One Year Later: Using Role Theory to Evaluate a New Delivery System

This is the second part of a two-part article that presents findings from a staff nurse survey one year after the implementation of primary nursing on four medical and surgical pilot units in a tertiary teaching hospital. The introduction of primary nursing was one phase of a project to develop theory-based nursing practice within the institution. The researchers hoped that obtaining the staff nurse perspective on the change to primary nursing would provide evaluative information and suggestions to provide additional support in the project. Role theory (Hardy, 1978) provides the theoretical framework for this study. While the previous article discussed issues related to the change process, this article focuses on evaluation of role transitions.     

CCAP 1 Year Later: Challenges and Accomplishments

University of Texas Medical Branch (UTMB) implemented the Clinical Competency and Advancement Program (CCAP) in January 2011. The program, built upon American Nurse Association (ANA) standards,¹ is a professional development tool for competency assessment, performance evaluation, and career advancement for nurse clinicians from levels Nurse Clinician (NC) I to NC V. UTMB requires each nurse clinician to complete and submit CCAP program documents annually to the manager. In CCAP, nurse clinicians have required and elective (self-selected) criteria that must be demonstrated through performance, activity, or documentation. Nurses earn points, weighted by complexity, for accomplishments. Eligibility criteria and point requirements are progressively higher for each NC level, I to V. Elective criteria include a wide range of professional activities from which the nurse clinician may select, whereas required criteria reflect the expected nursing practice and performance for every nurse. Implementing CCAP meets the definition of “innovation” as a core group of nurse clinicians and leaders constructed, created, and implemented a totally new visionary process. CCAP reflects a stronger UTMB culture of professional practice and personal accountability, with an overarching outcome of higher levels of professional performance in patient care delivery. CCAP changes the way nurses view their practice. In June of 2012, UTMB submitted an initial CCAP article that was published in AONE's Nurse Leader.²     

Pediatric Headaches: A One Year Retrospective Analysis

SYNOPSIS
Epidemiologically, headaches are common in children. In order to ascertain the type of headache problems that result in a referral by pediatricians to a pediatric neurology clinic, the charts were reviewed of all patients evaluated in 1978 with the diagnosis of headache.A chief complaint of headache was given in 116 (22%) of all new patients evaluated. Final diagnostic groups were migraine headaches or variants (47%), tension headaches (28%), seizure equivalent (15%) and miscellaneous (10%). Almost two thirds of the patients were female. The mean ages of the seizure equivalent group and the tension headache group were similar, 9.3 and 9.5 years respectively. The migraine group was older with a mean age of 9.8 years. Of the 54 patients with migraine headaches, 78% were characterized as common migraine. This evaluation of the migraine patients differed from that of patients considered to have seizure equivalents on the basis of family history (63% vs 12%), abnormalities noted on neurological examination (7% vs 24%) and EEG abnormalities (20% vs 84%). Abnormalities in the tension headache group were less than 10% in all three categories evaluated.Although some overlaps exist, these data suggest a bimodel curve with migraine headaches and recurrent seizures at the extreme ends of the spectrum rather than a single entity with varying manifestations. Historically, the family history is the most distinguishing characteristic, but abnormalities on neurological evaluation, especially the EEG, were considered more significant factors in arriving at a diagnosis.     

Changing handover practices: One private hospital's experiences

McKenna L, Walsh K. International Journal of Nursing Practice 1997; 3 : 128–132
Changing handover practices: One private hospital's experiences
The handover practice has long been an important component of clinical nursing practice allowing nurses to exchange relevant client information from one shift to the next and ensure continuity of patient care. Traditional approaches have seen nursing handovers taking place in a room away from general ward activity. Oncoming nursing staff receive the information verbally from nurses on the previous shift about all patients within the ward or unit. This practice has been proven over time to present difficulties and consequently, many hospitals are choosing to adopt models that better address current needs. This analysis describes the creative approaches taken by one private hospital in modifying handover practices with the view to reduce time and increase overall efficiency and effectiveness, whilst ensuring that staff and ward requirements are considered. The study highlights how action research principles can be applied to introduce change into the clinical practice environment.     

一对一式分娩护理模式的探讨

目的研究一对一式分娩对产科质量的影响.方法在传统式分娩的基础上,关注孕妇在产程中心理、生理和社会的需要,对每位进入活跃期的孕妇由一名助产士全程陪伴分娩至产后2小时的护理过程.结果采取一对一式分娩形式剖宫产率下降50%,产后大出血率下降69.23%,新生儿窒息率下降80%,第一产程缩短148分钟,第二产程缩短15分钟,有效促进产程进展;与传统式对比,孕妇情绪稳定率提高21.6%,对护理工作满意率提高28.6%.结论一对一式分娩护理使孕妇各种需要得到最大的满足,孕妇对护理工作满意率高,情绪稳定,有利于产科护理质量的提高.     

一对一式分娩护理模式的探讨

目的 研究一对一式分娩对产科质量的影响。方法 在传统式分娩的基础上，关注孕妇在产程中心理、生理和社会的需要，对每位进入活跃期的孕妇由一名助产士全程陪伴分娩至产后2小时的护理过程。结果 采取一对一式分娩形式剖宫产率下降50％，产后大出血率下降69.23％，新生儿窒息率下降80％，第一产程缩短148分钟，第二产程缩短15分钟，有效促进产程进展；与传统式对比，孕妇情绪稳定率提高21.6％，对护理工作满意率提高28.6％。结论 一对一式分娩护理使孕妇各种需要得到最大的满足，孕妇对护理工作满意率高，情绪稳定，有利于产科护理质量的提高。     

Cluster Headache in One Year Old Infant?

SYNOPSIS
Cluster headache is a type of essential headache affecting young or middle-age patients, whereas it is highly rare in children.
The case we are reporting here concerns a child who since the very first days after his birth appeared to suffer from severe attacks of agitation and sudden fits of weeping twice a day on average. When 21 months old, while in the hospital, he was found during the fits of weeping to complain of severe pain in the forehead, right temple and around the right eye. The examination carried out on him revealed no lesions of any type. The characteristics of 213 attacks were recorded up to the age of 27 months, when the crises disappeared spontaneously. The nature, duration and location of pain and the associated phenomena, as well as their regular occurrence every day make this type of headache affecting this patient fall within the category of cluster headache. The possibility of this type of headache appearing at such an early age seems to bear out the hypothesis that it may derive from a congenital biochemical disorder.     

妊娠晚期子宫浆膜下静脉自发性破裂

1病例资料32岁,孕1产0,孕29 6。因下腹部突发持续性疼痛6小时急诊入院。既往月经规律,孕期经过良好,6小时前在蹲位劳作时突感右下腹刀割样疼痛,并扩散至整个下腹部,伴恶心、呕吐1次,为晨间所进食物。查体:体温37℃,血压100/70 mmHg。宫底高28 cm,下腹部轻度膨胀,腹肌紧张,有压痛和反跳痛,以右侧为重。查血红蛋白90 g/L,血红细胞3·5×1012/L。经严密观察,予补液和抗生素治疗,当晚腹痛有所好转。次日下午,体温38·5℃,腹痛、腹胀加重,有肛门坠胀感,请外科医生会诊,见腹部中度膨胀,双侧下腹压痛和反跳痛,以右侧麦氏点为著,移动性浊音( ),肠…     

The 104th Congress at Midpoint of Year One

Some months ago I referred child psychiatric nurses and other reader of the column to your investment in the reality of the new landscape in Washington. While startling results took place with the election of 1994 in the composition of our U.S. Congress, the proposed agenda is even more alarming for advocates of vulnerable groups, such as children and youth. The new language centers on reinventing government, deregulation, public $ for limited public targets that clearly show impact, and balanced budget. While these are not necessarily negative goals in and of themselves, the difficulty comes with the underlying losses in accomplishing them. The House Republican "Contract With America" which calls for 354 billion in tax cuts has received more press coverage than the "New Deal" from its inception to present time. At midpoint of year one the new congress has achieved most of the minor agenda scheduled. There is still balanced budget, welfare reform, government reengineering and state block grant programs to be accomplished. Unfortunately, politics has one again taken the spotlight from action for the constituents. In the forefront are candidates positioning for the 1996 Presidential election.     

利培酮和氯丙嗪治疗首发精神分裂症的1年随访

目的:比较氯丙嗪和利培酮长期治疗首发精神分裂症的疗效、不良反应及依从性。方法:采用自然性观察研究方法,结合全病程管理模式对研究对象进行随访观察。研究对象符合ICD-10精神分裂症或分裂样精神障碍研究用诊断标准.年龄16～60岁,阳性和阴性症状评定量表(positive and negative symptom scale,PANSS)总分≥60,首次发病或首次来诊,总病程≤5年。研究中主要用PANSS评估疗效:副反应量表(treatment emergent symptom scale,TESS)评估治疗的不良反应;根据持续用药时间评估依从性;以健康状况调查问卷(SF-36)评估生命质量。结果:将PANSS减分率≥50%作为治疗有效。利培酮组第2、3、6、8、12个月时有效率分别为40.5%、46.6%、57.3%、64.1%、62.6%,氯丙嗪组的有效率分别为29.1%、41.8%、50.9%、50.9%、56.4%,两组无显著差异。经Ridit分析,利培酮组发生震颤、便秘、流涎的不良反应少于氯丙嗪组,而发生兴备激越、情感忧郁、失眠、恶心呕吐腹泻、月经紊乱的不良反应多于氟丙嗪组。利培酮组持续治疗时间平均为9.5±3.8个月,氯丙嗪组为8.9±3.8个月,两组间无显著差异。利培酮组终点时躯体角色功能、躯体疼痛、总体健康、社会功能、情绪角色功能和心理健康等生命质量的6个因子分显著高于相应的基线分,而氯丙嗪组仅社会功能和情绪角色功能2个因子分显著高于相应的基线分。结论:利培酮与氯丙嗪治疗首发精神分裂症是同样有效的。但两组的不良反应发生情况有所不同。与氯丙嗪相比,利培酮更能在多方面改善患者的生命质量。     

Changing Trends in Therapy Delivery with a Third Generation Noncommitted Implantable Defibrillator: Results of a Large Single Center Clinical Trial

Thirty-four patients underwent implantation of a third generation ICD, the 4210 ATP, for sudden cardiac death or ventricular tachycardia. This device incorporates significant telemetry logs as well as a detailed analysis of each arrhythmia episode detected. During the period of clinical follow-up, a mean of 12.2 months, a total of 26,569 VT or VF detections were made. The vast majority of these were either due to atrial fibrillation, nonsustained VT, or "noise" detection, and only 6% led to device therapy. ATP was successful in 86.3% of episodes, with 3.5% accelerations and 2.4% failure of ATP trains. The majority of inappropriate therapy episodes were clustered in seven patients, and all were easily diagnosed with the aid of the extensive telemetry Jogs and sense histories. Of five late deaths, three were from congestive heart failure, one from cerebrovascular accident, and one unknown. These data reveal that this "tiered" therapy noncommitted ICD performs to expectations; the stored data is of significant value in diagnosing the cause of ICD therapy. In addition, ATP is an effective modality for termination of VT.     

Factors Influencing Prognosis and Functional Outcome One Year After a First-Time Stroke in a Caribbean Population

Objective

To evaluate functional outcome and quality of life 1 year poststroke in a Caribbean population.

Design

Prospective study of patients with a first hemispheric stroke admitted consecutively between December 2010 and February 2011. The patients were evaluated (1) in the emergency department, (2) when discharged from the hospital, and (3) 1 year poststroke.

Setting

A university hospital.

Participants

Of the 140 consecutive patients with stroke, 78 (42% women, 24.4% hemorrhagic stroke) were included in the study.

Interventions

None.

Main Outcome Measures

Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), FIM, and Medical Outcomes Study 36-Item Short-Form Health Survey.

Results

The mean age of the participants was 62.1±17.7 years; 70.5% of patients had hypertension, 29.4% had diabetes, and 23.6% had chronic renal failure. At 1 year poststroke, the mortality rate was 29.4%, and the recurrence rate 2.6%. We evaluated 39 of the 55 survivors (71%). Score evolution (emergency department vs 1y later) is as follows: for the NIHSS, it was 6.2±4.9 versus 3.3±3.9 (z=−3.578; P<.001); and for the mRS score ≤2, it was 54.2% versus 66.7% (χ²=14.182; P=.25). The FIM score on discharge from the hospital versus 1 year later was 103.2±28.2 versus 101.7±31.5 (z=−1.008; P=.313). Multivariate analysis showed that aphasia, hemianopia, and incontinence significantly influenced the 1-year FIM score (P<.001). Quality of life, a patient-reported outcome measure of health-related quality of life, was significantly altered concerning vitality, role physical, and role emotional.

Conclusions

One year after a first stroke, despite significant improvement of neurologic impairment, the level of dependency did not change and quality of life was altered. Aphasia, hemianopia, and incontinence significantly influenced functional state.     

Predictors of One Year Outcome in Lupus Nephritis: The Importance of Renal Biopsy

The short-term prognosis of lupus nephritis was evaluated byassessing serum creatinine 12 months after renal biopsy in 87patients with lupus nephritis. On univariate analysis, significantclinical and laboratory predictors of this outcome includedclinical signs of renal injury (serum creatinine, 24-hour urinaryprotein, prolonged renal disease, nephrotic syndrome, serumalbumin), as well as thrombocytopenia, older age, and coexistingillness or hypertension at the time of biopsy. On renal biopsy,diffuse proliferative nephritis, higher activity, chronicity,or tubulointerstitial scores, or subendothelial or subepithelialelectron dense deposits predicted a higher serum creatinine12 months after biopsy. A clinical predictive model was developed which included asindependent predictors serum creatinine, age, platelet countand 24-hour urinary protein. Any one of three biopsy variablesadded information to the clinical prediction model: a markedquantity of subendothelial deposits (p=0.02), a higher activityindex score (p=0.02), or the presence of diffuse proliferativelupus nephritis (p=0.05). However, the relative predictive accuracyof the clinical model did not improve with the addition of anyof the biopsy variables. The value of renal biopsy in lupus nephritis is discussed basedon the ability of biopsy information to confirm the prognosis,to add new predictive information for a group of subjects, andto improve predictive accuracy for individual patients.