Wound Care Training Using Simulation: Impacts on Clinical Knowledge, Skill Performance, and Satisfaction Among Skilled Nursing Facility Staff

Impaired skin integrity, wound formation, and infections are significant health concerns. Therefore, competent wound care is essential for skilled nursing facility residents in long-term care. To recoup losses sustained during the COVID-19 pandemic, one skilled, nursing facility in North Carolina increased admissions from other facilities from 59% to 68%, which resulted in a surge of residents with pre-existing and complex wounds. High staff turnover and inconsistent wound care practices were also observed. Research suggests that healthcare institutions with high attrition may experience degradations of clinical knowledge, skill proficiency, and safe, quality nursing care delivery. Evidence supports the use of simulation-based education sessions to improve staff knowledge and clinical skill proficiency involving wound care. The purpose of this project was to ensure safe, quality, evidence-based nursing practice of long-term care residents at risk for impaired skin integrity and wound healing. The project aims included a systematic record review to evaluate the incorporation of simulation-based scenario techniques into an existing wound care training program and examine its effects on clinical knowledge, skill proficiency, and satisfaction. The Plan-Do-Study-Act quality improvement framework guided this project. Results of a paired-t test indicated a significant difference between Pre-test (M = 24.9, SD = 7.2) and Post-test knowledge following the implementation of simulation-based scenarios in wound care training (M = 64.3, SD = 19.4), t(26) = 9.8, p \u3c .001). Other results following the integration of hands-on wound care simulation-based training included 100% skill proficiency and 89% staff satisfaction (n = 27). Identified barriers and sustainment recommendations were provided to key stakeholders. The project results can serve as a beginning point for a greater understanding of evidence-based practices and quality improvement approaches for educators and leaders who oversee the nursing care of residents at risk for impaired skin integrity and wound healing in skilled nursing facilities.https://digitalcommons.odu.edu/gradposters2023_healthsciences/1016/thumbnail.jp

Effect of Perceived Stress on Cytokine Production in Healthy College Students

Chronic psychological stress impairs antibody synthesis following influenza vaccination. Chronic stress also increases circulating levels of proinflammatory cytokines and glucocorticoids in elders and caregivers, which can impair antibody synthesis. The purpose of this study was to determine whether psychological stress increases ex vivo cytokine production or decreases glucocorticoid sensitivity (GCS) of peripheral blood leukocytes from healthy college students. A convenience sample of Reserve Officer Training Corps (ROTC) students completed the Perceived Stress Scale (PSS). Whole blood was incubated in the presence of influenza vaccine and dexamethasone to evaluate production of interleukin-6 (IL-6), interleukin-1-beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ). Multiple regression models controlling for age, gender, and grade point average revealed a negative relationship between PSS and GCS for vaccine-stimulated production of IL-1β, IL-6, and TNF-α. These data increase our understanding of the complex relationship between chronic stress and immune function

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies

Evaluation of Completeness of Operative Records in Women Undergoing Gynecologic Surgery at Chiang Mai University Hospital

Objective: To evaluate the completeness of operative records at the general gynecologic surgery unit using the Good Surgical Practice (GSP) 2008 guidelines as a gold standard.Materials and methods: The operative records of women undergoing gynecologic operation at Chiang Mai University Hospital between January and July 2009 were reviewed. According to GSP 2008, the operative record should include all of the following data: (1) date and time of operation; (2) types of surgery ; (3) name of the operating surgeon and assistant; (4) operative procedure carried out; (5) incision; (6) operative diagnosis; (7) operative findings; (8) operative complications; (9) any extra procedure performed and its reason; (10) details of tissue removed, added or altered; (11) identification of any prosthesis used including serial numbers of such materials; (12) details of closure technique; (13) postoperative care instruction and (14) a signatureResults: During the study period, the medical records of 232 women who underwent gynecologic surgery were reviewed to determine the quality of the operative record. Postoperative care instruction was completely recorded in all operative notes (100%). Only 2 of the 14 items failed above 10% including details of incision (10.3%) and details of closure technique (12.9%). The signature was absent in 13 operative notes (5.6%).Conclusion: The evaluation results of operative records as per GSP 2008 guidelines in this study appear to be favorable. The details of incision and closure technique should be improved and periodic audit is required to assure that these standards are maintained

A review of the changing culture and social context relating to forensic facial depiction of the dead

The recognition of a decedent by a family member is commonplace in forensic investigation and is often employed as identity confirmation. However, it is recognised that misidentification from facial recognition is also common and faces of the dead may be extremely difficult to recognise due to decomposition or external damage, and even immediate post-mortem changes may be significant enough to confuse an observer. The depiction of faces of the dead can be a useful tool for promoting recognition leading to identification and post-mortem facial depiction is described as the interpretation of human remains in order to suggest the living appearance of an individual. This paper provides an historical context relating to the changing view of society to the presentation and publication of post-mortem facial depictions and discusses the current ethical, practical and academic challenges associated with these images

Daily Number of Bodies Buried in Banda Aceh and Surrounding Areas, 26 December 2004 to 22 February 2005

<div><p>Districts include Pantai Barat, Pantai Timur, Aceh Besar, and Band Aceh.</p> <p>(Source: Badan Koordinasi Nasional Penanggulangan Bencana Dan Penanganan Pengungsi—BAKORNAS PBP)</p></div