Monitoring Temperature: Knowledge and Skills of Outpatients With Cancer.

BACKGROUND: Elevated temperature can be the first sign of infection; obtaining an accurate temperature in patients undergoing chemotherapy is critical. OBJECTIVES: This study sought to determine outpatients' temperature-monitoring knowledge and skills; whether an educational DVD could increase knowledge; and the level of agreement between a home thermometer and a calibrated hospital thermometer. METHODS: The intervention was an educational DVD. Patients completed a survey and were observed taking their temperature. Investigators rated whether the correct steps were taken and then obtained the temperature. The bias and precision of the patient's thermometer were determined. FINDINGS: Knowledge scores averaged 68%. Most participants correctly identified elevated temperatures for fever (91%); less than 50% correctly identified other signs of infection, and less than 25% correctly identified activities that could falsely elevate or depress temperature readings.

Improving Mandatory Vaccination Against Influenza: Minimizing Anxiety of Employees to Maximize Health of Patients.

The objective was to describe qualitatively the attitudes among employees toward mandatory vaccination against influenza to ultimately improve such programs and prevent hospital-acquired influenza. Qualitative interviews were conducted with 21 employees at a freestanding children's hospital. Analysis of interview transcripts used grounded theory and the constant comparative method; codes were iteratively revised and refined as themes emerged. Themes emerged elucidating promoters and concerns. Promoters included a desire to protect self, family, and patients; perception of vaccination as part of professional responsibility; and free vaccination as a benefit from the organization. Concerns included negative feelings surrounding the forced nature and substantial anxiety about the physical injection. Participants expressed a strong desire for a private, compassionate, unhurried environment for the injection. Managing personal anxiety and a desire for privacy emerged as strong concerns among health care workers getting vaccinated at work. This information enabled future improvements in the mandatory vaccination campaign.

Do Elderly Patients Use Patient-Controlled Analgesia Medication Delivery Systems Correctly?

BACKGROUND: Although prior studies have shown patient-controlled analgesia (PCA) to be appropriate for use by children and adults, no studies have specifically evaluated the ability of elderly patients to use the technology correctly. PURPOSE: To determine whether elderly, postoperative patients can properly use PCA devices. METHODS: Using a descriptive study design, a convenience sample of elderly, postoperative orthopedic patients was observed while using a PCA device and surveyed about the proper use of the device. Participants were observed and surveyed 12 to 20 hours after admission to the postoperative patient care unit. Frequency and amount of analgesic medication administration over the postoperative time period were also recorded. Data were summarized with descriptive statistics and multiple regression analysis was used to determine whether confounding variables explained problems using the PCA device correctly. RESULTS: A total of 58 orthopedic patients were studied during the first day after surgery. Patients had used the PCA device for 16.6 ± 3.0 (mean ±SD) hours at the time of the observation and survey. Virtually all patients correctly identified and depressed the PCA activation button when instructed, knew when to use the PCA device, and who was allowed to depress the PCA button. Slightly more than half of the patients (57%) correctly identified how often they could have PCA medication, with 38% not sure of PCA medication frequency. The PCA medication was requested an average of 23.3 ± 52.7 times during the study period. The majority of the patients (86%) requested PCA medication less than 25% of the times that they could receive PCA medication. All patients in the study had PCA devices programmed to deliver up to 5 doses per hour of PCA medication, yet an average of 11.2 ± 10.8 doses of PCA medication were actually delivered during the entire study period (average 16.6 hours). Average doses of fentanyl and morphine sulfate received by patients were 13.5 µg/hour and 1.0 mg/hour, respectively. CONCLUSION: Elderly patients were very knowledgeable about how to use the PCA device but not about how often they could receive PCA medication. This lack of knowledge may have influenced how often they requested pain medication, because almost 90% of patients received less than 25% of the PCA allowable medication dose. This low usage of PCA medication delivery calls into question the cost-effectiveness of this method of medication delivery for the elderly. Additional studies are needed to verify these findings in other elderly patients.

Research priorities for nursing professional development: a modified e-Delphi study.

In 2010, the National Nursing Staff Development Organization Research Committee identified the need to delineate research priorities for nursing professional development (NPD). A Delphi study with 13 experts in NPD resulted in the identification of 24 priorities for the next 5 years. These priorities provide the future direction for NPD research and funding.

Immunogenicity of hepatitis B vaccine among hemodialysis patients: effect of revaccination of non-responders and duration of protection.

BACKGROUND: Hepatitis B vaccination is recommended for patients on hemodialysis, however, seroprotection after a primary vaccine series is suboptimum. Limited data are available on the effect of revaccination of non-responders and on persistence of immunity in this population. METHODS: Hepatitis B vaccine (40 µg/dose) was given to 77 susceptible patients on hemodialysis (0, 1, and 6 month schedule). Levels of hepatitis B surface antibody (anti-HBs) were tested ≥ 28 days after the third dose was administered, and non-responders revaccinated with an additional 3-dose series. Vaccine responders (anti-HBs ≥10 mIU/mL) were re-tested every 6 months and booster doses given as needed. Kaplan-Meier survival curve was used to estimate the probability of maintaining protective antibody level. Cox-proportional hazards models were used to assess the association between time to loss of protective antibody levels and certain explanatory variables. RESULTS: Overall primary vaccine-induced response was 79.2% (95% CI 68.2%, 87.3%), including 49/77 (63.6%; 95% CI 51.8%, 74.7%) patients who received the initial primary hepatitis B vaccine series and 12/21 (57.1%; 95% CI 34.4%, 77.4%) non-responders who were revaccinated with an additional series. Among weak responders (anti-HBs level 10.0-99.9 mIU/mL), protective antibody levels persisted in 44% for 12 months post-vaccination; whereas among strong responders (anti-HBs level ≥100 mIU/mL), protective antibody levels persisted in 92% for 12 months, and 68% for 24 months post-vaccination. A weak post-vaccination response increased the risk of losing protective antibody levels (adjusted hazard ratio, 9.7; 95% confidence interval, 3.5-28.5; p<0.0001). CONCLUSION: Revaccinating patients undergoing hemodialysis who do not respond to a primary vaccine series substantially increases the pool of protected patients. The threshold for defining hepatitis B vaccine-induced immunity should be revisited in this patient population to maximize the duration of protection.