哮喘患者自我管理现状和护理需求的质性研究

目的了解哮喘患者自我管理中存在的问题以及对医疗护理服务的需求,探索为患者提供针对性的医疗护理服务的内容和方法,并为实施以家庭为中心的自我护理提供依据。方法应用现象学研究方法,对17例住院期病情稳定后哮喘患者进行面对面访谈,并进行现场录音和笔录,收集资料。采用Colaizzi的现象学资料7步分析法,对获得的资料进行分析、整理,提炼出主题。结果哮喘患者的自我护理现状及家庭需求主要包括5个方面,即疾病知识不足,治疗不规则,对激素治疗缺乏正确认识,对强化哮喘防治知识的需求,与医护人员保持沟通交流的需求。结论医护人员应经常、反复对患者进行哮喘知识的教育、指导,提供针对性和可操作性的家庭照顾知识和技能培训。     

Psychosocial Care Needs of Children With Recent-Onset Asthma

PURPOSE.  To examine psychosocial care needs of children with recent-onset asthma.
DESIGN/METHODS.  Data were collected over 2 years from 63 children ages 8–14 years.
RESULTS.  Children's need for attention to specific aspects of their asthma care remained high over the 2 years, as did their perceived needs for information and support and their concerns and fears.
PRACTICE IMPLICATIONS.  Children have many needs, and healthcare professionals may not be providing care that addresses these needs. The Child Report of Psychosocial Care can be used as a quick tool to assess and guide interventions related to specific areas of need.     

哮喘患者社区延续护理模式建立的循证研究

目的以护理循证为基础,建立哮喘患者社区延续护理模式。方法采用量性研究和质性研究相结合的方法,通过：综合82篇文献的研究证据;对394份哮喘住院病历进行分析;对112名护士进行考试和问卷调查;考察现行临床护理和社区护理实践;征询6名多专业专家的意见;对100例患者进行问卷调查和对17例哮喘患者进行访谈获取循证证据,设计哮喘患者社区延续护理模式。结果建立了综合性三甲医院与社区卫生服务中心协作的哮喘患者延续护理的理论模式。结论护理模式应建立在当前最佳临床研究证据、临床实践需要的专业判断及患者需求三者结合的基础上。     

Evaluating the needs of children with asthma in home care: the vital role of nurses as caregivers and educators

To date, few evaluations have examined issues specific to children's asthma management in their homes. This study examined the characteristics, risk factors, and needs of children with asthma, and the impact of home health nurses on improving parents'/family caregivers' knowledge about asthma triggers and management. The medical records of children, 相似文献   

急诊重症哮喘患者家属焦虑相关因素及心理需求的调查分析

目的探讨急诊重症哮喘患者家属焦虑的相关因素以及心理需求,并制定合理有效的护理对策。方法采用问卷调查的形式调查患者家属焦虑的相关因素以及患者治疗前、后的心理需求。结果患者家属的焦虑症状主要有易紧张、常感觉疲惫、多梦易醒;患者焦虑的相关因素主要集中在对重度哮喘的相关知识以及治疗方法不了解、医生治疗该病的经验、不知如何照顾患者方面;患者治疗前家属的心理需求主要集中在病情是否危及生命、严重程度、是否有后遗症方面方面;患者治疗后,家属的心理需求主要集中在希望医护人员及时巡视、治疗后的注意事项以及住院时间方面。结论护理人员应根据重症哮喘患者家属的焦虑情况和心理需求在患者治疗的不同时期对患者家属进行沟通、交流。     

New delivery systems for asthma drugs

The therapy of asthma requires great attention to detail by both doctor and patient since the technique of drug administration always needs care. New developments in drug delivery systems for asthma may make this task easier and lead to reduced morbidity.     

Asthma management by an inpatient asthma care team

Recent surveillance data indicates that asthma continues to be a major health problem affecting children and African Americans disproportionately in terms of prevalence, emergency department visits, and hospitalization rates (Centers for Disease Control [CDC], 2002). Death rates due to asthma also remain higher in African Americans as compared to Caucasians. At Children's Hospital of Michigan, the Inpatient Asthma Service manages the majority of children hospitalized for asthma. An allergy/asthma specialist and a pediatric nurse trained in asthma management (asthma nurse specialist [ANS]) direct this service, which provides standardized inpatient asthma management according to current asthma care guidelines and asthma education to patients and their families before discharge, encourages referrals to the outpatient allergy/asthma clinic for further asthma management and education, and addresses other medical or social needs related to asthma care. The positive outcomes measured were a decreased length of hospital stay (LOS) by 12 hours per hospital admission and average cost savings of $300,000 annually for the hospital. Other positive outcomes included improved patient and family understanding of asthma and improved coordination of care. The asthma nurse specialists have had the benefit of further developing their pediatric asthma assessment, teaching, and communication skills.     

General principals of management: education

Asthma education is an essential part of the treatment of this disease. Health care professionals must establish a partnership with the patient with asthma and the patient's family to devise a plan of care with which the patient voluntarily will comply. The partnership with the patient begins at the first encounter and continues throughout the therapeutic relationship. Each member of the health care team can be instrumental in reinforcing the crucial information the patient must know to be an informed participant in his or her care. Nursing professionals are in a particularly advantageous position to foster this partnership because of their patient-focused outlook and the quality of time spent with patients. When the partnership is based on mutual trust and cooperation, the clinician can direct asthma care that is consistent with current expert guidelines. Educational interventions should be meaningful to the patient, learner centered to incorporate the patient's needs, and sensitive to the patient's cultural influences. The patient and his or her significant social and family support should be actively involved. The clinician should be alert to the patient's readiness to learn and tailor the message to suit the setting in which it is delivered. The patient should receive information that allows his or her participation in goal setting for treatment. Essentials to be included are the significance of the diagnosis, basics about inflammation as the primary cause of symptoms, the difference between controllers and relievers, how to use the medications and monitoring devices, how to reach the provider, and the need for continuous ongoing interaction with the clinician. Goals set in the partnership are objectified in the asthma action plan or guided self-management plan. The success of the treatment can be assessed from the patient's improved asthma control and reduced reliance on emergency treatment. Every health care provider is a potential wealth of patient education. Every patient encounter is an opportunity to reinforce knowledge and proficiency in asthma management. Nursing professionals can play a fundamental and crucial role in asthma education by maintaining the focus of the medical treatment on the priorities in asthma care--the learning needs and goals of the patient.     

77例哮喘患儿家庭情况调查与分析

本研究应用自拟的家庭情况调查问卷，对77例哮喘患儿和70名健康儿童的学习成绩、性格、生长发育及家庭情况进行了调查，探讨了儿童哮喘对患儿及家庭的影响和家庭应对，以及家庭对健康教育的需求情况，结果表明，哮喘对患儿的生长发育与学习成绩、对父母的体力、父母的工作、家庭经济、家庭关系等有显著影响；而家庭成员互相支持、分担照顾孩子的负担、接受医护人员关于疾病的建议等都是家庭对儿童哮喘积极的应对行为；家庭对哮喘的知识需求重点在治疗方法和预防保健知识方面，并乐以向医护人员咨询的形式获得。     

支气管哮喘患儿主要照顾者的延续护理需求调查分析

目的调查分析支气管哮喘患儿主要照顾者的延续护理需求情况。方法选取2018年1—12月本院门诊部治疗的支气管哮喘患儿78例,使用本院自制《支气管哮喘患儿主要照顾者延续性护理需求调查表》对患儿主要照顾者进行现场调查,分析主要照顾者的延续护理需求情况。结果需求服务内容方面,诱发支气管哮喘危险因素、用药指导和饮食指导得分最高;需求服务方式方面,电话随访、健康教育手册和网络平台得分最高;需求服务提供者方面,得分最高的为专业团队,其次为主管医师与责任护士;需求服务时间方面,得分最高为出院1个月。结论为支气管哮喘患儿主要照顾者提供延续护理服务是十分必要的,临床应依据患儿家长需求情况提供多种类、内容更为广泛的护理服务,以促进患儿康复,预防疾病复发。     

Nursing care of a school-age child with asthma: an ecological system theory approach

This research applied the Ecological System Theory of Dr. Bronfenbrenner (1979) to evaluate and analyze the impact of a school-age asthmatic child's ecological environment on the child's development. This project ran from March 16th to April 16th, 2010. A full range of data was collected during clinical care, outpatient follow-up services, telephone interviews, home visits, and school visits and then identified and analyzed. Results indicated that the family, household environment, campus, teachers, classmates, physical education program, and medical staffs comprised the most immediate microsystem and that parents, school nurses, teachers, and classmates formed the child's mesosystem. Researchers found a lack of understanding and appreciation in the mesosystem regarding asthmatic patient care needs. Hidden factors in the environment induced asthma, which eventually caused the child to be unable to obtain necessary medical care assistance. The exosystem reflected adequacy of the family social economy. The father's flexible working hours allowed him to allocate more time to childcare responsibilities. The government Asthma Medical Payment program also facilitated effective care. The macrosystem demonstrated parental cognition related to asthma treatment and caring to be deeply influenced by local customs. Thus, rather than using advanced medical treatments, parents preferred to follow traditional Chinese medicinal practices. Evaluation using the Ecological of Human Development Theory showed the subject's ecology environment relationships as based upon a foundation of family and school. Therefore, active family and school support for an asthma management plan appropriate to the subject's needs was critical. Asthma symptoms were better controlled after the child and his parents invested greater effort in mastering asthma management protocols.     

Developing critical care skills for nurses in the ward environment: a work-based learning approach

An account of collaborative working between an NHS trust and university in responding to the critical care agenda. An 'Introduction to Critical Care Skills' course initiative, which addresses the needs of nurses caring for level 1 and 2 patients in ward areas, is discussed. Work-based learning forms the focus of skills development using core competencies related to a holistic approach to caring for patients with complex needs. A dynamic evolving process of course development is promoting quality care for patients and closely reflects the needs of those caring for acutely ill patients outside the designated critical care environment.     

Implementation of a disease-specific care plan changes clinician behaviors

The study objective was to determine the impact on quality of care, resource use, and outcomes by developing an emergency department (ED)-based asthma-specific care plan. The design was a time based, prospective cohort and set at an urban university/trauma center, EM residency site, combined adult/pediatric department. Best practice was defined prospectively for ED asthma patients, leading to an asthma care plan (ACP). Triage nurses were instructed to begin use of ACP when patients presented with asthma as the primary complaint. Charts of all patients diagnosed with asthma during 3-month study period were retrospectively reviewed against predefined outcomes. Results were analyzed with chi2 or student's t tests. After ACP introduction, the timeliness of beta agonist treatments (three beta agonist treatments within 90 minutes; 86% versus 63%, P < .05) and ED length of stay (LOS) (3.39 +/- 1.88 hrs versus 3.87 +/- 2.12 hrs, P < .05) improved. After introduction of ACP, only 55% of patients diagnosed with asthma had care documented on the ACP (ACP+ group). ACP+ group had more timely beta agonist treatment (93% versus 74%, P < .01), shorter LOS (3.29 +/- 1.90 vs. 3.53 +/- 1.86 hrs, P < 0.5) more appropriate steroid dosages (67% versus 41%, P < .01), and fewer tests (41% versus 59%, P < .05). No improvements were noted in admission or relapse rates. In conclusion, care plans can improve quality of care and decrease LOS, but may have limited impact on outcomes of admission/discharge or relapse rates.     

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.     

A successful collaboration between a private nonprofit health plan and a state health department

This article describes the experience of a private, nonprofit health plan in establishing a collaborative relationship with a state health department. Through a federal grant project, efforts toward assuring quality care for children with special health care needs in managed care settings provided unique opportunities to form partnerships between multiple health plans, community groups, and other stakeholders. Collaborative activities included (1) formation of a pediatric asthma task force and a performance measurement and quality assurance committee; (2) planning and execution of a statewide conference; (3) development of a teaching manual for incorporating asthma education into elementary classroom curricula; and (4) publication of a parent resource manual for health plan members. Key ingredients and influencing factors for successful public-private partnerships are discussed.     

Compliance of physicians with documentation of an asthma management protocol

BACKGROUND: Studies continue to show poor physician compliance with asthma management guidelines in clinical practice. However, standardized protocols specifically designed to be practical and user-friendly improve patient outcomes. OBJECTIVE: To determine the degree of physicians' compliance with the documentation of an asthma management protocol in a university hospital. METHODS: A simple asthma management protocol was designed and applied in our pulmonary clinic and primary care clinic for asthma. The protocol was based on the 1998 Manual for the Management of Asthma, from the Oman Ministry of Health, which follows internationally recognized guidelines. The protocol consisted of 4 sections: clinical history, peak expiratory flow (PEF) data, medication section, and simplified asthma management guidelines. RESULTS: All 30 physicians scheduled to conduct asthma clinics in the pulmonary clinic (14 physicians) and the primary care clinic (16 physicians) agreed to use the protocol. A total of 282 protocol forms were collected: 130 forms from 6 senior physicians and 152 from 24 junior physicians. Documentation of the entire clinical history was 65%, with the senior physicians scoring significantly higher documentation-completion rates (82%) for all components of the history than the junior physicians (50%). Documentation of all PEF data was poor (26%), despite high documentation of the PEF value itself (95%). There were significant differences in documentation of percent-of-predicted PEF between junior physicians in primary care clinic (70%) and other physicians (19%). Documentation of the entire medication section was only 34%. Although documentation of prescribed medicines was high (92%), compliance (48%) and inhaler technique (49%) documentation was low, with similar patterns demonstrated by all physicians. Documentation of the entire protocol by all physicians was low (9%), with junior physicians in the primary care clinic completing 28% of their forms. CONCLUSIONS: Our protocol enabled us to identify opportunities for improvement in documentation of asthma management in both the pulmonary and primary care clinics. The findings highlight the need for regular asthma education programs for all physicians, with a focus on documentation of performance skills such as monitoring of PEF and inhaler technique.     

Data-driven graduate curriculum redesign: a case study

This article discusses the use of Knowles' adult learning theory as the framework for a curriculum redesign within the leadership and management track of a master's of science in nursing program. Health care executives within the university service area were surveyed regarding their organizational needs for advanced practice nurses. A second survey was mailed to a sampling of all RNs in the university service area. In response to perceived community needs, the curriculum of the leadership and management track was redesigned to allow for role specialization within the program. In addition, the university has an infrastructure to support distance learning and an experienced staff able to support distributive learning, providing wide geographical access to students in distant locations.     

Review of the new asthma guidelines

Asthma specialists will welcome the new guidelines, but they need to be disseminated to all those who care for people with asthma. Clinic protocols will need revision, new equipment may need to be purchased and there are likely to be training needs identified, with inevitable resource implications.     

Asthma management: Part 1: An overview of the problem and current trends.

Death rates from asthma have increased or remained stable over the past decade despite increased knowledge about the pathophysiology and improved treatment of the disease, a fact that is both puzzling and disconcerting. Some children with asthma experience severe and life-interfering exacerbations separated by long periods of normal lung function and no symptoms. Asthma management plans are developed by primary care providers and the family. School nurses implement and monitor the child's response to the plan. Therefore, the school nurse needs current information about asthma management. Part I of this two-part series describes the pathophysiology of asthma and the types, risk factors, and current trends in management of the disease. The role of the school nurse in asthma management is outlined, including how he or she can influence environmental factors that precipitate asthma symptoms or exacerbations. Part II will discuss the role of the school nurse in pharmacologic management of asthma. Complementary alternative medicine for asthma management will be described, as well as health teaching for the child with asthma and their family.     

Education for asthma care: lessons from Ireland

Despite the increase in prevalence of asthma among children and the importance of appropriate professional training in asthma management, no programme of study in children's asthma care was available to nurses in Ireland. A professional development module was designed to meet the education needs of nurses caring for children with asthma and their families. The module has theoretical and practical elements that are reflected in both module delivery and assessment. It was evaluated using a Likert scale questionnaire and focus group interviews with 15 students. The results indicate a high degree of student satisfaction with the module. Students reported changes in practice as a result of greater confidence, increased knowledge and improved skills. Future evaluation should include the ongoing impact on practice as well as the perspectives of service users and managers.