Relationship among safety culture, nursing care, and Standard Precautions adherence.

Standard Precautions (SP) are an essential, although unmet, component of nursing care. Understanding conditions fostering the integration of SP within nursing workflow is imperative. This research describes the relationships among patient safety culture, adherence to SP, and missed nursing care.

A Study on the Effectiveness of XMOOC Teaching in Improving Practical Nursing Teaching.

This article studies the effectiveness of xMOOC teaching in the area of nursing education, by making a comparison between two study groups. Though observation, academic tests and interview, this study finds out that the application of xMOOC to teaching scheme practice could effectively increase teaching ability of teachers, learning ability of students and their test scores which had positive significance in improving clinical nursing teaching quality.

La importancia de la Escucha Activa en la intervención Enfermera / Active listening importance in nurse intervention

Objetivos: Valorar la percepción que tienen los usuarios sobre algunos aspectos (aptitud y actitud) relacionados con la escucha activa durante el periodo de hospitalización. Material y métodos: Revisión bibliográfica, Estudio observacional descriptivo, con una muestra de 30 pacientes, mediante cuestionario con 10 preguntas cerradas y cuatro opciones de respuesta. Resultados: Más de un 66% (n=30) de los usuarios encuestados declararon en cada una de las cuestiones planteadas sobre la escucha activa que se cumplen las condiciones físicas adecuadas, de actitud y aptitud por parte del personal sanitario para que esta tenga el efecto deseado sobre el paciente. Conclusiones: Los cuestionarios reflejan que los pacientes se muestran en general satisfechos con los elementos que definen la escucha activa como forma de hacer frente a las barreras de la comunicación (AU)

Objectives: To evaluate the users' perception on some aspects (aptitude and attitude) related to active listening during the period of hospitalization. Material and methods:Bibliographical review; descriptive and observational study with a sample of 30 patients by means of a questionnaire with 10 closed questions and four answer choices. Results:Over than 66% (n = 30) of the users surveyed stated in each of the issues raised on active listening that the suitable conditions, attitude and aptitude for the medical staff are complied, so that it has the desired effect about the patient. Conclusions:The questionnaires reflect that patients are generally satisfied with the defining elements of active listening as a way of dealing with communication barriers (AU)

Afinación del instrumento para medir entornos de la práctica de Enfermería: "PracticeEnvironmentScale of theNursingWorkIndex PES-NWI" / Refinement of the instrument to measure Nursing practice environments: "PracticeEnvironmentScale of theNursingWorkIndex PES-NWI"

La medición de los Ambientes de Práctica cobra relevancia a medida que los mismos adquieren significado para el desarrollo de la Práctica Profesional de Enfermería. Actualmente en Colombia no se cuenta con un instrumento para la medición de los ambientes que esté totalmente validado para el contexto nacional, situación que motivó la realización de la presente investigación, cuyo contenido explica el desajuste con relación a la validez de constructo que presenta el instrumento para medir entornos de la práctica de Enfermería: "Practice Environment Scale of the Nursing Work Index PES - NWI", creado en Estados Unidos y tomado como referencia en estudios precedentes en Colombia. La investigación metodológica adquirió como punto de partida la estructura general para el diseño y elaboración de instrumentos, enfocada en la evaluación de la teoría subyacente del instrumento "PES - NWI". Los resultados obtenidos permiten visualizar que no se encuentra un desarrollo a profundidad del constructo que se pretende medir, por lo que se realizó una revisión teórica que conduce a la descripción aproximada de un sustento para el instrumento "PES - NWI". Con la investigación se relacionan los ítemes del instrumento con aspectos de la Sociología de las Organizaciones y se genera una nueva propuesta teórica que reformula tanto las dimensiones como la distribución de los ítemes en ellas. En esta investigación diecinueve de treinta y un ítemes son clasificados y organizados en cuatro dimensiones, una menos que en el "PES - NWI" original de Eileen Lake. No obstante se consideran pertinentes nuevas revisiones para el ajuste final del instrumento. (AU)

Measuring Practice Environments become relevant as they acquire meaning for the development of Nursing Practice. Currently in Colombia an instrument that is fully validated for the national context does not exist, situation which led to the completion of this investigation. The content explains the mismatch with respect to construct validity, introducing the instrument to measure Environments Nursing Practice: "Practice Environment Scale of the Nursing Work Index PES - NWI", created in the United States and used as a reference in previous studies in Colombia. Methodological research took as its starting point the general structure for the design and development of tools focused on assessing the underlying theory of the instrument "PES - NWI". The results obtained display that there is not in-depth development of the construct to be measured, so that a theoretical review leading to the approximate description of a livelihood for the "PES - NWI" instrument was made. Through research, the items of the instrument are related to aspects of the Sociology of Organizations, generating a new theoretical proposal which reformulates both the size and the distribution of items in them. In this current research, nineteen thirty-one items were classified and organized into four dimensions, one less than in the "PES - NWI" original Eileen Lake. However new revisions are considered relevant for the final adjustment of the instrument. (AU)

Medication administration by enrolled nurses: opinions of nurses in an Australian healthcare organization.

OBJECTIVE: This study examined the opinions of nurses about the introduction of enrolled nurse medication administration and analyzed its impact on the medication error rate. METHODS: Data were collected using a survey and examination of incident reports regarding nursing medication errors. Nurses (registered nurse, enrolled nurse with medication endorsement, enrolled nurse) responded to survey items regarding the introduction of enrolled nurse medication administration. Data analysis included descriptive statistics, Fischer's exact test, and chi-square analysis where appropriate. RESULTS: The majority of nurses (75.2%) supported enrolled nurse medication administration. However, differences in opinion were observed between registered nurse (RN) and enrolled nurse with medication endorsement (ENME) regarding clear understanding of responsibility and accountability (RN: 47.2% vs. ENME: 77.8%; p =.033), and whether suitable education was provided (RN: 34.7% vs. ENME: 73.7%; p =.012). Moreover, less than one-third of RNs agreed that the assessment process for EN medication endorsement clearly identified the competence of the ENME to administer medications. Nonetheless, nursing medication errors did not increase in the 12-month period after the introduction of enrolled nurse medication administration (pre: 314, post: 302). CONCLUSIONS: The findings of this study suggest areas that should be addressed in the future, including assessment of competence and focused education about accountability and responsibility.

An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments.

OBJECTIVES: To explore the type and frequency of activities and multitasking performed by emergency department clinicians. METHODS: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis. RESULTS: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses' and doctors' offices were the most common locations for multitasking in the emergency department. CONCLUSION: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

A survey of skin cancer screening practices among dermatology nurses.

OBJECTIVES: The objective of this study was to survey the current level of participation dermatology nurses have in screening and skin cancer detection. SAMPLE: Nursing professionals including registered nurses (RNs) and licensed practical nurses and their Ontario, Canadian equivalents (registered practical nurses), advanced practice nurses, such as nurse practitioners and dermatology nurse practitioners, were included in the sample. RN education ranged from associate's to master's degree preparation. DATA ANALYSIS: Demographic, clinical setting, and practice information were reported using descriptive statistics and cross tabulations. RESULTS: Eighty-three percent (n = 89) of nurses surveyed are performing a total-body skin examination (TBSE); 15% (n = 16) are confident and 52% (n = 56) are very confident with their skills. CONCLUSIONS: The vast majority of nurses surveyed reported that they practiced skin cancer screening. They also reported using dermatologic tools, such as dermatoscope and digital camera. Nurses trained to perform TBSEs, as well as those who use dermatoscopes and digital cameras when performing TSBEs, provide an important component in improving cancer screening and detection.

Difference in work-related violence by nurse license type.

Nurses are at considerable risk for work-related violence. This study compared the experiences of work-related violence among registered nurses (RNs) and licensed practical nurses (LPNs) to quantify differences in risks and exposures and to gain insight into possible interventions. A random sample (n = 6,300) of licensed Minnesota nurses was surveyed regarding the previous 12-month period. Nurses self-reported violent events and demographic information. After adjustment for potential confounders and nonresponse, LPNs had an increased risk for both physical assault (odds ratio = 1.4; 95% confidence interval = 1.1-1.9) and nonphysical violence (odds ratio = 1.2; 95% confidence interval = 1.0-1.5) compared to RNs. Some exposures resulted in increased risks for both types of violence for RNs and LPNs: working primarily in psychiatric departments and long-term care facilities. In contrast, working in clinics resulted in decreased risks for both license types. Some risks varied by license type. Risk of physical assault was increased for LPNs working with neonatal/pediatric patients, whereas RNs' risk was decreased. RNs' risk of physical violence increased while providing care, whereas LPNs' risk increased while supervising care. A better understanding of how this problem varies by license type and work setting will assist in designing efficacious interventions.

Propofol sedation in outpatient colonoscopy by trained practice nurses supervised by the gastroenterologist: a prospective evaluation of over 3000 cases.

BACKGROUND AND STUDY AIMS: Propofol has several advantages for sedation in endoscopic procedures. Sedation administered by anaesthesiologists is associated with high costs. In this study the safety of propofol sedation administered by trained practice nurses under the supervision of the gastroenterologist in a cohort of outpatients of an ambulatory practice for gastroenterology in Germany is evaluated. METHODS: During a period of 21 months all patients referred to colonoscopy were eligible for this prospective observational study. The familiar CRC risk of the individuals, indication, completeness and results of the colonoscopy were registered together with the dose of propofol used. Propofol was administered by intermittent intravenous bolus titration by trained practice nurses under supervision of the gastroenterologist. Oxygen saturation, heart rate and blood pressure were recorded constantly during the procedure and adverse cardiopulmonary events were monitored by the endoscopy team. A respiratory event was defined as an episode of apnoea or laryngospasm requiring assisted ventilation. 23 % of the patients received supplemental oxygen. RESULTS: A total of 3641 colonoscopies were recorded. 33 individuals were sedated with midazolam and were excluded from the evaluation. 3610 individuals were sedated with propofol (119 +/- 39 mg, mean dose +/- S. D.). 40 % of the procedures were performed as combined gastroscopy and colonoscopy. The cecum was reached in 99 % of the colonoscopies. Respiratory events occurred in five patients (0.14 %). Assisted ventilation in all cases was performed by mask ventilation. Bradycardia (HF < 60/min) and arterial hypotension (RR < 90 mmHg) occurred in 0.5 and 0.3 % of the colonoscopies, respectively, but medical intervention was necessary only in 0.2 % for both types of event. Minor events of hypoxaemia were observed in 51 patients (1.4 %), but only 1/3 of these events occurred in patients supplemented with oxygen. CONCLUSIONS: Propofol can be administered safely for ambulatory colonoscopy by trained practice nurses, with careful monitoring under supervision of the gastroenterologist.

Work-related injury among direct care occupations in British Columbia, Canada.

OBJECTIVES: To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada. METHODS: Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care). RESULTS: CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%). CONCLUSIONS: Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.

Nurses working in GI and endoscopic practice: a review.

BACKGROUND: Over the last 10 years, nurses increasingly perform tasks and procedures that were previously performed by physicians. OBJECTIVE: In this review, we investigated what types of GI care and endoscopic procedures nurses presently perform and reviewed the available evidence regarding the benefits of these activities. DESIGN: Review of published articles on nurses' involvement in GI and endoscopic practice. RESULTS: In total, 19 studies were identified that evaluated performance and participation of nurses in GI and endoscopic practice. Of these, 3 were randomized trials on the performance of nurses in flexible sigmoidoscopy (n = 2) and upper endoscopy (n = 1). Fourteen nonrandomized studies evaluated performance in upper endoscopy (n = 2), EUS (n = 1), flexible sigmoidoscopy (n = 7), capsule endoscopy (n = 2), and percutaneous endoscopic gastrostomy placement (n = 2). In all studies, it was found that nurses accurately and safely performed these procedures. Two further studies demonstrated that nurses adequately managed follow-up of patients with Barrett's esophagus and inflammatory bowel disease. Four of the 19 studies showed that patients were satisfied with the type of care nurses provided. Finally, it was suggested that costs were reduced if nurses performed a sigmoidoscopy and evaluated capsule endoscopy examinations compared with physicians performing these activities. CONCLUSIONS: The findings of this review support the involvement of nurses in diagnostic endoscopy and follow-up of patients with chronic GI disorders. Further randomized trials, however, are needed to demonstrate whether this involvement compares at least as favorably with gastroenterologists in terms of medical outcomes, patient satisfaction, and costs.

Diabetes care: practice nurse roles, attitudes and concerns.

BACKGROUND: Practice nurses (PNs) are the largest group of nurses providing primary care for patients with diabetes in New Zealand, and changes in the health system are likely to have a substantial effect on their roles. To inform the development of a new primary health care nursing structure and evaluate the new role associated with this, it will be important to have data on current practice nurse roles. AIMS: The aim of this paper is to report a study to compare the diabetes-related work roles, training and attitudes of practice nurses in New Zealand surveyed in 1990 and 1999, to consider whether barriers to practice nurse diabetes care changed through that decade, and whether ongoing barriers will be addressed by current changes in primary care. METHODS: Questionnaires were mailed to all 146 PNs in South Auckland in 1990 and to all 180 in 1999, asking about personal and practice descriptions, practice organization, time spent with patients with diabetes, screening practices, components of care undertaken by practice nurses, difficulties and barriers to good practice, training in diabetes and need for further education. The 1999 questionnaire also asked about nurse prescribing and influence on patient quality of life. RESULTS: More nurses surveyed in 1999 had postregistration diabetes training than those in 1990, although most of those surveyed in both years wanted further training. In 1999, nurses looked after more patients with diabetes, without spending more time on diabetes care than nurses in 1990. Nevertheless, they reported increased involvement in the more complex areas of diabetes care. Respondents in 1999 were no more likely than those in 1990 to adjust treatment, and gave a full range of opinion for and against proposals to allow nurse prescribing. The relatively low response rate to the 1990 survey may lead to an underestimate of changes between 1990 and 1999. CONCLUSIONS: Developments in New Zealand primary care are likely to increase the role of primary health care nurses in diabetes. Research and evaluation is required to ascertain whether this increasing role translates into improved outcomes for patients.

Work activities of practical nurses and risk factors for the development of musculoskeletal disorders.

Musculoskeletal and emotional disorders are important causes of reported diseases, causing medical absences, and eventually earlier decrease of work ability. This paper reports the results of a study carried out among practical nurses working at the Orthopedics and Trauma Institute. The objectives of the study were: (a) to describe the routine activities performed during day and night shifts, and (b) to compare the work activities performed in different wards during these shifts. A Brazilian version of the Work Ability Index--WAI (TUOMI et al., 1994) was answered by 83 practical nurses. Forty-three of them (52%) reported pains or musculoskeletal diseases, either based on their own opinion or diagnosed by a physician. These nurses were invited to join the second phase of the study and twenty-nine accepted it. All work activities performed in 29 shifts were observed and recorded. The results showed that day shifts were far more demanding in terms of the number of activities related to patients' care than afternoon and night shifts. Also, body postures associated with day work activities demanded important physical efforts. The number of nurses in charge during night shifts was substantially lower than during day shifts. This could lead to an overload and affect the health of the nurses.

Nursing professionals' views on the workplace. Survey results.

This article reports on a survey done among registered, enrolled and auxiliary nurses registered with the South African Nursing Council. The survey was carried out in the period from the end of December 1997 to the beginning of 1998. The purpose of the survey was to obtain the views of female nurses on various aspects of the workplace. The important findings were the fact that nurses liked working as part of a team and that this contributed the most to their job satisfaction. The item that contributed least to job satisfaction was pay. The most important problems were that they felt that they were not paid enough and that they need better benefits. The majority of nurses were however positive about their jobs and the items the highest on the list of career expectations were job satisfaction, followed by a need for recognition.

In a different voice: the attitudes of licensed practical nurses towards the future.

In the fall of 1997, the Idaho Commission of Nursing and Nursing Education undertook a survey of Idaho nurses to collect data on future workforce and educational needs. The results of the survey demonstrated substantial attitudinal differences between licensed practical nurses and registered nurses in the areas of educational motivation, role differentiation, skills by type of nurse, trends in nursing supply, and educational preparation. Given that the Idaho workforce is comparable to the national nursing workforce in numbers, educational background, and age, these findings have implications for health policy planners and nursing educators throughout the country. This article presents the findings and then uses the data as a basis for suggesting their implications for nursing education and workforce planning.

Applicants to B.Sc.N., R.N., and R.P.N. nursing programs: differences and predictors.

We surveyed 205 applicants to three types of nursing programs (B.Sc.N., diploma-R.N., and diploma-R.N.A.) offered in Toronto, Ontario. Applicants were predominately white, unmarried women living within commuting distance of the institutions to which they applied. Applicants to practical nursing programs tended to be older than applicants to B.Sc.N. and diploma-R.N. programs, be married, have at least one dependant, come from blue-collar families, be out of school longer, and submit fewer applications. Applicants with dependants were 11 times more likely to choose R.P.N. over R.N. programs. Recency of graduation and high school average were predictive of choosing B.Sc.N. over R.N. programs. While this 1992 cohort had some appreciation for the challenges facing the nursing profession, most applicants still expected to secure full-time employment in acute care post-graduation. The data provide an important benchmark for comparing current and future cohorts of applicants with respect to socio-demographic characteristics and expectations of nursing as a career choice.