Factors contributing to poor sleep in critically ill patients: A systematic review and meta-synthesis of qualitative studies

ObjectiveTo examine the causes of poor sleep in critically ill patients from nurses’ experiences.Review methodologyA meta-synthesis following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was conducted. Articles were searched systematically in the CINAHL, MEDLINE and Embase databases up to January 2020. Study selection and data extraction were performed by two authors working independently. Included articles were critically evaluated by both authors using the Critical Appraisal Screening Programme tool.FindingsThe meta-synthesis resulted in four analytical themes: (1) Inherent factors of critical illness, (2) Lack of implementation of evidence-based practice, (3) Lack of relational collaboration, (4) Hospital organisation and culture.ConclusionThis literature review indicates that promoting critically ill patients' sleep is difficult. Evidence-based interventions should be implemented into practice in order for nurses to be able to meet the patients' needs and improve sleep. Furthermore, the team surrounding the patient must have support from the health care organisation, and a culture change is necessary to improve communication between them to reach a shared goal to improve critically ill patients' sleep.     

Psychotic Experiences,Childhood Trauma,and Alcohol-Related Self-Efficacy in a Nonpsychiatric Sample of Individuals in Alcohol Dependence Treatment: A Pilot Study

There is a substantial co-occurrence between alcohol dependence and psychiatric symptoms. Moreover, research suggests that such symptoms, including psychotic experiences, are continuously distributed in the population. There is a lack of research concerning psychotic symptoms in otherwise non-psychiatric populations with alcohol dependence. The aim of this study was to investigate the prevalence of psychotic symptoms in this population, and to relate this to childhood trauma and management of alcohol dependence. From a population with alcohol dependence two sub-groups were extracted, with low and high levels of psychotic experiences respectively. These were compared concerning childhood trauma and management of dependence using ANOVA, and the resulting model was examined using binary logistic regression. There was a sub-group of 14,3% of the population with elevated levels of psychotic experiences. This group displayed higher degree of self-reported childhood trauma as well as difficulties in managing alcohol dependence, when compared to a sub-group with low levels of psychotic experiences. There may be a substantial sub-group in the otherwise non-psychiatric population with alcohol dependence, with significant difficulties concerning psychotic symptoms, trauma and management of dependence, where anxiety may have a mediating function. If so, this group calls for broader assessment and treatment than standard alcohol interventions.     

从瘀热辨治子痈的临证思路与经验——周仲瑛教授瘀热病机男科运用

国医大师周仲瑛教授结合多年的临床经验对"瘀热"病机理论进行较为系统的论述。在周仲瑛教授指导下,通过文献分析,结合临床实践,初步探讨子痈瘀热的病机概念、临床表现、辨证思路、组方用药特点,并举案例说明,以更好丰富"瘀热"理论,也为子痈的辨证施治提供新的思路。     

金妙文从痰瘀论治高血压病的经验

系统阐述金妙文教授临床辨治高血压病的思路及方法。痰瘀为高血压病病机的关键,贯穿于高血压病发生、发展和变化的整个过程,长期存在于病变的各个时期。临证应根据痰瘀互阻的主次先后、轻重缓急,采用治痰为主、治瘀为主或痰瘀同治,可取得良好的疗效。     

Exploration of the experiences of young mothers seeking and accessing health services

Objective: The objective was to explore young mothers’ experiences of seeking and accessing health services, specifically maternity care. Study design: A phenomenological approach underpinned by the work of Husserl and guided by the framework offered by Giorgi. Participants: A purposive sample of seven young mothers took part in audio-recorded unstructured interviews in either the young mother’s home or in a private room at their GP practice. Findings: Six themes emerged from the initial thematic analysis: (1) feeling abandoned, (2) information is vital, (3) feeling judged, (4) family and friends, (5) interference, (6) younger mothers need additional support. After ‘bracketing’ the preconceptions evident in the initial analysis, essential themes describing the young mothers’ experience of accessing healthcare were identified: (1) the need for support and information; (2) fear of stigmatisation and stigmatisation of self. Conclusions: The young mothers in this study experienced a need for support and information, which reflects the findings of previous studies. This study has added to the knowledge base as it also found that these young mothers were hindered from obtaining or making use of available support and information through fear or expectation of stigmatisation and self-stigmatisation. There is a need to improve availability of support and information for young mothers, who may benefit from one-to-one education to help them gain confidence to deal with pregnancy and parenthood issues. Further research on young mothers’ perceptions of maternity service provision will advance understanding of young mothers’ help and support needs during pregnancy, birth and the postnatal period.     

The effects of Ménière's disorder on the patient's significant others

Abstract

Objective: To determine the effects of their partners’ MD on the significant others of the patients. Design: Open-ended questionnaire. Study sample: Significant others of members of the Finnish Ménière's Federation. Results: The predominant responses concerned effects on their lives and lifestyle—participation restrictions (effects on personal and community life)—and on personal contextual factors (uncertainty of life). In contrast they fail to list such effects of the patients, focussing rather on the patients’ symptoms. Five percent of the responses given entailed positive experiences. Conclusions: Significant others of patients with MD listed a wide range of effects of their partner's condition on them. We encourage doctors and therapists to include the significant others in the rehabilitation process to enable them to understand the patient's condition, to help the significant other, and so better support the patients concerned.     

A Systematic Literature Review of Experiences of Professional Care and Support Among People Who Self-Harm

Self-harm is an increasing phenomenon among young people, with potentially fatal outcomes. Patient’s perceptions of treatment and support are poorly documented. The aim was to synthesise the experiences of those who self-harm, with special reference to professional care and support by family, friends, and the school system. A systematic review of the literature was conducted. Following retrieval of 1,623 abstracts, 14 studies were included in the final analysis, 11 of which are reported here. Two quantitative studies as well as 1 mixed method study on self-care could not be reported on here due to word limitations. Adult people who self-harm described the importance of quality in the caring relationship and a tailored care designed for each individual. There is a need for more studies into adolescents who self-harm but of importance is the adolescents’ need for support from the adult world. A positive relationship between patient and healthcare professional can be crucial in motivating continued treatment of people who self-harm. A major priority is radical improvement in the attitudes of healthcare personnel.