Quality improvement: Antimicrobial stewardship in pediatric primary care.

BACKGROUND: Antimicrobial resistance is the resistance of microorganisms to antibacterial, antiviral, antiparasitic, and antifungal medication resulting in increased healthcare costs with extended hospital stays in the United States. The goals of this quality improvement project were to increase the understanding and importance of antimicrobial stewardship by nurses and health care staff and increase pediatric parents'/guardians' knowledge of the proper use of antibiotics and differences between viruses and bacterial infections. METHODS: A retrospective pre-post study was conducted in a midwestern clinic to determine if an antimicrobial stewardship teaching leaflet increased parent/guardian antimicrobial stewardship knowledge. The two interventions for patient education were a modified United States Center for Disease Control antimicrobial stewardship teaching leaflet and a poster regarding antimicrobial stewardship. RESULTS: Seventy-six parents/guardians participated in the pre-intervention survey, with 56 being included in the post-intervention survey. There was a significant increase in knowledge between the pre-intervention survey and the post-intervention survey with a large effect size, p < .001, d = 0.86. This effect was also seen when comparing parents/guardians with no college education, who had a mean knowledge increased change score of 0.62, to those parents/guardians with a college education, whose mean knowledge increase was 0.23, p < .001 with a large effect size of 0.81. Health care staff thought the antimicrobial stewardship teaching leaflets and posters were beneficial. PRACTICE IMPLICATIONS: The use of an antimicrobial stewardship teaching leaflet and a patient education poster may be effective interventions for improving healthcare staff's and pediatric parents'/guardians' knowledge of antimicrobial stewardship.

Enhanced New Mothers Network Cell Phone Application Intervention: Interdisciplinary Team Development and Lessons Learned.

Single, low-income, African American mothers experience challenges caring for themselves and their infants. Nurse researchers, providing creative and theoretically based approaches for complex client health care, are increasingly becoming interdisciplinary leaders on research teams. The first purpose of this article was to describe this interdisciplinary team's development of a cellular (cell) phone application (app), the Enhanced New Mothers Network (ENMN). The second purpose of this article was to describe lessons learned by nursing members of the interdisciplinary team members about developing a cell phone app for delivery of the ENMN intervention. Interdisciplinary research is beneficial where providing interventions to assist patients to achieve optimal health outcomes is rarely dependent on the work of one profession.

Awakening: a qualitative study on maintaining weight loss after bariatric surgery.

AIMS AND OBJECTIVES: To describe the experiences of adults who were successful in maintaining weight loss after bariatric surgery. BACKGROUND: The majority of studies examine a homogenous demographic group of postbariatric surgical patients who have gone through initial weight loss, which occurs within the first 12-24 months post surgery. Maintenance of weight loss begins 24 months after bariatric surgery; however, there is a paucity of research examining experiences during this period. The lack of conclusive research related to interactions between intrapersonal, behavioural and environmental influences suggests a need to develop a better understanding of patients' experiences related to weight loss maintenance post bariatric surgery. DESIGN: Bandura's Social Cognitive Theory provided the framework for the semi-structured interviews for this qualitative descriptive study. METHODS: In-person interviews with n = 14 participants who were able to maintain weight loss at least 24 months after a bariatric surgery. RESULTS: Participants experienced an awakening and gained a new perspective on their life. They identified negative attitudes, influences and behaviours and modified their environment to support their desired healthy behaviour. CONCLUSIONS: To maintain weight loss, an individual must seek out and be surrounded by positive family and peer support influences. Positive support may provide the opportunity for an individual to place personal health needs as a priority. RELEVANCE TO CLINICAL PRACTICE: Therapeutic education and counselling for individuals, couples and families should occur during all phases of bariatric surgery. Communication techniques may empower clients to deflect negative comments and influences in a constructive manner. Support groups should accommodate the various phases of bariatric surgery. Clients should be prepared for how to work through emotions associated with weight fluctuations.

Nurse-Led Trauma-Informed Correctional Care for Women.

PURPOSE: Incarcerated women are a vulnerable and unique population of special concern to nurses as they have high rates of mental illness. In this article, the authors discuss how trauma exposure contributes to mental illness in incarcerated women through abuse, socioeconomic factors, and the prison environment, how this trauma exposure manifests in the inmate survivor, and the related implications for practice. CONCLUSIONS: A history of trauma and victimization is related to complex mental health issues which affect the majority of justice-involved women. The correctional environment can exacerbate these issues. PRACTICE IMPLICATIONS: Nursing implications include discussion of the trauma-informed care model. The authors recommend a model of trauma-informed care named "the 4 Es" that can guide nurses in preparing a trauma-informed correctional environment and discuss the importance of nurse-led policy change in finding alternatives to incarceration for women with mental illness.

Health promotion text blasts for minority adolescent mothers.

PURPOSE: To examine use of technology for delivering a health promotion intervention via text blasts in single, low-income, adolescent, minority mothers and to describe their perceptions and experiences with the intervention. STUDY DESIGN AND METHODS: A qualitative descriptive design was used for this study. Health promotion information was sent weekly in the form of text blasts and/or pictures to five mothers during the first 6 months postpartum. Topics included promotion of breastfeeding, effects of breast milk on infant growth and development, information about infant immunizations, and reminders about infant and maternal follow-up and well-being. Qualitative interviews occurred monthly with mothers about their perceptions and experiences with the health promotion intervention and their health promotion behaviors. Data were analyzed using qualitative analytic techniques to generate themes from the mothers' interviews. RESULTS: Four themes emerged: (a) Trustworthy Support System, (b) Overcoming Barriers to Health Promotion, (c) Parenting Validation, and (d) Preferred Mode of Communication. All mothers used breast milk through 6 months postpartum and were adherent with childhood immunizations and maternal and infant follow-up appointments, unlike lower proportions in the general population. CLINICAL IMPLICATIONS: Health promotion text blasts can improve single, low-income, adolescent, minority mothers' health behavior outcomes such as adherence with recommended immunizations for their infants, breastfeeding success, and recommended maternal and infant healthcare visits. Further, it is the preferred mode of communication for these mothers. Future studies are needed for examining the use of technology to deliver healthcare to a larger sample of minority adolescent mothers.

Compadrazgo: a literature review.

Compadrazgo, "coparenthood," is a traditional ritual fictive kinship system that provides a network of mutually supportive relationships in the Mexican American culture. A literature search of CINAHL, Medline, PsychoInfo, and Web of Science was used to identify peer-reviewed journals and original sources. Keywords included comadre, compadrazgo, fictive kin, social support, Mexican, and Mexican American. Additional resources were identified through a focused review of references. Findings from this study indicate knowledge about compadrazgo, is limited to the social organization, historical practices, and a preliminary description of the compadres role. Minimal information is available about the relationship between compadrazgo, and health, and variations in roles and responsibilities of compadrazgo, participants. Frequency of enactment of compadrazgo, responsibilities and barriers to the enactment of social support by compadres remain unknown. Variations in practice have not been explored. Nursing implication include the recommended ways that compadrazgo, can be encouraged or promoted in patient care.

Community leaders' perceptions of single, low-income mothers' needs and concerns for social support.

Purposes of this study were to (a) assess and describe needs and concerns of single, low-income mothers during their transition to parenthood from the perspective of 16 Midwestern community leaders working closely with families and (b) evaluate social support mechanisms that are available for families. Focus group questions were organized around social support theory to gather information. The following themes evolved from focus group discussions: (a) social support issues (emotional, tangible, informational, and appraisal support; positive and negative support); (b) personal barriers to success (stress, low self-esteem, isolation, and inadequate parenting competence); and (c) system barriers (fear of the system and insensitive and ineffective services). Community health nursing strategies were identified that include assessment and interventions for this vulnerable population throughout their infants' 1st year of life and beyond.