Emergency Response: A Cross-sectional Study of Core Competencies for Nurses Regarding Major Infectious Disease Outbreaks

INTRODUCTION

The core competencies of nursing personnel have been identified as a main factor affecting nursing effectiveness. This study examined core emergency response competencies of Chinese nursing personnel related to the outbreak of major infectious diseases.

METHODS

A survey was conducted among 960 nurses working in a tertiary hospital in Shanghai, China. Data were collected on core emergency response competencies of nursing personnel caring for patients with major infectious diseases, measuring overall competency as well as by dimensions of prevention ability, rescue ability, and preparation ability. A t-test and one-way analysis of variance were first analyzed for differences between groups, followed by multiple linear regression to analyze main influencing factors for core emergency response competencies.

RESULTS

The average score for core emergency response competencies of nursing personnel delivering care to patients with major infectious diseases was 128.05 (SD 22.23) (range 36-180 points); or 71%, which is equivalent to moderate performance. Multiple linear regression analysis demonstrated that the main influencing factors for these nursing personnel were before participation in emergency drills for infectious diseases, current educational background, and working experience in the realm of infectious disease nursing. The final model explained 8.4% of the variance in core emergency response competencies.

DISCUSSION

These findings indicate that it is necessary to strengthen the training of nursing staff with educational background deficits or no prior work or drill experience related to infectious diseases to effectively improve the core emergency response competencies of nursing personnel relative to infectious diseases.

Caring for the Youngest Students: The ABCs of Preschool Nursing

Caring for the preschool population presents unique challenges for the school nurse. These challenges are multiplied when the population includes those with special needs. Challenges include multiple risks to safety related to developmental stage, increased prevalence of infectious diseases due to the development of the child's immune system, management of chronic disease because of the student's ability to comprehend and follow directions, and many social and emotional issues. Using evidence-based strategies, the preschool nurse can gain the confidence to care for the youngest students.

An Integrated Intervention for Increasing Clinical Nurses' Knowledge of HIV/AIDS-Related Occupational Safety

Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses’ knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ² = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) (χ² = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre-test knowledge scores on universal precautions were relatively high. Correct answers about universal precautions improved significantly from pre-test (83.71%) to post-test (89.58%; χ² = 25.00, p = 0.00). After the intervention, nurses’ attitude scores improved significantly from pre-test (3.80 ± 0.79) to post-test (4.06 ± 0.75; t = 3.74, p = 0.00). Conclusions: Integrated educational interventions enhance nurses’ knowledge of risk reduction for occupationally acquired HIV infections and improve the observance of universal precautionary procedures. This enhancement allows nurses to assume a teaching role for prevention and management of HIV/AIDS.

Transplant infectious disease: implications for critical care nurses

Infection is an important issue for critical care nurses as they care for patients throughout all phases of the transplant continuum: potential organ donors, transplant candidates, and transplant recipients. This article has reviewed salient issues relative to infections in each of these patient populations, including patients with VADs, and has highlighted key points pertaining to bacterial, viral, and fungal infections.

Considering place in community health nursing

When a geographic location is assigned meaning, it becomes a place. The authors argue that place matters as both geographical location and lived experience. They extend the current conceptualization of nursing geography to encompass community health nursing and address intricacies of community nursing practice and research that often go unnoticed. They do so by exploring the notion of place in home and community, including the structural/spatial dimensions of the nurse-client relationship. The authors review the health geography literatures, then discuss the implications for practice and research in community health. They invite community health nurses to critically examine their practice and research with reference to such issues as the power of the nurse, marginalized places as determinants of health, and how best to care for clients living in diverse community settings.

Contamination: nursing diagnoses with outcome and intervention linkages

PURPOSE

To relate the collaborative processes involved in the evolution of environmental nursing diagnoses and the linkages between two new nursing diagnoses and their associated interventions and outcomes; to describe the environmental health implications of contamination.

DATA SOURCES

Published research articles, official reports, textbooks, and collaborative discussion with experts in community and global health.

DATA SYNTHESIS

Reflection following review of the literature and collaboration with experts led to the development of a new schema for environmental diagnoses and development of two new diagnoses, allowing for greater clarity and distinction between the contamination diagnoses and risk for poisoning diagnosis.

CONCLUSIONS

An environmental nursing diagnosis schema, with its emphasis on contamination, infection, and violence, provides nurses with a holistic framework for making judgments about environmental influences related to individual, family, community, and global health. The diagnoses of Contamination and Risk for Contamination provide necessary language to describe human responses and risk states that may arise following exposure to environmental contaminants.

PRACTICE IMPLICATIONS

Development of environmental diagnostic labels and delineation of the linkages to nursing outcomes and interventions will allow nurses to take active roles in identifying environmental components that affect health and planning care that responds to environmental health needs. Greater clarity in the use of language will allow nurses to incorporate environmental concepts appropriately in nursing assessments and improve the accuracy of the diagnostic process and selection of distinct interventions and outcomes. This will result in better outcomes for patients and communities and permit greater accountability of nursing's contribution to environmental health.

Nursing research and the prevention of infectious diseases among vulnerable populations

Racial and ethnic minorities, women and infants, youth, and other special needs populations have been found to be disproportionately affected by infectious disease morbidity and mortality, particularly Human Immunodeficiency Syndrome/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other sexually transmitted diseases (STDs). Being a vital component of the health care delivery system, nurses play an important role in improving the health of these vulnerable populations. Twenty-six studies reporting results from evaluations of prevention strategies targeting HIV/AIDS and other STDs among vulnerable populations were reviewed. The more effective interventions appeared to be those that tailored their program content to the specific risk factors of their target population and included skills training in their curriculum. Although nurses have contributed significantly in understanding the risk factors of vulnerable groups in the United States through cross-sectional research studies, more research is needed in the evaluation of intervention programs that use this knowledge to develop and implement prevention programs, particularly at a population-based level.

Student nurses' experiences of caring for infectious patients in source isolation. A hermeneutic phenomenological study

AIM

To illuminate issues central to general student nurses' experiences of caring for isolated patients within the hospital environment, which may assist facilitators of learning to prepare students for caring roles.

BACKGROUND

Because of the development of hospital-resistant micro-organisms, caring for patients in source isolation is a frequent occurrence for supernumerary students on the general nursing programme. Despite this, students' perceptions of caring for this client group remain under researched.

DESIGN AND METHODS

Through methods grounded in hermeneutic phenomenology, eight students in the second year of the three-year undergraduate programme in general nursing were interviewed using an un-structured, open-ended and face-to-face interview approach. Data analysis was approached through thematic analysis.

RESULTS

Four themes emerged: The organization: caring in context, Barriers and breaking the barriers, Theory and practice, Only a student. The imposed physical, psychological, social and emotional barriers of isolation dramatically alter the caring experience. Balancing the care of isolated patients to meet their individual needs while preventing the spread of infection has significance for students. Applying infection control theory to the care of patients in source isolation is vital for students' personal and professional development. Perceptions of supernumerary status influence students' experiences of caring for these patients.

RELEVANCE TO CLINICAL PRACTICE

Designating equipment for the sole use of isolated patients assists students in maintaining infection control standards. Balancing the art and science of caring for patients in source isolation is important to reduce barriers to the student-patient relationship and to promote delivery of holistic care. Staff nurses should consider using available opportunities to impart recommended isolation practices to students thereby linking the theory of infection control to patient care. Providing structured, continuing education for all grades of staff would acknowledge the interdependence of all healthcare workers in controlling hospital-acquired infection.

When disaster strikes

In response to the healthcare issues resulting from Hurricane Katrina, The Nurse Practitioner has compiled information from the Centers for Disease Control and Prevention (CDC) to educate nurse practitioners (NPs) about previously uncommon illnesses presenting in the wake of the disaster, CDC recommendations on immunizations and infection prevention, and guidelines for providing proper wound care. Visit http://www.cdc.gov for full text of these articles.

Nurses and the control of infectious disease. Understanding epidemiology and disease transmission is vital to nursing care

Epidemiology examines the distribution and source of a disease in a population. Understanding epidemiology and disease transmission is vital to nursing care. Infectious disease transmission requires three components: an agent (virus, bacterium, parasite or other microbe), a vulnerable host and a conducive environment. Disease spread can occur through direct contact or via indirect methods (airborne droplets, vectors, fomites, water or food). Intervention can occur by attacking the agent (e.g., using microbicides), changing the environment (e.g., providing negative pressure rooms) or strengthening the host (e.g., vaccination). Three epidemiologically relevant microbes are the SARS (severe acute respiratory syndrome)-associated coronavirus, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile). The first is an emerging pathogen, and the latter two are existing agents that have mutated such that they are resistant to their standard treatments. For SARS, control measures include screening for possible cases and appropriate triage, respiratory and barrier precautions within the healthcare facility, and voluntary isolation in the community for contacts or healthcare workers who exhibit symptoms. Control measures for MRSA include the screening of patient lesions, isolating or cohorting patients who are already infected, covering wounds with impermeable dressings, treating staff and patient carriers with antibiotics, and improved hygiene. Control measures for C. difficile Control measures include paying close attention to the hygiene of the clinical setting, disinfecting using bleach and the isolation of infected patients.

Effect of total attending period on infection episode rate in a child-care center

BACKGROUND

Attendance to a child-care facility is known to be associated with increased rate of episodes of infectious diseases in children. This retrospective cohort study investigates the infection episode rate and the effect of total attending period on infection episode rates in a child-care center (Gulveren Child-Care Center, Ankara, Turkey), at a stable environmental condition, over a 7-year follow-up period.

METHODS

During the study period, 288 children attended the center and enrolled. Sex, total duration of breastfeeding, starting age at the center, total duration of attendance, and the type and frequency of infections diseases were recorded. Episode rates were calculated for each child.

RESULTS

The mean starting age at the child care center was 4.1 +/- 0.7 years (range: 2.5-5.8 years); the mean total duration of attendance at the center was 20.4 +/- 9.9 months. Over the study period, 1000 infection episodes were detected. The general infection episode rate was calculated as 2.04/child per year. In bivariate analysis, children with longer attendance period (> or =12 months), and a younger starting age at the center (<4 years of age) had lower 'moderate general infection' (> or =3 episode/child per year) episode rates than those of other groups. In multiple logistic regression analysis, only total attending period in the center was significantly associated with 'moderate' level general infection episode rate. The presence of asthma slightly increased the lower respiratory tract infections episode rate in bivariate analysis, and was the only significant predictor of LRTI episode rate in multivariate analysis.

CONCLUSIONS

The results of the present study show that among children attending a single facility, longer periods of attendance at the facility was associated with a decreased risk of general infection episode, regardless of starting age at the center. Additional cohort studies are needed to determine whether this reduction in general infection episode rate extends into school-age years and whether children moving between different centers affects the incidence of infectious episodes.

Clinical nurse specialists and nurse practitioners: complementary roles for infectious disease and infection control

BACKGROUND

The escalation of infectious diseases worldwide heralds an unprecedented need for nurses with advanced practice graduate preparation.

OBJECTIVE

To describe how a graduate program prepares clinical nurse specialists and nurse practitioners in infectious diseases or infection control to provide distinct yet complementary care for patients with contagious disease and potentially antimicrobial-resistant infections.

RESULTS

The University of Washington School of Nursing launched a new master of nursing program for infectious disease and infection control to reduce the threat of infectious diseases and multiple-resistant organisms.

Establishing nursing research priorities on a paediatric haematology, oncology, immunology and infectious diseases unit: involving doctors and parents

Following a Delphi survey undertaken with nurses on a specialist children's unit to identify priorities for nursing research, this paper outlines the results of a survey to ascertain the views of doctors and parents regarding the results of the Delphi. This approach was in keeping with national guidance on multi-professional working in paediatric oncology and the importance of service-user involvement in planning and evaluating care. Convenience samples of doctors (n=16) and parents (n=10) were asked to rank the priorities previously identified by nurses. Results highlighted that in the main, nurses, doctors and parents agreed on the key areas that should take priority for research. Nurse's knowledge of day-to-day symptom management, children's quality of life, negotiation and communication in relation to care provision were identified by all three groups as high priorities. There were some areas where the views varied: this was generally in relation to the different primary focus of the individual groups-parents being very concerned with the effect of daily ward routines and procedures and their child's overall hospital experience, nurses with issues such as staff retention and morale, whereas doctors were more concerned with issues around information giving and consent to treatment. Limitations of the study, including sample selection and the transient nature of the population involved are discussed within the paper. The paper concludes that all three groups shared similar views, being focused on issues directly related to patient care. Consensus between the groups should result in future research initiatives reflecting a shared focus and responding to an identified need.

Applicability of the International Classification of Nursing Practice (ICNP) in the areas of nutrition and skin care

PURPOSE

To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the ICNP in the context of standardized nursing care planning in a clinical setting.

METHODS

An 35-bed acute care ward for infectious diseases at a Swedish university hospital was selected for clinical testing. A convenience sample of 56 patient records with data on nutrition and skin care was analyzed and mapped to the ICNP.

FINDINGS

Using the ICNP terminology, 59%-62% of the record content describing nursing phenomena and 30%-44% of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily. For about a quarter of the content describing nursing phenomena and interventions, no corresponding ICNP term was found.

CONCLUSIONS

The ICNP needs to be further developed to allow representation of the entire range of nursing care. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focus, and duration.

PRACTICE IMPLICATIONS

The practical usefulness of the ICNP needs further testing before conclusions about its clinical benefits can be determined.

Five-year surveillance of patients with communicable diseases nursed in isolation

During a five year surveillance program of patients with communicable diseases nursed in isolation, we gathered information on 2880 patients who were nursed in isolation for 28 145 days, from January 1994 to December 1998. The mean number of patients nursed in isolation was 575.4 (range, 427-709) per year. On average 2.4% of patients admitted yearly to the University Medical Center (UMC) were nursed in isolation. The mean number of days nursed in isolation was 9.8 days per patient.1996 was a peak year in isolations due to outbreaks of gentamicin-resistant enterobacteriaceae (GRB) and methicillin resistant Staphylococcus aureus (MRSA). The main reasons for requiring isolation were: GRB, MRSA (proven and suspected cases), Clostridium difficile, viral infections and Mycobacterium tuberculosis. Registration of quantitative data on nursing patients in isolation, as presented in this paper, makes it possible to gain insight into the type and number of isolation indications, the required isolation room capacity on different wards, the workload of healthcare workers resulting from isolation and the trends in incidence of communicable diseases.

[Nursing in transmissible diseases: how to approach this topic in nursing graduation?]

This study relates the attempts of the discipline Collective Health Nursing with focus in transmissible diseases to reorganize its teaching object, its theoretical and practical content, and its pedagogical atrategics, as a contribution to the formation of a nursing professional compromised with Collective Health. It describes the context of Collective Health in Brazil and the characteristics needed to improve the implementation of the Unified Health Care System in the Country. It also reports the content and the padagogical strategics used in the discipline and makes a critical analysis of its potentialities and limitations to the proposed goal.

Taking care as a relationship: a phenomenological view

The purpose of this study was to understand and analyse the meanings given to caring of patients on the isolation ward by nursing students, focusing particularly on the aspects of communication and interpersonal relationships. The data were collected from individual interviews with 18 nursing students who were performing nursing practice on the isolation ward. The results, analysed and interpreted according to existential phenomenology, describe the structure of the phenomenon 'taking care on the isolation ward' from a relational perspective. The students described their difficulties and anxieties, as well as their willingness to take care of isolated patients, resulting in the overcoming of obstacles and in contacting and becoming involved when taking care of these patients.

[Expectations of hospitalized patients as to their relationship with the nursing team]

This research has been made in infectious-parasitary disease sector of a public university hospital in Rio de Janeiro on the first semester of 1995. The logbook research has been introduced to 5 adult clients, from both sexes, who had been interned in the construction of two categories, which are: a) Category I: Feelings and expectations of the client and; b) Category II: Communication and relationship between client and nurse. The results found in the first category were: 1) Lack of affection; 2) Affection, fear and anxiety; 3) Loneliness and depression; 4) Reflection; 5) Insecurity; 6) Worry about the equipment, to be cut, to be impersonally treated, lose self-control and physical dependence. The results found in the second category were: 1) Doubts and interests in information about their disease, its evolution and how long they will stay in hospital: 2) Opportunity to express feelings and ideas; 3) Comprehension of the message given by the nurse. We emphasize the increase of interchange of information, ideas, beliefs, feelings and acts in nurse-client interaction to develop the therapeutic relationship aiming at helping the client to fulfill his basic needs.

Satisfaction with nursing care: a comparison of patients with HIV/AIDS, non-HIV/AIDS infectious diseases, and medical diagnoses

The purpose of this study was to describe patients' perceptions of nursing care and compare those perceptions based on patients' diagnoses (HIV/AIDS, non-HIV/AIDS infectious diseases, and medical diagnoses). One hundred forty-two patients on five units in a major medical center were surveyed using the Patient Satisfaction Instrument. In addition, 126 staff nurses completed the AIDS Vulnerability Survey. Results of data analysis indicated a statistically significant difference in patient satisfaction with nursing care among patients in the medical group compared to patients in the HIV/AIDS group, with the medical group being more satisfied with their nursing care. Further, there was a statistically significant difference across units between nurses' knowledge, attitude, and fear. In spite of their knowledge base related to HIV/AIDS, nurses felt vulnerable when providing care to this population, thus perpetuating fear and negative attitudes. Additional research into the dynamics of these relationships is imperative as we continue to see increases in the number of patients with HIV/AIDS.

Primary care for women. Management of common problems of the head and neck

As the companion article to Part I of the Journal of Nurse-Midwifery (JNM) series on "Primary Care for Women: Comprehensive Assessment of the Head and Neck", the pertinent primary care management steps involved in the prevention and treatment of problems of the head and neck in women are addressed. Emphasis is placed on the diagnosis and management of the most common head and neck illnesses; less common diagnoses that may be acute, seasonal, and/or life-threatening are also presented. Collaborative roles in the management of women with problems of the head and neck are discussed, and emphasis is placed on the importance of both preventive strategies and coordination of referrals.