Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

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Health literacy interventions and outcomes: an updated systematic review.

ESPEN guideline on clinical nutrition and hydration in geriatrics

Aim. This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest.

Background.  Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization.

Method.  A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords ‘cardiopulmonary resuscitation’, ‘basic life support’, ‘advanced life support’ and ‘training’. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review.

Results.  One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards.

Conclusions.  Resuscitation training should be based on in-hospital scenarios and current evidence-based guidelines, including recognition of sick patients, and should be taught using simulations of a variety of cardiac arrest scenarios. This will ensure that the training reflects the potential situations that nurses may face in practice. Nurses in clinical areas, who rarely see cardiac arrests, should receive automated external defibrillation training and have access to defibrillators to prevent delays in resuscitation. Staff should be formally assessed using a manikin with a feedback mechanism or an expert instructor to ensure that chest compressions and ventilations are adequate at the time of training. Remedial training must be provided as often as required. Resuscitation training equipment should be made available at ward/unit level to allow self-study and practice to prevent deterioration between updates. Video self-instruction has been shown to improve competence in resuscitation. An in-hospital scenario-based video should be devised and tested to assess the efficacy of this medium in resuscitation training for nurses.

Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature.

Moral distress, a complex human experience, has lacked a clear, complete definition. Intuitively, clinicians know that moral distress might be occurring for patients with increasing frequency due to technological advances that alter the natural order of life and death. Yet clinicians have not been able to evaluate the presence or extent of moral distress. To date, moral distress has been investigated mainly as an occupational issue using Jameton's (1984) definition, which has been problematic for several reasons. Without an adequate definition, moral distress can be unrecognized, yet have a silent, clinically significant impact on health. The literature is discussed from several perspectives to show the current state of the science in this topical area, and its potential future.

Moral distress: the state of the science.

Water-loss dehydration and aging ☆

Patient safety in the perioperative setting is determined by many interdependent factors including reliable systems, good teamwork, psychological safety, optimal communications and most crucially shared vision and goals. The necessary organizational, environmental and behavioural conditions for quality care are not new and were in fact known to Florence Nightingale as much as 150 years ago. As noted by Nightingale, and something that remains unchanged today, the greatest threat to patient safety are the frailties of the human condition, complacent attitudes and unconscious behaviours. Recognizing that error is normal and somewhat inevitable, given the complexity of modern surgery, is undoubtedly the first step to mitigating error and harm, and the basis from which to tackle variability and sub-optimal conditions to deliver quality improvement.

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Patient safety: a core value of nursing - so why is achieving it so difficult?:

This article reports on a project conducted by final-year students on a preregistration nursing programme. The students explored the potential to improve practice in a clinical area relevant to the trust at which they undertook their clinical placements. It is seen as innovative because it encourages partnership working between the educational institution and the NHS, helps to prepare students for their forthcoming registered nurse status and provides information of real practical value to the trust, enabling it to change and improve an important aspect of care.

Improving the monitoring and assessment of fluid balance.

Surgical procedures are intended to save lives and improve the quality of life, however omissions in essential practices (system and human error) contribute to unsafe surgical care, and cause significant harm to patients. For centuries it was believed that patients' co-morbidities and the surgeon's technical competence were the key determinants of surgical outcome; it is only within the last decade, that the relationship between failure to follow safety procedures, sub-optimal team work, poor communication and clinical outcomes has been appreciated (Vincent et al 2001). Recognition of the interdependencies for good surgical outcomes owes much to safety oriented research focusing on interpersonal behaviours and cognitive performance, the science of 'human factors', and the route cause analysis (RCA) of surgical harm.

Surgical Never Events should never happen...

Throughout 2011, and for much of this year, the national and professional press have been dominated by reports of failures in health and social care. Stories have focussed on the avoidable harm and disturbing cruelty suffered by individuals and the distress of distraught families seeking answers in the light of systemic organisational failure on an incredible scale (Francis 2010, CQC 2011a, CQC 2011b).

Respect, compassion and dignity: the foundations of ethical and professional caring.

Rounding can enhance but not ensure patient safety; better to focus on appropriate training

https://www.bmj.com/content/bmj/345/bmj.e4589.full.pdf

Jane Reid

Papers

Patient safety: a core value of nursing - so why is achieving it so difficult?:

Improving the monitoring and assessment of fluid balance.

Surgical Never Events should never happen...

Respect, compassion and dignity: the foundations of ethical and professional caring.

Nurse leadership and patient safety