Factors affecting the utilization of evidence- based practices for pregnant women with toxemia

The study aimed to determine the factors that affect nurse utilization of evidence based practices for nursing care of pregnant women with toxemia. Research questions of the study are there barriers that affecting the utilization of the evidence-based practices for pregnant women with toxemia? A descriptive study design was conducted at inpatient units and intensive care unit in [Ain Shams and Suez Canal] Maternity University Hospitals. Convenient sample was used to recruit 110 nurses' according to criteria of the study. Two tools were used for data collection. First tool: Arabic structured interviewing questionnaire sheet to assess: First part, demographic characteristics of study sample and second part, assess factors that affect nurse utilization of evidence based practices. Third part, knowledge assessment sheet to assess nurse's knowledge regarding EBP. Second tool observational check list: for assess nurse's practices regarding EBP. The duration of data collection started from October 2009 and completed by October 2010. Result of the present study revealed that, about slightly more than one third of nurses [36.4%] were has unsatisfactory knowledge about EBP ,Most of studied nurses [80%] didn't utilize EBP process, these results due some factors as lack of technological skills in find evidence [96.4%] and resistance to change are represented by [80%] between studied nurses. In addition, the present study revealed that, Positive significant correlation was found between both nurses' [Knowledge's and Practices] of EBP in relation to their qualification [highly qualified nurse], while there is negative significant correlation with their experience [< 10 years], from The present study concluded that, still there is a gap between EBP and toxemia care for pregnant women due to many barriers as lack of communication skills with technology, inability to read and analysis the EBP researches, not interested with changes or new scientific evidence, insufficient time to apply EBP in clinical area with patient. In the light of the study findings the researchers can recommend that enhance obligatory and motivation system for nursing staff to inform and apply EBP In their specialties bedside, improve awareness of nurses about the importance of application of EBP on health filed through training program for nurses, in different maternity services. In the light of the study findings the researcher can recommend that enhance obligatory and motivation system for nursing staff to inform and apply EBP. In their specialty bedside, improve awareness of nurses about the importance of application on health filed through training program for nurses, about nursing care of patient in different maternity services

Febre sem sinais localizatórios: avaliação de um protocolo de atendimento / Fever without source: evaluation of a guideline

OBJETIVO: Avaliar a aplicabilidade de um protocolo de atendimento padronizado para crianças de até 36 meses de idade com febre sem sinais localizatórios (FSSL). MÉTODOS: Estudo de coorte prospectivo em crianças com FSSL atendidas no Pronto-Socorro do Hospital Universitário da Universidade de São Paulo, São Paulo (SP), de junho de 2006 a maio de 2007. O protocolo estratifica o risco de infecção bacteriana grave (IBG) de acordo com a presença ou não de toxemia, idade e valor da temperatura. Conforme avaliação de risco, indicava-se triagem laboratorial: hemograma, hemocultura, sedimento urinário, urocultura e, se necessário, radiografia torácica, liquor e coprocultura. RESULTADOS: Foram estudadas 251 crianças das quais 215 foram acompanhadas até o diagnóstico final. Vinte crianças apresentavam toxemia, e 195 estavam em bom estado geral (30 com idade de até 3 meses, e 165, de 3 a 36 meses). Nas crianças de 3 a 36 meses não toxêmicas, 95 tinham temperatura axilar > 39 ºC. Em 107 crianças (49,8 por cento), houve melhora espontânea do quadro febril; em 88 (40,9 por cento), foi identificada doença benigna autolimitada; e em 20 (9,3 por cento), IBG. Dentre as IBG, identificamos 16 infecções urinárias, três pneumonias e uma bacteremia oculta. Das 215, 129 (60 por cento) não receberam qualquer antibioticoterapia, e 86 receberam antibiótico em algum momento (45, empiricamente). O antibiótico empírico foi mantido por, em média, 72 horas. CONCLUSÃO: O protocolo aplicado mostrou-se adequado para o seguimento destas crianças que fizeram coleta de exames simples e passíveis de serem realizados na maioria dos serviços. A infecção urinária foi a IBG mais frequente nas crianças com FSSL.

OBJECTIVE: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). METHODS: Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. RESULTS: We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8 percent) children, there was spontaneous resolution of fever; in 88 (40.9 percent), benign self-limited disease was identified; and in 20 (9.3 percent), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60 percent) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. CONCLUSION: The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.