Using War Language in a Pandemic: Rhetoric or Responsibility?

Frontline workers deserve protection and follow-up support.

The economic impact of rostering junior doctors to triage to assist nursing staff in the early part of the patient journey through the emergency department

Objective

This study aims to determine whether redeploying junior doctors to assist at triage represents good value for money and a good use of finite staffing resources.

Methods

We undertook a cost-minimisation analysis to produce new evidence, from an economic perspective, about the costs associated with reallocating junior doctors in the emergency department. We built a decision-analytic model, using a mix of prospectively collected data, routinely collected administrative databases and hospital costings to furnish the model. To measure the impact of uncertainty on the model’s inputs and outputs, probabilistic sensitivity analysis was undertaken, using Monte Carlo simulation.

Results

The mean costs for usual care were $27,035 (95% CI $27,016 to $27,054), while the mean costs for the new model of care were $25,474, (95% CI $25,453 to $25,494). As a result, the mean difference was -$1,561 (95% CI -$1,533 to -$1,588), with the new model of care being a less costly approach to managing staffing allocations, in comparison to the usual approach.

Conclusion

Our study shows that redeploying a junior doctor from the fast-track area of the department to assist at triage provides a modest reduction in cost. Our findings give decision-makers who seek to maximise benefit from their finite budget, support to reallocate personnel within the ED.

Original Research: Suicidal Ideation and Attitudes Toward Help Seeking in U.S. Nurses Relative to the General Working Population

PURPOSE

Although previous studies have revealed professional consequences of burnout among nurses, less is known about the potential personal consequences. This study investigated the prevalence of suicidal ideation and attitudes toward help seeking among U.S. nurses relative to other workers, and the extent to which personal and professional factors, including burnout, were related to suicidal ideation.

METHODS

In November 2017, a cross-sectional survey was sent to 86,858 nurses who were members of the American Nurses Association and to a probability-based sample of 5,198 U.S. workers. The survey included questions regarding suicidal ideation, burnout, symptoms of depression, individual and professional characteristics, and willingness to seek professional help if a serious emotional problem arose. Multivariable logistic regression analyses were conducted to identify factors associated with suicidal ideation after controlling for other factors.

RESULTS

Among the 7,378 nurse respondents, 403 (5.5%) reported having suicidal ideation within the past year. Most nurses (84.2%) indicated willingness to seek professional help for a serious emotional problem. Yet nurses with suicidal ideation were less likely to report that they'd seek such help (72.6%) than nurses without suicidal ideation (85%). In a multivariable analysis of nurses' data, after controlling for other personal and professional characteristics, we found that burnout was strongly associated with suicidal ideation. Adjusted combined multivariable analyses showed that nurses were more likely than other workers to have suicidal ideation. Both nurses and other workers who reported suicidal ideation were less likely to seek help than were those who did not report such ideation.

CONCLUSIONS

Compared with other U.S. workers, nurses are at higher risk for suicidal ideation, and nurses with such ideation are more reluctant to seek help than those without it. Burnout contributes to the risk of suicidal ideation. These issues warrant greater attention. Systems- and practice-level interventions must be identified and implemented, both to address the higher prevalences of burnout and suicidal ideation in nurses and to mitigate the stigma about mental health problems and other barriers to seeking help.

Development of the Perception of Opioid Use Survey Instrument

BACKGROUND AND PURPOSE

A new instrument was designed specifically to evaluate nurses' knowledge, attitude, and practice toward patients who use opioids. This study team developed and tested the psychometric properties of the Perception of Opioid Use Survey (POUS) instrument.

METHODS

The instrument was tested among 306 nurses at a 183 bed acute care community hospital, with psychometric evaluation for validity, reliability, and exploratory factor analysis.

RESULTS

Internal consistency results were Cronbach's alpha = .550 for the overall scale and each subscale: Self-Efficacy = .796, Attitudes = .744, Community Impact = .806, and Causative Factors = .763.

CONCLUSIONS

Psychometric testing results support that the POUS is valid, reliable, and significantly correlated with theoretically selected variables.

Depression and anxiety prevalence in nursing staff during the COVID-19 pandemic

This article reviews a study to determine the effects of COVID-19 on the rate of depression and anxiety in nurses and to identify potential strategies that nurse leaders can implement to reduce depression and anxiety in their staff.

Diversifying the health workforce: a mixed methods analysis of an employment integration strategy

BACKGROUND

Historically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions.

METHODS

A mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted.

RESULTS

In total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer.

CONCLUSIONS

The project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.

Nurses and Patients' Perspectives on Spiritual Health Assessment

Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.

Prayer Moderating Job Stress Among Muslim Nursing Staff at the University of Malaya Medical Centre (UMMC)

This study examines how Salat (prayer) in Islam moderates the relationship between job stress and life satisfaction among Muslim nursing staff. The researchers sampled 335 nursing staff employed at the University of Malaya Medical Centre in Kuala Lumpur, Malaysia. Their ages ranged from 21 to 60 years. The findings indicate the job stress was associated negatively with life satisfaction; there is a strong positive and significant correlation, respectively, between Salat and life satisfaction and that Salat reduces stress and increases the life satisfaction of Muslim nurses. Thus, Salat has a moderating effect on job stress and life satisfaction of Muslim nurses.

Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011-2015

PURPOSE

Critical care medicine continues to evolve. However, critical care cases require increasing amount of medical resources. Intensive care unit (ICU) mortality significantly impacts the overall efficiency of healthcare resources within a system of limited medical resources. This study investigated the factors related to ICU mortality using long-term nationwide cohort data in South Korea.

MATERIALS AND METHODS

This retrospective cohort study used data of 14905721 patients who submitted reimbursement claims to the Korean Health Insurance Service between January 1, 2011 and December 31, 2015. A total of 1498102 patients who were admitted to all ICU types, except neonatal and long-term acute care hospitals, were enrolled.

RESULTS

Of the total 1498102 participants, 861397 (57.5%) were male and 636705 (42.5%) were female. The mean age at admission was 63.4±18.2 years; most of the subjects were aged over 60 years. During the 5-year period, in-hospital mortality rate was 12.9%. In Cox analysis, both in-hospital and 28-day mortality rates were significantly higher in male patients and those of lower socioeconomic status. As age increased and the number of nursing staff decreased, the mortality risk increased significantly by two or three times. The mortality risk was lower in patients admitted to an ICU of a tertiary university hospital and an ICU where intensivists worked.

CONCLUSION

The number of nursing staff and the presence of an intensivist in ICU were associated with the ICU mortality rate. Also, increasing the number of nursing staff and the presence of intensivist might reduce the mortality rate among ICU patients.

Pressure injury related to the use of personal protective equipment in COVID-19 pandemic

OBJECTIVE

To describe the prevalence and factors associated with pressure injuries related to the use of personal protective equipment during the COVID-19 pandemic.

METHODS

Cross-sectional study conducted using an instrument made available in social networks with 1,106 health professionals. The data were analyzed using descriptive statistics and compared, considering pvalue < 0.05.

RESULTS

There was a prevalence of 69.4% for pressure injuries related to the use of personal protective equipment, with an average of 2.4 injuries per professional. The significant factors were: under 35 years of age, working and wearing personal protective equipment for more than six hours a day, in hospital units, and without the use of inputs for protection.

CONCLUSION

Pressure injuries related to the use of medical devices showed a high prevalence in this population. The recognition of the damage in these professionals makes it possible to advance in prevention strategies.

[Comparative study of the assaults to professionals in Primary Care against Specialized Care, in the Aragón Health Service during the year 2018.]

OBJECTIVE

The risk that health personnel have of being assaulted in the workplace is not homogeneous. Factors such as professional category, level of care or service, modulate their probability. The objective of this work was to analyze the aggressions registered by the Servicio Aragonés de Salud professionals, comparing the characteristics of those that occurred in primary care with those that took place in specialized care during 2018.

METHODS

A cross-sectional descriptive study was made, carried out using the information available in the Aragon aggression registry database, during the year 2018. The study variables included sociodemographic characteristics of the people attacked, type of aggression, level of assistance and sick leave. Frequencies and percentages were calculated for the qualitative variables and mean and standard deviation for the quantitative ones; the relationship between the variables was made using the Mann-Whitney and Chi-Square tests.

RESULTS

236 assaults were registered, of which 75.4% took place in AE. The average age was 45 years. Doctors were more attacked in primary care, while nursing staff was more attacked in specialized care. In primary there were more verbal attacks, while in specialized there were more physical attacks.

CONCLUSIONS

Occupational violence suffered by health professionals change depending on the level of care, where a higher incidence of assaults is observed in specialized care. It is necessary to establish improvements in the registry of aggressions in Aragón, to improve the prevention and safety of workers.

Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study

Background

It is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses.

Objective

Investigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana.

Methodology

This is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management.

Findings

Overall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93–0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027).

Conclusion

There is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.

Occurrence of adverse events in the activity of hospital wards in the opinions of doctors and nursing management staff

INTRODUCTION

An adverse event is an incident induced while providing health care services or resulting from it, not related to the natural course of a given disease or health condition, which causes or is likely to cause negative consequences for the patient, including their death, a threat to life, the necessity of hospitalisation or its prolongation, permanent or considerable health detriment; or is a foetal disease, congenital defect or the result of foetal damage.

OBJECTIVE

The aim of this analysis is to explore the problem of the occurrence of adverse events from the perspective of doctors and ward nurses who manage wards.

MATERIAL AND METHODS

The research on the occurrence of adverse events among doctors and nurses (the management staff) was conducted with the use of a postal survey.

RESULTS

It was ascertained that 86.5% of the medical personnel had taken part in an adverse event, of which 20.2% took part in an occurrence associated with pharmacotherapy, 16.2% - in an event related to diagnostics and diagnosis, or an infection - 15.7%. 14.2% of respondents were involved in an occurrence linked to a medical device malfunction, and 14.1% - in an adverse event related to an operation.

CONCLUSIONS

The adverse events most often identified in the nursing professional group are occurrences associated with pharmacotherapy, and in the doctors' professional group - occurrences related to diagnostics and diagnosis. The research established that the most frequent reason for not informing patients about the occurrence of an adverse event is fear of their filing a complaint. Medical management staff show high acceptance of an adverse event reporting system as a tool for improving patient safety.

Systematic training program for nursing home staff based on the concept of combination of medicine and care

It is important to improve the training for nursing home staff in order to achieve better quality of life for the elderly.This study aimed to develop a systematic training program for nursing home staff based on the concept of combination of medicine and care.Thirty-four nursing staff from 2 representative nursing homes in Qiqihar City were selected as study subjects and divided into experimental and control groups. The subjects in both groups received routine training following "National Occupational Standards of Elderly Nursing Staff". In addition, the subjects in experimental groups received systematic training at three levels based on the concept of combination of medicine and care for 4 months.After the training, the competence scores of nursing staff in experimental group increased significantly compared to control group, the living quality of the elderly in nursing homes cared by nursing staff in experimental group was significantly improved, and the satisfaction of the elderly to nursing staff in experimental group improved significantly, compared to control group (P < .05).We develop systematic training program for nursing home staff based on the concept of combination of medicine and care, which can improve nursing care for the elderly in nursing home.

Methods of nursing certification in North America-A scoping review

BACKGROUND

Definitions of nursing certification are lacking in the research literature and research on certification in nursing is remarkably limited.

METHODS

A six-stage scoping review framework was used to identify the nature, extent, and range of certification within the nursing literature.

FINDINGS

Thirty-six articles were included in this scoping review. Most originated in the United States (89%), were classified as research articles (56%), and used a quantitative approach (90%). The majority focused on initial certification (50%), and written examination was the most prevalent approach to certification (39%). Missing and incomplete data were prevalent.

DISCUSSION

The overall lack of nursing certification origin, focus, methodological rigor, and clear certification mastery criteria have hindered meaningful study of the relationship between nursing certification and patient outcomes. Common data elements, reporting standards, and observational studies linking common data elements and patient outcomes could guide future research and improve the transparency of certification processes and reporting.

Using tabletop exercises to evaluate nurses' clinical performance of hazardous materials disaster management: A cross-sectional study

BACKGROUND

Hazardous materials (Hazmat) disaster is a specific event with low probability but may be a heavy burden on public health. Competence in Hazmat disaster emergency management is necessary for nurses who care about mass casualties in the first line, especially for nurses in military hospitals. However, less attention has been paid to evaluation of competence of Hazmat disaster emergency responses using tabletop exercises.

OBJECTIVE

To identify competence in Hazmat disaster emergency response and factors influencing performance on tabletop exercises.

METHODS

A cross-sectional design was employed in this study. Competence of nurses responding to a hazardous materials invasion was evaluated by a tabletop exercise. In each case the "Task Based Checklist" was used for evaluation. Multivariate analysis of covariance was conducted to detect the effects of traditional training on performance in Hazmat disaster tabletop exercises.

RESULTS

A total of 161 nurses were recruited for this study. A checklist with 12 items comprised of two dimensions of disaster management was created and validated (CVI = 0.90). Inter-rater reliability for the evaluators ranged from 0.88 to 1. Performance on Hazmat site control, debris management and individual skills in decontamination were found to be suboptimal. Traditional disaster nursing training had no significant influence either on performance on Hazmat site control or patient care after controlling for differences in education level, age and gender.

CONCLUSIONS

The tabletop exercise is an innovative method for disaster nursing educators seeking to evaluate response competence in Hazmat disaster simulation exercises. It is necessary to consider the characteristics of the participants when designing the training program and educational strategies. Participants from the military hospital were shown to have limited competence in Hazmat disaster emergency management.

Cross-sectional study of aggression against Spanish nursing personnel and effects on somatisation of physical symptoms

INTRODUCTION

Violence against nursing personnel in their place of work is a severe problem generating important consequences for these workers. Even though there is a large body of research on the subject, the emotional impact of aggression against healthcare workers continues to be debated.

OBJECTIVES

The objective of this quantitative, observational cross-sectional study was to analyse the effects of aggression against nursing personnel and the mediating role of anxiety in somaticising physical symptoms.

METHOD

The sample was made up of 1357 nursing professionals who answered questionnaires evaluating their sensitivity to anxiety and the presence of somatic symptoms.

RESULTS

Of the professionals who indicated that they had been the victims of aggression by family members or patients in the previous year, 52.8% said it had happened to them on one occasion, 25.2% had experienced two episodes, while 6.9% and 15.1% said they had undergone three or more aggressions, respectively. Although 89.3% of the professionals affected by acts of indicated that they had not undergone physical or psychological consequences, there was a higher prevalence of somatic alteration among workers who had been victims of violence in the workplace. Furthermore, aggression at work had a direct effect on physical somatisation, which in turn acted as a mediator in the level of anxiety of nursing professionals. Thus, aggression increased the level of anxiety of nurses through the appearance of somatic symptoms.

CONCLUSIONS

The results are discussed based on some of the consequences that appeared after episodes of aggression in the healthcare sector and their relationship.

Influenza vaccine acceptance by healthcare workers in Saudi Arabia: A questionnaire-based analysis

The aim of this study was to gauge the reasons for accepting or declining influenza vaccine in healthcare staff in Saudi Arabia. A questionnaire was administered to healthcare workers in Saudi Arabia. In all, 633 respondents who provided gender, nationality and profession were included. Reasons for vaccine uptake or refusal were assessed according to profession and educational level. Uptake of vaccine was lower in the period from 2010 to 2014 (3-13.3%) compared to pre-2010 figures (20.7%), rising to 44.1% in 2015. Comparing data for 'never having been vaccinated' to 'being vaccinated in 2015', there was no significant difference in distribution between nurses (9.27% v 38.8%), physicians (13.9% v 56.0%) and laboratory technicians (15.9% v 33.5%) (p= 0.08). The top reason for vaccination was protection of self and family, while the top reason for refusal was not considering the vaccine to be necessary. Education level had no significant effect on the likelihood of being vaccinated. Improvement of healthcare worker vaccination levels in Saudi Arabia might be achieved by addressing staff concerns on vaccine safety and efficacy, emphasizing the potential dangers of influenza and capitalizing on the staff's focus on protecting themselves and their families.

Prevalence and risk factors of musculoskeletal disorders among Tunisian nurses

BACKGROUND

Musculoskeletal problems depict essentially the most worrying difficulties inside work health today.

AIMS

To evaluate the prevalence of musculoskeltal issues and to search relationships with individual characteristics and work-related risk factors among two public hospitals nurses in Sousse.

METHODS

It is a descriptive-correlational investigation based on a self-administered questionnaire destined for all nurses working in two public hospitals of Sousse. The potential risk of musculoskeletal issues was examined by logistical regression.

RESULTS

The prevalence of musculoskeletal disorders (MSD) over the last twelve months was 48.1%. Musculoskeletal problems developed mainly in low back (68.5%), upper back (36.9%), and knees (34.5%). The Chi-square test indicated that MSD is associated with female gender (p = 0.01), being single (p = 0.013), high BMI (p <0.001), seniority (p =0.001), repetitive work (p = 0.004), prolonged standing position (p = 0.007), intense physical effort (p <0.001), lifting heavy loads (p = 0.002), uncomfortable position (p = 0.008) and low social support (p <0.001). The logistic regression analysis showed that intense physical exertion (OR= 7.72, 95% CI: 2.98 - 19.97) and job-strain (OR= 3.24, 95% CI: 2.98 - 19.97) represent risk factors related to MSD.

CONCLUSION

A high amount of Tunisian nursing staff in this survey complained of musculoskeletal issues considering the low back pain most often affected. Education courses on prevention and coping approaches for musculoskeletal problems are appropriate for nurses as a way to minimize the rate of work risks and even promote performance patient care.

The Effects of the Nurse Navigation Program in Promoting Colorectal Cancer Screening Behaviors: a Randomized Controlled Trial

Although screening programs are known and recommended for the early detection of colorectal cancer (CRC), the screening rates for the fecal occult blood test (FOBT) and colonoscopy are very low among adult individuals. Navigation programs, also known as individualized counseling, have recently begun to be used for increasing screening rates. The purpose of this study was to compare the efficacy of the Nurse Navigation Program versus usual care on CRC screening participation and movement in stage of adoption for CRC screening and to examine perceived benefits of and barriers to CRC screening. This study was designed in line with a pre- and posttest two-group methodology. A total of 110 participants (55 nurse-navigated and 55 non-navigated patients) were studied. Data were collected using the following three tools: a sociodemographic information form, the Harvard Colorectal Cancer Risk Assessment Tool, and Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. Following the Nurse Navigation Program, the FOBT (82 and 84%, respectively) and colonoscopy completion rates (15 and 22%, respectively) were significantly higher in the nurse-navigated group than in the non-navigated group at 3 and 6 months follow-up. Following the program, the benefit perceptions of the nurse-navigated group about CRC screening were improved, and their barrier perceptions were reduced. The results showed that the Nurse Navigation Program had significant effects on CRC screening behavior and health-related beliefs concerning CRC screening. Further assessment of the Nurse Navigation Program in different groups should be performed to observe its effects.

Health-Care Workers' Perception of Reimbursement for Complex Surgical Oncology Procedures

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.

Elder abuse in Norwegian nursing homes: a cross-sectional exploratory study

BACKGROUND

Elder abuse is a global public health and human rights problem that is predicted to increase as many countries experience a rapid growth in their population of older adults. Elder abuse undermines an older person's well-being and is associated with a range of serious health consequences. In institutional care settings, older residents are particularly vulnerable and hence at higher risk of being abused, but few countries have explored the extent and nature of this phenomenon in national studies. The aim of this study is to estimate the prevalence of observed and perpetrated staff-to-resident abuse in Norwegian nursing homes.

METHODS

We conducted a cross-sectional exploratory study of nursing staff in 100 randomly drawn Norwegian nursing homes. Nursing staff completed a pen and paper survey measuring how often during the past year they had observed staff commit acts of neglect and psychological, physical, financial/material, and sexual abuse towards residents. They also reported how often they had perpetrated acts of abuse themselves, and these rates were disaggregated by nursing staff's gender, age and education.

RESULTS

Of 3693 nursing staff (response rate 60.1%), 76% had observed one or more incidents of elder abuse during the past year, and 60.3% reported they had perpetrated one or more incidents of abuse in the same period. Psychological abuse and neglect were most commonly reported. Male staff reported more acts of physical abuse, while female staff reported more acts of neglect. Higher education of staff was associated with higher rates of self-reported psychological abuse, physical abuse and neglect.

CONCLUSIONS

This first national survey of staff in Norwegian nursing homes is one of the largest studies globally estimating the prevalence of elder abuse in institutional settings. Overall, we found staff-to-resident abuse to be relatively common, and our findings propose a need for preventive strategies to improve the quality of life and safety of residents in Norwegian nursing homes.

Quality Assurance in Nursing Education: A Qualitative Study Involving Students and Newly Graduated Nurses

Background: Assuring quality training for future nursing professionals is essential to preserving population health and socio-economic development. Quality assurance in the European Higher Education Area places students in a leading role to transform and improve higher education programs. Therefore, an innovative way of reviewing strengths and weaknesses of the nursing education program of a Spanish university has been developed. Objectives: The aim of this paper was to explore the perceptions and opinions of nursing students and newly-qualified nurses regarding the contents of the nursing curriculum in order to improve its quality. Methods: Descriptive and exploratory qualitative research was carried out involving 12 newly-qualified nurses and 12 student nurses. Semi-structured interviews and focus groups were performed. Results: Based on the thematic analysis, two themes emerged: improving clinical practices and reviewing the theoretical curriculum. Conclusions: Among the improvements suggested by the participants, the most relevant ones were establishing a clear structure of learning contents in the practicum, and redistributing the European Credit Transfer and Accumulation System ECTS credits in various courses of the study program. However, additional evidence is needed prior to proceeding with any changes.

Assessing variability of antineoplastic drugs handling practices in clinical settings

The United States Pharmacopeia (USP) Chapter <800> guidelines will be adopted in the U.S. and Canada in 2019, requiring regular surface sampling for antineoplastic drug (AD) surface contamination as a means of environmental surveillance. USP Chapter <800> does not provide guidance on when and where to sample. Research to support the development of such guidance within a broader sampling strategy is limited. This study was conducted to help address some of the underlying information gaps by identifying surfaces pharmacy and nursing staff are likely to contact, presenting a potential dermal exposure risk. Observations were conducted at one regional and one urban clinic, providing insight into inter- and intra-worker variability and between-clinic differences based on size and patient load. Thirteen surfaces in the compounding pharmacies and 14 surfaces in the patient administration were initially selected for video observations. Following a preliminary assessment to eliminate surfaces that were touched infrequently or not at all, five commonly touched surfaces in the compounding pharmacy areas (vials, syringes, IV lines, IV bags, waste bags) and six commonly touched surfaces in the patient administration area (yellow containment bag, IV bag, IV line, patient port, computer workstation) were assessed further. Variability between healthcare staff and clinics in pharmacy staff was low for both the mean frequency and duration of touch to surfaces. Differences between clinics in frequency of contact among nursing staff in patient administration areas were significant (two-way ANOVA) for five of the six surfaces. Duration of contact was not significantly different except for duration of touching the IV pump. These insights will be used to give guidance in selecting locations for a longitudinal surveillance study and help tailor worker training to reduce exposure risks.

The Emeritus Nurse: Retired, Rehired, and Revolutionary

A strong culture rooted in excellent nursing practice is essential to the future success of healthcare organizations. Nursing leaders face the challenge of establishing and retaining this culture with the exodus of nursing knowledge and clinical reasoning expertise from retirements of experienced nurses. This article presents a novel plan to mitigate this looming problem by rehiring and reengaging recently retired nurses to return to practice for an emeritus RN program.

Clinical nurses's critical thinking level according to sociodemographic and professional variables (Phase II): A correlational study

Critical thinking ability is one of the basic competencies of clinical nurse and is widely accepted as being associated with the provision of quality care, however, the few evidence-based data related to the relationship between level of critical thinking ability and nurses' sociodemographic and professional characteristics. The aim of this study was to identify the level of critical thinking among nurses in clinical practice according to sociodemographic and professional variables. Descriptive cross-sectional and correlational study was carried out in a sample of 339 nurses from medical, surgical and critical care units at a tertiary care hospital. This study is related to a previous publication that presents psychometric analysis. Data were compiled using the Nursing Critical Thinking in Clinical Practice Questionnaire and ad hoc form for the recording of sociodemographic and professional characteristics. The statistical analysis of the data was performed using frequency, Mann-Whitney U Test, Kruskal-Wallis Test, and Pearson's correlation coefficients. Nurses reported moderate levels of critical thinking. Older nurses, with 11-15 years of experience in the actual unit, with continuous shift work, a permanent contract and master's degree indicated a higher level of critical thinking. Critical thinking skills are related to certain socio-demographic and professional variables, particularly age, years of experience, shift work, type of contract and educational level.

[Nursing sensitive outcomes: the results of a multicentre study]

. Nursing sensitive outcomes: the results of a multicentre study.

INTRODUCTION

The relationship between staffing characteristics and nursing sensitive outcomes has been explored in several studies.

AIMS

To assess the effect of staffing characteristics, nurses' wellbeing at work and hours of care on pressure sores, falls and physical restrains occurrence.

METHODS

Longitudinal study including from February 2014 to June 2015 a total of 24110 consecutive patients and 2606 nurses of 134 units (geriatrics and medicine (GM), orthopedic-traumatology (OT) and rehabilitation and long-term care (LR) of 12 Italian regions. Data was collected up to 15 days for each included patient, and regarding the staff of each shift by ad hoc trained personnel.

RESULTS

There is a large variability in both patients and nurses' characteristics across wards, as well as of outcomes, even in the same area (e.g., GM). Patients in GM received a mean of 144±35 minutes of care/day; 186±146 in OT and 140±40 in LR. The incidence of pressure sores was 5.3%±4.8% in GM; 5.1%±5.6% in OT and 8.6%±10.1% in LR. The incidence of falls was 1.9%±2.1% in GM, 0.8%±1% in OT and 2.9%±3.8% in LR. Restraints were used in 41.4%±30.3% of patients in GM, among 24.8%±23.4% in OT and 54.7%±29.7% in LR. The multilevel analyses confirmed the importance of clinical factors but also the positive effects of staff characteristics such as the number of expert nurses and the negative effects of a negative work environment, although with wide variations across settings have emerged.

CONCLUSIONS

Staff characteristics related to work environment affect patient outcomes but the large variability across wards would require further stratification of the data to better understand and interpret the findings.

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review

Background: Patient safety is a priority of any healthcare system, and one of the most effective measures is hand hygiene. For this, it is important that health staff have correct adherence and perform the technique properly. Otherwise, the incidence of nosocomial infections can increase, with consequent complications. The aim here was to analyze hand hygiene training and the effectiveness of different methods and educational strategies among nurses and whether they maintained correct adherence over time. Methods: A systematic review was conducted in the sources CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Lilacs (Latin American and Caribbean Health Sciences Literature), ProQuest (Proquest Health and Medical Complete), Medline, SciELO (Scientific Electronic Library Online), and Scopus. The search equation with Medical Subject Headings (MeSH) descriptors was “Nurs* AND (handwashing OR hand hygiene) AND clinical trial”. The review was performed following the recommendations of the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: n = 17 clinical trials were included, with a total of 5747 nurses and nursing students. Strategies such as reminder sounds, practical simulations, videos, and audiovisual media improved handwashing compliance. Adherence overtime increased by up to 60%. The greatest effectiveness was related to the use of povidone–iodine, which reduced colony formation compared Hand hygiene teaching strategies among nursing staff: a systematic review to soap. Conclusions: The strategies that go beyond teaching techniques such as lectures may be more effective at increasing hand hygiene compliance. Combined approaches to learning/instruction improve user satisfaction by enabling self-management, flexibility, and repetition.

Maternity staff immunization coverage against pertussis and maternal vaccination practices: Results of a 2017 cross-sectional survey in five public maternity hospitals

OBJECTIVES

To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage.

MATERIALS AND METHODS

2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service.

RESULTS

Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine "often" or "very often".

CONCLUSIONS

Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

Regarding the rights and duties of Clinical Laboratory Geneticists in genetic healthcare systems; results of a survey in over 50 countries

Specialists of human genetic diagnostics can be divided into four groups: Medical Geneticists (MDG), Genetic Nurses and/or Counsellors (GN/GC), Clinical Laboratory Geneticists (CLG) and Laboratory Genetics Technicians (LGT). While the first two groups are in direct patient contact, the work of the latter two, of equal importance for patient care, are often hidden as they work behind the scenes. Herein the first study on the rights and duties of CLGs is presented. We present the results of a survey performed in 35 European and 18 non-European countries with 100 participating specialists. A national CLG title is available in 60% of European countries, and in 77% of the surveyed European countries a CLG can be the main responsible head of the laboratory performing human genetic tests. However, in only 20% of European countries is a lab-report valid with only a CLGs' signature - even though the report is almost always formulated by the CLG, and an interpretation of the obtained results in a clinical context by the CLG is expected in nearly 90% of European countries. Interestingly, CLGs see patients in 30% of European countries, and are also regularly involved in student education. Overall, the CLG profession includes numerous duties, which are quite similar in all regions of the world. Strikingly, the CLG's rights and responsibilities of leading a lab, or signing a report are regulated differently according to country specific regulations. Overall, the CLG is a well-recognized profession worldwide and often working within a multidisciplinary team of human genetic diagnostics professionals.

Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya

OBJECTIVES

(1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research.

METHODS

This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention.

RESULTS

Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders.

CONCLUSIONS

Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.

Improving Nursing Staff Attitudes toward Vaccinations through Academic Detailing: The HProImmune Questionnaire as a Tool for Medical Management

Vaccinations remain the most effective way of preventing infection, disease, and mortality. Public health institutions consequently recommend vaccines to target groups, including healthcare workers, who are considered to be more at risk of exposure and transmission. The aim of this cross-sectional study is to assess, through the administration of a questionnaire, the nursing staff’s knowledge and attitude towards recommended vaccinations, and to explore the effects of a training course (carried out according to the academic detailing methodology) aimed at increasing operators’ knowledge and outreach on recommended vaccinations among healthcare workers. A total of 85 HCWs (30 nursing coordinators and 55 nurses) completed the questionnaire. Results demonstrate a higher rate of agreement towards vaccinations in nursing staff answers (75%), if compared with results of other studies (62–63%). Statistically significant differences between nursing coordinators and nurses can be found. Regarding vaccination attitudes, nursing coordinators agreed in 86% of the answers on healthcare workers’ vaccination vs 70% of nurses (p < 0.001). Considering immunization for influenza, 57% of nursing coordinators vs 18% of nurses reported for vaccination (p < 0.001). Educational programs, carried out according to academic detailing methods, could impact on vaccination attitudes and raise awareness about recommended vaccinations among healthcare workers. The questionnaire is a useful tool for investigating nursing staff knowledge and attitudes towards vaccinations, and to implement strategies to promoting vaccinations among healthcare workers.

Impact of Job Demands and Resources on Nurses' Burnout and Occupational Turnover Intention Towards an Age-Moderated Mediation Model for the Nursing Profession

This longitudinal study among Registered Nurses has four purposes: (1) to investigate whether emotional, quantitative and physical demands, and family-work conflict have a negative impact on nurses' perceived effort; (2) to investigate whether quality of leadership, developmental opportunities, and social support from supervisors and colleagues have a positive impact on meaning of work; (3) to investigate whether burnout from the combined impact of perceived effort and meaning of work mediates the relationship with occupational turnover intention; and (4) whether the relationships in our overall hypothesized framework are moderated by age (nurses categorized under 40 years versus ≥ 40 years old). In line with our expectations, emotional, quantitative, and physical demands, plus family-work conflict appeared to increase levels of perceived effort. Quality of leadership, developmental opportunities, and social support from supervisors and colleagues increased the meaning of work levels. In addition, increased perceived stress resulted in higher burnout levels, while increased meaning of work resulted in decreased burnout levels. Finally, higher burnout levels appeared to lead to a higher occupational turnover intention. Obviously, a nursing workforce that is in good physical and psychological condition is only conceivable when health care managers protect the employability of their nursing staff, and when there is a dual responsibility for a sustainable workforce. Additionally, thorough attention for the character of job demands and job resources according to nurses' age category is necessary in creating meaningful management interventions.

Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.

Registered nurses' use of computerised decision support in medication reviews

Purpose The purpose of this paper is to explore the implications of registered nurses' (RNs) use of a computerized decision support system (CDSS) in medication reviews. Design/methodology/approach The paper employs a quasi-experimental, one-group pre-test/post-test design with three- and six-month follow-ups subsequent to the introduction of a CDSS. In total, 11 RNs initiated and prepared a total of 54 medication reviews. The outcome measures were the number of drug-related problems (DRPs) as reported by the CDSS and the RNs, respectively, the RNs' views on the CDSS, and changes in the quality of drug treatment. Findings The CDSS significantly indicated more DRPs than the RNs did, such as potential adverse drug reactions (ADRs). The RNs detected additional problems, outside the scope of the CDSS, such as lack of adherence. They considered the CDSS beneficial and wanted to continue using it. Only minor changes were found in the quality of drug treatments, with no significant changes in the drug-specific quality indicators (e.g. inappropriate drugs). However, the use of renally excreted drugs in reduced renal function decreased. Practical implications The RNs' use of a CDSS in medication reviews is of value in detecting potential ADRs and interactions. Yet, in order to have an impact on outcomes in the quality of drug treatment, further measures are needed. These may involve development of inter-professional collaboration, such as established procedures for the implementation of medication reviews, including the use of CDSS. Originality/value This is, to the best of the authors' knowledge, the first study to explore the implications of medication reviews, initiated and prepared by RNs who use a CDSS. The paper adds further insight into the RNs' role in relation to quality of drug treatments.

Israeli staff nurse knowledge and perception of the nurse practitioner role

This study assessed Israeli nurses' knowledge of the emerging role of master's-prepared NPs. Based on an integrated review of the literature, a study-specific survey was developed, including dichotomous knowledge items, Likert scored perception items, and self-disclosed demographic data. Analyses of the 146 responses revealed that exposure to NPs was limited. Knowledge specific to the role or clinical competency was lacking, yet the assessment capabilities and overall perception of NPs were positive. Data demonstrate a willingness to include NPs in the care model and an awareness that doing so would positively contribute to the overall health of patients.

Professional Image and the Nursing Uniform

BACKGROUND

Traditional nursing uniforms have evolved and influenced nursing image, but professional image in nursing is unique and unclear. Institutional policies dictate uniform and appearance standards that portray professionalism in health care environments.

METHOD

Nurses were questioned using three structured open-ended questions about the nursing uniform and its effects on patients' perceptions of professionalism. Qualitative line-by-line analyses of transcribed data were conducted to identify emerging themes using van Manen's phenomenology.

RESULTS

Participants wore varying uniforms while in nursing school. The influences of uniform evolution on patients' perceptions of professionalism were acknowledged along with current challenges in maintaining a professional image in nursing.

CONCLUSION

Findings will be used for future exploration of the concept of professional image to improve educational practices that promote a professional work environment and professional image for the discipline. [J Contin Educ Nurs. 2018;49(12):555-557.].

Reduced Risks of Both Ischemic and Hemorrhagic Strokes in Nurses: A Population-Based Cohort Study in Taiwan

BACKGROUND

Nurses are typically required to address patient emergencies, and they experience high stress levels in their work, which may expose them to a higher risk of stroke. This cohort study compared the risk of stroke between nurses and the general population.

METHODS

We used the Taiwan National Health Insurance database to conduct our retrospective cohort study, and we identified 83,641 individuals in the nurse group and 334,564 individuals in the control group. For the nurse group and the control group, we used the chi-square test in addition to applying Student's t-test, in order to compare the distribution differences for the continuous variables. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke and hemorrhagic stroke through univariate and multivariate Cox proportional-hazards regression models, with stratification according to age, sex, and comorbidity.

RESULTS

The nurse group had a lower risk of ischemic stroke and hemorrhagic stroke in the crude model (HR = 0.66, 95% CI = 0.58⁻0.75; HR = 0.58, 95% CI = 0.47⁻0.72). After adjusting the prevalent variables, the nurse group still had a lower risk of stroke (HR = 0.68, 95% CI = 0.60⁻0.77; HR = 0.59, 95% CI = 0.48⁻0.73).

CONCLUSION

The risks of both stroke types were lower in the nurse group than in the control. For stroke prevention, more frequent physical examinations are needed in order to enhance the health and well-being of people, including the nurses.

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature

Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.

[The prevention of psychosocial risks in hospital]

The best way to prevent psychosocial risk is to support the teams in terms of their dynamics and their difficulties. We need to take care of caregivers and other hospital staff. Management has an essential role to play to achieve this objective.

The impact of shift work and organisational climate on nurse health: a cross-sectional study

BACKGROUND

The negative effects of shift work schedules, specifically night and rotating shifts, have been widely reported. However, little is understood whether particular aspects of the organisational environment, related to specific shifts, may influence the negative impact of shift work. This study investigated the variation in organisational climate and health outcomes across shift work schedules (day, night, rotating).

METHODS

This cross-sectional study involved nursing staff (n = 108) who were all registered nurses from two Melbourne health services. There were slightly more nursing staff that participated from one health service (n = 56) than the other health service (n = 52). Nursing staff completed a survey on either paper form or online which comprised of: demographic characteristics, organisational climate (work environment scale) and health outcomes (general health questionnaire).

RESULTS

The study found that organisational climate factors and health outcomes differed across shift types. Rotating shift staff exhibited significantly higher coworker cohesion scores when compared to night staff. Night staff reported significantly greater levels of physical comfort within their work environment than rotating staff. Overall, supervisor support emerged as a significant predictor of health outcomes such as somatic complaints, social dysfunction and overall distress. Task orientation was also shown to significantly predict levels of social dysfunction.

CONCLUSIONS

Findings suggest that interventions with a focus on enhancing the organisational climate, focused in increasing supervisor support, may mitigate the potential negative health outcomes experienced by shift workers.

TRIAL REGISTRATION

Not applicable to this study.

Prevalence and risk factors of MRSA colonisations: a cross-sectional study among personnel in outpatient care settings in Hamburg, Germany

OBJECTIVES

Healthcare workers frequently come into contact with infected individuals and are at a greater risk of infection than the general population due to their occupation. Multidrug-resistant organisms (MDROs) also pose a significant challenge for personnel and medical facilities. Currently, little is known about the occupational risk of methicillin-resistant Staphylococcus aureus (MRSA) in outpatient care settings. Therefore, a cross-sectional study was conducted in Hamburg to investigate MRSA colonisation among outpatient nursing staff.

METHODS

MRSA screening with nasal swabs was carried out, the known risk factors for colonisation were determined and information on infection control was inquired. Where tests were positive, a control swab was taken; if this confirmed a positive result, decolonisation was offered. A molecular biological examination of the MRSA samples was performed. The occupational MRSA exposure and risk factors were compared with the situation for personnel in inpatient geriatric care.

RESULTS

A total of 39 outpatient services participated in the study and 579 employees were tested. The MRSA prevalence was 1.2% in all and 1.7% in nursing staff. Most of the employees that tested positive had close or known contact with MRSA patients. Health personnel frequently reported personal protective measures and their application. Compared with inpatient care staff, outpatient staff were older and had worked in their profession for a longer time.

CONCLUSION

This study marks the first time that data has been made available on the occupational MRSA risk of outpatient care personnel in Hamburg. The MRSA prevalence is low and provides a good basis for describing the MRSA risk of occupational exposure by health personnel in outpatient care.

A MOOC as an immediate strategy to train health personnel in the cholera outbreak in Mexico

BACKGROUND

In September 2013, two cases of cholera were reported in Mexico; 1 week later, a new outbreak was reported in the Huasteca region of Hidalgo. Upon the determination that the diagnostic and therapeutic interventions implemented by health personnel overlooked predefined procedures, the National Institute of Public Health, in coordination with the Ministry of Health, immediately designed the massive open online course "Proper cholera containment and management measures" to strengthen and standardize basic prevention and control practices.

METHODS

During the first 5 months, 35,968 participants from across the country finished the course: medical and nursing personnel, health promoters, and hospital staff. To understand the magnitude of the data, an analysis was performed to calculate the MOOC coverage, and multiple linear regression models were generated to relate the score earned in the course to the characteristics of the participants. In addition, a qualitative analysis was performed to identify the dissemination of information, technological barriers, and feedback on course design. A total of 17% of participants were from the state where the outbreak originated, and 33.5% were from its neighboring states.

RESULTS

This study shows that the need for information is greater when an emergency occurs, and the involvement of the authorities increased the extent of the training response.

CONCLUSION

A MOOC can be a useful training strategy to prepare personnel for emergency situations.

The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews

BACKGROUND

Nurses leaving their jobs and the profession are an issue of international concern, with supply-demand gaps for nurses reported to be widening. There is a large body of existing literature, much of which is already in review form. In order to advance the usefulness of the literature for nurse and human resource managers, we undertook an overview (review of systematic reviews). The aim of the overview was to identify high quality evidence of the determinants and consequences of turnover in adult nursing.

METHODS

Reviews were identified which were published between 1990 and January 2015 in English using electronic databases (the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS) and forward searching. All stages of the review were conducted in parallel by two reviewers. Reviews were quality appraised using the Assessment of Multiple Systematic Reviews and their findings narratively synthesised.

RESULTS

Nine reviews were included. We found that the current evidence is incomplete and has a number of important limitations. However, a body of moderate quality review evidence does exist giving a picture of multiple determinants of turnover in adult nursing, with - at the individual level - nurse stress and dissatisfaction being important factors and -at the organisational level - managerial style and supervisory support factors holding most weight. The consequences of turnover are only described in economic terms, but are considered significant.

CONCLUSIONS

In making a quality assessment of the review as well as considering the quality of the included primary studies and specificity in the outcomes they measure, the overview found that the evidence is not as definitive as previously presented from individual reviews. Further research is required, of rigorous research design, whether quantitative or qualitative, particularly against the outcome of actual turnover as opposed to intention to leave.

TRIAL REGISTRATION

PROSPERO Registration 17 March 2015: CRD42015017613 .