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Nurses have voiced their lack of comfort during perinatal loss and communicating with families during this period. A mid-western organization provided bereavement education to its perinatal nurses, which included a didactic session, followed by two perinatal loss scenarios with standardized patients, and debriefing. Participant's knowledge (p = 0.000) and comfort (p = 0.000) levels significantly improved after the education session. Observations during the standardized patient scenarios, demonstrated that the majority of nurses used appropriate communication techniques with the bereaved mother that was reviewed throughout the education session. An education session that includes standardized patients acting out a perinatal loss may be an effective approach in promoting perinatal nurses comfort level in providing effective bereavement care and communication.

Objective Determine impact delayed newborn bathing for 24 hours has on exclusive breastfeeding rates, temperature and glucose stability, and percentage of weight loss and, to determine if there was a difference in the nurses’ knowledge and comfort levels regarding delayed bathing pre and post implementation. Design Pre-post retrospective chart review and, pre-post survey. Setting Midwestern health system with three hospitals that has a combined average delivery rate of 2100 births. Participants 330 charts were reviewed pre-implementation, 330 charts were reviewed post-implementation, and 100 RNs were asked to participate in the pre and post-survey. Methods Newborn baths were delayed 24 hours after birth unless contraindicated by a blood borne pathogen or upon parental requests. Results Post-intervention there was a significant decrease in the number of blood glucose level checks (p = .002) and the amount of blood glucose levels equal or below 45 (p = .001). There was a trend in decreased weight loss post-intervention, but was not significant (p = .227). Cold stress significantly decreased (p Conclusion Delaying an infant's bath until 24 hours after birth seems to have positive impact on the infant's temperature regulation as well as glucose stability.

Background: Lung volume reduction surgery (LVRS), a reduction in damaged lung tissue in end-stage chronic obstructive pulmonary disease, is a breakthrough surgical procedure requiring months of rigorous screening, testing, and conditioning. Engaging in this process is prolonged and challenging with no research found exploring patients and loved ones’ experiences through this demanding process. Objective: The purpose was to examine the experience of LVRS for patients and loved ones as they encounter the complex preparation required prior to, during, and throughout the extended convalescence following surgery. Methods: A mixed-methods approach was used, combining health outcomes with interview data. Participants and loved ones were purposefully selected, invited, and consented during the perioperative phase of LVRS. Quantitative data were obtained via chart review, while qualitative data were gathered through a 2-stage interview process, preoperatively and postoperatively. Qualitative data were analyzed using naturalistic inquiry approaches. Results: Patients and loved ones described difficulties of living with illness during the preoperative phase, and expressed relief and joy for an improved quality of life afterward. The overarching theme uncovered was hope. Preoperatively, hope was coupled with anxiety about the upcoming surgery and potential outcomes, whereas the hope expressed after surgery focused on the future, in particular, a shared future. Statistically significant differences were found in the quality of life measures. Conclusion: For both patients and loved ones, LVRS is filled with hope for a more expansive future. Although that future is unclear prior to surgery, clarification and a new normal signals hope for a shared future following LVRS.

AIMThe aim of this study was to evaluate the impact of simulation prebriefing on nursing students’ perceptions of overall effectiveness, learning, and self-confidence.BACKGROUNDMost research highlights debriefing as the most important component influencing learning outcomes; the focus on pre

Urinary tract infections are the most common type of health care-associated infection, and greater than 75% of them are attributed to an indwelling urinary catheter. A catheter-associated urinary infection may lead to a longer hospital length of stay by as many as 4 days. A new patient care standard requiring twice-daily chlorhexidine cleansing from umbilicus to knees was implemented on all patients of the pilot unit with a urinary catheter. This same technique was used after a patient with a urinary catheter had an incontinent bowel movement. The 9-month average catheter-associated urinary infection rate decreased from 3.06/1000 urinary catheter days to 0.46/1000 urinary catheter days after implementation of the new standard. The use of chlorhexidine for routine urinary catheter care and after bowel movements from umbilicus to knees for patients with urinary catheters may significantly decrease catheter-associated urinary tract infections when compared with the standard of care using soap and water. Standards for Quality Improvement Reporting Excellence guidelines were used in reporting these data.

The before phase of simulation, prebriefing, is a concept that is not clearly portrayed in the nursing literature. A concept analysis, utilizing Rodger's evolutionary framework, was performed to provide clarity to prebriefing. More than 20 articles were reviewed to construct the proposed definitive description of prebriefing which can be used to support the rigors of simulation research and development.

BACKGROUND: Many people with mental disorders in the United States remain either medically untreated or inadequately treated, which is often attributed to diagnostic overshadowing, a common occurrence across the nation in emergency departments. OBJECTIVE: The aim of this research is to create a tool that supports accurate assessment and distinguishing behavioral symptoms between psychiatric illness and coexisting medical conditions in the emergency department, thus leading to appropriate care and placement. DESIGN: Retrospective cohort design of 133 psychiatric admissions were reviewed between the years 2011 and 2015. RESULTS: Logistic regression retained three factors: age greater than 70 years (odds ratio [OR] = 6.575, 95% confidence interval [CI] = 2.58-16.76), abnormal heart rate (OR = 8.48, 95% CI = 3.39-28.42), and abnormal temperature (OR = 9.82, 95% CI = 3.91-18.40). The three factors were then placed into a screening tool. The presence of each factor equaled 1 point. If the total score was greater than 2, the sensitivity of the tool was 68.7% and the specificity of the tool was 85.8%. CONCLUSIONS: Coexisting medical conditions in the psychiatric population may present as behavioral symptoms; however, the use of a tool that focuses assessment toward medical factors such as abnormal heart rate, abnormal temperature, and advanced age can direct further investigation of behavioral symptoms.

Lake Victoria, the second largest freshwater lake in the world, plays a crucial role in the hydrology of equatorial eastern Africa. Understanding how climate change may alter rainfall and evaporation patterns is thus of vital importance for the economic development and the livelihood of the region. Regional rainfall distribution appears, up to a large extent, to be controlled by local drivers which may be not well resolved in general circulation model simulations. We investigate the performance over the Lake Victoria basin of an ensemble of UK Met Office Hadley Centre regional climate model (HadRM3P) simulations at 50 km, driven by five members of the Hadley Centre global perturbed-physics ensemble (QUMP). This is part of the validation of an ensemble of simulations that has been used to assess the impacts of climate change over the continent over the period 1950–2099. We find that the regional climate model is able to simulate a lake/land breeze over Lake Victoria, which is a significant improvement over the driving global climate model and a vital step towards reproducing precipitation characteristics in the region. The local precipitation correlates well with large-scale processes in the Pacific Ocean and Indian Ocean, which is in agreement with observations. We find that the spatial pattern of precipitation in the region and the diurnal cycle of convection is well represented although the amount of rainfall over the lake appears to be overestimated in most seasons. Reducing the observational uncertainty in precipitation over the lake through future field campaigns would enable this model bias to be better quantified. We conclude that increasing the spatial resolution of the model significantly improves its ability to simulate the current climate of the Lake Victoria basin. We suggest that, despite the higher computational costs, the inclusion of a model which allows two-way interactions between the lake and its surroundings should be seriously considered for any new climate projections for the region.

Lake Victoria in East Africa is one of the world's largest freshwater lakes and is used on a daily basis by thousands of fishermen. Each year, severe storms on the lake cause multiple boating accidents which often result in fatalities. Recent initiatives have seen an effort to reduce accidents by issuing storm warnings when severe weather is expected. Here the Met Office global Unified Model is evaluated along with a 4 km limited-area model which has been set up to assist forecasters in the region to issue these warnings. Findings indicate the 4 km model is capable of producing more realistic strong wind speeds and rain rates than the global model. Case studies relating to fatal boating accidents on 1 March and 4 March 2012, showed improved warning signals of severe storms in the 4 km model compared to the global model. Objective comparisons between model and observations were conducted on 2 months of data. An objective method was used to determine ‘storm’/‘no storm’ in the model forecasts. These were then compared against cloud top temperature from IR satellite and lightning data from the arrival time difference (ATD) radio ground network to determine whether each model was successful at forecasting storm/calm events. The 4 km model was able to capture more storm hits (thus had fewer storm misses), but also gained more false alarm events. Overall, the objective analysis showed that both models had some predictive skill and both were an improvement on a persistence forecast.

Application of this learning process (problem assessment, program planning, intervention, and evaluation) at the aggregate level, was a creative, enjoyable, growth producing experience for the senior nursing students. It is a process that is not only useful in the local community, but also prepares nurses for working at county, state, and national levels. They learn to make valid observations and firm decisions, to carry out actions, to overcome obstacles, to alter behavior, and to evaluate results. It does not replace other practices and former services of community health nursing, but complements them. There exists a tremendous potential for nurses in planning health care, already being realized in many settings. Certainly grass roots communities, rural populations and urban neighborhoods are in the highest need of creative, effective health programs that take into account the total population. Given such creativity, it is possible by the year 2000, that the Community Health Nurse may become a combination medical advisor, health instructor, community leader, playwright, photographer, author and television director; certainly a captivating career for people of the New World.