The Effects of Guided Imagery on Patients Being Weaned from Mechanical Ventilation.

The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials.

Hearing the voices of newly licensed RNs: the transition to practice: a qualitative study suggests that new nurses need more guidance and support than they're getting.

OBJECTIVE: The future of nursing depends on newly licensed RNs (NLRNs), who often need help in transitioning from an academic to a clinical setting. This study sought to describe the NLRN's orientation experience and to identify ways of enhancing it. METHODS: Using qualitative methods, a convenience sample of NLRNs was recruited and 21 were interviewed; audio recordings of the interviews were transcribed and validated for accuracy. Interpretative analysis of the transcripts sought to identify major patterns and themes. RESULTS: Four patterns and 10 themes emerged from the data analysis: preceptor variability (with themes of satisfactory and unsatisfactory preceptorship), professional growth and confidence changing with time (with themes of learning through experience, learning to manage time, and learning to communicate), a sense of being nurtured (with themes of support through the program, the preceptor, and peers), and enhancing the transition (with themes of orientation enhancements and human resource enhancements). CONCLUSIONS: These qualitative findings provide insight into the NLRN's transition from student to professional and suggest ways institutions might enhance orientation. Further study is warranted.

War on the spore: Clostridium difficile disease among patients in a long-term acute care hospital.

The transmission of Clostridium difficile infection (CDI) is evident in healthcare facilities across the country and poses a risk for patients and communities. A comprehensive infection control program along with an active surveillance process was developed and implemented in a 50-bed long-term acute care hospital (LTACH) in the southeastern United States. Patients are admitted from surrounding hospitals, have an expected stay of at least 25 days, and are acutely ill. The majority of the patient population is ventilator dependent, immunocompromised, and treated with antimicrobials. The program, implemented in December 2009, utilized a tiered approach that included environmental cleaning and disinfection, diagnostics and surveillance, and infection control measures including antibiotic stewardship. The goal of this study was to decrease the incidence rate of CDI 15% by June 2010. Based upon year-end results, the facility achieved a 27.61% decrease in the CDI rate. During the following 12 months, the program continued to demonstrate sustainability resulting in a 23.0% decrease in the CDI rate. This program was successful in decreasing the incidence of CDI in the LTACH creating a safe and cost-effective environment for patients, families, and the community.