Hasil untuk "Nursing"

J. Duchscher

Cristina Alfonso-Arias, Mireia Llaurado-Serra, Encarna Rodríguez-Higueras et al.

Abstract Background Safe medication administration is a core competence that nursing students need to acquire during their training. Clinical simulation facilitates the integration of theoretical and practical knowledge in a safe environment, facilitating engagement and greater confidence. However, it is important to integrate students’ perceptions to optimize their learning experience to achieve the desired learning outcomes. The purpose of this study was to explore nursing students’ perceptions about the use of clinical simulation to teach safe medication administration. Methods Descriptive qualitative study through focus groups with nursing students who had participated in simulation-based training on safe medication administration where they had been split into two groups that differed only on the degree of fidelity (low fidelity mannequin or standardized patient). Four focus groups were conducted with 24 nursing students who had participated in simulation-based training on safe medication administration. Group discussions were transcribed and subjected to thematic analysis. Results Two themes with four subthemes emerged. Theme (1) Usefulness of the clinical simulation for acquiring competence in safe medication administration; included three subthemes. Students reported that simulation-based training helped them link theory and practice, increasing self-awareness of their medication competence and highlighting the importance of training in safe medication administration. Theme (2) “Elements of simulation design that foster learning”; included one subtheme. Students highlighted that having to work individually heightened their sense of responsibility and enabled them to identify their current strengths and weaknesses. The opportunity to observe classmates was seen as useful for learning from mistakes. Conclusions The results of this study support the use of clinical simulation to teach nursing students the process of safe medication administration, although it is important that learning scenarios are adapted to students’ level of experience and competence.

Yafang Deng, Liping Wu, Linlin Cao et al.

Aims: This study aimed to construct a core competency index system for breastfeeding consultant nurses based on the Onion Model to improve their consulting abilities and promote breastfeeding rates. Design: This study adopted a phenomenological approach to explore the experiences of breastfeeding consultant nurses and lactating women through semi-structured interviews. The Delphi method was then used for expert validation of the initial competency framework. We focused on the core competencies of nurses and midwives who provide breastfeeding consultation in clinics, maternity wards, and Internet hospitals in China to improve their breastfeeding consultation ability and promote the improvement of breastfeeding rates. Methods: Through a literature review, competency items were extracted based on the clinical competencies of International Board-Certified Lactation Consultants (IBCLCs), and an initial competency framework was developed. In this study, 18 breastfeeding consultant nurses and 11 lactating women participated in semi-structured interviews to provide in-depth feedback on their experiences and challenges in breastfeeding consultation. Two rounds of Delphi expert consultations were conducted, and the Analytic Hierarchy Process (AHP) was used to determine the core competency indices and their weights. Results: The final core competency index system for breastfeeding consultant nurses in China consisted of four first-level, 15 ​second-level, and 95 third-level indices. The positive coefficients of the two rounds of expert consultation were both 100%; expert authority (Cr ​= ​0.92) was high, and Kendall's W values were 0.206 (χ2 ​= ​293.69) and 0.296 (χ2 ​= ​62.07), with statistical significance (P ​< ​0.01). The weight rankings of the first-level indices were as follows: core knowledge and skills (0.3498), professional ability (0.2858), maintenance of professional standards (0.1915), and professional and personal traits (0.1728). All consistency tests were passed (CR ​< ​0.10). Conclusions: The core competency index system for breastfeeding consultant nurses developed in this study is scientifically grounded, systematic, and authoritative. It provides strong support for the education and practice of breastfeeding consultant nurses in China and offers a theoretical foundation and practical framework to improve breastfeeding rates and nursing quality.

Brittney van de Water, Madelyn McLean, Colin Knutson et al.

Students often seek opportunities to enrich their classroom learning. Providing students the chance to engage in research studies or global health projects allows for experiential enrichment. However, the impact on partners and partner sites, financial implications, and equity of student opportunity, as well as the logistical burden potentially placed on multiple parties, all need to be considered. If challenges are minimized, students can make meaningful contributions to projects, be a catalyst for partner engagement, and allow for formative learning.

Hui Yang, Xi-Xi Wan, Hui Ma et al.

BackgroundPatients with critical illness often develop low skeletal muscle mass (LSMM) for multiple reasons. Numerous studies have explored the association between LSMM and mortality. The prevalence of LSMM and its association with mortality are unclear. This systematic review and meta-analysis was performed to examine the prevalence and mortality risk of LSMM among critically ill patients.MethodsThree internet databases (Embase, PubMed, and Web of Science) were searched by two independent investigators to identify relevant studies. A random-effects model was used to pool the prevalence of LSMM and its association with mortality. The GRADE assessment tool was used to assess the overall quality of evidence.ResultsIn total, 1,582 records were initially identified in our search, and 38 studies involving 6,891 patients were included in the final quantitative analysis. The pooled prevalence of LSMM was 51.0% [95% confidence interval (CI), 44.5–57.5%]. The subgroup analysis showed that the prevalence of LSMM in patients with and without mechanical ventilation was 53.4% (95% CI, 43.2–63.6%) and 48.9% (95% CI, 39.7–58.1%), respectively (P-value for difference = 0.44). The pooled results showed that critically ill patients with LSMM had a higher risk of mortality than those without LSMM, with a pooled odds ratio of 2.35 (95% CI, 1.91–2.89). The subgroup analysis based on the muscle mass assessment tool showed that critically ill patients with LSMM had a higher risk of mortality than those with normal skeletal muscle mass regardless of the different assessment tools used. In addition, the association between LSMM and mortality was statistically significant, independent of the different types of mortality.ConclusionOur study revealed that critically ill patients had a high prevalence of LSMM and that critically ill patients with LSMM had a higher risk of mortality than those without LSMM. However, large-scale and high-quality prospective cohort studies, especially those based on muscle ultrasound, are required to validate these findings.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022379200.

Renan Sallazar Ferreira Pereira, Cecília Angelita dos Santos, Adriano Marçal Pimenta

ABSTRACT Objectives: to analyze the temporal trend of accidents due to percutaneous exposure in a public hospital in Brazil, between 2007 and 2019, according to sociodemographic and professional characteristics. Methods: analysis of time series of accidents due to percutaneous exposure that occurred in health workers. Sociodemographic and professional variables, accident profile, post-accident behavior and accident incidence rates were evaluated. The Prais Winsten regression was used for trend analysis and calculation of the annual percentage change, with a significance level of 5%. Results: 761 occupational accidents were recorded. There was a downward trend in the rate of percutaneous injuries among female workers (-0.012%; p=0.009), who had secondary education (-0.011%; p=0.035) and among all health professional categories (-0.010%; p =0.019). There was an increasing trend (0.018%; p= 0.050) among workers with ≥ 61 months of professional experience. Conclusions: the analysis showed a decreasing incidence of percutaneous accidents, which can be explained by multiple factors.

Hee-Soon Juon, Donna T. Sheler, Jane Pan et al.

Hepatitis B vaccination protects newborns from contracting the hepatitis B virus that may lead to chronic infection, liver failure, or death. Trends and racial differences in the administration of the hepatitis B (HepB) birth dose in 2018–2020 were examined in the targeted region. A retrospective analysis of electronic birth dose vaccination data of newborns in 2018–2020 was performed. Birth data from six birthing facilities and home delivery records were obtained from the DC Health Department Vital Statistics Division. This data represented 40,269 newborns and included the mother’s race and ethnicity, health insurance type, birthing facility, and administration of the HepB birth dose. Descriptive analysis and multivariable logistic regression analysis were conducted. In addition, subgroup analysis by health insurance type was also conducted with a significant interaction of race/ethnicity and health insurance type. A total of 34,509 (85.7%) received the HepB birth dose within 12 h or before discharge from the facility. The rates of birth dose vaccination have seen an increase over the 3-year period (83.7% in 2018, 85.8% in 2018, 87.7% in 2020, <i>p</i> < 0.01). Multivariable logistic regression analysis revealed racial differences in HepB birth dose vaccination rates. Asian Americans had the highest rate of newborn vaccination consistently over the 3-year period. Conversely, African American infants were less likely to have the birth dose than non-Hispanic Whites (aOR = 0.77, 95% CI: 0.71–0.83). Our research indicates that further studies are needed to explore HepB birth dose hesitancy among African Americans.

Fellipe Roncholeta Santos, Matheus Vissoci Lima, Nathan Medeiros Fresneda et al.

A Síndrome de Klinefelter (SK) é definido geneticamente pela duplicação do cromossomo X, sendo a causa mais comum de hipogonadismo masculino. Cursa com alterações tardias que se tornam perceptíveis após a puberdade, sendo uma delas a infertilidade. Representa uma das principais causas de infertilidade masculina e hipogonadismo hipergonadotrófico, azoospermia e hipodesenvolvimento dos caracteres sexuais secundários. O objetivo deste relato é motivado pela apresentação clínica e diagnóstico tardios com síndrome rara de infertilidade, feminização e implicações biopsicossociais associado ao diagnóstico incidental de tumor de estroma gonadal. JCO, 41 anos, masculino, foi encaminhado ao endocrinologista para avaliação de ginecomastia. Queixavase de dor em região mamária, com piora progressiva há 1 ano, acompanhado de aumento do volume mamário bilateral e diminuição de libido. Sem antecedentes pessoais de relevância clínica ou uso de medicação contínua. Ao exame físico: Altura de 1,82m, peso de 77kg e IMC de 23,2kg/m2 . PA: 120x80 mmHg, FC: 80 bpm, FR: 20 irpm, Temperatura axilar: 36,4ºC. Acianótico, anictérico, normocorado, ginecomastia bilateral, ausência de galactorréia à expressão mamilar, distribuição de pelos normal e volume testicular reduzido. Exames laboratoriais: FSH 36,0 UI/L; LH 17,0 UI/L; PRL 12,0 ug/L; Testosterona total 214; Testosterona livre 6,0; Espermograma com oligospermia. USG testicular com dimensões reduzidas (testículo direito com 1,9 cm3 e testículo esquerdo 1,4 cm3 ), nódulos testiculares bilaterais e microlitíase testicular bilateral. Solicitado cariótipo com pesquisa de banda G, o qual teve como resultado 47, XXY (forma clássica), confirmando o diagnóstico de SK. Encaminhado ao urologista, onde o tratamento realizado foi orquiectomia bilateral com colocação de prótese, com diagnóstico de tumor de células de Leydig. O tratamento consistiu na reposição hormonal utilizando Undecilato de Testosterona intramuscular. Após o início do tratamento o paciente apresentou melhora significativa da libido e disposição geral, além de maior estabilidade emocional. A partir do presente relato, conclui-se que a SK tem como quadro clínico clássico: ginecomastia com dor e aumento bilateralmente e atrofia testicular. A redução dos níveis plasmáticos de testosterona são indutores da ginecomastia. Apesar de não ser totalmente conhecido o mecanismo de deficiência androgênica que ocorrem pela evolução da SK, o curso da patologia inclui imaturidade das células de Sertoli e hiperplasia das células de Leydig e do interstício, favorecendo o aparecimento de tumores testiculares. A degeneração dos túbulos seminíferos tem característica progressiva com o aumento da idade. Os tumores de células de Leydig são a variante mais frequente dos tumores não germinativos do testículo, que são bastante raro.

Emanoelle Aparecida Palangani, Victor Barbosa Assis, Yago Felyppe da Silveira Alvim Sant'ana et al.

As doenças cardiovasculares, como a cardiopatia isquêmica, são um relevante problema de saúde pública no Brasil e no mundo, com altas taxas de incidência e mortalidade. Esse impacto pode ser explicado devido a modificação da estrutura etária populacional, e também a maior prevalência de exposição aos fatores de risco, tais como sedentarismo, aumento da prevalência da obesidade, tabagismo e aumento do consumo de uma alimentação não equilibrada. O presente trabalho tem como objetivo, mostrar o estudo epidemiológico no estado de São Paulo relacionado às condições de vida que levam a internação por infarto agudo do miocárdio. Foi feito coleta e análise de dados do DATASUS, recorrendo ao intervalo entre 2010 a 2019. Como critérios de exclusão, foram retirados dados de pacientes com menos de 40 anos e de etnia indígena, pois faltavam informações ou apresentavam resultados irrelevantes para o estudo. Em consideração ao número de óbitos por infarto agudo do miocárdio no estado de São Paulo, que se totaliza em 23.998, foi possível destacar a predominância do sexo masculino (56,09%), com 13.462 mortes, enquanto que o sexo feminino (43,90%), apresentou 10.536. Com base na faixa etária, o intervalo de 40-49 anos (5,09%), representou 1.223 óbitos; 50-59 (16,29%), com 3.910 óbitos; 60- 69 (27,75%), com 6.660 óbitos; 70-79 (29,37%), com 7.049 óbitos; e 80 anos e mais (21,48%), apresentou 5.156 óbitos. Também foi analisado a influência da cor/etnia sobre essa condição, verificando que os pacientes brancos (73,71%) foram mais acometidos por essa patologia, sendo 17.691 mortes; seguidos pelos pardos (21,73%), com 5.217 mortes; e pacientes negros (4,54%), com 1.090 mortes. Além disso, observou-se o aumento no número de óbitos por infarto agudo do miocárdio (37,54%), onde no ano de 2010 ocorreram 2.083 mortes, enquanto que em 2019 aumentou para 2.865. Diante disso, é possível enfatizar o perfil epidemiológico das mortes associadas com essa patologia, sendo homens brancos, entre 70-79 anos, o grupo mais acometido. Assim como, o aumento da mortalidade, o que pode estar associado com as mudanças no estilo de vida da população e a carência da infraestrutura necessária para atender esses pacientes. Verifica-se a necessidade da criação de diretrizes clínicas adaptadas para os grupos de risco, com o intuito de realizar diagnósticos precoces e manejos mais efetivos, objetivando a redução da mortalidade no estado de São Paulo.

Farzad Sarshivi, Ebrahim Ghaderi, Arman Sarshivi et al.

Spinal anesthesia (SA) may impair thermoregulatory control, which may result in shivering, which is a potentially harassing complication. The aim of the current study was to evaluate the prophylactic effects of intravenous ketamine on the prevention of shivering in patients who underwent elective cesarean section (CSs) under SA. In this double-blind, randomized placebo controlled trial, a total of 90 parturients under SA using hyperbaric bupivacaine 12.5 mg were allocated in two groups to receive ketamine 0.3 mg/kg or 0.9% saline following delivery. After induction of SA, patients were observed for the incidence and intensity of shivering using a four-point scale. Shivering was observed in 24 patients (53.3%) in the saline group and 15 patients (33.3%) in the ketamine group. Median (quartiles 1 and 3) of the intensity of shivering was 1 (0-2) and 0 (0-2) in saline and ketamine groups, respectively. Time from spinal anesthesia to the beginning of shivering was 33.1±11.7 min in saline versus 41.6±20.7 min in the ketamine group. The incidence of nausea, vomiting, hypotension, and bradycardia was not different between the groups. A significantly higher incidence of nystagmus and sedation was observed in the ketamine group when compared with the saline group administration of low dose i.v. Ketamine (0.3 mg/kg) was effective in lowering shivering intensity during CSS under spinal anesthesia, though side effects such as nystagmus and sedation may restrict its effectiveness.

Juan Francisco Jiménez García, Gabriel Aguilera Manrique, Francisco González Jiménez et al.

RESUMEN Objetivo: Describir y analizar el rol clínico de la enfermera de práctica avanzada en heridas crónicas complejas (EPA-HCC) en Andalucía, en cuanto al seguimiento de pacientes con heridas crónicas. Métodos: Estudio descriptivo transversal en los distritos Poniente de Almería, del A.G.C. Jaén Norte-Nordeste, A.G.S. Serranía de Málaga y Distrito Metropolitano de Granada entre junio del 2015 y junio del 2018, midiendo variables descriptivas como: diagnóstico etiológico de las heridas crónicas, tiempo de evolución antes de ser remitidos a EPAHCC, tasas de cicatrización, mejoría, empeoramiento, total de heridas crónicas, tasas de derivación desde EPA-HCC a hospitales. Resultados: Se realizó seguimiento de un total de 767 personas con heridas crónicas, donde el 70% de todas ellas fueron úlceras por presión, úlceras venosas y lesiones de pie diabético, con una media de evolución de todas las lesiones de 21 meses y cuya derivación por parte de las EPA-HCC hacia los especialistas hospitalarios fue del 13,82%, siendo más del 86,18% (n = 661) de los pacientes gestionados de forma eficaz por las EPA-HCC. La derivación directa de los pacientes a consulta de especialistas médicos desde la implantación de la figura fue tan solo del 5%, con el importante ahorro en coste que esto supuso; además, las EPA-HCC atendieron a casi una de cada 4 heridas crónicas, datos estos que solo hicieron referencia a la atención directa, no de consultoría. Conclusiones: El rol clínico y coordinación que desempeñaron las EPA-HCC en los pacientes con heridas crónicas es efectiva en la mejora de los cuidados.

J. Sheehan, G. Roberts

Lynda Juall Carpenito‐Moyet

P. Chinn

P. Kemper, C. Murtaugh

Margaret A. Newman, A. Marilyn Sime, Sheila A. Corcoran-Perry

Yunita Sari, Iwan Purnawan, Agis Taufik et al.

Background: Diabetic foot ulcer will cause a reduction in quality of life (QOL), high care burden, and even mortality. An assessment of QOL and associated factors in patients with diabetic foot ulcer is important to provide evidence for establishing a care plan program for such patients. However, up to the present, there is no evidence of a published study that investigates the QOL and its associated factors in patients with diabetic foot ulcer in Indonesia. Purpose: The purpose of this study was to investigate the QOL in patients with diabetic foot ulcer in each domain and investigate the factors associated with this condition. Methods: The design of this study was a cross-sectional study. The total sample for this study was 55 patients. The QOL data were collected using a Diabetic Foot Ulcer Scale questionnaire. Statistical analyses were conducted using Mann-Whitney U-test and Kruskal-Wallis test. Results: The result showed that the QOL in the domains of emotions, positive compliance, family life, and friend were high, while the QOL in the domains of daily activities, physical health, leisure, finances, positive attitude, and treatment ranged from low to average. Significant differences were found between income (p=0.004), grade of the wound (p=0.047), number of wounds (p=0.029), and blood glucose (p=0.013) with QOL of patients. Other variables did not have a significant relationship with QOL, but marital status had a significant correlation with the domain of leisure (p=0.004) and duration of the ulcer had a significant correlation with the domain of emotions (p=0.001) Conclusion: There is a correlation between income, grade of the wound, the number of wounds, and blood glucose with QOL of patients with a diabetic foot ulcer. This study recommends to take into account economic status, grade and number of wound, and blood glucose level in order to improve the QOL of patients for an effective patient care plan.

J. Avorn, S. Soumerai, D. Everitt et al.

R. Nieswiadomy

Alireza Irajpour, Fatemeh Nazari, Mousa Alavi

Introduction: Educational programs are designed to meet learners’ educational needs. Therefore, needs assessment is the first step in educational planning which could increase learners’ participation in designing educational programs and improve the quality of programs. Therefore, the purpose of this study was to describe the educational needs of Isfahan emergency centers staff and emergency nurses of teaching hospitals affiliated to Isfahan University of Medical Sciences (IUMS) in 2012. Methods: The statistical population of this cross-sectional survey consisted of all the emergency nurses of teaching hospitals affiliated to IUMS and Isfahan emergency centers staff. Totally, 310 people were selected through census method. The data was collected through a valid and reliable researcher-made questionnaire. Descriptive statistical tests were used to analyze the data. Results: The means and SDs of the subjects’ age, work experience and work experience in emergency units were 33.3±7.1, 9.76±7.4 and 5.24±4.63 respectively. Moreover, the means and SDs of the five dimensions of educational needs including management, relationships, appraisal skills, equipment and practical skills were 5.28±2.1 (total=10), 6.1±2.2 (total=10), 8.1±3 (total=15), 2.6±1.3 (total=5) and 63.2±19.8 (total=75) respectively. Conclusion: It is necessary to take into account the educational needs of the emergency units staff which include five main categories namely management, relationships, appraisal skills, equipment and practical skills. Future research employing both qualitative and quantitative methods is recommended to examine each of these dimensions in greater depth.