When touch is not the best approach

• ? Health care professionals have long believed in the value of nonverbal components of communication and the highly significant roles such factors as distance, space, and touch can play in therapeutic relationships.
• ? The value of touch is not appreciated by all health care professionals or considered appropriate or desirable by some patients.
• ? While touch has been described as the most important of all the senses, the astute professional must be cognizant of the times when touch should not be used.

     

Spinal stenosis. When arthritis is more than arthritis!

Spinal stenosis is the result of disc degeneration and narrowing accompanied by facet joint changes culminating in nerve root entrapment. Symptoms of back and leg pain appear gradually usually over a period of years and slowly worsen. Patients are usually in their 50s or older. Most patients are treated initially with nonoperative measures concentrating on pain relief and maintenance of activity. If the symptoms worsen, surgical intervention to relieve pain by decompressing the affected nerve roots is appropriate. Some patients with instability require a fusion. Most patients are satisfied with the results of surgery in relieving preoperative leg pain. Pain relief is often dramatic, allowing most patients to return to normal activity. Elderly patients tolerate this procedure surprisingly well. Old age alone should not be a contra-indication for this surgery. Therefore, the elderly should not be denied the benefits of surgical decompression. Nursing interventions can help these patients learn about spinal stenosis and assist them in pursuing appropriate treatment resulting in improved quality of living.     

When CPR is not an option

What is to be learned from this situation? First, although Mr. Lockwood's consent for the DNR order is not needed, there is an obligation to communicate openly and clearly with the family and ensure that Mrs. Lockwood's advance directive is respected. This might mean a DNR order needs to be written. Also, there is an obligation to discuss goals of care with the family. The second lesson is that you should reflect on your employer's CPR policies and practice, and ask the following questions: Do the policy and/or practices support saying "no" in a situation such as Mrs. Lockwood's? Also, how does the policy support staff when there is a request for futile CPR, either from a competent patient or from a patient's family? What are the expectations about communication with the family when there is an advance directive and/or when CPR is found to be futile? Knowing what you ought to do for patients is not sufficient. Often you cannot act on these decisions because of the environment. If the policies are not in accord with the CNA Statement on Resuscitative Interventions, you should collaborate with colleagues to revise the CPR policy and practices. By doing so, you will be meeting your obligation to help foster and support a practice environment that promotes ethical, competent and compassionate nursing care.     

硒酸酯多糖联合治疗类风湿性关节炎的疼痛症状

目的观察硒酸酯多糖联合类风湿性关节炎(RA)的疗效。方法56例RA患者随机分成两组,治疗组加服硒酸酯多糖胶囊。观察两组的检测指标变化。结果经6周治疗两组患者晨僵时间、关节肿胀指数、关节压痛指数、血沉较治疗前均有显著改善(P<0.05或P<0.01),总有效率治疗组高于对照组(P<0.05),尤其是关节压痛指数治疗前后的差值治疗组高于对照组(P<0.05)。结论硒酸酯多糖是改善RA疼痛症状疗效好、毒副反应轻的协同性治疗药物。     

When a hospice is not a haven

Abstract

There has been little research conducted with terminally ill patients in the UK to date. This case study describes statements made by a palliative care patient during a face-to-face interview while he was being treated in a hospice. His comments illustrate his unhappiness within the hospice environment to an extent that could compromise his holistic management in this setting. We would suggest that the important aspects of patient care include not just the major palliation issues of symptom control and good communications, but also attention to the rituals of daily living of individuals pertaining to the environment. The atmosphere of the hospice, as experienced by patients through their interactions with staff members within the care setting, is seen to be a significant factor for good holistic care. Hospices may need to be more aware of the impact that every member of staff, both clinical and non-clinical, can make at each patient contact. Becoming more alert to the likes and dislikes of each patient as regards the substance of these contacts may allow hospices to avoid institutionalized care practices and instead to individualize the care they offer to a greater number of their patients.     

Falling short: When testing is mandated and follow-up is not

In 1999, the Texas Legislature mandated acanthosis nigricans (AN) screening in primary schools in designated regions of the state through the passage of House Bill 1860 to identify children at risk for diabetes by identifying the skin condition AN. AN is related to insulin resistance, and, thus, is associated with type 2 diabetes (diabetes mellitus type 2 [DMT2]), a growing concern among school-aged children. Since 1999, millions of children have been screened and hundreds of thousands have been screened positive. No data are available about the effectiveness of the program in identifying DMT2 among the school-aged population because no follow-up is mandated. The current practice is to send a letter to the parents of the child who screens positive, advising the parents to take the child to a health care provider for further assessment. Hence, children within the state may have diabetes or are developing diabetes but have yet to be diagnosed. In light of the presence of a law mandating AN screening, mandating a follow-up to identify those who have diabetes or are developing the condition of diabetes can provide early intervention and decrease costs of care. It is not known why the follow-up of those who screen positive was not included in the initial legislation. It may have been due to the cost of the necessary blood tests that are used to assess an individual for diabetes. Related to this is the reality that blood tests are invasive procedures, whereas screening for a skin disorder is not, thereby possibly explaining the omission of mandated follow-up from the legislation .     

When to recognize that breastfeeding is not an option

All members of the symposium panel agree that the best feeding option is exclusive breastfeeding. The benefits of breastfeeding are numerous, and the practice is advantageous to both mother and child. Yet, there are times when breastfeeding is not possible. As health care professionals, we need to realize when it is necessary to discuss feeding alternatives. We must make a point not to judge our patients in order to successfully educate parents about proper infant nutrition practices.     

Using lipid-lowering agents effectively. When diet is not enough

Lipid-lowering agents can be used safely and effectively if the physician understands the nature of the patient's disorder and the mechanism of action of the various drugs. The benefits of altering lipid levels are manifested over years, not months. Without a long-term plan for periodic follow-up and intervention, short-term gains will accomplish very little.