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Purpose To explore the experiences of military spouses living with veterans with combat-related posttraumatic stress disorder (PTSD). Design Husserlian phenomenology was chosen as the theoretical framework because it allowed a deeper understanding of the unfolding of the spouses' daily experience. Methods A purposive sample of 14 spouses living with veterans with symptoms of PTSD participated in unstructured interviews. Data were analyzed using a modification of the Colaizzi phenomenological method. Findings Spouses recognized that the veteran was no longer the same person, with life becoming one of living with the unpredictability of PTSD. The spouses bore the burden to maintain normalcy in the family and eventually created a new life. Conclusions Military spouses endure psychological stress and strain, while living with a veteran with PTSD. There is a need for more programs to support the resilience of military spouses. Clinical Relevance Life for military spouses of veterans with PTSD is ever-changing and unpredictable. Practitioners need to be aware of the stress that spouses experience and develop programs and interventions that bolster the resilience of military families. [ABSTRACT FROM AUTHOR]

Purpose: To describe the current state of design characteristics determined to be desirable by the Agency for Health Research and Quality (AHRQ) in U.S. adult medical, surgical, and intensive care units (ICUs). Design: Descriptive study of patient visibility; distance to hygiene, toileting, charting, and supplies; unit configuration; percentage of private rooms; and presence or absence of carpeting in 56 ICUs and 81 medical-surgical units in six metropolitan areas. Methods: Data were collected via observation, measurement, and interviews. Unit configurations were classified via an iterative process. Descriptive data were analyzed according to ICU and non-ICU status using SPSS (Version 15). Findings: Analysis of unit configurations indicated eight unit designs. Statistical analysis showed inter- and intrahospital variation in unit configurations, percentage private rooms, carpeting, visibility, and distance to supplies and charting. Few units met the AHRQ designated design elements studied. Conclusions: A wide gap exists between desirable characteristics in ICUs and medical-surgical units. Future research is needed to explore operationalization of unit design elements as risk adjustments, how design elements contribute to patient outcomes, and how design elements influence one another. Clinical Relevance: There is room for improvement on almost every design variable, particularly on medical-surgical units. Future planning should take into consideration the interaction of bed capacity and unit configuration. [ABSTRACT FROM AUTHOR]

Purpose: To describe physical restraint (PR) rates and contexts in U.S. hospitals. Design: This 2003–2005 descriptive study was done to measure PR prevalence and contexts (census, gender, age, ventilation status, PR type, and rationale) at 40 randomly selected acute care hospitals in six U.S. metropolitan areas. All units except psychiatric, emergency, operative, obstetric, and long-term care were included. Methods: On 18 randomly selected days between 0500 and 0700 (5:00 am and 7:00 am), data collectors determined PR use and contexts via observation and nurse report. Findings: PR prevalence was 50 per 1,000 patient days (based on 155,412 patient days). Preventing disruption of therapy was the chief reason cited. PR rates varied by unit type, with adult ICU rates the highest obtained. Intra- and interinstitutional variation was as high as 10-fold. Ventilator use was strongly associated with PR use. Elderly patients were over-represented among the physically restrained on some units (e.g., medical) but on many unit types (including most ICUs) their PR use was consistent with those of other adults. Conclusions: Wide rate variation indicates the need to examine administratively mediated variables and the promotion of unit-based improvement efforts. Anesthetic and sedation practices have contributed to high variation in ICU PR rates. Determining the types of units to target to achieve improvements in care of older adults requires study of PR sequelae rate by unit type. [ABSTRACT FROM AUTHOR]

The United States has the largest and most diverse general aviation (GA) community in the world, with more than 220,000 aircraft, flying almost 23 million hours annually. Accurate and economic estimating the exhaust emissions of general aviation will effectively support the practice of mitigating the environmental impacts from general aviation. Fuel flow rate in each phase of the Landing and Takeoff Cycle is one of the necessary factors recommended by the International Civil Aviation Organization to be used to estimate the exhaust emissions. This paper explores statistical models of predicting the fuel flow rate of piston-engine aircraft using general aviation flight operational data, including the aircraft altitude, the ground speed, and the vertical speed. A machine learning technique is applied to adapt the variability of flight operational data due to flexible operations of general aviation and random errors in flight data. The Classification and Regression Trees (CART) and the Smoothing Spline ANOVA (SS-ANOVA) are adopted as the modeling approaches. The modeling results are compared and interpreted from the standpoint of general aviation phases of flight in the Landing and Takeoff Cycle. Both models demonstrate good accuracy in predicting the fuel flow rate. The CART model provides intuitive outputs by the phases of flight, and is more robust to flight data outliers. The SS-ANOVA model is relatively more accurate in predicting the fuel flow rate, and is better at explaining the interaction between variables. A robust fuel flow rate prediction model of predicting the fuel flow rate of piston-engine aircraft is believed to be practical and economic for GA exhaust emissions estimation. [ABSTRACT FROM AUTHOR]

The article discusses a multisite study to establish national benchmarks to guide hospital nurse managers and other quality management personnel in physical restraint monitoring process. Side rails or bed rails is a commonly used safety measure to keep sedated, lethargic or confused patients from rolling out of bed. According to the U.S. Food & Drug Administration, there are over 400 deaths as a direct result of side rail entrapment from a variety of healthcare settings, including hospitals. Determining an acceptable benchmark for internal quality improvement monitoring is a major dilemma for most nurse managers. The study's methodology is explained.

Objective: Information is needed about patient-initiated device removal to guide quality initiatives addressing regulations aimed at minimizing physical restraint use. Research objectives were to determine the prevalence of device removal, describe patient contexts, examine unit-level adjusted risk factors, and describe consequences., Design: Prospective prevalence., Setting: Total of 49 adult intensive care units (ICUs) from a random sample of 39 hospitals in five states., Methods: Data were collected daily for 49,482 patient-days by trained nurses and included unit census, ventilator days, restraint days, and days accounted for by men and by elderly. For each device removal episode, data were collected on demographic and clinical variables., Results: Patients removed 1,623 devices on 1,097 occasions: overall rate, 22.1 episodes/1000 patient-days; range, 0-102.4. Surgical ICUs had lower rates (16.1 episodes) than general (23.6 episodes) and medical (23.4 episodes) ICUs. ICUs with fewer resources had fewer all-type device removal relative to ICUs with greater resources (relative risk, 0.76; 95% confidence interval, 0.66-0.87) but higher self-extubation rates (relative risk, 1.27; 95% confidence interval, 1.07-1.52). Men accounted for 57% of the episodes, 44% were restrained at the time, and 30% had not received any sedation, narcotic, or psychotropic drug in the previous 24 hrs. There was no association between rates of device removal with restraint rates, proportion of men, or elderly. Self-extubation rates were inversely associated with ventilator days (rs = -0.31, p = .03). Patient harm occurred in 250 (23%) episodes; ten incurred major harm. No deaths occurred. Reinsertion rates varied by device: 23.5% of surgical drains to 88.9% of monitor leads. Additional resources (e.g., radiography) were used in 58% of the episodes., Conclusion: Device removal by ICU patients is common, resulting in harm in one fourth of patients and significant resource expenditure. Further examination of patient-, unit-, and practitioner-level variables may help explain variation in rates and provide direction for further targeted interventions.

Objectives: To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources., Background: The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes., Methods: Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel., Results: No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources., Conclusions: Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.

Purpose: To describe (a) the extent of inter- and intrainstitutional variation in labor, capital, and process-of-care variables related to nursing service on U.S. adult acute and intensive care units; (b) the extent to which resource clustering exists; and (c) an analysis of resource cluster role that explains variation in physical restraint rates., Design: Descriptive., Methods: Staff at 82 adult acute care and 55 intensive care units from 40 randomly selected U.S. hospitals provided data about more than 100 capital, labor, and process variables via (a) a staff nurse survey, and (b) interviews with unit leaders and measurement of unit design. These data described resources during the period in which physical restraint rate was established via direct observation., Findings: Depending on the resource variable, 7% to 57% of hospitals in which more than one ICU was studied showed resource variation between their ICUs; the comparable statistics for adult acute units were 5% to 45%. Cluster analysis indicated a two-cluster solution for ICUs and a three-cluster solution for non-ICUs. ICU cluster assignment varied within 16% of hospitals in which more than one ICU was studied. Non-ICU cluster assignment varied within 20% of hospitals. Physical restraint use was best explained by patient characteristics, not resource clusters or individual resources., Conclusions: Studies of outcomes that are the product of a single unit must include measurement of resources at the unit level, assuming equal resources among units of similar types within a hospital is unwarranted. Further research regarding the effect of resource clusters on nurse sensitive outcomes is suggested.

Surveys of research-intensive doctoral programs in nursing reveal few differences between the doctor of nursing science (DNSc) and the doctor of philosophy (PhD) degrees in nursing. Yet the proportion of DNSc programs relative to PhD programs in nursing has declined progressively over the past 10 years. Recently, Rush University College of Nursing formed a task force to examine whether Rush should continue to offer the DNSc degree or change to a PhD in nursing program. Task force members interviewed 21 nurse leaders representing 18 universities granting doctoral degrees in nursing about their perceptions of the DNSc and PhD in nursing degrees, the focus of their doctoral programs, why their nursing school chose the degree it currently offers, and whether Rush should retain the DNSc degree. This article describes the results of those interviews, how their comments helped the task force re-evaluate its goals for doctoral education, and the rationale for ultimately choosing to retain the DNSc degree.