The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study.

OBJECTIVE: To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). DESIGN: Prospective cohort study, conducted in 2010-12, with a before and after design. SETTING: A major referral university hospital. PARTICIPANTS: Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. INTERVENTION: The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. MAIN OUTCOME MEASURES: The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. RESULTS: There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. CONCLUSIONS: A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.

The process of translating family nursing knowledge into clinical practice.

PURPOSE: To report on approaches that were used to assist with implementation of family systems nursing (FSN) at a university hospital level in Northern Europe. DESIGN AND METHODS: A quasi-experimental research design was used for the first phase of the study. For the second phase, a cross-sectional research design was used. Data were collected in the first phase of the study from 457 nurses in all except one of the divisions of the hospital regarding their attitudes towards involving families into their care before and after having participated in the education and training intervention (ETI) program in FSN. Furthermore, in the second phase, data were collected from 812 nurses, after FSN had been implemented in all divisions at Landspitali University Hospital, regarding the nurses' knowledge of FSN and their evaluation of the quality of the ETI program (i.e., theoretical lectures on FSN as well as the benefit of the skill lab training regarding applying FSN into their clinical practices). Graham and colleagues' Knowledge to Action framework was used as the conceptual framework for the research. RESULTS: Nurses who had taken a course in FSN reported a significantly more positive attitude towards involving families in their care after the ETI program compared to those who had not taken such a course. Furthermore, a majority of the nurses who participated in the ETI program reported that the program was a favorable experience and indicated readiness for applying FSN in clinical practice. CONCLUSIONS: Further research is needed regarding the benefits of offering FSN at an institutional level, but focusing international attention on effective strategies to implement FSN into nursing practice may result in better health care for individuals and families around the globe. CLINICAL RELEVANCE: Providing clinically meaningful education and training in family nursing through programs such as the ETI program for practicing nurses at a university hospital is essential in supporting nurses applying new knowledge, when providing evidence-based health care services, to individuals and their family members. Such training can facilitate integration of new and needed information in clinical practice.

"The Hidden Client"--women caring for husbands with COPD: their experience of quality of life.

The purpose of this phenomenological study was to describe the experience of quality of life of women, taking care of husbands with chronic obstructive pulmonary disease (COPD). Unstructured, in-depth, tape-recorded personal interviews were used to collect data from six women living with husbands with COPD. The women ranged from 47 to 69 years in age and their husbands had given up work because of the illness. The wives in the study were dissatisfied with their lack of recreation, as well as support from friends, families and health care providers. Factors that increased the wife's quality of life were children and grandchildren and being able to please the husband and care for him until the very end.