Collaboration: a concept analysis

Collaboration is a complex phenomenon, yet one that is of significance to nursing This concept analysis presents definitions and defining characteristics of collaboration so that the concept may be used in the creation of operational definitions, or to develop and evaluate tools for measuring collaboration Antecedents, consequences and empirical referents of collaboration are explored Model, contrary and related cases are presented to clarify this concept further     

The efficacy of speech intervention using electropalatography with an 18-year-old deaf client: A single case study

This single case study explored the use of EPG as a therapeutic tool for treating inaccurate articulation of the voiceless alveolar plosive /t/. The participant (M) is an 18-year-old deaf adult who consistently uses hearing aids, and who communicates using a combination of English, Sign Supported English and British Sign Language (BSL). M received traditional phonological therapy targeting his production of /t/ prior to EPG therapy, but without success. He requested further therapy and EPG was offered as an alternative approach. Pre-EPG therapy, M made tongue placement errors for both /t/ and the voiced alveolar plosive /d/. Based on perceptual analysis by M's speech and language therapist, the first author, his productions were inconsistent, though generally perceived as voiceless and voiced velar plosives respectively. The EPG therapy consisted of six bi-weekly therapy sessions, each lasting for 1 hour, targeting M's production of /t/ in familiar words, using the visual feedback from the EPG display. Trained and untrained listeners perceptually analysed audio recordings of words and sentences collected at three assessment points. Improvements, both over the course of the EPG therapy and during the follow-up period, were found to be statistically significant. Significantly, M was able to generalize his production skills to untaught words containing both /t/ and /d/. Equally significant was the lack of change in M's production of a control sound, the voiceless dental fricative /θ/. More globally, an improvement was observed in ratings of M's intelligibility in sentences and in his voice quality (assessed impressionistically).     

Factors in Childhood Drug and Alcohol Use: A Review of the Literature

TOPIC. Drug and alcohol use in children.
PURPOSE. To identify the prevalence of drug and alcohol use in children 12 and younger and the factors associated with this use.
SOURCE. A review of the literature.
CONCLUSIONS. The identified factors include: a) dijferences in use between boys and girls; b) influence of family members' drug and alcohol use; c) influence of peers; d) the child's self-esteem; and e) the child's knowledge about drug and alcohol use. Awareness by child psychiatric nurses of the identified factors is crucial to prevent, assess, and treat the problem of drug and alcohol use by children.     

Complications associated with therapeutic neck radiation

This retrospective study of patients who underwent neck radiation as part of their treatment for squamous cell carcinoma of the oral cavity sought to identify and quantify the morbidity associated with this treatment. Thirty-five patients who received neck radiation between 1985 and 1992 were randomly recalled for examination. All patients had been treated in a standardized fashion by the Department of Radiation Oncology. The long-term effects of neck radiation on skin changes, thyroid function, and neck range of motion, of atherosclerotic carotid artery disease, xerostomia, and glottic structures were measured. Fifty-seven percent of patients demonstrated grade 1 skin changes. No severe changes were noted, and no development of secondary neoplasia was observed. There was no linear trend observed between radiation dose and skin changes. Hypothyroidism developed in 14.3% of patients within 3.5 years posttreatment. Logistic regression demonstrated a significant association between hypothyroidism and radiation dose. Limitation of neck mobility was the most significant complication with deficits demonstrated in all ranges of motion. Carotid bruits were documented in 14.3% of patients, with a significant association between the higher neck dosage in N+ cases. Xerostomia was found in 68% of patients. There was persistent glottic erythema in 11.4% of patients. The results of this study indicate that there are persistent complications after neck radiation, which include limitation of neck movement, diminished thyroid function, accelerated carotid artery narrowing, and skin and salivary changes.     

Quality improvement intervention to stimulate early mobilisation of critically ill children

Background

Immobility during hospital stay is associated with muscle weakness, delirium, and delayed neurocognitive recovery. Early mobilisation of critically ill adults improves their physical functioning and shortens the duration of mechanical ventilation. However, comparable research in children is lacking.

Aims

To determine the effects of the implementation of an early mobilisation (EM) program on mobility activities for critically ill children and to explore barriers and facilitators and clinical outcomes before and after implementation.

Study design

A prospective single-centre before-and-after study. This study was conducted in a PICU of a large tertiary hospital. Children aged from 3 months to 18 years, with an expected stay of ≥3 days were eligible to participate. In the “before” phase, participants received usual care; in the “after” phase we implemented a multicomponent, multidisciplinary EM protocol. The primary outcome was a change in the process outcome “mobilisation activities”. Secondary outcomes were PICU staff opinions on mobilisation (survey), safety, process measures, involvement of parents and physical therapist, and clinical outcomes (sedative use and prevalence of delirium).

Results

A total of 113 children were included; 55 before and 58 after, with a median age of 31 months (IQR: 10–103) and 35 months (IQR: 7–152), respectively. The number of mobilisation activities (per patient per day) had significantly increased from 5 (IQR: 2–7) to 6 (IQR: 4–8) (U = 272185.0; p < .001). PT consultations for mobilisation had significantly increased from 23.6% (13/55) to 46.5% (27/58) (X² = 6.48; p = .011). In both phases, no mobilisation-related adverse events were documented. The survey showed that PICU staff found EM of critically ill children useful and feasible. In the after phase, PICU staff rated the perceived benefit of the support of the physical therapist during mobilisation activities significantly higher than in the before phase (X² = 34.80; p < .001).

Conclusions

Implementation of a structured EM program for critically ill children is feasible and safe.

Relevance to clinical practice

It is suggested to start the implementation of a structed EM program with the idendentification of local barriers and facilitators by an interdisciplinary PICU team. Further, an increased presence of physiotherapists on the PICU would improve mobilisation levels, and facilitate mobilisation in critically ill children. Also, they can support and advice PICU nurses and parents in mobilising children.