Seagrass soil archives reveal centennial-scale metal smelter contamination while acting as natural filters

The upper Spencer Gulf in South Australia hosts the world's largest single stream Pb-Zn smelter, which has caused environmental and health issues related to elevated metal concentrations in the surrounding environment. The area also has extensive seagrass meadows, occupying >4000 km². We reconstructed the fluxes of heavy metals over the last ~3000 years through a multi-parameter study of the soil archives formed by the seagrass Posidonia australis. Pb, Zn and Cd concentrations increased up to 9-fold following the onset of smelter operations in the 1880s, and the stable Pb isotopic signatures confirmed the smelter has been the main source of lead pollution in the seagrass soils until present. Preliminary estimates suggest that over the past 15 years seagrass meadows within 70 km² of the smelter accumulated ~7-15% of the smelter emissions in their soils. Here we demonstrate that seagrass meadows act as pollution filters and sinks while their soils provide a record of environmental conditions, allowing baseline conditions to be identified and revealing the time-course of environmental change.

The Posidonia oceanica marine sedimentary record: A Holocene archive of heavy metal pollution

The study of a Posidonia oceanica mat (a peat-like marine sediment) core has provided a record of changes in heavy metal abundances (Fe, Mn, Ni, Cr, Cu, Pb, Cd, Zn, As and Al) since the Mid-Holocene (last 4470yr) in Portlligat Bay (NW Mediterranean). Metal contents were determined in P. oceanica. Both, the concentration records and the results of principal components analysis showed that metal pollution in the studied bay started ca. 2800yr BP and steadily increased until present. The increase in Fe, Cu, Pb, Cd, Zn and As concentrations since ca. 2800yr BP and in particular during Greek (ca. 2680-2465cal BP) and Roman (ca. 2150-1740cal BP) times shows an early anthropogenic pollution rise in the bay, which might be associated with large- and short-scale cultural and technological development. In the last ca. 1000yr the concentrations of heavy metals, mainly derived from anthropogenic activities, have significantly increased (e.g. from ~15 to 47μg g(-1) for Pb, ~23 to 95μg g(-1) for Zn and ~8 to 228μg g(-1) for As). Our study demonstrates for the first time the uniqueness of P. oceanica meadows as long-term archives of abundances, patterns, and trends of heavy metals during the Late Holocene in Mediterranean coastal ecosystems.

Using evidence-based practice in providing care

Case managers are in prime positions that enable them to implement initiatives, which may lead to evidence-based practice. The possibilities abound regardless of the setting; case managers are charged with the delivery of patient care in the most efficient manner. When the best care is given to patients within the shortest time frame, everyone benefits--the patients and their families, case managers and other staff, and the entire organization. The various tools used to coordinate patient care--protocols and pathways--can be readily used to collect data in a standard way; this is a vital step in initiating evidence-based practice. Initiatives leading to evidence-based practice require several phases: obtaining evidence, monitoring the use of evidence, and evaluating the use of evidence in practice. This article will describe the use of evidence-based practice for case managers and demonstrate the steps to ensuring successful implementation in patient care activities.

When new employee orientation doesn't go as planned. "It is time for Plan B ... but, what is Plan B?"

Although organizations have standard orientation programs for newly hired registered nurses, there are times when orientees are unable to meet expectations. When this happens, it is important to implement a Plan B--a revised orientation program that includes individualized strategies and content--to meet the needs of the orientee who is not progressing. This article will identify factors that may predict the need for increased orientation time and strategies to assist the new employee to complete orientation successfully.

Determining indirect caregivers' contribution to patient care

It is critical to measure contributions of staff who are not direct caregivers so that organizations can continually maximize resource. Understanding the consumer's perceptions is necessary to identify activities that contribute to the perception of an effective CNE. An awareness of the values placed by consumers on education services helps the educators to focus their efforts on those activities with the greatest perceived value. If educators put their efforts toward valued activities, their services would be frequently used and the staff would be more willing to accept the information, thereby benefiting from the educator's expertise. Learning how a role directly benefits patient care helps nurses in leadership positions meet institutional objectives. It allows nurse leaders to ensure that the role is, in fact, contributing to care, and it is doing so to the fullest extent. This builds institutional support and value for the role. The process of evaluating the benefit also allows the educators to gain support and credibility among consumers and other individuals within the institution. This perpetuates the increased utilization and benefit of the role. Results of this project can be used as a guide in evaluating various roles. Understanding activities that are valued by consumers enables staff in the roles that are being evaluated to determine how and where they should focus their efforts. This is especially critical as staff is being asked to do more work with less time and must establish priorities in their ongoing workload. Finally, it is vital to identify ways of turning the invisible work that indirect caregivers provide into visible work.

Detection of specific IgM antibody in the investigation of an outbreak of pneumonia due to Legionella pneumophila serogroup 1

OBJECTIVE

Management of outbreaks of pneumonia due to Legionella pneumophila serogroup 1 (SG1) infection requires rapid and accurate diagnostic tests. Current serologic approaches, based on detection of seroconversion for total antibody, do not fulfil this requirement.

METHODS

A diagnostic test based on detection of IgM antibody to L. pneumophila SG1 by indirect immunofluorescence was developed and used to evaluate serum samples from patients involved in a community outbreak of L. pneumophila SG1 pneumonia that occurred in Spain.

RESULTS

Testing of samples from serologically proven, sporadic cases of pneumonia due to L. pneumophila SG1 (14), cases of atypical pneumonia due to other infectious agents (16) and healthy controls (100) supported the sensitivity and specificity of the assay. On samples from the outbreak, the IgM assay recognized five of six cases with isolation of L. pneumophila SG1 from respiratory secretions or lung tissue and more than 70% of cases with confirmed or presumptive diagnosis as determined by the current serologic criteria. In addition, the IgM assay was positive in 23-70% of patients who fulfilled the clinical and epidemiologic criteria of case definition but did not display diagnostically significant serologic results or who lacked a detectable antibody response in the routine assay. Among cases confirmed by the current criteria, detection of specific IgM was occasionally achieved before the conventional serology gave significant results.

CONCLUSION

Incorporation of IgM antibody detection in the current diagnostic criteria for L. pneumophila SG1 infection may help to improve the management of outbreaks of pneumonia due to this agent.

Revitalizing a departmental committee

Committees are vital and as such should be evaluated regularly for congruence with organizational mission and contribution to outcomes. The authors present an approach to revitalizing a committee, using the nursing education committee as an exemplar. Phases used in achieving this revitalization are: evaluating the congruence of the existing committee with the organizational strategic plan, addressing gaps between existing committee functions and the organizational plan, soliciting support for the new committee direction, and evaluating the new committee direction.

Designing measurements to assess case management outcomes

Evaluating outcomes begins with determining the goals of case management. As the emphasis on the delivery of cost-effective patient care increases, comparing outcomes across settings is desirable and essential. A key component to comparing how an organization rates with similar institutions is to identify commonly used measures. Conducting a literature search, benchmarking, participating in initiatives of accrediting bodies, and establishing ways to collect and manage reliable and valid data are vital in laying the groundwork for an organization's ability to join evaluation projects across settings.

Making planned and unplanned role transitions

Changes in organizations mean planned and unplanned role transitions for nurse administrators and managers. Keeping abreast of trends engaging in activities that promote professional growth, assessing work habits, maintaining job interviewing skills, and reviewing and updating resumes are essential to prepare for role changes. When unplanned changes occur because one is fired or a position is abolished, one has to organize personal needs, cope with the job loss, look for a job, and assume a new role. The authors discuss strategies that can be used personally or with others to facilitate job change.

Management skills in an era of shifting paradigms

Managers have vital roles in balancing clinical practice and business-related outcomes. Skills in recruiting and retaining a diversified staff, along with a broad perspective of health care and political savvy, are essential in implementing changes, negotiating, collaborating, conducting meetings, and managing workloads. Demystifying the myths related to management is a crucial step when the paradigm shifts and requires changing roles.

Nursing management of enteral tube feedings

OBJECTIVE

To describe the management practices of nurses when providing care to patients receiving enteral tube feedings.

DESIGN

A descriptive study was conducted with use of questionnaires distributed to registered nurses (RNs).

SETTING

A midwestern university medical center.

SAMPLE

A total of 235 questionnaires were distributed to RNs. Two hundred nineteen were considered eligible and 180 were usable. This represents an 82% response.

METHOD

A 43-item questionnaire with a return envelope was placed in the mailbox of RNs.

DATA ANALYSIS

Descriptive statistics were used to analyze data.

RESULTS

(1) Checking the flow rate of enteral feeding: Flow rates were checked between 1 to 4 hours by 70% of the nurses, whereas 16% checked every 8 hours, and the remaining 14% checked every 12 hours or longer. (2) Flushing the enteral tube: Ninety-four percent of respondents indicated they regularly flushed the enteral tube before each feeding (29%), after each feeding (43%), and every 4 hours (59%). The types of irrigants that were used for flushing included tap water, sterile water, and sterile normal saline solution. (3) Method of unclogging obstructed tubes: An irrigant solution is the primary intervention reported by nurses to unclog tubes (94%). The types of solutions reportedly used most frequently were carbonated beverage (81%), sterile water (49%), dissolved papain (46%), and tap water (42%). (4) Checking residuals: Most RNs (95%) reported that they check residuals every 4 hours; of these, 50% stated they discard residuals, and 49% stated that they readminister residuals. In regard to the volume of residual deemed to be excessive, 50% of the respondents stated that an amount greater than or equal to 100 ml is excessive. (5) Administering medications: Flushing the enteral tube with water is reported to be done before (47%) and after (95%) giving medicines. When multiple medicines are given, 38% report flushing the enteral tube between each medication.

CONCLUSION

The findings of this self-report study suggest that practices regarding management of enteral feedings vary widely among nurses.

Managing variances in case management

Timely management of variances is vital for cost effective patient care. A multifaceted approach that involves the healthcare team, patient, and family facilitates the identification and management of variances as they occur. The critical path can be used to monitor variances that influence fiscal outcomes in select patient populations. Strategies are described that can be used to monitor and manage variances, including developing a mechanism for monitoring and managing variances, implementing that mechanism, and evaluating the process for usability. Monitoring variances includes choosing tools that will be used and staff who will assume primary responsibility, and initiating an outcome analysis program. Managing variances comprises organizing an interdisciplinary committee, establishing a communication plan, creating strategies, and using continuous quality improvement teams.

Roles and responsibilities of clinical nurse researchers

A follow-up survey of 142 nurse researchers employed in clinical settings (NRECS) was conducted 10 years after the first one conducted by Knafl, Bevis, and Kirchhoff in which only 34 individuals qualified for inclusion. An 80-item questionnaire included items about the structure of the position, processes used, variables that may influence outcomes, and outside activities. When ineligible persons were excluded, the response rate was 75 per cent. Most commonly NRECS had positions in clinical settings only (55.7 per cent), offices (75.5 per cent), some staff (72.6 per cent), and secretarial support (52.8 per cent), and they usually reported to the chief nurse executives (71.7 per cent). Although the majority of NRECS reported responsibility for research activities, the average time spent on research is only 50 per cent. Most (82 per cent) have a nursing research committee, but NRECS also sit on other research-related committees in the department or hospital. Details about salary, responsibilities, and processes will be helpful to those preparing themselves or others for this role, for those who wish to start such a position for themselves or another, or for those in the role wanting to know how other NRECS perform.

Productivity of nurse researchers employed in clinical settings

With limited resources, there is increased scrutiny of the contributions of leadership staff, such as nurse researchers employed in the clinical setting (NRECS). The authors describe activities that pertain to research, presentations, publications, and procurement of funds for studies. Major obstacles that impede NRECS from achieving their goals, job performance evaluation and indices (staff, organization, and personal) that NRECS use to determine success in enacting their role also are presented.

Joint CNS appointment: is it viable?

A CNS joint appointment that is supported by the departments of nursing and medicine is viable when goals of the nurse and the organizations are congruent and expectations are delineated. Many challenges and strategies are associated with a joint appointment. Although the challenges and strategies were similar for the first (C.N.) and second authors (L.A.), their experiences differed. Based on the experience of the authors, feasibility of a joint appointment and benefits, challenges, and strategies for enacting the role are presented.

An approach to presentation skill development of nurses

When staff development specialists help nurses gain presentation skills, they benefit by increasing the pool of clinically expert nurses who can share information and ideas. In this article, the authors describe an approach that includes conducting a workshop and providing opportunities for participants to make a presentation. Strategies to enhance presentations and reduce fear are addressed.

Promoting the development of nurses' presentation and publication skills

When nurses share their clinical knowledge with others through presentations and publications, new ideas emerge that could result in improved patient care. Nurses also gain opportunities for professional recognition and advancement through such pursuits. Managers are in a strategic position to promote the development of presentation and publication skills. This article describes a three-phase model that can help managers utilize appropriate strategies and resources to facilitate skills development. Each phase of development is designed to increase skill level, confidence, and experience. With managerial support, this model can help nurses learn to communicate effectively with colleagues through presentations and publications.

Uncertainty: strategies for patients with brain tumor and their family

Patients diagnosed with a brain tumor and their families are faced with uncertainties that result from the progression of the disease and treatment regimen. Many strategies can be used to help patients and families deal with these uncertainties. A case report is used to illustrate how changing needs of a patient and family were met by using different strategies.

Unit-based product evaluation: Part 2: Planning product evaluation studies

This second article in this set gives you advice on how to set up your own product evaluations. Critical care nurse managers, educators, and Clinical Nurse Specialists, researchers, and even staff nurses are planning product evaluation studies to determine what equipment best meets the needs of the nurses and patients in their units. If you are interested in evaluating a product you are considering or have recently acquired, here are tips on how to develop a unit-based product evaluation.

Accurate data: the basis of decision

This article provides an overview of the process for obtaining accurate data. Information about organizing data collection, managing data, and communicating findings is given to assist nurses in developing and evaluating data used in practice and clinical nursing research.

An approach to publishing an edited book

This article outlines the steps taken by the authors to publish a co-edited nursing research book to assist nurses interested in editing a book or writing a book chapter. The authors' experiences are used to help illustrate the preparation and editing of manuscripts. Collaboration among co-editors, chapter authors (contributors), and the staff of the publishing company is vital when publishing an edited book.

Publication skill development in nurses. A vital role of nurse executives

Fostering a work environment that encourages nurses to pursue scholarly activities, such as publishing, is one of the responsibilities of a nurse executive. The authors discuss strategies for creating an environment that supports and inspires nurses to publish.