Trends in nursing research in France: a cross-sectional analysis.

AIM: To examine the engagement of French registered nurses with the Ministry of Health's initiative to spur scientific inquiry in the community. BACKGROUND: French nursing research has suffered from a lack of dedicated funding. Positive signs of change have recently appeared, with the launch of the first national public funding programme dedicated to nursing research. This initiative, begun in 2010, was launched by the French Ministry of Health. Through this initiative, 149 registered nurses, serving as principal investigators, and their teams submitted research proposals between 2010 and 2011. The administrative guidelines of the funding programme are clearly oriented towards producing quantitative and exogenous nursing research. METHOD: A cross-sectional analysis of 149 nursing research projects submitted during the first and second years of a French national funding programme for hospital-based nursing research was conducted. Research proposals were included in the analysis whether they received funding or not. Data collection took place in 2011. The categories used in the analysis were the following: (1) the socio-demographic data on the registered nurse principal investigators, (2) the research teams and (3) the research proposals (methodologies, bibliography, focus of the research, output, the status of the research proposals). RESULTS: This study highlights the presence of methodological homogeneity among the research proposals submitted for funding. Clear tendencies were towards interventional and quantitative studies and those with an exogenous factor research objective. Between 2010 and 2011, 25 projects were funded out of 149 submitted. They were mostly quantitative and/or focused on the exogenous factors in patient care. CONCLUSION: The socio-political context of a funding programme designed to encourage nursing research has had an implicit influence on the type of research to which French nurses have committed themselves to and the scientific positions with which these nurse researchers align themselves.

Undergraduate nursing education reform in France: from vocational to academic programmes.

BACKGROUND: France is currently implementing a number of reforms to the healthcare and education systems. Within this context, a comprehensive reform of undergraduate nurse education was launched in 2009, bringing nurse education closer to the higher education environment. It is likely in future to move from being vocational towards becoming an academic educational programme. AIM: In this paper, the 2009 reform of the French pre-registration nursing curriculum will be analysed in light of the European framework. PROCESS: The pedagogical approach, methods and content of nursing education in France are undergoing an in-depth reorganization. The main innovation that the reforms introduce is a competency-based approach. France is joining the group of countries that require first degree-level entry to the nursing profession. CONCLUSION: There are still many unanswered questions regarding the competencies and qualifications required by both the academic and clinical educators many of whom have not been previously involved in research or publications. The future status of nursing science is unclear, as is the way in which the nursing profession will be able to retain control over its educational mechanisms.

Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey.

In France, although there are 445,000 beds in nursing homes (NHs) for elderly people, no studies on the burden of infections in NHs have been published. We sought to estimate the prevalence of infection among the residents and to assess the extent to which infections were associated with the residents' risk factors. We performed a nationwide, multicentre, cross-sectional, clustered period prevalence survey over five one-month periods. Cases of infection were classified as definite or, in the absence of laboratory confirmation, as probable. A total of 44,869 residents in 578 volunteer facilities were enrolled in the survey. The overall prevalence rate of infections was 11.23% [95% confidence interval (CI): 10.50-11.97] and differed significantly (P<0.001) across survey periods (the time of the year the survey was carried out). The rate of definite cases was 4.60% (95% CI: 4.04-5.54) and the rate of probable cases was 6.63% (95% CI: 5.77-7.98). Respiratory tract infections were the most frequent and accounted for 41% of all infections. Infections were significantly associated with age, length of stay, full disability, urinary device, bedsores and the survey period. Only prevention programmes may reduce the impact of infections on this frail population.

Guidelines for infection control in nursing homes: a Delphi consensus web-based survey.

A nationwide survey was performed using a two-round web-based Delphi procedure to develop a set of consensus guidelines for preventing infections among residents in nursing homes (NHs). The research group was led by an investigative group of six specialists. Research analysts conducted a literature search and review of practice guidelines, systematic reviews and articles or abstracts published in English and French on the topic of infection prevention. The literature search was examined by 23 specialists (who compiled a preliminary list of 301 recommendations). Using a Delphi survey online instrument, 81 experts from all relevant medical specialties in the fields of infection prevention and control and geriatrics rated their agreement with each of the recommendations using a nine-point scale (1 = strongly disagree, 9 = strongly agree). During the second round, 79 participants received anonymous feedback from the first round and assessed a narrowed list of 130 recommendations. Recommendations were retained and classified according to the overall median score and ratings percentages by stakeholders. A total of 79 raters rated ≥ 10% of items, and 264 recommendations were retained and rated as follows: 240 items reached consensus, 24 items reached near consensus, 37 items were discarded and one recommendation was deleted. Many infections, though not all, can be prevented in the frail elderly. Thus, these guidelines should be adopted by each healthcare professional and facility to implement routine infection control procedures.

Randomised active programs on healthcare workers' flu vaccination in geriatric health care settings in France: the VESTA study.

BACKGROUND: Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still low in France. The French Geriatric Infection Risk Institute (ORIG) performed the VESTA study, a three-phase multicentre to identify factors limiting vaccination in HCWs, and to develop and implement active programs promoting HCWs influenza vaccination. OBJECTIVES: To implement multicenter programs to enhance HCW influenza vaccination. DESIGN: It was a cluster randomised interventional studies. SETTING: 43 geriatric health care settings (GHCSs), long term care and rehabilitation care settings in France. PARTICIPANTS: 1814 Health care workers from 20 GHCSs in the interventional group and 2,435 health care workers in 23 GHCSs in the control group. INTERVENTION: After the failure of a first educational program giving scientific information and. tested during the 2005-06 flu season in 43 HCSs, a second program was designed with the help of marketing experts, one year after Program 1. The objectives were to involve HCWs in the creation of "safety zones", and to give personal satisfaction. Program 2 was tested during the 2006-07 season. 20 of the 24 HCSs from the Program 1 cluster were included in the Program 2 cluster (1,814 HCWs), and 16 of the 19 HCSs from the Control 1 cluster, plus 7 new HCSs with interest in participating, were included in the Control 2 cluster (23 HCSs; 2,435 HCWs). MEASUREMENTS: The efficacy of each program was assessed by calculating and comparing the percentage of vaccinated HCWs, from all HCSs taken together, in the program and control clusters. RESULTS: Program 1 failed to increase the HCW vaccination coverage rate (VCR) (Program 1: 34%; Control 1: 32%; p > 0.05),). Program 2 increased the VCR in HCWs (Program 2: 44%; Control 2: 27%; Chi2 test, p < 0.001) regardless their occupational group but only in the non previous vaccinated subgroup. CONCLUSIONS: In geriatric health care centres in France, an active multicenter program giving personal satisfaction and taking into account the profile of non-vaccinated HCWs was more effective in promoting flu vaccination than a scientifically factual information program. HCW involvement is required in program implementation in order to avoid rejection of top-down information.

Nosocomial infections in geriatric long-term-care and rehabilitation facilities: exploration in the development of a risk index for epidemiological surveillance.

OBJECTIVE: To compute a risk index for nosocomial infection (NI) surveillance in geriatric long-term-care facilities (LTCFs) and rehabilitation facilities. DESIGN: Analysis of data collected during the French national prevalence survey on NIs conducted in 1996. Risk indices were constructed based on the patient case-mix defined according to risk factors for NIs identified in the elderly. SETTING: 248 geriatric units in 77 hospitals located in northern France. PARTICIPANTS: All hospital inpatients on the day of the survey were included. RESULTS: Data from 11,254 patients were recorded. The overall rate of infected patients was 9.9%. Urinary tract, respiratory tract, and skin were the most common infection sites in both rehabilitation facilities and LTCFs. Eleven risk indices, categorizing patients in 3 to 7 levels of increasing NI risk, ranging from 2.7% to 36.2%, were obtained. Indices offered risk adjustment according to NI rate stratification and clinical relevance of risk factors such as indwelling devices, open bedsores, swallowing disorders, sphincter incontinence, lack of mobility, immunodeficiency, or rehabilitation activity. CONCLUSION: The optimal index should be tailored to the strategy selected for NI surveillance in geriatric facilities in view of available financial and human resources.

[Impact of hospital infection on medical expenditures in a continuing care and rehabilitation service at a geriatric hospital]. / Impact de l'infection nosocomiale sur les consommations médicales en service de soins de suite et réadaptation dans un hôpital gériatrique.

The costs of medical expenditures such as drugs, medical devices (MD), biological assays and nurses workload, were measured, before and after the onset of nosocomial infection (NI), in rehabilitation care departments of a 1000-beds geriatric teaching hospital. Data were collected retrospectively in medical records and nursing records. Nurse's workload was measured by the French indicator "Soins Infirmiers Personnalisé à la Personne Soignée" (SIIPS). A week before and a week after the diagnosis of hospital-acquired infection, medical consumptions were compared. During the study 38 of the 206 patients admitted in rehabilitation care wards presented hospital-acquired infection. Data were collected for 31 of these 38 patients. Nosocomial infections are associated with an increased pharmaceutical dispensing: medication (mainly antibiotics) and medical device's cost; and an increased nurse's workload. This study suggests that infection surveillance may be helpful to a better understanding of pharmaceutical dispensing variation in geriatric rehabilitation care departments.