Observation of urinary tract infection signs and symptoms in nursing home residents with impaired awareness or ability to communicate signs and symptoms: The development of supportive tools

Background

Antibiotics are often inappropriately prescribed for urinary tract infections (UTIs) in nursing home (NH) residents. Research emphasises the importance of prescribing antibiotics only if there are UTI-related signs and symptoms (S&S). However, for many NH residents it is challenging to find out whether such S&S are present, for example due to cognitive disorders.

Objectives

To provide insight into the assessment of UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S, and to develop supportive tools for the observation of UTI-related S&S in this subgroup of NH residents, by nursing staff.

Methods

We performed a practice-based study using mixed methods. Data of 295 cases of suspected UTI were analysed to determine how often UTI-related S&S were ‘not assessed/non-assessable’ in residents with and without dementia. Barriers and facilitators in observing UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S were derived from interviews and focus groups with nursing staff. Literature review, focus group data, additional telephone interviews and questionnaires with nursing staff were used in a step-by-step process, including pilot testing, to develop supportive tools for the observation of UTI-related S&S.

Results

UTI-related S&S were assessable in the majority of NH residents with dementia. The proportion ‘not assessed/non-assessable’ S&S in residents with dementia increased with increasing severity of dementia. In residents with very severe dementia, up to 58% of the S&S were ‘not assessed/non-assessable’. Knowing the resident, working methodologically, and being sufficiently skilled to interpret observations in residents facilitate the assessment of UTI-related S&S. Insights acquired during the different study elements resulted in the development of an observation checklist and a 24-h observation tool.

Conclusions

The more NH residents have impaired awareness of ability to communicate S&S, the more difficult it seems to be to assess UTI-related S&S. The observation checklist and 24-h observation tool developed in the current study may support nursing staff in their observation of UTI-related S&S in this group of NH residents.     

疱疹性咽峡炎发展为手足口病患儿早期临床表现分析

目的 观察疱疹性咽峡炎患儿的早期临床症状和体征,以便早期识别有可能发展为手足口病的疱疹性咽峡炎患儿.方法 选取我院2012-2013年儿科病区临床早期诊断为疱疹性咽峡炎患儿80例,随病情进展分为3组.A组为单纯疱疹性咽峡炎组患儿42例;B组为疱疹性咽峡炎发展为手足口病组患儿28例,C组为发展为重症手足口病患儿10例.分别检测3组患儿血常规及淋巴细胞计数、中性粒细胞计数,并监测其发热程度、血压、心率、呼吸及消化系统、神经系统症状.结果 A、B、C组患儿白细胞计数、淋巴细胞计数、中性粒细胞计数比较差异均无统计学意义（P均＞0.05）;患儿发热程度、热程、心率、呼吸频率、收缩压、舒张压比较差异均有统计学意义（F值分别为5.03、3.62、4.83、3.65、6.72、3.74,P均＜0.05）;同时伴有明显食欲减退、呕吐、腹泻消化道症状和易惊、肢体抖动、嗜睡神经系统症状,差异均有统计学意义（x2值分别为6.10、5.75、4.86、3.58、3.42、4.35,P均＜0.05）.结论 疱疹性咽峡炎患儿如热度高、热程长,心率、呼吸偏快、血压偏高,伴有食欲减退、呕吐或腹泻和/或伴有易惊或肢体抖动、嗜睡症状,进一步发展为手足口病的可能性大.     

不同翻身角度对老年卧床患者皮肤受压及生命体征的影响

目的比较侧卧30°与90°皮肤压红面积及生命体征的变化情况,找出适合老年卧床患者翻身的方法。方法选择10例长期卧床的高龄患者,分别观察侧卧30°和90°的卧位2h后皮肤发红部位、面积及侧卧前、侧卧10min、30min、60min后生命体征的变化。结果侧卧90°皮肤受压发红部位数及发红平均面积数均大于侧卧30°（P〈0．05）。侧卧前与侧卧后10min、30min比较,心率、血压均有所升高（P〈0．05）,但侧卧前与其它侧卧时间比较,差异无显著意义,脉氧饱和度比较,差异无显著意义（P〉0．05）。结论侧卧30°对皮肤受压部位预防压疮的效果优于侧卧90°。应加强对长期卧床老年患者改变体位时生命体征的观察。     

老年病房内铜绿假单胞菌感染预防及护理

目的 :探讨老年病房内铜绿假单胞菌感染的相关因素和预防及护理。方法 :分析近 3年内老年病房铜绿假单胞菌 (Pseudomonasaerugi nosa,PA)感染患者的临床资料 ,常规痰培养分离鉴定PA ,采用K -B纸片法按NCCLS制定的标准进行药物试验 ,总结出PA感染的相关因素。结果 :免疫功能低下 ,气管切开及机械通气 ,长期卧床 ,呼吸道分泌物引流不畅 ,经鼻留置胃管 ,长期应用抗生素是住院老年患者PA感染的主要因素。结论 :对PA感染的预防及护理对策是减少PA侵袭机会 ,提高宿主防御机能 ,合理而有效的使用抗生素     

循证护理在预防老年髋部骨折围术期并发肺部感染中的应用

目的探讨循证护理在围术期中预防老年髋部骨折并发肺部感染的应用。方法将137例未发生肺部感染的老年髋部骨折患者随机分为循证护理组和常规护理组,比较两组患者肺部感染发生率及呼吸衰竭发生率。结果循证护理组肺部感染发生率及呼吸衰竭发生率上均低于常规护理组(P<0.05)。结论在老年髋部骨折患者中应用循证护理,可降低肺部感染及呼吸衰竭的发生率。     

老年社区获得性血流感染患者的病原学特点及预后

目的分析老年社区获得性血流感染(CABSI)患者的病原菌分布特点及耐药性,探讨影响预后的相关危险因素,为临床诊疗提供参考。方法回顾性分析2015年1月-2018年9月西南医科大学附属医院确诊为CABSI且年龄≥65岁住院患者的血培养及药敏试验结果、临床资料。结果157例老年CABSI患者中121例(77.1%)至少存在1种基础疾病,以2型糖尿病多见。原发感染部位明确者111例(70.7%),以泌尿道感染多见。内分泌科(25.5%,40/157)是病原菌检出率最高的科室。共分离出157株非重复病原菌,其中革兰阴性菌、革兰阳性菌、真菌分别占75.2%(118/157)、21.0%(33/157)、3.8%(6/157)。常见病原菌为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌。在常见革兰阴性菌中,未发现对碳青霉烯类耐药菌株,对氨苄西林耐药率最高。在常见革兰阳性菌中,对利奈唑胺、万古霉素均呈现敏感,而对青霉素耐药率最高。157例CABSI住院患者病死率为17.2%,结合单因素、多因素logistic回归分析结果显示患有2型糖尿病(OR=3.132)和降钙素原升高(OR=1.023)是患者死亡的危险因素。结论老年CABSI患者分离病原菌以革兰阴性菌为主,最常见的病原菌为大肠埃希菌。患2型糖尿病和降钙素原升高是影响患者预后的高危因素。     

坏死性淋巴结炎患者的辨证施护

报道了12例坏死性淋巴结炎患的辨证施护，包括情志调摄，发热的护理及口腔粘膜、皮疹、关节疼痛的护理，介绍了出院指导。12例患治疗护理均有满意效果。     

急性期面神经炎病人辨证施护的效果观察

[目的]探讨面神经炎急性期辨证施护的有效方法。[方法]将46例面神经炎病人随机分为实验组和对照组,对照组给予常规护理,实验组根据不同证候给予辨证施护,比较两组病人治疗后第7天、第14天的疗效。[结果]实验组第7天、第14天有效率优于对照组（P〈0.05）。[结论]采用中医辨证施护对促进面神经炎康复有较好的效果。     

腰椎间盘突出症的常见症状体征调查及其临床意义

目的　总结 1 1 2 6例腰椎间盘突出症的临床资料 ,依据常用临床诊断指标 ,探讨其临床意义。方法　回顾性调查 ,项目包括 :一般情况、症状和体征、CT检查 ,计算各指标所占比例。对直腿抬高试验本文采用自制测角器确定直腿抬高的度数。结果　①症状和体征 :间歇性疼痛 84.2 8% ,麻木 58.0 8% ,行走引起腰腿痛 59.1 5 %。腰椎前屈受限较少 ,腰及患下肢压痛 73 .0 0 %其中放射性疼痛 2 1 .0 5 % ,肌肉萎缩 6 .75 % ,皮肤感觉减退 5 .2 4 % ,跟腿反射减弱或消失 2 6 .82 % ,直腿抬高试验阳性率为 86.86 % ,30°～ 60°受限者 65 .0 1 % ,跟臀试验阳性率 1 1 .63 %。②CT扫描 :1 1 2 6例患者有 1 0 67例做了扫描 ,L4～ 5、L5～S1 突出占 91 .52 % ,突出物 <8mm者 97.46 % ,其中 <5mm者 83 .2 5 % ,中央型和侧后型突出占 95 .41 % ,突出合并关节突增生 1 9.31 % ,黄韧带肥厚或骨化 6 .65 % ,后纵韧带骨化 1 5 .1 8%。结论　腰椎间盘突出症男多发于 2 0～ 50岁人群 ,有近半数的患者无明显诱发因素 ,直腿抬高试验阳性率高 ,CT检查是目前最常用的检查方法 ,L4～ 5、L5～S1 节段多发 ,以中央性和侧后型为主     

Nurses' perceptions of sexuality in institutionalized elderly: a literature review

Background

Institutionalized elderly continue to have the need for sexual expression and intimacy. Nurses often display negative responses when they are confronted with the sexual behavior of residents. They feel ashamed and do not know how to react. This generates feelings of discomfort, resulting in the denial of resident's needs and desires for sexual fulfillment.

Objectives

The objective of this review is to thoroughly analyze the literature about the knowledge, attitudes, and experiences of nursing staff toward sexuality in institutionalized elderly. We shed light onto the relationship between knowledge and attitudes, and determined whether certain demographic factors relate to the knowledge and attitudes of nursing home caregivers.

Design

We conducted an extensive search of the electronic databases Medline, Cinahl, Psychinfo, Web of Science, Philosophers Index, Google Scholar, and Invert for papers published between January 1980 and September 2010. A broad range of search keywords was used.

Findings

The quantitative studies revealed nursing staff to show rather positive attitudes toward later-life sexuality. However, the extent of the staff's knowledge regarding sexuality in the aged seemed to be very limited. There was no consensus found about the relationship between knowledge and attitudes. As regards the influence of demographic variables, the results were very ambiguous. The qualitative studies showed that caregivers hold rather conservative attitudes toward sexuality in institutionalized elderly. Feelings of discomfort prevailed. The responses to residents’ sexual behavior were influenced by the staff's own level of comfort related to sexuality issues and the ethos within the institution where they work.

Conclusions

This review gives us a broad outline of the knowledge, attitudes, and experiences of geriatric nurses toward sexuality in institutionalized elderly. If we want the sexual needs of residents to be recognized, more research is needed. Especially needed are more in-depth qualitative studies that explore the experiences of nurses and managers. The development of a more accurate educational program could increase the knowledge of later-life sexuality and cultivate positive and permissive attitudes toward sexuality in the aged.     

老年冠心病患者术后主动脉内球囊反搏辅助治疗的医院感染分析及护理

目的 总结冠状动脉移植术后主动脉内球囊反搏（IABP）辅助的老年患者的医院感染情况和护理策略.方法 回顾性分析2006年4月至2009年2月冠状动脉移植术后IABP辅助治疗的111例老年患者的医院感染资料,并对结果进行分析.结果 111例患者中发生医院感染29例,其中死亡19例,非医院感染的患者死亡11例,两类患者病死率比较有显著差异.29例院内感染患者中,共分离出阳性菌87株,其中革兰阴性菌47株,革兰阳性菌23株,真菌17株.结论 医院感染是老年冠状动脉移植术后IABP辅助患者的死亡危险因素之一,应严格执行无菌技术,加强护理和监测,控制/减少医院感染的机会,以降低病死率.     

老年冠心病患者术后主动脉内球囊反搏辅助治疗的医院感染分析及护理

目的 总结冠状动脉移植术后主动脉内球囊反搏(IABP)辅助的老年患者的医院感染情况和护理策略.方法 回顾性分析2006年4月至2009年2月冠状动脉移植术后IABP辅助治疗的111例老年患者的医院感染资料,并对结果进行分析.结果 111例患者中发生医院感染29例,其中死亡19例,非医院感染的患者死亡11例,两类患者病死率比较有显著差异.29例院内感染患者中,共分离出阳性菌87株,其中革兰阴性菌47株,革兰阳性菌23株,真菌17株.结论 医院感染是老年冠状动脉移植术后IABP辅助患者的死亡危险因素之一,应严格执行无菌技术,加强护理和监测,控制/减少医院感染的机会,以降低病死率.     

Burnout: co-workers' perceptions of signs preceding workmates' burnout

AIM: This paper is a report of a study to describe co-workers' perceptions of signs preceding workmates' burnout. BACKGROUND: Burnout engenders emotional and economic suffering, both individual and societal. It is therefore important to learn to recognize early signs to prevent burnout and co-workers, who have opportunities to recognize such signs, are valuable resources in this context. METHOD: Fifteen interviews were conducted with nursing and medical staff in Sweden who had worked with a person who developed burnout. The interviews took place in 2004 and were analysed using a thematic content analysis. The narratives were obtained when co-workers already knew that their workmates were on sick leave because of burnout or had left their employment after sick leave because of burnout. FINDINGS: The findings show that co-workers retrospectively recalled a multiplicity of signs. They perceived that the people concerned were struggling to manage alone, showing self-sacrifice, struggling to achieve unattainable goals, becoming distanced and isolated, and showing signs of falling apart. CONCLUSIONS: Some of the signs preceding workmates' burnout may be difficult to interpret as signs of burnout, because they may be regarded as qualities which are to some extent encouraged in the prevailing culture. The findings provide a complex picture of these signs that will hopefully increase our awareness of and ability to recognize such signs to facilitate the possibilities of our helping in time. The sub-themes and themes in the present study may also serve as a basis for supervisors involved in supporting clinical staff.     

Development of a questionnaire assessing nursing staff 's knowledge,attitude, and practice on the prevention of the nosocomial infection in elderly patients: testing reliability and validity

Objective: To develop a questionnaire assessing nursing staff's knowledge, attitude, and practice on the prevention of the nosocomial infection in elderly patients and test its reliability and validity. Methods: After the drafted questionnaire was developed, two rounds of Delphi survey were conducted by consulting experts to improve the questionnaire. Subsequently, 700 copies of the questionnaire were distributed to nursing staff to assess its reliability and validity. Results: Exploratory factor analysis (EFA) identifies 3 aspects, namely knowledge, attitude, and practice, with a total of 38 items. The Cronbach's a coefficients of the questionnaire and each of the aspects are 0.85, 0.80, 0.886, and 0.77 (>0.7), respectively. Confirmatory factor analysis (CFA) of each of the aspects are c2/df = 3.99, 2.26, and 3.32; Goodness-of-fit index (GFI) = 0.91, 0.97, and 0.92; Root mean square error of approximation (RMSEA) = 0.06, 0.04, and 0.05; Comparative fit index (CFI) = 0.91, 0.96, and 0.90. Conclusions: Through this study, it can be ascer tained whether the developed questionnaire enjoys sound reliability and validity in assessing nursing staff's knowledge, attitude, and practice on preventing the nosocomial infection in elderly patients and thus has cer tain application value.