Changing Practice in Gastrointestinal Endoscopy: Reducing Distractions for Patient Safety.

Failure in communication during the process of delivering healthcare can have dangerous repercussions. Specifically, failure in interdisciplinary team communication contributes to lapses in patient care. Distractions in procedural areas disrupt team communication. Application of a structured communication algorithm creates agreed-upon cues that promote team communication and facilitate clinical decision making. Frequent disruptions before, during, and after gastro-intestinal endoscopy procedures place veterans at risk for an error. A hierarchical culture promotes intimidation and reduces the likelihood that staff will speak up for patient safety. An endoscopy procedure area implemented a "sterile cockpit" methodology to reduce the number of distractions during procedures. Data collected from a self-reported safety awareness were measured by two different questionnaires and collected through observation of actual practice. Improved awareness of distraction and the impact on patient safety was reported, with a reduction from 24 observed interruptions to zero in 9 months. After reducing distractions in the procedural area, there is a perception of improved nursing quality of care. Additional support is required to consistently remove electronic distractions during a procedure.

Nonlinear bifurcations of psychological stress negotiation: new properties of a formal dynamical model.

Dynamical systems analysis is applied to a nonlinear model of stress and coping (Neufeld, 1999). The model is composed of 6 order parameters and 11 control parameters, and integrates core constructs of the topic domain, including variants of cognitive appraisal, differential stress susceptibility, stress activation, and coping propensity. In part owing to recent advances in Competitive Modes Theory (Yao, Yu & Essex, 2002), previously intractable but substantively significant dynamical properties of the 6-dimensional model are identified. They include stable and unstable fixed-point equilibria (higher-dimensional saddle-node bifurcation), oscillatory patterns attending fixed-point de-stabilization, and chaotic behaviors. Examination of the nature of system fixed-point de-stabilization, in relation to its control parameters, unveils mechanisms of re-stabilization, and dynamic stability control. All identified dynamics emerge naturally from a system whose construction guideposts are lodged in the addressed content domain. Dynamical complexities therefore may be intrinsic to the present content domain, possibly no less so than in other disciplines where the presence of such attributes has been established.