Adults In Acute Care Settings Research Articles

Patient Blood Management: Mixing Versus Discard Methods for Central Venous Catheter Blood Specimen Collection.

A quasi-experimental study comparing the mixing and discard methods of laboratory specimen techniques in an adult acute care setting was conducted over a 30-month period. Primary end points were delta hemoglobin (Hgb) and transfusion rates. Secondary end points were redraws related to hemolysis and erroneous results, noting central venous access device (CVAD) type. Primary objectives included the comparison of hospital-acquired anemia and transfusion rates utilizing Hgb and venous sampling methods as part of a patient blood management (PBM) program. Secondary objectives tracked the type of CVAD used to acquire venous specimens and the impact on hemolysis rates or erroneous results. Considerations include exploring the benefits of utilizing the mixing method related to cost savings. In summary, the mixing versus discard method eliminates wasting blood to reduce hospital-acquired anemia as part of a PBM program. CVAD type did not influence hemolysis rates or impact erroneous results. The mixing method is easy to implement in any health care setting. Cost savings are feasible by elimination of external venous or arterial blood management protection devices. Removal of add-on devices supports standards by decreasing access points to reduce infection risk. Results, although inconclusive to superiority, demonstrated noninferiority and encouraged consideration of the mixing method for laboratory specimen collection.

REMOTE FAMILY CAREGIVERS: INVISIBLE YET INDISPENSABLE DURING HOSPITALIZATION OF OLDER ADULTS

Abstract Limited research has addressed the interplay between the roles of nursing staff and families of older adults in acute care settings, including those families involved in-person and those who are unable to be physically present (remote). This descriptive qualitative study explores nurses’ and family members’ perspectives on the roles and engaging family members or friends during an acute hospitalization in medical-surgical units. Semi-structured interviews were conducted via Zoom or phone with a convenience sample of 19 nurses and families between February and August 2023. Thematic analysis inductively captured key patterns in data. Nurses proactively engaged family members who were present in the hospital, while they engaged with remote family members in a more limited way, mostly during discharge planning. Nurses describe making decisions about including families based on their presence (e.g., education about medications, encouraging to engage the patient in the recommended care, ask to support with ADLs). In contrast, families describe providing support regardless of physical presence, including socio-emotional support, help with medical/nursing tasks, encouragement to recover, mediation of information provided by staff, learning to perform medical-nursing tasks and communication and interpretation of the information with other family members. The findings reveal a gap in nurses and family’s perspectives about the feasibility and contribution of remote family involvement during an acute hospitalization. This provides direction for further exploration of acute care structures and nursing care processes needed to support the preferred mode for family involvement.

Interrupting bedtime to reverse frailty levels in acute care: a study protocol for the Breaking Bad Rest randomized controlled trial

BackgroundHospitalized older patients spend most of the waking hours in bed, even if they can walk independently. Excessive bedrest contributes to the development of frailty and worse hospital outcomes. We describe the study protocol for the Breaking Bad Rest Study, a randomized clinical trial aimed to promoting more movement in acute care using a novel device-based approach that could mitigate the impact of too much bedrest on frailty.MethodsFifty patients in a geriatric unit will be randomized into an intervention or usual care control group. Both groups will be equipped with an activPAL (a measure of posture) and StepWatch (a measure of step counts) to wear throughout their entire hospital stay to capture their physical activity levels and posture. Frailty will be assessed via a multi-item questionnaire assessing health deficits at admission, weekly for the first month, then monthly thereafter, and at 1-month post-discharge. Secondary measures including geriatric assessments, cognitive function, falls, and hospital re-admissions will be assessed. Mixed models for repeated measures will determine whether daily activity differed between groups, changed over the course of their hospital stay, and impacted frailty levels.DiscussionThis randomized clinical trial will add to the evidence base on addressing frailty in older adults in acute care settings through a devices-based movement intervention. The findings of this trial may inform guidelines for limiting time spent sedentary or in bed during a patient’s stay in geriatric units, with the intention of scaling up this study model to other acute care sites if successful.Trial RegistrationThe protocol has been registered at clinicaltrials.gov (identifier: NCT03682523).

Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study.

There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams. To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN. An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings. A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores. Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps.

Modification and adaptation of the general self-efficacy scale to determine nursing students’ belief in their capability to care for older adults

It is necessary to determine nursing students’ self-efficacy to care for person's 60 + years to identify opportunities and challenges to support, facilitate effective learning and performance, and enhance confidence in providing care for older adults. However, we did not find a validated survey instrument to determine self-efficacy to care for older adults. This paper aimed to describe the modification of the General Self-efficacy scale to the General Self-efficacy to Care for Older scale appropriate for the Africa context. A cross-sectional study was conducted with second- and third-year nursing students from two public Nursing and Midwifery Training Colleges in the northern and southern sectors of Ghana. The 13-item General Self-Efficacy Scale was expanded by adding 17 items specific to providing nursing care for older adults in acute care settings. Cognitive interviews were conducted to ensure the items added were understood by participants. The 30-items were tested using Exploratory Factor analysis. The mean age of participants was 21 years (SD = 3.73). More than half (54%) of the participants were female. An exploratory factor analysis yielded a two-factor model. Four items were removed due to low factors and cross-loadings on both factors. The remaining 26 items had fourteen items that loaded on Factor one and 12 items that loaded on Factor two. The Cronbach Alpha coefficient for the revised 26-item scale was 0.85 indicating good internal consistency. The modified scale is appropriate to examine nursing students’ self-efficacy to care for older adults in the African context.

Detecting low-intake dehydration using bioelectrical impedance analysis in older adults in acute care settings: a systematic review

BackgroundDehydration is a frequent cause of excess morbidity and poor health outcomes, particularly in older adults who have an increased risk of fluid loss due to renal senescence, comorbidities, and polypharmacy. Detecting dehydration is key to instigating treatment to resolve the problem and prevent further adverse consequences; however, current approaches to diagnosis are unreliable and, as a result, under-detection remains a widespread problem. This systematic review sought to explore the value of bioelectrical impedance in detecting low-intake dehydration among older adults admitted to acute care settings.MethodsA literature search using MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane Library was undertaken from inception till May 2022 and led to the eventual evaluation of four studies. Risk of bias was assessed using the Cochrane tool for observational studies; three studies had a high risk of bias, and one had a low risk. Data were extracted using systematic proofs. Due to insufficient reporting, the data were analysed using narrative synthesis.ResultsOne study showed that the sensitivity and specificity of bioelectrical impedance in detecting low-intake dehydration varied considerably depending on the total body water percentage threshold used to ascertain dehydration status. Other included studies supported the technique's utility when compared to conventional measures of hydration status.ConclusionsGiven the scarcity of literature and inconsistency between findings, it is not possible to ascertain the value of bioelectrical impedance for detecting low-intake dehydration in older inpatients.

Nurse-pharmacist collaborations for promoting medication safety among community-dwelling adults: A scoping review.

Despite good evidence that supports improved clinical health outcomes and the cost effectiveness of nurse-pharmacist collaboration for promoting medication safety among adults in acute care settings, there is limited research in community settings. This scoping review examines, maps, and identifies gaps in the existing literature on nurse-pharmacist collaboration to augment medication safety among community-dwelling adults. Setting(s): Community setting. This review consists of 3,464 participants across 23 studies. We used the enhanced Arksey and O'Malley framework by Levac and colleagues. Studies from MEDLINE, CINAHL, ProQuest, Scopus, and PubMed databases implementing medication safety through nurse-pharmacist collaboration for community-dwelling adults were included. We extracted data according to country of origin, intervention, and relevance to the current review. Twenty-three studies were included in this review. Nurse-pharmacist collaborations in community settings are still evolving and are in a nascent form. Five sub-themes emerged from literature review of collaboration between nurses and pharmacists in community settings for medication safety. They are creating new opportunities to address gaps in community medication safety, enabling complementary interprofessional roles in medication safety, facilitating of efficient and cost-effective measures for medication safety, diverse nature of assessments done by nurses and pharmacists, and incohesive teams due to poor collaborative practices. Nurse-pharmacist collaborations in community settings improved disease management, prevented adverse drug events, and reduced hospitalizations. They resulted in early identification and correction of medication safety related issues, reduced wait periods to see general practitioners, and enhanced chronic disease self-management skills among community-dwelling adults. There is a need to improve existing systems and policies through research for sustaining such collaborations especially in community settings.

Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey.

PURPOSE:The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey.DESIGN:Observational, cohort study with cross-sectional data collection and retrospective data analysis.SUBJECTS AND SETTING:The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample.METHODS:Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units.RESULTS:Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00).CONCLUSION:Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.

Perception and Utilization of Standardized Outcome Measures in Acute Care Physical Therapy

Purpose: To assess the relationship between characteristics of acute care physical therapists (PTs) and use of standardized outcome measures (OMs); also describe the perceived barriers, facilitators, and resources to the use of OMs by PTs in the acute care setting. Methods: An electronic survey was distributed to PTs who currently work, or have worked, in the adult acute care setting in the past 5 years. Separate quantitative and qualitative analyses were performed followed by triangulation of findings. Results: A convenience sample included 227 respondents. Most respondents (n = 159, 70%) reported using OMs. PTs with a clinical specialty used OMs significantly more (P = .041) than those without. No significant difference was found in the frequency of OM use between years of experience, entry-level degree, and primary patient population. The top barrier was lack of time (60%). The top facilitator was support from administration (81%). Themes generated for barriers, facilitators, and resources included lack of resources, setting specificity, patient population and acuity, objective data, facility support, and continuing education. Conclusions: Most acute care PTs reported using OMs, although a higher frequency was observed in those with a clinical specialty. This study presents opportunities to provide knowledge translation and resources to combat barriers to OM use in the acute care setting.

Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey.

PURPOSE:The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey.DESIGN:Observational, cohort study with cross-sectional data collection and retrospective data analysis.SUBJECTS AND SETTING:The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years.METHODS:Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units.RESULTS:Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups.CONCLUSION:Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.

Current Practices in and Barriers to Physiotherapists' Use of Resistance Exercise with Older Adults in Acute Care.

Purpose: The purpose of this cross-sectional study was to describe physiotherapists' current use of resistance exercise (REx) with older adults in acute care and to identify barriers to its use with this population. Methods: We developed an online questionnaire guided by the theoretical domains framework and distributed it to physiotherapists across British Columbia. We used thematic analysis to code open-text questionnaire responses. Results: One hundred and five physiotherapists completed the questionnaire (78% female; mean age 39.9 [SD10.3] y; mean years of experience 12.4 [SD10.3] y). Respondents reported frequently performing functional testing (95%) and assessing muscle strength (70%) in older adults, but few often prescribed REx (34%). The greatest barriers to use of REx that respondents identified were lack of prioritization of REx among other duties and perceived poor patient motivation. Open-text data analysis revealed that respondents felt that some patients were unable to perform REx and that physiotherapists lacked a clear definition of REx and sufficient support personnel. Conclusions: Addressing treatment priorities, patient motivation, and staffing resources can support physiotherapists in increasing REx use, an important strategy for reducing the incidence of hospital-associated deconditioning among older adults in acute care settings.

'Owning the space'-person-centred practice in a 100% single-room acute-care environment: an ethnographic study.

Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting. Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care. Ethnography, underpinned by McCormack and McCance's Person-centred Practice Framework. Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n=108hours); face to face inpatient interviews (n=9); and participatory reflective staff groups (n=3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Themes relating to care delivery and interactions were identified. Staff and patients' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as 'visitors'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care. Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.

The relationship between the nursing practice environment and five nursing-sensitive patient outcomes in acute care hospitals: A systematic review.

AimTo synthesize the available evidence on the relationship between the nursing practice environment in acute care hospitals and five selected nursing‐sensitive patient outcomes (mortality, medication error, pressure injury, hospital‐acquired infection and patient fall).DesignA quantitative systematic review of literature was conducted using the PRISMA reporting guidelines (PROSPERO: CRD42020143104).MethodsA systematic review was undertaken up to October 2020 using: CINAHL, MEDLINE and Scopus. The review included studies exploring the relationship between the nursing practice environment in adult acute care settings and one of five selected patient outcomes using administrative data sources. Studies were published in English since 2000.ResultsTen studies were included. Seven studies reported that a favourable nursing practice environment reduced the likelihood of mortality in acute care hospitals, but estimates of the effect size varied. Evidence on the association between the nursing practice environment and medication administration error, pressure injury and hospital‐acquired infection was mixed.

Effectiveness of Bladder Training before Short-Term Indwelling Urinary Catheters Removal for Adults in Acute Care Settings: A Systematic Review and Meta-Analysis

Effectiveness of Bladder Training before Short-Term Indwelling Urinary Catheters Removal for Adults in Acute Care Settings: A Systematic Review and Meta-Analysis

Person-Centered Communication Between Health Care Professionals and COVID-19-Infected Older Adults in Acute Care Settings: Findings From Wuhan, China.

ObjectivesThe current study aims to explore person-centered communication between health care professionals and COVID-19 infected older patients in acute care settings.MethodsThe current qualitative study explored the communication between professionals and COVID-19 infected older adults in the acute care setting through two rounds of interviews with physicians and nurses who provided direct care and treatment for COVID-19 infected older patients in Wuhan, China. We explored the possibilities and significance of facilitating effective communication despite multiple challenges in the pandemic. Conventional content analysis was adopted to analyze the rich data collected from our participants.ResultsIt is possible and necessary to initiate and sustain person-centered communication despite multiple challenges brought by the pandemic. The achievement of person-centered communication can play significant roles in addressing challenges, building mutual trust, improving quality of care and relationships, and promoting treatment adherence and patients’ psychological wellbeing.DiscussionIt is challenging for healthcare professionals to provide care for COVID-19 infected older adults, especially for those with cognitive and sensory impairment, in acute care settings. Facilitating person-centered communication is a significant strategy in responding to the pandemic crisis and a core element of person-centered care.

Chronic conditions among children, adolescents, and young adults in acute care settings

Abstract Background Despite a growing prevalence of chronic disease risk factors, such as obesity, among young people in the United States and other countries, little is known about actual disease prevalence in this population. Almost nothing is known about this topic in many racial/ethnic groups that are rapidly growing in the United States, including Native Hawaiians, Other Pacific Islanders, and Filipinos. Yet these understudied groups are at high risk. The study goal was to determine the statewide prevalence of chronic disease in acute care for those aged 5-29 years, including Native Hawaiians, Filipinos, and Pacific Islanders. Methods Using Hawai'i statewide inpatient and emergency department (ED) data across all payers from 2015-2016, we considered the presence of at least one of five target chronic conditions (asthma, hypertension, chronic kidney disease, diabetes, stroke) from 13,514 inpatient stays by 9,467 unique individuals and 228,548 ED visits by 127,854 individuals. Results Twenty-eight percent of youth who were hospitalized and 12% with an ED visit had at least one chronic condition. In both inpatient and ED settings, race/ethnicity, age group, and payer varied significantly when comparing those with a chronic condition to those without a chronic condition. Notably, those with a chronic condition were disproportionately Native Hawaiian, Filipino, and Pacific Islander; 32.3% percent of those with an inpatient chronic condition and 34.9% of those with an ED chronic condition were Native Hawaiian. Conclusions Chronic diseases, including those more often seen in adulthood, are prevalent in young people in acute care settings in the state of Hawai'i with notable disparities. This data can help justify, guide, and support programs urgently needed to address these changing epidemiological trends, which may be of particular interest for Medicaid. Key messages We show that chronic conditions are prevalent in young people in acute care settings in the state of Hawai‘i with notable disparities. This can help justify, guide, and support programs to address these troubling epidemiological trends.

Prevalence of Selected Chronic Conditions Among Children, Adolescents, and Young Adults in Acute Care Settings in Hawai'i.

IntroductionChronic disease prevalence among young people is understudied generally and specifically for Native Hawaiian, Filipino, and Pacific Islander youth who are at high risk for these conditions. We determined the statewide prevalence of chronic diseases in acute care for those aged 5 to 29 years, including Native Hawaiians, Filipinos, and Pacific Islanders.MethodsWe used Hawai‘i statewide inpatient and emergency department (ED) data across all payers from 2015–2016 to determine the presence of at least 1 of 5 chronic conditions (ie, asthma, hypertension, chronic kidney disease, diabetes, stroke) from 13,514 inpatient stays by 9,467 unique individuals and 228,548 ED visits by 127,854 individuals.ResultsTwenty-eight percent of youth who were hospitalized and 12% with an ED visit had at least 1 chronic condition. Medicaid covered more than half of these visits. When comparing patients with and without a chronic condition, race/ethnicity, age group, and payer varied significantly in both inpatient and ED settings. Patients with a chronic condition were disproportionately Native Hawaiian, Filipino, and Pacific Islander; 32.3% of those with an inpatient chronic condition and 34.9% of those with an ED chronic condition were Native Hawaiian. Prevalence of chronic conditions among racial/ethnic groups varied significantly by age.ConclusionChronic diseases, including those more often seen in adulthood, are prevalent in young people in acute care settings in Hawai‘i, with notable disparities. These findings can help justify, guide, and support programs that are needed to address these changing epidemiological trends, which may be of particular interest for Medicaid.

Does Simulation Training for Acute Care Nurses Improve Patient Safety Outcomes: A Systematic Review to Inform Evidence-Based Practice.

Simulation is increasingly used as a training tool for acute care medical-surgical nurses to improve patient safety outcomes. A synthesis of the evidence is needed to describe the characteristics of research studies about acute care nurse simulation trainings and patient safety. An additional purpose is to examine the effects of acute care registered nurse (RN) simulation trainings on patient safety outcomes. Five Internet databases were searched for articles published on any date through October 2018 examining the effect of RN simulation trainings on patient safety outcomes in the adult acute care setting. N=12 articles represented 844 RNs of varying experience levels and 271 interprofessional participants. Nine studies (75%) used high-fidelity scenarios developed locally about high risk but infrequent events. Five studies (42%) incorporated interdisciplinary team members in the scenarios and/or outcome evaluations. Outcome measures were self-reported, direct observation, or clinical indicators. All studies in this review achieved improved patient safety outcomes. It is unknown how outcomes vary for different groups of RNs because of insufficient gender, ethnicity/race, and age reporting. Findings support the design of simulation training research studies for patient safety outcomes and use of simulation training and research in acute care RNs. Additional high-quality research is needed to support this field. Future studies should include descriptors that characterize the sample (i.e., age, gender, education level, type of nursing degree, ethnicity or race, or years of experience); incorporate interdisciplinary teams; evaluate a combination of outcome measure types (i.e., self-report, direct observation, and clinical outcomes) both proximal and distal to the simulation; and that utilize standardized scenarios, validated outcome measure instruments, and standardized debriefing tools.

Nasal high flow: physiology, efficacy and safety in the acute care setting, a narrative review.

Nasal high flow (NHF) is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. It is considered to have a number of physiological effects: it improves oxygenation, dynamic lung compliance, homogeneity and end expiratory lung volume; it decreases anatomical dead space and generates a positive airway pressure that can reduce respiratory rate, the work of breathing, and enhance patient comfort. NHF has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxemic respiratory failure such as pre-oxygenation before intubation, immunocompromised patients and acute heart failure. Moreover, there is some evidence that NHF could be used during procedural sedation. Finally, NHF was deemed to be effective in chronic obstructive pulmonary disease patients with its positive end expiratory pressure effects and dead-space washout. However, careful monitoring is crucial to maximize NHF settings aimed at maximizing patient comfort while limiting the risk of delayed intubation. The present review presents the most updated evidence for NHF use in the adult acute care setting with the goal of providing clinicians with useful insights on the physiologic effects, main clinical indications, and safety issues of NHF treatment.

Gender Differences in Sexual Health Knowledge Among Emerging Adults in Acute-Care Settings.

Emerging adults (aged 18-25 years) are increasingly seeking evaluation in acute-care clinics for sexual health-related concerns to receive treatment and education. To assess the sexual health knowledge of emerging adult patients by gender at acute-care health centers. A prospective, self-administered survey was distributed from August 2014 through May 2016 to patients aged 18 to 24 years who presented to 1 of 4 acute-care locations in a university town in a mid-Atlantic state. Analyses included descriptive statistics, as well as χ2 and Fisher exact test crosstabulations to determine differences between genders. A total of 388 patients aged 18 to 24 years responded to the survey, with 81% of the sample identifying themselves as students and 64% identifying as female. Women were more likely than men to state that they sought sexual health advice at an urgent-care or walk-in clinic (70.3% vs 52.1%; P<.05). Human papillomavirus knowledge among women was significantly greater than among men (P<.0001). Open-ended responses were widespread and often incorrect, specifically with regard to the human papillomavirus vaccine and routine testing for sexually transmitted infections. Women were more knowledgeable about sexual health than men. However, both genders were not as knowledgeable overall on sexual health topics as hypothesized. A stronger emphasis on gender-specific programming for sexual health education via community- and school-based programs throughout adolescence, supplemented with greater emphasis on routine preventive health care during adolescence and emerging adulthood, is encouraged.