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Risk factors regarding prolonged venting after thymectomy within thymoma myasthenia gravis sufferers.
Digital health technologies such as smartphones present the potential for increased access to care and on-demand services. selleck compound However, many patients with serious mental illnesses (eg, schizophrenia) have not been offered the digital health training necessary to fully utilize these innovative approaches. To bridge this digital divide in knowledge and skills, we created a hands-on and interactive training program grounded in self-determination theory, technology use cases, and the therapeutic alliance. This article introduces the need and theoretical foundation for and the experience of running the resulting Digital Opportunities for Outcomes in Recovery Services (DOORS) group in the setting of 2 programs a first-episode psychosis program and a clubhouse for individuals with serious mental illness. The experience of running these 2 DOORS groups resulted in 2 publicly available, free training manuals to empower others to run such groups and adapt them for local needs. Future work on DOORS will expand the curriculum to best support digital health needs and increase equity of access to and knowledge and skills related to technology use in serious mental illness.This study assessed the defense style of children referred to an outpatient clinic and examined what this style contributes to discriminating among various disorder categories, beyond internalizing and externalizing symptoms. A sample of 433 children and adolescents were grouped into four disorder categories disruptive, depressive, anxiety, and attention deficit hyperactivity disorder. Their parents completed the Comprehensive Assessment of Defense Style (CADS mature, self-oriented, and other-oriented) and the Child Behavior Checklist (CBCL internalizing and externalizing symptoms). The disorder categories differed in the use of other-oriented defenses (e.g., acting-out, projection), whereas the CADS helped in properly discriminating most diagnostic categories beyond the CBCL. Information provided by the children themselves was missing, as was a subsample of nonclinical participants; these sources could strengthen the conclusions of the study. Assessing children's defense style together with their symptoms may result in better statistical discrimination among diagnostic categories.In this study, we examine the influence of organizational trust on organizational commitment among licensed practical nurses (LPNs). Guided by prior research and theory, we also consider whether psychological empowerment mediates the influence of organizational trust on organizational commitment. To accomplish these tasks, we examine data from our survey of all registered LPNs in a Midwestern US state on their levels of organizational trust, psychological empowerment, and organizational commitment. Using path decomposition procedures, we isolate the net effect of organizational trust on organizational commitment into total, direct, and indirect effects. Our findings suggest that organizational trust is positively associated with higher levels of organizational commitment. Furthermore, more than a fifth of this relationship is mediated through one's level of psychological empowerment. These findings provide some insight into antecedents of organizational commitment among LPNs. The results of this investigation are especially timely considering the extant issues associated with staffing levels in facilities employing LPNs in the United States.Members of Generation Y (or Millennials) now make up more than 50% of those in the workplace. They are expected to comprise greater than 75% by 2025. The Millennial generation has brought new idiosyncrasies to the workplace, and most literature has focused on ways to manage these differences. The Baby Boom generation is retiring at an increasing pace, leaving ongoing leadership needs in the care of Millennials. Conversations must now shift from how to lead the Millennials to preparing them to lead others. The SHAPE framework highlights some of the idiosyncrasies of this generation and ways they can be leveraged when approaching the challenges of health care today.It is challenging to implement a hospital discharge process that effectively prepares patients for success at home, especially when self-care needs are immense. This article describes a disruptive model that leverages nurse autonomy on an acute care medical-surgical hospital unit. The integration of an education resource nurse within existing resources is showing positive gains in 30-day readmission rates and specific patient experience metrics. The continued success of this newly created role is dependent on an adaptive capacity to leverage principles of complexity leadership and to grow the role within the ever-changing health care environment.This article discusses role emergence from master's-prepared nurse practitioners to Doctor of Nursing Practice (DNP) innovative leaders who utilize Complexity science to impact health care organizations. DNP leaders are in position to disrupt linear traditional leadership and embark on new ideas for improvements in care delivery, organizational system processes, and policies within health care. Complexity science provides the necessary theoretical framework for nurse executives and stakeholders to interact with DNP leaders by engaging in collaborative efforts, cultivating communication from point of service providers to administrators, and coordinating interdisciplinary teams to approach gaps in practice, clinical issues, health care policy, and organizational sustainability. The DNP leader is aware that health care organizations are complex adaptive systems, continuously changing. These require skilled and knowledgeable leaders to support growth within an uncertain environment, and bring evidence to practice while promoting organizational wellness.As Doctor of Nursing Practice (DNP) students and graduates begin to apply new knowledge in real-life situations, they are transforming their organizations. The impact of DNP projects is noted by measurable outcomes in diverse settings. This article presents 4 unique clinical/organizational examples of DNP projects. The authors have identified an application of complexity science and leadership theory in their practice changes. In addition, they share their thoughts and feelings as emerging leaders.The school nurse role parallels the growing complexity of health care, education, and the social needs of youth in the United States. The complex and chaotic environment of the school setting requires leaders to be flexible and to have the ability to recognize and tackle the ever-changing needs of this environment. School nurses are in a prime position to enact change and drive the culture of the community, giving it purpose, while allowing its members to have a focus on their work. Nurses, as complexity leaders, are positioned to understand that change is a continual process that stems from collaboration, complex systems thinking, and innovation mindsets.The US health care system has seen unprecedented growth in health care cost with only a mediocre return on investment. Achieving sustained quality improvement will require innovation that is effectively integrated into complex systems of care. Complexity leadership has the ability to place value on traditional quality improvement processes, with less focus on rigid structure and more attention on the potential for flexibility and creativity at the point of care. Clinical team leaders, such as nurse practitioners, must nurture adaptability to the constantly changing clinical environment while balancing structured thinking of team members. Nurse practitioners operating in interdisciplinary teams are well positioned to foster adaptive change through rapid cycle improvements at the point of care. As a learning approach to quality improvement, the PDSA (plan-do-study-act) method should be seen as a useful tool for organizations to create an emergent quality improvement process. This article discusses the significance of nurse practitioner leadership using the PDSA method informed by complexity leadership theory and the impact for clinical practice.The Human-Centered Leadership model, which is relevant for leaders at all levels in a complex health care system, embraces change from the inside out. The Human-Centered Leader (HCL) is embedded in the organization, rather than positioned above it, and recognizes the expertise and value of those who serve at the point of care. The HCL starts with a focus on self-awareness, self-compassion, self-care, and mindfulness while focusing on others through demonstration of the characteristics of an Awakener, a Connector, and an Upholder. As an Awakener, the HCL grows and cultivates the team through the development of individual growth plans and staff empowerment in decision making. The result is a professionally prepared workforce that delivers market-leading patient outcomes. The HCL, as a Connector, builds the community in the microsystem by creating a healthy work environment. Finally, as an Upholder, the HCL recognizes the humanity in others and brings out the best in them. Demonstration of sincere care for those who care for patients results in improved staff satisfaction and, in turn, exceptional patient experience. The sustainable changes resulting from Human-Centered Leadership are realized through development of Cultures of Excellence, Trust, and Caring.Consolidation through mergers and acquisitions is occurring across health care as a strategic move to address the disruptive forces of complexity. While consolidation is improving the overall fitness and viability of health care organizations, it is having the opposite effect on the professionals working within them who are reporting increasing rates of burnout from ongoing complexity in the health care environment. This happens in all organizations that try to respond to complexity with traditional bureaucratic leadership approaches. What is needed is to replace bureaucratic leadership with the networked approach of complexity leadership. The idea is not to "do more with less" but to "do things better." In this article, we show how to do this by applying complexity leadership to the nursing context. Complexity leadership is a framework for enabling people and organizations for adaptability. It views leaders not as managerial implementers of top-down directives but as collaborators who work together to enhance the overall adaptability and fitness of the system. From a complexity leadership perspective, the role of nurse leaders should be not only to help the system run but also to help it run better by increasing organizational adaptability.Since the 1990s, complexity science has been utilized as a metaphor for understanding health care organizations and new ways of leading within them. In this article, 3 principles of complexity leadership put forth by Porter-O'Grady and Malloch in the text Quantum Leadership are explored (1) wholes are not just the sum of their parts; (2) all health care is local; and (3) value is now the centerpiece of service delivery. Each of these principles is discussed from a 20th-century "organization as machine" perspective, a complexity science perspective, and a complex relational processes (CRP) view. The CRP lens provides a useful bridge from the hard science (nonhuman) systems metaphor to what we often think of as the soft skills of relationship building and communication. CRP does this by drawing on philosophy and the social sciences of sociology and psychology as a way to humanize the nonhuman metaphors of complexity science. This opens up new ways of understanding and talking about leadership in organizations. This shifts our traditional thinking of individuals as leaders to a more relational process of complex relational leading that occurs between people within organizations.
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