Application of the updated CDC isolation guidelines for health care facilities

THE CENTERS FOR DISEASE CONTROL and Prevention has published updated guidelines for isolation precautions that outline how health care workers can prevent the transmission of infectious agents to their patients and to themselves.THE GUIDELINES RE-EMPHASIZE standard precautions, which guide clinicians in the use of appropriate personal protective equipment (PPE), depending on the expected type of exposure. Respiratory hygiene/cough etiquette is incorporated into infection control practices as a new component of standard precautions.THE ARTICLE PROVIDES information on the new guidelines as well as information on newly emerging patho gens and methods to prevent disease transmission in health care settings.     

Hardiness: a new perspective in health promotion

Hardiness is a developing concept of particular relevance to primary care nursing. Evolving out of existential psychology, hardiness is proposed as a personality characteristic that serves to mediate the stress-illness relationship, promoting health in the presence of high degrees of life change and stress. In this review, the concept of hardiness is analyzed and discussed. Its implications for nursing theory and primary care practice are demonstrated.     

The Bindler-Ball Healthcare Model: a new paradigm for health promotion

Nursing of children requires integration of components from many knowledge areas, and nurses must consistently plan and carry out interventions to promote health and prevent disease and injury for children and adolescents. A new healthcare model is applied to child health nursing within all healthcare contexts, from acute care settings to chronic care services to well child focused care. Health promotion and health maintenance are defined and explored, along with application of these concepts in major types of care along the healthcare continuum. The influences of family, culture, and community are viewed as integral to health promotion strategies. The nurse plans for health promotion and health maintenance activities during all acute, chronic, and end-of-life care for youth. The healthcare model is a new and creative method in which to frame healthcare for children.     

Education and health promotion for new patients with cancer

High levels of anxiety negatively affect how education is received by newly diagnosed patients with cancer by decreasing comprehension, retention, and patient satisfaction. Research has repeatedly shown that, after a careful assessment of individual needs, effective patient education delivered during the initial phase of diagnosis and treatment can improve symptoms of anxiety and fear, improve self-care decisions, decrease side effects of treatment, and enhance quality of life. The educational intervention presented in this article aims to improve the current system of providing education for newly diagnosed patients with cancer by assessing each patient and presenting an individualized information program in a controlled environment prior to chemotherapy.     

Orem's model used for health promotion: directions from research

Orem's theories of self-care and self-care deficit contain several propositions important to health promotion. This article presents results of tests of these relationships, which indicated partial support for the model. In an aggregate sample of 369 adolescents, self-care and self-care agency were significant predictors of health. This relationship held when health was defined as a general positive state of integrity and soundness, but not when it was considered as merely the absence of disease.     

Consensus guidelines for the promotion and management of continence by primary health care teams: development, implementation and evaluation

A project was undertaken as part of the NHS Executive Strategy for Major Clinical Guidelines, involving the development of national clinical guidelines for the promotion and management of continence by primary health care teams, through the process of managed consensus based on scientific review. The guidelines were then implemented at one urban general practice. This article outlines the development and implementation of the guidelines and describes the study undertaken to evaluate the impact of implementation on clinical outcomes. The study involved a pre-and post-implementation postal survey of a random sample of 17% of patients aged 18 years and over from the practice (n=1503). The pre-implementation survey determined the period prevalence of incontinence, related biological data and data on the pre-implementation management of incontinence. Incontinence sufferers were invited to have their condition assessed or reviewed. All sufferers who agreed to be followed-up were sent the post-implementation survey, which identified those patients who had sought help, and ascertained reasons for not seeking help. Data on the management of incontinence post-implementation were also obtained. Clinical outcomes measured pre- and post-implementation were a validated severity index for urinary incontinence, (also adapted for faecal incontinence) and perception of the incontinence as a problem. A 3-month period was allowed between pre- and post-implementation surveys. The study confirmed previous research which showed that few incontinence sufferers respond to invitations to seek help, and that help-seeking behaviour was significantly related to severity of incontinence. The guidelines did not have any positive impact on the clinical outcomes measured, although slight improvements in approaches taken by the primary health care team to the promotion and management of continence were recorded. However, the study was limited by the small sample size and short time scale. Further evaluation of the impact of the guidelines on these outcomes is therefore recommended.     

Vicarious traumatization: potential hazards and interventions for disaster and trauma workers

Disaster and trauma workers often disregard their own reactions and needs when focusing on caring for those directly exposed to traumatic events. This article discusses the concept of vicarious traumatization, a form of post-traumatic stress response sometimes experienced by those who indirectly are exposed to traumatic events. It includes an examination of how vicarious trauma reactions are experienced across different professions, and suggestions on how to limit or prevent vicarious traumatization. The authors review self-care strategies as well as training and organizational considerations that may be beneficial for individuals and organizations to address.     

Protecting infants in healthcare facilities from abduction: a facility's search for a sound infant security system

Metropolitan Methodist Hospital, a 279-bed facility, had an electronic infant security system frequently in need of repairs. The vendor became increasingly difficult to locate, and so the decision was made to replace the system. A literature search of vendors and agencies supporting hospitals in the prevention of infant abductions; solicitation of information from facilities experiencing abductions; and onsite tours of facilities were most beneficial in determining a new system. As a result, the facility purchased a state-of-the-art infant security system and agreed to participate as a beta site for mother-baby recognition identification bands, an added security feature not yet on the market. This article describes the process of evaluating and selecting an infant security system in order to reduce the risk of infant abduction.     

Health promotion: the new frontier

In a country where many U.S. children live in poverty, do not share equally in health and access to health care, and are at risk for several adolescent problems, health promotion has become the new frontier in health care. The newer approaches to health promotion are discussed.     

Heart failure: highlights from new consensus guidelines

New guidelines for managing heart failure urge physicians to identify patients likely to benefit from therapy, obtain an echocardiogram to measure the ejection fraction, and, in patients with systolic dysfunction (i.e., an ejection fraction < or = 40%), institute therapy with an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker if at all possible. Digoxin and diuretics can relieve symptoms but do not affect the mortality rate. Spironolactone in low nondiuretic doses may reduce mortality when added to baseline drug regimens. The proper role of angiotensin II receptor blocking agents has yet to be determined.