Nursing Care of Patients With Cirrhosis: The LiverHope Nursing Project.

Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients' quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers.

Pediatric Nurses' Perceptions of Their Role in Antimicrobial Stewardship: A Focus Group Study.

PURPOSE: To explore pediatric nurses' perceptions of their role in antimicrobial stewardship. DESIGN AND METHODS: Twelve focus group sessions were conducted at a freestanding children's hospital including 90 nurses across a range of settings, units, and years of experience. Transcripts of the focus group sessions were jointly coded, from which themes were developed. RESULTS: Specific nursing roles in antibiotic stewardship identified include: (1) advocating for the patient, (2) communicating with the team, (3) administering medications safely, (4) educating caregivers, and (5) educating themselves. Identified barriers hindering effective execution of these roles include inconsistent inclusion on rounds and lack of institutional protocols for antibiotic use. CONCLUSION: Nurses easily identified numerous daily nursing tasks that fit within the framework of antimicrobial stewardship and desired additional education and engagement in antibiotic stewardship. IMPLICATIONS: Engaging nurses could improve the structure of antibiotic stewardship programs and break down the barriers that keep nurses from fulfilling their role.

The Human Microbiome and Understanding the 16S rRNA Gene in Translational Nursing Science.

BACKGROUND: As more is understood regarding the human microbiome, it is increasingly important for nurse scientists and healthcare practitioners to analyze these microbial communities and their role in health and disease. 16S rRNA sequencing is a key methodology in identifying these bacterial populations that has recently transitioned from use primarily in research to having increased utility in clinical settings. OBJECTIVES: The objectives of this review are to (a) describe 16S rRNA sequencing and its role in answering research questions important to nursing science; (b) provide an overview of the oral, lung, and gut microbiomes and relevant research; and (c) identify future implications for microbiome research and 16S sequencing in translational nursing science. DISCUSSION: Sequencing using the 16S rRNA gene has revolutionized research and allowed scientists to easily and reliably characterize complex bacterial communities. This type of research has recently entered the clinical setting, one of the best examples involving the use of 16S sequencing to identify resistant pathogens, thereby improving the accuracy of bacterial identification in infection control. Clinical microbiota research and related requisite methods are of particular relevance to nurse scientists-individuals uniquely positioned to utilize these techniques in future studies in clinical settings.

[Antibiotic prescription usage and assessment in geriatric patients]. / Usage et évaluation des prescriptions antibiotiques en gériatrie.

Due to the high risk of infection, the geriatric population is regularly subjected to antibiotics. Faced with bacterial resistance, particularly among elderly dependent patients, it is essential to promote proper use and correct prescription of antibiotics. A study evaluated antibiotic prescription in a geriatric hospital with 598 beds and highlighted the importance of collaboration between geriatricians and infectious disease specialists.

Antibiotic resistance and irrational prescribing in paediatric clinics in Greece.

INTRODUCTION: Greece is among the countries with the highest rates of antimicrobial resistance (AMR) and simultaneous antibiotic consumption. AIM: The aim of this study was to assess the perceptions and knowledge of AMR and irrational antibiotic prescribing of nurses working in paediatric hospitals in Greece. METHOD: A self-administered questionnaire was distributed to nurses in paediatric hospitals and paediatric clinics in Greece. Descriptive and multivariate statistical analyses were performed. Levels of significance were two-tailed and statistical significance was p=0.05. RESULTS: A total of 87% of participants reported irrational prescribing to be an important cause of AMR. Diagnostic uncertainty was stated by 55.5% as the main cause of irrational antibiotic prescribing and 94% suggested the use of protocols and guidelines as the main measure to control overprescribing. Parental demand for antibiotics in hospitals has increased according to 51.8% of respondents. Strong correlation was observed between social-demographic characteristics and antibiotic resistance, as well as irrational prescribing. CONCLUSIONS: Assessing nurses' knowledge and perceptions of antimicrobial resistance and irrational prescribing is vital as nurses actively participate in the antibiotics administration process and antimicrobial management in Greece. Their involvement could contribute to educate patients and parents on the public-health implications of overprescribing and antimicrobial resistance.

A-voiding catastrophe: implementing a nurse-driven protocol.

PURPOSE: To evaluate the effectiveness of a nurse-driven indwelling urinary catheter removal protocol in an acute care setting. BACKGROUND: The most common hospital-acquired infection is catheter-associated urinary tract infection (CAUTI). These infections account for 40% of all hospital-acquired infections. Although indwelling urinary catheters may be a needed intervention, studies have demonstrated over half of the patients who receive a urinary catheter do not have a valid indication for its use. METHODOLOGY: A retrospective chart review allowed measurement of prevalence of catheter usage, dwell time, and CAUTIs before and after implementation of the protocol. Indwelling catheter usage was tabulated monthly from nursing clinical documentation. The sum of catheter days was divided by the total patient days and multiplied by 100 to get a percentage of catheter usage for each month. Dwell time was calculated by tabulating the length of time in days each patient had an indwelling catheter and dividing it by the total number of catheterized patients to determine the mean duration in days. The number of CAUTIs was divided by the total number of patients with urinary catheters and multiplied by 100 to get the percentage of CAUTI. RESULTS: Prior to implementing the nurse-driven removal protocol, indwelling urinary catheter usage was 37.6%, mean dwell time was 3.35 days, and the CAUTI rate was 0.77%. After implementation of the protocol, catheter usage was 27.7%, mean dwell time was 3.46 days, and the CAUTI rate 0.35%. IMPLICATIONS FOR NURSING: Findings support the use of a nurse-driven protocol to reduce the incidence and duration of urinary catheterization, to decrease incidence of CAUTI, and to improve the quality of care for hospitalized patients.

Does paracetamol help or hinder healing in bacterial infections?

Community nursing teams, alongside other primary care services and nurses in working in community hospitals, are caring for people who are older, sicker and require more complex care. The nurse's ability to use evidence to make informed judgements is vitally important to patient care. Nurses often give paracetamol that is prescribed on an 'as required' basis to patients with bacterial infections who are pyrexial. This practice is supported by guidelines from the National Institute of Health and Care Excellence and the British National Formulary. This article reviews the evidence and suggests that the administration of paracetamol in people with pyrexia should be reconsidered and given on an individualised basis rather than as a routine.

Audit of missed or delayed antimicrobial drugs.

Although the National Patient Safety Agency published a Rapid Response Report on reducing harm resulting from omitted or delayed medication in 2010, omitted doses continue to occur frequently. The Francis report raised awareness of the problem and its potential impact on care. This article discusses the findings from a multicentre point-incident collaborative audit, focused on antimicrobials. We reviewed records from 6,062 patients prescribed 21,825 doses of antimicrobials; 13% were affected by omitted doses. Some doses are omitted in patients' best interests, but organisations need to identify those that occur for no acceptable reason and target them as a priority. We need national initiatives, strong local nursing leadership and multidisciplinary engagement to support a range of targeted interventions to achieve effective, sustained improvements. The tools developed from this study may help others to begin tackling this issue.

Antibiotic resistance in the NICU.

Antimicrobial treatment is a mainstay therapy in the neo-natal intensive care unit (NICU). Given the lack of specificity for clinical symptoms of infection in the newborn and the overwhelming impact of infection with rapid multisystem dissemination, NICU providers tend to treat early while awaiting laboratory results. With the high vulnerability of our special population to a variety of potential infecting microbes, a combination of antibiotics is preferred for initial treatment. The selection of these antibiotics is based on the known or presumed environment of exposure. If the newborn is within a week of birth, we can reasonably expect the likely environment of exposure is the community or the mother. If the newborn is older or has undergone numerous procedures, we can presume the exposure is more likely to be hospital-based.

Neonatal PICC: one unit's six-year experience with limiting catheter complications.

Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days. The dressing technique described in this article differs from that seen in the literature with the addition of a protective base layer. Catheter complication rates are low, and catheter dressing changes are minimized with this dressing technique.