Reported blood exposure rates and staff nurse satisfaction with a closed surgical drainage system.

BACKGROUND: The purposes of this investigation were (1) to describe performance characteristics, incidence of exposure, and staff satisfaction with a closed drainage system, the Kendall Tru-Close, and (2) to compare performance, incidence of exposure, and satisfaction between the closed drainage system and a currently used surgical drainage system (the Hemovac). METHODS: Subjects were 40 adult male and female patients who had undergone selective orthopedic joint surgery. Twenty patients received the Hemovac drainage system, and 20 patients received the Tru-Close drainage system. Data collection instruments included a patient demographic data form, a daily assessment form, a nurses' bedside survey (self-report), and a satisfaction questionnaire. RESULTS: There were significantly fewer exposures with the closed drainage system when compared with the Hemovac system. An odds ratio of 5.09 indicated that the odds of exposure to fluids with the Hemovac system were five times greater than for the closed system. Nursing satisfaction scores were higher for the Tru-Close system than the Hemovac system for items that related to protection from exposure to self or environment. However, overall nursing satisfaction with the new device was mixed. CONCLUSIONS: Although nurses liked the increased protection from exposure afforded by the Tru-Close drainage system, other patient management issues emerged related to the increased weight of the reservoir bag.

Laminar air flow versus reverse isolation: nurses' assessments of moods, behaviors, and activity levels in patients receiving bone marrow transplants.

PURPOSE/OBJECTIVES: To compare nursing assessments of moods, behaviors, and activity levels of patients receiving bone marrow transplants (BMTs) according to type of isolation environment. DESIGN: Retrospective, descriptive. SETTING: University BMT unit. SAMPLE: Records of 22 patients receiving BMT treated over a two-year period-12 were treated in laminar air flow (LAF) rooms and 10 in reverse isolation. METHODS: Using a retrospective chart review, daily nursing assessments of patients' moods, behaviors, and activity levels were collected and compared based on type of isolation. MAIN RESEARCH VARIABLES: Type of isolation and patient's behavior, mood, and activity level. FINDINGS: Patients assigned to LAF had significantly higher anxiety levels at admission than those assigned to reverse isolation. CONCLUSIONS: Admission to LAF isolation appeared to be more anxiety-provoking than admission to reverse isolation; however, this finding needs to be replicated in a study with a prospective design using standardized psychosocial assessment. Findings are consistent with the evidence that patients view isolation as a temporary inconvenience rather than a major stressor. IMPLICATIONS FOR NURSING PRACTICE: Future research is needed. Preparing patients for isolation can include tours, educational materials, and explanations of procedures and events. Physical contact, even through gloves, can impart warmth and caring in the isolation environment.

Relationships between oral mucositis and treatment variables in bone marrow transplant patients.

The pattern of oral mucositis and related treatment variables was studied in 20 bone marrow transplant patients. Patients received either total body irradiation (TBI) or busulfan in combination with cyclophosphamide and etoposide as pretransplant conditioning. Daily oral assessment scores were analyzed. Mucosal changes began approximately 2 days before transplant and peaked approximately 8 days after transplant. There was a trend for patients receiving TBI to have slightly higher oral scores during the first week posttransplant than patients receiving busulfan. The TBI patients averaged almost twice the number of days of continuous intravenous morphine infusion for oral pain and 6 additional days of total parenteral nutrition when compared with patients receiving busulfan. Subjects who died during aplasia manifested mucositis that gradually worsened and did not return to baseline. Differences in oral status based on type of transplant, either autologous or allogeneic, were not shown in this study.

A new clinical educator role: bridging the education-practice gap.

A new clinical educator role implemented at Georgetown University Hospital is described in this article. Nurses in this role assume dual responsibilities for nursing staff development and clinical supervision of baccalaureate nursing students. These clinical educators have joint appointments in the Department of Nursing and the School of Nursing. This role helps to bridge the education-practice gap and encourages a more efficient use of nursing resources.

Planning a baccalaureate clinical practicum abroad.

Clinical practicum abroad can offer a wealth of unique professional and personal experiences for nursing students. Most of the resources and expertise necessary to develop an international programme may already exist within the nursing school. Below, some pointers on how to plan a study-abroad programme, based on the successful experience of the School of Nursing at Georgetown University.

A three-tiered team model for undergraduate preceptor programs.

At the Georgetown University School of Nursing, a three-tiered team model is used to ensure the effectiveness of the undergraduate preceptor program. Using the three-tiered model, clinical teaching activities are shared among preceptors, clinical instructors, and the course coordinator. This strategy allows the assignment of more complex patients and groups of patients in a closely supervised learning environment. Through evaluations of the program, students have indicated that the preceptorship has increased their sense of independence with patient care and enhanced their satisfaction with the clinical experience.

Reestablishing self-feeding in a nursing home resident.

An attempt was made to teach an elderly person to reacquire and maintain self-feeding skills. A single-subject ABAB reversal strategy, including assessment for generalization, was planned as experimental design. The treatment procedure consisted of a continuous, immediate reinforcement program contingent on self-feeding responses. Fast and stable control of self-feeding was obtained. A drop in feeding behavior resulted when the patient returned to base-line procedures. The patient died before the second treatment procedure could be carried out. The study found, however, that nursing home staff could facilitate healthy behavior through better use of behavioral management skills.