No-nit policies in schools: time for change.

No-nit policies that exist in many schools throughout the United States were established years ago based on fear and misinformation, rather than scientific evidence. Children who are found to have live lice are no more infectious on the day of diagnosis than they had been prior to the discovery. Transmission of head lice requires close personal contact, which is not common in the school setting. To date, no scientific literature exists to support the exclusion of children from school due to head lice infestation. Therefore, there is a need to develop updated school policies using research-based evidence to determine the best method of treating infestations while allowing children to remain in school.     

Visitation policies and practices in US ICUs

Introduction

Prior reports suggest that restrictive ICU visitation policies can negatively impact patients and their loved ones. However, visitation practices in US ICUs, and the hospital factors associated with them, are not well described.

Methods

A telephone survey was made of ICUs, stratified by US region and hospital type (community, federal, or university), between 2008 and 2009. Hospital characteristics were self-reported and included the hospitals'' bed number, critical care unit number, and presence of ICU leadership. Hospital and ICU visitation restrictions were based on five criteria: visiting hours; visit duration; number of visitors; age of visitors; and membership in the patient''s immediate family. Hospitals or ICUs without restrictions had open visitation policies; those with any restriction had restrictive policies.

Results

The study surveyed 606 hospitals in the Northeast (17.0%), Midwest (26.2%), South (36.6%), and West (20.1%) regions; most were community hospitals (n = 401, 66.2%). The mean hospital size was 239 ± 217 beds; the mean percentage of ICU beds was 11.6% ± 13.4%. Hospitals often had restrictive hospital (n = 463, 76.4%) and ICU (n = 543, 89.6%) visitation policies. Many ICUs had ≥ 3 restrictions (n = 375; 61.9%), most commonly related to visiting hours and visitor number or age. Nearly all ICUs allowed visitation exceptions (n = 474; 94.8%). ICUs with open policies were more common in hospitals with < 150 beds. Among restrictive ICUs, the bed size, hospital type, number of critical care units, and ICU leadership were not associated with the number of restrictions. On average, hospitals in the Midwest had the least restrictive policies, while those in the Northeast had the most restrictive.

Conclusion

In 2008 the overwhelming majority of US ICUs in this study had restrictive visitation policies. Wide variability in visitation policies suggests that further study into the impact of ICU visitations on care and outcomes remains necessary to standardize practice.     

"云探视"在新冠肺炎疫情期间ICU探视管理中的应用

目的探讨基于微信平台的"云探视"模式在新冠肺炎疫情期间ICU探视管理中的应用效果。方法选取2020年2月1日—3月1日收治于上海市松江区中心医院ICU 82例患者及其家属作为研究对象。以2020年2月1日—15日收治的45例患者为对照组,采用传统的规定时间限制人员进入ICU探视模式;以2020年2月16日—3月1日收治的37例患者作为观察组,采用基于微信群的"云探视"模式。通过空气采样细菌培养,比较两组患者所处的ICU环境的空气质量;并于患者转出ICU的当天采用"患者家属满意度调查表"了解两组患者家属对探视的满意度情况。结果连续3 d对10间ICU病房空气培养的结果显示,两组ICU病房空气细菌培养结果均为合格,但观察组菌落数≤10 cfu/m3的房间,有30间,而对照组仅22间,且两组比较差异有统计学意义(P0.05)。同时,观察组家属满意度(93.4%)亦高于对照组(76.9%),差异有统计学意义(P0.05)。结论在新冠肺炎疫情期间,对ICU患者及家属实施"云探视"模式,有利于优化ICU病房探视流程,可有效降低ICU病房空气细菌培养总数,有助于控制医院感染及提高家属的满意度。     

清单在重症监护室患者家属探视中的应用

目的探讨在重症监护室(intensive care unit,ICU)患者家属探视中采用清单管理模式的效果。方法 2013年5-7月,采用便利抽样法选取嘉兴第一医院ICU收治的84例患者家属作为研究对象。采用随机数字表法将其分为对照组和观察组,每组42例。对照组家属施行传统的探视流程;观察组家属在探视过程中导入清单管理模式。比较两组患者家属对护理工作满意度和家属投诉率。结果观察组患者家属满意度得分为(86.8±15.8)分,高于对照组的(78.5±17.2)分,差异有统计学意义(t=2.303,P0.05)。观察组未发生家属投诉,对照组发生家属投诉3例,差异有统计学意义(χ2=56.59,P0.05)。结论在ICU患者家属探视中,采用清单管理模式可以提高家属满意度,能有效减少医疗纠纷。     

Continuing education for nurses: a time for change

An education model developed in response to various education needs identified by nurses is outlined. The modular format and its advantages are described and set in the context of changes in the educational environment.     

Partial liberalization of visiting policies and ICU staff: a before-and-after study

Purpose

To investigate possible psychological distress among staff after partial liberalization of visiting policies in intensive care units (ICUs).

Methods

We surveyed eight Italian ICUs planning to increase daily visiting to at least 8 h. Participants completed the Maslach–Jackson Burnout Inventory and the State-Trait Anxiety Inventory before policy change (T0), after 6 months (T1) and 12 months (T2). At T0 and T2, their opinions on the new policy were solicited. Analyses were adjusted for main known confounders (age, gender, centre, educational and marital status, experience in ICU, baseline level of burnout or anxiety, and mortality rate).

Results

Baseline response rate was 89 % (230/258); 198 subjects (77 %) responded at T0 and T2, whereas 184 (71 %) participated in all three phases. High burnout levels were identified in 34.5 % of participants at T0 and 42.6 % at T2 (adjusted p = 0.001). All three phases showed a predominance of high burnout among nurses (adjusted p = 0.002). State and trait anxiety scores remained stable (adjusted p = 0.100 and 0.288, respectively). Most participants viewed the change positively at T0 (doctors 81.7 %; nurses 67.7 %) and T2 (doctors 87.0 %; nurses 62.7 %). At T2, 129 participants made comments (180 positive, 136 negative). Subjects with high burnout were more likely to comment negatively (p = 0.011).

Conclusions

Partial liberalization of ICU visiting policies was associated over the course of a year with a small but significant increase in staff members’ burnout levels. Nonetheless, doctors and nurses viewed the policy positively, maintaining this opinion after 1 year. Negative views were strongly correlated with burnout.     

Nursing in a time of change: a case for critical thinking

Like all professionals, nurses live with the inevitability of change. The extent to which change is experienced as a crisis rather than as an opportunity is determined by the degree of control that nurses have over the change process. This paper outlines the determinants of change, examines the impact of change on nursing practice, explores professional ways of knowing and proposes critical thinking as a means by which nurses can interpret and manipulate change and illustrates a curriculum approach that facilitates the acquisition of the capacity to think critically.     

Supporting junior faculty in the academic system: time for a change?

Recently, MIT professor and Nobel laureate Susumu Tonegawa has come under attack for allegedly opposing the recruitment of a female, prospective junior faculty member to MIT because her work would compete with that of his laboratory. While the accusations are still under internal investigation, this incident raises the important issue of how we scientists as a group succeed or fail as mentors for junior faculty.