Relación de las distracciones, las características sociodemográficas y contextuales con las prácticas seguras de inyecciones durante la práctica clínica del enfermero / Relationship of distractions, sociodemographic and contextual characteristics with safe injection practices during nurses' clinical practice

Objetivo: Analizar la relación entre las distracciones, las características sociodemográficas y contextuales con la realización de las prácticas seguras de inyecciones realizadas por el enfermero durante la preparación y administración de los medicamentos en los servicios de hospitalización y terapia intensiva de adultos. Método: Estudio cuantitativo, transversal y correlacional que utilizó la observación estructurada guiada por listas de chequeo, con un muestreo no probabilístico a propósito de 446 prácticas de inyecciones. Se realizó un análisis univariado y bivariado según el nivel de medición de las variables (correlación de Spearman, punto biserial y coeficiente Eta) en el paquete estadístico IBM SPSS Statistics 24.0 y un análisis de covarianza en el paquete estadístico Statgraphic XVII. Resultados: Se observaron 448 prácticas de inyecciones ejecutadas por 26 enfermeros con 5 años de experiencia, una mediana de 4 pacientes por turno y 3 medicamentos por ronda de medicación. Las distracciones fueron más frecuentes en la fase de preparación (67,9%), siendo las comunicaciones profesionales y sociales las más comunes con relevancias opuestas según la fase del proceso de medicación. La estrategia de manejo más usada fue "multitareas". Las prácticas de inyecciones conservaron la regla "un medicamento, una aguja, una jeringa, un solo diluyente por única vez" por paciente. El porcentaje total de ítems realizados de la lista de chequeo osciló entre el 47,3% y el 84,2%. Las variables de género (femenino p=0,028, IC 95%=0,051; 0,895), familia del medicamento (antiinfectivos: p=0,000, IC 95%=3,711; 5,568; preparaciones hormonales: p=0,000, IC 95%=1,197; 5,050 y sistema musculoesquelético: p=0,000, IC 95%=-2,046; 2,822), tipo de inyección (intravenosa: p=0,000, IC 95%=-0,749; 2,060), día de la semana (fin de semana: p=0,000, IC 95%=0,358; 1,404), servicio (hospitalización: p=0,001, IC 95%=6,613; 7,925) y turno (mañana: p=0,003, IC 95%=-0,227; 0,885) explicaron en un 81,67% la práctica segura de inyecciones. Conclusiones: Las distracciones (p=0,567, IC 95%=-0,742; 0,567) no fueron una variable que explicara la práctica segura de inyecciones a diferencia de las ocho características sociodemográficas y contextuales (turno, procedimiento e insumos) del enfermero.

Objective: Analyze the relationship between distractions, sociodemographic and contextual characteristics with the accomplishment of safe injection practices performed by the nurse during the preparation and administration of medications in hospitalization and adult intensive care services. Method: Quantitative, cross-sectional, correlational study that used structured observation guided by checklists, with a non-probabilistic sampling of 446 injection practices. A univariate and bivariate analysis was performed according to the level of measurement of the variables (spearman correlation, biserial point and eta coefficient) in the IBM SPSS Statistics 24.0 statistical package and an analysis of covariance in the Statgraphic XVII statistical package. Results: 448 injection practices were observed, carried out by 26 nurses with 5 years of experience, a median of 4 patients per shift and 3 medications per round of medication. Distractions were more frequent in the preparation phase (67.9%), the professional and social communications are the most common with opposite relevance according to the phase of the medication process and the most used management strategy was "multitasking". The injection practices kept the rule "one medicine, one needle, one syringe, one diluent at a time" per patient. The total percentage of items made from the checklist ranged between 47.3% and 84.2%. Gender variables (female p=0.028, 95% CI=0.051; 0.895), drug family (anti-infectives: p=0.000, 95% CI=3.711; 5.568, hormonal preparations: p=0.000, 95% CI=1.197; 5.050 and system musculoskeletal: p=0.000, 95% CI =-2.046; 2.822), type of injection (intravenous: p=0.000, 95% CI=-0.749; 2.060), day of the week (weekend: p=0.000, 95% CI=0.358; 1.404), service (hospitalization: p=0.001, 95% CI =6.613; 7.925) and shift (morning: p=0.003, 95% CI =-0.227; 0.885) explained the safe practice of injections by 81.67%. Conclusions: Distractions (p=0.567, 95% CI =-0.742; 0.567) were not a variable that explained the safe practice of injection, unlike the eight sociodemographic and contextual characteristics (shift, procedure, and supplies) of the nurse.

Effects of Rapid Vaccine Injection Without Aspiration and Applying Manual Pressure Before Vaccination on Pain and Crying Time in Infants.

AIM: To compare effects of rapid injection without aspiration and 10-second manual pressure before injection on pain severity and crying time in 4- to 6-month-old infants given the vaccine DTaP/IPV/Hib. METHODS: This is a randomized double-blind controlled study. The study population included all the infants presenting for DTaP/IPV/Hib to two family health centers between April and August in 2015. The study sample included 128 infants based on confidence interval of 95% and statistical power of 80%. The sample was divided into four groups: manual pressure, rapid injection without aspiration, manual pressure combined with rapid injection without aspiration, and control groups. There were 32 infants in each group. Gender was adjusted in all groups. Stratified and block randomizations were used. RESULTS: Pain severity scores and crying time during and after the injections were significantly lower in the three intervention groups than in the control group (p = .001). The lowest increase in the mean heart rate during and after the injections occurred in the rapid injection without aspiration group (p < .05). In addition, the mean oxygen saturation before, during and after the injections was significantly lower in this group than in the other groups (p < .05). However, two infants in the rapid injection without aspiration group had low oxygen saturation levels starting before the injections. In fact, mean oxygen saturations did not change across time. This suggests that lower oxygen saturation in the rapid injection without aspiration group cannot be due to vaccines or the techniques used. LINKING EVIDENCE TO ACTION: Manual pressure and rapid injection without aspiration are effective and useful in relief of pain and reduction of crying time due to vaccine injections in 4- to 6-month-old infants.

NURSES INFECTION PREVENTION PRACTICES IN HANDLING INJECTIONS: A CASE OF RIFT VALLEY PROVINCIAL HOSPITAL IN KENYA.

OBJECTIVE: To analyse the infection prevention practices in handling of injections by nurses in Rift Valley Provincial Hospital in Kenya. DESIGN: A cross-sectional observational study. SETTING: Rift Valley Provincial hospital which is a level five health facility situated in Nakuru County, Kenya. SUBJECTS: A sample of 386 injection procedures attributed to the nurses in Rift Valley Provincial Hospital was considered for this study. RESULTS: The study established that among all the injections administered in this study, 43.7% (386) adhered to aseptic techniques. Over seventy five percent (76.9%, n = 386) of the observed injections procedures did not involve the hand-washing, 53.4% (n = 206) did not involve swabbing of a vial rubber cap with alcohol swabs and 95.1%(n = 263) involved using of multidose drug in more than one designated patient. Over ninety five percent (95.6%, n = 364) of the observed procedures involved use of sterile the syringe bit of the devices only while the rest used either clean or contaminated syringes. Around forty percent (42.2%, n = 316) of the injections preparation was done elsewhere (not at the patient bedside) before administration. Slightly over thirty five percent (36.6%, n = 386) of the injections were administered immediately upon reconstitution(at the right time). The study also established the use of aseptic techniques to reconstitute and administer was significantly related to the number of nurses to patients ratio per shift (X2(1) = 3.5: p = 0.04). CONCLUSION: The findings of this study indicate that patient safety in public hospital is still relatively low. The adherence to basic infection prevention procedures/aseptic techniques in handling of injections by health workers is still a concern. The adherence to aseptic techniques in handling injections is significantly associated with the nurses to patients ratios. Therefore, it is imperative to improve nurse to patient ratio in public health facilities in Kenya.

Validation of a screening instrument for the fear of injection in dialysis patients.

BACKGROUND: Very little research has been conducted on the fear of injection (FOI) in patients on dialysis. However, feedback from hospital practice indicate that FOI is widespread. OBJECTIVES: The aim of this study was to develop and validate a screening instrument to assess FOI in dialysis patients. METHOD AND DESIGN: A group of patients (n = 86) completed the Dialysis Fear of Injection Questionnaire (DFIQ) and the Hospital Anxiety and Depression Scale (HADS). In semi-structured interviews, these patients were also asked about their FOI, general anxiety and depressive symptoms. Various analyses were used to examine the factor structure, sensitivity, accuracy and cut-off score. RESULTS: The most optimal set of items consists of 9 items. These items have the sensitivity of 0.88, a specificity of 0.72 and a cut-off value of 3.5. The Cronbach's α is 0.87. CONCLUSION: The DFIQ appears to be a good predictor for the presence of FOI. APPLICATION TO PRACTICE: Nurses can use this validated screening instrument to detect FOI. The cut-off score provides a good indication for psychological counselling.

Ergonomic procedure for heel sticks and shots in Kangaroo Care (skin-to-skin) position.

Kangaroo Care (KC) has been recommended as a pain-reducing strategy in neonates; however, KC has not been widely used to minimize procedural pain caused in part by nurses'/phlebotomists' discomfort when positioning themselves and the infant for blood drawing and injections. Therefore, an ergonomically designed setup incorporating the use of KC was introduced into clinical practice to facilitate blood draws and injections. The step-by-step procedure used for heel sticks and injections is presented in this manuscript. After implementing the ergonomic step-by-step protocol, complaints of discomfort by nurses and phlebotomists ceased, and an additional benefit was that infant pain responses were significantly reduced.

Survey of syringe and needle safety among student registered nurse anesthetists: are we making any progress?

Anesthesia providers serve a vital role in preventing the transmission of disease by following safe injection practices, yet violations of these standards have occurred. The goal of this study was to determine the extent of unsafe injection practices that exist among student anesthesia providers. An online survey containing 8 yes-no questions that assessed injection practices as outlined by the American Association of Nurse Anesthetists was sent to student registered nurse anesthetists with at least 3 months' clinical experience. Three hundred twenty-five students completed the survey. Results showed that 14 (approximately 4%) have administered medications from the same syringe to multiple patients, 59 (18%) have reused a needle on the same patient, 266 (82%) have refilled used syringes, and 2 (0.6%) have reused infusion sets for more than 1 patient. Furthermore, 71 (22%) have reused a syringe or needle to withdraw medication from a multidose vial, and 160 (49%) have reentered a single-use medication vial to prepare doses for multiple patients. Students also were asked to report their experiences with nurse anesthetists who engaged in these practices. The results demonstrate that additional education on injection safety must take place to improve practice, increase patient safety, and reduce healthcare costs.

Lesión del nervio ciático: aproximación médico legal / Sciatic nerve injury: medical legal correlation

Esta descripción reporta la revisión de peritajes realizados en el Centro de Estudio en Derecho y Salud (CENDES) sobre lesión del nervio ciático. El análisis de los hallazgos mostróque el 57,1 % de las causas de lesión del nervio ciático —con compromiso en todos los casos del nervio peroneo común, principalmente su rama peroneo superficial— se derivaron de la prestación de un servicio de salud. En la valoración de los pacientes se observó que el daño encontrado no essolo estructural, sino que involucra también los órdenes estético, funcional, psicológico y social que alteran, en su conjunto, el estado bio-sico-social y económico del individuo. Al igual puede implicar consecuencias de orden jurídico para el prestador de servicios de salud.

This paper reports the expert review conductedat the Center for Law and Health Study (CENDES)on sciatic nerve injury. Analysis of findings showed that 57.1% of the causes of the sciatic—nerve injury with involvement in all cases of common peroneal nerve, superficial peronealbranch mainly his— were derived from the provision of a health service. In the evaluation of patients showed that the damage found is notonly structural but also involves the aesthetic, functional, psychological and social alter, overall, the state bio-psycho-social and economicindividual. It may involve legal implications for the health care provider.

Numeracy for nursing, report of a pilot study to compare outcomes of two practical simulation tools--an online medication dosage assessment and practical assessment in the style of objective structured clinical examination.

UNLABELLED: This pilot study compares the results of medications calculations carried out by student nurses using an online assessment tool with the results of the same calculations carried out within simulated practice. The numeracy project, of which this is part, is funded by NHS Education for Scotland (NES). OBJECTIVE: To test the efficacy of a realistic computer-based assessment of pre-registration nurses' medication calculations skills by comparing outcomes from using an online assessment tool with a practical assessment tool in the style of an Objective Structured Clinical Examination OSCE. Both assessment methods used medicine calculations usually presenting authentically in the practice setting. DESIGN: A multi-stage quantitative study using a cross-over design. SAMPLE: Fifty early 3rd year students on the adult branch of a pre-registration nursing programme at a large school of nursing in England. RESULTS: Results showed that, for assessing accuracy of calculation, there was a high level of congruence between the two methods. CONCLUSIONS: Computerised assessment of medications calculations using this particular platform is likely to closely mirror assessment of medication calculations done in a practical setting. As such it could be a useful adjunct to current assessment methods.

What are the necessary practice competencies for two providers: dermal fillers and botulinum toxin type A injections?

There has been a steady increase in the number of individuals who undergo dermal fillers and botulinum toxin Type A injections. The majority of these procedures are performed by nurse providers. The purpose of this study was to collect national data on the current practice among nursing providers within the American Society of Plastic Surgical Nurses (ASPSN). The goal was to utilize the national data and develop a document of the necessary competencies to guide the practice of providers of dermal fillers and botulinum toxin Type A injections. A survey tool was developed and validated for content by expert nursing providers among the membership of the ASPSN and disseminated via e-mail to the membership of the ASPSN. In addition, data from investigator training, mentoring, and evidence from a review of the literature were also incorporated into the competency document utilizing the Competency Outcomes and Performance Assessment (COPA) model. Common core issues became apparent that included contraindications for the use of botulinum toxin Type A and dermal fillers, postprocedure complications as well as strategies in terms of managing complications. The data also revealed that there is no common method providers are taught to assess the aesthetic patient and a lack of a collaborative relationship in current practice. Overwhelmingly, the respondents supported the need for defined practice competencies. A competency document to guide the practice of providers of dermal fillers and botulinum toxin Type A has been developed for completion of this DNP project.

Risks and benefits of needle use in patients after axillary node surgery.

Lymphoedema may be triggered by any type of injection. This is not just an issue for the cured breast cancer patient but for any patient who has undergone under-arm (axillary) lymph node removal to any degree for any type of cancer. Standard advice given to patients following axillary node removal is to avoid any injection or blood pressure measurement on the ipsilateral arm. The evidence base in this area is severely lacking. Patients have reported frustration that nurses are not informed of contraindications in carrying out such procedures on patients at risk of developing swelling. This article discusses the current evidence available on the subject of non-accidental skin puncture (NASP) relating to the patient at risk of lymphoedema and provides guidelines for any professionals conducting such procedures for patients with a history of cancer. The results from a small audit of the guidelines are cited and they reveal that out of 14 patients who underwent NASP procedures in the at risk arm, no patients reported swelling to that limb within a month of these procedures.