RESUMEN
INTRODUCTION: Despite significant progress over past decades, neonatal and infant morbidity and mortality remain unacceptably high in Ethiopia. Simple interventions have been shown to improve the health of children and reduce mortality. These include promotion of exclusive breast feeding for the first 6 months of life, immunisation and utilisation of available newborn healthcare services, which are proven to improve newborn survival. This study aims to determine the impact of a behaviour change intervention that partners Orthodox priests with volunteer community health workers, known in Ethiopia as the Health Development Army and trains them to conduct newborn health outreach to improve care seeking, uptake of key interventions and identification of sick infants. METHODS: The study designed is a community-randomised trial conducted in the Central Gondar area. The behaviour change intervention pairs trained Orthodox priests with members of the Health Development Army to conduct community health outreach by identifying near-term pregnant women in their communities and educating them on the topics of exclusive breast feeding, immunisation, nutrition and uptake of available child healthcare services. The evaluation of the intervention will enrol up to 150 newborn-mother pairs from communities receiving the behaviour change intervention and another 150 pairs enrolled from control communities. The quantitative analysis will be done by comparing data between the intervention and control groups related to breast feeding, anthropometry, immunisation status and uptake of child health services. The primary outcomes are exclusive breastfeeding through 6 months, mid-upper arm circumference, completion of vaccinations and infant hospitalisation. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the University of Washington (STUDY00006942) and the University of Gondar (No.V/P/RCS/05/2523/2019) Institutional Review Boards. Oral consent was obtained for the formative study, whereas written consent (or witnessed thumbprint) will be obtained from all enrolled mothers. Results will be communicated to community members, relevant government agencies and other stakeholders. TRIAL REGISTRATION NUMBER: NCT05111899.
Asunto(s)
Lactancia Materna , Humanos , Etiopía , Femenino , Recién Nacido , Cristianismo , Lactante , Agentes Comunitarios de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Embarazo , Salud del Lactante , Aceptación de la Atención de Salud/estadística & datos numéricos , AdultoRESUMEN
The achievement of health equity requires the expansion of nursing roles to include assessing burdens of disease, practicing cultural humility, implementing prevention strategies, and developing partnerships. In 2017, deans and directors of schools and programs of nursing in Washington State came together to commit to the integration of population health concepts and social determinants of health into all areas of nursing curricula. Through online communications and in-person meetings, facilitated in part by the authors of this paper, and with subcommittee representation from several baccalaureate nursing programs, Washington State academic nursing leaders identified new strategies to increase faculty awareness of population health and how to inspire related curricular changes to their programs. This Washington-wide initiative resulted in a white paper that was formally endorsed by 38 deans and directors representing all 14 baccalaureate and higher degree nursing programs in the state.
Asunto(s)
Curriculum , Liderazgo , Enfermeras Administradoras , Salud Poblacional , Determinantes Sociales de la Salud , Bachillerato en Enfermería , Humanos , WashingtónRESUMEN
Many hospitalized adults cannot reposition themselves in their beds. Therefore, they are regularly turned by their nurses, primarily to prevent pressure ulcer formation. Earlier research indicates that turning is painful and that patients are rarely premedicated with analgesics. Nonpharmacologic interventions may be used to help with this painful procedure. However, no published research was found on the use of nonpharmacologic interventions for turning of hospitalized patients. The objectives of this study were: 1) to describe patient pain characteristics during turning and their association with patient demographic and clinical characteristics; 2) to determine the frequency of use of various nonpharmacologic interventions for hospitalized adult patients undergoing the painful procedure of turning; and 3) to identify factors that predict the use of specific nonpharmacologic interventions for pain associated with turning. Hospitalized adult patients who experienced turning, the nurses caring for them, and others who were present at the time of turning were asked if they used various nonpharmacologic interventions to manage pain during the turning. Out of 1,395 patients, 92.5% received at least one nonpharmacologic intervention. Most frequently used were calming voice (65.7%), information (60.6%), and deep breathing (37.9%). Critical-care patients were more likely to receive a calming voice (odds ratio [OR] 1.66, p < .01), receive information (OR 1.62, p < .001), and use deep breathing (OR= 1.36, p < .05) than those who were not critical-care patients. Those reporting higher pain were consistently more likely to receive each of the three interventions (OR 1.01, p < .05 for all 3). In conclusion, nonpharmacologic interventions are used frequently during a turning procedure. The specific interventions used most often are ones that can be initiated spontaneously. Our data suggest that patients, nurses, and family members respond to patients' turning-related pain by using nonpharmacologic interventions.
Asunto(s)
Dolor Agudo , Movimiento y Levantamiento de Pacientes/efectos adversos , Movimiento y Levantamiento de Pacientes/enfermería , Personal de Enfermería en Hospital , Manejo del Dolor/métodos , Manejo del Dolor/enfermería , Dolor Agudo/etiología , Dolor Agudo/enfermería , Dolor Agudo/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/enfermería , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
To achieve sustainable reductions in healthcare-associated infections (HAIs), the University of Washington Medical Center (UWMC) deployed a collaborative, systems-level initiative. With the sponsorship of senior leadership, multidisciplinary teams were established to address healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and respiratory virus infections. The goal of the initiative was to eliminate these four HAIs among medical center inpatients by 2012. In the first 24 months of the project, the number of healthcare-associated MRSA cases decreased 58%; CLABSI cases decreased 54%. Staff and provider compliance with infection prevention measures improved and remained strong, for example, 96% compliance with hand hygiene, 98% compliance with the recommended influenza vaccination program, and 100% compliance with the VAP bundle. Achieving these results required an array of coordinated, systems-level interventions. Critical project success factors were believed to include creating organizational alignment by declaring eliminating HAIs as an organizational breakthrough goal, having the organization's executive leadership highly engaged in the project, coordination by an experienced and effective project leader and manager, collaboration by multidisciplinary project teams, and promoting transparency of results across the organization.
Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Conducta Cooperativa , Infección Hospitalaria/prevención & control , Control de Infecciones/métodos , Staphylococcus aureus Resistente a Meticilina , Neumonía Asociada al Ventilador/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/virología , Infecciones Estafilocócicas/prevención & control , Humanos , Modelos Organizacionales , Objetivos Organizacionales , Washingtón/epidemiologíaRESUMEN
The purpose of this secondary data analysis of findings from a larger procedural pain study was to examine several factors related to pain during tracheal suctioning. In addition to tracheal suctioning, other procedures studied included turning, wound drain removal, femoral catheter removal, placement of a central venous catheter, and wound dressing change. A total of 755 patients underwent the tracheal suctioning procedure that was performed primarily in intensive care units (93%). A 0-10 numeric rating scale, a behavioural observation tool, and a modified McGill Pain Questionnaire-Short Form were used for pain assessment. Pain intensity scores were significantly greater during the tracheal suctioning procedure (M=3.96, S.D.=3.3) than prior to (M=2.14, S.D.=2.8) or after (M=1.98, S.D.=2.7) tracheal suctioning. Few patients received analgesics prior to or during the procedure. Surgical, younger, and non-white patients reported higher pain intensities. Although mean pain intensity during tracheal suctioning was mild, almost the half of the patients reported moderate-to-severe pain. Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as tracheal suctioning.
Asunto(s)
Intubación Intratraqueal/enfermería , Dolor/etiología , Succión/efectos adversos , Traqueostomía/enfermería , Adulto , Análisis de Varianza , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Dolor/prevención & control , Succión/enfermeríaRESUMEN
BACKGROUND: Wound care (WC) is an important part of treatment for hospitalized patients with wounds. There is a paucity of data about the type or amount of pain patients experience during WC. OBJECTIVES: The purpose of this study is to describe patients' (n = 412) WC-related pain perceptions and responses, examine the relationships between patients' WC pain and demographic variables, and describe the distress associated with WC. METHODS: A repeated-measures design was used to examine pain before, during, and after WC in hospitalized patients (n = 412) with wounds healing by secondary intention. RESULTS: Pain intensity was greatest during WC. It was most frequently described as tender, sharp, stinging, aching, and stabbing. Behaviors that occurred most often were no verbal response, no body movement, grimace, and complaints of pain. There were no differences in pain between genders. Nonwhites had significantly greater WC pain than whites. Pain during the procedure was the same in younger and older patients, and procedural distress was mild. CONCLUSION: Patients experience pain and distress with WC. Some behaviors and words consistently describe WC pain. Further work is warranted to refine pain assessment and management in patients undergoing WC procedures.
Asunto(s)
Hospitalización , Dolor/etiología , Cuidados Posoperatorios , Cicatrización de Heridas , Vendajes/efectos adversos , Presión Sanguínea , Desbridamiento/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Dolor/prevención & control , Dimensión del Dolor , Irrigación Terapéutica/efectos adversosRESUMEN
OBJECTIVE: Patients frequently display behaviors during procedures that may be pain related. Clinicians often rely on the patient's demonstration of behaviors as a cue to presence of pain. The purpose of this study was to identify specific pain-related behaviors and factors that predict the degree of behavioral responses during the following procedures: turning, central venous catheter insertion, wound drain removal, wound care, tracheal suctioning, and femoral sheath removal. DESIGN: Prospective, descriptive study. SETTING: Multiple units in 169 hospitals in United States, Canada, England, and Australia. PATIENTS: A total of 5,957 adult patients who underwent one of the six procedures. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A 30-item behavior observation tool was used to note patients' behaviors before and during a procedure. By comparing behaviors exhibited before and during the procedure as well as behaviors in those with and without procedural pain (as noted on a 0-10 numeric rating scale), we identified specific procedural pain behaviors: grimacing, rigidity, wincing, shutting of eyes, verbalization, moaning, and clenching of fists. On average, there were significantly more behaviors exhibited by patients with vs. without procedural pain (3.5 vs. 1.8 behaviors; t = 38.3, df = 5072.5; 95% confidence interval, 1.6-1.8). Patients with procedural pain were at least three times more likely to have increased behavioral responses than patients without procedural pain. A simultaneous regression model determined that 33% of the variance in amount of pain behaviors exhibited during a procedure was explained by three factors: degree of procedural pain intensity, degree of procedural distress, and undergoing the turning procedure. CONCLUSIONS: Because of the strong relationship between procedural pain and behavioral responses, clinicians can use behavioral responses of verbal and nonverbal patients to plan for, implement, and evaluate analgesic interventions.
Asunto(s)
Conducta , Dimensión del Dolor/métodos , Dolor/fisiopatología , Dolor/psicología , Terapéutica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: Research is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths. OBJECTIVES: To determine types of analgesics administered for procedures, the prevalence and amounts of drugs given, and factors predictive of analgesic administration. METHODS: Pain was assessed before and immediately after procedures. Analgesic, sedative, and anesthetic agents administered within 1 hour before and/or during each procedure were noted RESULTS: A total of 5957 adult patients at 164 national and 5 international sites participated. Pain intensity increased at the time of procedure for all procedures. More than 63% of patients received no analgesics. Less than 20% received opiates; mean total dose of opiate was 6.44 mg (SD, 8.96 mg). Only 10% of patients received combination therapy. Factors associated with the likelihood of receiving opiates were pain intensity before a procedure, femoral sheath removal, being white, and the duration of a procedure. Patients less likely to receive opiates had a medical diagnosis or were having tracheal suctioning. Only 14.5% of the variance in the amount of opiate administered was explained by factors entered into multiple regression models. Type of procedure was the only significant predictor of amount of opiate administered. CONCLUSIONS: Most patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.
Asunto(s)
Analgésicos/administración & dosificación , Anestésicos/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Analgésicos Opioides/administración & dosificación , Cateterismo Venoso Central/efectos adversos , Cuidados Críticos/métodos , Femenino , Humanos , Modelos Logísticos , Masculino , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Factores de Riesgo , Succión/efectos adversos , Factores de Tiempo , Tráquea , Resultado del Tratamiento , Incisión Venosa/efectos adversosRESUMEN
This report surveyed the pharmacologic knowledge of the physician housestaff and intensive care nurses regarding the analgesic and anxiolytic effects of narcotics, benzodiazepines and neuromuscular blockers. The results demonstrated a commonly held misconception that muscular paralysis is a calm and painless state. The authors instituted an educational program stressing the need for analgesic and anxiolytic medications in conjunction with paralytic agents.