Nurses’ knowledge,experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey

ObjectiveTo explore Australian intensive care nurses’ knowledge of ventilator-associated pneumonia and self-reported adherence to evidence-based guidelines for the prevention of ventilator-associated events.DesignA quantitative cross-sectional online survey was used.SettingThe study was conducted in two Australia intensive care units, in large health services in Victoria and an Australia-wide nurses’ professional association (Australian College of Critical Care Nurses).Main outcome measuresParticipants’ knowledge and self-reported adherence to evidence-based guidelines.ResultsThe median knowledge score was 6/10 (IQR: 5–7). There was a significant positive association between completion of post graduate qualification and their overall knowledge score p = 0.014). However, there was no association (p = 0.674) between participants’ years of experience in intensive care nursing and their overall score. The median self-reported adherence was 8/10 (IQR: 6–8). The most adhered to procedures were performing oral care on mechanically ventilated patients (n = 259, 90.9%) and semi-fowlers positioning of the patient (n = 241, 84.6%). There was no relationship between participants’ knowledge and adherence to evidence-based guidelines (p = 0.144).ConclusionParticipants lack knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia. Specific education on ventilator-associated events may improve awareness and guideline adherence.     

Approach to Complications of Ventricular Assist Devices: A Clinical Review for the Emergency Provider

BackgroundHeart failure is a major public health problem in the United States. Increasingly, patients with advanced heart failure that fail medical therapy are being treated with implanted ventricular assist devices (VADs).ObjectiveThis review provides an evidence-based summary of the current data for the evaluation and management of implanted VAD complications in an emergency department context.DiscussionWith a prevalence of >5.8 million individuals and >550,000 new cases diagnosed each year, heart failure is a major public health problem in the United States. Increasingly, patients with advanced heart failure that fail medical therapy are being treated with implanted VADs. As the prevalence of patients with VADs continues to grow, they will sporadically present to the emergency department, regardless of whether the facility is a designated VAD center. As a result, all emergency physicians must be familiar with the basic principles of VAD function, as well as the diagnosis and initial management of VAD-related complications. In this review, we address these topics, with a focus on contemporary third-generation continuous flow VADs. This review will help supplement the critical care skills of emergency physicians in managing this complex patient population.ConclusionsThe cornerstone of managing the unstable VAD patient is rapid initiation of high-quality supportive care and recognition of device-related complications, as well as the identification and use of specialist VAD teams and other resources for support. Emergency physicians must understand VADs so that they may optimally manage these complex patients.     

Time for change in community nursing? A critique of the implementation of the Review of Nursing in the Community across NHS Scotland

Aim Current literature underpinning change is examined and a critique offered of the implementation of the role of the generic Community Health Nurse in Scotland, from a leadership and cultural perspective. Background In November 2006, Government strategy outlined a new service model for community nursing to be implemented in four demonstration sites across Scotland. Almost two-thirds of community nurses were not supportive of the model. There was belief this generic role would not meet the health needs of patients and carers. Evaluation Evidence supporting the model is presented and the implementation process evaluated from leadership and cultural perspectives. The literature is examined to offer explanations as to why implementation was unsuccessful. Conclusions Transformational and transactional leadership at all levels of the organization are required to make change happen. Evidence supporting change provides an impetus for change. The culture of an organization should be recognized and harnessed during the change process. Effective facilitation will empower staff to make change happen. Implications for Nursing Management Engagement with staff is vital, at the beginning of the change process. The concept of ‘nearby’ leadership offers an enabling style of leadership at an individual and group level which will enable effective change.     

Are nurses prepared to curb the tobacco epidemic in China? A questionnaire survey of schools of nursing

BACKGROUND: Smoking prevalence among Chinese males is the highest in the world and its morbidity and mortality is growing. Previous studies suggested nurses are inadequately prepared to treat tobacco use and dependence. OBJECTIVES: To examine the inclusion and organization of tobacco control content in the undergraduate nursing curriculum of Hong Kong and Mainland China; and the smoking status of faculty and students. DESIGN: Cross-sectional survey. METHODS: Deans of 32 nursing schools in Hong Kong and China with an undergraduate programme (representing over 12000 students) completed a self-administered questionnaire. RESULTS: Most schools included the health hazards of tobacco (56.3-100%), but few covered tobacco cessation theory (31.3-62.5%), or behavioural (9.4-56.3%) and pharmacological (3.1-34.4%) interventions in the curriculum. Most curricula covered less than 1h of tobacco content per year of study. Nearly all schools (93.1%) reported smoking among faculty but only half reported access to smoking cessation programmes. CONCLUSIONS: This is the first known study to examine the extent of tobacco control education in the nursing curriculum in China. Results suggested deficiencies in the coverage and clinical practice in smoking and smoking cessation, and recommendations were made to strengthen the curriculum.     

Patientsmate©: the implementation and evaluation of an online prospective audit system

Introduction Inaccuracy in Hospital Inpatient Enquiry (HIPE)/Casemix‐based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web‐based outcome audit system. Methods A web‐based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1‐month period and involving two general surgical teams in April 2010. In addition, a Likert‐scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. Results During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6–7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. Conclusion The Patientsmate© system allows for increased accuracy in outcome‐based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services.     

Simulated electronic health documentation: A cross-sectional exploration of factors influencing nursing students’ intention to use

The aim of this study was to investigate factors influencing nursing students' intention to use a simulated web-application ‘Integrated Nursing Education System’ for practicing electronic health documentation. The cross-sectional study was conducted at a Malaysian University that provides undergraduate nursing degree program. A total of 133 undergraduate nursing students in their year 2 to year 4 of the program were recruited. They had accessed the simulated web-application as part of the teaching-learning activities during the academic year 2016/2017. Technology Acceptance Model was used to guide the study. Validated questionnaires were used to measure the students' perceived ease of use, perceived usefulness, attitudes and intention to use the application. Data collection was done at the end of the semester. Data analysis was done using SPSS (19.0) and AMOS (23.0). Perceived usefulness was the most influential factor of the students' intention to use the simulated web-application. Perceived ease of use influenced their perceived usefulness significantly. Nurse educators should explain the usefulness of the simulated web-application before assigning students to access it to practice electronic health documentation. The availability of a stable internet access and IT support is important to influence students' perceived ease of use and intention to use the application.     

Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses

Background

Compassion satisfaction and compassion fatigue influence nurses’ intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce.

A focused overview of anorexia nervosa and bulimia: Part II—Challenges to the practice of psychiatric nursing

Understanding the etiological issues of the eating disorders of anorexia nervosa and bulimia provides psychiatric nurses with an essential knowledge base on which to build treatment decisions and plans for therapeutic interventions. In Part II, diagnostic and treatment issues for clients with anorexia nervosa or bulimia is discussed. The unique role of the psychiatric nurse in this process will be explored. For the purposes of this article, the discussion of eating disorders will focus on the classification as specified in DSM-III-R (American Psychiatric Association, 1987) specifically limited to the categories of anorexia nervosa and bulimia nervosa.