Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Al-Mahdi - Gestalt och budskap : En litteraturstudie jämförande sudanesisk Mahdi och indisk Mahdi inom islam

Followers of three world religions, Judaism, Christianity and Islam are waiting for the Messiah. Muslims are even waiting for aspiritual leader al-Mahdi. Two different persons claimed the title of al-Mahdi, at the end of the nineteenth century. Theyappeared almost at the same time, at the totally different places of the earth, with a completely different message and underthe rule of the British colonial power. The aim of the study is to compare the both religious figures, Mirza Ghulam Ahmadfrom India and Muhammad Ahmad from Sudan regarding their different messages, to illustrate the social, political andreligious factors that lead to the entirely different profile and image of these two men and how their organizations havedeveloped after their death up till today. The result shows that the Sudanese Mahdi Muhammad Ahmad claimed hisMahdiship in the year 1881. He became a political leader in a time when Sudan was under the rule of a colonial power. Hetook advantage of the religion for personal purposes and tried to liberate his native country Sudan. The contemporaryMuslim clergy criticized him for his claim because the content of the Hadith traditions did not support his claim ofMahdiship. He maintained his sole right for the interpretation of religion and of the laws of Sharia. He made changes even inthe chief pillars of Islam by asserting that Jehad with sword was more imperative than the pilgrimage journey to Mecca. Heasserted that the Prophet Muhammad himself had entrusted him to launch the holy war against the non-believers. He hadimmense ambitions which were never fulfilled since he suddenly died four years after his claim for Mahdiship, in June 1885.This day his followers are organized as a political party in Sudan with a modest roll in the Sudanese politics. The IndianMahdi Mirza Ghulam Ahmad claimed in 1889 to be Mahdi, Mujaddid, Muhaddas, Messiah and a Prophet at a time of socialand political peace, though Islam as a religion was firmly pushed by the Hindu and Christian missionaries. He had no politicalambitions at all and was utterly loyal to the British colonial power. His mission was to crush the Cross and to demonstrateIslam’s excellence over all the religions of the world through overwhelming arguments. He proclaimed that Jesus was humanand a Prophet and not the son of God. Jesus survived from the cross and died a natural death after he had lived for manyyears. Ahmad claimed that God had commanded him to put stop to the religious wars. The contemporary Muslim clergyblamed him for being an imposter, melancholic and hypochondriac who had self invented the divine revelations. He died year1908, nineteen years after his claim and the communion he found is established today in more than hundred countries of theworld. Reasons for the breakdown of mission of the Sudanese Mahdi were that his objectives were political and he challengedthe colonial power with the sword. Another decisive factor was his sudden death merely four years after the beginning of hismission. Reasons for the success of Indian Mahdi were that his objectives were purely religious and he was wholly loyal to theforeign government. He survived nineteen years after the beginning of his mission which made it possible for him to create acommunion based on solid grounds. His followers continued on the same path and never engaged in local politics where everthey lived. For further studies it will be of great interest to study the life of Mirza Ghulam Ahmad and objectively examine thearguments he presented in support of his divine appointment. Furthermore it is enriching to study the organization andactivities of the Ahmadiyya Muslim community to explore if they are in accordance with the basic principles of Ahmad.

Med rena händer i kampen mot VRI : Sjuksköterskors följsamhet till riktlinjer om handhygien: främjande och hindrande faktorer En litteraturöversikt

Bakgrund: Uppkomsten av vårdrelaterade infektioner (VRI) är ett globalt problem. Den vanligaste smittvägen är via personalens händer. Bra handhygien är väsentligt för att minska VRI. Med bättre följsamhet till handhygien kan uppkomsten av VRI minskas, därför har forskning om följsamhet till handhygien och faktorer som inverkar, stort betydelse. Syfte: Syftet var att sammanställa och beskriva aktuell forskning om sjuksköterskors följsamhet till handhygien och vilka faktorer främjar respektive hindrar följsamheten till handhygien. Metod: En litteraturöversikt som baserades på artiklar publicerade de senaste fem åren, från länder som följer Världshälsoorganisationens (WHO) handhygieniska riktlinjer. Sexton artiklar valdes efter kvalitetsgranskning för analys och beskrivning. Artiklarna bearbetades med innehållsanalys. Resultat: Sjuksköterskors följsamhet till handhygien var låg. Följande främjande faktorer identifierades: handhygien efter patientkontakt, materialtillgång, förebilder, utbildning, verbala och visuella påminnelser, positiva individuella attityder, kvinnlig könstillhörighet, yrkesgrupp, specialitet, patientens skydd, arbetskultur och samhällets inställning till handhygien. Följande hindrande faktorer identifierades: hög arbetsbelastning, bristande utbildning, kunskapsbrist, individuella attityder, hudpåverkan, materialtillgång, arbetskultur och samhällets inställning till handhygien, manlig könstillhörighet, yrkesgrupp, specialitet. Slutsats: Enligt resultat rekommenderas: samspelet med kollegor och patienter, stöd av teamarbete ledare, förebilder, materialtillgång, utbildning, påminnelser, intervention med tillgång till information, stöd, resurser och möjligheter för regelbunden kunskapsuppföljning, motivera till handhygien före patientkontakt, involvera patienter.

En översikt av vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården : En litteraturstudie

Forskning visar på att patienter önskar kontinuitet, då de upplever att det bidrar till känslan av trygghet och närhet. Det ger sjuksköterskan möjlighet att lära känna personen och en möjlighet att bättre följa upp gjorda åtgärder. Syfte Syftet med denna studie var att beskriva vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården. Metod Studien har genomförts som en litteraturstudie. Resultat Resultatet visade att det var viktigt för kontinuiteten att de fick träffa en sjuksköterska som de kände sedan tidigare och att det var samma sjuksköterska vid alla vårdtillfällen. Det var även viktigt att sjuksköterskan de träffade var uppdaterad på deras medicinska historia. En viktig faktor som höjde kontinuiteten var om patienten hade en kronisk sjukdom, då de patienterna oftare kräver regelbunden uppföljning med fler besök hos vården. Patienterna upplevde större kontinuitet om vården utfördes av sjuksköterska istället för av andra vårdgivare Sjuksköterskorna var mer anpassningsbara, flexibla och tog sig mer tid med patienten. Slutsats Studien visar att kontinuitet är något som patienter upplever som viktigt när de möter vården men det saknas forskning om hur vården ska organiseras, för att kontinuiteten ska upplevas bättre ur ett patientperspektiv, balanserat mot organisationens behov av att spara tid och pengar.