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NZNO Library Current Awareness Newsletter

Issue 103 - 29 July 2009

Whakanuia Te Wiki o te Reo Māori 2009
Celebrate Māori Language Week 2009


JOURNAL: Journal of Infection Prevention, July 2009  
1. Vaccination uptake by healthcare workers
by S. Millership and A. Cummins. Journal of Infection Prevention 2009, Vol 10, No 4: 118-120 
Much time and effort is devoted to persuading the public to take up the offer of vaccination, as exemplified by the website at Efforts are aimed at provision of influenza and pneumococcal vaccines in those over 65 and in certain risk groups Department of Health (DH),2009), and the parents of children in regard to the national childhood programme, particularly the combined measles, mumps and rubella (MMR) vaccine following scares related to the suggestion that it is a cause of autism. Many of the reasons for refusal of vaccination (one of the safest and most cost-effective of healthcare interventions) are related to misconceptions and misinformation.

2. A review of the risks and disease transmission associated with aerosol generating medical procedures
by Anna Davies et al. Journal of Infection Prevention 2009, Vol 10, No 4: 122-126
Several medical procedures, including bronchoscopy, intubation, and non-invasive ventilation, frequently used in the treatment or diagnosis of respiratory diseases, have been identified as potentially `aerosol generating'. It is thought that the nature of the `aerosol generating' procedure (`AGP') results in an infectious aerosol beyond that which would normally be released by a patient coughing, breathing, or talking, presenting an increased risk to any healthcare worker in proximity to the patient. Smoke models on dummies have provided a visual image of possible aerosol behaviour and indicate a possible zone of transmission. However, they are not necessarily representative of the behaviour of a respiratory aerosol and any infectious particles contained therein. No quantitative study has yet been carried out on AGPs. Bronchoscopy and sputum induction have been associated with nosocomial transmission of tuberculosis, and guidelines have been produced describing the appropriate ventilation, isolation and respiratory protection that should be applied when carrying out such procedures. The uncertainty surrounding AGPs makes it difficult to construct effective infection control policy. The protection of healthcare workers is paramount. However, during a pandemic, resources may be stretched. Therefore it is important to clarify whether these procedures do generate aerosols.

3. Re-using intermittent pneumatic compression garments designed for single-patient-use is a potential source of cross-infection
by Carol Tweed and Neil Wigglesworth. Journal of Infection Prevention 2009, Vol 10, No 4: 128-133
Hospital acquired illnesses such as healthcare associated infection (HCAI) and venous thromboembolism (VTE) are often preventable; however, they occur frequently, are hugely expensive and cause increased patient morbidity and mortality. Intermittent pneumatic compression (IPC) has been proven to reduce the risk of patients developing a deep vein thrombosis (DVT). DVT prophylaxis IPC garments are designed to be single patient use, however anecdotally some hospitals re-use these products on multiple patients. This study examines the bacterial bio-burden present on IPC garments from three different manufacturers after an episode of single patient use and compares these results to a sample of unused (clean) garments. Sixty-one percent of used garments recorded >100 colony forming units (CFU) present on at least one sample plate, while the samples taken from unused garments reported either no growth (67%) or had very few organisms (less than five CFU) present (33%). IPC garment wear time and/or presence of graduated compression stockings worn beneath the garment had no impact on reducing the garment bio-burden. After an episode of single patient use, IPC garments carry a significant bio-burden and could be a source of pathogens. DVT prophylaxis IPC garments should be utilised as single patient use.

4.  Appraising the need for tighter control over the practices of the tattooing and body piercing industry
by Claire Chalmers. Journal of Infection Prevention 2009, Vol 10, No 4: 134-137
Tattooing and body piercing have had a resurgence in popularity over the past few decades, taking the activities of the industry from a place on the fringes of society into a position of mainstream status. This shift has led to debate on the level of legislation and control over the industry's practices, where concerns around risk to public health from such practices have prompted calls for tighter control over the industry (Anderson, 2006; Noah, 2006). This debate, however, is arguably more complex than simply reflecting upon the association between tattooing and body piercing activities and the risk of infection. This is the second in a three-part series of articles on the topical issue of tattooing and body piercing. It highlights and discusses additional key factors that have been influential, either explicitly or implicitly, within the debate to determine the need for tighter controls over the tattooing and body piercing industry.

5. Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting
by c. Roberts et al. Journal of Infection Prevention 2009, Vol 10, No 4: 138-142
The study assessed the impact on nursing home (NH) resident infection rates of providing staff with a personal alcohol-based hand product (ABHP) with and without training on its use. Fifteen North Wales NHs were recruited and randomly allocated into one of three groups. All monitored infection rates throughout the study period of 18 weeks (Phase I [weeks 1—9], Phase II [weeks 11—19]). NHs used liquid soap and water for hand washing throughout the study. Groups B and C introduced interventions during week ten: Group B were provided with personal ABHPs without training on use; Group C personal ABHPs with standard
training from the sponsoring hand hygiene company. Infection rates between groups and pre- and post-intervention were compared. Infection rates (per 1,000 bed days) for Phase I vs. Phase II of the study were: Group A: 6.99 vs. 7.16; Group B: 6.08 vs. 3.46; and Group C: 5.04 vs. 6.78 respectively. Change in infection rates in Groups B and C pre- and post-intervention did not reach statistical significance, p = 0.097 and p = 0.072 respectively. Comparison of rates in non-intervention Group A with the intervention groups indicated a significantly lower rate after the intervention in Group B (p = 0.035) but not Group C (p = 0.765). Findings are limited due to sample size; introduction of personal ABHPs with training did not reduce infection rates. This conflicts with other studies examining education and improvement of hand hygiene compliance. However, infection rates fell in NHs not receiving training, possibly mediated through a sense of `ownership' of the intervention.

6. Should the UK government's deep cleaning of hospitals programme have been evaluated?
by Celia A Brown and Richard J Lilford. Journal of Infection Prevention 2009, Vol 10, No 4: 143-147
In September 2007, the UK government announced a £57.5m programme of `deep cleaning' for every NHS hospital in England. The programme was met with some scepticism and this paper provides an outline economic evaluation of the programme.
Methods: We use information on costs of the programme, the opportunity cost of closing wards for cleaning and cost savings and health gains resulting from cleaning to model the reduction in the annual hospital acquired infection (HAI) rate required for the programme to be cost-effective. We compare our results with the potential headroom available, based on the available evidence and the beliefs of 15 experts.
Findings: If wards are closed for two days for cleaning, an annual HAI reduction of 7.8% (21,000 fewer non-fatal infections and 355 fewer deaths nationwide) would be required at a cost-effectiveness threshold of £30,000 per Quality Adjusted Life Year. This figure does not compare favourably with the effectiveness estimates of <1% obtained from the available evidence on cleaning and the pooled prior beliefs of 15 experts.
Interpretation: Our analysis shows that as it is very unlikely the deep cleaning programme would have been cost-effective, a full evaluation would not have been a good use of public funds.

7. Diary of Events. Journal of Infection Prevention 2009, Vol 10, No 4:148

JOURNAL: Nursing Ethics, March 2009
by Gallagher, Ann. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p143-144
The article discusses various reports published within the issue, including one by Ebin Arries on interactional justice in student nurse-staff nurse settings, another on the causes of distress among nurses and another by Franco Carnevale on the moral significance of suffering.

9. Dignity as a virtue: appreciating ambiguity
by Gallagher, Ann. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p145-146
The author comments on the ethical concept of dignity in nursing and medical care. She emphasizes the of need of nurses to understand the circumstances that promote or enhance dignity in their profession. The author stresses that professional dignity is a sense of virtue and disposition in accordance to the person's sense of worth as a professional. She adds that dignity must be accompanied with wisdom, courage and patience.

10. Interactional justice in student-staff nurse encounters.
by Arries, Ebin J. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p147-160
The focus of this article is on nursing students' perceptions of interactional justice during student-staff nurse encounters. A descriptive survey using a combined questionnaire on interactional justice was used to collect the data. Reliability analysis for the theoretical dimensions of interactional justice revealed a Cronbach's alpha value greater than 0.70. The student nurses perceived staff nurses to be interactionally unjust during their contact with them. Significant differences were observed between interactional justice and some demographic characteristics of students. Fourth year students perceived staff to provide better justifications for decisions that affect them than third and second year students. Although black students, in contrast to white students, perceived clinical staff as significantly more truthful, these results are inconclusive. Students who engage for longer periods of time in the clinical learning context perceived their relationships and how they are treated by clinical staff as more just. Recommendations for further research are made. [ABSTRACT FROM AUTHOR]

11. Ethical challenges in pain management post-surgery
by Rejeh, Nahid et al. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p161-172
This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with believing patients' complaints regarding pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice. [ABSTRACT FROM AUTHOR]

12. Conceptual and moral analysis of suffering.
by Carnevale, Franco A. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p173-183
This analysis presents an epistemological and moral examination of suffering. It addresses the specific questions: (1) What is suffering? (2) Can one's suffering be assessed by another? and (3) What is the moral significance of suffering? The epistemological analysis is orientated by Peter Hacker's framework for the investigation of emotions, demonstrating that suffering is an emotion. This leads to a discussion of whether suffering is a phenomenon that can be evaluated objectively by another person who is not experiencing the suffering, questioning the validity of some decisional models for limiting life-sustaining therapies with the aim of preventing suffering. This analysis highlights that understandings of suffering are value laden. It is conventionally implied that suffering is 'bad' and that it should be eliminated. Suffering is commonly regarded as a moral wrong that needs to be made right by health care. This article concludes with a recommendation for a paradigm shift in how suffering can be better understood, through the practice of empathic attunement. [ABSTRACT FROM AUTHOR]

13. Nurses moral problems in dialysis
by Hermsen, Maaike & Van der Donk, Marjolein. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p184-191
This article gives an overview of the moral problems experienced and described by nurses working in a dialysis unit in the Netherlands. The nurses raised a wide variety of issues that they considered were moral problems, which were grouped into seven topics. A selection of cases are described, one of which is analysed using the Nijmegen method of ethical case deliberation. This method facilitates practical approaches to the different types of moral
problems encountered. The argument is made that, owing to their specific moral position and responsibility, nurses' contribution to ethical reflection in ward discussions should be valued more. All caregivers involved are indispensable in developing a basis for well-reasoned decisions when deliberating about moral problems. [ABSTRACT FROM AUTHOR]

14. Placing physical restraints on older people with dementia
by Yamamoto, Miwa & Aso, Yoko. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p192-202
This study aimed to clarify the coping strategies of nurses working in general wards who face the ethical dilemma of restraining older people with dementia. The participants were 272 nurses working in general wards in the Kansai region of Japan. Coping strategies were measured using a questionnaire consisting of 16 items. A low score of 1-4 points suggested good coping strategies. Factors were difficult to interpret for three of the 16 coping items identified; these items were therefore deleted. Eleven of the remaining 13 items were used for analysis. An explanatory factor analysis revealed three factors concerning coping with ethical dilemma: (1) self-initiated positive cognition and action; (2) negative cognition and action; and (3) choosing not to act, or maintaining the status quo. These findings highlight the need for programs that could disseminate effective coping strategies among nurses faced with the ethical dilemma of restraining older people with dementia. [ABSTRACT FROM AUTHOR]

15. Autonomous decision making and moral capacities
by Moser, Albine et al. Nursing Ethics, Mar 2009, Vol 16 Issue 2: p203-218
This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family caregiver context. Later descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities. [ABSTRACT FROM AUTHOR]
Conferences, training and seminars

16. The Employment Agreements: bargaining Trends & Employment Law Update seminar series
For 17 years, the New Zealand HR and HR practitioners and policy makers (including employers, union officials, human resource managers, and OSH and legal professionals) have relied on this seminar series to keep abreast of bargaining and case law developments. All seminar participants receive a copy of the Employment Agreements: Bargaining Trends and Employment Law Update 2008/2009, New Zealand's most authorative source of information on collective bargaining outcomes.
- Auckland 28 October, 2009
- Hamilton 29 October, 2099
- Christchurch 5 November, 2009
- Dunedin 6 November, 2009
- Napier 11 November, 2009
- Wellington 17 November, 2009
Seminar enquiries:

17. National Carers Conference 2009 - Tomorrow's Care Today!
Date: 24 & 25 September 2009
Venue: Waipuna Events Centre, Auckland

Journals – Table of Contents

18. From Registered Nurse Journal, Volume 21, No 3, May/June 2009
The Journal of the Registered Nurses' Association of Ontario (RNAO)

18A. Inspiration through action
18B. Year ahead promises excitement, difficulty
18C. Government must remove regulatory handcuffs that limit NP practice
18D. BPSOs transform care, nursing [Meet the latest 12 Ontario health-care  organizations to complete partnerships with RNAO and become 'spotlight']
Amended legislation meant to keep nurses safe from violence; York University and UHN to create nursing academy; hallway nursing is not a solution; Program reaches out to mentally ill in legal trouble
18F. CNA report offers policy measures to eliminate nursing shortage; Protesters demand an end to hospital cuts
18G. Long-time NP reflects on her role [Retired Nurse Practitioner Jerry Gerow]
18H. Filling the gap [nurse practitioners across Ontario are helping improve access to care despite restrictions on their practice that hold them back from their full potential
18I. RNAO throws its weight behind calorie count bill; "More than 900" must translate into 3,000 additional nurses; Proposed law to reduce toxins needs teeth

19. From Canadian Nurse, June 2009, Volume 105, Number 6
President’s Message - Connecting to the energy within
19B. CEO Outlook - Let's start a conversation
Program helps in early identification and treatment of neonatal hyperbilirubinemia
Report maps out plan for taking control of the RN shortage; Jewish Eldercare Centre recognized for promoting excellence
19E. Symposium advances collaborative efforts in fighting malaria
19F. A confident INNA takes on new challenges; Sparking public discussion and debate about patient safety
19G. Supporting your practice: CNA’s new tools and resources; CMNG speaks out for men in nursing
NURSING IN NUNAVUT, PART II -  Great expectations in prenatal care
19I. Nurses to Know: Nancy McGrath and Robyne Ruff
19J. In conversation with the territory’s first chief nursing officer
WAITING TO BE WEIGHED: A PILOT STUDY OF THE EFFECT OF DELAYED NEWBORN WEIGHING ON BREASTFEEDING OUTCOMES [Comparing breastfeeding self-efficacy, intended duration of breastfeeding and formula supplementation rates in two groups of mothers and newborns using different weighing protocols]
19L. SOCIETAL ABUSE IN THE LIVES OF INDIVIDUALS WITH MENTAL ILLNESS [Nurses are in a unique position to address social inequity and societal abuse by advocating for people with mental illness]
19M. Getting on with the job of supporting research

20. From Emergency Nurse New Zealand, Winter 2009
20A. Includes comments on the letter that the CENNZ committee wrote to the new Minister of Health introducing the CENNZ organisation and its activities
20B. Concussion Assessment and Management
20C. Ministry of Health Emergency Department Advisory Group
20D. A letter to the nurses and doctors of our Emergency Departments
20E. Minor Injuries Clinic in the Emergency Department: a year in review
20F. CENNZ/NZ Flight Nurses Association Conference 2009 [Christchurch 27-29 August]
20G. Reflections of an Advanced Practitioner Scope of Practice
20H. When planets collide: mental health patients in the Emergency Department
20I. The Goodfellow Club on building learning communities for nurses
20J. Regional reports [Northern region; Auckland region]
20K. Regional reports [Auckland region; Midlands/Bay of Plenty region]
20L. Regional reports [Hawkes Bay Tai Rawhiti region; Central region; Wellington region]
20M. Regional reports [Top of the South region; Canterbury/Westland region]

News – National

21. MP sees red at lack of testing labs
Central Leader - 29 July 2009
Concerns over access to medical testing services for Mt Eden and Epsom residents have been raised by a local MP. Green Party list member Keith Locke says sick and elderly locals will have to travel further when collection centres on Mt Eden Rd and at Mercy Hospital in Epsom close next month. Larger "supercentres with more bleeding rooms will take over from current sites on Dominion Rd in Mt Eden and Remuera when Labtests succeeds current testing
provider Diagnostic Medlab on August 24.

22. Team work way forward for health
Hutt News - 28 July, 2009
The need for health carers to work as a multi-disciplinary team is not some trendy idea or medical mumbo jumbo to be forgotten when the next idea comes along Hutt Valley District Health Board chief executive Chai Chuah says it's the critical path forward in the face of workforce shortages, rising care expectations and pressure on funding.

23. Caregiver on trial over toddler's death
Otago Daily Times - 28 July 2009
A woman went on trial yesterday charged with the murder of a toddler in Bay of Plenty more than three years ago. Melissa Sale died in Auckland's Starship Children's Hospital on January 8, 2006, four days after she suffered a traumatic brain injury.

24. Kids taking up health challenge
The Marlborough Express - 28 July 2009
Picton five-year olds Zyraia Moon Flood-Adams and Billy Welborne like their vegetables raw rather than cooked. Billy's favourite vegetable is carrots and Zyraia's is celery sticks. Billy tucked into his soup but, always loyal to mum, said it wasn't as good as hers. They both enjoyed the soup at Picton School last Thursday thanks to the Nelson Marlborough District Health Board's Winter Challenge.

News - International

25. Obama: No reduced Medicare benefits in health care reform
CNN - 28 July 2009
WASHINGTON (CNN) -- President Obama tried Tuesday to alleviate senior citizens' concerns about health care reform, saying his plan will maintain Medicare benefits and allow people to keep the coverage and doctors they now have.

26. One week to a slimmer you: Focus on the little things
CNN - 28 July 2009
( -- When it comes to losing weight, the little things add up -- trying just one new thing every day can quickly make a big difference. With that in mind, we've taken science's best weight-loss strategies and created a week's worth of slimming to-do's.




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