Umbilical Cord Care Practices and Cord Care Education of Mothers Attending Health Care (Pakistan Prospect)

Neonatal mortality is of global concern, it is the death in the first month of life. According to WHO, 2.4 million children died globally in the first month of life2. Globally the neonatal mortality rate declined slowly from 28/100 live births in 2000 to 17.9/100 live births in 2019. It is a major challenge for the low socioeconomic group of countries. Most neonatal deaths occurred in south Asia and African countries, in 2019 out of 2.4 million death 81% occurred in the Southeast Asia. Objective: To evaluate and improve cord care practices of mothers to reduce the risk of cord related infections. Methodology: The mixed method will be used in this research, questionnaire is used for data collection, total collected sample is 391. Results: 354 (91.0%) of the 394 patients analyzed obtained prenatal care (ANC) in both traditional and nontraditional settings. Among these, 288 (72.3%) got cord care health education, whereas 106 (27.7%) did not. The overall documentation of the instructions for the use of metabolized spirits alone included 116 (48.9%) teaching institutions and 103 (43.5%) private hospitals. the average results show the age of the baby 1 - 7 days, the average age of the mother is 18 - 25 years. The average education of the mothers is primary. Participation of health centers is average. Most of the participants has 1 child. Conclusion: This research concludes the poor umbilical cord practices and knowledge. Those with information used it better. Raise awareness about umbilical cord care and improper behaviors, including using mentholated balms. Before women leave the hospital, they should learn cord care. Mothers must clean wires. Several healthcare organizations don’t provide cord care instruction, and what they provide isn’t research-based.

Cord Care Practices and Omphalitis among Neonates Aged 3 - 28 Days at Pumwani Maternity Hospital, Kenya

Background: Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually about 4 million neonatal deaths occur around the world;of these, more than 30% are caused by infections. Majority of these infections start as umbilical cord infection. Objective: The aim of the present study was to establish cord care practices associated with omphalitis among neonates aged 3-28 days at Pumwani Maternity Hospital, Kenya. Methodology: Cross-sectional descriptive study was employed among 178 mothers with neonates of 3-28 days. Participants were selected systematically and data was collected on new-born cord care practices. Omphalitis was defined as pus discharge, redness with or without pus and swelling of umbilical cord. Pearson’s chi-square test (P < 0.05) was performed to compare the significant discrepancies. Crude and adjusted odds ratios with corresponding 95% confidence interval were also used to determine the strength of association between omphalitis and cord care practices. Results: Among 178 neonates, 67 (37.6%) were diagnosed with omphalitis. In logistic regression analysis, the main predictors of omphalitis were initiation of breastfeeding after one hour of delivery [AOR = 2.47;95%CI = 1.15 - 5.30;P < 0.05] compared to within one hour and application of saliva to the cord [AOR = 6.59;95%CI = 2.02 - 21.46;P < 0.01] compared to dry cord. Conclusion: The prevalence of omphalitis among neonates was high. Health workers need to participate in educating the mothers to initiate breastfeeding within one hour and to avoid application of harmful cord care practices.

Neonatal Umbilical Cord Infections: Incidence, Associated Factors and Cord Care Practices by Nursing Mothers at a Tertiary Hospital in Western Uganda

Background: Umbilical cord infections complicate to neonatal sepsis that significantly contributes to neonatal mortality worldwide. There is paucity of data on the incidence, factors associated with neonatal umbilical cord infections in western Uganda, yet nursing mothers continue to practice potentially dangerous cord care practices. We described the incidence, factors associated with umbilical cord infections and cord care practices by nursing mothers at a tertiary hospital in western Uganda. Methods: This was a hospital based cross sectional study at a tertiary hospital in western Uganda between the months of March and June 2019. Two hundred and forty (240) neonates aged between 2 to 14 days attending the neonatal unit were recruited in the study. Umbilical cord infection was assessed based on the World Health Organisation (WHO) clinical definition: finding of any of discharge, redness and swelling on the umbilical stump. Data on sociodemographic characteristics, maternal and neonatal perinatal factors and cord care practices of the nursing mothers were analysed by bivariate and multivariate logistic regression using STATA 13.0 to determine factors associated with umbilical cord infection. Results: Sixty-five, 65 (27.1%) neonates had at least one sign of cord infection. Majority of the nursing mothers, 168 (70%) do not use the recommended umbilical cord care practices. Among these, 73 (30.4%) do not cleanse the cord while 95 (39.6%) cleanse with application of a dangerous substance. Application of dangerous substance to the cord (aOR: 3.0, 95% CI: 1.37 - 6.37, p = 0.006) and maternal secondary education level (aOR = 2.1, CI = 1.01 - 4.18, p = 0.046) were significantly associated with umbilical cord infection. Conclusions: The incidence of neonatal umbilical cord infection is high in this setting. Application of a dangerous substance to the umbilical stump and maternal secondary education level were significantly associated with umbilical cord infection. Clinicians should routinely examine the umbilical stump of every neonate for the signs of infection and encourage mothers to avoid application of dangerous substances to the cord. Maternal education on the recommended cord care practices during antenatal and postnatal period could reduce the incidence of umbilical cord infection among neonates in low resource setting.

Determinants of Cord Care Practices among Mothers in Abakaliki, Ebonyi State, South East, Nigeria

Introduction: Unhygienic cord-care practices are major public health concern because of the associated gross neonatal and infant morbidity and mortality. Various factors have been linked to these practices. This study aims to identify the determinants of cord care practices among mothers in Abakaliki, Ebonyi State, South East, Nigeria. Methods: A cross sectional questionnaire based study involving women attending antenatal clinics and those who brought their babies to the immunization clinics of Federal Teaching Hospital, Mile Four Hospital and Maternal/Child Primary Health Care Center, all in Abakaliki. Results: Two hundred and seventy three mothers participated in the study. The majority of the participants aged 26 to 35 years (60.07%), had tertiary education (49.45%) and were business women (38.46%). Mothers who had secondary and tertiary education basically applied methylated spirit (p-value 0.0014) and chlorhexidine (p-value 0.0289) as a form cord care while those who had primary or no formal education cared for cord using hot water, Vaseline, close up tooth paste and local herbs. The mothers educational status, occupation and parity also determined the care given the umbilical cord after birth. Conclusion: Cord care practices are determined and influenced by several factors in Ebonyi State. Health education and awareness campaigns should be upheld and targeted among women of child bearing age found in women meetings, local markets and primary health care delivery centers especially in the rural setting.

Newborn Cord Care Practices Amongst Mothers in Yenagoa Local Government Rea, Bayelsa State, Nigeria

Background: Clean cord care is one of the essential newborn care practices recommended by the World Health Organisation to reduce morbidity and mortality amongst the World’s newborns. Despite this, cord infections are still prevalent in developing countries because of the high rates of unhygienic cord care practices. The study aimed to explore cord care practices in our environment and identify areas for intervention. Methods: This was a cross-sectional study carried out amongst mothers attending three primary health care facilities with their infants in Yenagoa Local Government Area of Bayelsa State, Nigeria. Simple structured questionnaires were used to obtain information concerning the ages and sexes of babies, place of antenatal care and birth, treatments applied to the umbilical cord stump and the socioeconomic status of the parents. Data were analysed using SPSS version 16.0. Results: Two hundred and twenty one mothers participated in the study. The infants were aged 0 - 6 months with a male to female ratio of 1:1. Fifty four (24.4%) of mothers were of high social class. Cord care was done by grandmothers in 107(48.4%) and mothers in 89(40.3%) of babies. Sixty four (29.0%) mothers had their babies cord cleaned with Methylated spirit alone while 138(62.4%) cleaned with Methylated spirit and then applied other substances including antibiotic ointments and herbs. Maternal education, social class of parents and place of delivery were significantly associated with application of potentially harmful substances to the cord, (p = 0.049, 0.010 and 0.030 respectively). The commonest sources of information on cord care were nurses in 99 (44.8%) and grandmothers in 44 (19.9%). Conclusion: There is still a high rate of use of potentially harmful substances for cord care. All heath workers should participate in educating, mothers and grandmothers about optimal cord care.

Decision-Making and Management of Self-Care in Persons with Traumatic Spinal Cord Injuries: A Preliminary Study

Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobehavioral determinants of SCI self-care behavior, such as impulsivity, are not widely studied, yet understanding them could inform efforts to improve SCI self-care. We explored associations between impulsivity and self-care in an observational study of 35 US adults age 18 - 50 who had traumatic SCI with paraplegia at least six months before assessment. The primary outcome measure was self-reported self-care. In LASSO regression models that included all neurobehavioral measures and demographics as predictors of self-care, dispositional measures of greater impulsivity (negative urgency, lack of premeditation, lack of perseverance), and reduced mindfulness were associated with reduced self-care. Outcome (magnitude) sensitivity, a latent decision-making parameter derived from computationally modeling successive choices in a gambling task, was also associated with self-care behavior. These results are preliminary;more research is needed to demonstrate the utility of these findings in clinical settings. Information about associations between impulsivity and poor self-care in people with SCI could guide the development of interventions to improve SCI self-care and help patients with elevated risks related to self-care and secondary health conditions.

脊髓损伤患儿父母照顾体验的质性研究

目的深入了解脊髓损伤患儿父母的照顾体验,为促进其身心健康提供参考。方法采用现象学研究方法,以立意抽样法抽取11名脊髓损伤患儿的父母进行半结构化访谈,运用Colaizzi分析法归纳主题。结果提炼出4个主题,分别为承受照顾负荷、心理体验复杂、适应角色改变并提高照顾技能、渴望家庭和社会支持。结论脊髓损伤患儿父母的照顾负荷较重,存在负性心理,医护人员需重视评估患儿父母照顾感受,并提供积极的心理干预指导,必要时提供适当的社会支持,以减轻其照顾负荷,改善其心理状况。

基于回授式健康教育的延续护理方案对内窥镜下声带息肉摘除术患者嗓音康复的影响

目的:探讨基于回授式健康教育的延续护理方案对内窥镜下声带息肉摘除术患者嗓音康复的影响,为临床护理干预提供依据。方法:选取2021年1—12月福建医科大学附属第一医院收治的64例行内窥镜下声带息肉摘除术的患者作为研究对象,采用随机数表法分为对照组与回授组,每组各32例。对照组接受常规院外随访,回授组接受基于回授式健康教育的延续护理方案,两组患者均干预1个月。比较两组患者干预前后嗓音障碍程度[中文版嗓音障碍指数(VHI)量表评分]、嗓音声学参数[基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)、最高基频(Fhigh)、最长发声时间(MPT)]情况。结果:干预1个月,回授组患者VHI量表中F、P、E 3个维度评分及T评分均明显低于对照组患者,差异有统计学意义(t=4.567、8.468、6.697、6.577,P<0.05)。干预1个月,回授组患者Jitter、Shimmer、NHR及嗓音障碍严重指数(DSI)显著低于对照组患者,MPT显著长于对照组患者,差异有统计学意义(t=10.219、4.243、5.657、3.628、6.754,P<0.05)。结论:构建并实施基于回授式健康教育的延续护理方案,有利于促进内窥镜下声带息肉摘除术患者的声带功能恢复,提高嗓音质量。

以问题为导向实施靶向性康复护理训练结合聚焦解决模式对脊髓损伤神经源性膀胱患者排尿功能及自护能力的影响

目的探讨以问题为导向实施靶向性康复护理训练结合聚焦解决模式对脊髓损伤神经源性膀胱患者排尿功能及自护能力的影响。方法择取2021年1月至12月西安市中医医院针灸推拿康复科门诊和住院的80例脊髓损伤神经源性膀胱患者为研究对象,采用随机数字表法将其分为对照组与观察组,各40例。对照组采用聚焦解决模式干预,观察组在对照组基础上加以问题为导向实施靶向性康复护理训练。比较两组的干预效果。结果干预后,观察组的单次排尿量、尿流率高于对照组,排尿次数、残余尿量少于对照组(P<0.05)。干预后,观察组的自我护理能力测定量表(ESCA)各维度评分均高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论以问题为导向实施靶向性康复护理训练结合聚焦解决模式不仅能够改善脊髓损伤神经源性膀胱患者排尿功能,还能提高其自护能力,减少并发症发生,值得推广。

护士-患者-照护者协同康复训练在促进腰椎骨折伴脊髓损伤患者康复中的作用分析

目的探讨护士-患者-照护者协同康复训练在促进腰椎骨折伴脊髓损伤(spinal cord injury,SCI)患者康复中的作用。方法使用随机数表法将2022年1月-2023年1月在空军军医大学第二附属医院就诊的68例腰椎骨折伴SCI患者分为对照组(n=34)和观察组(n=34)。给予对照组常规护理,在此基础上给予观察组护士-患者-照护者协同康复训练干预。比较两组干预前后自我护理能力测量表(exercise of self-care agency scale,ESCA)评分、家庭支持自评量表(family support scale,PSS-Fa)评分、改良Barthel指数(modified barthel index,MBI)、功能独立性评定量表(function independent measure,FIM)评分。结果干预后,两组ESCA评分、PSS-Fa评分、MBI指数和FIM评分均显著上升(P<0.05),且观察组干预后ESCA评分、PSS-Fa评分、MBI指数和FIM评分均显著高于对照组(P<0.05)。结论护士-患者-照护者协同康复训练可有效提高腰椎骨折伴SCI患者自护能力和家庭支持水平,对于提高康复训练效果、促进患者自主生活能力恢复有积极作用。

Factors Associated with Umbilical Cord Stump Healing Practices: Literature Review

Objective: To analyze the evidence in the evolution of scientific production on the factors associated with curative practices of the umbilical stump. Materials and Methods: The study data collection took place in April 2017. The electronic databases used to search the articles were: PubMed (National Library of Medicine and National Institutes of Health) and VHL (Virtual Health Library). We used the keywords “perinatal care”, “umbilical cord”, “patient care team”, “neonatology”, “newborn”, in the Portuguese, English and Spanish languages, accompanied by the expression AND and selected through DeCS (Descriptors in Health Sciences). Results: A final sample of 9 articles was obtained from the PubMed and VHL databases, which met the inclusions criteria. It has been found that traditional umbilical stump care practices are still present in many communities, however, have been replaced by appropriate practices, the most recommended being: chlorhexidine 4% sanitation, soap and water and alcohol antisepsis 70%. Conclusions: There is a need for multi-professional involvement, approaching these women since pregnancy, with detailed information and accessible language about proper care with the newborn and the umbilical stump.

新生儿娩出后脐带处理的最佳证据总结

目的总结正常足月新生儿出生后脐带处理的最佳证据,为临床实践决策提供参考。方法系统检索新生儿脐带处理相关的临床决策、临床实践指南、专家共识、证据总结和系统评价,分别对其方法学质量进行评价,随后对资料进行提取、分析并汇总成最佳证据。结果共纳入21篇文献,包括1篇临床决策、16篇指南、3篇专家共识和1篇系统评价。总结为脐带结扎、脐带挤压、脐带检查、脐带护理和尊重妇女意愿5个方面24条最佳证据。结论正常足月儿娩出后脐部处理最佳证据可为临床提供决策依据。临床应用时,应结合具体情境,并充分考虑妇女意愿,使母婴获益最大化。

脊髓内马尔尼菲篮状菌感染伴脓毒性休克患儿的护理

总结1例脊髓内马尔尼菲篮状菌感染伴脓毒性休克患儿的护理体会。针对患儿出现的脓毒性休克、难治性腹胀、下肢肌力恢复困难等问题,采取了积极抗休克、抗感染治疗、胃肠道功能保护以及个性化的康复训练等措施。经过53d的积极治疗与精心护理,患儿痊愈出院。

马斯洛需求理论联合治疗性沟通对脊髓损伤患者情绪、自我护理能力及应对方式的影响

目的探讨马斯洛需求理论联合治疗性沟通对脊髓损伤患者情绪、自我护理能力及应对方式的影响。方法选取2020年6月—2021年12月来医院康复科实施康复治疗的脊髓损伤患者111例作为研究对象。按照组间基本特征具有可比性的原则分为观察组(马斯洛需求理论联合治疗性沟通护理,65例)和对照组(马斯洛需求理论,46例),比较两组患者干预前和干预后3个月的情绪状态、自我管理和应对方式。同时,分析三者的影响关系。结果干预后,观察组SAS、SDS评分低于对照组,差异具有统计学意义(P<0.05);观察组自我护理技能、健康知识水平、自护责任、自我概念评分高于对照组,差异具有统计学意义(P<0.05);干预后,观察组积极应对评分高于对照组,观察组消极应对评分低于对照组,差异具有统计学意义(P<0.05)。结构方程结果显示,情绪状态对自我管理有正向影响,应对方式对自我管理有负向影响。自我管理对情绪状态和应对方式均有正向影响。结论马斯洛需求理论联合治疗性沟通对脊髓损伤患者有积极影响,可消除负性情绪,提升自我护理能力,增加积极应对方式,且自我管理可影响正向情绪状态和应对方式。

Orem自我护理模型在脊柱骨折合并脊髓损伤高位截瘫患者中的应用

目的 分析Orem自我护理模型在脊柱骨折合并脊髓损伤高位截瘫患者的应用。方法 选取2016年1月至2021年7月收治的脊柱骨折合并脊髓损伤高位截瘫患者96例随机分为对照组和观察组,每组48例。对照组术后进行常规护理,观察组进行Orem自我护理模型护理,2组均干预至术后3个月。比较2组术后1周和术后3个月自我护理行为、心理状态和睡眠质量、生活质量,统计2组术后3个月功能锻炼依从性及干预期间并发症发生情况。结果 术后3个月与术后1周比较,2组日常行为、处理行为、控制行为、检测行为评分及独立性、生理、心理、环境、社会关系、精神支持评分均升高(P<0.05),且观察组高于对照组(P<0.05)。术后3个月与术后1周比较,2组SAS、SDS、PSQI评分降低(P<0.05),且观察组低于对照组(P<0.05)。术后3个月,观察组功能锻炼总依从率(93.75%)显著高于对照组(79.17%,P<0.05)。干预期间,对照组总并发症发生率高于观察组(P<0.05)。结论 Orem自我护理模型护理可有效提高脊柱骨折合并脊髓损伤高位截瘫患者自我护理行为、生活质量、功能锻炼依从性,改善患者心理状态和睡眠质量,降低并发症的发生,具有较好的干预效果。

颅脑损伤合并颈椎颈髓损伤手术研究

在颅脑损伤患者中有较多患者同时存在颈椎颈髓损伤,颈椎颈髓损伤存在一定的漏诊,而确诊颈椎颈髓损伤后的治疗时机、手术方案仍存在一定争议。该文就颅脑损伤合并颈椎颈髓损伤患者早期诊断、院前急救、如何提高确诊率、合并伤治疗方式选择、颈部手术方案及时机选择、术后注意事项、护理康复、前沿进展等方面进行综述,对提高多学科、多科室协同治疗多发伤有一定帮助,可在一定程度减少漏诊,提高诊断准确性,提高救治效果。

脊髓损伤患者延续性护理需求现状及影响因素分析

目的:探讨脊髓损伤患者延续性护理需求的现状及影响因素。方法:选取2018年1月—2022年4月常州市第一人民医院收治的脊髓损伤患者327例为调查对象,采用一般资料问卷和脊髓损伤患者出院后延续护理需求调查表进行问卷调查。结果:脊髓损伤患者延续性护理需求较高,其中排在前3位的是健康教育需求、并发症预防护理需求、康复指导需求;性别、文化程度、经济来源、付费方式、脊髓损伤严重程度评定标准分级和合并并发症是影响患者延续护理需求的因素。结论:脊髓损伤患者的延续护理需求较高且受多种因素的影响,因此,制定脊髓损伤患者延续护理模式,为其出院后提供专业、系统的延续护理服务尤为重要。

规范化康复护理对脊髓损伤后二便障碍患者的影响探究

目的:观察脊髓损伤后二便障碍患者采取规范化康复护理对患者的影响。方法:本文选取2020年1月到2021年12月我院收治的48例脊髓损伤后二便障碍患者作为研究对象,应用随机数表法分为两组,对照组行常规护理,观察组行规范化康复护理。结果:观察组首次排尿时间、首次排便时间、排便时间低于对照组,观察组SAS、SDS低于对照组,ADL评分高于对照组,差异有统计学意义(P<0.05)。结论:针对脊髓损伤二便障碍患者,采取规范化康复护理,能够有效缩短患者首次排尿以及排便时间,有利于改善患者负面情绪,提高日常生活能力。

老年创伤性脊髓损伤现状及延续护理研究进展

从老年创伤性脊髓损伤的发病率、受伤原因、损伤平面和严重程度、死亡率、生活质量及延续护理等方面进行综述,旨在进一步探索适合老年创伤性脊髓损伤病人的延续护理模式。

延续性护理在神经源性膀胱中的应用进展

神经源性膀胱(NGB)属于一类由于神经系统病变导致的膀胱或尿道功能出现障碍,是脊髓损伤后最严重的并发症之一,以尿频、尿急、尿失禁、尿潴留等为主要临床表现。针对患者实施治疗时必须紧密结合针对性护理,才能产生最佳的临床效果。延续性护理作为一种新型护理模式,相较于传统护理体系,其因具有连续性、协调性与高效性等护理优势而深受患者及照护者青睐。本研究中笔者就延续性护理在NGB患者中的应用情况进行了相关探讨,对延续性护理理念、方式、内容以及应用过程中存在的问题、解决措施等进行相关综述,取得了有价值的成果,旨在为更好服务于临床提供参考。