Preventing lawsuits by noting and acting on key aspects in a patient's condition

Nurses are often concerned about committing a wrong action that will result in a lawsuit. In reality, it is often omissions, failing to consistently and thoroughly perform the basic acts of nursing, that result in lawsuits. These include timely adequate assessments, following up on test or treatment results, and persistently notifying someone (up the chain of command, as necessary) when there is a significant abnormality. Red flags for concern include more severe pain than expected for the patient's condition, a sudden change in mental status, and a deteriorating trend. Institutional policies for standardized communication techniques and rapid response back-up assistance can be beneficial.     

我国骨肿瘤的研究进展及护理

回顾分析我国骨肿瘤的研究现状及相应的护理,提出:对恶性骨肿瘤,只要具备重建条件,应争取保肢并综合治疗,并进行全身心的护理。     

Psychiatric diagnosis: some implications for mental health nursing care

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.     

Malnutrition and pressure ulcers: nutritional assessment tools

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.     

Psychiatric diagnosis: some implications for mental health nursing care

This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.     

Perceiving risk in dangerous situations: risks of violence among mental health inpatients

BACKGROUND: Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day-to-day clinical practice. AIM: The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments. METHOD: Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in-depth literature search was also undertaken. FINDINGS: It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses 'tune in' to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team. CONCLUSION: The study indicates that the development of nurse-patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse-patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of 'working in a team' is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.     

The mental status examination

The mental status examination is a diagnostic procedure used to detect changes in or abnormalities of orientation, intellectual function (such as language, memory and calculation), thought content, judgment, and mood or affect in patients with medical, neurologic or psychiatric conditions that may affect brain function. The mental status examination can also be used to localize lesions in the brain. Much of the information needed for a mental status assessment can be obtained during a routine history. The elements of the examination depend on a patient's clinical presentation and cultural and educational background.     

The rehabilitation of children with anti-N-methyl-D-aspartate-receptor encephalitis: a case series

Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a serious, complex, and potentially fatal disease in children. Children with this condition frequently present with altered mental status, rapid functional deterioration, and seizures. Despite aggressive treatment with immune therapy such as corticosteroids, intravenous immunoglobin, and plasmapheresis, children often need extensive rehabilitative services and can be left with lasting deficits. In this case series, we report on six known consecutive pediatric cases of N-methyl-D-aspartate-receptor antibody encephalitis in Northern California requiring comprehensive inpatient rehabilitation. The children presented with a variety of symptoms and had waxing and waning clinical courses. All children progressed well through their rehabilitation programs but were discharged home with persistent functional deficits. At follow-up, all but one child had lasting deficits. Because of the complicated management and extensive rehabilitation needs of children with anti-N-methyl-D-aspartate-receptor encephalitis, physiatrists and other rehabilitation providers should be knowledgeable about this complex condition.     

Issues of non-compliance in mental health

This paper explores and questions the ideas and notions in respect of non-compliant behaviours. Traditionally, research into this area has focused on identifying individual characteristics from within the adult branch of nursing and within the confines of the medical model of compliance. Little research has investigated the phenomena of non-compliance within the specialty of mental health. It may be suggested that identifying characteristics in this setting is futile. There are many factors determining a client's compliance behaviours. These include gender, social class, race and socio-economic status. Those suffering from mental ill health are often the most vulnerable in society and it may be argued that as such are often coerced into accepting treatment with those who refuse frequently being labelled as non-conformist. The ability of the client to refuse treatment should be based upon informed consent, but is often dependent upon the social prejudice of the health care professional, their misuse of power to bring about compliance behaviours and their inability to act as an effective advocate. Finally, by eliciting information, shared negotiation, planning and improved communication health professionals may improve compliance behaviours based upon the client's needs and wishes.     

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.     

护理干预对脑栓塞后抑郁病人神经功能康复的影响

目的探讨护理干预对脑栓塞后抑郁病人神经功能恢复的影响效果。方法将80例脑栓塞后抑郁病人随机分为观察组40例和对照组40例。观察组采用认知、心理、行为干预等护理措施;对照组应用常规护理方法。应用汉密顿抑郁量表(HAMD)、神经功能缺损评分标准(NFA)、日常生活能力(ADL)和运动功能测定(FMA)量表,分别对两组病人进行疗效评价。结果干预前后两组病人各项测评指标比较,经统计学分析,P<0.05和P<0.01,差异有统计学意义。结论护理干预对脑栓塞后抑郁病人神经功能恢复有促进作用。     

Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing

BackgroundConducting mental status examination and suicide risk assessment is an important skill required of nurses when they are in the clinical setting. With nursing students often expressing the anxiety and lack of confidence in doing so, the use of standardized patients provide an excellent opportunity to practice and become proficient with this skill in a simulated environment.ObjectivesTo explore the learning experience of undergraduate nursing students using standardized patients while practising their mental status examination and suicide risk assessment skills in mental health nursing module.DesignA pre- and post-test, single group quasi experimental design was used in this study. A standard didactic tutorial session and a standardized patient session was conducted to evaluate the learning experience of undergraduate nursing students learning mental status examination and suicide risk assessment. Outcome measures for this study include Student Satisfaction and Self-Confidence in learning scale.Qualitative comments in the form of open-ended questions were also collected in this study.SettingsA University offering nursing program from undergraduate to postgraduate level.ParticipantsA convenience sample of Year 2 undergraduate nursing students undertaking the mental health nursing module was included in this study.ResultsThe use of standardized patient session had significantly increased students' satisfaction and confidence level before they are posted to a mental health setting for their clinical attachment. There was a significant difference on students' self-confidence level for those who have taken care of a patient with mental illness after adjusting for pre-test on score in learning. Qualitative feedback obtained from students showed a positive outlook towards the use of standardized patient as an effective tool in augmenting didactic learning into practical skills.ConclusionsUsing standardized patient in mental health nursing education enhanced the integration of didactic content into clinical setting allowing students to practice their assessment skills learned in classroom and transfer it to the clinical area. The benefits of using standardized patient include allowing students to practice their communication skills and improving their confidence level in conducting mental status examination and suicide risk assessment by reducing anxiety as compared with traditional classroom and textbook-based pedagogy.     

Roses by other names? Empathy,sympathy, and compassion in mental health nursing

Empathy and related concepts such as sympathy and compassion are considered fundamental to mental health nurses’ work with consumers. However, there is often little consensus on the relationship between these interpersonal interaction factors and their similarities and differences. In this paper, these three concepts are discussed. Theoretical frameworks of empathy, sympathy, and compassion are presented with a social psychological model of empathy focused upon. From this, discussion is undertaken of how the mental health nursing process may be explained by such frameworks, as well as what unique aspects of the nursing relationship need to be considered. It is contended that precise definitions and understandings of empathy, sympathy, and compassion are vital, and the use of models allows researchers to consider where gaps are in current knowledge, and to identify what might be important to consider from a nurse education perspective.     

冠心病介入治疗的心理特征及护理干预

目的探讨护理干预对冠心病介入治疗过程中心理问题的影响.方法对80例冠心病介入治疗患者进行心理问卷调查,分析其心理特征,并针对不同的心理行为予以护理干预.结果干预后患者的心理问题发生率较干预前显著下降(P＜0.01).结论在冠心病介入治疗过程中实行相应的护理干预,能有效地改善患者的心理状态,减少不良反应的发生.     

Oral measurement of temperature in orally intubated critical care patients: state-of-the-science review.

Many nurses are hesitant to use the oral site to measure body temperature when patients are orally intubated with an endotracheal tube. It is often thought that the temperature of the gases flowing through the tube and the patient's inability to form a tight seal around the tube may result in an inaccurate measurement that does not reflect body temperature. Consequently, other sites such as the rectum are used, resulting in embarrassment and increased stress for patients, increased use of resources, and inappropriate use of nursing time. An integrated review and synthesis of research on the validity of using the posterior sublingual site to measure temperature in critically ill patients intubated with an oral endotracheal tube were done to determine if a change in nursing practice is indicated for these patients. Of 10 studies that address this topic, 5 specifically investigated this nursing area. The results indicate that for critically ill patients with stable hemodynamic status, the posterior sublingual pocket is a valid site for measurement of body temperature in patients who are orally intubated with an endotracheal tube.     

Complications of the myeloproliferative system: Infection and sepsis

Living with cancer has become a more realistic hope for many patients as a result of newer combination-treatment modalities. However, impairment of the immune and inflammatory responses is a serious consequence of both aggressive disease and treatment.

Comprehensive nursing care during periods of granulocytopenia is critical to the survival of myelosuppressed patients. The primary nursing goals for these patients include (1) prevention of infection through promotion of the patient's optimal health status and reduction of environmental factors contributing to infection; and (2) early detection of infection through diligent assessment of the patient's health status, with prompt initiation of medical and nursing interventions.

Sepsis in the compromised cancer patient poses a major challenge in oncology nursing care. The importance of thorough nursing assessment and interventions to minimize exposure of the patient to potential pathogens during granulocytopenic periods cannot be overstated. The patient's life may well depend on it.     

A system for delivering care.

Despite partners and relatives providing care prior to a hospital admission, all too often they are not involved or informed about the treatment process during a patient's stay in hospital. The primary nurse system is an effective way of delivering care within the mental health framework. The primary nurse is responsible and accountable for the patient throughout his/her stay in hospital. Peplau's model of nursing care concentrates on the development of the nurse-patient relationship. Care plans should be negotiated with the patient. Care plan meetings are useful for discussing problems, receiving feedback and for supporting colleagues. Family meetings are essential so that the main carer's continuing involvement in care can be acknowledged.     

慢性前列腺炎患者心理分析与护理对策

目的 探讨慢性前列腺炎患者的心理状态及护理对策.方法 护理干预前及干预后3个月采用SCL-90量表对86例慢性前列腺炎患者对进行问卷调查分析.结果 护理干预后患者的躯体化、强迫、抑郁、焦虑、恐惧、精神病性和阳性项目均与护理干预前有显著性改善(P＜0.05或P＜0.01).结论 心理护理干预对慢性前列腺炎患者的康复有促进作用.