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!
I know, most of us try to forget all those nursing school tests, but for the sake of our patients and our profession, let’s consider those tests again and how important equity in nursing education is to our ability to attract, train, and retain a diverse nursing workforce.
According to the Robert Wood Johnson Foundation, “… it is essential to have a nursing workforce that will reflect the population of the United States so as to deliver cost-effective, quality care and improve patients’ satisfaction and health outcomes…”
The American Association of Colleges of Nursing adds, “…diversity in the nursing workforce provides opportunities to deliver quality care which promotes patient satisfaction and emotional well-being.”
But despite imperatives such as these, we still find a large gender discrepancy in nursing demographics. Statistics from the American Nursing Association show that just 11% of licensed nurses are male. Other sources put that number at just 9%, and research suggests that gender bias in nursing education could be playing a role.
According to a study published in Nursing Education Today, implicit gender discrimination in nursing education can affect how female and male students are graded on short-answer or essay exams (the types of tests with room for subjectivity in grading). In the study, the researchers looked at how students’ grades changed depending upon whether instructors were blinded or un-blinded to students’ gender. The instructors in the study graded the exams once and then two months later were asked to re-grade them after the identities of the students had been hidden.
The results showed that when instructors knew they were scoring a male student’s exam, he tended to score lower than when the instructors were blinded to his gender. The opposite was true among female students’ exam scores – their grades generally went up when instructors were aware of gender and down when they were not.
Granted, this was a small study including just eight nursing school instructors and 400 exams, but certainly the results are worth noting – especially by anyone involved in nursing education. Bias in our nursing education can result in negative feedback to male students, affecting nursing school retention rates and discouraging men from pursuing nursing careers.
Additional research in Nurse Education Today sheds more light on the situation. Called “Gender Differences in the academic and clinical performance of undergraduate nursing students: A systematic review,” the meta-analysis looked at 55 studies on gender bias in nursing education and found a few general trends including: negative experiences among male nursing students during their obstetric clinical placements, differences in learning styles among male and female nursing students perhaps affecting male success in nursing programs, and that many male nursing students do not feel supported in their nursing programs.
The good news?
Both men and women feel equally “called” to the profession of nursing, and really that’s the future of nursing.
Working nights? You’re certainly not alone. According to the Bureau of Labor Statistics, more than 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts.
If you’re working nights, you’ve probably heard warnings about how your alternative schedule could negatively affect your health and well-being.
But your schedule is your schedule and perhaps you can’t change it right now, or perhaps you don’t want to. With that in mind, let’s live in the nocturnal moment and talk about ways you can get better sleep and make the most of the work-life balance you’ve got.
1. Jump-start your night.
As night falls, get some exercise, expose yourself to bright light, and take a hot shower – each of these tricks can help you to feel alert and ready to take on the world.
2. Time your caffeine.
Drinking a cup of coffee at the beginning of your shift will help promote alertness. But don’t consume caffeine for the last 4 to 6 hours of your shift or it may be harder to get to sleep when you get home.
3. Block out and black out.
Just because the sun is coming up when you’re heading home to bed, doesn’t mean you have to take any notice. Wear dark, wrap-around sunglasses to block the morning rays that can wake you up. Keep those glasses on until you’re in the dark sanctity of your blackout-curtained bedroom. Blackout curtains are a must because, even if your eyes are closed, sunlight in your room rouses you. Add earplugs and an eye cover and your sleep is covered.
4. Avoid alcohol.
A glass of wine or beer may help you fall asleep, but you’ll likely pay for it later as alcohol disturbs the second half of your sleep. Go with grandma’s advice and sip warm milk instead.
5. Step away from that device.
Smartphones, tablets, and computers (as well as energy efficient light bulbs) all emit blue light that boosts wakefulness – not great when you’re hoping to catch some z’s. If possible, avoid using devices for one hour before you’d like to fall asleep. Charting until the last moment? Try blue-light-blocking or “sleep” glasses. Yes, you’ll look a little funny during hand-off, but isn’t sleep worth it?
6. Try melatonin (but not so much)!
Whoa, that melatonin in your medicine cabinet is 5mg per dose. Research in the journal Work shows you only need about 0.3mg to fall asleep faster. So grab a pill cutter, trim those tablets, sleep better, and save yourself money to boot. Older shift workers may particularly benefit from taking melatonin as the body’s natural melatonin production lessens with age. Quick review: the pineal gland in your brain produces melatonin in response to darkness – it’s a biological marker of night and makes sleep inviting.
7. Create rituals.
Tell your body it’s time to sleep with calming, soothing habits. Read a book, listen to soft music, or gently stretch. Write down things that are worrying you and tell yourself you are setting them aside while you rest.
8. Use your nose.
There is evidence that certain smells can improve sleep. Lavender, for instance, can decrease heart rate and blood pressure, potentially putting you in a more tranquil state. Vanilla, valerian, and jasmine are other possibly soporific options. If you enjoy scents, try soaps, lotions, or oils to find what works for you.
There you have it: 8 tips for the Holy Grail of sleep – those blissful 8 hours. Hope to see you in dreamland.
Big thank you to the National Sleep Foundation, the American Psychological Association, and the peer-reviewed journals Work and Sleep Medicine Clinics for the useful resources that informed this blog.
Welcome to the holiday season—a time for treats in the break room, holiday parties, cookie exchanges, and festive family meals. Sounds fun, but too often all this merriment prevents weight loss and leads to weight gain. Even worse, according to the Journal of the American Medical Association, most people NEVER lose the pounds they put on over the winter holidays. Which mean’s it’s much better to avoid gaining them in the first place.
Could coffee and other caffeinated beverages help?
Order yourself a nonfat full-caf latte and read on because the research is promising.
According to the Mayo Clinic, caffeine can reduce your desire to eat in the short term—perhaps helping you to avoid those calorie-dense finger foods and buying you time to find a healthy alternative.
If you actually fit in a workout this holiday season, researchers from Japan suggest adding caffeine to your pre-workout preparations. Their results, published in Clinical Physiology and Functional Imaging, show that caffeine consumption (about two cups of strong coffee) before exercise promotes more fat burning.
A study in the European Journal of Clinical Nutrition found that people who lose weight and manage to keep it off tend to drink significantly more coffee than the general population.
Of course, we wouldn’t be nurses if we didn’t consider the potential pitfalls of too much caffeine. Rest assured that 83% of adults in the United States are already drinking coffee and experts say that when used in moderation (400 milligrams or less per day, about the equivalent of four cups of coffee) caffeine is generally safe. But too much can, as you know, cause nervousness, insomnia, and other problems. If you’re new to caffeine, please let me know how you made it through nursing school. But seriously, if you’ve generally abstained until now, start slow and see how your body reacts.
Meanwhile, in the coffee shop, remember that those fancy holiday brews (like gingerbread cookie lattes, mint mochas, and eggnog decadence) can come with a hefty calorie count (not to mention the price tag!). Stick with the classics to avoid negating any potential caffeine benefits.
Now, please pass me my mug. It’s time for a coffee break.
