Addressing the childhood obesity crisis: a call to action

The prevalence of childhood obesity is increasing in the United States and globally. Associated with numerous comorbid conditions, childhood obesity is also recognized as a risk factor for multiple chronic conditions and premature mortality in adult life. Children and adolescents, particularly those from ethnic minorities and rural low income populations, bear an excess burden of obesity and its attendant comorbidities. A major contributor to childhood obesity is a physical and social environment that promotes foods high in fat and calories and minimizes the opportunities for physical activity. Despite the strong environmental influences that encourage overeating and sedentary behavior, weight maintenance is viewed as a personal responsibility. Addressing the obesity crisis requires a paradigm shift away from blaming individuals for the lack of will power to control their eating and physical activity to one of recognizing the "toxic" or "obesigenic" environment as a primary determinant. This article addresses the obesity crisis from individual, family, local community, and public policy perspectives. Emphasis is placed on the role of nurses and nursing, acting to promote change with individuals and families and acting as advocates for multilevel policy initiatives, in reversing the epidemic and improving the health of future generations.     

Myasthenia gravis: the patient in crisis

Crisis in the myasthenic patient is a life-threatening event. The expertise of the critical care nurse is crucial to the prevention of complications and the return of the patient to a functional capacity.     

A communication skills intervention for community healthcare workers reduces perceived patient aggression: A pretest-postest study

Background

Previous studies have shown that healthcare workers experience high levels of aggression from patients. Prevention packages to address this have received little research support. Communication skills have been shown to influence individuals’ experience of aggression and are also amenable to training.

Objectives

This study aims to deliver a communication skills training package that will reduce the experience of aggression in the workplace for healthcare workers.

Design

An interactive, multimedia communication skills package was developed that would be suitable for community healthcare workers. The training consisted of four workshops, including teaching, discussion and DVD illustrative examples. These were based on research and clinical experience.

Settings

This intervention was delivered in two community care organisations over several months.

Participants

Fifty-six community healthcare workers took part in the trial in small groups. There were 46 females and 10 males with a median age of 45–54 years.

Methods

For each group a series of four communication skills workshops were given. Measurements of perceived aggression and wellbeing were taken before the workshops, at the end of the workshops, one month after and two months after.

Results

Results show statistically significant reductions in perceived aggression one and two months after baseline measures (p < 0.01). Results also suggest reductions in distress and increases in general mental wellness (p < 0.01). Evaluation of the programme by participants was positive.

Conclusions

A brief communication skills training programme is both enjoyable and shows decreases in perceived aggression, distress, and increases in general mental wellness. A full RCT of this intervention is warranted.     

Blood product positive patient identification: comparative simulation-based usability test of two commercial products

BACKGROUND: The blood product administration process has been subject to various quality improvement initiatives aimed at reducing errors, including blood product labels that are missing, inaccessible, unreadable, or mismatched to orders and/or patients. This article reports the results of a formal simulation‐based usability test of two comparable technologies designed to reduce blood product administration errors. STUDY DESIGN AND METHODS: Nineteen nurses and three anesthesia providers evaluated one of the two products during simulated use in realistic scenarios during 90‐minute test sessions. Both products required additional learning despite 15 minutes of dedicated vendor‐provided pretest training. RESULTS: There were significant effectiveness differences between the two products, but use of both devices was less efficient than manual checking. Usability issues included poor access to subtasks, lack of process feedback, inadequate error messaging, and confusing device interactions. CONCLUSION: While clinicians' subjective ratings of both devices were similarly high, both products had significant usability issues likely to lead to clinician frustration and workarounds during actual use. This study suggests that usability testing is a valuable and more effective method than preference surveys of determining the ability of blood administration products to meet clinicians' needs in the complex world of patient care.     

The role of information technology in healthcare communications, efficiency, and patient safety: application and results

The authors document the development and deployment of technology that serves to enhance healthcare communications, efficiency, and patient safety at an 881-bed, level 2 trauma center. This technology includes a patient-centric call process using real-time, rules-based task assignments and tracking software that guides personalized and timely response to the individual patient' needs and allows the mining of data for outcome analysis.     

Forced oscillation technique in the sleep apnoea/hypopnoea syndrome: identification of respiratory events and nasal continuous positive airway pressure titration

Sleep breathing disorders (SBD) are related to obstructions resulting from repetitive narrowing and closure of the pharyngeal airway. Their diagnoses and treatment are critically dependent on an accurate identification of and discrimination between types of respiratory events. However, these disorders have been diagnosed using indirect or invasive measurements, which resulted in serious doubts concerning the correct evaluation of breathing events. The forced oscillation technique (FOT) has recently been suggested as a clinical tool able to accurately and non-invasively quantify respiratory obstruction during sleep. The present study investigates the morphology of the impedance signal during different sleep respiratory events and evaluates the ability of impedance measurements in providing adequate nasal continuous positive airway pressure (nCPAP) titration. The results evidenced characteristic patterns in impedance signal morphology that are useful in the identification and classification of abnormal respiratory events. Moreover, significantly higher impedance values were obtained during apnoea and hypopnoea events when compared with normal values (p < 0.01). Studies using impedance measurements to adjust nCPAP showed a significant reduction (p < 0.01) of abnormal respiratory events, and a consequent normalization of the patients. These findings support the use of the FOT as a versatile clinic diagnostic tool helping SBD diagnosis and treatment.     

Development of a positive professional identity: liberating oneself from the oppressor within

Although oppressed group behavior has been discussed as important for empowering nurses, little has been written about the process of liberation from oppression. One of the major factors that keeps the oppressed from becoming empowered is poor self- and group esteem and identity. This article explores models of positive identity development from other oppressed groups and explores their relevance for nursing. A model is created, based on the other models, which proposes a process for nurses as they begin to understand their oppression and develop more positive images of themselves and other nurses.