Pilot study of low-income parents' perspectives of managing asthma in high-risk infants and toddlers

This pilot study describes the challenges low-income parents face in managing asthma in their infants and toddlers who are at high risk of morbidity due to asthma. Five families of children younger than 3 years and recently hospitalized for asthma were interviewed from 1 to 5 times and asked to give narratives about the everyday management of asthma in their high risk infants and toddlers. Interpretive phenomenology was used as the method to describe parents' perspectives on managing the illness. The parents, all single mothers, struggled to manage asthma in crowded conditions, with limited transportation for frequently needed emergency care, and in face of the complicating needs of other children and family members. Not knowing then knowing the diagnosis, and provider availability and lack of availability were two dichotomous challenges mothers faced when managing asthma in their very young children.     

Health care crisis in the black community: an epidemiological view.

Health care professionals must recognize Black populations' health care needs and target efforts to meet those needs whenever possible. In the future we hope mandated by federal regulations--congressman Louis Stokes of Ohio forwarded me a copy of the Disadvantaged Minority Health Improvement Act of 1990 (H.R. 5702) which was passed by the House of Representatives in October (1990). This amends the Public Health Service Act and provides for a Deputy Assistant Secretary for Minority Health who is charged with, among a myriad of functions, promoting minority health through the support of "research, demonstrations and evaluations to test new and innovative models, to increase knowledge and understanding of health risk factors, and to develop mechanisms that support better information dissemination, education, prevention and service delivery to individuals from disadvantaged backgrounds, including racial and ethnic minorities" (Dingell, 1990, p.3). Scholarships will be available to increase the number of minority health care workers. Hopefully, all health care workers will recognize the needs of Blacks and attempt to meet those needs. Nurse educators can facilitate this through their practices, research and teaching to increase access to health care for the Black community. Epidemiology in the curriculum will help accomplish this goal.     

危机管理理论及其在护患纠纷管理中的应用

随着服务对象法律意识的提高和社会环境、医疗环境的复杂化,护患纠纷越来越多,给护理管理工作造成较大的危机。危机管理理论是决策学的重要分支,将它的管理模式和管理策略引入护理纠纷管理中可以很好地预防和应对护患纠纷的发生。文章介绍了危机管理理论,分析了护患纠纷产生的因素,并提出应用危机管理理论减少护患纠纷的措施。     

Burden of asthma in the hospital setting: an Australian analysis

OBJECTIVES: This study was designed to report factors associated with asthma hospital admission, such as patient characteristics, type of admission and subsequent outcome i.e. discharge or death, for the years 2000-2005. These data are used for health economic models regarding asthma burden in the hospital setting in Australia. METHODS: Data was obtained from the Australian Centre for Asthma Monitoring using their amalgamated dataset from all states and territories. Admissions under ICD-10 codes J45 'Asthma' plus all subcodes, and J46 'acute severe asthma' were included. Codes for associated comorbidity at the time of admission were identified, as well as the month of death, age, gender and length and the type of stay. Confidence intervals for death rate assumed a binomial distribution because of the rarity of event. RESULTS: The total number of all-cause deaths for the 5-year observation period was 289 from 202,739 asthma separations or 0.14% or 143 deaths/100,000 separations and the highest rate was seen in patients over 45 years. Acute upper respiratory tract infections were reported in up to 25% of all asthma hospital admissions. Length of stay was up to a mean average of 10.2 days in patients who died (SD 15.3). In 5 years observation there was 152,758 emergency asthma admissions which contributed greatly to Australian healthcare burden. CONCLUSIONS: The study demonstrates that emergency admissions dominate asthma care in the hospital setting in Australia, which suggests poor asthma control in some patients with subsequent economic burden. Asthma-related mortality remains a risk for specific patients in the hospital setting.     

护理危机管理理论在呼吸科安全管理中的运用

目的：探讨护理危机管理的实际运用效果与可行性。方法：通过对小组成员进行相关培训,采用座谈与回顾性分析的方法,对呼吸科安全管理中的“危机源”进行梳理,制定改进方案与应对策略,并运用于临床。结果：通过6个月的临床实践,呼吸科的安全质量明显提高,跌倒、坠床、非难免压疮等不良事件发生率明显下降,差异具有统计学意义（P〈0．05）。结论：在临床护理中引入危机管理理论,针对“护理危机源”制定相应的管理策略,将有效地化解、减少危机事件,并把其危害降到最低,切实保证患者的安全,并为医院赢得信誉和效益。     

Looking at the ICF and human communication through the lens of classification theory

This paper explores the insights that classification theory can provide about the application of the International Classification of Functioning, Disability and Health (ICF) to communication. It first considers the relationship between conceptual models and classification systems, highlighting that classification systems in speech-language pathology (SLP) have not historically been based on conceptual models of human communication. It then overviews the key concepts and criteria of classification theory. Applying classification theory to the ICF and communication raises a number of issues, some previously highlighted through clinical application. Six focus questions from classification theory are used to explore these issues, and to propose the creation of an ICF-related conceptual model of communicating for the field of communication disability, which would address some of the issues raised. Developing a conceptual model of communication for SLP purposes closely articulated with the ICF would foster productive intra-professional discourse, while at the same time allow the profession to continue to use the ICF for purposes in inter-disciplinary discourse. The paper concludes by suggesting the insights of classification theory can assist professionals to apply the ICF to communication with the necessary rigour, and to work further in developing a conceptual model of human communication.     

Looking at the ICF and human communication through the lens of classification theory

This paper explores the insights that classification theory can provide about the application of the International Classification of Functioning, Disability and Health (ICF) to communication. It first considers the relationship between conceptual models and classification systems, highlighting that classification systems in speech-language pathology (SLP) have not historically been based on conceptual models of human communication. It then overviews the key concepts and criteria of classification theory. Applying classification theory to the ICF and communication raises a number of issues, some previously highlighted through clinical application. Six focus questions from classification theory are used to explore these issues, and to propose the creation of an ICF-related conceptual model of communicating for the field of communication disability, which would address some of the issues raised. Developing a conceptual model of communication for SLP purposes closely articulated with the ICF would foster productive intra-professional discourse, while at the same time allow the profession to continue to use the ICF for purposes in inter-disciplinary discourse. The paper concludes by suggesting the insights of classification theory can assist professionals to apply the ICF to communication with the necessary rigour, and to work further in developing a conceptual model of human communication.     

护理风险与危机管理预警在医院新生儿保健工作中的作用

目的研究新生儿医院保健工作中应用护理风险与危机管理预警的作用。方法选取2018年9月至2019年3月在某院出生的新生婴儿110例,采用随机数表法分为观察组与对照组各55例。对观察组进行护理风险与危机管理,对照组予以常规护理。观察两组新生儿母亲护理满意度;观察住院期间两组新生儿护理风险事件发生率;观察产妇产后并发症发生率以及新生儿并发症发生率;观察两组产妇产褥期保健知识掌握率、自我护理能力。结果观察组母亲护理满意度明显高于对照组(P<0.05);观察组新生儿护理风险事件发生率明显低于对照组(P<0.05);观察组产妇产后出血、子宫脱垂等并发症发生率明显低于对照组(P<0.05);新生儿并发症发生率低于对照组(P<0.05);观察组产妇产褥期保健知识掌握率高于对照组(P<0.05)。结论护理风险及危机管理预警能提高医院新生儿护理保健工作质量,提升新生儿母亲对院内护理满意度,减少护理风险事件发生率,增强产妇产褥期相关保健知识及自理能力,有效减少产妇产褥期及新生儿并发症的发生。     

Challenges of implementating a doctoral program in an international exchange in Cuba through the lens of Kanter's empowerment theory

The literature in international education focuses primarily on the experiences of western students in developing countries, international students in western universities, the development of an educational program in a developing country, or internationalization of curricula in western universities. There is little in the literature that addresses the challenges students and participating faculty face when implementing a graduate program in a developing country. The purpose of this paper is to describe and analyze the challenges of implementing a doctoral program in an international exchange through the lens of Kanter's theory of empowerment. Recommendations to address these challenges will be made.     

基于4R危机管理理论的综合性医院手术室突发急性传染病护理应急管理体系的构建

目的构建一套科学、系统、规范且适用于综合性医院手术室突发急性传染病护理应急管理的指标体系。方法于2020年6月—2021年3月以4R危机管理理论为指导,采用文献研究、专家访谈的科学方法初步拟定指标框架,对16名来自手术室护理、护理管理、医院感染、疾病预防控制及传染病领域的医疗、护理专家应用德尔菲专家咨询法进一步筛选和确定各级指标,并采用层次分析法和优序图法确定各级指标的权重值,最终形成综合性医院手术室突发急性传染病护理应急管理体系。结果2轮咨询专家积极系数均为100.00%,提出意见的专家分别占68.75%和31.25%,专家权威系数为0.9063,各级指标的变异系数均<0.25,2轮咨询一、二、三级指标的协调系数分别为0.228、0.322、0.288和0.252、0.406、0.326(均P<0.01)。最终形成包括4项一级指标、13项二级指标和64项三级指标的综合性医院手术室突发急性传染病护理应急管理体系,且指标权重分配合理。结论构建的综合性医院手术室突发急性传染病护理应急管理体系具备较高的科学性和可靠性,能够为手术室护理管理者应对突发急性传染病的护理应急管理提供科学参考依据。     

An international collaboration in nursing education viewed through the lens of critical social theory

Critical social theory, including the work of Jurgen Habermas, provides a valuable lens for viewing phenomena within their sociopolitical contexts. According to Habermas, the lives and experiences of individuals, groups, and societies in the western world are strongly influenced by the forces of economics and power. These influences may interfere with communication and, therefore, the transmission and regeneration of culture and its meaning. This article describes the experience of initiating an international exchange program at a university school of nursing in the eastern United States. Examined through the lens of Habermas' theory, constraints and obstacles encountered in this process are revealed. Specifically, the inhibiting influence that politics and economics may have on active communication and the potential benefits of shared meaning and understanding achieved by interaction and discourse are examined.     

Fosphenytoin: an intravenous option for the management of acute trigeminal neuralgia crisis

Timely management of trigeminal neuralgia presenting with severe, sustained, crescendo pain can be difficult with oral medications. More rapid pain control often can be achieved using intravenous phenytoin. Fosphenytoin is a phosphate ester prodrug of phenytoin that is significantly better tolerated parenterally than phenytoin in the treatment of epilepsy. Three patients with trigeminal neuralgia refractory to oral medications and presenting with crisis pain were treated urgently with intravenous fosphenytoin. In each case complete relief of pain was achieved for a duration of two days, affording a window of opportunity to modify oral pharmacotherapeutic strategies or to control pain in preparation for invasive neurosurgical intervention.     

The value of elecromyography in the aetiological diagnosis of hypotonia in infants and toddlers

IntroductionDuring the first two years of life, hypotonia may be the only symptom of a central or peripheral nervous system disorder. We propose to assess the sensitivity of electroneuromyography (ENMG) in the aetiological diagnosis of hypotonia of neuromuscular origin in infants and toddlers.MethodThis is a retrospective, single-centre study with revision of the files of the 37 children aged between zero and 24 months who, between 1994 and 2006, underwent an ENMG in the etiological approach of their hypotonia and had a final diagnosis of neuromuscular disease.ResultsAll the 13 patients with spinal muscular atrophy or Charcot Marie-Tooth disease displayed neurogenic alterations on the electromyography (EMG). Among the 24 children ultimately diagnosed with myopathies, five only displayed myogenic alterations when tested before the age of two. Sixteen had normal EMG results and three showed neurogenic alterations.Discussion and conclusionIn infants presenting with hypotonia, ENMG is useful for the diagnosis of peripheral neuropathy. Normal ENMG is relatively common for confirmed muscle disorders in infants whereas myogenic alterations seem more unusual, so that muscle biopsy appears unquestionable. In a few cases, early onset myopathies may present with a neurogenic ENMG pattern. Such a result should not invalidate the clinically presumed diagnosis of myopathy and would indicate on the contrary the need for a muscle biopsy.     

The plight of the Marsh Arabs, an environmental and human rights crisis: an application of complexity theory

Saddam Hussein's calculated destruction of the marshes of southern Iraq had an overwhelming impact on the marsh ecosystem, the physical environment, and its inhabitants. Hussein succeeded in disrupting the 5000-year-old culture of the Marsh Arabs, severely affecting the health and well-being of this unique culture. Complexity science provides a foundation that supports an appreciation of the effects that changes in environment and climate have on health. Application of a complexity model provides guidance for understanding the intricate networks of connectivity among the components of the ecological system of the marshes of Southern Iraq that is necessary for restoration efforts.