Nurse managers could design interventions to reduce and prevent nurses from being influenced by burnout and secondary traumatic stress. Educating nurses to build effective social networks with relatives or friends and to seek support when experiencing secondary traumatic stress may also be needed.

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Purpose The purpose of this paper is to develop a deeper understanding of how to promote members’ beneficial behaviors toward other members and toward the virtual community (VC). The authors extend Ray et al.’s (2014) framework by developing a more precise definition of community embeddedness, and determining how such embeddedness relates to social support and community engagement. Design/methodology/approach The authors test the proposed research model using data collected from 333 users of online social support communities/groups dedicated to sharing knowledge about pregnancy and child care. Partial least squares is used to analyze the measurement and structural models. Findings The study shows that embeddedness and engagement are significant determinants of willingness to help others and willingness to help the community. Embeddedness has a strong, positive effect on engagement. Social support positively affects community identification and embeddedness. However, community identification does not have a significant effect on engagement. Research limitations/implications Some of the findings, such as the relative importance of embeddedness in fostering willingness to help the community and the relative importance of engagement in fostering willingness to help others, might not be generalizable to VCs where members join for fun and sharing interests. Practical implications Although knowledge contributors could self-derive some drivers of embeddedness and engagement, managers or hosts of VCs should develop strategies and mechanisms to provide or enhance the value they add to knowledge sharing and other beneficial behaviors, even though such added value might be largely intangible. Social implications Social support plays an important role in shaping an individual’s embeddedness within a VC. Managers of VCs should develop strategies to stimulate exchanges of support among members. Originality/value The authors believe that community embeddedness plays a more important role than engagement in shaping the VC’s success and effectiveness. However, the extant VC literature has indicated a relatively weak understanding of the notion of community embeddedness. This study intends to fill that void.

Background Hyper-pulsatility of hemodialysis arteriovenous fistula (AVF) is the basic physical examination finding when there is outflow stenosis. The arm elevation test can also be utilized to detect outflow stenosis. If there is no significant outflow stenosis, the AVF should collapse, at least partially, because of the effect of gravity when the AVF-bearing arm is elevated to a level above that of the heart. However, if there is significant outflow stenosis, the portion of the AVF downstream of the stenosis will collapse, while the portion upstream of the stenosis will remain distended (Clin J Am Soc Nephro 8:1220-7, 2013). In our daily practice, when performing the arm elevation test, we not only observe the collapsibility of the access outflow but also palpate the outflow to identify a background thrill that sometimes disappears with the arm at rest, only to reappear when the arm is elevated. If there is no thrill upon arm elevation, we assume that the outflow stenosis is severe and refer to this condition as “physical examination significant outflow stenosis” (PESOS). The aim of this study is to characterize PESOS using percentage stenosis and Doppler flow parameters. Methods We performed a case-control study using data collected prospectively between June 2019 and December 2019. A pulse- and thrill-based score system was developed to assess the severity of AVF outflow stenosis. We recorded the outflow scores and Doppler measurements performed in 84 patients with mature fistulas over a 6-month period. Angiograms were reviewed to determine the severity of outflow stenosis, which was assessed by calculation of percentage stenosis. Results Receiver operating characteristic analysis showed that a cutoff value of ≥74.44% stenosis discriminated PESOS from other AVF outflow scores, with an area under the curve of 0.9011. PESOS diagnosed cases with ≥75% outflow stenosis in an AVF, with a sensitivity of 80.39%, a specificity of 78.79%, a positive predictive value of 85.42%, and a negative predictive value of 72.22%. Conclusions PESOS can be used to diagnose ≥75% outflow stenosis in an AVF, with or without a significant collateral vein, and its diagnostic accuracy is high. The use of PESOS as an indicator for treatment implies that physical examination may represent a useful surveillance tool.