Facilitating comfort for hospitalized patients using non-pharmacological measures: Preliminary development of clinical practice guidelines

Nurses often use non-pharmacological measures to facilitate comfort for patients within the hospital setting. However, guidelines for use of these measures are commonly inadequate or absent. This paper presents 12 clinical practice guidelines that were developed from the findings of a literature review into non-pharmacological measures that are thought to facilitate patient comfort. The non-pharmacological measures addressed in these guidelines are: Aromotherapy, Distraction, Guided Imagery, Laughter, Massage, Music, Reiki, Heat or Cold, Meditation, Reflexology, Reposition and Transcutaneous Electrical Nerve Stimulation. These are preliminary guidelines for the use of non-pharmacological measures and further research and development of such guidelines is recommended.     

Psychological Comfort of Paramedics with Field Death Pronouncement: A National Asian Study to Prepare Paramedics for Field Termination of Resuscitation

Objectives: Paramedics' decision to terminate field resuscitation without a physician present may depend on personal and external factors. This study investigates factors associated with paramedic psychological comfort with termination of resuscitation (TOR) to inform future training. Methods: We administered an anonymous survey to all practicing paramedics in a large urban Asian Emergency Medical Services system where formal TOR training had not yet been conducted and field TOR was not routinely applied. The survey assessed psychological comfort using the validated Psychological Comfort Total (PCT) scale (summed score of 28 items, with higher scores representing greater comfort). We examined scores associated with four personal (prior resolution of personal loss, knowledge of survival probability, religious affiliation and experience with death pronouncements) and two external (location of patient and perceived trust of family) factors. Data were entered into Excel and analyzed by t-tests and ANOVA. Results: Response rate was 73.6% (254/345). Respondents were 30.3 years (mean, SD 7.1) with 7.2 years (mean, SD 5.54) of practice experience. Over 60% had been involved in 6 or more field death pronouncements in the prior 12 months. Higher PCT scores were associated with prior resolution of personal loss and knowledge of survival probability. Lower PCT scores were associated with patient location in a public place and perceived family lack of trust. PCT scores were not associated with paramedic religious affiliation or number of prior death pronouncements. Conclusions: Paramedic psychological comfort with field death pronouncement is associated with personal and external factors. Since paramedic comfort is important for protocol adoption, TOR education should target not only knowledge, but also public arena management, communication skills for engaging with families, and help paramedics resolve prior personal loss.     

情感安抚策略对于行电子结肠镜下息肉摘除术患者其负性情绪、疼痛程度及应激指标的影响

摘要：目的 探究情感安抚策略对于行电子结肠镜下息肉摘除术患者其负性情绪、疼痛程度及应激指标的影响。方法 选取我院于2014年2月~2016年2月收治的76例行电子结肠镜下息肉摘除术患者,以随机数字表作为分组手段,将纳入对象划分为研究组和对照组各38例。其中对照组开展常规护理干预,研究组则在对照组基础上引入情感安抚策略。记录两组患者在入院时、术前1d及退镜后15min的收缩压、心率值;记录两组患者在入院时、术前1d及术后1d的焦虑自评量表（SAS）和抑郁自评量表（SDS）评分;记录两组患者在入院时、术前1d及术后1d的视觉模拟疼痛评分。 结果 在入院时,两组患者的收缩压及心率值比较无统计学差异（P>0.05）;术前1d及退镜后15min的收缩压及心率值均低于对照组,差异有统计学意义（P<0.05）。在入院时,两组患者的焦虑及抑郁情绪评分差异无统计学意义（P>0.05）;术前1d及退镜后15min的焦虑及抑郁情绪评分均低于对照组（P<0.05）。两组患者在入院时的视觉模拟疼痛程度评分无统计学差异（P>0.05）;术前1d和术后1d的视觉模拟疼痛程度评分均低于对照组（P<0.05）。结论 情感安抚策略应用于行电子结肠下息肉摘除术患者,有助于改善其不良情绪,还能降低其疼痛程度及生理应激相关指标,取得较为可观的临床成效。     

穴位按摩结合“U”形枕干预在老年视网膜脱离术后病人中的应用

目的:探讨穴位按摩结合“U”形枕干预在老年视网膜脱离术后病人中的应用效果。方法:按随机数字表法将2017年9月—2019年9月收治的118例老年视网膜脱离术后病人分为观察组和对照组各59例,对照组行常规干预,观察组行穴位按摩结合“U”形枕干预。采用Kolcaba舒适状况量表对两组病人干预前、干预3 d、7 d、14 d的体位舒适度进行评价,采用匹兹堡睡眠质量指数量表(PSQI)对两组干预前、干预14 d后睡眠质量进行评价。结果:观察组病人干预3 d、7 d、14 d体位舒适度评分均高于对照组(P<0.05);观察组病人干预14 d后睡眠质量、睡眠时间、睡眠紊乱、睡眠效率、入睡时间、催眠药物、日间功能障碍、总分均低于对照组(P<0.05)。结论:对老年视网膜脱离术后病人实施穴位按摩结合“U”形枕干预可有效提升病人的舒适度,改善病人睡眠质量。     

A conceptual analysis of the meaning of comfort at the end-of-life using the Walker and Avant (2014) Framework

Objective: The aim of the authors is to clarify the concept of comfort at the end-of-life in order to support understandings of fundamental nursing care needed at this stage of healthcare. Methods: The Walker and Avant framework was applied to develop a deeper understanding of the concept of comfor t at the end of life. Results: Five defining attributes of comfort in the end-of-life were identified and they are having a peaceful home-life environment, trust and consolation, proximity and social-cultural support, alleviation of suffering, and a process of integrated intervention by nurses. Conclusions: At the end-of-life patients commonly experience physical, psychological, social-cultural, and environmental discomfor t. Patients' families also encounter significant challenges. However, their comfort needs are often secondary to that of the patient. Additionally, a lack of clarity exists regarding the holistic meaning of comfor t at the end-of-life, which can largely be confined to understandings of physical comfor t for the patient, with a limited understanding of addressing family/caregivers' needs. Therefore, this concept analysis may provide some guidance in this regard and also provides suppor t toward a more integrated understanding of the concept.     

功能性鼻内镜鼻窦术后纳吸棉填塞止血对患者舒适度和术腔恢复效果的影响

目的:探讨功能性鼻内镜鼻窦术(functional endoscopic sinus surgery,FESS)后纳吸棉填塞止血对患者舒适度和术腔恢复效果的影响。方法:前瞻性选取2017年7月至2020年5月期间在皖北煤电集团总医院耳鼻咽喉科接受FESS的90例慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者,采用随机数表法分为纳吸棉组(n=45)和明胶海绵组(n=45);纳吸棉组FESS术后采用纳吸棉填塞术腔止血,明胶海绵组采用明胶海绵填塞术腔止血,术后随访3个月。观察两组止血和鼻腔症状缓解情况,采用视觉模拟疼痛量表(Visual Analogue Scale,VAS)评分评估患者舒适度,利用鼻内镜检查Lund-Kennedy评分和测量鼻腔气道阻力观察术腔恢复效果。结果:两组均充分止血,术腔术后未出现活动性出血,纳吸棉组术后4周鼻阻塞、鼻痛症状程度明显轻于明胶海绵组(P<0.05);纳吸棉组术后2、4周VAS评分显著低于明胶海绵组,术后4周、3个月鼻内镜Lund-Kennedy评分均低于明胶海绵组,差异均有统计学意义(P<0.05);纳吸棉组术后第1次鼻腔气道阻力显著低于明胶海绵组(P<0.05)。结论:纳吸棉是CRS患者FESS术后理想的鼻腔填塞止血材料,在缓解术腔相关症状、减轻疼痛、促进术腔恢复和改善鼻腔通气方面效果显著。     

舒适护理对老年维持血液透析病人心理指标及并发症的影响

[目的]探讨舒适护理对老年维持血液透析病人心理指标及并发症的影响。[方法]选取112例进行维持血液透析的老年病人,随机分为对照组和观察组各56例,对照组采取常规护理,观察组在对照组的基础上实施舒适护理。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)比较两组病人护理前后心理状态,同时统计两组病人血液透析期间并发症的发生率。[结果]观察组病人采用舒适护理后的心理焦虑、抑郁程度明显低于对照组(P<0.05),透析期间并发症发生率明显低于对照组(P<0.05)。[结论]舒适护理可以提高老年维持血液透析病人的生活质量,消除病人的不良情绪,减少并发症的发生。     

自制水囊改善主动脉内球囊反搏治疗患者术肢局部舒适度的探讨

目的分析自制水囊对主动脉内球囊反搏治疗（IABP）患者术侧肢体舒适度的影响。方法人选急性心肌梗死伴心源性休克的患者42例。采用7号橡胶手套充水3／4容积制成水囊,将水囊置于患者术侧膝关节和足跟下方。采用自行设计的量表评估应用水囊患者的舒适度和满意度,比较患者应用水囊前后的舒适度。结果应用水囊前患者术侧肢体有不适感和麻木感,应用水囊后舒适度显著提高（P〈0．05）,无一例压疮发生。结论IABP治疗患者术侧肢体应用自制水囊可提高其舒适度和满意度。     

基于JACK的驾驶姿势的下肢关节受力及舒适度分析

目的 研究驾驶姿势下外力施加给人体下肢时,关节角度及外力大小对关节力矩大小的影响特征;根据力矩计算单关节舒适度并验证。方法 采集人体测量参数,在Jack中建立了10名志愿者对应的个性化数字人模型。模拟人的驾驶姿势,计算下肢各关节处的力矩大小。结果 Jack计算出关节力矩与角度和外力的相关性明显,变化趋势与实测结果一致。舒适度评价方法反映出真实关节感受。结论 各关节力矩与踝关节角度呈负相关,与外力呈正相关;驾驶员的膝关节角度取108°到113°度为宜;对于髋关节和踝关节力矩,外力的影响最大;对于膝关节力矩,膝关节角度的影响最大;关节力矩受踝关节角度的影响最小,与之负相关;基于力矩的舒适度概念定量地反映出关节舒适感,可以为驾驶环境设计提供参考。