Nurses’, physicians’ and radiographers’ perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

BackgroundA new initiative was introduced in Ireland following legislative changes that allowed nurses with special training to prescribe ionising radiation (X-ray) for the first time. A small number of studies on nurse prescribing of ionising radiation in other contexts have found it to be broadly as safe as ionising radiation prescribing by physicians. Sociological literature on perceptions of safety indicates that these tend to be shaped by the ideological position of the professional rather than based on objective evidence.ObjectivesTo describe, compare and analyse perceptions of the safety of a nurse prescribing of ionising radiation initiative across three occupational groups: nursing, radiography and medicine.DesignA cross-sectional survey design.SettingsParticipants were drawn from a range of clinical settings in Ireland.ParticipantsRespondents were 167 health professionals comprised of 49 nurses, 91 radiographers, and 27 physicians out of a total of 300 who were invited to participate. Non-probability sampling was employed and the survey was targeted specifically at health professionals with a specific interest in, or involvement with, the development of the nurse prescribing of ionising radiation initiative in Ireland.MethodsComparisons of perspectives on the safety of nurse prescribing of ionising radiation across the three occupational groups captured by questionnaire were analysed using the Kruskal–Wallis H test. Pairwise post hoc tests were conducted using the Mann–Whitney U test.ResultsWhile the majority of respondents from all three groups perceived nurse prescribing of ionising radiation to be safe, the extent to which this view was held varied. A higher proportion of nurses was found to display confidence in the safety of nurse prescribing of ionising radiation compared to physicians and radiographers with differences between nurses’ perceptions and those of the other two groups being statistically significant.ConclusionThat an occupational patterning emerged suggests that perceptions about safety and risk of nurse prescribing of ionising radiation are socially constructed according to the vantage point of the professional and may not reflect objective measures of safety. These findings need to be considered more broadly in the context of ideological barriers to expanding the role of nurses.     

Does psychological characteristic influence physicians’ communication styles? Impact of physicians’ locus of control on interviews with a cancer patient and a relative

Context Physicians psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication.Objective Our aim was to test the hypothesis that, in interviews with a cancer patient and a relative, physicians with an external locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different from that of physicians with an internal LOC (who believe that life outcomes are controlled by their own characteristics or actions).Design, setting, participants and intervention Eighty-one voluntary physicians practising in the field of oncology were recorded while performing an actual and a simulated interview with a cancer patient and a relative.Main outcome measures Physicians communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians LOC was assessed using the Rotter I–E scale. The communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Students t test.Results In actual interviews, physicians with an external LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an internal LOC. In simulated interviews, physicians with an external LOC used less utterances that give premature information (P=0.031) and used more utterances with a supportive function, such as empathy and reassurance (P=0.029), than physicians with an internal LOC.Conclusion These results provide evidence that physicians LOC can influence their communication styles. Physicians awareness of this influence constitutes a step towards a tailoring of their communication skills to every patients and relatives concerns and needs and thus towards a patient-centred communication.This research program was supported by the Fonds National de la Recherche Scientifique—Section Télévie of Belgium, the Fonds dEncouragement à la Recherche de lUniversité Libre de Bruxelles (Brussels, Belgium) and the CAM Training and Research Group (Brussels, Belgium).     

Patients’ and physicians’ views on the management of acute maxillary sinusitis

Objectives To study the views of patients and physicians on the management of suspected acute maxillary sinusitis and on suggested changes in practice.

Design Cross-sectional survey and focus group interviews of both patients and physicians.

Setting Primary care in Finland.

Results A total of 175 patients and 245 physicians replied to the survey (response rates 88% and 70%, respectively). Eight focus groups were conducted, four with patients (n=22) and four with physicians (n=20). Patients had less trust than physicians in the natural healing process of acute maxillary sinusitis: only 33% as opposed to 95% of physicians agreed that acute maxillary sinusitis might heal without medication. The patients emphasised the importance of careful diagnosis. Physicians experienced the diagnostic uncertainty and the demands from authorities to use fewer antibiotics as problematic.

Conclusions Most patients with suspected acute maxillary sinusitis primarily want the physician to aim at making a specific diagnosis. Physicians feel they are forced to prescribe too many antibiotics for sinusitis because of patient's expectations and lack of good diagnostic means for acute maxillary sinusitis. Better diagnostic tools, both national and local guidelines, and patient information might help to change practice towards the use of fewer antibiotics.     

Effect of a QI Intervention on Nursing Assistants’ Pain Knowledge and Reporting Behavior

BackgroundPain among long-term care residents is often underdiagnosed and inadequately treated. We examined the effect of a multimodal intervention on certified nursing assistants’ pain recognition knowledge and verbal reporting behavior. Secondarily, we examined pain documentation in a newly established pain log compared with pain verbally reported to nurses and documented in the electronic health record (EHR).DesignQuality improvement project using a pretest–posttest design.SettingA skilled nursing and rehabilitation facility in Southwestern Pennsylvania including two long-term care units and one transitional rehabilitation unit.Participants/SubjectsFifty-six nursing assistants.MethodsThe intervention was a face-to-face educational session with a training video and introduction of a new pain log used to document residents' pain. Pain knowledge was measured before and after the educational intervention. Multiple measures were used to examine nursing assistants’ pain reporting.ResultsNursing assistants’ pain knowledge improved (p < .001). There was no change in verbal pain reporting behaviors. The percent of pain episodes documented in the electronic health record that were reported to nurses varied by unit type (45% on the long-term care units vs. 100% on the rehabilitation unit) but remained unchanged postintervention. Pain logs were used more often on the rehabilitation than the long-term care units; use was low overall. Nursing assistant reports that nurses provided feedback on their reports of resident pain increased from 45% in week 1 to 75% in week 4.ConclusionsAlthough the multimodal intervention improved nursing assistants’ pain knowledge and their perceptions of the feedback they received from nurses when they reported pain, it had no effect on certified nursing assistants reporting of pain to nurses (per nurse report).     

Effect of educational intervention on intention of University students’ disuse of Hookah smoking: BASNEF model

There has been an increase in hookah smoking over the past years, hence implementing an intervention plan for its reduction is necessary. The present quasi-experimental study aimed to determine the effect of educational intervention on the hookah smoking behavior of dormitory students in Kerman University of Medical Sciences based on BASNEF model. SPSS/16 was used to analyze the data; the mean scores of attitude (P < 0.66), subjective norms (P < 0.103), and behavioral intention (P < 0.13) were no different prior to education in both intervention and control groups. The model decreased water pipe smoking among university students and the educational intervention positively influenced individuals ’attitude, subjective norms, and behavioral intention.     

Survey of pharmacists’ and physicians’ perceptions of therapeutic interchange

Therapeutic interchange has long been an integral part of drug formulary management, but physicians’ and pharmacists’ attitudes toward such programs are relatively unknown. This survey was undertaken to determine pharmacists’ attitudes, physicians’ potential response to a hypothetical interchange, and how well pharmacists predicted physicians’ responses. A survey that described a drug interchange program and several potential responses to the proposed switch was provided to 300 staff physicians at a 512-bed community facility in southwest Florida; the survey was also mailed to pharmacy directors or clinical pharmacy coordinators at 42 southwest Florida hospitals. Responses were obtained from 98 physicians and 95 pharmacists. Most physicians would not cooperate with an interchange if they were not familiar with the proposed drug; 16% would continue to prescribe the original drug, knowing that the new agent would be provided; and 58% would switch to another agent with which they had clinical experience. Only 26% of physicians would follow the interchange program. In contrast, 48% of pharmacists believed that physicians would continue to order the original therapy, 32% believed that physicians would order the new agent, and only 20% believed that physicians would switch to an alternative drug (P < .005 vs physician responses). Clearly, pharmacists’ expectations of physicians’ response to a therapeutic interchange differ significantly from the physicians’ expected behavior. This difference has potentially important implications for actual versus projected cost savings of therapeutic interchange. This paper was presented as a poster at the American Society of Health System Pharmacists Clinical Meeting and Exhibits in New Orleans, Louisiana, December, 1996. (Work completed while employed by Manatee Memorial Hospital in Bradenton, Florida.)     

Effect of sodium–chloride ion difference on pH regulation

BackgroundIn the Stewart approach, the difference between the cation and anion concentrations, especially between sodium, accounting for the majority of cations, and chloride, comprising the majority of anions, is an important factor in pH regulation. This study investigated the effect of sodium–chloride ion difference (SCD) on pH regulation comparing with those of PaCO₂ and lactate.MethodsArterial blood gas samples measured at our pediatric intensive care unit of a tertiary children’s hospital between January and June 2020 were included. Samples that met the following criteria were excluded: samples collected from patients taking potassium bromide and samples with lactate concentration of >25 mmol/L. From the eligible data, pH was chosen as the dependent variable and SCD, lactate, and PaCO₂ as independent variables, and then, a multiple regression analysis was performed.ResultsIn total, 5360 samples were included. Of these, five samples were excluded according to the exclusion criteria. Finally, 5355 samples were analyzed. As the variance inflation factors were <2.0 for all three variables, there was no multicollinearity. The following model was derived: pH = 7.384 + [0.97 × SCD (mEq/L) − 0.66 × PaCO₂ (mmHg) − 1.33 × Lac (mmol/L)] × 10⁻² (adjusted R-squared = 0.73; P value < 0.001). Based on the standardized partial regression coefficients (β), pH was affected in the order of PaCO₂ (β_PaCO2 = −0.95), SCD (β_SCD = 0.72), and lactate (β_lactate = −0.33).ConclusionsThe prevention of SCD reduction, together with respiratory and metabolic management, is important for pH regulation.     

Effect of early rehabilitation intervention on function of limbs after burn dermatoplasty

Background：Recoveryofmovementfunctionofaffectedlimbsafterburnisanimportanttopicoftreatmentandrehabilitationofburn．Bothheatandnon－heatfactorscaninjurebodyandleadtoper－manentdisability．Wetreated３６burndermatoplastycaseswithearlyrehabilitationinterventionfromFebruary１９９９toFebruary２００２andgainedsatisfactoryeffects．Objective：Toinvestigateeffectofearlyrehabilitationinterven－tiononfunctionoflimbsafterburndermatoplasty．Unit：DepartmentofSurgery，SecondPeopleHospitalofBingzhouCity…     

Effect of a legal prime on clinician’s assessment of suicide risk

The present study evaluates how liability influences mental health clinicians’ assessment of suicide risk. In this online vignette-based experiment, clinicians (N = 268) were either primed with a legal standard prior to a case vignette or presented the case vignette alone. Clinicians then rated the patient’s likelihood of suicide and need for hospitalization. Results indicated that trainees provided significantly lower ratings of suicide risk following presentation of the legal standard, but this was not associated with hospitalization endorsement. Results have training and legal implications for improving the accuracy of suicide risk assessment in both trainees and licensed professionals.     

Breast cancer survivors’ perspectives on a weight loss and physical activity lifestyle intervention

Purpose

The purpose of this study is to qualitatively describe the experiences of breast cancer survivors who took part in a successful 24-week lifestyle intervention aimed at weight loss. The aim was to inform future study designs and lifestyle interventions.

Methods

Nine women who completed the lifestyle intervention took part in either a focus group or telephone interviews with trained facilitators who were not involved in the delivery of the intervention. Interviews were transcribed verbatim and thematic analysis was conducted.

Results

Women appreciated the group-based nature of the program, the presence of other breast cancer survivors, and the safe and supportive environment provided by program leaders. The intervention supported women in reframing their dietary habits, and the exercise component had unexpected benefits on their psychological wellbeing. The logistics of fitting the intervention into busy work and family schedules was a challenge experienced by most women. Recommendations for future programming included offering the intervention to all survivors immediately following adjuvant treatment, integrating participants’ social networks into the program and including a maintenance phase for sustainability of healthy behaviors.

Conclusion

This qualitative study provides insight into breast cancer survivors’ experiences in a group-based lifestyle intervention and offers suggestions for the development of future lifestyle programming in cancer care.     

Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study

BackgroundJob stress and burnout are highly frequent in healthcare professionals, and prevalence in nurses can be as high as 40%. Mindfulness-based interventions have been shown to be effective in reducing stress and increasing well-being in a wide range of populations and contexts. However, controlled studies with healthcare professionals, and especially nurses, are scarce.Objectives, design and settingThe aim of this study was to explore the effectiveness of an on-site, abbreviated mindfulness-based intervention for nurses, using a nonrandomized, wait-list comparison design. The effectiveness of the intervention was measured through several validated self-report measures that participants completed before and after the intervention, assessing burnout, compassion fatigue, psychological symptoms, mindfulness, self-compassion, experiential avoidances, rumination, and satisfaction with life.ParticipantsA sample of 94 oncology nurses agreed to participate in the study and self-selected into an experimental (n = 45) and comparison condition (n = 48). Complete data was obtained for 48 of the initial 94 participants, mainly due to poor follow-up data rather than high drop-out rate.ResultsStatistical analyses included a series of 2 × 2 ANOVAs and ANCOVAs. Results indicated that nurses in the intervention reported significant decreases in compassion fatigue, burnout, stress, experiential avoidance, and increases in satisfaction with life, mindfulness and self-compassion, with medium to large effect sizes. Nurses in the comparison group didn’t present significant changes in these variables. Results also pointed to a high degree of acceptability of the intervention.ConclusionsThis study provides preliminary evidence that mindfulness-based interventions may be efficacious in reducing oncology nurses’ psychological symptoms and improving their overall well-being, and thus may be worthy of further study in this population.     

The effect of a more community-oriented curriculum on nursing students’ intervention choice in community care: A quasi-experimental cohort study

AimThe aim of this study is to investigate the effect of a more ‘community-oriented’ baccalaureate nursing curriculum on students’ intervention choice in community care.BackgroundFollowing a healthcare shift with increased chronic diseases in an ageing patient population receiving care at home, nursing education is revising its curricula with new themes (e.g., self-management) on community care. Although it seems obvious that students incorporate these themes in their nursing care interventions, this is unclear. This study investigates the effect of a redesigned curriculum on students’ care intervention choice in community nursing.DesignA quasi-experimental quantitative study.MethodsThis study with an historic control group (n = 328; study cohorts graduating in 2016 and 2017; response rate 83 %) and an intervention group n = 152; graduating in 2018; response rate 80 %) was performed at a University of Applied Sciences in the Netherlands. The intervention group experienced a curriculum-redesign containing five new themes related to community care (e.g., enhancing self-management, collaboration with the patients’ social network, shared decision making, using health technology and care allocation). The primary outcome 'intervention choice in community nursing’ was assessed with a specially developed vignette instrument ‘Assessment of Intervention choice in Community Nursing’ (AICN). Through multiple regression analyses we investigated the effect of the curriculum-redesign on students’ intervention choice (more ‘traditional’ interventions versus interventions related to the five new themes). The control and intervention groups were compared on the number of interventions per theme and on the number of students choosing a theme, with a chi-square or T-test.ResultsStudents who studied under the more community-oriented curriculum chose interventions related to the new themes significantly more often, F(1461) = 14.827, p = <0.001, R² = .031. However, more traditional interventions are still favourite (although less in the intervention group): 74.5 % of the chosen interventions in the historic control group had no relation with the new curriculum-themes, vs. 71.3 % in the intervention group; p = .055).ConclusionsStudents who experienced a more ‘community-oriented’ curriculum were more likely, albeit to a limited extent, to choose the new community care themes in their caregiving. Seeing this shift in choices as a step in the right direction, it can be expected that the community care field in the longer term will benefit from these better skilled graduates.     

Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010–2015

PurposeAustralia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation.MethodCohort study of New South Wales donor referrals, 2010–2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation.ResultsOf 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29–0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41–0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49–0.91) or give consent (OR 0.24; 95%CI0.16–0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6).ConclusionIntervention to improve consent rates from CALD families may increase donation.