ABSTRACT
OBJECTIVE: The present study aims to describe fall-related self-efficacy as perceived by patients with chemotherapy-induced peripheral neuropathy (CIPN). The characteristics of patients associated with low perceived self-efficacy of preventing falls were investigated. METHODS: A cross-sectional study of four hospitals in Japan. In this study, 100 outpatients who were receiving chemotherapy for cancer and experiencing CIPN were recruited. Participants completed an anonymous, self-administered questionnaire. Self-efficacy was measured with the falling self-efficacy (FSE) scale, and the severity and impact of CIPN was assessed with the Comprehensive Assessment Scale for CIPN in Survivors of Cancer (CAS-CIPN). Data about the demographic information of the patients, cancer diagnosis and treatment, pain and fatigue symptoms, and history of previous falls were collected. Logistic regression analysis was used to assess relationships between variables. RESULTS: A total of 81 (81.0%) participants with CIPN completed the questionnaire. They reported experiencing fear of falling during their daily activities, which include the act of standing up, walking, and using the stairs. Small events, such as unstable postures and uncomfortable situations, affected their confidence of preventing falls. Logistic regression revealed that low FSE scores were significantly associated with female sex (P = 0.022), low body mass index (BMI; P = 0.026), and the CAS-CIPN score (P < 0.001). CONCLUSIONS: Female patients with CIPN and low BMI might have an increased need for enhanced fall-related self-efficacy. A comprehensive assessment of CIPN in patients at risk of low FSE scores is likely to be beneficial.
ABSTRACT
BACKGROUND: Catheter care is considered to be important for prevention of catheter-associated bloodstream infections (CABSIs) although epidemiological evidence is sparse. OBJECTIVES: To identify problems associated with catheter care and evaluate the effectiveness of nurse-initiated interventions to reduce CABSIs. DESIGN: An intervention study with before and after comparison. SETTINGS: CABSI surveillance was conducted in a 560-bed acute hospital located in a major urban area in Japan. PARTICIPANTS: Patients were enrolled in this study from April 2000 to December 2002 based on the following criteria: (1) adult inpatients; and (2) those in whom central venous lines or Swan-Ganz catheters were inserted for 2 days or longer. METHODS: In the first year, risk factors for CABSI and problems associated with catheter care were identified by inspection of the infection control nurse (ICN) or four trained link nurses, and the laboratory results. In the subsequent 2 years, the following interventions based on the surveillance results were implemented: (1) enhanced skin preparation by scrubbing with regular bathing soap and tap water; (2) a new method for stabilisation of the catheter inserted into the internal jugular vein, where additional dressing was placed over the sterilised dressing; (3) educating the staff on maximal sterile precautions by teaching staff members at their section meetings and displaying posters; (4) use of a check list and observation of catheter insertion by link nurses to monitor compliance; and (5) selection of a disinfectant that requires shorter contact time and has longer residual effect. RESULTS: After these interventions were implemented, the overall bloodstream infection (BSI) rate declined from 4.0/1000 device-days to 1.1/1000 device-days (p<0.005). CONCLUSIONS: We identified four problems-those related to skin preparation, dressing, sterile precautions and disinfectant. We implemented a series of interventions to reduce CABSIs; the overall CABSI rate decreased significantly.
