Aim
The aim of this study was to examine the impact of leadership styles on the reported rates of lateral hostility in nurses.
Background
Previous explanations of horizontal incivility point to ...oppressed group behaviour and socialisation of nurses. Leadership and organisational culture are known to have a profound impact on workplace behaviour, yet few studies have examined the relationship between leadership style and nurse‐to‐nurse incivility.
Methods
A survey was used to assess the perceived levels of incivility and the leadership styles experienced by 237 participants defined as ‘staff nurses’.
Results
Transformational leadership style had the strongest correlation with low levels of incivility. Staff input and leader/staff teamwork also influence staff incivility.
Conclusions
Leadership style is not a definitive factor of incivility, but leader behaviours impact the level of incivility between staff nurses. The relationship between leaders and staff and the empowerment of staff have the strongest impact on nurse incivility.
Implications for nursing management
The factors found to correlate with incivility in this study are under the influence of nurse leaders. Relationships and interpersonal dynamics must be attended to. Leaders can also instil the structures known to foster nurse empowerment, which are discussed.
The Sars-CoV-2 disease (known as COVID-19) has become a global public health emergency. Researchers have been unveiling the transmission mechanisms and disclosing possible contributing factors. ...Studies have theorized plausible linkage mechanisms between air pollution exposure and COVID-19 infection and have divided the air pollution exposure into two types: long-term exposure and short-term exposure. However, present studies on impacts of short-term exposure have not reached a conclusive result and are mostly focusing on Asian and European countries. In this study, we conduct a nationwide analysis to examine the association between short-term air pollution exposure and COVID-19 infection in the United States. Daily confirmed cases, air pollution information, and meteorological factors at the county level were collected between March 1st and June 30th, 2020. A total of 806 (out of 3143) counties were included in this study, with 554 counties for PM2.5 and 670 counties for ozone (O3), which account for around 2.1 million cumulative confirmed cases, i.e., about 80% of all confirmed cases in the U.S. over the study period. A generalized additive model was applied to investigate the relationship between short-term exposure to PM2.5/O3 and COVID-19 confirmed cases. The statistically significant results indicate that, with every 10 μg/m3 increase in mean pollutant concentration, the number of daily confirmed cases increases by 9.41% (CI: 8.77%–10.04%) for PM2.5 and by 2.42% (CI: 1.56%–3.28%) for O3. The relative risks associated with short-term PM2.5 exposure remain positive after isolating the impacts of long-term exposure. The results of this study suggest that short-term exposure to air pollution, especially to PM2.5, may contribute to the spread and course of the pandemic. This finding has important implications for policymakers and the public to take preventive measures such as staying at home on polluted days while improving ventilation indoors to lower the probability of infection.
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•Positive associations were found for PM2.5/O3 and COVID-19 infection.•Relative risk associated with short-term PM2.5 exposure is higher than that of O3.•The positive associations persist when removing data from New York counties.•Increased exposure was also correlated with higher COVID-19 deaths.•Short-term PM2.5 exposure may contribute to the spread and course of the pandemic.
Many clinicians have concerns about the safety of atopic dermatitis (AD) treatments, particularly in children requiring long-term daily maintenance therapy. Topical corticosteroids (TCS) have been ...widely used for >5 decades. Long-term TCS monotherapy has been associated with adverse cutaneous effects including atrophy, rebound flares, and increased percutaneous absorption with potential for adverse systemic effects. Topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, available for 1-2 decades, are not associated with atrophy or increased percutaneous absorption after prolonged use and have much lower potential for systemic effects. However, since 2006 TCIs have carried a controversial Boxed Warning based on a theoretical risk of malignancy (eg, skin and lymphoma) that has limited TCI use for standard-of-care maintenance therapy.
A comparative systematic search of PubMed was done for long-term (≥12 week) clinical trials of TCS or TCI treatment in patients <12 years with AD. Citations were reviewed for inclusion based on MeSH terms, abstracts, and relevant article text. Studies were excluded if they did not encompass subjects <12 years, or were <12 weeks' duration, retrospective, meta-analyses, or limited to anecdotal case reports.
Of 27 trials meeting criteria, 21 included 5825 pediatric patients treated with TCIs, and 6 included 1999 patients treated with TCS. TCS studies were limited to low- to mid-potency products, and all but one study lacked a vehicle control. Eight TCI studies were vehicle-controlled, and safety data were well reported, with ≤5 % of patients reporting discontinuation due to adverse effects (DAEs). Cutaneous and systemic adverse events (AEs) were similar in TCI and vehicle groups, with no reports of lymphoma. Safety data in TCS trials were less well reported. DAE incidence was addressed in just 2 trials, and systemic and cutaneous AEs were mostly unreported.
Data supporting long-term use of TCIs are robust, documenting safety and efficacy, while data supporting long-term TCS use are limited to low- to mid-potency products. Our review identifies a lack of information on the safety of commonly prescribed, long-term monotherapy with mid- to high-potency TCS in pediatric AD, and supports standard-of-care maintenance therapy with TCIs and intermittent use of low- to mid-potency TCS for flares.
This randomized noninferiority trial compared the levonorgestrel IUD with the copper IUD for emergency contraception in participants (who were unaware of group assignment) within 5 days after at ...least one episode of unprotected intercourse and showed that the levonorgestrel IUD was noninferior with respect to pregnancy rates at 1 month.
Aim
The aim of this study was to examine how the facets of teamwork exist among nurse‐only teams in acute and continuing care settings.
Background
The health care ‘team’ conventionally describes the ...interdisciplinary team in both literature and practice. Nursing‐specific teams are rarely considered in the literature. An examination of this specific professional cohort is important to understand how teamwork exists among those who provide the majority of patient care.
Method
This was a descriptive, comparative, cross‐sectional study using the Nursing Teamwork Survey to measure teamwork of nursing‐based teams among 1414 participants in multiple acute care environments across a large Midwestern health system.
Results
The characteristics of nursing teams were analysed. The results from the subscales within the teamwork model showed that nursing teams had a good understanding of the various roles and responsibilities. However, nurse team members held a more individualistic rather than collective team‐oriented mindset.
Conclusions and Implications for Nursing Management
Increased teamwork has a positive effect on job satisfaction, staffing efficiencies, retention and care delivery. Nurse leaders can use the information provided in this study to target the aspects of highly functioning teams by improving team orientation, trust and backup behaviours.
Left ventricular assist device (LVAD) therapy is becoming a widespread treatment for advanced heart failure. Implantation of an LVAD introduces complications that contribute to high rates of ...rehospitalization. This study examines the presenting signs and symptoms in LVAD patients at the time of readmission and explores the prevalence of psychosocial factors that are significantly associated with readmissions in this patient population.
This is a retrospective review of 226 patients who had an LVAD implanted at a single transplant center. Data were extracted from individual electronic health record review and analyzed for readmissions within 6 months of discharge from the index hospitalization.
Post-LVAD readmission rates are high and occur more frequently in destination therapy (DT) patients. Anxiety and depression are significant predictors of readmission. These factors negatively affect post-LVAD quality of life, particularly in DT patients.
By understanding the etiologies and factors related to readmission after an LVAD, nurse practitioners can identify and address these issues before they result in rehospitalization to improve post-LVAD quality of life. With these considerations, ongoing nonemergent discussions of goals of care and quality of life are imperative because more patients will be offered the choice of an LVAD as a potentially life-long treatment.
To determine a 1-month pregnancy rate point estimate and 95% confidence interval for guideline-supported, same-day initiation of an etonogestrel implant plus oral levonorgestrel emergency ...contraception.
In this single-arm, prospective observational study, all emergency contraception clients who presented to four Planned Parenthood Association of Utah clinics from February 2021 to March 2023 received information about oral levonorgestrel with same-day etonogestrel implant insertion. Participants were ≤35 years and reported unprotected intercourse within 5 days with negative pregnancy testing. The primary outcome measure was a 1-month home pregnancy test. We calculated the efficacy using a test of proportions with Yates continuity correction.
A total of 160 emergency contraception clients (7.6% of 2106 approached) enrolled and 153 had 1-month pregnancy outcomes. A positive pregnancy test occurred in 2 participants resulting in an overall pregnancy rate of 1.32% (95% confidence interval 0.23%−5.19%). Ultrasound gestational dating assigned conception of the first pregnancy to 8 days before enrollment. For the second pregnancy, ultrasound dating designated conception at 5 days prior to enrollment. Limiting the efficacy rate to the single pregnancy that occurred within 5 days of unprotected intercourse, we report a pregnancy rate of 0.66% (95% confidence interval 0.03%−4.19%).
In this observational study of emergency contraception clients selecting oral levonorgestrel with same-day etonogestrel implant, we identified a pregnancy rate within the established range of oral emergency contraception methods alone.
Clients presenting for emergency contraception may also desire ongoing highly-effective contraception, yet current clinical guidelines serve as a barrier to same-day method initiation for the etonogestrel implant and other hormonal methods. Improving access to contraceptive method initiation will reduce the ongoing risk of unwanted pregnancy for this population.
Clinicaltrials.gov NCT04678817; registered 12/16/20
OBJECTIVE:
To explore the association of the
Dobbs v Jackson Women's Health Organization
(
Dobbs
) decision on future practice locations of graduating obstetrics and gynecology residents.
METHODS:
...This is a mixed-methods survey study of obstetrics and gynecology residents graduating from sites with Ryan Program abortion training programs (109 sites) between March 8, 2023, and April 25, 2023. We conducted both univariate and multivariable logistic regression analyses to identify factors that were associated with post-
Dobbs
change in career plans, particularly location. We also performed a thematic analysis using responses to the survey's optional, open-ended prompt, “Please describe how the
Dobbs v Jackson Women's Health Organization
decision impacted your professional plans.”
RESULTS:
Of an estimated 724 residents graduating from residencies with Ryan Program abortion training programs, 349 participated in the survey (48.2% response rate); 17.6% of residents indicated that the
Dobbs
decision changed the location of intended future practice or fellowship plans. Residents who before the
Dobbs
decision intended to practice in abortion-restrictive states were eight times more likely to change their practice plans than those who planned to practice in protected states before the
Dobbs
decision (odds ratio 8.52, 95% CI 3.81–21.0). In a thematic analysis of open-ended responses, 90 residents wrote responses related to “not living in a state with abortion restrictions.” Of residents pursuing fellowship, 36 indicated that they did not rank or ranked lower programs in restrictive states.
CONCLUSION:
These findings demonstrate reduced desire of residents in obstetrics and gynecology to practice or pursue fellowship in restrictive states after residency. This reduction in obstetrics and gynecology workforce could significantly exacerbate maternity care deserts.
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