Research Article: Participation of patients with chronic illness in nursing care: An Iranian perspective

The increasing number of chronically ill people has served as an impetus for the promotion of patient participation in nursing care. However, little is known about patient participation in Iran. The aim of this study was to identify the factors that are relevant to patient participation and the nature of that participation, as experienced by chronically ill patients and registered nurses in Iran. Grounded theory was used as the method. Twenty‐two participants were recruited by using purposeful and theoretical sampling. The data were generated by semistructured interviews and participant observations. Constant comparison was used for the data analysis. This study indicated that participation is an interactive process between nurses, patients, and family members in the caregiving context. Participation occurred when the caring agents worked together. The core category of “convergence of the caring agents” emerged. The subcategories emerged as the levels of participation and included “adhering”, “involving”, “sharing”, and “true participation”. The factors related to the caring agents and caregiving context could be considered as predictors of the level of participation when caring for these patients.     

An observational study on the open-system endotracheal suctioning practices of critical care nurses

Aim and objectives. The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses’ practices prior to, during and post‐ETS and to compare nurses’ ETS practices with current research recommendations. Background. ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life‐threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis. Design and method. In March 2005, a structured observational study was conducted using a piloted 20‐item observational schedule on two adult intensive‐care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to. Results. The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower‐quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions. Conclusion. The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses’ daily suctioning practices. Relevance to clinical practice. As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses’ ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures.     

An observational study of how patients are identified before medication administrations in medical and surgical wards

The aims of this study were to clarify how a patient's identity was verified before the administration of medication in medical and surgical wards in a hospital, as well as to study the association between patient identification and the registered nurse's work experience, observed interruptions, and distractions. The study material was collected during April and May 2012 in two surgical and two medical wards in one university hospital in Finland, using a direct, structured observation method. A total of 32 registered nurses were observed while they administered 1058 medications to 122 patients. Patients were not identified at all in 66.8% (n = 707) of medication administrations. Patient identifications were made more often by nurses with shorter work experience in the nursing profession or in the wards (4 years or less), or if distractions existed during medication administration. According to the results, patient identification was not adequately conducted. There is a need for education and change in the culture of medication processes and nursing practice.     

老年慢性病患者抑郁情绪与躯体症状的相关性研究

目的调查老年慢性病患者抑郁情绪与躯体症状,并探讨二者之间的关系。方法应用抑郁自评量表与躯体化症状自评量表对300例老年慢性病患者进行调查,比较不同抑郁程度患者躯体症状的差异,分析抑郁情绪与躯体症状的关系。结果慢性病患者抑郁自评量表总分为(65.91±8.26)分,抑郁患者占54.67%;慢性病患者躯体化症状呈自评量表总分为(67.79±3.52)分。相关分析显示,抑郁与躯体化症状呈正相关(P0.01)。结论抑郁情绪是影响老年慢性病患者躯体症状的因素,临床医护工作者应重视心理因素在躯体疾病中的治疗作用,对患者做好相应的心理护理。     

延续性护理服务模式在老年慢性病病人护理中的应用

[目的]探讨延续性护理服务模式应用于老年慢性病病人中的效果。[方法]将800例病人随机分为观察组412例和对照组388例,两组病人均给予常规的护理干预,观察组在此基础上提供延续性护理。[结果]观察组合理膳食、良好生活习惯、准确服药、定期复诊率及出院后满意度明显高于对照组(P0.05),再次住院次数明显少于对照组(P0.05)。[结论]根据病人不同康复阶段,制订有针对性的延续性护理方案,可以提高病人对治疗和服药的依从性,提高病人的生活质量以及对医疗护理服务的满意度。     

对老年慢性病患者实施居家护理的效果分析

目的探讨居家护理对提高老年慢性病患者居家护理的效果分析。方法将141例老年慢性病患者分为观察组和对照组,观察组75例,对照组66例。观察组实施出院后居家护理：包括电话随访和上门访视。对照组出院后不实施居家护理。比较两组患者出院后6个月的Barthel指数得分、再住院率,并对居家护理工作满意度进行问卷调查。结果出院后6个月观察组Barthel指数、再住院率与同期对照组比较差异具有统计学意义（P〈0．01）,出院后观察组患者对居家护理工作表示满意。结论实施居家护理可以提高老年慢性病患者的日常生活能力,降低再住院率。     

Information level of patients in discharge training given by nurses following open heart surgery

Ozcan H, Findik UY, Sut N. International Journal of Nursing Practice 2010; 16 : 289–294
Information level of patients in discharge training given by nurses following open heart surgery Providing discharge information following a surgery is one of the most common nursing approaches. Patients should be given discharge training after open heart surgery in order to eliminate or reduce physical and emotional problems. The study aims to assess the information level of patients in discharge training provided by nurses following open heart surgery. The study is a prospective study including 50 patients who underwent open heart surgery. The information level of patients who received discharge training was assessed before training and 1 month after the training. Data were collected using the personal information form, and pretest and post‐test questionnaires. Data were assessed by using percentage, McNemar chi‐squared, Wilcoxon signed ranks and stepwise linear regression analysis tests. Results indicated that patients were well informed following discharge training (Z = ?6.166, P < 0.05), and that age and marriage variables affected the information level (P = 0.032, P = 0.045, respectively). Discharge training following open heart surgery increases the knowledge of patients and should be given to patients in a planned manner.     

What do lymphedema patients expect from a treatment and what do they achieve? A descriptive study

PurposeLymphedema is characterized by swelling and fibroadipose tissue deposition that is a physically, psychologically, and socially debilitating condition due to chronic and progressive nature of the disease. Treatment benefit evaluation from the patient's perspective is important for medical decision-making. The aim of this study is to investigate important treatment goals and benefits of treatment from the patients’ perspective.MethodEighty-one patients with lymphedema, lipoedema, or lipolymphoedema who are currenlty treated or who underwent previous treatment were included in the study. Socio-demographic data was recorded. Important goals and benefit from treatment were assessed with Patients Needs Questionnaire and Patient Benefit Questionnaire which are sub-questionnaires of Patient Benefit Index-Lymphedema.ResultsThe most important expectation and needed item was “To find a clear diagnosis and therapy” (n:59, 72%). The least important item for the lymphedema patients was “To feel more attractive” (n:9, 11%). Most beneficial effect of treatment was “To have no fear that the disease will become worse” (n:37, 45.7%). “To have fewer out of pocket treatment expenses” was rated as the least beneficial effect of treatment (n:24, 29.6%).ConclusionsIt is important to identify patients' needs and expectations. Patients should be referred for treatment according to their needs. The effectiveness of the treatment should be evaluated objectively. Patient education should be considered as a part of the effective treatment to teach patients how to control their lymphedema. A clear diagnosis and access to treatment should be ensured for lymphedema patients. Regulations for health insurance benefit coverage are needed to cover cost of compression garments.     

The emergency nurse responses to triage interruptions and how these responses are perceived by patients: An observational,prospective study

BackgroundHealthcare providers’ responses to triage interruptions in the emergency department affect quality of care. The purposes for this study were to (1) Examine the relationship between nurses’ response to triage interruption and each of, patients’ perceived confidence in nurses’ technical skills, perceived competence of triage nurse, and satisfaction with the triage experience, (2) Examine the relationship between nurses’ response to triage interruption and nurse demographics.MethodsUsing an observational, prospective design, this study was conducted in an adult academic level 1 trauma center. Data collection tools were: The Triage Interruptions Assessment Tool, Triage and Provider Satisfaction and Confidence Survey, and Demographic Questionnaire.ResultsThe number of observed triage interviews is 93. Of them, 66 interviews were interrupted. No significant relationships were found between nurses’ response to the interruption and patients’ perceived confidence in nurses’ technical skills, competence of triage nurse, or satisfaction with triage experience. There were no significant relationships between nurses’ response to triage interruptions and nurses’ demographics.ConclusionsTriage interruptions in the emergency environment are common and most often result in delays in care. In the current study, this has not been shown to affect patients’ satisfaction. Nurses’ individual characteristics did not affect their responses to triage interruptions.     

社区护士在促进慢性病病人自我管理中的作用

对慢性病目前的流行现状及其病人的自我管理情况进行分析,重点阐述社区护士在促进慢性病病人自我管理中的作用。     

信息-动机-行为技巧模型在慢性病病人中的应用现状

对信息-动机-行为技巧模型的理论背景、理论框架进行概述,探讨在慢性病病人护理中的应用现状,以期为慢性病病人的健康行为干预提供参考依据。     

Family functioning evaluated by family members of older patients and nurses in emergency departments

The functioning of families in emergency departments (ED s) encompasses the level at which the families of older patients perform as a whole during the ED stay. Currently, little is known about how the families of older patients function in EDs. In this study, family functioning included the subareas of family strengths, structural factors and relationships both inside and outside the family. The study aimed to describe family functioning in EDs as evaluated by both the family members (n  = 111) of older patients and nurses (n  = 93). The data were collected from four Estonian hospitals, and the scale used was the Family Functioning, Health and Social Support scale. The results showed that both the family members and nurses evaluated family functioning and all its subareas as being moderate. Family structural factors were found to be associated with the family members’ social status. The scores in the subareas were higher when older patients had received help from family members before the ED visit. The family members and nurses differed significantly in the scores they gave for family functioning in general and for all the subareas. No association was found between family functioning as rated by nurses and the families’ demographic characteristics. These results suggest that nurses should pay more attention to family functioning in general and to the structural factors within the family, including internal relationships, while older patients are in the ED . Comprehensive knowledge about how families function during an ED stay may help nurses to better meet the needs of older patients and their families and help them to prepare families to provide aftercare at home. Our findings support the idea that healthcare organisation and delivery should be more family centred.     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

慢性阻塞性肺疾病急性加重期患者的院前急救护理

目的观察慢性阻塞性肺疾病急性加重期（acute exacerbations of chronic obstructive pulmonary disease,AECOPD）患者的院前急救护理经验。方法对实施院前急救护理的80例AECOPD患者的临床资料进行回顾性分析和总结。结果经院前急救护理,80例患者病情程度评分为（1.27±0.50）分,为轻～中度。死亡1例（1.25%）,无1例患者发生呼吸道阻塞。结论院前急救护理有助于改善AECOPD症状,降低病死率,提高救护效果。     

老年慢性病患者抗菌药物使用知识与使用行为现状调查

目的了解老年慢性病患者抗菌药物使用知识与使用行为的现状,为规范老年慢性病患者健康教育提供依据。方法选取232例既往1年内使用过抗菌药物的老年慢性病患者进行抗菌药物使用知识和使用行为调查。结果老年慢性病患者抗菌药物知识总得分率为67.57%,在5个知识维度中,得分率最低的是耐药性维度(58.13%);老年慢性病患者抗菌药物使用行为总得分率为70.16%,使用方法维度得分率最低(64.32%)。结论老年慢性病患者抗菌药物使用相关知识不足,其抗菌药物使用行为有待纠正。医护人员要重视对使用抗菌药物的老年慢性病患者进行健康教育和用药指导,以促成其正确合理地使用抗菌药物,减少不合理用药行为的发生。