Racial grouping and women''s experience of giving birth in hospital

An interview study of women's experience of giving birth in hospital was undertaken to compare the views of Caucasian, Afro-Caribbean and Asian women. A total of 89 women from Nottingham took part. The vast majority of all women were satisfied with the medical and midwifery care and attention they had received during labour, birth and post-partum. There were few areas in which the experience reported by women differed according to racial grouping. Asian women were however more likely than others to have difficulties with communication and to need the services of an interpreter. Afro-Caribbean women were less happy than others to be subjected to technical measurements, such as fetal monitoring, during labour and would have liked more relief from pain during delivery. The service was found where possible to accommodate differing cultural traditions associated with birthing. It would appear that the hospitals in this study were successful in meeting the majority of the needs of black and white women during childbirth.     

Induction of Abnormal Ventilatory Responses to CO2 and Evaluation of Agents Given to Prevent or Reverse These Responses

Induction of Abnormal Ventilatory Responses to CO2 and Evaluationof Agents Given to Prevent or Reverse These Responses. SCHAPER,M., AND ALARIE, Y. (1988). Fundam. Appl Toxicol 10, 506–516.This study demonstrates how a previously described animal modelcan be utilized to evaluate the effects of multiple aerosols.For the exposures presented in this report, unanesthetized butmildly restrained guinea pigs were used. Airflow (V), tidalvolume (V_T), and respiratory frequency (f) were continuouslymeasured in all animals and their flow-volume (V–V_T) loopswere also obtained. The animals were first exposed to room airand then challenged with a 10% CO2 (in 19% O₂, 71% N₂) mixture.The normal ventilatory response to 10% CO₂ consists of increasesin V, VT, and f. This response is very stable for long periodsof time and is highly reproducible. It is possible, however,to alter the normal CO₂ response by adding an aerosol to theCO₂ mixture. Two types of acute responses can be induced, TypeI and Type II. In this study, histamine and carbamylcholineaerosols were used to induce the Type I response while propranololaerosols were used to induce the Type II response. Serotoninaerosols were used to induce both types of effects. We reportthat the bronchodilator, isoproterenol, reversed the Type Ipulmonary effects where the level of reversal was deoendentupon isoproterenol concentration. The rapid, shallow breathing,characteristic of the Type II response, was not reversed byisoproterenol but could be prevented by blocking the vagus nervewith cocaine. Since no invasive techniques are required andthe same animals can be used repeatedly, combinations of aerosolscan be tested in order to delineate how Type I or Type II abnormalventilatory responses to CO₂ are induced by a wide variety ofairborne chemicals.     

Effects of Discontinuing Cover Gowns on a Postpartal Ward upon Cord Colonization of the Newborn

To determine if the incidence of bacterial cord colonization in neonates increased when cover gowns were discontinued on a postpartal ward, a study was conducted. All infants who were admitted to and discharged from the well infant nursery at an Army medical center in Denver, Colorado, were cultured at the umbilicus at the time of admission and at discharge. The control group (N = 74) continued to gown as usual; the experimental group (N = 50) did not wear gowns, Visitors in both groups received the same instructions regarding handwashing. For all organisms, the control group demonstrated 80% colonization of infants who were negative on admission, and the experimental group demonstrated a colonization rate of 62%. When the chi square is applied, these data are statistically significant for P = 0.02 and P = 0.05. The experimental group had less colonization than the control group.     

Preoperative Teaching on a Gynecology Unit

The patient undergoing gynecologic surgery may have many questions and concerns. The nurse, whose role includes teaching and counseling, can provide important information to help allay patient fears and answer questions. A preoperative class on a gynecology unit, presented by nurses, is described below. Recommendations are given for problems that may be encountered when implementing such a class.     

Continuous quality improvement for patients with back pain

Recent evidence has changed traditional approaches to low back pain, suggesting minimal bed rest, highly selective imaging, and early return to normal activities. However, there are wide geographical variations in care, and substantial gaps between practice and evidence. This project sought to merge scientific evidence about back pain and knowledge about behavior change to help organizations improve care for back pain. Participating insurance plans, HMOs, and group practices focused on problems they themselves identified. The year-long program included quarterly meetings, coaching for rapid cycles of change, a menu of potential interventions, and recommendations for monitoring outcomes. Participants interacted through meetings, e-mail, and conference calls. Of the 22 participating organizations, 6 (27%) made major progress. Typical changes were reduced imaging, bed rest, and work loss, and increased patient education and satisfaction. Specific examples were a 30% decrease in plain x-rays, a 100% increase in use of patient education materials, and an 81% drop in prescribed bed rest. Despite the complexity of care for back pain, rapid improvements appear feasible. Several organizations had major improvements, and most experienced at least modest improvements. Key elements of successful programs included focus on a small number of clinical goals, frequent measurement of outcomes among small samples of patients, vigilance in maintaining gains; involvement of office staffs as well as physicians, and changes in standard protocols for imaging, physical therapy, and referral. This work was supported by the Institute for Healthcare Improvement, Boston, Mass.     

The prevalence of peripheral intravenous cannulae and pattern of use: A point prevalence in a private hospital setting

Aims and objectives

To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards.

Background

Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital‐acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people.

Design

Observational, point prevalence study.

Methods

Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail.

Results

Approximately one‐quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one‐third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one‐third of these were receiving intravenous fluids.

Conclusions

There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids.

Relevance to clinical practice

Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.     

Goals and potential career advancement of licensed practical nurses in Japan

Aim To investigate the effects of personal and professional variables on career advancement intentions of working Licensed Practical Nurses (LPNs). Background In Japan, two levels of professional nursing licensures, the LPN and the registered nurse (RN), are likely to be integrated in the future. Therefore, it is important to know the career advancement intentions of LPNs. Method Questionnaires were sent to a sample of 356 LPNs. Analysis of variance (anova ) and discriminative analysis were used. Results We found that those who had a positive image of LPNs along with a positive image of RNs were identified as showing interest in career advancement. The results of anova showed that age had a negative effect; however, discriminative analysis suggested that age is not as significant compared with other variables. Conclusion Our results indicate that the ‘image of RNs’, and ‘role‐acceptance factors’ have an effect on career advancement intentions of LPNs. Implications for nursing management Our results suggest that Nursing Managers should create a supportive working environment where the LPN would feel encouraged to carry out the nursing role, thereby creating a positive image of nursing in general which would lead to career motivation and pursuing RN status.