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Claudia Gorecki Jane Nixon Donna L. Lamping Yasmene Alavi Julia M. Brown 《International journal of nursing studies》2014
Objectives
Pressure ulcers are a major health problem, affect patient psychological, physical and social functioning, and cause significant treatment burden. For comprehensive assessment of the benefits of an intervention, patient-reported evidence of the impact of an intervention on important patient outcomes should be made. We systematically reviewed the quality of life literature on chronic wounds to determine the suitability of generic and chronic wound-specific outcome measures for use in evaluating patient outcomes in pressure ulcer research.Design
A systematic review of the literature.Data sources
Searches of eight electronic databases from inception until May 2012 were undertaken.Review methods
Quality of life domains, item content and content relevance were determined for identified outcome measures. The content validity of identified measures was assessed against an empirically derived pressure ulcer-specific conceptual framework.Results
Three generic and 14 chronic wound measures were identified but no pressure ulcer-specific measures. None of the existing measures cover all quality of life domains important in pressure ulcers. One condition-specific measure, the Venous Leg Ulcer Measure, matched most closely conceptually, but failed to represent three important domains and contained items not specific to pressure ulcers.Conclusions
Currently, outcomes important in pressure ulcers are inadequately covered by generic and chronic wound-specific instruments despite similar conceptual models. Highlighted is the need for clear conceptualisation of content as well as determining appropriateness when selecting outcome measures in the future. 相似文献3.
K. Balzer L. Kremer A. Junghans R.J.G. Halfens T. Dassen J. Kottner 《International journal of nursing studies》2014
Background
Nurses’ clinical judgement plays a vital role in pressure ulcer risk assessment, but evidence is lacking which patient characteristics are important for nurses’ perception of patients’ risk exposure.Objectives
To explore which patient characteristics nurses employ when assessing pressure ulcer risk without use of a risk assessment scale.Design
Mixed methods design triangulating observational data from the control group of a quasi-experimental trial and data from semi-structured interviews with nurses.Setting
Two traumatological wards at a university hospital.Participants
Quantitative data: A consecutive sample of 106 patients matching the eligibility criteria (age ≥18 years, no pressure ulcers category ≥2 at admission and ≥5 days expected length of stay). Qualitative data: A purposive sample of 16 nurses.Methods
Quantitative data: Predictor variables for pressure ulcer risk were measured by study assistants at the bedside each second day. Concurrently, nurses documented their clinical judgement on patients’ pressure ulcer risk by means of a 4-step global judgement scale. Bivariate correlations between predictor variables and nurses’ risk estimates were established. Qualitative data: In interviews, nurses were asked to assess fictitious patients’ pressure ulcer risk and to justify their risk estimates. Patient characteristics perceived as relevant for nurses’ judements were thematically clustered. Triangulation: Firstly, predictors of nurses’ risk estimates identified in bivariate analysis were cross-mapped with interview findings. Secondly, three models to predict nurses’ risk estimates underwent multiple linear regression analysis.Results
Nurses consider multiple patient characteristics for pressure ulcer risk assessment, but regard some conditions more important than others. Triangulation showed that these are measures reflecting patients’ exposure to pressure or overall care dependency. Qualitative data furthermore indicate that nurses are likely to trade off risk-enhancing conditions against conditions perceived to be protective. Here, patients’ mental capabilities like willingness to engage in one owns care seem to be particularly important. Due to missing information on these variables in the quantitative data, they could not be incorporated into triangulation.Conclusions
Nurses’ clinical judgement draws on well-known aetiological factors, and tends to expand conditions covered by risk assessment scales. Patients’ care dependency and self-care abilities seem to be core concepts for nurses’ risk assessment. 相似文献4.
Purpose
The study explores how patients diagnosed with incurable oesophageal cancer experience living with the illness, and provides insight into and an understanding of the patients’ situation, reality and phenomena in their life world.Method
The method takes a phenomenological-hermeneutic approach, inspired by the French philosopher Paul Ricoeur’s narrative theory on mimesis as the structure and process of the method, and Ricoeur’s theory of interpretation for the analysis of patient stories. The stories materialise from narrative interviews, and the phenomena of the patients’ life world results in an analysis of these stories.Results
Through the analysis of the narrative interviews, phenomena of the patients’ life world appear which are described in themes such as debut of the illness, denial, the person’s own suspicion, existential turning point, despair, hope, the body, affirmation of irrevocable illness, acknowledgement of dying, life phenomena, relations and feeling of independence. The understanding of the patients’ experiences is augmented and improved through a discussion of the themes in a philosophical perspective, drawing upon theoretical and philosophical viewpoints of Kierkegaard, Løgstrup, Merleau-Ponty, Ricoeur, Benner & Wrubel, and on empirical research.Conclusions
Based on the phenomena in the ill person’s life world brought about by analysis, it seems that incurably ill oesophageal cancer patients find themselves in a complex life situation, in which they need more than an objective estimate and fulfilment of need from hospital service. Our study illustrates some perspectives on the life situation of the incurably ill, which will contribute to the improved development of supportive care in nursing. 相似文献5.
Jones JM McPherson CJ Zimmermann C Rodin G Le LW Cohen SR 《Journal of pain and symptom management》2011,42(3):354-365
Context
Proxy ratings, if valid, may provide an alternative approach to evaluating patient quality of life (QoL) at the end of life.Objectives
To examine agreement between terminally ill cancer patients’ self-reported QoL and proxy assessment of patient QoL by their family caregiver (FCG) and palliative care physicians (PCPs) at two time points.Methods
Patients admitted to an acute palliative care unit and their FCGs and PCPs completed the McGill Quality of Life Questionnaire (MQOL) at Days 3 and 6 after admission. Response bias and response precision were examined at the individual and group levels. Furthermore, we examined patient factors affecting agreement and responsiveness of proxy MQOL scores to changes in patients’ QoL between Days 3 and 6.Results
Statistically and clinically significant mean differences were detected between the patient and both proxy groups’ reports of QoL on Day 3, with the magnitude of the differences decreasing somewhat by Day 6. Proxies underestimated patients’ QoL compared with patients' self-report. Response precision based on intraclass correlation values and proportion of approximate agreement was poor to fair at both time points. Agreement was better for patients with greater physical burden and more cognitive difficulties. Proxies' responsiveness to change from Day 3 to Day 6 was low, and proxies were not able to detect minimally important changes in QoL.Conclusion
The findings suggest that moderate agreement between patient and proxy ratings of QoL develops over time but that precision at the individual level, which is more clinically relevant, is less reliable. New strategies for improving proxy reliability are needed. 相似文献6.
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Aim
To explore physiotherapists’ perceptions, views and experiences of ethnic diversity in relation to the physiotherapy profession.Design
Qualitative research study, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed verbatim and the data were analysed using thematic analysis. Several verification procedures were incorporated into the design to ensure quality.Setting
Venues chosen by the participants in North West England.Participants
A purposive sample of 22 physiotherapists (five students, seven clinicians and 10 academics) with a range of ethnicities.Findings
Most participants’ experiences and perceptions were of a lack of ethnic diversity within the profession. Further findings related to the impact of this included: the perception that physiotherapy is a White profession; some Black and Minority Ethnic (BME) physiotherapists felt ‘out of place’ on occasions; and failure to meet patients’ needs. The potential benefits of increased ethnic diversity and the possible risks of valuing BME staff solely in terms of their ethnicity were also illuminated by the findings.Conclusions
This study of the perceptions and experiences of physiotherapists identified a lack of ethnic diversity within the profession. It is argued that a lack of ethnic diversity may result in a failure to meet patients’ needs. A workforce that is reflective of the population it serves can have greater cultural knowledge, and is more likely to understand and respond to patients’ needs. 相似文献9.
Background
Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge.Methods
A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.Results
Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).Conclusion
Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.10.
Background
Pressure ulcers are common in acute and long-term care. However, critically ill patients usually have multiple risk factors for pressure ulcers.Objectives
The study was conducted to assess pressure ulcer incidence in intensive care patients, the factors related to pressure ulcer incidence and the course of pressure ulcers after the admission to an intensive care unit.Design
A longitudinal design.Setting
This study was carried out in cardiological and surgical intensive care of a general hospital and in a nephrological intensive care of a university hospital.Participants
All patients admitted to intensive care wards during the period from April until October 2006 were invited to take a part in the study. One hundred and twenty-one patients were involved in the study. The inclusion criteria were adult intensive care patients, males and females, all diagnosis were included. The exclusion criterion was patients whose age less than 18 years.Method
Each patient was assessed twice; first, upon admission and second upon discharge or death, or after 2 weeks if the patient was still in intensive care. The assessed data included pressure ulcer preventive measures, risk factors using Braden score, pressure ulcer characteristics and treatment. Additionally, incontinence supplies (urine/bowel) if used and the severity of illness using Acute Physiology and Chronic Health Evaluation (APACHE II score) were assessd.Results
This study revealed a total incidence of 3.3% (4.5% in nephrological patients and 2.9% in surgical patients). Sixteen patients with a total of 21 pressure ulcers were admitted to the intensive care units. During the patients’ stay at the intensive care units six pressure ulcers developed newly and five pressure ulcers healed. The mean of the APACHE II score of patients with new pressure ulcers (16.6) were higher than in patients without new pressure ulcers (11.5).Conclusion
Pressure ulcer incidence is low in this study compared to other studies. Pressure ulcers can be healed in intensive care patients. Using some preventive measures such as foam and alternating air pressure mattresses may help to decrease pressure ulcer development. Hydrocolloid dressing may help to increase the healing rate of pressure ulcers. 相似文献11.
Background
The study was performed to reveal the effect of an individualized personal outpatient therapy program, based on a multidisciplinary assessment, on pain and health-related quality of life in patients with chronic pain.Methods
Fifty patients were prospectively evaluated before and 3 months after establishment of an individualized outpatient therapy program. Health-related quality of life, pain and pain-related disability, depression and motivation to adopt self-management of chronic pain were assessed. Therapy adherence was tested with a structured interview.Results
Only marginal improvements were observed in terms of pain and health-related quality of life. Therapy adherence varied between the different therapies.Conclusions
An individualized personal outpatient therapy program has only marginal effects on pain and health-related quality of life in patients with chronic pain.12.
Annelies Wassenaar Jeroen Schouten Lisette Schoonhoven 《International journal of nursing studies》2014
Background
Feeling safe in the intensive care unit is of great importance while recovering from critical illness. Moreover, feeling unsafe can result in distress. In order to meet the safety needs of intensive care patients as well as to stimulate their recovery and prevent distress, nurses must be aware of factors promoting patients’ perception of feeling safe during an intensive care admission. To our knowledge, there is no synthesis of these factors available as yet.Objective
To systematically describe the factors that promote patients’ perception of feeling safe in an intensive care unit.Design
A systematic review of qualitative and quantitative studies.Data sources
PubMed, Embase, CINAHL, and PsycINFO were searched up to March 2012.Review methods
Methodological quality was assessed by two authors using the QualSyst tool. Data from the included studies were extracted into a customised data extraction form.Results
The initial search resulted in 1326 records. Ultimately, eleven studies were relevant to the research question and included in the review. No studies needed to be excluded because of low quality scores. Analysis of the factors in these studies resulted in four overarching themes that promote intensive care patients’ perception of feeling safe. These themes were: nursing care, patients’ issues, relatives, and technological support. Nursing care was described most frequently as an important factor promoting patients’ feeling of safety in an intensive care unit. Relatives were the link between intensive care patients and staff.Conclusions
Nurses can increase the perception of feeling safe in critically ill patients by taking into account the promoting factors described in this review. By being aware of these factors nurses can improve quality of care in their intensive care unit. 相似文献13.
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Background
Patients affected by acute coronary syndrome (ACS) report several symptoms subsequent to their discharge from hospital. These symptoms prolong their sick leave and complicate their return to the normal activities of everyday life. To improve health outcomes and establish quicker recovery for these patients, there is a need to better understand patients’ perceptions of their illness.Objective
To explore patients’ experiences of ACS during their hospital stay.Design
A qualitative interpretative interview study was conducted among patients during their hospitalization for ACS.Setting
The study was performed in two designated coronary care units at a hospital in Sweden.Participants
Twelve participants (five women and seven men; age range, 45–72 years), hospitalized with a diagnosis of ACS, were included in this study.Methods
Patient narratives were recorded and transcribed. The records were later analyzed using a phenomenological hermeneutic approach.Results
Patient experiences of ACS were formulated into one main theme: “awareness that life is lived forwards and understood backwards”. Two minor themes predominated in this main theme. The first was a sense of “struggling to manage the acute overwhelming phase”, which included four sub-themes: onset of life-threatening symptoms; fear and anxiety; being taken by surprise; and experiencing life as a hazardous adventure. The second theme was “striving to obtain a sense of inner security”, which also included four sub-themes: searching for and processing the cause and its explanation; maintaining a personal explanation; dealing with concern and uncertainty; and having a readiness to negotiate with life-pattern activities.Conclusions
Hospitalized patients affected by ACS consider the cause of the onset and prepare to optimize their future health. These patients construct personal models to explain their disease, which may persist throughout continuum of care. One way to improve health outcomes for patients with ACS is to establish a shared knowledge about the illness and formulate personal care plans that cover the hospital stay as well as possibly extending into primary care after discharge, based on the patients’ point of view. 相似文献18.
Carol L. Hodgson Michael Bailey Jonathan Barrett Rinaldo Bellomo Tracey Bucknall Belinda J. Gabbe Alisa M. Higgins Theodore J. Iwashyna Julian Hunt-Smith Lynne J. Murray Jennie Ponsford David Pilcher Meredith Young D. J. Cooper 《Intensive care medicine》2017,43(7):992-1001
Purpose
To use the World Health Organisation’s International Classification of Functioning to measure disability following critical illness using patient-reported outcomes.Methods
A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation’s Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU.Results
We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23), P = 0.001]; being separated or divorced [OR 2.87 (CI 1.35, 6.08), P = 0.006]; increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08), P = 0.03 per day]; and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70) P = 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (P < 0.002), and reduced health-related quality of life (P < 0.001).Conclusion
Disability measured using patient-reported outcomes was prevalent at 6 months after critical illness in survivors and was associated with reduced health-related quality of life. Predictors of moderate or severe disability included a prior history of anxiety or depression, separation or divorce and a longer duration of mechanical ventilation.Trial registration: NCT02225938.19.
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Josiane J.J. Boyne Hubertus J.M. Vrijhoef Anton P.M. Gorgels 《International journal of nursing studies》2011,48(1):94-99