The approach to developing Ireland's first national health protection strategy and lessons learnt, December 2021 to October 2022.

The COVID-19 pandemic highlighted the importance of strengthening health protection worldwide. To address this as a public health priority in Ireland, between December 2021 and October 2022 the first national Health Protection Strategy (2022-2027) for the Irish Health Service Executive (HSE) was developed. We describe the approach taken to develop a first national health protection strategy for Ireland, and highlight the key lessons learned. Key steps in strategy formation included detailed stakeholder analysis, exploration of the context for the strategy and development of a comprehensive consultation plan. Two stakeholder consultation workshops were held. The first focused on defining strategic vision, aim and objectives, the second verified objectives and identified enablers. A subsequent e-consultation invited feedback from wider stakeholders. The published strategy outlines 10 strategic objectives and 11 enablers. Key lessons identified from the strategy development process include the importance of clear leadership and oversight, the value of identifying the context for change, ensuring adequate consultation planning, taking a multidisciplinary approach with strong stakeholder engagement and the need to maintain a strategic perspective. Lessons from our experience can support colleagues internationally to strategically set out their priorities for health protection beyond COVID-19.

Enhancing Baccalaureate Nursing Students' Perception of Competence and Confidence During an Alternative Dedicated Education Unit Experience: A Pilot Study.

This quasiexperimental pilot study explored the effect three consecutive adult health Dedicated Education Unit (DEU) clinical placements would have on baccalaureate nursing students' self-perception of growth in competence and confidence. A Likert-type Competence/Confidence Self-Assessment Scale was constructed as a pretest/posttest measure; competence and confidence posttest means increased in each course. The study provides nursing professional development practitioners with information about the alternative DEU concept, its effect on student outcomes, and benefits nursing staff can gain by participating in a DEU experience.

Establishing a 'train the trainer' education model for clinical skills development.

Demographic trends and service reform present healthcare providers with the challenge of developing appropriate resources to manage increasing numbers of sick and disabled older people. But these changes bring increased opportunities for nursing, and the expansion of the nursing role is crucial as health services strive to meet the changing needs of older people. Against a background of reforms in Ireland and backed by an education and training needs analysis of nursing staff, two stakeholders devised a model of education that would best meet identified demands. This article sets out a model for skill attainment that acknowledges the diversity of care settings and improves the sustainability of training provided. Advantages and disadvantages are discussed, and lessons learned are shared.

Adriamycin injection into the medial cord of the brachial plexus: computed tomography-guided targeted pain therapy.

Recent advances in radiographic imaging technology allow for therapeutic agents to be placed within the subepineurium of peripheral nerve tissue. Adriamycin, a chemotherapeutic agent, is retrogradely transported by nerves to their cell bodies residing in the dorsal root ganglia. The combined process of radiological approach, an understanding of the anatomy of the brachial nerve plexus, and the use of agents that are retrogradely transported by nerves allows for targeted neuroablation of nerves. Advantages of this allow for the use of very small volumes of even toxic drugs, the volume of which allows for safe administration. Here, we report on the transcutaneous computed tomography (CT)-guided injection of adriamycin into specific branches of the brachial plexus in a patient with metastatic cervical cancer involving the lower plexus whose pain was untreatable by aggressive medical therapy that included epidural trials of opioids. Identification of the medial brachial cord was achieved using CT-guided techniques that included accurate localization with intra-neural dye injection, followed by injection of 0.5 mg of adriamycin. The patient reported complete pain relief within 12 h of the injection.

Aromatase inhibitors and musculoskeletal pain in patients with breast cancer.

Aromatase inhibitors are recommended for use by postmenopausal women who have estrogen receptor-positive early-stage breast cancer. They reduce local and distant recurrence more effectively than tamoxifen. Anastrozole (Arimidex, AstraZeneca Pharmaceuticals LP), letrozole (Femara, Novartis Pharmaceuticals Corporation), and exemestane (Aromasin, Pfizer Inc.) inhibit aromatase activity, thus significantly decreasing estrogen production in tissues such as liver, muscle, and fat. Very low levels of estrogen may be one cause of musculoskeletal pain, a common side effect associated with the drugs. In the major adjuvant aromatase inhibitor clinical trials, 25%-30% of the patients enrolled experienced musculoskeletal pain. Although quality-of-life studies demonstrate that aromatase inhibitors are well tolerated overall, some women discontinue this treatment because of musculoskeletal pain. Little is known about how to predict, measure, or manage musculoskeletal pain caused by aromatase inhibition. Oncology nurses play an important role in the assessment and management of side effects related to cancer. This article provides an overview of the current knowledge about musculoskeletal pain in patients with breast cancer receiving aromatase inhibitor therapy.

A randomized trial of standardized nursing patient assessment using wireless devices.

A complete and accurate patient assessment database is essential for effective communication, problem identification, planning and evaluation of patient status. When employed consistently for point-of-care documentation, information systems are associated with completeness and quality of documentation. The purpose of this paper is to report on the findings of a randomized, cross-over study conducted to evaluate the adequacy of a standard patient assessment module to support problem identification, care planning and tracking of nursing sensitive patient outcomes. The feasibility of wireless devices to support patient assessment data collection at the point-of-care was evaluated using wireless PDAs and tablet PCs. Seventy-nine (79) nurses from two patient care units at Massachusetts General Hospital (Boston, MA) were recruited into the study and randomized to complete patient assessment using wireless or paper devices. At the end of six weeks, nurses who where randomized to the paper assessment module were assigned to a device and those who used a device were assigned to paper for an additional six weeks. Impact was evaluated with regard to data capture, workflow implications and nurse satisfaction. Findings suggest that a standard patient assessment set promotes patient sensitive and quality data capture, which is augmented by the use of wireless devices.

A systematic approach to baseline assessment of nursing documentation and enterprise-wide prioritization for electronic conversion.

An important challenge associated with making the transition from paper to electronic documentation systems is achieving consensus regarding priorities for electronic conversion across diverse groups. In our work we focus on applying a systematic approach to evaluating the baseline state of nursing documentation across a large healthcare system and establishing a unified vision for electronic conversion. A review of the current state of nursing documentation across PHS was conducted using structured tools. Data from this assessment was employed to facilitate an evidence-based approach to decision-making regarding conversion to electronic documentation at local and PHS levels. In this paper we present highlights of the assessment process and the outcomes of this multi-site collaboration.

Challenges of creating a one-size-fits-all oncology CPOE application.

Since August 1996, the oncology clinicians at Massachusetts General Hospital (MGH) have been using an in-house developed CPOE system to order chemotherapy for their adult population. While the pediatric chemotherapy ordering remained on paper until November 2003, designing the pediatric chemotherapy functionality into the existing CPOE product proved to be very challenging. It was helpful in one sense because there was an existing framework that was familiar to everyone. It was also restrictive, in the sense that it is hard to enhance it without impacting others already using the same system.

Surveying acute care providers in the U.S. to explore the impact of HIT on the role of nurses and interdisciplinary communication in acute care settings.

In 2005, the Healthcare Information and Management Systems Society's Nursing Informatics Task Force surveyed acute care providers across the United States to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. More than 1,700 healthcare professionals responded to the online survey and provided numerous insights into the impact that clinical information systems have in their daily communication and workflow patterns. This paper provides an overview of survey results from four large healthcare delivery systems with a focus on how the results will be employed to support an evidence-based approach to improving acute care IT systems across the following healthcare delivery systems: Partners and Lifespan Health Systems in the Northeast, Baptist Health South Florida in the Southeast, and Providence HealthSystem in the Northwest.A case study approach is employed to describe survey findings at the healthcare system level and then provide a set of recommendations to leverage findings to capitalize on the strengths of existing IT applications and tools, and work towards overcoming barriers to interdisciplinary communication or acute care workflows.

The feasibility of digital pen and paper technology for vital sign data capture in acute care settings.

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to "bridge" the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record.