Abstract Objective: The purpose of the study was to determine the incidence and risk factors for the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in our community. Design: This study used a cross-sectional design to assess patients colonized or infected with MRSA. Patients: The study population consisted of residents of London, Ontario, Canada, who were identified as MRSA-positive for the first time in 1997. Setting: All acute- and chronic-care hospitals, long-term healthcare facilities, and community physicians' offices in the city of London participated in the study. Main Outcome Measure: Incidence of MRSA in the community, risk factors for acquisition, especially previous hospitalization over a defined period, and strain type were evaluated. Results: In 1997, 331 residents of London were newly identified as MRSA-positive, representing an annual incidence of 100/100,000 persons (95% confidence interval, 88.8-110.7). Thirty-one (9.4%) individuals were not healthcare-facility patients in the previous month, and 11 (3.3%), 10 (3.0%), and 6 (1.8%) individuals had no such contact in the previous 3, 6, and 12 months, respectively. One hundred seventy-seven strains, including five of the isolates from patients with no healthcare-facility contact in the previous year, were typed. One hundred sixty (90.3%) of these isolates, including all typed strains from patients with no healthcare facility contact, belonged to a single clone. Conclusion: These findings demonstrate that the incidence of MRSA is higher than previously reported and that hospital contact is the single most important risk factor for the acquisition of MRSA in our community. Screening for MRSA in previously hospitalized patients at the time of hospitalization may reduce nosocomial spread and indirectly reduce the incidence of MRSA in the community.
The study aim was to develop and psychometrically assess an instrument to measure baccalaureate nursing students' self-efficacy for practice competence. Social cognitive theory includes the construct of self-efficacy and supports this study.Before the Nursing Competence Self-Efficacy Scale (NCSES) was administered to senior nursing students (N = 252), nursing experts in research, practice, instrument development, and psychometrics participated in a two-step validation process consisting of two reviews. Construct validity assessments included content, face, contrasting groups, criterion, and exploratory factor analysis (EFA). The chosen EFA solution consisted of 22 items, each moderately or highly loaded by one of four factors deemed to be interpretable and parsimonious.The initial psychometric assessment of the NCSES supported construct validity, internal consistency reliability (.919), and test-retest stability reliability (r = .831).With further psychometric assessment, the NCSES can be useful to evaluate new curriculum interventions aimed at increasing students' self-efficacy for comprehensive practice competence.
The objective of this study was to determine the degree to which the educational outcomes of the accelerated, redesigned bachelor of science in nursing (BSN) program at The British Columbia Institute of Technology are similar to those of its previous program.A prospective cohort study compared outcomes for the first two classes of students in the redesigned program with those of the final class of students in the original program. Data were gathered from administrative records, focus group discussions, and online surveys for BSN students (later, graduates), faculty, and staff, a focus group discussion with Specialty Nursing faculty, and interviews with program leadership and representatives of provincial health authorities.No differences were found between the two programs for most outcomes.Although hindered by some low response levels, the evaluation data indicate that the British Columbia Institute of Technology's redesigned BSN program's educational outcomes are largely similar to those of its predecessor. [J Nurs Educ. 2017;56(8):484-489.].
In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. Increased team awareness and a higher acceptance of the provider roles were some of the key successes. Challenges included role confusion and the learning curve for the new providers. While overall the project was a success, lessons learned included the need for physician buy-in, communication, planning for unintended consequences and management of expectations. The project emphasized the importance of a managed process, including team development, in the implementation of change.
