The effect of ward design on the well-being of post-operative patients

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions, the views and preferences of patients have seldom been sought directly The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities Visibility to nurses was lower on the bay ward The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting     

Cognitive behaviour therapy approach to disputing automatic thoughts: a two-stage model

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self-evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two-stage practise-based disputing model, guided by research, that aims to 'bring' an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.     

Community attitudes towards people with mental health problems: a discourse analytic approach

This paper addresses some methodological issues related to the generation of knowledge for mental health practice. It is suggested that a knowledge and understanding of attitudes towards the mentally ill has the potential to inform policy and practice regarding the establishment of community mental health facilities in order to encourage their acceptance by the public. Traditional approaches to attitude research are outlined followed by the proposal of an alternative approach: discourse analysis. The utility of each approach is assessed with regard to the potential relevance and applicability of research findings to practice. Traditional approaches are criticized on the grounds that they fail to take into consideration the social contexts within which attitudes are naturally expressed. As a result, information which is of potential interest to mental health practitioners is lost and it is unclear how the findings of such research might relate to or be translated into practice. It is argued, that since this information is to be found in the language used to describe people with mental health problems and to express attitudes towards them, that discourse analysis is ideally suited to the study of attitudes towards the mentally ill. The potential utility of the approach is demonstrated by an empirical example. Implications for practice are considered.     

Health-related quality of life and pressure ulceration assessment in patients treated in the community

Little is known of the impact of pressure ulceration on adult patients' health-related quality of life. The purpose of this study was to determine the impact pressure ulceration has on pressure ulcer patients cared for in the community. A case control study design was used by drawing a random sample from patients receiving community nursing care, stratified by the presence of pressure ulceration. In all, 75 patients with pressure ulcers were compared with 100 controls without ulcers using the four-point ulcer grading scale described by United Kingdom consensus guidelines. Patients were interviewed using the Short Form-36 (SF-36) questionnaire and activities of daily living assessed using the modified Barthel scale. Patients with pressure ulcers had significantly poorer physical function (mean difference (d) = 37.6, 95% CI 28.6-46.6, p < 0.001) and social functioning (d = 33.9, 95 % CI 24.0-43.9, p < 0.001) than published age- and sex-matched normative data from the United Kingdom. The difference between cases and controls was much smaller in these domains, with neither approaching statistical significance. After adjustment for age and gender, scores for bodily pain were poorer in patients with no ulceration (d = -10.5, 95% CI - 20.6 to - 0.4, p = 0.042) indicating greater pain in these patients compared with the cases with ulceration. Activities of daily living determined by the modified Barthel scale showed reduced self-care (d = -7.6, 95% CI -12.5 to - 2.7, p = 0.010) and mobility (d = -9.2, 95% CI -14.6 to - 3.8, p = 0.001) in patients with pressure ulceration. The overall ability to perform these activities was also significantly poorer in this group (d = -16.3, 95% CI -27.3 to -5.3, p = 0.004). While patients with pressure ulceration experience some deficits in their health-related quality of life compared with a normal population, these differences are similar to those experienced by other patients receiving community nursing care.     

A comparison of the relative risk of vessel injury with conical versus pyramidal laparoscopic trocars in a rabbit model

OBJECTIVE: Our purpose was to compare the relative risk of vessel injury after use of a 5 mm conical-tipped trocar, a 5 mm pyramidal-tipped trocar, and a 10 mm pyramidal-tipped trocar in a rabbit vessel model.STUDY DESIGN: Plastic templates were placed in front of and behind 108 mesenteric vessels in 11 anesthetized New Zealand White rabbits. Laparoscopic trocars were inserted through the templates and mesentery. The incidence of vessel injury was determined at distances from the vessels ranging from 0 to 5 mm.RESULTS: The 5 mm conical trocar resulted in a vessel injury rate of 88% at 0 mm from the vessel but 0% at 1 or 2 mm. The 5 mm pyramidal trocar resulted in 100%, 88%, and 62% injury rates of 0, 1, and 2 mm from the vessels, respectively. The 10 mm pyramidal trocar resulted in a 100% injury rate at 0, 1, 2, or 3 mm from the vessels and 80% and 40% at 4 mm and 5mm, respectively.CONCLUSION: The relative risk of vessel injury is significantly increased by the use of pyramidal-tipped trocars when compared with conical-tipped trocars, especially if larger diameter trocars are used.