RESUMEN
PROBLEM: The aging population and the growing number of home hospice patients have resulted in increased utilization of emergency departments. This situation poses a clinical challenge to the ED staff in determining when lifesaving treatment is indicated and when end of life care begins. METHODS: Through a shared governance model, ED physicians and nursing staff aimed to implement a best practice model for the care of dying patients. An ED interdisciplinary team identified gaps and brainstormed methods to improve palliative measures and comprehensive care for actively dying patients. RESULTS: A best practice initiative called "Life Sustaining Management and Alternatives" was developed and implemented to provide palliative care services and comprehensive care for patients who are actively dying in the emergency department. IMPLICATIONS FOR PRACTICE: The emergency department became better equipped to handle end of life care, providing adequate pain management, optimal comfort measures, and emotional support with respect and dignity for the dying patient and family. The practices implemented resulted in improved patient care, increased patient satisfaction, and reduced overall hospital admissions.
Asunto(s)
Actitud Frente a la Muerte , Enfermería de Urgencia/métodos , Servicio de Urgencia en Hospital , Cuidados Paliativos/métodos , Evaluación de Programas y Proyectos de Salud , Cuidado Terminal/métodos , Hemorragia Gastrointestinal , Humanos , Masculino , Persona de Mediana Edad , Neumonía por Aspiración , Cuadriplejía , Insuficiencia Respiratoria , SepsisRESUMEN
PRIMARY OBJECTIVE: To verify criterion validity of measures from a functional cognitive task (FCT) carried out with patients with severe traumatic brain injury (sTBI) at 2-5 years post-injury. METHODS AND PROCEDURES: Forty-six patients with sTBI took part in a long-term outcome study where the FCT and the Neurobehavioural Rating Scale-Revised (NBRS-R) were administered and the FIM™ instrument was rated. The FCT is a telephone information gathering task for evaluating functional cognitive skills. RESULTS: Ten of 16 measures of the FCT were significantly correlated with similar or related concepts from the NBRS-R. The FIM™ cognitive score and the individual items of this score were significantly correlated with 13 of the FCT measures and with the percentage of amount of information gathered. Internal consistency was good for 13 of 16 measures. Overall, patients generally had mild difficulty on the FCT concepts. CONCLUSION: The FCT can be used with patients with sTBI to evaluate certain aspects of functional cognition. It has good criterion validity and internal consistency, but additional research is required to further measure reliability and its applicability to other severity of TBI and to other phases of recovery.
Asunto(s)
Actividades Cotidianas , Lesiones Encefálicas/psicología , Trastornos del Conocimiento/psicología , Terapia Ocupacional/métodos , Teléfono , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas/fisiopatología , Cognición , Trastornos del Conocimiento/diagnóstico , Evaluación de la Discapacidad , Emociones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Análisis y Desempeño de Tareas , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To obtain a comprehensive understanding of long-term outcome after severe traumatic brain injury (sTBI). PARTICIPANTS: Forty-six patients with sTBI. DESIGN: Comparison of interdisciplinary evaluation results at discharge from acute care and at 2 to 5 year follow-up. MAIN MEASURES: Extended Glasgow Outcome Scale, the FIM instrument, and the Neurobehavioral Rating Scale-Revised. RESULTS: Significant improvement was observed on the FIM instrument, the Extended Glasgow Outcome Scale, and on 3 factors of the Neurobehavioral Rating Scale-Revised. These measures at discharge were significant predictors of outcome. CONCLUSION: Patients with sTBI 2 to 5 years postinjury showed relatively good physical and functional outcome but poorer cognitive and emotional outcome.
Asunto(s)
Lesiones Encefálicas/rehabilitación , Lesiones Encefálicas/complicaciones , Trastornos del Conocimiento/etiología , Femenino , Estudios de Seguimiento , Indicadores de Salud , Humanos , Modelos Lineales , Masculino , Pronóstico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Patients with potential or confirmed spinal injuries are challenging for hospitals delivering care for trauma patients. In order to minimize further injury and complications, to maximize positive patient outcomes and to reduce length of stay, efficient and effective methods of caring for such patients are required. The purpose of this paper is to describe the creation and implementation of a "Spinal Education Program" at a Level I trauma center in Canada. It was designed to teach a large group of health care professionals how to care for patients with potential or confirmed spinal injuries in a comprehensive and consistent manner.