Coping With Stress: Dispositional Coping Strategies of Project Managers

This study explores the relationship between project management practices, control appraisals and dispositional coping strategies used by project managers when dealing with stressful situations. Seventy-one project managers from a global sample participated by completing a web-based questionnaire. Results support the hypotheses that project managers apply more Active Coping and Planning strategies when dealing with stressful situations and that the level of maturity of the organisational practices is related to an increased use of Planning coping strategies. Findings and limitations are discussed

Accuracy of a Qsofa Based Sepsis Screening Tool

Introduction: Early recognition of sepsis is vital to initiate timely treatment. The quick Sequential [Sepsisrelated] Organ Failure Assessment (qSOFA) has been proposed to identify sepsis outside the critical care setting. However there is limited evidence regarding its accuracy in the acute medical-surgical context. Objectives: The aim of this study was to test the diagnostic accuracy of a sepsis-screening tool that incorporated qSOFA (respiratory rate ≥22, altered mentation and systolic blood pressure ≤90mmHg) and the presence of confirmed/suspected infection in general hospitalised patients. Methods: An interrupted time series study was conducted in 2017 in a private hospital in Buenos Aires. Screening was positive where the qSOFA was ≥2 in patients with a confirmed or suspected infection. Screening tool performance was compared to the discharge diagnosis assessed by an experienced intensivist blinded to screening tool performance. Comorbidities were assessed with the Charlson Comorbidity Index (CCI). Descriptive statistics and accuracy tests were conducted with SPSS® Version 25. Results: 434 patients with a median (IQR) age 70(31) years were included. The majority were female (n=239; 55.0%); 272 (62.7%) were medical patients with a median (IQR) CCI 2(3). Patients stayed a median (IQR) of 4(3) days in hospital, 38 (8.8%) required intensive care for 1.4 (2 days); 12 (3%) died. The most common sources of confirmed/suspected infection were pulmonary (79, 18.2%), skin/soft tissue (44, 10.1%) and urinary (42, 9.7%). Eighty-two patients (18.9%) had a qSOFA ≥2; 58 (13.4%) were screened positive. Diagnosis at discharge were sepsis (15, 3.5%), infection (153, 35.3%) and other (260, 59.9%). Accuracy tests of the screening tool resulted in 60.0% sensitivity, 88.9% specificity, 16.4% positive and 98.4% negative predictive values. Conclusion(s): While the screening tool performed moderately well ruling-out non-septic patients, sensitivity was modest, with poor performance in predicting sepsis.Full Tex

Does simulation enhance nurses' ability to assess deteriorating patients?

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care

High Resolution Millimeter-Wave Mapping of Linearly Polarized Dust Emission: Magnetic Field Structure in Orion

We present 1.3 and 3.3 mm polarization maps of Orion-KL obtained with the BIMA array at approximately 4 arcsec resolution. Thermal emission from magnetically aligned dust grains produces the polarization. Along the Orion ``ridge'' the polarization position angle varies smoothly from about 10 degrees to 40 degrees, in agreement with previous lower resolution maps. In a small region south of the Orion ``hot core,'' however, the position angle changes by 90 degrees. This abrupt change in polarization direction is not necessarily the signpost of a twisted magnetic field. Rather, in this localized region processes other than the usual Davis-Greenstein mechanism might align the dust grains with their long axes parallel with the field, orthogonal to their normal orientation.Comment: AAS preprint:14 pages, 2 figures (3mm.eps and 1mm.eps); requires aaspp4.sty To be published in Astrophysical Journal Letter

Applying social network analysis to the examination of interruptions in healthcare

Examinations of interruptions in healthcare often focus on a single clinical discipline, and solutions are targeted accordingly. This approach does not take into account the inter-disciplinary dependencies and other sociotechnical aspects that make up the healthcare work system, and suggested solutions may not meet the needs of all stakeholders. In this article a sociotechnical systems perspective is used to uncover the interdependencies between 16 unique work roles that result in interruptions in an intensive care unit (ICU). By applying social network analysis techniques to data collected using the Dual Perspectives Method, we identified targeted systems-based interventions that may reduce unnecessary interruptions while avoiding unintended consequences that impose additional burden on ICU staff. The rich insights gained into the interruptive communication patterns in the ICU work system stand in contrast to findings that would have otherwise been obtained by focusing only on a single clinical discipline or a single perspective

Strategies to Improve Information Transfer for Multitrauma Patients.

The aim of this multiphase mixed-method study was to improve access, flow, and consistency of information transfer for multitrauma patients leaving the Emergency Department. Methods included literature review, focus group interviews, chart audits, staff surveys, and a review of international trauma forms to inform an intervention developed with a researcher-led, clinician stakeholder group. Analysis included descriptive and inferential statistics. Baseline data revealed variability existed in patient-care documentation, showing little standardization. Improvement strategies implemented included a gold standard for information embedded in handover tools, raising staff awareness of complexities for information transfer. Improvement was seen in communication between wards coordinating transfer, improved documentation, decreased information duplication, improved legibility, and increased ease and efficiency in navigating to key information. Improvement in communication at patient transition is essential to continuity of safe, effective care, and is impacted by complex interactions between multiple factors. Difficulty increases for patients with high acuity

Implementation of an evidence-based practice nursing handover tool in intensive care using the knowledge-to-action framework

Background Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, s tandardised handover tools for nursing team leader s in intensive care are limited. Aims The study aim was to implement and evaluate an evidence- based electronic minimum dataset for nursing team leader shift -to-shift handover in the intensive care unit using the k nowledge- to-action framework. Methods This study was conducted in a 21- bed medical/surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in team leader handover were recruited. Three phases of the knowledge- to-action framework (select, tailor and implement interventions, monitor knowledge use and evaluate outcomes ) guided the implementation and evaluation process. A post -implementation practice audit and survey were carried out to determine nursing team leader use and perceptions of the electronic minimum dataset three months after implementation. Results are presented using descriptive statistics ( median, IQR, frequency and percentage) . Results Overall (86%, n=49) , team leader s used the electronic minimum dataset for handover and communication regarding patient plan increased . K ey content items however were absent from handovers and additional documentation was required alongside the minimum dataset to conduct handover. Of the team leader s surveyed (n=35), those receiving handover perceived the electronic minimum dataset more Page 4 of 24 positive ly than team leader s giving handover (n=35) . Benefits to using the electronic minimum dataset included the pat ient content (48%), suitability for short -stay patients (16%), decreased time updating (12%) and print ing the tool (12%) . Almost half of the participants however, found the minimum dataset contained irrelevant information, reported difficulties navigating and locating relevant information and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface. Linking evidence to action Prior to developing and implementing electronic handover tools , adequate infrastructure is required to support knowledge translation and ensure clinician and organisational needs are met

Inconsistent VAP definitions raise questions of usefulness

Ventilator Associated Pneumonia (VAP) is recognised as one of the most frequent nosocomial infections in Intensive Care Unit (ICU), with infection rates varying from 10 to 30% of mechanically ventilated patients. VAP is undoubtedly a burden on the health care system and has been associated with adverse patient outcomes; increases in ICU Length of stay (LOS), hospital LOS and crudely associated with increased mortality. Furthermore, it has been widely reported to impact on health care resources resulting in significant inflation of health care costs

Sample size: How many is enough?

Sample size is an element of research design that significantly affects the validity and clinical relevance of the findings identified in research studies. Factors that influence sample size include the effect size, or difference expected between groups or time points, the homogeneity of the study participants, the risk of error that investigators consider acceptable and the rate of participant attrition expected during the study. Appropriate planning in regard to each of these elements optimises the likelihood of finding an important result that is both clinically and statistically meaningful