The implementation of an infection control bundle within a Total Care Burns Unit.

AIM: To evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit. BACKGROUND: Burn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them. METHODS: An interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice. RESULTS: During the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013. CONCLUSION: The implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.

Psychiatric genetic counseling for serious mental illness: Impact on psychopathology and psychotropic medication adherence.

For people with serious mental illness (SMI) (schizophrenia, bipolar disorder, schizoaffective disorder), psychiatric genetic counseling (PGC) has been shown to significantly increase empowerment and illness management self-efficacy. While these outcomes are important, they are also theoretical precursors for behavior changes (e.g. improved medication adherence), and improved mental health. Therefore, we conducted the first study (repeated-measures/within-subjects design) to test the hypothesis that PGC would reduce psychiatric symptoms due to increased medication adherence. Between 2013-2018, we recruited N = 109 individuals (age 19-72) with SMI and administered the short Positive and Negative Syndrome Scale (short-PANSS) and Brief Adherence Rating Scale (BARS) at four timepoints; twice Pre-PGC (T1: 1-month Pre-PGC and T2: immediately Pre-PGC), to assess change in adherence/symptoms without any intervention (internal control condition), and twice Post-PGC (T3: 1-month and T4: 2-months Post-PGC), to assess impact of PGC. A quantile regression model investigated the relationships between short-PANSS, timepoints, and BARS. There was a significant relationship between short-PANSS and timepoints at the 75th (T4 short-PANSS scores < T1 and T2) and 90th quantiles (T4 short-PANSS scores < T2), but these results were not explained by improved medication adherence. PGC for SMI may reduce psychiatric symptoms, but confirmatory work and studies to examine mechanism are needed.

Quality improvement collaborative: A novel approach to improve infection prevention and control. Perceptions of lead infection prevention nurses who participated.

BACKGROUND: In response to the ongoing infection prevention (IP) challenges in England, a 90-day quality improvement (QI) collaborative programme was developed. The paper discusses the approach, benefits, challenges and evaluation of the programme. OBJECTIVE: The objective of the collaborative was to develop new approaches to enable sustainable and effective IP. METHODOLOGY: Six trusts in the region participated in the collaborative. Each defined their bespoke IP focus. There was no expectation that statistically significant measurable improvements would be identified during the short time frame. The experiences of the participants were sought both during the programme to facilitate its constant review and at the end of the programme to evaluate its effectiveness. The feedback focused on achievements, barriers to change and benefits of participating in a QI collaborative. To measure the potential success of the projects, participants completed the Model for Understanding Success in Quality framework. (MUSIQ; Kaplan et al., 2012). RESULTS: Since each trusts IP focus was bespoke commonalities of success were not evaluated. Participants identified a positive outcome from their QI interventions. The MUSIQ score identified the projects had the potential for success. DISCUSSION: The feedback from the participants demonstrated that it is worthy of further development.

Incivility Across the Nursing Continuum.

Incivility affects nurses throughout education and practice; it directly affects patient safety as well as nurses' decisions to remain in academia and clinical practice. This article reviews the current literature on incivility and proposes the application of social learning theory to evidence-based strategies that can be implemented to combat incivility.

Preterm Births: A Global Health Problem.

Globally, in 2012, there were 15 million babies born preterm. The majority of preterm births occur in resource-poor countries including India, Nigeria, Pakistan, and the Democratic Republic of Congo where many die due to lack of basic skilled nursing care. In September 2000, the United Nations signed the Millennium Development Declaration establishing eight Millennium Development Goals (MDGs). These MDGs provide specific, measurable targets that are designed to provide equitable health to all, particularly the most vulnerable including preterm babies. On May 2, 2014, the World Health Organization specifically targeted the nursing workforce as a key stakeholder in strategies to reduce global prematurity and end preventable preterm newborn deaths. Specific strategies include primary care, screening for risk factors, kangaroo mother care, and early initiation of breastfeeding with exclusive breastfeeding for the first 6 months of life. By sharing our knowledge and skills, nurses can contribute to global actions being taken to end preventable preterm newborn deaths.

Womb Outsourcing: Commercial Surrogacy in India.

Infertility affects more than 7 million American couples. As traditional treatments fail and the costs of hiring a surrogate increase in the United States, transnational commercial surrogacy becomes a feasible alternative for many couples. Infertile couples may opt for this choice after reading enticing Internet advertisements of global medical tourism offering "special deals" on commercial surrogacy. This is particularly true in India where couples from the United States can purchase transnational surrogacy for less than one-half or even one-third of the costs in the United States, including the cost of travel. The majority of surrogate mothers in India come from impoverished, poorly educated rural areas of India. Commercial surrogacy offers the lure of earning the equivalent of 5 years of family income. This multidisciplinary review of the literature suggests that the issue of commercial surrogacy is complex and influenced by a number of factors including expensive infertility costs, ease of global travel, and the financial vulnerability of Indian commercial surrogate mothers and their families. Questions are being raised about decision making by the surrogate mother particularly as influenced by gender inequities, power differentials, and inadequate legal protection for the surrogate mother. More research is needed to understand commercial surrogacy, especially research inclusive of the viewpoints of the Indian mothers and their families involved in these transactions.

Ethical issues associated with genetic counseling in the context of adolescent psychiatry.

Genetic counseling is a well-established healthcare discipline that provides individuals and families with health information about disorders that have a genetic component in a supportive counseling encounter. It has recently been applied in the context of psychiatric disorders (like schizophrenia, bipolar disorder, schizoaffective disorder, obsessive compulsive disorder, depression and anxiety) that typically appear sometime during later childhood through to early adulthood. Psychiatric genetic counseling is emerging as an important service that fills a growing need to reframe understandings of the causes of mental health disorders. In this review, we will define psychiatric genetic counseling, and address important ethical concerns (we will particularly give attention to the principles of autonomy, beneficence, non-maleficence and justice) that must be considered in the context of its application in adolescent psychiatry, whilst integrating evidence regarding patient outcomes from the literature. We discuss the developing capacity and autonomy of adolescents as an essential and dynamic component of genetic counseling provision in this population and discuss how traditional viewpoints regarding beneficence and non-maleficence should be considered in the unique situation of adolescents with, or at risk for, psychiatric conditions. We argue that thoughtful and tailored counseling in this setting can be done in a manner that addresses the important health needs of this population while respecting the core principles of biomedical ethics, including the ethic of care.

Massive open online courses in nursing education.

MOOCs are changing the face of higher education. Online programs provide nurses with access to technologies, networking with other professionals, and opportunities reflect on their practice. The changing climate of online, higher education provides access and flexibility to students balancing work, family, and financial responsibilities. Offering free courses may provide nursing students ambivalent about online learning the chance to experience otherwise unavailable educational opportunities including the chance to earn a BSN degree.

Maternal psychosocial determinants of fetal and infant health and the National Children's Study.

The purpose of this article is to inform perinatal nurses about the longitudinal National Children's Study (NCS), which was mandated by Congress. The NCS was designed to follow infants from before birth to age 21, and researchers propose to study 100,000 children. This complex and extensive study will provide especially relevant information to perinatal nurses in practice, teaching, and research.

The placenta as a research biospecimen.

The placenta provides a unique opportunity to study the prenatal environment of the fetus to better understand subsequent infant and child health and illness. In this article we describe the role of the placenta as a research biospecimen, including placental morphology and cytokine biomarkers. Because of the role of the placenta in contemporary research, members of the perinatal health care team involved in birth have an important role in advancing science.

A concept analysis of otherness.

Otherness is an important concept in understanding the health provider-patient relationship and in creating insights into how to be more present with patients and families. This is an analysis of the concept of Otherness that leads to a definition of the construct.

An Orally Available 3-Ethoxybenzisoxazole Capsid Binder with Clinical Activity against Human Rhinovirus.

Respiratory infections caused by human rhinovirus are responsible for severe exacerbations of underlying clinical conditions such as asthma in addition to their economic cost in terms of lost working days due to illness. While several antiviral compounds for treating rhinoviral infections have been discovered, none have succeeded, to date, in reaching approval for clinical use. We have developed a potent, orally available rhinovirus inhibitor 6 that has progressed through early clinical trials. The compound shows favorable pharmacokinetic and activity profiles and has a confirmed mechanism of action through crystallographic studies of a rhinovirus-compound complex. The compound has now progressed to phase IIb clinical studies of its effect on natural rhinovirus infection in humans.

Aesthetic physical caring--valuing the visible.

The aim of this article was to define the term 'aesthetics' in order to demonstrate that aesthetic physical caring is administered to the intensive care patient. Johns's model of structured reflection (10th version) was used to reflect upon three nursing narratives with intensive care unit nurses and relatives and reveals why physical caring is fundamental for the patient.

Continuous professional development along the continuum of lifelong learning.

AIM: To identify what factors influenced motivation to participate in continuous professional development (CPD), among a group of qualified nurses, occupational therapists and physiotherapists. METHOD: Ninety-four nurses, 38 occupational therapists and 50 physiotherapists participated. They completed a questionnaire derived from research literature. Views on the concepts of lifelong learning (LLL) and CPD were sought. RESULTS: One hundred and eighty-two questionnaires were returned from 300 giving a response rate of 60.6%. Professional knowledge was reported as the prime motivator to seek CPD. Other motivators, which featured in the top four most important factors included updating existing qualifications, increasing the status of the profession as a whole and demonstrating that an individual was professionally competent. These factors overlapped with respondents reasons for CPD and a general consensus of opinion was reached among respondents on the meanings of LLL and CPD. CONCLUSION: In conclusion there were no observable differences between the professions and seeking CPD is intrinsically driven.