Establishment of the First Comprehensive Adult and Pediatric Hematopoietic Stem Cell Transplant Unit in the United Arab Emirates: Rising to the Challenge.

Hematopoietic stem cell transplantation (HSCT) is increasingly indicated for various malignant and non-malignant diseases. In the United Arab Emirates (UAE), patients that could benefit from the procedure commonly need to seek medical care abroad in view of the lack of a comprehensive HSCT facility that could offer the full spectrum of interventions and monitoring protocols. This comes with considerable challenges related to coverage and logistics of travel. It also limits the continuity of clinical care, and presents inconvenience to patients who come from a different cultural background. In this article, we share our experiences and lessons learned during the establishment of the first comprehensive adult and pediatric HSCT unit in the UAE that is designed to cater for local citizens and residents, as well as neighboring countries facing similar availability challenges.

Impact of personalized report cards on nurses managing central lines.

BACKGROUND: The purpose of this quality improvement project was to determine the effect of providing feedback to managers and bedside nurses on the nurses' central line-associated bloodstream infection (CLABSI) contributing factors, found on visual and documentation audits. METHODS: This nonexperimental, quality improvement project was conducted in a 715-bed, 2-campus acute care community hospital health care system in Southwest Florida. The intervention consisted of providing confidential feedback on central line audits deviations, through the systematic delivery of unit case reports and personalized nurse report cards. Analysis of central line audit deviations and subsequent report cards was undertaken. RESULTS: Of the 620 lines visually audited from 14 nursing units, over 16 weeks, 113 lines (19.2%) failed the audit. Each line triggered an electronic medical record audit, which identified 628 CLABSI contributing factors. Subsequently, nurse managers received 113 unit case reports and 487 bedside nurses received report cards. Over time, the frequency of CLABSI contributing factors decreased (ρ = -0.12, n = 620, P = .003). CONCLUSIONS: Central line audit analysis, providing unit case reports to nursing managers and 1-on-1 personalized nurse report cards, has shown an increase in compliance with established guidelines for the management of central lines.

What do nursing students contribute to clinical practice? The perceptions of working nurses.

PURPOSE: The study purpose was to elicit factors that caused satisfaction and dissatisfaction for staff registered nurses (RNs) who participated in two types of nurse student interactions: clinical rotation role-model and student preceptorship. BACKGROUND: The limited availability of practice sites for clinical experiences places essential importance on the need to understand RNs' perceptions of students' effect on their practice. METHODS: This cross sectional descriptive study surveyed RNs who worked at six acute care hospitals in two multi-hospital not-for-profit community healthcare systems in southeastern United States, using the Nursing Students' Contributions to Clinical Agencies (NSCCA) survey via SurveyMonkey®. RESULTS: Registered nurses had positive perceptions of students' contributions in clinical rotations and student preceptorships, specifically, enhancement of the nurses' professional development was a satisfier for participants. Nurses who were student preceptors and nurses with less than ten years of experience had the most positive perceptions. Nurses in the peri-natal setting had the least positive perceptions of students' contributions. CONCLUSIONS: Findings from the NSCCA survey can reveal satisfiers and dis-satisfiers for RNs participating in nurse-student interactions, which academic and clinical practice nurse leaders can use to enhance the RNs' experiences. Results were used to create a series RN student preceptor training classes, which incorporated educational content that highlighted satisfiers and remediated dis-satisfiers.

Color-Coded Labels Cued Nurses to Adhere to Central Line Connector Change.

PURPOSE: This study examined nurses' adherence to policies regarding needleless connector changes using a novel, day-of-the-week, color-coded label compared with usual care that relied on electronic medical record (EMR) documentation. DESIGN: This was a prospective, comparative study. SETTING: The study was performed on 4 medical-surgical units in a seasonally fluctuating, 715-bed healthcare system composed of 2 community hospitals. SAMPLE: Convenience sample was composed of adults with central lines hospitalized for 4 or more days. METHODS: At 4-day intervals, investigators observed bedside label use and EMR needleless connector change documentation. Control patients received standard care-needleless connector change with associated documentation in the EMR. Intervention patients, in addition to standard care, had a day-of-the-week, color-coded label placed on each needleless connector. To account for clustering within unit, multinomial logistic regression models using survey sampling methodology were used to conduct Wald χ tests. A multinominal odds ratio and 95% confidence interval (CI) provided an estimate of using labels that were provided on units relative to usual care documentation of needleless connector change in the EMR. RESULTS: In 335 central line observations, the units with labels (n = 205) had a 321% increase rate of documentation of needleless connector change in the EMR (odds ratio, 4.21; 95% CI, 1.76-10.10; P = .003) compared with the usual care control patients. For units with labels, when labels were present, placement of labels on needleless connectors increased the odds that nurses documented connector changes per policy (4.72; 95% CI, 2.02, 10.98; P = .003). CONCLUSIONS: Day-of-the-week, color-coded labels cued nurses to document central line needleless connector change in the EMR, which increased adherence to the needleless connector change policy. IMPLICATIONS: Providing day-of-the-week, color-coded needleless connector labels increased EMR documentation of timely needleless connector changes. Timely needleless connector changes may lower the incidence of central line-associated bloodstream infection.

Qualitative analysis of central and midline care in the medical/surgical setting.

PURPOSE/OBJECTIVES: Community hospital medical-surgical nurses have a limited understanding of the complexities of preventing central line-associated bloodstream infections (CLABSIs). The purpose of this study was to look at the phenomenon of central line care from a human perspective and to develop an understanding of the lived experience as it relates to nursing care. DESIGN: A qualitative, phenomenology framework was applied for this study. SETTING: The study was performed at a seasonally fluctuating, 400- to 600-bed community hospital in southwest Florida. SAMPLE: Fifteen full-time medical-surgical bedside registered nurses, 8 working the 12-hour day shift and 7 working the 12-hour night shift, were interviewed. METHODS: Experiences from recorded, 45-minute, in-depth telephone interviews from nurses assigned to 4 medical-surgical units, with the greatest CLABSI frequency, were analyzed. FINDINGS: Findings identified myriad challenges when it comes to administering proper technique and preventing CLABSIs. The themes, time and locus of responsibility, patient population and unit, and variations in experience with CLABSIs, are illuminated. CONCLUSIONS: Nurses have strong feelings and suggestions for organizations to consider in reducing infection rates. Line care education should focus on the relationship of the nurse to understanding CLABSIs, education on line care, supplies, and charting/documentation. IMPLICATIONS: The revealed nature and meaning of the human experience of the central line dressing change and skill actions, identified by the nurses, were brought to the CLABSI committee, and a plan was formed. Six months after implementation of the plan, based on the nurses' lived experiences, the rate of infections has dropped 64%.

Response to breast health screening program at a not-for-profit clinic for working poor, uninsured, ethnically diverse women.

AIMS AND OBJECTIVES: Examine the effect of an ongoing breast health screening program, at a not-for-profit, non-government assisted, volunteer clinic, specifically examining mammography usage and to discover variables to improve the rate of mammography. BACKGROUND: Detection of breast cancer in women of low socio-economic status, lacking health insurance, can be improved by increasing annual mammography rates, yet little is known about their screening behaviour. DESIGN: Quantitative, retrospective subject-controlled study. METHODS: Subject-controlled, longitudinal study of English and Spanish-speaking women 40 years old and over, working poor, and uninsured, who participated in a comprehensive screening program that included a 7-minute breast health educational DVD (n = 223). RESULTS: Radiology records, breast health behaviours and beliefs indicated 76% of women invited for a second test completed it over a year after viewing the educational DVD. Chi-square and t-test indicated two significant findings for completing annual mammography in the 12th month: receiving a reminder postcard and scoring lower on perceptions of breast cancer susceptibility. Two significant findings for completing annual mammography even if late are knowledgeable about screening recommendations and ethnically identifying as Hispanic. CONCLUSIONS: This study shows statistically significant actions that can be undertaken to strengthen programs: reminder postcards, assessing susceptibility score and screening recommendation education. RELEVANCE TO CLINICAL PRACTICE: Simple, inexpensive interventions encourage working, uninsured, Hispanic women to complete mammography.

Response from the southwest Florida nursing community supporting the future of nursing.

The aim of this study was to examine community hospital nurses' interest and potential barriers in pursuing advanced education. In October 2010, nursing leaders in Florida formed a task force to implement the Institute of Medicine Future of Nursing recommendations pertaining to the education of nurses. A survey-based descriptive analysis of nurses employed at 3 community hospitals in Florida was performed. A total of 746 nurses answered open-ended questions related to current status in regard to advancing education. The greatest barriers were (1) time constraints, specifically family and work schedule conflicts, and (2) financial concerns. Eleven percent (n = 73) noted the lack of pay incentive and 11% (n = 71) noted that they were nearing retirement. The findings bring an evidence-based approach to summarizing the trials, concerns, and barriers to nurses continuing their education. The Web-based survey proved to be a useful tool to quickly and inexpensively gather feedback from nurses concerning their plans and perceived barriers related to continuing their education.