共查询到20条相似文献，搜索用时 15 毫秒
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K. Innes-Walker C.N. Parker K.J. Finlayson M. Brooks L. Young N. Morley D. Maresco-Pennisi H.E. Edwards 《Collegian (Royal College of Nursing, Australia)》2019,26(1):62-68
Background
Wound management is frequently performed in the community and forms a large part of daily activities of General Practice health professionals. However, previous research has acknowledged a need for further education and training on evidence based wound management for these health professionals.Aim
The aim of this project was to develop and trial a Cooperative Wound Clinic model of care in General Practices, using a nurse led, interdisciplinary, holistic approach; including training and coaching to increase the wound management expertise and capacity of health professionals working in the primary healthcare environment.Methods
A longitudinal, pre-post design was used. Four Cooperative Wound Clinic pilot sites and nine wound clinics were established in General Practices across three Australian states with the intervention of the study being the model care and incorporating a local wound expert employed to provide the training and coaching. Pre and post survey data were collected on wound management practices, health professional confidence in evidence based wound management, patient health, wellbeing and healing outcomes. Longitudinal patient data were collected for 24 weeks.Findings
Results included an increase in the confidence of health professionals to manage wounds. Utilisation of a repetitive coaching model over a six month period empowered the decision making process and assessment knowledge for a variety of wound types. A positive impact on patient outcomes for a variety of wound types was also observed.Conclusion
The potential for expanding this model will bring many benefits including: empowerment of nurses’ confidence in managing wounds, promoting the role of nurse led clinics; improved wound related capability and confidence of health professionals; improved wound management, patient knowledge and better patient satisfaction and outcomes. 相似文献3.
Evdokia Kalaitzidis Ann Harrington 《Collegian (Royal College of Nursing, Australia)》2018,25(5):509-515
Background
Worldwide research confirms that older people value autonomy, want to remain independent and want control over their lives for as long as possible. Accordingly, the aged care system in Australia is undergoing major government-initiated reforms and is moving towards consumer directed care.Aim
To explore the views of residents and care staff of resident decision-making, choice and control in the residential aged care context.Methods
Residents from across four residential aged care facilities in Adelaide were interviewed and staff focus groups were held. A thematic analysis of the data was conducted.Findings
Residents valued opportunities for privacy, communal engagement, productivity, negotiation with staff, and for opportunities to engage with systems of governance. How staff prioritise resident decision-making is influenced by the carer’s judgement of the resident’s characteristics and of the organisation’s rules and polices.Discussion
Older people living in residential care are no longer living in their own home but instead are dealing with organisational rules and routines framed by others upon whom they are dependent.Conclusion
The day-to-day decision-making process for residents is likely to remain complex due to residents having to take into account rules, regulations and policies operationalized through organisational channels. 相似文献4.
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Mark K. Su Jessica Hetherington Lopez Aldo Crossa Robert S. Hoffman 《The American journal of emergency medicine》2018,36(11):1951-1956
Study objective
To assess the efficacy of 10 mg intramuscular (IM) methadone in patients with opioid withdrawal syndrome (OWS).Methods
This was a prospective observational, convenience sample of patients presenting to the ED with mild to moderate OWS. Evaluations included the Clinical Opiate Withdrawal Scale (COWS), Withdrawal Symptoms Scale (WSS), Altered Mental Status Scale (AMSS) and a physician assessment of the patient's WSS (MDWSS). After enrollment, 10 mg of IM methadone was administered and patients were reassessed at 30 min post-methadone administration. The primary outcome was the change in COWS at baseline and after methadone administration. Secondary outcomes were the differences between AMSS, and WSS post-methadone.Results
Fifty-seven patients had COWS scores recorded at baseline and 30 min. Fifty-six had mild to moderate OWS. The COWS improved a mean of 7.6 after methadone administration (P < 0.001). The improvement was greater among patients presenting with moderate versus mild withdrawal (mean decrease = ?9.1 vs. ?5.5, P < 0.001). Patients were more likely to self-score themselves as having withdrawal compared to MDs (93.6% vs. 76.6% respectively, P = 0.027). Of the 62 patients with baseline and follow-up WSS by self-assessments, 69% improved post-methadone administration. In addition, the AMSS score remained the same or improved among 86% of cases with measurements at baseline and follow-up.Conclusion
A single IM dose of 10 mg methadone in the ED reduces the severity of acute mild to moderate OWS by 30 min. Larger prospective, randomized controlled, and blinded studies would be needed to confirm these results. 相似文献6.
Miguel Glatstein Gary Carbell Dennis Scolnik Ayelet Rimon Christopher Hoyte 《The American journal of emergency medicine》2018,36(6):998-1002
Background
Black widow species (Latrodectus species) envenomation can produce a syndrome characterized by painful muscle rigidity and autonomic disturbances. Symptoms tend to be more severe in young children and adults. We describe black widow spider exposures and treatment in the pediatric age group, and investigate reasons for not using antivenom in severe cases.Methods
All black widow exposures reported to the Rocky Mountain Poison Center between January 1, 2012, and December 31, 2015, were reviewed. Demographic data were recorded. Patients were divided into 2 groups. Group 1: contact through families from their place of residence, public schools and/or cases where patients were not referred to healthcare facilities. Group 2: patient contact through healthcare facilities.Results
93 patients were included. Forty (43%) calls were in Group 1 and 53 (57%) in Group 2. Symptoms were evident in all victims; 43 (46.2%) were grade 1, 16 (17.2%) grade 2 and 34 (36.5%) grade 3, but only 14 patients (41.1%) of this group received antivenom. Antivenom use was associated with improvement of symptoms within minutes, and all treated patients were discharged within hours, without an analgesic requirement or any complications. Reasons for not receiving antivenom included: skin test positive (2/20), strong history of asthma or allergies (2/20), physician preference (2/20), non-availability of the antivenom at the health care facility (14/20).Conclusion
In our study, most symptomatic black widow envenomations were minor. Relatively few patients received antivenom, but antivenom use was associated with shorter symptom duration among moderate and major outcome groups. 相似文献7.
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Catherine M. Stephen Oshana S Hermiz Elizabeth J. Halcomb Susan McInnes Nicholas Zwar 《Collegian (Royal College of Nursing, Australia)》2018,25(1):33-38
Background
Hypertension is the most frequently seen condition in Australian general practice. Despite the availability of effective therapies, many hypertensive individuals struggle to maintain adequate blood pressure control and are at increased risk of cardiovascular disease and premature morbidity. As such there is an urgent need for research to identify evidence based strategies to improve hypertension management in general practice. General Practice Nurses (GPNs) are conceptually ideally placed to support consumers to receive best practice care and achieve behavioural change. However, their specific role in managing hypertension is unclear. The purpose of this paper is to evaluate the acceptability and feasibility of a GPN-led intervention to manage hypertension in Australian general practice.Methods
Individuals with uncontrolled hypertension were identified from electronic medical records. GPNs provided 4 face-to-face appointments and 2 telephone support calls to deliver the intervention. Qualitative evaluation of the interventions’ feasibility and acceptability was achieved through semi-structured interviews with 6 GPs, 7 GPNs and 12 consumers.Findings
Thematic analysis revealed 5 themes, namely; pre-intervention training, GP/GPN roles, time and workload, acceptability and feasibility. Most GPNs appreciated the pre-intervention training, however the need for additional motivational interviewing education was identified. Consumers were satisfied with the intervention valuing the GPN as a ‘coach’, although they valued ongoing GP input. Issues relating to lack of time and competing work priorities were identified as barriers to successfully delivering the intervention, however, the intervention was perceived to be feasible and acceptable in practice.Conclusion
Despite the demonstrated acceptability and feasibility of the intervention, the ongoing sustainability of the model rests largely upon overcoming the organisational, educational and professional barriers that constrain the GPN’s role. Findings demonstrate great potential for GPNs to significantly contribute to improved health outcomes and play a more active role in hypertension management. This role could be optimised with the development of motivational interviewing skills, enhanced GP/GPN collaborative practice and increased opportunity for consumer follow up. 相似文献10.
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D. Kılıç E. Göksu T. Kılıç C.S. Buyurgan 《The American journal of emergency medicine》2018,36(5):829-833
Objective
The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ED.Materials and methods
Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p = 0.83), mean compression depth (p = 0.61), good compressions (p = 0.31), the percentage of complete release (p = 0.07), adequate compression depth (p = 0.11) or the percentage of good rate (p = 51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p < 0.001). In the 2-minute group, the mean compression depth (p = 0.19), good compression (p = 0.92), the percentage of complete release (p = 0.28), adequate compression depth (p = 0.96), and the percentage of good rate (p = 0.09) were not statistically significant over time. In this group, the number of compressions (248 ± 31 vs 253 ± 33, p = 0.01) and mean compression rates (123 ± 15 vs 126 ± 17, p = 0.01) and flow time (p = 0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups.Conclusion
There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups. 相似文献13.
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Debra E Jackson Lisa A Durrant Marie Hutchinson Charlotte A Ballard Stephen Neville Kim Usher 《Collegian (Royal College of Nursing, Australia)》2018,25(4):409-414
Background
Pressure injury is a common problem. Its prevention and treatment is predominantly focussed on views, perceptions and knowledge of healthcare staff rather than on patient experience, particularly those patients living in their own homes.Aim
This paper reports findings on patients experiences and perceptions of loss associated with PI. These findings are drawn from a larger study of pressure injury patients living and receiving care in the community.Methods
Qualitative interviews with 12 participants with pressure injury and five carers. Data was audio recorded and thematically analysed. The study is reported in accordance with the COREQ guidelines.Findings
Having a pressure injury negatively affected many aspects of life for our participants resulting in multiple losses. These losses included loss of mobility and independence, privacy and dignity, and social engagement and ability to engage in preferred activities.Discussion
Although the effects of a pressure injury may be similar for many people, the most important issues will differ from person-to-person thus treatment and prevention of pressure injury requires a multidisciplinary team having a holistic care approach. Some patients’ pressure injury will never heal and it is increasingly important to involve the patient to find out what matters most to them and how their wound is impacting on them, to jointly develop a holistic, person-centred plan.Conclusion
Policy and practice should recognise and reflect that patients living with a pressure injury at home have different challenges and needs to those in acute or long term care. Pragmatic solutions in the delivery of pressure injury care are needed to compliment the drive to move healthcare from the hospital-to-home. 相似文献17.
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