What is ventilator-associated pneumonia and why is it important?

Hospital-associated pneumonia (HAP) is one of the most common infections acquired among hospitalized patients. HAP is associated with excess mortality and increased medical care costs. The rise in HAP due to antibiotic-resistant bacteria has resulted in more common administration of inappropriate antimicrobial treatment, with an associated increased risk of hospital mortality. Ventilator-associated pneumonia (VAP) refers to HAP occurring in patients requiring mechanical ventilation. VAP is the most common nosocomial infection among patients with acute respiratory failure. Physicians treating patients with HAP and VAP should be aware of the predominant local pathogens associated with these infections and their antimicrobial susceptibility patterns. This will allow more appropriate initial antibiotic selection in order to optimize treatment regimens and clinical outcomes. Additionally, clinical strategies aimed at the prevention of HAP and VAP should be employed in all hospital settings caring for patients at risk for these infections.     

Implementing client-centred practice: why is it so difficult to do?

This paper explores the challenges of implementing client-centred occupational therapy practice. While many occupational therapists believe in the principles of client-centred practice and espouse them, it seems much more difficult to implement these into everyday practice. Findings from three qualitative studies with three different populations (i.e., family-centred care for children and their families, community-based home care, facility-based care for older adults) are used to illustrate the challenges which are divided into three broad categories: challenges at the level of the system, at the level of the therapist and at the level of the client. Suggestions for change at each level are addressed. Organizations, therapists and clients must work together to facilitate these changes and ensure that each occupational therapy client receives respectful, supportive, coordinated, flexible and individualized service.     

Respiratory research in the critically ill pediatric patient: why is it so difficult?

Pediatric clinicians strive to base their management decisions on best available evidence. In the quantitative research paradigm, the highest level of evidence is derived from a conclusive randomized controlled clinical trial (RCT). Currently, there are few adequately powered RCTs to support pediatric acute respiratory care, but this landscape is changing. We are all obligated to ensure the relevance of our research, to mentor junior investigators, and to support knowledge development in our field. This paper reviews the hurdles faced by clinical investigators in the field of pediatric critical care and offers suggestions for future clinical studies.     

Dehydration: why is it still a problem?

Reports from organisations such as the Care Quality Commission have identified many hospital patients, particularly older people, are suffering from dehydration. A range of national initiatives have emphasised the importance of hydration and nutrition, and offered guidance to help address shortcomings, yet the problems persist. This article examines the interplay of factors that affect the assessment and identification of dehydration, and its prevention. It also offers strategies to help nurses to ensure patients receive adequate hydration.     

Barriers to women's health: why is it so hard for women to stay healthy?

Women's health care has made great strides in the past two decades. The recognition that women have different health care needs than men has enabled changes to take place in clinical care, research, and education. However, much remains to be done. Providing health care coverage to all women must be a high priority. Research must address the differences between men and women and how they respond to disease and treatment. The physician workforce needs to be expanded; physicians should be well trained to provide comprehensive health care to women. Strategies, such as used in Comprehensive Centers of Women's Health and women's health residencies, can improve education and increase the number of women in academia.     

What is the VN role in preventing dental disease in dogs and why is this so important?

ABSTRACT

Dental disease is extremely prevalent among dogs and it is essential that it is prevented because it affects health and quality of life. Many factors including breed, genetics, age, weight and systemic diseases can increase the chances of getting dental disease. Owner compliance and a lack of education in dental disease is also a key factor contributing to poor oral health. However, educating owners on the importance of preventing dental disease is crucial to prevention and professional cleaning, daily tooth brushing, dental chews and dry food can all significantly improve dental health.     

Nursing morale: what is it like and why?

BACKGROUND: There has been increased concern in the United Kingdom about the problems of recruitment and retention in the nursing profession, and how this is influenced by low morale. Despite this, however, there are relatively few studies, particularly of a qualitative nature, where nurses are asked about their morale and what factors affect it. AIMS: The present study aimed to explore nursing morale and determine the factors which nurses believed to influence it. By doing so, it was hoped that factors which affect nurse recruitment and retention could be identified. METHODS: Fifty-eight nurses (28 males, 30 females) working in the National Health Service in Scotland were interviewed in depth about their morale and their concerns about their career. Thematic analysis was carried out and a number of main issues emerged. FINDINGS: Morale in this group was very low. A large number of nurses were considering leaving the profession and the majority would discourage others from becoming a nurse. The themes that emerged, which related to their disillusionment, included low pay, lack of support for education, limited opportunity for promotion, lack of resources and job insecurity. CONCLUSIONS: The findings suggest that while recent salary increases may have helped to improve morale, other factors must also be addressed if further decline in morale and a subsequent nursing shortage is to be avoided.     

Cancer pain in palliative care: why is management so difficult?

Pain is the major source of anxiety and distress at the end of life, particularly in cases of end-stage cancer. However, pain management is not always effective or effectively implemented. This article identifies several barriers to effective pain relief in terminal cancer--the complexity of pain; difficulties in physical, emotional and spiritual assessment; difficulties in the delivery of medication--that challenge the skills of all professionals involved in palliative care. There are no simple answers, but awareness of the breadth of the issues may help focus nurses' minds on the patient in every encounter.     

Recruiting patients into a primary care based study of palliative care: why is it so difficult?

In the UK, researchers' access to study populations and control over selection of participants is becoming increasingly constrained by data protection and research governance legislation. Intervening stages placed between researchers and the population they wish to study can have serious effects on recruitment and ultimately on the validity of studies. In this paper we describe our experiences of gaining access to patients for a study of palliative care in primary care. Despite considerable time and resources dedicated to recruitment, a smaller than anticipated study sample was achieved. We found that gatekeeping by ethics committees and practitioner control over sample selection were significant hurdles in accessing patients for the study. Gatekeeping responsibilities represent considerable challenges for researchers seeking to obtain a representative study sample, not just in palliative care, but for research in general in health care.