Nurse manager support of graduate nurse development of work readiness: An integrative review.

AIM: To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness. BACKGROUND: Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. DESIGN: A five-step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist. METHODS: The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework. DATA SOURCES: MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020. RESULTS: Studies eligible for inclusion (N = 40) represented research from 15 countries; most (67.5%, n = 27) used a qualitative design, 22.5% (n = 9) were quantitative and 10% (n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning. CONCLUSION: The review identified a lack of robust evidence about the effectiveness of specific nurse manager-led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness. IMPLICATIONS FOR THE PROFESSION OR PATIENT CARE: Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce. IMPACT: What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).

Informing the Spectrum of Approaches: Institutional Review of Placenta Accreta Spectrum Disorders Management.

OBJECTIVE: Placenta accreta spectrum (PAS) is a condition defined by abnormal adherence of the placenta. Cesarean hysterectomy is the preferred management, but practice patterns vary based on local resources and expertise. We retrospectively reviewed the clinical course of patients diagnosed antenatally with PAS who underwent surgical management in our centre. METHODS: We conducted a retrospective records review involving patients with an antenatal diagnosis of PAS between 2014 and 2019. The primary outcome was a composite score of maternal morbidity, and secondary outcomes were total estimated blood loss and composite neonatal morbidity. Patients were stratified based on the presence or absence of PAS on final pathology. Antenatal diagnosis by ultrasound and magnetic resonance imaging (MRI) was compared with final histologic diagnosis. RESULTS: A total of 34 patients were diagnosed with PAS antenatally and managed at our institution. Final histology confirmed PAS in 29 patients. The overall composite morbidity rate was 44%, with no significant difference between patients with and without PAS on pathology (P = 0.355). Intraoperative blood loss was similar between the 2 groups (2374 ± 2212 mL vs. 1080 ± 852 mL; P = 0.232). The rate of composite neonatal morbidity was 47%. Ultrasound achieved a high positive predictive value in the diagnosis of PAS (96%) and more accurately predicted pathology than MRI. CONCLUSIONS: PAS is associated with high rates of morbidity. Dissemination of our local experience serves to inform best practices in the management of this complex condition.

Developing work readiness in graduate nurses undertaking transition to practice programs: An integrative review.

OBJECTIVE: Investigate the strategies used to support graduate transition-to-practice, and how they align with the four domains of work readiness: work competence; personal work characteristics; organisational acumen; and social intelligence. DESIGN: Integrative review with narrative synthesis. DATA SOURCES: Databases searched in 2019 included Medline, CINAHL, PsychINFO, Embase via EBSCO, ERIC and MIDIRS. Grey literature was obtained through Proquest Dissertations and Thesis Global, and Trove. REVIEW METHODS: The 5-step method included: 1) Independent title and abstract review; 2) discussion of conflicting findings after title and abstract review; 3) independent full text review; 4) discussion of conflicting findings after full text review; and 5) quality evaluation using the Mixed Methods Appraisal Tool. Twenty eligible studies were analyzed and synthesized using the framework method informed by four domains of Graduate Work Readiness. RESULTS: Of the 24 strategies identified, most (n = 20) supported graduate development across two or more work readiness domains. Structured education (n = 14) and preceptorship (n = 13) were most often used, and findings related to development of graduate work competence (n = 17) were most often measured. All four domains of work readiness were seldom addressed, with social intelligence a common gap. CONCLUSIONS: This review provides two important considerations for graduate nurse programs. First, a combination of strategies is required to address all four domains of work readiness. Second, there is a need to tailor strategies, and their implementation, to the context of the organisation and clinical workplace.

Dental Management of Siblings with GAPO Syndrome.

GAPO syndrome is a rare autosomal recessive genetic disorder, characterized by growth retardation, alopecia, pseudoanodontia, and progressive ocular changes. This disorder is caused by recessive mutations in the ANTXR1 gene and has characteristic dysmorphic facial features along with connective tissue changes, cardiomyopathy, gonadal dysfunction and craniosynostosis. The most common dental implication of GAPO syndrome is pseudoanodontia caused by eruption failure of the primary and permanent dentition. Currently, there is no standard treatment for patients with GAPO syndrome. Management often includes multidisciplinary care in the surveillance of syndromic sequelae and supportive treatment of symptomatic health concerns, which are unique to each patient. The purpose of this paper is to describe the dental rehabilitation of two brothers with GAPO syndrome.

Case Report: Extrapelvic Endometriosis in the Medial Thigh.

Extrapelvic endometriosis, although rare, can present in the musculoskeletal system of reproductive-age women and cause significant pain and morbidity. The pathophysiology of this disease is not well understood. In this study, we described the case of a 39-year-old women with an inner-thigh mass causing catamenial pain. Core-biopsy of the mass confirmed endometriosis and she was referred to minimally-invasive gynecology for management. Surgical excision was performed by a multidisciplinary team and she remains pain-free postoperatively on hormonal therapy. Unique to this case, the patient had a history of pelvic fracture. Through this case report, we discuss possible pathophysiologic mechanisms of extrapelvic musculoskeletal endometriosis including the stem/progenitor cell theory and the role that musculoskeletal trauma may have in the development of this condition. Gynecologists play an important role in the recognition, diagnosis, and management of musculoskeletal endometriosis.

A phosphodiesterase inhibitor, cilomilast, enhances cAMP activity to restore conditioned odor preference memory after serotonergic depletion in the neonate rat.

In various learning and memory models, preventing the breakdown of cyclic adenosine monophosphate (cAMP) by using a phosphodiesterase (PDE) inhibitor promotes memory. In the rat pup odor preference learning model serotonin, acting through 5-HT(2A/C) receptors, has been shown to influence cAMP levels in the olfactory bulb initiated by beta-adrenoceptor activation, as also seen in the neocortex. Since depletion of olfactory bulb serotonin prevents learning in the rat pup odor preference model, we ask whether a PDE inhibitor could restore that learning and also examined the influence of these manipulations on the temporal bulbar cAMP signal associated with successful learning. In this study, we found that a PDE4 inhibitor overcame learning deficits seen 24h after a 10min training trial on postnatal day 6 using the beta-adrenoceptor agonist, isoproterenol as the unconditioned stimulus. We found in a previous study, that use of a PDE4 inhibitor during learning in normal pups extended memory to more than 48h. However, in the present study the PDE4 treatment did not enable this memory extension in 5-HT depleted pups. An increase in the cAMP signal at the end of the 10min training trial occurred in the presence of the PDE4 inhibitor. Such a cAMP increase has been associated with successful learning and is normally absent with bulbar 5-HT depletion. These results suggest PDE4 inhibitors may be useful therapeutically in disorders associated with reductions in serotonergic function.

The 80-hour workweek restriction: How are OB/GYN resident procedure numbers affected?

OBJECTIVE: To evaluate the surgical caseload in a military obstetrics and gynecology residency program, prior to and after implementation of an 80-hour workweek. METHODS: A retrospective cohort study evaluating data submitted to the Accreditation Council for Graduate Medical Education (ACGME) for cumulative resident procedures in obstetrics and gynecology for the years before (July 2001-June 2002) and after (July 2002-June 2003) 80-hour workweek implementation. Total obstetric and gynecology procedures were examined using both the Student's paired t-test and a two-way mixed factor analysis of variance. RESULTS: Between July 2001 and June 2002 there were 822 gynecological cases and 3958 deliveries done by 17 OB/GYN residents; these were compared with 827 cases and 3504 deliveries done by 18 OB/GYN residents between July 2002 and June 2003 (p=0.189). The total numbers of obstetric and gynecology cases pre- and post-80-hour workweek intervention were similar when evaluated by month (July through June of 2001/2 vs. 2002/3; p=0.908). There was a significantly greater number of obstetrics cases compared with gynecological cases (p < 0.001) in the pre- vs. post-80-hour workweek groups; the number of gynecological cases remained constant in the post-80-hour workweek group while the obstetric numbers dropped (p=0.001). CONCLUSION: The 80-hour workweek restriction resulted in similar total numbers of obstetrics and gynecology cases, although the total number of obstetric cases per resident declined after implementation.