Infection prevention needs assessment in Colorado hospitals: rural and urban settings.

BACKGROUND: The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. METHODS: Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. RESULTS: Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. CONCLUSIONS: Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments.

Assessment of the quality of publicly reported central line-associated bloodstream infection data in Colorado, 2010.

BACKGROUND: Validation of self-reported health care-associated infection data is essential to verify correct understanding of definition criteria, surveillance practices, and reporting integrity. Recent studies have found significant under-reporting of central line-associated bloodstream infections (CLABSI) leading Colorado Department of Public Health and Environment to examine the quality of Colorado's CLABSI data. METHODS: Trained Colorado Department of Public Health and Environment staff members performed onsite validation visits that included interviews with infection preventionists to assess surveillance practices and retrospective chart reviews of patients with positive blood cultures in specific intensive care units (adult and neonatal) and long-term acute care hospitals during the first quarter of 2010. RESULTS: Fifty-five CLABSIs from the original sample were identified; 33 (60%) in the adult intensive care unit, 7 (12.7%) in the neonatal intensive care unit, and 15 (27.3%) in the long-term acute care hospital. Of the 55 CLABSIs identified by reviewers, 18 (32.7%) were not reported by the hospitals, 37 CLABSIs (67.3%) were reported correctly into the National Healthcare Safety Network, and 1 CLABSI was over-reported. CONCLUSIONS: There was wide variation noted in surveillance practices as well as in application of definition criteria. With 33% under-reported cases, it was concluded that ongoing validation of health care-associated infection data is necessary.

No essence no self: using a Buddhist perspective to characterize the nature of nursing.

A fresh perspective is needed on the historical roots and contemporary politics of the essentials of nursing. In the 21st century, the profession needs to move past separatist thinking and the pursuit of identifying what can be called a professional self. Two ways that nurses have tried to characterize a professional self is through claiming caring as the essence of nursing and using the esoteric taxonomy system of nursing diagnoses. The Buddhist teaching of nonself (anatman) is proposed as an alternative way of viewing the nature of the profession.

A United States perspective on the challenges in nursing education.

Nursing education in the US today is at crossroads. The profession has made great strides in gaining public respect and recognition for the work that nurses do. Nurses' voices are being heard in important political debates about revolutionary changes in the problematic US health care system. Advanced practice nurses are becoming valued providers of primary care to US citizens. It is innovative educational programs and educators that have provided the foundation to help nursing use its voice and to propel the profession forward. However, nurse educators are finding that they face major challenges in keeping nursing on track to be in the forefront of health care in the future. Some of these challenges include confronting nursing and faculty shortages, eliminating inconsistent and confusing educational choices, taking responsibility for mandates to stay on the cutting edge of quality initiatives, providing excellent clinical experiences for students and being willing to step out of old comfort zones to engage in designing imaginative and innovative ways to educate nurses in the future. Nurse educators must be successful in turning these challenges into opportunities if nursing is to command a key role in an evolving US health care system.

Using a Buddhist Sangha as a model of communitarianism in nursing.

In spite of a continuing long and rich history of caring for patients, many nurses have not been satisfied with their work. One cause among others for this dissatisfaction is that nurses often do not care for one another. The philosophy of a Buddhist Sangha, or community, is similar to the philosophy of western communitarian ethics. Both philosophies emphasize the importance of people working together harmoniously towards a common good. In this article, unsatisfactory nurse-nurse relationships have been considered and a model for communitarian nursing practice has been suggested based on a Buddhist Sangha.

Acknowledging dependence: a MacIntyrean perspective on relationships involving Alzheimer's disease.

As people living with Alzheimer's disease experience their lifetime of memories slowly slipping away, they become dependent on society's independent practical reasoners family, health care professionals and society. Many people grow accustomed to the cognitive decline and begin to view the person with dementia as less than a person. In Dependent rational animals, Alasdair MacIntyre emphasized a moral framework that encompasses two sets of virtues needed for human beings to flourish in society and to achieve genuine common goods--the virtues of independent practical reasoners and the virtues of acknowledged dependence. Virtues of acknowledged dependence are discussed ethically in terms of benevolence towards those who are disabled or dependent upon people who are strong and independent. The authors propose that using MacIntyre's perspective of the two sets of virtues is valuable in the care of persons with Alzheimer's disease. According to MacIntyre, independent reasoners who understand and practice these two sets of virtues will help those people in communities who are dependent and vulnerable, and, subsequently, human flourishing can occur.

Rational suicide: uncertain moral ground.

BACKGROUND: The ambiguities involving end-of-life issues, such as physician-assisted suicide and voluntary stopping of eating and drinking, have caused a blurring of the definition of rational suicide and have prompted rich dialogue with moral deliberations that seem to be on disparate paths among bioethicists and other health care professionals. With the evolution of advanced medical technology extending life expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate. AIM: The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care. FINDINGS: Attitudes towards suicide have been controversial, varying from acceptance to non-acceptance depending on social, political and religious influences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. CONCLUSION: Nurses who have not reflected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions.