Nursing Care Strategies Research Articles

Application of Watson's Theory of Human Caring to End of Life Care in the Burns Intensive Care Unit: A Case Report

Abstract Care provision to severely burned patients is a challenging task that has the potential of putting aside other spheres of the patient and placing emphasis on the physical injury. Thus, Watson's Theory of Human Caring was applied to a burned patient. Though his stay was short, it offered an opportunity to assess the applicability of Watson's theory to end of life care. The theory proved useful to end of life care in the unit but it was identified that the current nursing care strategies will have to change to the primary nursing approach to enable a continuity of this application.

Nursing care in old patients with heart failure: current status and future perspectives.

The prognosis of heart failure (HF) patients has significantly improved in the last 20 years, given the advent of therapies such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), beta-blockers, and implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy devices (CRT). In addition to these promising therapies, proper nursing-care is also important. Here we summarize recent progress of nursing-care strategies in older HF patients, including routine nursing care, transitional care model, self-care, and role of exercise training in old patients with HF.

Intelligence Care: A Nursing Care Strategy in Respiratory Intensive Care Unit

Background:Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients.Objectives:The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU.Materials and Methods:This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient’s reports and documents were used. Information saturation was determined as an interview termination criterion.Results:Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications).Conclusions:Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

COMPLEX THINKING suPPOrTING CArE sTrATEGIEs FOr THE PrEVENTION OF sTDs/AIDs IN ADOLEsCENCE

ABsTrACTThis was qualitative research performed with 15 nursing professionals of a study cohort on adolescent health, in the capital of Rio de Janeiro/Brazil. The objective of the study was to discuss nursing care strategies for the prevention of STDs/AIDS in adolescence, from the perspective of complexity. A semi-structured interview was used for data collection from January to August of 2012. Grounded Theory was used as the methodological framework. The category "Starting points for the nursing care of adolescents in the context of STDs/AIDS" is presented, which discusses aspects related to interdisciplinarity; multidimensionality and specificities of the adolescence-related process, in the midst of vulnerabilities to STDs/AIDS, thereby revealing the importance of contemplating the phenomenon as delimited by its complexity.

Analysis of costs and benefits of transparent, gauze, or no dressing for a tunnelled central venous catheter in Canadian stem cell transplant recipients

Catheter-related bloodstream infection (CRBSI), an avoidable risk in cancer nursing, contributes to patient morbidity, and increases health care spending. The objectives of the study were to evaluate the impact of three different nursing care strategies for tunnelled central venous catheter (CVC) exit sites on infection outcomes and compare costs of each strategy. The study hypothesis proposed that CRBSI and charges for nursing care differ in adult Canadian blood and marrow cell transplant recipients with a tunnelled CVC that use a transparent dressing, no dressing, or a gauze dressing. A sample of 432 records at a single centre compared CRBSI across dressing groups. A micro-costing approach was used to estimate dressing supply charges for an evaluation of the costs and benefits of each exit care strategy. Results of the study indicated no significant differences in CRBSI, number of organisms, gram stain of organisms, or days until the onset of an infection between the three dressing groups. The gauze dressing was considerably more expensive than both the transparent dressing and the no dressing strategy. In terms of supplies and nursing labour fees, transparent dressings were most economical, closely followed by no dressing. The no-dressing strategy was arguably the best option overall, as removing the dressing presents several other non-monetary and monetary benefits too broad for measurement by this study.

Participation of the family in hospital-based palliative cancer care: perspective of nurses

The objective was to understand the perspective of nurses about the participation of the family in palliative cancer care and to analyze the nursing care strategies to meet their needs. Descriptive and qualitative research, conducted at the National Cancer Institute between January and March 2013, with 17 nurses. Elements of the Roy Adaptation Model were used for the interpretation of the data. Two categoriesemergedfrom the thematic analysis: perspective of nurses about the presence and valuation of family in the hospital; and appointing strategies to encourage family participation in care and meet their needs. This participation is essentialand represents a training opportunity for the purpose of homecare. Nurses create strategies to encourage it and seek to meet the needs. The results contribute to promote the family adaptation and integrity, in order to balance the dependent and independent behaviors, aimingfor quality of life and comfort. Further studies are neededdue to the challenges of the specialty.

Strategies for nursing care of alcohol users with published in proceedings CBEn

Objetivo: Analisar os estudos sobre estratégias de cuidados em enfermagem com usuários de álcool. Método: Estudo de revisão de literatura, com busca nos livros de anais e resumos do Congresso Brasileiro de Enfermagem (CBEn), a partir da questão “Quais estudos sobre as estratégias de cuidado aos usuários de álcool na área da Enfermagem vêm sendo realizados e publicados no CBEn?”. Os achados foram apresentados por ano de publicação, região, instituição de filiação e Estado da Federação e agrupados em cinco categorias temáticas. Resultados: O ano de 2006 concentrou a maior parte dos estudos (24%), assim como a maioria deles (41%) abordaram principalmente as reflexões sobre o manejo do alcoolista. Conclusão: Foram encontrados poucos estudos que envolvem as estratégias de cuidados em enfermagem com usuários de álcool, embora se tenha notado que estes estudos têm sido realizados principalmente nas regiões sul e sudeste do país.

Quality of life in nursing home settings: Perspectives from elderly residents with frailty

Frailty in older people is a challenge for governments, policy makers and healthcare professionals. It decreases quality of life (QoL) in older people, particularly those in nursing home settings. By adopting exploratory qualitative design with focus group interviews, this study aimed to explore perception of QoL in Chinese nursing home residents with frailty to inform nursing care strategies for improving the QoL of Chinese nursing home residents with frailty. Twenty-four Chinese nursing home residents with the frailty scores of 2 or above and at least 18 in the Mini Mental State Examination formed four focus groups to share their views on QoL. Analyzed by qualitative content analysis, the focus group data identified five themes – physical well-being to maximize independence in self-care, peace of mind to cope with irreversible impairment, connection to society, fulfillment of basic needs, and harmony in interpersonal relationships – and four sub-themes.

Examination of Three Case Studies of Caring for Psychiatric Patients on a Medical Surgical Unit

Medical surgical nurses frequently care for patients with psychiatric disorders as one in four people have a diagnosed psychiatric disorder. Since these nurses specialize in medical surgical nursing, they often feel they lack the expertise to care for patients with co-morbid psychiatric problems. This article presents three case studies and delineates nursing care strategies which could assist the medical-surgical nurses in caring for this population.

Strategies for recreating normal life: Iranian coronary heart disease patients' perspectives on coping strategies

To identify coping strategies used by Iranian patients with coronary heart disease. One of the most important nursing interventions is facilitating adjustment for patients. A deeper understanding of patients' coping strategies for controlling illness and its consequences is needed. A qualitative design. Participants were hospitalised patients diagnosed with coronary heart disease, based on documented angiographic results. A qualitative study using semi-structured interviews was conducted, and purposive sampling was performed. The qualitative content analysis determined categories and subcategories for describing and understanding coping strategies. The term 'coping strategies' refers to the strategies used by participants living with coronary heart disease as they attempt to understand and control their chronic condition and return to a social and physical state as similar to their predisease condition as possible. During the data analysis, six strategies emerged: searching for meaning and information; trying to achieve comfort and control; resting more, doing less and slowing down; motivating, prioritising and caring for self; turning to religion and spirituality; and expectations and receiving assistance and support. This qualitative study describes the coping strategies of Iranian patients with coronary heart disease and the commonalities with strategies for others dealing with chronic illnesses in Iran. The patients were found to use a variety of coping strategies to deal with their illness and its impacts on their lives. This study contributes to the existing body of knowledge about optimal nursing care strategies for patients with coronary heart disease. Through increasing awareness of coping strategies, nurses can help their patients employ the most effective tools and reinforce constructive successful coping styles for patients who are dealing with coronary heart disease.

Developing relationships: A strategy for compassionate nursing care of the dying in Japan

The aim of this study was to explore the type of relationship and the process of developing these relationships between nurses and patients in palliative care units in Japan. The special contribution that culture makes was examined to better understand the intensity of nurses' grief after the death of their patient. Thirteen Japanese registered nurses currently practicing in palliative care units were interviewed between July 2006 to June 2009. Theoretical sampling was utilised and the data were analysed using grounded theory methodology. Constant comparison was undertaken during coding processes until data saturation was achieved. Significant cultural influences emerged both in the type of relationship nurses formed with patients and in the way they developed relationships. The type of relationship was termed 'human-to-human', meaning truly interpersonal. The cultural values of 'Uchi (inside) and Soto (outside)' have particular implications for the relationship. Four actions Being open, Trying to understand, Devoting time and energy, and Applying a primary nurse role, were identified as strategies for nurses to develop such relationships. The quality of this deeply committed encounter with patients caused nurses to grieve following patients' death. Culture is a major influence upon the reasons, complexities, and impact that lie behind nurses' behaviours. Attention is needed to support nurses to sustain a fundamental caring quality in their relationships with patients.

An Integrative Review of Skin Breakdown in the Preterm Infant Associated with Nasal Continuous Positive Airway Pressure

To identify factors associated with skin injury during nasal continuous positive airway pressure (NCPAP) and describe differences in frequency, severity, and type of skin injuries when comparing nasal interfaces used during NCPAP in the preterm infant. Scientific databases were searched using provided key terms and yielded 113 articles. Forty-six articles were included in this integrative review: six case studies, 22 with identified aim of examining skin and nasal injury during NCPAP; 18 included skin care considerations during NCPAP. Studies were categorized into four themes: types of nasal injuries; associated risk factors that increase incidence of injury; differences between NCPAP devices and/or nasal interface and corresponding rate and severity of nasal injury; and recommended prevention strategies to reduce iatrogenic cutaneous injury. Skin injury was a common theme during neonatal NCPAP with skin breakdown rates of 20% to 60%. Increased skin injury risk was associated with smaller infant size, gestational age, and duration of therapy. Nursing care strategies to improve skin integrity during NCPAP had little supportive evidence. Nursing practice is varied with reportedly little standardized care during NCPAP therapy. Recommendations for specific care strategies to reduce skin injury during NCPAP were supported by limited experimental studies. Risk factors during NCPAP include nasal injury and trauma secondary to tight-fitting nasal interfaces necessary to provide continuous distending pressure for respiratory stability. Identifying strategies to reduce skin breakdown will support noninvasive treatment success, reduce reintubation rates, reduce sepsis, reduce patient discomfort, and improve developmental outcomes during NCPAP use.

Interventional patient hygiene: Discussion of the issues and a proposed model for implementation of the nursing care basics

More than 140 years ago, Florence Nightingale wrote "It may seem a strange principal to enunciate as the very first requirement in a Hospital that it should do the sick no harm." Data suggests that 63% of all preventable errors are related to clinical problems that are within nursing's independent scope of practice. Many of these fall in the category of "interventional hygiene" activities and include prevention of skin injury, post-operative respiratory complications and failure to rescue. As nurses we are called upon to assure higher levels of safety and quality for our patients by our governments, professional organisations and hospital administrations. It is essential that we implement evidence based nursing care strategies to reduce avoidable errors in care so that clinical outcomes improve. The author of this paper, who coined the team "interventional patient hygiene", discusses the science related to many of these care issues and proposes an Interventional Care Model for use by nurses in redesigning how we approach nurse sensitive care practices in the future. Additionally, a change framework called "Sustaining Nursing Clinical Practice" is described to ensure reintroduction and valuing of evidence basic nursing care in conjunction with the right resources and systems to sustain the new practice.

Trends in Home-visit Nursing Care by Agencies' Characteristics under the National Long-term Care Insurance System

Purpose: This study aimed to investigate trends in home-visit nursing care by agencies' characteristics under the national long-term care insurance system. Methods: Cochran-Mantel-Haenzel tests were conducted, using data drawn from the nationwide long-term care insurance claim database of the Korean National Health Insurance Corporation from 2009 to 2011. Results: The number of home-visit nursing care agencies has decreased continuously since 2009. There were also similar trends in the total amount of service provided by home-visit nursing care agencies, the number of recipients, the number of employees, and payments. This study showed that there were statistically significant differences in the trends in home-visit nursing care by agencies' characteristics. Despite the overall downward trend, there were some increases in the percentage of home-visit nursing care provided by agencies which were established by individuals, located in large cities, and which combined home-visit care with home-visit bathing. Conclusion: Home-visit nursing care agencies are responsible for providing community-based healthcare services. For past three years, however, they have not been utilized to their full potential. Understanding the trends in home-visit nursing care by agencies' characteristics is important to develop utilization strategies for home-visit nursing care.

Effect of Nursing Care Strategy on the Functional and Physical Abilities of Patients Following Stroke

Stroke is an increasing problem with advancing age which may result in many physical disabilities affecting daily activities. The nurse can help stroke patients with best utilization of their remaining physical and functional abilities. This study aim was to assess the effect of application of nursing care strategies on the functional and physical abilities of patients following stroke. The study was carried out at Elnasr Insurance Hospital, in Helwan City, Egypt using a controlled quasi-experimental design. It involved 60 stroke patients equally divided into an intervention group and a control receiving the routine hospital care. The researchers developed and implemented an individualized plan of care for each patient in the intervention group based on assessment, priorities, goals, and expected outcomes. The Stroke Specific Quality of Life Scale (SS-QOL) was used to assess the effect of the intervention at three and six months follow-up. The results demonstrated significant improvements only among the study group patients at the 3 and 6-month follow-up (p<0.001) in both physical and functional domains as well as in total QOL. A strong positive correlation (r=0.87, p<0.001) was found between the improvements in the scores of physical and functional QOL. Multivariate analysis showed that being in the study group and attending the intervention program were statistically significant independent predictors of score improvement. In conclusion, the implementation of nursing care strategies is successful in improving stroke patients’ physical and functional status and QOL. It is recommended to generalize such strategies in the routine hospital care. Future research is suggested to assess the effect of such interventions on family caregivers’ burden.

Exploration of Nursing Care Strategies for the Management of Urinary Incontinence in Hospitalized Women

Urinary incontinence is a major health condition among hospitalized women. The assessment, identification, and treatment of this condition are lacking. A review of the literature was undertaken to determine the state of the science for managing this condition. Five factors that induce or exacerbate urinary incontinence were identified and are presented here.

Human milk bank as a strategy for the nursing care to the newborn

ABSTRACTObjective: to evaluate the impact of the human milk bank (HMB) on the nursing care to the newborn and her/his family and highlight the importance of this strategy for the nurse's work. Method: this is an observational research with a qualitative approach, consisting in the experience lived by university students from the undergraduate Nursing course during their 5th semester and the experience of nursing professionals, accomplished through the practice of performing educative activities in the HMB of a university hospital, in 2010, in Rio de Janeiro, Brazil. The research was approved by the Research Ethics Committee of Faculdade de Medicina/Hospital Universitario Antonio Pedro (CEP CMM/HUAP), under the Protocol 129/08. The experiences lived were reported in a field diary and posteriorly analyzed. Results: It was observed that anxiety, along with maternal fears, collaborate to increase the difficulty in the process of breast feeding (BF). This fact reflects the unqualified prenatal care, the importance of the education process for preventing complications in the BF during the puerperium, and the importance of having a quiet and adequate environment for these practices, which is HMB. Besides, one can notice that the work of HMB with regard to these women provides an increase in the quality of life of the mother, the baby, and the whole community around them. Conclusion: one stresses the need for creating systematic nursing actions that contribute to a better treatment offered to these women, considering the impact that the nursing actions in HMB have on them. Descriptors: nursing care; breast feeding; infant, newborn.RESUMOObjetivo: avaliar o impacto do banco de leite humano (BLH) no cuidado de enfermagem ao neonato e seus familiares e destacar a importância dessa estratégia para o trabalho do enfermeiro. Metodologia: trata-se de pesquisa observacional com abordagem qualitativa, consistindo na experiência vivenciada por acadêmicas do curso de graduação em Enfermagem durante o 5º período e na experiência de profissionais de enfermagem, concretizada na prática com a realização de atividades educativas no BLH de um hospital universitário, em 2010, no Rio de Janeiro. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Faculdade de Medicina/Hospital Universitário Antônio Pedro (CEP CMM/HUAP), sob o Protocolo n. 129/08. As experiências vivenciadas foram relatadas num diário de campo e posteriormente analisadas. Resultados: observou-se que a ansiedade, unida aos medos maternos, colaboram para o aumento da dificuldade no processo de aleitamento materno (AM). Tal fato reflete o atendimento pré-natal desqualificado, a importância do processo de educação para prevenção de complicações no AM durante o puerpério e a importância de se ter um ambiente tranquilo e adequado para essas práticas, que é o BLH. Além disso, pode-se notar que a atuação do BLH em relação a essas mulheres proporciona o aumento da qualidade de vida da mãe, do bebê e de toda comunidade ao redor destes. Conclusão: ressalta-se a necessidade de criar ações sistematizadas de enfermagem que contribuam para um melhor atendimento oferecido a essas mulheres, dado o impacto que as ações de enfermagem no BLH geram sobre estas. Descritores: cuidado de enfermagem; aleitamento materno; recém-nascidoRESUMENObjetivo: evaluar el impacto del banco de leche humana (BLH) en la atención de enfermería al neonato y sus familiares y resaltar la importancia de esa estrategia para el trabajo del enfermero. Método: esta es una investigación observacional con abordaje cualitativo, consistiendo en la experiencia vivida por académicas del curso de graduación en Enfermería durante el 5º periodo y en la experiencia de profesionales de enfermería, concretizada en la práctica con la realización de actividades educativas en el BLH de un hospital universitario, en 2010, en Rio de Janeiro, Brasil. La investigación fue aprobada por el Comité de Ética en Investigación de la Faculdade de Medicina/Hospital Universitário Antônio Pedro (CEP CMM/HUAP), bajo el Protocolo 129/08. Las experiencias vividas fueron relatadas en un diario de campo y analizadas posteriormente. Resultados: se observó que la ansiedad, junto con los miedos maternos, colaboran con el aumento de la dificultad en el proceso de lactancia materna (LM). Ese facto refleja la atención prenatal descalificada, la importancia del proceso de educación para prevención de complicaciones en el LM durante el puerperio y la importancia de se tener un ambiente tranquilo y adecuado para esas prácticas, que es el BLH. Además, es posible notar que la actuación del BLH con relación a esas mujeres proporciona el aumento de la calidad de vida de la madre, del bebé y de toda la comunidad en torno de ellos. Conclusión: resaltase la necesidad de crear acciones sistematizadas de enfermería que contribuyan para un mejor atendimiento ofrecido a esas mujeres, dado el impacto que las acciones de enfermería en el BLH generan sobre estas. Descriptores: atención de enfermería; lactancia materna; recién nacido.

Antineoplastic agents extravasation from peripheral intravenous line in children: A simple strategy for a safer nursing care

PurposeThe antineoplastic agents infusion through peripheral lines may lead to several adverse events such as extravasation that is one of the most severe acute reactions of this sort of treatment. The extravasation prevention and management must be part of a safe and evidence-based nursing care. Due to this fact, two algorithms were developed with the purpose of guiding nursing care to children who undergo chemotherapy through peripheral line. The objectives of this study were to determine the content validity of both algorithms with pediatric oncology nurses in Brazil and United States of America, and to verify the agreement between the evaluations of both groups. Methods and SampleA descriptive validation study was carried out through the Delphi Technique that has the following steps: development of the data collection instrument, application to the specialists, data analysis, algorithms’ review, re-evaluation by the specialists, final data analysis and content validity determination. ResultsThe data analysis was descriptive and based on the specialists agreement consensus equal or higher than 80% in every step of the algorithms. The process showed that the agreement with both instruments ranged from 92.8% to 99.0%. ConclusionThe algorithms are valid for application in nursing care with the main purpose of preventing and managing the antineoplastic agents’ extravasation.

Pediatric Palliative Care in Childhood Cancer Nursing: From Diagnosis to Cure or End of Life

To describe selected components of pediatric palliative care from diagnosis to cure or end of life that combine to help nurses and other clinicians achieve goals of care for children with cancer and their families. Published articles. Pediatric palliative care is characterized by diversity of care delivery models; effect of cancer on the family as the central focus of care; and consideration of culture, spirituality, communication, and ethical standards. End-of-life issues that can be anticipated by nurses and other clinicians include symptoms of cancer or its treatment, the importance of hopefulness, the relevance of trying to be a good parent in decision making, the meaning of legacy making of ill children, and family bereavement. Direct nursing care strategies to achieve pediatric palliative care goals are vital to reduce child and family suffering from cancer.

The current nursing status of intensive insulin therapy in acute patients with stress-induced hyperglycemia

The intensive insulin therapy in acute patients with stress-induced hyperglycemia has a positive significance in the process of prognosis. The regular, timely monitor and accurate application of treatment program by nurses are the keys to successful treatment. This thesis is an overview about stress-induced hyperglycemia, intensive insulin therapy-related knowledge, the dangers of stress-induced hyperglycemia, the benefits of enhanced insulin treatment and the nursing care strategy. Key words: Stress-induced hyperglycemia; Intensive insulin therapy; Nursing; Iiterautre Review