Termination of professional responsibility: Exploring the process of discharging patients with heart failure from hospitals

Hekmatpou D, Mohammadi E, Ahmadi F, Arefi SH. International Journal of Nursing Practice 2010; 16 : 389–396
Termination of professional responsibility: Exploring the process of discharging patients with heart failure from hospitals Despite the emphasized importance of the discharge process for patients with heart failure, this process is not taken as seriously as it should be. The objective of this qualitative study is to explore the concept of discharge and its associated factors in 42 experienced patients, family members, nurses and cardiologists at two educational hospitals in Tehran, Iran. The content analysis of the data indicates that the participants consider hospital discharge as the termination of professional responsibility on the part of physicians and nurses as far as health‐care support is involved. Three themes were identified as factors related to the treating team, health‐care system and patients and their families. Adverse outcomes of inappropriate discharge planning which manifested as incompliance with ‘diet and medical regimen’ and lack of lifestyle modification were also noted. It seems proper to try and change the attitude of physicians and nurses towards the concept of discharge, and raise their sensitivity to organizing and executing discharge plans. It is also recommended that postdischarge care should be established.     

布洛芬解热过程的观察及护理

2010年1月-2010年4月,我科用布洛芬（又名异丁苯丙酸）治疗发热病人43例.效果满意,现介绍如下.     

From the Cover: Highly conductive paper for energy-storage devices

Paper, invented more than 2,000 years ago and widely used today in our everyday lives, is explored in this study as a platform for energy-storage devices by integration with 1D nanomaterials. Here, we show that commercially available paper can be made highly conductive with a sheet resistance as low as 1 ohm per square (Ω/sq) by using simple solution processes to achieve conformal coating of single-walled carbon nanotube (CNT) and silver nanowire films. Compared with plastics, paper substrates can dramatically improve film adhesion, greatly simplify the coating process, and significantly lower the cost. Supercapacitors based on CNT-conductive paper show excellent performance. When only CNT mass is considered, a specific capacitance of 200 F/g, a specific energy of 30–47 Watt-hour/kilogram (Wh/kg), a specific power of 200,000 W/kg, and a stable cycling life over 40,000 cycles are achieved. These values are much better than those of devices on other flat substrates, such as plastics. Even in a case in which the weight of all of the dead components is considered, a specific energy of 7.5 Wh/kg is achieved. In addition, this conductive paper can be used as an excellent lightweight current collector in lithium-ion batteries to replace the existing metallic counterparts. This work suggests that our conductive paper can be a highly scalable and low-cost solution for high-performance energy storage devices.     

Influences of context, process and individual differences on nurses' readiness for change to Magnet status

Title.  Influences of context, process and individual differences on nurses' readiness for change to Magnet status.
Aim.  The aim of this study was to test hypotheses associated with a model which explains individuals' readiness in early stages of a change.
Background.  In an effort to improve the quality of nursing care, hospitals in the United States of America seek to obtain Magnet recognition. While it is commonly known that Magnet hospitals provide higher quality patient care, little is known about the variability in nurses' attitudes and behaviour within Magnet hospitals.
Method.  We collected data in 2006 from 310 Registered Nurses to investigate the factors that influence their willingness to embrace the changes necessary for the high levels of excellence accompanying Magnet status. Hierarchical linear modelling was used because the data were multi-level.
Results.  Both change-specific context, such as a culture of research exhibited by the manager, and formal education of the nurse moderated the positive influences of the organization's procedural justice actions. Specifically, procedural justice was stronger when the nurse manager demonstrated a culture of research, and negative effects of low justice were mitigated when nurses had a higher level of formal education.
Conclusion.  Preparing managers beforehand to appreciate and adopt new behaviours associated with a forthcoming organizational change should enhance the success of change practices as new changes are initiated. Moreover, education that exposes employees to the pending realities of their industry, such as nursing research, can play an important role in the development of positive beliefs about changes facing their organizations.     

Review of deprescribing processes and development of an evidence-based,patient-centred deprescribing process

Inappropriate use of medication is widespread, especially in older people, and is associated with risks, including adverse drug reactions, hospitalization and increased mortality. Optimization of appropriate medication use to minimize these harms is an ongoing challenge in healthcare. The term ‘deprescribing’ has been used to describe the complex process that is required for safe and effective cessation of medication. Patients play an important role in their own health and, while they may complain about the number of medications they have to take, they may also be reluctant to cease a medication when given the opportunity to do so. A review of previously proposed deprescribing processes and relevant literature was used to develop the patient-centred deprescribing process, which is a five-step cycle that encompasses gaining a comprehensive medication history, identifying potentially inappropriate medications, determining whether the potentially inappropriate medication can be ceased, planning the withdrawal regimen (e.g. tapering where necessary) and provision of monitoring, support and documentation. This is the first deprescribing process developed using knowledge of the patients'' views of medication cessation; it focuses on engaging patients throughout the process, with the aim of improving long-term health outcomes. Despite a comprehensive review of the literature, there is still a lack in the evidence base on which to conduct deprescribing. The next step in broadening the evidence to support deprescribing will be to test the developed process to determine feasibility in the clinical setting.     

Cone/Plate Viscosimeter and Sub-Specimen Volume

Owing to its geometry, the observed viscosity obtained with a Wells-Brook-field Micro Viscometer (LVT Cone/Plate, 1.565°) depends on sub-specimen volume. For each apparatus a compromise volume should be found, preferably giving both correct nominal values for Newtonian reference liquids and minimal variation with volume. Besides oil comparison liquids, the use of a water-ethanol comparison liquid is recommended for hemorheological measurements.     

Process evaluation of school-based peer education for HIV prevention among Yemeni adolescents

In 2005, a survey was conducted among all the 27 high schools of Aden, which revealed low levels of knowledge on major prevention measures, and a high level of stigma and discrimination towards people living with HIV (PLWH). The results served as a baseline for implementing a school-based peer education intervention for HIV prevention in the 27 schools of Aden. In 2008, and after 3 years of implementation, a quasi-experimental evaluation was conducted, which revealed that the peer education intervention has succeeded in improving HIV knowledge and skills; and in decreasing stigmatization of PLWH. This process evaluation aims to give a deeper understanding of the quasi-experimental evaluation which was conducted in the 27 high schools of Aden, and to highlight the factors that facilitated or inhibited school peer education in such a conservative Muslim setting. Qualitative methodologies were pursued, where 12 focus group discussions and 12 in-depth interviews were conducted with peer educators, targeted students, school principals, social workers, and parents of peer educators. Results revealed that school-peer education was well received. There was an apparent positive effect on the life skills of peer educators, but the intervention had a lesser effect on targeted students. Key enabling factors have been the high quality of training for peer educators, supportive school principals, and acceptance of the intervention by parents. These findings are important for improving the life skills and peer education intervention at the school level, and in better planning and implementation of life skills and peer programmes at a national scale.