Individual Health Care Plans Research Articles

Experiences of surviving a cardiac arrest after therapeutic hypothermia treatment. An interview study

BackgroundCardiac arrest (CA) is often associated with high mortality. In Sweden, it is reported that 13–52 per 100,000 people suffer out-of-hospital CA, and survival to one month is 2–14%. ObjectiveThis study aimed to describe people’s experiences of surviving a CA after therapeutic hypothermia treatment. MethodA descriptive qualitative design was used. Data were collected through individual interviews with seven CA survivors. The collected data were analyzed using qualitative content analysis. ResultsThe analysis resulted in six subthemes and three emerging themes. The themes were “Dealing with issues of mortality”, “Living a changed life”, and “Being confident with health care and family members”. ConclusionSurviving a CA after therapeutic hypothermia treatment means having to deal with issues of mortality, and these patients face a turning point in life. The near-death event can create regression or progression in ethos among these patients.Relevance to clinical practice.This study implies that persons who have survived a CA need support to cope. One way to provide support might be to initially establish an individualized health care plan, including bringing up existential issues and involving family members in such conversations.

Behaviours of students who have repeated urinary tract infections

ABSTRACTTo determine the behaviours of students and the variables that have an effect on repeated urinary tract infections (UTIs). A cross‐sectional study was implemented on elementary and high school students in Izmir, Turkey. The sample consisted of 318 volunteers from the 6–17 years of age students. Written consent was obtained from parents and institutions. The data were collected through sociodemographic characteristics and a behavioural assessment semi‐structured design questionnaire. The data for closed‐ended questions were evaluated for frequencies, variance, Chi‐square and logistic regression. Content analysis was used for examining the open‐ended questions. Students' mean age was 10·28 ± 2·27 (6–15 years of age), 68·2% were females and 70·4% were in elementary school. Of the students, 26·1% avoided using school toilets, 70·4% held urine too long and 30·2% cleaned the perineum from back‐to‐front. In the prediction of the factors that affect students' behaviours with ages, it was determined that ‘washed the genital area after defecation/urination’, ‘method of cleaning the perineum’, ‘urination status at school’, ‘enuresis’, ‘frequency of changing underwear’ and ‘washing hands before going to the toilet’ increased linearly with age (p < 0·05). Most of the students may have negative perceptions about toilet habits. Students' behaviours are important for improving social well‐being. Health professionals and teachers serve a key role in the psychosocial development of students. They can develop individualized health care plans and help parents and students to understand strategies that can prevent UTIs.

Ontological security and connectivity provided by pets: a study in the self-management of the everyday lives of people diagnosed with a long-term mental health condition.

BackgroundDespite evidence that connecting people to relevant wellbeing-related resources brings therapeutic benefit, there is limited understanding, in the context of mental health recovery, of the potential value and contribution of pet ownership to personal support networks for self-management. This study aimed to explore the role of pets in the support and management activities in the personal networks of people with long-term mental health problems.MethodsSemi-structured interviews centred on ‘ego’ network mapping were conducted in two locations (in the North West and in the South of England) with 54 participants with a diagnosis of a long-term mental health problem. Interviews explored the day-to-day experience of living with a mental illness, informed by the notion of illness work undertaken by social network members within personal networks. Narratives were elicited that explored the relationship, value, utility and meaning of pets in the context of the provision of social support and management provided by other network members. Interviews were recorded, then transcribed verbatim before being analysed using a framework analysis.ResultsThe majority of pets were placed in the central, most valued circle of support within the network diagrams. Pets were implicated in relational work through the provision of secure and intimate relationships not available elsewhere. Pets constituted a valuable source of illness work in managing feelings through distraction from symptoms and upsetting experiences, and provided a form of encouragement for activity. Pets were of enhanced salience where relationships with other network members were limited or difficult. Despite these benefits, pets were unanimously neither considered nor incorporated into individual mental health care plans.ConclusionsDrawing on a conceptual framework built on Corbin and Strauss’s notion of illness ‘work’ and notions of a personal workforce of support undertaken within whole networks of individuals, this study contributes to our understanding of the role of pets in the daily management of long-term mental health problems. Pets should be considered a main rather than a marginal source of support in the management of long-term mental health problems, and this has implications for the planning and delivery of mental health services.

Collaboration Between PNPs and School Nurses: Meeting the Complex Medical and Academic Needs of the Child With ADHD

Pediatric nurse practitioners take a lead role in diagnosing and coordinating the care of children with attention deficit hyperactivity disorder (ADHD). School nurses offer rich insight into the child's health and social and academic functioning in the school setting. School nurses develop individualized health care plans, administer and monitor medications, provide valuable input on Individualized Education Plans and Section 504 Accommodation Plans, and serve as the point person in communicating with the medical provider. Pediatric nurse practitioners can enhance the collaboration with school nurses by establishing communication parameters, streamlining medication regimens, and facilitating development of educational curricula for school nurses regarding evidence-based ADHD management. Optimizing partnerships with school nurses will provide better surveillance of treatment efficacy and can facilitate improved health and academic and social outcomes for children with ADHD.

Individualized Health Care Plans

Individualized Health Care Plans

Is It PANS, CANS, or PANDAS? Neuropsychiatric Pediatric Disorders That Are Not Black and White--Implications for the School Nurse.

The terms pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), pediatric acute-onset neuropsychiatric syndrome (PANS), and childhood acute neuropsychiatric symptoms (CANS) have all been used to describe certain acute onset neuropsychiatric pediatric disorders. Additionally, controversy is ongoing concerning the diagnosis and etiology of the disorders. The school nurse, as a member of a multidisciplinary team, benefits from an awareness of these disorders, the resulting impact on school performance, and the recommended treatment. The school nurse assists the team through the development of an Individualized Healthcare Plan to help the student to achieve success in school.

Allergy/Anaphylaxis Management in the School Setting

It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse) is the leader in a comprehensive management approach that includes planning and coordination of care, educating staff, providing a safe environment, and ensuring prompt emergency response should exposure to a life-threatening allergen occur. Furthermore, NASN supports, in states where laws and regulations allow, the maintenance of stock nonpatient-specific epinephrine and physician-standing orders for school nurses to administer epinephrine in life-threatening situations in the school setting. School districts must have a clear, concise, all-inclusive policy in place to address the management of allergies in the school setting that should be reviewed annually (National School Boards Association [NSBA], 2012). This policy shall be consistent with federal and state laws, nursing practice standards, and established safe practices in accordance with evidence-based information and include development of a developmentally appropriate Individualized Healthcare Plan (IHP) and Emergency Care Plan (ECP).

Encopresis

Encopresis is a medical condition that can be seen in the school setting with children of all ages, though primarily at the early childhood and elementary level. This condition can cause a great amount of frustration with the student, family, and teachers due to the child's inability to control elimination patterns. The school nurse must be aware of the warning signs that a student may be experiencing encopresis in order to promote treatment. This article will assist the school nurse in understanding typical causes for functional encopresis, knowing how to help a student who soils, and developing an individualized healthcare plan that assists a student to become continent of stool again. Encopresis is not just an accident.

How Can Individualized Healthcare Plans Be Used Most Effectively?

IHPs represent an underutilized "voice" of school nursing. Modern data methods and health information technology tools provide many examples and avenues for school nursing to contribute to documentation and interpretation of evidence to support the statement that "every child needs a school nurse". Using reliable and valid data measures that are relevant not only to school nursing practice but also to the greater U.S. health care and educational systems, school nurses have a compelling message to tell about the state of children today and challenges children face in arriving at future success. Equally compelling, we have at our fingertips in our IHPs the substance of evidence of the work we do and the contributions we make in helping every child succeed and be well. Failing to step forward to tell this story ourselves only means that someone else might tell it for us.

Managing the Student With Severe Food Allergies

School nurses play a key role in managing students with food allergies. It is becoming more common to encounter students with severe allergies to multiple foods, putting them at risk for anaphylaxis. It is essential that the school nurse have a clear understanding of food allergies and how to effectively manage students in the school setting. Effective communication between families, health care providers, faculty, staff, and students, is of utmost importance when developing a plan of care to ensure the safety of the student with food allergies. Using an interdisciplinary approach to case management, the school nurse can develop comprehensive individualized health care plans for all students with food allergies.

Women's perception of the menopause and hormone treatment: barriers against hormone therapy

Objectives To identify the mean age of menopause, menopausal symptoms, and perceptions of hormone therapy (HT) among women aged 20–64 years in Turkey.Methods The study was descriptive and cross-sectional. A total of 729 Turkish women between 20 and 64 years old, living in urban areas (Samsun, Manisa and Isparta, three big cities in Turkey), participated in the study.Results The mean age of menopause was found out to be 47 ± 4.8 years. In the present study, 53.6%% of the menopausal women did not consult a doctor; 42.3%% of the women who consulted their doctor did not start taking HT. HT was recommended to 23.9%% of the women, but they refused to use it, while the remaining 33.8%% started HT. However, even those who started HT stopped taking it later. Of the women using HT, 80.8%% started to take their medications regularly; however, 50%% of these discontinued HT due to the fear of cancer, and the other 50%% discontinued the treatment on the recommendation of their doctors.Conclusions The treatment of half of the women who used HT was terminated by doctors, while the other half chose to discontinue the therapy themselves due to their fear of cancer. The present study offers a significant insight into the barriers against HT for women in the menopausal period. Health professionals should inform women about evidence-based studies and implement an individualized treatment and health-care plan by sharing information with potential users.

Health Care Plans to Manage Diabetes at School

The DMMP, prepared and signed by the student’s personal diabetes health care provider(s), contains tailored medical orders for each student. The DMMP is the basis for all of the health care and education plans designed to help the student manage diabetes effectively at school. The DMMP should be in place to ensure that the student’s diabetes health care needs are safely and appropriately met at school. The school nurse uses the DMMP to develop the other health care plans used at school for the student with diabetes: the student’s Individualized Health Care Plan and other education plans (e.g., a Section 504 Plan or Individualized Education Program [IEP]). Although the DMMP is not required by Section 504 of the Rehabilitation Act of 1973 (504), the Americans With Disabilities Act, or the Individuals With Disabilities Education Act, for the student with diabetes who is eligible for these additional educational plans, the medical orders contained in the DMMP should be incorporated into these additional educational plans. Information in the DMMP may include:

The perception of the clinical relevance of the MDS-Home Care(C) tool by trainers in general practice in Belgium

comprehensive geriatric assessment has been advocated as an effective way to first identify multidimensional needs and second to establish priorities for organizing an individual health care plan for community-dwelling elderly. This paper reports on the perception of an internationally evaluated assessment system for use in community care programmes, the Minimal Data Set-Home Care (MDS-HC), by a group of experienced GP trainers. the primary study aim was to determine the perception of a standardized home care assessment system (MDS-HC) by GP trainers in terms of acceptability, perceived clinical relevance, care planning empowerment and valorization of the GP. sixty-five first-year GP trainees were educated about the MDS-HC and the use of a first version of an electronic interface. Each trainee included two elderly patients, based on strict inclusion criteria. Prior to the assessment, GP trainers and trainees were invited to complete together a basic medical record on the basis of their knowledge of the included patients. Next, the collected data, covering the multiple domains by MDS-HC, were introduced in the electronic interface by the trainee. Based on the collected data for each patient, a series of clinical assessment protocols (CAP's) were generated. Afterwards, these CAP's were critically discussed with the trainer. To investigate how the application of the MDS-HC was perceived, a 21 Likert-type item scale was drawn up based on four dimensions regarding the tool. the perception questionnaire had a good internal consistency (Cronbach's alpha 0.93). The first version of the electronic interface was considered not 'user-friendly' enough and the introduction of data time-consuming. The perception of the GP's about the overall clinical relevance of the MDS-HC was found to have little added value for the GP in the establishment of a personal management plan. many developments in health care result in an increasing demand for a standardized home care assessment system. In Belgium, the federal public health service advised to promote the MDS-HC for use in the community setting. In this study, it appears that its added value was not perceived by this sample of 37 experienced GP trainers as an empowering tool in term of management of the patient and valorization of the role of GP.

Honoring Do-Not-Attempt-Resuscitation Requests in Schools

Increasingly, children and adolescents with complex chronic conditions are living in the community. Federal legislation and regulations facilitate their participation in school. Some of these children and adolescents and their families may wish to forego life-sustaining medical treatment, including cardiopulmonary resuscitation, because they would be ineffective or because the risks outweigh the benefits. Honoring these requests in the school environment is complex because of the limited availability of school nurses and the frequent lack of supporting state legislation and regulations. Understanding and collaboration on the part of all parties is essential. Pediatricians have an important role in helping school nurses incorporate a specific action plan into the student's individualized health care plan. The action plan should include both communication and comfort-care plans. Pediatricians who work directly with schools can also help implement policies, and professional organizations can advocate for regulations and legislation that enable students and their families to effectuate their preferences.

Physical education teachers’ knowledge of type 1 diabetes

All children spend a significant amount of time at school and therefore rely on school staff for help with their health care needs. The Department of Health (DoH) published a...

Can Individualized Health Care Plans Help Increase Continence in Children With Dysfunctional Elimination Syndrome?

School-age children with dysfunctional elimination syndrome (DES) do not always have school support for their treatment plans, including an every 2-hr voiding schedule. The objective of this study was to increase school support of treatment plans by allowing access to bathrooms, thereby improving continence. An eight-question survey about bathroom access at schools was given to parents at baseline. The author contacted school nurses requesting that treatment plans be incorporated into individual health plans (IHPs) with teacher support of the IHP. Six weeks later, school nurses were contacted and parents completed a postintervention survey to determine whether IHPs were supported by teachers. Voiding diaries were used to document continence. Seventeen parents completed the survey at baseline, and 13 children were enrolled in the intervention. After the intervention, 100% of the children had IHPs and teacher support of treatment plans. Ninety-two percent had increased continence. IHPs improved teacher support of children's treatment plans and improved their continence.

Local authorities and the education of young people with sickle cell disorders in England

The successful inclusion of minority ethnic pupils with sickle cell disorders (SCD) raises a number of challenges for educational systems. In England, local education authorities were important drivers for innovative responses to complex needs and the former Inner London Education Authority produced guidance in 1989 on SCD in schools. Local education authorities, however, have been superseded by centralised curricula on the one hand and by local management of schools on the other. We know little about the impact of these changes on managing chronic conditions such as SCD. A survey was conducted with 107 local authorities in England to assess responses to needs of pupils with SCD. The majority of authorities did not know the numbers of children with SCD under their jurisdiction, even though most agreed with government guidance that all such children should have individual healthcare plans. Only two had policies on SCD and most authorities referred to generic guidance on pupils with medical needs in schools. The paper concludes, however, that such generic guidance fails in a number of ways to meet the needs of young people with SCD, in terms of prevention, challenging disability discrimination and, crucially, in failing to recognise how ethnicity and racism mediate the experiences of young black disabled students. Developing policies suitable for the education needs of young people with SCD would also help develop the very narrow guidance currently suggested for inclusion of pupils with medical conditions.

Oppositional Defiant Disorder: Information for School Nurses

Oppositional defiant disorder, one of the disruptive behavior disorders, has far-reaching consequences for the individual, family, school, community, and society. Early recognition allows interventions geared toward promotion of prosocial behaviors, possibly halting progression to the more deviant conduct disorder. Awareness of this disorder and associated comorbidities is the first step that enables the school nurse to use assessment techniques and to assist in planning of interventions for the child. Children at risk often show tendencies toward oppositional defiant disorder as early as preschool. Interventions should be in place by the elementary school years to interrupt the pathways that may be difficult or impossible to change once adolescence begins. The school nurse can be instrumental in educating staff about risk factors, early associated behaviors, and referrals. Implementation of an individualized healthcare plan targets specific behaviors and provides a means of observing and documenting a child's improvements.

Oppositional Defiant Disorder: Information for School Nurses

Oppositional defiant disorder, one of the disruptive behavior disorders, has far-reaching consequences for the individual, family, school, community, and society. Early recognition allows interventions geared toward promotion of prosocial behaviors, possibly halting progression to the more deviant conduct disorder. Awareness of this disorder and associated comorbidities is the first step that enables the school nurse to use assessment techniques and to assist in planning of interventions for the child. Children at risk often show tendencies toward oppositional defiant disorder as early as preschool. Interventions should be in place by the elementary school years to interrupt the pathways that may be difficult or impossible to change once adolescence begins. The school nurse can be instrumental in educating staff about risk factors, early associated behaviors, and referrals. Implementation of an individualized healthcare plan targets specific behaviors and provides a means of observing and documenting a child’s improvements.

Caring for Children With Autism in the School Setting

Children with autism present unique challenges related to communication, behavior, and social skills. Each child with an autistic spectrum disorder (ASD) exhibits individual characteristics of the disorder. Early identification of autistic spectrum disorder has been shown to improve the child's benefit from educational interventions. There may be health issues related to autism including seizure disorders and dietary restrictions. Students with autism need special consideration when they come to the health office for screening, assessment of injuries, or administration of medication. Collaboration between educators and school nurses is needed to develop and implement Individual Education Plans and Individual Healthcare Plans. Community resources provide valuable assistance to families of children with this challenging disorder.