Are unit based turn teams likely to reduce pressure ulcers in hospital stays?

A number of related articles can be found in PubMed using the search strategies listed below. To execute the searches:
1. Go to www.health.library.emory.edu and then click on the PubMed link on right side of page.
2. When PubMed opens, copy/paste this search strategy in the search box (articles):
(“Pressure Ulcer/prevention and control”[MAJR] AND “Patient Positioning”[MeSH]) AND English[lang]
3. For a broader search, copy/paste this: pressure ulcer AND (turning OR patient position) AND (English[lang])

When results appear, click on title to view abstract, then use the “Find It@Emory” button to link to full text, if available.

One article of note:

Still, Mary D, et al. “The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive care unit.” Journal of the American College of Surgeons 216.3 (2013):373-379.

“At baseline, when frequent turning was encouraged but not required, a total of 42 pressure ulcers were identified in 278 patients. After implementation of the turn team, a total of 12 pressure ulcers were identified in 229 patients (p < 0.0001). The preintervention group included 34 stage I and II ulcers and 8 higher stage ulcers. After implementation of the turn team, there were 7 stage I and II ulcers and 5 higher stage ulcers. The average Braden score was 16.5 in the preintervention group and 13.4 in the postintervention group (p = 0.04), suggesting that pressure ulcers were occurring in higher risk patients after implementation of the turn team.”

What is the latest evidence and nursing implications on the use of high frequency ocsillatory ventilation?

Mechanical Ventilation.  In:  DynaMed. 
See a summary of current evidence in the “Ventilator Settings (Evidence)” section>High Frequency Oscillatory Ventilation (HFOV).

A systematic review ( Cochrane Database Syst Rev 2013 Feb 28;(2):CD004085) of studies (N=419) with methodological limitations concluded that may reduce mortality and treatment failure.  However it did not include results of two recent RCTs:

1.  HFOV does not reduce mortality compared to conventional ventilation (N Engl J Med 2013 Feb 28;368(9):806)  RCT (N=795 adults with ARDS).  RESULTS:  All-cause mortality rate 41.7% for HFOV group v. 41.1% for conventional ventilation group (not significant).

2. HFOV may increase risk of mortality compared to conventional ventilation protocol.  RCT (N=548 adults with moderate to severe ARDS).  RESULTS:   12% of patients in control group received HFOV for refractory hypoxemia.  In-hospital mortality 47% for HFOV group vs. 35% for control group.

What is the risk for transmitting infection by healthcare providers using a stethoscope as he or she moves from patient to patient?

Bottom line:  Stethoscopes, mostly the earpieces, are a reservoir for bacteria, but there is no evidence directly addressing any association between use of stethoscopes on multiple patients and transmission of the bacteria found on the stethoscope

Halcomb E, et al. Role of MRSA reservoirs in the acute care setting. JBI Library of Systematic Reviews. 2008; 6(16): 633-685.
Identified one observational study of the eartips of stethoscopes dedicated to patients on contact precaution for MRSA.  13 of 78 (17%) eartips examined had potentially pathogenic bacteria on them, but none of the bacteria were the same as the infectious agents in the patients.

Other similar studies were identifed in a PubMed search.   Only the Brook (1997) paper below describes an actual infection (in a nurse) traced to an earpiece of a stethoscope.  The other studies show that most common organisms identified on stethoscopes (mostly earpieces) is S. aureas.

Gopinath KG, et al. Pagers and stethoscopes as vehicles of potential nosocomial pathogens in a tertiary care hospital in a developing country.  Trop Doct. 2011 Jan;41(1):43-5.  PMID: 21109607

Youngster I, et al. The stethoscope as a vector of infectious diseases in the paediatric division.  Acta Paediatr. 2008 Sep;97(9):1253-5.   PMID:18554272

Bernard L, et al.  Bacterial contamination of hospital physicians’ stethoscopes.  Infect Control Hosp Epidemiol. 1999 Sep;20(9):626-8.  PMID:10501265

Brook I.  Bacterial flora of stethoscopes’ earpieces and otitis externa.  Ann Otol Rhinol Laryngol. 1997 Sep;106(9):751-2.  PMID:9302906

Smith MA, et al.  Contaminated stethoscopes revisited.  Arch Intern Med. 1996 Jan 8;156(1):82-4.  PMID:8526701

Wright IM, et al.  Stethoscope contamination in the neonatal intensive care unit.  J Hosp Infect. 1995 Jan;29(1):65-8.  PMID:7738341

Search strategy:
Consulted and evidence summary source:  Searched Joanna Briggs Institute for “stethoscope and infection” – Identified a systematic review, which cited a paper on stethoscopes dedicated to MRSA-infected patients as as reservoirs.
Looked up that reference in PubMed and identified terms for a focused PubMed search:
(“Stethoscopes/microbiology”[MAJR] OR “Equipment contamination”[MAJR]) AND (nosocomial OR “hospital-acquired infection”)

Used QUOSA to identify articles from this set that discuss stethoscopes.

What are the costs associated with nursing turnover in acute care environments?

Jones, Cheryl B. “The costs of nurse turnover: part 1: an economic perspective.” The Journal of nursing administration 34.12 (2004):562-570.

Jones, Cheryl B. “The costs of nurse turnover, part 2: application of the Nursing Turnover Cost Calculation Methodology.” The Journal of nursing administration 35.1 (2005):41-49.

Jones, Cheryl B. “Revisiting nurse turnover costs: adjusting for inflation.” The Journal of nursing administration 38.1 (2008):11-18.

Halfer, Diana. “A magnetic strategy for new graduate nurses.” Nursing economic$ 25.1 (2007):6-11, 3.

PubMed search keywords: nursing turnover, cost, acute care

Click here to run a CINAHL search on costs associated with nursing turnover in acute care environments

What are the benefits of a pre-shift huddle or patient handoff?

An integrative review of research on nursing handoffs in acute care settings… Transitions: Unifying Practice, Education, and Research to Improve Health: Communicating nursing research 2011 vol:44 pg:27

Gordon, Morris ; Educational interventions to improve handover in health care: a systematic review. Medical Education 2011 Nov; 45 (11): 1081-9.
http://web.ebscohost.com.proxy.library.emory.edu/ehost/pdfviewer/pdfviewer?sid=cb5c9931-f575-416d-a721-11e07d306885%40sessionmgr115&vid=2&hid=127

Evidence-based inpatient handovers: a literature review and research agenda. Clinical Governance 17.1 (2012):14.

Halm, Margo A. NURSING HANDOFFS: ENSURING SAFE PASSAGE FOR PATIENTS. American Journal of Critical Care 2013 Mar; 22 (2): 158-62.

Staggers, Nancy Research on nursing handoffs for medical and surgical settings: an integrative review. Journal of Advanced Nursing 2013 Feb; 69 (2): 247-62.

Searched CINAHL with keywords: handover, hand off. (Also selected “Evidence Based Practice” limiter)

You can also search Joanna Briggs, under the Clinical Tab in the Nursing Community and cutting and pasting the following search terms into the search box:

Nursing Clinical Handover
Hand off

Do patients respond differently to nurses who wear uniforms on inpatient mental health units?

Preferences of dress and address: views of attendees and mental health professionals of the psychiatric services.” Irish journal of psychological medicine 29.1 (2012)27.

Miller, Tracy, NancyMann, and Rodney DGrim. “Clothes encounter: patient perception of nursing attire in a behavioral health unit.” Journal of the American Psychiatric Nurses Association 16.3 (2010):178-183.

Adams, John. “Nursing in a therapeutic community: the Fulbourn experience, 1955-1985.” Journal of clinical nursing 18.19 (2009):2747-2753.

Lavender, A. “The effects of nurses changing from uniforms to everyday clothes on a psychiatric rehabilitation ward.” the British journal of medical psychology 60 pt. 2 (1987):189-199.

Sterling, F E. “Net positive social approaches of young psychiatric inpatients as influenced by nurses’ attire.” Journal of consulting and clinical psychology 48.1 (1980):58-62.

Trauer, T, and A V VMoss. “Psychiatric patients’ opinions of nurses ceasing to wear uniform.” Journal of advanced nursing 5.1 (1980):47-53.

Rinn, R C. “Effects of nursing apparel upon psychiatric inpatients’ behavior.” Perceptual and motor skills 43.3 pt. 1 (1976):939 -945.

Klein, R H, et al. “Psychiatric staff: uniforms or street clothes?” Archives of general psychiatry 26.1 (1972):19-22.

Walker, V J, GVoineskos, and D L LDunleavy. “The effects of psychiatric nurses ceasing to wear uniform.” British journal of psychiatry 118.546 (1971):581-582.

Leff, H S, R V VNydegger, and MBuck. “Effect of nurses’ mode of dress on behavior of psychiatric patients differing in information-processing complexity.” Journal of consulting and clinical psychology 34.1 (1970):72-79.

Petrovich, D V, J R Bennett, and J Jackson. “Nursing apparel and psychiatric patients: a comparison of uniforms and street clothes.” Journal of psychiatric nursing and mental health services 6.6 (1968):344-348.

Hawkins, E, J L Claghorn, and W Zentay. “Nursing dress, and experimental evaluation of its effect on psychiatric patients.” Journal of psychiatric nursing 4.2 (1966):148-157.

Databases searched: PubMed and CINAHL
Keywords: dress, uniform, attire, apparel, nurse*, psychiatric, mental health

Reviewed and updated 4/8/2014 ldt

What is the evidence on the effect of nurses’ sleep habits on patient safety?

A search of Joanna Briggs, PubMed, and CINAHL identified the following relevant references.

Joanna Briggs Institute
No documents focusing on sleep and patient safety

CINAHL
The search (MH “Nursing Staff, Hospital” OR MH “Nurses+”) AND (safety OR error*) AND sleep LIMITERS: Research articles identified observational studies on effects of sleep on safety, including Johsnon 2014, Lockley 2007, Admi 2008, Biddle 2011, and Muecke 2005.  There was at least one study evaluating an intervention (Scott 2010). No articles by Geiger-Brown, who has written on nurses and sleep, appeared in search results above or in this search: sleep AND safety AND geiger-brown.

A search of Geiger Brown and sleep in CINAHL identified these papers.

PubMed

A search for articles by Geiger-Brown and sleep in PubMed identified an additional article that specifically mentions safety:
Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiol Int. 2012 Mar;29(2):211-219.

An additional search in PubMed for “Nurses”[Mesh] AND “Sleep”[Mesh] AND (“Safety”[Mesh] OR “Medical Errors”[Mesh]) found the following two articles.

Dorrian, Jillian, et al. “Sleep and errors in a group of Australian hospital nurses at work and during the commute.” Applied Ergonomics 39.5 (2008):605-613.

Dorrian, Jillian, et al. “A pilot study of the safety implications of Australian nurses’ sleep and work hours.” Chronobiology international 23.6 (2006):1149-1163.

Reviewed and updated 4/8/2014 ldt