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Simulating contamination of the operator and surrounding environment during wound debridement through fluorescent labelling

Abstract

We investigated the contamination of the operator and the surrounding environment during wound debridement through simulated operations using fluorescent labelling. On-site simulated operation assessment was performed before and after the training. Oranges and square towels were used to simulate wounds and the inpatient units, respectively. Fluorescent powder was applied to the surfaces. Operations on oranges simulated bedside debridement, and the postoperative distribution of the fluorescent powder was employed to reflect the contamination of the operator and the surrounding environment. During the pre-training assessment, contamination was observed in 28 of the 29 trainees. The commonly contaminated parts were the extensor side of the forearm, middle abdomen, upper abdomen, and hands. The right side of the operating area was contaminated in 24 trainees. During the post-training assessment, contamination was observed in 13 of the 15 trainees. The commonly parts were the hands, extensor side of the forearm, and the lower abdomen. The front, back, left, and right sides of the operating area were contaminated in 12, 9, 11, and 14 trainees, respectively. Contamination of the treatment cart was observed in 5 trainees. Operator and the surrounding environment can be contaminated during wound debridement. Attention should be paid to hand hygiene, wearing and changing of work clothes, and disinfection of the surrounding environment. Moreover, regular training is recommended.

Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in the Elderly with Alzheimer’s Disease (D-PRESCRIBE-AD): Trial protocol and rationale of an open-label pragmatic, prospective randomized controlled

by Sonal Singh, Noelle M. Cocoros, Xiaojuan Li, Kathleen M. Mazor, Mary T. Antonelli, Lauren Parlett, Mark Paullin, Thomas P. Harkins, Yunping Zhou, Paula A. Rochon, Richard Platt, Inna Dashevsky, Carly Massino, Cassandra Saphirak, Sybil L. Crawford, Jerry H. Gurwitz

Context

Potentially inappropriate prescribing of medications in older adults, particular those with dementia, can lead to adverse drug events including falls and fractures, worsening cognitive impairment, emergency department visits, and hospitalizations. Educational mailings from health plans to patients and their providers to encourage deprescribing conversations may represent an effective, low-cost, “light touch”, approach to reducing the burden of potentially inappropriate prescription use in older adults with dementia.

Objectives

The objective of the Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer’s Disease (D-PRESCRIBE-AD) trial is to evaluate the effect of a health plan based multi-faceted educational outreach intervention to community dwelling patients with dementia who are currently prescribed sedative/hypnotics, antipsychotics, or strong anticholinergics.

Methods

The D-PRESCRIBE-AD is an open-label pragmatic, prospective randomized controlled trial (RCT) comparing three arms: 1) educational mailing to both the health plan patient and their prescribing physician (patient plus physician arm, n = 4814); 2) educational mailing to prescribing physician only (physician only arm, n = 4814); and 3) usual care (n = 4814) among patients with dementia enrolled in two large United States based health plans. The primary outcome is the absence of any dispensing of the targeted potentially inappropriate prescription during the 6-month study observation period after a 3-month black out period following the mailing. Secondary outcomes include dose-reduction, polypharmacy, healthcare utilization, mortality and therapeutic switching within targeted drug classes.

Conclusion

This large pragmatic RCT will contribute to the evidence base on promoting deprescribing of potentially inappropriate medications among older adults with dementia. If successful, such light touch, inexpensive and highly scalable interventions have the potential to reduce the burden of potentially inappropriate prescribing for patients with dementia.ClinicalTrials.gov Identifier: NCT05147428.

The effect of neoadjuvant chemotherapy on surgical site wound infection after immediate breast reconstruction in patients with breast cancer: A meta‐analysis

Abstract

Using a meta-analysis approach, we conducted a comprehensive evaluation of the effect of neoadjuvant chemotherapy (NACT) on the incidence of surgical site wound infection during immediate breast reconstruction (IBR) following breast cancer. The aim was to provide evidence-based support for the prevention of wound surgical site infection during IBR after breast cancer surgery. Relevant literature on the effects of NACT on IBR in patients with breast cancer published up until May 2023, was retrieved from various databases, including PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang databases, and China Biology Medicine Database. Two researchers performed the literature screening, data collection, and quality assessment of the included studies independently. The meta-analysis was conducted using Stata version 17.0. Fourteen studies involving 3401 patients (599 in the intervention group and 2802 in the control group) were included in the analysis. The incidence of surgical site infection in the NACT group was higher than that in the control group, but the difference between the two groups was not statistically significant (7.17% vs. 4.85%, odds ratio: 1.02, 95% confidence interval: 0.70–1.50, p = 0.902). These findings suggest that NACT does not increase the risk of surgical site infection during IBR. However, owing to the variation in sample size and literature quality among the included studies, randomised controlled trials are needed to confirm the safety of IBR in patients receiving neoadjuvant chemotherapy.

Experience of rehabilitation specialist nurses in providing bowel care for stroke patients: A qualitative study

Abstract

Aims

This study aims to explore the experiences of rehabilitation specialist nurses in providing bowel care to stroke patients and to identify the factors that either facilitate or hinder their practice.

Design

This was a descriptive qualitative design study.

Methods

Between May 2022 and October 2022, we conducted in-depth and semi-structured interviews with 12 rehabilitation specialist nurses from two tertiary hospitals in Changsha, China. Thematic analysis was employed to analyse the interview transcripts.

Findings

Three key themes were revealed from our analysis: (1) acceptance of bowel care as a process, (2) high level of recognition improves the experience and (3) challenges stemming from limited knowledge and rights. Acceptance of bowel care as a dynamic process, coupled with a high level of recognition, enabled nurses to prioritize the health and safety of patients over personal feelings and achieve professional accomplishments. However, they encountered challenges in terms of professional development and restricted prescribing rights for bowel care.

Conclusion

The experiences of rehabilitation specialist nurses in providing bowel care are dynamic. These findings have important implications for healthcare improvement, including the need for collaboration with healthcare professionals and nurturing nurses' self-identity, comprehensive training plans, innovative programs and expanding the scope of rehabilitation specialist nurses' rights.

Impact

This study enhances our understanding of the challenges faced by rehabilitation specialist nurses caring for stroke patients with neurogenic bowel dysfunction. The findings provide insights into how to enhance bowel care experience and develop further in this field.

Reporting Method

This study adhered to the EQUATOR guideline and utilized the COREQ checklist.

Patient or Public Contributions

This study involved participants who were registered nurses, and there were no contributions from patients or public.

Relationship between emotional intelligence and job stressors of psychiatric nurses: A multi‐centre cross‐sectional study

Abstract

Aim

To investigate the impact of socio-demographic factors and job stressors on the emotional intelligence of psychiatric nurses.

Background

Emotional intelligence plays a crucial role in enabling nurses to effectively manage their own emotions, comprehend the emotions of others and assist individuals in dealing with diverse stressors. Nevertheless, a comprehensive conceptualization of the relationship between job stressors and emotional intelligence remains lacking.

Design

This study employs a multi-centre cross-sectional design.

Methods

A multi-centre cross-sectional survey involving 1083 registered nurses from 11 psychiatric hospitals across four provinces in China was conducted. Non-probability sampling was utilised. The survey encompassed assessments of nurse job stressors, emotional intelligence using a scale and socio-demographic characteristics using a questionnaire. A multiple linear regression model was applied to identify significant variables associated with emotional intelligence based on demographic attributes and various nurse job stressors. The study adhered to the STROBE checklist.

Results

The findings revealed a noteworthy negative correlation between nurse job stressors and emotional intelligence. Socio-demographic factors and job stressors of certain nurses were able to predict emotional intelligence and its dimensions among psychiatric nurses, with percentages of 44.50%, 40.10%, 36.40%, 36.60% and 34.60%.

Conclusion

Providing emotional intelligence training for psychiatric nurses could enhance their capacity to cope effectively with workplace stress, particularly among younger nurses who engage in limited physical activities.

Relevance to Clinical Practice

The analysis of the relationship between emotional intelligence and nurse job stressors could facilitate early detection and intervention by managers based on pertinent factors. This, in turn, could elevate the emotional intelligence level of psychiatric nurses.

No Patient or Public Contribution

This study did not recruit participants, so details of participants were not be involved.

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