The last time you walked into a patient’s hospital room, what was touching the floor? A purse or briefcase? A cell phone charger? The call button? The TV remote? A blood pressure cuff? Pulse ox? Water bottle?
I don’t know about you, but whenever I see high-touch items like these casually dropped or placed on the hospital floor, I cringe. Until recently, however, I didn’t have any data to back up my revulsion.
For better or for worse, I do now. Yes, bacteria and viruses really can get transferred from patients, to floors, and back up again to other patients, health care providers, and even visitors.
According to a recent study published in the American Journal of Infection Control, patient room floors in five Cleveland-area hospitals were often contaminated with health care-associated pathogens, and objects on the floor frequently resulted in the transfer of pathogens to hands.
Of particular concern, the study found that C. difficile (Clostridium difficile) was the most frequently recovered pathogen from patient room floors. The frequency of contamination was similar in each of the five hospitals studied and in patient rooms and bathrooms, alike.
How should this impact your day-to-day practice? Here’s what I think:
1. If you aren’t already educating patients and visitors to avoid putting personal items directly on the floor, start doing so.
2. If and when items land on the floor, make sure that patients and visitors have access to sanitizing wipes to clean those items, and remind them to do just that.
3. Educate your coworkers on the importance of using sanitizing wipes on items that have touched the floor.
4. Remind patients and health care workers to wash hands or to use hand sanitizers frequently and as per hospital policy, but also after touching items that may have been in contact with the floor.
5. Advocate for institutions to provide patients and visitors with more hooks for hanging up items that might otherwise end up on the floor.
6. Work with environmental services to improve the efficacy of your institution’s current floor cleaning. Does your hospital use sporicidal agents or ultraviolet-C room decontamination? Find out and voice concerns if you have them.
But the buck doesn’t stop on the floor.
According to a study in the Journal of Hospital Infection last year, patients’ nonslip socks are frequently contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). In fact, 85% of the nonslip socks tested were contaminated with VRE. Ick!
Here again I see a role for nurses in educating patients and caregivers to help prevent pathogen transfer:
- Teach proper doffing techniques for sock removal.
- Advise patients to refrain from touching socks with their hands unless necessary.
- Provide clean socks often.
- Provide hand-sanitizing opportunities throughout the day.
Likewise, similar research in World Journal of Microbiology and Biotechnology has suggested that wheelchairs could be a source of pathogen dissemination in health care facilities. Which, I venture, gives nurses a chance to remind patients and coworkers to clean their hands after taking wheelchairs for a spin. And it certainly couldn’t hurt to disinfect the wheels on a regular basis.
Finally, the ubiquitous smartphone: Recent research finds that mobile phones serve as reservoirs of infection in the health care environment. The study, published in the American Journal of Infection Control, looked at genetically identical strains of Staphylococcus aureus recovered from mobile phones and palms and fingers of users and multiple users. The results reinforce, yet again, the need for frequent hand washing or hand sanitizing throughout the day for patients and health care providers—particularly after touching common items like phones.
Spring is always a time for a fresh start and thanks to the research I’ve covered today, it seems we’ve got even more great reasons to clean up and clean often. Now, if only I could get my family to help by putting away their phones and picking their stuff up off the floors at home!
The preceptorship of a nurse or student has far-reaching effects, influencing everything from the safety of the patient, to the quality of care the patient receives, and the employment, retention, and job satisfaction of the new nurse. The preceptorship experience will be remembered long after the preceptee has left the facility. How the preceptor conducts both himself or herself and the orientation period will not only influence how the preceptee feels about the profession of nursing for years to come, but the quality of care his or her future patients receive.
Listed below are behaviors attributable to an ineffectual nursing preceptor. If you notice that they reflect your teaching style, then take advantage of preceptor education. Recognize that these behaviors can be changed and that the most successful preceptors do not exhibit these qualities. You are an ineffectual preceptor if:
- You are unclear about the goals of orientation.
- You do not ascertain the preceptee’s skill and knowledge level prior to the start of orientation.
- You do not question the preceptee to determine if there are any patient care areas in which he or she feels weak.
- You do not introduce the preceptee to fellow team members and do not help the preceptee feel like part of the team.
- You do not orient the preceptee to the unit so that he or she does not know where items or located or typical procedures to follow.
- The goals and expectations for orientation are unclear and are not stated in writing.
- The goals you establish are not measurable or achievable.
- You do not review the goals for the day or for orientation with the preceptee.
- You are inconsistent in your communication style.
- You do not allow the preceptee time to practice skills prior to attempting them.
- You do not build new skills upon current skill level.
- You delegate to the preceptee beyond his or her skill level.
- You do not seek out new learning experiences for the preceptee but instead allow the preceptee to find learning situations on his or her own.
- You fail to provide guidance in the completion of a new skill, assessment, or other nursing function.
- Your clinical skills and technique are not evidence-based or correct; you take shortcuts to save your time but in doing so may unknowingly endanger the patient. You pressure the preceptee to perform these skills as you do.
- You leave the preceptee to do the work that other staff do not wish to complete.
- You are continually rude to the preceptee, fellow staff, families and patients.
- You allow the preceptee to experience a lot of “down time,” for example by allowing him or her to “hang around” the nurses’ station rather than engaging in patient care or learning new skills.
- You frequently cancel scheduled meeting times with the preceptee, the unit manager, the unit educator, or faculty members, therefore fallowing communication to break down among all parties.
- You allow the preceptee to be utilized as staff prior to the end of preceptorship.
We know about the dangers of opioid prescriptions: A recent study linked opioid addiction to just one encounter with opioids for pain control, usually prescribed in an emergency department. (To learn more about safe opioid prescription medication patient teaching, read an article here.) The question is, how can you effectively manage pain without opioids? Pain requires frequent assessment and the setting of realistic expectations by a patient and his or her care team. Patients need to know that although it may not be possible for them to feel entirely pain-free, they are still entitled to some level of pain control. Below is a review of non-pharmacological methods for controlling your patients’ pain.
Heat it up or cool it down. Many of us neglect the value that a hot blanket or heating pad or a cold pack or bag of ice can have on our patients’ pain. It may not help with their chronic pain, but for acute pain, applying heat or cold can be very effective. Just monitor the patient’s skin for any burns or skin irritation at the site, and leave heat or cold on for no longer than 15 minutes at a time.
Guided imagery or relaxation. There are several guided imagery scripts you can find online that you can run through with a patient or even print off and hand to a family member at the bedside. Several institutions have caring or healing patient channels that provide relaxing music or imagery exercises.
Distraction. Can you help your patient turn on the TV, or bring them some magazines or books? When patients are lying in a bed with nothing to focus on but their pain, their perception of the pain can increase. Try to distract the patients with music, TV, art therapy, or books. These methods can help a patient alter their perception of pain.
Promote rest. Make sure your patients can get plenty of sleep. We all know that the hospital is ironically one of the worst places to get a good night’s sleep, but sleep deprivation decreases the patient’s pain threshold and increases their stress response. Excessive stimuli should be reduced for patients as much as possible, so take care to eliminate excess noise by closing doors, adjusting the room temperature, and decreasing harsh artificial lighting.
Fed is best. If your patient is able to eat, ensure they are getting adequate nutrition and enough food to feel full. Hospital food can be notoriously unappetizing, but a feeling of hunger can also exacerbate patient perception of pain. If possible, suggest to family or friends that they bring some favorite snacks or meals for the patient to enjoy.
Advocate. Frequent assessment and evaluation of patients’ pain and their response to pain interventions is crucial for our patients. Be sure you are re-assessing frequently and advocating to the physician if you feel that pain is being inadequately managed.
It’s that time of year: almost everyone is being discharged from hospital visits with an antibiotic. From pneumonia to skin infections to strep throat, there are a myriad of reasons your patients may leave with an antibiotic prescription. With microbial resistance on the rise, and because of the many complications of antibiotic use (C. Diff comes to mind), nurses play a crucial role in ensuring medication compliance and proper home use. Below are some tips for making sure you are teaching your patients correctly about their medications—from penicillin to Cipro and beyond.
1. Make sure your patients know to take their antibiotics with food, preferably at mealtimes.
Many antibiotics can upset the stomach or cause gastritis, so avoid taking them on an empty stomach. (The only antibiotics that should be taken on an empty stomach are ampicillin, dicloxacillin, rifabutin, and rifampin.) A heavy meal is not necessary, but a small snack can prevent indigestion.
2. It is imperative that the patient take the full bottle or dispensed amount, even if they start feeling better before completion.
In fact, it is very likely that the patient will feel better before the prescribed amount is finished. Even so, feeling better is not an indication that the bacteria are all gone. Patients who do not complete their entire prescription help promote antibiotic resistance, because any bacteria not killed yet can go on to reproduce with genes that allow them to avoid destruction by common antibiotics. Sometimes, emphasizing to patients that future antibiotics may not work for them can be an effective way to ensure compliance.
3. If the patient has a reaction to an antibiotic he or she needs to call their doctor immediately.
Several antibiotics can cause rashes or hives, or more seriously, an anaphylactic response. It is important to teach your patients to be on alert if it is a medication they’ve never taken before or if they have had reactions in the past.
For some specific classes of antibiotics, some additional teaching is required.
Fluoroquinolones, such as ciprofloxacin, levofloxacin, or moxifloxacin, can cause tendon injuries. Specifically, patients may experience peripheral neuropathy that can have permanent effects. Caution patients to immediately report any symptoms of pain, burning, pins and needles, or tingling or numbness. Rupture of the Achilles tendon is possible even with short-term use of these drugs.
Antibiotic–associated diarrhea is an overgrowth of usually harmless bacteria that live in the GI tract, most usually Clostridium difficile. In severe cases, C. diff can be life-threatening. The antibiotics most likely to cause a C. diff infection are fluoroquinolones and clindamycin, but diarrhea remains a risk when taking any antibiotic. To help prevent cases of C. diff, patients can take an over-the-counter probiotic or eat yogurt with live and active cultures (but yogurt must be ingested three times a day to be effective).
Certain antibiotics, such as tetracyclines (doxycycline) and fluoroquinolones, need to be separated from divalent cations—found in dairy products, antacids, and vitamins—by at least two hours. These antibiotics can also cause gastritis, so it is important to still eat them with a small meal to decrease this effect.
It’s no wonder our patients can be overwhelmed when taking antibiotics—there is a lot of information to remember! But proper patient education can help nurses play a role in preventing microbial resistance and ensuring safe medication compliance.
Evidence-based practice. Those three words seem to be all the buzz in health care in recent years, and there is a good reason why. Evidence-based practice (EBP) is the science of our nursing care: It keeps us current, up-to-date, and providing the best care to our patients for the best reasons.
When you break EBP down to its core, it’s an approach to making decisions and providing nursing care not just on the most current research, but also on the basis of personal clinical experience. It’s the why for your nursing care, validating your decision-making for certain tasks on the basis of outcomes and research. It incorporates the most relevant studies, literature reviews, and clinical cases, but it also emphasizes observations made in your own care over the tenure of your own practice. It aims to incorporate what you and others have found to be the most effective treatments, practices, and ideas. EBP improves patient outcomes and patient safety.
How can you bring EBP to your unit?
Use the Internet
It can be as simple as a Google Scholar search, checking Up-to-Date, or reviewing some of the recent articles from your nursing specialty’s society journal. Changes are easy to implement on the unit, whether you’re a staff nurse or a manager. Do you feel that shift report is rushed or could be improved for better patient safety? Take a look at what the literature says about the topic and what the evidence supports to increase patient satisfaction, outcomes, and safety. It’s often surprising just how much information is already published on a topic you may be interested it. Would your unit benefit from a subscription to the Annual Review of Nursing Research, the Journal of Perinatal Education, or Neonatal Network? Ask your manager to subscribe, or whether your hospital system can provide physical copies for unit reference.
Start a Unit Council
Evidence-based practice is best incorporated into nursing units with a dedicated safety nurse, educator, or EBP leader. In units without such a position, clinical practice councils can be formed by any nurse on a unit to bring together a core team of individuals to tackle unit-based issues and find literature-supported solutions. It is difficult to imagine a unit leader or manager who wouldn’t welcome this type of employee engagement in both patient safety and unit success.
It is easy to be discouraged when one considers the breadth of nursing research about a given topic. But the root of evidence-based care is in the real-world, at the bedside, and on the unit. It starts with the observation of a problem, and the drive to find the best way to fix it. You don’t have to fix the problems plaguing nursing as a profession; you are just aiming to fix issues on your own unit and in your own practice.
The PICO model can help you define a clinical question you’re attempting to address. It stands for problem, intervention, comparison, and outcome. Well-built questions identify all four components when reviewing the literature on a certain topic. It can help format your study, research, and plan of attack.
Involve New Graduate Nurses
Oftentimes, the nurses most familiar with research and clinical questions are the new graduates. New graduates today are given the tools to conduct EBP research, and have been taught the most cutting-edge and up-to-date recommendations for practice available.
After learning about cultural diversity by reading a nursing textbook, five nursing students from Pennsylvania College of Technology got to go out and experience diversity firsthand. Participating in a study abroad course, students traveled to the small town of Nueva Santa Rosa, Guatemala to treat patients in a medical clinic for seven days.
The Penn College students were led by Christine B. Kavanagh, the instructor of nursing programs, and accompanied by a larger volunteer group from Glens Falls Medical Mission. Glens Falls is based in New York and leads weekly trips to the small Guatemala community twice a year to help patients who live two hours away from the nearest hospital.
During their weeklong stint at the medical clinic, the group of volunteers saw over 1,300 patients by communicating through translators. They practiced in five clinical areas including triage, dental, pediatrics, women’s health, and general medicine, providing basic screenings, treatments, medical education, fluoride for dental care, and referrals to outside specialists when needed. Students were amazed by the positivity exuded by their patients who experience a wide variety of issues, not just medical.
Penn College offers a variety of study abroad courses, but this was the first time nursing students participated in a trip. After a successful mission, they hope to offer the course and service trip to nursing students every fall. In addition to the nursing trip, Penn College also offers a course in providing dental hygiene education in the Dominican Republic.