Factors influencing inpatient bowel preparation: a scoping review.

BACKGROUND AND AIM: Inpatients undergoing colonoscopy experience a higher-than-average rate of inadequate bowel preparation (compared to outpatients) leading to canceled procedures, increased stress on the patient, increased time in hospital, and increased cost to the healthcare system. The aim of this scoping review was to identify research surrounding inpatient bowel preparation and to identify modifiable and non-modifiable factors that influence the adequacy of bowel preparation in hospitalized patients undergoing colonoscopy and establish areas where nursing interventions may help improve overall bowel preparation rates. METHODS: An initial search of MEDLINE, CINAHL, Scopus, and Embase was undertaken to identify seed articles, followed by a structured search using keywords and subject headings. Studies conducted between 2000 and 2022 and published in English were included. A total of 37 full-text studies were screened for inclusion, with 22 meeting inclusion criteria. RESULTS: Advanced age, decreased mobility, constipation, extended length of stay, and multiple comorbidities were identified as non-modifiable factors associated with inadequate bowel preparation. Narcotic use, failure to follow preparation instruction, and delayed time to colonoscopy were identified as modifiable factors associated with poor bowel preparation. CONCLUSIONS: Educational interventions and interprofessional programs, using a multifaceted approach, increase the odds of adequate bowel preparation, including nursing tip sheets, troubleshooting flowsheets, and bowel movement assessment scoring.

Animal sheltering: A scoping literature review grounded in institutional ethnography.

A diverse research literature now exists on the animals, staff and organisations involved in animal sheltering. We reviewed this research through the lens of institutional ethnography, a method of inquiry that focuses on the actual work that people do within institutions. The main topics, identified through a larger ethnographic study of animal sheltering, were: (i) research about shelter staff and officers; (ii) the relinquishment of animals to shelters; and (iii) animals' length of stay in shelters. After reviewing the literature, we held focus groups with shelter personnel to explore how their work experiences are or are not represented in the research. The review showed that stress caused by performing euthanasia has attracted much research, but the decision-making that leads to euthanasia, which may involve multiple staff and potential conflict, has received little attention. Research on 'compassion fatigue' has also tended to focus on euthanasia but a granular description about the practical and emotional work that personnel undertake that generates such fatigue is missing. Published research on both relinquishment and length of stay is dominated by metrics (questionnaires) and often relies upon shelter records, despite their limitations. Less research has examined the actual work processes involved in managing relinquishment as well as monitoring and reducing animals' length of stay. Institutional ethnography's focus on people's work activities can provide a different and more nuanced understanding of what is happening in animal sheltering and how it might better serve the needs of the animals and staff.

Using institutional ethnography to analyse animal sheltering and protection I: Animal protection work.

Animal protection laws exist at federal, provincial and municipal levels in Canada, with enforcement agencies relying largely upon citizens to report concerns. Existing research about animal protection law focuses on general approaches to enforcement and how legal terms function in the courts, but the actual work processes of animal law enforcement have received little study. We used institutional ethnography to explore the everyday work of Call Centre operators and Animal Protection Officers, and we map how this work is organised by laws and institutional polices. When receiving and responding to calls staff try to identify evidence of animal 'distress' as legally defined, because various interventions (writing orders, seizing animals) then become possible. However, many cases, such as animals living in deprived or isolated situations, fall short of constituting 'distress' and the legally mandated interventions cannot be used. Officers are also constrained by privacy and property law and by the need to record attempts to secure compliance in order to justify further action including obtaining search warrants. As a result, beneficial intervention can be delayed or prevented. Officers sometimes work strategically to advocate for animals when the available legal tools cannot resolve problems. Recommendations arising from this research include expanding the legal definition of 'distress' to better fit animals' needs, developing ways for officers to intervene in a broader range of situations, and more ethnographic research on enforcement work in jurisdictions with different legal systems to better understand how animal protection work is organised and constrained by laws and policies.

Using institutional ethnography to analyse animal sheltering and protection II: Animal shelter work.

Efficient adoption is an important aim of animal shelters, but it is not possible for all animals including those with serious behavioural problems. We used institutional ethnography to explore the everyday work of frontline shelter staff in a large animal sheltering and protection organisation and to examine how their work is organised by standardised institutional procedures. Shelter staff routinely conduct behavioural evaluations of dogs and review intake documents, in part to plan care for animals and inform potential adopters about animal characteristics as well as protect volunteers and community members from human-directed aggression. Staff were challenged and felt pressure, however, to find time to work with animals identified as having behavioural problems because much of their work is directed toward other goals such as facilitating efficient adoption for the majority and anticipating future demands for kennel space. This work is organised by management approaches that broadly aim to maintain a manageable shelter animal population based on available resources, decrease the length of time animals spend in shelters and house animals based on individual needs. However, this organisation limits the ability of staff to work closely with long-stay animals whose behavioural problems require modification and management. This also creates stress for staff who care for these animals and are emotionally invested in them. Further inquiry and improvements might involve supporting the work of behavioural modification and management where it is needed and expanding fostering programmes for animals with special needs.

Climate Change, Air Pollution, and Physical Inactivity: Is Active Transportation Part of the Solution?

Active transportation is defined as self-propelled, human-powered transportation modes, such as walking and bicycling. In this article, we review the evidence that reliance on gasoline-powered transportation is contributing to global climate change, air pollution, and physical inactivity and that this is harmful to human health. Global climate change poses a major threat to human health and in the future could offset the health gains achieved over the last 100 yr. Based on hundreds of scientific studies, there is strong evidence that human-caused greenhouse gas emissions are contributing to global climate change. Climate change is associated with increased severity of storms, flooding, rising sea levels, hotter climates, and drought, all leading to increased morbidity and mortality. Along with increases in atmospheric CO2, other pollutants such as nitrogen dioxide, ozone, and particulate matter (e.g., PM2.5) are released by combustion engines and industry, which can lead to pulmonary and cardiovascular diseases. Also, as car ownership and vehicle miles traveled have increased, the shift toward motorized transport has contributed to physical inactivity. Each of these global challenges has resulted in, or is projected to result in, millions of premature deaths each year. One of the ways that nations can mitigate the health consequences of climate change, air pollution, and chronic diseases is through the use of active transportation. Research indicates that populations that rely heavily on active transportation enjoy better health and increased longevity. In summary, active transportation has tremendous potential to simultaneously address three global public health challenges of the 21st century.

The Social Organization of Neonatal Nurses' Feeding Work.

PURPOSE: We report findings from an institutional ethnography (IE) of nurses' work of feeding infants within an increasingly technical organization of NICUs. SAMPLE: Five primary informants; 18 secondary informants. DESIGN: The institutional ethnographic approach included field observations, interviews, and phone and e-mail conversations. Our analysis followed accounts of what actually happened within the textual organization of nurses' work. MAIN OUTCOME: Nurses' feeding practices are directed by protocols that arise within multiple documentation systems and clinical technologies. These systems produce barriers to nurses' efforts to skillfully feed infants. RESULTS: Prioritization of quality and safety perspectives can obscure and constrain the ordinary yet critical clinical reasoning neonatal nurses employ during feeding work. Clinical technologies that have been developed to improve safety can paradoxically disrupt the ability of nurses to respond in the moment to neonatal feeding cues. This finding provides nurses, leaders, and policymakers with insight into why policies and procedures may not be followed as expected.

Effects of Seasonal Vitamin D3 Supplementation on Strength, Power, and Body Composition in College Swimmers.

The purpose of this study was to evaluate the impact of fall season vitamin D3 supplementation on strength/power, body composition, and anabolic hormones in swimmers with optimal vitamin D status at summer's end. Male and female National Collegiate Athletic Association Division I swimmers (N = 19) with optimal 25-hydroxyvitamin D [25(OH)D] randomly received 5,000 IU of vitamin D3 (VITD) or placebo (PLA) daily for 12 weeks while participating in swimming and strength and conditioning training (August-November). Before and after the intervention, the participants underwent blood sampling for analysis of serum 25(OH)D, parathyroid hormone, total testosterone, free testosterone, sex hormone-binding globulin, and insulin-like growth factor 1, dual-energy X-ray absorptiometry, and strength/power testing (bench press, squat, dead lift, standing broad jump, vertical jump, and dips and pull-ups). Sex was used as a covariate for analyses. The 25(OH)D was decreased by 44% in PLA (p < .05) and increased by 8% in VITD over the 12 weeks. Fat-free mass increased in VITD (56.4-59.1 kg; p < .05), but not PLA (59.4-59.7 kg; p < .01). Significant Group × Time interaction effects were observed for dead lift (F = 21.577, p < .01) and vertical jump (F = 11.219, p < .01), but no other strength/power tests. Total testosterone decreased similarly in both groups, but free testosterone decreased and sex hormone-binding globulin increased only in PLA (p < .01). There were no group differences or changes in insulin-like growth factor 1 with the intervention. The findings suggest that vitamin D supplementation is an efficacious strategy to maintain 25(OH)D during the fall season training and to enhance some aspects of strength/power and fat-free mass in swimmers. Further research on the relationship between vitamin D and anabolic hormones is needed.

Overruling uncertainty about preventative medications: the social organisation of healthcare professionals' knowledge and practices.

In this article, we draw on an institutional ethnographic (IE) study of cardiovascular disease prevention in general practice, exploring the work of healthcare professionals who introduce a discussion of risk and preventative medications into consultations with patients. Our aim is to explicate, using IE's theoretical ontology and analytical tools, how troubling patient experiences in this clinical context are coordinated institutionally. We focus our attention on the social organisation of healthcare professionals' knowledge and front-line practices, highlighting the textual processes through which they overrule patients' concerns and uncertainties about taking preventative medication, such that some patients feel unable to openly discuss their health needs in preventative consultations. We show how healthcare professionals activate knowledge of 'evidence-based risk reduction' to frame patients' queries as 'barriers' to be overcome. Our analysis points not to deficiencies of healthcare professionals who lack the expertise or inclination to adequately 'share decisions' with patients, but to the ways in which their work is institutionally orientated towards performance measures which will demonstrate to local and national policymakers that they are tackling the 'burden of (cardiovascular) disease'.

Nurses' knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses' agency inside ruling.

This article shows how Barcoded Medication Administration technology institutionally organizes and rules the daily actions of nurses. Although it is widely assumed that Barcoded Medication Administration technology improves quality and safety by reducing the risk of human error, little research has been done on how this technology alters the work of nurses. Drawing on empirical and conceptual strategies of analysis, this qualitative study used certain tools of institutional ethnography to provide a view of how nurses negotiate Barcoded Medication Administration technology. The approach also uses elements from practice theory in order to discern how technology operates as a player on the field instead of being viewed as a 'mere' tool. A literature review preceded participant observation, whereby 17 nurses were followed and data on an orthopaedic ward were collected over a period of 9 months in 2011 and 2012. Barcoded Medication Administration technology relies on nurses' knowledge to mediate between the embedded logics of its design and the unpredictable needs of patients. Nurses negotiate their own professional logic of care in the form of moment-to-moment deliberations which subvert the ruling frame of the barcoded system and its objectified model of patient safety. The logic of Barcoded Medication Administration technology differs from the logic of nursing care, as this technology presumes medication distribution to be linear, even though nurses follow another line of actor-bound safety practices that we characterize as 'deliberations'.

The hierarchy of evidence in advanced wound care: The social organization of limitations in knowledge.

In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses' wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health-care system. In efforts to address this burden, Canadian health-care administrators and policy-makers rely on scientific evidence about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses' wound work as it arises within the established uptake of scientific evidence.

What Are the Challenges and Facilitators for Implementing a 24-Hour Telephone Cancer Service in Qatar? A Literature Review.

Objective: To identify the challenges and facilitators for implementing a 24-h telephone cancer service. Data sources: English language articles were retrieved from Medline, Cumulative Index of Nursing and Allied Health Literature, and Ovid Nursing electronic databases published from 2000 to 2015. Study Design: The authors performed an integrative literature review. The qualitative and quantitative articles were evaluated using the Critical Appraisal Skills Program. All mixed-methods articles were evaluated using the Mixed Methods Appraisal Tool. Thematic analyses were used to synthesize the findings from the included articles. Findings: The literature of this review highlights the complexity of the decisions that accompany the consideration of implementing a teleoncology in Qatar. The literature review detailed challenges and facilitators for implementing 24-h call service for cancer patients. These were grouped as human, technology, documentary tools, and organizational domains. The core concept that integrates each of these domains is communication. Conclusions: If the telephone triage is to be implemented in National Center for Cancer Care and Research (NCCCR), more research is needed about the characteristics of cancer patients in Qatar. A more robust understanding of this population will inform decisions about the utility of developing a teleoncology service at NCCCR.

A Hermeneutic Interpretation of Nurses' Experiences of Truth Telling and Harms in Cancer Care in Qatar.

BACKGROUND: Telling the truth to cancer patients remains under debate in the Middle East, where concealment about diagnosis and prognosis occurs in some cases. Concealment results in challenges for nurses providing care. OBJECTIVE: The aim of this study was to understand nurses' lived experiences of caring for cancer patients whose cancer diagnosis or prognosis has been withheld from them. METHODS: Eight nurses from the national cancer center in Qatar were interviewed. The transcripts of the interview texts were interpreted using Gadamer's hermeneutic approach. RESULTS: The interpretations are shaped by understandings of harm. Nurses assessed harm using empathy. Nurses' empathy was permeated with fears that accompany a cancer diagnosis; the language of cancer is interpreted as a language of fear. It is ideas about harms and evoking patients' fear that generates nurses' experiences of complexity, ambiguity, and conflicting feelings regarding truth telling and concealment. The meanings nurses drew from their experiences rested on understandings about love, vulnerability, and opportunities to atone. We interpret nurses' descriptions of being enmeshed in a web of lies through which multidimensional harms are experienced. The complexities of nurses' experiences go well beyond the universal concepts of informed consent and patients' rights. CONCLUSIONS: Nurses' experiences reveal insights that likely resonate across other jurisdictions in the Arabic Gulf and other Eastern cultures, where nurses deal with these sensitive issues case by case. IMPLICATIONS FOR PRACTICE: Leaders and health professionals in cancer care in such cultures must establish more nuanced and transparent interdisciplinary approaches to respond to the complexities of truth telling in cancer care.

Factors affecting empathetic patient care behaviour among medical doctors and nurses: an integrative literature review.

BACKGROUND: Healthcare professionals' empathic behaviour is an important component of quality health care. Patients' reports suggest that empathy is often lacking. Specific factors that may facilitate or inhibit empathetic behaviour have not been extensively examined. In Qatar, empathy may be affected by a completely multicultural, multilinguistic setting where healthcare professionals and patients interact. AIM: The purpose of this integrative literature review is to provide the latest evidence on factors that influence the demonstration of empathetic behaviour of nurses and physicians toward patients and to draw general conclusions that increase understanding. METHODS: A literature search was conducted in CINAHL, Medline (Ovid), PsycINFO, Psychology and Behavioral Sciences Collection, Middle Eastern and Central Asian Studies, Education Research Complete, ERIC, Health Source: Nursing/ Academic databases, and Google Scholar to identify relevant studies. A total of 18 quantitative and qualitative studies that satisfied the inclusion criteria were selected to be included in the review. RESULTS: Three high order factors are described: organizational, personal and interpersonal, and demographic factors. Seven subfactors included: burnout, increased workload, lack of organizational support, training workshops, patient behaviour, inappropriate role modelling, and informal, experiential learning. CONCLUSION: The organizational culture is strongly implicated in inhibiting empathy. Healthcare providers' empathetic responses to patients are linked and connected to a well-resourced, collegial, professional organizational environment that builds empathy towards everyone (not only patients).

Rationing nurses: Realities, practicalities, and nursing leadership theories.

In this paper, we examine the practicalities of nurse managers' work. We expose how managers' commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We learned how nurse managers' responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers' responsibilities are shaped to conform to institutional purposes.

Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge.

Institutional ethnography (IE) is used to examine transformations in a professional nurse's work associated with her engagement with a hospital's electronic health record (EHR) which is being updated to integrate professional caregiving and produce more efficient and effective health care. We review in the technical and scholarly literature the practices and promises of information technology and, especially of its applications in health care, finding useful the more critical and analytic perspectives. Among the latter, scholarship on the activities of economising is important to our inquiry into the actual activities that transform 'things' (in our case, nursing knowledge and action) into calculable information for objective and financially relevant decision-making. Beginning with an excerpt of observational data, we explicate observed nurse-patient interactions, discovering in them traces of institutional ruling relations that the nurse's activation of the EHR carries into the nursing setting. The EHR, we argue, materialises and generalises the ruling relations across institutionally located caregivers; its authorised information stabilises their knowing and acting, shaping health care towards a calculated effective and efficient form. Participating in the EHR's ruling practices, nurses adopt its ruling standpoint; a transformation that we conclude needs more careful analysis and debate.

The social organization of a sedentary life for residents in long-term care.

Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.

The Social Organization of Nurses' Pain Management Work in Qatar.

The purpose of this study was to explore the social organization of nurses' pain management work in Qatar. The research data drew our attention to unacceptable delays in intervening with patients in pain. We describe and analyze delays in opioid administration. Institutional ethnography was the method of inquiry used to guide the study. The main findings of the study reveal that there is a socially organized system of delays built into nurses' work to manage pain. Nurses are subject to time-consuming processes of securing, handling, and administering opioids. This study's innovative approach introduces a promising "alternate" analysis to prior work investigating hospital nurses' pain management practices. Both the method of inquiry and the findings have international relevance for researchers interested in undertreated pain.

The rhetoric of patient and family centred care: an institutional ethnography into what actually happens.

AIMS: This paper uses Dorothy Smith's institutional ethnography to examine technological advances designed to improve nurses' work. The analysis interrogates how nurses' work is coordinated, in disquieting ways, in an apparent commitment to 'patient and family centred care'. BACKGROUND: The discussion is part of a larger programme of research that focuses ethnographic attention on nurses' activating technological managerial improvement strategies. DESIGN: This discussion paper describes suboptimal hospital experiences to show how they were organized. The institutional ethnographic analysis addresses discrepancies that arise between the different organizational standpoints. Overall the discussion focuses on how institutional ethnographers enquire into people's everyday activities to discover and make understandable, in the material world, what actually happens that shapes them. DATA SOURCES: Data include observations and interviews with nurses, nurse managers, patients and families. It also includes screenshots of computer fields and other documents being used by nurses. IMPLICATIONS FOR NURSING: Nursing work is methodically being oriented to interests that undermine nurses' capacity to contribute their knowledgeable activity to intervene in people's health and well-being. CONCLUSION: Nurses' work is overwhelmed with the imperative to discharge patients. This happens with an ideological construction of patient centred care that obscures what is actually happening.

Docosahexaenoic acid affects markers of inflammation and muscle damage after eccentric exercise.

The effect of docosahexaenoic acid (DHA) on inflammatory and muscle damage response to acute eccentric exercise and to the subsequent initiation of a resistance training program was studied in 41 untrained men. Subjects consumed either 2 g·d of either DHA or placebo (PL) for 28 days before a 17-day exercise phase (day 1 to day 17) that began with an eccentric exercise bout of the elbow flexors (day 1). For analysis, the exercise period was further divided into an acute response phase (day 1-4). Isometric muscle strength (STR), range of motion (ROM), and delayed onset muscle soreness (DOMS) were measured on days 1, 2, 3, 4, 7, 12, and 17. Fasted blood was measured for interleukin 6 (IL-6), interleukin 1 receptor antagonist, C-reactive protein (CRP), and creatine kinase (CK) on days 1, 2, and 4. Serum CK and CRP were also measured in blood collected on days 7, 12, and 17. In the acute phase, DHA significantly reduced the serum CK (12.5%) and the IL-6 response (32%) but did not affect STR or DOMS. Over the entire 17-day resistance exercise period, DOMS area under the curve was 183.2 ± 96.2 for DHA and 203.2 ± 120.9 for PL (p = 0.054) and the CK response was numerically lower for DHA (p = 0.093). Docosahexaenoic acid supplementation reduced some but not all indicators of muscle damage and inflammation in the 4 days after an acute eccentric exercise bout but did not significantly affect the response to initiation of resistance exercise.

Evidence-based evaluation of potential benefits and safety of beta-alanine supplementation for military personnel.

This Department of Defense-sponsored evidence-based review evaluates the safety and putative outcomes of enhancement of athletic performance or improved recovery from exhaustion in studies involving beta-alanine alone or in combination with other ingredients. Beta-alanine intervention studies and review articles were collected from 13 databases, and safety information was collected from adverse event reporting portals. Due to the lack of systematic studies involving military populations, all the available literature was assessed with a subgroup analysis of studies on athletes to determine if beta-alanine would be suitable for the military. Available literature provided only limited evidence concerning the benefits of beta-alanine use, and a majority of the studies were not designed to address safety. Overall, the strength of evidence in terms of the potential for risk of bias in the quality of the available literature, consistency, directness, and precision did not support the use of beta-alanine by military personnel. The strength of evidence for a causal relation between beta-alanine and paresthesia was moderate.