The relationship between managerial coaching and role ambiguity among nurses in the military health system.

Managerial coaching may be an effective strategy to reduce role ambiguity among nurses. Although the benefits of coaching relationships have been demonstrated outside of nursing, there is a lack of evidence about this career development relationship in nursing. A cross-sectional design was used to determine the relationship between managerial coaching and role ambiguity among military and civilian nurses who work in the Military Health System (MHS). Nurses who worked at a large academic medical center in San Antonio, Texas were asked to participate by completing a survey to examine the variables of interest. Among the 382 nurses that responded, perceived role ambiguity was low and managerial coaching was seldom perceived from first-line supervisors. However, there was a significant negative relationship between managerial coaching and role ambiguity. This study provides foundational knowledge about the relationship between managerial coaching and role ambiguity for nurses working in the MHS.

A Scoping Review of Graduate Nurses' Education and Use of QSEN Competencies.

INTRODUCTION: The QSEN Institute developed the quality and safety education for nurses (QSEN) competencies for both undergraduate and graduate-prepared nurses to support their development of the knowledge, skills, and attitudes needed to deliver safe, quality care. The purpose of this scoping review was to (1) determine the extent of evidence about the current use of QSEN competencies in graduate nursing curricula and (2) determine the application of the QSEN competencies among graduate-prepared nurses in clinical practice. MATERIALS AND METHODS: Arksey and O'Malley's methodological framework for scoping reviews was used to explore the literature about the use of the QSEN competencies in graduate nursing education and practice available in PubMed, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and Web of Science. Quality was assessed using Melnyk, Gallagher-Ford, and Fineout-Overholt's critical appraisal tools. RESULTS: In total, 423 articles were reviewed, 10 of which met inclusion criteria; five described quality improvement projects, two addressed curricular design, and three were program evaluations. Only one article described the use of QSEN competencies in practice. Overall, the amount of literature was scant and of low quality. All the articles described the use of QSEN competencies in graduate education except one, which also described them in practice in a graduate nurse residency program. CONCLUSIONS: Although the QSEN competencies were adopted for use in graduate curricula and practice settings, there is a wide variation in the actual use and application with limited reporting of outcomes. The graduate QSEN competencies can be leveraged to equip nurses with the knowledge, skills, and attitudes to address quality and safety challenges in any nursing environment including the operational environment in deployed and austere settings. This review provides recommendations to address gaps in research, graduate nursing education, and clinical practice.

Post traumatic growth among military enroute care nurses: A secondary analysis.

To date, little is known about the experience of military nurses and post traumatic growth (PTG). An analysis focusing on PTG was performed using data from the surveys and qualitative interviews of military enroute care nurses. In a mixed methods study designed to understand behavioral health symptoms experienced by military enroute care nurses, the qualitative data confirmed the experiences of nurses found in the quantitative data regarding the presence of PTG. Although the mean PTG total score was low in the quantitative findings, the qualitative data supported the presence of important factors comprising PTG. More research is needed to determine the experience of PTG among nurses.

An innovative academic-practice partnership to enhance the development and training of military nurses.

Academic-practice partnerships have been identified by the American Association of Colleges of Nursing as a best practice for advancing the profession of nursing in a collaborative manner by sharing goals, knowledge, and respect in a mutually beneficial line of effort. Training military nurses poses a unique challenge to academia and military nurse corps to produce competent nursing professionals who are also effective military officers. The academic-practice partnership between the United States Army Cadet Command's ROTC program and the University of San Francisco's School of Nursing is a prime example of such a partnership. Through the innovative month-long nurse summer training internship program, Army nursing students work one-on-one with an experienced Army nurse preceptor to receive an intense clinical experience with a minimum of 150 h of hands-on patient care in a military medical treatment facility. This example of cognitive apprenticeship learning provides an adjunct to nursing program curricula in addition to an introduction of the roles and responsibilities of a military officer. This academic-practice partnership helps develop a strong group of novice nurses who are confident leaders and critical thinkers that easily make the transition from academia to professional practice.

Decreasing inpatient length of stay at a military medical treatment facility.

This article describes an evidence-based approach to decreasing the length of stay of inpatient adults on the medicine oncology ward of a large urban military medical center. A strong and diverse team was formed, which worked together for the length of the project. A formalized approach involving weekly discharge-planning meetings with a discharge advocate as the planner, coupled with solid documentation, was adopted. There was a decrease in the average length of stay on the inpatient wards, resulting in cost savings for the facility. This approach using strong evidence can overcome institutional challenges, with a positive impact on patient care.

Two-dimensional Fourier transform electronic spectroscopy at a conical intersection.

We report measurement and modeling of two-dimensional (2D) electronic spectra of a silicon naphthalocyanine (SiNc) in benzonitrile, a system for which the polarization anisotropy reveals passage through a square-symmetric Jahn-Teller conical intersection in ∼100 fs [D. A. Farrow, W. Qian, E. R. Smith, A. A. Ferro, and D. M. Jonas, J. Chem. Phys. 128, 144510 (2008)]. The measured 2D Fourier transform (FT) spectra indicate loss of electronic coherence on a similar timescale. The 2D spectra arising from femtosecond vibronic dynamics through the conical funnel are modeled by full non-adiabatic treatment of the coupled electronic and vibrational dynamics for a pair of un-damped Jahn-Teller active vibrations responsible for both electronic decoherence and population transfer. Additional damped Jahn-Teller active modes that can cause only decoherence or population transfer are treated with analytical response functions that can be incorporated into the numerical non-adiabatic calculation by exploiting symmetry assignment of degenerate vibronic eigenstates to one of two electronic states. Franck-Condon active totally symmetric modes are incorporated analytically. The calculations reveal that these conical intersection dynamics alone are incapable of destroying the coherence of the initially prepared wavepacket on the experimentally observed timescale and predict an unobserved recurrence in the photon echo slice at ∼200 fs. Agreement with the experimental two-dimensional electronic spectra necessitates a role for totally symmetric vibrational dynamics in causing the echo slice to decay on a ∼100 fs timescale. This extended model also reproduces the ∼100 fs ultrafast electronic anisotropy decay in SiNc when an "asymmetric solvation mode" with a small stabilization energy of ∼2 cm(-1) is included. Although calculations show that inhomogeneities in the energy gap between excited states can broaden the anti-diagonal 2D lineshape, the anti-diagonal width is dominated by totally symmetric vibrational motions in SiNc. For this shallow conical intersection, the non-adiabatic dynamics destroy electronic coherence more slowly than they destroy electronic alignment.

Polarized pump-probe measurements of electronic motion via a conical intersection.

Polarized femtosecond pump-probe spectroscopy is used to observe electronic wavepacket motion for vibrational wavepackets centered on a conical intersection. After excitation of a doubly degenerate electronic state in a square symmetric silicon naphthalocyanine molecule, electronic motions cause a approximately 100 fs drop in the polarization anisotropy that can be quantitatively predicted from vibrational quantum beat modulations of the pump-probe signal. Vibrational symmetries are determined from the polarization anisotropy of the vibrational quantum beats. The polarization anisotropy of the totally symmetric vibrational quantum beats shows that the electronic wavepackets equilibrate via the conical intersection within approximately 200 fs. The relationship used to predict the initial electronic polarization anisotropy decay from the asymmetric vibrational quantum beat amplitudes indicates that the initial width of the vibrational wavepacket determines the initial speed of electronic wavepacket motion. For chemically reactive conical intersections, which can have 1000 times greater stabilization energies than the one observed here, the same theory predicts electronic equilibration within 2 fs. Such electronic movements would be the fastest known chemical processes.