Promote Radiation Safety for Nurses: A Policy Perspective

Radiologic and imaging nurses (RINs) continue to be exposed to radiation at the workplace. However, many studies identified that most health care systems do not have policies on radiation safety training for RINs; the less educated they are on radiation safety, the more fear they have with radiation and the less comfortable they are with assisting patients while receiving medical imaging procedures. This policy perspective will identify gaps in radiation protection training, and development of education training, and suggest strategies for compliance with annual radiation training. We recommend that radiology or nursing departments should develop and enforce a policy mandating annual radiation safety training for RINs and that The Joint Commission should evaluate the institutional adherence to that policy.     

Clinical risk management and patient safety education for nurses: a critique

Nurses have a pivotal role to play in clinical risk management (CRM) and promoting patient safety in health care domains. Accordingly, nurses need to be prepared educationally to manage clinical risk effectively when delivering patient care. Just what form the CRM and safety education of nurses should take, however, remains an open question. A recent search of the literature has revealed a surprising lack of evidence substantiating models of effective CRM and safety education for nurses. In this paper, a critical discussion is advanced on the question of CRM and safety education for nurses and the need for nurse education in this area to be reviewed and systematically researched as a strategic priority, nationally and internationally. It is a key contention of this paper that without 'good' safety education research it will not be possible to ensure that the educational programs that are being offered to nurses in this area are evidence-based and designed in a manner that will enable nurses to develop the capabilities they need to respond effectively to the multifaceted and complex demands that are inherent in their ethical and professional responsibilities to promote and protect patient safety and quality care in health care domains.     

A remembrance of the past, an investment for the future.

Occupational health nursing has evolved from a single dimension practice into a complex role providing primary care, health maintenance, and disease prevention programs at the worksite. The focus of the 1990s will be on managed care, health care reform, and competition for resources. Occupational health nurses are in a strategic position to foster the objectives set forth in Healthy People 2000. Occupational health nurses must take the lead in the development and implementation of cost effective health care programs at the worksite. Occupational health nurses must communicate and demonstrate the nature and value of their contributions; demonstrate their competencies; and become knowledgeable in all areas of occupational health and safety. They must acknowledge that they are leaders in workplace health and safety.     

ALARA study of teaching effectiveness on reducing radiation exposure.

The purpose of this study was to measure the effectiveness of radiation safety instruction and the impact on radiation film badge levels. A convenience sample of 144 endoscopy nurses and technicians was pretested for radiation safety knowledge, given a course in radiation safety, and then posttested immediately after the course and then 6 months later. Radiation badges were analyzed for radiation exposure at preinstruction, 1 month postinstruction, and 6 months postinstruction. Results showed that the instruction was effective. There was only a slight decrease in radiation badge readings; the decrease, however, was not statistically significant.     

Caring for those who care: a tribute to nurses and their safety

From the clinics of South Africa, where there are "No Gun" signs on the walls; to the rural island hospital in Micronesia, where there is no running water; to the urban hospitals of Los Angeles serving non-English speaking clients from around the globe; to the nurse-run clinics in the harsh Alaska frontier, nurses are focused on doing their best to give quality nursing care. This focus on providing quality care is commendable. However, nurses must also focus on taking care of themselves so they are able both to continue providing quality care for their patients and to maintain the profession's ability to recruit and retain new nurses. In nursing textbooks from the late 1980s and early 1990s, risks to health care workers were listed only as sub headings in sections such as infectious agents and musculoskeletal injuries, or in general chapters on "women's work." It is a remarkable sign of progress that there is now a discrete focus on the health and safety of health care workers. This article provides a general introduction to the topic of nurse safety. First the major areas of health and safety concerns and the Hierarchy of Controls framework for risk reduction will be outlined. Next, findings from American Nurses Association (ANA) surveys which helped to crystallize the issue of safety and challenged the profession to focus on nurse safety will be presented. Following this, the linkages between patient safety and nurse safety will be discussed. Finally national reports, environmental initiatives, and policy successes and opportunities related to nurse safety will be noted.     

数字减影血管造影手术室护理人员辐射恐惧心理现况分析

目的了解数字减影血管造影(DSA)手术室护理人员辐射恐惧心理现状及对辐射防护知识的认知度。方法选取115名DSA手术室护理人员进行问卷调查,调查内容包括辐射恐惧心理状况和辐射防护知识。比较不同特征人员辐射恐惧感差异。结果回收有效问卷115份。愿意从事DSA辐射环境工作的人数占80.87%(93/115),护理人员在从事DSA工作前对辐射防护知识了解占80.87%(93/115),具有个人辐射防护习惯的护士占91.30%(105/115),对职业辐射照射有恐惧感的护士占59.13%(68/115),担心DSA辐射环境对胎儿和本人健康影响的人数分别占90.43%(104/115)和86.96%(100/115),知道3种辐射防护方法、电离辐射的生物效应、个人年剂量限值和人体对辐射高度敏感组织4项放射卫生知识的人数分别占86.09%(99/115)、67.83%(78/115)、67.83%(78/115)和81.74%(94/115)。担心DSA手术室职业辐射对本人健康影响的护理人员辐射恐惧发生率更高,差异有统计学意义(x2=19.647,P<0.05)。结论DSA手术室护理人员职业辐射恐惧心理较普遍,对辐射防护知识认识和掌握并不全面应,应建立一个完善、持续的DSA手术室护士辐射安全教案。     

Public health emergencies: nurses' recommendations for effective actions.

During a public health emergency such as an influenza pandemic or a bioterrorism attack, nurses may be at risk for exposure to lethal infectious diseases when caring for victims. The aim of this study was to identify interventions nurses believe will support their ability to cope during public health emergencies. A qualitative research design was used with 33 nurses from designated bioterrorism-receiving hospitals. Nurses recommended adequate protective equipment, education, drills, accessible information and available content experts, and available administrators. Other recommendations included increased security to protect nurses, emotional and physical support, communication with nurses' families, and commitment from institutions to care for ill or injured nurses. Preparations for emergencies should include assessments of nurses' and other stakeholders' concerns. These nurses proposed specific measures to improve safety, reduce anxiety, increase trust in hospitals, and provide physical and emotional support.     

The professional doctorate: rationale and characteristics.

The position that it is time for the nursing profession to develop programs leading to the N.D. degree, or professional doctorate, (for the college graduates) derives from consideration of the nature of nursing, the contributions that nurses can make to development of an exemplary health care system, and from the recognized need for nursing to emerge as a full-fledged profession. It derives from pride in the accomplishments made by nurses of the past; from discontent with the meager influence that nurses now have; and from anticipation of a future that will be created when a critical mass of nurses are provided opportunities for completing pre-service doctoral study. It derives from confidence that those nurses can and will so influence the health care system that all persons will be properly served with care that promotes their health, restores their function,, and enhances their independence in knowledgeably exploiting their own health-seeking behaviors.     

Potential role of physical therapists in hyperthermia in cancer therapy. The need for further training

Clinical trials using hyperthermia in the treatment of local and regional malignant tumors have demonstrated significant potential for hyperthermia to become one of the important adjunctive modalities in cancer management. As this treatment method is used more widely, more allied health practitioners with basic knowledge and training in hyperthermia will be needed to administer hyperthermia treatments. Currently, a variety of allied health professionals such as nurses, radiation therapy technologists, and physical therapists are recruited to operate hyperthermia equipment. No formal programs exist, however, for training these practitioners to administer hyperthermia treatments properly. Just as federal regulations on investigational medical devices ensure the effectiveness and safety of their application, guidelines for the training and education of hyperthermia equipment operators will benefit the welfare of cancer patients who receive these treatments. The Food and Drug Administration awarded a contract to the University of Washington to initiate a preliminary study to develop guidelines and recommendations for training hyperthermia equipment operators. This article presents the results of the study and our preliminary impressions.     

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.     

Child day care arrangements and employee health.

With the changing demographics of the work force and predictions that two thirds of new job entrants will be female, it is vital that occupational health nurses develop programs to meet these changes to ensure the health and safety of the work force. Workers and their families can no longer be viewed as separate from the workplace. There is an interactive relationship between workers, their families, and their work. Child day care arrangements can positively or negatively affect all three domains. Available, affordable, accessible, and dependable child day care are only part of the answer for the child care crisis facing today's workers. The perception of the quality of the day care center seems to be a major factor affecting mothers in the work force. Occupational health nurses are in a pivotal position to assist workers in meeting the unique demands and challenges of the dual career family--including child day care--thus promoting a more productive, healthier, and safer work force.     

Promoting culturally competent care for gay youth.

Gay youth and those questioning their sexual identity have been referred to as "hidden," "invisible," "stigmatized," and "marginalized." As a result, the unique safety and health needs of this subculture have been overlooked, or worse, ignored, placing these youth at risk. Because school nurses have been identifying at-risk populations of students and developing programs to promote youth and family health for years, they should be prepared to provide health care for the subculture of gay youth. However, nurses are saying they do not have the knowledge or skills needed to identify and address the needs of this group. Providing school nursing care for gay youth requires the school nurse to be culturally competent. School nurses need to be aware of, sensitive to, and knowledgeable about the subculture. They must also possess communication skills required to relate appropriately to this group. This article presents information and nursing strategies that will promote the safety and health of gay youth while enhancing the school nurse's cultural competence.     

Management of radiation skin reactions: literature review and clinical application.

As many as 95% of patients treated with radiation therapy for cancer will experience a skin reaction. Some reactions are immediate, while others may be later (e.g., months after treatment). Therefore, nurses must be familiar with management of this side effect. This paper reviews current knowledge related to skin reactions from ionizing radiation and recommends guidelines for nursing practice.     

Radiation therapy treatment planning and delivery

OBJECTIVES: To provide an overview of radiation therapy treatment planning and delivery, and discuss technologic advances and their importance in present and future oncologic care. DATA SOURCES: Radiation oncology textbooks and radiation physics and treatment planning textbooks. CONCLUSIONS: The increased sophistication and complex abilities of modern radiation therapy planning and delivery are steadily improving cancer treatment outcomes and quality of life. Radiation is now an essential and integral part of cancer care and may be used alone or as part of combined modality therapy. Further technologic advances will allow improvement in the ability of radiation therapy to cure cancer and improve quality of life for an ever-increasing variety of patients. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses with an understanding of the components of radiation treatment plans and their delivery will be able to provide appropriate education for patients offered radiation and prepare them for the lengthy and complex process of radiation therapy.     

Quality assurance in school health.

School nurses need to become more influential administrators, managers, and entrepreneurs. They must learn to lead and collaborate effectively in designing, implementing, and evaluating coordinated school health programs. Quality assurance is an essential ingredient in this process that requires accurate, timely, and confidential incident reporting and data analysis structures. These structures, in turn, can serve as the foundation of evidence-based practice and overall system improvement. School nurses can and should assume a key role in the process and thereby continue to meet the challenges of the more sophisticated school health services that today's student population requires. In this way, school nurses will continue to protect and advance the health and safety of the students who are entrusted to their care.     

Cultural safety: a new concept in nursing people of different ethnicities

Cultural safety is a concept which has been developed by Maori nurses in New Zealand in order to reflect on nursing practice from their point of view as the indigenous minority in our country. The paper contrasts this new concept critically with Leininger's well-known model of transcultural nursing in order to suggest its potential significance. To date work on cultural safety in New Zealand has focused on the attitudes which individual nurses bring to their practice, attempting to change the effects of their social conditioning on their approach to nursing. The paper supports the view that all nursing care is provided in a social context which influences its efficacy, and specifies that the structural elements, such as the institutional context within which nursing care is provided and policies which influence how care is the provided, need to be explicitly recognized. The paper concludes that until the effects on the health care system of inequalities in power between groups in society are addressed we cannot ensure that the needs of persons from minority cultures will be met. Because it illuminates this dimension of nursing care, cultural safety is a concept of general significance for all nurses.     

Occupational response to terrorism.

Occupational health nurses are facing new challenges that seriously imperil health and safety in the workplace. The risks faced in the current world pose threats for which the occupational health nurse may not be prepared. These threats go beyond any unexpected workplace emergency. It is critical for all occupational health professionals to understand the implications of these modern threats and the proper response procedures, including the limits of a safe and prudent response. This knowledge will prevent further fatalities. Occupational health nurses need to translate this knowledge into corporate policies and procedures written so safety is the paramount consideration.     

Health care providers' attitudes toward current food safety recommendations for pregnant women.

Semistructured interviews were conducted with 23 health care professionals who work with pregnant women in a preliminary study to understand health care providers' attitudes regarding current food safety recommendations for pregnant women and interest in education and patient materials on food safety during pregnancy. Only 8 of 23 interviewed currently provided food safety information to their pregnant clients. Limited understanding of food safety issues and limited time with patients were barriers to providing such information. Based on their contact time with patients, background, and interest in food safety issues, nurses, visiting nurses, and Special Supplemental Nutrition Program for Women, Infants and Children professionals should be targeted as conveyers of food safety information to pregnant women.