Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study.

AIMS AND OBJECTIVES: To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications. BACKGROUND: Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking. DESIGN: Cross-sectional study. METHODS: A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models. RESULTS: Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia. CONCLUSION: Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.

Remember the risks of intravenous therapy and know how to reduce them.

Nicola Brooks, Associate Dean, Faculty of Health and Life Sciences, De Montfort University, reflects on the potential problems that can occur with the administration of intravenous therapy.

Complications of deep vein thrombosis.

Post-thrombotic syndrome is a common and chronic complication of deep vein thrombosis (DVT) that may develop in one out of two to three patients despite optimal anticoagulant treatment.

A randomised clinical trial comparing the patient comfort and efficacy of three different graduated compression stockings in the prevention of postoperative deep vein thrombosis.

AIMS AND OBJECTIVES: To compare the comfort levels of patients regarding the use of three different graduated compression stockings and to analyse the efficacies of the graduated compression stockings in relation to patient comfort and compliance in prevention of postoperative deep vein thrombosis. BACKGROUND: Graduated compression stockings are very important with other prophylaxis methods in postoperative deep vein thrombosis prophylaxis. In meta-analyses and systematic review studies, it was reported that knee-length and thigh-length graduated compression stockings had similar efficacies. However, there is no randomised study in literature regarding the patient problems and levels of comfort with the use of graduated compression stockings of different sizes and pressures. DESIGN: A randomised clinical trial design. METHODS: A total of 219 patients were randomised into three groups (n = 73 in each group). Group I was given low-pressure, knee-length graduated compression stockings, group II was given low-pressure, thigh-length graduated compression stockings and group III was given moderate-pressure, knee-length graduated compression stockings. The level of patients comfort regarding the graduated compression stockings and occurrence of deep vein thrombosis were examined. RESULTS: The vast majority of the patients (79·5%) in group III and 52·1% of the patients in group II stated experiencing problems during the use of the graduated compression stockings (p < 0·001). The graduated compression stockings were reported by the patients as being very comfortable in the group I (p < 0·001). No findings of thrombosis were observed in any of the groups. CONCLUSION: The low-pressure, knee-length graduated compression stockings are as effective as the other graduated compression stockings of different pressures and sizes in the postoperative deep vein thrombosis prophylaxis, and the patients have fewer problems while using these graduated compression stockings with a high satisfaction. RELEVANCE TO CLINICAL PRACTICE: The combined use of pharmacological, mechanical and physical methods and patient education is effective in the prevention of postoperative deep vein thrombosis. The use of low-pressure, knee-length graduated compression stockings in clinical practice may be recommended, as the patients have fewer problems while using these graduated compression stockings with a high satisfaction.

Venous Thromboembolism: New Concepts in Perioperative Management.

Venous thromboembolism (VTE) is a serious pathophysiologic condition that is a major cause of morbidity and mortality, especially during the perioperative period. A collective term, VTE is used to describe a blood clot that develops inside the vasculature and results in a deep vein thrombosis (DVT) and/or a pulmonary embolism (PE). Deep vein thrombosis and PE are the third leading cause of cardiovascular mortality, superseded only by myocardial infarction and stroke. Patients who receive treatment for acute PE are 4 times more likely to die of a recurrent VTE within the next year. In hospitalized patients who have had surgery, the incidence of VTE and PE is estimated to be 100 times more prevalent than in the general population. The Joint Commission has established Surgical Care Improvement Project measures to address prophylactic interventions to minimize the incidence of VTE. This journal course will review the current approaches to pharmacologic and nonpharmacologic prevention and management of VTE during the perioperative period. Identification and treatment of deep vein thrombosis and acute PE are also described.

Differentiating between red legs and cellulitis and reviewing treatment options.

Red legs (RL) is a chronic inflammatory condition often misdiagnosed as cellulitis. Antibiotic therapy is not required and does not resolve the symptoms. The main causes of RL are chronic dermatological and venous disease, including chronic oedema. Raising awareness of this condition among health professionals could prevent misdiagnosis and unnecessary costly and potentially harmful antibiotic therapy. The aim of this paper is to highlight the differential diagnoses and management of red legs, and the author also includes an example through a case history.

Proactivity in VTE prevention: a concept analysis.

Venous thromboembolism (VTE) prevention is an international patient safety issue. The author has observed gaps in prescription and provision of VTE prophylaxis, and that the attitude to VTE is often reactive rather than proactive. This concept analysis aims to explore proactivity and apply it to VTE prevention to address this. Ten databases were searched (1992-2012) using the keywords proactive, proactivity, nurse, nursing, VTE/venous thromboembolism, prevent/prevention/preventing, behaviour, DVT/PE (deep vein thrombosis, pulmonary embolism). The Walker and Avant (2010) method of concept analysis identified the defining attributes as personal initiative, taking charge and feedback-seeking behaviour. Antecedents and consequences have been identified, and empirical referents are demonstrated. Defining proactivity in VTE prevention has the potential to increase prescription and, crucially, provision of prophylaxis, thereby improving patient care, reducing avoidable harm and improving the patient experience.

Baccalaureate education in nursing and patient outcomes.

OBJECTIVES: The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. BACKGROUND: The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. METHODS: This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals, analyzed the association between RN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. RESULTS: Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. CONCLUSION: The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

Nursing assessment of deep vein thrombosis.

The seriousness of deep vein thrombosis (DVT) and its accompanying morbidity and mortality make early and accurate diagnosis of key importance. Best clinical practice is supported by the use of a clinical decision model that determines risk based on predisposing factors and certain clinical signs and symptoms.

We've got it covered! Graduated compression stockings.

Hypercoagulability is a well documented feature of pregnancy and contributes to the increased incidences of venous thromboembolism (VTE) in pregnancy. Thromboembolism remains a leading cause of maternal death in the UK, though it's predicted that up to two thirds of these deaths could be prevented if appropriate thrombophylaxsis is adopted. This article aims to further midwives' knowledge in relation to thromboprophylaxsis, focusing in particular on graduated compression stockings (GCS). It aims to assist midwives in identifying those women at high risk of developing a VTE, explain the way in which compressio stockings can reduce thromboembolism and provide advice on their application and the clinical observations required.

Reducing upper extremity deep vein thrombosis when inserting PICCs.

While peripherally inserted central catheters (PICC) provide a positive contribution in the delivery of intravenous therapies, complications following insertion can occur. One of the more common of these is upper extremity deep vein thrombosis (UEDVT). Several elements of insertion are contributory factors. Research has been undertaken on patient assessment, catheter materials and size, insertion site, tip position and ultrasound placement, as well as on the value of anticoagulants. The resulting evidence informs opinion and shapes clinical practice. Inserting clinicians and advance-level nurses have a responsibility to reduce the incidence of UEDVT and improve outcomes following PICC insertion.

Nurses critical to quality, safety, and now financial performance.

Preventable hospital errors are the accepted impetus to the establishment of quality measures and served as a catalyst for the ongoing evolution of healthcare reform. Nurses are crucial members of the hospital quality team, and their actions are integral to the hospital's quality performance. The authors explore some of the practical challenges created by quality performance standards, specifically around venous thromboembolism, and the contribution nurses can make, to patient safety, quality of care, and the institutions financial performance.

Dealing honestly with an honest mistake.

A 70-year-old woman was admitted for a symptomatic left iliofemoral deep vein thrombosis. She underwent percutaneous mechanical thrombectomy, followed by overnight thrombolysis. The next day her clot had resolved, and a culprit left iliac vein stenosis was identified. After stent placement, a heparin infusion was initiated and the patient was taken back to the ward. At 11 the evening after the procedure, the resident on call was contacted to verify the written order. The resident stated that the heparin dose was to be 250 U/h; however, the nurse documented 2500 U/h and changed the infusion pump at the patient's bedside. At 5:30 the next morning, the resident was notified that the patient's partial thromboplastin time was >300 seconds and promptly shut off the heparin infusion. No noticeable adverse events occurred because of the high heparin dosing. The charge nurse was notified, as was risk management. What should the patient be told?

[Survey of nurses about compression therapy of acute deep venous thrombosis. Field study in Saxony-Anhalt]. / Befragung Pflegender zur Kompressionstherapie der akuten tiefen Beinvenenthrombose. Feldstudie in Sachsen-Anhalt.

BACKGROUND: In clinical practice, the compression therapy is an established method for the treatment of acute deep vein thrombosis (DVT). The aim of this study was to clarify the extent to which current guidelines and results of studies done in the field for the treatment of acute DVT--particularly compression therapy--are implemented in clinical practice. METHOD: All hospitals in Saxony-Anhalt using primary diagnosis and therapy for DVT (n = 34) were informed about a survey in 2007 and the nursing staff of angiology and internistical wards in these hospitals was asked to take part. The collection of data was done with the help of a questionnaire that had been designed and tested for its validity in a specialised hospital. 510 questionnaires were distributed. The response rate of questionnaires was 69 percent. RESULTS: 79 percent of the nursing staff of internistical wards in Saxony-Anhalt and 94 percent of the nursing staff of angiology wards said that patients with acute DVT have initially received a compression bandage. Significant deficits were visible in transferring the knowledge of evidence-based medicine and nursing regarding techniques of compression bandage. The recommended Fischer-Bandage was only put on in exceptional cases in internistical wards (3 percent) and Angiology (2 percent). Compression stockings were not a suitable method into the treatment of acute deep vein thrombosis of Angiology. 21 percent of the nursing staff of internistical wards said that they have initially applied compression stockings. CONCLUSION: The treatment of acute DVT is important in clinical practice. The compression bandage should be effectively put on the leg. The quality of care and long-term compliance of the patients could be increased this way, leading to prevention of post thrombotic syndrome (PTS) and reduction the duration of patients stay in the clinics.

Development of the Nurses' Intention to Use Deep Vein Thrombosis Preventive Measures Questionnaire.

BACKGROUND AND PURPOSE: Deep vein thrombosis (DVT) is a serious condition resulting in poor patient outcomes. Therefore, methods to improve nurses' use of preventive measures for DVT are paramount. The purpose of this study was to develop and validate an instrument that captured nurses' intentions to use DVT preventive measures. METHODS: Instrument development occurred in several stages stemming from the recommended formatted structure associated with theory of planned behavior (TPB). Content validity was established with a panel of experts, then the instrument was pilot tested with a sample of intensive care unit (ICU) nurses. RESULTS: The final instrument consisted of four subscales, each subscale was tested with four items by content validity index (CVI) ranging between 0.8 and 1.0, and an overall S-CVI/Ave of 0.93. CONCLUSIONS: The instrument demonstrated high content validity. Future research will test the instrument for psychometric properties.

[Knowledge of nurses about compression therapy. Survey about treatment of acute deep venous thrombosis]. / Das Wissen Pflegender zur Kompressionstherapie. Studie zur Therapie der akuten tiefen Beinvenenthrombose.

Compression therapy is an established method to treat acute deep vein thrombosis (DVT) in clinical practice. The aim ofthis study was to clarify the extent to which current guidelines for the treatment of acute DVT and results of the studies done in this field, particularly in terms of compression therapy, are considered in training courses for nursing staff and patients. All hospitals in Saxony-Anhalt using primary diagnosis and therapy for DVT (n=34) had been informed about a survey in summer 2007 and the nursing staff of angiology and internal wards in these hospitals were asked to take part in the survey. Data was collected with the help of a questionnaire that had been designed and tested for its validity in a specialised hospital. 510 questionnaires were distributed (15/ hospital). The response rate of questionnaires was 69 percent. The acute DVT is part of the nursing training. 92.3 percent of the nursing staff said that they have discussed DVT and 91.5 percent said that they have learned different techniques of compression bandage. 89,2 percent of the nursing staff indicated that they practiced applying compression bandages under the guidance of a teacher. Significant deficits were visible in transferring the knowledge of evidence-based medicine and nursing. The recommended Fischer-Bandage was only taught exceptionally in theory (1.7 percent) and practice (1.9 percent). 47.1 percent of the nursing staff took part in continued training for compression therapy. Patient trainings were only carried out in 18.1 percent. The treatment of acute DVT plays an important role in the nursing training. The compression bandage that is recommended in guidelines and studies should be effectively taught and implemented in nursing education and training of patients.

Lower extremity venous disorders: implications for nursing practice.

Lower extremity chronic venous disorders are significant and common causes of vascular morbidity and mortality worldwide. Venous ulcer relapse rates are as high as 72% and account for approximately 80% to 90% of all lower extremity ulcers. Venous disorders, much like arterial disease, are often progressive and chronic in nature, resulting in enormous economic and human costs in terms of treatment, pain, and suffering. Individuals with skin changes are at high risk of recurrent leg ulcers, which negatively affect the quality of life for both the individual and the family. Prevention efforts should target anatomical vein dysfunction, edema, and skin changes to prevent leg ulcers. This article presents an overview of both clinical and laboratory assessments of lower extremity chronic venous disorders, including descriptions of the risks and pathogenesis for differential diagnosis and implications for nursing.