Continuing Nursing Education: Best Practice Initiative in Nursing Practice Environment

AbstractContinuing Nursing Education (CNE) within the Nursing Practice Environment (NPE) is important in determining issues associated with unsafe practice, unproductiveness or incompetent nurses. A descriptive correlational study was designed to determine the best practice initiative in NPE whereby 395 (94.3%) nurses participated. This study showed that the highest mean score was 2.91 on ‘Nursing Foundations for Quality of Care’ of which 314 (79.5%) nurses highly agreed that CNE programs are the most important. In conclusion, CNE program is the best practice initiative and it is recommended that CNE will encourage lifelong and transformational learning in the nursing career

The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review

BACKGROUND: Multimorbidity, the presence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies that have been used to reduce the complexity of patient management. However, each element of telemedicine and CDSSs is often examined separately and with great variability. Telemedicine has been used for simple patient education as well as more complex consultations and case management. For CDSSs, there is variability in data inputs, intended users, and outputs. Thus, there are several gaps in knowledge about how to integrate CDSSs into telemedicine and to what extent these integrated technological interventions can help improve patient outcomes for those with multimorbidity. OBJECTIVE: Our aims were to (1) broadly review system designs for CDSSs that have been integrated into each function of telemedicine for multimorbid patients in primary care, (2) summarize the effectiveness of the interventions, and (3) identify gaps in the literature. METHODS: An online search for literature was conducted up to November 2021 on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference lists was done to find additional potential studies. The eligibility criterion was that the study focused on the use of CDSSs in telemedicine for patients with multimorbidity in primary care. The system design for the CDSS was extracted based on its software and hardware, source of input, input, tasks, output, and users. Each component was grouped by telemedicine functions: telemonitoring, teleconsultation, tele-case management, and tele-education. RESULTS: Seven experimental studies were included in this review: 3 randomized controlled trials (RCTs) and 4 non-RCTs. The interventions were designed to manage patients with diabetes mellitus, hypertension, polypharmacy, and gestational diabetes mellitus. CDSSs can be used for various telemedicine functions: telemonitoring (eg, feedback), teleconsultation (eg, guideline suggestions, advisory material provisions, and responses to simple queries), tele-case management (eg, sharing information across facilities and teams), and tele-education (eg, patient self-management). However, the structure of CDSSs, such as data input, tasks, output, and intended users or decision-makers, varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions. CONCLUSIONS: Telemedicine and CDSSs have a role in supporting patients with multimorbidity. CDSSs can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined; examining tasks of CDSSs, particularly for screening and diagnosis of multiple conditions; and exploring the role of the patient as the direct user of the CDSS

The relationship between nurse managers' leadership style and patients' perception of the quality of the care provided by nurses: Cross sectional survey

Background:  In healthcare systems, human resources play a strategic role that has a significant impact on the whole caring process. When the wellbeing of professionals is low their performance decreases, counterproductive work behaviours may became more likely, and as a result the quality of care is compromised. Studies have shown that leadership style is particularly relevant in relation to the quality of work environments in healthcare organizations. Objective:  The main purpose of this study is to test a model that investigates the relationships between nurse managers’ leadership style and patients’ perception of the quality of the care provided by the nurses, through the mediation of the quality of the working environment (in terms of burnout, interpersonal strain and counterproductive work behaviour). Design:  A multi-centre cross-sectional study was conducted. Setting:  The study was conducted in five hospitals located two in the north, two in the centre and one in the south of Italy. Participants:  Participants were 479 registered nurses (working as staff nurses, while head nurses and nurse managers were excluded) and 829 patients aged 18 years or older, able to read and write Italian and hospitalized for at least 3 days. Severely ill or mentally disabled patients who were not able to fill in the questionnaire were excluded. Methods:  The data were collected through two different questionnaires, one for the nurses and one for the patients. A multilevel analysis was conducted to examine the hypothesized model. Results:  Results confirmed the hypothesis that, when nurses were satisfied with leadership, they felt less burned-out and strained in interpersonal relationships, they engaged less in misbehaviour, and, in turn, patients were more satisfied with the quality of the care provided by the nurses. Conclusions:  The results of this study showed that the characteristics of the organizational context, the leadership, and the behaviours of nurses, influenced patients’ perceptions of nurses’ care. Therefore, managers of healthcare services should take these results into account seriously in order to improve the quality of care provided to patients

Adult-Onset Still’s Disease-like Syndrome following COVID-19 Vaccination: A Case Report and Review of the Literature

Adult-onset Still’s disease (AOSD)-like syndrome has rarely been reported as a complication of COVID-19 vaccination. This study reports a 31-year-old female patient who presented with fever, myalgia, arthralgia, pleuropericarditis, leukocytosis, and transaminitis following ChAdOx1 vaccination, and met Yamaguchi’s criteria. A PubMed literature search, performed up until March 2022, identified 10 such cases. A total of 11 cases, including the one in this report, developed AOSD-like syndrome after administration of the viral vector (ChAdOx1) vaccine (six patients) and mRNA vaccine (five patients: BNT162b2 in four and mRNA-1273 in one). There were four male and seven female patients, with their median (Q1, Q3) age and the onset of symptoms after vaccination being 36 years (29, 45) and 10 days (6, 13), respectively. Fever (100%), arthralgia/arthritis (90.9%), skin rashes (81.8%), and sore throat (81.8%) were the main clinical findings. Pericarditis (45.5%), myocarditis/cardiac dysfunction (36.4%), pleuritis (54.6%), and pulmonary infiltrations (36.4%) were also common. One patient developed macrophage activation syndrome. One patient responded well to non-steroidal anti-inflammatory drugs, and the other six showed a good response to high-dose corticosteroids alone. Of the remaining four patients, who showed partial responses to high dose corticosteroids, showed good responses to biological agents. AOSD-like syndrome following COVID-19 vaccination shared many similar clinical features and treatment outcomes to those of idiopathic AOSD (but with a higher prevalence of cardiopulmonary involvement in the former). Physicians should be aware of this extremely rare complication to achieve early diagnosis and provide proper management

Gait Characteristics in Patients With Chronic Obstructive Pulmonary Disease

Background: Patients with chronic obstructive pulmonary disease (COPD) have reduced gait speeds and more frequent falls. We analyzed gait characteristics and fall risk in these patients using video recordings and questionnaires to determine if these patients had any quantitative changes in gait characteristics and to determine if screening for fall risk provided useful information. Methods: Patients with COPD who had participated in pulmonary rehabilitation completed a short history falls and the Activities-Specific Balance Confidence Scale questionnaire. They performed the Get Up and Go Test. Their typical gait was video recorded and analyzed with Dartfish software. Results: Fourteen patients completed this study. The mean age was 69.7 ± 6.0 years, and the mean forced expiratory volume in 1 second was 1.01 ± 0.38 L (36.9% ± 15.6% predicted). Three patients had a history of falls without significant injury. The mean Activities-Specific Balance Confidence Scale score was 91.8 ± 14.9, but the scores ranged from 10 to 100. Patients reported decreased balance confidence when “stepping onto or off an escalator while holding onto parcels.” The mean time in the Get Up and Go Test was 11.9 ± 2.0 seconds. Spatiotemporal parameters of gait included mean step length 0.65 ± 0.6 m, mean double support time 0.36 ± 0.05 seconds, mean double support time ratio 30.4% ± 3.1%, average free walking speed 65.3 ± 6.9 m/min, and number of steps per minute 100.4 ± 8.8. The speed was significantly slower and the double support time was significantly longer when compared with normal values. Conclusions: Most patients had good balance confidence scores. Their gait and balance were qualitatively normal using the Tinetti tools for assessment. Therefore, their risk for falls seems low. They had a reduced step length and increased time spent in double support, changes which might represent subtle adaptations to reduced balance

Chest radiographs as predictors of length of stay in right-sided infective endocarditis

Background: Right-sided infective endocarditis (IE) occurs less frequently than left-sided IE and is usually caused by intravenous drug use or intravascular device-related infection. Septic pulmonary embolism can cause abnormal chest radiograph (CXR), possibly raise pulmonary artery pressures, and may influence clinical and hospital outcomes. Methods: We conducted a retrospective chart review of patients diagnosed with right-sided IE from January 2000 to December 2011. Clinical parameters were collected and analyzed to define patients’ characteristics and the association with clinical outcomes, including length of stay (LOS). Result: 208 eligible patients had a diagnosis of IE; 19 (9.1%) had right-sided IE. Most were related to intravenous drug use (73.7%) and presented with dyspnea and fever (55.6%).  78.9% of patients had abnormal CXR (parenchymal involvement, cardiomegaly, or pleural effusion). Echocardiography revealed tricuspid valve involvement in all patients; their median mean pulmonary artery pressure (MPAP) by transthoracic echocardiographic estimation was 26.4 mm Hg. Patients with abnormal CXR had significantly longer LOS than those with normal CXR (21.4 vs. 7.5 days, p = 0.008). MPAP was not associated with LOS (p = 0.72). Conclusion: Right-sided IE is often associated with intravenous drug use. The majority of these patients have mild pulmonary hypertension, which could be due to hyperdynamic circulation and probable septic emboli. CXR with pulmonary involvement may be useful in predicting the length of hospital stay in these patients and identifying patients with more complications

Factors affecting mortality in patients with COPD exacerbations requiring ICU admission

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often require hospital admission and have a significant mortality rate. Patients with AECOPD who need intensive care (ICU) have higher mortality rates. Identifying factors associated with increased mortality might change approaches to treatment and improve communication with patients’ families about prognosis. Methods: Patients with AECOPD (ICD 9 code 491.21) directly admitted to the ICU between 1/1/2006 and 12/31/2010 were retrospectively reviewed. The inclusion criteria were age 45 years or older, diagnosis of AECOPD, and admission to an ICU. The exclusion criteria included any history of another respiratory disease or decompensated cardiac disease. The primary goal was to determine factors which affect survival. Result: Two hundred and seventeen patients were included this study. The mean ages were 70.4±10.4 years in the in-hospital death group and 66.4±10.9 years in the survivors. The overall mortality rate was 12%.  Multivariate analysis showed that the mortality rate was significantly associated with a low mean arterial blood pressure (MAP) (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.96), an intubation event (OR 6.12, 95% CI 1.24-30.87), and an elevated blood urea nitrogen (BUN) (OR 1.06, 95% CI 1.01-1.12) (p<0.05 for each factor). Conclusion: This study identified clinical parameters associated with increased mortality in patients with AECOPD admitted to an ICU. These factors include a low MAP, intubation, and a high BUN and are easily obtained during the initial evaluation of the patient. They reflect the severity of the acute exacerbation and complications in other organ systems