Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology.

BACKGROUND: Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). PRIMARY OBJECTIVE: Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. SECONDARY OBJECTIVE: Estimate the rate of SSIs and associated predisposing factors. METHODS: Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. RESULTS: A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. CONCLUSIONS: Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.

Wound Dressings During Radiotherapy for Cancer: A Survey of Practice.

BACKGROUND: Patients undergoing radiotherapy may experience changes to the skin that require dressings. Recommendations regarding radiating through wound dressings have been variable and relate to the concern regarding surface dose increase or bolus effect. OBJECTIVES: The purpose of this article is to identify current evidence and practice through literature review and a national environmental scan. METHODS: Nurses from 18 radiation oncology centers in Canada were surveyed about current practice. In-depth telephone interviews were conducted with four nurse participants to further understand the context of this issue within the nursing practice environment. FINDINGS: The integrated results of the study were reviewed with five clinical experts to make recommendations for research, practice, leadership, and policy. Implications for clinical practice included the involvement of radiation oncology nurses in the treatment planning team, development of clinical practice tools, and the relevance of the Person-Centered Nursing framework for wound management during radiotherapy.

Prescriptive authority for nurses: the Canadian perspective.

PURPOSE: This study aims to describe the role of prescriptive authority for nurses within Canada. CONCLUSIONS: Prescriptive authority for Canadian nurses is linked to the development of advanced practice nursing generally and nurse practitioners specifically. Recent legislative changes allow nurse practitioners to function more independently regardless of the availability of medical practitioners. The smaller population results in less legislative variety for specific nurse practitioner specialty areas. Facilitators and barriers to implementing effective prescriptive authority remain as challenges and mirror findings from other literature. PRACTICE IMPLICATIONS: Role clarity, strength in nursing focus, and support from administrators and legislation are required for prescriptive authority to be fully enacted.

Doing the right thing: using hermeneutic phenomenology to understand management of wound pain.

Despite the availability of assessment tools, analgesic medications, and technologically advanced dressings, achieving adequate pain control in wound care continues to present challenges for healthcare practitioners, patients, and their families. Pain in general has been the subject of much clinical and scientific investigation, but most has focused on the biological aspects of pain management. The psychological aspects of pain management and factors stemming from the relationship between caregivers and care recipients have received less attention. Relational issues are particularly relevant when dealing with medical procedures that involve a caregiver actively touching a care recipient. This paper explores pain management in chronic wound care, particularly at dressing change, with an emphasis on the relational aspects of care. Work from a recently completed hermeneutic phenomenological study of 18 registered nurses performing wound care in long-term, acute, and community care suggests strengthening the therapeutic relationship between patient and nurse may have a positive impact on healthcare providers' pain management practices and patient quality of life. Although nursing was the focus of the study, the observations provided are relevant for any clinician providing hands-on, compassionate wound care.

Advanced practice nurses' role in the treatment of pain.

In 2003, the Canadian Association of Advanced Practice Nurses (CAAPN), with an educational grant from Purdue Pharma Canada, conducted a web-based survey to examine the pain management practices of advanced practice nurses (APNs). The survey objectives were to explore the role of APNs with respect to the treatment of pain, to determine the extent of their influence over treatment outcomes of patients with pain and to ascertain their level of knowledge of controlled-release pain medication. One hundred and sixteen surveys were collected. Results of the survey showed that APNs from a variety of patient care areas are caring for patients seeking pain management. Other results support the current literature that identifies lack of knowledge, education and experience as barriers to pain management practice, influencing the decision to prescribe pain medication. APNs need the tools to develop and implement effective pain management plans for their patients.

Practical treatment of wound pain and trauma: a patient-centered approach. An overview.

Chronic wound pain is distressing and influences the patient's ability to function. One of the failures of modern medicine is the inadequate assessment and treatment of pain. The clinician's approach to chronic wound pain combines the "preparing the wound bed" paradigm with chronic wound pain models. A holistic approach must include the diagnosis and treatment of the underlying cause, identification and correction of patient-centered concerns, and the three major components of local wound care (debridement, bacterial balance/prolonged inflammation, and moisture balance). The Krasner pain model defines chronic (persistent), noncyclic acute, and cyclic acute wound pain. Chronic persistent wound pain without an event or trigger often relates to the cause of the wound that needs to be corrected to relieve the pain. Noncyclic acute pain is often experienced with a surgical procedure such as sharp debridement. Cyclical acute pain may occur repeatedly with removal or application of new local wound dressings. Securing a thorough pain history focusing on pain patterns will help healthcare professionals develop specific pain relief initiatives. Pain is a component of quality of life. Patient-centered concerns need to address pain control measures until the cause of the pain can be corrected. Controlling pain, however, may not always improve quality of life scores. Each of the components of local wound care also may be responsible for the production of pain; strategies need to be implemented to ensure adequate patient comfort.