Behavioral Self-Management

While behavioral treatments have been increasingly utilized with older patients, they have almost entirely involved operant, rather than self-management, approaches. In the present paper, differences between operant and self-control behavioral approaches are discussed. A case example is presented of the successful use of a behavioral self-management treatment with an elderly patient with severe agitation. The potential utility of the self-management approach with older patients is discussed.     

Durée d’isolement et levée de la mesure ; étude de l’influence des facteurs anamnestiques et institutionnels

IntroductionIn France, the use of seclusion in psychiatric hospitals is regulated by the Act of January 26th 2016 which enforces a reduction of the use of coercive measures and limiting their duration. Criteria that are unrelated to the patient's symptoms might affect this decision and extend the duration of seclusion. The goal of the current observational study is, firstly, to determine which factors - unrelated to the patient's symptoms - influence the length of stay in seclusion. Secondly, it is to compare the composition of the medical and nursing teams at two times, the beginning and the end of the seclusion time period.MethodWe conducted this study in a La Rochelle regional hospital from October 2017 to July 2018. There were one hundred and twenty-four episodes of seclusion that occurred in the different psychiatric inpatient wards during this time. The episodes were divided into two groups: short-term and long-term seclusion, defined by the median duration of seclusion. Data were collected using a survey, completed by the nursing teams, based on the recommendations of good clinical practice published in 1998 and revised in 2017 by the French health authority. For each episode of seclusion, we collected the following data: socio-demographic information, history of psychiatric care of the patient and of violent acting-out, admission status, medical indication for seclusion, day of the week and time at the beginning and the end of seclusion, prior administration of a sedative before seclusion, exceptional events that might justify the end of seclusion, transfer to a protected room after seclusion, as well as the composition of the medical and nursing team on duty at the beginning and the end of the seclusion period. We compared the anamnesis between the short-term and the long-term seclusion groups, and we analyzed the composition of the medical and nursing teams at the two time points of seclusion. Statistical analyses were performed using R software (v. 3.5.1).ResultsThe mean duration of seclusion was 4.7 days and the median was 1.9 days. The average age was 37-years-old, with a ratio of 0.6 for females to males. Variables associated with a long-duration of seclusion were: the male gender (P = 0.005), Compulsory Admission at the Request of a State Representative (P = 0.008), a prevention measure of any hetero-aggressive action (P = 0.007), the lack of psychiatric care (P = 0.004), previous medico-legal issues (P = 0.006), violent behavior during a previous hospitalization (P = 0.022) and the use of seclusion on the weekend (P = 0.01). The composition of the medical and nursing teams related to the period of the end of seclusion were: the presence of the physician in charge of the patient (P < 0.001), a male caregiver in the team (P < 0.001), a specialized psychiatric nurse (P < 0.001) and the training of caregivers in the management of violence (P < 0.001). The presence of nurses who do not usually work in the psychiatric ward was associated with the period of the beginning of seclusion (P < 0.001).ConclusionOur findings showed a strong relationship between several anamnestic factors and the duration of seclusion. Caregivers lacking information about patients, potential violent behaviors and the beginnings of seclusion on weekends are associated with a long-duration of seclusion. Our study also highlights the roles played by the caregivers according to their composition and level of training to determine the ending of patient's seclusion.     

老年住院患者健康教育效果及其相关因素分析

目的探讨老年住院患者健康教育的效果,并分析健康教育得分与人口学资料之间的关系。方法选取我科2012年10月~2013年3月收治的161例老年住院患者作为研究对象。研究工具包括健康教育效果评价表及患者一般人口学资料问卷。结果 161例患者健康教育得分为(17.06±2.40);不同人口学特征(包括年龄、住院天数、文化程度)的患者健康教育总得分之间有显著性差异(P0.05)。结论护士对老年患者进行健康教育时,应针对不同患者的人口学特征进行有针对性的健康教育,以提高健康教育效果。     

Promoting Health Literacy in the Inpatient Setting: Assessment and Interventions

Limited health literacy (LHL) is typically identified in the outpatient setting, at a physician’s office or clinic, and addressed through interventions designed to promote patient understanding of self-care and preventative measures. When a patient with limited health literacy is hospitalized, information needs shift to inpatient, discharge, and posthospitalization care. Hospitalized patients present unique challenges which may affect their abilities to ask questions and retain information. Hospital personnel may also face the challenges of identifying limited health literacy in inpatients and providing appropriate education, in addition to patient care. Implementing hospital-wide health literacy screening is a feasible solution to identifying LHL patients and providing interventions.     

Development of the inpatient attitudes towards the patient role scale

Aim: The purpose of this study was to develop a reliable, valid scale that can measure inpatients' tendencies and level of effort in dealing with their role of patient. Methods: The question items were developed from interviews and a review of the literature. After examining the content validity, a pretest and pilot study were conducted. Then, the 27 item Inpatient Attitudes Towards the Patient Role Scale was created. A self‐administered questionnaire survey with 399 inpatients was conducted in order to examine the reliability and validity of this scale. Results: Two‐hundred‐and‐sixteen patients completed and returned the questionnaire (54.1% response rate). The respondents were aged between 20 years and ≥80 years (median: 60s); 60% were male and 39% were female. Based on a factor analysis, the following four common factors were extracted from 21 out of the 27 original items: “patient adherence”, “consideration”, “self‐expression”, and “mental attitude”. The evidence from an examination of the construct validity and stability suggests that the scale has good reliability and promising validity. Older adult patients tended to make more effort than younger patients. The patients who believed that it would take them a certain amount of time to recover and those who trusted the healthcare staff tended to make more effort. Conclusion: A reliable and valid scale to measure inpatient attitudes towards the patient role was developed. This scale might provide useful information for nursing practice.     

骨科患者万古霉素使用的专项点评

目的 通过骨科万古霉素使用情况的专项点评,促进其合理使用。方法 调取本院骨科2011—2013年使用万古霉素的病历,对其适应症、用法用量、疗程、序贯治疗、病原学检查5个方面进行合理性点评。结果 本院骨科不存在滥用万古霉素,重视病原学检查。但存在选药或疗程不合理、药液稀释浓度高以及医师对病原学检查认识不全面等现象。结论 开展万古霉素的专项点评,及时干预使用过程中存在的问题,从而促进其合理使用。     

六西格玛管理方法对住院患者给药查对缺陷的影响

目的：探讨六西格玛管理方法对降低住院患者给药查对缺陷率的影响。方法采用六西格玛管理方法（即通过定义、测量、分析、改进和控制（ DMAIC）的五个环节）对2013年1月—2013年6月该院住院患者给药查对缺陷进行分析并提出改进的措施。结果护士对住院患者给药查对缺陷率从改进前的6．0％降低到现在的0．9％,改进前后比较差异显著具有统计学意义（P＜0．05）;改进前后住院患者对给药的满意度由改进前的88．0％提高到现在的97．3％,改进前后比较差异显著具有统计学意义（P＜0．05）;医生对给药查对的满意度由改进前的90．5％提高到现在的98．4％,改进前后比较差异显著具有统计学意义（P＜0．05）;改进前给药错误纠纷共12起,改进后未发生因给药错误导致的纠纷和赔款。结论六西格玛科学的管理方法,可有效改进住院患者给药查对工作流程和降低住院患者给药查对缺陷率,提高用药的安全性,值得推广应用。