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Biomedical subjects

Mary Lou Sole

Publications and source records attributed to Mary Lou Sole.

10 recordsLinked to original sources
PubMed2006

Implementing best practice strategies to prevent infection in the ICU.

Critically ill patients are at high risk for infection because of many factors. Quality and regulatory groups have published guidelines regarding infection prevention in the ICU. A multifaceted, multiprofessional team approach is necessary to develop and implement strategies to prevent infection in the critically ill patient. Bundles of intervention along with daily rounds an assessment are essential program components. Ongoing surveillance and re- education and reinforcement are also part of a strong infection prevention program.

Benchmarking↗
PubMed2003

A multisite survey of suctioning techniques and airway management practices.

BACKGROUND: Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices. OBJECTIVES: To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists. METHODS: A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices. RESULTS: A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years' experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did. CONCLUSIONS: Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.

Adult↗
PubMed2002

A comparison of nurses' needs/concerns and hospital disaster plans following Florida's Hurricane Floyd.

INTRODUCTION: The idea for this study was inspired by the response to Hurricane Floyd. Nurses are relied upon and expected to fulfill responsible roles during disaster situations, but little is known about the needs or concerns that nurses experience when they meet expectations and function as disaster responders. METHODS: Official copies of disaster protocols from 4 area hospitals were reviewed, and 4 focus groups consisting of ED nurses from respective hospitals provided information about nurses' concerns or needs in response to Hurricane Floyd. RESULTS: Of primary importance to nurses was family safety, pet care, and personal safety while at work. Secondary concerns were basic needs such as food, water, sleep, shelter, and rest. Group commitment levels to providing care during disaster situations varied greatly. Participants requested that hospital policy revisions address work assignments, pay/financial compensation, flexibility for extenuating circumstances, pet care, family sheltering, and provision of basic needs. DISCUSSION: It is not sufficient for a few key officials and planners to know their roles and responsibilities during a disaster; the roles of everyone involved must be clearly understood. Many participants described their conflict as family commitment versus professional obligation. We identified several areas of concerns in our interviews, and those areas have been clearly defined in the revised protocols. Other areas have yet to be addressed.

Adult↗
PubMed2002

Adult anemia: determine clinical significance.

Severity of adult anemia does not reliably indicate its origin or clinical significance. Causes range from dietary insufficiency to occult bleeding and from chronic disease processes to hemolysis. NPs can identify the different types of anemia with a thorough history, physical examination, and appropriate laboratory testing.

Adult↗
PubMed2002

Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study.

BACKGROUND: Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia. OBJECTIVES: To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment. METHODS: Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n=18) and 48 hours (n=10). RESULTS: After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples. CANCLUSIONS: The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients' normal flora, equipment may be a source of cross-contamination.

Adult↗
PubMedDate not supplied

A review of instruments measuring resilience.

The objectives of the study were to evaluate the psychometric properties and appropriateness of instruments for the study of resilience in adolescents. A search was completed using the terms resilience and instruments or scales using the EBSCO database (CINAHL, PreCINAHL, and Academic Search Premier), MEDLINE, PsychINFO and PsychARTICLES, and the Internet. After instruments were identified, a second search was performed for studies reporting the psychometric development of these instruments. Using inclusion and exclusion criteria, six psychometric development of instrument studies were selected for a full review. A data extraction table was used to compare the six instruments. Two of the six instruments (Baruth Protective Factors Inventory [BPFI] and Brief-Resilient Coping Scale) lacked evidence that they were appropriate for administration with the adolescent population due to lack of research applications. Three instruments (Adolescent Resilience Scale [ARS], Connor-Davidson Resilience Scale, and Resilience Scale for Adults) had acceptable credibility but needed further study in adolescents. One instrument (Resilience Scale [RS]) was determined to be the best instrument to study resilience in the adolescent population due to psychometric properties of the instrument and applications in a variety of age groups, including adolescence. Findings of this review indicate that the RS is the most appropriate instrument to study resilience in the adolescent population. While other instruments have potential (e.g., ARS, BPFI) as they were tested in the adolescent and young adult populations, they lack evidence for their use at this time. An evaluation of the review and recommendations are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Outcomes of an infection prevention project focusing on hand hygiene and isolation practices.

Nosocomial infections are a major health problem for hospitalized patients and their families. Since the 1800s, hand hygiene has been recognized as the single best method to prevent the spread of pathogens and nosocomial infections. Despite this fact, many healthcare workers do not adhere to hand hygiene policies. The Centers for Disease Control and Prevention issued a guideline for hand hygiene practices in 2002. Multifaceted approaches to improve hand hygiene have been shown to increase compliance among healthcare workers and subsequently reduce infections. A performance improvement project was initiated to implement this guideline and other strategies to prevent nosocomial infection. This article summarizes the performance improvement processes and the preliminary outcomes on adherence to infection prevention policies related to hand hygiene and isolation practices. Clinically and statistically significant increases were noted for hand hygiene prior to patient care and in wearing masks when indicated. Nurses and patient care technicians had the greatest increases in compliance. Increases in hand hygiene after patient contact and wearing of gown and gloves were also noted, but results were not statistically significant. Nosocomial infection rates from antibiotic-resistant organisms decreased in the first surveillance, but rates increased during the 1-year surveillance. Consumption of alcohol-based foam disinfectant doubled from baseline. Findings are consistent with other published studies. The project will continue with further reinforcement and education over the second year.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Web-based triage in a college health setting.

The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours; however, it recommended self-care management in 22.7% of encounters. Sore throat was the most frequent chief complaint (14.2%). A subset of 59 students received treatment at student health services after requesting an appointment via e-mail. The authors used kappa statistics to compare congruence between chief complaint and 24/7 WebMed classification (kappa = .94), between chief complaint and student health center diagnosis (kappa = .91), and between 24/7 WebMed classification and student health center diagnosis (kappa = .89). Initial evaluation showed high use and good accuracy of Web-based triage. This service provides education and advice to students about their health care concerns.

Adolescent↗