The relationship between maternal mental health and infant development has been established in the literature. The Neonatal Intensive Care Unit (NICU) is a particularly challenging environment for new mothers as several natural processes are disrupted. The objective of this study is to elucidate protective factors and environmental deficits associated with the NICU. The experiences of forty-six (n = 46) mothers of infants admitted to a Level III NICU in the Midwestern United States, who responded to a related open-ended question, were analyzed thematically. Five themes related to the NICU environment emerged as being either stressful or helpful: (1) amount and quality of communication with medical staff, (2) bedside manner of medical staff, (3) feeling alienated from infant’s care, (4) support from other NICU mothers and families, and (5) NICU Physical Environment and Regulations. There is a need for medical staff training on awareness, communication, empathy, and other behaviors that might improve maternal (and parental) experiences in the NICU. The physical environment, including rules and regulations of the NICU, should be reexamined with family comfort in mind in addition to the clinical care of the infant.

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There is very little research literature that addresses sexuality at the end of life. Although end-of-life care has become a priority for nursing education, the issue of end-of-life sexuality is not included in the curriculum. Nurses are frequently in a position to establish relationships with couples that encourage a frank discussion and information sharing. As patient advocates, nurses can address end-of-life sexuality issues by taking a sexual history and implementing a general intervention model, such as the PLISSIT. Couples need to be reassured that if they have enjoyed a close sexual relationship, sexual intimacy may continue to be part of their relationship, even at the end of life.

This project demonstrated successful development of a low-cost, easy-to-construct penile model combined with a high-fidelity infant simulator that, according to the responses of the participants in this study, enhances the simulated neonatal circumcision training. A tutorial for model construction and investigator-developed skill assessment checklists for Gomco and Mogen techniques are included in this technical report.

Background:Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published.Purpose:Elbow and upper extremity overuse injuries are on the rise in fast-pitch softball pitchers. This study attempts to describe forearm muscle activity in softball pitchers during the windmill softball pitch. Overuse injuries can be prevented if a better understanding of mechanics is defined.Study Design:Descriptive laboratory study.Methods:Surface EMG and high-speed videography was used to study forearm muscle activation patterns during the windmill softball pitch on 10 female collegiate-level pitchers. Maximum voluntary isometric contraction of each muscle was used as a normalizing value. Each subject was tested during a single laboratory session per pitcher. Data included peak muscle activation, average muscle activation, and time to peak activation for 6 pitch types: fastball, changeup, riseball, curveball, screwball, and dropball.Results:During the first 4 phases, muscle activity (seen as signal strength on the EMG recordings) was limited and static in nature. The greatest activation occurred in phases 5 and 6, with increased signal strength, evidence of stretch-shortening cycle, and different muscle characteristics with each pitch style. These 2 phases of the windmill pitch are where the arm is placed in the 6 o’clock position and then at release of the ball. The flexor carpi ulnaris signal strength was significantly greater than the other forearm flexors. Timing of phases 1 through 5 was successively shorter for each pitch. There was a secondary pattern of activation in the flexor carpi ulnaris in phase 4 for all pitches except the fastball and riseball.Conclusion:During the 6 pitches, the greatest muscular activity was in phases 5 and 6. Flexor carpi ulnaris activity was greatest among the muscles tested. The riseball had the highest peak activity, but the curveball and dropball had the highest average signal strength. This muscle activity correlates with increasing distraction in the elbow, suggesting that flexor muscles act to counterdistract the elbow as they do for the baseball pitch.Clinical Relevance:Windmill pitchers are unique among overhead athletes as they throw, on average, more pitches per overhead athlete. Understanding the mechanics and physiology of the elbow in windmill pitchers is crucial to prevention and treatment of these increasingly common elbow injuries. This study establishes baseline data that will be useful to further prevent windmill pitch elbow injury.

C ritical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources. Additionally, they are expected to identify and implement the latest evidence-based practices (EBPs) into their own clinical practice. Ideally, advanced practice nurses would be present at every institution to assist department managers and bedside nurses with quality improvement and research projects specific to their department and organizational needs. Unfortunately, out of 4999 registered community hospitals in the United States (January 2014), only 395 (8%) have American Nurses Credentialing Center Magnet status.1 Although not a direct measure of the availability of nursing research resources at every type of institution, the low percentage underscores the important fact that many critical care units are on their own when it comes to implementing a quality improvement or clinical research project.This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing projects within their own units. The purpose of this first article is to provide a broad overview of the differences between quality improvement and research, as well as a discussion of the factors that should be considered when deciding which road to take. Future articles will discuss (1) how to identify worthwhile projects; (2) project design, implementation, and documentation; and (3) how to publish quality improvement activities by using the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines. Quality ImprovementCritical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources while implementing the latest evidence-based practices into their own clinical practice. This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing system process or performance improvement projects within their own units. Part 1 is designed to answer the question "What method is better for measuring real-world patient outcomes-quality improvement or clinical research?" A broad overview of the differences between quality improvement and clinical research is provided. A newly published checklist to differentiate between attributes of each process is introduced, and readers can test their own knowledge between quality improvement and research with a quick quiz of studies recently published in Critical Care Nurse. (Critical Care Nurse.

This article is the second of a 4-part quality improvement resource series for critical care nurses interested in implementing system process or performance improvement projects. The article is a brainstorming session on paper, written to assist nurses and managers in identifying possible quality improvement projects that are meaningful to them and will make a real difference in their critical care units. Every unit and institution has its own unique mix of resources, culture, physical environment, patient population, technology, documentation processes, health care providers, and multiple other factors. Thus specific patient care and safety challenges must be identified and prioritized individually for quality improvement by each unit. Projects also must be manageable and within the scope of time, effort, and expertise available-no quality improvement project is "too small" if it is applicable to your critical care area and will improve outcomes. A s the nurse manager of the trauma intensive care unit, you have just received the most recent patient satisfaction scores, and they are still below the preferred institutional benchmark. The lowest scoring items are (1) staff effort to include patients/families in decisions about treatment, (2) how well nurses kept patients/family informed, and (3) the amount of attention paid to the patient's special or personal needs. At the next team meeting, you invite your staff to offer suggestions on how to improve satisfaction scores. A lively discussion erupts, with some nurses recommending a research project and others a quality improvement (QI) project. Using published guidelines, 1 the group decides to use current evidence-based knowledge and best practices applicable to their patient population that will address the identified deficiencies (QI) versus trying to generate new knowledge or This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Describe how to determine process improvement priorities 2. Review the use of process improvement methods that will work for your facility 3. Review patient safety strategies and initiatives endorsed by the Agency for Healthcare Research and Quality to prevent harm

This study describes the results of a survey on the use of EM-POCUS for clinical decision making by Ohio EPs. A majority of them continues to rely on gold standard testing for confirmatory diagnosis, in addition to EM-POCUS.