Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital?

With 90% of people needing some inpatient hospital care in the final year of life, it is evident that the provision and awareness of palliative care, and education surrounding this, are widely needed. This study aims to evaluate a palliative care link nurse initiative (PCLN) in an NHS acute hospital, identifying key factors affecting link nurses' ability to influence palliative care practice. This qualitative study used semi-structured interviews and a focus group to show the anticipated and actual influence of link nurses on practice. Findings suggest that link nurses had increased knowledge and skills in palliative care due to education provided. Link nurses were seen to have an influence on the presence and quality of palliative care practice in hospital wards. Factors that could help link nurses to have greater influence are reported, as are difficulties in providing care and accessing training.     

Contemporary therapy: aromatherapy in the management of acute pain?

Recent surveys indicate that people are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being. Whilst complementary therapies such as aromatherapy have been utilised in clinical settings as diverse as long term care facilities and palliative care, its application to the acute care setting has not been explored in depth. The changes in contemporary health care practices such as post-operative pain management and length of hospital admissions have provided nurses with the challenge of examining the range of therapeutic interventions that can be applied to their practice. The purpose of this paper is to examine critically the potential uses of aromatherapy in the management of acute post-operative pain. The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects. Specific reference will be made to Lavender (Lavandula angustifolia) and its use in aromatherapy. A review of the literature points to gaps in the knowledge related to the clinical application of aromatherapy in relation to issues of dosage, methods of administration and therapeutic effects. The relatively small number of studies that have looked at aromatherapy in the acute care setting supports the literature reviewed. Issues such as small sample sizes and the difficulty in replicating these studies make it difficult to generalize the findings. In order to achieve best practice, further research is necessary to explore the use of aromatherapy in the management of acute post-operative pain.     

Administration of atropine in the setting of acute myocardial infarction: potentiation of the ischemic process?

Atropine has also been suggested to potentially worsen the ischemic situation in patients who are in the midst of acute coronary ischemia. We report the case of a female patient with ischemic chest pain and third degree atrioventricular block who developed acute myocardial infarction (AMI) immediately after atropine administration. The use of atropine in this instance remains a reasonable option and should be strongly considered-despite this apparent complication. Undoubtedly in some cases, acute ischemia is intensified by hypoperfusion attributable to vagally mediated bradyarrhythmia; atropine is the antidote for such situations. An awareness of this potential adverse reaction coupled with a prudent selection of candidates for atropine therapy will show the risk/benefit ratio in each individual patient and, therefore, guide the clinician.     

“If I can do it I will do it,if I can’t,I can’t”: a study of adaptive self-regulatory strategies following lower limb amputation

Abstract

Purpose: To explore the goal-related strategies employed by people following lower limb amputation using a framework based on the dual-process model of adaptive self-regulation. Methods: Semi-structured interviews were conducted with 30 individuals with a lower limb amputation. Results: Theoretical thematic analysis identified four broad assimilative/goal pursuit strategies; internal resource use, planning, technology use and help use. The most common strategies were maintaining a specific leisure activity (n?=?20), seeking instrumental help (n?=?15) and determination (n?=?15). Three broad categories of accommodative/goal adjustment strategies were also identified; interpersonal accommodation, managing limitations and meaning-making. The most common were accepting limitations (n?=?18), emotional support from friends and family (n?=?17) and adjusting goals to constraints (n?=?16). There was also evidence of strategies that combined the use of accommodative and assimilative strategies, and the use of avoidant strategies. Conclusions: The findings point towards key assimilative/goal pursuit and accommodative/goal adjustment strategies that may be adaptive following lower limb amputation. The study highlights the potential usefulness of the dual-process model in understanding how individuals adapt to functional disability, while bringing to light issues warranting further explication within this framework.

• Implications for Rehabilitation

• People adopt specific adaptive goal pursuit and goal adjustment strategies in response to goal disruptions following limb loss.

• Being aware of the processes involved in regulating goals in response to challenges is useful for understanding adjustment to limb loss.

• Greater understanding of adaptive and maladaptive goal strategies may help the rehabilitation team to foster positive outcomes in people with lower limb amputation.

     

Accessing residential care from an acute hospital: can we be more efficient?

Hospitalized patients who require admission to residential care are often thought to make prolonged and inappropriate use of hospital resources. There are no Australian data on the factors that contribute to length of hospital stay for such patients. The aim of this study was to determine the timing of critical steps in discharge planning for hospitalized patients who need residential care. We prospectively audited 100 consecutive referrals to an Aged Care Assessment Team (ACAT) from one acute hospital in South Australia. Case notes were examined to determine the timings of critical events in discharge planning. We found 47% of patients were discharged to a nursing home, 16% to a hostel, 11% died, 10% returned home and 16% went to another facility. The average length of hospital stay was 27.2 days, and an average of 8.4 days elapsed before a decision to seek residential care was first recorded. A further 4.5 days elapsed before ACAT referral, 4.6 days before ACAT approval and 9.7 days before a residential care bed became available. We conclude that people admitted to our hospital from the community and who subsequently need residential care, spend 36% of their stay awaiting a residential care bed. Most of their hospital stay has elapsed before residential care is considered necessary and referral and approval processes have been activated. Strategies to reduce length of stay should perhaps focus on the earlier recognition of the need for residential care and accelerated referral and assessment processes. Earlier involvement by social work and occupational therapy should be considered.     

Warfarin therapeutic monitoring: is 70% time in the therapeutic range the best we can do?

Heavier than air flying machines are impossible. Lord Kelvin, President, Royal Society of England, 1895 What is known and Objective: Warfarin, an oral anticoagulant, which has been in clinical use for over sixty years, remains a challenge for clinicians to utilize, given the multiplicity of items which can limit its efficacy. Our objective is to review the evidence and comment on whether INR control can be better than has been currently reported in various studies. Comment: The duration of time a patient’s international normalized ratio (INR) is maintained within the therapeutic range (time in the therapeutic range, TTR) for his or her particular indication for the drug impacts the effectiveness and safety of warfarin therapy. Maintaining a therapeutic INR while on warfarin is difficult, and numerous studies employing various strategies confirm the challenge, but not the impossibility of achieving a TTR above 70%. What is new and Conclusion: Maintaining a therapeutic INR requires a dedicated multi‐faceted approach. With diligence, skill and various therapeutic strategies, a TTR >70% can be achieved.     

Virtual navigation in colorectal cancer and melanoma: an exploration of patients’ views

Purpose

Individuals with cancer frequently report significant gaps in information, support, and health care service navigation at diagnosis and in the survivorship phase. A comprehensive web-based tool called the Oncology Interactive Navigator? (OIN) appears promising in addressing these gaps. The present qualitative inquiry explores the perceptions of individuals concerning the OIN?, as a complementary resource to support psychosocial adjustment to cancer and guide access to cancer care services.

Method

As part of a pilot multi-method multi-site study, 151 individuals newly diagnosed with colorectal cancer or melanoma were offered unrestricted access to the OIN? for 8 weeks. Qualitative interviews were undertaken with a subset of participants (n?=?20) to explore their experience with the tool. Interviews were digitally audio-recorded and transcribed verbatim.

Results

The OIN? was reported to be instrumental in fulfilling participants’ cancer information and supportive care needs, particularly early in the cancer trajectory. More specifically, the tool was seen as a “go to” resource to obtain more detailed information, validate information provided elsewhere, and pace exposure to cancer information. Content also was perceived to be of high quality, practical, and comprehensive. All participants underscored how the tool improved their cancer knowledge, facilitated communication, and prepared them for subsequent medical consultations.

Conclusion

Given the rapid proliferation of web-based tools of varying scope, quality, and relevance, the exploration of users’ perspectives is key to informing the development, refinement, implementation, and sustainability of promising web-based tools such as the OIN?.     

‘Student-y or studious’: An exploration of students’ perceptions of parallel learning in preregistration physiotherapy education

Background/Aim: Within the United Kingdom (UK), physiotherapy preregistration training is provided at both undergraduate and postgraduate level at 17 higher education institutions (HEIs). Some course teams approach this by teaching preregistration BSc and MSc students simultaneously to meet the same learning outcomes. This is often termed “parallel learning” and it is not known how students perceive this mode of learning. The aim of the study was to explore the perceived benefits and challenges to parallel learning of preregistration BSc and MSc physiotherapy students. Methods: Students from two different UK-based HEIs participated in an exploratory qualitative research design, with data collected in focus groups of each cohort and HEI. Data were analyzed using thematic analysis. Results: Several themes arose from student perceptions of parallel learning that were sceptical: “starting over again,” “misunderstanding each other’s motivations,” “establishing knowledge hierarchies,” and “competing for space”. However, some themes emerged from students reflections on the perceived benefits of parallel learning including “healthy competition” and “learning from difference.” Conclusions: It is clear from findings that students perceive the benefits of parallel learning of mixed groups. However, to avoid perceptions that it is merely cost cutting, learning resources need to be maintained and from the outset clear explanations of the purposes should be given to students.     

Thoughts on the management of myalgic encephalomyelitis: The problem of ‘?ME’

For the past few years an increasing number of patients have been presenting with ‘symptoms suggestive of myalgic encephalomyelitis’ (?ME). A very active and vociferous support group has been formed. Controversy about the nature of the illness has raged in the medical profession since the Royal Free disease outbreak in the 1950s.     

Palliative cancer patients in the acute hospital setting – Physiotherapists attitudes and beliefs towards this patient group

Abstract

Background

With advances in medical technology, increasing numbers of patients are ‘living with’ a terminal cancer diagnosis for longer periods; this coupled with changes in government policy is resulting in patients being treated closer to home rather than in specialist centres, bringing acute hospital physiotherapists into increasing contact with this patient group.

Aim

To describe the experience of acute hospital physiotherapists with palliative cancer patients.

Design

Semi-structured interviews analysed utilizing Colaizzi's method of analysis, reported using the COREQ guidelines.

Setting

Acute Hospital in the UK.

Participants

The first 12 physiotherapists who volunteered for the study who met the inclusion criteria.

Results

Two main themes were identified, attitudes and issues, with four sub-themes in attitudes (terminology, physiotherapists perceptions, other professionals perceived attitudes towards physiotherapists, and patients and families perceived attitudes towards physiotherapists'); there were six sub-themes in issues (communication, education, emotions, boundaries, referring onward from the acute setting, and time).

Conclusions and implications for practice

Some physiotherapists understand and apply their skills to improve the quality of life of palliative cancer patients. However, it is suggested that the majority of physiotherapists regard these patients as ‘dying from’ rather than ‘living with’ a terminal cancer diagnosis. Referral protocols and service pathways are lacking. There is an opportunity to improve how the profession promotes itself to other professionals, the public and physiotherapists of the future, to facilitate palliative cancer patients' access to rehabilitation when and where they need it, and to deliver services in line with government policy.     

Unmet supportive needs of cancer patients in an acute care hospital in Japan—a census study

Purpose

Little research has been done on supportive needs of cancer patients in acute hospitals in Japan. This study aims to comprehensively assess the unmet supportive needs of hospitalized cancer patients, as well as literacy and utilization of appropriate professional care.

Methods

All cancer patients (aged 20 to 80 years) who were hospitalized in a university hospital in Tokyo during the designated 3-day period between September 1 and October 31, 2007 were recruited for participation in the study. The M.D. Anderson Symptom Inventory, Brief Cancer-Related Worry Inventory, and Hospital Anxiety and Depression Scale were administered. Patients’ knowledge and use of relevant services were evaluated. The results were compared with those of non-cancer patients in the same treatment settings.

Results

A total of 125 cancer patients and 59 non-cancer patients were enrolled. Cancer patients and non-cancer patients equally suffered from physical symptoms (15–26% had severe appetite loss, 18–19% had severe dry mouth, and 16–22% had severe pain); however, psychological distress of cancer patients exceeded that of non-cancer patients (28.0% vs 8.5%; p?≤ 0.05). Severe psychological distress was associated with severe worry about future prospects or interpersonal and social issues and presence of two or more severe symptoms. Two thirds of the patients with severe psychological distress knew about the psychiatric division, but only one third actually sought treatment.

Conclusions

Needs related to psychological issues were more prevalent among cancer patients than among non-cancer patients, despite a similar level of physical distress. Special attention should be paid to cancer patients who worry over future prospects or interpersonal and social issues, and those who have two or more severe symptoms.     

Monitoring the corrected QT in the acute care setting: A comparison of the 12‑lead ECG and bedside monitor

Introduction

Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12?lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12?lead ECG to that reported by single brand of bedside monitor.