Nutrition support of the chronically critically ill patient

Providing nutrition and metabolic support to the CCI patient is based on the rational application of scientifically derived data and clinical experience with this unique population. Much of the data presented has been extrapolated from the critically ill ICU patients and the chronically ill hospitalized or nursing home patient, as there are limited data solely based on an experience with the CCI [table: see text] patient population. The key principles are: (1) primacy of protein provision and avoidance of overfeeding energy, (2) use of combined modality (enteral, parenteral, and oral) nutrition to meet needs as required, (3) use of adjunctive agents to promote nitrogen retention when needed, and (4) recognition of and adjustment for altered nutrient requirements (Table 3).     

Social dramatics: social skills development for the chronically mentally ill

The purpose of this study was to investigate the use of social dramatics as a clinical tool for teaching social skills to the chronically mentally ill on adult inpatient units of a state hospital. The research tested the hypothesis that patients exposed to social dramatics with videotape feedback would demonstrate greater ability to perform social skills as measured by the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). Fifteen schizophrenic adults of both sexes meeting specific criteria were randomly assigned to experimental and control groups. Subjects were exposed over an 8-week period to randomly introduced social dramatic scenarios. The Wilcoxin test for two independent samples was used for testing differences between experimental and control groups. The research findings supported the hypothesis for one positive factor, social competence. The findings did not support any treatment effect on either social interest and personal neatness or irritability, manifest psychosis, and psychotic depression. There were no significant differences on the total score NOSIE-30. Recommendations for psychiatric nursing are made. Limitations of research methodologies and sample size were addressed.     

Self-care and the chronically ill patient

The care of patients coping with chronic illness is a major priority and challenge to nursing. This is a result of the increased incidence of chronic illness and a recognition that effective care can significantly retard its progression and interference in the life of the patient. However, because most care in chronic illness is on an ambulatory basis, effective care is directly related to the extent to which patients practice self-care. As a result, the role of the nurse in working with chronically ill patients is less as a provider of treatment and more a facilitator of self-care by the patient. In addition, characteristics of chronic illness and treatment emphasize the complexity of factors and variables that impact on care. The model of self-care in chronic illness has been described to guide nurses in assessing the major issues that influence patients' participation in self-care. Regular assessment of patients' perceptions and circumstances relative to the variables identified by the model will guide nurses in promoting and supporting self-care by chronically ill patients.     

Comfort and the hospitalized chronically ill

1. Although comfort is a word nurses use in their daily practice to describe a nursing measure, an outcome, and a goal, there has been very little research to determine the meaning of comfort from the patient's perspective. 2. The institutionalized elderly in this study described their comfort according to five themes: disease process; self-esteem; positioning; approach and attitudes of staff; and hospital life. So, as well as the physical component of comfort, the elderly viewed their comfort equally in terms of their relationships with others, their environment, and their feelings. 3. In order to best meet the patient's needs for comfort, the nurse should clarify the meaning of comfort with the patient so that he/she may individualize care.     

A need for social support. The chronically mentally ill institutionalized elderly

Now that nursing homes are playing a major role in community care of psychiatric patients, they must be evaluated for the extent to which they offer and provide opportunities for social reintegration. Reality orientation and therapeutic milieu are the interventions used most often with elderly institutionalized chronically mentally ill patients. Attention that the elderly chronically mentally ill patients receive in reality orientation or in therapeutic milieu is probably more beneficial than the treatment itself.     

Take the challenge: strategies to improve support for parents of chronically ill children

Parents of children with chronic illnesses experience tremendous burden when caring for their children at home. There are many challenges that are present throughout the course of chronic illnesses. To provide better care to the family caring for an ill child at home, clinicians must understand the experiences family members go through on a daily basis. The purpose of this article is to help clinicians better understand these parental experiences; by increasing clinicians' awareness, strategies can then be used, which will improve the outcome for the child, parents, and siblings.     

Work adjustments among the chronically ill

Work(place) adjustments can help restore the work capacity of persons with a chronic disease. This study aims to quantify the presence of work adjustments among chronically ill workers in the Netherlands, and to investigate the extent to which the presence of work adjustments are related to the experience of work-interfering problems, disease characteristics or work characteristics. Data for this study are derived from the Dutch Panel of Patients with Chronic Diseases. The results discussed here relate to data collected in 1999 from a representative sample of 556 working people with various chronic somatic diseases. Of the work-interfering problems, the ones related to physical disabilities, concentration or memory deficits and transportation emerged as the most important factors related to the presence of either immaterial (i.e. not material) or material work adjustments. In addition, higher age and lower educational level were associated with a higher probability of immaterial adjustments; pain, attack frequency and physical demands of the job were important predictors of material work adjustments.     

Caring for the chronically critically ill

The multiple needs of the "chronically critically ill"--patients who require long stays in the ICU--present special nursing challenges. Here's an overview of the complications they may develop and how you can anticipate them.     

Coping strategies of the chronically ill

Coping with chronic illness is both a challenging and threatening process for patients. Health care professionals need to be aware of situations when a patient's usual strategies are no longer adequate for effective coping. At those times health care professionals are in a primary position to assist patients in managing their illness by discovering coping strategies not previously used, designing ways of controlling new stressors, and using resources not needed before. Coping strategies when effectively used are powerful methods for influencing functioning and well-being. Understanding the processes patients go through when confronted with chronic illness can make health care professionals better able to help patients manage their illness effectively.