Physiology of wound healing

Despite the emphasis placed on skin care, hospitalized infants often experience injury to their skin. Although skin injuries vary, they have a common innate mechanism for repair and healing. Wound healing is a physiologic process that involves a series of sequential yet overlapping stages. The first stage, hemostasis, occurs immediately at the time of injury. During hemostasis, a provisional matrix seals the injury site and initiates the process of wound healing. The second stage, inflammation, is triggered by a variety of mediators released from injured tissue cells and capillaries, activated platelets and their cytokines, and the by-products of hemostasis. During the third stage, the wound surface is covered with new skin and vascular and structural integrity are restored as granulation tissue fills the defect. The final stage, remodeling, is responsible for maturation of the granulation tissue into mature connective tissue and/or scar. A thorough understanding of wound healing physiology is an important prerequisite to providing care that optimizes wound healing and prevents unnecessary complications. Many of the current wound care practices are based on tradition rather than scientific knowledge. As the interface between the infant and the environment, nurses are in an ideal position to evaluate the soundness of these wound care practices. Physiologic-based care strategies to enhance wound healing are proposed. Copyright © 2001 by W.B. Saunders Company     

Postpartal Nursing Diagnosis

The responsibility of nurses for postpartal patients has changed greatly in the past few years. No longer is it adequate to assess and manage only those physical problems that occur during the hospital stay. Today, potential psychosocial problems and consequences of parental knowledge deficit are part of nursing's domain of diagnosis and management. A review of the purpose of nursing diagnosis is important. Clarifying the difference between medical diagnosis and nursing diagnosis is also essential if one is to be comfortable with the process. Careful scrutiny of the unique needs of new parents will form the basis for formulating meaningful postpartal nursing diagnosis.     

The nurse expert witness

An emerging role for nurses is that of expert witness for medical liability cases that involve nursing care. Medical liability cases require that the trier of evidence (judge or jury) have an understanding of the facts and the relevant standards of the case for equitable resolution. The attorney, judge, or jury member may not possess the information necessary to understand the issues. Someone with the requisite knowledge and skills to review the information, interpret facts, offer an opinion about whether or not the standard of care was met, and explain this to the appropriate people is crucial for the legal system to work. If nursing care is at issue, that expert is a nurse with the appropriate knowledge, experience, and education. This report explores the role, qualifications, and expectations for nurses who serve as expert witnesses. Personal insights from the authors will provide practical information for nurses who are interested in the role. Copyright © 2001 by W.B. Saunders Company     

The Effect of Promoting Intrauterine Attachment in Primiparas on Postdelivery Attachment

Twenty-two women participated in a modified replicate study which examined the effects of prenatal maternal attachment behaviors during first pregnancies. A pretest reflected the degree of maternal-fetal attachment behaviors and attitudes already formed. The women in the experimental group received three interventions aimed at directing the mothers' attentions toward their fetuses. The remaining women received routine prenatal care only. All mothers were observed once in the first few days postpartum to assess maternal attachment behaviors. Data analysis did not substantiate the findings of the earlier study. Factors identified in the added pretest may have accounted for this difference.     

Effect of cerumen removal on the hearing ability of geriatric patients

The purposes of this study were to estimate the prevalence of impacted cerumen in a population of hospitalized elderly patients, and to evaluate the effect of cerumen removal in reversing hearing impairment. The design was a pre-test/post-test static-group comparison. Over a 1-year period, a random sample (n = 226) was drawn every third day from daily admission lists of English-speaking patients aged 65 or older, admitted to non-intensive care units of one hospital. On either the second or third day of hospital stay, subjects were given a hearing test using an AudioScope and then their ear canals were examined for impacted cerumen. Ear canal irrigations were performed on those subjects with impacted cerumen. All subjects received a second hearing test. Results indicate that impacted cerumen is a common condition in the hospitalized elderly. Thirty-five per cent of the sample had impacted cerumen, 19.9% bilaterally and 15.0% unilaterally. Furthermore, removal of cerumen significantly improved hearing ability. Improved hearing scores were obtained in 75.0% of the ears after the impacted cerumen was removed, with subjects hearing from one to three more tones per ear on the second hearing test. An analysis of variance for repeated measures on hearing was computed to test for the effect of removing cerumen from individuals who had neither, one or both ears occluded. A significant interaction (F = 146.83, d.f. = 2/223, P less than 0.0001) between hearing tests and cerumen removal was found indicating that those with no occlusion had no change in hearing whereas both occluded groups increased with the greatest change for the bilateral group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Four Ways To Teach PHC in a Changing World

Nurse educators are challenged to revise teaching/learning methods to support community-based primary health care (PHC) systems. The key elements are: integrating education with the realities of practice and people's needs; moving communities to strive towards solving their own health problems; and recognizing the socioeconomic health determinants. Described below are four educational methods based on PHC: inquiry-based learning, IMPACTS (a game to encourage multisectoral collaboration), distance education and community-based education.     

Physiologic Effects of Maternal Smoking on Breast-Feeding Infants

Women who smoke and breast-feed pose an unknown threat to their infants' health. In this pilot study, relationships between ingestion of nicotine in breast milk and physiologic effects in the infant were investigated. Infant physiologic effects measured were temperature, pulse, respiration, systolic blood pressure, and oxygen saturation. Five smoking and five nonsmoking mother-infant pairs were studied. Breast milk was analyzed for nicotine using gas chromatography. Breast milk from smoking mothers contained a mean of 33.1 ng/mL of nicotine while the breast milk from nonsmoking mothers contained a mean of less than 6.45 ng/mL of nicotine. Infant physiologic measures were taken before and 20 min after breast-feeding. After breast-feeding, infants of smoking mothers had a significant change in respirations and oxygen saturation while infants of nonsmoking mothers had a significant change in pulse only. Results provide a scientific basis for counseling smoking, breast-feeding mothers.