Navigating the trauma-The experiences of significant others supporting patients with severe burn injury: A narrative inquiry.

AIM: To explore the experiences of significant others of adult patients with severe burn injury in the Intensive Care Unit. Specifically, this study explored the strategies implemented by significant others and obstacles faced that served to protect or placed them at risk of psychological sequelae during their experience of trauma. DESIGN: A qualitative study using a Narrative Inquiry approach was undertaken. METHODS: Individual semi-structured interviews were conducted with 17 participants during 2021-2022, who were a significant other of an adult patient in ICU with severe burn injury. These participants were recruited from the two major severe burns receiving hospitals in New South Wales, Australia. Participants' stories were analysed using a narrative analysis approach informed by Polkinghorne. The COREQ guideline was used in reporting. RESULTS: As each participant navigated the traumatic experience of supporting a loved one with a severe burn injury, they faced unique obstacles to maintaining their own mental health and well-being. They employed strategies that were likely to protect them on this journey. Psychologically protective factors included taking back control, coexisting in the trauma with the patient and forging a trauma bond. These strategies effectively contained the trauma and protected others (such as children, extended family and friends). While this allowed significant others an element of control, it also effectively isolated them from the support of family and friends. CONCLUSION: This study shows that significant others may also experience personal trauma and may not recognize this as they focus all their attention on supporting the patient with the burn injury. IMPLICATIONS FOR PRACTICE: With increased awareness of both protective and risk factors, support can be directed towards enhancing protective factors and addressing risk factors, thereby decreasing their impact and improving support for significant others. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

How clinicians recognise people who are dying: An integrative review.

BACKGROUND: Timely recognition of dying is important for high quality end-of-life care however, little is known about how clinicians recognise dying. Late recognition is common and can lead to futile treatment that can prolong or increase suffering and prevent a change in the focus of care. AIM: To explore how clinicians caring for dying people recognise that they are in the last days or hours of life, as well as the factors that influence the recognition of dying. DESIGN: A systematically constructed integrative review of the literature. METHODS: Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycInfo and Allied and Complementary Medicine were searched in July 2022. Papers were included if they were original research, discussed how clinicians recognise dying, available in English language and published in 2012 or later. A constant comparison approach was applied to the analysis and synthesis of the literature. RESULTS: 24 papers met the inclusion criteria. There were 3 main categories identified: 'Clues and signals' refers to prompts and signs that lead a clinician to believe a person is dying, incorporating the sub-categories 'knowing the patient over time', and 'intuition and experience'. 'Recognition by others' is where clinicians come to recognise someone is dying through others. This can be through a change in the context of care such as a tool or care plan or by communication with the team. 'Culture, system and practice' refers to the cultural beliefs of a setting that influences awareness of dying and denial of death as a possibility and avoidance of naming death and dying directly. System and practice of the setting also impact on recognition of dying. This involves work pace and intensity, shift systems and timing of senior reviews of patients. Uncertainty and its impact on recognition of dying are evident throughout the findings of this review. The seeking of certainty and the absence of the possibility of dying contributes to late recognition of dying. DISCUSSION: Recognition of dying is a complex process that occurs over time, involving a combination of intuition and gathering of information, that is influenced by contextual factors. A culture where dying is not openly acknowledged or even named explicitly contributes to late recognition of dying. A shared language and consistent terminology for explicitly naming dying are needed. Uncertainty is intrinsic to the recognition of dying and therefore a shift to recognising the possibility of dying rather than seeking certainty is needed. REGISTRATION: (PROSPERO) CRD42022360900. Registered September 2022.

Managing the elephant in the room: responding to COVID-19's impact on data collection.

BACKGROUND: The global COVID-19 pandemic has affected data collection for many researchers, in particular research that involves face-to-face interviews. AIM: To share learning about the challenges encountered when face-to-face interviews could not continue as planned in a study and how to adapt data collection so that it can continue despite severe disruption. DISCUSSION: This article examines the considerations and actions taken by the authors to ensure the continuity of data collection. The research aimed to use narrative inquiry to understand the experiences of significant others supporting people in intensive care units with severe burn injuries. But the pandemic meant the researchers could not meet face-to-face with participants as originally intended and so they had to consider new ways to approach data collection. The authors explore the process of adapting the interviews to video conferencing and telephone use while preserving the study's person-centred focus to remain coherent with narrative methodology. CONCLUSION: Adapting data collection is valuable in ensuring the continuity of research. Careful consideration and planning are required to ensure the research remains robust and ethically sound. IMPLICATIONS FOR PRACTICE: Adapting data collection methods can allow for greater flexibility when participants cannot attend face-to-face interviews.

Effects of a whole food diet on immune function and inflammatory phenotype in healthy dogs: A randomized, open-labeled, cross-over clinical trial.

Whole foods in humans decrease inflammation and risk for various diseases, as well as increase weight loss and immune function. Nutrition has been shown to be an integral component in the management of various diseases in dogs but the immunologic and anti-inflammatory effects of whole food diets have not been explored. Therefore, our objective was to assess the effect of feeding a whole food diet on immune function and inflammatory phenotype in healthy dogs. A prospective, randomized, open-labeled, cross-over clinical trial was performed. Sixteen healthy client-owned dogs were fed either a whole food or an extruded dry diet, and after 67 days, they were fed the alternate diet for an additional 67 days. Blood samples were obtained at the completion of each treatment arm (i.e., days 67 and 134). Serum c-reactive protein (CRP), haptoglobin (Hp), and serum amyloid-A (SAA) were measured with ELISA assays. Whole blood cultures were performed with exposure to a phosphate-buffered solution (PBS), lipopolysaccharide (LPS), and lipoteichoic acid (LTA). A canine specific multiplex bead-based assay was then used to measure tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-2, IL-8, and monocyte chemoattractant protein (MCP)-1 concentrations. Granulocyte/monocyte (GM) phagocytosis and oxidative burst associated with Escherichia coli were evaluated via flow cytometry. Dogs fed a whole food diet had significantly lower TNF-α-to-IL-10 ratios (P = 0.05) and higher production of IL-8 (P = 0.03) with LTA-exposed leukocytes compared to dogs fed an extruded dry diet. There were no between-treatment differences in the remaining leukocyte cytokine responses, serum CRP, Hp, SAA concentrations, or GM phagocytic and oxidative burst capacities. Whole food diets could have immunomodulatory effects in dogs. Future studies in non-healthy dogs are warranted.

The experiences of 'significant others' supporting people with severe burn injury: An integrative literature review.

BACKGROUND: Severe burn injury is a traumatic experience for both patients and their significant others. Although research has focused on the experience of people with burn injury, there is a paucity of research focusing on the experiences of the significant other. Significant others are frequently expected to advocate and make decisions on behalf of the patient, which may have an impact on their psychological wellbeing. An understanding of the experiences of significant others will inform strategies to better support their needs. OBJECTIVES: The aim of this integrative literature review was to critically examine research related to the experiences of significant others supporting a patient with a severe burn injury in the hospital. METHODS: CINAHL Plus with Full Text (EBSCO), MEDLINE ALL (Ovid), Scopus, and APA PsycINFO were searched up to December 2019 for English language studies using search terms burns, significant other, ICU, and psychological impact. Records were independently screened and assessed for methodological quality, and the data were synthesised. RESULTS: Nine articles were included in the review. Three used a quantitative approach, and six were qualitative studies. Three major themes were identified, namely, (i) psychological consequences and emotional trauma, (ii) redefining relationships, and (iii) coping strategies. CONCLUSION: The review identified that significant others experience adverse psychological consequences including post-traumatic stress, anxiety, and depression. The burn injury resulted in a redefining of relationships with others and particularly with the patient through this shared experience. Significant others found ways to adapt to stressors, including taking control of the situation and seeking greater involvement in the patient's care.

An Increase in Healthcare-Associated Clostridium difficile Infection Associated with Use of a Defective Peracetic Acid-Based Surface Disinfectant.

BACKGROUND We investigated an increase in the incidence of healthcare-associated Clostridium difficile infection (CDI) that occurred following a change from a bleach disinfectant to a peracetic acid-based disinfectant. OBJECTIVE To evaluate the efficacy of the peracetic acid-based disinfectant. DESIGN Laboratory-based product evaluation. METHODS The commercial peracetic acid-based product is activated on site by mixing a small volume of concentrated hydrogen peroxide and peracetic acid present in a "SmartCap" reservoir with the remaining contents of the container. We measured concentrations of peracetic acid in newly activated and in-use product and determined the stability of nonactivated and activated product. We tested the efficacy of the product against C. difficile spores using the American Society for Testing and Materials standard quantitative carrier disk test method. RESULTS Measured concentrations of peracetic acid (50-800 parts per million [ppm]) were significantly lower than the level stated on the product label (1,500 ppm), and similar results were obtained for containers from multiple lot numbers and from another hospital. Product with peracetic acid levels below 600 ppm had significantly reduced activity against C. difficile spores. Peracetic acid concentrations were reduced markedly after storage of either activated or nonactivated product for several weeks. The Environmental Protection Agency confirmed the finding of low disinfectant levels and ordered discontinuation of sale of the product. CONCLUSION Use of a defective peracetic acid-based surface disinfectant may have contributed to an increase in healthcare-associated CDI. Our findings highlight the importance of evaluating the efficacy of liquid disinfectants in healthcare settings. Infect Control Hosp Epidemiol 2017;38:300-305.

Perception vs Reality: Methicillin-Resistant Staphylococcus aureus Carriage Among Healthcare Workers at a Veterans Affairs Medical Center.

In a prevalence study of 209 healthcare workers, 18 (8.6%) and 13 (6.2%) carried methicillin-resistant Staphylococcus aureus in their nares or on their hands, respectively. However, 100 (62%) of 162 workers completing an associated survey believed themselves to be colonized, revealing a knowledge deficit about methicillin-resistant Staphylococcus aureus epidemiology. Infect. Control Hosp. Epidemiol. 2015;37(1):110-112.