Stimulating Appetite And Nursing management By Nurse Ibrahim Isah Musa

Definition
Any Substance (i.e. drugs, food or hormones) or strategies (e.g. oral care) that can be used to stimulate appetite in order to increase eating desire in anyone.

Appetite is the desire to eat food, sometimes due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the type of food, digestive tract and the brain. Appetite has a relationship with every individual’s behavior.

A loss of appetite occurs when you have a low desire to eat. Different factors can cause poor appetite, including mental and physical illness. If your lack of appetite last more than a couple of days, it can cause weight loss or malnutrition. Not having appetite can befrustrating for any one especially people who are underweight and trying to gain weight or build mass.

Causes
There are various causes that may lead to decrease appetite and subsequently lead to unwanted weight loss
i. Medical conditions (e.g. common malaria, gastritis and stomatitis and so on)
ii. Psychological and psychiatric disorders (e.g. anxiety and depression)
iii. Eating disorders (e.g. anorexia nervosa and bulimia nervosa)
iv. Alcoholism
v. Prematurity
vi. Congenital malformation (e.g. clef plate)
vii. Old age
viii. Pharmacological agent (e.g. digoxin hydralazine)
ix. Visual influence.

Sign and symptoms
Patient with decrease in appetite usually present the following signs and symptoms:
Nausea and vomiting
Regurgitation and rumination
Lump in the throat
Psychological disturbance
Fatigue
Anxious
Anemia
Dehydration
Electrolyte imbalance (e.g. hypocalcaemia and hypocalcaemia)

Nursing management
Assess patient general conditions and re assure patient before and during meal
Give patient oral toilet before and after meal
Provide privacy and allow patient to eat in confortable place needed
Give light exercise for 10-15 minute before eating this help to improve appetite
Administer prescribe appetite stimulant that help in stimulating patient appetite
Avoid any food or beverages that has no over powering smell
Provide patient with different choice of menu
Make food a pleasant experience allow patient to eat in attractive setting, playing his favorite music
Provide patients with snacks between meal and bed time choose food high in calorie and protein
Prove patient with small and frequent food
Continue to re assure patient allay his fear and anxiety.

Education on patient on discharge
i. Advice patient to eat nutrient rich foods
iii. Advice patient to add more calories to his meal
iv. Advice patientmake meal time an enjoyable and social activity
v. patient should learn on how to schedule meal time
vi. Advice patient not to skip breakfast
vii. Eat less fiber
viii. Eat more of your favorite food

Nursing diagnoses in patient with a decrease appetite
Anxiety related to decrease appetite
Risk for unstable blood glucose level
Risk for metabolic imbalance syndrome
Risk for imbalance fluid volume
Nursing intervention
Anxiety related to decrease appetite
Re-assure patient
Stay with patient to allay fear and anxiety during eating
Make meal time a joy able one
Risk for unstable blood glucose level
Provide oral care
Encourage patient to eat high calorie diet
Encourage patient on frequent food intake
Measure patient blood glucose level
Risk for imbalance fluid volume
Give fluid between diet and after dietary intake
Administer calorie rich fluid
Monitor input and output balance
Patient out come
Patient is free from anxiety
Patient fluid volume is restored
Patient nutritional status is stable

By Nurse Ibrahim Isah Musa RN, HND NS, BNSc

What Makes a Good Nurse Manager?

What Makes a Good Nurse Manager

Who is a Nurse manager?

A Nurse manager directs and coordinates a team of Nurses in a medical facility. These managers typically focus on Nurse recruitment and retention, as well as supervise a team of nurses on a daily basis.

The supervisory role means that Nurse managers are responsible for everything concerning the nursing unit, including resources, personnel, patient care problems and budgetary issues.

At times, a Nurse manager collaborates with doctors regarding patient care and treatment, while also bridging the communication gap between a patient’s family and his or her doctor.

Additionally, a Nurse manager represents the team of nurses and communicates the team’s ideas, concerns and needs to hospital management.

Roles/responsibilities of a nurse manager

Nurse managers are expected to recruit, mentor and appraise performance; develop new nurse orientation; maintain a healthy work environment; and monitor and improve patient care.

A nurse manager also functions as the representative of Nurses and often is expected to talk to the top management on behalf of the nurses they lead.

Moreover, Nurse managers are expected to establish and ensure proper inventory of medical supplies and equipment, ensure a healthy and safe working environment, stay constantly updated on patients’ health status and incorporate fresh and proven health care practices for improving patient care.

Top skills needed for effective nurse managers

A Nurse manager is someone who often has a multifaceted knowledge of his or her field. This expertise is why Nurse managers are often in charge of planning, interacting with patients and families, and managing nurses, as well as a host of other responsibilities over the course of their day.

These managers also are adept at working against a strict deadline. Thanks to this
all – encompassing skill set, Nurse managers are not just restricted to the medical industry but also can serve other sectors.

If you’re keen on being a competent Nurse manager, ensure you have the following set of skills:

Communication

Nurse managers know how to effectively communicate with their staff and patients in addition to the doctors and administrators with whom they work closely.

They are expected to be liaisons between the management and nursing teams while ensuring their patients feel comfortable.

Team Player

Nurse managers are accustomed to the dynamics of a team and know how to successfully support them — even in times of conflict. In order to ensure their team is operating effectively, managers also must work to create a sense of trust and togetherness amongst their nurses and staff.

By creating a maintainable bond of trust and coordination, nurses and staff will be far more likely to work without conflict.

Positive Attitude

The medical industry is no stranger to tense and stressful job situations. At such times, a Nurse manager offers support and strength to team members, if needed.

Leadership

Nurse managers know how to lead a team of professionals with confidence and decisiveness, especially in times of high stress and tight deadlines.

Mentoring

A Nurse manager is willing to mentor Nurses whenever possible. Because mentoring plays an essential role in a nursing team’s growth, it is important for managers to guide their team to strive for leadership roles.

If another Nurse takes an interest in a Nurse management role, current managers have the extraordinary opportunity to take those Nurses under their wings to teach them how to successfully move up and manage a group of health care professionals.

Because a Nurse manager is not much different from a business leader, it is important for current or aspiring Nurse managers to acquire these necessary skills in addition to their medical training in order to thrive in their career.

Enjoy a beautiful night rest colleagues.

By Lateef Yusuf Mary

Procedure of Bed Making: Hospital Bed Making Steps

Procedure of Bed Making: Hospital Bed Making Steps

The bed is the most important and essential piece of furniture in the ward. It is the most noticeable to one entering the ward and is the one which, perhaps, concerns the patient most, and upon which his comfort largely depends, as he spends most of his time in it. It also perhaps concerns the nurse most, as the greatest part of her work is around, and with the bed. Its appearance can make or mar the whole appearance of the ward. The manner in which it is made can make or mar the patient’s comfort, and therefore hasten or delay his recovery.

The standard hospital bed is a single bed, six feet and six inches long, three feet wide, and twenty-six inches from the floor, made of steel or enameled iron tubing which does not harbor bedbugs. It is simple, free from decoration, knobs or angles, light, easily moved, convenient to handle, easily cleansed and disinfected, an possesses strength and durability. The height and size while not always comfortable to the patient are convenient to the nurse and doctor in the care of the patient. The castors are made of hard rubber or hard rubber tire, and are an important factor in moving the bed without jarring the patient. The springs are usually the national or woven wire which are the most durable and sanitary.

unoccupied bed making procedure

Why are Nurses Important: What Would A Hospital Be Without Its Nurses?

Why are Nurses Important?

What would a hospital be without its nurses? Not only are they responsible for a patient’s medical wellbeing, they are also round-the-clock caregivers that attend to the mental and emotional health of their patients, and those patients’ family members as well. You can ask almost anyone, and they will tell you about especially attentive nurses who went above and beyond to make their hospital stay a million times better. Now, a new study shows something most patients already know: nurses are essential to the success of a hospital. Without them, patients suffer.

Researchers from the University of Pennsylvania, knowing that nurses could make or break a hospital, sought to study what kind of effects a bigger, happier nursing staff had on the proceedings of a hospital. In order to do this, they looked to the Kaiser Permanente health care system, a health network present in eight states that integrates hospitals, insurance, and doctors’ offices into one system. Kaiser is known to be an exemplary health care organization that many other hospitals have tried to replicate, but with little success. Researchers believe this is most likely due to one key difference: its nurses.

When conducting their study, researchers from UPenn looked at 550 hospitals in California, New Jersey, Pennsylvania, and Florida, including 25 Kaiser Permanente hospitals in California and 56 Magnet hospitals. Magnet hospitals are also known as exemplary health care systems, recognized by the American Nurses Credentialing Center as a great place for nurses to work.

Researchers then administered a survey to nurses, asking them about their work environment, level of education, job satisfaction, and the typical number of patients they see each day. In addition to this, they checked mortality data from each hospital.

“It turns out that, by and large, nursing differences accounted for much of the mortality difference that we saw in Kaiser Permanente hospitals,” Matthew McHugh, a registered nurse and professor at UPenn’s School of Nursing told Yahoo.

Interestingly enough, mortality rates decreased by as much as 20 percent in Kaiser and Magnet hospitals compared to their opponents, and the nursing staff made for “a sizeable portion of the advantage,” the study said.

“It turns out that these differences we see in nursing, in terms of work environment, staffing levels, investment in nursing around a highly educated workforce, those things translate to better outcomes,” McHugh said.

McHugh and his team found that there were a few differences that accounted for this result. The first was that nurses who claimed they enjoyed their work environments were also better at taking care of patients. “We find that places where nurses have a good experience working are places where nurses are better able to do their jobs,” McHugh said. “They’re more autonomous, they’re supported by management, and they’re integrated into hospital decision making.”

Empowering nurses is also essential to creating a better working environment; nurses need to be taken seriously, and feel comfortable telling a physician when something is being handled incorrectly. If nurses are also given the opportunity to make more decisions, patients can receive faster and higher quality care. A study published last year in the Journal of Nursing Administration found that when nurses have more authority within their units, those units report having more effective patient care.

Another way to empower nurses is to show a willingness to make tangible changes that will make their jobs easier. For instance, during the nursing shortage of the early 2000s, Kaiser Permanente worked to make its hospitals cater to the needs of its nursing staff. After investing in research efforts regarding nursing, Kaiser found in studies conducted in both 2005 and 2006 that nurses spent 35 percent of their time documenting patient records. In order to reduce this, Kaiser switched to an electronics-based system for medical records in 2005. It also found that nurses spent a fair amount of time searching for equipment and information, like whether or not a patient’s medication was ready. So it responded by giving nurses electronic notifications for when medications are ready for pick-up.

“We wanted to make sure that we were a place that nurses wanted to work,” said registered nurse Marilyn Chow, vice president of Patient Care Services and Innovation for Kaiser Permanente. “If you have nurses who are happy and joyful at work, they will definitely pass that on and be caring and compassionate.”

Researchers also found that Kaiser and Magnet hospitals were hiring more nurses with Bachelor’s degrees. According to Chow, the nursing field is more complex and demanding than it ever has been before. “The role is not only surveillance, but facilitating and coordinating the care, and not just for one patient, but for four to five patients,” Chow said. “There are so many things to take care of.”

Chow and McHugh also noted that many patients are arriving at hospitals in worse conditions, but leaving hospitals more quickly. Because the length of their stay is shortened, there is more pressure on nurses to spend enough time with patients and their families in order to teach them how to care for themselves when they arrive home.

“Hospitals are very complex, and integrating all of that information requires a certain set of skills and requires you have a pool of knowledge within the overall nursing staff,” McHugh said. When nurses were less educated, the study noted, there were more mistakes being made.

Finally, the study found that the more nurses there are, the better. Kaiser Permanente hospitals are known to have four patients for every one nurse, while non-Magnet hospitals have about a five to one ratio. Quite simply, when there are more nurses, there are more people to care for patients, and those patients receive more personalized, specified attention.

“Nurses are at the bedside and are working with all the other providers,” McHugh explained. “They’re the essential person for monitoring patient condition, and if something bad does happen, intervening and mobilizing the intervention response.”

So, when it comes down to it, a happy hospital means happy nurses. Nurses have always been the lifeblood of hospitals; now, there’s just a study to prove it.

Source: McHugh M, Aiken L, Burns L, et al. Achieving Kaiser Permanente quality. Healthcare Manage Rev. 2015.

Read E, Laschinger H, Finegan J, et al. The influence of nursing unit empowerment and social capital on unit effectiveness and nurse perceptions of patient care quality. Journal of Nursing Administration. 2015.

Body Mass Index Definition, Formula, Equation and Range

Body Mass Index Definition, Formula, Equation and Range

Body Mass Index (BMI) is a way to measure whether or not a person is underweight, overweight or normal weight. It is a calculation that evaluates body mass compared to height. It is widely used to determine if people fall within a weight range that is healthy.

We are living in a time when people are more obsessed than ever in being thin.

Body Mass Index
BMI = Weight (kg) divide by Height (m) divide again by Height.
BMI = 60kg/1.5m
=40 divide again by 1.5m
=26.7
BMI RANGE

18.5 – 24.9 = Normal weight
25.0 – 29.9 =Overweight
30.0 – 34.9 =Obese
35.0 – 39.9 =Grossly Obese
40.0 – Above =Morbid Obese

Summary of the results as per the World Health Organization

body mass index chart

Nurse vs Doctor Pros and Cons: The Only Thing That Truly Separates Doctors From Nurses

Nurse vs Doctor Pros and Cons

Academic Medicine, journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor? What is a nurse?” Thirty years ago this would have been an absurd question. Not only would it have been absurd for doctors and nurses, but for patients too. Roles were clearly delineated within the disciplines, and the white coat indicated a doctor and the white uniform and cap identified the nurse.

There are several reasons why we have to ask the question posed by Academic Medicine. A big reason is the entry of women into the field of medicine. Another is the development of advanced degrees for nurses. The computerization of medical records has spurred increases the need for physician extenders to support practices. A huge reason recently has been cost-containment considerations. The erosion of the doctor as an ultimate authority figure and the rise of patient autonomy have leveled the field as well. To some extent access to education is in the mix also.

Educational level is usually part of the definition of a doctor or nurse. This is no longer a reliable indicator. A doctor has an undergraduate degree and an MD. But a doctor might be a DO also, a doctor of osteopathic medicine. A nurse has an undergraduate degree in nursing. Except that a nurse might have an undergraduate degree in something other than nursing, and get the nursing training later in a master’s degree program. Up until relatively recently you didn’t have to have a BSN to be a nurse, an associates degree was enough. Now a nurse might have a master’s degree or a PhD. A nurse practitioner has a master’s degree. A physicians assistant might also.

Authority used to be used to separate doctors from nurses. Doctors can prescribe medicines. But now so can many advanced-practice nurses. Doctors can write orders. So can nurse practitioners. Doctors can examine you and diagnose you. So does your NP.

Nurses and doctors used to look different. The physical appearance and dress of nurses and doctors in hospitals today is actually emblematic of the blurring of the lines of identity that have characterized medicine in recent years. A doctor might wear scrubs; a nurse practitioner might wear a white coat; in the operating room, everybody wears the same thing. Clothing has long been a tangible symbol of turbulent times. The casting off of corsets was a signal of relaxing social restrictions. The shock of a woman wearing pants coincided with women entering the workforce. Burning bras were a way of protesting gender inequality. It is no accident that the shedding of the nurses cap happened around the same time nurses became college educated.

Lifestyle and money? Nope. A primary care doctor makes less than a nurse anesthetist. Some doctors don’t take call anymore, and many nurses do, even those without advanced degrees.

Surely knowledge, skill, and ability separate nurses from doctors? Of course not. Your experienced floor nurse knows way more about medicine than your average intern. Physicians assistants can sew up wounds and assist in surgery. A person who becomes a nurse is just as smart as a person who becomes a doctor, which has always been true but not always acknowledged. An MD is just a piece of paper that gives a person permission to start learning how to be an actual doctor. An RN is much the same. Clinical experience and training are the only things that matter materially to patients. Some argue that training level is also part of the definitional differences between doctors and nurses. Doctor’s clinical training in a formal educational system is usually longer. So you could equivocally say that a doctor has longer training.

I would suggest to my readers that the only thing that truly separates doctors from nurses is ultimate responsibility. The editor of Academic Medicine says in his introductory remarks introducing the question that his daughter was trying to decide between medicine and nursing. This is the decision she must make. Does she want to live with the ultimate responsibility for every patient under her care? Because of our investment of time and money, and presumably because of the economic and social standing granted to us, we doctors bear this ultimate burden. This is not to say that nurses don’t also have a responsibility to their patients and their field, or that they haven’t invested just as much time and money.

I have been both a nurse and a doctor, and am a huge proponent of the expanded role of nurse practitioners. But the law and society have laid the ultimate privilege and burden on the person that people call “doctor.” That’s the difference.

SHIRIE LENG, MD | PHYSICIAN

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

Nursing Uniforms and Infection Control: Nurses Uniform Habour Nasty Germs

Nursing Uniforms and Infection Control

The “scrubs” of intensive care unit (ICU) nurses often pick up disease-causing germs, including those resistant to antibiotics, a new study reports.

“We know there are bad germs in hospitals, but we’re just beginning to understand how they are spread,” said study lead author Dr. Deverick Anderson, an associate professor of medicine at Duke University School of Medicine in Durham, N.C.

These bad germs spread from patients to the nurses’ uniforms (usually the sleeves and pockets) and objects around the room, most often to bed railings, the researchers found.

“This study is a good wake-up call that health care personnel need to concentrate on the idea that the health care environment can be contaminated,” said Anderson.

“Any type of patient care, or even just entry into a room where care is provided, truly should be considered a chance for interacting with organisms that can cause disease,” he added in a university news release.

The study included 40 intensive care unit nurses at Duke University Hospital. Samples were collected from their scrubs before and after each 12-hour shift. Samples were also collected from all the patients the nurses cared for and items in the patients’ rooms.

The researchers focused on five pathogens known to cause hard-to-treat infections, including an antibiotic-resistant superbug called methicillin-resistant Staphylococcus aureus (MRSA).

The study found 22 instances when at least one of the five germs was transmitted from the patient or the room to a nurse’s scrubs. In six incidents, the germs spread from patient to nurse and room to nurse, and in 10 instances, bacteria was transmitted from the patient to the room.

There were no nurse-to-patient or nurse-to-room transmissions, according to the findings.

The study is scheduled for presentation in New Orleans Thursday at ID Week, the annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

“I think sometimes there’s the misconception that if, for instance, a nurse is just talking to patients and not actually touching them, that it might be OK to skip protocols that help reduce pathogen transmission, like washing hands or wearing gloves,” Anderson said.

“The study’s results demonstrate the need for caution whenever health care providers enter a patient room, regardless of the task they’re completing,” he added.

Anderson noted that previous studies focused mainly on the patient-nurse connection, while this one showed that a patient’s room also poses a threat.

“Our study shows following prevention strategies has to be a top priority, and that health care providers should be looking for ways to improve the likelihood that they are,” he concluded.

Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

Soource HealthDay

Informed Consent in Nursing Practice: Nurses Responsibilities

Informed Consent in Nursing Practice: Nurses Responsibilities

Obtaining informed consent for specific medical and surgical treatment is the responsibility of a physician. This responsibility is delegated to nurses in some private hospital and no law prohibits the nurse from being part of the information – giving process.

The practice however is highly undesirable. This is so because it is not right for you to obtain consent
for a procedure that you are not in control of. The person who is going to carry out the procedure and who knows what is involved in the procedure is in the position to obtain the consent as he is expected to explain to the client what is intended before asking for consent to carry it out. Since you are not the one that will perform the surgery nor are you the one to administer the anesthesia, you might not be in a good position to explain to the client what is involved and therefore should not be the one to obtain the consent.

Often your responsibility is to witness the giving of the informed consent for medical procedures.

This involves the following:
– Witnessing the exchange between the client and the physician.
– Establishing that the client really did understand, that is, was really informed.
– That the client freely or voluntarily gives his/her consent
– Witness the client’s signature or thumb printing

If you witness only the client’s signature and not the exchange between the client and the physician, you should write “witnessed signature only’’ on the form. If you find that the client really does not understand the physician’s explanation, then the physician must be notified.

Obtaining informed consent for nursing procedures is the responsibility of the nurse. This applies in particular to nurse anesthetists, nurse midwives, and nurse practitioners performing procedures in their advanced practices. However, it applies to other nurses, including you, who perform direct care such as insertion of nasogastric tubes or administration of medication.

Needle Stick Injury Protocol, Prevention and Management

Needle Stick Injury Protocol, Prevention and Management

Needle Stick Injury and Accidental Exposure to Blood

Needlestick Injury : the accidental puncture of the skin by a needle during a medical intervention
Accidental exposure to blood: the unintended contact with blood and or with body fluids mixed with blood during a medical intervention.

Risks
Accidental exposure to blood caused by needle injuries or injuries following, cutting, biting or splashing incidents carries the risk of infection by blood-borne viruses such as the hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

HBV risk= 5 – 40% HCV risk= 3 – 10% HIV risk = 0.2 – 0.5%
HBV prevalence is higher than average in intravenous drug users, homosexual men and in people from developing countries.

HCV prevalence is higher in people who have had multiple blood
transfusions, in dialysis patients and intravenous drug users.
HIV prevalence is also higher in homosexual men, in intravenous drug users and in people from areas where the condition is endemic.

Accidental contact with blood occurs especially in the following situations:
1. During re-capping
2. During surgery, especially during wound closure
3. During biopsy
4. When an uncapped needle has ended up in bed linen, surgery clothing etc
5. When taking an unsheathed used needle to the waste container
6. During the cleaning up and transporting of waste material
7. When using more complex collection & injection techniques
8. In A&E (Accident and Emergency) departments
9. In high-stress interventions (diagnostic or therapeutic endoscopy in patients with gastrointestinal bleeding)

Although this does not occur very often, there are other blood-borne microorganisms which can be transmitted via blood exposure:
• Other hepatitis viruses
• Cytomegalovirus (CMV)
• Epstein-Barr virus (EBV)
• Parvovirus
• Treponema pallidum (syphilis)
• Yersinia
• Plasmodium
Accidental exposure to blood following a needlestick injury is probably one of the most common occupational health accidents in medical care.


Avoiding needlestick injury and avoiding infection

The single most important measure to prevent needlestick injury is to not put the used needle back in its original cover; re-capping and re-sheathing must be avoided. Instead use a rigid puncture-proof container for used needles. It is important that the container is always close to hand to avoid the temptation of re-capping. It is equally important to use proper protective clothing such as gloves, mouth mask, and goggles which are appropriate during the performance of endoscopy.

Prevention

The most important rule for preventing needlestick injury is not to put the needle back in its cover, instead, the needle should be put in a specially designed, rigid, puncture-proof needle container. Make sure the container is always at hand.

Vaccination
Every hospital employee or any healthcare personnel at risk from accidental exposure to blood should be vaccinated against HBV. There are no preventive vaccines available yet for HCV and HIV.

Prevention of accidental blood contact
Personal protective equipment and clothing is very important. Use mouthmasks, gloves and gowns. Double gloving is safer than single gloving. Each additional layer of protective barrier (such as one or two gloves) significantly reduces the threat of any infectious agent present on the outside of the needle. Research shows a decreased or absent needlestick injury risk when using prior skin puncture techniques, or when using a needle-free delivery mechanism such as jet-injection devices. Needle type and design is also important. For example needles with safeguard mechanisms (safety barrel) or blunt tipped needles, can reduce the frequency of needlestick injury. Adequate training in safety procedures and improved compliance with safe operating room behavior can significantly reduce injury and infection risks. The maintenance of a safe operating room atmosphere is totally dependent on the atmosphere set by the operator.

Disinfection of contaminated material

After spilling possibly contaminated materials the affected area should be cleaned immediately (wearing gloves!) and then disinfected. Nursing equipment and materials , tools and small surfaces are cleaned with 70% alcohol. Large surfaces such as floors are disinfected with a chlorine solution 1000 ppm.

Immediate action after injury

Taking care of the wound immediately after the accident
Let the wound bleed for a moment and then cleanse thoroughly with water or a saline solution. Disinfect the wound using an ample amount of soap and water followed by 70% alcohol. In case of contact with mucous membranes it is important to rinse immediately and thoroughly, using water or a saline solution only, not alcohol.

Reporting the incident

It is important to report the incident immediately to the department dealing with occupational accidents. This will allow proper registration and subsequent management of the event.

Immediate action (injured person)

A blood sample should be taken as soon as possible after the injury. This sample should be kept for at least one year. It can act as a baseline value in case infection takes place and it becomes necessary to determine whether infection by one of the three viruses occurred at work. The kept sample may only be analysed for this particular purpose. Further blood samples to test for HBV, HCV and HIV are collected after 1, 3, 6 and 12 months.
Immediate action (dealing with the potential source)
If the source of the blood is known the patient must be asked for permission to sample blood for a HCV and HIV test. If the patient refuses then it must be assumed the patient is a carrier of the virus. If the origin of the blood is unknown then any blood present on the needle can be used for a serological examination.

Treatment approaches

General Prophylaxis
Management is based on finding out whether there is a risk of HBV, HCV or HIV . Depending on the serological analysis of the sample, steps must be taken to limit infection risks from the identified virus.

What to do after a potential HBV infection

Management of the situation is based on whether or not the injured person is immune for HBV, either as a result of vaccination or otherwise. There are two possibilities:
1. Subject has full immunity, if:
a. the person has had at least three vaccinations against HBV plus a subsequent check for antibodies
b. the response after vaccination is more than 10 IU/l
c. the person has had hepatitis B in the past.
2. Subject has a partial (or no) immunity, if:
o there was only a limited vaccination against HBV or none at all. Should this be the case then 5 ml intramuscular hepatitis B immunoglobulin (HBIG) should be given within 48 hours of the injury.

What to do after a potential HCV infection

There is no effective drug prophylaxis for HCV. There are some experimental treatment possibilities provided the infection is diagnosed at an early stage. The case should be followed closely for 12 months and a serological examination for HCV should be done after 3, 6 and 9-12 months. If one of these follow up analyses finds HCV antibodies then a comparison with the baseline blood sample taken immediately after the accident will show whether or not this involves an occupational accident. In case of a positive HCV test, a combination treatment of interferon and ribavirin is the treatment of choice. A liver specialist should be consulted.

Risks and what to do after a potential HIV infection
1. Risk of HIV Infection
The risk of a HIV infection following exposure to blood is very small (0.1-0.5%). The actual risk depends on type of contact and on the amount of virus in the contaminated material.

There are some factors which are associated with a higher risk
1. Deep wounds
2. Visible blood on the instrument
3. Needlestick injury by using hollow-bore needles containing blood
4. Intravenous or intramuscular injection of contaminated blood
5. Blood from a patient with a high virus level (for example untreated or terminal AIDS patients)

Immediate action after Needlestick Injury

After a review of the accident with the doctor responsible for occupational health and safety a recommendation is given whether or not to prescribe Post Exposure Prophylaxis (PEP). If in doubt it is best to contact an AIDS expert. If PEP is advisable then it is important to discuss :
1. the advantages and disadvantages of PEP
2. the necessary follow-up examinations (of liver and kidneys) after 2 weeks, 1, 3 and 6 months)
3. follow up examination for HIV infection (after 1, 3 and 6 months)
4. the importance of avoiding transmission to sexual partner(s) (use of condoms)

Start PEP as soon as possible after this.

Post Exposure Prophylaxis (PEP) for high HIV infection risk cases
General

PEP is the treatment of choice. Recommended is a 3-drug combination consisting of 2 RT (reverse transcriptase) inhibitors and 1 protease inhibitor. If the source patient is infected with a resistent virus it may be advisable to discuss a modified regimen with an internist-AIDS specialist.

The standard PEP consists of :
Indinavir Lamivudine Zidovudine
Early monotherapy with zidovudine reduces the likelihood of HIV infection by as much as 80%. The main disadvantages of PEP concern the potentially harmful side-effects and the fact that its longterm drug toxicity is unknown.

Commence treatment early

Considering the speed with which the virus multiplies and the results of animal experiments it is recommended to start PEP within 6 hours of suspected exposure. Do not wait for laboratory results , start PEP at once. In most cases it is possible to stop PEP immediately after the results prove negative and thus avoid potential adverse events.

Which drugs to use
A standard PEP set can be used. The total course should take 4 weeks (28 days). See tables 5 and 6 for dosing information.
Potential side-effects
Indinavir
stones in kidneys and urinary tract if not drinking enough water
Lamivudine
side effects are rare
Zidovudine
headache and nausea (temporary) anemia liver function disorders

Follow-up
Follow-up examinations are important. Privacy should always be respected and laboratory results should be anonymous. Blood samples in connection with possible side effects (hematologic, hepatic,renal, etc) are taken at the start of treatment and after 2 and 4 weeks. Blood samples for HIV are taken at the start of the treatment and after 1, 3 , 6 and 12 months. If the results are still negative after 6 months, it is very unlikely that an HIV infection has taken place, but blood should be taken after 12 months to exclude rare delayed seroconversion. More than 95% of well-documented HIV seroconversions occur within the first 3-12 weeks.

Implementation and registration

Compliance and Training Issues
There is a clear relationship in the literature between risk, compliance and training. Good training will improve compliance with safe operating room behavior and reduce the risk of Needlestick Injury.
All healthcare staff should be vaccinated for HBV. All Needlestick Injury events should be registered and carefully documented.

Healthcare workers who suffer needlestick injuries require immediate identification and attention to avoid transmission of such infectious diseases as HIV, HBV, and HCV.

If the exposure is mucosal or the wound is large enough to irrigate, irrigate with copious amounts of saline or other clean fluid.

Irrigate and clean wound.

The need for tetanus and/or hepatitis B prophylaxis is based on medical history. Health care providers should have been immunized against hepatitis B. Hepatitis A prophylaxis may (rarely) need to be considered depending on the source-patient situation.

The need for HIV or chemoprophylaxis (antiretrovirals) is based on an assessment of the risk by using the 3-step process developed by the Centers for Disease Control and Prevention (CDC)

The Relationship Between Shift Work And Obesity Among Canadian Nurses

The Relationship Between Shift Work and Obesity Among Canadian Nurses

Smith P, Fritschi L, Reid A, Mustard C

Shift Work and Obesity

Shift work is associated with many negative health effects, such as obesity. However, the mechanism that leads to the relationship between shift work and obesity and the direction of the relationship are unclear. Does shift work lead to increased body mass index (BMI) and, if so, why? Or are individuals with a higher BMI more likely to choose to work the night shift? Equally unclear is what can be done to mitigate this relationship. The purpose of this study was to examine the relative contribution of factors known to affect BMI, such as health behaviors and working conditions (employer-supported health clubs, healthy food options) in nurses working evening and night shifts. The second goal was to determine whether employer-supported facilities had an effect on BMI.

Methods. The researchers conducted a secondary analysis of data from a random, national, cross-sectional survey of Canadian nurses conducted in 2005. Height, weight, shift typically worked (days, evenings, nights, or rotating), whether the respondent had a say in hours or days they worked, and tenure in current job were all reported. A job questionnaire assessed job strain and effort-reward imbalance, including measures such as job control, psychological demands, and respect and support. Two health behaviors, smoking and alcohol use, were assessed. Survey participants were asked about facilities for physical activity and places to purchase healthy food. Finally, potential confounders such as age, marital status, children, restrictions to physical activity, self-reported episodes of major depression, type of nurse, and type of workplace were included.

More than 18,000 nurses completed the telephone interview. Researchers eliminated nurses who were not working in direct care facilities, those who were pregnant, those working multiple jobs, and individuals with incomplete responses, leaving a final sample of approximately 8600 female nurses.

Findings. BMI levels were higher in nurses working night or rotating-shift schedules compared with day-shift nurses, even after adjusting for all potential confounders. That difference in BMI, although statistically significant, was within 1 point across all shift schedules. The difference in BMI level for nurses working the night shift was not attenuated by differences in working conditions, the presence of employer-supported facilities, or health behaviors that are thought to be associated with weight gain. After adjusting for confounders, nurses working the night shift, on average, had BMI scores that were 0.67 points higher than those working the day shift; the BMI scores of nurses working rotating-shift schedules were 0.44 points higher. Higher levels of job strain were also associated with higher BMI levels, although the actual differences in BMI were less than 1 point. An interesting ancillary finding was that nurses working rotating shifts had higher job strain scores, increased imbalance in efforts and rewards, and were more likely to smoke.
Viewpoint

This study is limited by the lack of direct measures of physical activity and diet and the fact that height and weight data were obtained only by self-report. However, the large sample size and the inclusion of multiple variables that may affect BMI are strengths, and the conclusions are worth noting. Nurses working off shifts have higher BMIs — and hospital efforts such as providing fitness facilities and options for healthy food do not attenuate that relationship. It is encouraging, however, that the difference, although achieving statistical significance because of this large sample size, is not likely to be significant in terms of health.

There probably isn’t a nurse out there who can’t identify with how difficult it is to work nights or a rotating-shift schedule and still fit in exercise, preparing and eating healthy foods, family obligations, and the myriad tasks that many women juggle. It is no surprise that the researchers also found that rotating shifts was particularly stressful and led to more job strain. My take on this study is that nurses working these schedules are to be congratulated on maintaining a BMI that is more or less in line with their day-shift colleagues’ despite the obstacles to doing so.