Twenty years: the American Academy of Nursing and the Institute of Medicine in perspective.
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American Nurses' Association↗
Biomedical subjects
E Larson
Publications and source records attributed to E Larson.
Emerging infectious diseases: nursing responses.
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Communicable Disease Control↗
Intravenous site care practices in critical care: a national survey.
OBJECTIVE: To collect and compare written procedures for central line intravenous site care. DESIGN: Descriptive, stratified, random sample survey. SETTING: Adult medical-surgical critical care units among hospitals throughout the United States. SAMPLE: One hundred fifty-two returned surveys. RESULTS: A 24.6% response rate with underrepresentation from smaller institutions and hospitals in the Mid-Atlantic and West South Central regions of the country. There were wide variations in procedures for intravenous site care related to type of dressing used and frequency of dressing changes. CONCLUSIONS: Standardization of catheter care is needed to ensure consistent quality of intravenous site care. Lack of standardization may be due to lack of a research data base linking various components of care to outcomes such as infection, patient comfort, or catheter retention.
Adult↗
Intravascular site care: are critical care nurses practicing according to written protocols?
OBJECTIVE: To observe and describe site care for intravascular devices, to identify internurse variations in site care, and to compare written protocols for site care with actual practice in one geographic area. DESIGN: Observational, descriptive study. SETTING: Adult critical care units in one community, and one university teaching hospital in the Washington, D.C., metropolitan area. SAMPLE: Direct observation of 86 central and 30 peripheral site care episodes. RESULTS: A total of 116 site care episodes were observed on five critical care units. There were wide variations between units from the same hospital in gloving practices and use of aseptic technique. Significant differences across both hospitals, as well as between individual units, were noted for a number of other practices including: time since last site care, use of ointment and skin adhesive, type of dressing used, and duration of care. In both hospitals, compliance with all steps of the written protocol was similar-23.2% and 23.3%. Compliance with documentation requirements ranged from 53.3% to 85.7%, and was significantly different between the two hospitals with regard to recording the dressing change and whether the dressing label and chart agreed. CONCLUSIONS: Intravascular site care varies significantly among critical care units within the same institution, as well as between different hospitals, and varies from written protocol. Standardized, well-defined site care protocols and education of staff, along with quality improvement surveillance systems are needed to ensure consistent quality intravascular site care.
Adult↗
Effect of intravascular surveillance and education program on rates of nosocomial bloodstream infections.
BACKGROUND: Because of high proportions of central line-related bloodstream infections (BSIs), an intravascular surveillance and education program (IVSP) was instituted in the study institution in 1987. METHODS: A 6 1/2-year historical prospective study was conducted to evaluate the effects of the IVSP on incidence of nosocomial BSIs. With use of Centers for Disease Control and Prevention criteria, concurrent data on nosocomial BSIs were collected by two infection control professionals before, during, and for 3 years after the IVSP. RESULTS: Hospital-wide BSIs during the 3-year IVSP and for 3 years after were 0.9% and 0.9% (p = 0.58) or 1.4 and 1.2/1000 patient-days (p = 0.24). Central line-related BSIs represented 29%, 24%, and 29% of the total BSIs 6 months before, 3 years during, and 6 months after the intervention, respectively (p = 0.62). CONCLUSIONS: The IVSP resulted neither in a reduction in the total intravascular catheter-related BSIs nor in a change in the proportion of potentially preventable central line-related BSIs. To be successful, an intervention must include the authority to mandate practice changes; education and feedback without such authority were inadequate.
Catheterization, Central Venous↗
Prevalence and correlates of skin damage on the hands of nurses.
OBJECTIVE: To describe the prevalence and correlates of skin damage on nurses' hands. DESIGN: Prevalence survey using self-report questionnaire of hand care regimens, problems, and skin condition, and visual examination of the hands at 30X magnification by trained investigators to evaluate degree of skin scaling. SETTING: Four hospitals: two in the Mid-Atlantic and two in the northern United States. PARTICIPANTS: Convenience sample of 410 nurses working 30 hours or more per week in acute care units. OUTCOME MEASURES: Damage to skin of the hands. RESULTS: Approximately one fourth of subjects (n = 106) met the criteria for currently damaged hands; 85.6% (n = 351) reported ever having skin problems. Damage was not correlated with age (p = 0.43), sex (p = 0.14), or skin type (p = 0.25), type of soap used at home (p = 0.58), reported duration of handwashing (p = 0.12), or glove brand (p = 0.90), but was significantly correlated with the type of soap used at work (p = 0.01), number of hand washes per shift (p = 0.0003), number of times gloves were worn (p = 0.008), and study site (p = 0.009). Variables significantly predictive of skin damage in a logistic regression analysis were type of soap used at work and number of times gloves were worn (p = 0.04). Geographic location was not a factor, because both the highest and lowest prevalence of skin damage occurred in the northern study institutions. CONCLUSIONS: Damage to skin of the hands is a common and potentially serious problem among nurses, and is associated with gloving and handwashing practices rather than with geographic or demographic factors. Efforts to improve skin condition must focus on improving products and identifying any interactive effects between hand care products and glove materials and brands.
Adult↗
Academic freedom amidst competing demands.
Academic freedom means freedom from control in the fulfillment of the faculty roles of teaching and scholarship, but conflicts and misunderstandings regarding this right and responsibility occur, particularly during a time of rapid change. This article discusses the potential conflicts inherent in the academic setting between faculty and administration and differentiates between the role of a faculty member and the academic administrator in three areas: service, scholarship, and support.
Education, Nursing↗
Home hygiene practices and infectious disease symptoms among household members.
Public health programs are generally targeted to communitywide, population-based prevention strategies, with little attention focused on the home environment as one potential source of transmission of infectious diseases. The purpose of this correlational prevalence survey was to describe the relationship between home hygiene practices and prevalence of infectious disease symptoms among household members. Three hundred and ninety-eight households with 1,662 members in an inner-city population (96.4% Hispanic) were surveyed to examine hygiene practices and determine the presence of transmission of infection, defined as the presence of the same symptom(s) in two or more household members for which at least one individual sought medical attention and received treatment. At least one individual in 78.6% of households reported symptoms of infection in the previous 30 days, and 37.9% of households met the definition of disease transmission. In univariate analyses, five factors were significantly associated with risk of household transmission, but in the logistic regression model, only use of communal laundry (p = 0.009) and lack of bleach use (p = 0.04) were significantly predictive of increased risk of transmission. This is the first comprehensive survey of home hygiene practices and the first study to identify a potential link between laundry and risk of disease transmission in homes. This potential link warrants further study in clinical trials.
Adolescent↗
Education-service interaction group.
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Faculty, Nursing↗
Clinical application of undergraduate research skills: the Student Teams Utilizing Research (STUR) Project.
Although the desired outcome for undergraduate research curricula is to produce informed consumers/critiquers of research, baccalaureate students often have difficulty linking research concepts with clinical practice. The authors describe an innovative approach to integrating research content with a clinical experience through use of student teams working with practicing nursing preceptors to identify and study research problems.
Clinical Competence↗
Trends in neonatal infections.
The changing epidemiology of neonatal infections manifested in the first few weeks of life is described. The six infections discussed are herpes, hepatitis B, chlamydial infection, infection due to the group B streptococcus, gonococcal disease, and acquired immunodeficiency syndrome. Nursing actions to prevent the spread of these diseases are described, with particular emphasis on the importance of body substance precautions for all neonates.
Acquired Immunodeficiency Syndrome↗
Rituals in infection control: what works in the newborn nursery?
Two infection control practices common in the newborn nursery, handwashing and gowning, are compared with regards to historic origins, effectiveness, and extent of practice. The practice of handwashing is the direct result of efforts to prevent puerperal sepsis and has been shown to be effective in reducing neonatal risk of infection. Gowning has evolved from operating room practices and has been shown to be generally ineffective in reducing risk of infant infection. Nevertheless, gowning is practiced extensively and handwashing is often omitted. Such rituals need occasional reexamination so that those practices associated with maximum effectiveness receive appropriate attention.
Austria↗
Obstetric infection control in a developing country.
In Ghana, infection has been identified as a major cause of birth-related mortality. Results of a 2-month observation of infection control practices among Ghanaian obstetric nurses and midwives indicated that most personnel did not practice basic rules of asepsis. Problems included frequent breaks in technique, inadequate sterilization and disinfection, and repeated exposure to large amounts of blood and vaginal secretions. Supplies were limited and, even when available, not always used appropriately. The situation in developing countries is different from that in the United States. Therefore, an observational needs assessment is essential to plan relevant and practical measures for change.
Cesarean Section↗
Long-term visual outcomes of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion.
PURPOSE: To report the long-term surgical outcome of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion (CRVO). METHODS: A retrospective chart review of 25 consecutive eyes (25 patients) with cystoid macular edema due to nonischemic CRVO treated with vitrectomy was performed. All patients underwent a pars plana vitrectomy with the creation of a posterior vitreous detachment if still attached. Simultaneous phacoemulsification with intraocular lens implantation was also performed in phakic eyes. The main outcome measures were best-corrected visual acuity (BCVA) and changes in macular edema shown by contact-lens biomicroscopy. The mean follow-up time was 49 months (range, 16-108). RESULTS: The median BCVA before surgery was 0.31 and the median BCVA at last follow-up was 0.67. The BCVA at the last follow-up improved at least two Snellen lines in 17 (68%), remained unchanged in 4 (16%), and worsened in 4 (16%). The BCVA was 20/40 or better in 3 eyes (12%) preoperatively and in 18 eyes (72%) at the last follow-up. During the follow-up, four patients progressed to ischemic CRVO; one of them had neovascular glaucoma requiring surgical intervention. CONCLUSION: The data indicate that vitrectomy appears to be a possibly effective treatment in some eyes with cystoid macular edema associated with nonischemic CRVO.
Aged↗
Hygiene of the skin: when is clean too clean?
Skin hygiene, particularly of the hands, is a primary mechanism for reducing contact and fecal-oral transmission of infectious agents. Widespread use of antimicrobial products has prompted concern about emergence of resistance to antiseptics and damage to the skin barrier associated with frequent washing. This article reviews evidence for the relationship between skin hygiene and infection, the effects of washing on skin integrity, and recommendations for skin care practices.
Hand Disinfection↗
Effects of enforced behavior change on attitudes.
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Attitude of Health Personnel↗
Social and economic impact of infectious diseases--United States.
Despite major strides in the prevention and control of infectious diseases, they continue to take a significant economic and social toll in the United States. While progress toward meeting the Healthy People (HP) 2000 goals related to infections is generally on target, major disparities among certain groups (e.g., low-income, racial and ethnic minorities) still exist with regard to indicators such as immunization rates and rates of preventable infections. Preventable services for infectious diseases are among the most cost-effective. Progress toward meeting and sustaining the HP 2000 goals would be improved by universal entitlement for certain prevention services; reducing inconvenience as well as economic costs; appropriate utilization of all healthcare professionals and lay experts, as well as physicians; reducing inappropriate and costly use of resources such as antibiotics and specialist time; and engagement of the public and providers in national dialogue about risk benefit decision making, prioritization of use resources, and a focus on prevention rather than cure.
Communicable Disease Control↗
Predictors of functional status in patients in a chronic-care facility.
OBJECTIVE: To identify those factors correlated with functional status levels (activities of daily living and mobility) in a chronically ill population in long-term care. METHODS: Retrospective chart reviews were conducted over 3 months for information associated with functional status on all 220 patients in an urban extended-care facility. Independent variables included demographic variables, presence of selected medical conditions, current mental status, and baseline functional status on admission. Mean length of stay was 39 months. Multivariate analysis was performed to identify predictors of functional status. RESULTS: Factors correlated with functional status levels for 217 patients included total score on admission functional status and total score on current mental status (both P < .0001). There were no significant differences in mean scores of total functional status by medical problem, age, gender, length of stay, condition, level of care, presence of infection, or use of psychotropic drugs.
Activities of Daily Living↗