This study explored the experiences of Hmong American students that contributed to their academic success regarding staying in college, feeling of a sense of belonging on campus, and positive ...interaction with faculty and student affairs professionals. The researcher conducted one-on-one interviews with eight Hmong American students who attended a 4-year, public institution in the western United States. Participants experienced challenges with their academics and in navigating the institutional space as first-generation college students. However, they received support from the institution through advising by professors, student affairs professionals, and student organizations. They had expectations for Hmong students to be proactive on campus and to receive support from Hmong educational figures. Insights into these experiences could provide faculty, student affairs professionals, and administrators a better understanding of how to create an environment of support for Hmong American students at 4-year public institutions. It could also support the development of programs and cultivation of a campus culture that supports Hmong American students’ academic success and sense of belonging in higher education.
As an inpatient medical oncology unit, we recognize the increased risk of hospital acquired infections (HAIs) when caring for a large population of immunocompromised patients. This became an ...especially pressing concern to our 25 bed mixed hematology/oncology unit, when between August-September 2019, we had a cluster of three Central Line Associated Blood Stream Infections (CLABSIs) and two Catheter Associated Urinary Tract Infections (CAUTIs) in two months. In reviewing these cases in detail, we looked closely at identifying trends between patient infections, recognizing there were interventions we could offer as a nursing staff to decrease the risk of HAIs for our patients. A literature review provided overwhelmingly convincing data to support the use of daily CHG bathing on our patient population, which has been a CDC recommendation for the reduction of CLABSIs since 2011 but is likely underutilized across hospital systems nationwide. Acknowledging that daily bathing has previously been a challenge to complete consistently on 25 patients, we focused our efforts on identifying our most at-risk patients for our initiation of a CHG protocol. In again reviewing the commonalities between the five patient cases, we identified that the most consistent shared risk factor was patient age. In January of 2020, our unit implemented a 3 month pilot of a CHG bathing protocol on all patients with a central line or Foley catheter, who were age 60 or above. In this pilot, which included a total of 528 patients, there was an 80% compliance rate on bathing and zero occurrences of HAL The protocol was adopted as a unit standard and since implementation in January 2020, we have had a total of two CLABSIs and zero CAUTIs over 21 months. Our Fiscal Year 2021 GLĀBSI Standardized Infection Ratio (SIR), which is the comparison of the actual number of infections to the predicted number of infections, decreased to .218 from a FY2020 GLĀBSI SIR of .632. Our GAUTI SIR decreased to 0.00 from 2.324 in the same time frame. The key factors to our success included frequent and comprehensive education for patients and staff on the risk of HAI, focusing our efforts on the most at-risk population, reviewing staff feedback often to identify barriers and modify our strategies, and continued review of audits to maintain compliance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
For patients on dialysis with poor quality of life and prognosis, dialysis withdrawal and subsequent transition to palliative care is recommended. This study aims to understand multi-stakeholder ...perspectives regarding dialysis withdrawal and identify their information needs and support for decision-making regarding withdrawing from dialysis and end-of-life care.
Participants were recruited through purposive sampling from eight dialysis centers and two public hospitals in Singapore. Semi-structured in-depth interviews were conducted with 10 patients on dialysis, 8 family caregivers, and 16 renal healthcare providers. They were held in-person at dialysis clinics with patients and caregivers, and virtually via video-conferencing with healthcare providers. Interviews were audio-recorded, transcribed, and thematically analyzed. The Ottawa Decision Support Framework's decisional-needs manual was used as a guide for data collection and analysis, with two independent team members coding the data.
Four themes reflecting perceptions and support for decision-making were identified: a) poor knowledge and fatalistic perceptions; b) inadequate resources and support for decision-making; c) complexity of decision-making, unclear timing, and unpreparedness; and d) internal emotions of decisional conflict and regret. Participants displayed limited awareness of dialysis withdrawal and palliative care, often perceiving dialysis withdrawal as medical abandonment. Patient preferences regarding decision-making ranged from autonomous control to physician or family-delegated choices. Cultural factors contributed to hesitancy and reluctance to discuss end-of-life matters, resulting in a lack of conversations between patients and providers, as well as between patients and their caregivers.
Decision-making for dialysis withdrawal is complicated, exacerbated by a lack of awareness and conversations on end-of-life care among patients, caregivers, and providers. These findings emphasize the need for a culturally-sensitive tool that informs and prepares patients and their caregivers to navigate decisions about dialysis withdrawal and the transition to palliative care. Such a tool could bridge information gaps and stimulate meaningful conversations, fostering informed and culturally aligned decisions during this critical juncture of care.
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