Multidrug-resistant bacteria infection and nursing quality management application in the department of physical examination.

The main problem of clinical prevention and control of multi drug resistant bacteria infection is to strengthen the monitoring of pathogenic bacteria spectrum, this study research on the multi drug-resistant bacteria infection and nursing quality management application in the department of physical examination. The results of this study showed that the number of patients with multiple drug resistant infections showed an increasing trend. Therefore, once the patients with multiple drug-resistant bacteria infection are found, the prevention and control of the patients with multiple drug-resistant bacteria should be strictly followed, and the patient's medication care should be highly valued. Also, the nurses need to be classified based on the knowledge and skill characteristics of the nurses in the department of physical examination, and compare the nursing effect before and after classification and grouping. The physicians and individuals receiving physical examinations in the department of physical examination had a higher degree of satisfaction for nursing effect after classification compared with those before classification. Classification and grouping management helps improve the nursing quality and overall quality of the nurses in the department of physical examination.

Defining a Role for Nursing Education in Staff Nurse Participation in Antimicrobial Stewardship.

The role of the staff nurse in antimicrobial stewardship programs (ASPs) is not clearly defined. This study explored the ASP educational needs of staff nurses, using survey, focus group, and Delphi methods of engaging nurse educators. Low awareness of components of ASPs and areas of educational need were identified.

Preventing and managing complications of CVADs.

Patient assessment and the appropriate management of long-term central venous access devices are essential to diminishing the potential for complications. When complications do occur, they tend to be the consequence of a series of events. Recognising problems at an early stage means they can be addressed sooner and improves the chances of resolving them without any long-term consequences.

Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics. / Nurseped: tecnología educativa para la seguridad en el manejo de antibióticos intravenosos en pediatría.

OBJECTIVE: to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics. METHOD: methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8). RESULTS: the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content. CONCLUSION: the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

Nurse staffing and patient safety in hospitals: new variable and longitudinal approaches.

BACKGROUND: Most studies of the relationship between nurse staffing and patient outcomes in hospitals have shown that worse patient outcomes are associated with lower registered nurse (RN) staffing. However, inconsistent results exist, possibly because of the use of a variety of nurse staffing and patient outcomes measures and because of statistical methods that employ static, instead of change, relationships. OBJECTIVES: The aim of the study was to examine the relationship between changes in RN staffing and patient safety events in Florida hospitals from 1996 through 2004. METHODS: Using 9 years of data from 124 Florida hospitals, latent growth curve models were used to assess the impact on patient safety of RN staffing changes in hospitals. Patient safety measures were 4 of the 20 provider-level patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality. Two measures of RN staffing-RN full-time equivalents and RN per adjusted patient day-were analyzed. RESULTS: Changes in RN full-time equivalents were positively related to changes in RN per adjusted patient day. All PSIs were negatively and significantly related to one or both RN staffing measures. Failure to rescue had the strongest relationship to RN staffing. Models of change relationships between staffing and PSIs were more likely to show significant relationships than models using initial levels. Initial levels of RN staffing tended to be unrelated to initial levels of PSIs. DISCUSSION: A negative relationship between RN staffing and PSIs was strongly supported with failure to rescue and was weakly supported with decubitus ulcers, selected infections, and postoperative sepsis. The PSIs should be retested in an expanded change model study using multistate or national sample Healthcare Cost and Utilization Project data.

The impact of different nursing skill mix models on patient outcomes in a respiratory care center.

BACKGROUND: Many hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs. However, the nursing skill mix model that most successfully achieves both cost effectiveness and quality care has yet to be determined. AIM: The aim of this study was to explore the impact of different nurse staffing models on patient outcomes in a respiratory care center (RCC). METHODS: Retrospective data from 2006 to 2008 were obtained from records monitoring nursing care quality, as well as patient records and nursing personnel costs in an RCC as a medical center, in southern Taiwan. A total of 487 patients were categorized into two groups according to the RCC's mix of nursing staff. The "RN/Aide" group comprised 247 patients who received RN and aide care, with a 0.7-0.8 proportion of RNs, from July 2006 to June 2007. The other 240 patients ("All-RN") received 100% RN care from January 2008 to December 2008. RESULTS: The results of this study indicated no significant differences in occurrence of pressure ulcer or respiratory tract infections, days of hospitalization, mortality, or nursing costs. However, significant differences were observed in ventilator weaning and occurrence of urinary tract and bloodstream infections. CONCLUSIONS: A higher proportion of RNs was associated not only with a lower rate of urinary tract infection but also with more patients being weaned successfully from ventilators. The findings of this study have implications for how managers and administrators manage nurse staffing in respiratory care.

[Approach of a person with infected venous ulcers]. / Abordaje de una persona con ulceras venosas infectadas.

People infected with venous wounds need to solve the acute problem (infection), later to treat the underlying cause (venous hypertension). By a proper assessment of the person can establish a comprehensive treatment. In the case above is achieved healing a venous ulcer 12 years of evolution in 11 weeks of treatment, with consequent savings for the health system, improving the quality of life of the person and the environment and cut red tape care.

Post-kidney transplant rejection and infection complications.

The care of a patient after kidney transplant is multifactorial and complex, often involving other organ systems. The clinical picture can frequently be complicated with symptoms that may be misleading, and hence, challenging to assess. The nephrology nurse caring for the recipient of a transplant should be able to assess the entire clinical situation, rather than focus only on renal function. When caring for recipients of transplants, nephrology nurses need to use their extensive knowledge base and employ critical thinking skills. Although all members of the multidisciplinary team are important for success, the patient remains the focal point of the team. Post-transplant management will be successful when patients actively participate in their care. Patient teaching plays a critical role in this success, and it starts when a transplant is anticipated and continues as long as the grafted kidney is functioning.

Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: A qualitative interview study.

BACKGROUND: There is an increase in the number of individuals who receive care at home. A significant proportion of these patients acquire infections during their care episode. Whilst there has been significant focus on strategies for infection prevention and control in acute care environments, there is a lack of research into infection prevention in a home care setting. OBJECTIVES: To understand (1) if and how home care nurses identify patients at high risk of infection and (2) the strategies they use to mitigate that risk. DESIGN: A qualitative descriptive study, using semi-structured interviews. SETTING: A large not for profit home care agency located in the New York region of the United States. PARTICIPANTS: Fifty nurses with a range of experience in home care nursing. METHODS: Purposive and snowball sampling was used to recruit nurses from across the home care agency with varied years of work experience. Interviews were audio recorded and transcribed. The interviews explored how home care nurses evaluate their patients' risk of developing an infection and if/how they modify the plan of care based on that risk. Data were analysed using thematic analysis. RESULTS: Three themes were derived from the data; assessing a patient's risk of infection, the risk assessment process, and strategies for mitigating infection risk. Factors identified by nurses as putting a patient at higher risk of infection included being older, having diabetes, inadequate nutrition; along with inadequate clinical information available at start of care. The patient's knowledge and understanding of infection prevention, and the availability and knowledge of caregivers were also important, as was the cleanliness of the home environment. Given the context of home care, where nurses have little control over the environment and care processes in-between visits, the main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviours, and the ability to adjust a patient's plan of care according to their infection risk. CONCLUSIONS: The study highlights the complexity of the risk assessment process in relation to infection. Existing guidelines for infection prevention and control do not adequately cover the home care environment and more research needs to determine which interventions (such as patient/caregiver education) would be most effective to prevent infections in the home care setting.

Infections in Heart and Lung Transplant Recipients.

Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management.

Special populations: telehealth advance practice nursing: the lived experiences of individuals with acute infections transitioning in the home.

AIM: This paper aims to describe the "lived experience" of individuals with acute infections transitioning in the home with support by an advance practice nurse using telehealth. BACKGROUND: The use of telehealth in individuals' homes in the United States is increasing in an effort to cut cost by limiting admissions to hospitals and/or reducing length of stay. This increase has not been driven by conclusive research findings in support of this technology; furthermore, the majority of research conducted has been in the area of chronic disease management. METHOD: A qualitative approach was used to describe the essential structure of the lived experience as told during taped interviews by individuals who had been enrolled in a pilot quantitative telehealth study over the past 2 years. FINDINGS: Major findings consisted of three theme categories: Initial response, Engaging in care, and Experiencing the downside. The transition that occurred when an individual with an acute infection was discharged from the hospital to the home supported by telehealth technology revealed an overall positive experience from the 10 participants. There was one negative experience in a participant who had two separate telehealth enrollments. CONCLUSIONS: The findings add valuable insight for advanced practice nurses into the experience of participants with acute illness who are receiving telehealth as they transition from hospital care to home care. The findings highlighted the importance of the participants having a sense of control when recovering from their illness, which could be achieved at home with a family member acting as a substitute nurse. The participants shared that the hospital environment may not be optimal for recovering from an illness. This provides the advanced practice nurse with information on risk and benefits of telehealth from the individuals' perspective.

[Burnout and occupational stress in nurses]. / Burnout e stress lavorativo in infermieri professionali.

BACKGROUND: In the last few years there has been a growing interest in the psychosocial work environment of health care workers, since they are both at high risk of burnout, role conflict and job dissatifaction. Burnout, as a type of prolonged response to chronic job-related stress, has a special significance in health care settings, where staff experience both psychological--emotional and physical stress. OBJECTIVES: The present study investigated the interrelationship between burnout, occupational stress and personality characteristics in a sample of 120 nurses employed in the Infectious Diseases Department and the Department of Medical Oncology of two major hospitals in Messina, Italy. METHODS: Three questionnaire surveys were administered: The Maslach Burnout Inventory (MBI) to estimate the job stress level, Occupational Stress Inventory to measure occupational stress and the Comrey Personality Scale to identify major personality characteristics. RESULTS: The results showed a significant statistical diference regarding the burnout levels in the two groups under study, with a higher burnout level in the Medical Oncology staff with respect to the Infectious Diseases Staff. The latter group also showed a higher occupational stress compared to the second group, with a significant statistical difference regarding "stress sources", coping strategies" and psychological health". Concerning the CPS results, some personality characteristics, as predictors for burnout syndrome, were found in the Medical Oncology staff. CONCLUSIONS: The study results underline the importance of the role ofpsychosocial work environment and the interrelationships between burnout, occupational stress and psychosomatic health in health care workers. In addition, in order to reduce a burnout risk, the Authors suggest improving the psychosocial work environment as a preventive measure.