Delivering Internet health resources to an underserved health care profession: school nurses.
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PURPOSE: This paper reports on a course developed for school nurses. The course focused on locating reliable and high-quality medical information resources on the Internet. SETTING/PARTICIPANTS/RESOURCES: The Health Sciences Library System (HSLS) of the University of Pittsburgh formed a partnership with the Pennsylvania Association of School Nurses and Practitioners (PASNAP). Through this partnership, a hands-on course was offered at the PASNAP annual conference. BRIEF DESCRIPTION: As one component of the Health Information for the Public Project, a subcontract of the National Library of Medicine, HSLS collaborated with PASNAP. This collaboration resulted in HSLS librarians' offering a course titled "Access to Electronic Health Information for School Nurses" at PASNAP's annual conference. This paper describes the school nurse population, their professional information needs, and the development of the course curriculum. RESULTS/OUTCOME: This course provided participants with the skills to effectively utilize the Internet to locate high-quality medical information. EVALUATION METHOD: A course evaluation and impact survey were used to assess the effectiveness of the instruction. (+info)
A randomised controlled trial to evaluate the clinical and cost-effectiveness of Hickman line insertions in adult cancer patients by nurses.
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OBJECTIVES: To examine the clinical and cost-effectiveness of image-guided Hickman line insertions versus blind Hickman line insertions undertaken by nurses in adult cancer patients. DESIGN: A cost-effectiveness analysis was carried out alongside a randomised controlled trial. SETTING: A large acute cancer centre in Manchester, UK. PARTICIPANTS: Cancer patients due to have a Hickman line insertion who were over 18 years of age and were clinically and physically compliant with specified protocols. INTERVENTIONS: In order to obtain central venous access for the patient, two interventions were investigated: (i) blind insertion of a Hickman line and (ii) image-guided insertion of a Hickman line. Both interventions involved blind venipuncture of the subclavian vein. In the blind arm, the Hickman line was routinely inserted without the use of image guidance at any point in the procedure. Transfer to the interventional X-ray suite and use of image guidance were options immediately available to the operator during the procedure if required. In the image-guided arm, the position of the guidewire was checked before the Hickman line was introduced and later the Hickman line was positioned with the use of X-ray fluoroscopy. MAIN OUTCOME MEASURES: The primary clinical outcome measure was catheter-tip misplacement and this was expected to be higher in the blind arm. When comparing the skill level of the trainer and the trainees, pneumothorax was the primary clinical outcome measure. Other outcomes measures included arterial puncture, haematoma, infection, failed insertion and assistance from other healthcare professionals. RESULTS: No statistically significant difference was found between the mean cost per patient in the two arms of the trial. The only statistically significant difference in clinical outcomes was the frequency of catheter-tip misplacement, which was higher in the blind arm of the trial. At very low costs, the image-guided approach dominates the blind approach as fewer costs and greater benefits are incurred. It is evident that nurses previously inexperienced in the procedure can be trained to insert Hickman lines successfully both at the bedside and under image guidance within a 3-month period. CONCLUSIONS: This report indicates that nurse insertion of Hickman lines in the majority of adult cancer patients is both safe and effective. However, there are a select group of patients for whom image-guided insertion may be preferred. The results reveal that skills and expertise can be transferred from trainer to trainee through a relatively short, but intensive, training course. It is also evident that patients support nurse insertion. Further research is suggested to compare the safety and efficacy of nurse versus doctor insertions in particular subgroups of patients and also to assess the quantity and quality of current service provision in order to inform NHS decision-making in this area. (+info)
Effects of a 105 hours psychological training program on attitudes, communication skills and occupational stress in oncology: a randomised study.
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There is today a wide consensus regarding the need to improve communication skills (CS) of health-care professionals (HCPs) dealing with cancer patients. Psychological training programs (PTPs) may be useful to acquire the needed CS. Testing the efficacy of PTP will allow to define their optimal content. The present study was designed to assess the impact of a PTP on HCP stress, attitudes and CS, and on HCP and patients' satisfaction with HCP communication skills in a randomised study. A total of 115 oncology nurses were randomly assigned to a 105-h PTP or to a waiting list. Stress was assessed with the Nursing Stress Scale, attitudes with a Semantic Differential Questionnaire, CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual, and satisfaction with the nurses' CS with a questionnaire completed by the patients and the nurses. Trained (TG) and control (CG) groups were compared at baseline, after 3 months (just following training for TG) and after 6 months (3 months after the end of training for TG). Compared to controls, trained nurses reported positive changes on their stress levels (P+info)
Effect of a medication management training package for nurses on clinical outcomes for patients with schizophrenia: cluster randomised controlled trial.
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BACKGROUND: Non-compliance attenuates the efficacy of treatments for physical and mental disorders. AIMS: To assess the effectiveness of a medication management training package for community mental health nurses (CMHNs) in improving compliance and clinical outcomes in patients with schizophrenia. METHOD: Pragmatic randomised controlled trial. Sixty CMHNs in geographical clusters were assigned randomly to medication management training or treatment as usual. Each CMHN identified two patients on their case-load who were assessed at baseline and again after 6 months by a research worker. The primary efficacy outcome of interest was psychopathology, measured using the Positive and Negative Syndrome Scale (PANSS). RESULTS: Nurses who had received medication management training produced a significantly greater reduction in patients'overall psychopathology compared with treatment as usual at the end of the 6-month study period (change in PANSS total scores: medication management -16.62, treatment as usual 1.17; difference -17.79; 95% CI -24.12 to -11.45; P<0.001). CONCLUSIONS: Medication management training for CMHNs is effective in improving clinical outcomes in patients with schizophrenia. (+info)
The COPe concept for the training of communication in highly emotional situations.
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Members of transplant teams are oft confronted with highly emotional situations. Inability to handle these situations leads to burn-out and impairs the performance of the team. We introduce and discuss first experiences with a training program--COPe--specifically concentrating on establishing and maintaining communication in such situations. (+info)
Reducing medication errors in the neonatal intensive care unit.
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BACKGROUND: Medication errors are common in the neonatal intensive care unit (NICU). Various strategies to reduce errors have been described in adult and paediatric patients but there are few published data on their effect in the NICU. AIM: To describe the medication errors occurring within an NICU, and assess the impact of a combined risk management/clinical pharmacist led education programme on these errors. METHODS: Medication errors were identified prospectively over one year by critical incident reporting. Four months into the study, a pharmacist led education programme was instituted. This involved a daily, cot side, pharmacist led review of medication orders. Each new member of pharmacy, nursing, or medical staff was also required to successfully complete a series of dose calculations. In addition, a risk management approach was used to make several changes in practice during the study period. RESULTS: A total of 105 errors were identified, four serious, 45 potentially serious, and 56 minor. The four serious errors included two tenfold dose miscalculations. Most (71%) of the errors were due to poor prescribing. After the introduction of our interventions, monthly medication errors fell from a mean (SD) of 24.1 (1.7) per 1000 neonatal activity days to 5.1 (3.6) per 1000 days (p < 0.001) in the following three months. The subsequent change over of junior medical staff was associated with a significant increase in medication errors to 12.2 (3.6) per 1000 neonatal activity days (p = 0.037). However, the number remained significantly less than before our interventions (p < 0.001). Three serious errors occurred in the first four months compared with one in the second eight month period, the latter corresponding to the six monthly change over of junior medical staff. CONCLUSIONS: Medication errors are common in NICUs. Fortunately, actual harm to an infant is rare. Interventions to reduce errors, particularly within the context of a risk management programme, are effective. (+info)
A three year multiphase pressure ulcer prevalence/incidence study in a regional referral hospital.
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Pressure ulcers can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. To evaluate the outcomes of prevention education and skin integrity interventions on the incidence of pressure ulcers, a multiphase project was initiated in an urban 154-bed regional referral community hospital in Ontario, Canada that provides care to an urban and rural population. The prevalence study included 84 adult subjects at baseline, 77 after one year (Phase 1), and 100 after 3 years (Phase 2). The Braden Scale for Predicting Pressure Sore Risk and a data collection form were used to record prevalence, incidence, stage and location of pressure ulcers, and related documented interventions. Incidence data were obtained from patient charts and defined as ulcers that developed over 24 hours following admission. Phase 1 interventions involved staff education and replacement of existing skin care products. Phase 2 interventions included adoption of pressure ulcer prevention protocols, advanced wound care products, improved support surface usage, modification of documentation methods, and staff education. Of the 84 patients assessed at baseline , 15 (17.9 %) developed 22 pressure ulcers compared to 4 of 77 (5.2%) during Phase 1 and 2 out of 100 (2.0%) during Phase 2. The difference between baseline and both subsequent time points was statistically significant (P greater than 0.05). These results suggest that education and the implementation of appropriate skin care products and procedures and pressure ulcer prevention protocols may reduce the incidence of hospital-acquired pressure ulcers. (+info)
Functional foods: delivering information to the oncology nurse.
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Recent research suggests a beneficial role of nutrition as possible supportive therapy for cancer patients. A national survey of oncology nurses has shown that nutrition-related issues are an important subject discussed during nurse-patient meetings. The authors applied the activation theory of information exposure to oncology nurses in regard to nutrition information. Findings suggest that oncology nurses who consider nutrition important at a personal level tend to discuss nutrition more with patients and to seek more information about nutrition and cancer. Personal rather than professional motives appear to be triggers for the information search. Implications for health care communication professionals are discussed. (+info)