4th Austrian SIDS Consensus-Consultation and the Viennese SIDS prevention campaign "Secure Sleep"

Despite numerous investigations the pathophysiologic mechanisms of SIDS have not been fully elucidated. In large epidemiologic studies highly variable SIDS mortality rates were noted between different countries and cultures. This presumably is due not only to differences in diagnostics and classification of SIDS but also in lifestyle and newborn care. The common denominator is the identification and prevention of the main risk factors: smoking, sleeping in the prone position, over-heating, wrong "bedding". SIDS prevention campaigns that have focussed upon these risk factors have led to a dramatic reduction in the incidence of SIDS. In preparation for the SIDS prevention campaign of Vienna ("Safe Sleep") the content, strategy and procedure of the Austrian prevention campaigns were analysed. The current focus is to convey a clear and uniform message in personal conversations before and after birth of the child. These conversations with parents are the most important tool to detect SIDS related anxiety and a possibly increased risk of SIDS. In the last 30 years various polysomnographic parameters were published that were associated with an increased risk of SIDS. Today there is international consent that polysomnography is not an efficient screening method to demonstrate increased risk of SIDS. Therefore the use of polysomnography, besides research purposes, has been limited to investigating clinical symptoms of infants and children. Concerning monitoring it is important to note that--in contrast to the undisputed importance of monitoring breathing disorders--the effectiveness in SIDS prevention is unproven. State of the art are instruments that monitor heart and breathing rate and have adequate storage functions. The duration of monitoring should encompass the symptomatic period as well as a safety period of three months. The monitor should not be routinely prescribed for a year. The guiding principle is "As short as possible with stringent indication". Prerequisite for the monitoring is good instruction of the parents and a continuous consultation by competent outpatient clinics.     

Role of the speech-language pathologist in palliative hospice care

In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. Swallowing difficulties may result in discomfort for patients and concern from caregivers. Patient care provided by the speech-language pathologist can align with the framework of the World Health Organization's components of palliative care. Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.     

Clinical nurse specialist practice within the Acute Care for Elders interdisciplinary team model

As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.     

Interdisciplinary roles in stroke care

Care of the stroke patient presents a complex challenge to the interdisciplinary stroke team. The physical therapist, occupational therapist, and clinical social worker are important members of that team, each of whom contributes specialized knowledge and interventions in behalf of the patient. The physical therapist focuses on prevention of joint and tissue injury and retraining of lost motor skills. The occupational therapist considers the total patient in his or her environment and assists the patient in regaining or improving function in all areas of daily living. The clinical social worker concentrates on psychosocial assessment and intervention with the patient and family, aiding them in the adjustment process and planning for discharge. The nurse, in addition to playing a unique role in the delivery of nursing care to the stroke patient, is in a position to serve as coordinator of the interdisciplinary team. The nurse can facilitate the work of the physical and occupational therapists and the social worker by providing them with timely referrals, valuable assessment information and insights, and reinforcement of therapeutic activity while the patient is on the nursing unit. The keys to making the interdisciplinary team work for the maximal benefit of the patient are threefold: mutual respect and understanding among team members; ongoing coordination of efforts; and open communication between all team members, the patient, and the family. These elements are interrelated and essential if the interdisciplinary team is to be successful at meeting its ultimate goal: expert care of the total patient to achieve maximal independence.     

INTERDISCIPLINARY REHABILITATION

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Postdoctoral Research Training in Palliative Care: Lessons Learned From a T32 Program

Our aging population and advances in chronic disease management that prolong the time that patients live with a chronic illness have combined to create an enormous need for improved palliative care research across diverse diseases. In this article, we describe the structure and processes of a National Institutes of Health-funded T32 postdoctoral research fellowship at the University of Washington and our experiences in developing and implementing the program. We recognize a broad definition of palliative care research, including research focused on improving quality of life, minimizing symptoms, providing psychological and spiritual support, and improving communication about patients' values and goals of care, all in the context of a serious illness. We describe our four core principles for postdoctoral training in palliative care research, each with a number of specific approaches: 1) mastering a set of essential content and research skills; 2) structured mentoring and academic career development; 3) creating and supporting early success; and 4) interdisciplinary training and team science. In addition, we also describe our framework for the essential competencies necessary for a palliative care research training program, our methods for identification and selection of applicants, our outcomes to date, and our processes of continuous quality assessment and improvement. Our goal is to describe our successful postdoctoral research training program in palliative care to promote development of new programs and share information between programs to continue to build the field of collaborative and interdisciplinary palliative care research.     

SIDS related anxiety--a risk factor analysis

BACKGROUND: The growing public interest in the Sudden Infant Death Syndrome (SIDS) has led to a new psychological problem--SIDS related anxiety (SRA). General public awareness, unfavourable experience in the past, present problems with the infant or insufficient support from the family may lead or contribute to SRA. OBJECTIVE: The study was conducted to explore which of these factors contribute most to the development of SRA. PATIENTS AND METHODS: Families visiting our outpatient clinic during 18 months were interviewed by means of a structured questionnaire. We assessed demographic data, obstetric history, experience of child loss, pregnancy and delivery complications, infant morbidity, family-child interaction, family support and the relation of each of these single factors to SRA. RESULTS: Of 169 families, 58% (98/169) admitted to suffer from SRA and 21% (32/156) from severe SRA. We found a strong and significant relationship between previous experience of child loss and SRA (OR: 2.95, 95% CI: 1.43-6.09, P < 0.005) and between pregnancy complications and SRA (OR: 2.19, 95% CI: 1.18-4.08, P < 0.05). There were no significant relationships between SRA and either delivery complications, child morbidity, impaired family-child interaction or insufficient support from the family. CONCLUSIONS: SRA occurs in an unexpectedly large proportion of families visiting a SIDS counseling clinic. SRA must be taken seriously, and psychological or psychotherapeutic help should be offered. Prevention of SRA should include psychological care for families who experience loss of children or high-risk pregnancies.     

Communication and end-of-life care in the intensive care unit: patient, family, and clinician outcomes

Even though good communication among clinicians, patients, and family members is identified as the most important factor in end-of-life care in ICUs, it is the least accomplished. According to accumulated evidence, communication about end-of-life decisions in ICUs is difficult and flawed. Poor communication leaves clinicians and family members stressed and dissatisfied, as well as patients' wishes neglected. Conflict and anger both among clinicians and between clinicians and family members also result. Physicians and nurses lack communication skills, an essential element to achieve better outcomes at end of life. There is an emerging evidence base that proactive, multidisciplinary strategies such as formal and informal family meetings, daily team consensus procedures, palliative care team case finding, and ethics consultation improve communication about end-of-life decisions. Evidence suggests that improving end-of-life communication in ICUs can improve the quality of care by resulting in earlier transition to palliative care for patients who ultimately do not survive and by increasing family and clinician satisfaction. Both larger, randomized controlled trials and mixed methods designs are needed in future work. In addition, research to improve clinician communication skills and to assess the effects of organizational and unit context and culture on end-of-life outcomes is essential.     

Achieving clinical nurse specialist competencies and outcomes through interdisciplinary education

Without formal education, many healthcare professionals fail to develop interdisciplinary team skills; however, when students are socialized to interdisciplinary practice through academic clinical learning experiences, effective collaboration skills can be developed. Increasingly, educational environments are challenged to include clinical experiences for students that teach and model interdisciplinary collaboration. PURPOSE: The purpose of this quality improvement initiative was to create an interdisciplinary educational experience for clinical nurse specialist (CNS) students and postgraduate physicians. DESCRIPTION OF THE PROJECT: The interdisciplinary learning experience, supported by an educational grant, provided an interdisciplinary cohort of learners an opportunity to engage in a clinically focused learning experience. The interdisciplinary cohort consisted of CNS students and physicians in various stages of postgraduate training. The clinical experience selected was a quality improvement initiative in which the students were introduced to the concepts and tools of quality improvement. During this 1-month clinical experience, students applied the new skills by implementing a quality improvement project focusing on medication reconciliation in the outpatient setting. The CNS core competencies and outcomes were used to shape the experience for the CNS students. OUTCOME: The CNS students exhibited 5 of the 7 essential characteristics of the CNS (leadership, collaboration, consultation skills, ethical conduct, and professional attributes) while demonstrating competencies and fulfilling performance expectations. During this learning experience, the CNS students focused on competencies and outcomes in the organizational sphere of influence. Multiple facilitating factors and barriers were identified. CONCLUSION: This interdisciplinary clinical experience in a quality improvement initiative provided valuable opportunities for CNS students to develop essential CNS characteristics and to explore practice competencies in the area of systems. IMPLICATIONS: Interdisciplinary clinical experiences offer students opportunities to develop needed collaboration and communication skills. Educators should create interdisciplinary educational experiences for students to better prepare them for their roles in a clinical setting.     

Postoperative Delirium Prevention as Standard Practice in Occupational Therapy in Acute Care

Abstract

Postoperative delirium (POD) is common, especially among older adults, and can significantly impact health and rehabilitation outcomes. Research evidence suggests that a multicomponent intervention is most effective for delirium prevention. Given that this intervention includes diverse components, interdisciplinary collaboration among members of the healthcare team is essential. This paper presents how occupational therapists, as part of the interdisciplinary acute care team, contribute to preventing POD and embed their unique value, skills, and strengths in each component of the collaborative intervention. This paper also argues that POD preventive care should be standard practice for occupational therapy in the acute care setting.     

呼吸道护理小组的建立与实践

目的探讨医院内建立呼吸道护理小组的方法与效果。方法成立了呼吸道护理小组,修订和完善呼吸道管理的实践标准,进行呼吸道护理理论及技能培训,建立质量监督体系和呼吸道护理会诊制度。结果提高了呼吸道护理小组成员的理论知识及专科技能水平,降低了呼吸道护理意外的发生,提高了医生及病人对护理工作的满意度。结论呼吸道护理小组可以使住院病人的呼吸道管理更趋安全性,促进了医院专科护理的发展。     

ICU新型冠状病毒感染防控管理体系的建立及成效

目的 探讨ICU新型冠状病毒感染防控管理体系的效果。方法 通过文献回顾、总结并结合科室现状,成立ICU新型冠状病毒感染防控管理小组,并制定了ICU新型冠状病毒感染防控管理体系,内容包括ICU在新型冠状病毒感染预防和管理措施、人力资源的调配、上岗前的防护培训、前线队伍的组建、特殊时期的人文关怀等方面。在执行防控管理体系的过程中,根据专家意见和不断更新的知识,以及效果反馈,对防控管理体系持续改进优化。结果 本管理体系自执行以来,共开展线上培训16场,派出6个批次共60人次的前线队伍,组建了1个心理咨询小组,完成10人次的心理咨询,截止2月12日,ICU医务人员零感染,患者之间未出现交叉感染。结论 通过科学构建和执行ICU新型冠状病毒感染防控管理体系,能够有效应对新型冠状病毒感染疫情,完成对重症患者的救治和护理,同时保障了前线ICU医务人员的身心健康,为抗击疫情提供高质量的人力资源保障。     

急诊实习护生护患沟通技巧与能力的培养

目的:探讨急诊实习护生护患沟通技巧与能力的培养方法。方法:针对急诊不同人群心理需求特征,指导护生多观察多总结,掌握语言沟通技巧和非语言沟通技巧,并根据患者不同心理需求灵活运用语言和非语言沟通技巧,使护生与患者在较短时间内得到有效沟通。结果:对患者不同心理需求灵活运用语言和非语言沟通技巧,使护生与患者的沟通能力在较短时间内得到了有效提高。结论:针对性地对急诊实习护生进行护患沟通技巧与能力的培养,可以提高护理质量,减少护患纠纷,建立和谐的急诊护患关系。     

Comprehensive care of adults with acute ischemic stroke

Stroke continues to represent the leading cause of long term disability despite positive achievements in the last few years. An estimated 50 million stroke survivors world wide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors will require some assistance or are fully dependent on caregivers for activities of daily living. The interdisciplinary team approach, with the nurse playing the central role, is important across the continuum of care. Families must cope with the impact of stoke on their daily lives once the acute phase of stroke care is over. Studies have shown personal and environmental factors influence outcomes after stroke. Patient and family education during the acute phase of stroke care is vitally important. There is also a need to educate nursing and other members of the interdisciplinary team about the potential for recovery in the later or more chronic phases of stroke care. The goal of hospitals seeking and obtaining certification as a Primary Stroke Center is to provide the best possible outcomes for patients suffering a stroke. An organized evidence-based approach to each aspect of stroke care contributes to the quality of the outcomes and requires an infrastructure that the organized center can provide. Stroke is a complex disease process that requires the skills of an interdisciplinary team. Prevention of medical complications and neurologic deterioration is key in managing patients with acute ischemic stroke. The use of clinical pathways and physician standing orders helps to guide the team in managing the care of stroke patients in the acute phase of care. Traditionally the role of educating patients and families about the modifiable and treatable risk factors, and the nonmodifiable risk factors for stroke has been a nursing responsibility. Because patient education is a performance standard for primary stroke centers, nurses must be well informed regarding evidence-based practices associated with effective lifestyle modification strategies for a diverse population.     

The palliative care interdisciplinary team: where is the community pharmacist?

Palliative care emphasizes an interdisciplinary approach to care to improve quality of life and relieve symptoms. Palliative care is provided in many ways; in hospices, hospital units, and the community. However, the greatest proportion of palliative care is in the community. In hospice and palliative care units in hospitals, clinical pharmacists are part of the interdisciplinary team and work closely with other health care professionals. Their expertise in the therapeutic use of medications is highly regarded, particularly as many palliative care patients have complex medication regimens, involving off-label or off-license prescribing that increases their risk for drug-related problems. However, this active involvement in the palliative care team is not reflected in the community setting, despite the community pharmacist being one of the most accessible professionals in the community, and visiting a community pharmacist is convenient for most people, even those who have limited access to private or public transport. This may be due to a general lack of understanding of skills and knowledge that particular health professionals bring to the interdisciplinary team, a lack of rigorous research supporting the necessity for the community pharmacist's involvement in the team, or it could be due to professional tensions. If these barriers can be overcome, community pharmacists are well positioned to become active members of the community palliative care interdisciplinary team and respond to the palliative care needs of patients with whom they often have a primary relationship.     

Interdisciplinary teamwork: is the influence of emotional intelligence fully appreciated?

AIM: The purpose of this study is to discuss how emotional intelligence affects interdisciplinary team effectiveness. Some findings from a larger study on interdisciplinary teamworking are discussed. BACKGROUND: Teams are often evaluated for complementary skill mix and expertise that are integrated for specialist service delivery. Interactional skills and emotional intelligence also affect team behaviour and performance. An effective team needs both emotional intelligence and expertise, including technical, clinical, social and interactional skills, so that teamwork becomes greater or lesser than the whole, depending on how well individuals work together. KEY ISSUES: Team diversity, individuality and personality differences, and interprofessional safety are analysed to raise awareness for nurse managers of the complexity of interdisciplinary working relationships. CONCLUSION: If nursing input into interdisciplinary work is to be maximized, nurse managers might consider the role of emotional intelligence in influencing team effectiveness, the quality of client care, staff retention and job satisfaction.