The physiologic health care needs of HIV-infected black men on admission to an AIDS-dedicated nursing home.

The purpose of this study is to describe the physiologic health care needs of HIV-infected Black men on admission to an AIDS-dedicated nursing home. Participants were 68 Black men aged 26 to 60 years who were admitted to an AIDS-dedicated nursing home in the southern New England area between 1995 and 1999. The participants were very ill and weak on their admission to the nursing home, with most having diagnoses of AIDS (n = 65), an average Karnofsky Performance Scale score of 44 (SD = 14.90), and some degree of mental impairment. The late-stage of disease of the participants was reflected in their multiple symptomatology and functional impairment in activities of daily living. With patients living longer in the chronic disease stages of HIV disease, the results of this study provide support for the further investigation of the most effective long-term care settings for Black men with HIV/AIDS. The results also have implications for the multiple clinical roles nursing can assume within HIV/AIDS long-term care settings.     

脑卒中患者家庭护理服务项目需求的调查与分析

目的了解脑卒中患者家庭护理的需求,为采取有针对性的家庭护理干预提供依据。方法应用Barthel指数ADI。量表及自行编制的“护理服务项目调查表”,调查某社区40例脑卒中患者对家庭护理服务项目的需求状况。结果脑卒中患者家庭护理服务项目需求总分为10～38分,平均（26．30±7．17）分;所有护理服务项目中得分最高项为康复护理服务中的“告知偏瘫后潜在的并发症及预防措施”,平均为（2．29±0．70）分;恢复欠佳组（ADL≤60分）家庭护理服务项目需求总分高于恢复良好组（ADL〉60分）,且基础护理、康复护理服务项目需求高于恢复良好组。结论在脑卒中患者的康复过程中,护理人员需加强对脑卒中患者及家属的健康教育,重视家庭在脑卒中患者康复中的重要作用及对患者与家属的心理护理。     

Nursing interventions and other factors associated with discharge disposition in older patients after hip fractures

BACKGROUND: The research on hip fractures has been focused on surgical procedures for hip fracture repair; little is known about the contribution of nursing interventions to outcomes. OBJECTIVES: To investigate factors, including nursing interventions, associated with the discharge destination of an older patient population hospitalized for a fractured hip or an elective hip procedure. Nursing interventions used during the hospitalized period are identified. METHODS: A design model composed of patient characteristics; clinical conditions; nursing unit characteristics; and medical, pharmacy, and nursing interventions related to the outcome of discharge disposition was tested using generalized estimating equations analysis. A total of 116 variables were examined in a sample of 569 hospitalizations from 524 patients aged 60 years and older admitted for treatment of a hip fracture or elective hip procedure in one tertiary care agency over a 4-year period. Data were obtained retrospectively from five clinical databases. RESULTS: Fifty-four percent of the population was discharged to a location other than to home. The predictors of discharge to home were a younger age, admission from home, and having a spouse, as well as receipt of intravenous solutions, diagnostic ultrasound, a lower number of medications, and moderate use of the nursing intervention of bathing. The identification of nursing interventions indicates that those who received routine nursing care for this condition returned home while those who required interventions for complications or prevention of complications were discharged to an institution. DISCUSSION: Using a standardized nursing language with the hospital's information system can provide nurses and others with information that demonstrates the contribution of nursing care to outcomes, including the outcome of discharge to home.     

How home care agencies in Germany view the AIDS challenge: results of an exploratory study.

The purpose of this article is to examine the current state of home care services for people living with HIV/AIDS and other seriously ill patients in Germany. It is based on a research project promoted by the Federal Ministry for Labor that aimed to investigate the possibilities and problems related to home care of the critically ill and thus establish basic scientific principles that could be used to close a health care gap that has long been of concern. The article will initially offer a brief explanation of the causes underlying the current problems in the field of home care for seriously ill patients. The authors then present the implications for nursing qualification that will have to be addressed to develop a patient-oriented, priority-level home nursing care program for people with HIV/AIDS in Germany.     

Sleep deprivation in critical care units

Sleep deprivation is a significant problem for patients in critical care units. Sleep is a complex, active process that is divided into 4 stages of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. Noise, lights, discomfort, pain, medications, and stress all contribute to a patient's inability to sleep. Lack of knowledge about the sleep stages, nursing routines, and frequent nursing assessment and interventions also impact the critically ill patient's ability to sleep. Education about sleep deprivation needs to be integrated into critical care courses and orientation programs. Sleep deprivation should be addressed on the multidisciplinary care plan and in health team conference, and nursing care planned accordingly. Sleep medications and their effects should be evaluated for each patient, as well as identifying medications that might be preventing or disturbing sleep.     

The emergence of Medicare hospice care in US nursing homes

Although Medicare-financed hospice care has been provided in nursing homes in the USA for over 10 years, very little is known regarding the use of this government health care benefit in nursing homes. Using resident assessment data and hospice and inpatient Medicare claim data from five US states, we were able to identify and describe nursing home residents receiving hospice care between 1992 and 1996, and their hospice utilization patterns. Six per cent of all dying nursing home residents received hospice care at some point in time and, in 1996, an estimated 24% of all Medicare hospice patients in the five study states received hospice while in a nursing home. Of those residents beginning hospice care after nursing home admission, 48% were 85 years or older, 70% were female, 94% were white, 76% were unmarried and 62% had a non-cancer principal diagnosis. The average length of stay in the hospice programme for residents receiving hospice care while in the nursing home was 90.6 days, the median 35 and the mode 2. Hospice care in US nursing homes is a prevalent model of care that appears further to extend the Medicare hospice benefit to older adults who are female and to those with non-cancer diagnoses. Lengths of stay in the programme are similar to those observed in the community and the average length of stay is substantially shorter than previously estimated by an influential government study.     

SpitexPlus: assessment of and specialised nursing care for elderly and their families living in the community

Current demographic developments and the high prevalence of chronic conditions require new approaches to nursing care of the elderly population in Switzerland. New care models need to be developed that go beyond traditional nursing practice with its focus on the individual. Existing preventive home visit and case management programmes have mostly focussed on the young old with the goal to maintain functional health and prevent institutionalisation. Families, who play a crucial role in the care of the elderly at home, were not included. The purpose of this article is to describe the development of the SpitexPlus Project, which is directed at people 80 years and older and their families, irrespective of their health status and social situation. It aims to improve self-care capabilities and quality of life in people 80+ and their families and to enable them to manage the challenges of daily life at home. Evidence based nursing interventions, based on the principles of health promotion, empowerment, family centeredness, and partnership were developed. The development of the programme phases, interventions, and the role of the advanced practice nurses are described in detail. Potential benefits for nursing practice are delineated.     

Application of Home Health Nursing Abroad:A Literature Review

Currently, with advancesin medical science, the average lifespan of citizens is gradually increasing worldwide, resulting in the emergence of an aging society. Aged patients are especially prone to suffering from various chronic diseases, and many elderly patients select to receive home-based care. Thus, professional care in elderly patients' homes is needed,which also represents a mark of social development. Today, home health nursing is widely applied, including nursing of post labor mothers and their infants, and osteoporosis patients, among others.The aim of the present study was to explore the home health nursing model and its applicable range, as well as existing problems and the impact of the model in the domestic settings.     

Psychiatric nursing management of medication-free psychotic patients

This article discusses how a team of psychiatric nurses manages acutely psychotic patients on a clinical research unit without the use of psychotropic medications. The article describes a schizophrenia research unit, identifies the behaviors of acutely psychotic patients, and provides examples of effective nursing interventions used on the unit. These interventions are grounded in principles of interpersonal psychiatric nursing practice and milieu therapy. The discussion is directed to psychiatric nurses and other health care professionals who are employed on research units.     

Nurse delivered medication safety screening program for home care visits

Home care clients have safety barriers related to medication storage, disposal, and safe use of opioids. Limited research is available regarding medication safety initiatives in the home care setting. This study evaluates a medication safety initiative, linked with opioid misuse and overdose prevention screening, for home care clients with different levels of service. Training and screening tools designed for community pharmacies by the Opioid & Naloxone Education (ONE) Program were modified for use by home health nurses. All new admits to the home health services were screened for medication storage, medication disposal, and use of pain medications. Patients taking opioids were screened for opioid-specific risks. Interventions based on screening results included education, provision of medication lock boxes, drug disposal packets, and/or naloxone. Most home care clients (85%) are properly storing their medication and 38% were not properly disposing unused medications. Higher levels of care had greater pain medication needs, including the provision of naloxone. This study demonstrates the opportunity to incorporate medication safety screening into nursing home health visits.     

Validity and reliability of the Nursing Minimum Data Set for the Netherlands (NMDSN)

The Nursing Minimum Data Set for the Netherlands (NMDSN) describes nursing care based on nursing phenomena, interventions and outcomes. The validity and reliability of its data collection has not been tested yet. PURPOSE: To report about the discriminative validity and the interrater reliability of the NMDSN. DESIGN: Data were collected in an intensive care ward, in a nursing home and in a residential home. The unit of measurement and analysis is the 'patient day'. The analysis for validity consisted of ridits calculations, and their graphical representations. Interrater reliability was measured by percentage agreement and Cohen's kappa. RESULTS: Graphs illustrate the differences on most nursing phenomena and interventions as expected beforehand. The percentage agreements for the residential home vary from 60.4 to 100%, and the kappa statistics from -0.09 to 0.85, indicating a poor to almost perfect interrater reliability. CONCLUSION: Intensive care patients and patients in the nursing home have more problems and need more nursing interventions compared with general hospital patients, while the patients in the residential home have lesser of both. This illustrates the discriminative validity of the NMDSN. The kappa values for various NMDSN variables are sufficient. A similar test in the general hospital is recommended.     

艾滋病病人口腔护理程序的临床研究

[目的]探讨应用艾滋病（AIDS）护理程序进行口腔护理的效果,寻找预防AIDS病人口腔感染及病损的最佳方案。[方法]将2011年10月—2012年3月住院确诊的200例AIDS病人随机分为试验组和对照组,试验组采用护理程序对病人进行口腔护理;对照组采用常规口腔护理。观察两组病人口腔护理的效果及病人掌握口腔护理知识的情况。[结果]干预1周后两组病人口腔护理疗效、口腔病损情况差异有统计学意义（P〈0.01）。试验组病人第7天对口腔护理健康认知程度明显提高。[结论]AIDS病人口腔护理程序应用于AIDS病人口腔护理中,能促进病人口腔健康,帮助病人养成良好的口腔卫生习惯。     

The concept of vulnerability in relation to child protection: health visitors'' perceptions

Patients with AIDS are permanently dependent on medical and technical nursing care. During a certain phase of the disease some of the patients have to visit the out-patient clinic of the hospital for regular treatment. It was noticed that AIDS patients find these visits a severe burden. Therefore in Rotterdam an experiment has been started to provide them the technical-medical and nursing care at home instead of at the out-patient clinic. During the experiment, specialized hospital nurses visited the patients at home. They worked in close collaboration with the community nurses. An exploratory study was carried out to assess the prospects and difficulties of this new kind of home care for AIDS patients from a medical, psycho-social and organizational point of view. The results suggested that it is possible to relocate the technical-medical and nursing care from the out-patient clinic to the patients' home. This specialized home care is seen as desirable from the perspectives of the AIDS patients and informal and professional caregivers. However, some organizational aspects, like the co-ordination and communication among caregivers and the availability of the specialized hospital nurses during the weekend, must be improved in the future.     

Nurses and 'difficult' patients: negotiating non-compliance

BACKGROUND: There is a large body of nursing literature on patient non-compliance. While some articles address non-compliance as a patient problem to be resolved by nursing interventions, there is also a growing number that critique this approach. This reflects the discomfort many nurses feel about the practice of labelling patients as non-compliant. AIM: The aim of this discussion paper is to build on the critical nursing literature to offer an alternative to the interventions commonly directed at patients who do not follow health care advice. This alternative approach locates patients within their social context and focuses on those who adapt health care advice to fit with their beliefs, life situation and circumstances. The aim is to encourage nurses to learn about how health care treatments affect patients'lives, and not merely their health. METHOD: Specific nursing articles were reviewed to demonstrate the ways in which the concept of compliance is used within the nursing literature. These articles were then used to support an argument that promotes a patient-centred approach to health care. CONCLUSION: A patient-centred approach involves transferring power and authority away from health care professionals and towards patients. We encourage nurses to take a leadership role by changing the way in which health care is delivered towards a focus on patients'lives. Learning about patients' lives may assist nurses to offer health information to patients that is more relevant and, therefore, useful.     

Nursing interventions in crisis-oriented and long-term psychiatric home care.

Psychiatric nurses in The Netherlands are moving out of residential mental health institutions and are pioneering home care for the acutely and chronically mentally ill. The purpose of this study was to identify the interventions nurses currently use and to describe the differences between crisis-oriented and long-term psychiatric home care. Data was collected of 159 nursing care plans from four participating crisis-oriented and two long-term psychiatric home care teams. All stated nursing activities were identified and subsequently labelled and classified using the Nursing Intervention Classification (NIC). Results revealed that in both crisis-oriented and long-term psychiatric home care, nurses used a wide range of nursing interventions. Medication Management, Coping Assistance and Activity Therapy were the most frequently undertaken nursing interventions in both types of care. Within crisis-oriented care, Emotional Support and Self-esteem Enhancement dominated, whereas long-term care focused on Socialization Enhancement and Home Maintenance Assistance. The results will be used for further research and for standardization of nursing care plans within these categories of nursing practice.     

Older adults and NSAIDs: avoiding adverse reactions

Monitoring which medications geriatric patients are taking is crucial to their health and well-being. Many take over-the-counter nonsteroidal anti-inflammatory drugs on a daily basis for common ailments. Even when taken correctly, these drugs can harm the elderly because of normal changes that occur as people age. Techniques to monitor this population and their use of these medications are included to help nurses assist patients avoid adverse reactions and complications. This information can be valuable whether you are a nurse working in a hospital, office, nursing home, assisted living facility, or any setting where care is rendered to the elderly.