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Standard Precautions (SP) are an essential, although unmet, component of nursing care. Understanding conditions fostering the integration of SP within nursing workflow is imperative. This research describes the relationships among patient safety culture, adherence to SP, and missed nursing care., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

This article studies the effectiveness of xMOOC teaching in the area of nursing education, by making a comparison between two study groups. Though observation, academic tests and interview, this study finds out that the application of xMOOC to teaching scheme practice could effectively increase teaching ability of teachers, learning ability of students and their test scores which had positive significance in improving clinical nursing teaching quality.

Objective: This study examined the opinions of nurses about the introduction of enrolled nurse medication administration and analyzed its impact on the medication error rate., Methods: Data were collected using a survey and examination of incident reports regarding nursing medication errors. Nurses (registered nurse, enrolled nurse with medication endorsement, enrolled nurse) responded to survey items regarding the introduction of enrolled nurse medication administration. Data analysis included descriptive statistics, Fischer's exact test, and chi-square analysis where appropriate., Results: The majority of nurses (75.2%) supported enrolled nurse medication administration. However, differences in opinion were observed between registered nurse (RN) and enrolled nurse with medication endorsement (ENME) regarding clear understanding of responsibility and accountability (RN: 47.2% vs. ENME: 77.8%; p =.033), and whether suitable education was provided (RN: 34.7% vs. ENME: 73.7%; p =.012). Moreover, less than one-third of RNs agreed that the assessment process for EN medication endorsement clearly identified the competence of the ENME to administer medications. Nonetheless, nursing medication errors did not increase in the 12-month period after the introduction of enrolled nurse medication administration (pre: 314, post: 302)., Conclusions: The findings of this study suggest areas that should be addressed in the future, including assessment of competence and focused education about accountability and responsibility., (© 2012 Wiley Periodicals, Inc.)

Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians., Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis., Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses' and doctors' offices were the most common locations for multitasking in the emergency department., Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

Objectives: The objective of this study was to survey the current level of participation dermatology nurses have in screening and skin cancer detection., Sample: Nursing professionals including registered nurses (RNs) and licensed practical nurses and their Ontario, Canadian equivalents (registered practical nurses), advanced practice nurses, such as nurse practitioners and dermatology nurse practitioners, were included in the sample. RN education ranged from associate's to master's degree preparation., Data Analysis: Demographic, clinical setting, and practice information were reported using descriptive statistics and cross tabulations., Results: Eighty-three percent (n = 89) of nurses surveyed are performing a total-body skin examination (TBSE); 15% (n = 16) are confident and 52% (n = 56) are very confident with their skills., Conclusions: The vast majority of nurses surveyed reported that they practiced skin cancer screening. They also reported using dermatologic tools, such as dermatoscope and digital camera. Nurses trained to perform TBSEs, as well as those who use dermatoscopes and digital cameras when performing TSBEs, provide an important component in improving cancer screening and detection.

Objectives: To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada., Methods: Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care)., Results: CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%)., Conclusions: Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.

Nurses are at considerable risk for work-related violence. This study compared the experiences of work-related violence among registered nurses (RNs) and licensed practical nurses (LPNs) to quantify differences in risks and exposures and to gain insight into possible interventions. A random sample (n = 6,300) of licensed Minnesota nurses was surveyed regarding the previous 12-month period. Nurses self-reported violent events and demographic information. After adjustment for potential confounders and nonresponse, LPNs had an increased risk for both physical assault (odds ratio = 1.4; 95% confidence interval = 1.1-1.9) and nonphysical violence (odds ratio = 1.2; 95% confidence interval = 1.0-1.5) compared to RNs. Some exposures resulted in increased risks for both types of violence for RNs and LPNs: working primarily in psychiatric departments and long-term care facilities. In contrast, working in clinics resulted in decreased risks for both license types. Some risks varied by license type. Risk of physical assault was increased for LPNs working with neonatal/pediatric patients, whereas RNs' risk was decreased. RNs' risk of physical violence increased while providing care, whereas LPNs' risk increased while supervising care. A better understanding of how this problem varies by license type and work setting will assist in designing efficacious interventions.

Background and Study Aims: Propofol has several advantages for sedation in endoscopic procedures. Sedation administered by anaesthesiologists is associated with high costs. In this study the safety of propofol sedation administered by trained practice nurses under the supervision of the gastroenterologist in a cohort of outpatients of an ambulatory practice for gastroenterology in Germany is evaluated., Methods: During a period of 21 months all patients referred to colonoscopy were eligible for this prospective observational study. The familiar CRC risk of the individuals, indication, completeness and results of the colonoscopy were registered together with the dose of propofol used. Propofol was administered by intermittent intravenous bolus titration by trained practice nurses under supervision of the gastroenterologist. Oxygen saturation, heart rate and blood pressure were recorded constantly during the procedure and adverse cardiopulmonary events were monitored by the endoscopy team. A respiratory event was defined as an episode of apnoea or laryngospasm requiring assisted ventilation. 23 % of the patients received supplemental oxygen., Results: A total of 3641 colonoscopies were recorded. 33 individuals were sedated with midazolam and were excluded from the evaluation. 3610 individuals were sedated with propofol (119 +/- 39 mg, mean dose +/- S. D.). 40 % of the procedures were performed as combined gastroscopy and colonoscopy. The cecum was reached in 99 % of the colonoscopies. Respiratory events occurred in five patients (0.14 %). Assisted ventilation in all cases was performed by mask ventilation. Bradycardia (HF < 60/min) and arterial hypotension (RR < 90 mmHg) occurred in 0.5 and 0.3 % of the colonoscopies, respectively, but medical intervention was necessary only in 0.2 % for both types of event. Minor events of hypoxaemia were observed in 51 patients (1.4 %), but only 1/3 of these events occurred in patients supplemented with oxygen., Conclusions: Propofol can be administered safely for ambulatory colonoscopy by trained practice nurses, with careful monitoring under supervision of the gastroenterologist.

Background: Over the last 10 years, nurses increasingly perform tasks and procedures that were previously performed by physicians., Objective: In this review, we investigated what types of GI care and endoscopic procedures nurses presently perform and reviewed the available evidence regarding the benefits of these activities., Design: Review of published articles on nurses' involvement in GI and endoscopic practice., Results: In total, 19 studies were identified that evaluated performance and participation of nurses in GI and endoscopic practice. Of these, 3 were randomized trials on the performance of nurses in flexible sigmoidoscopy (n = 2) and upper endoscopy (n = 1). Fourteen nonrandomized studies evaluated performance in upper endoscopy (n = 2), EUS (n = 1), flexible sigmoidoscopy (n = 7), capsule endoscopy (n = 2), and percutaneous endoscopic gastrostomy placement (n = 2). In all studies, it was found that nurses accurately and safely performed these procedures. Two further studies demonstrated that nurses adequately managed follow-up of patients with Barrett's esophagus and inflammatory bowel disease. Four of the 19 studies showed that patients were satisfied with the type of care nurses provided. Finally, it was suggested that costs were reduced if nurses performed a sigmoidoscopy and evaluated capsule endoscopy examinations compared with physicians performing these activities., Conclusions: The findings of this review support the involvement of nurses in diagnostic endoscopy and follow-up of patients with chronic GI disorders. Further randomized trials, however, are needed to demonstrate whether this involvement compares at least as favorably with gastroenterologists in terms of medical outcomes, patient satisfaction, and costs.

Background: Practice nurses (PNs) are the largest group of nurses providing primary care for patients with diabetes in New Zealand, and changes in the health system are likely to have a substantial effect on their roles. To inform the development of a new primary health care nursing structure and evaluate the new role associated with this, it will be important to have data on current practice nurse roles., Aims: The aim of this paper is to report a study to compare the diabetes-related work roles, training and attitudes of practice nurses in New Zealand surveyed in 1990 and 1999, to consider whether barriers to practice nurse diabetes care changed through that decade, and whether ongoing barriers will be addressed by current changes in primary care., Methods: Questionnaires were mailed to all 146 PNs in South Auckland in 1990 and to all 180 in 1999, asking about personal and practice descriptions, practice organization, time spent with patients with diabetes, screening practices, components of care undertaken by practice nurses, difficulties and barriers to good practice, training in diabetes and need for further education. The 1999 questionnaire also asked about nurse prescribing and influence on patient quality of life., Results: More nurses surveyed in 1999 had postregistration diabetes training than those in 1990, although most of those surveyed in both years wanted further training. In 1999, nurses looked after more patients with diabetes, without spending more time on diabetes care than nurses in 1990. Nevertheless, they reported increased involvement in the more complex areas of diabetes care. Respondents in 1999 were no more likely than those in 1990 to adjust treatment, and gave a full range of opinion for and against proposals to allow nurse prescribing. The relatively low response rate to the 1990 survey may lead to an underestimate of changes between 1990 and 1999., Conclusions: Developments in New Zealand primary care are likely to increase the role of primary health care nurses in diabetes. Research and evaluation is required to ascertain whether this increasing role translates into improved outcomes for patients.

Musculoskeletal and emotional disorders are important causes of reported diseases, causing medical absences, and eventually earlier decrease of work ability. This paper reports the results of a study carried out among practical nurses working at the Orthopedics and Trauma Institute. The objectives of the study were: (a) to describe the routine activities performed during day and night shifts, and (b) to compare the work activities performed in different wards during these shifts. A Brazilian version of the Work Ability Index--WAI (TUOMI et al., 1994) was answered by 83 practical nurses. Forty-three of them (52%) reported pains or musculoskeletal diseases, either based on their own opinion or diagnosed by a physician. These nurses were invited to join the second phase of the study and twenty-nine accepted it. All work activities performed in 29 shifts were observed and recorded. The results showed that day shifts were far more demanding in terms of the number of activities related to patients' care than afternoon and night shifts. Also, body postures associated with day work activities demanded important physical efforts. The number of nurses in charge during night shifts was substantially lower than during day shifts. This could lead to an overload and affect the health of the nurses.

This article reports on a survey done among registered, enrolled and auxiliary nurses registered with the South African Nursing Council. The survey was carried out in the period from the end of December 1997 to the beginning of 1998. The purpose of the survey was to obtain the views of female nurses on various aspects of the workplace. The important findings were the fact that nurses liked working as part of a team and that this contributed the most to their job satisfaction. The item that contributed least to job satisfaction was pay. The most important problems were that they felt that they were not paid enough and that they need better benefits. The majority of nurses were however positive about their jobs and the items the highest on the list of career expectations were job satisfaction, followed by a need for recognition.

In the fall of 1997, the Idaho Commission of Nursing and Nursing Education undertook a survey of Idaho nurses to collect data on future workforce and educational needs. The results of the survey demonstrated substantial attitudinal differences between licensed practical nurses and registered nurses in the areas of educational motivation, role differentiation, skills by type of nurse, trends in nursing supply, and educational preparation. Given that the Idaho workforce is comparable to the national nursing workforce in numbers, educational background, and age, these findings have implications for health policy planners and nursing educators throughout the country. This article presents the findings and then uses the data as a basis for suggesting their implications for nursing education and workforce planning.

We surveyed 205 applicants to three types of nursing programs (B.Sc.N., diploma-R.N., and diploma-R.N.A.) offered in Toronto, Ontario. Applicants were predominately white, unmarried women living within commuting distance of the institutions to which they applied. Applicants to practical nursing programs tended to be older than applicants to B.Sc.N. and diploma-R.N. programs, be married, have at least one dependant, come from blue-collar families, be out of school longer, and submit fewer applications. Applicants with dependants were 11 times more likely to choose R.P.N. over R.N. programs. Recency of graduation and high school average were predictive of choosing B.Sc.N. over R.N. programs. While this 1992 cohort had some appreciation for the challenges facing the nursing profession, most applicants still expected to secure full-time employment in acute care post-graduation. The data provide an important benchmark for comparing current and future cohorts of applicants with respect to socio-demographic characteristics and expectations of nursing as a career choice.

Objectives: To assess the knowledge of unintentional injury epidemiology, the attitudes towards, and current practices in injury prevention among practice nurses., Setting: Practice nurses employed by general practitioners in Nottinghamshire, United Kingdom., Method: A postal questionnaire was sent to all practice nurses on the Family Health Services Authority list (n = 322) with questions covering sociodemographic details, occupational details, unintentional injury epidemiology, attitudes towards the injury prevention activities suggested by a government report as part of the role of the primary health care team, and current practices in injury prevention., Results: A response rate of 71.1% was achieved. More than 50% knew that unintentional injuries were the most common cause of death in childhood. A similar per cent knew the site of most fatal injuries in the under 1 and 5-16 year age groups. More than two thirds correctly identified a range of risk factors for unintentional injury. However, only two fifths of nurses believed they could be effective in preventing injuries. There were considerable gaps between attitudes and practice for most activities. The activities most commonly undertaken include displaying posters and leaflets (69.4%), giving advice on prevention (51.1%), and advice on first aid (45.0%) during injury consultations., Conclusions: Most practice nurses hold positive attitudes towards injury prevention activities, but fewer undertake these activities regularly. The activities most commonly undertaken employ an educational model. Further research is needed on the barriers to practice nurses undertaking more injury prevention work, the effectiveness of systems to overcome such barriers, and the effectiveness of these injury prevention activities.

Background: There are calls for the role of the practice nurse to be developed and extended. Before areas for further training and education can be identified, baseline data are needed on practice nurses' current activity and workload., Aim: A study was undertaken to analyse the activity of practice nurses in two large inner city general practices and to assess the skills mix of the nursing staff required to meet the needs of the practices., Method: The study practices had a combined list of 26,000 patients, 80% of patients attracting a deprivation allowance. Each practice employed three practice nurses. A nurse activity index with 45 codes was constructed to describe patient-nurse consultations. Activity codes were categorized into traditional treatment tasks, extended role tasks or diagnosis and management tasks. For eight months, practice nurses in practices Y and Z recorded activity index codes for each patient consultation. Practice Y also recorded the source of referral and the age and sex of the patient., Results: There were 13,898 practice nurse consultations during the study period, equivalent to an annual nurse consultation rate of 0.8 per patient. Compared with the practice population as a whole, the patients attending the practice nurses in practice Y were older (mean age 43 years versus 37 years, P < 0.001). Those attending the practice nurses in practice Y were also more likely to be female (61% of consultations were with female patients compared with 50% of the practice population as a whole, P < 0.001). In practice Y, patients referred themselves to the practice nurse in 42% of consultations, 32% were follow-up consultations and in 25% of cases the patient had been referred by a doctor. The most common reasons for nurse consultation were blood tests (15% of procedures in practice Y and 18% in practice Z) and dressings (13% in both practices). Most procedures in practices Y and Z were in the traditional treatment category (61%), 26% were in the extended role category and 9% in the diagnosis and management category (3% coded 'other', 1% uncoded). Between practices, the greatest difference in recorded procedures was for asthma check ups (7% of procedures in practice Y compared with 2% in practice Z)., Conclusion: This study describes the workload of practice nurses in two inner city practices over eight months. Other practices could use the activity index to make comparisons over time and between practices. Up to 60% of nurses' work in the study practices could be done by a nurse without extended training and up to 30% could be done by a health care assistant, but with some loss of quality. It is suggested that half the nursing hours available to a practice should be offered by a nurse with extended training in order to undertake and develop extended role tasks and diagnosis and management tasks.

Licensed practical nurses are the smallest major segment of the home care industry, providing services with registered nurses and home care aides. Although they report high job satisfaction, LPNs are caught at a middle stage in the health care system. With new demographics, labor market considerations, and recruitment experiences, this report points out the discrepancy between the stalled LPN status and their industry growth.

Race and social class differences in the quality of job and parenting experiences, and multiple role gains and strains, are examined in a sample of 229 black and white female social workers and licensed practical nurses. Both race and class differences in job-role quality were found, but only class differences were found in parenting concerns. Race and class differences were found in multiple role gains and strains.

A serious shortage of nurses has developed since 1984 despite a growing number of employed nurses and a substantial decline in the number of hospital inpatient days. The evidence suggests that the shortage is the result of an increased demand for nurses, not a decline in supply. The increased demand in large part has resulted from the substitution of registered nurses for licensed practical nurses, aides, and other patient services personnel. The substitution was feasible because nurses' wages have been depressed compared with those of other hospital employees. The shortage is likely to abate if nurses' wages increase, making substitution more costly. Even in the absence of continuing wage increases, hospitals could ease the shortage by restructuring patient services and enabling nurses to spend a greater portion of their time in direct patient care.