Collaboration among registered nurses and practical nurses in acute care hospitals: A scoping review.

AIM: This study examined the extent, range, and nature of registered nurse (RN) and practical nurse (PN) collaboration in acute care hospitals and identified research gaps in the existing literature. BACKGROUND: Optimal patient care requires collaboration between RNs and PNs. A lack of unity and unresolved tension among different types of nurses influences collaboration and has significant implications on practice and the organizations where nurses work. METHODS: Using Arksey and O'Malley's (2005) framework, a scoping review was undertaken to answer the research question: what is known from the existing literature about the structures, processes, and outcomes of RN-PN collaboration in hospitals? RESULTS: Twenty-nine studies were included with the majority coming from North America. Donabedian's model assisted with the identification of three themes: scope of practice, interpersonal skills, and nurse and patient-related outcomes. CONCLUSION: The findings demonstrate there is a paucity of research specific to RN-PN collaboration. Nurse administrators/managers play an important role in addressing the interpersonal skills of nurses and providing an ongoing education on collaboration in the practice setting. Additional studies should focus on the development of nursing collaborative practice models of patient care, the examination of interventions to improve RN-PN collaborative practice, and the assessment of outcomes relating to collaboration among nurses.

Ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis.

BACKGROUND: The aim of this study is to describe a case of ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis (SE) and present a comprehensive review of the literature. METHODS: A 66-year-old man with a past medical history of coronary artery bypass graft (CABG) and polymylagia rheumatica (PMR) presented with a 2-day history of right-flank-to-groin pain and fever. He was found to have tenderness on the right of the umbilical region and laboratory data showed leukocytosis, raised C-reactive protein, and a significant drop in hemoglobin level as compared with his first visit 17 days earlier, with no hemodynamic instability. An immediate computed tomography angiogram (CTA) was performed, which showed a 4-cm, fusiform, ruptured infrarenal aortic aneurysm. Exploratory laparatomy was performed and the aorta was isolated and excised from the infrarenal level to the common iliac bificuration. A straight silver Dacron graft soaked in rifampicin was placed with an end-to-end anastomosis. The excised aorta and the lymph nodes were sent for histologic and microbiologic assessment. RESULTS: Blood culture and specimen microbiology grew Salmonella enteritidis (SE). The histology exhibited atherosclerosis at the rupture point with decreasing neutrophil deposition from the intima to the adventitia layer, respectively. CONCLUSIONS: Infrarenal abdominal mycotic aneurysm (MA) by SE was observed and showed vague, nonspecific signs and symptoms. We recommend a high index of suspicion and low threshold for use of CT imaging in any infected patient of age >60 years with fever and abdominal pain on a background of diabetes and connective tissue disease. A comprehensive review of the literature was performed due to a lack of consensus on the best surgical treatment and limited information on the path of SE-induced aortitis or MA from presentation to final outcome.