Academic literature on the topic 'Clinical Nursing: Secondary (Acute Care)'
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Journal articles on the topic "Clinical Nursing: Secondary (Acute Care)"
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Kalánková, Dominika, Daniela Bartoníčková, Ewelina Kolarczyk, Katarína Žiaková, and Agnieszka Młynarska. "Factors Contributing to Rationed Nursing Care in the Slovak Republic—A Secondary Analysis of Quantitative Data." International Journal of Environmental Research and Public Health 19, no. 2 (January 8, 2022): 702. http://dx.doi.org/10.3390/ijerph19020702.
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Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses’ experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.
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Mc Lernon, Siobhan, Philip S. Nash, and David Werring. "Acute spontaneous intracerebral haemorrhage: treatment and management." British Journal of Neuroscience Nursing 18, no. 3 (June 2, 2022): 116–24. http://dx.doi.org/10.12968/bjnn.2022.18.3.116.
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Acute spontaneous intracerebral haemorrhage is a devastating form of stroke, with high rates of mortality and disability in survivors. Despite the burden of intracerebral haemorrhage, there remain few effective treatments that improve the patient outcome when compared to ischaemic stroke. Nonetheless, patients still benefit from specialist stroke unit care, including early interventions to prevent complications. Therapeutic nihilism should be avoided during the acute phase, as well as early care limitations. A proactive multi-targeted approach based on therapeutic strategies to prevent early haematoma expansion and attenuation of secondary brain injury are likely to be important in improving patient outcomes.
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Gott, Merryn, Christine Ingleton, Michael I. Bennett, and Clare Gardiner. "Transitions to palliative care in acute hospitals in England: qualitative study." BMJ 342 (2011): d1773. http://dx.doi.org/10.1136/bmj.d1773.
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Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.Design Qualitative study.Setting Secondary or primary care settings in two contrasting areas of England.Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with “false hope” of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of “standing back” in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.
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Rountree, W. Donald. "The Hemopump Temporary Cardiac Assist System." AACN Advanced Critical Care 2, no. 3 (August 1, 1991): 562–74. http://dx.doi.org/10.4037/15597768-1991-3020.
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The Hemopump temporary cardiac assist system is currently in clinical trials at several centers across the United States and abroad. Patients with postcardiotomy low cardiac output or patients with cardiogenic shock secondary to acute myocardial infarction may greatly benefit from this device. Theory of pump operation, patient selection, and nursing management is discussed. Presentation of a case study demonstrating the effect of Hemopump support will be provided. A detailed nursing care plan as well as application of research findings to clinical practice will be outlined. As cardiovascular technology progresses, the critical care nurse must continue to be involved in all aspects of patient care. The Hemopump may prove to be a highly beneficial mode of ventricular assistance for patients with inadequate cardiac function
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Yang, Meijuan, Lijiao Chen, Min Zhang, Xiaoling Huang, Wenjun Zhao, and Hui Wang. "Evidence-Based Nursing Model in Interventional Thrombolysis for Acute Lower Extremity Arterial Embolism." Contrast Media & Molecular Imaging 2022 (May 25, 2022): 1–9. http://dx.doi.org/10.1155/2022/4488797.
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Acute lower extremity arterial embolism (AE) is a serious clinical emergency, and, if not treated in time, it can easily lead to limb ischemia and necrosis and eventually facing amputation, which seriously damages patients' physical and mental health. In the past, the conventional drug thrombolytic therapy had slow and limited efficacy, and the best time for treatment is easily delayed, while arterial dissection and thrombectomy treatment, although fast, is traumatic and has many complications, which is not easily accepted by patients. The aim of this study was to investigate the value of evidence-based care model in the application of interventional thrombolysis for acute lower limb arterial embolism. Seventy-two patients with acute lower limb arterial embolism who underwent interventional thrombolysis treatment received by the Department of Vascular Surgery of our hospital from July 2016 to December 2021 were randomly divided into a control group (given conventional nursing services) and a quality group (given full quality nursing services) to compare the effect of nursing services in the two groups. The results showed that the postoperative psychological status of patients in the quality group was significantly better than that of patients in the control group ( P < 0.05 ). The total incidence of postoperative adverse events and the total treatment efficiency of the quality group were better than those of the control group ( P < 0.05 ). The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than conventional nursing care and is recommended. The site of vascular occlusion after bypass surgery can be clarified when angiography is performed after thrombolytic therapy, which can help secondary surgical intervention to prolong the time to patency. The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than that of conventional nursing care and is recommended.
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Tan, Maria, Andrea Adjetey, Catalina Wee, Ian Perry, Chris Corbett, Azeez Olajide, Aaron Yamamoto, James Owen, and Saqib Mumtaz. "Decompensated cirrhosis: targeted training of acute medical teams to improve quality of care in first 24 hours." British Journal of Nursing 31, no. 21 (November 24, 2022): 1112–19. http://dx.doi.org/10.12968/bjon.2022.31.21.1112.
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Background: A quality improvement project in a secondary care centre was initiated to investigate and evaluate the impact of staff education and the use of the British Society of Gastroenterology/British Association for the Study of the Liver cirrhosis care bundle in improving care of patients admitted to hospital with decompensated liver cirrhosis. Method: A staff training programme was implemented, involving around 30 health professionals consisting of consultants, junior doctors, physician associates and nurses from the acute medical unit. A review of electronic documentation and analysis of key clinical parameters, pre- and post-intervention, was carried out. Results: The data show that the intervention has led to an improvement in patient management and clinical outcomes. Conclusion: This project illustrates that collaboration between hepatology and medical teams, with emphasis on education and training, benefits patients who present to hospital with decompensated liver cirrhosis.
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Bourassa, Stephane, Emmanuelle Paquette-Raynard, Daniel Noebert, Marc Dauphin, Pelumi Samuel Akinola, Jason Marseilles, Philippe Jouvet, and Jacinthe Leclerc. "Gaps in Prehospital Care for Patients Exposed to a Chemical Attack – A Systematic Review." Prehospital and Disaster Medicine 37, no. 2 (March 11, 2022): 230–39. http://dx.doi.org/10.1017/s1049023x22000401.
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AbstractIntroduction:The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure to chemicals.Methods:This systematic review was conducted from November 2018 through September 2020 in compliance with Cochrane guidelines. Five databases were used (MEDLINE, Web of Science Core Collection, Embase, Cochrane, and CINAHL) to retrieve studies describing interventions performed to treat victims of chemical attacks (protection, decontamination, and treatment). The outcomes were patient’s health condition leading to his/her stabilization (primary) and death (secondary) due to interventions applied (medical, protection, and decontamination).Results:Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria. According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. No study reported comprehensive prehospital clinical data in acute settings. No mention was made of the integration of specialized capabilities in medical interventions such as personal protective equipment (PPE) and decontamination to prevent a secondary exposure. Unfortunately, it was not possible to perform the planned meta-analysis.Conclusions:This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack. Further research is required to optimize clinical practice integrating mixed capabilities (protection and decontamination) for the patient and medical staff.
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Duncan, Pamela W., Cheryl Bushnell, Mysha Sissine, Sylvia Coleman, Barbara J. Lutz, Anna M. Johnson, Meghan Radman, Janet Pvru Bettger, Richard D. Zorowitz, and Joel Stein. "Comprehensive Stroke Care and Outcomes." Stroke 52, no. 1 (January 2021): 385–93. http://dx.doi.org/10.1161/strokeaha.120.029678.
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Worldwide, stroke is prevalent, costly, and disabling in >80 million survivors. The burden of stroke is increasing despite incredible progress and advancements in evidence-based acute care therapies and despite the substantial changes being made in acute care stroke systems, processes, and quality metrics. Although there has been increased global emphasis on the importance of postacute stroke care, stroke system changes have not expanded to include postacute care and outcome follow-up. Our objectives are to describe the gaps and challenges in postacute stroke care and suboptimal stroke outcomes; to report on stroke survivors’ and caregivers’ perceptions of current postacute stroke care and their call for improvements in follow-up services for recovery and secondary prevention; and, ultimately, to make the case that a paradigm shift is needed in the definition of comprehensive stroke care and the designation of Comprehensive Stroke Center. Three recommendations are made for a paradigm shift in comprehensive stroke care: (1) criteria should be established for designation of rehabilitation readiness for Comprehensive Stroke Centers, (2) The American Heart Association/American Stroke Association implement an expanded Get With The Guidelines–Stroke program and criteria for comprehensive stroke centers to be inclusive of rehabilitation readiness and measure outcomes at 90 days, and (3) a public health campaign should be launched to offer hopeful and actionable messaging for secondary prevention and recovery of function and health. Now is the time to honor the patients’ and caregivers’ strongest ask: better access and improved secondary prevention, stroke rehabilitation, and personalized care.
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Quinn, Charlene C., Anthony Roggio, Barr Erik, and Ann Gruber-Baldini. "NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS." Innovation in Aging 3, Supplement_1 (November 2019): S337—S338. http://dx.doi.org/10.1093/geroni/igz038.1225.
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Abstract New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any change in condition. ED physicians used tablets with secure access to conduct the resident assessment. Provider satisfaction measures imbedded in EMRs were completed at consultation visit end. 460 patients had changes in condition, 327 resulted in 911 calls, 85 deemed eligible for telemedicine consult. Conducted 57 telehealth consults. Forty (70%) telemedicine consult residents remained in the SNF. Fourteen residents were transferred to the ED. Average satisfaction scores were 5.8/7 for SNF nurses (n=49) and 5.6 for ED physicians (n=45). Lower-rated items related to technical equipment problems. ED physicians reported residents transferred to ED after telehealth visit had better continuity of care. The intervention was effective in preventing or delaying transfer of acutely ill, medically complex SNF residents. Implementation of the intervention identified need for SNF admission policy and procedure changes; weekly telemedicine training; SNF clinical advocates; on-site tracking and linkage of EMRs across providers; HIPAA shared medical record concerns. Future research plans include analyses of detailed SNF resident characteristics and business case assessment for reduction of transfers, ED and hospital utilization.
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Wong, Chui King, Glen Chiang Hong Tan, and Mohd Johar Jaafar. "An acute ST-elevation myocardial infarction which went viral." Journal of Emergency Practice and Trauma 8, no. 1 (November 30, 2021): 74–76. http://dx.doi.org/10.34172/jept.2021.27.
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Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications. Case Presentation: A previously well 19-year-old male presented with two episodes of central chest pain which were resolved spontaneously. His presentation was preceded by multiple episodes of vomiting, diarrhoea and abdominal pain. Physical examination was unremarkable except for a low-grade temperature of 37.7°C. The first ECG revealed ST-segment elevations in anterior leads without reciprocal changes. Serial ECGs showed increasing ST elevations and his cardiac markers were significantly raised. As the initial clinical presentation was potentially an acute coronary syndrome, he was instinctively treated with anti-platelets. Fortunately, this patient was not given thrombolysis as there were clinical suspicions of an acute myocarditis due to his young age, presence of viral symptoms, and absence of cardiac risk factors. Subsequent cardiac MRI confirmed the diagnosis of an acute myocarditis. Conclusion: An acute myocarditis is well known but less common presentation of viral infections. ST-segment elevations in ECG of any young patients with chest pain but without risk factors for acute coronary syndrome should always raise the suspicion of acute myocarditis especially in the presence of viral symptoms. Investigations such as cardiac magnetic resonance imaging (MRI) should be carried out emergently to distinguish both conditions.
Dissertations / Theses on the topic "Clinical Nursing: Secondary (Acute Care)"
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Ashcraft, Alyce Louise Smithson. "The clinical reasoning of expert acute care registered nurses in pre-cardiopulmonary arrest events." Thesis, Full text (PDF) from UMI/Dissertation Abstracts International, 2001. http://wwwlib.umi.com/cr/utexas/fullcit?p3008269.
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Osyanju, Bernadette. "Clinical experiences of second year nursing students on their first acute care practicum." Thesis, Osyanju, Bernadette (2012) Clinical experiences of second year nursing students on their first acute care practicum. Honours thesis, Murdoch University, 2012. https://researchrepository.murdoch.edu.au/id/eprint/41683/.
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Acute care units are known to be busy and complex in nature with many stressors of which students find challenging. While some students with prior exposures to these areas are able to cope, special cohorts of young, inexperienced, unexposed students undergo a unique experience. The first acute care practicum is important in nursing education and influences a student‘s long term goal of becoming a nurse.
This study explored the experiences of second year nursing students who did not have prior experience in acute care while undertaking their first acute care practicum. The perceptions of clinical educators on students‘ first acute care practicum was equally explored.
This explorative qualitative study was conducted on a purposive sample of four nursing students and three clinical educators. Data was obtained by conducting audio recorded interviews with clinical educators and nursing students individually, from which verbatim transcripts were derived. Thematic data analysis was employed to interpret the findings and five major themes were identified: experiencing a new environment, situational learning, experiencing stress, supporting students and reflecting on placement allocation. Students and their clinical educators acknowledged there being positive and negative experiences of the practicum that influenced clinical learning.
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings." Thesis, Curtin University, 1997. http://hdl.handle.net/20.500.11937/1517.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings." Curtin University of Technology, School of Nursing, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11092.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++
process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
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Hourigan, Margaret. "Characteristics of the professional, clinical, and administrative information networks evolved by nurse managers in decentralized nursing departments in acute care hospitals /." Access Digital Full Text version, 1989. http://pocketknowledge.tc.columbia.edu/home.php/bybib/10857795.
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Thesis (Ed.D.) -- Teachers College, Columbia University, 1989.Sponsor: Elaine L. La Monica. Dissertation Committee: James E. Corter. Typescript; issued also on microfilm. Bibliography: leaves 158-166.
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Mogan, Susan. "A Clinical Practice Guideline for Pain Management in the Post Anesthesia Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6247.
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Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and professional organizations' guidelines. Nursing practice guidelines were developed and evaluated by 3 expert panelists using the Agree II guidelines. The panelists selected included; Two anesthesiologists, one who is trained in pain management and is also a pharmacist. The third expert is a practicing nurse practitioner in an acute setting who is also a surgical first assist and the associate director of robotics. The panel endorsed the guidelines for advancement through the hospital's review committees. Implementation of the evidence-based pain management guideline in the PACU might provide nurses with tools to guide their interventions and improve patient outcomes. Social changes resulting from the use of evidence-based pain management guidelines include decreased time to opiate administration, decreased adverse effects, improved assessment of pain, and an increase in the number of patients who receive proper pain management.
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Downey, Debora Ann. "The Effectiveness of AAC Training Protocols for Acute Care Nurses| A Randomized Controlled Trial of an Instructional On-line Medium for Clinical Skills Teaching." Thesis, The University of Iowa, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=3628382.
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Acutely ill patients, across the age continuum, often present with complex communication needs (CCN) due to motor, sensory, cognitive and linguistic barriers they may experience during their hospital encounter. While hospital administrators recognize the importance of improving communication among the healthcare team members to increase quality and safety measures, few have focused on improving the patient-provider communication process, especially for patients with CCN. Recent Joint Commission standards mandates hospitals and healthcare providers improve communication for patients with CCN across all points of the care continuum. The study investigated the effectiveness of AAC training protocols for acute care nurses and ancillary healthcare providers using an on-line instructional medium for clinical skills teaching. The study design allowed for the measurement of learning following exposure to the tutorial and the analysis of possible clinical skill application. The current study invited a total of 377 nurses and graduate students to participate. Eight-three participated in the study and were divided randomly into two groups. Seventeen (20.5%) were assigned to in the control group, and 66 (79.5%) participants were into the test group. Both groups were directed to complete a pre-test measure. This was followed by exposure to the tutorial for the test group. The groups then were instructed to complete a post-test measure. For all participants in the test condition, the mean difference score (post-pre) was 19.2. The average pre-test score was 60.8 with a standard deviation of 12.4 while the average post-test score was 80.1 with a standard deviation of 11.3. This difference was significant (p<.00001). This suggests the on-line tutorial as a mode of delivery for clinical skills teaching of AAC solutions for patients with CCN was effective. The study also involved the design of a set of scenarios to assess transfer of knowledge from the tutorial to clinical practice in a safe environment. The scenarios targeted three areas for participants to problem solve through: the development of a yes/no response, recognition of sensory issues displayed by patients with CCN; and, candidacy for AAC use in an acute care setting. The scenarios were presented to both groups after completion of the post-test measure. No significant difference across the groups was noted. However, findings suggested that the use of scenarios may be a viable method for assessing the application of clinical skills when the participant had to generate a narrative outlining clinical practice as opposed being scaffold by the selection of correct and incorrect clinical skill strategies presented. The study emphasizes the need to enhance the patient-provider communication experience for patients with CCN and outlines basic elements for nurse training modules.
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Baker, Melanie Jane. "The application of evidence based practice in the acute care hospital setting: A grounded theory study of the perspective of nurses in Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2377.
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Evidence based practice (EBP) in nursing is an important part of care provision, both in Australia and globally. The experience of applying evidence in practice presents many challenges for nurses. This study focused on the application of EBP in the acute care hospital setting. Grounded Theory methodology was used and 21 semi-structured recorded interviews with Registered Nurses from two acute care hospitals were conducted. Data were analysed using the constant comparative method.
A substantive theory was developed, Traversing the EBP Conundrum, as the process used to manage the core issue: The Challenge of Applying EBP. Time Constraints, Nurses’ Inherent Traits, and The Organisation Talking the Talk but not Walking the Walk, were conditions affecting the nurses’ daily practice. These conditions resulted in a discrepancy between the ideal mandated by the nursing profession and organisations, and the reality of working in a context of Consideration for Quality and Safety. In applying the process, nurses were found to Survive the Conundrum: Navigating Alternative Pathways; by Getting Lost in the Bush: Going Their Own Way; by Scaling New Heights Working Over and Above to Optimise Outcomes.
This study raises questions regarding the quality and safety of patient care, as well as the wellbeing of nurses, and the ideal of EBP which is mandated by professional bodies. The findings lead to recommendations including: further research into the reality of EBP for nurses and its impact upon patient outcomes, safety, nurses job satisfaction and nurse retention; consideration by the professional body as to how realistic professional and organisational expectations of EBP are in nursing; and a review of decision making by leaders in relationship to EBP, therefore quality and safety.
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Hopes, Scott L. "Healthcare IT in Skilled Nursing and Post-Acute Care Facilities: Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations." Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.
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Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013).
Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).
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Myers, Helen. "Fall risk assessment : A prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls in an acute care setting." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1494.
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Falls are a significant problem in acute care, hospital settings, and can have serious consequences, especially for older patients. Fall prevention has therefore been recognised as an important area for research and intervention. In order to target interventions and use resources effectively, a major strategy of many fall prevention programmes has been the development and/or use of risk assessment tools to identify patients who are at high risk of falling. Although many tools have been developed, few have been rigorously tested, and there is currently no evidence to support the clinical utility of fall risk assessment tools. There is a need to conduct further research to establish the efficacy of fall risk assessment tools for inpatient populations. Additionally, nurses clinical judgement in assessing fall risk may aid the development of fall risk assessment protocols and further research is needed to build on limited knowledge in this area. A prospective cohort study was used to evaluate two fall risk assessment tools and nurses' clinical judgement in predicting patient falls. Each patient was assessed for fall risk by the clinical judgement of the nurse caring for the patient and by the researcher using a data collection form containing the two fall risk assessment tools. The study wards comprised two aged care and rehabilitation wards, within a 570 bed acute care tertiary teaching hospital facility in Western Australia. Test-retest reliability of the two fall risk assessment tools and nurses' clinical judgement was established over a twenty four hour period. The ability of the fall risk assessment tools, and nurses' clinical judgements to discriminate between patients with a high probability of falling and , patients with a low probability of falling; was determined by calculating the sensitivity, specificity, positive predictive value and negative-predictive value for each method. The reference criterion used for these calculations was whether or not the patient fell within the hospitalisation period in which they were admitted to the study. In addition, the accuracy of each method was determined by calculating the number of times the risk assessment tool or clinical judgement classified the patient into the correct, fall risk category, expressed as a percentage. The same reference criterion was used for this calculation. Both the fall risk assessment tools and nurses' clinical judgement had good test-retest reliability. When assessing validity, all three methods of determining fall risk showed good sensitivity, ranging from 88% to 91 %,but poor specificity, ranging from 25% to 26%. This meant that the risk assessment methods classified too many patients who did not fall as at high risk for falling. All methods also had limited accuracy, ranging from 35% to 36%, and overall exhibited an inability to adequately discriminate between patient populations at risk of falling and those not at risk of falling. Consequently, neither nurses' clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in the clinical setting. In addition, results indicated that there was a large difference between the accuracy of first year enrolled and registered nurses in assessing patient fall risk. First year enrolled nurses accurately predicted fall risk 44.4% of the time while first year registered nurses achieved an accuracy level of only 8.6%. These results are potentially biased, as measuring differences in accuracy between types of nurses was not a main focus of this study and in many cases the same nurse gave multiple judgements about patients' fall risk. The results however, provide an indication that further study is warranted using a specifically methodology to explore this issue. There are a number of specific recommendations arising from the results of this study. It is recommended that further studies be undertaken to assess the reliability and validity of current fall risk assessment tools in inpatient populations. If no valid and reliable fall risk assessment tool can be identified, research should be undertaken to develop such a tool. It is also recommended that studies be conducted to assess changes in fall risk profiles over time to determine if the sensitivity and specificity of instruments changes depending on the timing of the risk assessment. Differentiating between stable and transient risk factors should be an integral component of these types of studies. Further research is also required to determine if there are differences in fall risk factors between different specialties or if a generic risk assessment tool can be used for all inpatient populations. Additionally, further investigation into the clinical judgement of registered and enrolled nurses in .their first year of clinical practice should be undertaken and results reported to appropriate educational institutions. Changes in accuracy of clinical judgement in the first five years of clinical practice should also be measured.
Books on the topic "Clinical Nursing: Secondary (Acute Care)"
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Deborah, Hamwi, and American Association of Critical-Care Nurses., eds. Acute care nurse practitioner: Clinical reference and certification review. Philadelphia: Saunders, 1999.
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Association, American Nurses', and Research in Marketing Inc, eds. The acute care nurse in transition. Washington, DC: American Nurses Association, 1996.
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Lee, Hooper-Kyriakidis Patricia, and Stannard Daphne, eds. Clinical wisdom and interventions in acute and critical care: A thinking-in-action approach. 2nd ed. New York: Springer Pub., 2011.
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Archibald, Carole. People with dementia in acute hospitals: A practice guide for clinical support workers. Stirling: University of Stirling, Dementia Services Development Centre, 2003.
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Institute of Medicine (U.S.). Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and agent orange: Herbicide/dioxin exposure and acute myelogenous leukemia in the children of Vietnam veterans. 3rd ed. Washington, D.C: National Academy Press, 2002.
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Institute of Medicine (U.S.). Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Update 1998. Washington, D.C: National Academy Press, 1999.
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Veterans and agent orange: Update 2002. 4th ed. Washington, D.C: National Academies Press, 2003.
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Veterans and Agent Orange: Update 2004. 5th ed. Washington, D.C: National Academies Press, 2005.
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Veterans and Agent Orange: Update 2006. 6th ed. Washington, D.C: National Academies Press, 2007.
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Institute of Medicine (U.S.). Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Health effects of herbicides used in Vietnam. Washington, D.C: National Academy Press, 1994.
Find full textBook chapters on the topic "Clinical Nursing: Secondary (Acute Care)"
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Geirsdóttir, Ólöf G., Karen Hertz, Julie Santy-Tomlinson, Antony Johansen, and Jack J. Bell. "Overview of Nutrition Care in Geriatrics and Orthogeriatrics." In Perspectives in Nursing Management and Care for Older Adults, 3–18. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-63892-4_1.
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AbstractEngaging older adults, and all those who care for them, is pivotal to providing high-value nutrition care for older adults. Nurses and other interdisciplinary team members are essential to this process. The aim of this chapter is to provide an overview of the rationale and evidence for interdisciplinary and systematised nutrition care as an effective nutrition care approach for older adults with or at risk of malnutrition. This chapter also serves as a guide to detailed chapters across this book to provide focal points on different aspects of nutrition care that should be considered across primary prevention, acute care, rehabilitation, secondary prevention and community settings (Dreinhöfer et al., Injury 49(8):1393–1397, 2018).
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Bramwell, Donna, Kath Checkland, Jolanta Shields, and Pauline Allen. "2000s: Transforming Community Services." In Community Nursing Services in England, 61–73. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-17084-3_6.
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AbstractThe new millennium saw the publication of The NHS Plan in 2000, which bought a welcome focus to community health services (CHS) and the role of community nursing. We outline the proposals contained in the plan which furthered the quasi-marketisation of the NHS and increased commissioning of health care at the local level of Primary Care Trusts (PCTs)—replacing Health Authorities (HAs) and Primary Care Groups (PCGs). A further review by Lord Darzi and subsequent policy, Transforming Community Services: Enabling new patterns of provision (DoH, 2009) instigated the separation of commissioning/provision and laid out timetables for how PCTs were to do this. The long held roles of the district nursing service continues in this era, although not always clearly defined, understood or acknowledged and policy attempts to expand their remit feature heavily. This included more clinical tasks as well as focusing on such things as public health/health protection and promotion programmes that improve health and reduce inequalities. This chapter also describes the uncertainty for frontline nurses that the Transforming Community Services (TCS) brought in terms of who their employer would be or what management arrangements they would work under given the establishment of some standalone Trusts, some third sector and some combined acute/community Trusts. The aims of the TCS programme were bold but in reality achieved little by the end of the era.
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Saccardi, Riccardo, and Fermin Sanchez-Guijo. "How Can Accreditation Bodies, Such as JACIE or FACT, Support Centres in Getting Qualified?" In The EBMT/EHA CAR-T Cell Handbook, 199–201. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-94353-0_38.
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AbstractThe FACT-JACIE accreditation system is based on a standard-driven process covering all the steps of HSC transplant activity, from donor selection to clinical care. Since the first approval of the First Edition of the Standards in 1998, over 360 HSCT programmes or facilities have been accredited at least once, most of them achieving subsequent re-accreditations (Snowden et al. 2017). The positive impact of the accreditation process in the EBMT Registry has been well established (Gratwohl et al. 2014). Starting with version 6.1, the standards include new items specifically developed for other cellular therapy products, with special reference to immune effector cells (IECs). This reflects the rapid evolution of the field of cellular therapy, primarily (but not exclusively) through the use of genetically modified cells, such as CAR-T cells. FACT-JACIE standards cover a wide range of important aspects that can be of use for centres that aim to be accredited in their countries to provide IEC therapy. Notably, FACT-JACIE accreditation itself is a key (or even a prerequisite) condition in some countries for approval by health authorities to provide commercial CAR-T cell therapy and is also valued by pharmaceutical companies (both those developing clinical trials and those manufacturing commercial products), which also inspect the cell therapy programmes and facilities established at each centre (Yakoub-Agha et al. 2020). Interest in applying for FACT-JACIE accreditation that includes IEC therapeutic programmes is clearly increasing, from four applications in 2017 to 36 applications approved in 2019. The standards do not cover the manufacturing of such cells but include the chain of responsibilities when the product is provided by a third party (Maus and Nikiforow 2017). In any case, all the steps in the process in which the centre is involved (e.g., patient or donor evaluations, cell collection, cell reception, and storage) are covered by the standards, including the appropriate agreements with the internal partners, including the pharmacy department. In addition, from a clinical perspective, IECs may require special safety monitoring systems due to the high frequency of acute adverse events related to the massive immunological reaction against the tumour. Although examples and explanations are found in the standard manual, here, the special importance of identifying and managing cytokine release syndrome (CRS) should be emphasized, and the standards focus not on specific therapeutic algorithms but on ensuring that medical and nursing teams are sufficiently trained in the early detection of this and other potential complications (e.g., neurological complications). They also pay attention to the full-time availability within the institution and its pharmacy of the necessary medication to address complications and the capacitation and involvement of Intensive Care and Neurology Department professionals to provide urgent care if needed. Forthcoming cellular therapy products, currently under investigation, will show a wider range of risk profiles, therefore requiring product-specific risk assessment and consequent adaptation of the clinical procedures for different classes of products. The FACT-JACIE standards will continue to adapt to these future needs to assist centres in their achievement of optimal clinical outcomes.
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Flynn, Maria, and Dave Mercer. "Renal and urinary tract conditions." In Oxford Handbook of Adult Nursing, edited by Maria Flynn and Dave Mercer, 313–38. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198743477.003.0018.
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Renal conditions can be an acute health problem or a debilitating life-limiting condition. Kidney failure can present as a slowly progressing chronic disease (chronic kidney disease) or as acute life-threatening medical emergencies known as acute kidney injury (AKI). People with chronic kidney failure will normally be cared for by specialist nurses and clinical teams working in hospital or community settings. General adult nurses will encounter people with kidney disease in all areas of clinical practice, either as a primary complaint or as a secondary complication of other disorders or treatments. This chapter outlines key facts about kidney disease which are likely to be useful to the general nurse. These include an overview of renal conditions and the principles of renal replacement therapy. Common urinary tract conditions and the management of urinary incontinence are also discussed, as are key nursing considerations when working with people with renal or urinary tract disorders. An overview of frequently prescribed medicines for renal and urinary tract conditions is presented in a summary table.
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Ugboma, Debra, and Helen Willis. "Understanding Renal Disorders." In Adult Nursing Practice. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199697410.003.0021.
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The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with the renal disorders chronic kidney disease (CKD) and acute kidney injury (AKI) in an evidence-based and person-centred way. In recent years, AKI has replaced the term ‘acute renal failure’. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CKD and AKI, before exploring best practice to deliver care, as well as to prevent further progression of these conditions. Nursing assessments and priorities are highlighted throughout, and further nursing management of some of the symptoms and common health problems associated with CKD and AKI can be found in Chapters 6, 9, 15, and 19, respectively. Chronic kidney disease (CKD) is the gradual and usually permanent loss of some kidney function over time (Department of Health, 2007). In CKD, the damage and decline in renal function usually occurs over years, and in early stages can go undetected (Department of Health, 2005a). CKD has rapidly moved up the healthcare agenda in recent years, primarily because of the links with cardiovascular risk, and with a shift in focus away from the treatment of established renal failure towards the detection and prevention of CKD in primary care (O’Donohue, 2009). Glomerular filtration rate (GFR) is an indicator of renal function and is the rate at which blood flows through, and is ‘filtered’ by, the kidney; a normal GFR is approximately 125 ml/min. CKD is classified into five stages according to an estimated glomerular filtration rate (eGFR) and, in the milder stages, further evidence of renal damage such as proteinuria and haematuria. This classification holds regardless of the underlying cause of kidney damage. The understanding of GFR is pivotal to caring for patients with renal disorders. Monitoring, management, and referral of the patient in the earlier stages of CKD became much clearer following the publication of the National Clinical Guidelines for the Management of Adults with Chronic Kidney Disease in Primary and Secondary Care (NICE, 2008a). Many people with stage 3 CKD, unless they have proteinuria, diabetes, or other comorbidity such as cardiovascular disease, have a good prognosis and can be managed in primary care (Andrews, 2008).
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Flynn, Maria, and Dave Mercer. "Gastrointestinal conditions." In Oxford Handbook of Adult Nursing, edited by Maria Flynn and Dave Mercer, 277–312. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198743477.003.0017.
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Gastrointestinal complaints range from mild and transient disorders, through to life-threatening diseases. People with disorders of the gastrointestinal system may be encountered in both hospital and community settings. In the community, people with long-term or other acute health conditions may experience disturbances in their eating patterns or bowel habits, and within the hospital, people having treatment for other diagnosed conditions may develop associated gastrointestinal disorders. People with severe gastrointestinal conditions will often be cared for by specialist nurses, but general adult nurses will encounter people with gastrointestinal disorders in all areas of clinical practice, either as a primary complaint or as a secondary complication of other illnesses or treatments. This chapter outlines key facts about gastrointestinal conditions which are likely to be useful to the general nurse and describes key nursing considerations for working with people with these disorders. An overview of frequently prescribed medicines for gastrointestinal conditions is presented in a summary table.
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Knutson, Lori, and Valerie Lincoln. "Integrative Nursing in Acute Care Settings." In Integrative Nursing, 331–43. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199860739.003.0025.
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Over the past ten years, there has been significant growth in the number of hospitals offering integrative therapies. A strong clinical and business case is emerging that is fueled by consumer demand and the expanding evidence base that demonstrates positive outcomes. Two exemplars of hospitals are highlighted where integrative nursing principles and concepts are deeply woven into the care model. In both institutions highlighted, aligning integrative health with organizational vision, mission and priorities was critical to success. Nurses are well positioned to provide leadership in advancing integrative health and nursing within acute care settings.
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Kumar, Ashok, Sukhpal Kaur, and Dheeraj Khurana. "Role of Nurse in Acute Stroke Management." In Clinical Neurosciences and Critical Care Nursing, 319. Jaypee Brothers Medical Publishers (P) Ltd., 2014. http://dx.doi.org/10.5005/jp/books/12229_24.
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Rajpal, Megha. "Abdominal Distention." In Acute Care Casebook, edited by Julie Mayglothling Winkle, 193–96. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190865412.003.0039.
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This chapter presents the case of a young burn victim who developed secondary abdominal compartment syndrome from fluid resuscitation. It discusses the difference between intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It also reviews the rule of nines to calculate the percentage of body surface area burned and the Parkland formula to calculate fluid requirements in burn victims. Key management points include recognizing that patients receiving aggressive fluid resuscitation are at risk for development of IAH and ACS and knowledge of the clinical signs (low urine output, increased peak pressures, decreased tidal volumes, and hypotension) and risk factors of ACS.
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Creed, Fiona. "Recognition of Acute Deterioration." In Nursing OSCEs. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199693580.003.0018.
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Recognition and prompt treatment of the acutely ill patient is a significant issue in clinical practice (NICE 2007). The need for all nurses to be able to recognize, assess and promptly escalate (ensure timely and effective management) patients whose condition is deteriorating is stressed in the literature (NCEPOD 2005; NPSA 2007). Therefore it is an important skill and your university will want to ensure via OSCE that you are adequately prepared for any emergency that may arise in practice. It must be emphasized that this skill is a complex skill and most universities do not assess this skill until the final year of your course. The key to succeeding in this OSCE is understanding the need for systematic assessment, and timely intervention and escalation will be stressed throughout this chapter. It is likely that you will be allowed approximately half an hour to demonstrate this skill and answer related questions. Revision of key material will enable you to understand why assessment is important and provide you with a systematic framework to use in the OSCE and in clinical practice. Concern over NHS staff ’s management of the deteriorating patient has been highlighted in the literature since the late 1990s. McQuillan et al. (1998) first discussed the concept of suboptimal care suggesting that often deterioration in patients was ignored, misdiagnosed and/or poorly managed in ward environments resulting in increased mortality and morbidity in ward patients. Since McQuillan’s work several other studies have identified similar problems (McGloin et al. 1999; NCEPOD 2005). More recently NICE (2007) has published guidance on recognition and management of deterioration and the Department of Health (2009) has published competencies related to recognition and management of deterioration that all acute staff should achieve. Review of this literature highlights that several issues are clearly important in recognition of acute deterioration and the need to utilize a systematic assessment tool linked to a robust track and trigger scoring system is an important consideration in practice. Smith (2003) was instrumental in developing the ALERT® framework that has been adopted internationally as a robust systematic assessment tool.
Conference papers on the topic "Clinical Nursing: Secondary (Acute Care)"
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Ferreira, Hanna dos Santos, Agata Layanne Soares da Silva, and João Lucas de Sousa Peres. "Fibrinolytic therapy in the treatment of pediatric ischemic stroke." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.033.
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Introduction: Pediatric stroke is a disorder that can result in morbidity and mortality. The ischemic type is the most common and has thrombolytics as the preferred therapy. Objective: To evaluate the therapeutic management and efficacy of fibrinolytics in pediatric patients with ischemic stroke. Methodology: The literature review was carried out in PUBMED, MEDLINE, Embase databases, with the descriptors “Fibrinolytic Agents”, “Thrombolytic Therapy”, “Ischemic Stroke”, “Stroke”, “Pediatrics” and “Treatment”. Included were clinical trials, randomized controlled trials, cohort, case- control, and case series in English or Portuguese published in the last 5 years. It gathered 8 articles. Results: Treatment in the acute phase and for secondary prevention in the chronic phase of pediatric stroke are antithrombotic therapies and platelet antiaggregants, commonly aspirin. Comparing the latter and low molecular weight heparin, neither has shown superiority in preventing stroke recurrence. Without good evidence, however, aspirin is indicated for idiopathic stroke and anticoagulants in cardioembolic stroke by some guidelines. In recombinant tissue plasminogen activator therapy in one paper it was suggested there is more risk for conversion to hemorrhagic events compared to untreated, but in another paper hemorrhage was not seen. There was high mortality with this therapy and higher chances of being discharged to short term hospital, skilled nursing facility or intermediate care facility. In endovascular therapy, delay in diagnosis limits its use and stroke complications did not differ between patients who did or did not undergo this therapy. Conclusion: Further studies are needed to evaluate the efficacy of fibrinolytics.
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Adamson, Alexander, Ian Sinha, C. Mike Roberts, and Jennifer K. Quint. "Management of children aged 1-5 admitted and treated for a clinical diagnosis of acute asthma compared to those aged 6-16 in secondary care in England and Wales." In ERS International Congress 2021 abstracts. European Respiratory Society, 2021. http://dx.doi.org/10.1183/13993003.congress-2021.pa2169.
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"Remaining Connected with our Graduates: A Pilot Study." In InSITE 2019: Informing Science + IT Education Conferences: Jerusalem. Informing Science Institute, 2019. http://dx.doi.org/10.28945/4162.
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[This Proceedings paper was revised and published in the 2019 issue of the Interdisciplinary Journal of E-Skills and Lifelong Learning, Volume 15.] Aim/Purpose This study aims to determine where nursing students from a metropolitan university subsequently work following graduation, identify the factors that influence decisions to pursue careers in particular locations, ascertain educational plans in the immediate future; and explore the factors that might attract students to pursue postgraduate study. Background The global nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. A recurrent pattern of maldistribution of nurses in clinical specialities and work locations has also occurred. It is imperative that institutions of learning examine their directions and priorities with the goal of meeting the mounting health needs of the wider community. Methodology Qualitative and quantitative data were obtained through an online 21-item questionnaire. The questionnaire gathered data such as year of graduation, employment status, the location of main and secondary jobs, the principal area of nursing activity, and plans for postgraduate study. It sought graduates’ reasons for seeking employment in particular workplaces and the factors encouraging them to pursue postgraduate study. Contribution This study is meaningful and relevant as it provided a window to see the gaps in higher education and nursing practice, and opportunities in research and collaboration. It conveys many insights that were informative, valuable and illuminating in the context of nurse shortage and nurse education. The partnership with hospitals and health services in providing education and support at the workplace is emphasized. Findings Twenty-three students completed the online questionnaire. All respondents were employed, 22 were working in Australia on a permanent basis (96%), 19 in urban areas (83%) with three in regional/rural areas (13%), and one was working internationally (4%). This pilot study revealed that there were varied reasons for workplace decisions, but the most common answer was the opportunity provided to students to undertake their graduate year and subsequent employment offered. Moreover, the prevailing culture of the organization and high-quality clinical experiences afforded to students were significant contributory factors. Data analysis revealed their plans for postgraduate studies in the next five years (61%), with critical care nursing as the most popular specialty option. The majority of the respondents (78%) signified their interest in taking further courses, being familiar with the educational system and expressing high satisfaction with the university’s program delivery. Recommendations for Practitioners The results of the pilot should be tested in a full study with validated instruments in the future. With a larger dataset, the conclusions about graduate destinations and postgraduate educational pursuits of graduates would be generalizable, valid and reliable. Recommendation for Researchers Further research to explore how graduates might be encouraged to work in rural and regional areas, determine courses that meet the demand of the market, and how to better engage with clinical partners are recommended. Impact on Society It is expected that the study will be extended in the future to benefit other academics, service managers, recruiters, and stakeholders to alert them of strategies that may be used to entice graduates to seek employment in various areas and plan for addressing the educational needs of postgraduate nursing students. The end goal is to help enhance the nursing workforce by focusing on leadership and retention. Future Research Future directions for research will include canvassing a bigger sample of alumni students and continuously monitoring graduate destinations and educational aspirations. How graduates might be encouraged to work in rural and regional areas will be further explored. Further research will also be undertaken involving graduates from other universities and other countries in order to compare the work practice of graduates over the same time frame.
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Balestra, Amanda Fernandes de Sousa Oliveira, Flávia Pascoal Teles, and Karine Felipe Martins. "Fetal surgery in the context of myelomeningocele: repercussions and prognosis." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.055.
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Background: Myelomeningocele (MMC) is a congenital malformation of neural tube closure. The clinical picture comprises sensory and motor deficits at the point of spinal cord injury and below, in addition to ventriculomegaly, which requires ventriculo-peritoneal drains (DVP). Exposure of nervous tissue to amniotic fluid and trauma to the uterine wall, generates secondary damage. Intrauterine correction is the gold standard for MMC and aims to reduce organic and functional sequelae, improving the patient’s neurological prognosis. Objectives: The objective of this work is to identify the impact of fetal surgery against MMC. Methods: An integrative literature review was carried out based on articles selected from the Google Scholar and Scientific Eletronic Library Online databases. Results: The benefits of intrauterine neurosurgery outweigh the harm, based on maternal complications. Such maternal risks are: oligohydramnios, spontaneous rupture of the membrane, uterine dehiscence, premature birth, infections, blood transfusion, acute lung edema and contraindication for vaginal delivery due to uterine scarring. For the child, all the studies analyzed showed the same gains, extremely significant when compared to postnatal surgery: better cognitive development, greater probability of walking without using orthoses, less need for DVP. The gains from the fetal surgery technique go beyond the postnatal intervention. Conclusions: Therefore, the importance of early intrauterine treatment, in a properly equipped place and by qualified professionals, is reiterated, offering comprehensive care to pregnant women, preventing potential impasses and aiming at a better prognosis and quality of life for the child.
Reports on the topic "Clinical Nursing: Secondary (Acute Care)"
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Villa, Michele, Massimo Le Pera, and Michela Bottega. Quality of Abstracts in Randomized Controlled Trials Published in Leading Critical Care Nursing Journals. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, June 2022. http://dx.doi.org/10.37766/inplasy2022.6.0039.
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Review question / Objective: This review aims to evaluate the methodological quality of RCT-abstracts in leading critical care nursing journals. A methodological quality review with the Consolidated Standards of Reporting Trials (CONSORT) criteria will be performed in RCT-abstracts published between 2011-2021 in the first Scopus-ranking (2021) nursing journals. Eligibility criteria: Abstracts of scientific articles will be included if they fulfil the following inclusion criteria: 1) they report the results of parallel and/or cross-over group RCTs, 2) they are written in English, 3) they refer to the care of adult patients with acute/critical illness or conducted in adult ICUs.Manuscripts reporting results of pilot or feasibility studies, cluster trials, observational or cohort studies, interim analyses, economic analyses of RCTs, post-trial follow-up studies, subgroup and secondary analyses of previously published RCTs, editorials and RCTs without an abstract such as RCTs published as letters to the editor, single-subject clinical trials will be excluded.
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Harris, Gregory, Brooke Hatchell, Davelin Woodard, and Dwayne Accardo. Intraoperative Dexmedetomidine for Reduction of Postoperative Delirium in the Elderly: A Scoping Review. University of Tennessee Health Science Center, July 2021. http://dx.doi.org/10.21007/con.dnp.2021.0010.
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Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain. Methods: The authors developed eligibility criteria for inclusion of articles and performed a systematic search of several databases. Each of the authors initially selected five articles for inclusion in the scoping review. We created annotated literature tables for easy screening by co-authors. After reviewing the annotated literature table four articles were excluded, leaving 11 articles for inclusion in the scoping review. There were six level I meta-analysis/systematic reviews, four level II randomized clinical trials, and one level IV qualitative research article. Next, we created a data-charting form on Microsoft Word for extraction of data items and synthesis of results. Results: Two of the studies found no significant difference in POD between dexmedetomidine groups and control groups. The nine remaining studies noted decreases in the rate, duration, and risk of POD in the groups receiving dexmedetomidine either intraoperatively or postoperatively. Multiple studies found secondary benefits in addition to decreased POD, such as a reduction of tachycardia, hypertension, stroke, hypoxemia, and narcotic use. One study, however, found that the incidence of hypotension and bradycardia were increased among the elderly population. Implications for Nursing Practice: Surgery is a tremendous stressor in any age group, but especially the elderly population. It has been shown postoperative delirium occurs in 17-61% of major surgery procedures with 30-40% of the cases assumed to be preventable. Opioid administration in the elderly surgical population is one of the most significant risk factors for developing POD. With anesthesia practice already leaning towards opioid-free and opioid-limited anesthetic, the incorporation of dexmedetomidine could prove to be a valuable resource in both reducing opioid use and POD in the elderly surgical population. Although more research is needed, the current evidence is promising.