DiversityNursing Blog

By Rebecca Riffkin

In 2014, Americans say nurses have the highest honesty and ethical standards. Members of Congress and car salespeople were given the worst ratings among the 11 professions included in this year's poll. Eighty percent of Americans say nurses have "very high" or "high" standards of honesty and ethics, compared with a 7% rating for members of Congress and 8% for car salespeople.

Americans have been asked to rate the honesty and ethics of various professions annually since 1990, and periodically since 1976. Nurses have topped the list each year since they were first included in 1999, with the exception of 2001 when firefighters were included in response to their work during and after the 9/11 attacks. Since 2005, at least 80% of Americans have said nurses have high ethics and honesty. Two other medical professions -- medical doctors and pharmacists -- tie this year for second place at 65%, with police officers and clergy approaching 50%.

Historically, honesty and ethics ratings for members of Congress have generally not been positive, with the highest rating reaching 25% in 2001. Since 2009, Congress has ranked at or near the bottom of the list, usually tied with other poorly viewed professions like car salespeople and -- when they have been included -- lobbyists, telemarketers, HMO managers, stockbrokers and advertising practitioners.

Although members of Congress and car salespeople have similar percentages rating their honesty and ethics as "very high" or "high," members of Congress are much more likely to receive "low" or "very low" ratings (61%), compared with 45% for car salespeople. Last year, 66% of Americans rated Congress' honesty and ethics "low" or "very low," the worst Gallup has measured for any profession historically.

Other relatively poorly rated professions, including advertising practitioners, lawyers, business executives and bankers are more likely to receive "average" than "low" honesty and ethical ratings. So while several of these professions rank about as low as members of Congress in terms of having high ethics, they are less likely than members of Congress to be viewed as having low ethics.

No Professions Improved in Ratings of High Honesty, Ethics Since 2013

Since 2013, all professions either dropped or stayed the same in the percentage of Americans who said they have high honesty and ethics. The only profession to show a small increase was lawyers, and this rise was small (one percentage point) and within the margin of error. The largest drops were among police officers, pharmacists and business executives. But medical doctors, bankers and advertising practitioners also saw drops.

Honesty and ethics ratings of police dropped six percentage points since last year, driven down by many fewer nonwhite Americans saying the police have high honesty and ethical standards. The clergy's 47% rating last year marked the first year that less than 50% of Americans said the clergy had high ethical and honesty standards -- and the current 46% rating is, by one percentage point, the lowest Gallup has measured for that profession to date.

Bottom Line

Americans continue to rate those in medical professions as having higher honesty and ethical standards than those in most other professions. Nurses have consistently been the top-rated profession -- although doctors and pharmacists also receive high ratings, despite the drops since 2013 in the percentage of Americans who say they have high ethics. The high ratings of medical professions this year is significant after the Ebola outbreak which infected a number of medical professionals both in the U.S. and in West Africa.

At the other end of the spectrum, in recent years, members of Congress have sunk to the same depths as car salespeople and advertising practitioners. However, in one respect, Congress is even worse, given the historically high percentages rating its members' honesty and ethics as being "low" or "very low." And although November's midterm elections did produce a significant change in membership for the new Congress that begins in January, there were also major shakeups in the 2006 and 2010 midterm elections with little improvement in the way Americans viewed the members who serve in that institution.

Previously in 2014, Gallup found that Americans continue to have low confidence in banks, and while Americans continue to have confidence in small businesses, big businesses do not earn a lot of confidence. This may be the result of Americans' views that bankers and business executives do not have high honesty and ethical standards, and the fact that their ratings dropped since last year.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted Dec. 8-11, 2014, with a random sample of 805 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level.

Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

Source: www.gallup.com

By Jen Christensen and Elizabeth Cohen

A young Liberian woman who saved three of her relatives by nursing them back to health after they contracted the Ebola virus is coming to the United States to finish her nursing degree.

The news comes as Time magazine announced Wednesday that its "Person of the Year" honors go to the Ebola fighters, the "unprecedented numbers" of doctors and nurses who responded when Ebola overtook an already-weak public health infrastructure this year in West Africa.

Fatu Kekula is not named in the article, but she definitely holds a place among those being honored.

The 22-year-old, who was in her final year of nursing school earlier this year, single-handedly took care of her father, mother, sister and cousin when they became ill with Ebola beginning in July.

And she did so with remarkable success. Three out of her four patients survived. That's a 25% death rate -- considerably better than the estimated Ebola death rate of 70%.

Kekula stayed healthy, which is noteworthy considering that hundreds of health care workers have become infected with Ebola, and she didn't even have personal protection equipment -- those white space suits and goggles used in Ebola treatment units.

Instead, Kekula invented her own equipment. International aid workers heard about her "trash bag method" and taught it to other West Africans who can't get into hospitals and don't have protective gear of their own.

Every day, several times a day for about two weeks, Kekula put trash bags over her socks and tied them in a knot over her calves. Then she put on a pair of rubber boots and then another set of trash bags over the boots.

She wrapped her hair in a pair of stockings and over that a trash bag. Next she donned a raincoat and four pairs of gloves on each hand, followed by a mask.

It was an arduous and time-consuming process, but she was religious about it, never cutting corners.

UNICEF Spokeswoman Sarah Crowe said Kekula is amazing.

"Essentially this is a tale of how communities are doing things for themselves," Crowe said. "Our approach is to listen and work with communities and help them do the best they can with what they have."

She emphasized, of course, that it would be better for patients to be in real hospitals with doctors and nurses in protective gear -- it's just that those things aren't available to many West Africans.

No one knows that better than Kekula.

Her Ebola nightmare started July 27, when her father, Moses, had a spike in blood pressure. She took him to a hospital in their home city of Kakata.

A bed was free because a patient had just passed away. What no one realized at the time was that the patient had died of Ebola.

Moses, 52, developed a fever, vomiting and diarrhea. Then the hospital closed down because nurses started dying of Ebola.

Kekula took her father to Monrovia, the capital city, about a 90-minute drive via difficult roads. Three hospitals turned him away because they were full.

She took him back to another hospital in Kakata. They said he had typhoid fever and did little for him, so Kekula took him home, where he infected three other family members: Kekula's mother, Victoria, 57; Kekula's sister, Vivian, 28, and their 14-year-old cousin who was living with them, Alfred Winnie.

While operating her one-woman Ebola hospital for two weeks, Kekula consulted with their family doctor, who would talk to her on the phone, but wouldn't come to the house. She gave them medicines she obtained from the local clinic and fluids through intravenous lines that she started.

At times, her patients' blood pressure plummeted so low she feared they would die.

"I cried many times," she said. "I said 'God, you want to tell me I'm going to lose my entire family?' "

But her father, mother, and sister rallied and were well on their way to recovery when space became available at JFK Medical Center on August 17. Alfred never recovered, though, and passed away at the hospital the next day.

"I'm very, very proud," Kekula's father said. "She saved my life through the almighty God."

Her father immediately began working to find a scholarship for Kekula, so she could finish her final year of nursing school. But the Ebola epidemic shut down many of Liberia's schools, including hers.

After a story about Kekula ran on CNN in September, many people wanted to help her.

A non-profit group called iamprojects.org also got involved.

With some help, Kekula applied to Emory University in Atlanta, the campus with the hospital that has successfully cared for American Ebola patients. Emory accepted the young woman so that she could complete her nursing degree starting this winter semester.

In order to attend, iamprojects will have to raise $40,000 to pay for her reduced tuition rate, living expenses, books and her travel and visa so that she can travel between Africa and the United States.

Kekula's father has no doubt that his daughter will go on to save many more people during her lifetime.

"I'm sure she'll be a great giant of Liberia," he said.

Source: www.cnn.com

By John Gever

Not all children with severe brain injuries need to be monitored for subclinical seizures, researchers said here, which means that resources can be focused on those at the highest risk.

Victims of abuse, those younger than 2, and those with bleeding within the brain rather than only in the epidural compartment are the pediatric ICU patients most likely to show significant seizure activity that should be detected and treated, said Rajsekar Rajaraman, MD, of the University of California Los Angeles (UCLA).

A separate study by many of the same investigators also found that, in a broader range of pediatric brain injury cases, risk of seizures could be predicted with "fair-to-good" accuracy on the basis of clinical characteristics that would be recorded routinely at admission.

Both studies were reported at the American Epilepsy Society's annual meeting here.

A senior author on both studies, Nicholas Abend, MD, of Children's Hospital of Philadelphia, said at an AES press briefing that identifying and treating seizures is important in the pediatric ICU. When seizures are extremely frequent or long-lasting -- and these can easily go without detection in hospitalized children who are unconscious or lethargic -- they significantly increase the likelihood of poor short- and long-term outcomes.

Such seizures can only be detected via continuous EEG monitoring, Abend explained, which also requires interpretation from trained electroneurologists.

Another investigator in the studies, UCLA's Jason Lerner, MD, noted that children may appear to be napping peacefully while actually undergoing continuous seizures.

Although it would be desirable to perform intense monitoring on all pediatric cases involving head trauma, that is not feasible at most centers, Abend said. He said the field could benefit from risk-stratification models that would allow the care team to track only those patients at the highest risk for damaging subclinical seizures.

Such models, he added, could be tailored to meet the needs of individual centers on the basis of their patient mix, staffing, and other factors.

In a platform session at AES, Rajaraman described one approach to developing such a model. He and colleagues collected data on 135 consecutive pediatric patients (ranging in age from infant to late adolescent) with traumatic brain injury who were treated in ICUs at UCLA and at Children's Hospital of Colorado in Denver. These children had continuous EEG monitoring for detecting subclinical seizures.

They found that all such seizures occurred in children younger than 2 and in those with intradural bleeding, and that the vast majority also involved abusive head trauma. Rajaraman and colleagues then sought to validate these associations in a separate cohort of 44 pediatric ICU patients with head injuries treated at Children's Hospital of Philadelphia. The same patterns were seen.

Across both cohorts, 81% of those with subclinical seizures were determined to have been victims of abusive head trauma, whereas the prevalence of such trauma in all the patients was 25%. Abend said it was uncertain why abusive trauma should be such a strong predictor of these seizures, but speculated that "shaken baby syndrome" -- the most common form of abuse of infants and toddlers -- may produce fundamentally different injuries in the brain compared with falls and car accidents.

Also, such abuse is often chronic, such that the episode that brings a child to the hospital is only the latest in a series of abusive incidents.

The other study, led by Abend, was aimed at producing a predictive model yielding a risk index score that pediatric centers could use to identify critically ill children who could benefit the most from continuous EEG monitoring. It was based on clinical information to which the attending neurologist would have ready access: age, seizure etiology, presence of clinical seizures prior to beginning continuous EEG, initial EEG background category, and interictal discharge category.

Data to design the model were drawn from a database of 336 patients from 11 centers, and then tested against a separate validation dataset of 222 patients treated at Children's Hospital of Philadelphia.

Normalized scores in the model could range from 0 to 1.0, and Abend and colleagues examined the sensitivity and specificity of various cutoffs. When set at 0.10 in the validation cohort, sensitivity was 86% but sensitivity was only 58% -- the high sensitivity meant that 43% of patients would be identified as candidates for continuous monitoring. At the other end, a cutoff of 0.45 reversed the sensitivity and specificity percentages to 19% and 97%, respectively, such that only 5% of patients would be assigned to monitoring.

Abend said the beauty of this approach is that an individual center could choose its own optimal cutoff depending on the resources it has available to monitor multiple patients at one time. A well-equipped and staffed ICU could thus opt for high sensitivity whereas one with more limited resources could be more restrictive.

Source: www.medpagetoday.com

Jessica Zegre-Hemsey, a cardiac monitoring expert at the University of North Carolina at Chapel Hill, and her colleagues at the University of California San Francisco, revealed more than 2.5 million alarms were triggered on bedside monitors in a single month - the first figure ever reported from a real-world hospital setting.

Alarm fatigue occurs when nurses and other clinicians are exposed to a high number of physiological alarms generated by modern monitoring systems. In turn, alarms are ignored and critical alarms are missed because many alarms are false or non-actionable.

The work, the first of its kind to investigate the frequency and accuracy of alarms, addresses a growing patient safety issue that has gained national attention in recent years when a patient died despite multiple alarms that indicated low heart rate. The issue also addresses hidden downsides to modern monitoring technologies.

"Current technologies have been instrumental in saving lives but they can be improved," said Zègre-Hemsey, who is an assistant professor at the UNC-Chapel Hill School of Nursing. "For example, current monitoring systems do not take into account differences among patients. If alarm settings were tailored more specifically to individuals that could go a long way in reducing the number of alarms health care providers respond to."

Zègre-Hemsey and her colleagues collected alarm data on 461 adults in five intensive care units at the UCSF Medical Center for a period of 31 days. Zègre-Hemsey was one of four scientists who analyzed the alarms and helped to determine if they were true or false.

Investigators analyzed a subset of 12,671 arrhythmia alarms, which are designed to alert providers to abnormal cardiac conditions, and found 88.8 percent were false positives. Most of the false alarms were caused by deficiencies in the computer's algorithms, inappropriate user settings, technical malfunctions, and non-actionable events, such as brief spikes in heart rate, that don't require treatment.

A potential solution the researchers suggested would be to design monitors that could be configured to individual patients. No two bodies are exactly the same, and if the monitors could be adjusted to a patient's unique vital signs, the machines would not mistake a normal condition for an abnormal one. A "gold standard" database of annotated alarms could also help developers create computer algorithms that are less sensitive to artifacts.

According to Zègre-Hemsey, reducing alarm fatigue will ultimately require strong collaborations between clinicians, engineers, and hospital administrators as well as additional research.

"Alarm fatigue is a large and complex problem," she said. "Yet the implications are far-reaching since sentinel events like patient death have been reported. This is a current patient safety crisis."

The study was led by primary investigator Barbara J. Drew at UCSF. Co-authors on the paper include UCSF researchers Patricia Harris, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, and Xiao Hu from the UCSF department of physiological nursing and Tina Mammone from the UCSF department of nursing.

Source: www.medicalnewstoday.com

By Dennis Thompson

Already-strong public support for right-to-die legislation has grown even stronger in the days since the planned death of 29-year-old brain cancer patient Brittany Maynard, a new HealthDay/Harris Poll has found.

An overwhelming 74 percent of American adults now believe that terminally ill patients who are in great pain should have the right to end their lives, the poll found. Only 14 percent were opposed.

Broad majorities also favor physician-assisted suicide and physician-administered euthanasia.

Only three states -- Oregon, Washington and Vermont -- currently have right-to-die laws that allow physician-assisted suicide.

"Public opinion on these issues seems to be far ahead of political leadership and legislative actions," said Humphrey Taylor, chairman of The Harris Poll. "Only a few states have legalized physician-assisted suicide and none have legalized physician-administered euthanasia."

People responded to the poll in the weeks after Maynard took medication to end her life in early November.

Maynard moved from California to Oregon following her diagnosis with late-stage brain cancer so she could take advantage of the state's "Death With Dignity Act." Her story went viral online, with a video explaining her choice garnering nearly 11.5 million views on YouTube.

A "poster child for the movement," Maynard helped spark conversations that allowed people to put themselves in her shoes, said Frank Kavanaugh, a board member of the Final Exit Network, a right-to-die advocacy group.

"I think it is just a natural evolution over a period of time," Kavanaugh said of the HealthDay/Harris Poll results. "There was a time when people didn't talk about suicide. These days, each time conversations occur, people think it through for themselves, and more and more are saying, 'That's a reasonable thing to me.'"

The poll also found that:

• Support for a person's right to die has increased to 74 percent, up from 70 percent in 2011. Those opposed decreased to 14 percent from 17 percent during the same period.
• Physician-assisted suicide also received increased support, with 72 percent now in favor, compared with 67 percent in 2011. Opposition declined from 19 percent to 15 percent.
• Sixty-six percent of respondents said doctors should be allowed to comply with the wishes of dying patients in severe distress who ask to have their lives ended, up from 58 percent in 2011. Opposition decreased from 20 percent in 2011 to 15 percent now.

"The very large -- more than 4-to-1 and increasing -- majorities in favor of physician-assisted suicide, and the right of terminally ill patients to end their lives are consistent with other liberal social policy trends, such as support for same-sex marriage, gay rights and the decriminalization of marijuana, seen in the results of referendums and initiatives in the recent mid-term elections," Taylor said.

Support for the right-to-die movement cut across all generations and educational groups, both genders, and even political affiliation, the poll found.

Democrats tended to be more supportive of right-to-die legislation, but 56 percent of Republicans said they favor voluntary euthanasia and 63 percent favor physician-assisted suicide.

Kavanaugh was not surprised. "People think of this as a liberal issue. But I find that as I talk to [conservatives], you can appeal to them on the basis of 'get the government the hell out of my life,'" he said.

But the public is split over how such policies should be enacted, with 35 percent saying that the states should decide on their own while 33 percent believe the decision should be made by the federal government, the poll found.

"Most of the people I know in the field whose opinion I put stock in don't feel there's ever going to be federal movement on it," Kavanaugh said. "You're just going to have to suffer through a state-by-state process."

Kavanaugh does believe this overwhelming public support will result in steady adoption of right-to-die laws.

"I think this will become the ultimate human right of the 21st century, the right to die with dignity," he said. "There are good deaths and bad deaths, and it is possible to have a good death."

Despite increasing public support for assisted suicide, stiff opposition remains in some quarters.

"Assisted suicide sows confusion about the purpose of life and death. It suggests that a life can lose its purpose and that death has no meaning," Rev. Alexander Sample, archbishop of the Archdiocese of Portland in Oregon, said in a pastoral statement issued during Maynard's final days.

"Cutting life short is not the answer to death," he said. "Instead of hastening death, we encourage all to embrace the sometimes difficult but precious moments at the end of life, for it is often in these moments that we come to understand what is most important about life. Our final days help us to prepare for our eternal destiny."

Todd Cooper, a spokesman for the Portland archdiocese, said the debate over assisted suicide touches him on a very deep level because of his wife, Kathie.

About 10 years ago, she also was diagnosed with terminal brain cancer. She endured two brain surgeries, two years of chemotherapy and six weeks of radiation therapy, and remains alive to this day.

"If she'd given up the fight for life, she wouldn't be here," Cooper said. "That doesn't necessarily happen in every case, but it gives hope for those who struggle to the very end."

source: www.medicinenet.com

By Honor Whiteman

Cancer is one of the leading causes of morbidity and mortality worldwide. In 2012, there were around 14 million new cases of cancer and around 8.2 million deaths from the disease. But despite such alarming numbers, a new study by researchers from the UK finds that most people ignore cancer warning signs, attributing them instead to symptoms of less serious illnesses.

Lead study author Dr. Katriina Whitaker, senior research fellow at University College London in the UK, analyzed the responses of 1,724 people aged 50 and over to a health questionnaire that was sent to them in April 2012.

The questionnaire asked participants whether they had experienced any of 17 symptoms, 10 of which are defined as cancer "alarm" symptoms by Cancer Research UK. These symptoms include unexplained cough, changes in mole appearance, unexplained bleeding, persistent change in bowel habits, unexplained weight loss, difficulty swallowing and unexplained lumps. 

Participants were not told which symptoms are cancer warning signs.

The respondents were also asked what they thought was the cause of any symptoms they experienced, whether they deemed the symptoms to be serious and whether they visited their doctor as a result of their symptoms.

Only 2% of respondents considered warning symptoms to be cancer-related

Results of study - published in the journal PLOS ONE - revealed that 53% of participants reported that they had experienced at least one cancer warning sign over the past 3 months.

The most common cancer warning symptoms reported were persistent cough and persistent change in bowel habits, while unexplained weight loss and problems swallowing were the least common.

However, the researchers were surprised to find that of the respondents who reported cancer warning symptoms, only 2% considered cancer to be a potential cause.

What is more, Dr. Whitaker says that of participants who reported the most obvious signs of cancer - such as unexplained lumps or changes in mole appearance - most did not consider them to be cancer-related.

"Even when people thought warning symptoms might be serious, cancer didn't tend to spring to mind," adds Dr. Whitaker. "This might be because people were frightened and reluctant to mention cancer, thought cancer wouldn't happen to them or believed other causes were more likely."

On a positive note, respondents did deem the cancer warning signs to be more serious than symptoms not linked to cancer - such as shortness of breath, fatigue and sore throat- and 59% of those who experienced cancer warning signs visited their doctor.

But the researchers say their findings show that the majority of people are dismissing potential warning signs of cancer, which could be putting their health at serious risk. Dr. Whitaker says:

"Most people with potential warning symptoms don't have cancer, but some will and others may have other diseases that would benefit from early attention. That's why it's important that these symptoms are checked out, especially if they don't go away. But people could delay seeing a doctor if they don't acknowledge cancer as a possible cause."

"Most cancers are picked up through people going to their general practitioner (GP) about symptoms, and this study indicates that opportunities for early diagnosis are being missed," adds Sara Hiom, director of early diagnosis at Cancer Research UK. "Its results could help us find new ways of encouraging people with worrying symptoms to consider cancer as a possible cause and to get them checked out straight away with a GP."

Source: www.medicalnewstoday.com

That’s right—there are men in nursing, too! It’s time to rid ourselves of outdated stereotypes. We don’t live in a society where boys only like blue and girls only like pink. Where boys can only play with legos and girls can only play with dolls. There’s too much variety in this world to limit ourselves to what we think is expected of us. There are women in engineering and mathematics, and there are men in nursing and healthcare.

Population Growing for Men in Nursing

Nursing is a fantastic career. In fact, the number of men in nursing is growing, with the percentage of male nurses increasing almost every year. In addition, there are more men in nursing schools, making up 13% of nursing school students. Find out more facts about male nurses by reading the men in nursing infographic below.

Source: www.collegeamerica.edu

By  Carly Dell

In the Future of Nursing report published by the Institute of Medicine, it is recommended that health care facilities throughout the United States increase the proportion of nurses with a BSN to 80 percent and double the number of nurses with a DNP by the year 2020. Research shows that nurses who are prepared at baccalaureate and graduate degree levels are linked to lower readmission rates, shorter lengths of patient stay, and lower mortality rates in health care facilities.

What does the job market look like for RNs who are looking to advance their careers?

We tackle this question in our latest infographic, “Career Paths for RNs,” where we look in-depth at the three higher education paths RNs can choose from to advance their careers — Bachelor of Science in Nursing, Master of Science in Nursing, and Doctor of Nursing Practice.

For each career path, we outline the various in-demand specialties, salaries, and job outlook.

Source: onlinenursing.simmons.edu

In the wake of media focus on the trials and bravery of nurses in the context of the Ebola crisis, leaders in the fields of nursing and clinical ethics have released an unprecedented report on the ethical issues facing the profession, as the American Nursing Association prepares to release a revised Code of Ethics in 2015.

The report captures the discussion at the first National Nursing Ethics Summit, held at Johns Hopkins University in August. Fifty leaders in nursing and ethics gathered to discuss a broad range of timely issues and develop guidance. The report, A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit, is available in full online at www.bioethicsinstitute.org/nursing-ethics-summit-report. It covers issues including weighing personal risk with professional responsibilities and moral courage to expose deficiencies in care, among other topics.

An executive summary of the report is available at: http://www.bioethicsinstitute.org/wp-content/uploads/2014/09/Executive_summary.pdf

"This blueprint was in development before the Ebola epidemic really hit the media and certainly before the first U.S. infections, which have since reinforced the critical need for our nation's healthcare culture to more strongly support ethical principles that enable effective ethical nursing practice," says Cynda Hylton Rushton, PhD, RN, FAAN, the Bunting Professor of Clinical Ethics at the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and lead organizer of the summit.

The report makes both overarching and specific recommendations in four key areas: Clinical Practice, Nursing Education, Nursing Research, and Nursing Policy. Among the specific recommendations are:

• Clinical Practice: Create tools and guidelines for achieving ethical work environments, evaluate their use in practice, and make the results easily accessible.
• Education: Develop recommendations for preparing faculty to teach ethics effectively
• Nursing Research: Develop metrics that enable ethics research projects to identify common outcomes, including improvements in the quality of care, clinical outcomes, costs, and impacts on staff and the work environment
• Policy: Develop measurement criteria and an evaluation component that could be used to assess workplace culture and moral distress

What does this blueprint mean for nurses on the front line?

"It's our hope this will serve as a blueprint for cultural change that will more fully support nurses in their daily practice and ultimately improve how healthcare is administered -- for patients, their families and nurses," says Rushton. "We want to start a movement within nursing and our healthcare system to address the ethical challenges embedded in all settings where nurses work."

On the report's website, nurses and the public can learn more about ethical challenges and proposed solutions, share personal stories, and endorse the vision of the report by signing a pledge.

"This is only a beginning," says Marion Broom, PhD, RN, FAAN, Dean and Vice Chancellor for Nursing Affairs at Duke University and Associate Vice President for Academic Affairs for Nursing at Duke University Health System. "The next phase is to have these national nursing organizations and partners move the conversation and recommendations forward to their respective constituencies and garner feedback and buy-in. Transformative change will come through innovative clinical practice, education, advocacy and policy."

At the time of publication, the vision statement of the report has been endorsed by the nation's largest nursing organizations, representing more than 700,000 nurses:

• American Academy of Nursing
• American Association of Critical-Care Nurses
• American Nurses Association
• American Association of Colleges of Nursing
• American Organization of Nurse Executives
• Association of Women's Health, Obstetric and Neonatal Nurses
• The Center for Practical Bioethics
• National League for Nursing
• National Student Nurses' Association
• Oncology Nursing Society
• Sigma Theta Tau International

Source: www.sciencedaily.com

Use of "antibiograms" in skilled nursing facilities could improve antibiotic effectiveness and help address problems with antibiotic resistance that are becoming a national crisis, researchers conclude in a new study.

Antibiograms are tools that aid health care practitioners in prescribing antibiotics in local populations, such as a hospital, nursing home or the community. They are based on information from microbiology laboratory tests and provide information on how likely a certain antibiotic is to effectively treat a particular infection.

The recent research, published by researchers from Oregon State University in Infection Control and Hospital Epidemiology, pointed out that 85 percent of antibiotic prescriptions in the skilled nursing facility residents who were studied were made "empirically," or without culture data to help determine what drug, if any, would be effective.

Of those prescriptions, 65 percent were found to be inappropriate, in that they were unlikely to effectively treat the target infection.

By contrast, use of antibiograms in one facility improved appropriate prescribing by 40 percent, although due to small sample sizes the improvement was not statistically significant.

"When we're only prescribing an appropriate antibiotic 35 percent of the time, that's clearly a problem," said Jon Furuno, lead author on the study and an associate professor in the Oregon State University/Oregon Health & Science University College of Pharmacy.

"Wider use of antibiograms won't solve this problem, but in combination with other approaches, such as better dose and therapy monitoring, and limiting use of certain drugs, we should be able to be more effective," Furuno said.

"And it's essential we do more to address the issues of antibiotic resistance," he said. "We're not keeping up with this problem. Pretty soon, there won't be anything left in the medical cabinet that works for certain infections."

In September, President Obama called antibiotic resistant infections "a serious threat to public health and the economy," and outlined a new national initiative to address the issue. The Centers for Disease Control and Prevention has concluded that the problem is associated with an additional 23,000 deaths and 2 million illnesses each year in the U.S., as well as up to $55 billion in direct health care costs and lost productivity.

Antibiograms may literally be pocket-sized documents that outline which antibiotics in a local setting are most likely to be effective. They are often used in hospitals but less so in other health care settings, researchers say. There are opportunities to increase their use in nursing homes but also in large medical clinics and other local health care facilities for outpatient treatment. The recent study was based on analysis of 839 resident and patient records from skilled nursing and acute care facilities.

"Antibiograms help support appropriate and prudent antibiotic use," said Jessina McGregor, also an associate professor in the OSU/OHSU College of Pharmacy, and lead author on another recent publication on evaluating antimicrobial programs.

"Improved antimicrobial prescriptions can help save lives, but they also benefit more than just an individual patient," McGregor said. "The judicious use of antibiotics helps everyone in a community by slowing the spread of drug-resistant genes. It's an issue that each person should be aware of and consider."

Multi-drug resistant organisms, such as methicillin-resistant Staphylococcus aureus, or MRSA, and other bacterial attacks that are being called "superinfections" have become a major issue.

Improved antibiotic treatment using a range of tactics, researchers say, could ultimately reduce morbidity, save money and lives, and improve patients' quality of life.

Source: www.medicalnewstoday.com