Nursing student patient safety errors in the practice domain: a scoping review protocol of the quantitative and qualitative evidence.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to identify the range of patient safety events that includes patient safety errors, harms or near misses that student nurses make while nursing in their clinical placements. The question that will guide this review is: what types of hazards, healthcare-associated harms, patient safety incidents, reportable circumstances, near misses, harmful incidents, no harm incidents and injuries to patients are being made and reported by nursing students during their practice in healthcare facilities?

Core competencies: the next generation. Comparison of a common framework for multiple professions.

This report demonstrates the application of a competency model to the regulated and unregulated professions of medical radiation technology, social work, pharmacy, and psychology. The competency model is based on the CanMEDS framework and was originally applied to the professions of medicine, occupational therapy, physical therapy, and nursing in an earlier work. The framework identifies the core competencies common to learners in health care, which are professional (and health advocate), expert, scholar, manager, communicator, and collaborator. In this report, these core competencies are applied to four additional disciplines in an effort to make the cultural shift from discipline-based silos to a common language for ascertaining the skills, knowledge, and attitudes needed to function in interprofessional teams.

Multidisciplinary collaborative maternity care in Canada: easier said than done.

OBJECTIVE: To describe care provider attitudes towards multidisciplinary collaborative maternity care in Canada and the factors influencing such care from the perspective of members of national professional associations of care providers. METHODS: A qualitative descriptive approach was used. Leaders of national associations nominated key members, who were invited to participate in semi-structured telephone interviews. RESULTS: Twenty-five participants from six national care provider associations (family physicians, obstetricians, registered midwives, registered nurses, nurse practitioners, and rural physicians) were interviewed. Participants described at least one of two main benefits of collaborative maternity care: a partial solution to the human resources shortage in maternity care, and improved maternity care for women. Despite their belief that collaboration is needed, participants expressed concern about the effects of collaboration on their practice. In particular, some participants were concerned about how collaborative models could support woman-centred care or respond to local community needs and promote continuity of care. Significant barriers to collaboration include structural factors (fee structure, liability issues) and interdisciplinary rivalry between groups of providers (turf protection, lack of mutual respect). Strategies to promote collaboration that were supported by the participants include strong national leadership and interdisciplinary education. CONCLUSION: Representatives of professional associations of care providers believe that multidisciplinary collaborative maternity care is needed to sustain the availability of care providers and to improve access and women's choices for maternity care in Canada. However, they perceive that strong leadership and education are needed to address significant structural and relational barriers to collaborative practice.

The symptom of pain in individuals recently hospitalized for heart failure.

UNLABELLED: The symptom of pain is not typically associated with heart failure. Yet, emerging evidence suggests that pain is an important issue for this population. OBJECTIVES: (1) To determine whether pain was reported by a cohort of individuals with heart failure at the time of discharge from hospital, at 2 and 6 weeks postdischarge; (2) To examine the profile of individuals who reported pain at discharge and to determine if there were differences from individuals who did not report pain; (3) To determine whether there was a difference in health-related quality of life between reported pain and no pain groups. METHODS: This study was part of a larger randomized controlled trial with a 3-month follow-up. Data were obtained from 169 individuals diagnosed with heart failure who completed the first 6 weeks of the follow-up period. RESULTS: At time of discharge, 68% of the cohort reported pain. Both frequency and severity of pain fluctuated throughout the study for the entire cohort. There were no sociodemographic characteristics that distinguished those who reported pain from those who did not report pain. Differences in health-related quality of life were found between the reported pain and no pain groups at discharge and week 2. Depression, worry, feeling a loss of control over one's life, and feeling as if one was a burden to family were significantly more prevalent in individuals who reported pain. Differences were also found in self-rated health status, and number of prescription medications taken daily. Throughout the 6 weeks, 63 individuals (37%) consistently reported pain and 23 (14%) never reported pain. CONCLUSION: Pain was a concern for this cohort of individuals diagnosed with heart failure and was noted to impact their health-related quality of life. Further research is needed into the nature of the pain and the role of pain in self-management once patients are discharged home.

Preparing professionals from a wide range of disciplines for life and work in rural and small communities.

A new inter-professional subject has been offered at a Canadian university, which examines issues related to professionals' integrating into rural practice; understanding the history and geography of rural communities and important issues affecting life in rural settings.

For work and for school: internal migration of Canada's rural nurses.

Using data from the Registered Nurses Database and a recently conducted national survey, this study examined the internal migration patterns of Canadian-educated rural RNs. Inter-provincial migration rates, ranging from 11% to 27% depending on the database used, mask much wider variations in sub-provincial movement rates, which are particularly relevant when considering the provision of nursing services in rural and remote communities. Rural RNs are more likely to migrate if they are female, older, working in nursing stations, and living in remote communities. A majority of RNs whose migration is associated with going to school after their initial nursing education do not return to the jurisdiction where they were first registered. Targeted migration studies are needed to fully understand both the detailed patterns and the predictors of such movements in order to better assess recruitment and retention policies and to enhance our overall health human resources planning models.

A systematic integrative review of infant pain assessment tools.

PURPOSE: To examine the issue of pain assessment in infants by acquiring all available published pain assessment tools and evaluating their reported reliability, validity, clinical utility, and feasibility. DESIGN AND METHODS: A systematic integrative review of the literature was conducted using the following databases: MEDLINE and CINAHL (through February 2004), and Health and Psychosocial Instruments, and Cochrane Systematic Reviews (through 2003). MeSH headings searched included "pain measurement," with limit of "newborn infant"; "infant newborn"; and "pain perception." SUBJECTS: Thirty-five neonatal pain assessment tools were found and evaluated using predetermined criteria. The critique consisted of a structured comparison of the classification and dimensions measured. Further, the population tested and reports of reliability, validity, clinical utility, and feasibility were reviewed. RESULTS: Of the 35 measures reviewed, 18 were unidimensional and 17 were multidimensional. Six of the multidimensional measures were published as abstracts only, were not published at all, or the original work could not be obtained. None of the existing instruments fulfilled all criteria for an ideal measure; many require further psychometric testing. CONCLUSIONS: When choosing a pain assessment tool, one must also consider the infant population and setting, and the type of pain experienced. The decision should be made after carefully considering the existing published options. Confidence that the instrument will assess pain in a reproducible way is essential, and must be demonstrated with validity and reliability testing. Using an untested instrument is not recommended, and should only occur within a research protocol, with appropriate ethics and parental approval. Because pain is a multidimensional phenomenon, well-tested multidimensional instruments may be preferable.

Responding to pandemic influenza: a local perspective.

OBJECTIVE: To assess, via a tabletop exercise, the ability of a rural health unit to manage an influenza pandemic. PARTICIPANTS: The exercise brought together community stakeholders including representation from public health, hospitals, long-term care, social services, first responders, morticians, local government and the media. SETTING: Leeds, Grenville and Lanark, a rural region of Ontario. INTERVENTION: In June 2002, exercise participants were presented with a scenario involving the local response to pandemic influenza. Facilitators prepared a framework for the mock emergency in advance. However, the scenario was guided by decisions made by participants and the probable consequences of those decisions. Following the exercise, a debriefing session identified recommendations to be included in future plan development. OUTCOMES: The exercise identified critical issues, including communication, emergency decision-making, vaccination priorization, local surge capacity, and disease containment. Both participants and observers deemed the exercise successful. CONCLUSION: Improvements in the local contingency plan for pandemic influenza were identified. The exercise was an opportunity to familiarize participants with the contingency plan, practice working collectively and identify areas for further planning. The principles and lessons generated from the exercise can be used to guide the response to other large-scale infectious disease outbreaks.

Milk whey protein decreases oxygen free radical production in a murine model of chronic iron-overload cardiomyopathy.

BACKGROUND: Chronic iron overload is a major cause of organ failure worldwide, but its pathogenesis remains to be elucidated. OBJECTIVES: To examine in an experimental murine model of iron-overload cardiomyopathy the relation between milk whey protein and, first, the production of reactive oxygen free radical species and, second, antioxidant reserve status. METHODS: B6D2F1 mice were randomly assigned to four treatment groups (n=8 per treatment group): placebo control; iron only; whey only; and iron with whey. Reactive oxygen free radical species in the heart were quantified by the cytotoxic aldehydes malondialdehyde (MDA), 4-hydroxy-nonenal (HNE) and hexanal, while antioxidant reserve status was quantified by glutathione (GSH) and glutathione peroxidase (GPx) activity in the heart tissue. RESULTS: Significantly decreased concentrations (pmol/100 mg wet weight tissue) of MDA (2468+/-261), HNE (912+/-38) and hexanal (5385+/-927) were observed in the heart tissue of the group receiving iron with whey, in comparison with the iron-only treatment group (MDA 9307+/-387, HNE 1416+/-157, hexanal 14,874+/-2955; P<0.001). Significantly increased GPx (141+/-38 IU/L) and GSH (521+/-136 IU/L) activity were observed in mice receiving iron with whey, in comparison with mice receiving iron only (GPx 100+/-10 IU/L, GSH 446+/-33 IU/L; P<0.001). CONCLUSION: Mice receiving iron treatments with whey supplementation had significantly lower concentrations of cytotoxic aldehydes and significantly higher cardiac levels of GPx and GSH activity than did iron-only treated mice. Additional basic research is warranted to examine the exact mechanisms by which milk whey protein protects the heart.

Three infant care interventions: reconsidering the evidence.

Newborn care in the first 24 hours of life has been based on tradition for many years. Nurses recognize that many practices are not based on good scientific evidence and are not individualized. Instead, all newborns are treated as though they acquire potential pathogens during birth and are oblivious to noxious interventions such as intramuscular injections and heel sticks. In this article, obtaining blood samples from heel sticks and administering vitamin K and prophylaxis for ophthalmia neonatorum are presented as practices that require scrutiny by nurses to promote evidence-based care of newborns in the 1st day of life.