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An award-winning journalist spoke to a group of students during their first month in a baccalaureate nursing program, challenging the nursing profession to abandon its image of nurses as angels and promote an image of nurses as competent professionals who are both knowledgeable and caring. This presentation elicited an unanticipated level of emotion, primarily anger, on the part of the students. This unexpected reaction prompted faculty to explore the students' motivations for entering the nursing profession and their perceptions of the relative importance of competence and caring in nursing. The authors begin this article by reviewing the literature related to motivations for selecting a profession and the contributions of competence and caring to nursing care. Next they describe their survey method and analysis and report their findings regarding student motivations and perceptions of competence and caring in nursing. Emerging themes for motivation reflected nursing values, especially altruism, and coincided with students' beliefs of self-efficacy and goal attainment. Student responses indicated their understanding of the need for competence and revealed idealistic perceptions of caring. The authors conclude with a discussion of these themes and recommendations for student recruitment, curricular emphasis, and future research in this area.
Keywords: nursing profession, nursing shortage, competence, caring, motivation, image of nursing, nursing education, altruism, nursing values, self-efficacy, nursing student recruitment
The image of nursing is changing. Images of angels in starched skirts and nursing caps eagerly awaiting guidance from physicians has long since been replaced by images of competent, independent men and women of diverse backgrounds. Yet iconic images in nursing may continue to play a role in choosing a career. For example, individuals may choose nursing because they identify with certain nursing role models, such as Florence Nightingale, the lady with the lamp, who cared for soldiers in the Crimean War and changed the status of nurses in the 19th century. Newer images, such as those of competent and caring nurses, can also attract new members to the profession. This study explored students' motivation(s) for entering nursing and perceptions of the importance of competence and caring in nursing.
They took offense that a 'non-nurse' had the audacity to say that nurses should consider relinquishing the image of "angels in white" and demand recognition for their work. An award-winning journalist spoke to a group of students during their first month of a baccalaureate program at a southeastern school of nursing in the United States (US). These students were junior level in college and beginning their nursing courses. Faculty selected this speaker with the goal of increasing both student awareness of iconic and current images associated with nursing and student recognition that nursing is a cognitively challenging discipline. The faculty wanted the students to gain an informed consumer's perspective on the importance of nurses and to create their own personal philosophies of nursing. The speaker, who was not a nurse, focused on the importance of making the public aware of both the competencies (knowledge and skill) of registered nurses (RNs) and the caring component of nursing. She emphasized the essential work of nurses, and noted that the public remains less familiar with the competencies needed by today's nurses than with the angelic image of nurses who put the needs of others before those of their own health and careers. Students responded with an unanticipated degree of emotion, primarily anger. Some students verbalized that nursing is a 'calling.' They took offense that a 'non-nurse' had the audacity to say that nurses should consider relinquishing the image of "angels in white" and demand recognition for their work.
Faculty feared that the students did not have a clear understanding of, or appreciation for, the knowledge required by a professional nurse. Student comments regarding the presentation suggested to the faculty that many of the students believed the most important attribute for a nurse was the ability to provide compassionate care. Faculty feared that the students did not have a clear understanding of, or appreciation for, the knowledge required by a professional nurse. In response three faculty members who worked closely with these first semester nursing students decided to explore the source(s) of student comments and reactions. They began planning an investigation of students' motivations for seeking careers as nurses and students' perceptions and assumptions related to nurse competence and caring in nursing. They decided to ask the following questions:
- What is the stated primary motivation of students for entering the nursing profession?
- What are student perceptions and assumptions regarding competence in nursing?
- What are student perceptions and assumptions regarding caring in nursing?
Review of Related Literature
Gordon (2005) described the historical, stereotypical (iconic) view of the nurse as that of a physician's handmaiden, dependent on the physician for direction. She explained that the nursing profession has been negligent in sharing with the public the importance of nurses' critical thinking, problem-solving, and research skills. Nurses have failed to help the public understand that nurses' actions involve more than nurturing; they also include assessing, surveying for risks, identifying client goals, planning independent actions, and prioritizing care. Gordon (2006) has stated that in order to gain and maintain the respect of the public and other healthcare professionals, nurses must emphasize and communicate the knowledge and skills required for professional nursing. It is also imperative that those responsible for reimbursement of nursing care understand that nurses "save lives, prevent complications, prevent suffering, and save money" (para. 5). O'Mara (1999) has argued that in order to assure reimbursement and access to needed resources nurses need to articulate the cognitive abilities nurses need in order to provide competent care. Benner, Sutphen, Leonard, and Day (2010), too, have written that nurses must learn to emphasize the tangible benefits of nurses, beyond that of caring. In the remainder of this literature review we will look at motivations for choosing nursing as a career and review the literature identifying the need for both competence and caring skills in nursing.
According to Locke and Latham (2002), personal goals are vital for direction and maintenance of behaviors that help to achieve future rewards. Effective goal setting can be a source of motivation as an individual pursues a career. The social cognitive career theory (SCCT) has postulated that self-efficacy beliefs and outcome expectations are key motivators for career selection. Individuals who are confident of goals, who believe in their ability to reach their goals, and who believe that goal attainment will lead to a successful career are able to complete the tasks required to achieve their goals (Lent, Brown, & Hackett, 1994).
In a systematic review of literature related to career choices of gifted and talented students, Miller and Cummings (2009) identified one career motivator as the perception of a fit between a career and one's personal self-concept. Miller and Cummings found career choices to be based on the belief that an individual possesses the necessary traits to be successful. They also found that career choices were influenced by family members, specifically mothers. These gifted students preferred careers that were prestigious and required higher levels of education. Hoke (2006) observed that to recruit talented students, the nursing profession must educate the public regarding the high level of critical thinking required for nurses and the potential for nurses to impact global problems.
Emmons (1999) approached career choices from a strivings perspective in which goals are assessed based on what the individual is striving to achieve. The list of possible goals is then assessed for the impact of specific motives on the person's choice of goals. Other motivating factors for career choices may be based on spiritual beliefs, feelings of being 'called' into a specific area, and materialistic desires (Dik, Sargent, & Steger, 2009).
The U.S. Institute of Medicine (IOM) (2003) mandated increased attention to factors that promote quality and safety of patient care. Since this mandate was issued, outcomes of patient care have become increasingly important. In response, Cronenwett et al. (2007) have proposed that "statements of the knowledge, skills, and attitudes (KSAs) for each competency … should be developed during prelicensure nursing education" (p. 122). Competencies identified by the IOM and addressed by the Quality and Safety Education for Nurses (QSEN) now include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (Cronenwett et al., 2007; IOM, 2003).
The American Association of Colleges of Nursing (1998, 2008) and the National League for Nursing (2007) have identified caring as a foundational value for nursing. Shultz (2009) has described attempts in nursing education to guide progression from a personal identification as a caring person to a professional 'identity of caring.' Benner (2000), Benner, Tanner, and Chelsa (2009), and Benner and Wrubel (1989) have proposed that caring is a requisite for the development of critical thinking. Stowe (2006) investigated educational strategies in nursing education that were designed to promote understanding of caring as an abstract concept and concluded that nursing education's efforts to "impact a more consciously caring individual for our society is invaluable" (pp. 127-128).
The above insights support Purnell's (2009) conclusion that caring includes themes of struggle, discovery, hope, humility, and spirituality (p. 115). Falk-Rafael (1996) proposed that caring in nursing has evolved from an ordered (or required) caring (associated with characteristics such as nurturing), to an assimilated caring (as nursing developed into an autonomous profession), and then further evolved to an empowered caring (as individual nurses realized nursing interactions support caring connections) within an interprofessional healthcare delivery system that has an ever-changing power base. Falk-Rafael suggested that empowered caring is informed by both knowledge and experience.
Study Survey and Analysis
After receiving approval from the Auburn University at Montgomery Institutional Review Board, one member of the research team met, less than one week after the presentation, with the 78 students who had heard the presentation. These students had completed the first month of their baccalaureate nursing curriculum, but had not yet started their clinical experience. Students were currently enrolled in nursing concepts, pathology, nursing skills, and physical assessment courses. The faculty member explained that the student reaction to the recent speaker had been noted by the faculty who sensed that the students did not wish to relinquish their angelic image of nurses because they identified with the image of the nurse as a caring person. She added that the faculty desired to further study and understand the students' motivation for entering a nursing program, their reactions to the presentation, and their perceptions of the importance of caring and competency in providing patient care. Students were invited to participate voluntarily in the study and assured of anonymity; informed consents were obtained. The surveys were completed individually in the classroom.
Participating nursing students were asked to write answers to the following three open-ended questions as they appeared on the questionnaire:
- What was your primary motivation for entering the profession of nursing?
- In what way is competence important in the role of the professional nurse and how can this best be explained to non-nurses? Fully explain your answers with examples and specifics.
- In what way is caring important in the role of the professional nurse and how can this best be explained to non-nurses? Fully explain your answer with examples and specifics.
Seventy-four of the 78 junior level students responded to the survey. This included 62 (84%) female and 12 (16%) male respondents. In terms of ethnicity, 54 (73%) of the responders were Caucasian, 15 (20%) African American, 1 (1.4%) Mexican American, 1 (1.4%) Hispanic, 1, (1.4%) Filipino, and 2 (2.8%) were described as 'other.'
Ages ranged from 19 to 48 years of age with 1 student (1%) being 19 years old, 14 students (19%) being 20 years of age; 23 students (31%) being 21-year-olds, 22 students (30%) ranging from 22 - 29 years of age, and 13 students (18%) being 30 - 48 years old. One student did not provide an age.
Surveys were transcribed by typing the responses onto an Excel spreadsheet; copies were distributed among the three faculty members (authors) for independent content analysis of student comments. The researchers analyzed the data using a deductive form of content analysis. As a deductive process, data analysis began with previously accepted theory (Glaser & Strauss, 1967). In this study, the question topics of motivation, caring, and competence, which are pivotal to nursing, constituted the foci for this data analysis and were used in the coding process. After researchers each conducted an independent content analysis considering the question topics, they met and determined categories of responses within the three question topic areas; these categories included motivation, competence, and caring. After the second independent analysis, faculty collectively identified emerging themes from the categorized data (see Table). For example, one category of responses included "intellectual challenge," "love of science," and "interest in human body." This category of responses was described as the 'intellectual' theme. Individual comments often met criteria for multiple themes within a single category, e.g. under Motivation, comments may have addressed both Altruism and Attractiveness of profession. In these cases the researchers included the comments under all appropriate themes. Additionally, a numerical count of the frequency with which the categories of responses occurred was conducted, determining the most prevalent themes as presented in the Findings section
Among the 74 respondents, Altruism was identified as the most dominant theme. Students identified themselves as caring individuals. One stated, "I have a caring heart." Several students specifically stated that they wished to help children or others "in need." Some addressed the vulnerability of individuals and their wish to contribute to society; others identified global health needs.
Second in prevalence was Attractiveness of the nursing profession. In this theme, job security, flexibility, work conditions, and professional status were identified. Job flexibility included work schedule, the variety of options in nursing, and the ability to change jobs within a facility or throughout the country. Autonomy of practice and interaction with people were also identified as attractors. Several commented that nursing, rather than medicine, attracted them because they perceived nursing involved greater interaction with people.
In addition, students identified Background knowledge of the nursing profession as a motivator, explaining that family members who were nurses or who worked as healthcare team members gave them some understanding of what nursing is about. Others developed either positive or negative impressions of nursing as a result of personal or family illnesses. One respondent described that caring for grandparents "even being young" provided the motivation to choose nursing as a career.
Within the Spirituality theme, five respondents referenced God as their motivation for nursing. One participant stated, "I was blessed with a gentle heart, I need to share His blessing…be His instrument." Others indicated that nursing was their "calling from God" or "purpose." One student added that nursing would allow participation in medical mission trips.
Researchers identified the Intellectual theme from student responses indicating it would be intellectually challenging to gain nursing knowledge and skill proficiency. Several stated the human body was "fascinating" or that they had always been interested in the science of human anatomy. Some combined their interest in both science and caring for people.
The Fulfill personal needs theme emerged as students expressed the need to help others in such a way that the researchers perceived students' self-need as greater than an expressed altruistic intention. "I want to have a rewarding [career] …need human contact" and "I would always have a job and always be needed" were examples of self-need. Others described themselves as caring people and expressed a desire for fulfillment of their dreams or goals.
Students overwhelmingly acknowledged Intelligence as a major factor in nursing competence. Three distinct areas describing Intelligence included saving lives, understanding disease processes and preventing mistakes, and patient surveillance. Students depicted saving lives in comments such as "knowledge saves lives." Fifteen students used the words "life or death" in describing the importance of competence in nursing. Respondents acknowledged that nursing "mistakes can be fatal" indicating that knowledge is required to prevent untoward patient outcomes. Students explained the importance of Intelligence regarding patient surveillance in explaining that nurses "make assessments" and "use the knowledge and expertise for a positive outcome." Several stated "critical thinking" was required to "make decisions" and "provide care."
Eight respondents addressed the need for competence with regard to Skills. Several added the need to understand or use their critical thinking abilities to "perform skills and tasks well." Two included the need for documenting patient care "accurately." Some remarked that competence was "required to be professional;" others stated that nurses need to be accountable for their competence, both in "practicing skills" and "maintaining currency."
Students responded with contrasting themes regarding Self as it refers to competence. Several responded "with competence comes confidence," indicating that once a nurse was competent in critical thinking, clinical judgment, and performing skills, the nurse would become confident. Others responded that experience and confidence preceded competence. Two suggested that competence is required for success in effectively providing care as well as success in one's career.
The final theme in this category involved being Other focused. Students identified competence as prerequisite to establishing trust with others. One wrote that competence is important because "it makes patients want you to take care of them." Another student stated "patients and health professionals trust competent nurses." Still others discussed the role of competence in the ability to understand holistic care, adding, for example that competence "addresses patients holistically - in all dimensions."
Altruism and attractiveness of the profession were identified as primary motivations for seeking nursing as a career. Over two-thirds expressed caring as an essential Nursing characteristic. Many described caring as "essential," "the most important trait," "central to nursing," or "critical to the role." Some provided perspectives from those receiving care: "non-caring [nurses] will give a negative persona," a caring nurse can cause patients "not to be scared," and the absence of care "will affect patients psychologically, emotionally and physically." Others indicated that caring separated nursing from other professions and is essential for providing holistic care, writing for example, "must care to give patients the best possible care." Other comments included "without caring…not a nurse" and "even if no one else cares, nurses do."
Students identified caring as a motivation to be competent so as to promote positive Outcomes for patients. They noted that caring increases competence, ensuring nurses will properly assess patients and perform skills. Other responses included:
Without caring, you will not do your best.
This will impact the dedication of nurses to provide holistic care.
One willing to teach, listen while giving competent care.
Caring also was considered necessary to "prevent complications" by "checking the patient" as often as needed and "performing skills that may be unpleasant."
Regarding the theme Connection and Trust, students described the importance of caring in establishing the nurse-patient relationship from both the nurse and patient perspectives. Caring is "essential in developing the trust in the nurse-patient relationship," a "patient [is] more likely to interact and communicate with a caring nurse," "allows clients to understand their self-worth," and "a nurse connects and develops relationships" by caring. Comments indicated that caring leads to trust which results in a positive impact for the patient. Responses included comments, such as "patients will most likely trust and relax/reduce anxiety" and "once a positive relationship [has developed, the nurse] can focus on health promotion of the client." Additionally, students addressed potential problems if caring were absent, noting that the nurse "might be competent but not show any compassion or care to your patient. This builds a wall ….then your patient will not open up to you….This could interrupt a nurse's assessment of a patient."
...these students freely explained why they chose nursing as their profession. Students also indicated Giving of self was an important measure of nurses' caring. One student defined caring as "the unselfish extension of one's self." Another stated that a nurse who does not care about anything but her/himself will not be concerned for a patient. Several students discussed going "the extra mile" to "help in any way possible." Others described a more angelic perception of nurses' caring, noting that nurses care for a client or family of a client "because you do so willingly, without hesitation," and "a nurse who cares will do what needs to be done to provide the best care for her patient."
Valuing another was described by students as showing "concern" for patients' well-being and "empathy" towards others. One explained that caring was an "attitude toward others" and "clients need to feel that nurses care….It seems to be one of the easiest skills of nursing….Just being with someone can show that you care and respect and want to understand their situation." Others added the following responses:
[Caring] "helps a patient feel better"
[Caring] is important when the nurse has to provide unfavorable information.
By taking a few extra minutes, we can give our patients a feeling of importance
Additionally, one student wrote, "I believe nurses are the number one most trusted profession because of their ability to care for each patient."
In summary, these students freely explained why they chose nursing as their profession. They also identified the need for both competence and caring on the part of the nurse.
[Students] especially noted the importance of intelligence for making sound patient care decisions. Students' descriptions of their motivation for entering the nursing profession and their perceptions and assumptions related to nurse competence and caring both support previous research and provide implications for recruiting and retaining students in nursing education programs. Altruism and attractiveness of the profession were identified as primary motivations for seeking nursing as a career. Students demonstrated an understanding that nurse competence and caring are both essential for safe and quality patient care. Most identified caring as an essential quality of nurses. They especially noted the importance of intelligence for making sound patient care decisions and the benefits of valuing another, connection and trust, and giving of self as important ways of demonstrating care to patients. In this section themes will be discussed in the order of prevalence from student responses.
To attract new nurses into the field nursing needs to be perceived as a financially secure career. In this study students identified Altruism, i.e., making a difference for others, as motivation for a nursing career. This finding supports the work of Cook, Gilmer, and Bess (2003) who also reported that the beginning nursing students they studied identified their desire to help others as a major reason for choosing nursing as a career. It also supports the social cognitive career theory (SCCT) premise of self-efficacy, i.e., ability to make a difference, as a career motivator (Lent, Brown, and Hackett; 1994).
The finding that Attractiveness of the nursing profession influenced the choice of nursing as a career supports the SCCT construct postulating that people will continue in a task as long as doing so has value to them. To attract new nurses into the field nursing needs to be perceived as a financially secure career. In the late 1980s and early 1990s nursing was not seen as desirable career because it lacked adequate long-term compensation and a clear career pathway (Bonawit, 1989; Champion, Austin, & Tzeng, 1987; Fagin & Maraldo, 1988; Lumby & Zetler, 1990; Meleis, 1991). Participants in this study repeatedly stated that the flexibility and job security were major factors motivating them to choose nursing as a career.
Participants in this study repeatedly stated that the flexibility and job security were major factors motivating them to choose nursing as a career.Background in nursing was another strong motivator for these nursing students. This finding supports the work of Hoke (2006) who identified that one's perception of a given field influences interest in the field as a career, and the work of Beck (2000) who reported that one of the top eight reasons nursing was chosen as a career was because of prior work or volunteer efforts in the healthcare field.
Dik, Sargent, and Steger (2009) also found that ideas related to Spirituality or a 'calling' were strong motivators for selecting a career. More research is needed to better understand the nature of this individualistic motivator of career choices.
The perceived Intellectual nature of nursing motivated some students to enroll in the nursing program. The perceived Intellectual nature of nursing motivated some students to enroll in the nursing program. Miller and Cummings (2009) reported that gifted and talented students preferred careers that were prestigious and required higher levels of education. Hoke (2006) recommended that nursing better educate the public as to the high levels of critical thinking required in nursing and the potential nursing has to impact global problems. A greater understanding of this motivator may well attract more students into nursing.
Our finding of the motivating power of Personal needs were similar to those of Buddeberg-Fischer, Klaghofer, Abel, and Buddeberg (2006) who reported career choices to be based on personality traits, career motivation, and life goals. Beck (2000) also reported that love of helping others and the desire for a fulfilling profession led students into the study of nursing.
Although this cohort of students became agitated when the angelic image of nursing was questioned, their responses clearly indicated their belief that competence was at least as important as caring. Hoke (2006) posits that nursing could recruit more young people if the image of nursing was that of an intellectually challenging profession rather than that of a feminine and angelic profession. Within only weeks of beginning their nursing courses, the responses of these students touched on the three areas of competence addressed by the Quality and Safety Education for Nurses (QSEN) initiative (Cronenwett, et al, 2007), namely, knowledge, skills, and attitudes.
We identified four major themes within the Competence category: Intelligence, Skill/Tasks, Self, and Other focused. Students indicated that nurses must think critically so as to make appropriate assessments and promote positive patient outcomes. They noted that self-awareness was important because competence and confidence coexist. Students also addressed competence as a requirement for effective interactions with other healthcare professionals and for providing holistic care for patients. The competency outcomes performance assessment (COPA) model outlines eight essential competency categories for teaching nursing competencies to pre-licensure students: assessment and intervention skills, communication, critical thinking skills, human caring/relationship skills, teaching skills, management skills, leadership skills, and knowledge integration skills (Lenburg, Klein, Abdur-Rahman, Spencer, & Boyer, 2009). Students in their first semester of nursing education remarked on all of the eight categories except management and leadership in their responses regarding nursing competence. The fact that they did not address management and leadership is not surprising given their status as beginning students. We were surprised and pleased that these new students identified the majority of competencies recognized as essential by QSEN and the COPA models.
...nursing curricula can translate the desire to care into motivation for competence. Findings from this research supported Purnell's (2009) identified themes of struggle, discovery, hope, humility, and spirituality. Students identified caring as the essential quality, the essential Nursing characteristic, of nurses and as the focus of all nursing actions. Student statements conveyed struggle in the potential for causing harm if caring was absent. Discovery, hope, humility, and spirituality were represented in nursing interactions with patients and the development of the relationships between nurses and patients that are required for effective nursing care. Findings also supported Falk-Rafael's 1996 discussion of caring and power in nursing as described above. Falk-Rafael proposed that caring in nursing has evolved from a required caring to an assimilated caring, and then further developed to empowered caring within the interprofessional healthcare delivery system, suggesting that empowered caring is informed by knowledge and experience.
Student descriptions regarding the theme Connection & trust supported and further informed challenges inherent in communicating within professional boundaries while building a relationship. Hart (2010) stated that professional boundaries dictate professional behavior and include "issues of self-disclosure…the use of touch, and the overall manner of relating to the patient" (p. 92). Students recognized the challenge of developing therapeutic communication with patients that would promote effective nursing care.
Student responses within the theme Giving of self sustain Roach's premise that caring is a criterion of humanness that can give meaning to one's life. The students' responses support Roach's conceptualization of caring as "the locus of all attributes used to describe nursing" (2002, p. 39). The most frequently mentioned theme was caring as the essential quality of nurses.
Responses from the Valuing another theme revealed students' respect for patients as foundational for using their critical thinking skills and serving as a client advocate. These responses support the IOM's recommendation for patient-centered care in which the critical thinking of nurses, patients, and families merge to provide the best care for a given individual (Rubenfeld & Scheffer, 2010).
Limitations of this study include the small sample size and conducting the study at a single school of nursing in only one location. One factor that may have influenced new nursing students to respond as they did is that the overwhelming majority of the student population was comprised of traditional, southern students active in their Christian churches. Another factor is that although students had not yet started their clinical experiences, they had already explored concepts of caring and communication, roles of professional nurses within the healthcare delivery system, and the importance of critical thinking for clinical judgment. Also the reaction to the speaker may have galvanized students' idealistic views of nursing caring as well as increased their thinking about nursing competence. If this study is to be replicated, we would advise that the survey be given before any classes begin and before students are challenged with thinking about the image of the nursing profession.
Implications and Recommendations
In short, nursing is a very marketable profession – we all need to talk loudly about the value of a career in nursing. Students shared that they entered a nursing program because they valued a career involving altruism, making a difference, intellectual challenges, goal attainment, job security, and flexibility. Nursing needs to present itself, early and often, as a profession that offers these opportunities. Practicing nurses can share these job characteristics with children and young people as they talk with them about career options. Recruiters for nursing programs are encouraged to highlight these opportunities as they meet with potential nursing students. In short, nursing is a very marketable profession – we all need to talk loudly about the value of a career in nursing.
The findings from this study also have implications for the curriculum in nursing education programs. The findings in this study indicate that students do indeed understand the need for competence in practice. Nursing curricula can capitalize on the motivation of students to engage in intellectual challenges and become competent nurses. This suggests that nursing programs should design courses that stimulate and stretch students' cognitive abilities.
...nursing programs should design courses that stimulate and stretch students' cognitive abilities. Nursing students often hold idealistic perceptions of caring. Curricula design should lead students to understand that caring "stimulates critical thinking" (Zimmerman & Phillips, 2000) and is foundational in the development of competencies that will lead to better client outcomes. This research suggests that nursing curricula can translate the desire to care into motivation for competence.
Deliberate use of dissonance to promote critical thinking and reflection can be used to focus on specific concepts so as to promote transformative learning (Forbes & Hickey, 2009). Students in this study noted that while the speaker challenged their image of nurses, the experience prompted them to review their assumptions about caring and personal identity as future nurses, thus contributing to their professional transformation.
Further research to identify effective teaching strategies to promote both competence and caring in nursing will assist faculty to retain students and maintain the balance of competence and caring in nursing. A research study is already being planned to follow this cohort of students and identify their values and beliefs about nursing at the time of their graduation to determine in what ways their educational experiences may have changed their perceptions of competence and caring. Researching experienced nurses' insights regarding competence and caring as well as reviewing their motivations for entering and remaining in the nursing profession may offer strategies that will help nursing managers improve nurse retention. Additional research should include replication of this study in associate degree and diploma pre-licensure nursing programs, registered nurse to baccalaureate programs, and baccalaureate programs in other regions of the United States.
The image of nurses as 'competent and intelligent caregivers' must become as well known as the image of nurses as 'angels in white' so as to attract qualified individuals to the nursing profession. This study explained how a speaker created cognitive dissonance within students that was resolved when students intentionally considered their assumptions about nursing in a reflective self-assessment that led to their growth in professional identity. The findings of this study suggest that although these students did not wish to relinquish the image of nurses as angelic care givers, they saw considerable value in promoting the image of nurses as competent and intelligent caregivers. The image of nurses as 'competent and intelligent caregivers' must become as well known as the image of nurses as 'angels in white' so as to attract qualified individuals to the nursing profession. Competence and caring are interrelated. These traits need to be developed in students and sustained in nurses to recruit nurses into the profession and move nursing forward as a profession that truly makes a difference in patient outcomes.
Letter to the Editor
by Avila
Marilyn K. Rhodes, EdD, MSN, RN, CNM
E-mail: firstname.lastname@example.com
Dr. Rhodes is an Assistant Professor at Auburn University Montgomery School of Nursing in Montgomery, AL. She has taught baccalaureate nursing students for over six years and held midwifery faculty and clinical appointments since 1982. She retired at the rank of Colonel from the United States Air Force Nurse Corps after 30 years of service. Dr. Rhodes earned a BSN at Spalding University, Louisville, KY, and an MSN with a Certificate in Midwifery from the University of KY, Lexington, KY. After nearly twenty years of midwifery, she began teaching as a clinical adjunct and returned to school to obtain an EdD in Leadership Education from her alma mater, Spalding University.
Arlene H. Morris, EdD, MSN, RN, CNE
E-mail: firstname.lastname@example.com
Dr. Morris is an Associate Professor at Auburn University Montgomery School of Nursing in Montgomery, AL. She has taught baccalaureate and RN to BSN students for the past 18 years. Dr. Morris, a Certified Nurse Educator, teaches a variety of courses and especially enjoys teaching professional nursing issues and gerontology. She was awarded the Distinguished Teaching Award from Auburn Montgomery. Dr. Morris graduated with her BSN from Harding University in Searcy, AR, and with her MSN from Troy University in Troy, AL. She received her EdD from Auburn University in Auburn, AL.
Ramona Browder Lazenby, EdD, RN, FNP-BC, CNE
E-mail: email@example.com
Dr. Lazenby is the Associate Dean and Professor at Auburn University Montgomery School of Nursing. She has taught nearly every course in the baccalaureate and graduate nursing programs and is a certified registered nurse practitioner with the university nursing care center and outreach programs. Dr. Lazenby has been awarded the Distinguished Teaching Award from Auburn Montgomery and is a Certified Nurse Educator. She received her BSN from the University of Alabama (Birmingham); her MSN from Troy University in Montgomery, AL; her Family Nurse Practitioner Certificate from the University of Alabama (Birmingham), and her EdD from Auburn University, Auburn, AL.
MOTIVATION | Love of people | Altruism |
Job security | Attractiveness | |
Experiences with nurses or health care system | Background | |
God | Spirituality | |
Intellectual challenge | Intellectual | |
Fulfill personal need | Fulfill personal need | |
COMPETENCE | Life or death | Intelligence |
Skill / Tasks | Skill / Tasks | |
Confidence | Self | |
Establish trust | Other focused | |
CARING | Innate quality | Nursing characteristics |
Motivation to be competent | Outcomes | |
Builds / establishes trust | Connection & trust | |
Angelic / servant; do what it takes | Giving of self | |
Valuing another | Valuing another |
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Buddeberg-Fischer, B., Klaghofer, R., Abel, T., & Buddeberg, C. (2006). Swiss residents' specialty choices — Impact of gender, personality traits, career motivation and life goals. BMC Health Services Research, 6, 137-145.
Champion, V. L., Austin, J. K., & Tzeng, O. C. S. (1987). Cross-cultural comparison of images of nurses and physicians. International Nursing Review, 34(2), 43-48.
Cook, T. H., Gilmer, M. J., & Bess, C. (2003). Beginning students' definitions of nursing: An inductive framework of professional identity. Journal of Nursing Education, 42(7), 311-317.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., …Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122-131. doi: 10.1016/j.outlook.2007.02.006
Dik, B. J., Sargent, A. M., & Steger, M. F. (2008). Career development strivings: Assessing goals and motivation in career decision-making and planning. Journal of Career Development, 35(1), 23-41. doi: 10.1177/0894845308317934
Emmons, R. A. (1999). The psychology of ultimate concerns: Motivation and spirituality in personality. New York, NY: Guilford.
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Forbes, M. O., & Hickey, M. T. (2009). Curriculum reform in baccalaureate nursing education: Review of the literature. International Journal of Nursing Education Scholarship, 6(1), Article 7. doi: 10.2202/1548-923X.1797
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Gordon, S. (2005). Nursing against the odds: How health care cost cutting, media stereotypes, and medical hubris undermine nurses and patient care. Ithica, NY: Cornell University.
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Lumby, J., & Zetler, J. (1990). The image of nurse in the nineties: 1890 or 1990? Paper presented at Nursing in the Nineties at the 12th National Conference Nursing of the Royal College of Nursing, Sydney, Australia.
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text:
Isaiah 40:10 Behold, the Lord God shall come with a strong hand, And His arm shall rule for Him; Behold, His reward is with Him, And His work before Him.
Revelation 22:12 "And behold, I am coming quickly, and My reward is with Me, to give to every one according to his work."
Isaiah tells us that the LORD'S Arm shall rule for Him and that He is coming with reward — and a similar passage in Revelation declares that the Lord Yeshua (Jesus) is coming to reward His saints.
We live this earthly life recognizing that we are "strangers and pilgrims" [Hebrews 11:13] in this world — but are working now in full expectation of a heavenly future. C.S. Lewis once wrote, "If I find in myself a desire which no experience in this world can satisfy, the most probable explanation is that I was made for another world!"
We know we were made for another world, where the treasure we have stored while working here will neither rust nor corrode, nor be stolen. If you're looking for a pat on the back now [not that praises shouldn't be given or received], you've missed the point of ministry.
This reminds me of a story. There was a husband and wife who served many years in the ministry as missionaries in a far away land. As they returned to the States, the arriving ship was greeted by a brass band. Their initial thought was that this was an arranged greeting to honor them — but soon discovered that a dignitary was also on the ship. They collected their luggage and booked a cheap motel room. While sitting on the bed, the husband started to cry and said, "We've served God for many years. We've got no money, no house, and when we've returned home, there's not even anyone to meet us!" His wife looked at him and said, "Hon, we're not home yet!"
We're not home yet! Don't believe for a minute that your work in this world is going unseen in Heaven. "For God is not unrighteous to forget your work and the love which ye showed toward his name, in that ye ministered unto the saints, and still do minister." [Hebrews 6:10] Let's be earnestly seeking His praise that when we see Him face to face, He may say to all of us, "Well done, thou good and faithful servant!" A true homecoming…and a true reward!

subset: commoncrawl


text:
16-30 September 2013 Cyber Attacks Timeline
It's time for analyzing the main cyber Attacks happened in September.
From an information security perspective, the second half of September has been characterized by the discovery of three operations related to targeted attacks against different countries and sectors. Two in particular, DeputyDog and IceFrog, targeting have a common denominator: Japan.
In the same period. despite the numerous members brought to court, the Anonymous have continued their operations all over the World (Cambodia and New Zealand have been the hottest fronts).
Considering Cyber Crime, this month has raised the attention to the risks posed by fake KVM switches. With a similar device, a gang of cyber-thieves was able to steal £1.3 M from a Barclays Computer. Unfortunately for them this magic box was not able to avoid them to get busted (in any case they deserved a mention in the timeline). For sure you will remember that a similar cyber-plot has also been tried against Santander.
On the cyber warfare front, the temperature of the virtual battlefield among India, Pakistan and Bangladesh remains quite hot. On the other side of the World, US officials have unveiled an escalation of cyber attacks from Iran. Curiously this admission was done few days before Mojtaba Ahmad, the head of Iran's cyber warfare programme, has been shot dead (although Iranian officials are denying similar claims).
Last but not least the Belgium Government has admitted to have been the victim of a targeted attack. Unfortunately, in this case the suspects are directed to NSA!
As usual, if you want to have an idea of how fragile our data are inside the cyberspace, have a look at the timelines of the main Cyber Attacks in 2011, 2012 and now 2013 (regularly updated). You may also want to have a look at the Cyber Attack Statistics, and follow @paulsparrows on Twitter for the latest updates.
Also, feel free to submit remarkable incidents that in your opinion deserve to be included in the timelines (and charts).


text:
The Economist Magazine on Steve Levitt and Abortion
But what is most amazing is that despite all the statistical significance being eliminated from their panel data set being eliminated when the results are done Donohue and Levitt's way with the the data they want to use, John Donohue now says what they wanted to do:
There was no warning that these were the wrong tests at all in either of their previous papers or in Levitt's book. Levitt now refers to the "collage of evidence," but the panel data was the only test that really amounted to anything worthwhile. The rest of the data was merely cross sectional or time series.
Labels: Abortion, Crime, JohnDonohue, SteveLevitt


text:
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text:
Why Choose GC Realty?
- Des Plaines's Premier Property Management Team w/over 20 Years Experience
- Responsive approach to real estate property management
- Providing investors peace of mind and their time back
- We minimize risks
- Right solutions for property and tenant challenges
- Market-rate rents from top-tier, carefully screened tenants
- In-house maintenance team
- Commitment to excellence
- Easy and rewarding to work with us
- Experience the Signature GC Realty "Touch"
Let us manage your Des Plaines Rental Property
Having a successful Des Plaines rental property requires a lot of time, effort, experience and knowledge. As a full service Des Plaines property management company, our team is responsible for taking care of all aspects of managing your rental(s).
GCR&D provides Des Plaines property management services for all Residential Properties in the Des Plaines West & Northwest Suburbs to include Kane County, DuPage County, Western Cook County and parts of McHenry County and Lake County.
If you're not 100% sure that your current Des Plaines property management property manager is doing a good job, then they're probably not. Contact us for a free quote and start getting the returns you deserve!
Schedule Your Free Consultation
HOW MUCH RENT can you get
for your investment?
- Tell us where your property is. Start by simply entering your Des Plaines area property address.
- Expert evaluations. The actual rental value may increase or decrease based on property location, condition and amenities. To receive the most accurate rental analysis contact us after you receive your rental report and speak with one of our Des Plaines property management experts.
- Receive your FREE report in a matter of minutes. You'll receive a personalized property report analyzing your home with a suggested rent range and market data.
- Get quality tenants, fast. Explore our packages for rental leasing and Des Plaines property management services.
Des Plaines PROPERTY MANAGER
FROM OTHER Des Plaines PROPERTY MANAGERS
Des Plaines's
Answering resident calls and responding to owner emails timely is what is going to set this team apart from all of our competitors - it's our mission to be the most responsive property management company.
No Fees
Many property management companies will charge you a management fee during vacancy. We don't believe that is fair. We think we should only get paid if we are delivering a valuable service.
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We research the current rental market to determine the highest rental price the market will bear. Due to our aggressive marketing techniques and accurate pricing, most properties are leased out within 21 days or less.
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The GCR&D operation includes a Maintenance Department that has proven to save owners hundreds of dollars per year since most jobs can be completed in house.
GCR&D Management fees may vary and are quoted on a case by case basis but listed below are the current rate ranges for residential management.
Residential 7-8% of the gross rent
Residential 8-10% of the gross rent (Areas of Des Plaines Only)
GCR&D welcomes the opportunity to speak with you about your Property management needs. Please feel free to contact our office for additional information at any time.
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text:
#60 Sports Nutrition
Guest: Ashley Hagensick
December 2023
Show Notes
A grant from Primary Children's Hospital is associated with this CME activity. They have no influence over the speakers or content.
Disclosure of Financial Relationships and Resolution of Conflicts of Interest for KAAP CME Activities
The KAAP CME program develops, maintains, and improves the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The KAAP CME program strives to meet the educational needs of pediatricians and pediatric healthcare professionals and support their lifelong learning with a goal of improving care for children and families.
KAAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. KAAP strives to ensure quality, objective, balanced, and scientifically rigorous CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. KAAP has taken steps to resolve any potential conflicts of interest.
All KAAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. KAAP is committed to providing learners with commercially unbiased CME activities.
All individuals in a position to influence and/or control the content of CME activities are required to disclose to KAAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities. Listed below are the disclosures provided by individuals in a position to influence and/or control CME activity content.
* A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Disclosure of Commercial Support for AAP CME Activities
A grant from Primary Children's Hospital is associated with this CME activity. They have no influence over the speakers or content.
Name | Role |
Relevant Financial Relationship (Please indicate Yes or No) |
Name of Commercial Interest(s)* Please list name(s) of entity AND Nature of Relevant Financial Relationship(s) (Please list: Research Grant, Speaker's Bureau, Stock/Bonds excluding mutual funds, Consultant, Other – identify) |
Disclosure of Off-Label (Unapproved)/Investigational Uses of Products (Do intend to discuss or Do not intend to discuss) |
Paul Wirkus | Planner/Moderator | NO | NONE | Do not intend to discuss |
Ashley Hagensick | Faculty | NO | NONE | Do not intend to discuss |
Alisa Stoddard | UTAAP Staff/COI Reviewer-Resolver | NO | NONE | Do not intend to discuss |
ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
AMA Credit Designation Statement
Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Guest: Ashley Hagensick
Quiz available after 4th episode airs, typically the fourth week of the month.
Virtual Curbside Podcast – Sports Nutrition
Release date: December 4, 2023
Expiration date: December 3, 2026
Last review date: December 26, 2023
Claim for Credit
- Learners who complete the activity are eligible for 1.0 AMA PRA Category 1 Credit TM.
- Learners who complete all quiz questions, and who meet the 60% minimum passing score requirements, will be eligible for 1.0 MOC Part 2 points.
Learning Objectives
After listening to these episodes listeners will…
- Discuss appropriate nutrient needs and timing for adolescent athletes
- Identify gaps in nutrition and hydration for adolescents
- Explain the importantce of choosing a 3rd party tested supplement to the growing and developing adoslecent athlete, if choosing one at all
Written and Hosted by: Paul Wirkus, MD, FAAP
Administrator/Producer/Photographer: Alisa Stoddard, UTAAP Executive Director
Audio Engineer: Alisa Stoddard
Music by: Phil Wirkus
Guest: Ashley Hagensick
Questions? Send us an email.


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British actress Kate Winslet, who has charmed audiences in films like "Titanic" and "Eternal Sunshine of the Spotless Mind," is taking on a familiar role as a mom! But Winslet is anything but a first time mother – the silver screen star already has two great kids, Mia and Joe.
Daughter Mia and son Joe are from previous marriages, and this new bundle of joy is with Winslet's current husband, Ned Rocknroll. They made the announcement in early June, less than a year after the two were wed. But it's evident from photos that the pair is enamored with each other and already take great care of Mia and Joe.
According to intel gathered by USA Today, Kate is keeping her pregnancy on the down low on the set of "Divergent," in which she plays the villainous Jeanine Matthews – a serious trip from her usual work. Rumor has it that when the cameras are rolling, Winslet uses a suitcase to disguise her growing little one, along with a few Hollywood camera tricks of the trade.
Be sure to sign up for our weekly celebrity pregnancy newsletter so you don't miss a single bump!


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IMPORTANT: Please refer to the APPLICATIONS section on the front page of the datasheet to determine if this product has been validated and approved for use with this protocol.
NOTE: Prepare solutions with Milli-Q or equivalently purified water.
NOTE: Cells should be grown, treated, fixed and stained directly in multi-well plates, chamber slides or on coverslips.
NOTE: All subsequent incubations should be carried out at room temperature unless otherwise noted in a humid light-tight box or covered dish/plate to prevent drying and fluorochrome fading.
*Recommended Secondary Antibodies:
posted December 2010


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At the Break II
After the enthralling Midsummer Classic last night (has anything good happened in the All Star Game in the last 20 years outside of Bo Jackson and Sandy Alomar's HR in the Jake?), it's one more night without baseball.
You would think the PD would have an analysis on the first half today, but nothing. Maybe Hoynes is getting it together for tomorrow, or maybe they'll do a big piece on Doug Johnson (the new backup QB). We wonder why the town hasn't embraced this team yet and you have to look no further at the negativity and overall lack of optimism in the local sports page. People read the same sarcastic comments from the luminaries at the PD and scoff at the progress being made. Don't even get me started on WKNR.
This perception that Dolan is a cheapskate (despite the Tribe spending the most of any ML team on player development in the past few years) is truly ignorant. People rant and rave that Omar and Thome and Manny aren't here, neglecting to remember that Dolan offered Manny $18M to stay here, Shapiro was right on the length of Thome's contract because of his back, and Peralta is a budding star at age 23.
Let's look at what we would have if we had kept that "Golden Era" team intact (just counting the players still in the league):
- Manny - too much $, remember the Sawx tried to cut him
- Thome - will be unproductive for the remainder of his contract, which runs through 2008
- Omar - the Giants are already trying to move him, and he's under contract until he's 41
- Lofton - once he lost his legs, was exposed as an athlete playing baseball
- Sean Casey - would look nice here, but has no power
- Sexson - again, would look nice here, but not for his contract
- Giles - a mistake
- Colon - I'd make that trade every day and twice on Tuesdays
- Sandy - a backup catcher
Who am I missing? Where have you gone Albert Belle, Carlos Baerga, Matt Williams, Travis Fryman, Robby Alomar?
There's such a thing as fiscal responsibility in baseball. That's why what the Indians are doing is the right way to approach building a baseball team. Call it the Atlanta Braves method: develop home-grown talent and add pieces, where needed, to put a consistent product on the field. Is anyone arguing that the Braves do it correctly? Right now, the Indians are at the stage where they're developing young talent and finding out what they have before adding the needed pieces.
As as been said many times, it's time for the fans of this town to turn the page and embrace this team. Root for the name on the front of the jersey, not the back.
Moving on to the pitchers, here's what the starters are on pace to achieve:The stats are listed as Wins - Losses - ERA - K's - WHIP
C.C. Sabathia
11 - 9 - 4.50 - 129 - 1.33
Kevin Millwood
5 - 13 - 3.58 - 133 - 1.30
Jake Westbrook
11-20 - 4.67 -127 - 1.23
Cliff Lee
17 - 7 - 3.89 - 145 - 1.31
Scott Elarton
11 - 5 - 4.72 - 114 - 1.31
The Sticky one is on pace for 42 saves. Looking at these numbers, you can't help but be optimistic for the second half. No way that Westbrook continues his losing, or Millwood doesn't get W's.
Biggest Surprise:
The consistency of Lee and Elarton has given the Indians a shot all 5 days of the rotation. Expect Lee to get Westbrook money in the off-season, with Elarton getting a long look.
Pitching MVP:
Wicky gives balance to the strong bullpen and, though he quickens the heart rate, gets the job done.
Biggest Disappointment:
The Crooked Cap, in a landslide. I can't get into it right now, or it will ruin my night. Just for a snapshot, look at C.C.'s numbers against Elarton's.
Enjoy the second half. Against the protests of everyone, I'll be in the stands for the first game of the White Sox series tomorrow.


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Vast methane 'plumes' seen in Arctic ocean as sea ice retreats
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Louise Thomas
Dramatic and unprecedented plumes of methane - a greenhouse gas 20 times more potent than carbon dioxide - have been seen bubbling to the surface of the Arctic Ocean by scientists undertaking an extensive survey of the region.
The scale and volume of the methane release has astonished the head of the Russian research team who has been surveying the seabed of the East Siberian Arctic Shelf off northern Russia for nearly 20 years.
In an exclusive interview with The Independent, Igor Semiletov of the International Arctic Research Centre at the University of Alaska Fairbanks, who led the 8th joint US-Russia cruise of the East Siberian Arctic seas, said that he has never before witnessed the scale and force of the methane being released from beneath the Arctic seabed.
"Earlier we found torch-like structures like this but they were only tens of metres in diameter. This is the first time that we've found continuous, powerful and impressive seeping structures more than 1,000 metres in diameter. It's amazing," Dr Semiletov said.
"I was most impressed by the sheer scale and the high density of the plumes. Over a relatively small area we found more than 100, but over a wider area there should be thousands of them," he said.
Scientists estimate that there are hundreds of millions of tons of methane gas locked away beneath the Arctic permafrost, which extends from the mainland into the seabed of the relatively shallow sea of the East Siberian Arctic Shelf.
One of the greatest fears is that with the disappearance of the Arctic sea ice in summer, and rapidly rising temperatures across the entire Arctic region, which are already melting the Siberian permafrost, the trapped methane could be suddenly released into the atmosphere leading to rapid and severe climate change.
Dr Semiletov's team published a study in 2010 estimating that the methane emissions from this region were in the region of 8 million tons a year but the latest expedition suggests this is a significant underestimate of the true scale of the phenomenon.
In late summer, the Russian research vessel Academician Lavrentiev conducted an extensive survey of about 10,000 square miles of sea off the East Siberian coast, in cooperating with the University of Georgia Athens. Scientists deployed four highly sensitive instruments, both seismic and acoustic, to monitor the "fountains" or plumes of methane bubbles rising to the sea surface from beneath the seabed.
"In a very small area, less than 10,000 square miles, we have counted more than 100 fountains, or torch-like structures, bubbling through the water column and injected directly into the atmosphere from the seabed," Dr Semiletov said.
"We carried out checks at about 115 stationary points and discovered methane fields of a fantastic scale - I think on a scale not seen before. Some of the plumes were a kilometre or more wide and the emissions went directly into the atmosphere - the concentration was a hundred times higher than normal," he said.
Dr Semiletov released his findings for the first time last week at the American Geophysical Union meeting in San Francisco. He is now preparing the study for publication in a scientific journal.
The total amount of methane stored beneath the Arctic is calculated to be greater than the overall quantity of carbon locked up in global coal reserves so there is intense interest in the stability of these deposits as the polar region warms at a faster rate than other places on earth.
Natalia Shakhova, a colleague at the International Arctic Research Centre at the University of Alaska Fairbanks, said that the Arctic is becoming a major source of atmospheric methane and the concentrations of the powerful greenhouse gas have risen dramatically since pre-industrial times, largely due to agriculture.
However, with the melting of Arctic sea ice and permafrost, the huge stores of methane that have been locked away underground for many thousands of years might be released over a relatively short period of time, Dr Shakhova said.
"I am concerned about this process, I am really concerned. But no-one can tell the timescale of catastrophic releases. There is a probability of future massive releases might occur within the decadal scale, but to be more accurate about how high that probability is, we just don't know," Dr Shakova said.
"Methane released from the Arctic shelf deposits contributes to global increase and the best evidence for that is the higher concentration of atmospheric methane above the Arctic Ocean," she said.
"The concentration of atmospheric methane increased unto three times in the past two centuries from 0.7 parts per million to 1.7ppm, and in the Arctic to 1.9ppm. That's a huge increase, between two and three times, and this has never happened in the history of the planet," she added.
Each methane molecule is about 70 times more potent in terms of trapping heat than a molecule of carbon dioxide. However, because methane it broken down more rapidly in the atmosphere than carbon dioxide, scientist calculate that methane is about 20 times more potent than carbon dioxide over a hundred-year cycle.
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Powered by a low-emission engine that features the STIHL Easy2Start™ system. Price and weight shown is for power head only. All attachments sold separately.
Powered by a proven STIHL 4-MIXTM engine designed for demanding professional use. Updates include a larger fuel tank for 30% longer run times along with improved handling and control. Price and weight shown is for power head only.
All attachments sold separately.
The NEW KM 94 R is an operator's dream; enhanced with ECOSPEED and a stratified scavenging engine technology that reduces fuel consumption by 20% and fulfils all emission regulations, this unit boasts enough power to efficiently run all KombiTools. Equipped with a multifunction control handle for easy operation, loop handle with barrier bar, split shaft with tool-less quick release coupling for easier storage and transport, landscapers and avid users will love this NEW addition to the KombiSystem line-up. Price and weight shown is for power head only. All attachments sold separately.
A new and improved professional 4-MIX unit with low-exhaust emissions. Updates include a larger fuel tank for 30% longer run times along with improved handling and control. Price and weight shown is for power head only. All attachments sold separately.
Our most powerful tool in the KombiSystem family. Featuring a low-emission engine and longer running times — so you can count on the best power and performance to get the job done. Price and weight shown is for power head only. All attachments sold separately.
For those who prefer a curved shaft trimmer.
Uses the dependable AutoCut® head. Designed for mowing and trimming around obstacles.
Used for mowing heavy grass and weeds.
For edging along walkways and planting beds. Adjustable depth control wheel and built-in blade "sight" helps with making the correct cut.
Straight shaft edger delivers more power to the cut. Depth control wheel, as well as open guard design.
Makes it easier to reach those hard-to-trim hedges.
Has the added flexibility of being able to be adjusted to 270° (145° working range).
Unique grass and weed trimmer for precision trimming. The grass "lies down" after it is cut. Ideal for parking lots, golf course sand traps and tight trimming conditions.
A lightweight cultivator for getting into tight places. Ideal for rejuvenation of flower beds and plantings, and for mixing amendments into the soil.
A powerful, lightweight blower attachment that's ideal for outside clean-up tasks.
Makes quick work of pruning trees and shrubs. Side-access chain tensioner makes it easy to adjust the chain. Oil tank cap comes with retainer.
An effective tool for removing debris from cracks and crevices of hard surfaces.
The STIHL PowerSweep™ attachment cleans up dirt along roads and sidewalks, moves pebbles and sand in turf, as well as water and light snow along flat surfaces.
FBD - KM bed re-definer - New KombiSystem KombiTool with rugged construction for maximum durability. With a unique blade design, it provides smooth cutting through existing or new flower beds.
The RG-KM KombiTool easily removes grass and weeds from a wide variety of surfaces. The attachment consists of an upper and lower blade that operates much like a hedge trimmer. The cutting action of the Weeder reduces the probability of kicking up objects, thus reducing the risk of damage or injury. The NEW RG-KM Weeder is an excellent addition to the KombiTool line-up.
Extends shaft by 37" for more reach.
A 37" carbon fiber shaft extension for HT and HL applications. Extremely lightweight - less than 2 lbs.
Featuring the same versatility as the MM 56, but now available with the Easy2Start™ system. All other attachments sold separately Weight shown is for power head only.
Used to cut a defined or distinct edge to separate the grass lawn from the cultivated soil in a planting area.
Creates a series of slits into the soil of the lawn, allowing air, moisture, fertilizers and other nutrients to get to the roots.
Helps to prepare the soil for planting by loosening the compacted soil.
Variation of BF Pick Tines. Designed to provide versatility for cultivating in a rocky, sandy, clay-like soil compaction.
Trimmer attachment for MM Yardboss System
24" wide broom makes quick work of sweeping jobs on hard surfaces.
Cleans up dirt, moves pebbles and sand, water and light snow.
Removes dead grass and other accumulated material from the top of the turf.
Increases the downward pressure on the tool for enhanced performance and ensures deeper penetration in the ground.
For ease of handling and transport, and better maneuverability with most attachments.


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- Part Number: 2177903
- Description: H2 SDAS Center Chassis Assembly (no cards included but are available; inquire)
- Manufacturer: GE
- Modality: PET/CT
- Model: Discovery LS4
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