Cultural Congruence and Infusion Nursing Practice.

The importance of cultural competence in every nursing practice setting in today's world cannot be understated. Unconscious bias can have detrimental effects on therapeutic relationships and health outcomes. Nursing models of cultural competence by Purnell, Leininger, and Campinha-Bacote are reviewed. The Kleinman Model and LEARN Model offer questions and guidelines to facilitate assessment of patients' understanding of illness and treatment. The Infusion Nursing Standards of Practice contains elements of diversity and cultural competence throughout. Self-reflection of one's own values, beliefs, biases, and practice as an infusion nurse will promote the development of cultural competence.

Oral Parenteral Antimicrobial Therapy Administration in a Homeless Population.

Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat serious infections. Patients who identify themselves as homeless may receive OPAT less often, and little is known about their treatment outcomes. The purpose of this study was to describe challenges, treatment completion rates, and cost savings of OPAT in homeless patients discharged from a public safety-net hospital.

The Importance of Glycemic Control in the Hospital and the Role of the Infusion Nurse.

Diabetes is reaching epidemic proportions. Patients undergoing surgery, regardless of diabetes history, are at high risk for complications of poor glycemic control, including infection, mortality, and longer lengths of stay. This article provides an overview of the evidence about glycemic control in the hospital, risk factors for hyperglycemia and hypoglycemia, and the role of infusion nurses in improving outcomes for hospitalized patients with diabetes.

Evaluating an Educational Module on Home Inotrope Therapy.

Educating home health nurses presents significant challenges for nurse educators because of the vast geographical areas served and the types of patient cared for. The integration of technology into the home health care arena offers new and innovative opportunities to address the ongoing educational needs of nurses as required by accrediting bodies. This exploratory study evaluated a Web-based educational module on home inotrope therapy in regard to nurses' perceived knowledge and confidence.

Moral Distress: Recognition, Diagnosis, and Treatment.

Infusion nursing is a unique hybrid of inpatient and ambulatory nursing. The subspecialty of nurses cares for patients requiring treatment over long periods, including cancer patients receiving chemotherapy and patients who require short bursts of treatment, such as those with multiple sclerosis, Crohn's disease, and rheumatoid arthritis. Infusion nurses are exposed to many of the common root causes of moral distress in their practice, similar to nurses caring for terminally ill or critically ill patients. The specific aims of this article are to (1) define moral distress, moral residue, and the crescendo effect; (2) describe ethical stressors that can be confused with moral distress; (3) review the effects of moral distress on different health care providers; and (4) provide strategies to manage moral distress in the workplace using a case example.

Utilidad de las tiras reactivas multistix 10 SG(R) en el diagnóstico de peritonitis en diálisis peritoneal / Utility of the Multistix 10 SG (R) reagent strips in the diagnosis of peritonitis in peritoneal dialysis

Introducción: La infección peritoneal es una complicación frecuente en diálisis peritoneal, que condiciona una importante morbimortalidad. Habitualmente el diagnóstico se establece mediante signos y síntomas clínicos, efluente turbio y cultivo positivo. En ocasiones los síntomas son poco evidentes, el recuento leucocitario puede no estar disponible y el cultivo se demora varios días. Por otro lado se sabe que el inicio precoz del tratamiento antibiótico aumenta la eficacia y favorece la resolución de los episodios de infección peritoneal. Objetivo: Estudiar la capacidad diagnóstica de las tiras reactivas Multistix 10 SG Siemens® en la determinación de peritonitis en pacientes en diálisis peritoneal. Material y métodos: Estudio observacional prospectivo donde se analizaron muestras de líquido peritoneal efluente de pacientes prevalentes en diálisis peritoneal, durante seis meses. Se tomó como criterio de peritonitis la presencia de más de 100 Leucocitos (L)/ μl y más de 50% de ellos polimorfonucleares. Las muestras de líquido peritoneal efluente fueron obtenidas después de permanencias mínimas de dos horas y volumen mínimo de 1500 cc. Todas las muestras se analizaron usando tiras reactivas de Multistix ® 10 SG Siemens durante 2 minutos, anotando el observador el resultado de acuerdo a la escala cromática (valor 0= 0-15 L/μl, valor 1= 16-70 L/μl, valor 2=71-125 L/μl y valor 3=126-500 L/μl) y se compararon con las enviadas al laboratorio de nuestro hospital para el recuento manual de leucocitos. Se recogieron otras variables clínicas y epidemiológicas. Resultados: Se analizaron 111 muestras de efluente peritoneal. Detectándose infección peritoneal en 28 muestras (25.2%). No se observaron diferencias significativas entre infectados y no infectados por razón de edad, sexo, diabetes ni número de peritonitis anteriores. El 68 % de los pacientes infectados declararon sufrir dolor. El 73% de las muestras con infección presentaron líquido turbio. En relación al resultado del Multistix, y considerando infección un valor por encima de 1, encontramos una sensibilidad del 100% y una especificidad del 95.2%. Si el punto de corte se toma en el valor 2 encontramos una sensibilidad del 96,4% y una especificidad del 100%. Conclusiones: La utilización de las tiras Multistix® 10 SG Siemens como prueba diagnóstica para la detección de infección peritoneal, tiene una validez excelente, pudiendo sustituir al recuento manual de leucocitos (AU)

Introduction: Peritoneal infection is a common com- plication in peritoneal dialysis, which determined a significant morbidity and mortality. Usually the diagnosis is established by clinical signs and symptoms, cloudy effluent and positive culture. Sometimes the symptoms are not evident, the leukocyte count may not be available and culture takes several days. On the other hand it is known that early antibiotic therapy increases effectiveness and promotes the resolution of the episodes of peritoneal infection. Objective: Study the diagnostic capacity of Siemens Multistix 10 SG® reagent strips in determining peritonitis in patients on peritoneal dialysis. Methods: A prospective observational study was carried out. Samples of peritoneal fluid effluent from prevalent patients on peritoneal dialysis were analyzed for six months. It was taken as the criterion of peritonitis, the presence of more than 100 leukocytes (L)/ μl and over 50% of these polymorphs. Samples of peritoneal fluid effluent were obtained after two-hours minimum stays and minimum volume of 1500 cc. All samples were analyzed using Siemens Multistix 10 SG® reagent strips for 2 minutes, scoring the observer the result according to the chromatic scale (value 0 = 0-15 L / μl; value 1 = 16-70 L / μl; value 2 = 71-125 L / μl; and value 3 = 126-500 L / μl) and compared to those sent to the hospital laboratory for manual leukocyte count. Other clinical and epidemiological variables were collected. Results: 111 samples of peritoneal dialysis were analyzed. Peritoneal infection were detected in 28 samples (25.2%). No significant differences between infected and uninfected by reason of age, sex, diabetes or number of previous peritonitis were observed. 68% of infected patients reported suffering from pain. In those infected samples, 73% presented cloudy fluid. In relation to the result of Multistix and considering infection a value greater than 1, we found a sensitivity of 100% and a specificity of 95.2%. If the cut point is taken in the value 2 we found a sensitivity of 96.4% and a specificity of 100%. Conclusions: The use Siemens Multistix 10 SG® reagent strips as a diagnostic test for the detection of peritoneal infection has excellent validity and could replace the manual leukocyte count (AU)

Drug shortages and patient safety: an overview of essential information for the infusion nurse.

Drug shortages present a growing problem in the United States, with the majority of shortages occurring among sterile injectable medications. Although the impact of shortages has been shown to adversely affect patient care in a variety of settings, those who are dependent on outpatient or home infusion therapy are especially vulnerable. Legislative action and the efforts of the U.S. Food and Drug Administration have helped reduce the occurrence of new shortages; however, the problem is not likely to be eliminated in the short term and requires effective management strategies.

Root cause analysis in infusion nursing: applying quality improvement tools for adverse events.

The application of root cause analysis (RCA) to health care began in the Veteran's Administration system and spread to Joint Commission-accredited organizations when it became a requirement for accreditation. The success of this valuable quality improvement tool relies on understanding the principles of patient safety, assembling a team, and producing and completing action items aimed at correcting root causes of adverse events. This article describes optimal RCA techniques based on published literature and expert opinion and then provides a sample RCA for a fictitious but common adverse event: catheter-associated bloodstream infection.

Teaching new graduate nurses about infusion therapy in a nurse residency program.

The purpose of this article is to describe how the concept of infusion nursing was incorporated into orientation for new graduate nurses at an academic medical center in the Midwest. Strategies were identified based on their unique learning needs and a desire to instill safe infusion practices early in their nursing careers. (A Supplemental Video Abstract for this article is available at http://links.lww.com/JIN/A64.).