The Clinical Value of Implementing Early Rehabilitation in the Nursing of Patients with Cerebral Infarction

Objective:This research studied the clinical value of implementing early rehabilitation in the nursing of patients with cerebral infarction.Methods:Eighty-four patients with cerebral infarction in Hubei Third People's Hospital from January 2019 to January 2021 were selected and divided into a control group and a study group using the digital table method in which routine care and early rehabilitation care were given respectively and the effects were observed.Results:Prior to the nursing intervention,there was no significant difference in the National Institutes of Health Stroke Scale(NIHSS)and Barthel index between the two groups of patients,P>0.05.After the nursing intervention,the NIHSS of the study group was lower than that of the control group whereas the Barthel index,Quality of Life Scale,and patient satisfaction in the study group were higher than the control group,P<0.05.Conclusion:The implementation of early rehabilitation in the nursing of patients with cerebral infarction can effectively improve their neurological function and quality of life in addition to a higher satisfaction among them.

The effect of the quality of vital sign recording on clinical decision making in a regional acute care trauma ward

Purpose： Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score （MEWS） uses vital signs to categorise the severity of a patient＇s physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Methods： Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator- measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL Results： The details of lgl newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88~; for respiratory rate, 98~; for blood pressure, 92% for temperature and 41~ for GCS. The recorded heart rate was positively correlated with the investigator＇s measurement （Pearson＇s correlation coefficient of 0.76）; while the respiratory rate did not correlate （Pearson＇s correlation coefficient of 0.02）. In 59~ of patients the recorded respiratory rate （RR） was exactly 20 breaths per minute and 27~ had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded （MEWS（R）） and investigator （MEWS（1）） vitals, with the range of MEWS（R） 0-7 and MEWS（1） 0-9. Analysis showed 59% of the MEWS（R） underestimated the physiological derangement （scores were lower than the MEWS（1））; 80%; of patients had a MEWS（R） requiring 4 hourly checks which was only completed in 2%;; 86% of patients had a MEWS（R） of less than three （i.e. not necessitating escalation of care）, but 33% of these showed a MEWS（1） greater than three （i.e. actually necessitating escalation of care）. Conclusion： Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients＇ physi- ological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts.

Purposeful and Ethical Early Childhood Teacher:The Underlying Values Guiding Finnish Early Childhood Education

Purpose:The new Finnish National Core Curriculum for Early Childhood Education and Care(2018)strongly highlights pedagogical knowledge and practice,demanding teachers to develop their pedagogical thinking,evaluation,judgment,and operating culture.Since ethics is viewed as vital characteristics of the teaching profession,our objective is to make these complex ethical issues more visible to be subject to democratic discussion and change.Design/Approach/Methods:The framework comprises a broad theory base of codes of ethics and professional codes of ethics of teaching.The research materials were national curricula of early childhood education and care(ECEC)-and pre-primary education.The eight-step qualitative analysis process was applied to identify and shed light on the codes of ethics laying the foundations forpurposeful and ethical earlychildhood education(ECE)teacher.Findings:The results indicate that through both theoretical lenses,the Finnish ECEC curricula comprise several ethical codes.For the future purposeful ECE teachers as ethical professionals,the results raise questions for further discussion.Particularly,issues related to the ethics of care,intellectual freedom,inquiry stance,and professional competence,and diversity may further enhance our ECEC curricula.

Effect of nursing-based on early rehabilitation on quality of life in elderly patients with cardiovascular disease:A randomized controlled trial

Background Patients with cardiovascular disease（CVD） have a reduced quality of life（QOL） partly due to their limited range of physical activity and independence. The objective of this study was to investigate whether the nurse based early cardiac rehabilitation will be improved QOL in elderly patients with CVD after8-week treatment from baseline and post intervention, compared with conventional care. Methods Sixty-six elderly patients with CVD were randomly assigned（using the coin tossing method） to either the ‘early cardiac rehabilitation＇ group（i.e. the experimental group）, and the control group（i.e. routine care group） for 8weeks between June 2013 and June 2014, with 33 participants in each group. The control group received routine CVD care, and the experiment group received early rehabilitation care in addition to routine CVD care.The outcome measures included the Short Form-36 Health Survey（SF-36）, and Self-rating Anxiety Scale（SAS）. Results There were non-significant differences between the groups at baseline in age, sex, duration of the disease, length of hospitalization, total number of comorbid conditions, and total number of medications（P 〉 0.05）. Following 8-week treatment, all groups improved their QOL scores and SAS anxiety scores（P 〈 0.05）. In addition, the nursing based on early cardiac rehabilitation group was significantly improved in QOL and SAS anxiety scores（P 〈 0.05）, when compared with the control group. Conclusions This study has demonstrated that the nurse based early cardiac rehabilitation is effective in increasing selected aspects of a general QOL and improved the anxiety situation in elderly patients with CVD. It is worthwhile to be widely used in clinical practice.

Orthopaedic management in the polytrauma patient

The past century has seen many changes in the management of the polytraumatized orthopaedic patient.Early recommendations for non-operative treatment have evolved into early total care(ETC)and damage control orthopaedic(DCO)treatment principles.These principles force the treating orthopaedist to take into account multiple patient parameters including hypothermia,coagulopathy and volume status before deciding upon the operative plan.This requires a multidisciplinary approach involving critical care physicians,anesthesiologists and others.