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Noise has been shown to interfere with the healing process and can disrupt the patient's experience. This study assessed patients' and staff's perceptions of noise levels and sources in the hospital environment and identified interventions to reduce the noise level. The interventions significantly reduced noise as perceived by patients and staff. Identification of a structured process to identify noise sources and standardization of noise measurement methods can improve the patient hospital experience.
PURPOSE - To describe physical restraint (PR) rates and contexts in U.S. hospitals.
DESIGN - This 2003-2005 descriptive study was done to measure PR prevalence and contexts (census, gender, age, ventilation status, PR type, and rationale) at 40 randomly selected acute care hospitals in six U.S. metropolitan areas. All units except psychiatric, emergency, operative, obstetric, and long-term care were included.
METHODS - On 18 randomly selected days between 0500 and 0700 (5:00 am and 7:00 am), data collectors determined PR use and contexts via observation and nurse report.
FINDINGS - PR prevalence was 50 per 1,000 patient days (based on 155,412 patient days). Preventing disruption of therapy was the chief reason cited. PR rates varied by unit type, with adult ICU rates the highest obtained. Intra- and interinstitutional variation was as high as 10-fold. Ventilator use was strongly associated with PR use. Elderly patients were over-represented among the physically restrained on some units (e.g., medical) but on many unit types (including most ICUs) their PR use was consistent with those of other adults.
CONCLUSIONS - Wide rate variation indicates the need to examine administratively mediated variables and the promotion of unit-based improvement efforts. Anesthetic and sedation practices have contributed to high variation in ICU PR rates. Determining the types of units to target to achieve improvements in care of older adults requires study of PR sequelae rate by unit type.
Home parenteral nutrition carries a risk of infectious, metabolic, and mechanical complications that cause significant morbidity and mortality. This study investigated the incidence and the causative factors of these complications that occur within the first 90 days after discharge from the hospital to home. Data were prospectively collected and analyzed for 97 adult patients. A complication developed in one third of the patients, and the majority required rehospitalization. Infectious complications were the most prevalent, followed by mechanical and then metabolic complications. The authors describe their methods of collecting data in a quantifiable manner with the ultimate goal of improving patient outcomes.
PURPOSE - To identify variations in practices used by nurses for pediatric patients with sickle cell disease (SCD) receiving chronic blood transfusion therapy for strokes.
DATA SOURCES - Descriptive study of a convenience sample of 11 nurses who care for children with SCD from nine institutions completed a closed-ended questionnaire consisting of 37 items. Responses reflected practice experience with a total of 189 transfused patients with SCD.
CONCLUSIONS - A wide range of nursing practices exists for blood transfusion therapy for children with SCD and strokes. Manual partial exchange transfusion (66%) was the most commonly used method for blood transfusion in children with strokes reported among the nurses surveyed. Simple transfusions and erythrocytapheresis account for 21% and 13% of the practices reported. Opportunities exist to establish evidence-based nursing care guidelines to improve the care of children with strokes receiving blood transfusion therapy.
IMPLICATIONS FOR PRACTICE - A wide range of local standard care guidelines for blood transfusion therapy exists. The results of this survey indicate that partial manual exchange transfusion is the most commonly used method of chronic blood transfusion therapy in children with SCD and stroke despite the fact that the magnitude of benefit in comparison with simple transfusion has not been established. Factors such as peripheral venous access, compliance with current chelation regimen, and the presence of antibodies are important considerations in the choice of method.
BACKGROUND - Considerable debate has occurred concerning the utility of different methods of obtaining joint counts and their usefulness in predicting outcomes in persons with rheumatoid arthritis.
OBJECTIVE - The purpose of this study was to compare two methods of assessing disease activity in the joints (clinician joint count, self-reported joint count), and to compare their relative utility in predicting two methods of assessing outcomes (self-reported ratings of impairment and pain, objective performance index) with and without controlling for negative affectivity.
METHOD - Data for this study were obtained during home visits from 185 persons diagnosed with rheumatoid arthritis. Individuals completed a series of self-report measures including the joint count. Trained research assistants completed a 28-joint count and timed participants on a series of measured performance activities (e.g., grip strength, pinch strength, walk time).
RESULTS - The self-report joint count was highly correlated with the clinician joint count and also accounted for as much, if not more, variance in the subjective outcome measures than did clinician assessments. Both types of indicators predicted unique variance in the objective performance index.
CONCLUSIONS - For most research purposes, measures such as self-report joint counts have sufficient validity to be used in place of more costly clinician assessment of joint counts.
With increased consideration being given to technological supports as a way to increase productivity, much attention is being paid to automated documentation systems. The purpose of this study was to determine (A) if bedside documentation technology decreased the time nurses spent in documentation activities and (B) if time of day, location, and quality of documentation differed between automated and nonautomated units. Nurses on the automated unit were able to decrease time spent in documentation activities and they were able to increase time spent in direct patient care. Some increase in standby time also was reported. Nurses were not able to increase patient loads as a result of this technology alone. Managers must consider ways to maximize use of time saved as a result of technology. Nurses on the automated unit were able to update care plans more easily and, along with other professionals, reported both positive and negative aspects of the printed output.
PURPOSE/OBJECTIVES - To determine if adverse reactions to IV immunoglobulin G (IVIG) were being detected by nurses and frequent vital sign monitoring.
DESIGN - Retrospective chart review.
SETTING - Bone marrow transplant (BMT), medical oncology, and pediatric units and the outpatient clinic of a 720-bed hospital in middle Tennessee.
SAMPLE - 62 charts of patients undergoing BMT who had received IVIG. METHODS/MAIN RESEARCH VARIABLES: Charts were reviewed for patient demographics, number and type of IVIG infusion, incidence of adverse reactions, and related information.
FINDINGS - Nine reactions were documented out of 731 separate infusions. Only three reactions could be linked directly to IVIG infusion. Of the nine reactions, only four were detected by nursing personnel during vital sign monitoring.
CONCLUSIONS - Nursing time devoted to frequent vital sign assessment does not seem to be warranted. Protocol for administration and monitoring of IVIG at this institution was changed to reflect these findings.
IMPLICATIONS FOR NURSING PRACTICE - Frequent vital sign monitoring is advised for the initial IVIG dose. If no adverse reactions occur, only baseline vital sign monitoring is advised for subsequent infusions. Patients are taught to recognize and report symptoms of adverse reactions.