Alcohol Withdrawal Assessment Tool (AWAT) Reliability and Validity: Implications for Nurses Caring for Inpatients With Mental Health Disorders.

BACKGROUND: Alcohol use affects 14.5 million Americans and high prevalence of use and potential for withdrawal among hospitalized patients presents a challenge for health care professionals to anticipate and manage effectively. Due to the acuity and fast-paced nature of the hospital environment, nurses need assessment tools that can be readily completed and drive efficient protocol-based treatment. The purpose of this study was to examine psychometric properties of the alcohol withdrawal assessment tool (AWAT). AIMS: The aims were to examine AWAT (1) reliability, (2) validity, and (3) usability. METHODS: Patients (n = 55) and nurses (n = 47) were recruited from six hospitals within one health care system in the Midwest. Psychometric testing included inter-rater reliability and criterion-related validity testing, using the Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised (CIWA-Ar) as a comparison. Usability was assessed with a 5-item Likert-type scale. RESULTS: Findings supported strong agreement (ICC: .931) between raters on the AWAT and a moderate correlation (Pearson r: .548) between scores on the AWAT and CIWA-Ar. Nurses agreed/strongly agreed that the AWAT took 2 min or less to complete (n = 42; 89%), was easy to use for assessment (n = 42; 89%) was easy to learn (n = 40; 85%), and they were confident using the AWAT (n = 39; 83%). CONCLUSIONS: Study findings provide evidence of reliability, validity, and usability of the AWAT in the hospital setting. The AWAT has potential to improve assessment efficiency and nurses caring for inpatients with mental health disorders should consider implementing the tool into practice.

Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections.

PURPOSE: The purpose of this study was to examine the effectiveness of an external female urinary management system (external urinary device for female anatomy [EUDFA]) in critically ill women unable to self-toilet and to identify rates of indwelling catheter use, catheter-associated urinary tract infections (CAUTIs), urinary incontinence (UI), and incontinence-associated dermatitis (IAD) before and after the introduction of the EUDFA. DESIGN: Prospective, observational, and quasi-experimental design. SUBJECTS AND SETTING: The sample comprised 50 adult female patients in 4 critical/progressive care units using an EUDFA at a large academic hospital in the Midwestern United States. All adult patients in these units were included in the aggregate data. METHODS: Prospective data collected from the adult female patients over 7 days included urine diverted from the device to a canister and total leakage. Aggregate unit rates of indwelling catheter use, CAUTIs, UI, and IAD were retrospectively examined during 2016, 2018, and 2019. Means and percentages were compared using t tests or chi-square tests. RESULTS: The EUDFA successfully diverted 85.5% of patients' urine. Indwelling urinary catheter use was significantly lower in 2018 (40.6%) and 2019 (36.6%) compared with 2016 (43.9%) (P < .01). The rate of CAUTIs was lower in 2019 than in 2016, but not significantly (1.34 per 1000 catheter-days vs 0.50, P = .08). The percentage of incontinent patients with IAD was 69.2% in 2016 and 39.5% in 2018-2019 (P = .06). CONCLUSIONS: The EUDFA was effective in diverting urine from critically ill female incontinent patients and indwelling catheter utilization.

Who Cares More about Chemical Defenses - the Macroalgal Producer or Its Main Grazer?

The consequences of defensive secondary metabolite concentrations and interspecific metabolite diversity on grazers have been extensively investigated. Grazers which prefer certain food sources are often found in high abundance on their host and as a result, understanding the interaction between the two is important to understand community structure. The effects of intraspecific diversity, however, on the grazer are not well understood. Within a single, localized geographic area, the Antarctic red seaweed Plocamium sp. produces 15 quantitatively and qualitatively distinct mixtures of halogenated monoterpenes ("chemogroups"). Plocamium sp. is strongly chemically defended which makes it unpalatable to most grazers, except for the amphipod Paradexamine fissicauda. We investigated differences in the feeding and growth rates of both Plocamium sp. and P. fissicauda, in addition to grazer reproductive output, in relation to different chemogroups. Some chemogroups significantly reduced the grazer's feeding rate compared to other chemogroups and a non-chemically defended control. The growth rate of Plocamium sp. did not differ between chemogroups and the growth rates of P. fissicauda also did not show clear patterns between the feeding treatments. Reproductive output, however, was significantly reduced for amphipods on a diet of algae possessing one of the chemogroups when compared to a non-chemically defended control. Hence, intraspecific chemodiversity benefits the producer since certain chemogroups are consumed at a slower rate and the grazer's reproductive output is reduced. Nevertheless, the benefits outweigh the costs to the grazer as it can still feed on its host and closely associates with the alga for protection from predation.

Strategies for the successful implementation of disinfecting port protectors to reduce CLABSI in a large tertiary care teaching hospital.

Disinfecting port protectors are a supplement to the central line-associated bloodstream infection prevention bundle as an optional recommendation from the Centers for Disease Control and Prevention. Despite evidence of effectiveness, few centers have successfully reported systematic, sustained implementation of these devices. In this article, we discuss a successful implementation in a large tertiary care teaching hospital, using an evidence-based, multidisciplinary approach. Infection prevention; Bacteremia; Ethanol caps; Bundle measures; Quality improvement; Hub infection.

Alcohol Withdrawal Assessment Tool: Validity and Reliability Testing in Acute Care.

PURPOSE/AIMS: The purpose of this study was to validate a tool to assess alcohol withdrawal in acute care patients. Study aims included (1) establish content validity, (2) examine criterion-related validity, (3) test interrater reliability, and (4) assess nurse usability. DESIGN: A psychometric research study was designed to evaluate the Alcohol Withdrawal Assessment Tool. METHODS: Validation was conducted using an expert panel to determine content validity. The Clinical Institute Withdrawal Assessment for Alcohol-Revised was used as comparison for the criterion related validity. Interrater reliability was determined by having 2 investigators simultaneously complete the assessment on the same patients. Usability was determined using a Likert scale survey. RESULTS: The average age of participants was 53 years, with a range of 27 to 81 years. Interrater reliability was supported by a κ statistic range of 0.61 to 0.6957, and content validity was supported by a content validity index of 1.0. Criterion-related validity was supported with a Pearson r correlation of 0.665 (P < .000). Of nurses surveyed, all answered agree or strongly agree to the usability survey. CONCLUSIONS: The assessment tool may be an effective alternative to utilize in the acute care setting. It is easy to use and drives frequency of assessment and appropriate pharmacologic treatment.

Urinary Management With an External Female Collection Device.

BACKGROUND: Strategies to decrease use of female indwelling urinary catheters and catheter-associated urinary tract infections are challenging due to the limited availability of proper fitting external collection devices. Female urinary incontinence predisposes the skin to potential pain, itching, burning, infection, or pressure injuries. CASE STUDIES: This article discusses 3 patients' trajectory of care with use of an external female urinary collection device. All of these females were incontinent of urine after the indwelling urinary catheter was removed and managed with an external female urinary collection device. CONCLUSIONS: The use of an external female urinary collection device is a feasible alternative to an indwelling urinary catheter as well as managing urinary incontinence.

Comparison of Nurses' Self-Reported and Objectively Measured Evidence-Based Practice Knowledge.

BACKGROUND: This study provides a first-time, objective assessment of the evidence-based practice (EBP) knowledge of RNs working in Magnet®-designated hospitals. METHOD: This multisite, cross-sectional, descriptive, correlational study uses the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN) and Evidence-Based Practice Questionnaire (EBPQ). RESULTS: EBPQ subscale scores revealed overall positive self-ratings of EBP knowledge/skills, attitudes, and practice/use. EKAN sum scores were not correlated with EBPQ scores (r = .017 to .123, p = not significant). Higher levels of nursing education were associated with higher scores on EKAN and were the only statistically significant predictor of EKAN scores. CONCLUSION: Nurses' self-reported EBP knowledge/skills, attitudes, and practice/use were not statistically significantly correlated with objectively measured EBP knowledge. Direct, objective measurement is recommended as the standard when testing interventions aimed at advancing EBP knowledge, skills, and ability. J Contin Educ Nurs. 2017;48(2):65-70.