ขั้นตอนในการเก็บข้อมูลที่อังกฤษ ก็คงจะเหมือนกับที่เมืองไทย แต่ว่าคงจะพิถีพิถันและก็ค่อนข้างเข้มงวดกวดขันมากกว่า เพราะว่าที่นี่จะมีการร้องเรียน ฟ้องร้องกันเยอะถ้าขืนบุ่มบ่ามเก็บ เพราะคนที่นี่เขาไม่ใจดีแบบคนไทย ดังนั้นกว่าจะได้เข้าไปเก็บต้องผ่านขั้นตอนดังนี้คือ

1) ต้องผ่านกรรมการจริยธรรมของทางมหาวิทยาลัย หรือต้นสังกัดก่อน 2) เมื่อผ่านขั้นตอนแรก จึงสู่ขั้นการขอ ethical approval จาก คณะกรรมการจริยธรรมระดับประเทศ National Research Ethics Service (NRES) ซึ่งจะต้องกรอกเอกสารหรือ application form ผ่านเวบของเขา http://www.nres.npsa.nhs.uk/ มีประมาณห้าสิบกว่าหน้า กรอกกันตาลายค่ะ วันเดียวไม่เสร็จ ขอบอก และมีรายละเอียดมาก กรอกไปงงไป เกือบจะกรอกยานอนหลับตามกันเลย เฮ้อ ไม่รู้ว่าคิดผิดคิดถูกไงคะ ทำไมหาเรื่องให้กับตัวเองเยี่ยงนี้ เดือดร้อนต้องพึ่งซุป ก็จริงนะ ซุปที่นี่รับเงินจากค่าเทอมเราไปเยอะ ต้องพึ่งกันหน่อย กรอกเสร็จก็ submit ผ่านเวบเลย และก็ปริ้นตัวจริงออกมาให้ทางกรรมการจริยธรรมมหาวิทยาลัย และซุปเราเซ็นต์ด้วย จะต้องส่งเอกสารหลายอย่างแนบไปกับตัวจริง ได้แต่ proposal, CV ของผู้วิจัย ใบรับรองว่าผ่านกรรมการจริยธรรมของมหาลัย และพวกโปสเตอร์ หรือเครื่องมือต่างๆที่ใช้ในงานวิจัย

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A Comparison of Stress Factors in Home and Inpatient Hospice Nurses

Mary Lynn Martens, PhD, RN, CHPN

Abstract

Generally considered a philosophy of care rather than a place, hospice is a unique blend of services that addresses the needs of dying persons and those close to them. Frontline workers are critical to the success of hospice, so it follows that the level of stress and general well-being felt by these workers is centrally important. An overly stressed, demoralized, or alienated direct service staff is unlikely to personify hospice caring or deliver high-quality, compassionate care for the terminally ill and their families, which epitomizes the hospice caliber philosophy of care. The purpose of this study was to determine the perceived stress factors of inpatient and home hospice nurses and their correlation to perceived self-efficacy. The top stressors perceived by participating hospice nurses were “making a mistake when treating a patient,” “insufficient personnel to handle workload,” “fellow workers not doing their job,” “inadequate support from supervisor/manager,” “disagreement with a medical professional concerning treatment of patient,” and “personal insult from patients or families.” Statistically significant relationships exist between some of the stressors surveyed in different areas and the stressors’ total and general perceived self-efficacy score. In the statistically significant relationships with perceived self-efficacy, the direction is negative, indicating a high ranking of the stressor or the total correlates to a lower score on perceived self-efficacy. Analysis was also done on the relationship of stress to age, education level, and years of experience in healthcare. This study used the research approach of a quantitative cross-sectional descriptive study using the method of survey research. Nurses working in 14 hospice organizations in Midwest United States were surveyed to learn about perceived sources of stress and perceived self-efficacy. The importance of this study is the identification of perceived occupational stressors among hospice nurses, combined with an understanding of the relationship to perceived self-efficacy. This identification of perceived stress factors in hospice nurses can lead to a better understanding of the needs of hospice nurses as it relates to hiring, education, in-services, and retention of personnel in this unique area of healthcare.

Full Paper http://www.medscape.com/viewarticle/703301?src=mp&spon=24&uac=121280EY

Infants Born at 32-36 Weeks’ Gestation and Subsequent School Performance

William T. Basco, Jr, MD, FAAP

Summary

The study authors note that the percentage of births occurring in the 32- to 36-week gestation window is increasing, while the rate of children born before 32 weeks has remained essentially unchanged in recent decades. “Near-term” infants, born at 32-36 weeks’ gestation, do not typically qualify for high-risk follow-up because the prevailing assumption is that they generally do as well as term newborns.

The authors tested that assumption in this study by analyzing a dataset of US public-school children which was developed by the US Department of Education and is available to the public. The sample is meant to be nationally representative. The dataset collected participants’ pre-school medical history via parental report at school entry.

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According to federal law, a prescription for a controlled substance must include the following information (21 CFR 1306.05[a]):

• Date of issue
• Patient’s name and address
• Practitioner’s name, address, and DEA registration number
• Drug name
• Drug strength
• Dosage form
• Quantity prescribed
• Directions for use
• Number of refills (if any) authorized
• Manual signature of prescriber

From http://www.medscape.com/viewarticle/587412?src=mp&spon=24&uac=121280EY

A bundle is a set of interventions (usually 3 to 5), when grouped and implemented together, promote best outcomes with a greater impact than if performed individually. Care bundles aim to ensure that patients receive recommended treatments on a consistent basis.

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Discourse analysis is a qualitative method that has been adopted and developed by social constructionists. It emerged between the sociology and scientific knowledge. It established a departure from realist accounts of scientists’ actions to a study of scientists’ accounting practices. It processes that language is used variably. Accounts are constructed from a range of descriptive possibilities, and are intimately tied to the context in which they are produced and functions they perform.

The analysis proceeds by trying to identify themes in what people say. By looking at each utterance, the researcher asks whether some theme can be abstracted about what is being said.

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ไม่รู้พยาบาลจะเคยเจอปัญหาแบบนี้หรือเปล่า เวลาเจอเพื่อนร่วมงานทำอะไรไม่ถูกต้องแล้ว มันก็ลำบากใจเหลือเกินนะ เวลาเราจะรายงานผุ้บังคับบัญชาให้ทราบกัน บทความนี้อ่านแล้วโดนเลยค่ะ เลยนำมาฝากกัน

By Carolyn Buppert, NP, JD; Tracy A. Klein, RN, MS, FNP

Most nurses will never be faced with the dilemma of reporting another nurse’s actions to the board of nursing. Should the need arise, many of us wouldn’t even be certain how to proceed. What is reportable, and to whom should we report? What happens if we don’t report? And if we do report another nurse, will we ruin his or her livelihood or career?

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Laura A. Stokowski, RN, MS

Catheter-Associated Urinary Tract Infections

Catheter-associated urinary tract infection (CAUTI), a frequent although rarely serious healthcare complication, has moved into the spotlight. The reason? The Centers for Medicare Services (CMS) has announced that it will no longer reimburse healthcare institutions for care related to preventable conditions, including CAUTI, because evidence-based guidelines exist that may effectively prevent these conditions.

It is not surprising that CMS has targeted CAUTI. Urinary tract infections (UTIs) are common, accounting for about 40% of healthcare-associated (formerly called nosocomial) infections.[1] The overwhelming majority of UTIs are associated with indwelling urinary catheters, in both hospital and community settings, placed for indications such as postoperative bladder drainage, monitoring urine output closely in critically ill patients, or managing ongoing retention or incontinence disorders.[1,2]

Although CAUTI may not be directly associated with septicemia or increased mortality, CAUTI is responsible for raising hospital costs, prolonging length of stay, and complicating the recovery of critically ill patients.[3] The cumulative impact of CAUTI is significant, and the loss of reimbursement for treating CAUTI along with the costs of preventing CAUTI will surely be felt by hospitals.

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Hospital Cleaning Products, Disinfectants Raise Nurses’ Asthma Risk

By Megan Rauscher

NEW YORK (Reuters Health) Jan 30 - Nursing professionals exposed to general hospital cleaning products and instrument disinfectants at work are at increased risk of developing asthma, results of a new study indicate.

“I think it’s time that hospitals start exploring substituting products containing chemicals known to be respiratory irritants/sensitizers with products that may pose less health risk, just like what they did with substituting powdered latex gloves with powder free/vinyl gloves,” Dr. Ahmed A. Arif of the University of North Carolina at Charlotte told Reuters Health.

“It is important to recognize,” Dr. Arif added, “that ours is not the only study, although it is one of the larger studies, that has shown association between exposure to cleaning-related chemicals and asthma in nurses.”

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Commentary on the 19th Annual Clinical Meeting of the American Academy of Pain Management CME/CE Gerald Greenfield, MS, MD

This conference was organized by pain practitioners representing a variety of disciplines convened at the 19th Annual Meeting of the American Academy of Pain Management (AAPM), held September 8-11, 2008 at the Gaylord Opryland Resort & Convention Center in Nashville, Tennessee, and the theme of this year’s meeting, “Cultivating a Community of Care,” centered on disparities in pain management.

An Update on Chronic Pain Treatments CME/CE Andrew N. Wilner, MD, FAAN, FACP

“In order to treat the common problem of chronic pelvic pain in women, clinicians must focus on identifying one of the multiple causes, as many women will respond to therapy. When no cause is found, empiric treatment for unseen endometriosis may be successful.

For patients with chronic headache, the differential diagnosis is wide but severe underlying causes are rare, with most patients suffering from migraine, chronic daily headache, or cluster headache. Because of comorbidities such as bipolar and personality disorder, variability of response to medications, and other factors, algorithms are of limited usefulness and treatment must be individualized.

Fibromyalgia is a disease of multifactorial origin that is still not accepted as a “real disease” by many clinicians but can be diagnosed by specific criteria from the American College of Rheumatology (ACR). The identification and treatment of comorbidities may be even more important in fibromyalgia than in patients with migraine. In all patients with chronic pain, providers must be aware of the potential for addiction in their patients and develop safeguards for its prevention.”

Conclusions

“The treatment of chronic pelvic pain, migraine, and fibromyalgia requires a directed history, physical examination, and laboratory evaluations to rule out other diagnoses and appreciation of multiple comorbidities that may influence the expression of symptoms and guide treatment choice. Multiple treatment modalities are available, which must be individualized for each patient.”

More information please go to http://www.medscape.com/viewarticle/581929