Lifestyle changes: effects on an obese patient

Obesity is often caused by an unhealthy lifestyle, which is a composite of various individual behaviors. Nurses may assist obese patients to lose weight and avoid chronic disease by identifying risky lifestyle behaviors and helping to develop improvement strategies. This article describes the nursing experience of the authors in caring for an obese patient who had made several unsuccessful attempts to reduce weight. An intervention approach was used to review the patient's lifestyle. Using self-regulation theory, the authors identified that the patient's fat-related daily behavior included: lack of exercise, high-fat diet, and daily snacks consumed even late at night. The authors also helped the patient discover the reasons underlying his fat- related behavior and his previous failed attempts to lose weight and to develop a feasible improved approach that considered such. After six weeks of care, the patient's body weight had reduced and body fat and body mass index had decreased with no relapse. The patient further lost significant weight and body fat during the three-month follow up period. The authors would like to share with nursing professionals this approach to weight loss, with the hope that this case study can contribute to medical efforts to help obese patients not only lose weight but also prevent chronic illnesses.     

Applying cognitive-behavioral therapy to a patient with schizophrenia

The purpose of this article was to describe a nursing experience with a patient who suffered from delusions and hallucinations due to schizophrenia. Through conversation and observation, the authors gathered both subjective and objective data and identified two major nursing problems, as follows: altered thought processes and sensor/ perceptual alteration (auditory). During the nursing process, the authors established a rapport with the patient and provided cognitive-behavioral therapy to help him to reduce his irrational beliefs and improve his coping methods. The behavioral therapy enabled the patient to face his negative beliefs, and he developed cognitive-behavioral skills to improve his self-management of delusions and hallucinations. From this perspective, cognitive-behavioral therapy was an effective intervention in the nursing process of caring for this patient with positive symptoms.     

Application of therapeutic play in the process of nursing a preschool patient

This report describes the application of therapeutic play to a 4-year-old female patient with intestinal obstruction during the process of nursing. The patient suffered a Port-A in the clavicle and an ileostomy in the right upper abdomen. She cried incessantly and resisted nurses who attempted to change her dressing. Data were collected by participant observation, and it was found that the patient had problems dealing with anticipatory pain and body image and lacked an emotional outlet. Therapeutic play therefore was applied during the process of nursing in an effort to accomplish the following: (1) establish trust between the patient and the health care providers; (2) reduce the patient's fear of therapy; (3) help the patient to understand her own self-image; (4) provide an emotional outlet for her. During the nursing process, we improved her overall compliance, provided her with an emotional outlet, and helped her to understand her self-image. Through this nursing process we experienced the nature of children's play. Pediatric nurses may consider employing play as a means to communicate with patients in an effort to reduce their stress during hospitalization. Therapeutic play may also improve patient compliance with the process of nursing.     

Nursing care experiences of a borderline personality patient with spiritual distress

Patients with Borderline Personality Disorder (BPD) often question the purpose and value of their life. Understanding the spiritual needs of BPD patients is essential to providing more appropriate care and achieving greater care efficacy. This case report investigated a woman with BPD who had experienced spiritual distress during nursing care. Between February 24th and December 15th, 2010, the authors conducted an assessment of the four dimensions of spiritual care for the patient using observation, interviews and patient medical records. The four dimensions included the relations between the individual and herself, others, religious belief, and the natural environment. After integrating and analyzing data, the authors found the patient questioned the purpose and value of her life and contemplated self-injury / suicide due to inadequate support systems and a lack of effective stress management and coping skills caused by illness-induced depression and the lingering effects of a difficult childhood. In the process of nursing care, the authors employed one-to-one interviews with listening skills to induce the patient to describe her spiritual distress, and then employed dialectical behavior therapy groups and education skills training to enhance the values of positive thinking and reduce suicidal / self-injury tendencies to help the patient foster a more positive outlook toward life. The result increased patient self-respect and quality of life. The authors hope this case may provide a reference for treating similar clinical cases in the future.     

Nursing considerations in psychotropic medication-induced weight gain

PURPOSE/OBJECTIVES: The purpose of this clinical project is to emphasize the importance of prevention/treatment of psychotropic medication-induced weight gain. Professionals who work with patients taking psychotropic medications should provide a weight management program specifically designed to address the unique needs of the mentally ill patient. BACKGROUND/RATIONALE: Psychotropic medications used in the treatment of serious psychiatric disorders are associated with body weight gain. Medication-induced weight gain can lead to serious health issues and noncompliance with needed treatment. DESCRIPTION OF THE PROJECT: Current literature and discussion of possible mechanisms of pharmacologically induced weight gain are reviewed. Health issues related to weight gain are summarized. The nursing process is then used to assess, diagnose, plan, implement, and evaluate a program of weight management for pharmacologically treated psychiatric patients. OUTCOMES: Research findings demonstrate an increased rate of obesity in pharmacologically treated psychiatric patients. This phenomenon is probably multifactorial and leads to physical complications, psychological consequences, and noncompliance with treatment. Patients with mental health disorders can effectively control their weight if they are supported by a weight management program specifically designed to meet their needs. INTERPRETATION/CONCLUSIONS: Early intervention can prevent or minimize weight gain. Weight gain when it does occur can be reversed through a program of weight management. Nurses can utilize the nursing process to develop a weight management program that provides for the special needs of mentally ill clients. IMPLICATIONS FOR NURSING PRACTICE: Psychotropic medication-induced weight gain is an often neglected problem that is not readily addressed in the clinical setting. On the basis of the scope of the problem, nurses should view medication-induced weight gain as a priority. Nurses are in a unique position to design and implement an individualized weight management program through the collaborative and holistic strategies that the nursing process provides.     

Theorizing the knowledge that nurses use in the conduct of their work.

The authors propose a classification of knowledge that they call case, patient, and person and that reflects the content of the knowledge necessary to the conduct of nursing work. This classification represents an attempt to theorize from their respective empirical research data. Case knowledge is general knowledge of pathophysiology, disease processes, pharmacology, and other therapeutic protocols. Patient knowledge is that knowledge that defines the individual within the health care system, the knowledge expressed in the individual's response to therapeutics, and the knowledge that enables nurses to move the recipient of care through the health care system and along the illness trajectory. Person knowledge is knowledge of the individual as a subject with a personal biography who occupies a certain social space and who acts with his or her own desires and intentions for reasons that make sense to him or her. Two types of social knowledge serve as relational knowledge, or a bridge that links case knowledge to patient knowledge and patient knowledge to person knowledge. Each type of knowledge is accessed differently and the extent to which each is attained and used is determined by the circumstances of the patient's illness and his or her location in the health care system. The authors make a case for why this classification might be useful to the discipline.     

Does yoga therapy reduce blood pressure in patients with hypertension?: an integrative review

The aim of this article was to present a evidence-based integrative research review that validates yoga therapy as an effective complementary treatment in the management of high blood pressure (BP). The article also uses the theoretical framework of Dr Hans Selye's general adaptation syndrome. Yoga researchers demonstrate that yoga works because it modulates the physiological system of the body, specifically its effect on the heart rate. This review is significant because yoga presents an effective method of treating hypertension that is nonpharmacologic and therefore there are no adverse effects and there are other valuable health benefits. Research suggests that stress is a contributing factor to high BP; hence, the use of the general adaptation syndrome and the most important attribute of yoga, that is, it is a physical and mental exercise program, that is in sync with the philosophy of holistic nursing care where one treats the whole individual and not just the disease. The review was conducted with a search of computerized databases such as OVID, Academic Search Premier, CINAHL, MEDLINE, and Health Source: Nursing/Academic edition, PsychINFO, as well as reliable Web sites such as the cdc.gov, among others. An integrative review search was conducted, and 10 studies met the inclusion criteria. They include a combination of randomized controlled trials, quasi-experimental studies, and pilot studies. Yoga therapy is a multifunctional exercise modality with numerous benefits. Not only does yoga reduce high BP but it has also been demonstrated to effectively reduce blood glucose level, cholesterol level, and body weight, major problems affecting the American society. The completed integrative review provides guidelines for nursing implementation as a complementary treatment of high BP.     

基层医院护士岗位管理绩效考核的实践与成效

正在护士管理中,实现由身份管理向岗位管理的转变,是深化我国公立医院护士管理机制改革的重要举措[1]。2012年《关于实施医院护士岗位管理的指导意见》[2](以下简称指导意见)中明确提出,应在医院护士队伍中实施岗位管理。在此背景下,国内部分大型三级甲等医院已开展了对护士岗位管理的探索与实践,但基层医院岗位管理绩效考核体系的研究尚属起步阶段,鲜有相关报道。浙江省海宁市人民医院是一所三级乙等县级综合性医院,2012年2月与海军军医     

An Analysis of the Nursing Diagnosis Ineffective Management of Therapeutic Regimen Compared to Noncompliance and Orem's Self-Care Deficit Theory of Nursing

The authors compare the nursing diagnosis ineffective management of therapeutic regimen with that of noncompliance and with Orem's concept of self-care deficit. The article describes how the diagnosis of ineffective management of therapeutic regimen is more comprehensive than noncompliance. A question of patient autonomy is raised considering how the patient manages his or her therapeutic regimen. The major conclusion is that the nursing diagnosis of ineffective management of therapeutic regimen is based on continuous interaction between patient and nurse. The authors recommend that noncompliance be eliminated as a nursing diagnosis.     

Leadership in action: students learn with resource persons

The faculty maintain close contact with the resource persons and are aware of their interaction with students on a weekly basis. Faculty and resource persons exchange observations, assessments, suggestions and problems they have either anticipated or experienced. The resource persons report that as students gain from the experiences, so do they. In particular, resource persons state interactions with students have stimulated them to increase their own clinical inquiry. A head nurse, functioning as a resource person, recently told the members of the Nursing Curriculum Committee she wished she had had such a course seven years ago when she was a senior in the program (S. Collier, personal communication, October 1987). She further elaborated that the learning opportunities she sees students experiencing today would have been invaluable to her and her peers as they began their professional nursing careers. We, the authors, believe individual learning opportunities with nurse leaders as resource persons is a unique, invaluable experience for nursing leadership students. These interactions provide a variety of learning opportunities sufficient for undergraduate students to develop beginning leadership skills, while also narrowing the education-practice gap. These experiences enhance the students' orientation to "real-world" nursing leadership and management. Students recognize the uniqueness of this teaching-learning strategy and value the time spent with resource persons. They frequently report never dreaming "that such problems have to be dealt with." They agree that learning with resource persons provides an essential ingredient for reinforcing the theoretical concepts of nursing leadership and putting classroom lectures into action.     

Nursing experience using motivational interview techniques in caring for an obese patient with type 2 diabetes

Global prevalence and incidence of diabetes for all age groups are increasing. Research evidence reveals that lifestyle modification can both significantly improve glycemic control and delay complications. Obese patients suffering from type 2 Diabetes Mellitus in particular require food therapy and weight reduction through behavior modification in order to regain a healthy quality of life. This article used motivational interviews and the transtheoretical model to develop a behavioral change strategy to set health behavior as well as to assist the patient to attain weight reduction and glycemic control goals. Over the study period (April 30, 2009 to June 10, 2009), the patient's weight declined from 93.4kg to 90kg. Also, her blood sugar is gradually stable. Because of the effectiveness of behavior modification, the patient exhibited sustained motivation to continue maintaining diet control, which reflects motivation is an important component for behavior modification. The authors would like to share this case report to provide nursing professionals with a reference for using motivational interview techniques and transtheoretical model.     

Inpatient survey of nursing care measures for treatment of patients with anorexia nervosa

This study identifies and describes the inpatient nursing treatment and rationale for patients with anorexia nervosa in nationally recognized psychiatric inpatient settings. The study was undertaken to guide planned change in the nursing protocol on the authors' unit. Sixteen units were surveyed in an extensive telephone interview using structured interview guides. Findings indicated that behavioral management with contingency plans was the mainstay of treatment for the patients regardless of the identified unit treatment philosophy. This approach is effective for patient weight gain within an inpatient setting. Based on these data, the authors concluded that the program which was ongoing at their site was more restrictive than that in most other settings. Changes were made in the unit program to lessen the controls. Objective measures of weight and length of stay indicated that patients do as well with the revised plan as they did with the more controlled plan.     

On-site occupational health nursing services: estimating the net savings: Part II.

1. A primary management use of this quantitative assessment model is to estimate the overall net cost savings from operating an entire on-site occupational health nursing program. 2. Another management use of this model is to estimate the net cost savings contributed by individual occupational health nursing services included in the on-site program. 3. The exclusive focus of the model on the net cost savings arising from the direct substitution of on-site for off-site occupational health nursing services can be extended with the application of a break even analysis. 4. A sensitivity analysis can be applied to factors of the model to help overcome the effects of substantial uncertainty concerning their estimates.     

The benefits of hospital sponsored home care programs

Faced with increasing financial and government restraints, nursing administrators must search for effective ways to continue providing quality patient care. These authors believe that the relationships inherent within a hospital-sponsored home health care program benefit both the hospital and the home health care program as they try to meet patient and community needs.     

Managing by behavior and results--linking supervisory accountability to effective organizational control

Of all the components of the management process, control has received the least attention in nursing. These authors present a performance management program that provides nursing administrators with an effective control system, yet maximizes individual professional accountability.     

A nursing experience of cognitive therapy with a major depression patient

The increasing number of major depressive patients with negative thinking warrants that cognitive therapy be recommended to correct negative-automatic thinking and inculcate positive thinking as a way to face problems. The purpose of this paper was to describe the nursing experience and effectiveness of implementing individual cognitive therapy on a patient with major depression in an acute ward over a one-month period. Through observation, interviewing, and comprehensive nursing assessment, the patient's negative thinking toward herself and her problems was identified, and her thoughts of suicide emerged. The following three major health problems were identified: risk of suicide, disturbed sleep pattern and ineffective coping. The patient underwent homework training throughout the ten individual cognitive therapy sessions, and was expected to use positive thinking instead of automatic thinking. After the intervention, the patient's depressive mood, sleep quality, and coping ability were improved. In addition, the patient no longer talked of suicide and was able to show stable emotions, maintain a homework, and attend church activities on her own initiative after discharge. It is therefore, suggested that cognitive therapy can be an effective intervention for nurses planning to care for this group of people.     

Case study: a young male with auditory hallucinations in paranoid schizophrenia

PURPOSE. The purpose of this case study is to demonstrate use of the nursing process and the standardized nursing languages of NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a young male with paranoid schizophrenia to deal with auditory hallucinations. DATA SOURCES. Data were obtained from the experience and expertise of the author and published literature. DATA SYNTHESIS. This case study demonstrates nurses' clinical decision making in providing care for an adolescent with mental illness. CONCLUSION. This case study provides the pertinent nursing diagnosis, patient outcomes, and nursing interventions for a young male with auditory hallucinations in paranoid schizophrenia. IMPLICATIONS FOR NURSING. The use of NANDA‐I, NOC, and NIC can provide the necessary framework for enhancing and improving the management of care with patients who experience auditory hallucinations in paranoid schizophrenia.     

Weight Loss: A Patient and Physician’s Perspective

This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient’s experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.     

Behavior Modification: A Patient and Physician’s Perspective

This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient’s experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.