Improvement in Health-related Quality of Life After Hospitalization Predicts Event-free Survival in Patients With Advanced Heart Failure

BackgroundHealth-related quality of life (HRQOL) is a major clinical outcome for heart failure (HF) patients. We aimed to determine the frequency, durability, and prognostic significance of improved HRQOL after hospitalization for decompensated HF.Methods and ResultsWe analyzed HRQOL, measured serially using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), for 425 patients who survived to discharge in a multicenter randomized clinical trial of pulmonary artery catheter versus clinical assessment to guide therapy for patients with advanced HF. All patients enrolled had 1 or more prior HF hospitalizations or chronic high diuretic doses and 1 or more symptom and 1 sign of fluid overload at admission. Improvement, defined as a decrease of more than 5 points in MLHFQ total score, occurred in 68% of patients by 1 month and stabilized. The degree of 1-month improvement differed (P < .0001 group × time interaction) between 6-month survivors and non-survivors. In a Cox regression model, after adjustment for traditional risk factors for HF morbidity and mortality, improvement in HRQOL by 1 month compared to worsening at 1 month or no change predicted time to subsequent event-free survival (P = .013).ConclusionsIn patients hospitalized with severe HF decompensation, HRQOL is seriously impaired but improves substantially within 1 month for most patients and remains improved for 6 months. Patients for whom HRQOL does not improve by 1 month after hospital admission merit specific attention both to improve HRQOL and to address high risk for poor event-free survival.     

Comparisons of tympanic membrane, abdominal skin, axillary, and rectal temperature measurements in term and preterm neonates

Abstract Quasi-experimental research was conducted to investigate the optimum placement time and normative values of temperature measurements from the tympanic membrane, abdominal skin, axilla, and rectum of neonates at a newborn nursery of a university medical center in Thailand. A convenience sample of 52 growing preterm and 57 healthy term neonates was enrolled. Simultaneous temperature measurements were made at the four sites. Temperatures were recorded when they had remained unchanged for 2 min. The axillary temperature was as accurate as the rectal temperature measured with a glass thermometer if the placement times were optimal. The mean placement times in preterm and term neonates were 2.8 and 3.4 min for the rectum, 5.4 and 7.9 min for axilla, and 4.0 and 6.1 min for abdominal skin, respectively. The rectal temperature equalled the abdominal skin temperature plus 0.3°C for preterm and plus 0.2°C for term neonates. However, temperatures obtained with an infrared tympanic thermometer in the rectal-equivalent mode did not give an accurate reading and are not recommended as a substitute for rectal temperatures in neonates.     

Using quality improvement methodology to improve neuropathic pain screening and assessment in patients with cancer

Background. Quality improvement methodology was used to improve neuropathic pain (NP) screening at a comprehensive cancer center. Methods. Nurses participated in educational sessions about screening and assessment. Clinical systems to facilitate documentation of NP severity scores were developed. Results. Pretest and posttest score results demonstrated nurse acquisition of new knowledge. A 90% NP screening adherence rate was achieved (N=3831). Patients with no reported general pain (n=291) were found to have moderate to severe NP. Conclusions. Keys to success are (1) health care professional education and periodic reinforcement of learning and (2) system infrastructure changes.     

Perceptions of Single vs. Partnered Adult Gravidas in the Midtrimester

Perceptions of the pregnancy experience, pregnancy intendedness, and partner status were compared in a sample of 30 women in the midtrimester. Half of the sample defined themselves as single and half as partnered. Interview data showed a full range in pregnancy intendedness and partner status, and shared areas of concern among the sample as a whole and areas of concern specific to single women. Single women's concerns clustered into four categories: decision-making, disclosure, social support, and legal issues.     

Experiences of Mistreatment Among Women with Cerebral Palsy

Abuse and mistreatment of women with disabilities is a complex problem that affects their health and well-being. Previous studies have focused on heterogeneous groups of women with disabilities, with only small numbers of women with cerebral palsy included, but different disabilities may play specific roles in relation to abuse. Exploring mistreatment of women with cerebral palsy is important in determining the relationship between mistreatment and a specific disability. The aim of this article was to describe experiences and meanings of mistreatment among women with cerebral palsy. The feminist biographical method was used to provide an in-depth exploration of women's storied lives, uncover the meaning of women's lives from their own perspective, and provide understanding of women whose stories are seldom told. A sample of eight participants participated in two in-depth, audio-recorded interviews. Two major themes and five subthemes emerged. The meaning of mistreatment included participants' definition of mistreatment and their explanation for mistreatment. Outcomes of mistreatment were divided into emotional, social, and physical outcomes. Health care providers need to understand the meaning and outcomes of mistreatment in their patients' lives to begin to address mistreatment, listen to patients, advocate when needed, and provide appropriate health care.     

Managing emergency department overload

The problem of patient flow in the ED and throughout the hospital is serious, and hospitals are trying to address it through many organizational initiatives. While a variety of factors contribute, there is one important solution—ED case managers. In using such staff, hospitals can ensure efficient, cost-effective, and timely patient care and services. Case managers also affirm compliance with accreditation standards such as JCAHO's Managing Patient Flow standard. As advocates for patients, educators on behalf of hospitals, and coordinators of care and treatment, case managers operate as a hub within a complex and fast-paced system. Their ability to coordinate, collaborate, facilitate, and monitor care contributes to an ED operation that is more efficient, less chaotic, revenue-maximizing, and ultimately more satisfying in terms of the patient's experience and the ability of the staff to deliver quality, safe, timely, and appropriate care.     

Divergence and convergence in nursing and health care among six countries participating in ICN's 2010 Global Nursing Leadership Institute

ZITTEL B., EZZEDDINE S.H., MAKATJANE M., GRAHAM I., LUANGAMORNLERT S. & PEMO T. (2011) Divergence and convergence in nursing and health care among six countries participating in ICN's 2010 Global Nursing Leadership Institute. International Nursing Review 59 , 48–54 In 2009 the International Council of Nursing (ICN) launched, with support from Pfizer External Medical Affairs, a Global Nursing Leadership Institute (GNLI) which was again repeated in the fall of 2010. The programme, provided in English, at a location near ICN headquarters in Geneva, Switzerland, provided the opportunity for senior and executive level nursing leaders throughout the world to acquire new knowledge and skills about national and global leadership within a supportive and stimulating learning environment. Once selected for participation, GNLI members are requested to complete a country profile – a two to three page précis providing information regarding health and nursing specific to their respective country encompassing the following: the country's health system and how it is funded; identification of current or proposed changes in the health system; national demographic data such as population, gross national income, average life expectancy, number of nurses and physicians, and the top three causes of deaths; and key issues facing the health system and nursing in the country. On arrival at the Institute, participants were divided into leadership development teams, small groups of six persons each, which met throughout the week to discuss the ways in which health challenges and nursing in their respective countries both converged and diverged. Shared insights learned are presented from one such 2010 GNLI team representing nursing leaders from the countries of Australia, Bhutan, Lebanon, Lesotho, Thailand and the USA. A comparative analysis of the health profiles of their respective countries is also provided.     

Community as Client: Reaching an Underserved Urban Community and Meeting Unmet Primary Health Care Needs

In a collaborative effort to address the health disparities within 1 urban underserved community, the Hunter-Bellevue School of Nursing, Hunter College, and the Mount Sinai Medical Center organized a health fair. Nursing faculty worked side by side with undergraduate nursing students to offer several health promotion activities, screening, and educational sessions for residents of East Harlem, New York. In addition, nursing students provided individual patient education on nutrition, hand washing hygiene, medication review, and glucometer usage. Educational materials on lifestyle issues (sample meals, maintaining normal blood glucose, blood pressure, cholesterol levels, and smoking cessation) were provided. To help bridge the gap between health education and health promotion activities, nursing students, many of whom were bilingual, served as translators for non-English speaking Spanish and Chinese residents. In addition to the new professional partnerships developed, new clinical placements for nursing students were established.