新生儿行纤支镜下支气管-肺灌洗术的护理

回顾性总结20例新生儿行纤支镜下支气管-肺灌洗术的护理经验。认为术前做好充分的准备工作,术中配合医师做好病情观察及抢救,术后做好呼吸道护理,是保证新生儿支气管-肺灌洗术顺利进行的关键。     

双胎妊娠晚期一胎胎死宫内的围产期护理

总结20例双胎妊娠晚期一胎胎死宫内的围产期护理。认为护理重点为产前监测母体凝血功能及存活儿宫内情况,加强对症支持治疗,做好心理护理,产时严密观察产程进展,做好新生儿复苏准备,产后预防大出血和感染,指导母乳喂养。20例中无孕产妇及存活儿死亡。     

20例先天性梅毒新生儿的护理体会

总结20例先天性梅毒新生儿的护理。认为严格做好消毒隔离，加强病情观察及用药护理，做好一般护理及对家长的心理护理、喂养指导，重视出院指导，有利于提高治疗效果。20例中失访3例；17例随访满1年，甲苯胺红不加热血清试验复查均转阴性。     

新生儿高压氧治疗中的护理策略

目的 探讨新生儿行高压氧治疗的护理策略.方法 对需行高压氧治疗的212例新生儿,规范护理操作,做好在高压氧治疗中可能出现问题的处理预案.结果 212例患儿均安全出舱,出现哭闹20例,呕吐11例,其余病例均未出现不良反应,无意外事故发生.结论 掌握好适应证和禁忌症,严格操作程序,做好不良反应处理预案,对新生儿行高压氧治疗是安全的.     

人类免疫缺陷病毒感染产妇所生新生儿的护理体会

总结26例人类免疫缺陷病毒感染产妇所生新生儿的护理。护理重点为加强围生期护理,做好喂养护理和抗病毒治疗的给药护理,同时做好家长的健康教育,以提高新生儿的存活率,从而提高母婴阻断的成功率。26例新生儿均平稳度过新生儿早期,随访18个月,均未感染人类免疫缺陷病毒。     

低分子肝素治疗新生儿DIC的观察与护理

目的：探讨低分子肝素在新生儿DIC治疗中的应用及护理要点。方法：对20例确诊为DIC的新生儿行低分子肝素脐周皮下注射治疗。结果：20例患儿中除1例自动出院，1例死亡外，余18例均痊愈出院。结论：低分子肝素脐周皮下注射治疗DIC安全有效，做好治疗期间的护理，保证用药安全可降低不良反应。     

晚期妊娠合并骨盆骨折的护理

总结7例晚期妊娠合并骨盆骨折的护理。护理重点为在成立多学科抢救小组的前提下,做好急救处理与护理,加强患者及家属心理护理,重视骨盆骨折的治疗及护理,同时做好疼痛护理,以保证抢救成功。7例患者均抢救成功,其中1例胎死腹中、1例新生儿死亡、5例新生儿健康出院。     

新生儿原发性乳糜腹8例的护理

总结8例新生儿原发性乳糜腹的护理经验。护理重点是密切观察病情变化,及时预防和处理并发症,做好腹腔穿刺和引流的护理,加强营养支持,预防感染发生,做好出院指导。除1例死于严重腹腔感染以外,其余7例均好转出院,随访2~20个月,患儿生长发育良好,4例出院后3月腹水消失,2例患儿出院后6个月腹水消失,1例出院后18个月腹水消失。     

妊娠合并系统性红斑狼疮47例的护理

总结47例妊娠合并系统性红斑狼疮的护理。护理的重点是:做好孕期随访及健康知识宣教,提高患者服药的依从性,重视胎儿监护,做好产时护理及产后并发症的观察和护理。43例病情控制稳定,4例转院治疗;药物流产1例,自然分娩7例,剖宫产39例;死胎2例,2例新生儿放弃抢救,42例新生儿存活。     

新生儿早期先天性梅毒的护理

回顾性总结28例新生儿早期先天性梅毒的临床观察及护理措施,主要措施包括做好家长心理护理,严格执行消毒隔离,保护皮肤,骨损害护理和正确做好出院指导。认为正规、全程、彻底的治疗与护理是治疗新生儿早期先天性梅毒和预防院内感染的关键。     

Integrating Nursing Care into Systems of Care for Children with Emotional and Behavioral Disorders

PROBLEM: Recent developments in providing care to children with emotional and behavioral disorders, especially those with serious emotional disturbance, have included the establishment of systems of care. Guided by a set of principles and values, these systems of care have organized and delivered services to children and families with complex needs. To date, nurses have not had a salient role in systems of care. RESULTS: It is estimated that 20% of American children and adolescents have an emotional or mental disorder. As many as two thirds of these children are not receiving services. Systems of care have been funded to provide services for these children, particularly for the most severely affected. To date, nursing has not had a prominent role in these systems of care. CONCLUSIONS: Based on their knowledge, skills, and holistic approach to care, nurses could better integrate nursing care into systems of care. Possible roles as case managers, primary therapists, in-home interventionists, and in educational programs are suggested.     

Effects of promoting patients' participation in self-care on postoperative recovery and satisfaction with care.

The effectiveness of patients' participation in self-care aimed at expediting the rate of recovery from surgery and increasing satisfaction with care received was tested with adult patients undergoing pyelolithotomy and nephrolithotomy. Forty subjects participating in the study were randomly assigned to either an experimental (n = 20) or a control group (n = 20). Patients in the experimental group participated in their self-care through nurse-patient interaction in addition to the usual care received in the setting. Results of the study indicated that patients in the experimental group had significantly less pain sensation and distress, used fewer analgesics, ambulated more, had fewer complications, and had higher satisfaction with care than patients in the control group. Since the experimental intervention was based on Orem's and King's theories, these findings support the value of application of these two nursing theories in practice.     

Residential care placement: perceptions among elderly Chinese people in Hong Kong

A qualitative study was designed to explore the perceptions of residential care placement among elderly Chinese people in Hong Kong. Content analysis of the semi-structured interviews with 20 community residents aged 60 years or over revealed that elderly people in Hong Kong generally had mixed feelings towards such placement. While they believed that residential care was an unavoidable alternative to family care in their later lives it was an important source of fear in their later years, especially for those who perceived their health as deteriorating. Residential care homes were generally seen as the ultimate 'dumping place' where one would 'idle till death' and the quality of care provided in these homes was anticipated to be problematic. It was found that most of these beliefs were formed as a result of indirect experience through 'listening to stories of neglect or abuse from friends and relatives whose relatives were residential care home residents'. Implications for professionals working with elderly people are discussed in the light of these findings.     

Elderly patients' satisfaction with care under HMO versus private systems

In one community, 100 elderly persons (25 HMO and 75 private patients) completed a 20-item scale that measured satisfaction with medical care. Data on demographics, health care utilization, and self-assessed health status also were collected to determine whether these variables would relate to HMO membership. Satisfaction scores were compared between HMO and private care groups by multivariate analysis of variance. Satisfaction with the doctor-patient relationship and convenience of care was higher in the private care group, whereas satisfaction with cost was higher in the HMO group. Interestingly, the HMO group evaluated private care and HMO care similarly. The private group rated HMO care less favorably. Additional comments reveal specific areas of satisfaction/dissatisfaction.     

Career choices: a comparison of two occupational therapy practice groups

The increasing number of elderly people in the population and their greater use of the health care system require an increasing number of health care providers to work with older adults. A shortage of health care professionals to provide this care, as well as a reluctance to provide such care have been reported in the literature. The purpose of this qualitative study was to investigate how occupational therapists decide to work with older adults. Using a comparative approach, 40 occupational therapists were interviewed, 20 working in gerontology and 20 working in paediatrics. The findings indicate that social characteristics and experiences of the individual, as well as the context of work are important influences for practice choice decisions. Mapping of career paths led to the development of a typology to further describe the different influences involved in the career choices of these occupational therapists. Recommendations related to education and practice provide practical means by which to implement change.     

Factors associated with delayed initiation of HIV medical care among infected persons attending a southern HIV/AIDS clinic

BACKGROUND: Despite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States. METHODS: We evaluated the extent of, and characteristics associated with, delayed presentation to HIV care among 1,209 patients at an HIV/AIDS Outpatient Clinic in Birmingham, Alabama between 1996 and 2005. RESULTS: Two out of five (41.2%) patients first engaged care only after they had progressed to CDC-defined AIDS. Among these, 53.6% were diagnosed with HIV in the year preceding entry to care. Recent presentation (2002 - 2005), male sex, age > or = 25, Medicare or Medicaid insurance coverage, and presentation within six months of HIV diagnosis were independently associated with initiating care after progression to AIDS. CONCLUSIONS: A high proportion of patients entered clinical care after experiencing substantial disease progression. Interventions that effectively improve the timing of HIV diagnosis and presentation to care are needed.     

Characteristics of pediatric intermediate care units in pediatric training programs.

BACKGROUND/OBJECTIVE: To assess effective alternate care sites for the technology-dependent, but less acute critically ill child, we surveyed pediatric training programs to determine the availability and characteristics of non-neonatal pediatric intermediate care units. METHODS: A questionnaire was mailed to the program directors of all 226 United States pediatric residency programs in October 1988. Institutions were queried about pediatric residency program and hospital demographics, along with specific day-to-day management issues in an intermediate care unit. RESULTS: The intermediate care unit offers highly skilled nursing care with greater than 90% of the units primarily covered by RNs in a 1:2 or 1:3 RN/patient ratio. The technologies used in these units were similar to those technologies used in an ICU, and the average daily bed charge was 40% less than the average daily bed charge in an ICU. However, an intermediate care unit was present in only 33% of pediatric training programs and pediatric residents were not specifically trained to care for patients in these units; 37% of these units did not have daily attending physician/nurse/resident rounds, despite the complexity and degree of illness in the patients located in these units. In addition, greater than 20% of intermediate care units were predominantly staffed by RNs with degrees less than BSN. Thirteen percent of these units had a predominance of RNs with only routine experience. CONCLUSIONS: Standard levels of care and academic and financial guidelines should be established to optimize the value of pediatric intermediate care units.     

Nurses' experiences of working in emerging primary care groups

Primary care in England is being restructured and reorganized around primary care groups and primary care trusts, and a new system of clinical governance has been put in place to standardise levels of clinical care. There has been little exploration of the effect of these changes on the working practices of nurses in primary care. Telephone interviews were conducted with 20 nurses working in two primary care groups. The participants described an involvement in traditional roles within primary care. Access to information was problematic, with poor information technology support a particular problem. The respondents reported limited engagement with the primary care groups and the implementation of clinical governance. Ongoing staff shortages and the resulting increased workloads were identified as 'disablers' that need to be addressed as they will limit the capacity of the nurses to embrace new ways of working and prevent full engagement in the primary care trusts.     

Clinical informatics in critical care

Health care information systems have the potential to enable better care of patients in much the same manner as the widespread use of the automobile and telephone did in the early 20th century. The car and phone were rapidly accepted and embraced throughout the world when these breakthroughs occurred. However, the automation of health care with use of computerized information systems has not been as widely accepted and implemented as computer technology use in all other sectors of the global economy. In this article, the authors examine the need, risks, and rewards of clinical informatics in health care as well as its specific relationship to critical care medicine.     

Neonatal back-transport. Cost-effectiveness

This study examines the cost-effectiveness of returning previously ill neonates to community hospitals after treatment in a tertiary center, a concept known as "back-transport." The authors compared the charges for medical care during convalescence of a group of back-transported infants (BT infants; n = 20) with a similar group of infants who remained in a tertiary center for convalescence (NT infants; n = 20). The total charges for convalescent care (inpatient plus transport charges) for 20 representative BT infants was $61,840, compared with $68,240 for 20 matched NT infants, an average savings of $320 per BT infant. The average daily bed charge and charges for laboratory tests and medications were significantly less for BT infants compared with NT infants, and these reductions offset the transport charges for BT infants. The authors conclude that back transport decreases the charges for medical care for most infants. Therefore, the decision to back-transport an individual infant usually can be based on factors other than cost.