Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 6 Articles
Background: Despite global efforts, HIV-related stigma continues to negatively impact the health and well-being of\npeople living with HIV/AIDS. Even in healthcare settings, people with HIV/AIDS experience discrimination. Anecdotal\nevidence suggests that healthcare professionals in the Lao People's Democratic Republic, a lower-middle income country\nsituated in Southeast Asia, stigmatize HIV/AID patients. The purpose of this study was to assess HIV stigmatizing attitudes\nwithin Laotian healthcare service providers and examine some of the factors associated with HIV/AIDS-related stigma\namong doctors and nurses.\nMethods: A structured questionnaire, which included a HIV-related stigma scale consisting of 17 items, was\nself-completed by 558 healthcare workers from 12 of the 17 hospitals in Vientiane. Five hospitals were excluded because\nthey had less than 10 staff and these staff were not always present. The questionnaire was pre-tested with 40 healthcare\nworkers. Descriptive statistical analysis was performed and comparisons between groups undertaken using chi-square test\nand t-test. Bivariate and multiple linear regression analyses were carried out to examine the associations between\nstigmatizing attitudes and independent variables.\nResults: Out of the 558 participating healthcare workers, 277 (49.7%) were doctors and 281 (50.3%) were nurses. Nearly\n50% of doctors and nurses included in the study had high levels of stigmatizing attitudes towards people living with\nHIV/AIDS. Across the different health professionals included in this study, lower levels of HIV/AIDS knowledge were\nassociated with higher levels of stigmatizing attitudes towards people living with HIV/AIDS. Stigmatizing attitudes,\nincluding discrimination at work, fear of AIDS, and prejudice, were lower in healthcare workers with more experience\nin treating HIV/AIDS patients.\nConclusions: This study is the first to report on HIV/AIDS-related stigmatization among healthcare workers in Lao PDR.\nStigmatizing attitudes contribute to missed opportunities for prevention, education and treatment, undermining efforts\nto manage and prevent HIV. Reversing stigmatizing attitudes and practices requires interventions that address affective,\ncognitive and behavioral aspects of stigma. Alongside this, health professionals need to be enabled to enact universal\nprecautions and prevent occupational transmission of HIV....
Background: Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to\nreduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project\nwas to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful\nadoption and sustainability in an ICU of a Veterans Administration Hospital.\nMethods: We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13\nregistered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU. We used qualitative content analysis to\ncode and analyze the data. Dedoose software was used to facilitate data management and coding. Trustworthiness and\nscientific integrity of the data were ensured by having two authors corroborate the coding process, conducting member\nchecks and keeping an audit trail of all the decisions made.\nResults: Duration of the interviews was 15 to 39 min (average = 26 min). Five steps of bathing were identified: 1)\ndecision to give a bath; 2) ability to give a bath; 3) decision about which soap to use; 4) delegation of a bath; and 5)\ngetting assistance to do a bath. The bathing process resulted in one of the following three outcomes: 1) complete\nbath; 2) interrupted bath; and 3) bath not done. The outcome was influenced by a combination of barriers and\nfacilitators at each step. Most barriers were related to perceived workload, patient factors, and scheduling. Facilitators\nwere mainly organizational factors such as the policy of daily CHG bathing, the consistent supply of CHG soap, and\nsupport such as reminders to conduct CHG baths by nurse managers.\nConclusions: Patient bathing in ICUs is a complex process that can be hindered and interrupted by numerous factors.\nThe decision to use CHG soap for bathing was only one of 5 steps of bathing and was largely influenced by scheduling/\nworkload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and\ngeneral hygiene. Interventions that address the organizational, provider, and patient barriers to bathing could improve\nadherence to a daily CHG bathing protocol....
Background: Providing end of life care in rural areas is challenging. We evaluated in a pilot whether nurse\npractitioner (NP)-led care, including clinical care plans negotiated with involved health professionals including the\ngeneral practitioner(GP), Ã?± patient and/or carer, through a single multidisciplinary case conference (SMCC), could\ninfluence patient and health system outcomes.\nMethods: Setting ââ?¬â?? Australian rural district 50 kilometers from the nearest specialist palliative care service.\nParticipants: Adults nearing the end of life from any cause, life expectancy several months. Intervention- NP led\nassessment, then SMCC as soon as possible after referral. A clinical care plan recorded management plans for\ncurrent and anticipated problems and who was responsible for each action. Eligible patients had baseline, 1 and\n3 month patient-reported assessment of function, quality of life, depression and carer stress, and a clinical record\naudit. Interviews with key service providers assessed the utility and feasibility of the service.\nResults: Sixty-two patients were referred to the service, forty from the specialist service. Many patients required\nimmediate treatment, prior to both the planned baseline assessment and the planned SMCC (therefore ineligible\nfor enrollment). Only six patients were assessed per protocol, so we amended the protocol. There were 23 case\nconferences. Reasons for not conducting the case conference included the patient approaching death, or assessed\nas not having immediate problems. Pain (25 %) and depression (23 %) were the most common symptoms\ndiscussed in the case conferences. Ten new advance care plans were initiated, with most patients already having\none. The NP or RN made 101 follow-up visits, 169 phone calls, and made 17 referrals to other health professionals.\nThe NP prescribed 24 new medications and altered the dose in nine. There were 14 hospitalisations in the time\nframe of the project. Participants were satisfied with the service, but the service cost exceeded income from\nnational health insurance alone.\nConclusions: NP-coordinated, GP supported care resulted in prompt initiation of treatment, good follow up, and a\ncare plan where all professionals had named responsibilities. NP coordinated palliative care appears to enable more\nintegrated care and may be effective in reducing hospitalisations....
Background: Time trends and seasonal patterns have been observed in nurse staffing and nursing-sensitive patient\noutcomes in recent years. It is unknown whether these changes were associated.\nMethods: Quarterly unit-level nursing data in 2004ââ?¬â??2012 were extracted from the National Database of Nursing\nQuality IndicatorsÃ?® (NDNQIÃ?®). Units were divided into groups based on patterns of missing data. All variables were\naggregated across units within these groups and analyses were conducted at the group level. Patient outcomes\nincluded rates of inpatient falls and hospital-acquired pressure ulcers. Staffing variables included total nursing hours\nper patient days (HPPD) and percent of nursing hours provided by registered nurses (RN skill-mix). Weighted linear\nmixed models were used to examine the associations between nurse staffing and patient outcomes at trend and\nseasonal levels.\nResults: At trend level, both staffing variables were inversely associated with all outcomes (p < 0.001); at seasonal\nlevel, total HPPD was inversely associated (higher staffing related to lower event rate) with all outcomes (p < 0.001)\nwhile RN skill-mix was positively associated (higher staffing related to higher event rate) with fall rate (p < 0.001)\nand pressure ulcer rate (p = 0.03). It was found that total HPPD tended to be lower and RN skill-mix tended to be\nhigher in Quarter 1 (January-March) when falls and pressure ulcers were more likely to happen.\nConclusions: By aggregating data across units we were able to detect associations between nurse staffing and\npatient outcomes at both trend and seasonal levels. More rigorous research is needed to study the underlying\nmechanism of these associations....
Background: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads\nto better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is\nless clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care\nfacilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we\nfocus on BRNs, as they are expected to serve as role models and change agents, while little is known about their\nunique contribution to quality of care in long-term care facilities.\nMethods: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term\ncare facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for\nbackground characteristics, i.e. ward size, and residents� age, gender, length of stay, comorbidities, and care\ndependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach,\nwere performed.\nResults: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care\nper resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a\nfall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher,\nwhereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among\nresidents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident\nwas lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from\nnosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs.\nConclusions: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of\ncare on most wards was acceptable. No consistent evidence was found for a relationship between the presence of\nBRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider\nthe mediating and moderating role of staffing-related work processes and ward environment characteristics on quality\nof care....
Background: Delirium is a common clinical problem with acute and fluctuating onset. Early notification of its\nsymptoms can lead to earlier detection and management of this state. Valid and reliable instruments are required\nfor successful nursing practice. The purpose of the study was to psychometrically test the Finnish versions of the\nNeecham Confusion Scale (NEECHAM) and the Nursing Delirium Screening Scale (Nu-DESC) in surgical nursing care,\nutilizing the Confusion Assessment Method (CAM) algorithm as a comparison scale.\nMethods: This randomized, blinded, instrument testing study was conducted at one university hospital in one\nsurgical unit. Study patients (n = 112) meeting the pre-set criteria were assessed by the principal investigator (PI)\nand a registered nurse (RN, n = 18). Internal consistency, inter-rater reliability, and concurrent validity of the scales\nwere calculated and face validity and usability evaluated.\nResults: Internal consistency was from .76 to .86 for all three scales. Inter-rater reliability between PI and RNs was\n.87 with NEECHAM, .60 with CAM and .47 with Nu-DESC. Concurrent validity was .56 and .59 between CAM and\nNEECHAM, and .68 and .72 between NEECHAM and Nu-DESC. In the PI group, the correlation between CAM and\nNu-DESC was .91, in the RN�s group .42. Nu-DESC was evaluated as the most usable scale.\nConclusion: The findings strengthen the earlier research on the scales and indicate that the Finnish NEECHAM and\nNu-DESC correlates with CAM algorithm and with each other. They seem to be clinically viable in assessing\npatients� delirium in surgical wards but more validity testing is needed....
Loading....