Search

To evaluate the effectiveness of a foot self-management strategy that utilized a commercially-available infrared thermometer (CAIT) for prevention of diabetic foot ulcers. In this six-month pilot randomized controlled trial, Phase 2 of a three-phase mixed methods research study, 62 participants were randomized to a thermometer and education group (n = 34) and an education-only group (n = 26). Both groups received foot care education and were assessed by a certified orthotist. All participants recorded their number of steps and recorded a foot assessment in a logbook daily. The thermometer and education group also recorded their daily temperature assessment. A temperature difference of >4° Fahrenheit (F) between the two feet prompted participants to rest their feet. Participants were directed to see their healthcare provider if the temperature difference did not decrease to below 4° F in two days. Phase 3 of the study explored the Phase 2 results to understand the findings further. The strategy improved foot assessment and action: the thermometer and education group had significantly more days with any assessment completed than the education-only group (150.98/180 vs. 119.84/180, p = 0.02). Phase 3 findings showed that the thermometer engaged participants, prompted action, and offered reassurance regarding foot health. A CAIT is a tool that could support foot self-management and may offer several benefits, such as promoting and providing structure for a foot assessment and direction for action. NCT0306776 clinicaltrials.gov. • Monitoring of foot temperature with a medical-grade thermometer is a strategy to help patients identify inflammation that could lead to an ulcer. • We wanted to ask whether daily temperature monitoring with a low-cost commercially available infrared thermometer supports self-management. • We found that the strategy engaged patients, improved foot assessment, and prompted action to address foot concerns. • The low-cost commercially available thermometer is a tool that could support foot self-management and prevent foot ulcers. [ABSTRACT FROM AUTHOR]

Background: High nursing workload, negative role models, and inconvenient location of alcohol-based hand-rub dispensers are among the most common barriers that prevent nursing students and nurses from adhering to Routine Practices (RP). The aim of this study was to identify if nursing students and instructors encountered these three barriers, what strategies they used to address them, and how confident they were about applying problem solving in addressing them. Method: A cross-sectional survey was conducted in three nursing schools in Eastern Canada, and included 577 undergraduate nursing students, and 20 nursing instructors. Data were collected using the Routine Practices Problem-Solving Questionnaire. Frequency distributions were used to describe the participants' characteristics and each item in the questionnaire. Pearson chi-square test was used to assess relationships between the level of confidence and participants' characteristics. Results: We found that only 25% to 44.2% of students and instructors reported that high nursing workload, negative role models, and inconvenient location of alcohol- based hand rub were among the most common barriers which prevented them from adhering to Routine Practices. Although they encountered these three barriers, only 21.1% to 30.2% of students indicated that they used problem solving to address them. However, both groups of participants identified other strategies that can be used to address these three barriers. More instructors, compared to students, were very confident/confident about applying problem solving to address these barriers. There was a significant association between nursing students' levels of confidence and their training in RP as well as their training in problem solving related to RP (p< .0001), but no significant association between the instructors' level of confidence and these characteristics (p > 0.05). Conclusion: Understanding of these three barriers, and knowing possible strategies to address them, including problem solving, can potentially help infection control practitioners in their discussions with nurses, students, and instructors to improve adherence to RP. [ABSTRACT FROM AUTHOR]

Abstract Background Policies and procedures (P&Ps) have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1) nurses' use of eight specific research-based practices (RBPs) and RBP overall, 2) nurses' use and understanding of P&Ps, and 3) the role of P&Ps in promoting research utilization. Methods Staff nurses from the eight health regions governing acute care services across the Canadian province of Newfoundland and Labrador completed an anonymous questionnaire regarding their use of eight RBPs and associated P&Ps. Data were also obtained from authorities in six of the eight regions about existing relevant P&Ps. We used descriptive statistics and multivariate regression analysis to assess the relationship between key independent variables and self-reported use of RBP. Results Use of the eight RBPs ranged from 7.8% to 88.6%, depending on the practice. Nurses ranked P&P manuals as their number one source of practice knowledge. Most respondents (84.8%) reported that the main reason they consult the P&P manual is to confirm they are practicing according to agency rules. Multivariate regression analysis identified three significant predictors of being a user versus non-user of RBP overall: awareness, awareness by regular use, and persuasion. Six significant predictors of being a consistent versus less consistent user of RBP overall were also identified: perception of P&P existence, unit, nursing experience, personal experience as a source of practice knowledge, number of existing research-based P&Ps, and lack of time as a barrier to consulting P&P manuals. Conclusion Findings suggest that nurses use P&Ps to guide their practice. However, the mere existence of P&Ps is not sufficient to translate research into nursing practice. Individual and organizational factors related to nurses' understanding and use of P&Ps also play key roles. Thus, moving research evidence into practice will require careful interplay between the organization and the individual. P&Ps may be the interface through which this occurs.

Objectives Hand hygiene is considered the most important preventive measure for healthcare-associated infections, but adherence is suboptimal. We previously undertook a Cochrane Review that demonstrated that interventions to improve adherence are moderately effective. Impact varied between organisations and sites with the same intervention and implementation approaches. This study seeks to explore these differences. Methods A thematic synthesis was applied to the original authors' interpretation and commentary that offered explanations of how hand hygiene interventions exerted their effects and suggested reasons why success varied. The synthesis used a published Cochrane Review followed by three-stage synthesis. Results Twenty-one papers were reviewed: 11 randomised, 1 non-randomised and 9 interrupted time series studies. Thirteen descriptive themes were identified. They reflected a range of factors perceived to influence effectiveness. Descriptive themes were synthesised into three analytical themes: methodological explanations for failure or success (eg, Hawthorne effect) and two related themes that address issues with implementing hand hygiene interventions: successful implementation needs leadership and cooperation throughout the organisation (eg, visible managerial support) and understanding the context and aligning the intervention with it drives implementation (eg, embedding the intervention into wider patient safety initiatives). Conclusions The analytical themes help to explain the original authors' perceptions of the degree to which interventions were effective and suggested new directions for research: exploring ways to avoid the Hawthorne effect; exploring the impact of components of multimodal interventions; the use of theoretical frameworks for behaviour change; potential to embed interventions into wider patient safety initiatives; adaptations to demonstrate sustainability; and the development of systematic approaches to implementation. Our findings corroborate studies exploring the success or failure of other clinical interventions: context and leadership are important. [ABSTRACT FROM AUTHOR]

This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website. [ABSTRACT FROM AUTHOR]

Purpose. To understand what faculty members can do to improve students' learning. we explored (1) program and course characteristics important to students, (2) choices within courses students feel are important, and (3) students' perceptions of learning online. Backgroulld. Web delivery alters interactions among students and faculty, thereby changing the learning environment. Methods. Master ofNursing students currendy enrolled in one graduate program were invited to participate in a webbased survey. Filldillgs. The students valued (1) frequent feedback and interaction with the instructor, (2) organized, structured, and current content, (3) flexibility in deadlines and participation, (4) seamless navigation and technical support, and (5) choices in assignments. Students perceived their learning in online courses as less than if they had taken the course on campus. Conclusions. Professors can address some of the items identified by students as important, such as being flexible with due dates and expectations for participation in online discussion. [ABSTRACT FROM AUTHOR]

Background: Policies and procedures (P&Ps) have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1) nurses' use of eight specific research-based practices (RBPs) and RBP overall, 2) nurses' use and understanding of P&Ps, and 3) the role of P&Ps in promoting research utilization. Methods: Staff nurses from the eight health regions governing acute care services across the Canadian province of Newfoundland and Labrador completed an anonymous questionnaire regarding their use of eight RBPs and associated P&Ps. Data were also obtained from authorities in six of the eight regions about existing relevant P&Ps. We used descriptive statistics and multivariate regression analysis to assess the relationship between key independent variables and self-reported use of RBP. Results: Use of the eight RBPs ranged from 7.8% to 88.6%, depending on the practice. Nurses ranked P&P manuals as their number one source of practice knowledge. Most respondents (84.8%) reported that the main reason they consult the P&P manual is to confirm they are practicing according to agency rules. Multivariate regression analysis identified three significant predictors of being a user versus non-user of RBP overall: awareness, awareness by regular use, and persuasion. Six significant predictors of being a consistent versus less consistent user of RBP overall were also identified: perception of P&P existence, unit, nursing experience, personal experience as a source of practice knowledge, number of existing research-based P&Ps, and lack of time as a barrier to consulting P&P manuals. Conclusion: Findings suggest that nurses use P&Ps to guide their practice. However, the mere existence of P&Ps is not sufficient to translate research into nursing practice. Individual and organizational factors related to nurses' understanding and use of P&Ps also play key roles. Thus, moving research evidence into practice will require careful interplay between the organization and the individual. P&Ps may be the interface through which this occurs. [ABSTRACT FROM AUTHOR]

Diarrhea-related dehydration is a leading cause of childhood death in developing countries such as Indonesia, despite being largely preventable and treatable through use of Oral Rehydration Solution (ORS). While the extent to which ORS is used in Indonesia has been explored in earlier studies, the issue of whether it is being used correctly has not been adequately investigated. The purpose of this study was to assess mothers' ORS preparation and administration practices and to determine their source of instruction for these practices. A structured questionnaire was administered orally to 100 mothers of children under the age of 5 years, in a rural village of West Java, Indonesia. Only 23.7% of mothers were found to have correctly prepared ORS, and none exhibited fully correct administration practices. Primary sources of instruction were health workers (62.9%), package instructions (23.7%), and family members or friends (12.4%). Resulting recommendations include education of health care workers, community health education programs, reallocation of health care resources, and revision of ORS packaging guidelines. [ABSTRACT FROM AUTHOR]