Handwashing practices are persistently suboptimal among healthcare professionals and are also stubbornly resistant to change. The purpose of this quasi-experimental intervention trial was to assess the impact of an intervention to change organizational culture on frequency of staff handwashing (as measured by counting devices inserted into soap dispensers on four critical care units) and nosocomial infections associated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). All staff in one of two hospitals in the mid-Atlantic region received an intervention with multiple components designed to change organizational culture; the second hospital served as a comparison. Over a period of 8 months, 860,567 soap dispensings were recorded, with significant improvements in the study hospital after 6 months of follow-up. Rates of MRSA were not significantly different between the two hospitals, but rates of VRE were significantly reduced in the intervention hospital during implementation.

Programme participants reported increased capacity to perform their professional roles as a result of their having participated in this programme. More capacity building activities are needed to further enable nursing professionals to meet the demands for health care around the world.

The imperatives of the Affordable Care Act to reduce 30-day readmissions present challenges and opportunities for nurse administrators. The literature suggests success in reducing readmissions through enhancing patient-centered discharge processes, focusing on medication reconciliation, improving coordination with community-based providers, and effective patient self-management of their disease and treatment. Evidence-based interventions addressing low health literacy, when used with all patients, hold promise to promote understanding and self-management. Strategies addressing low health literacy aimed at reducing 30-day readmissions are identified and discussed.

Concerns about stubbornly persistent high rates both of error-related patient injuries and of occupational injuries among healthcare workers have generated intense exploration of etiologies, interventions, and the role of underlying safety culture. Much of this work has centered on the role of physicians and nurses in health care, and suggests common issues related to safety culture. However, the role of front-line health care workers, such as nursing assistants, ward clerks, environmental service workers, food workers and transportation workers, among others, has not been explored sufficiently. This article provides the background for a workshop held in Washington, D.C., to identify gaps and opportunities for integrating front-line hospital workers into safety efforts. It provides a brief review of available information, the results of a series of focus groups of front-line workers from a single urban hospital addressing the question, and a series of framing questions for the workshop itself.

Previous work on the relationship between worker safety and patient safety has focused on nurses and physicians. 1 Safety climate and nurses' working conditions predict both patient injuries and nurse injuries, supporting the premise that these outcomes may be linked. 2 Less attention has been paid to other members of the health care team, including nursing assistants, orderlies, aides, food service workers, janitors and other environmental service workers, ward clerks, and others. (We use the term health care workers [HCWs] to include frontline hospital workers rather than "support personnel" or other terms that may unintentionally exclude them.) Engaging frontline HCWs in developing, implementing, and evaluating interventions to improve safety may improve patient as well as worker outcomes.

To determine if there is a body of essential content that should be common to master's-level home care programs, a purposive sample of 200 nurses involved in home health or community health nursing was selected. The respondents (N = 118), including faculty and educational administrators (N = 61) and supervisors and administrators of home health agencies (N = 57), were asked their perceptions of the knowledge needed and their priorities for curriculum content for master's-prepared home care specialists in both clinical and administrative roles. There was agreement in most content areas, but significant differences were found between faculty and agency personnel in their priorities for community health concepts, and in their evaluation of nursing theory and epidemiology as essential content in both roles. We believe these results have important implications for nurse educators. As schools prepare students for leadership roles in today's home care environment, it is critical that pertinent content be well integrated into the curriculum.

A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

Prospective payment by diagnosis-related groups (DRGs) has influenced hospital care in at least two ways: patients are experiencing shorter hospital stay and they are being discharged in a less healthy state than in the past. As a result, home health agencies are reporting an increase in the number of patients needing services, with the majority of these patients being sicker, older, and requiring more complex care. As hospital-based care shifts to community care, the impact on community home health agencies continues to increase. To date, little has been written about role changes for community health nurses, especially home health nurses, as a result of the ripple effect of DRGs. The authors suggest likely changes in the caring, counseling, and coordination aspects of the nurse's role. The community health nurse's role is evolving into one that requires expertise in advanced technologies, more sophisticated assessment and counseling skills, and a more comprehensive case management component. Concomitant alterations must be made in resource requirements and distribution. Such changes provide opportunities for innovative and creative nursing strategies. Elayne Kornblatt Phillips is Associate Professor of Nursing and Assistant Professor of Epidemiology at the University of Virginia. Patricia Cloonan is a doctoral student at rhe University of Virginia School of Nursing. Address correspondence to Elayne Kornblan Phillips, R. N . , University of Virginia School of Nursing, McLeod Hall, Charlonesville, V A 22903. Telephone (804) 924-0124.