2018 RDML Mary F. Hall Award Presented to NMCSD Nursing Scientists

2018 RDML Mary F. Hall Award Presented to NMCSD Nursing Scientists

Two nurse scientists from the Naval Medical Center San Diego (NMCSD) recently received the 2018 RDML Mary F. Hall award for nursing publication. This highly acclaimed award was created to recognize the contributions to nursing made through professional publications.

This is the second year in a row that Cmdr. Wendy Cook, a Nurse Corps scientist and head of Nursing Research and Analysis at the Clinical Investigation department at NMSCD, has won the award for co-authoring “U.S. Military Service Members’ Reasons for Deciding to Participate in Health Research,” which was published on Research in Nursing and Health.

“It’s a great feeling,” Cook told Defense Visual Information Distribution Services (DVIDS). “I am delighted to have two separate publications recognized two years in a row, especially because I am aware of the high quality of the other nominated publications.”

Cmdr. Abigail Yablonsky, principal investigator for Naval Health Research Center’s Directorate for Military Population Health, is another recipient of the RDML Mary F. Hall award. Her publication, “Research, Readiness, and Military Parents,” which was published by the Defense Visual Information Distribution Service, won first place.

“Both Cmdr. Cook and Cmdr. Yablonsky have been wonderful to work with,” Capt. Heather King, Senior Nurse Researcher at NMSCD, shared with DVIDS. “They are dedicated nurse scientists who continually strive to create and disseminate new knowledge to benefit our NMSCD service members and beneficiaries.”

To read more about the NMCSD recipients of the 2018 RDML Mary F. Hall Award, click here. For more information about the Naval Medical Center San Diego, click here.

Research of the Week: Resisting the Slow Undoing of Human Rights

Research of the Week: Resisting the Slow Undoing of Human Rights

This week we’re featuring Resisting the Slow Undoing of Human Rights, a Nursing Knowledge Activities column from the journal Research and Theory for Nursing Practice. Author Debra R. Hanna, PhD, RN, ACNS-BC, provided some insight as to how she prepared this column to write about the Transcultural Nursing Society. Read more below:

The column about Nursing Knowledge Activities, is intended to inform readers about events and developments in nursing knowledge. Having had a long-term interest in theory and research I wrote a series of columns to showcase different professional organizations dedicated to nursing theory activities.

 

Usually I write the Nursing Knowledge Activities column about 4-6 months before it  appears in print. In October 2017 I began writing the May 2018 column. Having already written about several nursing theory organizations, I  wanted to write about the Transcultural Nursing Society started by Madeleine Leininger. That Fall, I was doing background reading about twentieth century American history for a book I am currently writing. Each evening, the national news mentioned Congress wanting to overturn the Affordable Care Act. Also, there were news stories about refugees fleeing crisis situations from several parts of the world. Our politicians seemed divided about wanting to help refugees. That news broke my heart since it seemed that some politicians were not interested in helping humanity.

 

My first column for May 2018 was focused on a different topic. But then things came together on December 12, 2017. I decided to write a completely different column for May 2018. That morning I had read President Kennedy’s speech during my background reading. It reminded me of Leininger’s approach to human beings that was so nurturing, caring, and respectful of human dignity. The stark contrast between Kennedy’s approach to humanity and current political conversations, created a clear insight. I then examined the Transcultural Nursing Society’s website equipped with that insight. Once I saw the rich treasures that the Transcultural Nursing Society has to offer nurses today, I scrapped my other column. Within a half hour I wrote May’s column from beginning to end.

You can ready Dr. Hanna’s column, Resisting the Slow Undoing of Human Rights, here. To subscribe to Research and Theory for Nursing Practice, click here.

Research of the Week: The Design and Testing of the Psychometric Properties of the Person Engagement Index Instrument to Measure a Person’s Capacity to Engage in Health Care

Research of the Week: The Design and Testing of the Psychometric Properties of the Person Engagement Index Instrument to Measure a Person’s Capacity to Engage in Health Care

We’re starting a new feature for DailyNurse.com called Research of the Week! We’ll be sharing relevant and interesting research articles from our journals at Springer Publishing Company that we hope you find useful and helpful in your career.

This week we’re featuring The Design and Testing of the Psychometric Properties of the Person Engagement Index Instrument to Measure a Person’s Capacity to Engage in Health Care, from the Journal of Nursing Measurement. Author Ellen Swartwout, PhD, RN, NEA-BC, FAAN, provided some insight as to why the person engagement index is so crucial for patient care. Read more below:

Previous research has identified patient and family engagement as an essential element to optimize self-care management and improve patient outcomes1. Although much has been written about the importance of patient and family engagement, clinical care delivery models, processes and tools to translate patient engagement strategies into practice are needed2. In the July 2018 issue of the Journal of Nursing Measurement, the article entitled, “The Design and Testing of the Psychometric Properties of the Person Engagement Index (PEI) Instrument to Measure a Person’s Capacity to Engage in Health Care” discusses the development and testing of an instrument to measure a person’s capacity to engage in their health care3. The instrument was created based on review of the literature and underwent clinical expert review and validation prior to cognitive testing among adult medical-surgical patients. After cognitive testing, instrument items were revised to reflect patients’ feedback and tested in a multi-site research study involving four healthcare systems with five unique inpatient medical-surgical units. The PEI was developed for use in the assessment phase of the Interactive Care ModelTM — a five phase care delivery model for clinicians to use with people to engage them in their health care journey4.

 

The psychometric properties of the instrument were tested among 338 medical–surgical adult inpatients and found that four subscales comprised the total scale. Using exploratory factor analysis, four factors explained 63.9% of the total variance. The total and subscale reliability testing (Cronbach’s α) all exceeded the .70 threshold. The overall scale Cronbach’s = .896 and the four subscales corresponding Cronbach’s α were: Engagement in Health Care = .885, Technology Use in Health Care = .854, Proactive Approach to Health Care = .728, and Psychosocial Social Support = .880.

 

The results of the study indicate that the PEI is a valid and reliable instrument among the inpatient medical –surgical to measure a person’s capacity to engage in their health care. The importance of creating evidenced-based tools and resources to foster engagement and partnerships between clinicians and those they serve is an important step towards implementing patient engagement strategies. There are currently clinical and research cohorts of healthcare organizations using the PEI in clinical practice demonstration projects and formal research studies to test its use among various populations and settings.

You can read more about Dr. Swartwout’s research on the PEI here. To subscribe to the Journal of Nursing Measurement, click here.

References
  1. Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207–214.
  2. Carman, K.L., Dardess, P., Maurer, M.E., Workman, T., Ganachari D., & Pathak-Sen, E. A Roadmap for Patient and Family Engagement in Healthcare Practice and Research. (Prepared by the American Institutes for Research under a grant from the Gordon and Betty Moore Foundation, Dominick Frosch, Project Officer and Fellow; Susan Baade, Program Officer.) Gordon and Betty Moore Foundation: Palo Alto, CA; September 2014. www.patientfamilyengagement.org.
  3. Swartwout, E., El-Zein, A., Barnett, S., & Drenkard, K. (2018). The design and testing of the psychometric properties of the person engagement index instrument to measure a person’s capacity to engage in health care. Journal of Nursing Measurement, 26(2), 278-295.
  4. Drenkard, K., Swartwout, E., Deyo, P., & O’Neil, M. Interactive Care Model:  A framework for more fully engaging people in their healthcare. Journal of Nursing Administration, 2015; 45(10), 503-510.
Preventing PIV Infections

Preventing PIV Infections

Peripheral Intravenous Line (PIV) complications can be aggravating at best and deadly at worst. To get more information about this topic and to learn about a new invention from 3M, we interviewed Joseph Hommes, VSN, RN, VA-BC, Technical Service Specialist, 3M Medical Solutions Division to find out more.

Please explain PIVs, their complications, and the use of CHG skin preps and regrowth of bacteria.

Peripheral intravenous (PIV) lines are commonly placed in the arm to administer medications and fluids for therapeutic purposes. In fact, they are the most common vascular access procedure performed on hospitalized patients with 60 to 90 percent of patients requiring an IV catheter during their hospital stay.1

PIVs are often considered lower risk for infection than central lines because of their shorter dwell time and placement,2 but PIVs can be associated with preventable complications such as inflammation, dislodgement, phlebitis, and peripheral line-associated bloodstream infections (PLABSI). And like central line-associated bloodstream infections (CLABSI), PLABSI can lead to a rise in patient morbidity, length of stay, and health care costs for the patient and facility.3

The reason why regrowth may occur so quickly even after the use of CHG skin preps is related to the location of the bacteria,4 the presence of microbial biofilms on skin,5 and the significant variability of bacteria density and species from one person’s skin to another.6 Research studies show that up to 20 percent or more of the total skin flora is beyond the reach of routine disinfection. These bacteria are located in skin crevices where lipids and the superficial cornified epithelium protect them; and deep in the roots of hair follicles and sebaceous glands where they cannot be removed without injuring the skin.7 According to Gonzalez et al, biofilms with or without underlying dermal disease, will help reduce the efficacy of CHG, which, in turn can contribute to bacterial regrowth.8 In the case of peripheral vascular catheter or needleless connector use, the sustained presence of an antimicrobial agent serves to keep the bacterial counts low to absent.9

How can health care systems protect patients against these PIVs?

All IVs have the potential to be contaminated through two sources: extraluminal, where bacteria originate on the skin surface and intraluminal, where bacteria enter via the catheter hub or IV access point.

Although PIVs aren’t monitored or researched as frequently as central lines, it’s extremely important that health care facilities and clinicians pay close attention to these lines because approximately 1.6 million PIV infections occur each year globally.10

A growing interest in comprehensive PIV maintenance bundles is emerging based on different recommendations or practice standards from the Centers for Disease Control and Prevention (CDC) guidelines,11 Infusion Nurses Society (INS),12 and the Society for Healthcare Epidemiology of America (SHEA) compendium guidelines.13 One recently published study from Mercy Hospital in St. Louis, MO found that implementing a comprehensive PIV maintenance bundle was associated with a decrease in the rate of PLABSIs, from 0.57 to 0.11 per 1000 patient days (p < 0.001).14

Why should health care systems work harder to protect patients against these PIV infections? How dangerous are they?

PLABSI can be incredibly detrimental to both patients and health care facilities. In addition to PLABSI being potentially fatal for some patients, it can significantly impact a facility financially, with some cases costing $10,000 to $20,000 per patient,15 and up to $40,000 in intensive care unit (ICU) settings,16 giving hospitals a large incentive to prevent PLABSIs to improve patient outcomes and reduce costs.

What do the 3M antimicrobial PIV dressings do? How is this better than what is otherwise offered? Have you done any research on their effectiveness? If so, can you give me some information about the research and its conclusions?

Short-term PIVs account for a mean of 23 percent of all hospital-acquired CRBSIs.17 Additionally, one hospital determined that the leading source of health care-acquired S. aureus bloodstream infections over an 8-year period was associated with PIVs due to normal skin flora migrating down the catheter tract through the IV line.18

Protecting patients from risks associated with PIVs needs to start with the surface of the skin, disinfecting the catheter IV access points and continuing through monitoring the catheter insertion site until it is removed. The latest addition to 3M’s portfolio in the fight against extraluminal contamination of PIVs is the 3M Tegaderm™ Antimicrobial I.V. Advanced Securement Dressing. This dressing provides site visibility, catheter securement, and enables consistent application. Chlorhexidine Gluconate (CHG) is integrated throughout the adhesive to better suppress regrowth of skin flora on prepped skin for up to 7 days as compared to non-antimicrobial dressings.19 The transparent dressing allows continuous site visibility to enable early identification of complications at the insertion site. It is also designed to minimize catheter movement and dislodgement.

It’s important to note that peripheral line bundles should also include disinfection and protection at all intraluminal access points too. Using a peripheral line bundle that includes 3M Curos™ Disinfecting Caps for Needleless Connectors and 3M Curos Tips™ Disinfecting Cap for Male Luers provides effective disinfection of catheter IV access points. Effective disinfection of needleless connectors and male luers on PIV lines has been associated with a significant decrease in primary PLABSI.20

What else do you think is important for people to know about PIV bloodstream infections?

It’s critical for clinicians to better understand that PIVs are responsible for a significant number of total infections. According to a recent survey of 650 U.S. infection preventionists and clinicians, only 60 percent of infection preventionists are familiar with their facility’s PLABSI prevention protocols and procedures, yet 56 percent of all respondents believe that PLABSI poses a real threat to patient safety.21

With up to 90 percent of patients requiring a PIV during their hospital stay,22 clinicians should be paying closer attention to PIV care, making it a central part of their infection risk reduction programs. To get started, free educational courses about how to address clinical challenges associated with PIVs are available at 3M’s online learning platform, 3M Health Care Academy.

 


  1. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: Peripheral IV catheter failure. J Infus Nurs. 2015; 38(3): 189-203.
  2. Hadaway L. Short Peripheral intravenous catheters and infections. J Infus Nurs. 2012; 35(4): 230-240.
  3. Kilgore, M. and Brossette, S. Cost of bloodstream infections. Am J Infect Control. 2008; 36: S172 (e171-e173).
  4. Selwyn, S and Ellis, H. Skin Bacteria and Skin Disinfection Reconsidered, British medical journal, 1972, 1, 136-140.
  5. Gonzalez T, Biagini, Myers JM, Herr AB and Hershey K. Staphylococcal biofilms in atopic dermatitis. Curr Allergy Asthma Rep (2017) 17: 81.
  6. Gao Z, Tseng, C-h, Pei Z and Blaser MJ Molecular analysis of human forearm superficial skin bacterial biota. Proc Natl Acad Sci USA (2007) 104: 2927-2932.
  7. Selwyn, S and Ellis, H. Skin Bacteria and Skin Disinfection Reconsidered, British medical journal, 1972, 1, 136-140.
  8. Gonzalez T, Biagini, Myers JM, Herr AB and Hershey K. Staphylococcal biofilms in atopic dermatitis. Curr Allergy Asthma Rep (2017) 17: 81.
  9. Casey AL, Karpanen TH, Nightingale P, and Elliott TSJ. An invitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle free connectors. Antimicrobial Resist Infect Ctrl (2018) 7:50.
  10. Assumes median PVC infection incidence 0.2% (Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: Peripheral IV catheter failure. J Infus Nurs. 2015; 38(3): 189-203.); and average PVC dwell time of 3 days.
  11. Centers for Disease Control and Prevention. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
  12. Gorski L. A., Hadaway L., Hagle M., McGoldrick M., Orr M., Doellman D. Infusion therapy standards of practice. J Infus Nurs. 2016;39(suppl 1):S1-S159. https://www.ins1.org/Default.aspx?TabID=251&productId=113266
  13. Society for Healthcare Epidemiology of America (SHEA). Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, 2014. http://www.shea-online.org/index.php/practice-resources/priority-topics/compendium-of-strategies-to-prevent-hais
  14. Duncan, M, Bernatchez, S.F. et al. A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters The Journal of the Association for Vascular Access, Volume 23, Issue 1, 15 – 22.
  15. Kilgore, M. and Brossette, S. Cost of bloodstream infections. Am J Infect Control. 2008; 36: S172 (e171-e173).
  16. Elward, A.M., Hollenbeak, C.S., Warren, D.K., and Fraser, V.J. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics. 2005; 115: 868–872.
  17. Mermel L. Short-term peripheral venous catheter-related bloodstream infections: A systematic review. Clin Infect Dis. 2017; 65(10):1757-62
  18. Mestre G, Berbel C, Tortajada P, et al. Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasiexperimental study. Am J Infect Control. 2013;41: 520-526.
  19. 3M data on file.
  20. 3M data on file.
  21. Survey of 650 infection preventionists and clinicians, commissioned by 3M and conducted by a third-party research firm in April 2018, Human Factors and the Future of Infection Prevention, 2018. 3M data on file.
  22. Znigg, Walter et al, peripheral venous catheters: an under-evaluated problem. International Journal of Antimicrobial Age sj. Volume l34 S38-S42.
Educate Staff on How to Prevent Infection Transmission

Educate Staff on How to Prevent Infection Transmission

Healthcare personnel in the ambulatory care setting should be educated about how to best prevent the transmission of infectious agents, and infection prevention and control policies should be updated every 2 years, according to the American Academy of Pediatrics.

Writing in Pediatrics, an updated policy statement emphasized the importance of hand hygiene, as well as implementing specific isolation precautions when dealing with patients with specific highly infectious illnesses. The authors said that respiratory hygiene and cough etiquette strategies are necessary when handling patients with respiratory tract infections, such as cystic fibrosis. They further discussed the necessity of separating infected children from uninfected children, as well as proper disposal of all needles and medical devices and the appropriate use of personal protective equipment.

Finally, the authors addressed public health interventions, including that both patients and healthcare personnel should be up to date with their immunizations.

 

This story was originally published by MedPage Today, a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals and provider of free CME.

How to Teach Patients about Antibiotics

How to Teach Patients about Antibiotics

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.

Antibioticassociated 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 cationsfound 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.

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