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1.
Itay Zmora Yonit Wiener-Well Evan Avraham Alpert 《The American journal of emergency medicine》2019,37(5):1006.e5-1006.e7
Background
Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge.Case report
An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis. The drainage was purulent and later cultures grew out Streptococcus pneumoniae.Why should an emergency physician be aware of this?
Purulent pericarditis is extremely rare but should be considered in the patient with a fulminant infectious process (particularly pneumonia) and signs of pericardial effusion. Treatment should include appropriate antibiotics and early drainage. 相似文献2.
Nancy Hoffart Thomas P. McCoy Lynne P. Lewallen Shemeka Thorpe 《Journal of Professional Nursing》2019,35(2):93-100
Background
The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points.Purpose
The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes.Method
An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates.Results
Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts.Conclusion
Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male. 相似文献3.
Objectives
This study examined the incidence of symptomatological post-traumatic stress disorder (PTSD) in bereaved Tibetan adolescents 3?years after the 2010 Yushu earthquake, then to identify possible and relational risk factors of PTSD by a cross-sectional study.Methods
A total of 867 bereaved Tibetan adolescents seriously impacted by the 2010 earthquake were investigated. Symptomatological PTSD was evaluated by the PTSD Checklist–Civilian Version. And coping styles were evaluated by the Coping Styles Scale. Exposure of trauma to the 2010 Yushu earthquake was evaluated by a checklist about earthquake containing sociodemographic variables.Results
3?years after the Yushu earthquake, 24.4% of the bereaved Tibetan adolescents had symptomatological PTSD. The results also indicated that coping styles and disaster-related experiences after the 2010 earthquake were connected with PTSD among survivors. When the 2010 earthquake struck, those having symptomatological PTSD were more probably to be buried/injured/amputated, and to witness burial/injury/death, and to have property damage. An individual who adopted positive coping skill was probably to have less symptomatological PTSD.Conclusions
The results showed that the existence of PTSD in bereaved Tibetan adolescents in the Yushu earthquake was very prevailing after 3?years. Effective psychological rescue work should be carried out, especially targeting bereaved Tibetan adolescents with more severe PTSD. 相似文献4.
Cynthia M Thomas Diana L Bantz Constance E. McIntosh 《Teaching and Learning in Nursing》2019,14(2):111-116
Background
Eight out of ten Americans report they experience job stress. Nurses (74%) are reporting acute and chronic stress as a contributing factor to nurse burnout. Stress can be the result of organizational, interpersonal or individual/personal factors and could eventually lead to burnout if ignored. It has long been reported about the shortage of nursing faculty but very little about how current nurse faculty experience burnout. Faculty burnout can be due to a variety of reasons (e.g., employment requirements, working in understaffed environment, lack of support).Problem
Although stress at work has become common nurses may avoid acknowledging stress. Nurse faculty have not received as much attention related to chronic stress and burnout or recognize personal chronic stress potentially leading to burnout.Approach
This paper discusses how to recognize the chronic stress that may lead to nurse faculty burnout, provides a case study for reflection and learning, and offers strategies to reduce and avoid burnout.Conclusion
Nurse faculty may gain greater understanding of stressors leading to burnout, determine if they are experiencing symptoms of burnout and apply strategies to reduce or prevent burnout. Burnout, Nurse Faculty, Chronic Stress, Work/Life Balance. 相似文献5.
Jay D. Fisher Robert J. Bechtel Korrina N. Siddiqui David G. Nelson Ahmad Nezam 《The American journal of emergency medicine》2019,37(5):933-936
Previously undiagnosed pediatric cardiac disease represents a clinical challenge for the emergency physician. The clinical presentation of these disorders can mimic other conditions of the respiratory, gastrointestinal and neurologic systems at a time when the need for early identification and treatment is at a premium. A high index of suspicion and superb clinical acumen is required to make a timely diagnosis and initiate optimal care.
Methods
A retrospective chart review using explicit criteria and a structured data collection process was performed on all children presenting with previously undiagnosed cardiac disease over a five and half year period.Results
Thirty-six patients were identified over a five and a half year period representing one patient per 4838 pediatric ED presentations. A diverse set of chief complaints, triage categories, clinical presentations and diagnoses were identified. Undiagnosed congenital lesions, acquired cardiac disease, dysrhythmias and infectious diseases of the heart were represented. The need for surgical intervention (22%) and mortality (6%) was substantial.Conclusion
In the aggregate, these conditions occur at an important rate and represent a high risk subset of pediatric patients presenting to the emergency department. Individually, the conditions occur infrequently and ‘pattern recognition’ may not aid the clinician. Early diagnosis and prompt intervention is important in this population. 相似文献6.
Introduction
The Ratu's Model is a nursing model to prevent postpartum depression, is a product of Ratu's dissertation. Depression is one of the common psychological problem experienced by postpartum women. The number is estimated to reach 20% in Indonesia, 15–20% in the Riau Province, and must to be pressed to 1%.Objectives
This study aims to identify the effectiveness of Ratu's Model to prevent postpartum depression.Method
Quasi-experiment research alongside with pre–post test analysis of the control group, number of the respondents was undergone among 54 women pregnant and the spouses in each intervention and control group. Educational intervention was given toward intervention group for 3 times, with 3 times monitoring, and 3 times measurement.Result
A significant correlation between Ratu's Model with lowered postpartum depression incidence.Conclusion
The Ratu's Model is effective lowering the incidence of postpartum depression. 相似文献7.
Cheryl Ross Cath Rogers Christine King 《Collegian (Royal College of Nursing, Australia)》2019,26(1):1-7
Background
Nursing workload remains an issue in current health care contexts. The use of quantitative methodologies, methods and tools to measure workload has not produced adequate data to inform workforce policy to resolve workforce concerns about workload.Objective
This study aimed to identify the influence of both culture and climate as factors in nursing workload.Methods
This research used an overall critical ethnographic methodology to investigate the real lifeworkload issues of nurses. Methods included fieldwork observations and informal discussions over a 3 year period and 11 in-depth interviews.Results
The study identifies the impact of safety mandates on nursing workload as an invisible phenomenon within current workload methodologies. Such mandates add to nursing roles and routines, and become a ‘taken-for-granted’ activity that is not always directly related to patient care, nor is a visible factor in workload measurement.Conclusion
Given that workload measurements are formulated on direct patient care activities, indirect and unrecognised activities may create additional nursing workload. 相似文献8.
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10.
Nalan Kozaci Mustafa Avcı Ertan Ararat Tansu Pinarbasili Muharrem Ozkaya Ibrahim Etli Eda Donertas Omer F. Karakoyun 《The American journal of emergency medicine》2019,37(5):864-868
Objective
In this study, the accuracy of bedside thoracic ultrasonography (TUSG) performed by emergency physicians with patients in the supine position was compared with that of thoracic computed tomography (TCT) for the determination of thoracic injuries due to trauma.Methods
Patients who suffered the multiple traumas, whose thoracic trauma was identified on physical examination or TCT imaging were included in the study. TUSG was performed following a physical examination by the emergency physician who managed the trauma patient. Subcutaneous emphysema, pneumothorax, pulmonary contusions (PCs), hemothorax, pericardial effusion and tamponade, sternal and clavicular fractures and rib fractures were identified by TUSG. TCT imaging was performed after the ultrasonography examination was completed.Results
Eighty-one patients were included in the study. TCT scans showed subcutaneous emphysema in 16 (19.8%) patients, pneumothorax in 21 (25.9%), PCs in 27 (33.3%), hemothorax in 20 (24.7%), sternum and clavicular fractures in 6 (7.4%) and rib fractures in 21 (25.9%). The sensitivity and specificity of ultrasonography varied for detecting the following pathologies: subcutaneous emphysema (56% and 95%), pneumothorax (86% and 97%), hemothorax (45% and 98%), PCs (63% and 91%), sternal fractures (83% and 97%), clavicular fractures (83% and 100%) and rib fractures (67% and 98%), respectively.Conclusion
In conclusion, ultrasound was found to be highly specific but only moderately sensitive for the identification of thoracic injuries. 相似文献11.
Michelle Ng Jerrold Perrott Sarah Burgess 《The American journal of emergency medicine》2019,37(3):444-449
Introduction
Tranexamic acid (TXA) has been shown to decrease mortality in adult trauma patients with or at significant risk of hemorrhage when administered within 3?h of injury. The use and appropriateness of TXA in adult trauma patients presenting to Royal Columbian Hospital (RCH) was investigated.Methods
This retrospective chart review utilized the British Columbia Trauma Registry to identify 100 consecutive trauma patients that presented to the emergency department at RCH between April 2012 to June 2015 and met the following indications for TXA: systolic blood pressure <90?mm?Hg and/or heart rate >110?bpm and presentation within 8?h of injury. Primary outcomes included: percentage that met indications for TXA, received TXA according to the CRASH-2 protocol, received a pre-hospital dose, and received TXA ≤1, >1 to ≤3, or >3?h from injury.Results
During the given time period, 117 subjects (2.7%) met indications for TXA. 67 patients (57%) received TXA in any dose, with 10 subjects (8.5%) receiving TXA according to the CRASH-2 protocol. Of the 67 patients who received any TXA, 76% did so ≤3?h. 22 patients (19%) received TXA as a pre-hospital dose.Conclusions
<10% of adult trauma patients that met the indication for TXA received it according to the CRASH-2 protocol. Of those patients that received TXA, 76% did so within 3?h. Further inquiry to identify reasons trauma patients are not receiving TXA as well as quality improvement initiatives in trauma care are required.Level of evidence
IIIStudy type
Therapeutic 相似文献12.
Introduction
Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success.Aim/question
The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons.Method
The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review.Results
Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments, staff knowledge and response) and health prevention (enacted stigma, racial disparities and intersectional insensitivity).Discussion
Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency.Implications for practice
Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula. 相似文献13.
14.
Problem
Throughout the world people who are homeless experience high rates of hospitalisation. Nurses who work in hospitals have the potential to improve outcomes for this group. To date, a review of qualitative literature pertaining to hospital-based nursing for people who are homeless has been lacking.Aim
To synthesize findings of contemporary qualitative studies related to hospital-based nursing care for people who are homeless in Organisation for Economic Cooperation and Development (OECD) nations.Design
A systematic database search was conducted in mid-2017 using search terms: homeless*, hospital* and nurs*, combined by the Boolean operator ‘AND’. Inclusion and exclusion criteria that mandated publication year, language, method, quality, participants, and setting were applied. 341 abstracts were screened for relevancy resulting in the final inclusion of 8 qualitative and 2 mixed method studies.Findings
Three overarching themes emerged; (1) Homelessness challenges rigid approaches to hospital-based care (2) Stigma impedes healthcare for people who are homeless (3) Hospitals can provide a platform to address homelessness.Discussion
Delivering flexible, non-stigmatising nursing in a way that empowers people experiencing homelessness challenges hospitals around the globe. Research is needed to explore local approaches and subgroups within the homeless population.Conclusion
Experiences of homelessness vary across nations and between cities necessitating local solutions. Within hospitals, if nurses can provide flexible, non-stigmatising care, they have potential to make a huge difference both the lives of individuals who are homeless and in the wellbeing of society as a whole. 相似文献15.
16.
Carole Elledge Ayoade Avworo Josefina Cochetti Clarissa Carvalho Patti Grota 《Collegian (Royal College of Nursing, Australia)》2019,26(1):171-182
Background
Quality healthcare is increasingly measured through the integration of research findings into clinical practice. Individuals recognized as facilitators are essential to bridging the chasm between knowledge generation and translation.Aim
This integrative review synthesizes evidence describing attributes of effective facilitators involved in knowledge translation.Methods
Multiple databases were explored to identify publications issued between January 2000 and July 2016 describing facilitator characteristics. A rigorous methodology, applied by two assessors using quality assessment tools determined inclusion. Eighteen publications were identified.Findings
Facilitator characteristics were extracted and assigned into one of the six domains of the facilitation competency framework: self-awareness, self-management, social awareness, relationship management, skills, and knowledge translation and understanding.Discussion
This review highlighted the lack of research exploring characteristics of successful facilitators. Recognizing that contextual elements within an organization may be “fixed”, facilitator characteristics may be key influencers in the success of knowledge translation into the clinical setting and therefore, merit attention.Conclusion
This integrative review provides an important listing of facilitator attributes attendant with successful knowledge translation in healthcare. Future research should focus on exploring the influence of these unique facilitator characteristics in supporting the uptake of evidence into the clinical setting. 相似文献17.
Background
Stigmatization and bias toward the obese population has been studied globally in a variety of professional groups, supporting the existence of negative attitudes and weight bias against this population. Attitudes fostering the prevalence of stigmatization undermine the effectiveness and quality of health care. Studies have not compared attitudes and beliefs of graduate and undergraduate students from professional schools within the same university. As an exemplar, this study compared nursing students' attitudes and beliefs toward obese individuals with students' attitudes in other professional schools.Methods
The Attitudes Toward Obese Persons and Beliefs About Obese Persons scales were administered to undergraduate and graduate nursing students and graduate education and social work students at a US northeastern university.Results
Analyses indicated students who were younger; in nursing programs; and reported not having a friend or family member who is overweight had significantly worse attitudes than others. Gender, location of residence, perceptions of own body weight, and participating in an exercise regimen were not significant.Conclusion
Understanding attitudes toward obese people may guide educators as they train nursing, education, and social work students. Reducing negative attitudes, beliefs, and stigmatization is an important starting point in the battle against this growing public health concern. 相似文献18.
Michelle Barakat-Johnson Michelle Lai Timothy Wand Kathryn White 《Collegian (Royal College of Nursing, Australia)》2019,26(1):95-102
Background
Hospital-acquired pressure injuries are a quality indicator in healthcare, including nursing care. Successful implementation of interventions to prevent pressure injuries can be impeded by factors beyond the control of nursing staff. Limited research exists on nurses’ experiences of providing pressure injury prevention and management in a hospital setting.Aim
To gain an in-depth understanding of nurses’ experiences concerning pressure injury prevention and management in a hospital setting.Methods
A qualitative study design was employed. The purposive sample consisted of twenty nurses working in units with a high incidence of pressure injuries across a local health district in Sydney, Australia. Participants were interviewed between May and September 2016, either individually or as a group using semi-structured interviews.Findings
Four themes were identified that captured the experiences of nurses providing pressure injury prevention and management in a hospital setting: “managing competing demands in complex clinical settings”; “the importance of knowledge and skill”; “clarifying organisational expectations, purpose and successes”; and “feeling ethically challenged when unable to provide quality patient care”.Discussion
Participants were aware of the importance of pressure injury prevention and management but found it difficult to provide quality care due to competing priorities and challenges faced at both an organisational and patient level.Conclusion
Pressure injury prevention and management is just one aspect of patient care and should not be considered on its own to change existing practice. Participants wanted to implement preventative strategies and provide optimal pressure injury care, however, complexities associated with a hospital setting hindered this process. Hospitals need to put measures in place that support and enable nurses to deliver the quality care required to prevent and manage pressure injuries. 相似文献19.
Birgitte Lerbæk Rikke Jørgensen Jørgen Aagaard Julie Nordgaard Niels Buus 《Archives of Psychiatric Nursing》2019,33(2):174-181
Background
Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI.Methods
Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis.Results
Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions.Discussion and conclusion
Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care. 相似文献20.
Jui-Yuan Chung Chien-Chin Hsu Jiann-Hwa Chen Wei-Lung Chen Hung-Jung Lin How-Ran Guo Chien-Cheng Huang 《The American journal of emergency medicine》2019,37(3):391-394