Music listening alleviates anxiety and physiological responses in patients receiving spinal anesthesia

ObjectiveThe aim of this study was to explore the effects of listening to music on the anxiety levels and physiological responses of surgical patients receiving spinal anesthesia.MethodsAn experimental design was used in the study with an experimental group (n = 50) and a control group (n = 50). The experimental group received 30 min of musical intervention and routine nursing care in the Post-Anesthesia Care Unit (PACU) while the control group received only routine nursing care.ResultsThe study found significant differences in both anxiety and physiological indices between the two groups. The mean score of the State-Trait Anxiety Inventory (STAI) in the study group decreased from a pre-test score of 59.0 to a post-test score of 31.20 (t = 28.63, p < 0.001). Physiological indices such as heart rate (t = 2.61, p = 0.012), respiration rate (t = 2.29, p = 0.026), systolic blood pressure (t = 2.30, p = 0.026), and diastolic blood pressure (t = 3.02, p = 0.004) decreased significantly as well. Control group was not seeing significant changes from pre-op values.ConclusionListening to music while in the recovery room may decrease the level of anxiety in surgical patients receiving spinal anesthesia. The results of this study can serve as a reference for PACU nurses in utilizing music listening programs to achieve the goal of holistic care.     

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.Designrandomised controlled trial.Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n = 43) or the control group (n = 41).MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β = −2.22, p < .001), daytime sleepiness (β = −4.23, p < .001), anxiety (β = −1.94, p < .001), and depression (β = −3.05, p < .001) after 12 weeks of the intervention.ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.     

Evaluación del efecto de la terapia de relajación en pacientes con hipertensión arterial

ObjectivesTo evaluate whether the application of a relaxation therapy reduces the blood pressure in hypertensive patients and whether there is improvement in several parameters which can influence blood pressure such as anxiety, quality of life and sleep.MethodsA quasi-experimental study (measures before-after) was performed in 25 Primary Care patients with hypertension poorly controlled by pharmacological treatment. The intervention consisted of relaxation therapy composed of 3 techniques: passive relaxation of Schwartz-Haynes, diaphragmatic breathing and imaginary visualization. A total of 14 group sessions of 30 min each (2/week) were conducted. Systolic and diastolic blood pressure were taken at the beginning and end of the relaxation programme implemented and after each of the programme sessions. The Pittsburgh Sleep Quality, Quality of Life Hypertension, State-Trait Anxiety and Perceived Stress questionnaires were used to measure psychosocial parameters.ResultsAfter intervention, a reduction in systolic blood pressure of 20 mmHg (p < .001) and of 8 mmHg (p < .001) in diastolic blood pressure was observed. Regarding other factors, sleep quality (p < .001), quality of life (p< .001) and state anxiety (p = .004) were significantly improved.ConclusionsRelaxation therapy had positive effects in improving blood pressure parameters, as well as the other factors evaluated. In our opinion, such strategies should be evaluated more thoroughly to consider their inclusion in Primary Care.     

The effect of music therapy on mood and anxiety–depression: An observational study in institutionalised patients with traumatic brain injury

IntroductionA previous study (carried out in 2003–2004) had included 34 patients with traumatic brain injury in order to study the feasibility and usefulness of music therapy in patients with this type of injury.ObjectiveTo evaluate the effect of music therapy on mood, anxiety and depression in institutionalised patients with traumatic brain injury.Study methodologyA prospective, observational study.Materials and methodsThirteen patients with traumatic brain injury were included in the present study and took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods – one devoted to listening to music (receptive music therapy) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety–depression (on the Hospital Anxiety and Depression [HAD] Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session.ResultsMusic therapy enabled a significant improvement in mood, from the first session onwards. This short-term effect was confirmed by the immediate changes in the scores after music therapy sessions (from 4.6 ± 3.2 to 2.6 ± 2; p < 0.01). Music therapy also led to a significant reduction in anxiety–depression (p < 0.05) from week 10 onwards and up until the end of the study (week 20).ConclusionThese results confirm the usefulness of music therapy in the treatment of anxiety–depression and mood in patients with traumatic brain injury. Music therapy could usefully form an integral part of the management programme for these patients.     

Nasal high-flow oxygen therapy in ICU: A before-and-after study

BackgroundNon-intubated intensive care patients commonly receive supplemental oxygen by high-flow face mask (HFFM), simple face mask (FM) and nasal prongs (NP) during their ICU admission. However, high-flow nasal prongs (HFNP) offer considerable performance capabilities that may sufficiently meet all their oxygen therapy requirements.Study aimsTo assess the feasibility, safety and cost-effectiveness of introducing a protocol in which HFNP was the primary oxygen delivery device for non-intubated intensive care patients.MethodProspective 4-week before-and-after study (6 months apart) for all adult patients admitted to a 22-bed tertiary ICU in Melbourne, Australia.Results117 patients (57 before, 60 after) were included: 86 (73.5%) received mechanical ventilation. Feasibility revealed a significant reduction in HFFM (52.6–0%, p < .001), FM (35.1–8.3%, p = .002) and NP (75.4–36.7%, p < .001) use and an increase in HFNP use (31.6–81.7%, p < .05) during the after period. Following extubation, there was a significant reduction in HFFM use (65.7% vs. 0%, p < .05) and an increase HFNP use (8.6% vs. 87.5%, p < .05). Costing was in favour of the after period with a consumable cost saving per patient (AUD $32.56 vs. $17.62, p < .05). During the after period, more patients were discharged from ICU with HFNP than during the before period (5 vs. 33 patients, p < .05) and fewer patients (5 vs. 14 patients) used three or more oxygen delivery devices. Safety outcomes demonstrated no significant difference in the number of intubations, re-intubations, readmissions or non-invasive ventilation use between the two time periods.ConclusionsUsing HFNP as the primary oxygen delivery method for non-intubated intensive care patients was feasible, appeared safe, and the oxygen device costs were reduced. The findings of our single-centre study support further multi-centre evaluations of HFNP therapy protocols in non-ventilated intensive care patients.     

Efecto de la musicoterapia sobre la ansiedad y el dolor en el paciente crítico politraumatizado

ObjectiveTo determine the effectiveness of music therapy on anxiety and pain in critical polytraumatised patients admitted to the resuscitation unit of a tertiary level hospital in Spain.Material and methodRandomised clinical trial conducted in a tertiary level hospital, from June 2016 to May 2018. The study sample was 60 patients, 30 belonging to the intervention group (IG), and 30 to the control group (CG). The IG were given a 30-minute music session and heart rate (HR) and blood pressure (BP) were measured. The VAS (Visual Analogue Scale) was applied for anxiety and pain before and after each session. The same measures and scales were applied in the CG who did not receive a music session. The music session comprised 3 parts: the first was standard music selected by music therapists; the second was personalised, chosen by the patient and the third was a new standard. The intervention took place in a booth with headphones.ResultsSignificant changes in anxiety levels (P < .01) were detected in the group of patients undergoing the intervention, measured with the VAS scale for anxiety, and pain levels (P < .01), measured with the VAS scale for pain. No significant differences were found in the physiological parameters of HR and BP.ConclusionThe use of music in critical polytraumatised patients reduces anxiety and pain levels, increasing the patient's well-being and improving the quality of care. Music therapy, therefore, is considered beneficial as a complementary measure in critical care units. It would be worthwhile to continue studies in this and other hospital areas.     

Factors influencing preventive behavior against Middle East Respiratory Syndrome-Coronavirus among nursing students in South Korea

BackgroundMiddle East Respiratory Syndrome Coronavirus (MERS-CoV), an emerging infectious disease introduced in South Korea in 2015, spreads quickly through hospitals, and Korea became one of the major areas affected by the disease after the Middle East region. To stop the spread of an emerging disease, it is important to practice prevention guidelines correctly.ObjectivesThe purpose of this study was to investigate factors influencing preventive behavior against MERS-CoV among Korean nursing students.MethodsThis is a cross-sectional study using a questionnaire survey. Data were collected from 429 nursing students from three colleges of nursing in Korea from June 25 to July 3 in 2015.ResultsPreventive behavior against MERS-CoV was affected mostly by attitude (β = .243, p < .001). Such behavior was also high in relation to the variables of perceived risk (β = .232, p < .001), older students (β = .202, p < .001), knowledge level (β = .153, p < .01), and female respondents (β = .115, p < .05).ConclusionPreventive behavior against emerging infectious diseases such as MERS-CoV was found to be affected most significantly by attitude and risk perception. It is crucial to provide nursing students with information or knowledge, but it is also important to help those in nursing education recognize that active preventive behavior can prevent this infectious disease and stop its spread.     

A cross-sectional study of the relationships between illness insight,internalized stigma,and suicide risk in individuals with schizophrenia

BackgroundSuicide is the major cause of premature death among individuals with schizophrenia. Ironically, one factor that heightens suicide risk is insight into mental illness. Little is known, however, about how insight contributes to suicidality. Recent evidence suggests that negative outcomes related to insight might depend on whether or not the individual accepts the stigmatizing beliefs about the mental illness.ObjectiveThe present study examined the interactive effects of insight and internalized stigma on suicide risk in individuals with schizophrenia. We hypothesized that insight into mental illness and internalized stigma would increase suicide risk and that internalized stigma would moderate the effect of insight on suicide risk.Design and participantsA cross-sectional design was used in this study. A convenience sample of 200 individuals with schizophrenia was recruited from an outpatient clinic in the Eastern catchment area in Alexandria, Egypt.MethodsEligible study participants were individuals with an illness duration not exceeding ten years, currently in outpatient treatment and follow-up, and post-acute or in a stable phase of their disorder. Individuals provided signed consent to participate and were interviewed to assess suicide risk, insight, internalized stigma of mental illness and depression.ResultsSlightly more than 38% of the study participants were classified as having a severe suicide risk. As predicted, suicide risk was positively associated with insight (r = .55, p < .001), internalized stigma (r = .79, p < .001), and depression (r = .78, p < .001). However, the influence of insight was not significant after controlling for covariates in the regression model (β = ?.02, ns). Internalized stigma and depression independently predicted suicide risk, explaining 74% of variance in suicide risk, F_change (6, 191) = 11.54, p < .001. Greater insight was significantly linked to increased levels of internalized stigma (r = .59, p < .001) and depression (r = .61, p < .001). Internalized stigma did not moderate the influence of insight on suicide risk.ConclusionThe present study draws attention to the robust influence of internalized stigma in increasing suicide risk and suggests clinical approaches for managing internalized stigma and suicide risk among individuals with schizophrenia.     

Music intervention during daily weaning trials—A 6 day prospective randomized crossover trial

PurposeTo examine the effect of patient-selected music intervention during daily weaning trials for patients on prolonged mechanical ventilation.MethodsUsing a crossover repeated measures design, patients were randomized to music vs no music on the first intervention day. Provision of music was alternated for 6 days, resulting in 3 music and 3 no music days. During weaning trials on music days, data were obtained for 30 min prior to music listening and continued for 60 min while patients listened to selected music (total 90 min). On no music days, data were collected for 90 min. Outcome measures were heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), blood pressure (BP), dyspnea and anxiety assessed with a visual analog scale (VAS-D, VAS-A) and weaning duration (mean h per day on music and non-music days).ResultsOf 31 patients randomized, 23 completed the 6-day intervention. When comparisons were made between the 3 music and 3 no music days, there were significant decreases in RR and VAS-D and a significant increase in daily weaning duration on music days (p < 0.05). A multivariate mixed-effects model analysis that included patients who completed ≥2 days of the intervention (n = 28) demonstrated significant decreases in HR, RR, VAS-A, and VAS-D and a significant increase in daily weaning duration on music days (p < 0.05).ConclusionsProviding patient selected music during daily weaning trials is a simple, low-cost, potentially beneficial intervention for patients on prolonged mechanical ventilation. Further study is indicated to test ability of this intervention to promote weaning success and benefits earlier in the weaning process.     

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit

BackgroundPatients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents.ObjectiveThis study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit.MethodsThis was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test.ResultsThe oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p = .004) respectively, while in the intervention group 11.89 and 8.33 (p < .001). Mean differences in both groups were 4.95 (p < .001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p < .05).ConclusionOral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.     

Symptom manageability in Swiss HIV-infected patients

BackgroundManaging symptoms in daily life is a challenging problem for people living with HIV. As traditional parameters used to identify symptoms needing management do not integrate aspects of daily living with symptoms, we introduced ‘perceived symptom manageability’ to fill this gap.AimThe aim of this study was to quantitatively explore ‘perceived symptom manageability’ in a sample of 268 persons living with HIV.MethodsSecondary analysis of existing cross-sectional data. Social support, gender, age, depressive and anxiety symptoms were bivariately and multivariately analyzed and related to symptom experience and manageability as measured by the HIV Symptom Assessment Scale and the HIV Symptom Manageability Scale.ResultsLeast manageable symptoms were hair loss, vomiting and insomnia. Multivariately, age (beta = ? .11; p = .024), symptom distress (beta = ? .62; p < .001) and total anxiety and depressive symptoms (beta = ? .18; p = .003) were statistically significant correlates of symptom manageability.ConclusionsAlthough a promising concept to identify symptoms needing management, further research employing primary data is recommended.     

The effect of music listening on the anxiety of nursing students during their first blood draw experience

BackgroundNursing education is a process aimed both at theoretical knowledge and skill development. The Fundamentals of Nursing is a course that furnishes students with professional knowledge, concepts and technical skills, and, also, is the keystone of nursing education in our country. Students experience a great deal of anxiety as they face basic nursing practices for the first time. Studies have revealed the effectiveness of music in relieving anxiety in many patient groups. However, no previous studies were found where music was used with the intent to lower the anxiety that students experience over the course of skill learning. The experimental study is aimed at determining the effect of music in decreasing anxiety during the first nursing practices of students in a laboratory setting.MethodsThe experimental study was conducted on nursing students of Akdeniz University attending Fundamentals of Nursing, a freshman course, during the 2013–2014 academic year. A total of 73 students, of which 34 were assigned to the experimental group and 39 to the control group, participated in the study. Data collection was carried out using (a) the student identification form prepared by the authors, (b) skill control lists and (c) the Situational Anxiety Scale. The students in the experimental group listened to music during blood draw skill practice in a laboratory environment. The students were assessed with respect to their performance of blood drawing through skill control lists using the statements “True”, “False” and “Forgotten”. The anxiety levels and vital signs of students were assessed before and after the practice.ResultsThe mean age of the students was 19.08. 64.7% of the experimental group and 82.1% of the control group were female. The age group of 64.7% of the students in the experimental group was female. The age group of 82.1% of the students in the control group was female. After music listening, the mean anxiety score of the students was 38.70 ± 3.83 in the experimental group and 39.76 ± 4.72 in the control group. The difference between the mean anxiety scores of the two groups was statistically significant (p < 0.05). The evaluation made before and after the blood draw revealed a statistically significant difference in diastolic blood pressure values in the experimental group that listened to music(p < 0.05).ConclusionsThe results of the study showed that listening to music decreased the anxiety levels of nursing students during their first blood draw experience.     

Acid-base disturbances in acute poisoning and their association with survival

PurposeThe purpose was to investigate the association between acid-base disturbances and mortality in acute poisoning.Materials and methodsWe performed a retrospective cross-sectional exploratory study on all acutely poisoned patients older than 12 years who had been admitted to the main tertiary toxicology hospital in Tehran between March and August 2010.ResultsOf a total of 1167 patients (median age = 25 years, 50.9% male), 98 died (74.5% male). Psychotropic medications were the most common cause of poisoning (36.5%), whereas narcotics and psychodysleptics were the most common cause of death (23.5%). Mixed respiratory alkalosis and metabolic acidosis with normal pH were the most common acid-base status (333, 28.5%). However, patients with primary metabolic acidosis and respiratory compensation had significantly higher mortality (31 cases, 18.8%). Logistic regression analysis identified age (odds ratio [OR], 1.051; 95% confidence interval [CI], 1.031-1.070; P < .001), intensive care unit admission (OR, 12.405; 95% CI, 7.178-21.440; P < .001), consciousness level (OR, 1.752; 95% CI, 1.301-2.359; P < .001), hospitalization period (OR, 1.1361; 95% CI, 1.079-1.195; P < .001), severe metabolic acidosis (OR, 6.016; 95% CI, 1.647-21.968; P = .007), and primary respiratory alkalosis (OR, 5.579; 95% CI, 1.353-23.001; P = .017) as death predictors during hospitalization (P < .001).ConclusionOn-arrival acid-base status predicts survival and can be used in prognostication of the poisoned patients.     

Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest

ObjectiveCardiopulmonary resuscitation (CPR) guidelines recommend the administration of chest compressions (CC) at a standardized rate and depth without guidance from patient physiologic output. The relationship between CC performance and actual CPR-generated blood flow is poorly understood, limiting the ability to define “optimal” CPR delivery. End-tidal carbon dioxide (ETCO₂) has been proposed as a surrogate measure of blood flow during CPR, and has been suggested as a tool to guide CPR despite a paucity of clinical data. We sought to quantify the relationship between ETCO₂ and CPR characteristics during clinical resuscitation care.MethodsMulticenter cohort study of 583 in- and out-of-hospital cardiac arrests with time-synchronized ETCO₂ and CPR performance data captured between 4/2006 and 5/2013. ETCO₂, ventilation rate, CC rate and depth were averaged over 15-s epochs. A total of 29,028 epochs were processed for analysis using mixed-effects regression techniques.ResultsCC depth was a significant predictor of increased ETCO₂. For every 10 mm increase in depth, ETCO₂ was elevated by 1.4 mmHg (p < .001). For every 10 breaths/min increase in ventilation rate, ETCO₂ was lowered by 3.0 mmHg (p < .001). CC rate was not a predictor of ETCO₂ over the dynamic range of actual CC delivery. Case-averaged ETCO₂ values in patients with return of spontaneous circulation were higher compared to those who did not have a pulse restored (34.5 ± 4.5 vs 23.1 ± 12.9 mmHg, p < .001).ConclusionsETCO₂ values generated during CPR were statistically associated with CC depth and ventilation rate. Further studies are needed to assess ETCO₂ as a potential tool to guide care.     

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial

BackgroundEmpowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.AimsTo evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.DesignA randomized control trial.MethodsSixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.ResultsThe family empowerment program decreased parental stress (F = 13.993, p < .0001) and increased family function (cohesion, expression, conflict solving, and independence) (F = 19.848, p < .0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F = 26.483, p < .0001) and forced expiratory volume in first second (FEV1) (F = 7.381, p = .001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.ConclusionWe empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families’ life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.     

The daily relationships between staffing,safety perceptions and personality in hospital nursing: A longitudinal on-line diary study

BackgroundThe association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context.ObjectiveTo further our understanding of these associations, this paper takes a within-person approach to examine nurses’ daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations.MethodWe recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three–five shifts which collected information on perceptions of staffing, patient–nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator.ResultsOn days when lower patient–nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p = .011) and more favourable perceptions of patient safety (p = <.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner (p = <.001), more favourable perceptions of patient safety (p = <.001) and experienced less workplace cognitive failure (p = <.001). Conscientiousness and emotional stability emerged as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors.ConclusionThe findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis.     

Serum caspase 3 levels are associated with early mortality in severe septic patients

ObjectiveHigher caspase 3 activity has been found in lymphocytes of septic patients than of healthy controls. However, an association between serum caspase 3 levels at moment of severe sepsis diagnosis and mortality in septic patients has not been previously demonstrated, and this was the main objective of the present study.MethodsThis is an observational study of 216 patients with severe sepsis in 6 Spanish intensive care units. We collected serum samples at moment of severe sepsis diagnosis to determine levels of caspase 3 and caspase-cleaved cytokeratin (CCCK) 18. End point was 30-day mortality.ResultsWe found higher serum caspase 3 levels (P < .001) and caspase-cleaved cytokeratin 18 (P = .001) in nonsurvivors (n = 76) than in survivors (n = 140). Multiple binary logistic regression analysis showed that serum caspase 3 levels greater than 0.25 ng/mL were associated with 30-day mortality (odds ratio, 6.51; 95% confidence interval, 3.32-12.77; P < .001). Receiver operating characteristic analysis showed that the area under the curve to predict 30-day mortality for serum caspase 3 levels was 0.73 (95% confidence interval, 0.67-0.79; P < .001).ConclusionsThe major novel findings of our study were that there is an association between serum caspase 3 levels at moment of severe sepsis diagnosis and mortality in septic patients and that serum caspase 3 levels could be used as prognostic biomarker, and further studies are needed to corroborate these findings.     

Nurse workload and inexperienced medical staff members are associated with seasonal peaks in severe adverse events in the adult medical intensive care unit: A seven-year prospective study

ObjectiveOur purpose was to identify potential organizational factors that contributed to life-threatening adverse events in adult intensive care unit.MethodsA prospective, observational, dynamic cohort study was carried out from January 2006 to December 2013 in a 20-bed adult medical intensive care unit. All patients admitted to the intensive care unit and who experienced one or more selected life-threatening adverse events (mainly unexpected cardiac arrest, unplanned extubation, reintubation after planned extubation, and readmission within 48 h of intensive care unit discharge) were included in the analysis. Negative binomial regression was used to model how human resources, work organization, and intensive care activity influenced the monthly rate of selected severe adverse events. Data were collected from local and national databases.ResultsOverall, 638 severe adverse events involving 498 patients were recorded. Adverse events increased seasonally in May, November and December (p < .001 vs other months). The proportion of inexperienced nurses and doctors’ working hours could not explain these seasonal peaks of adverse events. Multivariate analysis identified bed-to-nurse ratio and the arrival of inexperienced residents or senior registrars as being independently associated with the rate of adverse events (incidence risk ratio = 1.36 (95% confidence interval, 1.05–1.75), and 1.07 (95% confidence interval, 1.01–1.13), respectively; p = .01 in both cases). According to this model, a one-unit increase in the day–night shifts carried out by each nurse per month tended to reduce the rate of adverse events (incidence risk ratio = 0.60 (95% confidence interval, 0.36–1.01), p = .05). Severity at intensive care unit admission did not influence the rate of adverse events (incidence risk ratio = 1.02 (95% confidence interval, 1.00–1.04), p = .12).ConclusionsResults identify nurse workload and the arrival of inexperienced residents or senior registrars as risk factors for the occurrence of life-threatening adverse events in the adult medical intensive care unit. Limiting fluctuations in bed-to-nurse ratio and providing inexperienced medical staff members with sufficient supervision may decrease severe adverse events in critically ill patients.     

Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial

BackgroundLifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome.ObjectivesTo examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome.Research design and methodA randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n = 115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects.ResultsWomen in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β = 846, p = .01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β = −0.17, p = .003), and decreased the number of metabolic risks from 4.0 to 3.6 (β = −0.50, p < .001), compared to the usual care group (4.4–4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean = 4.0 vs. 4.6, β = −0.2, p = .02) compared to the usual care group.ConclusionsMotivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.