Decreasing Sudden Unexpected Infant Death

Background: Sleep-related sudden unexpected infant death (SUID) is an alarming, potentially preventable event with over 3,500 annual occurrences in the United States (US). In response to sleep-related SUIDs, the American Academy of Pediatrics and National Institutes of Health advocate for safe sleep practices to promote establishment of safe sleep environments for infants through the Safe to Sleep initiative. However, research evidence shows that lack of knowledge in hospital staff and community members (parents/caregivers) and cultural barriers/biases are factors associated with the inability or resistance to adopting safe sleep practices for infants. Methods: In 2017, internal evidence within a local South Florida hospital emergency department (ED) revealed eight sleep-related SUID cases. A Sleep Safe Task Force was initiated followed by implementation of a quality improvement project using the Plan-Do-Check-Act model. The purpose of the project was to improve knowledge through education on safe sleep practices among hospital staff and parents/caregivers of infants within the community to decrease the number of infant sleep-related deaths presenting to the ED. The implementation plan included education for hospital staff, community members, and local pediatric/obstetric office staff, coupled with distribution of sleep sacks to parents/caregivers. Results: Post-implementation of education sessions, SUID cases presenting to the ED decreased by 50% (n = 4) in 2018, with zero cases in 2019 and 2020, one case in 2021, and zero in 2022. Conclusions: The results of the project suggested that providing education and safe sleep resources helped reduce the rate of SUID cases. Further studies are needed to evaluate efficacy of the education in community members by examining adoption of safe sleep practices for infants. Keywords: SIDS, SUIDS, safe sleep, Safe Sleep Task Force, crib death, newborn safe sleep, sleep sack

A Performance Improvement Project to Improve Hand-off Communication Documentation within the Surgical Services Department

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary staff exposures and delays in treatment. The quality improvement nurse noticed a significant drop in the use of the standardized hand-off report form used during this time. This drop in compliance lead to concerns for patient and staff safety. The purpose of this performance improvement project was to improve the quality of handoff reports as measured by the level of documentation using the standardized handoff report. The project followed the Plan-Do-Check-Act model for performance improvement, monitoring documentation compliance and reporting the results to the leaders and staff. The handoff report form was revised with input from the staff, resulting in improved efficiency. The nurses’ level of satisfaction with the form improved resulting in improved compliance and reducing miscommunications

Nurses - Tab Down Your Stress Level: A Pilot Study on the Use of Aromatherapy to Decrease Stress Levels

Introduction: The average day-to-day nursing profession is a stressful one. The job often requires dealing with patients enduring some of the worst times of their lives, as well as contending with patients\u27 emotional family members. This stressful environment is heightened even more for nurses employed in critical access hospitals (CAHs) due to the limited resources usually associated with these smaller facilities. Methods: Research and Evidence-Based Practice Council members at one CAH explored how to help nurses deal with the elevated work stress level. Aromatherapy tabs were used as an intervention to reduce nurses\u27 stress. The nurses who participated in this pilot study took a short survey before starting their shifts, indicating their stress levels. Following the survey, scented aromatherapy tabs were attached to the nurses\u27 uniforms and worn for the entirety of their shifts. At the end of their shifts, the participating nurses completed the same stress survey. Results: Twenty-five nurses participated in the pilot study. Nurses who did not wear the aromatherapy tab reported higher stress levels at the end of the shift than at the start, with a 3% overall average increase. Nurses who wore the aromatherapy tab reported lower stress levels at the end of the shift with a 12% overall average decrease. Discussion: Using aromatherapy tabs positively impacted nurses\u27 reported stress levels, indicating that aromatherapy tabs can be a tool for nurses to utilize within the workplace, supporting the need for further research

Is the metabolic cost of walking higher in people with diabetes?

People with diabetes walk slower and display biomechanical gait alterations compared with controls, but it remains unknown whether the metabolic cost of walking (CoW) is elevated. The aim of this study was to investigate the CoW and the lower limb concentric joint work as a major determinant of the CoW, in patients with diabetes and diabetic peripheral neuropathy (DPN). Thirty-one nondiabetic controls (Ctrl), 22 diabetic patients without peripheral neuropathy (DM), and 14 patients with moderate/severe DPN underwent gait analysis using a motion analysis system and force plates and treadmill walking using a gas analyzer to measure oxygen uptake. The CoW was significantly higher particularly in the DPN group compared with controls and also in the DM group (at selected speeds only) compared with controls, across a range of matched walking speeds. Despite the higher CoW in patients with diabetes, concentric lower limb joint work was significantly lower in DM and DPN groups compared with controls. The higher CoW is likely due to energetic inefficiencies associated with diabetes and DPN reflecting physiological and biomechanical characteristics. The lower concentric joint work in patients with diabetes might be a consequence of kinematic gait alterations and may represent a natural strategy aimed at minimizing the CoW

Marital Transitions and Mental Health

Most research identifies marital disruption as a precursor for poor mental health but is generally unable to discount the potential selection effect of poor mental health leading to marital disruption. We use data from nine annual waves of the British Household Panel Survey to examine social selection and social causation as competing explanations. Mental health is measured using the general health questionnaire. We examine mental health at multiple time points prior to and after a marital transition through separation or divorce and compare this process to those who experience widowhood. All groups transitioning out of marriage have a higher prevalence of poor mental health afterwards but for those separated or divorced, poor mental health also precedes marital disruption, lending support to both social-causation and social-selection processes. The processes both preceding and after the transition to widowhood differ, with increased prevalence of disorder centering around the time surrounding the death itself. </jats:p

Healthcare worker's attitudes to working during pandemic influenza: a qualitative study

Background: Healthcare workers (HCWs) will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic.This paper reports the results of a qualitative study that explored UK HCWs' views (n = 64) about working during an influenza pandemic, in order to identify factors that might influence their willingness and ability to work and to identify potential sources of any perceived duty on HCWs to work.Methods: A qualitative study, using focus groups (n = 9) and interviews (n = 5).Results: HCWs across a range of roles and grades tended to feel motivated by a sense of obligation to work through an influenza pandemic. A number of significant barriers that may prevent them from doing so were also identified. Perceived barriers to the ability to work included being ill oneself, transport difficulties, and childcare responsibilities. Perceived barriers to the willingness to work included: prioritising the wellbeing of family members; a lack of trust in, and goodwill towards, the NHS; a lack of information about the risks and what is expected of them during the crisis; fear of litigation; and the feeling that employers do not take the needs of staff seriously. Barriers to ability and barriers to willingness, however, are difficult to separate out.Conclusion: Although our participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc.), there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc). We suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability. <br/