Gel and a Poster: A Hand Hygiene Campaign Gets Tested in Two Outpatient Clinics

By Sylvia Foley, AJN senior editor

hand.sochacki.98193355_eb8473c967 Hand by sochacki.info, via Flickr

The trouble with hands is that they get into everything, and rapidly move between mouths, noses, eyes, and other people’s hands.

So says David Owen in his recent New Yorker article “Hands Across America,” which describes the development of the first gel sanitizer—and of course it’s nothing nurses and other clinicians don’t already know, just as they know that the practice of hand hygiene is crucial to reducing health care–associated infection rates. Yet adherence to hand hygiene guidelines among health care workers remains low. Interventions to improve hand hygiene have been tested in hospitals with demonstrated success, but have seldom been evaluated in other settings. In this month’s CE–Original Research feature, authors Kate Stenske KuKanich and colleagues describe their evaluation of a hand hygiene campaign in an outpatient oncology clinic and an outpatient gastrointestinal (GI) clinic.

The intervention. At each clinic, the researchers observed health care workers for the frequency of hand hygiene (attempts versus opportunities). After compiling baseline data, they initiated an intervention, which consisted of introducing an alcohol-based gel sanitizer and an informational poster to each clinic. (The gel sanitizer was provided as an alternative to foam sanitizer and soap and water.) One week later, interventional data were collected for five nonconsecutive days. Afterwards the posters and gel sanitizers were removed, and one month later, follow-up data were collected. Lastly, three months after follow-up observations ended, workers at […]

2017-07-27T14:51:38-04:00March 11th, 2013|nursing research|1 Comment
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‘My Professor Said to Submit My Paper’ (We Hope They Also Told You This)

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Niklas Bildhauer/ Wikimedia Commons Niklas Bildhauer/ Wikimedia Commons

When we get a manuscript submission, I always read the cover letter first to learn about the author and why the article was written. Often, the first sentence goes something like this: “I am a student and I’m submitting my capstone paper as required by my professor.” Or the letter may say, “My professor encouraged me to submit this paper, my capstone work.”

The paper is usually the very paper the student wrote and submitted to the professor. And that almost always means it’s not suitable for a professional journal.

The problem is not that we won’t consider manuscripts written by students—we sometimes welcome them, especially papers written by nurses who are experienced clinicians and working toward a graduate degree. The problem with the submissions I’m talking about here is inherent in the purpose of the papers themselves. Student papers are written primarily to demonstrate what the student knows about a subject; these papers tend to be expansive, cover the topic in a superficial way, and include a long list of references of books, articles, and Web sites (or, conversely, they may only have a few references, mostly Web sites, plus perhaps one much-cited textbook—thankfully, few are citing Wikipedia).

Student papers that describe themselves as “literature reviews” often have no information about the search strategy—and little synthesis. Instead, they contain a long list of various studies related to the […]

2018-03-27T15:43:18-04:00February 22nd, 2013|nursing perspective, nursing research|1 Comment
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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained […]

2017-07-27T14:51:56-04:00February 4th, 2013|nursing research|1 Comment
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What’s So Hard to Understand: Patient Safety, Quality Care Linked to Nurse Staffing

shawnkennedy

The evidence linking nurse staffing and patient safety is strong.

The data linking nurse staffing as well as shift length with patient outcomes and satisfaction with care continue to roll in. The latest report on nurse staffing, published in the January 13 issue of Medical Care by McHugh and MA, links higher nurse–patient ratios and good work environments to reduced 30-day readmission rates. Read the abstract here.

Most nurses seem to support better nurse–patient ratios, but there’s continuing ambivalence about reducing shift length, as seen in the comments we received on a recent blog post asking whether it’s time to retire the 12-hour nursing shift.

In August, researchers reported a link between nurse staffing and hospital-acquired infections.  Publishing in the American Journal of Infection Control, the authors noted a “significant association” between nurse–patient staffing ratios and both urinary tract infections and surgical site infections. Further, they noted that reducing nurse burnout was associated with fewer infections. (Read our news report on the study here.)

Health Affairs published a report in November called “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction.” The findings were there, loud and clear—researchers Stimpfel, Sloane, and Aiken found that “extended shifts undermine nurses’ well-being, may result in expensive turnover and can negatively affect patient […]

2018-03-13T10:41:13-04:00January 29th, 2013|nursing perspective, nursing research|20 Comments
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Original Research: Perioperative Medication Withholding in Patients With Parkinson’s Disease

Drawing of the face of a Parkinson's disease patient showing characteristic symptoms: mainly hypomimia, a expression-less mask-like face. Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux / publiée sous la direction du professeur Charcot,... ; par Paul Richer,... Gilles de la Tourette,... Albert Londe,.... - 1888. Chapter "Habitude exterieure et facies dans la paralyse agitante". Plate XL1V 1888 drawing of face of a Parkinson’s patient revealing “characteristic symptoms: mainly hypomimia, a expression-less mask-like face.” Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux./Wikimedia Here’s the abstract of our January original research CE article, “Original Research: Perioperative Medication Withholding in Patients with Parkinson’s Disease: A Retrospective Electronic Health Records Review.”

Abstract

Background: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson’s disease, has a short half-life of one to two hours. When patients with Parkinson’s disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson’s disease symptoms. Clear guidelines regarding perioperative symptom management are lacking.

Objectives: The goals of this study were threefold: to measure the perioperative duration of the withholding of carbidopa-levodopa in patients with Parkinson’s disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson’s disease symptoms.

Methods: We conducted a retrospective review of patient electronic health records at a […]

2016-11-21T13:08:31-05:00January 18th, 2013|nursing research|0 Comments
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