Managerial strategy and nursing commitment in Australian hospitals

This study examined the relationship of managerial strategy and nursing commitment in Australian hospitals The general principles of managerial strategy and employee response were illustrated and the meaning of commitment and resistance were defined Data were collected by questionnaire survey and interviews The result demonstrated that the middle manager/nurse unit manager played an important role in generating nursing commitment in the workplace Trust and identification were the most relevant components of nursing commitment However, the study also found that there was still a high degree of distrust between senior management and nurses Change strategies which nurse managers could apply to promote greater organizational commitment in nursing are discussed     

Moderate Alcohol Intake and Risk of Functional Decline: The Health, Aging, and Body Composition Study

OBJECTIVES: To investigate the prospective relationship between alcohol consumption and incident mobility limitation. DESIGN: Cohort study. SETTING: The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Three thousand sixty‐one adults aged 70 to 79 without mobility disability at baseline. MEASUREMENTS: Incidence of mobility limitation, defined as self‐report at two consecutive semiannual interviews of any difficulty walking one‐quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle‐related variables, diseases, and health status indicators were assessed at baseline. RESULTS: During a follow‐up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person‐years (person‐years); men: 6.4 per 100 person‐years; women: 7.3 per 100 person‐years) and mobility disability (total: 2.7 per 100 person‐years; men: 2.5 per 100 person‐years; women: 2.9 per 100 person‐years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55–0.89) and mobility disability (HR=0.66, 95% CI=0.45–0.95) than never or occasional consumption. Additional adjustment for lifestyle‐related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66–1.08 and HR=0.81, 95% CI=0.56–1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship. CONCLUSION: Lifestyle‐related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.     

Medication errors involving oral chemotherapy

BACKGROUND:

Given the expanding use of oral chemotherapies, the authors set out to examine errors in the prescribing, dispensing, administration, and monitoring of these drugs.

METHODS:

Reports were collected of oral chemotherapy‐associated medication errors from a medical literature and Internet search and review of reports to the Medication Errors Reporting Program and MEDMARX. The authors solicited incident reports from 14 comprehensive cancer centers, and also collected incident reports, pharmacy interventions, and prompted clinician reports from their own center. They classified the type of incident, severity, stage in the medication use process, and type of medication error. They examined the yield of the various reporting methods to identify oral chemotherapy‐related medication errors.

RESULTS:

The authors identified 99 adverse drug events, 322 near misses, and 87 medical errors with low risk of harm. Of the 99 adverse drug events, 20 were serious or life‐threatening, 52 were significant, and 25 were minor. The most common medication errors involved wrong dose (38.8%), wrong drug (13.6%), wrong number of days supplied (11.0%), and missed dose (10.0%). The majority of errors resulted in a near miss; however, 39.3% of reports involving the wrong number of days supplied resulted in adverse drug events. Incidents derived from the literature search and hospital incident reporting system included a larger percentage of adverse drug events (73.1% and 58.8%, respectively) compared with other sources.

CONCLUSIONS:

Ensuring oral chemotherapy safety requires improvements in the way these drugs are ordered, dispensed, administered, and monitored. Cancer 2010. © 2010 American Cancer Society.     

Stressors, coping mechanisms and quality of life among dialysis patients in Australia

The aim of this study was to determine the significant stressors and coping methods which are related to quality of life in dialysis patients A survey was conducted on patients in two dialysis centres in Sydney The response rate was 58% ( n = 64) The results revealed that limitation of physical activity was the most troublesome stressor followed by decrease in social life, uncertainty about the future, fatigue and muscle cramps Although their ranking was not identical to that found in prior studies, these five stressors were considered to be compatible with the high stressors identified in previous studies Problem-solving methods were considered to be more effective than affective measures in dealing with stressors Quality of life was perceived as below average in both haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients However, CAPD patients were experiencing a higher quality of life than haemodialysis patients The length of time on the dialysis programme was not significantly related to coping behaviour The findings of this study can further facilitate nurse practitioners in providing support, information, alternative solutions and in assisting patients to better utilize problem-solving methods to enhance their quality of life on dialysis