Nurses' and Physicians' Experiences After Implementation of a Quality Improvement Project to Improve Sepsis Awareness in Hospitals.

Purpose: Previous research has explored nurses´ experience with the implementation of early detection alert systems, and nurses and physicians' perceptions of sepsis management and use of sepsis triage. As one of the first, this study aims to investigate the perceived usefulness of an interdisciplinary quality improvement project including standardized sepsis patient pathway to improve the early identification and treatment of sepsis patients. Participants and Methods: This study was a qualitative study that employed semi-structured interviews with thirteen ward nurses and five ward physicians recruited by convenience and respondent-driven sampling, respectively. The interviews explored the perceived usefulness of mutual training in sepsis care in medical hospital wards. We applied Systematic Text Condensation to analyze the experiences and knowledge of professional identification and cooperation in early identification of sepsis patients. Results: The results revealed three main themes: Awareness of sepsis, collaboration between nurses and physicians, and clinical assessment and judgement. The findings highlighted the positive impact of the project in terms of raising awareness, improving communication, and enhancing the ability to detect and treat sepsis. The study also identified the importance of repetition and reminders to maintain awareness, the need for ongoing training for new healthcare professionals, and the challenges of collaboration and decision-making processes. Conclusion: The sepsis intervention seemed successful in improving awareness of sepsis and enhancing interprofessional collaboration between nurses and physicians. Health professionals continued to rely on their clinical judgment but increased the use of objective measurements and communication of vital signs. Continuous repetition and education for new colleagues were identified as important factors for the sustainability of the intervention. Overall, the study highlights the importance of standardized protocols and training for early detection and management of sepsis in healthcare settings.

Has "The Ceiling" Rendered the Readiness for Interprofessional Learning Scale (RIPLS) Outdated?

PURPOSE: The present study aimed to investigate the preliminary effects of collaborative learning and simulation on readiness to engage in and attitudes toward future interprofessional learning activities. We translated into Norwegian and validated the original Readiness for Interprofessional Learning Scale (RIPLS) (part 1) to measure the efficacy and feasibility of a structured collaborative learning activity (part 2). MATERIALS AND METHODS: Undergraduate social and health care professional students from five Norwegian universities (n = 307) participated in the validation stage of this study (part 1). A Norwegian version of the RIPLS was developed using forward and backward translation. An expert panel discussed discrepancies between the translations and professional concepts. We planned to conduct a principal component analysis to evaluate the structure, reliability, and internal consistency of the Norwegian version of the RIPLS, after investigating the skewness, kurtosis, and range of items included. One hundred fifty students participated in collaborative learning activities; 72 (48%) of these individuals answered the translated RIPLS questionnaire. RESULTS: We found a substantial ceiling effect in the majority of items in the RIPLS, making it difficult to use the instrument as a measure of change. We evaluated the efficacy and feasibility of the collaborative activities based on the changes in the single items that had sufficient univariate normality and ultimately confirmed positive changes in two of these items. CONCLUSION: Norwegian students appear ready for interprofessional learning; however, due to significant ceiling effects, the majority of items in the RIPLS no longer seem suitable for measuring and evaluating the effects of interprofessional learning (part 1). Single-item analysis revealed a potential effect of collaborative learning (part 2). A new questionnaire is needed where readiness is instead understood as self-efficacy in areas such as role awareness and interprofessional communication. Researchers should be aware that even previously validated questionnaires may lose their applicability over time and require revision. Demands for interprofessional learning and practice are continuously evolving, and evaluation methods should be adjusted accordingly.

Work Role Perspectives of Clinical Instructors From Three Countries.

BACKGROUND: Educational institutions partner with health facilities to provide clinical education, but the impact of these partnerships on clinical instructors is rarely examined. METHOD: A cross-sectional study was used to obtain surveys from a convenience sample of clinical instructors (n = 135) working in Israel, Norway, and the United States. The Nursing Clinical Instruction Role Assessment Tool (N-CIRAT) was developed to elicit clinical instructors' perspectives on the importance and nature of their work roles. FINDINGS: The N-CIRAT exhibited good reliability and revealed three different work roles: educator, hospital partner, and patient advocate. The educator work role did not differ by primary employer; it did for the work role of hospital partner (p < .05) and patient advocate (p < .05). Patient advocate work role importance was rated high for all clinical instructors. CONCLUSION: The educator role of clinical nurse educators, including being a role model and encouraging reflection, is universal among clinical instructors.

Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival.

BACKGROUND: Systemic inflammatory response syndrome (SIRS) and sepsis are now frequently identified by observations of vital signs and detection of organ failure during triage in the emergency room. However, there is less focus on the effect on patient outcome with better observation and treatment at the ward level. METHODS: This was a before-and-after intervention study in one emergency and community hospital within the Mid-Norway Sepsis Study catchment area. All patients with confirmed bloodstream infection have been prospectively registered continuously since 1994. Severity of sepsis, observation frequency of vital signs, treatment data, length of stay (LOS) in high dependency and intensive care units, and mortality were retrospectively registered from the patients' medical journals. RESULTS: The post-intervention group (n = 409) were observed better and had higher odds of surviving 30 days (OR 2.7, 95 % CI 1.6, 4.6), lower probability of developing severe organ failure (0.7, 95 % CI 0.4, 0.9), and on average, 3.7 days (95 % CI 1.5, 5.9 days) shorter LOS than the pre-intervention group (n = 472). CONCLUSIONS: In a cohort with stable mortality rates, early sepsis recognition by ward nurses may have reduced progression of disease and improved survival for patients in hospital with sepsis.

Therapeutic efficacy of IL-17A antibody injection in preventing the development of colitis associated carcinogenesis in mice.

Chronic inflammation increases colorectal cancer (CRC) risk as seen in ulcerative colitis (UC). Proinflammatory cytokines play a critical role in mediating the development of colitis associated cancer (CAC). In this study, the therapeutic efficacy of anti-interleukin (IL)-17A by anti-IL-17A antibody injection on the development of CAC was assessed in 1,2-dimethylhydrazine (DMH) plus dextran sulfate sodium (DSS) induced CAC mouse model. The results showed that mice dosed with DMH plus DSS for 10 weeks evoked high degree dysplastic lesion in the large bowel that accompanied with significant increased IL-17A expression, proliferation index and inflammation degree in mice. After anti-IL-17A antibody injection for 2 weeks, the number of tumors, proliferation index and the expression level of IL-17A protein in the large bowel tissues were significantly decreased. Therefore, we concluded that the anti-IL-17A blockade can suppress the development of CAC and is a potential therapeutic agent for the prevention of CAC in colitis mice.

Cultural encounters in reflective dialogue about nursing care: a qualitative study.

AIM: This paper is a report of a study to explore how students developed reflective nursing practice through cultural encounters between students from Tanzania and Norway. BACKGROUND: Nursing students need to develop cultural care competence to care for patients in a globalized world. One way to achieve this goal may be through international practice experience. Previous studies have shown that students visiting developing countries matured personally and intellectually more than those who experienced encounters between developed countries. METHOD: The study was exploratory, using qualitative data about nursing practice and cultural encounters experienced by nursing students from Tanzania and Norway. Data were collected through participatory observation, students' logs and focus group interviews in 2006. FINDINGS: The encounter was characterized with an open attitude facilitating a good context for co-learning between the students. Three main themes were identified. The Norwegian students emphasized nurse-patient relationships, individualized care, direct communication and emotional involvement. The Tanzanian nursing students demonstrated a collectivist approach in nursing characterized by nurse-relative-patient relationships, and they emphasized curing attributes with skillful performance of procedures. CONCLUSION: A cultural encounter between students from different culture proved to be a fruitful way of teaching nurses. The opportunity to share thoughts, reflect on value systems and personal practice through dialogue with students from a different culture offer possibility in terms of cultural competence, reflexivity and consciousness of various ways practising nursing. This may contribute to bringing the practice of nursing a step forward in both cultures.

Cardiovascular autonomic function tests in an African population.

BACKGROUND: Diabetes mellitus is becoming increasingly common in sub-Saharan Africa. Autonomic dysfunction contributes to morbidity and mortality in diabetic patients. Data on autonomic dysfunction in the African population is scarce, and no reference values for standardized autonomic function tests are available. The aim of this study was to establish cut off values for five easy-to-use cardiovascular autonomic function tests that may be suitable for resource-poor settings. METHODS: We recruited 276 healthy African individuals, 156 men and 120 women, aged > 20 years. Participants were tested for (1) resting heart rate (HR), (2) HR variation in response to deep breathing, (3) HR response to standing, and (4) postural changes in systolic and diastolic blood pressure (SBP and DBP). Respective cut-off values were calculated according to the 95th or 5th percentile. RESULTS: Taking an association of the autonomic test results with gender and age into consideration, we defined the following cut-off values: resting HR (bpm) >or= 89 for men and >or= 97 for women; HR (bpm) in response to deep breathing or= 17 mmHg for all age groups; and postural decreases in DBP (mmHg) >or= 2 for men and >or= 5 for women. CONCLUSION: The test battery revealed cut-off values different from those measured in Caucasians. Further studies are recommended a) to assess whether these cut off values are generally applicable, and b) to establish population specific reference values for Africans.