Protecting the Skin of Older Adults Through Surveillance and Pressure Ulcer Prevention Beginning in Emergency Services

ED (emergency department) personnel are admitting to inpatient services increasing numbers of elderly clients who are at risk for skin breakdown. The ED environment is designed for short term care in response to emergent situations. Pressure related injuries originating in the ED lead to both physical suffering and financial burdens. Pressure relief strategies have been actively employed on an inpatient basis without translation to the ED environment. Evidence for best practice in PUP (pressure ulcer prevention) in the ED is not widely embraced. Prevention of PUs is primarily within the scope of nursing practice and amenable to improvements in the standard of care. Therefore, the purpose of this project is to translate current evidence for PUP from the literature to sustainable best practice in emergency nursing. Synthesis of existing literature revealed the most effective strategies for PUP focused on enhanced support surfaces, patient positioning, moisturizing dry skin, restricting head of bed (HOB) elevation, and timely removal of backboards. These measures reflect current evidence and were proposed as innovative strategies in the ED. A logic model was utilized to guide planning and evaluation of the program. The theory of planned behavior, the consolidated framework for implementation research, and polarity thinking were employed to ensure theory driven practice. Following an organizational assessment and IRB approval, the project was implemented at a 254 bed community hospital in the Midwestern United States with a 20 bed ED. A significant challenge to implementation was the culture of ED nursing which was focused upon stabilization and disposition versus prevention. The timeline for the project involved data collection, intervention, and evaluation over a four month period. A chart review was conducted to establish current practice of skin assessments and ED interventions directed at maintaining skin integrity. Nursing and support staff participated in an educational intervention addressing the relationship between routine care and the unintended consequence of skin breakdown. Evidence for best practice in prevention was reviewed and realistic measures for PUP presented for adoption. Learning was evaluated in pre-test/post-test format. Nurse\u27s intention to implement best practice measures and perceived barriers/facilitators were identified. The post intervention evaluation period lasted two months and documented utilization of skin moisturizer from ED supply. The terminal outcome was repeat chart audit of vulnerable elderly patients which assessed for increased documentation of skin assessments and identified PU strategies. Follow up chart audit revealed a 56.6% improvement in the frequency of nursing documentation of integumentary assessments. Documentation of prevention measure improved less dramatically. Inventory analysis, however, demonstrated actual use of recommended products. Nursing knowledge regarding pressure ulcer identification, staging, and prevention increased in 93% of participants. All four evidence-based strategies were embraced with greater than 70% of participants reporting intent to implement. The most frequently identified barriers to implementing prevention measures were time and staffing. The most common facilitators were availability of supplies and visual reminders. Recommendations include revision of the electronic health record to facilitate documentation of strategies by staff and inclusion of the protective dressing in the bedside treatment carts

Home Health Care Nurses\u27 Knowledge of Advance Directives

The purpose of this study was to describe home health care nurses\u27 knowledge of advance directives. Dorothea Orem\u27s Theory of Self-Care guided this descriptive correlational study which investigated the relationship between knowledge of advance directives and the variables of nursing educational preparation and years of nursing experience. A convenience sample of 40 subjects employed by a Michigan home care agency completed a 39 item questionnaire adapted from Crego and Lipp (1998). The mean knowledge score was 84.68%. Analysis of the demographic profile showed no significant difference in knowledge levels by educational preparation. Years of nursing experience was found to have a weak, negative, non-significant relationship to knowledge of advance directives. Additionally, the majority of subjects had no experience with assisting clients in advance directive formation and did not feel prepared to counsel clients on advance directives

Tracing the sustainable development of nations with integrated indicators

Managing sustainable development as a policy issue is a complex task. The European Union Sustainable Development Strategy (CEC 2001) has stimulated EU member states to develop national sustainable development strategies. However policy makers are mostly lacking reliable and practical tools to measure progress and to indicate where adaptation to new or unbalanced developments is needed. In this chapter a new approach to develop an integrated sustainability index for nations is proposed and illustrated. Since the UN World Commission on Environment and Development (1987) published its report ‘Our Common Future’, sustainable development has been accepted widely by governments, businesses and civil society as a common goal. Sustainable develop ment was defi ned in this report, I paraphrase, as our obligation to increase and not reduce overall devel opment possibilities for the next generations. We should leave our Earth behind in a better shape than we found her at the moment we were born, not only for moral reasons, but also to promote future pros perity. Many attempts have been made to defi ne the concept of sustainable development in a way that makes it possible to link operational targets to it. (Biesiot 1997; Bossel 1997; Daly and Cobb 1990; Hueting and Bosch 1990; Meadows 1998; Wackernagel and Rees 1996). As yet no defi nition obtained general support and I have not the pretense to provide the ultimat e solution to the operational ization of sustainability. But the proposals presented here may serve as a contribution from the viewpoint of a former policy-maker

Hoe ambitieus zetten gemeenten Duurzaam Inkopen in?

Centrum gemeenten, die doorgaans tot de grotere gemeenten behoren, scoren beter op duurzaam inkopen. Verklaringen daarvoor zijn hun grotere ambitie, hun inkoopkracht - waarmee zij innovaties in de markt kunnen teweegbrengen - en hun grotere vermogen om intern regie over hun budgethouders te voeren en zo beter hun eigen duurzaamheidsagenda te realiseren. Een meer dynamische actualisering, verspreiding en facilitering van de toepassing van criteria voor productgroepen, zoals ontwikkeld door PIANOo, is belangrijk. Scholing en kennisuitwisseling, ook voor budgethouders, vergt meer aandacht van HRM afdelingen. Op de werkvloer werkt men graag met preferred supplier lijsten en keurmerken. Dat is een goede zaak mits zij regelmatig worden ge-update. Landelijke monitoring zou zoveel mogelijk op bestaande databestanden zoals Tendernet gebaseerd moeten zijn en budgethouders moeten inspireren zonder nieuwe administratieve lasten te veroorzaken. Voortgaande digitalisering van inkoop en aanbesteding is daarbij behulpzaam