Children and adolescents in outpatient chemotherapy: nursing implications

Hospitalization was common in the care to the child with cancer. However, a great focus is being given to dehospitalization, whose viability occurred through the outpatient clinic follow up, the outpatient clinic chemotherapy, the day-hospitals and/or home care. This paper aims at analyzing the difficulties that the families face at the home environment when their children or adolescents are submitted to the outpatient clinic chemotherapy. The study was developed at the chemotherapy room of the University of S?o Paulo Hospital at Ribeir?o Preto School of Medicine and the empirical data were collected through semi-structured interviews with the children's parents in January and February, 2000. Results showed the following difficulties: changes in family daily life, health team inefficient communication; self-image alteration and chemotherapy side effects. This work enabled access to information that is of real interest in the care to children and/or adolescents with cancer and their families. Based on empirical data, authors elaborated a booklet on home care.     

Weight loss in nursing home patients: prognostic implications

Weight loss is commonly used as a screening tool to assess quality of care and nutritional status in the nursing home setting. To evaluate the prognostic value of weight loss, the charts of 199 nursing home patients (414 nursing home patient years; mean age 87 years) were reviewed over a 3-year period. Weights recorded at nursing home admission and during the study period were compared with weights at the time of acute care hospitalization, transfer between levels of nursing home care, change in level of functional status, and death. There were no significant changes in weight before acute care hospitalizations, although patients who died lost an average of 10% of their body weight from the time of nursing home admission (P less than .001). In addition, weight loss was associated with decreased functional ability and transfer to a higher level of nursing home care. Despite the association of weight loss with subsequent morbidity and mortality, moderate weight loss of up to 20% was a poor predictor of mortality. Although weight loss is routinely used as a screening tool in the nursing home setting, it is not a sensitive marker for underlying disease. The efficacy of active intervention in nursing home patients who lose weight requires further study.     

Therapeutic use of nitric oxide: implications for nursing

Nitric oxide (NO) is a gas that transmits signals in the organism. Such signal transmission takes place by means of the gas synthesis and release in different cell types. After it is released, the gas penetrates the membrane of a neighboring cell and regulates its function. Such mechanism represents an entirely new signaling principle in biological systems. The discoverers of NO as a signaling molecule were awarded the Nobel Prize in Medicine and Physiology in 1998. This discovery has revolutionized medicine and originated new treatments for old problems. In this study, we review the role of NO in some pathologies such as sepsis, arterial hypertension and pulmonary hypertension and Nitric Oxide is explained in terms of its current merit for treatment and its impact on nursing care.     

Quality of care in teaching nursing homes: findings and implications

This article explores policy implications and selected methodological topics relating to long-term care (LTC) quality. We first discuss the Teaching Nursing Home Program (TNHP), in which quality of care in teaching nursing homes (TNHs) was found to be superior to the quality of care in comparison nursing homes (CNHs). A combination of outcome and process/structural measures was used to evaluate the effects of care and underlying reasons for superior TNH outcomes. Second, we explore policy and analytic ramifications. Conceptual, methodological, and applied issues in measuring and improving the quality of LTC are discussed in the context of TNH research and related research in home care.     

Patterns of medical and nursing staff communication in nursing homes: implications and insights from complexity science

Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization, and innovation in nursing homes. Two facilities participated in 6-month case studies using field observations, shadowing, and depth interviews. In one facility, the dominant pattern of communication was a vertical "chain of command" between care providers, characterized by thin connections and limited information exchange. This pattern limited cognitive diversity and innovation in clinical problem solving. The second facility used an open communication pattern between medical and frontline staff. The authors saw higher levels of information flow, cognitive diversity, innovation, and self-organization, although tempered by staff turnover. The patterns of communication between care providers in nursing facilities have an important impact on their ability to provide quality, innovative care.     

Caring, researching and teaching: meanings and implications of nursing practice

This article aims to discuss the problem of caring, researching and teaching in hospital nursing: general characteristics of Modern Nursing -- teaching and practice paradigm; characteristics of the Nightingale System. The research methodology was based on the analysis of fundamental care, research and teaching concepts in nursing practice, involving technical and gnoseological implications for pedagogical and research practice, which are illustrated through examples of hospital research. These entail repercussions for an epistemology of nursing. We highlight professional attitudes for the state of the art. The author evokes the need for disclosure, for efficient research methods and result reliability in (oncology?) nursing care, research and teaching activities. The conclusion points towards the relevance of nursing as a social practice and the problem of nursing activities in any area of care pragmatics -- whether in or outside the hospital context.     

Pay for performance in hospitals: implications for nurses and nursing care

As pay-for-performance programs gain momentum, hospital administrators and clinical leaders will need to consider the organization's infrastructure and measures that promote quality management initiatives. Many hospital performance measures by the Centers for Medicare & Medicaid Services involve chronic diseases that may be best managed by an interdisciplinary team-based approach, of which nurses are significant members. While the primary focus of pay-for-performance has been concentrated on physicians, comparatively less attention has been given to the potential impact on nurses and nursing care. Moreover, the impact of the pay-for-performance measures on nursing labor and processes has not been well studied. Within acute care settings, increasing attention has focused on the structure of nursing, such as number and skill mix of nursing personnel, processes of care, and influence on patient outcomes. As pay-for-performance standards evolve and encompass patient outcomes, attention to nursing's contribution will follow. Nursing leadership will need to address a number of strategies to (a) address the impact of pay-for-performance on nursing performance measures as well as (b) on staff nurses' ability to contribute to the organization's efforts in achieving pay-for-performance standards, including education, documentation, team collaboration, and patterns of care.     

Orotracheal aspiration in babies: implications in physiological parameters and nursing interventions

This study aimed to investigate the interventions performed by nurses in response to changes expressed by the babies in use of oxygenotherapy hospitalized at the neonatal intensive care unit during the implementation of the procedures aspiration of tracheal tube and upper airway. Quantitative study, conducted with 56 babies. The aspiration led to increased heart rate and pulse and decreased respiratory rate after the procedure, causing falls in oxygen saturation and extremes peaks in pulse during implementation. It was predominant the non-performance of specific intervention that had as objective the improvement of the parameters of the baby. It was concluded that the study was important for bringing benefits to identifying and interpreting the changes expressed by the babies.