caregivers, chronically- ill, community, family support, caregiving
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
This qualitative case series aimed to determine the preparedness of caregivers with chronically-ill patients in the community of Tacloban City, Leyte. There were 3 caregivers, aliased Buttercup, Bubbles and Blossom. Buttercup is a 50-year old housewife to a 64-year old post below knee amputation (BKA) patient. Buttercup’s husband is a retired government employee. Bubbles is a 34-year old housewife taking care of her 75 year old father diagnosed with osteoarthritis. Aside from taking care of her father, husband and children, Bubbles runs a small store just outside their house. Blossom, on the other hand, is an 18 year old nursing student. She takes care of a grandfather who just had his second stroke attack. Blossom’s grandfather is a retired barangay captain.
The qualitative data showed that the caregivers address the physical and emotional needs of their ailing family member. They also prepare for any complications and emergencies that are brought about by the condition of their patient. Enabling and disabling factors contributing to the caregiving preparedness were determined. Knowledge and anticipation and family support were enabling factors; while caregiver role strain, other responsibilities and economic changes were identified as disabling factors.
Caregivers are prepared when it comes to the physical needs of their patients. They are somewhat prepared for the emotional challenges that come with caregiving, and a little prepared when it comes to emergencies. Caregivers were enabled and disabled by a variety of factors.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Introductions: Light or no sedation has been more common while receiving mechanical ventilation treatment and it is preferable from a medical perspective. Patients who are mechanical ventilated treatment are unable to speak verbally. To communicate was perceived as difficult and evoked feelings of helplessness. When patients are conscious communication becomes a major problem compared to the situation when patients are deeply sedated. Not being able to communicate created feelings of losing power and control.
Aims: The aim was to describe patients’ communication during a video - recorded interview while undergoing mechanical ventilation treatment.
Methods: Fourteen patients treated with no or light sedation while receiving ventilator treatment was interviewed and video recorded. A quantitative content analysis was used focusing on how the patients communicated. Each type of communicative strategy the patients used during the recording was registered and counted.
Results: The patients developed individual styles of communication while on the ventilator, but there were common characteristics. All the patients nodded and shook their head; except two who blinked.
Most of the patients used aids such as pen and paper, although some were unable to write due to injuries caused by trauma, disease or shaky hands. The patients gesticulated and used facial expressions to varying extent. Some frowned and raised their eyebrows but some had the same facial expression during the interview. Only one of the four patients with oral endotracheal tube mouthed and three nasally intubated mouthed their answers during the interview.
Conclusions: Patients developed their own individual communication patterns which takes time to establish and understood by carer and relatives. Some techniques could easily be taught so that communication can be facilitated. As ability to communicate seems vital for patients’ feelings of security it is important to establish a continuing caring and well- functioning relationship between patients and their carers.
endotracheal suction , normal saline , ventilated pateint
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Endotracheal suction is a corner procedure in the management of secretions in mechanically ventilated patients. Normal saline instillation is used by nurses during treatment of intubated patients within the intensive care unit, usually to enhance sputum yield. Its use is controversial; detrimental effects have been documented and evidence of any benefit is limited. Some studies have suggested routine use be discontinued. This study investigates the effect of endotracheal suction with and without instillation of normal saline on oxygen saturation, heart rate, blood pressure and arterial blood gases in mechanically ventilated patients. An experimental cross over design was adopted. The study was carried out at medical and surgical Intensive Care Units of King Fahad University Hospital. The study sample consists of 25 adult male and female patients. They were randomly assigned to two techniques of suction (with and without instillation of normal saline) participants are randomly assigned to different orderings of treatment. An Observational checklist was developed by the researcher to collect the needed data that covers patients’ demographic data, heart rate, blood pressure, SPO2, and arterial blood gases before & after suction for 5 minutes. The study reveals that there was statistical significant difference between mean heart rate, PCo2, PaO2 and PaO2/FiO2 over time after suction with instillation of normal saline while there was no significant difference between mean heart rate, blood pressure and arterial blood gases among the two techniques of suction. The researcher strongly recommended that saline instillation should not be used as a routine clinical practice and the nurses should consider other interventions to promote secretion clearance include providing adequate systemic hydration, humidification, chest percussion and vibration.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
[Aim] Physical restraint was, in principle, prohibited in a nursing-care setting by the Nursing Care Insurance Law on April, 2000 in Japan, which had partly been in response to some sensational mass media reports on restraint cases and the public mood at that time. Since then, there has been a growing trend, even in a hospital setting, to avoid any physical restraint. However in critical care, minimal physical restraint is inevitable to avoid self-extubation of the tubes for life-support. To provide a clear implementation guideline for this dilemma, the task force conducted a nation-wide survey in Japan and presented a guideline based on the survey data.
[Subjects & Methods] A questionnaire regarding physical restraint was sent to nursing directors of all the hospitals with ICU facilities in 2007. Four hundred and ninety three replies out of 1,188 hospitals surveyed (41.5%) were obtained.
[Results] The percentages of the hospital employing / not employing physical restraint were 94.7 / 1.4 %, respectively. In total, 84.2 % of the hospitals surveyed had handling guidelines in any form for physical restraint, which mostly included ‘starting criteria’ and ‘methods to obtain informed consent’. Fifty percent had ‘criteria to discontinue physical restraint’ and 24.3 % had ‘methods to avoid unnecessary physical restraint’ as well.
[Discussion] An ethically-acceptable consensus has been built in Japan to draft a guideline for physical restraint in the ICU setting. The followings are the contents of the guideline currently posted at the web site of the society. 1. Basic concept of physical restraint, 2. Criteria to place, 3. Methods to place, 4. Practical tube management including removal. The guideline should be further evaluated for the utilization in hospital care.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Present ICUs are primarily developed from a medical and technological view and not attuned to present insights about what environmental factors may have on the ICU patients’ recovery processes. Present ICU environments can per se lead to development ICU delirium/syndrome, which leads to a longer ICU-stay, hospitalization and in some cases deaths. We therefore questioning existing ICU design practices and pose an overall research question; if a specially designed patient room in an ICU affects the people who stay there, i.e. patients, next of kin and staff compared to an ordinary ICU patient room.
Aim: This presentation will describe the process of the planning, implement and the testing of a research design of an intervention study performed in an ICU.
Methods: The project has an experimental design.
Results: The intervention consists of the construction of one patient room in an ICU. The planning took place during the years 2008-2010 and started with a review of literature describing physical environments in hospitals. The intervention study involves co-operation among scholars from architecture, environmental medicine and experts from companies within the health care area as well as ICU care practitioners. The intervention room was refurbished according to principles of evidence-based design regard to sound, light, shape and access to nature. New and innovative products, e.g. bed linen in ecological textile materials, cyclic lightning and sound absorbents were installed. Examples of the interior shaping of the intervention room will be presented as well as the planning and implementation process.
Conclusion: There is a great challenge in developing research programs that create healing environments that are more conductive to patients’ recovery processes, next of kin and staff.
