Current Issue : April-June Volume : 2022 Issue Number : 2 Articles : 5 Articles
Background: The early integration of palliative care in the emergency department (ED-PC) provides several benefits, including improved quality of life with optimal comfort measures, and symptom control. Whether palliative care could affect the intensive care unit admissions, hospital care and resource utilization requires further investigation. Aim: To determine the differences in inpatient characteristics, hospital care, survival, and resource utilization between patients receiving palliative care (ED-PC) and usual care (UC). Design: Retrospective observational study. Setting/participants: We enrolled consecutive, acute, critically ill patients admitted to the emergency intensive care unit at Taipei Veterans General Hospital from 1 February 2018 to 31 January 2020. Results: A total of 1273 patients were evaluated for unmet palliative care needs; 685 patients received ED-PC and 588 received UC. The palliative care patients were more severely frail (AOR 2.217 (1.295–3.797), p = 0.004), had functional deterioration with three ADLs (AOR 1.348 (1.040–1.748), p = 0.024), biopsychosocial discomfort (AOR 1.696 (1.315–2.187), p < 0.001), higher Taiwan Triage and Acuity Scale 1 (p = 0.024), higher in-hospital mortality (AOR 1.983 (1.540–2.555), p < 0.001), were four times more likely to sign an DNR (AOR 4.536 (2.522–8.158), p < 0.001), and were twice as likely to sign an DNR at admission (AOR 2.1331.619–2.811), p < 0.001). Palliative care patients received less epinephrine (AOR 0.424 (0.265–0.678), p < 0.001), more frequent withdrawal of an endotracheal tube (AOR 8.780 (1.122–68.720), p = 0.038), and more narcotics (AOR1.675 (1.132–2.477), p = 0.010). Palliative care patients exhibited lower 7-day, 30-day, and 90-day survival rates (p < 0.001). There was no significant difference in the hospital length of stay (LOS) (21.2 26.6 vs. 21.7 20.6, p = 0.709) nor total hospital expenses (293,169 350,043 vs. 294,161 315,275, p = 0.958). Conclusion: Acute critically ill patients receiving palliative care were more frail, more critical, and had higher in-hospital mortality. Palliative care patients received less epinephrine, more endotracheal extubation, and more narcotics. There was no difference in the hospital LOS or hospital costs between the palliative and usual care groups. The synthesis of ED-PC is new but achievable with potential benefits to align care with patient goals....
Background: When family members and/or patients behave in a problematic way, this hinders the provision of safe and secure medical care. During the perinatal period, a family’s relationships and functions change significantly, and each family member is prone to experiencing stress. As such, conflict arises easily between family members and medical staff. Aims: Therefore, we conducted this study to shed light on the following phenomena: 1) family members’ problematic behaviors; 2) the concerns of a perinatal ward nurse manager (hereafter referred to as the manager) and ward nurses; and 3) countermeasures carried out by the manager, together with the ward nurses, based on the manager’s experiences. Methods: We conducted an 80-minute, semi-structured interview with the manager, following which we analyzed the content of her narrated accounts. Results: According to the findings, 1) family members’ problematic actions include verbal abuse; arrogance, unreasonableness, and selfish behaviors; and violent conduct; 2) the manager’s and ward nurses’ fears and worries about family members’ problematic behaviors; responses to gradually becoming involved with family members; and resistance to staying involved with family members following patient discharge. In addition, we examined 3) countermeasures carried out by the manager together with the ward nurses: resolute and consistent responses to family members’ problematic behaviors; attempted enforcement measures taken to deal with family members who exhibit problematic behaviors; engagement while trying to avoid conflict with family members; preparation that anticipates the occurrence of problematic conduct; cooperation with the medical team; cooperation with the hospital organization; cooperation with social resources outside the hospital; and patient protection..................
Objective: This article examines what the adoption and use of advanced medical technologies – computed tomography (CT) and magnetic resonance imaging (MRI) – by public hospitals depend on and to what extent. Methods: From a sample of panel data for all public hospitals in the health service of Galicia (a subregion of the Galicia-North of Portugal Euroregion) for the 2010–2017 period, we grouped explanatory variables into inputs (resources), outputs (activities) and socio-demographic variables. Factor analysis was used to reduce as much as possible the number of analysed variables, discriminant analysis to examine the technologies adoption decision, and multiple regression analysis to investigate their use. Results: Factor analysis identified motivators on adoption and use of CT and MRI medical technologies as follows: hospital inputs/outputs (Factor 1); radiology studies and adoption of CT by public hospitals (Factor 2); research/ teaching role and big-ticket diagnostic and therapeutic (lithotripsy) technologies (Factor 3); number of transplants (Factor 4); cancer diagnosis/treatment (Factor 5); and catchment area geographical dispersion (Factor 6). Cronbach’s alpha of 0.881 indicated an acceptable degree of reliability of the factor variables. Regarding adoption of these technologies, Factor 1 is the most influential, explaining 37% of the variance and showing adequate global internal consistency, whereas Factor 2 is limited to 13% of the variance. In the discriminant analysis, values for Box’s M test and canonical correlations such as Wilks’s lambda for the two technologies underpin the reliability and predictive capacity of the discriminant equations. Finally, and according to the regression analysis, the factor with the greatest influence on CT and MRI use is Factor 2, followed by Factors 1 and 3 in the case of CT use, and Factors 3 and 5 in the case of MRI use. Conclusion: CT and MRI adoption by public hospitals is mainly determined by hospital inputs and outputs. However, the use of both medical technologies is mainly influenced by conventional radiology studies and CT adoption. These results suggest that both choices – adoption and use of advanced medical technology – may be separate decisions as they are taken possibly by different people (the former by managers and policymakers and the latter by physicians)....
Background of the study: Catheter-associated urinary tract infection (CAUTI) is the most prevalent healthcare-associated infection worldwide, according to reports. Nurses are also accountable to acquire appropriate knowledge and practices of catheter care that will prevent UTI. Nurses’ knowledge is seen to be one of the most important factors in their practice. Aim of the study: To assess the nurse’s knowledge toward the prevention of catheter-associated urinary tract infection in public hospitals at Amran City. Methods: A descriptive cross-sectional study was conducted among nurses at public hospitals in Amran City, Yemen. A convenience sampling technique was of the study consisted of 93 nurses from different public hospitals that were participated in this study. Self-administered questionnaire was used to collect data from March 2021 to April 2021. Results: The distribution of nurses’ ware female 65.6%, belonged to age group between (25 to <30 years) 43.0%. The Diploma degree was the most available qualification 88.2%, 81.7% between 1 - 5 years’ experience as nurses. Knowledge regarding prevention of catheter-associated urinary tract infection was fair 72%, while 18.3% had a good. There is a significant statistical difference between knowledge level regarding prevention of CAUTI, and sex (P-value = 0.042). Conclusion: Most of nurses had fair knowledge level regarding prevention of catheter-associated urinary tract infection. Recommendations: We recommended increasing the knowledge of nursing staff through the courses training, workshop, and curriculums....
Background: With Electro-Convulsive Therapy (ECT) during the COVID-19 pandemic at risk, nurse administered ECT has become a treatment resource. This study aims to investigate the experiences of two senior ECT nurses practicing Nurse Administered ECT. Method: Qualitative reflective interviews were conducted; the data was then analyzed and presented as corresponding themes for inductive data driven analysis. Each nurse was asked to recall positive and negative events from their practice and describe how their experiences have enabled them to cope. Results: Theme 1: The nurse’s competence is positively influenced by feedback, leading to enhancement of personal and professional development. Theme 2: During the COVID-19 pandemic, nurses report an increased sense of teamwork among staff, and feel that “we are all in this together”. Theme 3: The nurse’s ability to manage difficult situations is dependent on their education, individual knowledge, and experience. Limitations: The authors had the role of both researcher and participant. Conclusion: This study found that both nurses valued feedback above any medical and technical skills they had acquired. This strengthened their advanced practice enabling them to handle difficult situations with confidence. The COVID 19 pandemic has led to advanced nursing practice replacing the junior doctor role within ECT treatment. The nurses felt this had been recognised by their organisation and has led to an increased pride in their work. This paper would suggest that Nurse administered ECT is a valuable resource and that, future nurses could be at the forefront of delivering ECT services....
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