A Time to be Born

This vignette is a true story related by a nurse to a colleague. The setting is an obstetric unit of a modern hospital in New England. The situation is the birth of a genetically defective infant to a middle-aged couple, with a focus on the physicians'and nurses'responsibilities in informing the parents. In this story, the importance of the nurse's role in the decision-making process was acknowledged by both physicians and patients.     

Participation of informal caregivers in the hospital care of elderly patients and their evaluations of the care given: pilot study in three different hospitals

This action research is an ongoing study which will last from 1991 to 1993. The main purpose of the study is to increase the participation of informal caregivers in the hospital care of elderly patients without decreasing the quality of care. The data reported here are from a pilot study. This study had three aims: (a) to test reliability and validity of the measure used, (b) to investigate the current participation of informal caregivers in the hospital care of elderly patients (aged over 75), and (c) to evaluate and compare the quality of care from both the patients' and the informal caregivers' point of view in three different hospitals. The measure of quality of care was developed on the basis of need theories, mainly those of Maslow and Alderfer. Patients and caregivers were also asked to rate the participation of the caregivers in the hospital care of elderly patients. Participation consisted of 18 activities of daily living. The pilot test with 18 elderly hospital patients and seven family members or significant others showed differences between the two groups in perception of care received. Statistically significant differences (P < 0.001) were found in the following categories: mainly social needs, psychic and spiritual needs and totals. The results supported earlier findings that elderly patients are satisfied with and do not criticize their care. The younger generation (i.e. their children) is more demanding and has precise perceptions about the care given. Relatives could be used more in planning, evaluation and even implementation of care; however, their current participation in patient hospital care is minimal.     

Factors strengthening and weakening vaccination competence

The purpose of this study was to describe factors strengthening and weakening vaccination competence. The data were collected by focus group and individual interviews with 40 participants, consisting of health-care professionals, students and clients, and were then analysed by content analysis. The results could be classified into four categories: vaccinator professional conduct, education, client conduct and the vaccination environment. Successful client encounters, comprehensive knowledge of vaccinating, adequate education, clients' positive attitude, suitable physical environment and centralization of vaccinations were considered strengthening factors, whereas their opposites weakened vaccination competence. The two most important factors were vaccinator professional conduct and education, and therefore these factors should be considered the most in education, clinical practice and administration. Further research is necessary to determine how well current education, clinical practice and administration support factors strengthening, and help alleviate factors weakening vaccination competence.     

Clinical correlates of prolonged pain in Japanese patients with acute herpes zoster

To determine which risk factors are relevant to the occurrence of post-herpetic neuralgia in Japanese patients with acute herpes zoster, correlations between the prolongation of pain and various disease factors were examined in 263 adult patients presenting within 10 days of the onset of rash at 17 institutions in the Hyogo region of Japan. All patients in whom pain persisted for more than 3 months were over 60 years of age. The pain also tended to be more prolonged in those with clustered vesicles, disturbed sleep and hypanaesthesia. Other factors such as underlying disease states, critically involved regions, scar tissue, generalized rash and allodynia were not relevant to the duration of pain. Although decreased pain persistence was observed in patients in whom acyclovir therapy was initiated within 72 h of the onset of symptoms in comparison with those in whom it was initiated after this time, the difference between the two groups of patients was not statistically significant. Our results suggest that advanced age, the presence of clustered vesicles, and disturbed sleep and hypanaesthesia influence the prolongation of herpes zoster pain.     

Participation of caregivers in elderly-patient hospital care: informal caregiver approach

This preliminary study is part of an ongoing action research project in three different kinds of hospitals Two wards in each hospital volunteered for the study The purpose was to discover in which activities of daily living informal caregivers currently participate and to what extent Participation of informal caregivers consisted of 17 activities Elderly patients ( n = 45) eligible for the study and informal caregivers ( n = 147) completed a questionnaire They were asked in which daily activities informal caregivers participate and how often, options ranging from daily to never Responses of informal caregivers are reported in this paper Results indicated that relatives and other significant others visited elderly hospital patients often, however, their participation in activities of daily living in hospitals was limited Mostly they gave emotional support and helped the patient to drink, stand up/get into bed and sit Implications for nursing are discussed