Emotional Support and Well-Being of Adults with Congenital Heart Disease (ACHD): Contributions of a Specialist Nursing Service

Living with a congenital heart condition can require a daunting and uncertain patient journey during which the support of a specialist nursing service is vital. A descriptive, cross-sectional evaluation completed over two years, utilised a postal questionnaire to investigate patient’s satisfaction with aspects of service. Qualitative responses to open questions on satisfaction with emotional support (n = 103) and contributions to well-being (n = 90) were analysed using a framework approach which identified eight themes. Professional knowledge and expertise, service accessibility, caring attributes, enabling patients to cope with anxiety, depression and meeting changing needs contributed positively to both patient well-being and emotional support. Family support was influential on emotional support alone, whilst mediating medical liaison exerted an impact on well-being by enhancing feelings of security. In conclusion, the specialist nursing service contributed positively to well-being and emotional support of patients and thereby to selective aspects of continuity of care.

Effect of continuous nursing on rehabilitation of older patients with joint replacement after discharge

BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.

Perioperative Nursing for Adult Congenital Heart Disease with Severe Pulmonary Arterial Hypertension

Objectives: To explore the main points of perioperative nursing for adult congenital heart disease with severe pulmonary arterial hypertension. Methods: A retrospective study of 13 patients with congenital heart disease and severe pulmonary arterial hypertension who admitted to the perioperative period of care from January 2018 to December 2019. To prevent perioperative complications of the patients, the focus is on respiratory and circulatory system care, followed by blood coagulation monitoring, digestive system protection and psychological care. Results: All 13 patients passed the perioperative period and were discharged from ICU. Conclusion: Adult congenital heart disease with severe pulmonary arterial hypertension has high perioperative risk, respiratory and circulatory system care is the key.

Art making and expressive art therapy in adult health and nursing care:A scoping review

Objectives:While receptive art engagement is known to promote health and wellbeing,active art engagement has not been fully explored in health and nursing care.This review is to describe the existing knowledge on art making and expressive art therapy in adult health and nursing care between 2010 and 2020.Methods:Relevant studies and grey literature were searched and identified between March 17 and April 10,2020 from EBSCO,CINAHL,Medline and ERIC databases and a general Internet search.Following data charting and extraction,the data(n=42 papers)were summarized and reported in accordance with PRISMA-ScR guidelines.Results:In the included papers,both art making and expressive art therapy were seen in different health care and nursing contexts:yet not the home care context.The emphasis of art activities were group activities for chronically or terminally ill residents,adults aged 65 years or older.A focus on personal narrative was often seen,which may explain why art activities appear to be linked to acknowledging and building new strengths and skills,making meaning of experiences,personal growth,symptom alleviation,and communication;all used to foster collaboration between patients,patients’near-ones and health care professionals.Conclusions:Art activities appear to be suitable for every context and can promote personcenteredness and the measurement of nursing outcomes,and they should be considered an essential part of health and nursing care,nursing education and care for health care personnel.

Characteristics of a Transactive Phenomenon in Relationships among Older Adults with Dementia, Nurses as Intermediaries, and Communication Robot

Healthcare for older adults with dementia is an important healthcare problem in Japan and in other developed countries. Importantly, healthcare workers in Japan are also getting older. In order to address solutions to this problem, using robots is being realized and is starting to assist healthcare and welfare practice needs. The aim of this study was to identify the characteristics of a transactive phenomenon in relationships among older adults with dementia, with nurses as intermediaries and with a cognitive skill-aid robot. Subjects were two institutionalized older adults who were diagnosed with dementia using Hasegawa’s Dementia Scale-Revised;a Kabochan (Nodding Kabochan) fixed with a remote-controlled speaker, Pechat (Kabochan with Pechat). Measurements of autonomic nervous activity were done using wearable electrocardiography attached to the subjects for four hours. Heart Rate Variability data were assessed at various frequency bands using a HRV software tool. In a continuously recorded data, interbeat (R-R) intervals were obtained for a 1-min segment using the maximum entropy method. In this study, the two major spectral components of HRV, the variances of the low-frequency (LF: 0.04 - 0.15 Hz) band and high-frequency (HF: 0.15 - 0.4 Hz) band, were calculated. Activities and behaviors of subjects transacting with Kabochan were observed by the expert nurses and video-recorded. Throughout the transaction period, observations were recorded of patients’ behavior, words uttered and over-all contents of the transactive conversation with the Kabochan or Kabochan with Pechat. Identified characteristics were transactive relationship phenomenon;changes in autonomic nervous system activity of persons with dementia are expressed as per one minute, linguistic response of elderly people, transactive relations among Kabochan, Kabochan with Pechat, and nurses as intermediaries. These were exhibited as Figures: Situation 1, A Sense of Fear, Situation 2, A Pleasant Sensation, and Situation 3, Misunderstanding and Confusion. It also showed that autonomic nervous system activity of persons with communication skills is actively changing in older adults with dementia. Conversation of adding Pechat to the Kabochan illustrated that nurses as intermediaries showed emotional conversations as established by effectively manipulating the Pechat. Also, it was revealed that if Kabochan with Pechat uttered words about patient’s personal information in a conversation, the patient felt a sense of fear. The researchers suggest that when developing future communication robot for elderly with dementia, it is necessary to consider, for an effective conversation, transactive relationships including nurses as intermediaries. The role functions of these intermediaries have been shown of high versatility, indicating that situations such as these can also be controlled by other healthcare providers such as by occupational therapists.

Analysis of the evidence of related factors,associated conditions and at-risk populations of the NANDA-I nursing diagnosis insomnia

Objectives:To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.Methods:An integrative review performed in Pubmed,Virtual Health Library and CINAHL.Forty-eight articles published in Portuguese,English or Spanish from 2011 to 2018 were included.An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.Results:There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions,except for grieving and frequent naps during the day.Smoking,caffeine intake,dysfunctional sleep beliefs,obesity and caregiver role strain are possible new related factors;chronic illness is a possible new associated condition and individuals going through changes in marital status,economically disadvantaged,female gender,increasing age and night shift worker are possible new at-risk populations.Conclusion:The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis.The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification,thereby supporting the clinical reasoning of nurses and students.

Care Prevention Needs in Community-Dwelling Older Adults in Japan

Care prevention comprises an integral part of long-term care in Japan and is provided across the following populations: those without problems when screened by the Basic Check List (BCL, Type 1), those having problems when screened by the BCL (Type 2), and those certified in the “support need levels” by the long-term care insurance eligibility assessment (Type 3). We aimed to clarify the care prevention needs across these three populations by using the interRAI Check-Up, an internationally developed instrument. We conducted cross-sectional surveys to assess care prevention needs for convenience samples of community-dwelling older adults in two cities in western Japan from October 2016 to December 2017, and we integrated the secondary data of older adults’ assessment from September 2014 to June 2018. Prevalence rates of nine domains of care prevention needs were calculated. Among the 125 participants, 20 were Type 1, 23 were Type 2, and 82 were Type 3. All three types had the following needs that had not been assessed in the BCL: pains, risk of hospital-emergency room visits, driving reviews, and instrumental activities of daily living capacity. The results showed that interventions for a wide range of care prevention needs should be considered in the long-term care prevention project.

Knowledge and Tube Feeding Practices for Older Adult Patients among Japanese Registered Nurses

The aim of this study was to examine nurses’ thinking regarding the indications for tube feeding in older adults with eating difficulties and to determine whether the team approach can improve their knowledge and tube feeding practices. We sent self-administered questionnaires to 436 nurses and collected them from November to December 2010 (response rate, 70.0%). The results indicated that approximately 30% of the Japanese nurses thought that older patients with dementia should be on tube feeding and more than half of the nurses answered that tube feeding is indicated for aspiration-prone, frail, older adults. Moreover, our findings showed that nurses who organize multidisciplinary teams performed more interventions for dysphagia before introducing tube feeding than the reference group as analyzed by multivariate adjustment (odds ratio, 2.1-6.6). In conclusion, a multidisciplinary team approach is expected to make better decisions on the treatment and care of older patients with difficulty eating, including the need for tube

Experiencing Participation in Health Care: “Through the Eyes of Older Adults”

Background: Patient participation is well understood by health care professionals but not many studies have focused on the older adults and their perceptions of patient participation. Aim and Objectives: To report an analysis of the concept of participation from the perspective of the older adult. Design: Concept analysis. Methods: An integrative review approach was undertaken and the searches were limited from January 2003 to December 2014, guiding question was;“what constitutes patient participation according to the older adult?” Results: Through the eyes of the older adults, a two-way communication should be initiated by the staff. Equality and sharing power between older adults and staffs was perceived as a precondition. Been given time was an essential issue, implying that older adults wished to have enough time from staffs and be in the right context surrounded by the appropriate environment in order to experience participation. Conclusion: In order to experience participation for older adults, it is important that the health care professionals are aware of how and in what ways they can contribute to participation among older adults. The need or wish to create participation is not enough;the health care professional needs to see and understand participation through the older adult’s eyes. Thus, a person-centered nursing approach is relevant for the health care professional in order to both give and maintain the experience of participation to the older adult.

Aspiring for competence in a multifaceted everyday life:A qualitative study of adult students’experiences of a blended learning master programme in Norway

Aim:To gain knowledge of how adult students experienced the first year of a blended learning master programme to better understand their learning process.Methods:A qualitative,exploratory,descriptive study based on data from two focus group interviews with students attending a blended learning Master programme.Qualitative content analysis based on Graneheim and Lundman’s procedures was applied.Findings:Our analyses revealed one main theme:aspiring for competence in a multifaceted everyday life and four main categories:acquiring professional competence,struggling to manage diverse forms of communication,demanding task juggling and confused student role.Conclusions:The participants experienced that the programme enabled them to acquire professional competence relevant to practice.Despite the challenges,the programme is recommended for prospective students who live in both urban and rural areas,who are working and also responsible for children and other family tasks.

成人吸入性损伤肺康复管理最佳证据总结

目的检索、评价及汇总成人吸入性损伤肺康复相关证据。方法计算机检索BMJ Best Practice、UpToDate临床顾问、JBI图书馆、Cochrane图书馆、国际烧伤协会、欧洲烧伤协会、美国烧伤协会、日本皮肤病学协会、中国知网、万方数据库、中国生物医学数据库等网站中关于成人吸入性损伤相关的临床实践指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2022年12月31日。进行文献质量评价后,根据主题对证据进行提取与汇总。结果根据纳入标准筛选出证据16篇,包括临床实践指南7篇、专家共识5篇、系统评价3篇、随机对照试验1篇。通过阅读、提取和归类,总结了对证据进行梳理,最终形成肺康复评估、肺康复模式、肺康复时机、肺康复时长、肺康复地点、肺康复方式、肺康复营养支持及效果评价8个维度,20条证据。结论本研究基于总结多个国家及地域成人吸入性损伤的肺康复管理证据,供医护人员根据临床实际情况选择证据进行干预。

成人急性呼吸道传染病患者俯卧位通气管理的最佳证据总结

目的检索、评价、提取并汇总成人急性呼吸道传染病患者俯卧位通气管理的最佳证据,为俯卧位通气规范化治疗提供循证依据。方法根据“6S”证据模型,系统检索各指南网站及中英文数据库相关文献,由研究人员对纳入文献进行质量评价、证据提取与汇总。结果共纳入11篇文献,包括3篇临床决策、5篇指南、1篇证据总结、2篇专家共识。最终形成包括人员准备、院感防控、护理评估、实施要点、风险管理、健康教育和特殊人群照护等7个方面共48条的最佳证据。结论在证据应用过程中医护人员应基于具体临床情境,制订个体化俯卧位通气治疗方案,以改善患者临床结局。

随访护理在缓解期成年癫痫患者中的应用效果

目的探讨随访护理在缓解期成年癫痫患者中的应用效果。方法使用随机数表法将2022年1月至2023年6月在郑州大学第一附属医院就诊的68例缓解期成年癫痫患者分为对照组(34例)和观察组(34例)。在对对照组实施常规护理基础上给予观察组随访护理干预。比较两组干预前后的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、志气缺失综合征量表(DS-MV)、中文改良版癫痫自我管理行为量表(ESME)、癫痫患者生活质量评定量表(QOLIE-31)评分。结果干预后,两组HAMA、HAMD、DS-MV评分均下降,ESME、QOLIE-31评分均上升,且观察组HAMA、HAMD、DS-MV评分较低,ESME、QOLIE-31评分较高(P<0.05)。结论随访护理可有效改善缓解期成人癫痫患者的焦虑、抑郁情绪和志气缺失水平,对提高患者自护能力和生活质量有积极作用。

成人患者经鼻胃管喂养临床实践指南(2023年更新版)

目的 对2015年构建的《成人患者经鼻胃管喂养临床实践指南》进行更新。方法 于2022年1月-2023年3月,基于NICE更新流程,通过专家函询和护士访谈确定需要新增和修订的章节,系统检索专业网站和数据库中关于鼻饲护理的最佳证据,3名研究者独立对文献进行资料提取和证据汇总,通过专家函询确定推荐级别;根据CheckUP更新指南报告清单形成指南初稿,通过现场论证和外部评审对指南进行修改及完善,形成指南更新的终稿。结果 与原版指南相比,更新版指南新增了改善胃肠道功能和血糖控制章节,删除了营养配方和鼻饲不良事件的上报章节,重点更新了鼻饲置管前评估、胃管置管、鼻饲喂养等13个章节,指南更新及补充的条目共67条,52条强推荐,15条弱推荐。结论 本研究汇总了目前成人患者鼻饲相关的最新证据,对原有的《成人患者经鼻胃管喂养临床实践指南》进行更新,可进一步为临床鼻饲护理管理提供最佳临床决策,规范鼻饲护理流程。

社区老年人社会隔离的潜在剖面分析及影响因素研究

目的分析社区老年人社会隔离特征及影响因素,为制定干预措施以促进积极老龄化提供参考。方法采取便利抽样法,随机选取渭南市3所社区卫生服务中心接受健康体检的老年人308人为调查对象。采用一般资料调查表、Lubben社交网络量表-6、老年人社会参与能力评估标准、日常生活活动能力量表进行调查。结果社区老年人社会隔离得分为(11.26±4.74)分,老年人中51.62%存在社会隔离。社区老年人社会隔离可划分为高朋友隔离组(52.92%)和低朋友隔离组(47.08%)2个潜在剖面。logistic回归分析显示,日常生活自理能力、社会参与能力、退休前职业、患病年限、年均住院次数是老年人社会隔离潜在剖面类别的影响因素(均P<0.05)。结论社区老年人社会隔离现象严重,且存在明显的分类特征,可针对不同类型特征老年人实施个体化干预,改善老年人社会隔离情况。

成人心搏骤停患者骨髓腔输液的证据总结

目的 :总结成人心搏骤停患者骨髓腔输液治疗的有关证据,为规范临床实践,优化成人心搏骤停患者血管通路建立提供参考依据。方法 :系统检索国内外数据库中关于成人心搏骤停患者骨髓腔输液治疗的所有证据,检索时限为建库至2023年5月1日,对纳入文献质量进行独立评价,提取并汇总证据。结果 :共纳入11篇文献,包括指南2篇、专家共识3篇、系统评价2篇、证据总结1篇和随机对照试验3篇。从人员组织管理、建立与移除时机、穿刺部位的选择、疼痛管理、并发症的预防和置管与输液效果6个方面总结了18条证据。结论 :本研究总结的成人心搏骤停患者骨髓腔输液的证据,可为医护人员正确使用骨髓腔输液提供参考依据,但在临床实践中还应有针对性地应用证据,从而提高心搏骤停患者骨髓腔输液治疗的效果及安全性。

上海市护理学会《成人住院患者肠外营养输注护理》团体标准解读

上海市护理学会于2023年11月发布了《成人住院患者肠外营养输注护理》团体标准,内容包括基本要求、操作流程、操作要点、通路维护及并发症的预防处理,旨在规范成人住院患者肠外营养输注护理。文章对该标准的护理实施要点进行解读,以期为临床护士更好地理解及正确应用标准、规范临床实践提供参考。

上海市护理学会《成人吸入性损伤患者的气道护理》团体标准解读

上海市护理学会于2024年5月发布了《成人吸入性损伤患者的气道护理》团体标准,对吸入性损伤患者气道护理的基本要求、护理要点、并发症预防及护理等进行了规范。本文对该团体标准的重点内容进行详细解读,并提出具体使用建议等,以期帮助临床护士更好地理解与应用标准,促进成人吸入性损伤患者气道护理质量提升提供参考。

ICU成人患者静脉血管通路装置评估与选择的最佳证据总结

目的系统检索、评价并整合ICU成人患者静脉血管通路装置评估与选择的最佳证据。方法依据PIPOST确立循证问题,按照“6S”金字塔模型系统检索相关数据库中ICU成人患者血管通路装置评估与适宜性选择的相关决策、指南、专家共识、证据总结、推荐实践、系统评价及原始研究等。检索时间为2018年6月1日至2023年6月1日。由2名经过循证护理培训的研究者对纳入文献独立进行文献质量评价与证据提取。结果共纳入14篇文献,其中临床决策3篇,证据总结1篇,指南4篇,专家共识4篇,随机对照试验2篇。共提取9个主题总结出34条最佳证据。结论ICU成人患者血管通路装置评估与选择的最佳证据总结可以为医护人员临床决策提供借鉴,但临床情境复杂多样,应根据患者病情变化及其自身情况适当调整选择策略。

ICU护士对体外循环心血管术后成年患者机械通气管理的现况调查

目的:调查国内ICU护士对体外循环(CPB)心血管术后成年患者机械通气管理的临床实践现况。方法:采用横断面问卷调查方法,2023年4月1日~6月1日向全国15个省、自治区、直辖市36家医疗机构的心脏外科重症监护病房(CSICU)护士发送电子调查问卷,并对调查结果进行分析。结果:共回收有效问卷132份,有效回收率99.25%。心脏外科术后初始机械通气模式中容量触发通气模式占60.61%,压力触发通气模式占19.70%,选择兼容2种触发优势的新型通气模式占15.91%。心脏外科术后潮气量初始设置中81名(61.36%)采用标准体重核算潮气量;有关PEEP的设定,60名(45.45%)护士选择5cm H_(2)O。机械通气管理权属44.70%医生负责、41.66%医生/护士协同调整,9.09%呼吸治疗师主导,4.55%护士主导。患者脱机时使用呼吸机通气模式CPAP为42.42%、SIMV为37.12%、PSV为8.33%、SPONT及其他12.12%。脱机拔管标准化流程,脱机前100.00%行自主呼吸实验,71.97%行气管插管气囊上分泌物清除,35.61%选择行气囊漏气实验,33.33%行最大吸气压监测,30.30%行咳嗽峰流速检测。结论:大多数CSICU护士对CPB心血管术后成人患者机械通气管理具备一定专业知识,但临床实践存在较大差异,亟需出台相关指南/专家共识等指导性文件。