Calm Patients Research Articles

Mandalas as a Source of Self-Expression

The article is a presentation of the meaning and characteristics of mandalas that derive from Sanskrit symbolism. The Kabbalistic overtones of their compositions intrigued early psychoanalysts. They have been assimilated to treat and calm patients suffering from neurosis, psychosis, depression. They were seen as expressive, diagnostic and therapeutic. The article presents different views on the values and effects of the use of mandalas in education, relaxation and therapy. Due to the lack of scientific premises for use, relaxation use is encouraged during rehabilitation, after-school and speech therapy classes. A substantive approach to the subject encourages the search for applications in education in various fields, but this requires undertaking scientific research and verification of applications. The article is an exhaustive analysis of the literature on the use of mandalas.

Strategical Ways for Dental Anxiety Management Prior to Third Molar Extraction.

A patient experiencing moderate to severe anxiety often skips regular check-ups, choosing to visit only when necessary. As a result, their oral health worsens. Various variables can affect anxiety such as age, gender, culture, and previous experiences. One of the most frequent oral surgical procedures is extracting the third molar, which is accompanied by severe pain, tension, and anxiety, the use of invasive equipment, and local anesthetic. A combined effect was found of four factors, including the patient, dental employees, setting, and dental procedure, which can trigger and affect dental anxiety. Both pharmacological and non-pharmacological approaches were explored; as a non-drug approach, anxiety was managed by music therapy. Acupuncture, music, audio-visual aids, and lavender oil showed an effect that helped in reducing anxiety. Patients' dental anxiety can be reduced through behavioral management such as educating the patients before the surgical procedure, relaxation strategies, biofeedback, and exposure therapy. Medicationsinclude benzodiazepines, nitrous oxide (N2O), and midazolam. Effective treatment relies on collaboration between the patients anddentists; calm patients not only provide a manageable environment for the dental team but can also result in better treatment outcomes.

Aspects and dilemmas of euthanasia in modern times

Euthanasia is a very complex medical and moral issue. The name has taken throughout history quite different meanings especially in recent decades. There have been many controversial debates and ethical questions raised in modern society. The aim of the paper was to introduce in more detail the issue of euthanasia in the modern world and to review the decisions on this issue. The end of life is still a part of life. It is of great importance for every person and requires true compassion and solidarity. The task is to restore human dignity, by respecting the will of the sedating patient. It is the responsibility of doctors and medical staff to use their comprehensive knowledge and ethical approach to provide calm patients with peace and tranquillity. Euthanasia is a discipline. It is also a concept and a term full of conflicts, which need to be analysed. Therefore, it is necessary to consider the criteria of the bioethical aspect of this activity. The right to euthanasia is not ethically indifferent. We can expect in the near future a deeper understanding of the euthanasia issue.

Effects of Sevoflurane versus Propofol on Endogenous Nitric Oxide Metabolism during Laparoscopic Surgery.

For laparoscopic surgery, it is very difficult to assess the effect of different medicines used in the surgical procedure on the surgical results. In the past, doctors could use sevoflurane to numb and calm patients. For decades, this type of treatment has been fairly reliable and effective, but for laparoscopic surgery, the use of sevoflurane can lead to a wide range of blood glucose changes, so in recent years, sevoflurane compared to propofol in laparoscopic surgery on endogenous and nitrogen oxide metabolism has been studied more and more. In this paper, a variety of research methods were used to study the phenomenon of shock and excessive anesthesia encountered by patients in the treatment process. Through observation and drug experiment of patients in different treatment courses and treatment stages, patients were asked to use sevoflurane and propofol to conduct double-blind experiments on their own drug effects. At the same time, through the long-term observation of patients with different diseases and patients who need laparoscopic surgery, the nitrogen oxide metabolism in patients with sevoflurane compared with propofol endogenous was studied and analyzed. Through three groups of different conditions, the experimental group, the blind test group, and the control group were studied. To conclude, in laparoscopic surgery, the use of sevoflurane compared with propofol can have a good impact on the endogenous drug and nitrogen oxide metabolism. It can achieve a good effect on the anesthesia effect of surgery, the maintenance of patient's physical signs and heart rate, which is very beneficial to the operation. Conclusion. Sevoflurane compared with propofol has a good effect on endogenous nitrogen oxide metabolism in laparoscopic surgery.

Use of Sitters for Patient Safety in a Veteran Population

Patient safety including falls risk, is a high priority and an increasing challenge for all health care facilities. Safety risk factors include both physical factors and psychological factors. One common strategy to increase safety has been the use of “sitters.”. Studies on functions and outcomes are conflicting some have reported no differences in falls, decreases in falls and restraints, and increases in falls. A total survey sample of 22 “sitters” and 56 registered nurses conducted at a large midwestern VA facility to assess perceptions of sitters. Groups were similar in ages (41-50 years) with sitters having slightly more experience (11-20 years) versus nurses (6-10 years). Safety conditions most likely to be identified with sitter usage were delirium, elopement, and being a hospice patient. Sitters were more likely to identify falls risk, sitters 63% of time versus RN perception 30.9% (Chi Square=7.0, df=l, p=.008); dementia 59% vs 13% (Chi square=17.15, df=1, p=.001); and weakness 66.7% vs 18.2% (Chi square=16.54, df=1, p=.001). Sitters were more likely to have training in delirium 55% vs nurses, 34% (Chi sq=2.557, df=1 p=.11). Nurses identified that the use of sitters were very likely to prevent falls 29.8%, calm patients 25.2%, maintain lines 25.2%, prevent elopement 30.5% and redirect patients 29.7%. Nurses identified the following available safety strategies: alarms (67.2%), adjusting assignment (47.2%), music therapy (5.4%), use of restraints (<2%), pet therapy (<2%), and video monitoring (<1%). Implementation of safety programs must address availability of multiple strategies including: matching sitter competencies with patient populations served.

Structural Racism in American Psychiatry and APA: Part 1

Structural Racism in American Psychiatry and APA: Part 1

A simple prognostic score predicts one-year mortality of alert and calm emergency department patients: A prospective two-center observational study.

To derive and validate a prognostic score to predict 1-year mortality using vital signs, mobility and other variables that are readily available at the bedside at no additional cost. Post hoc analysis of two independent prospective observational studies in two emergency departments, one in Denmark and the other in Switzerland. Alert and calm emergency department patients. The prediction of mortality from presentation to 365days by vital signs, mobility and other variables that are readily available at the bedside at no additional cost. One thousand six hundred and eighteen alert and calm patients were in the Danish cohort and 1331 in the Swiss cohort. Logistic regression identified age>68years, abnormal vital signs, impaired mobility and the decision to admit as significant predictors of 365-day mortality. A simple prognostic score awarded one point to each of these predictors. Less than two of these predictors were present in 45.6% of patients, and only 0.4% of these patients died within a year. If two or more of these predictors were present, 365-day mortality increased exponentially. Age>68years, the decision for hospital admission, any vital sign abnormality at presentation and impaired mobility at presentation are equally powerful predictors of 1-year mortality in alert and calm emergency department patients. If validated by others these predictors could be used to discharge patients with confidence since nearly half of these patients had less than two predictors and none of them died within 30days. However, when two or more predictors were present 365-day mortality increased exponentially.

Delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale (RASS): Inattention and visuo-spatial impairment as potential screening domains.

In the intensive care setting, delirium is a common occurrence; however, the impact of the level of alertness has never been evaluated. Therefore, this study aimed to assess the delirium characteristics in the drowsy, as well as the alert and calm patient. In this prospective cohort study, 225 intensive care patients with Richmond Agitation and Sedation Scale (RASS) scores of -1 - drowsy and 0 - alert and calm were evaluated with the Delirium Rating Scale-Revised-1998 (DRS-R-98) and the Diagnostic and Statistical Manual 4th edition text revision (DSM-IV-TR)-determined diagnosis of delirium. In total, 85 drowsy and 140 alert and calm patients were included. Crucial items for the correct identification of delirium were sleep-wake cycle disturbances, language abnormalities, thought process alterations, psychomotor retardation, disorientation, inattention, short- and long-term memory, as well as visuo-spatial impairment, and the temporal onset. Conversely, perceptual disturbances, delusions, affective lability, psychomotor agitation, or fluctuations were items, which identified delirium less correctly. Further, the severities of inattentiveness and visuo-spatial impairment were indicative of delirium in both alert- or calmness and drowsiness. The impairment in the cognitive domain, psychomotor retardation, and sleep-wake cycle disturbances correctly identified delirium irrespective of the level alertness. Further, inattentiveness and - to a lesser degree - visuo-spatial impairment could represent a specific marker for delirium in the intensive care setting meriting further evaluation.

TINGKAT KECEMASAN PADA PASIEN ANAK USIA SEKOLAH (6-12 TAHUN) DI RUANG IGD RSUD MAJALAYA KABUPATEN BANDUNG

Kecemasan muncul karena anak tidak bisa melakukan apa yang diinginkan dan hanya bisa berbaring di tempat tidur. Kecemasan anak yang terjadi salah satunya akibat perlukaan pada tubuh seperti dilakukan infus dan perawatan luka. Efek dari kecemasan anak terhadap perawat diantaranya adalah tindakan perawatan lebih lama dan infus sering terlepas karena anak terus berontak. Tujuan penelitian ini adalah untuk mengetahui gambaran tingkat kecemasan pada pasien anak usia sekolah (6-12 tahun) di ruang IGD RSUD Majalaya Kabupaten Bandung tahun 2017. Desain penelitian yang digunakan adalah jenis penelitian deskriptif, dengan teknik pengumpulan sampel purposive sampling. Pengumpulan data dilakukan dengan cara observasi kepada responden. Data disajikan dalam bentuk distribusi frekuensi, dengan sampel sebanyak 93 orang. Berdasarkan hasil penelitian diketahui bahwa kecemasan pada pasien anak usia sekolah (6-12 tahun) di ruang IGD RSUD Majalaya Kabupaten Bandung sebagian besar mengalami kecemasan sebanyak 72 orang (77,4%) dan sebagian kecil tidak mengalami kecemasan sebanyak 21 orang (22,6%). Simpulan didapatkan bahwa sebagian besar pasien anak usia sekolah mengalami kecemasan. Saran bagi perawat untuk mampu menghadapi segala permasalahan yang dihadapi oleh pasien dan keluarga pasien seperti perawat mampu melakukan komunikasi terapeutik untuk menenangkan pasien.

Emergency department waiting room nurses in practice: An observational study.

To identify the activities and behaviours of waiting room nurses in emergency department settings. Emergency care has expanded into waiting rooms in some emergency departments. Often viewed as an adjunct to triage, the aim of waiting room nurses is to commence care early, reassess patients and improve communication between patients, families and staff. There is however a paucity of literature relating to waiting room nurses, especially in relation to their current activities and behaviours. Part of a larger exploratory sequential mixed methods designed study. This phase used a nonparticipant observer role to observe waiting room nurses in their natural setting undertaking normal care and responsibilities. One observer, using a tool and reflective journal, collected data on participant interactions, processes and practices on eight waiting room nurses over 13 episodes of observation (total 65hr:50min) in two emergency departments. Data analysis used descriptive statistics and thematic analysis. Participants were observed to anticipate and prioritise to deliver holistic, patient-centred care in emergency department waiting rooms. Waiting room nurses had a varied and unpredictable workload, including facilitating the flow of patients from the waiting room. They contributed to patient safety in the waiting room, primarily by reassessing and detecting clinical deterioration. Further research into this role is required, including linking efficacy with experience of nurses, impact the role has on patient safety, and patient and family perceptions of the role. Therapeutic engagement allowed waiting room nurses to reassure and calm patients and families, and deliver holistic, patient-centred care. Waiting room nurses contributed to patient safety in the waiting room, by promptly commencing episodes of care in the waiting room and through close monitoring and assessment to detect patient deterioration.

Defining hypotension in anesthetized infants by individual awake blood pressure values: a prospective observational study.

Blood pressure (BP) is the most commonly applied clinical surrogate parameter for tissue perfusion and cerebral autoregulation. Hypotension during anesthesia may contribute to unfavorable outcome in young children. Hypotension in anesthetized infants can be defined using BP values relative to individual awake baseline or absolute BP values. The aim of this study was to investigate the applicability of the two definitions and to compare the incidences of hypotension. This was a prospective observational study in 151 infants <12 months of age. The percentage of successful awake BP measurements was calculated and related to the infant's behavioral state. Hypotension under sevoflurane anesthesia was defined by a decrease of mean arterial pressure (MAP) relative to awake baseline (>20% in infants <6 months, >40% in infants >6 months) or absolute MAP values (<35 mmHg in infants <6 months, <43 mmHg in infants >6 months). The incidences of hypotension using the two definitions were compared. Awake BP values were obtained in 85% of the patients. Calm patients were more likely to allow their BP to be measured than anxious patients. Anxious patients had higher preinduction MAP values than calm patients. The relative BP approach resulted in a higher incidence of postinduction hypotension than using absolute BP values. Awake BP values were unobtainable in 15% of our patients, resulting in the necessity to define hypotension under anesthesia using absolute BP values. Definitions of hypotension using either absolute MAP or values relative to awake baseline are not interchangeable.

Not Calm and Aminoff Suffering Syndrome in Advanced Alzheimer's Disease.

We studied 183 patients with advanced dementia who had been admitted to the Geriatric-Internal Medicine Department of a general hospital, with a 1 year follow-up evaluated by Mini-Suffering State Examination (MSSE) scores on first days after admission. The not calm compared to calm patients with advanced dementia had a high suffering level (6.12 ± 2.16 versus 3.21 ± 1.71) with a statistically significant difference (P = 0.001). The not calm patients were sicker, a higher percentage had fever (P = 0.005), elevated levels of white blood cells WBC (P = 0.003) and C-reactive protein (CRP) (P = 0.020). The Kaplan-Meier function analysis showed a shorter survival of not calm versus calm advanced dementia patients, with a statistically significant difference (Log Rank [Mantel-Cox] P = 0.002). Not calm in advanced dementia patients is the first item of the MSSE and is a very important symptom of Aminoff Suffering Syndrome.

Severe chronic insomnia is not associated with higher body mass index.

Short sleep duration is widely considered to be a risk factor for weight gain, suggesting that patients suffering from sleep disorders are a risk group. Despite some positive preliminary data on patients with organic sleep disorders, empirical evidence for an increased body mass index in patients with insomnia is scarce. Two-hundred and thirty-three patients with a confirmed diagnosis of severe and chronic insomnia without co-morbidity showing objectively impaired sleep quality were compared with respect to their body mass index with control data derived from a representative population survey matched in gender and age. As a result, patients with insomnia showed a lower body mass index (23.8kgm(-2) versus 27.1kgm(-2) ; P<0.0005). Our findings suggest that patients with chronic insomnia do not exhibit overweight. These data are a valuable educational tool to calm patients' fears about the consequences of insomnia, and contribute to the understanding of chronically disturbed sleep and weight regulation.

Benefit of BP Measurement in Pediatric ED Patients.

Introduction. Obtaining blood pressures in pediatric emergency department patients is the standard of care; however, there is little evidence to support its utility. This prospective study assesses the benefit of BP acquisition in patients ≤5 years. Methods. Data were collected by the ED triage nurses on 649 patients in two community hospital EDs. Relationships between abnormal blood pressures and the patients' age, acuity, and calm versus not-calm emotional state were analyzed. Results. There were significant differences in the rate of elevated BPs in the calm and not-calm groups of patients. Overall, one- and two-year-old patients were more likely to have elevated BPs than those in other age groups. Very few patients in the sample had hypotension (1%). There was no relationship between Emergency Severity Index (ESI) acuity level and an abnormal BP. Nineteen percent of calm patients had elevated BPs, with 3.6% of patients in the stage two class of hypertension. Conclusions. There is limited benefit in obtaining BPs in children age of five or less regardless of whether the child is calm or not in ESI acuity levels 3 and 4.

Anesthesia techniques for carotid endarterectomy

Stroke is one of the leading causes of death in the modern countries. Mainstay treatment for stroke prevention is carotid endarterectomy (CEA). Patients scheduled for surgery often have many associate systemic illnesses that pose a risk of peri-operative cardiac and neurological complications. Detailed preoperative evaluation of neurological and cardiac function with optimization of the systemic illnesses therapy is obligatory. Ideal anesthesiology technique should provide adequate analgesia, minimal stress response, optimal brain perfusion and oxygenation, optimal hemodynamic and myocardial oxygen balance while assuring calm and relaxed patients with good surgical comfort. Both regional anesthesia and general ane-sthesia have some advantages and drawbacks. Regarding to cerebral and myocardial ischemia and adverse outcome after CEA, especially in high risk patients, today still it is not clear which anesthesia technique is preferred for CEA. Greatest risk in the early postoperative period is new neurological deficit caused by cerebral ischemia end myocardial infarction caused with hemodynamic instability and therefore CEA patients are placed in the Intensive Care Unit for at least six or more hours where they are monitored for neurological and hemodynamic complications.

Agitation in the Inpatient Psychiatric Setting

Agitation among psychiatric inpatients (particularly those diagnosed with schizophrenia or bipolar disorder) is common and, unless recognized early and managed effectively, can rapidly escalate to potentially dangerous behaviors, including physical violence. Inpatient aggression and violence have substantial adverse psychological and physical consequences for both patients and providers, and they are costly to the healthcare system. In contrast to the commonly held view that inpatient violence occurs without warning or can be predicted by "static" risk factors, such as patient demographics or clinical characteristics, research indicates that violence is usually preceded by observable behaviors, especially non-violent agitation. When agitation is recognized, staff should employ nonpharmacological de-escalation strategies and, if the behavior continues, offer pharmacological treatment to calm patients rapidly. Given the poor therapeutic efficacy and potential for adverse events associated with physical restraint and seclusion, and the potential adverse sequelae of involuntary drug treatment, these interventions should be considered last resorts. Pharmacological agents used to treat agitation include benzodiazepines and first- and second-generation antipsychotic drugs. Although no currently available agent is ideal, recommendations for selecting among them are provided. There remains an unmet need for a non-invasive and rapidly acting agent that effectively calms without excessively sedating patients, addresses the patient's underlying psychiatric symptoms, and is reasonably safe and tolerable. A treatment with these characteristics could substantially reduce the clinical and economic burden of agitation in the inpatient psychiatric setting.

Comparison of Emergency Physiciansʼ and Juris Doctorsʼ Opinions on Emergency Department Patient Restraints Usage

Emergency physicians (EPs) and Juris Doctors (JDs) often disagree on the correct use of restraints for emergency department (ED) patients. The objective of the study was to compare EPs and JDs propensity to restrain patients given various scenarios. The study hypothesis was that EPs and JDs would agree on when to restrain emergency patients. This was a prospective cross-sectional study. Twenty-two EPs and 27 JDs were asked to complete the Video Assessment of Propensity to use Emergency Restraints Scale (VAPERS). The VAPERS scale consists of 17 scenarios utilizing actors who were videotaped to produce a scale. Results obtained include overall likelihood to restrain and likelihood to restrain specific subgroups of patients such as those who are a danger to themselves, a danger to others, medically unstable, trauma patients, altered patients, belligerent patients, agitated patients, calm patients, and patients with normal mental status. A two-way mixed model average intraclass correlation coefficient (ICC) was used to determine scale reliability. Unpaired t-tests with confidence intervals (CI) were used to compare the two professions on VAPERS results and on individual scenarios. Overall, EPs were more likely to restrain patients than JDs (46% vs 37%), although this did not reach statistical significance. The statistically significant EP-JD disagreement, with EPs more likely to restrain patients, occurred if the patients were calm. Common themes in the differences emerged from evaluation of the two groups' comments. EPs and JDs disagree on restraint use. These EP-JD differences were statistically significant in patients who were calm.

Calming patient agitation with dexmedetomidine

An ICU stay can make patients agitated, delirious, and anxious. This drug may help calm patients without causing respiratory depression, and has a fast onset and analgesic action.

Study of confusion syndrome in patients admitted to a trauma unit: Why do elderly patients get disorientated?

Acute confusion is a frequent health care problem amongst hospitalised elderly patients. The study investigated the incidence of acute confusion during the hospitalisation of elderly patients, identified associated physical and/or psycho-social factors and outlined measures to help minimise risk factors. Two sets of data were collected using the Mini-Mental State test (MMST) and a questionnaire. The MMST was given on hospital admission and repeated when patients showed the first signs of disorientation and in a non-confused control group. Of 200 patients included in the study, 43 suffered acute confusion during hospitalisation (mean age 82.7). The mean age of the non-confused group was 76 ( p<0.002). Patients who suffered acute confusion scored significantly lower on the initial MMST ( p<0.001) had received more blood transfusions ( p<0.04) and were more incontinent ( p<0.001) than those who did not. In 67% of cases acute confusion first appeared during the night shift and worried patients’ relatives (79%). The study showed that there is a higher risk of confusion in older male patients who score low on initial MMST. Confusion tends to first appear at night and requires extra nursing attention. Nurses must be aware of this phenomenon and take prompt action to calm patients’ relatives and provide a safe environment for the confused patient.

THE PRACTICES OF EXPERT PSYCHIATRIC NURSES: ACCOMPANYING THE PATIENT TO A CALMER PERSONAL SPACE

The focus of the care of potentially aggressive psychiatric patients has been on the use of seclusion and restraints. Recent concerns, however, about the potential for patient injury have made it imperative that nurses use alternative methods to calm patients who are escalating. Little is known about how expert nurses de-escalate the escalating patient. The purpose of this interpretive phenomenological study was to uncover and describe the knowledge embedded in the stories of psychiatric nurses who are skilled in the practices of de-escalating an escalating patient. Twenty registered nurses were interviewed using an unstructured format. The analysis of the data revealed that these nurses were skilled at noticing the patient, reading the situation and the patient, knowing where the patient was on the continuum, understanding the meaning of the behavior, knowing what the patient needed, connecting with the patient, and matching the intervention with the patient's needs.