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Drawing from transformational leadership (TFL) theory and research on contextual leadership, we examined a conditional process model of leadership in nursing teams to predict patient loyalty. Using TFL's individualized consideration dimension as a salient facet of the construct in care services, we first posited that nurses' team affective commitment would partially mediate the impact of nurse leadership. We further conceptualized nurse–physician collaboration, organizational formalization and task feedback as discrete contexts that may curb the influence of head nurses' individualized consideration. In a three‐wave, multisource and multilevel study, we surveyed 654 nurses and 1770 patients from 91 hospital units. We found that team‐level head nurses' individualized consideration positively and partially related to patient loyalty through nurses' team commitment and that higher levels of nurse–physician collaboration, organizational formalization and task feedback were associated with reduced influence of individualized consideration on team commitment and patient loyalty. We discuss the implications of these findings for advancing theory and research on TFL and contextual factors of leadership. [ABSTRACT FROM AUTHOR]

Nursing is a person-to-person profession characterized by continuous communication and interaction with the patient and members of the nursing team as part of daily work activities. It is often accompanied by high stress and increased levels of fatigue. Fatigue is a condition in which a person has difficulty performing work activities at a desired level as a result of mental and/or physical weakness. Prolonged fatigue is causes physical and mental health problems. Occupational fatigue is defined as a multidimensional condition that ranges from acute to chronic. In nursing, physical fatigue is caused by activities related to the professional duties of nurses. Mental fatigue is caused by work-related emotional stress. In the long term, fatigue can negatively affect the health and well-being of nurses, which in turn can negatively affect patient safety. Managing fatigue in the work process is a mutual responsibility between the workers and the supervisor. [ABSTRACT FROM AUTHOR]

Homelessness, particularly unsheltered homelessness is a public health emergency in the U.S. Street outreach programs have demonstrated efficacy in connecting people to housing, initiating or retaining people in primary care, improving access to mental health services, and increasing treatment for substance use disorder. Effective outreach is generally characterized by trained, multidisciplinary teams that visit clients where they are, forming trusting relationships over time. Public health nurses working on outreach teams have opportunities to exercise their full scope and standards of practice and advance street outreach to the benefit of a distinctly marginalized group. [ABSTRACT FROM AUTHOR]

Objective To explore the mediating role of work passion in the association between psychological capital and occupational well -being among emergency department nurses, providing reference for enhancing their well -being and thereby contributing to the stability of the emergency nursing team. Methods A cross-sectional survey was conducted from August 2023 to September 2023 among 210 emergency department nurses from two top tertiary general hospitals and two secondary hospitals in Shanghai. The questionnaires of the Occupational Well -being Scale for Medical Workers, the Nurses’ Psychological Capital Scale, and the Work Passion Scale were utilized for data collection. Data analysis was performed using SPSS 24.0 software, followed by mediation effect analysis with the Process V3.3 plugin. Results A total of 203 valid questionnaires were collected, with a response rate of 96.7%. The occupational well-being score of emergency department nurses was (81.33 ± 13.93), the psychological capital score was (85.82 ± 15.73), and the work passion score was (64.60 ± 13.05). Nurses with a bachelor’s degree, voluntarily choosing nursing as a profession, as the only child of family, and receiving non -resident training scored higher in occupational well -being (all P < 0.05); the scores of occupational well-being showed a trend of increasing with the years of nursing experience before decreasing (P < 0.05). Occupational well-being was positively correlated with work passion and psychological capital (r = 0.751, 0.685， both P < 0.01), and psychological capital was positively correlated with work passion (r = 0.601， P < 0.01). Psychological capital had a direct impact on the occupational well -being of emergency department nurses, accounting for 41.85% of the total effect, while work passion served as a mediator between psychological capital and occupational well -being, and the mediating effect accounted for 58.15% of the total effect. Conclusions Nursing managers can enhance the occupational well-being of emergency department nurses by strengthening their psychological capital and regulating their work passion. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the Balanced Scorecard strategic business management framework • To read about a study using the Balanced Scorecard model to map the nurse ward manager role • To explore nurse ward managers’ core competencies from the viewpoint of healthcare professionals in Italy. Background: Nurse ward managers have a crucial role in the effective functioning of hospital wards and in organising the work of the nursing team. The Balanced Scorecard model is a management framework that enables strategy to be translated into action by setting goals that lead to measurable outcomes. Few studies have used the Balanced Scorecard model to map the competencies of healthcare professionals. Aim: To use the Balanced Scorecard model to map the core competencies of nurse ward managers and determine relevant key performance areas (KPAs) and key performance indicators (KPIs). Method: This mixed-methods study was conducted in the surgical department of an Italian hospital using a qualitative and quantitative exploratory sequential approach. For the quantitative part, the authors asked a convenience sample of various clinical staff to rate a list of nine competencies in terms of their importance for the work of nurse ward managers. For the qualitative part, two focus group discussions were held with nurse ward managers. Findings: Responses to the questionnaires showed that all nine competencies were important to respondents, with no statistically significant differences between roles. Findings from the focus group discussions broadly confirmed the relevance and importance of the nine competencies. Based on these findings, the authors formulated a strategic map of the nurse ward manager role, with core competencies and associated objectives mapped against the four dimensions of the Balanced Scorecard model. Conclusion: A strategic map of the nurse ward manager role informed by the Balanced Scorecard model can help measure nurse ward managers’ performance and provide a benchmark for them to improve their competencies. [ABSTRACT FROM AUTHOR]

The organizational climate is related to the degree of motivation of its employees. This perception is essentially felt, it is neither seen nor touched, but it is real. This study aims to identify difficulties and potentialities related to the organizational climate of the nursing staff at a public hospital in the Federal District. Methodologically, a descriptive and exploratory study was carried out characterized by a qualitative approach. The thematic content analysis led to three interpretative dimensions: environment and working conditions; communication, interpersonal relationship and work flows; motivation to improve the work environment. The results indicate a deficit of human resources, scarcity of material resources, supplies, precarious physical structure, in addition to interpersonal relationship problems, such as the (de)valuation of professional nurses and nursing. The challenges posed to managers go beyond the technical and structural dimension, the technological complexity of equipment without maintenance, as it unfolds through the human dimension, feelings and unmet needs (of appreciation) of nursing, which needs to be cared for, valued, heard and seen in their care process. [ABSTRACT FROM AUTHOR]

Problem definition: We examine the effects of prolonged consecutive working days without breaks on care quality and explore its association with daily staffing levels in neonatal intensive care nursing teams. Academic/practical relevance: Healthcare organizations typically base staffing guidelines on safe daily metrics like nurse-to-patient ratios. However, in response to unforeseen demand spikes or staff shortages, managers often depend on staff working additional consecutive days to bridge staffing gaps. This approach, although addressing immediate staffing needs, can inadvertently impact care quality and safety, potentially undermining the benefits of higher staffing levels. Methodology: Using longitudinal data from 62 German neonatal units, we analyze the effect of nursing teams' consecutive working days on the time from admission to full enteral feeding for 847 low-birth-weight babies, considering nurse-to-patient ratios and patient complexity. Results: Longer consecutive working periods harmfully affect care quality, especially during staffing shortages. The detrimental impact on days with low staffing is particularly pronounced in patients with less complex medical needs. Limiting the team-average number of consecutive working days to two days would have reduced the time to full enteral feeding in our study by 6.4%. Shifting from half a day less to half a day more than the average number of consecutive working days has an impact equal to 20% of the difference in time taken to reach full enteral feeding between low- and high-birth-weight babies. Managerial implications: Limiting consecutive working days could significantly improve intensive care outcomes. Management should monitor consecutive working days alongside daily staffing levels. Policy makers should consider introducing limits on the number of consecutive working days for intensive care nurses. Funding: This work was supported by the Federal Ministry of Education and Research in Germany [Grant 01GY1152]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0021. [ABSTRACT FROM AUTHOR]

Background: Nurses play an important role in multidisciplinary teams while treating children and adolescents with mental health issues. Nurses should recognize and capitalize on the client’s and family’s strengths as they develop interventions, provide education, and refer to resources as appropriate. Materials and Methods: It is a mixed‑method research, with an initial qualitative phase of obtaining data by in‑depth interviews of parents on caring for children and adolescents with mental illness followed by quantitative assessment of the level of care dependency and implementation of need‑based nursing interventions to the children and adolescents with mental illness. Results: A total of 235 boys and 123 girls received the interventions. The majority of them (51.4%) were boys aged between 6 and 12 years and the highest diagnosis was attention deficit and hyperactivity disorder (ADHD) (34%). The need‑based interventions required were nutrition (90%), prevention of injury and infection (83%), and positive and productive engagement (80%). Other interventions included self‑care, physical activity, and medication. Conclusion: Need‑based nursing interventions help in promoting the mental health of children and adolescents. This approach may be extended to primary care facilities and community mental healthcare by nurses. [ABSTRACT FROM AUTHOR]

Objective: To address the gap in effective nursing training for quality management, this study aims to implement and assess a nursing training program based on the Holton Learning Transfer System Inventory, utilizing action research to enhance the practicality and effectiveness of training outcomes. Methods: The study involved the formation of a dedicated training team, with program development informed by an extensive situation analysis and literature review. Key focus areas included motivation to transfer, learning environment, and transfer design. The program was implemented in a structured four-step process: plan, action, observation, reflection. Results: Over a 11-month period, 22 nurses completed 14 h of theoretical training and 18 h of practical training with a 100% attendance rate and 97.75% satisfaction rate. The nursing team successfully led and completed 22 quality improvement projects, attaining a practical level of application. Quality management implementation difficulties, literature review, current situation analysis, cause analysis, formulation of plans, implementation plans, and report writing showed significant improvement and statistical significance after training. Conclusion: The study confirms the efficacy of action research guided by Holton's model in significantly enhancing the capabilities of nursing staff in executing quality improvement projects, thereby improving the overall quality of nursing training. Future research should focus on refining the training program through long-term observation, developing a multidimensional evaluation index system, exploring training experiences qualitatively, and investigating the personality characteristics of nurses to enhance training transfer effects. [ABSTRACT FROM AUTHOR]

An unpredictable emergency situation might happen due to the adverse reaction to psychoactive drug plus physiological disease problems. When a first aid incident occurs, psychiatry nurses who are inexperienced and lack confidence might have impared judgements and inefficient division of labor, which can contribute to an issue of first aid. The current analysis confirmed that task assignment is not specific, a lack of recognition of the accurate position of the first aid cart materials and standard operation procedure, and that the education training is deficient. Moreover, the restrictions of the first aid environment is also related to first aid results. This project defined the division of task assignment, developed first aid cart material pairing software, revised standard operation procedure, and conducted first aid simulation training classes. Results indicated a rise in the accuracy of first aid procedure from 63.7% to 95.6%, and the first aid procedure cognition rose from 64.89% to 92.12%. Additionally, the project increased the awareness of first aid procedure, self-confidence, and brought the team together to reduce the misstep of first aid procedure. [ABSTRACT FROM AUTHOR]

Aim. To explore the association of rationed nursing care and the level of teamwork from the perspective of nurses working in an acute care setting in Slovakia. Material and methods. The descriptive cross-sectional study was conducted between November 2022 and February 2023. Data collection was carried out using a set of questionnaires that involved the Basel Extent of Rationing of Nursing Care – Revised (BERNCA-R) and the Nursing Teamwork Survey (NTS) to explore the level of teamwork. The sample consisted of 206 nurses from three district hospitals from Slovakia. Results. The mean score of the BERNCA-R was 2.11 (SD = 0.65) and for NTS, it was 3.64 (SD = 0.35). A statistically significant association was found between rationed nursing care and the level of teamwork, more specifically, Trust (r = -0.583), Team orientation (r = -0.381), Backup (r = -0.657), Shared mental model (r = -0.768), and Team leader (r = -0.535) and the overall score of the NTS (r = -0.174). Conclusions. These findings underscore the importance of addressing the phenomenon of rationed nursing care among registered and practical nurses to foster better teamwork and enhance patient care outcomes in acute care settings. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Nursing Journal is the property of University of Applied Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Clinical outcomes in gestational trophoblastic disease (GTD) are generally excellent, but GTD is a rare and complex condition that requires specialist information and support to offer a gold standard of care. Across Europe, specialist nurses and/or midwives are increasingly common in the GTD multidisciplinary team to work alongside medical professionals in a holistic model of care; however, the role is sometimes non-existent or can vary significantly between GTD centres. Objectives: The aim of the European Organisation for Treatment of Trophoblastic Diseases' (EOTTD) is to harmonise best practice in Europe. To provide a basis for the European standardisation of best practice nursing care in GTD, a group of European GTD nurses/midwives composed guidelines for minimal requirements and optimal nursing care of GTD patients. Methods: Members of the EOTTD member countries with nursing representation attended multiple workshops, both virtual and in person, and guidelines were created by consensus and evidence where available. Outcome: 16 nurses and 1 midwife from 4 countries (England, Ireland, Sweden, and the Netherlands) contributed. The group created flow diagrams for treatment and screening patients, showing minimum and best practice nursing care for patients with GTD. Conclusion: Despite the many different models of care and resources available to GTD services, this consensus working group has provided a set of guidelines to drive forward a patient focused holistic model of care for GTD patients. This is an original paper, whereby no such guidelines in GTD nursing have been developed before. The implementation of guidelines will encourage other health care professionals to improve the provision of patient care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of craniopagus, a rare condition in which identical twins are joined at the head • To identify the multidisciplinary skills and expertise required for successful separation of craniopagus twins • To explore the pivotal role of nurses in the management and care of craniopagus twins in hospital. Craniopagus is a rare condition in which the skulls of conjoined twins, and the neurovascular structures in their skulls, are incompletely separated. Separation surgery is complex and requires a range of skills and expertise, including from all the nursing teams involved. A multidisciplinary group of professionals in a tertiary paediatric care setting in Italy developed a comprehensive protocol for the nursing care of craniopagus twins in hospital, informed by the findings of a literature review and the expertise of its members. The protocol was applied to the management of a pair of craniopagus twins who successfully underwent separation surgery at the authors’ hospital. The protocol describes the crucial role of nurses in the care of craniopagus twins and their families before, during and after separation surgery. [ABSTRACT FROM AUTHOR]

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life. [ABSTRACT FROM AUTHOR]

Background: The attrition of nursing staff significantly contributes to the shortage of healthcare professionals. This study entailed an examination of the propensity of nurses to sustain employment within Grade-A tertiary general hospitals and the various influencing factors. Methods: A total of 2,457 nurses from three grade-A tertiary general hospitals were surveyed. The survey instruments included a general information questionnaire, a scale measuring their willingness to continue working, and a Chinese version of the Magnet Hospital Factor scale. Results: The scores of the willingness to continue working scale and the Magnet Hospital Factor scale were 21.53 ± 4.52 and 145.46 ± 25.82, respectively. There were statistically significant differences in the scores of willingness of nurses to continue working across various factors, including the department, age, marital status, family location, length of service as nurses, professional title, position, and employment type, upon comparison (P < 0.001). The correlation analysis showed that there was a positive correlation between the willingness of nurses to continue working and the magnet hospital factors, with a correlation coefficient of 0.523 (P < 0.01). Regression analysis showed that department, length of service as nurses, professional title, position, average monthly income, number of night shifts, medical care relationship, educational support, and nursing manager support among the magnet hospital factors were important predictors of willingness to continue working (P < 0.001). Conclusion: The willingness of nurses to continue working in grade-A tertiary general hospitals in Shanxi Province was determined to be at an upper-middle level. The magnet status of grade-A tertiary general hospitals needs to be improved, and there are many factors that influenced willingness of nurses to continue working. To cultivate a more favorable environment and bolster nurse recruitment and retention, all healthcare institutions should strive to establish a magnet nursing environment, thereby fostering the robust development of the nursing team. [ABSTRACT FROM AUTHOR]

Background: A global COVID-19 pandemic was declared by the World Health Organization in March 2020. Aim: To explore COVID-19's impact on one specialist community palliative care nurse (SCPCN) team 8 months after the first COVID-19 wave in the UK. Method: The Gibbs Reflective Cycle was used. Findings: This SCPCN team described the COVID-19 pandemic as the most difficult and challenging time experienced at work, due to the increased workload and having to provide unsustainable levels of support for patients and their families. Conclusion: Despite the COVID-19 pandemic's significant demands on community palliative care, the SCPCN team was able to adapt accordingly. This resulted in an increasingly collaborative, reflexive, responsive, skilled and resilient team, proud of the personalised support offered to patients, their families and to other services. [ABSTRACT FROM AUTHOR]

Introduction: Through guided and conscious deep breathing, cardiovascular biofeedback, an innovative technological tool that enables improved cardiac coherence and activation of the parasympathetic nervous system, which are vital for recovering and maintaining homeostasis and psycho-emotional health. Objective: To verify the effect of cardiovascular biofeedback on heart rate variability parameters in nursing professionals. Materials and Methods: This is a randomized clinical trial conducted in two groups — biofeedback and placebo — with 115 nursing professionals working in clinical and surgical inpatient units at a university hospital, who presented an overall stress level higher than 1, according to the Stress Symptom Scale. The groups participated in nine appointments over three weeks. The outcome was assessed by rMSSD parameters and cardiac coherence at the end of each appointment, which were measured using EmWave Pro Plus®, which uses photoplethysmography to quantify physiological data related to the heartbeat. The analysis was performed using generalized estimation equations, considering α = 5 %. Results: There was a significant time-group interaction in cardiac coherence parameters; the intervention group presented an increase in the mean cardiac coherence parameters at all measurement times, when compared to the control group (p < 0.001; r > 0.98). There was no significant time-group interaction in the rMSSD parameters at any of the measurement times (p = 0.432). As a mind-body therapy, cardiovascular biofeedback proved to be useful and promising. By promoting parasympathetic activation and relaxation, it is possible to prevent the deleterious effects associated with occupational stressors. Conclusion: The intervention with cardiovascular biofeedback proved to be superior to placebo in improving cardiac coherence, resulting in the recovery of the body’s homeostasis. Clinical Trials Register: NCT04446689 [ABSTRACT FROM AUTHOR]

Background: Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant‐related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. Methods: This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. Results: No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection. [ABSTRACT FROM AUTHOR]

Introduction: Following a significant recovery from Coronavirus Disease-2019 (COVID-19) pandemic, the world has recognised that Hand Hygiene (HH) and facial masks are key preventive measures against various cross infections, particularly in hospital settings. Studying the incidence of Methicillin Resistant Staphylococcus aureus (MRSA) as a part of Healthcare Associated Infections (HAI) surveillance is crucial, as MRSA transmission can be effectively prevented through HH. Aim: To assess the knowledge and compliance of HH among health personnel using the World Health Organisation (WHO) HH questionnaire. Materials and Methods: A prospective observational study was conducted at Bhaarath Medical College and Hospital, Chennai, Tamil Nadu, India, over one year, from December 2020 to November 2021. The Hospital Infection Control Committee (HICC) team carried out an HH survey using the WHO HH questionnaire to evaluate knowledge and attitudes among 115 Healthcare Workers (HCWs), including doctors and nursing staff, in a tertiary care hospital in Kanchipuram, Southern India. The study also involved monitoring monthly MRSA incidence density rates in Intensive Care Unit (ICU) settings as part of HAI surveillance, followed by regular HH audits. MRSA infectivity rates were statistically analysed using paired t-tests with Statistical Package for Social Sciences (SPSS) software version 21.0 to determine p-values and address standard deviations. Results: In this study, 26 (65%) of doctors had undergone training, while 57 (76%) of nurses reported recent formal HH training. Only 16 (40%) of doctors and 21 (28%) of nurses used alcohol-based handrub. Doctors exhibited knowledge ranging from 60-77.5% on germ transmission and hand rub-related questions, while nurses demonstrated better knowledge ranging from 72-93.3%. HH adherence was 30% among doctors and 72% among nurses. The MRSA infectivity rate varied over the year, starting at 1.33 per 1000 resident days before HH audits and decreasing to 0.3. Each HH audit led to a significant improvement in MRSA rates, with a p-value <0.0001, indicating statistical significance. Conclusion: Present study evaluated HCWs knowledge and attitudes toward HH, along with the impact of HH audits on reducing MRSA rates, has proven to be beneficial for hospital infection control practices, particularly during the COVID-19 pandemic and its aftermath, when vigilance tends to decrease over time. [ABSTRACT FROM AUTHOR]

This research investigates how to sustain process improvement (PI) initiatives in healthcare. Despite the abundant knowledge on PI, we know very little on why and how PI sustains over time. This is particularly true in the context of heterogeneous frontline teams of physicians and nurses with different operational characteristics such as attrition rates, skill sets, training, and goals. Our study builds a model that simulates the mutual, dynamic interaction of these stakeholders with each other and with processes with different characteristics in the presence of endogenous management prioritization. We build confidence in the model by calibrating it to data from PI teams at several family medicine clinics at a large US Midwestern healthcare system. The computational experiments performed using data from these teams yield several important insights for theory and practice. First, we find that process metrics, which are leading metrics related to the day-to-day functioning of the units, and outcome metrics, which are lagging metrics often tied to the unit's bottom line, are both critical for the functioning of the PI teams. Emphasizing one over the other can reduce sustainability while a mixed case in which one group of employees is incentivized to leading and another group to lagging can create a regime that is more effective in many scenarios. Second, we find that management interventions that improve short-term PI gains generally also reduce the likelihood of long-run sustainment. Third, we find that attrition and turnover among the team members affect sustainability of PI initiatives and reducing turnover for one class of employee, which attends lagging metrics, facilitates sustainment while reducing it for the other class, which attends leading metrics, can hinder sustainment. We conclude by discussing these implications to the practice of PI among healthcare teams. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the dynamics of teamwork and the challenges of managing giving, taking, and lurking within teams. It emphasizes the importance of clear leadership, well-defined roles, effective communication, and feedback mechanisms for cohesive team functioning. The article also explores the complex nature of giving and taking in the workplace and addresses the concept of social loafing. The Journal of Nursing Management covers various topics related to nursing, including leadership styles, workplace violence, and the impact of technology on nursing practice. It offers valuable insights and research findings to support nursing professionals and is a valuable resource for research in the field. [Extracted from the article]

Background: Surgical opioid overprescribing can result in long-term use or misuse. Between July 2018 and March 2019, the multicomponent intervention, Minimizing Opioid Prescribing in Surgery (MOPiS) was implemented in the general surgery clinics of five hospitals and successfully reduced opioid prescribing. To date, various studies have shown a positive outcome of similar reduction initiatives. However, in addition to evaluating the impact on clinical outcomes, it is important to understand the implementation process of an intervention to extend sustainability of interventions and allow for dissemination of the intervention into other contexts. This study aims to evaluate the contextual factors impacting intervention implementation. Methods: We conducted a qualitative study with semi-structured interviews held with providers and patients of the general surgery clinics of five hospitals of a single health system between March and November of 2019. Interview questions focused on how contextual factors affected implementation of the intervention. We coded interview transcripts deductively, using the Consolidated Framework for Implementation Research (CFIR) to identify the relevant contextual factors. Content analyses were conducted using a constant comparative approach to identify overarching themes. Results: We interviewed 15 clinicians (e.g., surgeons, nurses), 1 quality representative, 1 scheduler, and 28 adult patients and identified 3 key themes. First, we found high variability in the responses of clinicians and patients to the intervention. There was a strong need for intervention components to be locally adaptable, particularly for the format and content of the patient and clinician education materials. Second, surgical pain management should be recognized as a team effort. We identified specific gaps in the engagement of team members, including nurses. We also found that the hierarchical relationships between surgical residents and attendings impacted implementation. Finally, we found that established patient and clinician views on opioid prescribing were an important facilitator to effective implementation. Conclusion: Successful implementation of a complex set of opioid reduction interventions in surgery requires locally adaptable elements of the intervention, a team-centric approach, and an understanding of patient and clinician views regarding changes being proposed. [ABSTRACT FROM AUTHOR]

The nursing shortage is a critical issue in health care, sometimes addressed with team nursing. This article reviews patient, nursing, and organizational outcomes with team nursing, and reports high nurse satisfaction with this model. [ABSTRACT FROM AUTHOR]

Background: We applied a longitudinal network analysis approach to assess the formation of knowledge sharing and collaboration networks among care aide-led quality improvement (QI) teams in Canadian nursing homes participating in the Safer Care for Older Persons (in residential) Environments (SCOPE) trial which aimed to support unregulated front-line staff to lead unit-based quality improvement (QI) teams in nursing homes. We hypothesized that SCOPE's communicative and participatory nature would provide opportunities for peer support, knowledge sharing, and collaboration building among teams. Methods: Fourteen QI teams in Alberta (AB) and seventeen QI teams in British Columbia (BC) participated in the study. Communications across nursing homes occurred through a series of 4 collaborative Learning Congresses (training sessions) over a 1-year period. The senior leaders of QI teams participated in two online network surveys about the communication/collaboration between teams in their province, 1 month after the first, and 6 months later, after the fourth Learning Congress. We developed communication and collaboration network maps pertaining to three time points: before SCOPE, at 2 months, and at 9 months. Results: Over time, teams made significantly more new connections and strengthened existing ones, within and across regions. Geographic proximity and co-membership in organizational chains were important predictors of connectivity before and during SCOPE. Teams whose members were well connected at baseline disproportionately improved connectivity over time. On the other hand, teams that did not have prior opportunities to connect appeared to use SCOPE to build new ties. Conclusions: Our findings suggest the importance of network-altering activities to the formation of collaboration networks among QI teams across nursing homes. Active strategies could be used to better connect less connected teams and facilitate collaboration among geographically proximate teams. These findings may inform the development of interventions to leverage existing networks and provide new networking opportunities to develop and sustain organizational improvements. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background In the inflammatory bowel disease (IBD) multidisciplinary team, a key figure is the IBD care manager, usually an independent practice nurse, responsible for evidence-based assessment, care planning, treatment evaluation, and provision of practical information, health education, and emotional support to patients. The objective of this study was to evaluate the profile of this figure in Italy. Methods A team of experienced nurses created a questionnaire based on the Second N-ECCO declaration, which was administered to nurses who worked in an IBD unit for a period of at least 3 years. A definition of IBD care manager was provided to every participant. The questionnaire consisted of 3 sections: behavioral, knowledge and managerial skills that an IBD care manager should exhibit. Results were studied in relation to the benefits for the patient, organizational advantages, clinical advantages and Italian state of the art. Results Fifty-five nurses participated in the study, from 28 Italian centers. In the evaluation of behavioral skills of IBD care managers, "management and support of the pregnant patient" was the lowest scored item, while "patient privacy" obtained higher scores. In the evaluation of knowledge, "knowledge of intimacy and sexuality" obtained the lowest scores, while "knowledge of psychophysical and social impact of the disease" obtained a higher score. In managerial skills "management of pain" obtained the lowest scores. Conclusion Our study confirmed that IBD care managers are invaluable nursing figures within the multidisciplinary team that cares for IBD patients, providing benefits to both patients' clinics and management. [ABSTRACT FROM AUTHOR]

Objective: to analyze the characteristics of the teams and the practices associated with the monitoring and coordination of care in Pará and to understand how this practice is carried out by the nurse as a member of the team in Primary Health Care. Methods: study of mixed methods. The participants were primary care nurses in Pará. The collection took place between November 2019 and August 2021, through an electronic form and interview. The integrative data analysis was performed by connecting qualitative and quantitative methods. Results: The proportion of nurses who monitor and coordinate users who are using other services was 50% (90/180). There was a significant association (p <0.05) between monitoring and coordination of care and the type of team, workload, regulation of local demands from the perspective of the network, articulation with health professionals from other levels of care, work with professionals from other backgrounds and conducting the expanded clinic/matrix support. The thematic categories "relationship between Primary Health Care and the care network" and "practices of coordination and continuity of horizontal and vertical care" showed convergence with the quantitative data and the thematic category "Practices of coordination of care in the form of work in a team" converges with the quantitative data, but differs in matrix support. Conclusion: Nurses carry out monitoring and coordination of care, but they face difficulties that result in overload and carrying out tasks that are not of the professional category. [ABSTRACT FROM AUTHOR]

Background/Local Problem: Hypertension is a major risk factor for heart diseases and stroke among Americans; only 25% have this under control nationwide. Methods: This quality improvement project evaluated the outcomes of team-based care in hypertension control by registered nurses and certified nurse practitioners in a primary care setting. Pre/post–data analysis of blood pressure (BP) control, and BP knowledge, was done. Intervention: The team provided education and counseling based on knowledge assessment during visits and used unattended automated blood pressure measurement (uAOBPM) techniques to measure BP. Results: There was a significant reduction in systolic and diastolic BP control (P < .001). There was a statistically significant increase in disease knowledge score pre- and postintervention (P < .001). Conclusion: The team-based care approach improved patients’ BP control and knowledge of the disease. The uAOBPM technique could be incorporated into clinical settings for accurate BP measurements. [ABSTRACT FROM AUTHOR]

Background: Time management in nursing is essential for stress reduction, effective job management, and positive results for both patients and the organization. Objectives: The aim of the study is to explore the lived experience of nurses and method use in time management strategy for dimension of time management for Intensive Care Unit nurses. Methodology: A phenomenological study design was used, targeting ten nurses who worked in the intensive care unit were interviewed. The seven-step phenomenological by Colaizzi. . Results: The intensive care unit nurses managed time/tasks delegated to the nursing team through the make planning to identify the objectives, goal to be realistic, goals based on the needs. Priority by move to a new task before the end of the previous task, the work more than once, lack goals, priorities, or plans daily. Goals setting, by Recognize the errors, many requests in same time, and poor performance, modify plans and good relationships with other nurses, and schedule. Time commitment, by Arrive late, leaving work, allotted time off to nurse during the official feast. Share in decision-making. Time waster, by Shortage of nurses. Ineffective delegation, Lack of motivation. no coordination between the administration and nurses disorganized work, Miscommunication, Procrastinating. The intensive care unit nurses managed time/tasks delegated to the nursing team through the make planning to identify the objectives, Goal to be realistic, Goals based on the needs. Priority by Move to a new task before the end of the previous task, the work more than once, Lack goals, priorities, or plans daily. Goals setting, by Recognize the errors, many requests in same time, and poor performance, modify plans and good relationships with other nurses, in addition, schedule. Time commitment, by Arrive late. Leaving work. Allotted time off to nurse during the official feast. share in decision making. time waster, by Shortage of nurses. Ineffective delegation, Lack of motivation. no coordination between the administration and nurses disorganized work, Miscommunication, Procrastinating. Conclusion: Intensive care unit nurses make a time management, extend available time, and prevent time waste by maximizing available time, facilities, and opportunities. Nursing in intensive care unit make plan, priority, goalsetting, time commitment, time waster. Nursing Implication: It challenges the idea that time management is all about the nurses. It shows how five-time management dimension plaining, goalsetting, time commitment, priority, and time waster. Time management is a relationship with care can provided by nurses. Good time management is a skill that can be honed; it is not innate. Every nurse needs to acquire the means that will allow him/her to effectively manage time. [ABSTRACT FROM AUTHOR]

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Introduction: Mobilisation of hospital patients is important for their functioning, and nurses play an important role in providing assistance. Manual handling training programs aim to help nurses to move patients safely, but most do not include dynamic risk assessment. We aimed to explore the experiences of members of the nursing team working in inpatient wards in a private hospital who participated in the manual handling training program Risk Assessment for moving Individuals SafEly (RAISE). Methods: Members of the nursing team who attended a 4-hour dynamic risk assessment training program led by physiotherapists participated in one of two focus groups guided by semi-structured questions 4 months post training. Focus groups were facilitated by an experienced qualitative researcher (physiotherapist). Results: Three themes emerged: (1) empowerment, (2) role and (3) implementation. The training session improved the nurses' confidence and empowerment to employ a risk assessment model for mobility-related care, which was central to their role. Organisational factors, including cluttered environments, equipment and staffing challenges, were identified as the key barriers to implementation. Conclusion: Risk assessment manual handling training was perceived to improve confidence and empower the nursing team to provide safe mobility-related care. It is recommended that training sessions be relatively short, provide refresher training and consistent access to training within departments across the target health service and take into consideration organisational factors that may affect implementation. [ABSTRACT FROM AUTHOR]

Copyright of Desacatos is the property of Centro de Investigaciones y Estudios Superiores en Antropologia Social and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Health crises expose nurses to numerous psychological challenges and affect their daily interactions. Objectives: This study aimed to explore the relationship between social capital and psychological symptoms among nurses caring for COVID-19 patients. Methods: In this descriptive-analytical study using systematic random sampling, data from 207 nurses were collected through a demographic questionnaire, the Onyx and Bolen Social Capital Scale, the Corona Disease Anxiety Scale (CDAS), and the Buss Perry Aggression Questionnaire (BPAQ). Results: The mean ± SD age of the nurses was 33.6 ± 7.76 years. The mean ± SD scores for social capital, anxiety, and aggression among participants were moderate, low, and low, respectively. A significant inverse relationship was observed between social capital and both COVID-19 anxiety and aggression. Conclusions: It is recommended that officials work to empower the nursing care team by providing opportunities for the development of social capital and anger management skills. [ABSTRACT FROM AUTHOR]

There is a well-known saying that nurses ‘eat their young’ – which suggests there can be times when support and communication between nurses from different generations might be lacking. But does this remain the case in 2024 – or is it an outdated and misleading view of the profession? [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Team resilience can help nurse to respond positively to adversity at work and maintain normal team function in complex and unstable environments. However, much less research attention has been paid to team resilience than to individual resilience, and nurses lack reliable and valid tools to measure team resilience. This study aimed to develop and evaluate the psychometric properties of a scale that measures the nursing team resilience in the context of a public health emergency. Methods: The study was conducted in three stages that item development, scale development, and scale evaluation. This scale was based on that of Morgan and Sharma et al. proposed four-factor team resilience model, and the draft scale was generated based on the literature review, existing scales, experts' validations, and cognitive interviews. During July 2022 to August 2022, the construct validity and the internal consistency reliability of the NTRS were evaluated through an online survey of 421 nurses. Results: The 8-item NTRS scale has good reliability and validity and is suitable for measuring the nurse team resilience. The EFA found a common factor solution and explained 72.33% of the common varianc and the CFA score showed construct validity. Reliability of the internal consistency of the scale with a good Cronbach alpha of 0.94. Conclusion: This scale can assess team resilience in nurses that nursing education and management resources can be allocated to improve policies and training programs to provide effective positive support to nurses in challenging workplace situations and to enable greater health systems resilience in the future. [ABSTRACT FROM AUTHOR]

The problem of finding a Master Surgical Schedule (MSS) consists of scheduling different specialties to the operating rooms (ORs) of a hospital clinic. To produce a proper MSS, each specialty must be assigned to some ORs, where the number of assignments is different for each specialty and can also vary during the considered planning horizon. The problem is enriched by considering resource availability such as beds, surgical teams and nurses. Realizing a satisfying schedule is of upmost importance for a hospital clinic, since a poorly scheduled MSS may lead to unbalanced specialties availability and increase patients' waiting list, thus negatively affecting both the administrative costs of the hospital and the patient satisfaction. In this paper, we present compact solutions based on Answer Set Programming (ASP) to the MSS problem. We tested our solutions on different scenarios: experiments show that our ASP solutions provide satisfying results in short time, also when compared to other logic-based formalisms. Finally, we describe a web application we have developed for easy usage of our solution. [ABSTRACT FROM AUTHOR]

Purpose: Elucidation of the cardio-oncologic knowledge among the oncology nurses of tertiary hospitals in Shanxi Province to provide better insights and directions for management by nursing managers.Background: China's National Health and Wellness Commission issued the Action Plan for Further Improving Nursing Services in June 2023, which requires nurses to provide patients with physical and mental holistic nursing services, such as medical care, condition observation, assistance with treatment, and health guidance. Most oncology patients are treated with chemotherapy, but the modality can cause greater harm to patients, especially cardiotoxicity. How to provide precise care for chemotherapy patients is a problem for nursing managers.Methods: In order to investigate the level of cardio-oncologic knowledge among the oncology nurses of tertiary care hospitals in Shanxi Province, China, a questionnaire was created based on the relevant literature and the provided instructions on cardio-oncology. The chi-squared test was performed for multiple comparisons of the level of knowledge of disease observation, health guidance, and implementation of treatment. Spearman correlation analysis was performed to analyze the correlation between the levels of cardio-oncologic knowledge and general information of hospitals and nurses.Results: Cardio-oncology awareness among the oncology nurses was 0.1%– 44.7%, the awareness rate of single dimension was 0 to 3.9%, and overall awareness rate was 0. A partially significant difference was revealed in the two-by-two comparisons of the awareness rates of the three dimensions of disease observation, health guidance, and implementation of treatment (P < 0.05). A correlation was observed between the cardio-oncologic knowledge and some of the hospital and the nurses' general information data (P < 0.05).Conclusion: Oncology nurses exhibited a low rate of awareness related to cardio-oncology. Hospitals could establish oncology nursing teams to train the oncology nurses to promote their cardio-oncologic knowledge and ensure the quality of daily care provided by these nurses. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Stroke is accounted as the second-most mortality and adult disability factor in worldwide, while causes the bleeding promptly and lifetime consequences. The employed functional recovery after stroke is highly variable, allowing to deliver proper interventions to the right stroke patient at a specific time. Accordingly, the multidisciplinary nursing team, and the administrated drugs are major keybuilding- blocks to enhance stroke treatment efficiency. Regarding the healthcare team, adequate continuum of care have been declared as an integral part of the treatment process from the pre-hospital, in-hospital, to acute post-discharge phases. As a curative perspective, drugs administration is also vital in surviving at the early step and reducing the probability of disabilities in later. In this regard, nanotechnology-based medicinal strategy is exorbitantly burgeoning. In this review, we have highlighted the effectiveness of current clinical care considered by nursing teams to treat stroke. Also, the advancement of drugs through synthesis of miniaturized nanodrug formations relating stroke treatment is remarked. Finally, the remained challenges toward standardizing the healthcare team and minimizing the nanodrugs downsides are discussed. The findings ensure that future works on normalizing the healthcare nursing teams integrated with artificial intelligence technology, as well as advancing the operative nanodrugs can provide value-based stroke cares. [ABSTRACT FROM AUTHOR]

Background: In recent years, Iran has encountered a growing frequency of earthquake disasters. Given that nurses constitute the largest group of healthcare providers, it is imperative that they possess adequate disaster preparedness skills, irrespective of the location or time. Despite the operating room nurses' roles in disasters, their experiences and challenges in disaster preparedness have been overlooked. Consequently, this study aimed to investigate the experiences, challenges, perspectives, and factors influencing the disaster preparedness of operating room nurses during the 2017 earthquake in Kermanshah, Iran. Methods: The present qualitative research was carried out in Iran In 2022 utilizing conventional content analysis. The study involved conducting semi-structured interviews with 16 operating room nurses who had participated in disaster preparedness during the Kermanshah earthquake. The participants were selected using a purposive sampling approach that aimed to achieve maximum diversity. The interviews were continued until the point of data saturation was reached, and the verbatim transcripts were analyzed using conventional content analysis in MAXQDA software. To ensure the rigor of the research, Guba and Lincoln's criteria were employed. Results: The study conducted data analysis to identify the main theme as "insufficient disaster preparedness due to a faded preparedness", along with six major categories and eighteen subcategories related to earthquake disaster preparedness. The major categories included: knowledge and perception of preparedness for disasters; educational and training programs for disaster preparedness; equipment preparedness for disasters; managerial-organizational preparedness for disasters; clinical skills for responding to disasters; and resilient ability in disaster response situations. Conclusion: The findings of the study provide valuable insights into the dimensions of disaster preparedness in earthquake disasters among operating room nurses. Nursing managers can utilize these findings to develop effective strategies and provide support in areas such as improving knowledge and educational level, equipment preparedness, strengthening plans and managerial structures, enhancing skills, and explaining resilience strategies to improve the disaster preparedness of operating room nurses and medical organizations' disaster response teams. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Little is written about the management of psychological contracts by nurse unit managers (NUMs) in critical care settings and how this perspective contributes to the performance, experiences, and views of nurses and nursing teams. Psychological contracts are important regulators of the employer–employee relationship, with managers (NUMs) being the embodiment of the employer in managing the contract. Objectives: This qualitative study answers a call for research on the NUM perspective of the psychological contract given the role they play in the wellbeing of critical care nurses and quality of care provided. The study aims to understand the expectations and obligations that constitute the psychological contract NUMs have with their nursing teams, the nature of the contract, and how NUMs practically manage these aspects on their teams. Methods: Using an interpretive qualitative research design and a purposive sampling technique, semi-structured interviews were conducted with 10 of the 14 NUMs from a public health facility about critical incidents relating to their obligations and expectations of managing critical care nurses. Results: A thematic analysis of their responses revealed five main themes that represent the contents of their psychological contracts with critical care nurses: professional commitment and obligation; leading by example; trust and support; teamwork; and on-the-job training and further development. In their discussion of these components, the NUMs also revealed how they manage the psychological contract with nurses. Conclusion: Based on the expectations and obligations NUMs hold with their staff, their psychological contracts were found to be largely relational, with elements of the balanced type, suggesting that they rely on interpersonal connection and coordination, as well as knowledge dissemination, to uphold the contract. This contract appears to be effective in inculcating the commitment of nurses to their profession and professional standards through the building of trust and offering of support. However, recommendations are offered to ensure NUMs are best prepared to sustain these psychological contracts and continue to support nurse wellbeing and related patient care. [ABSTRACT FROM AUTHOR]

The study set out to perform a systematic literature review of evidence-based interventions that target the reduction of secondary stroke risk in Africa. The review analyzed longitudinal intervention studies conducted in Sub-Saharan Africa, focusing on adult participants who had suffered a prior stroke. It encompassed publications and peer-reviewed papers sourced from reputable databases, including PubMed, Ovid, Cochrane, and Web of Science. Three randomized clinical trial (RCT) studies were included with sample sizes ranging from 16 to 400 participants, mean age ranged between 50 and 66 years, with 64.5% male participants. All studies applied multidisciplinary team interventions of enhanced patient follow-up involving care givers, nurse educators, physicians, and social workers. Interventions ranged from comprehensive patient education, tracking of medication adherence and enforcing healthy lifestyle behaviors (regular exercise, regular BP checks, and dietary changes). We found a decrease in Systolic Blood Pressure over time in 2 of 3 treatment groups, an improvement in medical adherence in all treatment groups, and a decrease in cholesterol levels in 1 treatment group. Evidence-based interventions involving multidisciplinary teams and comprehensive patient education were found to demonstrate promising results in reducing secondary stroke risk in Africa, leading to significant improvements in medical adherence and reductions in systolic blood pressure in the majority of treatment groups. However, more research is required to confirm the influence of these interventions on cholesterol levels and to establish their lasting advantages in preventing strokes among African communities. [ABSTRACT FROM AUTHOR]

Persistent nursing workforce shortages, in conjunction with the COVID-19 pandemic and increased patient acuity, have led to increased utilization of nursing assistive personnel (NAP) within acute care settings. Although the work demand of NAPs continues to increase, their delegated work autonomy remains ambiguous and diverse. This lack of clarity impacts effective teamwork, collaboration, and delegation. This study successfully enhanced the scope of practice for NAPs, resulting in increased staff and patient satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)