YSN Library May 1 - May 5

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 5/1
8:30 - 5:00
Class 4:00 - 5:00 Advanced Searching Techniques

Tuesday 5/2
See me in Medical Library for assistance - 737-2964

Wednesday 5/3
Call the Medical Library for assistance - 737-2964

Thursday 5/4
See me in Medical Library for assistance - 737-2964
Class 3:00 - 4:00 EndNote Basics

Friday 5/5
8:30 - 5:00

Complete list of classes

YSN Library April 24 - April 28

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 4/24
12:00 - 3:30

Tuesday 4/25
See me in Medical Library for assistance - 737-2964
Class 7:00 - 8:00 PowerPoint Basics

Wednesday 4/26
12:00 - 5:00

Thursday 4/27
See me in Medical Library for assistance - 737-2964
Class 1:00 - 2:00 RefWorks Basics

Friday 4/28
Call the Medical Library for assistance - 737-2964

Complete list of classes

Measuring safety climate in health care

Flin R, Burns C, Mearns K, Yule S, Robertson EM. (2006) Measuring safety climate in health care. Quality & safety in health care. 15(2):109-15.

AIM: To review quantitative studies of safety climate in health care to examine the psychometric properties of the questionnaires designed to measure this construct.
METHOD: A systematic literature review was undertaken to study sample and questionnaire design characteristics (source, no of items, scale type), construct validity (content validity, factor structure and internal reliability, concurrent validity), within group agreement, and level of analysis.
RESULTS: Twelve studies were examined. There was a lack of explicit theoretical underpinning for most questionnaires and some instruments did not report standard psychometric criteria. Where this information was available, several questionnaires appeared to have limitations. CONCLUSIONS: More consideration should be given to psychometric factors in the design of healthcare safety climate instruments, especially as these are beginning to be used in large scale surveys across healthcare organisations.

When should a leader apologize and when not?

"When corporate leaders or the organizations they represent mess up, they face the difficult decision of whether or not to apologize publicly. A public apology is a risky move. It's highly political, and every word matters. Refusal to apologize can be smart, or it can be suicidal. Readiness to apologize can be seen as a sign of character or one of weakness. A successful apology can turn enmity into personal and organizational triumph--while an apology that's too little, too late, or too transparently tactical can open the floodgates to individual and institutional ruin. Since the stakes are so high, Kellerman says, leaders should not extend public apologies often or lightly. One or more of the following conditions should apply: The apology is likely to serve an important purpose. The offense is of serious consequence. It's appropriate that the leader assume responsibility for the offense. The leader is the only one who can get the job done. The cost of saying something is likely lower than the cost of staying silent. The author draws her conclusions from hard data and abundant anecdotal evidence, examining notoriously bad apologizers as well as exceptionally good ones. While selectivity is key, good apologies usually do work. What constitutes a good apology? Acknowledgment of the mistake or wrongdoing, acceptance of responsibility, expression of regret, and assurance that the offense will not be repeated."

Kellerman B. (2006) When should a leader apologize and when not? Harvard Business Review. 84(4):72-81; 148.

How Long and How Much Are Nurses Now Working?

In this study the authors analyzed results from a national survey and found that nurses work more hours than recommended by the Institute of Medicine in Keeping Patients Safe. They conclude that an increased awareness of fatigue in nursing and its impact on safety is necessary to realize improvements.

"Extended work schedules—those that vary from the standard eight hours per day, 35 to 40 hours per week—are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings."
"More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts."

To read the full article:
Trinkoff A, Geiger-Brown J, Brady B, Lipscomb J, Muntaner C. (2006) How long and how much are nurses now working? American Journal of Nursing 106(4):60-71.

YSN Library April 17 - April 21

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 4/17
Call the Medical Library for assistance - 737-2964

Tuesday 4/18
See me in Medical Library for assistance - 737-2964
Class 5:00 - 6:00 EndNote Basics

Wednesday 4/19
8:30 - 2:30

Thursday 4/20
1:30 - 5:00
Class 4:00 - 5:00 EndNote Advanced
Class 5:00 - 6:00 Library 101

Friday 4/21
8:30 - 5:00

Complete list of classes

LactMed

The National Library of Medicine just released a new database called LactMed - a peer reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

It is one of the National Library of Medicine's (NLM) TOXNET system, a Web-based collection of resources covering toxicology, chemical safety, and environmental health. Geared to the healthcare practitioner and nursing mother, LactMed contains over 450 drug records. It includes information such as maternal levels in breast milk, infant levels in blood, potential effects in breastfeeding infants and on lactation itself, the American Academy of Pediatrics category indicating the level of compatibility of the drug with breastfeeding, and alternate drugs to consider. References are included, as is nomenclature information, such as the drug's Chemical Abstract Service's (CAS) Registry number and its broad drug class.

LactMed was developed by pharmacist who is an expert in this subject area. Three other recognized authorities serve as the database's scientific review panel. Ancillary resources, such as a glossary of terms related to drugs and lactation, and breastfeeding links are also offered. LactMed can be searched together with TOXNET's other databases in a multi-database environment, to obtain other relevant information about drugs. As a work in progress, LactMed will continue to expand with additional drugs and be enhanced with other substances, such as industrial chemicals and radiation.

Find the database at:
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Public Health Strategies for Pandemic Influenza

Ethics and the Law: from this week's JAMA

Gostin, L. (2006) Health Strategies for Pandemic Influenza. JAMA. 2006;295:1700-1704.

"Highly pathogenic influenza A(H5N1) is endemic in avian populations in Southeast Asia, with serious outbreaks now in Africa, Europe, and the Middle East.¹ Human cases, although rare, continue to increase, with high reported case-fatality rates. Industrialized countries place great emphasis on scientific solutions. The White House strategic plan and congressional appropriation both devote more than 90% of pandemic influenza spending to vaccines and antiviral medications.² Yet, medical countermeasures, discussed in a previous JAMA Commentary, will not impede pandemic spread: experimental H5N1 vaccines may not be effective against a novel human subtype, neuraminidase inhibitors may become resistant, and medical countermeasures will be extremely scarce.³ This Commentary focuses on traditional public health interventions, drawing lessons from past influenza pandemics and the outbreaks of severe acute respiratory syndrome (SARS)."

More Flu web sites ...

CDC Pandemic Flu: Worldwide Preparedness
Pandemicflu.gov
WHO Epidemic and pandemic alert and response
The White House National strategy for pandemic influenza
US Department of Health and Human Services HHS Pandemic Influenza Plan
US Department of Health and Human Services National Vaccine Program
NPR Bird flu indepth
International Monetary Fund The Global Economic and Financial Impact of an Avian Flu Pandemic and the Role of the IMF

Terminal Sedation and Euthanasia

A recent study was done in the Netherlands regarding the use of terminal sedation to keep patients in deep sedation or coma until death. Personal interviews of physicians were done in order to compare the characteristics of the patients, the decision-making process and the medical care of both practices. Conclusions of the study found that terminal sedation is used to address "severe physical and psychological suffering of dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for pattients requesting euthanasia."

To see the full article:
Rietjens, J.A.C., van Delden, J.J.M., van der Heide, A., Vrakking A.M., Onwuteaka-Philipsen, B.D., van der Maas, P.J. and van der Wa, G. (2006). Terminal Sedation and Euthanasia: A Comparison of Clinical Practices Archives of Internal Medicine, 166 749-753.

YSN Library April 10 - April 14

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 4/10
8:00-11:30
Class 5:00 -6:00 RefWorks Basics

Tuesday 4/11
See me in Medical Library for assistance - 737-2964
Class 10:00 - 11:00 PubMed Basics

Wednesday 4/12
1:30 - 5:00
Class: 7:00-8:00 PowerPoint Basics

Thursday 4/13
See me in Medical Library for assistance - 737-2964

Friday 4/14
University Holiday

Complete list of classes

Credentialing, Regulation, Certification, and Scope

The following articles are great reading for the graduating nurse practitioner.

Smolenski, M. C. (2005). "Credentialing, Certification, and Competence: Issues for New and Seasoned Nurse Practitioners." Journal of the American Academy of Nurse Practitioners 17 (6), 201-204.
From the abstract ... "As new nurse practitioner (NP) graduates enter the workforce, they are faced with the sometimes confusing issues related to establishing credibility in their first job as an advanced practice nurse (APN). Establishing this credibility incorporates not only graduating from an accredited NP program but also dealing with the concepts of certification, licensure, or authorization to practice, and the issue of credentialing and privileging. Even seasoned NPs are facing some of these issues for the first time in their careers as the complex areas of competence, scope of practice, and regulation continue to evolve. This article will provide a brief overview of each of these concepts, which are especially important for the new APN graduate; describe some of the misconceptions that cause problems for APNs; identify the current questions on regulation of APNs being debated; and outline some of the proactive steps that can be taken to stay ahead of the curve."

Klein, T. A. (2005). "Scope of Practice and the Nurse Practitioner: Regulation, Competency, Expansion and Evolution". Topics in Advanced Practice Nursing 5 (2), 1-10. [you will need to create a free user name and password to access this article]

From the abstract ... "The purpose of this article is to evaluate current mechanisms for credentialing and recognizing scope of practice for NPs. Each NP, whether governed by state regulations providing for independent, supervised, collaborative, or other practice requirements, is independently responsible for his/her patient care. This article will help you sort out some of the ethical and practical questions you should ask yourself when faced with a scope-of-practice decision."

EBN: How Far Have We Come

While I was in Australia at the Joanna Briggs evidence-based practice convention I had the honor to hear Donna Ciliska from the School of Nursing at McMaster University in Canada. The topic she covered was the state of the science of evidence-based nursing. Her talk was published in this month's issue of Evidence-based Nursing.

This is the abstract for the paper:
"This paper provides an opportunity to reflect on evidence-based nursing. Where have we been? How far we have come? What are the current issues, and where are we going in terms of incorporating high quality evidence into clinical, education, management, and policy decisions? Is evidence-based nursing a passing fad, or does it contribute to quality, efficient health care? "

To read the whole article:
Ciliska D. (2006) Evidence-based nursing: how far have we come? What's next? Evid Based Nurs 2006;9 38-40 http://ebn.bmjjournals.com/cgi/content/full/9/2/38?etoc

AHRQ Launches New Web-based Tool for States to Measure Quality Performance

AHRQ recently released a new interactive Web-based tool for States to use in measuring health care quality.

The new State Snapshot Web tool is based on the 2005 National Healthcare Quality Report and 2005 National Healthcare Disparities Report, released January 9, and provides quick and easy access to the many measures and tables of the quality report from each State's perspective.

Select to view the State Snapshot tool.
The 2005 National Healthcare Quality Report and the 2005 National Healthcare Disparities Report are available online at AHRQ's Qualitytools.gov.

In addition, there is an audio Newscast about the State Snapshot tool. The newscast features an interview with AHRQ Director Carolyn M. Clancy, M.D., discussing the importance of the tool and its key elements. In addition, AHRQ's Dr. Dwight McNeill explains how to use some of the tool's features. Select to listen to the program.

Nationwide Increase in Antipsychotic Medications Used for Children

An AHRQ-funded study, "Trends in Prescribing of Antipsychotic Medications for U.S. Children," that was published in the March-April issue of Ambulatory Pediatrics found that the overall frequency of antipsychotic prescribing in the U.S. increased fivefold—from 8.6 out of 1,000 U.S. children in 1995-1996 to 39.4 out of 1,000 children in 2001-2002.

According to the researchers, led by William Cooper, M.D., M.P.H., associate professor of Pediatrics in the Child and Adolescent Health Research Unit, at Vanderbilt University, the increase in frequencies of antipsychotic prescribing and the large number of children receiving antipsychotics each year reinforce the urgent need to conduct well-controlled studies of these medications in children.

Cooper WO, Arbogast PG, Ding H, Hickson GB, Fuchs DC, Ray WA. Trends in prescribing of antipsychotic medications for US children. Ambul Pediatr. 2006 Mar-Apr;6(2):79-83.