A holistic intervention programme for families with a child with a disability

BACKGROUND: The birth of a child with a disability may cause serious stress for the parents and affect each member of the family. Parents need support to deal with such a situation; however, health care professionals themselves are not always well equipped to help them and often adopt an attitude of withdrawal. AIM: The aim of this paper is to describe a family intervention programme developed in collaboration with families who were adapting to the birth of a child with a disability. DISCUSSION: The primary purpose of the programme is to help family members adapt to the situation in which they suddenly find themselves, primarily by reducing stress. The family's autonomy and competencies in providing care for the child are promoted and called into action. The programme encompasses different aspects of family relations: the individual, marital, parental, family, extended family and non-family sub-systems. Its theoretical foundations, clinical experience with families of a child with a health problem, and our previous research have enabled a remodelled vision of the way individuals and families adapt to such a situation. CONCLUSION: The symbioses of the design of the programme, training in its application, and intervention itself have transformed families of a child with a disability as well as the nurses themselves. The key element of this transformation has been the mutual recognition of relevant skills and authority by families and health care professionals that has led to new competencies, self-determination and an individuality that may change their lives.     

Camptocormia in a patient with Parkinson disease and a myopathy with nemaline rods

Camptocormia, also referred to as bent spine, is a gait disorder characterized by hyperflexion of the thoracolumbar spine that develops in recumbent position while walking and that disappears in supine position. Myopathy is one of the frequent causes of camptocormia. A 77-yr-old male patient who was followed up with the diagnosis of rheumatoid arthritis for 2 yrs was admitted with progressive gait deterioration. Hyperflexion of trunk, disappearing in supine position, was detected and diagnosed as camptocormia. He also exhibited the signs of parkinsonism. A paraspinal muscle biopsy showed myopathy with rods in many muscle fibers. Camptocormia in this patient may be attributable to the myopathic weakness of thoracolumbar paraspinal muscles. The normal biceps brachii muscle biopsy refers to the isolated affection of paraspinal muscles in this patient. A camptocormia (bent spine) case of myopathy with nemaline rods associated with Parkinson disease is presented.     

Working with a Microscope

Active clinical teaching may seem like a lot of work in a busy veterinary practice. It is, however, a vital component of veterinary nursing training. Here, Libby Earle outlines some ways in which assessors and qualified veterinary nurses who work with students can positively enhance their teaching skills     

Successful pregnancy in a patient with a double inlet left ventricle treated with a septation procedure

Because of improved medical and surgical care, women with univentricular hearts may live to enter the reproductive years and become pregnant. Pregnancy in a woman with a history of a univentricular heart treated successfully with a septation repair can follow a favorable course if she is acyanotic without functional or cardiovascular compromise.     

Dying with a Capital D

Abstract

The use of group discussions in death-and-dying courses is a common technique to increase students' awareness of their feelings and of other students' perspectives. A structured small-group discussion format in which discussion is preceded by reading material and a written reaction paper is described. Evaluations indicate that students react favorably to this approach.     

Branding: a promise with a solid base

Over the past several decades, branding as a process of differentiating one company, product, or service from another has been central to the business efforts of a wide range of commercial enterprises. In more recent years, branding has become part of the lexicon of health care, where its function is accepted and its potential benefits desired. Much of the emphasis regarding brand building, however, is in the area of marketing. Although communications and their inherent promises remain an essential component in brand development for health care providers and managed care companies, the ultimate value of branding lies in its integration into an organization's operational structure and strategies.     

Endobronchial myofibroblastic sarcoma presenting with hemoptysis in a patient with a normal chest x-ray

Hemoptysis is an important symptom in clinical practice. The diagnosis of the underlying cause is often difficult, particularly in patients presenting with a normal chest x-ray. We report a case of hemoptysis with a normal chest x-ray due to a rare endobronchial neoplasm: myofibroblastic sarcoma.     

Nursing a patient with frostbite

Frostbite is a condition that is associated with people living in countries with an extremely cold climate. However, it can affect people in the UK who are involved in winter sports, and is also associated with the homeless, people with a psychiatric illness, and those who misuse drugs and alcohol. Angela Davies describes the assessment and management of a patient with frostbite and identifies the challenges of managing these complex tissue injuries     

Resilience in families with a member with chronic pain: a mixed methods study

Aims and objective. To measure and explore between 2007–2010 measure and explore the nature of family resilience in the context of families with a member with chronic pain. Background. Chronic pain impacts on the entire family. The literature suggests that it is possible to strengthen resilience in individuals with chronic conditions, but little is known about the impact of chronic pain on family resilience. Design. A explanatory sequential mixed method study was undertaken. Methods. In the initial quantitative phase, assessment measures were administered using the Connor‐Davidson Resilience Scale, Family Impact of Pain Scale, Medical Outcomes Study Short Form 36 and Medical Outcomes Study Social Support Survey. Data were collected and analysed from 31 family cases (n = 67 participants). In the second, qualitative phase, follow‐up semi‐structured interviews were undertaken with 10 families to help explain the quantitative results. Results. The impact of pain on the family was high overall, but the perceived impact was greater for the person with pain. Resilience scores were above average for both the person with pain and other family members. However, the person with pain scored lower on the resilience scale than other members of the family. The families scored high for social support overall, while the person with pain perceived they had greater support than their family members. Conclusions. Identifying the strengths or resilient properties inherent in families and using those strengths in the planning and implementation of care, especially of chronic conditions such as chronic pain, is pivotal to quality health outcomes. Relevance to clinical practice.  It is important that nurses and healthcare professionals include family members when planning and delivering care for persons with chronic pain. Identification of strengths within families can help tailor nursing interventions to meet family needs.     

An organisation with a memory

Patient safety has been an under-recognised and under-researched concept until recently. It is now high on the healthcare quality agenda in many countries of the world including the UK. The recognition that human error is inevitable in a highly complex and technical field like medicine is a first step in promoting greater awareness of the importance of systems failure in the causation of accidents. Plane crashes are not usually caused by pilot error per se but by an amalgam of technical, environmental, organisational, social and communication factors which predispose to human error or worsen its consequences. In healthcare, the systematic investigation of error in the administration of medication will often reveal similarly complex causation. Experience and research from other sectors, in particular the airline industry, show that the impact of human error can be reduced if the necessary work is put in to detect and then remove weaknesses and vulnerabilties in the system. The NHS is putting in place a comprehensive programme to learn more effectively from adverse events and near misses. This aims to reduce the burden of the estimated 850,000 adverse events which occur in hospitals each year as well as targeting high risk areas such as medication error.     

Travelling overseas with a pet

ABSTRACT:

Overseas travel with a pet is increasingly common among British owners. The introduction of the EU Pet Passport in 2001 made it easier for owners to travel between member countries with their pets and removed the need for lengthy quarantining in many cases. The Pet Travel Scheme (PETS) is frequently updated and currently allows UK owners to take pet cats, dogs and ferrets to any country and bring them back into the UK without quarantine, providing certain conditions are met.     

Clonidine-induced hypertension in a patient with a spinal lesion

OBJECTIVE: To report a case of possible clonidine-induced hypertension (by Naranjo score) in a patient with a C4 spinal lesion. BACKGROUND: Clonidine is a medication long used to treat hypertension, and it is still used in the treatment of refractory hypertension. Although effective, clonidine use is hindered by adverse effects and its dual mechanism of action. CASE SUMMARY: A 39-year-old white, quadriplegic man with poorly controlled pain displayed many characteristics consistent with autonomic dysfunction (e.g., C4 spinal lesion, orthostatic hypotension, hypertension). The patient was routinely receiving transdermal clonidine and also received transdermal nitroglycerin paste as needed for control of acute hypertensive episodes. On the recommendation of the home healthcare pharmacists, clonidine was discontinued. Since that time, the patient's blood pressure and the use of emergent antihypertensive treatment have decreased significantly (maximum systolic and diastolic BP by approximately 50 and 25 mm Hg, respectively). CONCLUSIONS: Many of the characteristics of autonomic dysfunction, such as refractory hypertension, can seem selective for the use of clonidine and, because of its reliance on central alpha(2)-activity for its hypotensive effects, clonidine may induce hypertension in patients with autonomic dysfunction. Clonidine should be used with great caution when autonomic dysfunction is suspected.     

Evidence-based care of a patient with a myocardial infarction

Quality nursing care of the patient with a myocardial infarction is realized in accordance with evidence-based practice and by the willingness of nurses to adjust nursing practice as new evidence emerges. The framework for the holistic care of the patient following a myocardial infarction encompasses a comprehensive assessment, planning, intervention and evaluation process. The intention of this case study is to illustrate the rationale and evidence base underpinning the holistic approach to the care of this patient group.     

Nursing management of a patient with a subarachnoid hemorrhage

Nursing care of the aneurysm patient is as demanding as any challenge the neuro unit can offer. Because these patients are extremely ill with major neurological deficits, close observation of their neurological status and its many physiologic parameters is demanded. Monitoring the patient's status and helping to prevent complications related to re-bleed and vasospasm are critical. Assisting the patient and his family to cope with the many problems presented during his hospitalization provides many stressors to the neurology staff nurse. A multi-disciplinary approach to the long-term care of this patient helps to reduce stress for the neurology nursing staff and optimizes the benefits for the cerebral aneurysm patient.     

Otalgia with a normal ear

Ear pain is a diagnostic problem when examination of the ear shows no pathology. Referred otalgia may be caused by neoplasms; dental abnormalities or infections; temporomandibular joint dysfunction; sinus, pharyngeal or salivary gland infections; temporal arteritis; cervical arthritis, or one of the neuralgias. Ear pain may also be psychogenic.     

Dizziness in a patient with a permanent VVI pacemaker

A 83-year-old woman with a single-chamber pacemaker implanted 15 years earlier was brought to the ED due to symptomatic bradycardia. ECG continuous monitoring allowed the diagnosis of atrial fibrillation with complete atrioventricular block in the setting of a complete failure to capture. The differing timing cycles of pacing outputs can confirm that sensing is preserved in the absence of a pacemaker programmer.     

Having a sibling with schizophrenia: a phenomenological study

Limited attention has been paid to experiences of individuals with siblings diagnosed with schizophrenia. The purpose of this article is to address this gap by exploring the impact of having a brother or sister with schizophrenia. The lived experience of 6 individuals with a sibling with schizophrenia was explored using van Manen's (1997) Hermeneutic Phenomenology. Four themes were identified: struggling to understand, struggling with the system, caring for the sibling, and seeing beyond the illness. Health care providers need to re-evaluate current approaches for assisting individuals to cope with having a sibling with schizophrenia. Inclusion in the plan of care and recognition of their struggle is essential for individuals having a sibling with schizophrenia.     

Parenting a child with chronic illness: a metasynthesis

Increasing numbers of children are diagnosed with chronic illnesses each year. Some parents are finding themselves providing all the care to these children. The experience of parents caring for a child with a chronic illness is examined in this metasynthesis.     

Communication barriers when managing a patient with a wound

The management of a wound can prove challenging to the nurse when the needs of a patient are complex and there are barriers to overcome. This case study discusses the methods used by a community nurse when considering some of the problems that presented as a result of communication difficulties with a patient. The use of a wound assessment tool proved valuable when collecting and organizing information and the importance of gaining adequate information at assessment is outline. The article shows how communication impacts on the quality of care given, and how it affects the experiences of both nurse and patients, especially when the psychological and physical aspects of care are both equally demanding. The need for nurse and patient to work in concordance is reflected on as one of the lessons learnt from this case study.     

Caring for a patient with a urostomy in a community setting

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.