Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters - Four U.S. Cities, March 27-April 15, 2020.

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three). The investigations were performed in coordination with academic partners, health care providers, and homeless service providers. Investigations included reverse transcription-polymerase chain reaction testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1-2 weeks for residents and staff members at the five shelters. During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas.

Nurses keeping patients safe by managing risk in perioperative settings: A classic grounded theory study.

AIM: To develop and expand how nurses promote safety in perioperative settings. BACKGROUND: This article presents orchestrating a sub-core category from the theory of anticipatory vigilance in promoting safety within preoperative settings (Journal of Clinical Nursing, 27, 2018, 247). Orchestrating explains this and involves effective planning, delegating, co-ordinating and communication. METHOD: A classic grounded theory methodology was used. Ethical approval was granted. Data comprised of 37 interviews and 33 hr of non-participant observation. Data analysis followed the principals of classic grounded theory. RESULTS: Orchestrating is fundamental in promoting safety and minimizing risk of errors and adverse events in the perioperative setting. Nurses achieve this through four categories: macro orchestrating, locational orchestrating, situational orchestrating and being in the know. CONCLUSION(S): Nurses minimize risk by fostering a culture of safety, risk awareness, effective management and leadership. IMPLICATIONS: Effective management structures and support systems are essential in promoting a culture of safety in perioperative setting.

Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting.

AIMS AND OBJECTIVES: To explore and explain how nurses minimise risk in the perioperative setting. BACKGROUND: Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. DESIGN: Classic grounded theory. METHODS: Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. RESULTS: Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. CONCLUSION: Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. RELEVANCE TO CLINICAL PRACTICE: This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting.

An observational study on the open-system endotracheal suctioning practices of critical care nurses.

AIM AND OBJECTIVES: The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses' practices prior to, during and post-ETS and to compare nurses' ETS practices with current research recommendations. BACKGROUND: ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life-threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis. DESIGN AND METHOD: In March 2005, a structured observational study was conducted using a piloted 20-item observational schedule on two adult intensive-care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to. RESULTS: The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower-quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions. CONCLUSION: The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses' daily suctioning practices. RELEVANCE TO CLINICAL PRACTICE: As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses' ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures.