Neonatal hyperbilirubinemia

Evidence of bilirubin-related brain damage has been reported in infants with kernicterus discharged as healthy from well-baby nurseries. Lapses in care have been attributed as root causes for kernicterus in an era when there should be no barriers to safe and effective bilirubin reduction strategies. Between 1984 and 2002, at least 125 cases of kernicterus occurred in the United States. This may be an underestimate because kernicterus is not a reportable condition in this country. In almost all cases, kernicterus is a preventable condition. The updated 2004 American Academy of Pediatrics guidelines recommend a systems approach, which, if implemented by all birthing institutions, should prevent virtually all cases of kernicterus in term and near-term infants.     

Critical thinking and contemporary mental health care: Michel Foucault's “history of the present”

In order to be able to provide informed, effective and responsive mental health care and to do so in an evidence‐based, collaborative and recovery‐focused way with those who use mental health services, there is a recognition of the need for mental health professionals to possess sophisticated critical thinking capabilities. This article will therefore propose that such capabilities can be productively situated within the context of the work of the French philosopher Michel Foucault, one of the most challenging, innovative and influential thinkers of the 20th century. However, rather than focusing exclusively upon the content of Foucault's work, it will be suggested that it is possible to discern a general methodological approach across that work, a methodological approach that he refers to as “the history of the present.” In doing so, Foucault's history of the present can be understood as a productive, albeit provisional, framework in which to orientate the purpose and process of critical thinking for mental health professionals by emphasizing the need to both historicize and politicize the theoretical perspectives and therapeutic practices that characterize contemporary mental health care.     

Using the “big picture” to get what you want

Few basic nursing education programs provide the student nurse with courses in business and finance. Those skills were most often acquired by nurse managers when they were promoted from a staff position to a management position and they were acquired on the job. As the health care environment becomes more complex, so too does the scope of business and financial skills. Today's nurse manager must develop a wider range of skills to survive. Among the most important is an ability to connect unit level needs to the overall goals of the organization.     

“We are always asked; ‘where are you from?’”: Chilean women’s reflections in midlife about their health and influence of migration to Sweden

Scand J Caring Sci; 2010; 24; 445–453
“We are always asked; ‘where are you from?’”: Chilean women’s reflections in midlife about their health and influence of migration to Sweden Aim: This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences. Method: Three focus group discussions (FGDs) were performed with 21 middle‐aged Chilean women (40–60 years) who had lived in Stockholm for at least 15–20 years. In‐depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape‐recorded and transcribed data. Findings: Three main themes emerged from the data: (i) Chilean women’s reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. They also expressed confusion about the health care they had received in Sweden including conflicting and mistrusting relationship with some health care providers. Important for their way of coping with their own health seemed to be a recognition of their own space, level of independence, self‐acceptance and awareness of power relationships. Conclusion: The results illuminate the importance of awareness of influence of gender and socio‐cultural aspects, power relationships and communication skills among health care providers on women’s health. Complementary interventions to the biomedical paradigm are needed and should be addressed in Swedish health staff educational programmes as well as in clinical training.     

结核性脑膜炎患者的观察及护理

结核性脑膜炎是指患者出现以脑压升高，脑膜刺激征为主的一系列症状。初期有轻度头痛、嗜睡、羞明、表情淡漠等。中期为脑膜刺激期，患者脑压升高，出现剧烈头痛、角弓反张、喷射性呕吐。晚期为昏迷瘫痪期，患者可出现昏睡、失明、抽搐、大小便失禁等症状，危重时发生脑疝，如不及时处理，会危及患者生命。因此恰当的治疗护理对患者顺利恢复非常重要。笔者对我科收治的49例结核性脑膜炎患者的护理经验进行总结，现报道如下。     

“Used parts”: The rational approach to understanding organizational systems and structures

Nurses, especially advanced practice nurses, involved in different levels of the health care system will be exposed often to managerial and business issues. This sociological analogy can provide a concise explanation and exposure to the interdisciplinary world of organizational systems. The rational systems perspective, over all, adequately fits these two different organizations. Whether not-for-profit or for-profit, distinct goals and maximum efficiency are necessary for the success of each organization. The parallels are easily made and nicely fit. Who would have thought that “used parts” could be so very similar whether for-profit or nonprofit is involved? However, the rational system works whether it is for-profit or nonprofit. Thus, the overall importance of understanding different organizational systems is paramount.Some nurses are flexible enough to work in any organizational structure. Depending on beliefs and needs, a nurse will find an organizational structure that fits her long-range goals. There are many different kinds of organizational designs in health care, and the organizational model will depend on the services provided and the philosophy of the institution. Learning about organizational perspectives will provide a better understanding of relationships, patterns of communication, priorities, and how people work within organizations.It is likely that when a nurse understands these differences in organizational structure and systems, the choice of where to work will fit the individuals' value systems and work ethics, thus enhancing retention and individual satisfaction in the workplace.     

Valuing leadership: Transforming the “we/they” dichotomy in nursing organizations

It is an open secret in health care settings that clinicians do not value management. This attitude goes beyond the normal manager/subordinate tensions to a fundamental lack of trust and respect for leadership roles and performance. It manifests itself in everything from open adversarial relationships and power struggles to negative sotto voce remarks about “the suits” or “the high-heel brigade.”     

Bilirubin toxicity to human erythrocytes: a review

Neonatal jaundice, a physiologic condition reflecting the interplay between developmentally modulated changes in bilirubin production and metabolism, affects virtually all newborn infants. Usually, it is an entirely benign process that is resolved at the end of the first week of life without treatment or sequelae. However, in a small percentage of neonates, unconjugated hyperbilirubinemia can pose a neurotoxic risk especially in the presence of aggravating conditions such as a diminished albumin binding capacity and/or affinity, acidosis, displacing drugs and prematurity. Although neuronal cells are considered the main target for unconjugated bilirubin (UCB) toxicity, circulating cells are also affected during neonatal hyperbilirubinemia. Moreover, the UCB ability to cause hemolysis shall further aggravate neonatal jaundice through a vicious circle. In this review, we summarize the most relevant data obtained by our group regarding UCB toxicity and the role of some risk factors for kernicterus. In order to improve the risk assessment of neurotoxicity it is essential to understand the underlying mechanisms of UCB pathophysiology.     

“An Evil Heritage”: Interview Study of Pain and Autosomal Dominant Polycystic Kidney Disease

Pain is a common problem for patients with autosomal dominant polycystic kidney disease (ADPKD). Knowledge about patients' experience of the pain, pain management, and pain's effect on everyday life is, however, limited. In clinical practice there is a need to improve the care of these patients. To be able to do so, information about how the disease and its pain affect the patients is required. This study explores patients' experience of living with ADPKD and its pain. The findings are based on in-depth semistructured interviews. The participants were 22 patients with ADPKD. The data were transcribed and analyzed by using phenomenology. Findings showed that the patients experienced limitations in their everyday life due to inexplicable and unpredictable pain and fatigue. Also, pain management was experienced as suboptimal and pain was seldom discussed at health care appointments. Emotional distress concerning the hereditary nature of the disease was also present. Health care providers need to increase their focus on pain and pain management to reduce the disease's intrusion in patients' everyday life. Also, patients and people in the patients' immediate surroundings need to be given information and education about the disease and its pain as well as the opportunity to talk about their worries concerning heredity. By implementing the findings of the present study when meeting a patient with ADPKD, improved patient satisfaction and health-related quality of life could be accomplished.     

新生儿游泳对生长发育影响的探讨

目的探讨正常新生儿连续游泳后部分指标变化及临床意义。方法将400例正常新生儿按分娩序号随机分观察组(游泳组)200例和对照组(单纯沐浴组)200例,分别测量新生儿出生时及产后5d、42d的体重、身长、头围和胎粪转黄时间、黄疸指数的变化。结果两组新生儿出生时体重、身长、头围无明显差异,出生5d、42d时的体重身长、头围和胎粪转黄时间、黄疸指数,两组比较均有显著性差异。结论游泳有助于新生儿的生长发育、减少发生核黄疸的危险和降低新生儿病理性黄疸的发生率。     

Management of neonatal jaundice

Jaundice is the most commonly encountered neonatal clinical problem; 80 percent of neonates become clinically jaundiced, while 5 percent develop serum bilirubin levels above currently recommended treatment standards. This article outlines theories about the pathophysiology of neonatal jaundice and presents a logical approach to its management. First, the health care provider must distinguish between physiologic, exaggerated and pathologic jaundice. The treatment modalities of exchange transfusion, phototherapy and cessation of nursing are discussed.     

Baby massage ameliorates neonatal jaundice in full-term newborn infants

Neonatal jaundice is a common physiological problem affecting over half of all full term and most preterm infants. Thus, newborn infants must be monitored for signs of hyperbilirubinemia to prevent acute bilirubin encephalopathy or kernicterus. Evidence exists supporting the benefits of baby massage as a form of mild hand to skin contact, to increase neonatal physical and mental development. In the present study, the effects of gentle baby massage on neonatal jaundice in full term newborn infants were evaluated by a controlled clinical trial. The inclusion criteria of newborn neonates were as follows: (1) gestational age of 37-41 weeks, (2) birth weight of 2,800-3,600 g, (3) Apgar score at birth of 8-10, and (4) being a healthy neonate without neonatal asphyxia and hemolytic condition. Breastfed newborns without phototherapy were included: 20 in the massage group and 22 in the control group. We found the mean stool frequency of the massaged infants on day 1 and day 2 (4.6 and 4.3) was significantly higher than that of the control group (3.3 and 2.6) (p<0.05). The transcutaneous bilirubin levels on the second to fifth day and serum total bilirubin levels on fourth day were significantly decreased in the massage group, compared to the control group. In conclusion, baby massage at an early stage after birth could reduce neonatal bilirubin levels. We suggest baby massage is beneficial for ameliorating neonatal jaundice.     

Modern medicine and the one‐size‐fits‐all approach: A clinician's comment to Alexandra Pârvan's “Mind Electric” article

As a clinician, I can easily agree with the author that a person's own reality of being healthy is independent of physical evidence or clinical categories and that this perspective should be considered to improve clinical care. However, I cannot follow the assumptions about the nature and working of modern medicine and psychiatry as typically using “black box” and one‐size‐fits‐all treatments in daily practice. I outline several working contexts of doctors where this criticism does only marginally apply or not at all and wonder whether the author might wish, if possible at all from a philosophical viewpoint, to differentiate her concepts with regard to these different contexts. In addition, I think that ill health in the field of psychiatry might have to be dealt with differently than physical ill health.     

Refractory Migraine in a “Just World”

The “just world hypothesis” is the belief that a poor outcome to treatment always implies patient noncompliance. However, all disease states have a spectrum of severity, with the most severe end representing treatment failures despite compliant patients and excellent care. Some refractory headache patients represent this group of compliant patients, who had excellent care but who have bad disease.     

Female “tweens” and sexual development

Sexual development as a component of interpersonal relationships is essential to healthy personality development. Nurses, as health professionals who advise and counsel “tweens” (early adolescent females) in a variety of settings, have important roles to play in promoting their healthy sexual development. To date, empirical documentation has contributed to health professionals' ability to describe factors that influence early sexual debuts, but it has contributed minimally to their understanding of the processes of sexual development. The purposes of this article are (a) to generate thoughtful discussions about the sexual development of early adolescent females and (b) to discuss how societal constructions of female sexual development and identity create particular challenges for open communication about sexual expression.     

“Just see the person who is still a person (…) they still have feelings”: Qualitative description of the skills required to establish therapeutic alliance with patients with a diagnosis of dementia

Establishing a relationship is considered the foundation of providing person‐centred care (PCC) when working with a person who has a diagnosis of dementia. Currently, there is a lack of consensus about the how to develop this relationship. This aim of this study was to explore the key skills adopted by clinicians to establish an effective care relationship, referred to as therapeutic alliance, specific to working with patients who have dementia. Participants were clinicians (nursing and allied health professionals) from two older person’s mental health service teams (inpatient and community) who routinely provided clinical care to patients with a diagnosis of dementia. Participants self‐selected from a purposive sample to complete a semi‐structured interview about their provision of care to, and strategies used to engage with, people with a diagnosis of dementia. Exploratory qualitative thematic analysis was conducted using mixed inductive and deductive procedures. Five themes were identified as the interpersonal skills used to develop relationships with patients including the following: empathy, unconditional positive regard, congruence, psychological flexibility, and communication. Findings from this study provide direction for training of clinicians employed in a dementia setting and can also be generalized to other non‐specific clinical settings where clinicians may incidentally provide treatment to patients with a diagnosis of dementia.     

Terminology Matters: Patient Understanding of “Opioids” and “Narcotics”

Background: The terms “opioid” and “narcotic” are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding “narcotics” vs. “opioids.” Methods: A convenience sample of English‐speaking women (n = 188), aged 21–45 years, seeking care at a primary care clinic were asked (1) “What is an opioid/narcotic?” (2) “Give an example of an opioid/narcotic?” (3) “Why does someone take an opioid/narcotic?” and (4) “What happens when someone takes an opioid/narcotic for a long time?” Responses were recorded verbatim by a research assistant and then coded independently by two investigators. Results: More than half of respondents (55.9%) responded “don’t know” to all 4 opioid questions, while just 3.2% responded “don’t know” to all 4 narcotic questions (P < 0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two‐thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long‐term narcotic use (63.2%). Conclusions: While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.     

Issues in newborn care

During the provision of newborn care, the primary care provider must identify any apparent or potential health concerns, while at the same time dealing with the concerns of new mothers and other members of the now expanded family. Efficiently managing outpatient problems such as colic, dysfunctional sleep, skin disorders, neonatal jaundice, feeding problems, and newborn circumcision is the purpose of this article.