Implementation of guideline recommendations in coloanal anastomosis: results from the Tender Loving Care in Coloanal Anastomosis survey

Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

Background: Studies have shown that combining tender loving care (TLC) with the treatment of patients with recurrent miscarriages can improve pregnancy outcomes. The importance of TLC has long been recognised in studies on psychiatric, gerontological, and end-of-life nursing in Western countries. Recently, randomised controlled trials (RCTs) have been used to examine the improvement in outcomes with the addition of TLC to the treatment of patients with recurrent miscarriages; however, no conclusions have been reached. TLC is a highly beneficial and harmless intervention that is not necessary for conducting RCTs. Therefore, healthcare professionals need to be aware of exercising TLC when treating patients with recurrent miscarriages. However, the concept of TLC is ambiguous and its definition is unclear.
 Purpose: This study aimed to conduct a conceptual analysis of TLC and clarify its constructs. Clarifying the definition of TLC will provide professionals with basic information that will be helpful when exercising TLC with patients who experienced repeated miscarriages despite of hopes of having a baby.
 Methods: This study was conducted using Walker and Avant’s concept analysis approach. Research published between the first edition of the journal till January 2022 were searched, and the titles and abstracts of the studies were reviewed to determine their suitability. Consequently, 28 articles, all of which were in English, were selected for conceptual analysis. The were CINAHL Plus with Full Text and MEDLINE databases were examined. The search term used was ‘tender loving care’.
 Results: The results of the conceptual analysis of TLC revealed the following antecedents, defining attributes, and consequences. The antecedents involve patients with the following diseases or disabilities: (1) suffering from mental or physical distress, (2) facing significant barriers in life (illness, disability, etc.), and (3) being unable to manage their mental health and well-being through self-care.
 Conclusion: In this study, a conceptual analysis of TLC was conducted using Walker and Avant's (2000) method. As a result of the conceptual analysis, ‘tender loving care’ was defined as ‘the care for mentally or physically distressed or impaired subjects by health professionals, parents, and teachers based on compassion and empathy, who perceive the condition of the subject and respond appropriately, thereby reducing tension, distress, and anxiety and achieving a state of mental and physical well-being’.

The recent novel coronavirus (COVID-19) crisis has affected humanity and education worldwide as continued learning amidst massive school closures required the unprecedented decision to make a rapid transition from in-person learning to remote online learning. This abrupt and temporary shift to remote online learning due to crisis circumstances was described as emergency remote teaching (ERT). Using a multi-method approach, this study aimed to explore college students’ emergency remote teaching experiences during the COVID-19 crisis. Analysis of online survey data revealed the various detrimental effects of the recent outbreak of COVID-19 and emergency remote teaching on the participants’ educational and personal experiences. The results revealed not only that the participants have experienced learning loss and lack of motivation, but also that the pre-existing educational and social inequities seemed exacerbated and amplified during ERT and the COVID-19 crisis. Issues in terms of accessibility, digital divide, inequity, and mental/emotional/physical health that the participants, more likely females, experienced during emergency remote learning were especially concerning. The results highlighted the importance of addressing and combating the inequities, creating and maintaining a sense of community, and most significantly providing socio-emotional support, ‘TLC’ (Tender Loving Care; TLC (Tender Loving Care) is an expression, describing extra attention to make someone or something look or feel better), and compassion, to college students and the instructors during the uncertain times and as we move forward.

In the West, the term 'tender, loving care' (TLC) has traditionally been used as a defining term that characterizes nursing. When this expression informs practice, it can comfort the human spirit at times of fear and vulnerability. Such notions offer meaning and resonance to the 'lived experience' of giving and receiving care. This suggests that, in a nursing context, TLC is rooted firmly in relationship, that is, the dynamic that exists between carer and cared for. Despite this emphasis on relationship, there is a scarcity of literature that draws a connection between TLC and the moral challenge that is so much a part of human interaction. In this article we will address this deficit and present a narrative that places TLC at the centre of moral engagement between nurse and patient; in essence, we offer an alternative means of viewing relational ethics.

Use, don't lose, the wind Presidential address

In Defense of "Tender Loving Care"

The main purpose of this paper, which features all the shop volunteers in the town of Ruislip (and some in a neighbouring town), is to build a picture of the volunteer workforce and to note some distinguishing features about volunteer groupings that have been identified. It discusses some of the management challenges facing charities in marshalling their volunteers and notes the very important part the local shop manager plays in that process. Finally it discusses some of the consequences to volunteering of the migration to ‘professionalism’.It is suggested that charities, by understanding what is happening to volunteering in the retail sector, will extract maximum contribution from the efforts of their volunteers, present and future. A competitive edge may be found by some if they employ a humanistic approach to the management of volunteers. Copyright © 1999 Henry Stewart Publications

In Defense of "Tender Loving Care"

Overview Feline viral rhinotracheitis, caused by feline herpesvirus (FHV), is an upper respiratory tract disease that is often associated with feline calicivirus and bacteria. In most cats, FHV remains latent after recovery, and they become lifelong virus carriers. Stress or corticosteroid treatment may lead to virus reactivation and shedding in oronasal and conjunctival secretions.Infection Sick cats shed FHV in oral, nasal and conjunctival secretions; shedding may last for 3 weeks. Infection requires direct contact with a shedding cat.Disease signs Feline herpesvirus infections cause acute rhinitis and conjunctivitis, usually accompanied by fever, depression and anorexia. Affected cats may also develop typical ulcerative, dendritic keratitis.Diagnosis Samples consist of conjunctival, corneal or oropharyngeal swabs, corneal scrapings or biopsies. It is not recommended that cats recently vaccinated with a modified-live virus vaccine are sampled. Positive PCR results should be interpreted with caution, as they may be produced by low-level shedding or viral latency.Disease management ‘Tender loving care’ from the owner, supportive therapy and good nursing are essential. Anorexic cats should be fed blended, highly palatable food - warmed up if required. Mucolytic drugs (eg, bromhexine) or nebulisation with saline may offer relief. Broad-spectrum antibiotics should be given to prevent secondary bacterial infections. Topical antiviral drugs may be used for the treatment of acute FHV ocular disease. The virus is labile and susceptible to most disinfectants, antiseptics and detergents.

I agree with Dr Forgacs (December 2005 JRSM1) that referring to a patient as being `haemodynamically stable' is unacceptable and the offending practitioner should be requested to return to basics and provide actual values. However, I admit to being fond of `common things occur commonly' and the similar `when you hear the sound of hooves, don't look for zebras', both of which, in the thinking individual, do not exclude the uncommon diagnosis. I also believe that `irregular irregularity' is perfectly acceptable when describing a pulse or a magnified abnormal volar skin appearance. What about cliches in general? `See you later' annoys when, as is often the case, the speaker is unlikely to see you again. The simile cliche `bald as a coot' may sometimes be accurate but it is a rude expression ready for burial. `Quality of life' is expanding its meaning as it becomes overused, and its use should be restricted. Other cliches are no doubt `in the pipeline'. Unoriginal and trite they may be, but many still deserve `tender loving care' (Henry VI Part ii Act 3 Sc.2).

Two years ago a newspaper's foreign correspondent in Russia described her observations of health care in post-communist Moscow. Through her visits to a sick friend in hospital and conversations with her taxi driver, whose mother was in hospital, the correspondent came to see a system of health care based on contractual, material rewards: flowers, chocolates, and perfume for the nurses; crates of whisky for the doctors. Sitting on her friend's bed (for which the patient had to provide her own linen and pillows), the correspondent watched in horror as nurses provided the expected “tender loving care” to some patients—changing bedclothes, taking temperatures, and giving tea—but ignored other patients completely, even if their sheets were horribly soiled and they were crying out for a glass of water. These patients, or their relatives, had failed to give the nurses any presents: no presents, no nursing. The correspondent concluded that we should be thankful for our own NHS.1 But I wonder if the correspondent's horror at the cold hearted contractual nursing she witnessed was the result of her own assumed and inherited expectations that nurses are inducted into a tradition of “tender loving care”? Does she still taste the fruit of a tree which is now almost cut down? British nursing, under the powerful influence of North American sociological, psychological, and educational nursing theory, has undergone a rapid transformation since the 1970s, which makes such assumptions questionable. Indeed the past 20 years have seen a revision of nursing history and a rejection of the traditional nursing ethos. Contemporary British nursing theorists …

South Korea is the first country to shift from strong son preference to preferring daughters. This paper examines the factors associated with daughter preference, using data from the 2012 Korea General Social Survey, a nationally-representative survey of 1,379 people. The outcome variable was derived from the survey question, 'If you were to have one child, which one would you like to have - son, daughter, or no preference?' Multinomial logistic regression was used to examine the association between reported child gender preference and several social and cultural variables. 43 per cent of respondents preferred daughters, 36 per cent preferred sons, and 21 per cent were indifferent. The probability of preferring daughters over sons increased with exposure to Korea's social transformations (younger, more educated, and urban residents); and among those less vested in the traditional patriarchal norms (women, non-Buddhists, and less conservative views on gender roles). Other studies in South Korea find increasing intergenerational support between parents and daughters. This is no longer an agrarian society where aging parents depend financially on sons. Today people can save for retirement and have national health insurance. However, people live longer and need companionship and care which they feel daughters provide more than sons.

Commitment to excellence in quality preschool education plus reach-out programs that help families enhance the learning careers of their children can ensure true TLC for every child born in America — Tender Loving Care in Total Learning Centers.

“Truth,” wrote Emily Dickinson, “is such a rare thing, it is delightful to tell it.” I cannot agree. Telling the truth of what I witnessed and was unwillingly party to has been a wretched, distressing, and costly business. For three years, from August 1987, I worked as a charge nurse on night duty with overall responsibility for the care of 72 desperately ill and dying men and women on the short stay, medical, and geriatric wards at Stepping Hill Hospital, Stockport. Patients were admitted only if critically ill from a stroke, heart attack, chest infection, kidney failure, cancer, other life threatening illness, or, more usually, a combination of such conditions. Those few able to move alone were liable to wander. Often patients would end up on the floor and injure themselves. Incontinent patients required regular bed changes; the rest needed frequent toileting during the night. On admission most were in shock, frightened, and often in despair. A sick or disabled spouse left alone at home would give them cause for great concern and worry. Others were completely alone in the world, perhaps grieving over the loss of a lifetime partner or in fear of impending death. Each was highly dependent. For example, the statistics for ward A14 (a 26 bed male ward) show that on average in 1989 each night over seven patients (28%) fell into category III (highly dependent) and 11 patients (42%) were in category IV (totally dependent). Total dependency means all care with feeding, hydration, turning, toileting, medication, treatment, close observation, etc. A typical handover report would contain liberal use of such words as incontinent, confused, unconscious, paralysed, distressed, aggressive, depressed, collapse, suicidal, moribund, very poorly, fell out of bed today, anxious, dysphagia, dementia, observe closely, wanders, vomiting, and tender loving care—an inelegant and often totally inappropriate …

From a very early stage in the development of the College the Council became aware of the need for a motto for the College aims with an obvious relation to the range of work of general practitioners. The consideration of this was begun by the first chairman of Council, G. F. Abercrombie, in his choice of a motto, brief but easily remembered by fellows, members and associates — the Latin phrase ‘Cum Scientia Caritas’ was submitted to Council and unanimously agreed. Constant use of these words, with their contemporary English translation, for formal and informal occasions, has confirmed the wisdom of the choice. Many interpretations expressing the personal features of their work can be placed upon the phrase. They range from ‘Skill with care’ or ‘Scientific knowledge applied with compassion’ to the fuller one of ‘Skill and scientific knowledge used with tender loving care’, and others also.