Today's Health Care Research Articles

Role expectations and workplace relations experienced by men in nursing: A qualitative study through an interpretive description lens.

The aim of this study was to investigate the lived experiences of male nurses in today's healthcare environment to understand the persistently low numbers of men in nursing. This study used interpretive description methodology, which aligns with nursing's approach to knowledge discovery by acknowledging the evolution and complexity of shared and individual experiences. Participants, (N=11), were recruited through the American Association for Men in Nursing using purposive sampling. Focused interviews were conducted between May 2018 - June 2018. Interviews were semi-structured, guided by open-ended questions and video and audio recorded. Data were analysed according to study design with categories and themes extracted using reliability measures. This study's findings reflected the unique experiences of each participant in a primarily female dominated work environment in clinical and academic settings. Our study identified thematic categories of role expectations and workplace relations for the men in the study. Role expectations were influenced by sociocultural views, professional acceptance and patient/family perceptions. Workplace relations were associated with being male, social cliques and peer support. Participants shared similar and distinctly individual experiences. Findings from this study indicate there has been progress toward improving male presence in nursing but additional efforts are needed to increase inclusivity. Findings can be used to make recommendations for professional change in nursing, strengthen diversity by refining ways to recruit more men, enhance patients' experiences and improve experiences for future male nurses. This study addressed low numbers of men in nursing. Main findings included role expectations and workplace relations and how they are experienced by men in nursing. Findings from this research have a multidisciplinary impact in the workplace, and affect care of patients and their families.

Evolving Populations in Biofilms Contain More Persistent Plasmids.

Bacterial plasmids substantially contribute to the rapid spread of antibiotic resistance, which is a crisis in healthcare today. Coevolution of plasmids and their hosts promotes this spread of resistance by ameliorating the cost of plasmid carriage. However, our knowledge of plasmid–bacteria coevolution is solely based on studies done in well-mixed liquid cultures, even though biofilms represent the main way of bacterial life on Earth and are responsible for most infections. The spatial structure and the heterogeneity provided by biofilms are known to lead to increased genetic diversity as compared with well-mixed liquids. Therefore, we expect that growth in this complex environment could affect the evolutionary trajectories of plasmid–host dyads. We experimentally evolved Shewanella oneidensis MR-1 with plasmid pBP136Gm in biofilms and chemostats and sequenced the genomes of clones and populations. Biofilm populations not only maintained a higher diversity of mutations than chemostat populations but contained a few clones with markedly more persistent plasmids that evolved via multiple distinct trajectories. These included the acquisition of a putative toxin–antitoxin transposon by the plasmid and chromosomal mutations. Some of these genetic changes resulted in loss of plasmid transferability or decrease in plasmid cost. Growth in chemostats led to a higher proportion of variants with decreased plasmid persistence, a phenomenon not detected in biofilms. We suggest that the presence of more stable plasmid–host dyads in biofilms reflects higher genetic diversity and possibly unknown selection pressures. Overall, this study underscores the importance of the mode of growth in the evolution of antibiotic-resistant bacteria.

Impact and Reasoning: Applying Community Service Learning in a Non-Traditional Field

Background: Health care today is presented with a complex set of circumstances requiring exploration of new and varied teaching methodologies to produce requisite student reasoning and prepare them for professional practice. Health care practitioners require high-level clinical reasoning skills to practice, skills traditionally achieved through clinical experiences. Purpose: The purpose of this study was to explore the impact of a community service learning clinical experience on the clinical reasoning skills of pre-licensure nursing students. Methodology/Approach: A sample of junior-level nursing students was recruited and given the Health Science Reasoning Test pre-test. Participants then completed a community service learning clinical experience, after which they took a post-test and completed a reflective journal entry. Findings/Conclusions: Quantitative data analysis was inconclusive due to limitations. Qualitative data analysis suggested that clinical reasoning skills were affected and identified major themes (communication, holistic care, and knowledge and skills). Implications: Community service learning clinical experiences have the potential to enhance clinical reasoning skills and should be further evaluated for inclusion in today’s nursing programs.

Psychoanalysis: neglected ally in an emerging “critical healthcare management studies” (CHMS)?

PurposeThe purpose of this paper is to demonstrate the relevance of psychoanalysis to an emerging sub-field known as “critical healthcare management studies” (CHMS).Design/methodology/approachBuilding upon a wave of critical scholarship in the broader field of management, scholars and practitioners of healthcare management have begun to forge a critical scholarly movement of their own. CHMS, short for “critical healthcare management studies,” formally denotes a new subfield of inquiry dedicated to challenging entrenched assumptions, exposing power relations, and cultivating critical praxis, all the while serving as a vital counterpoint to mainstream scholarship. This paper seeks to augment the CHMS movement with psychoanalysis, and particularly the critical vein of organizational psychoanalysis already well-established in critical management studies.FindingsThe argument is made that a greater engagement with psychoanalysis offers novel avenues for critical theorizing and practice in healthcare management. Specifically three areas are considered: 1) the exploitative role of guilt in the caring professions, 2) the resurgence of authoritarianism and its implications for unconscious organizational dynamics, and 3) the potential for a psychoanalytically informed critical healthcare praxis.Originality/valueWhile there remain wide differences of opinion about the utility of psychoanalysis outside of the clinical arena, this paper reveals just how psychoanalysis can inform today's healthcare organizations, and more broadly the social and political organization of health in society.

Review of emotional intelligence in health care: an introduction to emotional intelligence for surgeons

The aim of this review is to explain the components of emotional intelligence (EI) and explore the benefits within today's health care system with an emphasis on surgery. EI is a person's ability to understand their own emotions and those of the individuals they interact with. Higher individual EI has multiple proposed benefits, such as reducing stress, burnout and increasing work satisfaction. The business world recognizes EI as beneficial in terms of performance and outcomes. Could surgeons benefit from being more cognisant of EI and methods of assessing and improving EI to reap the aforementioned benefits? A search of Embase, Cochrane and Medline databases using the following search terms; emotional intelligen*, surg*, medic* yielded 95 articles. After review of all the literature 39 remaining articles and five text books were included. To perform optimally, surgeons must be aware of their own emotions and others. EI differs from IQ and can be taught, learnt and improved upon. EI is measured via validated self-reporting questionnaires and 'multi-rater' assessments. High EI is positively associated with leadership skills in surgeons, non-technical skills, reduction in surgeon stress, burnout and increased job satisfaction, all of which translate to better patient relationships and care. Future implications of EI have been postulated as a measure of performance, a selection tool for training positions and a marker of burnout. EI should be an explicit part of contemporary surgical education and training.

Improving breast cancer care coordination and symptom management by using AI driven predictive toolkits

Integrated breast cancer care is complex, marked by multiple hand-offs between primary care and specialists over an extensive period of time. Communication is essential for treatment compliance, lowering error and complication risk, as well as handling co-morbidity. The director role of care, however, becomes often unclear, and patients remain lost across departments. Digital tools can add significant value to care communication but need clarity about the directives to perform in the care team. In effective breast cancer care, multidisciplinary team meetings can drive care planning, create directives and structured data collection. Subsequently, nurse navigators can take the director’s role and become a pivotal determinant for patient care continuity. In the complexity of care, automated AI driven planning can facilitate their tasks, however, human intervention stays needed for psychosocial support and tackling unexpected urgency. Care allocation of patients across centres, is often still done by hand and phone demanding time due to overbooked agenda’s and discontinuous system solutions limited by privacy rules and moreover, competition among providers. Collection of complete outcome information is limited to specific collaborative networks today. With data continuity over time, AI tools can facilitate both care allocation and risk prediction which may unveil non-compliance due to local scarce resources, distance and costs. Applied research is needed to bring AI modelling into clinical practice and drive well-coordinated, patient-centric cancer care in the complex web of modern healthcare today.

Contact dermatitis: etiologies of the allergic and irritant type

The term contact dermatitis describes an inflammatory process of the skin that occurs in response to contact with exogenous substances and involves pruritic and erythematous patches. Approximately 80% of all contact dermatitis is primary irritant contact dermatitis (ICD), whereas allergic contact dermatitis (ACD) makes up only 20% of contact dermatitis cases, the estimated prevalence of contact dermatitis in the United States being 1.4%. Among patch-tested patients, nickel has been identified as the most common allergen. Cobalt is the second most common metal allergen and is found in various dental alloys, paints, and coloring components of porcelain and glass. The average prevalence of dermatitis due to p-phenylenediamine (PPD) was found to be 4.3% in Asia, 4.0% in Europe, and 6.2% in North America. Rubber gloves are a major cause of occupational ACD in healthcare workers. Occupations involving frequent handwashing, between 20 and 40 times per day, have shown an increased incidence in cumulative ICD. The prevalence of occupational hand dermatitis was 69.7% in workers that reported a handwashing frequency exceeding 35 times per shift. The use of alcohol-based sanitizers is much more prevalent among today's healthcare workers than frequent handwashing. Both allergic and ICD are worldwide problems.

Multi-Point Near-Field RF Sensing of Blood Pressures and Heartbeat Dynamics

Systolic and diastolic blood pressure estimation using arm-cuff monitors is one of the most common cardiovascular evaluation criteria in healthcare today, however these measures lack critical heartbeat and pressure dynamics. Pulse-transit time can be used as an alternative for arm-cuff monitors, but gives only one parameter for two pressure quantities. Ultrasound, computed tomography scan, and magnetic resonance imaging can retrieve geometrical features of the heart, but cannot directly estimate vascular pressures. Here we show a novel radio-frequency heartbeat sensor based on multi-point near-field observation. By comparing to synchronized electrocardiogram and auscultation, the multi-point sensor can assess motion and pressure in different parts of the heart following the Wiggers diagram. By applying the Hilbert-Huang frequency-time transform, the central blood pressure can be derived from the vascular vibration characteristics as continuous transients, including during the pulmonary cycle which is previously inaccessible from branchial measurements. Our scheme can be further extended to a full multiple-input-multiple-output (MIMO) channel arrangement, producing rich content for diagnostic and biometric applications. We employ dynamic time warping analyses to illustrate the sensor's wealth of diversified information across different channels and persons. This new multi-point sensor, which can be worn conveniently over clothing, enables unprecedented monitoring capabilities of detailed central blood pressure transients and heartbeat dynamics under the given measurement instructions for at-home and clinical cardiovascular diagnostics.

Towards a Health 4.0 Framework for the Design of Wearables: Leveraging Human-Centered and Robust Design

With the introduction of Health 4.0 we face a new era in healthcare and notice the disruption of delivery, adoption and use through newly introduced technology. Wearables have become increasingly important in the medical sector and their remote application and widespread use are significant to the development of technology in healthcare today and the future. The implementation of wearables requires regulations and clinical approval when intended to use for health tracking and monitoring. Within this process designers play a crucial role. Design methodologies are the guideline to accomplish a successful path towards the creation of a new product. In this paper the authors explore and draw from established design methodologies to support the creation of a framework for design of wearables in a health 4.0 context. Identifying the positions of design practices and analyzing the correlations in the context of Health 4.0 is therefore presented within this paper.

Клинико-лабораторная диагностика HBsAg-негативной формы хронической HBV-инфекции

The purpose of the work is to determine the clinical and laboratory criteria for the activity of the infectious process in HBsAg-negative chronic HBV infection. Material and methods. An in-depth clinical and laboratory examination of 59 patients with the HBsAg-negative form of chronic HBV infection was carried out. According to the preliminary results of an enzyme immunoassay of blood serum, the patients had the only marker of the disease — total antibodies to the core antigen of the hepatitis B virus (anti-HBcor) in the absence of HBsAg. Traditional methods of biological statistics were used with Student’s reliability not less that 95%. Results. Comparative characteristics of the two groups based on the results of DNA detection in the polymerase chain reaction (DNA HBV+; n = 30 and DNA HBV–; n = 29) established comparability in terms of the minimum clinical picture, mainly due to concomitant pathology of the gastrointestinal tract in 40, 31% of cases, respectively; serological spectrum with the detection of total anti-HBcor in 100% of cases in the absence of HBsAg, a marker of inflammation and increased permeability of the hepatitis membrane — the activity of the enzyme alanine aminotransferase at a normal level in 65% of cases, and the absence of liver fibrosis in 89% of cases. Сonclusion. Thus, the relevance of studying HBsAg-negative (hidden, latent, occult) hepatitis B is of particular importance for the science and practice of healthcare today, as a source of infection with a risk of reactivation and subsequent development of the process with an outcome in liver cirrhosis and hepatocellular carcinoma.

A smartphone-integrated paper sensing system for fluorescent and colorimetric dual-channel detection of foodborne pathogenic bacteria.

Infections caused by foodborne microorganisms are a great threat to the global environment and public healthcare today. Thus, rapid, portable and sensitive assays that can realize the identification of foodborne bacteria are highly desired. In this study, a smart fluorescent and colorimetric dual-readout sensing system has been established for simple and rapid E. coli determination by utilizing the Cu2+-triggered oxidation of o-phenylenediamine (OPD). Initially, Cu2+ can oxidize OPD to OPDox, resulting in an orange-yellow fluorescence and visible pale-yellow color. However, E. coli can effectively reduce Cu2+ into Cu+, inhibiting the Cu2+-triggered oxidation of OPD to OPDox. Consequently, the introduction of E. coli can turn off both the fluorescence and the UV-vis absorbance signals of the OPD-Cu2+ system, illustrating an original mechanism for fluorescent and colorimetric dual-channel detection of E. coli. Moreover, a filter paper-based visual sensor was built and coupled with OPD-Cu2+ solution under the assistance of a UV lamp. The as-prepared sensor can detect E. coli quantitatively with the help of a typical smartphone color-scanning application (APP). Thus, this study offers a valid dual-mode assay for sensitive and on-site visible detection of E. coli, guaranteeing the reliability of the results and is more attractive for practical use. Graphical Abstract Schematic illustration of the smartphone-integrated sensing system for fluorescent and colorimetric dual-channel detection of E. coli based on the Cu2+-OPD system.

What's Important: The 3 A's Revisited.

What's Important: The 3 A's Revisited.

Leading Effectively Through Change.

The pace of change in today's healthcare environment is unprecedented. What used to happen every few months now seems to happen every day. From rapidly shifting technology to evolving models of care to new payment systems, nursing leaders must navigate constant change to stay relevant. How well they manage it has a direct bearing on everything from patient safety and outcomes to nursing cohesion and satisfaction. In this month's Magnet Perspectives column, we explore the essential elements that contribute to successful change management and the strategies leaders can employ to keep their nurses, and their organizations, forward-focused. In addition, we take a deep dive into the Magnet Model component of transformational leadership and examine its impact on creating and sustaining an environment where change flourishes and nurses thrive.

An Archetype Query Language interpreter into MongoDB: Managing NoSQL standardized Electronic Health Record extracts systems.

The fast development of today's healthcare and the need to extract new medical knowledge from exponentially-growing volumes of standardized Electronic Health Records data, as required by studies in Precision Medicine, brings up a challenge that may probably only be addressed using NoSQL DBMSs, due to the non-optimal performance of traditional relational DBMSs on standardized data; and these database systems operated by semantic archetype-based query languages, because of the expected generalized extension of standardized EHR systems. An AQL into MongoDB interpreter has been developed to its first version. It translates system-independent AQL queries posed on ISO/EN 13606 standardized EHR extracts into the NoSQL MongoDB query language. The new interpreter has the advantages of both the archetype-based system-independent AQL queries and the dual-model-based standardized EHR extracts stored on document-centric NoSQL DBMSs, such as MongoDB. AQL queries are independent of applications, programming languages and system environments due to the use of the dual model, but EHR extracts featuring this model are best persisted on document-based NoSQL databases. Consequently, the interpreter allows us to query standardized EHR extracts semantically, and also affording optimal performance.

Is there equity of access to revascularisation in Wales by socioeconomic deprivation?

Background Long-standing evidence of inequity has been shown to exist in the management of patients with heart disease. The majority of UK studies during the last 20 years have concluded that patients living in the most deprived areas were disadvantaged by lower revascularisation rates, despite having a higher level of need.
 Over the last 10 years, a systematic approach at tackling health inequity has played an important role in public health policy and practice throughout the UK. National service frameworks for cardiac disease have contributed to significant changes to the way coronary revascularisation is provided. Their aim is to provide access to the best possible treatment in timely fashion for all with heart disease.
 Aim To investigate the impact of service redesign in the provision of revascularisation procedures on the historical socioeconomic inequity in revascularisation rates for patients with heart disease.
 Methods A retrospective cohort design was created through the linkage of population administrative datasets, with cohorts created in both the pre- and post-service redesign periods.
 Cox Proportional Hazards models were used to estimate the likelihood of receiving revascularisation to see did these differ between periods by socioeconomic status.
 Results Revascularisation was provided equitably by socioeconomic deprivation after the service redesign, whereas pre-service redesign, subjects resident in the most deprived quintile were 20% less likely to receive revascularisation.
 Measures to improve access to services are working, with previous signs of socioeconomic inequity of access to revascularisation not apparent, but rather increased access for all and in a timelier manner regardless of socioeconomic deprivation.
 Conclusion While inequities and inequalities remain throughout healthcare today, this research provides evidence that measures can be successful in hard to reach groups such as those living in the most deprived areas, and these unnecessary variations can be reduced or eradicated in the future.

Vascular access complications in specialised clinical practice: strategies for first insertion success

Vascular access in clinical practice is an integral part of healthcare today. Most patients will experience some aspect of vascular access as some point in their treatment, and complications are common. Using vein location and access-assist technology should become routine.

Male nursing students' experiences of simulation used to replace maternal-child clinical learning in Qatar

BackgroundIn today's health care context, nurse educators teach with limited clinical placement availability, competition for available spaces and increasingly complex clients. SettingAs part of the baccalaureate of nursing program at the University of Calgary in Qatar, students are required to complete 208 h of maternal-child clinical. Unfortunately, due to social and cultural norms in this predominantly Muslim country, male nursing students are prohibited from practicing with mothers and babies in Qatar. In order to address this need, we developed a fully simulated clinical practice module for these male students. ObjectivesThe aim of the current study was to better understand the learning experiences of the students undertaking this experience. DesignThe authors developed and implemented a fully simulated, campus-based, maternity clinical experience that used a variety of levels of fidelity, incorporated the tenets of Kolb's (1984) experiential learning theory, and Jeffries' (2005) simulation design framework. Post-simulation debriefing sessions were recorded and transcribed. Typed weekly reflections were provided. All data was blinded. ParticipantsA convenience sample of ten adult, male participants was obtained. MethodsUsing an inductive qualitative approach, researchers analyzed transcripts of debriefing sessions and reflective journals. ResultsThe main themes were knowledge application, clinical judgement, communication, and crossing cultural barriers. ConclusionsThemes from this study can be used to support and/or change existing practices in a way that supports learner-centered, experiential teaching practices.

Appropriate Use of Transesophageal Echocardiogram for Infective Endocarditis: A Single Center Experience

Background Transesophageal echocardiogram (TEE) is a valuable tool in healthcare today with its ease of use, ability to visualize important structures not seen on transthoracic echocardiogram (TTE), and the relatively lower cost of TEE, high yield, and no significant radiation exposure. The American Society of Echocardiography (ASE) has developed an appropriate use criteria for use of TTE and TEE, which outline various scenarios where a TEE is indicated as an initial diagnostic testing modality and when it is useful as an adjunctive test in hopes of decreasing inappropriate use. Using these criteria as a guide, we devised a quality assessment study to investigate how well TEEs performed at our institution fit the appropriate use criteria specifically for the diagnostic workup of infective endocarditis. Methods A retrospective chart review was performed for all TEEs performed in 2017 with the indication of endocarditis. Baseline patient characteristics, presence of bacteremia, and the quality of the TTE preceding the TEE were noted, as well as whether a vegetation, abscess, or perforation was visualized. We also determined if there was a cardiology consultation placed prior to TEE and if the patient had met the definition for endocarditis as defined by the Duke criteria. Finally, we made note of the TEE findings and assessed whether the TEE met appropriate use criteria developed by the American Society of Echocardiography. Results A total of 50 patients who underwent TEE with the indication of “endocarditis” were identified. 36% of the TTEs prior to the TEE were rated as good quality, 40% as adequate, 4% as fair, 4% as suboptimal, 12% as technically difficult, and 4% were not rated. Vegetations were visualized on 12% of TTEs, 6% of patients had a prosthetic valve, and 6% had a cardiac device. In 20% of the cases, there was no cardiology consultation prior to the TEE and in 20% of the cases, there was no documented bacteremia. 26% of patients met the Duke criteria for endocarditis prior to TEE. Only 36% of TEEs revealed evidence of infection and of the patients with no evidence of infection, only 38% met appropriate use criteria. Overall, only 56% of patients met appropriate use criteria for TEE. Conclusion Transesophageal echocardiography is a valuable tool in a modern physician's arsenal for managing a variety of diseases and conditions. However, the procedure is not without associated risks and its ease of use and widespread adoption has led to frequent questionable appropriateness of use of the test. Only 56% of the TEEs performed in our analysis met appropriate use. More awareness and education is needed for the appropriate use criteria for transesophageal echocardiography as outlined by the ASE to help reduce patient exposure to procedure related complications and to decrease medical costs on unnecessary procedures.

The image of the profession in the mass consciousness

The issues of nursing staff shortage and quality of their work are relevant for the health-care management today. In this regard, the established image of the profession is important, as it can lead to the unpopularity of nursing profession and affect the effectiveness of the treatment process through the self-perception of nurses. So studying the image of nursing in social media is of particular relevance today. The role of social media in dissemination of opinions is increasing every day. Unloading (31613 messages) from social media was made using keywords for 2017. А random subsample (403 messages) was formed from them, coded manually by coders (authors). According to analysis of the obtained data, nursing is perceived as a “female profession,” a nurse is a Caucasoid woman in a white uniform. She works at public hospitals, her work is discussed primarily in the context of the specialties of obstetrics, gynecology and pediatrics. Her status is rather low, nursing is not perceived as an intellectual and promising profession. Messages about nurses are mostly neutral, emotionally colored messages are devoted mainly to the personal qualities of nurses. Autoimage (self-perception) of nurses is poor. In conclusion, there is given a number of recommendations for improving the image of nurses. Implementation of organizational changes may contribute to enhancing the prestige of the profession: introducing special insignia for nurses, designating career prospects. It is also possible for these purposes to conduct an information policy aimed at demonstrating the attractive aspects of nursing and emphasizing the gender neutrality of the profession.

Applying Conflict Management Strategies to the Pediatric Operating Room.

Effective communication is essential in today's health care environment, and poor communication can lead to conflict among health care providers. Differences in cultures and beliefs can further incite conflict among health care team members, families, and patients. Pediatric patient care has a higher potential for conflict because decision-making responsibilities are shared among patients, parents/guardians, and clinicians. It is important to understand the phases and types of conflict because each conflict situation requires a different approach to optimize management. Equally important is an understanding of styles used by individuals to manage conflict. The Thomas-Kilmann Conflict Mode Instrument and the Dutch Test for Conflict Handling are 2 validated tools used to assess conflict management styles. The different styles include competing/forcing, collaborating/problem solving, compromising, avoiding, and yielding/accommodating. A successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict.There are several techniques for managing conflict in the pediatric operating room. Acknowledging and managing one's own emotions during conflict is a pivotal first step toward diffusing the situation. Active listening is an important communication skill that improves team dynamics. Aligning the interests of the parties involved in conflict will encourage collaborative problem solving. Cultural competency training can improve communication and conflict management skills. Effective conflict management through formal education of all perioperative team members can lead to improved communication and teamwork and better patient outcomes.