To determine the cost and efficacy of 4 different regimens of incontinence-associated dermatitis (IAD) prevention in nursing home residents.
A multi-site open-label quasi-experimental study was ...conducted in 16 nursing homes stratified by location in 1 of 4 regions of the United States and randomly selected. In 3 of the 4 regimens, a moisture barrier ointment or cream of different compositions was applied after each episode of incontinence, and in 1 regimen, a polymer-based barrier film was applied 3 times per week. All regimens used a pH-balanced moisturizing cleanser. Time and motion measures were documented for the amount of skin care products used; the number, type, and time of caregivers performing IAD prevention care; and the number and type of supplies used. Rates of incontinence in each nursing home were determined during a 3-day surveillance period.
A total of 1,918 nursing home residents were screened, and 51% (n = 981) qualified for prospective surveillance of incontinence dermatitis; the majority were female (80.1%) and elderly (96% > or = 65 years old). A total of 78.6% (771/981) of the participants were incontinent of both urine and feces. Compared to the 3 regimens in which a barrier was applied after each episode of incontinence, the use of a regimen in which a barrier film was applied 3 times weekly had significantly lower costs for the barrier product, labor associated with barrier application, and total cost, which included products, labor, and supplies. There were also savings in total product (cleanser and barrier) and total labor costs.
The use of a defined skin care regimen that includes a cleanser and a moisture barrier is associated with a low rate of IAD in nursing home residents who are incontinent. Use of a polymer skin barrier film 3 times weekly is effective for preventing incontinence-associated skin breakdown and can provide significant cost savings.
The purpose of this study was to describe the prevalence, incidence, and effectiveness of home health care (HHC) agencies' services with and without a WOC nurse related to wounds, incontinence, and ...urinary tract infection (UTI) patient outcomes.
There were 449,243 episodes of care from a national convenience sample of 785 HHC agencies representing nonmaternity patients who were aged 18 years or older and receiving skilled home health services between October 1, 2008, and December 31, 2009.
This study employed descriptive and comparative designs for data collection and analysis. We analyzed data from HHC agencies' electronic health records and conducted an Internet-based survey of HHC agencies.
Data for this study were documented by HHC clinicians using the Outcome and Assessment Information Set. An Internet survey identified if a WOC nurse provided care or consultations within an HHC agency.
The majority of HHC agencies (88.5%) had some influence of a WOC nurse. The incidence of wounds, incontinence, and UTIs was higher for agencies with no WOC nurse. Home health care agencies with WOC nurses had significantly better improvement outcomes for pressure ulcers, lower extremity ulcers, surgical wounds, urinary incontinence, bowel incontinence, and UTIs as well as significantly better stabilization outcomes for these outcomes except lower extremity ulcers. Virtually all patients in HHC agencies with and without a WOC nurse had stabilization of their lower extremity ulcers.
Findings of this study suggest that influence of a WOC nurse is effective in achieving several important positive outcomes of HHC agencies' services for wounds, incontinence, and UTIs.
Little is known about whether patients who develop
Clostridium-difficile-associated diarrhoea (CDAD) are culture-positive or culture-negative before illness. The most important risk factor is ...antibiotic exposure. We aimed to find out whether patients identified as primary symptom-free
C difficile carriers are at higher risk of developing CDAD than patients who are culture-negative.
We reviewed four longitudinal studies in which 810 patients admitted to hospital were followed up by prospective rectal-swab culture. At least two consecutive weekly cultures were obtained. We calculated the difference in risk of CDAD between colonised and non-colonised patients in each study and combined the results of the four studies in a random-effects model.
Of 618 non-colonised patients (mean follow-up 1·7 weeks SD 1·3), 22 (3·6%) developed CDAD, whereas only two (1·0%) of 192 primary symptom-free carriers (1·5 1·5) developed CDAD (pooled risk difference -2·3% 95% CI 0·3–4·3, p=0·021). Of patients who received antibiotics, the risk difference was increased: 22 (4·5%) of 491 noncolonised patients compared with two (1·1%) of 176 colonised patients developed CDAD (-3·2% 0·4–6·0, p=0·024). Of the primary symptom-free
C difficile carriers, 95 were colonised with toxigenic strains, 76 with nontoxigenic strains, 12 with both toxigenic and non-toxigenic strains (non-concurrently), and nine with strains of undetermined toxigenicity. Nine of the 12 toxogenic strains of
C difficile isolates that cause CDAD were also recovered from stools of symptom-free patients.
Primary symptomless
C difficile colonisation is associated with a decreased risk of CDAD. Although the mechanism is unknown, risk reduction is found in colonisation with non-toxigenic and toxigenic strains.
Writing a successful research abstract Bliss, Donna Z
Journal of wound, ostomy, and continence nursing,
05/2012, Letnik:
39, Številka:
3
Journal Article
Recenzirano
Writing and submitting a research abstract provides timely dissemination of the findings of a study and offers peer input for the subsequent development of a quality manuscript. Acceptance of ...abstracts is competitive. Understanding the expected content of an abstract, the abstract review process and tips for skillful writing will improve the chance of acceptance.
Racial/ethnic disparities in preventing health problems have been reported in nursing homes. Incontinence is common among nursing home residents and can result in inflammatory-type skin damage, ...referred to as incontinence-associated skin damage (IASD). Little is known about the prevention of IASD and whether there are racial/ethnic disparities in its prevention. This study assessed the proportion of older nursing home residents receiving IASD prevention after developing incontinence after admission (n = 10,713) and whether there were racial/ethnic disparities in IASD prevention. Predictors of preventing IASD were also examined. Four national data sets provided potential predictors at multiple levels. Disparities were analyzed using the Peters–Belson method; predictors of preventing IASD were assessed using hierarchical logistic regression. Prevention of IASD was received by 0.12 of residents and no racial/ethnic disparities were found. Predictors of preventing IASD were primarily resident-level factors including limitations in activities of daily living, poor nutrition, and more oxygenation problems.
The primary purpose of this study was to examine continence literacy of individuals with fecal incontinence (FI) by identifying terms they used to refer to FI and to explore their emotional responses ...to FI. A secondary aim was to compare differences based on gender and age in younger (<65 years) versus older persons (>65 years) with FI.
Secondary analysis of data collected prospectively in a clinical trial of fiber supplementation for FI.
Content analysis of participants' statements reported in field notes of data collectors and their responses to data forms and questions.
Only one participant used the term fecal incontinence to describe FI. Alternate terms described stool characteristics, named other gastrointestinal problems, or respondents referred to FI, using a term that seemed to depersonalize the problem. Emotional responses to FI focused on the influence of bothersome symptoms, interference with social activities, and need for control. Some participants used humor to cope with FI and reported emotional benefits gained through participation in a study. Women were impacted by the social limitations of having FI more than men. Younger people were more likely to express feelings of emotional upset than were older respondents.
There is a need to increase health literacy about FI. WOC nurses are well qualified to educate patients about FI and to evaluate if higher continence literacy increases reporting of FI. Understanding the various emotional responses to FI may guide the optimal support that WOC nurses can provide and facilitate better management of FI.
We sought to identify perioperative factors associated with long-term adjustment to an incontinent ostomy.
The Ostomy Adjustment Scale (OAS), a demographic form, and a $5 gift certificate were mailed ...to 200 ostomates. Associations between items from the Survey of Perioperative Factors of Ostomy Adjustment, demographic forms, and total OAS scores were assessed using bivariate and multiple linear regression analysis.
The survey response rate was 74%. About half (70/146, 49%) of the respondents were women, 99% (144/145) were Caucasian, and 74% (109/146) were married. Their mean age was 65+/-14 years. Fifty-six percent (79/141) of the respondents had an ileostomy, 28% (39/141) had a colostomy, and 15% (21/141) had a urostomy. The mean OAS score for all the respondents was 159.5+/-26.2, indicating a good overall adjustment to an incontinent ostomy. In bivariate analyses, the factor associated with a lower OAS score indicating poorer adjustment was distress related to affording and obtaining ostomy supplies. The more helpful the ostomates found the preoperative education provided by a wound, ostomy, and continence specialist nurse, the better was their adjustment as indicated by a higher OAS score. Having ongoing/recurrent illness and having an ostomy created by a specialty surgeon were also associated with better adjustment. When multiple factors were considered in a stepwise regression analysis, adjustment was lowered by distress about obtaining ostomy supplies. Adjustment was improved when preoperative education provided by a wound, ostomy, and continence specialist nurse was considered helpful for the ongoing/ recurrent illness.
Many ostomates have a good long-term adjustment to ostomy surgery and value education provided by a wound, ostomy, and continence nurse. Perioperative patient education and addressing patient distress over obtaining supplies are areas that can benefit from wound, ostomy, and continence nurse intervention.
The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the ...instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas.
Observational, evaluative design.
Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female.
Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed.
The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience.
The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.
Widely used by patients to control symptoms of chronic conditions such as diabetes, asthma, and arthritis, self-management can also help patients with urinary or fecal incontinence. The authors ...discuss the principles of self-management, the behaviors and skills self-managing patients need to acquire, and the nurse's role in reinforcing their use. They then describe strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence.
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