Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital

A methicillin-resistant Staphylococcus aureus (MRSA) control policy, aimed at eradication, was established at a 1000-bed hospital in 1985, applied consistently for 10.5 years, and then relaxed. Its components included screening of high-risk patients, transfer of carriers to exhaust-ventilated isolation rooms, closure of wards to new admissions when local transmission was detected, MRSA screening during outbreaks, and prospective collection of clinical and epidemiological information. During the eradication policy period, every 6 months, a mean of 5.1 patients (range 1-12) already carrying MRSA were admitted, and a mean of 3.6 (range 0-16) acquired carriage in the hospital. The largest outbreak comprised 11 patients despite epidemic MRSA strain EMRSA-16 being introduced six times, and MRSA did not become endemic. MRSA- positive admissions increased progressively from 1993; nursing staff workload increased, areas available for alternative patient accommodation were reduced, the resulting ward closures interfered with clinical services, and hence the control policy was relaxed in mid- 1995. Isolation facilities were overwhelmed with 622 new patient- isolates in the next 18 months, and there were 67 clinical infections in 1996. The proportion of blood cultures positive for MRSA rose nearly sevenfold by 1996 and 27-fold by 1997. Thus, repeated eradication of MRSA, even epidemic strains, by use of a stringent policy, is possible given sufficient resources, whereas flexible national guidelines designed to control, but not eradicate, epidemic staphylococci, are currently unlikely to be successful. The costs of eradication policies need to be weighed against those of endemicity.      

Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature

BACKGROUND: The United Kingdom (UK), alongside other industrialised countries, is experiencing a shortage of nurses partly due to low retention rates. Job satisfaction has been highlighted as a contributing factor to intent to leave and turnover, yet this is a complex area with many elements affecting its measurement. AIM: The aim of this paper is to explore the impact of job satisfaction components on intent to leave and turnover for hospital-based nurses in order to identify the most influential factors. METHODS: To achieve this, a systematic search of the literature was undertaken to identify relevant international research. Three databases (i.e. BNI, CINAHL and PsychInfo) were utilised, resulting in nine articles that met the inclusion criteria. Four recurrent themes were identified in the literature: leadership, educational attainment, pay and stress. FINDINGS: The key findings suggest that stress and leadership issues continue to exert influence on dissatisfaction and turnover for nurses. Level of education achieved and pay were found to be associated with job satisfaction, although the results for these factors were not consistent. CONCLUSION: Investigating possible changes over time in sources of dissatisfaction revealed that factors related to the work environment rather than individual or demographic factors were still of most importance to nurses' turnover intentions. The differences found to occur across work settings necessitates analysis of job satisfaction at ward level, and the contribution of qualitative methods to develop more detailed insight is emphasised. The inconsistent findings over time associated with the effects of educational attainment and pay on intent to leave suggest that it is imperative that sources of job satisfaction are reassessed in the light of ongoing changes.     

The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: comparison between summer and winter

Aims and objectives. This research aimed to evaluate the use of aromatherapy massage and music as an intervention to cope with the occupational stress and anxiety that emergency department staff experience. The study also aimed to compare any differences in results between a summer and winter 12‐week massage plan. Background. Emergency nurses are subjected to significant stressors during their work and it is known that workloads and patient demands influence the role stress has on nurses. The perception that winter months are busier for emergency departments has long been held and there is some evidence that people with cardiac and respiratory dysfunction do present more frequently in the winter months. Massage has been found to decrease staff anxiety. Design. The study used a one‐group pre‐test, post‐test quasi‐experimental design with random assignment. Method. Staff occupational stress was assessed pre‐ and post‐ 12 weeks of aromatherapy massage with music and anxiety was measured pre and post each massage session. Sick leave was also measured. Comparisons of summer and winter data were undertaken. Results. A total of 365 massages were given over two 12‐week periods, one during summer and the other during winter. Analysis identified that aromatherapy massage with music significantly reduced anxiety for both seasonal periods. Premassage anxiety was significantly higher in winter than summer. No differences in sick leave and workload were found. There was no difference in the occupational stress levels of nurses following the two 12‐week periods of massage. Conclusion. Emergency nurses were significantly more anxious in winter than summer but this cannot be attributed to increased sick leave or workloads. Aromatherapy massage with music significantly reduced emergency nurses’ anxiety. Relevance to clinical practice. High levels of anxiety and stress can be detrimental to the physical and emotional health of emergency nurses and the provision of a support mechanism such as on‐site massage as an effective strategy should be considered.     

Reliability of maximal voluntary muscle strength and power testing in older men

BACKGROUND: Maximal voluntary muscle strength (MVMS) and leg power are important measures of physical function in older adults. We hypothesized that performing these measures twice within 7-10 days would demonstrate a >5% increase due to learning and familiarization of the testing procedures. METHODS: Data were collected from three studies in older adult men (60-87 years) and were divided into two cohorts defined by study site and type of exercise equipment. MVMS was assessed in 116 participants using the one-repetition maximum method at two separate study visits for the chest press, latissimus pull-down, leg press, leg flexion, and leg extension exercises along with unilateral leg extension power. RESULTS: Test-retest scores were not different and did not exceed 0.8 +/- 9.0% in Cohort 1 or 2.3 +/- 9.8% in Cohort 2, except for leg extension, which improved by 6.6 +/- 14.4% (p <.009) and 3.4 +/- 6.8% (p <.016), respectively. Repeat tests were closely correlated with initial tests (all p <.001). Pearson correlation coefficients ranged from 0.74 for leg extension power to 0.96 for leg press. Coefficients of variation were <10% (4.2%-9.0%) for all exercises except for leg extension power, which was 15.5%. CONCLUSIONS: Our findings demonstrated that test-retest measures of MVMS and power in older adult men do not differ by more than 2.3% except for leg extension, and have relatively low coefficients of variation using data collected from three studies. Moreover, these findings were similar between two study sites using different equipment, which further supports the reliability of MVMS and power testing in older adult men.     

Change in attachment anxiety is associated with improved depression among women with binge eating disorder

The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved).