RESUMEN
In the neurosurgery patient population, one of the most frequent complications is postoperative nausea and vomiting (PONV). The purpose of this predictive correlational study was to examine the incidence and predictors of PONV in a cohort of 519 neurosurgery patients undergoing elective spinal and intracranial procedures. Patients were interviewed, and their medical records were reviewed every 24 hours for up to 72 hours postoperatively to identify risk factors for PONV development. After summarizing univariate associations, a multivariable logistic regression model for each outcome was developed using forward and backward stepwise selection, with the p value for a variable to enter or leave the model set to .05. Women, especially those who were younger and with a history of PONV, were most likely to have PONV. In addition, those undergoing craniotomy, particularly infratentorial craniotomy, were more likely to have PONV compared with patients undergoing spine surgery. This study provides a foundation for nursing and interdisciplinary intervention studies aimed at reducing this postoperative symptom in the most susceptible patients.
Asunto(s)
Craneotomía/efectos adversos , Procedimientos Neuroquirúrgicos/efectos adversos , Náusea y Vómito Posoperatorios/epidemiología , Anestesia General/efectos adversos , Humanos , Incidencia , Persona de Mediana Edad , Enfermería en Neurociencias , Náusea y Vómito Posoperatorios/etiología , Factores de Riesgo , Factores SexualesRESUMEN
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars. SUMMARY OF BACKGROUND DATA: This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications. METHODS: A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex. RESULTS: All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar. CONCLUSION: All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.
Asunto(s)
Vértebras Cervicales/fisiopatología , Aparatos Ortopédicos/efectos adversos , Aparatos Ortopédicos/estadística & datos numéricos , Rango del Movimiento Articular/fisiología , Adolescente , Adulto , Anciano , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión , Adulto JovenRESUMEN
BACKGROUND: Ethical conflicts, often leading to poor teamwork and moral distress, are very challenging to patients, patients' families, and health care providers. A proactive approach to ethical conflicts may improve patient care outcomes. OBJECTIVES: To examine acceptability and feasibility of an ethics screening and early intervention tool for use by nurses caring for critically ill patients. METHODS: Twenty-eight nurses in 2 medical centers applied the ethics screening tool to 55 patient situations. Nurses assessed situations for risk factors and early indicators of ethical conflicts and analyzed level of risk. At study completion, nurses participated in focus group discussions about the tool's benefits and challenges. Frequency counts were performed on risk factors and early indicators of ethical conflicts. Content analysis was used on written explanations regarding high-, medium-, and low-risk situations and on focus group data. RESULTS: Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium- and low-risk situations. Certain risk factors featured prominently in high-risk situations. CONCLUSIONS: A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.
Asunto(s)
Actitud del Personal de Salud , Conflicto Psicológico , Enfermería de Cuidados Críticos/ética , Ética en Enfermería , Personal de Enfermería en Hospital/ética , Relaciones Médico-Enfermero , Estudios de Factibilidad , Femenino , Grupos Focales , Humanos , Masculino , Proyectos Piloto , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
We developed and assessed feasibility of an Ethics Screening and Early Intervention Tool that identifies at-risk clinical situations and prompts early actions to mitigate conflict and moral distress. Despite intensive care unit and oncology nurses' reports of tool benefits, they noted some risk to themselves when initiating follow-up actions. The riskiest actions were discussing ethical concerns with physicians, calling for ethics consultation, and initiating patient conversations. When discussing why initiating action was risky, participants revealed themes such as "being the troublemaker" and "questioning myself." To improve patient care and teamwork, all members of the health care team need to feel safe in raising ethics-related questions.
Asunto(s)
Barreras de Comunicación , Ética en Enfermería , Principios Morales , Personal de Enfermería en Hospital/ética , Cultura Organizacional , Cuidado Terminal/ética , Actitud del Personal de Salud , Estudios de Factibilidad , Grupos Focales , Humanos , Unidades de Cuidados Intensivos , Modelos Teóricos , Personal de Enfermería en Hospital/psicología , Servicio de Oncología en Hospital , Relaciones Médico-Enfermero , Investigación Cualitativa , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: There has been an increase in the use and awareness of complementary and integrative therapies in the United States over the last 10 years. Clinical nurse specialists (CNSs) are in an ideal place to influence this paradigm shift in medicine to provide holistic care. PURPOSE: This study was designed to describe the knowledge, attitudes, and use of complementary and alternative medicine (CAM) by CNSs in a large Midwest medical center. DESIGN: This study used a descriptive exploratory correlational design. SAMPLE/SETTING: Seventy-six CNSs who work in various inpatient and outpatient units within this medical facility were surveyed electronically, in the fall of 2008, using a 26-item questionnaire developed by the research team. METHOD: Data were analyzed using descriptive statistics. FINDINGS: The results demonstrate that CNSs at this academic medical center use several CAM therapies for their personal use and for professional practice with patients. The top therapies that CNSs personally used were humor, massage, spirituality/prayer, music therapy, and relaxed breathing. The top therapies requested most by patients were massage, spirituality/prayer, healing touch, acupuncture, and music therapy. The results indicated that most CNSs thought CAM therapies were beneficial and that there was some evidence for use of these therapies for use by patients or by CNSs. IMPLICATIONS: The results of this study will help to determine educational needs and clinical practice of CAM therapies with CNSs at this academic medical center. The survey used and the research results from this study can be a template for other CNSs to use to begin to address this topic of CAM use in other hospitals and clinical settings. This survey could be used to explore CAM use by patients in specialty areas for practice enhancement.
Asunto(s)
Actitud del Personal de Salud , Terapias Complementarias , Conocimientos, Actitudes y Práctica en Salud , Enfermeras Clínicas , Pautas de la Práctica en Enfermería/organización & administración , Autocuidado , Centros Médicos Académicos , Enfermería de Práctica Avanzada/educación , Enfermería de Práctica Avanzada/organización & administración , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Competencia Clínica , Terapias Complementarias/educación , Terapias Complementarias/psicología , Terapias Complementarias/estadística & datos numéricos , Evaluación Educacional , Enfermería Holística/educación , Enfermería Holística/organización & administración , Humanos , Persona de Mediana Edad , Medio Oeste de Estados Unidos/epidemiología , Evaluación de Necesidades , Enfermeras Clínicas/educación , Enfermeras Clínicas/organización & administración , Enfermeras Clínicas/psicología , Rol de la Enfermera/psicología , Investigación en Evaluación de Enfermería , Estudios Prospectivos , Autocuidado/métodos , Autocuidado/psicología , Autocuidado/estadística & datos numéricos , Autoeficacia , Encuestas y CuestionariosRESUMEN
Cervical collars are necessary to stabilize the cervical spine of trauma patients but are known to contribute to the development of occipital pressure ulcers. A quality improvement project that began on one nursing unit stimulated the development of evidence-based practice guidelines and a multidisciplinary research study. As a result, a standardized plan of care and cervical collar recommendations were implemented, resulting in a sharp decline in the incidence of occipital pressure ulcers.
Asunto(s)
Tirantes/efectos adversos , Vértebras Cervicales/lesiones , Hueso Occipital , Úlcera por Presión/prevención & control , Gestión de la Calidad Total/organización & administración , Tirantes/provisión & distribución , Educación Continua en Enfermería , Diseño de Equipo , Medicina Basada en la Evidencia , Humanos , Inmovilización/efectos adversos , Inmovilización/instrumentación , Inmovilización/métodos , Incidencia , Difusión de la Información , Enfermeras Clínicas , Evaluación en Enfermería , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educación , Planificación de Atención al Paciente , Grupo de Atención al Paciente , Guías de Práctica Clínica como Asunto , Úlcera por Presión/epidemiología , Úlcera por Presión/etiología , Factores de Riesgo , Cuidados de la Piel/métodos , Cuidados de la Piel/enfermería , Centros TraumatológicosRESUMEN
BACKGROUND: Occipital pressure ulcers are well-known complications for trauma patients wearing cervical collars. We assessed the effects of four commercial cervical collars (Aspen, Philadelphia, Miami J, and Miami J with Occian back [Miami J/Occian]) on cervical range of motion (CROM) and mandibular and occipital tissue-interface pressure (TIP). METHODS: Forty-eight healthy volunteers (24 men, 24 women; mean age, 38.9 years +/- 10.5 years) were stratified by body mass index. CROM was measured in the seated position without and with collars. Sagittal, coronal, and rotatory CROM was measured with a goniometer. Occipital and mandibular pressures were mapped with subjects in upright and supine positions. RESULTS: All collars significantly restricted CROM in all planes (p < 0.001). The Philadelphia and standard Miami J collars were the most restrictive. The Aspen collar was the least restrictive for flexion and rotation. The Miami J/Occian back was the least restrictive for extension and lateral flexion. For supine measurements, Miami J and Miami J/Occian back had the lowest mean TIP, whereas Aspen and Philadelphia collars had the greatest (p < 0.001). For upright measurements, the Miami J/Occian back produced the smallest mean TIPs; the other collars, ranked by ascending TIP, were Philadelphia, Miami J, and Aspen (p < 0.001). Philadelphia and Miami J collars had significant collar-body mass index interaction effects on supine occiput mean pressure (p = 0.04). CONCLUSIONS: Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.