Best practice standards for the delivery of NHS infection services in the United Kingdom.

Infection expertise in the NHS has historically been provided predominantly by hospital-based medical microbiologists responsible for provision of diagnostic services and advice to front-line clinicians. While most hospitals had consultant-led microbiology departments, infectious iiseases departments were based in a small number of specialist centres. The demand for infection expertise is growing in the NHS, driven by advances in medical care, increasing awareness of the impact of antibiotic resistant and healthcare associated infections and threats from emerging infectious diseases. At the same time diagnostic services are being reorganised into pathology networks. The Combined Infection Training (CIT) is delivering a consultant workforce with expertise both in laboratory diagnostic practice and delivery of direct patient care. These changes create challenges for delivery of high quality infection expertise equitably across the NHS. They also offer an opportunity to shape infection services to meet clinical and laboratory demands. To date there has not been an attempt to bring together a single set of best practice guidelines for the requirements of an infection service. This document sets out seven standards. These are written to be practical and flexible according to the diverse ways in which infection expertise may be required across the NHS. It has been prepared by the Clinical Services Committee of the British Infection Association drawing on published evidence and guidance where they exist and on the group's extensive experience of delivering infection services in hospitals across the NHS. It was then refined with input from the RCP Joint Specialist committee (JSC) and the RCPath Specialist Advisory Committee (SAC) and through consultation with the RCPath membership. It has been endorsed by the Royal College of Pathologists and the Royal College of Physicians. It will be reviewed annually by the CSC and updated as additional evidence becomes available.

Transformative Learning in an Online Doctor of Nursing Practice Population Health Course.

BACKGROUND: Population health is a critical component of Doctor of Nursing Practice (DNP) education, providing the foundation for clinical prevention, health equity, responsible policy, and practice change. Many DNP learners enter population health courses focused on individual patient care in microsystems. Transformative learning broadens learners' perspectives about health determinants and implications for health system transformation. METHOD: Transformative learning strategies were imbedded in a 10-week, online population health course. Students engaged with readings and multimedia content and wrote anonymous reflective analyses about population health determinants. Qualitative survey data were explored for transformative content using line-by-line content analysis. The stages of transformative learning were used as a priori codes. RESULTS: Learners questioned their own beliefs and epistemologies and demonstrated all aspects of transformative learning, although not equally across course topics. CONCLUSION: To achieve the promised outcomes of DNP education, population health content should be professionally transformative and integrated across the curriculum. [J Nurs Educ. 2019;58(8):481-484.].

PsyConnect: Constructing Layered Engagement for Optimal Learning in Clinical Education.

BACKGROUND: The increasing volume of nursing students placed in shrinking numbers of clinical sites has resulted in clinical overcrowding in behavioral care settings. Overcrowding has resulted in the deterioration of the clinical teaching and learning experience for students, faculty, and nurses. PsyConnect is a layered, multiplatform engagement learning experience that uses multiple teaching methods to increase student engagement, reduce inpatient overcrowding, maximize learning opportunities, and improve teaching and learning experiences. METHOD: PsyConnect was implemented in a baccalaureate mental health nursing course during one term. Investigators surveyed students, faculty, and nurses who attended campus simulation. Data analysis included measures of central tendency and Pearson correlation coefficient. RESULTS: Setting rotations, clinical checklists, off-unit learning modules, and simulation with staff nurses improved educational experiences, as reported by students, faculty, and participating nurses. CONCLUSION: The PsyConnect evaluation suggested that layered, multiplatform, engagement-based learning addressed critical barriers to high-quality, clinical education. [J Nurs Educ. 2016;55(9):541-543.].

Redesigning a graduate research course for evidence-based competencies.

Nursing research is critical to establish the science for the discipline and to provide a foundation for evidence-based practice. All nurses need to understand the research process and engage in research at the level for which they were prepared. The American Association of Colleges of Nursing has clearly outlined essential learning outcomes for each level of nursing education, including the competent application of research findings to clinical problems. This article describes the evolution of a graduate-level research course to provide master's level students with a sound foundational understanding of the research process, the innovation undertaken to address identified learning needs, and the important lessons learned.

Development and psychometric testing of the Register - Connectedness Scale for Older Adults.

Connectedness, maintaining active engagement with life, is crucial to successful aging. Yet, no instruments were found to measure connectedness. The purpose of this study was to develop and test a connectedness scale for older adults. A 72-item instrument was administered to 428 community-dwelling older adults. The sample was largely female, White widows/widowers, with a mean age of 76 (SD 6.95) years. The instrument was reduced to 45 items representing five factors with loadings ranging from .40 to .86. The factor labels and their reliability estimates were: (a) self-regulating (.86), (b) facing aging (.85), (c) being part of a family (.87), (d) having friends (.87), and (e) being spiritual (.88). This promising instrument may advance the science of successful aging.

Quality of life revisited: the concept of connectedness in older adults.

Viewing quality of life from a generative context gave rise to a new perspective and the old term quality of life failed to capture the essence of the new idea. Creation of a new term required a series of deliberate studies to develop the concept of connectedness. This article traces the conceptual progression and presents the concept synthesis of connectedness using literary synthesis, qualitative synthesis, and quantitative synthesis. Based on the concept synthesis, connectedness in community-dwelling older adults can be defined as engaging life by self-regulating, facing aging, being part of a family, having friends, and being spiritual.

A middle range theory for generative quality of life for the elderly.

Decades of quality of life (QOL) research has failed to produce widely recognized QOL definitions or measurements. The inconsistency may be due to an ontological error in the perspective of researchers. Most researchers portray QOL as a given or inherent condition that declines in the face of challenges. We believe QOL is a cumulative process that results from a series of connections and disconnections that elders experience in their daily lives. The Register theory of Generative Quality of Life for the Elderly offers an alternative ontological perspective by placing elder QOL in a generative context.

Use of a pregnancy support web site by low-income African American women.

OBJECTIVE: To examine the feasibility and usage pattern of a social support Web site by low-income pregnant African American women. DESIGN: Descriptive. SETTING: Homes of participants. PARTICIPANTS: Nineteen pregnant African American women who were pregnant for the first time, were low risk, and attending a prenatal clinic. INTERVENTION: Culturally congruent Web site providing information on pregnancy-related health behaviors and other pregnancy issues. MAIN OUTCOME MEASURES: Number of visits to Web site, most popular pages, content analysis of postings, and e-mails to a nurse. RESULTS: Participants were able to learn to use the Web site easily. They accessed the discussion board the most frequently, followed by changes during pregnancy by month, ask-a-nurse feature, ultrasound, stories about pregnant women, and spirituality. CONCLUSIONS: The discussion board is the most effective way to deliver informational social support on a comprehensive social support Web site.

Skin temperature and chronic venous insufficiency.

OBJECTIVE: This study compared lower leg skin temperatures in adults age 50 years and older with and without chronic venous insufficiency (CVI). Norms and ranges of skin temperature were also established. DESIGN: A descriptive comparative design was used. SETTING AND SUBJECTS: Sixty-six adults recruited from hospital clinics and senior community dwellings participated in the study, which was conducted in an examination room of an outpatient clinic. To be included in the study, those with CVI showed stage 4 and 5 clinical signs. Those without CVI had no clinical signs. INSTRUMENTS: Skin temperature was measured with an infrared dermal thermometer. METHODS: Subjects were seated with legs extended, free of clothing and socks, and loosely covered with a draped sheet for 10 minutes to acclimatize to room temperature. The skin temperature of 4 sites on the lower legs was measured. Analysis of variance and independent t tests were used to compare groups. RESULTS: There was a significant increase in skin temperature at all 4 sites in the ankle area in the group with CVI compared with the comparison group (89.9 degrees F +/- 2.7 degrees F versus 88.1 degrees F +/- 2.1 degrees F, P =.004). CONCLUSIONS: Elevated skin temperature may be an important nursing assessment parameter to evaluate worsening or impending CVI complications such as venous ulcers.

The effect of auricular acupuncture on psychophysiological measures of cocaine craving.

This study used a randomized pretest/posttest control group design to test the effectiveness of auricular acupuncture interventions in diminishing psychological and physiological changes associated with cocaine craving in 30 treatment-seeking cocaine-dependent patients. The experimental group received the real auricular acupuncture intervention, insertion of needles into ear point locations specifically targeted for drug withdrawal. The control group received sham or placebo auricular acupuncture, insertion of needles into ear point locations not targeted for any specific therapeutic benefit. Psychological (Cocaine Craving Questionnaire - Now) and physiological (skin conductance activity) changes associated with cocaine craving were measured. Results showed no differences between the control and the experimental group in diminishing psychological and physiological measures associated with craving. There were differences from pre- to posttest on measures of psychological but not physiological craving for the combined experimental and control groups.