临床护理路径对乳腺癌术后患者生活质量与自护能力影响的分析

目的分析应用临床护理路径对乳腺癌术后患者生活质量与自护能力的影响。方法选择180例乳腺癌术后患者，依据随机原则分为对照组90例，予以常规护理模式；研究组90例，依据临床护理路径予以护理措施。应用多种生活质量量表，包括：SF-36量表、QLQ-B2R3量表评估两组患者的生活质量；应用自我护理能力测量量表（ESCA），评估两组患者的自护能力；应用家庭关怀度指数测评量表（APGAR），调查评估两组患者的家庭支持状况。结果与对照组相比，研究组的SF-36量表与QLQ-B2R3量表评分总分及各维度得分、ESCA量表评分总分及各维度得分、APGAR量表调查总分及各维度得分与对照组相比差异有显著意义（P〈0．05）。结论应用临床护理路径，能显著改善乳腺癌术后患者生活质量与自护能力。     

Repeatability and reliability of the diabetic foot self-care questionnaire in Arabic patients: A transcultural adaptation

PurposeThe diabetic foot self-care questionnaire is considered a self-care evaluation tool with 16 questions for assessing diabetic foot health disorders. To date, the DFSQ has been validated in different languages, but an Arabic version was lacking. Consequently, the purpose of this study was to translate and validate the Arabic version of the DFSQ (DFSQ-AR).MethodA suitable method was developed for the translation protocol and cross-cultural validation from Spanish to Arabic. Regarding the total marks from each sub-scale, agreement degrees and confidence were analyzed using Cronbach's α and intraclass correlation coefficient (ICC), respectively. In addition, the mean ± standard deviation differences between pre and post-tests were calculated and completed using Bland-Altman distribution plots.ResultsExcellent agreement between the two versions was demonstrated based on Cronbach's α. Three sub-scales consisting of knowledge of foot hygiene, the appropriate use of footwear and socks, and podiatric self-care were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the self-care and shoe and socks sub-scales. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (P = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75–102.43] and 97.96 ± 13.88 [94.5–101.86] points, respectively). Bland-Altman plots or clinically pertinent variations were not statistically significantly different.ConclusionsThe DFSQ-AR is considered a strong and valid questionnaire with adequate repeatability in the Arabic language population.     

系统性急救护理程序在重型颅脑损伤患者急救中的应用效果

目的 分析系统性急救护理程序应用于重型颅脑损伤患者急救中的效果。 方法 选取急诊科2015年4月-2016年4月接受治疗的重型颅脑损伤患者142例为研究对象。将其随机分为观察组和对照组各71例。观察组按照系统性急救护理程序进行护理,对照组给予常规急救护理。比较2组患者的急救时间、抢救成功率、NIHSS评分、Barthel指数、并发症发生情况及患者对护理工作的满意度。 结果 观察组的抢救时间明显短于对照组(t=6.458,P=0.002),抢救成功率高于对照组(χ²=4.508,P=0.034)。治疗后观察组的NIHSS评分及Barthel指数均优于对照组(t=4.632,P=0.025; t=2.731,P=0.043),并发症发生率明显低于对照组(χ²=31.071,P<0.001),对护理工作的满意度明显高于对照组(Z=-3.036,P=0.002)。 结论 系统性急救护理程序能够明显缩短重型颅脑损伤患者的抢救时间,提高抢救成功率,减少了并发症的发生,有利于患者的神经功能及自理能力的恢复,提高患者对护理工作的满意度,值得提倡和推广。     

Implementing healthy work environment standards in an academic workplace: An update

In 2005 the American Association of Critical Care Nurses defined six Healthy Work Environment (HWE) standards for the clinical setting (AACN, 2005), which were reaffirmed and expanded in 2016 (AACN, 2016). These clinical standards were adapted for use in the academic setting by Fontaine, Koh, and Carroll in 2012. The intention of this article is threefold: to present a revised version of the academic workplace standards which are appropriate for all School of Nursing (SON) employees, staff as well as faculty; to proposes the addition of a seventh standard, self-care, which provides the foundation for all standards; and to describe the continuing implementation of these seven standards at the University of Virginia School of Nursing (UVA SON).     

How older adults and their informal carers prevent falls: An integrative review of the literature

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons.AimTo synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines.Data sourcesHealth sciences databases for full text articles published in English plus reference list searching of included articles.Review methodAn integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes.ResultsOf the seventeen studies included in the review, eleven identified older adults’ falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence.ConclusionsThe fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines.     

Pilot testing of the effectiveness of nurse-guided,patient-centered heart failure education for older adults

Heart failure (HF) is the most common cause of hospitalization and rehospitalization among those 65 years and older. Effective HF self-management is recommended for reducing readmissions. This pilot study, through a one-group, pretest-posttest design, examines the effects of nurse-guided, patient-centered HF education on readmissions among older adults (n?=?26) in a post-acute care unit. All selected participants received 3 sessions of tailored patient education. Their knowledge and self-care skills were measured pre- and post-intervention with the Atlanta Heart Failure Knowledge Test (A-HFKT) and the Self-Care of Heart Failure Index (SCHFI). Patients' HF-related knowledge and self-care skills showed statistically significant improvements, and only 1 patient was rehospitalized for any HF-related reason within 30 days post-discharge. These results suggest that HF rehabilitation teams could support better patient outcomes by assigning nursing staff to provide individualized patient education, as this can help ensure that patients understand discharge instructions for effective self-care.     

The Mental Health Team: Evaluation From a Professional Viewpoint. A Qualitative Study

Background

Health care institutions include workers who must operate in accordance with the requirements of the position, even though there are psychosocial influences that can affect the stability of the worker.

Defining Optimal Self-Management in Osteoarthritis: Racial Differences in a Population-Based Sample

The aim of this study was to examine optimal self-management in osteoarthritis and its association with patient-reported outcomes. We recruited a population-based sample of Medicare beneficiaries (n = 551) residing in Allegheny County, PA, USA and elicited an expanded set of self-management behaviors using open-ended inquiry. We defined optimal self-management according to clinical recommendations, including use of hot compresses on affected joints, alteration of activity, and exercise. Only 20% practiced optimal self-management as defined by two or more of these criteria. Optimal and suboptimal self-managers did not differ in sociodemographic features. Both white and African–Americans who practiced optimal self-management reported significantly less pain, but the benefit was greatest in severe disease for whites and for mild-moderate disease among African–Americans. This backdrop of naturally occurring self-management behaviors may be important to recognize in planning programs that seek to bolster self-management skills.     

Combining mHealth and health-coaching for improving self-management in chronic care. A scoping review

BackgroundSelf-management approaches are widely used to improve chronic care. In this context, health care professionals call for efficient tools to engage patients in managing their illness. Mobile health (mHealth), defined by WHO as medical and public health practice supported by mobile devices, is demonstrated to enhance self-management and health-coaching as an engaging tool in supporting behaviour change. Nevertheless, it is unclear how health-coaching and mHealth can benefit from each other.ObjectiveWe conducted a scoping review to provide a literature-overview and identify any existing gaps in knowledge of mHealth in combination with health-coaching interventions for improving self-management in patients with chronic diseases.Patient involvementNo patients were involved in the review process.MethodsThe five-stage framework by Arksey and O'Malley was used. The review surveys; PubMed, CINAHL, Embase, Scopus, and PsycInfo. Two independent reviewers performed review selection and characterization.ResultsThe review points at two approaches; (i) coaching used to support mHealth and (ii) mHealth as support for coaching. The findings suggest that patients prefer physical interactions to telecommunication. mHealth was primarily used to facilitate telecommunication and to monitor disease aspects.DiscussionWe found that mHealth and health-coaching interventions benefit from each other. The review report on a considerable unclarity in the coaching-methods and that the patients were more satisfied with physical interactions than mHealth. We suggest to prioritize human contact and to explore more personalized health technology.Practical valueThis scoping review can provide a framework for researchers and care providers to support discussion and introduction of new approaches and technology in self-management for patients with chronic diseases, thereby improving patients’ quality of life.