[Reducing the Incidence of Incontinence Associated Dermatitis in Intensive Care Unit Diarrhea Patients].

BACKGROUND & PROBLEMS: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) DEVICES: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use. PURPOSE: To decrease the incidence of IAD from 34.72% to 22%. METHODS: The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system. RESULT: The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April - October 2014). CONCLUSION: This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.

[Coping strategies: bullying in the nursing workplace].

High nurse turnover rates and the related rise in patient-to-nurse ratios correlate with the integrity and maturity of nursing organizations and patient safety issues. Previous studies indicate bullying among nurses to be significantly related to high turnover rates and to impact negatively on the physical and mental health of nurses. The situation has been severe enough to lead to nurse suicides (Yildirim & Yildirim, 2007). In light of such, the International Council of Nurses (ICN) reviewed the literature about nursing workplace bullying and proclaimed the importance of fostering a positive work environment in 2007. Most studies on nursing workplace bullying have focused on western societies. In order to clarify the state of nursing bullying in Taiwan, this paper worked to summarize observations in the literature regarding the causes of and management strategies for nursing workplace bullying in order to increase the attention of nursing managers and staff toward this issue. The authors hope that this article may help raise awareness and both prevent nursing workplace bullying and reduce currently high turnover rates.