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INTRODUCTION: Clostridioides difficile infection (CDI) is a clinical and laboratory diagnosis. Populations at higher risk of developing disease require a high clinical index of suspicion for laboratory testing to avoid incorrect assumptions of colonization. Common risk factors include recent antibiotic use, elderly (>65 years old), and immunocompromised patients. C. difficile assays should be ordered in an algorithm approach to diagnose an infection rather than colonization. Screening tests are widely available in hospital systems, but novel molecular testing may aid in diagnosis in patients with inconclusive or discordant antigen and toxin test results.  Methods: Data was extracted from PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases based on the keywords "clostridioides difficile", "toxin assay", and "toxic megacolon". The data extracted is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A total of 27 reports were included in this systematic review. RESULTS: Testing patients with a significant gastrointestinal surgical history, hypogammaglobulinemia, inflammatory bowel disease, intensive care unit, and immunocompromised patients for CDI is highly recommended. Diarrhea in these subsets of patients requires correlation of clinical context and an understanding of assay results to avoid over- and under-treating. CONCLUSION: CDI should be considered in all patients with traditional risk factors. Heightened clinical suspicion of CDI is required in patients with hypogammaglobulinemia, transplant recipients, patients with gastrointestinal surgical history, and inflammatory bowel disease. Testing should be limited to patients with clinical manifestations of CDI to ensure a high pretest probability for test interpretation. Healthcare workers should adhere to testing algorithms to optimize yield in the appropriate clinical context. Diagnostic assays should follow a sequential, stepwise approach to categorize the toxin expression status of the bacteria accurately.

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OBJECTIVE: The purpose of this integrative review was to explore, appraise and synthesize the current literature on correlates of suicide risk in nurses. DESIGN: Integrative literature review. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Joanna Briggs Institute, PubMed, PsycInfo and Scopus electronic databases were searched for abstracts published between 2005 and 2020. Reference lists were hand searched. REVIEW METHODS: The integrative review was based on the Whittemore and Knafl review methodology. Primary qualitative and quantitative studies about suicidal behaviour in nurses published in peer-reviewed journals were included. The methodological quality of included articles was assessed using the Mixed Methods Assessment Tool. RESULTS: Separate correlates of risk and protective factors were identified for suicidal ideation, suicide attempt and death by suicide in nurses. IMPLICATIONS: Due to a number of factors at the individual, interpersonal and work levels, nurses are uniquely positioned to be at risk of dying by suicide. The ideation-to-action framework provides a theoretical guide to understand the interplay between correlates and the effect it has on increasing a nurses' capability for suicide. CONCLUSIONS: This review integrates the empirical literature to elucidate the concept of suicidal behaviour as it applies to nurses.

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Evidence-based practice (EBP), communication, and interprofessional collaboration are all essential for safe, quality care. As members of the interprofessional team, nurse leaders are in a unique position to advance patient safety with a strategic plan, infrastructure, resources, reporting structure, and recognition program to guide the way. Leaders of a 152-bed children's and women's hospital formed an academic-practice partnership to create an interprofessional council to foster the principles of collaboration and EBP among frontline staff.

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Utilizing a hermeneutic philosophical approach, the researchers explored the perceptions and experiences of people who are homeless in Mobile, Alabama, receiving health care and interacting with health care providers. Using the voice of the participants, discussions among the researchers, and supporting literature reinforcing key concepts, a framework was created illustrating the lived experience. The following themes were identified: social determinants of health, compromised systems, professionalism, dehumanization, engagement, and downward trajectory. The experiences described and themes identified indicate a breakdown in therapeutic relationships between homeless individuals and health care providers, contributing to the continuing destabilization common in this population.

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