Continuous quality improvement project: decreasing the potential for the development in the inpatient setting of drug resistance by improving nursing practice for HAART administration.

HIV/AIDS patients' dissatisfaction with highly active antiretroviral therapy (HAART) medication administration in the inpatient setting was the impetus for a continuous quality improvement (CQI) project. The purpose of the CQI project was to initiate a change in nursing practice for HAART medication administration. The goal of the project was to decrease the potential for development of drug resistance in the inpatient setting related to nonadherence with food requirements for drug administration and to incomplete or "missed" doses of prescribed HAART. A secondary goal was to increase the provision of patient education on HAART medications by nurses. The interdisciplinary CQI team found that medication administration in the inpatient setting involved more than nurses simply "passing meds." Inpatient medication administration was a complex process involving a variety of hospital systems, departments, and traditions, all of which had an impact on patient care. The article describes the CQI methodology that was used for the project and how each step of the project was planned and implemented. Specific problems related to administering HAART in the hospital setting are listed as areas for needed nursing research.

Body temperature alterations in hospitalized HIV/AIDS patients.

Because of the questions raised by the staff nurses regarding their observations of fever and alterations in body temperature in AIDS patients, a nursing research study was conducted to examine the incidence and degree of temperature elevation in hospitalized AIDS patients. Study findings suggest that temperature elevation and fever are common occurrences in hospitalized HIV/AIDS patients, although the fever may be self-limiting. An elevation in the white blood cell count was not seen, making fever in HIV/AIDS patients different than other medical/surgical patients. Phenomena noted by staff nurses in the clinical setting should be verified by nursing research because the data derived from nursing observation can be used in designing nursing interventions.

Knowledge, perceptions, and practice of nurses toward HIV+/AIDS patients diagnosed with tuberculosis.

BACKGROUND: Tuberculosis (TB) continues to be a major health problem in the United States. Nurses may be exposed to TB and not realize their risks for becoming infected. The presentation of HIV-associated TB is somewhat different from "standard TB." PURPOSE: The purpose of this study was to determine if an educational program could improve nurses' attitudes, level of knowledge, and compliance with infection control standards for HIV/AIDS patients diagnosed with TB. METHOD: Participants included 50 staff nurses. The experimental group (35) and control group (15) completed a knowledge test and an attitude survey. Researchers observed participants for compliance with infection control standards pretest and posttest. RESULTS: Following an educational program, the experimental group demonstrated a greater knowledge of TB than the control group who did not participate in the educational program (F [1.47] = 14.43, p = .000). In addition, the experimental group had a greater improvement in their Nursing Intervention Observation Tool adherence to respiratory isolation and universal precaution protocols scores as compared to the control group (F [1.47] = 8.95, p = .004). However, there was not a tangible increase in knowledge level of AIDS, attitudes or concerns about caring for these patients. CONCLUSION: This nursing research study supports the need for an ongoing educational program with continual monitoring of infection control practices to positively affect client and caregiver outcomes.

Length of stay. Significant variables.

An analysis of data from medical records of 500 patients discharged from an acute care hospital in 1983 found seven of ten variables studied to be significantly related to length of stay. The results of this correlational study can lead to experimental research to determine the effects of nursing care on length of stay, which greatly affects hospitals' financial survival.

Consultation and referral between physicians in new medical practice environments.

The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.