Nursing research and HIV infection: state-of-the-science.

PURPOSE: To provide an update of the nursing research literature on HIV infection and to develop an HIV/AIDS database using arcs computer software. METHODS: Nursing research literature from 1986 through 1997 on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) was reviewed. With an emphasis on client-focused research, 246 studies were entered into the arcs HIV/AIDS database. FINDINGS: Analysis of over 1,000 citations in the HIV/AIDS nursing research literature over the past decade indicated that 22% (n = 219) of the nursing studies were client- or patient-focused; 29% (n = 292) were risk-group focused; and 49% (n = 492) were provider-focused. Of the 246 studies entered into the arcs HIV/AIDS database, 88 (35.7%) were classified in the psychologic domain, 65 (26.4%) in the physiologic domain, 24 (9.7%) in the behavioral domain, and 25 (10%) in the social domain. In addition, 17 (6.9%) of the studies were classified in the quality of life domain, and 27 (10.9%) in the stage of HIV disease domain. The majority (53%) of the 246 studies (n = 131) were correlational, 86 (35%) were descriptive, and 29 (12%) had experimental or quasi-experimental designs. CONCLUSIONS: Although nursing studies have described some of the problems that affect HIV-infected people, further research is needed, particularly related to clinical interventions.

Infection control programs in long-term-care facilities: structure and process.

Due to the rapid transfer of patients from the acute-care setting, the intensity of nursing care among residents in long-term-care facilities (LTCFs) has increased, transforming today's LTCFs into subacute healthcare facilities. Given the increased risk of infection among residents in LTCFs and the associated morbidity and mortality, evaluation of infection control programs in skilled nursing LTCFs is warranted. This article addresses the current structure and process of infection control programs in skilled nursing LTCFs.

Infection control programs in skilled nursing long-term care facilities: an assessment, 1995.

BACKGROUND: In 1989 the Health Care Financing Administration mandated that long-term care facilities (LTCFs) maintain infection control programs; however, few data are available to guide the design of these programs. The purpose of this study was to assess the current status of infection control programs in LTCFs by using methodology adapted from Phase I of the Centers for Disease Control and Prevention Study on the Efficacy of Nosocomial Infection Control. METHODS: A descriptive study of infection control programs in skilled nursing LTCFs was undertaken in a representative sample of 136 New England skilled nursing LTCFs that have >/=25 beds, with use of a self-report Infection Surveillance and Control Questionnaire. RESULTS: Nearly all (98%) the LTCFs reported having personnel responsible for infection control, with a median of 8 hours per week spent on infection control activities. Ninety percent of these persons were registered nurses; 52% had formal training in infection control. Twenty-five percent of the respondents reported that their infection control program was either "inactive" or nonexistent in 1988, and 60% rated their programs as either "moderately active" (43%) or "very active" (17%) during that year. By 1994, most LTCFs (67%) rated themselves as "very active," and only 3% as inactive or nonexistent. The mean scores on the questionnaire's surveillance and control indices were 23 (out of a possible 30) and 47 (out of a possible 60), respectively, which indicates medium infection surveillance and control activity. On the basis of the data provided by 72% of the respondents (n = 98), a crude estimate of 13.97 infections per 1000 resident-days was calculated, which is a higher rate than previously reported for LTCFs. CONCLUSIONS: Findings from the study indicate that it is feasible to use methodology adapted from Phase I of the Centers for Disease Control and Prevention Study on the Efficacy of Nosocomial Infection Control to assess infection control programs in LTCFs; however, further research into the efficacy of nosocomial infection control in skilled nursing LTCFs is needed.

Conflict of interest in academia.

Conflict of interest in academia has been increasingly recognized over the past decade. Yet, comparatively little is written in respect to this problem. The authors provide an overview of conflict of interest as it applies to nursing research and addresses how it can also affect practice and education. Resources for the development of guidelines to prevent conflicts of interest are presented.

Wound management in home care: an assessment.

The purpose of this study was to determine the status of wound care management among home health agencies (HHAs) in the U.S. The survey was mailed to 562 randomly selected HHAs within all 10 HCFA regions. Two hundred and ninety-six agencies (53%) responded to the survey. The majority (56%) of the respondents did not have written policies and procedures specific to wound management. The investigators were able to analyze the documents of those who had indicated that they had written policies and sent copies of them (n = 87, 67%). The majority (76%) of these had separate wound assessment protocols, but only 14% had separate preventive skin assessment protocols. Sixty-four percent had treatment protocols for more than one type of wound, while the remaining 46% used no specific treatment protocol or used treatments based on physicians' orders only. Most of the HHAs with written wound management policies required documentation of wound status; however, only half had patient/caregiver teaching as part of the policy. Although there is a need for clinically useful, well-tested, standardized approaches to wound care, the results of this study indicated that there is inconsistency regarding wound care management among HHAs within the U.S.

Assessing the need for infection control programs: a diagnostic approach.

By using the PRECEDE model, we concluded that the need for standardized infection control programs in long-term care facilities is imminent and believe that the PRECEDE model has wide applicability in infection prevention and control. For example, it could be used to plan continuing education needs for the infection control department in a facility, or to plan a program to improve compliance with universal precautions or handwashing. Its use is limited only by the creativity of the planner.

Programmed instruction revisited: a solution to infection control inservice education.

Recent standards established by the Occupational Safety and Health Administration (OSHA) regarding protection against occupational exposure to hepatitis B virus (HBV) and human immunodeficiency virus (HIV) presents a challenge to staff development and inservice educators to provide the necessary education and training in light of the 24-hour operation of a hospital, the nursing shortage, and the use of part-time personnel. In order to provide initial and periodic infection control programs for nursing personnel, a self-managed module in the form of a programmed unit of instruction (PUI) was developed and tested to determine its effectiveness and efficiency for teaching the basic principles of infection control to inservice nurses. Results of the study indicated that nurses who took a PUI in the basic principles of infection control scored higher on posttests than those who attended a lecture, regardless of their pretest scores, educational level, and experience (p less than .0001).

Effectiveness of an infection control programmed unit of instruction in nursing education.

To determine whether programmed instruction is an acceptable, cost-effective alternative to classroom lectures for teaching the basic principles of infection control to nursing students, a 46-frame programmed unit of instruction (PUI), with a pretest and posttest, was developed, piloted, and tested for reliability and validity. The instruments were developed on the basis of current knowledge of the epidemiology of infectious diseases and the 1983 revised Centers for Disease Control guideline for category-specific isolation precautions. A study was undertaken to test the hypothesis: Student nurses who take a PUI in the basic principles of infection control will score higher on posttests than those who do not take the PUI. A sample of 40 subjects was selected from the senior class in a baccalaureate nursing program at a public university. The subjects were randomly assigned to four groups of 10. A Solomon four-group design was used for data analysis, and a two-way analysis of variance was performed on the posttest means. Results indicated that the treatment (PUI) effect was significant (p less than 0.001). Therefore, it was concluded that the PUI in the basic principles of infection control is an effective instrument for nursing education.