An innovative leap: Embracing new pedagogical approaches for clinical education.

In response to increasingly complex care environments, a mid-sized research-intensive university in Western Canada engaged in an extensive curriculum redesign of the BSN program, including the development of an Innovative Clinical Learning Model. In this article, the authors share their experience of developing and implementing two innovative pedagogical approaches for clinical teaching in the medical surgical context. Program evaluation data indicated that these pedagogical strategies provided increased opportunities for timely application of theory in practice and facilitated students' development of clinical reasoning, skill mastery, and professional identities as accountable, responsible, ethical nurses.

Nursing students' experiences of moral uncertainty in the context of global health practicums.

More students than ever are electing to take part in international practicums from health-related disciplines. With the goal of better understanding the moral experiences and ethical implications of global health practicums (GHPs), the purpose of this Interpretive Descriptive study was to examine the moral uncertainty of nursing students from one university in Canada. Seventeen nurses who had participated in a GHP in their undergraduate nursing program participated in semi-structured interviews.

Radical transformation: Embracing constructivism and pedagogy for an innovative nursing curriculum.

To effectively navigate today's complex and rapidly changing health care environments, nurses require a high level of knowledge, sound psychomotor skills, diverse thinking and reasoning abilities, and a strong professional identity. The evidence showed that programs that offer students focused clinical practice experiences and offer students opportunities to 'think like a nurse' enable them to become sound practitioners. Faculty and staff at one mid-sized research-intensive university in Western Canada, engaged in an iterative process of rethinking the theoretical and pedagogical underpinnings of a BSN curriculum for educating nurses for the complexity of today's practice.

Safety culture in healthcare: mixed method study.

Purpose: Healthcare providers' perceptions of management's effectiveness in achieving safety culture improvements are low, and there is little information in the literature on the subject. Objective: The overall aim of this study was to examine the patient safety culture within an interprofessional team - physicians, nurses, nurse technicians, speech therapist, psychologist, social worker, administrative support - practicing in an advanced neurology and neurosurgery center in Southern Brazil.

Design/methodology/approach: The authors applied the safety attitudes questionnaire (SAQ) in a mixed methods study, with a quan→QUAL sequential explanatory approach.

Cardiac Oxidative Signaling and Physiological Hypertrophy in the Na/K-ATPase α1α2 Mouse Model of High Affinity for Cardiotonic Steroids.

The Na/K-ATPase is the specific receptor for cardiotonic steroids (CTS) such as ouabain and digoxin. At pharmacological concentrations used in the treatment of cardiac conditions, CTS inhibit the ion-pumping function of Na/K-ATPase. At much lower concentrations, in the range of those reported for endogenous CTS in the blood, they stimulate hypertrophic growth of cultured cardiac myocytes through initiation of a Na/K-ATPase-mediated and reactive oxygen species (ROS)-dependent signaling.

Biased Effect of Cardiotonic Steroids on Na/K-ATPase-Mediated Signal Transduction.

Recent studies have revealed that Na/K-ATPase (NKA) can transmit signals through ion-pumping-independent activation of pathways relayed by distinct intracellular protein/lipid kinases, and endocytosis challenges the traditional definition that cardiotonic steroids (CTS) are NKA inhibitors. Although additional effects of CTS have long been suspected, revealing its agonist impact through the NKA receptor could be a novel mechanism in understanding the basic biology of NKA. In this study, we tested whether different structural CTS could trigger different sets of NKA/effector interactions, resulting in biased signaling responses without compromising ion-pumping capacity.

Na/K-ATPase Signaling and Cardiac Pre/Postconditioning with Cardiotonic Steroids.

The first reports of cardiac Na/K-ATPase signaling, published 20 years ago, have opened several major fields of investigations into the cardioprotective action of low/subinotropic concentrations of cardiotonic steroids (CTS). This review focuses on the protective cardiac Na/K-ATPase-mediated signaling triggered by low concentrations of ouabain and other CTS, in the context of the enduring debate over the use of CTS in the ischemic heart. Indeed, as basic and clinical research continues to support effectiveness and feasibility of conditioning interventions against ischemia/reperfusion injury in acute myocardial infarction (AMI), the mechanistic information available to date suggests that unique features of CTS-based conditioning could be highly suitable, alone /or as a combinatory approach.

Use of participatory visual narrative methods to explore older adults' experiences of managing multiple chronic conditions during care transitions.

Background: Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care.

Preconditioning and Postconditioning by Cardiac Glycosides in the Mouse Heart.

Ouabain preconditioning (OPC) initiated by low concentrations of the cardiac glycoside (CG) ouabain binding to Na/K-ATPase is relayed by a unique intracellular signaling and protects cardiac myocytes against ischemia/reperfusion injury. To explore more clinically applicable protocols based on CG properties, we tested whether the FDA-approved CG digoxin could trigger cardioprotective effects comparable with those of ouabain using PC, preconditioning and PostC, postconditioning protocols in the Langendorff-perfused mouse heart subjected to global ischemia and reperfusion. Ouabain or digoxin at 10 μmol/L inhibited Na/K-ATPase activity by approximately 30% and activated PKCε translocation by approximately 50%.

Researching safety culture: deliberative dialogue with a restorative lens.

Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results.

Characteristics of nursing professionals and the practice of ecologically sustainable actions in the medication processes.

Objectives: to verify the correlation between the characteristics of professionals and the practice of sustainable actions in the medication processes in an ICU, and to determine if interventions such as training and awareness can promote sustainable practices performed by nursing staff in the hospital.

Methods: before-and-after design study using Lean Six Sigma methodology, applied in an intensive care unit. Nursing staff were observed regarding the practice of ecologically sustainable actions during medication processes (n = 324 cases for each group (pre and post-intervention)) through a data collection instrument.

Mast cells regulate myofilament calcium sensitization and heart function after myocardial infarction.

Acute myocardial infarction (MI) is a severe ischemic disease responsible for heart failure and sudden death. Inflammatory cells orchestrate postischemic cardiac remodeling after MI. Studies using mice with defective mast/stem cell growth factor receptor c-Kit have suggested key roles for mast cells (MCs) in postischemic cardiac remodeling.

Contributions of the sandwich doctoral program to methodological approaches: an experience report.

Objective To share our experience on theoretical and methodological insights we have gained as researchers working together during the Sandwich Doctoral Program. Method This is a descriptive experience report. Results We have incorporated restoration thinking into a study on patient safety culture and will enhance knowledge translation by applying principles of deliberative dialogue to increase the uptake and implementation of research results.

Myoscape controls cardiac calcium cycling and contractility via regulation of L-type calcium channel surface expression.

Calcium signalling plays a critical role in the pathogenesis of heart failure. Here we describe a cardiac protein named Myoscape/FAM40B/STRIP2, which directly interacts with the L-type calcium channel. Knockdown of Myoscape in cardiomyocytes decreases calcium transients associated with smaller Ca(2+) amplitudes and a lower diastolic Ca(2+) content.

Periodontal dysbiosis linked to periodontitis is associated with cardiometabolic adaptation to high-fat diet in mice.

Periodontitis and type 2 diabetes are connected pandemic diseases, and both are risk factors for cardiovascular complications. Nevertheless, the molecular factors relating these two chronic pathologies are poorly understood. We have shown that, in response to a long-term fat-enriched diet, mice present particular gut microbiota profiles related to three metabolic phenotypes: diabetic-resistant (DR), intermediate (Inter), and diabetic-sensitive (DS).

Engaging Direct Care Providers in Improving Infection Prevention and Control Practices Using Participatory Visual Methods.

The purpose of this quality improvement project was to determine the feasibility of using provider-led participatory visual methods to scrutinize 4 hospital units' infection prevention and control practices. Methods included provider-led photo walkabouts, photo elicitation sessions, and postimprovement photo walkabouts. Nurses readily engaged in using the methods to examine and improve their units' practices and reorganize their work environment.

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

Background: Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs.

Understanding Perceptions and Practices for Zambian Adults in Western Province at Risk for Hypertension: An Exploratory Descriptive Study.

Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants.

Development and evaluation of a workshop to support evidence-based practice change in long-term care.

To support evidence-based practice changes in long-term care, we used a practice development approach with interactive workshops to engage teams from 10 organizations in participatory change. Data from postworkshop surveys and subsequent semistructured interviews indicated that participants felt empowered to identify a priority challenge and initiate change. Notably, the workshop intervention enhanced collaboration between professional and unregulated staff, fostered the development of shared vision, and provided the impetus to tackle workplace barriers to change.

Carabin protects against cardiac hypertrophy by blocking calcineurin, Ras, and Ca2+/calmodulin-dependent protein kinase II signaling.

Background: Cardiac hypertrophy is an early hallmark during the clinical course of heart failure and is regulated by various signaling pathways. However, the molecular mechanisms that negatively regulate these signal transduction pathways remain poorly understood.

Methods And Results: Here, we characterized Carabin, a protein expressed in cardiomyocytes that was downregulated in cardiac hypertrophy and human heart failure.

Engaging nurses to strengthen medication safety: Fostering and capturing change with restorative photographic research methods.

We used participatory photographic research methods adapted from the field of ecological restoration to engage Brazilian intensive care unit nurses in a critical review of medication safety in their work environment. Using focus groups, practitioner-led photo walkabouts with photo narration, and photo elicitation focus groups in iterative phases of data collection and analysis, nurses developed and implemented several practical and cultural improvements for their unit. Participants focussed on organizing the medication room for efficient workflow and accessible supplies, improving reporting practices, and reconsidering how they could manage safety issues in their unit and in the hospital as a whole.

Exploring safety and quality in a hemodialysis environment with participatory photographic methods: a restorative approach.

This study used principles and methods of good ecological restoration, including participatory photographic research methods, to explore perceptions of safety and quality in one hemodialysis unit. Using a list of potential safety and quality issues developed during an initial focus group, a practitioner-led photo walkabout was conducted to obtain photographs of the patient care unit and nurses' stories (photo narration) about safety and quality in their environment. Following a process of iterative coding, photos were used to discuss preliminary themes in a photo elicitation focus group with four additional unit staff The major themes identified related to clutter, infection control, unit design, chemicals and air quality, lack of storage space, and health and safety hazards (including wet floors, tripping hazards from hoses, moving furniture/chairs).

Using video-elicitation to assess risks and potential falls reduction strategies in long term care.

Purpose: To assess the ability to use and the usefulness of video-elicitation to study risks and potential ways to reduce transfer-related falls in long term care.

Method: A qualitative research study was conducted in a long term care facility and included a purposeful sample of 16 subjects (6 residents, 6 health care providers, and 4 family members). Field observations, interviews, video-recordings of assisted transfers, and video-elicitation sessions were conducted with the participants.