Identifying the needs of critical and acute cardiac care nurses within the first two years of practice in Egypt using a nominal group technique

Nursing in Egypt faces many challenges and working conditions in health care settings are generally poor. Little is known about the needs of new nurses transitioning in Egypt. The literature focuses on the first year of practice and only a small body of research has explored the transition needs within acute care speciality settings. This paper reports on the important professional needs of new graduate nurses working in an acute cardiac setting in Egypt during the first two years of practice and differences between their perceived most important needs. The total population participated and two group interviews were conducted (n = 5; n = 6) using the nominal group technique. Needs were identified and prioritised using both rankings and ratings to attain consensus. Content analysis was conducted to produce themes and enable cross-group comparison. Rating scores were standardised for comparison within and between groups. Both groups ranked and rated items as important: 1) education, training and continued professional development; 2) professional standards; 3) supportive clinical practice environment; 4) manageable work patterns, and 5) organisational structure. It is important that health care organisations are responsive to these needs to ensure support strategies reflect the priorities of new nurses transitioning in acute care hospitals within Egypt

Comparative study on the effect of enteral feeding on blood glucose

Stress hyperglycaemia is common in intensive care patients. There is recent evidence to suggest that maintaining the blood glucose of a patient in intensive care between 4 mmol/litre and 6.1 mmol/litre reduces morbidity and mortality. The aim of this comparative study was to determine if blood glucose control improves with abolishing feeding breaks and introducing continuous enteral feeding. Twenty ventilated patients admitted to a combined medical and surgical intensive care unit were sampled. Ten patients received standard care (enteral feeding for 18 hours with an 8-hour break). The interventional group received continuous enteral feeding over the 24 hours. Analysis of the data revealed that continuous enteral feeding reduced blood glucose levels significantly, improved blood glucose control and reduced insulin requirements. Research should continue to determine if the results of this study can be replicated within a larger group of intensive care patients

Minimising central line associated bloodstream infections' (CLABSIs) rate in inserting central venous catheters (CVCs) in the Adult Intensive Care Units (AICUs)

Aim: To investigate the procedural aspects in inserting central venous catheters that minimise central line associated bloodstream infections rates in adult intensive care units through a structured literature review. Background: In adult intensive care units (AICU), central line associated bloodstream infections (CLABSI) are a major cause of high mortality rates and increased in costs due to the consequences of complications. Methods: Eligible articles were identified by combining indexed keywords using Boolean operator of “AND” under databases of Ovid and CINAHL. Titles and abstract of retrieved papers were screened and duplicates removed. An inclusion and exclusion criteria was applied to derive the final papers which contained seminal studies. The quality of papers was assessed using a special data extraction form. Results: The number of papers retrieved from all databases was 337, reduced to 302 after removing duplicates. Papers were scanned for titles and abstract to locate those relevant to the review question. After this, 250 papers were excluded for different reasons and a total of 52 papers were fully accessed to assess for eligibility. The final number of papers included was 10 articles. Conclusion: Many interventions can be implemented in the AICU during the insertion of a central venous catheter (CVC) to minimise CLABSI rates. These include choosing the subclavian site to insert the catheters as the least infectious and decolonising patients’ skin with alcoholic chlorhexidine gluconate (CHG) preparation due to its broad antimicrobial effect and durability. Relevance to clinical practice: Choosing optimal sites for CVC insertion is a complex process that relies on many factors. Furthermore, the introduction of CHG preparations should be accompanied with multifaceted interventions including quality improvement initiatives to improve healthcare workers’ compliance. As a quality marker in AICUs, healthcare sectors should work on establishing benchmarks with other sectors around the world

Decision-making: initiating insulin therapy for adults with diabetes

Aim. This paper is a report of a study to describe nurses’ perceptions of decision-making and the evidence base for the initiation of insulin therapy. Background. Several theoretical perspectives and professional’s attributes underpin decision-making to commence insulin therapy. The management of type 2 diabetes is moving from secondary to primary care and this affects how clinical decisions are made, by whom and the evidence base for these decisions. Method. A postal survey was conducted with a stratified sample of 3478 Diabetes Specialist Nurses and Practice Nurses with a special interest in diabetes across the four countries of the United Kingdom. A total of 1310 valid responses were returned, giving a response rate of 37·7%. The questionnaire was designed for the study and pilot-tested before use. Responses were given using Likert-type scales. Data were collected during 2005 and 2006, and one reminder was sent. Results. People with diabetes are seen as having little influence in decision-making. Consultant physicians appear to be influential in most decisions, and the nursing groups held varying perceptions of who made clinical decisions. Nurses’ identified different responsibilities for those working solely in secondary care from those working in both community and secondary care. Practice nurses were not as involved as anticipated. Conclusion. Nurses working with people with diabetes need to encourage them to become more active partners in care. Clinical guidelines can assist in decision-making where nurses are least experienced in initiating insulin therapy