for all clinicians to raise concerns about the care and management of patients with tracheostomies. METHODS: This quality improvement initiative used the Define, Measure, Analyze, Improve, and Control framework with a pre- and postintervention design. The TSC created a TRPI-prevention bundle that included recommendations for protective foam dressing and skin barrier film use, suture tension, timing of suture removal, stoma care, offloading and positioning, escalation, documentation, and dual skin assessment. An electronic tracheostomy report was developed to track patients with a tracheostomy across the enterprise. RESULTS: A total of 289 patients had a tracheostomy during their inpatient hospital stay from January 2018 through December 2019. There was an observed a reduction in the daily rate of TRPIs by 50% with the use of the standardized TRPI-prevention bundle. CONCLUSIONS: Use of the bundle resulted in a significant reduction in the incidence of TRPI. Timely escalation of possible tracheostomy injuries or tracheostomies at risk enabled rapid intervention, likely preventing many injuries, and real-time feedback to clinicians reinforced best practices. Interprofessional collaboration is necessary to provide optimal tracheostomy care and ensure the best outcomes.

Integrating Education and Competency for Safe Patient Care.

In an effort to streamline educational initiatives at our institution, we developed the Nursing Education and Competency Algorithm and the Nursing Education and Competency Advisory Panel. The Nursing Education and Competency Algorithm serves as a framework in differentiating education and competency through standardization of practice. Utilizing the algorithm assists in distinguishing initiatives as one time, on-going, or if they are specific to a specialty. The Nursing Education and Competency Advisory Panel serves as a vetting structure to improve collaboration through decision-making and shared governance.

Intraguild dynamics of understudied carnivores in a human-altered landscape.

Mesocarnivores constitute a diverse and often abundant group of species, which are increasingly occupying hweigher trophic levels within multi-use landscapes. Yet, we know relatively little about their interactions with each other, especially in human-altered areas. Using camera trap data collected in a forestry concession in the Greater Gorongosa ecosystem of central Mozambique, we examined the spatiotemporal relationships and potential for intraguild competition among three understudied African carnivores: African civets (Civettictis civetta), bushy-tailed mongooses (Bdeogale crassicauda), and large-spotted genets (Genetta maculata). After accounting for habitat preferences and tolerance to anthropogenic factors, we found that African civets and bushy-tailed mongooses avoid each other spatially and temporally. Additionally, civets and mongooses were also both more likely to use sites farther away from human settlements, possibly decreasing the total available habitat for each species if competition is driving this spatial partitioning. In contrast, we did not find evidence for spatial or temporal partitioning between large-spotted genets and African civets, but bushy-tailed mongooses altered their activity patterns where they co-occurred with genets. Our study contributes to scant ecological knowledge of these mesocarnivores and adds to our understanding of community dynamics in human-altered ecosystems.

Road development in Asia: Assessing the range-wide risks to tigers.

Roads are proliferating worldwide at an unprecedented rate, with potentially severe impacts on wildlife. We calculated the extent and potential impacts of road networks across the 1,160,000-km2, 13-country range of the globally endangered tiger (Panthera tigris)-a conservation umbrella species. We found that roads were pervasive, totaling 134,000 km across tiger conservation landscapes (TCLs), even in tiger priority sites and protected areas. Approximately 43% of the area where tiger breeding occurs and 57% of the area in TCLs fell within the road-effect zone. Consequently, current road networks may be decreasing tiger and prey abundances by more than 20%. Nearly 24,000 km of new roads will be built in TCLs by 2050, stimulated through major investment projects such as China's Belt and Road Initiative. Given that roads will be a pervasive challenge to tiger recovery in the future, we urge decision-makers to make sustainable road development a top priority.

Rapid human-induced divergence of life-history strategies in Bahamian livebearing fishes (family Poeciliidae).

Human-induced rapid environmental change (HIREC) can have dramatic impacts on ecosystems, leading to rapid trait changes in some organisms and extinction in others. Such changes in traits signify that human actions can lead to cases of increased phenotypic diversity and consequently can strongly impact population-, community- and ecosystem-level dynamics. Here, we examine whether the ecological consequences of habitat fragmentation have led to changes in the life histories of three native species of mosquitofish (Gambusia spp.) inhabiting tidal creeks on six different Bahamian islands. We address two important questions: (i) How predictable and parallel are life-history changes in response to HIREC across islands and species, and (ii) what is the relative importance of shared (i.e. parallel) responses to fragmentation, differences between species or islands and species- or island-specific responses to fragmentation? Phenotypic differences between fragmentation regimes were as great or greater than differences between species or islands. While some adult life histories (lean weight and fat content) showed strong, shared responses to fragmentation, offspring-related life histories (embryo fat and fecundity) exhibited idiosyncratic, island-specific responses. While shared responses to fragmentation appeared largely driven by a reduction in piscivorous fish density, increased conspecific density and changes in salinity, we found some evidence that among-population variation in male reproductive investment and embryo fat content may have arisen via variation in conspecific density. Our results suggest that phenotypic responses to HIREC can be complex, with the predictability of response varying across traits. We therefore emphasize the need for more theoretical and empirical work to better understand the predictability of phenotypic responses to human-induced disturbances.

Cultural competence among staff nurses who participated in a family-centered geriatric care program.

The purpose of this training program was to prepare nursing staff in family-centered geriatric care that emphasizes providing culturally competent care to hospitalized elders at two major tertiary hospitals in New York. This research report corresponds to the first phase of a 3-year project. In this research project, a descriptive exploratory design was used to identify the levels of cultural awareness and cultural competence of nursing staff who participated in a family-centered geriatric care training program.

Themes from a grounded theory analysis of elder neglect assessment by experts.

PURPOSE: This paper describes one program that has developed a screening procedure for assessing elder mistreatment, with a special focus on elder neglect. The aim is to understand how expert neglect assessment teams process and diagnose complex geriatric cases referred for suspected elder neglect. What are the key themes that must be understood in order to determine if neglect should be suspected and confirmed? DESIGN AND METHODS: Transcripts of audio recordings of neglect assessment team meetings were analyzed by using grounded theory analysis. RESULTS: Four major themes emerged from the analysis of the transcripts. These themes were understanding the underlying health status of the elder and caregiver, understanding the socioeconomic and life circumstances of the dyad, credibility of data collected by others, and the consequences of the assessment outcome. IMPLICATIONS: These findings offer insight into the development of future clinical screening and assessment procedures used to make diagnoses about elder neglect, as well as the guidelines that govern neglect assessment. Understanding not only the high-risk signs and symptoms but also the context and consequences of neglect is critical. Future screening and assessment procedures should be developed with these data in mind.