Surrogate decision-maker for end-of-life care in terminally ill patients at Chiang Mai University Hospital, Thailand

Surrogate decision-maker for end-of-life care is indicated at certain points during care for patients with terminal illnesses. This study aimed at identifying person(s) to whom northern Thai patients with terminal illnesses wished to transfer their decisions on end-of-life care and for cardiopulmonary resuscitation. From interviews with 152 eligible subjects, 57.2% had a high regard for their physicians' authority in making decisions on end-of-life care, 28.3% transferred their decisions to relative(s) and only 14.5% opted for shared decision-making among relative(s) and physicians. In the provision of cardiopulmonary resuscitation, 44.1% of subjects expressed a desire for family to make decisions together with physicians, 33.6% gave directives to the family alone and only 22.4% transferred their decisions to physicians. The differences that were observed in patients' preferences between the two situations indicate that patients should be assessed individually and adequate information for decision-making should be provided.     

Physicians' attitudes and practices regarding advanced end‐of‐life care planning for terminally ill patients at Chiang Mai University Hospital,Thailand

This study examined physicians' attitudes toward advanced directives and practices for the end‐of‐life care at Chiang Mai University Hospital, Thailand. The data were collected from 55 physicians (24 instructors and 31 residents) using self‐reported questionnaires. The majority of the participants affirmed the usefulness of the advance directive (AD) for cardiopulmonary resuscitation and respected the patients' wish for this directive, although advanced end‐of‐life care and resuscitation planning with the patients was limited. Mostly, the relatives were consulted regarding ADs. This study suggests that, in traditional Thai culture, physicians and families are more inclined to make decisions for the patient when they feel that it is in the patient's best interest. Further research is needed to investigate how and to what extent such attitudes can affect medical practice for end‐of‐life care in the context of the rapid development and consequent changes taking place in Thailand.     

Effectiveness of advance directives for the care of terminally ill patients in Chiang Mai University Hospital, Thailand

Abstract The key hypothesis behind advance directives (ADs) proposes that, if an intervention enhances a person's right to choose, a dying person will not opt for expensive, life-prolonging medical care and an ethically acceptable saving of resources will result. In order to assess the acceptability and effectiveness of ADs in reducing cardiopulmonary resuscitation (CPR) attempts and in-hospital death among terminally ill patients in a tertiary care hospital in northern Thailand, a non-randomized, controlled intervention study using an after-only unequivalent control group design was conducted. The majority of the subjects and the surrogates preferred to employ ADs in expressing their preferences on CPR and there was a high level of agreement between the subjects and surrogates on the decision. The use of ADs appeared to be effective in reducing futile CPR attempts and the in-hospital mortality rate among subjects during the index hospitalization. Advance directives were accepted well in this study setting.     

Education: improving quality through service enhancement

The quality of service provision in educational contexts is becoming increasingly important. There is a need to demonstrate value for money and convey a positive image to retain and attract students and other stakeholders. This article examines the concept of service and its relevance to nurse education in the UK.     

Attitudes toward advance directives and the impact of prognostic information on the preference for cardiopulmonary resuscitation in medical inpatients in Chiang Mai University Hospital, Thailand

Our previous study revealed that cardiopulmonary resuscitation (CPR) was performed in 65.7% of 411 terminally ill patients who died in a tertiary-care university hospital in northern Thailand. Advance directives (ADs) are needed to ensure that life-sustaining therapies are used more appropriately. To investigate inpatients' attitudes regarding ADs for CPR and the impact of providing prognostic information on treatment preferences for CPR, we interviewed a randomly selected group of 200 ambulatory medical inpatients in multiple sessions. The results showed that most subjects had a positive attitude towards ADs for CPR. The majority preferred to have CPR when no information was provided on the chance of survival. However, this proportion decreased depending on the prognostic scenarios. Our investigation suggested that the preference of patients for CPR should be assessed individually and gradually, with adequate information given on the chance of survival.     

An RCT of adherence therapy for people with schizophrenia in Chiang Mai, Thailand

Aim. The aim of this paper was to evaluate the effectiveness of adherence therapy‐a brief intervention based on compliance therapy and motivational interviewing techniques‐in a sample of people with schizophrenia in Thailand. Background. Poor adherence is problematic, but knowledge about how to improve medication adherence is limited. Studies focusing on the effects of interventions used to improve adherence have produced inconsistent outcomes and have been mainly conducted in western countries. Methods. An exploratory single blind randomized controlled trial was conducted in Chiang Mai, Thailand. Thirty‐two patients with schizophrenia were randomly allocated to receive eight weekly sessions of adherence therapy or continue with their treatment as usual. Patients were assessed at baseline and after nine weeks. The primary outcome was overall psychotic symptoms. Secondary outcomes were general functioning, attitude towards and satisfaction with antipsychotic medication and medication side effects. Results. The findings of this study indicated that patients who received adherence therapy significantly improved in overall psychotic symptoms, attitude towards and satisfaction with medication compared with treatment as usual but no significant difference was found in general functioning or side effects compared with treatment as usual. Relevance to clinical practice. Adherence therapy has a positive impact on patients’ psychiatric symptoms, attitude towards and satisfaction with medication. Nurses can effectively deliver adherence therapy following intensive training.     

Comparison of knowledge, attitudes, experience, and opinions between teachers and guardians regarding the emergency contraceptive pill in Chiang Mai, Thailand

Teachers and guardians (parents or authorized persons) are expected to collaborate in educating female students about emergency contraceptive pills (ECPs) but it is unknown whether they have similar perspectives on ECPs. This study aimed to compare their knowledge, attitudes, experience, and opinions regarding ECPs. Questionnaires were distributed to 720 female teachers and guardians of eight randomly selected high schools and vocational schools in Chiang Mai, Thailand. There were significantly more teachers who knew about the existence of ECPs than guardians. More guardians reported some accurate information regarding ECPs than did teachers. More teachers than guardians believed that the use of ECPs was not morally wrong. Both teachers and guardians had similar experience with ECP use and similar agreement in teaching female adolescents about ECPs. The teachers and guardians had some different opinions on teaching barriers. It is suggested that both teachers and guardians are suited to teach female adolescents about ECPs, but they need preparation in different aspects.     

Hospital readmissions at the communitywide level: implications for case management

This study describes the development of information concerning the distribution of hospital readmissions by diagnosis in seven different United States metropolitan areas. The data demonstrated that circulatory disorders were associated with the largest number of communitywide readmissions in all of the communities. It also showed that circulatory, respiratory, and digestive disorders accounted for a majority of readmissions in all of the areas. This information suggested that case management efforts to reduce readmissions can focus on a limited range of clinical diagnoses. This approach should enable the process to function effectively within resource constraints.     

加强节日人文关怀 提升优质护理服务品质

目的:加强精神科节日人文关怀,提升优质护理服务品质。方法:分析节日期间患者的心理,对住院患者实施人文关怀,落实对患者家属的人性化服务。结果:护士了解病情更全面,满足了患者及家属的需求,满意度得到提升,患者不良心理得到缓解,促进了患者社会功能的恢复。结论:精神科加强节日人文关怀,对提升优质护理服务品质具有重要作用。     

产后延伸护理服务模式对产后缺乳产妇的护理分析

目的:探讨产后延伸护理服务模式对产后缺乳产妇的护理效果.方法:选择2018年12月至2019年12月在本院分娩的200例产妇为研究对象,按照抽签法将其分成观察组与对照组各100例,分别行产后延伸护理服务模式、常规产后护理服务模式,比较两组产后缺乳发生率、护理满意度.结果:观察组产后缺乳发生率明显低于对照组,护理满意度明...     

Tertiary prevention: implications for improving the quality of life of long-term survivors of cancer

OBJECTIVE: To provide an overview of the incidence, epidemiology, and appropriate screening for second primary malignancies, as well as the nursing implications of tertiary cancer prevention. DATA SOURCES: Published review articles, book chapters, research reports, and the clinical experience of the author. CONCLUSION: Many persons successfully treated for malignancy are at risk for a second malignancy. This risk is related to shared risk factors, genetic predisposition, and the toxic effects of therapy. Persons particularly at risk are those who have been successfully treated for breast, gynecologic, colorectal, skin, and lymphoma malignancies. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be knowledgeable regarding the principles of tertiary prevention, be able to identify persons at risk, and provide appropriate patient education and psychosocial support on how to manage the risk and detect second malignancies early.     

开展优质护理服务提升糖尿病专科护理水平

[目的]提升糖尿病专科护理水平,提高病人满意度。[方法]制订内分泌科“优质护理服务”工作计划,改变护理工作模式,实行包干责任制整体护理;加强培训,提高护士糖尿病专科知识水平和能力,为糖尿病病人提供多样化的健康教育方式,提高护理质量,密切护惠关系。[结果]优质护理服务开展前后病人满意度、护理质量评分、护士糖尿病专科知识评分比较差异有统计学意义（P〈0．01）。[结论]深入推进优质护理服务,能提高护士的专科护理知识和水平,提升病区护理质量,为病人提供更专业的优质护理服务。     

疗养院提高优质护理服务的管理策略

随着现代医学及护理模式的转变,护理服务客体日趋广泛,需求呈现多元化,给护理工作提出了更高的职业要求。沈阳军区大连疗养院护理部本着练就一流的技     

Monitoring transfusionist practices: a strategy for improving transfusion safety

BACKGROUND: Data from New York State indicate that about 1 of every 33,000 red cell units transfused is ABO-incompatible with the recipient. National application of these data suggests that as many as 360 ABO-incompatible whole blood and red cell transfusions might occur annually in the United States. Phlebotomy and blood bank laboratory errors cause some of these ABO-incompatible transfusions, but the greatest number result either partially or solely from the failure of transfusionists to identify properly either a patient or the blood component a patient receives. STUDY DESIGN AND METHODS: A quality assessment/quality improvement (QA/QI), process is described that allowed for the direct oversight (monitoring) of transfusionists' practices and for the assessment of institutional policies for blood administration. RESULTS: At the beginning of the QA/QI process, monitoring of blood administration practices revealed that a variance from institutional blood administration policy occurred during 50 percent of blood and component transfusions. As a result of the QA/QI process, the percentage of transfusions with an associated variance from institutional policy dropped to nearly zero. CONCLUSION: The QA/QI process described in this report, or one similar to it, could improve transfusion safety and serve as a model for increased involvement by transfusion service medical directors in the oversight of transfusionists' practices.