Academic literature on the topic 'Wounds and injuries Nursing Victoria'

This paper aims at analyzing how the trauma inflicted by the First World War is described by Vera Brittain in her autobiographical novel Testament of Youth (1933). The author, who shares many features in common with Virginia Woolf – regarding witnessing and writing about trauma – also lost her loved ones to the War: her fiancé, Roland Leighton, her brother, Edward Brittain, and her friend, Victor Richardson.For Vera Brittain and some of her contemporaries, nursing became a woman‟s experience of taking part in the male-dominated realm of the First War. From treating wounds to listening to injured soldiers‟ talks, First War nurses grasped the geographies of men‟s bodies and minds, something regarded as “improper” by most parents whose daughters were born between the late Victorian and early Edwardian ages. Nursing was the closest a woman could get to the battleground in those days; in Brittain‟s case, for instance, the only safe way to see Roland again. V.A.D. nursing also allowed many women to evolve from tactile experience to the subjective activity of writing about the War, and Brittain‟s Testament of Youth may be regarded as one of its best examples.What may account for the title Testament of Youth is the thought Brittain kept that writing about the distress she and her contemporaries felt due to war would probably have an impact on coming generations. She leaves a “testament” of a terrible incident that would more likely recede; yet, she acknowledges that, whatever may happen, it would never surpass the impact that the First War had on her generation of young women, who were deprived of the innocence of their youth.

Introduction. The first prospective noninterventional registry study (RESPOND) evaluated the clinical effectiveness of a native type I collagen matrix plus polyhexamethylene biguanide antimicrobial barrier (PCMP) in various nonhealing wounds. This product is intended for the management of partial- and full-thickness wounds and acts as an effective barrier to reduce microbes penetrating through the dressing. The RESPOND study demonstrated that PCMP has clinically meaningful benefits in managing a variety of wounds. Objective. The authors describe the effects of PCMP in the subgroup of patients with pressure injuries (PIs) from the RESPOND registry. Materials and Methods. The prospective, noninterventional study was designed to collect information regarding the use of PCMP in a real-world situation. Eligibility included male and female patients aged 18 years and older with target wounds (partial- or full-thickness) suitable for the use of PCMP. Enrolled patients were followed approximately weekly for up to 32 weeks. All wounds and the subgroups were analyzed to determine the frequency and median time to wound closure using Kaplan-Meier methods. Results. The patients with PIs were older adults with a mean age of 69 years and a mean BMI of 27 kg/m2. At baseline, the mean measured wound length was 3 cm, the mean depth was 8.0 mm, the mean volume was 12.6 cm3, and the mean area was 10.5 cm2. Complete wound closures were evident in 5% of patients (n = 2) at week 4, and were achieved in 39% of patients (n = 18) by week 16, in 49% (n = 22) by week 24, and in 62% (n = 28) by week 32. The median time to wound closure was 32 weeks. For all 45 PIs managed with PCMP, the incidence of achieving greater than 60% reduction in baseline area and depth was 78% (n = 35) and 64% (n = 29), respectively, with approximately 82% (n = 37) of wounds showing a reduction in volume greater than 75%. Conclusions. It appears that PCMP is a useful adjunct in managing chronic deep wounds such as PIs.

Introduction. Thermal burn injuries are common, devastating medical emergencies that are challenging to manage. Timely and effective treatment is paramount to both short- and long-term patient outcomes. Currently, medical providers and health care facilities worldwide are emphasizing the need for cost-efficient and accessible treatments; such treatments are particularly vital for vulnerable populations with limited access to advanced medical resources. The use of extracellular matrix (ECM) technologies has become widespread in the management of acute and chronic wounds, including burns. Ovine forestomach matrix (OFM) is an ECM bioscaffold isolated from sheep forestomach tissue and has been shown to be effective in soft tissue reconstruction procedures. Case Report. The use of OFM in the treatment of 2 facial thermal burn injuries, including in a pediatric patient, is described. Both patients fully recovered from their facial injuries with satisfactory cosmetic outcomes. Conclusions. Although OFM technology is widely used in the management of acute and chronic wounds, the authors believe this to be the first published report of its use to aid healing in burns. Ovine forestomach matrix may provide a valuable additional tool for the management of complex burns.

The incidence of injuries in the world throughout the year is increasing, both acute and chronic wounds. In Indonesia, the prevalence of incisional wounds is 8.2%. Wound healing can be assisted with herbal plants, one of which is aloe vera. The purpose of this evidence-based nursing study was to determine aloe vera's effectiveness in the healing process of incisional wounds. The method used is a literature review. Database searches were conducted through Pubmed, Science Direct, Science Open and Google Scholar. The inclusion criteria of the journal in this study were journals that examined incisions, cuts or surgical wounds given intervention using aloe vera in a quasi-experimental research design, case study, double-blind, controlled trial, journals published in 2016-2021 and used Indonesian or English. This study's results indicate an influence of aloe vera in the wound-healing process, especially in the proliferative phase. This literature study can be used as evidence-based nursing at the level of nursing health services, especially wound care management based on aloe vera.

Objective: Children are at high risk of injuries and wounds. The application of medical grade honey is a promising approach to improving the healing of wounds of various origin and severity. However, the use of medical grade honey in young paediatric patients remains limited. The aim of this study is to show the safety, efficacy and usefulness of medical grade honey in abdominal wounds, of different causes, in paediatric patients. Method: This was a prospective, observational case series evaluating five young infants with abdominal wounds at the General Hospital in Thessaloniki. All wounds were treated in the same manner with daily medical grade honey applied to the wound area and closely monitored. Results: All treated wounds rapidly presented granulation tissue formation and underwent re-epithelialisation. Peripheral oedema and inflammation decreased upon initial application. Necrotic tissue was effectively debrided when present. Slough was removed and no signs of infection were detected, irrespective of initial wound presentations. Scar formation was minimal and the full range of motion was preserved in all cases. Conclusion: Based on this case study, medical grade honey is safe and effective in treating different abdominal wounds, including infected or dehisced wounds as well as burns. The easy application and broad applicability make medical grade honey recommendable as a first-line treatment in paediatric patients.

Objective: Skin wounds, such as leg ulcers and pressure ulcers (PUs), can have a negative effect on quality of life (QoL). This effect has been confirmed among self-treaters of wounds, specifically. The aim of the study was to investigate the effect of self-treatment of wounds on the physical, emotional, lifestyle and financial domains of QoL. The findings of the study may be used to optimise the wellbeing of people who have wounds. Method: A qualitative study was conducted with people who were 18 years of age or older; lived in Victoria, Australia; spoke English; and had a wound that they had self-treated. Participants were interviewed and the data thematically analysed to identify themes that represented the effect of self-treatment on the physical, emotional, lifestyle and financial domains of QoL. Results: The participants (n=25) averaged 71 years of age and the majority (n=20) had leg wounds. Participants described mostly positive effects on QoL that were attributable to self-treatment. Self-treatment improved physical wellbeing because it resulted in better pain management and wound healing; however, it was a physical challenge for some. Self-treatment enhanced emotional wellbeing because it helped to manage worry about infection and resolve dissatisfaction with professional care. Self-treatment lessened the social consequences of the wound by enabling participants to create an acceptable appearance, maintain their lifestyle and minimise time receiving professional care. Self-treatment reduced the financial cost of wound dressings and the expense associated with receiving professional care. Conclusion: As an approach to care, self-treatment of wounds may offer QoL gains that might otherwise be unachievable. The importance of engaging patients in their own management, and the increasing accountability of healthcare providers to report consumer-focused outcomes, are further reasons to consider self-treatment of wounds as an approach to care in the community setting.

Needle-stick injuries (NSIs) are a hazard for nursing staff and public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens via sharp injuries of the needle-stick. Needle-stick injuries (NSIs) are described as penetrating wounds caused by a device that is contaminated with another person’s body fluids. Needle-stick injuries are injuries acquired by needles like -scalp vein needles, hypodermic needles, blood sample collection needles, intracath stylets, lumbar puncture needles used to connect parts of IV delivery systems. Needle-stick injuries (NSIs) form a medium for the transmission of bloodborne infections. Strict use of personnel protective equipment while working in the hospital should be made compulsory. To study incidences of needle stick injury among nurses working in Rural tertiary care Unit, Loni. Ethical approval for this study was obtained from the Institutional Ethical Committee. Seventy-six nurses, who fulfilled inclusion criteria were included and data was obtained through survey. This study involves 76 nursing staff. Of them all, 27(35.5%) nursing staff experienced NSIsThe administration of medication was common action that caused most of needle-stick injuries mentioned by 14 (18.4%) nursing staff. IV cannula was the device that caused many needle-stick injuries reported by 17 (21.1%) nursing staff. Thenursing professionals are the main key players in both elective and emergency situations. There is a quite higher incidence of needle stick injury among critical care nurses. This might be due to handling of emergency cases and attempting to secure the intravenous line or to deliver the medications. Creating awareness and training appropriately is mandatory for critical care nurses.

Objective: Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. Method: The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (−80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72–96 hours. Results: This protocol was followed in five male patients (aged 23–68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20–61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. Conclusion: The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.

Objective: To demonstrate the associated use of progressive tension sutures (PTS) with negative pressure wound therapy (NPWT) in large torso degloving wounds. Methods: This is a case report of two patients with large torso degloving wounds caused by trauma, both of whom were treated with combined PTS and NPWT. Statistics related to wound treatment responses are presented. Results: Initial wound area for Patient 1 was 2400cm2 and 900cm2 for Patient 2. Within 21 and 12 days, respectively, using the combined method, the following data were observed: wound reduction of 94% and 99%, respectively; a closing speed rate of 98cm2/day and 75cm2/day, respectively; and a closing percentage of 4.45% per day and 8.25% per day, respectively. Conclusion: The use of combined PTS and NPWT techniques may be useful in the treatment of traumatic degloving injuries, reducing the wound area and facilitating reconstruction.

Introduction. Moisture-associated skin damage occurs in 4% to 37% of the pediatric population. Commonly described treatments can be challenging to apply to small neonatal wounds, and concerns exist about absorption, cutaneous side effects, and use in certain populations (eg, preterm neonates). Objective. This single-center, retrospective case series evaluated the use of cyanoacrylate liquid skin protectant (CSP) to manage moisture-, friction-, and trauma-associated pediatric and neonatal wounds. Materials and Methods. Fifteen pediatric and neonatal patients with wounds of various etiologies were treated with 1 to 3 applications of CSP. The product is a purple-colored liquid that comes in a small-sized and large-sized applicator and immediately adheres to the skin, taking approximately 1 minute to dry. One to 2 coats were applied to the affected area. Subsequent applications were prescribed as needed, depending on the skin condition. Before CSP application, some patients underwent different treatments deemed necessary by the treating practitioners. Results. There were 7 neonate patients (age range, 4 days–3 weeks), with a gestational age of 25 weeks to full term. Wounds included incontinence-associated dermatitis; peristomal, gastrostomy-associated, and tracheostomy-associated dermatitis; and skin tears. In the 8 older patients (age, 1–5 months; 10 years; 12 years; 16 years), wounds included gastrostomy and tracheostomy-associated dermatitis and granulation tissue, epidermal stripping from adhesive dressing removal, intertriginous dermatitis, and lesions resulting from graft-versus-host disease. Application of CSP facilitated the healing of dermatitis and peristomal excoriations as well as facilitated skin dryness, leading to increased wear time of a peristomal appliance. Peristomal dryness contributed to less friction and likely was the reason for granulation tissue recession. Conclusions. Cyanoacrylate liquid skin protectant can be considered in the management of pediatric moisture- and friction-associated cutaneous injuries, skin tears, and exudative wounds. It can be used as a stand-alone therapy or in combination with standard of care.

[Truncated abstract] The aim of the research was to explore the association between wrist guard use and wrist fracture risk in snowboarders in Australia. During the study, the opportunity was also taken to examine the relationship between wearing wrist guards and the severity of wrist and elbow injury. A case-control study was conducted at the Mount Buller Medical Centre, Victoria, Australia. A total of 494 participants was recruited during the 2004 and 2005 ski seasons. Cases were defined as any snowboarder seen at the Clinic with a fractured wrist (N = 119), and controls as any snowboarder seen at the clinic for any reasons other than a fractured wrist (N = 375). Severity of forearm injuries were defined and analysed separately. Study participants completed a questionnaire consisting of: basic demographics (age and sex only); wrist guard use on the day of presentation; normal use of protective equipment; the number of days spent snowboarding that season; the ability of the snowboarder; and ski run difficulty. Risk taking behaviour was assessed by a history of any previous fracture or joint injury and psychometric questions. Clinic medical staff recorded site and severity of fractures and soft tissue injuries. Logistic regression was used to obtain adjusted odds ratios for these risk factors against the main outcome measure. Presence of wrist fracture and injury in snowboarders with and without wrist guards. ... There was a significant association between wrist guard use and soft tissue elbow injuries (adjusted odds ratio = 17.6, p = 0.011, 95% CI: 1.93 – 160.2), but no significant association with elbow fractures (adjusted odds ratio = 1.84, p = 0.385, 95% CI: 0.46 – 7.30). There was thus no evidence in this study that wrist guards increase the occurrence of other severe injuries in the forearm by transferring the impact force away from the protected wrist up the arm. No evidence was found for compensatory risk taking behaviour in participants wearing protective equipment. A local injury prevention strategy was implemented in schools in the Mt Buller district during the course of this study. Education about the protective effects of wrist guards enabled a policy change in the local secondary college so that wrist guard use is now mandatory for all snowboarders in the school ski programme: That policy states:

Thesis (MCUR)--University of stellenbosch, 2001.
ENGLISH ABSTRACT: In trauma the priority is given to identifying the life-threatening injuries and immediately implementing treatment (Demetriades, 1993:3). Severe trauma resuscitation and assessment often have to be carried out simultaneously to detect and treat conditions that are rapidly fatal if not attended to immediately and according to priority. Urgent priorities in trauma management include maintaining a clear and patent airway to facilitate respiration and cervical spine protection by avoiding rough manipulation of the head and neck by supporting the neck with a neck immobiliser. Any external bleeding has to be controlled by applying direct pressure to the wound. Cardiovascular problems, for example shock or myocardial infarction, respiratory problems and hypoxia which are detrimental, particularly in the case of head injury, should be excluded. A detailed head-to-toe examination which includes the head, neck, chest, abdomen, back, musculo-skeletal system, rectum and vagina has to be performed. For the head-injured patient, correct any condition, which may complicate the existing head injury, for example hypoxia, shock, pneumothorax and fractures of long bones or pelvis. Implement the A (airway), B (breathing), C (circulation), D (disability, neurological and drugs) and E (environment) for structured management of the patient. Muller's, (1996) two-phase model was utilised to formulate and validate nursing outcome standards. In phase one literature was explored to develop provisional standards on polytrauma patients with traumatic brain injuries. In phase two the provisional standards were validated by experts (doctors and nurses) in critical care, trauma and emergency nursing including nurses and a doctor working in the casualty department of a provincial hospital in Mafikeng. Final standards were formulated and adapted accordingly. Standards for the management of a polytrauma patient with traumatic brain injuries included: A safe environment for patients, nurses and doctors Primary survey in casualty department which includes the maintenance of airway, breathing, circulation, disability/ neurological, drugs and exposure The secondary survey that includes the head to toe examination, definitive orthopaedic care and stabilisation before transfer to the intensive care unit A standard on all relevant equipment which might be needed in case the patient goes into cardiac arrest on the way to the intensive care unit, was also formulated. The standard on documentation included the primary and secondary survey in the casualty department, transport to the intensive care unit, activities and the condition of the patient. The final standards dealt with the accurate handing over of the patient to the intensive care personnel. The following recommendations were made: • Implement the outcome standard by means of a quality improvement programme through a top-down approach. • Provide training: Nurses and doctors have an obligation to render quality care, therefore they have the right to be trained in emergency procedures. • All registered nurses working in the casualty or emergency departmentsshould be trained in at least Basic Life Support (CPR), Advanced Cardiac Life Support (ACLS), Advanced Paediatric Life Support (APLS) and Advanced Trauma Life Support (ATLS) while waiting to be sent for the trauma-nursing course. • Improve infection control measures in the casualty department • Emergency drugs must always be available. • Improve the on-call system. • Formulate a policy on sharing of the equipment by both casualty and ICU staff. • Motivate for the necessary equipment. Implement procedures for debriefing of staff, the evaluation of actions during resuscitation and implement measures for psychological support of the family. • For further research, implement and test a training programme whereby nurses can formulate their own standards. • Evaluate whether the standards have improved the quality of trauma care, and develop standards for leu nursing of the brain injured patient and the rehabilitation of polytrauma patients with traumatic brain injuries The uniqueness of the study lies in the fact that no formal outcomes standard for trauma patients with traumatic brain injuries have been developed in any of the North West Provincial hospitals.
AFRIKAANSE OPSOMMING: Die identifisering van lewensbedreigende beserings en die onmiddellike implementering van behandeling, is in trauma 'n eerste prioriteit (Demetriades, 1993: 3). Resussitasie en die beraming van erge traumagevalle noodsaak in baie gevalle, gelyktydige hantering. Sou hierdie hantering nie gelyktydig en onmiddellik volgens prioriteit plaasvind nie, kan dit noodlottige gevolge inhou. Belangrike prioriteite in traumabehandeling sluit in, die instandhouding van 'n patente lugweg om asemhaling te onderhou asook die beskerming van die servikale rugmurgkolom, deur die ruwe manipulasie van die kop en nek te vermy deur die implementering van 'n nekimmobiliseerder. Kardiovaskulere probleme, byvoorbeeld skok of miokardiale infarksie, asook respiratoriese probleme wat lewensbedreigend vir die pasient met 'n hoofbeseering is, moet uitgesluit word. 'n Gedetailleerde van kop-tot-tone ondersoek, wat die kop, nek, borskas, abdomen, rug, muskulo-sketale stelsel, rektum en vagina insluit, moet uitgevoer word. In die pasient met hoofbeserings moet enige toestand byvoorbeeld frakture van die langbene of die pelvis, skok of 'n pneumothorax, eers behandel word. Implementeer die A (Iugweg - "airway"), B (asemhaling - "breathing"), C (sirkulasie -"circulation"), D (gestremdheid - "disability", neurologies- "neurological" en drogerye-"drugs") en E (omgewing - "environment") vir die gestruktureerde behandeling van die pasient. Die twee fase model van Muller (1996) is gebruik vir die formulering en validering van die verpleeguitkomsstandaarde. In fase een is die literatuur verken om die voorlopige standaarde vir polytrauma pasiente met traumatiese breinbeserings te ontwikkel. In fase twee is die voorlopige standaarde gevalideer deur kundiges (dokters en verpleegkundiges) in kritieke sorg, trauma en noodverpleging. Die verpleegkundiges en dokter wat werksaam is in die ongevalle-eenheid van 'n plaaslike provinsiale hospitaal in Mafikeng is ook ingesluit. Finale standaarde is geformuleer en dienooreenkomstig aanvaar. Die standaarde vir die politrauma pasient met traumatiese breinbeserings, sluit in: 'n Veilige omgewing vir pasiente, verpleegkundiges en dokters. Die prirnere beraming in ongevalle ten opsigte van instandhouding van die lugweg, asemhaling, sirkulasie, gestremdheid, drogerye en blootstelling. Die sekondere beraming: wat behels die kop-tot-tone ondersoek. Definitiewe ortopediese behandeling en stabilisering voor oorplasing na die intensiewe-sorg-eenheid. 'n Standaard met betrekking tot die nodige toerusting wat benodig mag word tydens 'n hart stilstand, oppad na die intensiewe-sorg-eenheid, is ook geformuleer. Die standaard ten opsigte van dokumentasie sluit die primere, en sekondere beraming, vervoer na die intensiewe-sorg-eenheid, aktiwiteite en toestand van die pasient, in. Die finale standaarde is gebaseer op die oorhandiging van die pasient aan die intensiewe-sorg-personeel. Die volgende aanbevelings word gemaak: • Implementeer die uitkomsstandaarde deur middel van 'n gehalteverbeteringsprogram deur gebruik te maak van 'n "top-down" benadering -, • Voorsien opleiding: Verpleegkundiges en dokters het 'n verpligting om gehaltesorg te lewer, hulle het dus 'n reg om onderrig te ontvang in noodprosedures, en verder het die pasient die req op gehalter noodbehandeling. • Aile geregistreerde verpleegkundiges wat in die ongevalle en die noodafdeling werk, behoort opgelei word in ten minste basiese lewensondersteuning (CPR), Gevorderde Trauma Lewens Ondersteuning (ACLS), Gevorderde Pediatriese lewensondersteuning (APLS) en Gevorderde Trauma lewensondersteuning (ATLS), terwyl gewag word om die trauma verpleegkundigekursus te deurloop. • Verbeter mteksiebeheermaatreels in ongevalle. • Noodmedikasie moet ten aile tye beskikbaar wees. • Verbeter die op-roepstelsel ("on cali"). • Formuleer 'n beleid oor die gesamentlike gebruik van toerusting deur beide ongevalle- en intensiewe-sorg-eenheid-personeel. • Motiveer vir die nodige toerusting. • Implementeer prosedures om personeel to te laat vir ontlonting (debriefing), die evaluering van aksies tydens die resusitasie prosedure en implementeer metodes vir die sielkundige ondersteuning van die familie. • Ten opsigte van verdere narvorsing behoort 'n opleidingsprogram qeunplernenteer en getoets te word met betrekking tot verpleegkundiges wat hulle eie standaarde will formuleer. • Evalueer of die standaarde die gehalte van traumasorg verbeter het en ontwikkel standaarde vir intensierwe-sorg-verpleging van die breinbeseerde pasient asook die rehabilitasie van politrauma pasiente met traumatise breinbeesering. Die unieke bydra van die studie word gevind in die feit dat daar nog geen gerformaliseerde uitkomstandaarde vir traumapasiente met breinbeseerings in enige van die Noord Wes Provinsie se hospitale ontwikkel is nie.

One of the major contributions that midwives can make to the comfort and well-being of child-bearing women is the skilful care of the perineum during delivery. This study investigated the short and long-term effects of perineal trauma in order to provide a basis for decision-making in the midwives' perineal management at delivery and client self-care. Specifically, the study examined the relationship between the extent of perineal trauma and the intensity and duration of perineal pain during the first three months following a vaginal birth; and compared discomfort among mothers whose perineal trauma was the result of an episiotomy, perineal, vaginal or labial lacerations, or who delivered with an intact perineum. All women, who required perineal repair during a six-month period at a large metropolitan hospital, were surveyed by a series of three structured questionnaires, at three days, six weeks and three months postpartum. One hundred and one women, who delivered over an intact perineum, were selected to serve as a control group. Analysis of variance with Tukey studentized Range (HSD) test using the General Linear Models Program, Wilcoxon matched-pairs signed-ranks test, Kruskal-Wallis chi-square approximation and chi-square analysis were applied to the data, using the SAS program. Results of the analyses demonstrated statistically significant differences between the perineal outcome subgroups. For the women who underwent an episiotomy during delivery, there was a general trend for increased pain and associated healing problems with the perineum. Further, factors found to be significantly associated with increased postpartum perineal pain were epidural analgesia and prior dyspareunia. Infant birthweight was significantly associated with perineal outcome. The results of this study will form the basis for: improving midwives' knowledge and understanding of perineal trauma, giving direction to the evaluation and revision of decision-making and clinical practice skills during delivery, integrating midwives' theory base and practice base, and anticipating associated problems with perineal trauma. The knowledge gained will provide a basis for guiding clients towards the ability to self-manage pain relief, overcome associated problems of perineal trauma, and their adaptation to the motherhood role.

Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p<0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p<0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p<0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p<0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.

Thesis (Master of Nursing)--Cape Peninsula University of Technology, 2019
Background: Like other health care providers, nursing students are unprotected from occupational dangers such as sharp object injuries (SOIs) due to imperfect knowledge and experience. These students face a great risk of exposure to blood borne infections by pathogens such as HIV and the hepatitis B and C viruses while executing their clinical actions in hospitals. SOIs are a significant problem for nursing students, as they increase the risk of contracting blood-borne infections. Purpose: The purpose of this study was to determine nursing students' knowledge and practices related to SOIs and their management at a university in the Western Cape Province. Objectives: The objectives of this study include determining the occurrence of SOIs, and knowledge of risk of SOIs, as well as the reporting and management of SOIs at a university in the Western Cape. Method and sample: A cross-sectional descriptive survey was conducted with nursing students from the second to fourth year of study, registered at a university in the Western Cape Province for the 2017 academic year. Quota sampling was applied to select respondents who, after providing informed consent, then completed and handed the self- administered questionnaires back to the researcher on the same day that they were distributed. Data were obtained from nursing students about whether or not they had experienced an SOI, what they did after the SOI, their perception of the risk, and management of and preventive measures for SOIs. Validity and reliability were ensured, and all ethical principles were adhered to. SPSS was used for the quantitative data analysis. Results: A total of 252 nursing students from the second to fourth years participated in this study. The average age of respondents was 24 years, with a minimum of 19 and maximum of 46 years; 211 (83.7%) of them were females. During their course 63 (25%) respondents experienced SOIs; only 42 (66.67%; N=63) of them reported the occurrence of an SOI, most (25 or 59.52%) reporting it to the professional nurse in charge. The highest occurrence of SOIs was reported by fourth-year students (26 respondents, 41.3%). It was found that 21 (33.3%) of SOIs were not reported, and the main reason for this was because there was little or no perception of associated risk (15, 71.43%). Forty-six (73.02%) respondents experienced a single SOI, while 11 (17.46%) had two SOIs, 4 (6.35%) reported having had three SOIs, and one each (1.59%) had more than four and more than ten SOIs. The activity causing most of the SOIs was administration of medication by injection (48 cases, 76.2%), and in most cases (57, 90.47%) the instruments causing injury were needles or hollow-bore needles. Most of the affected respondents squeezed the puncture site after the SOI (42, 66.7%), followed by washing the area with water and soap (40; 63.5%), and cleaning the site with antiseptic (15, 23.8%). Among those students exposed to SOIs, only 22 (52.4%) had undergone blood tests, and very few of them took post-exposure prophylaxis or treatment (16, 25.40%). The emotion that most of them felt after the SOI was fear (42, 66.7%), and the main reason for not getting treatment was fear of side effects (18, 38.29%). Also, only 61 (24.2%) respondents reported recapping needles after use, while most reported incomplete vaccination against hepatitis B (195, 77.38%). The main reason for not using personal protective equipment (PPE) was noted as the unavailability thereof at the institution (43, 49.4%). Conclusion: This study documented a low rate of reporting SOIs among nursing students. It is plain that there are inadequate levels of knowledge and practice related to SOI management among these students at a university in the Western Cape. One would imagine that because the majority of nursing students had a measure for the practice of universal precautions and used PPE, their management after exposure to SOIs during work training in hospital would be efficient. This was not the instance in this study, where application of these actions in their practical training was poor.

Self-intermittent catheterisation (SIMC) is one of the most common and safest methods of bladder emptying in people with spinal cord injury (SCI). There is a large amount of literature relating to the biomedical aspects of SIMC, such as infection rates and renal complications. There is however, very little information about how people actually experience SIMC and its effect on their daily lives. Through a series of semi-structured interviews this study describes the lived experience of eight men with spinal cord injuries who perform self-intermittent catheterisation to empty their bladder. The study uses Husserlian phenomenology and Colaizzi's method to analyse data gathered through the interviews. Clusters of similar themes were extracted from the transcribed interviews and reduced into six theme categories. The data showed that SIMC has an effect on almost all aspects of a person's life including work and social lives, their personal relationships and body esteem, even what they drink and how they sleep. The themes are discussed and relevant literature provides a legitimate basis for the issues that arose for participants. New knowledge is detailed and there are recommendations for changes in practice and suggestions for further research.

O trauma desponta como mais uma doença a que os idosos podem estar vulneráveis. Além disso, tendo em vista o aumento desta faixa etária, é possível que, em breve, a realidade do trauma nesta população também cresça. Dessa forma, é fundamental que os profissionais dos serviços de saúde conheçam as alterações que ocorrem com o processo de envelhecimento e as características específicas do trauma, com a finalidade de melhor assistir esta população. Assim, os objetivos deste estudo foram: identificar o perfil sociodemográfico de idosos, vítimas de trauma; caracterizar as doenças preexistentes e os medicamentos em uso; descrever as características do trauma e sua evolução; verificar a existência de associação entre variáveis sociodemográficas, doenças preexistentes, características e evolução do trauma; verificar a existência de correlação entre dias internados em CTI e ISS. Trata-se de um estudo não experimental, retrospectivo e exploratório. Realizado a partir da análise de dados de natureza secundária contidos em um banco de dados do Núcleo Hospitalar de Epidemiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, referentes às notificações dos pacientes, vítimas de trauma, atendidos na Unidade de Emergência, deste hospital, no período de 2008 a 2010. Dessa forma, a coleta dos dados seguiu as informações contidas no referido banco, além da busca nos prontuários médicos para identificação de doenças preexistentes, do uso de medicamentos em domicílio e das complicações clínicas após o trauma. Foram estudados 131 idosos, vítimas de trauma, média de idade 69,9 anos (s=7,7); 73,3% eram homens; 55,1%, casados; 54,7%, aposentados; 65,6% possuíam doenças preexistentes, sendo 38,9% hipertensão arterial sistêmica e 19,8% etilismo, média de doenças 2,3 (s=1,4); 48,9% tomavam medicação em domicílio, média 3,2 medicamentos (s=2,3). Quanto às características do trauma, para 31,3%, o mecanismo de trauma foi queda e para 28,2%, pedestre; 83,2% por trauma contuso; 59,5% possuíam lesão em cabeça/pescoço, 45,8% em extremidades e ossos da pelve, média 1,8 (s=1,0); 44,3% obtiveram ISS entre 9 e 15 (trauma moderado) e 30,5% ISS de 25 ou mais (trauma muito grave); 80,2% apresentaram TRISS entre 51% ou mais (francas condições de se evitar o óbito). Com relação à evolução do trauma, 30,5% internaram em CTI, média de 4,2 dias; 62,6% desenvolveram complicações clínicas, sendo 43,5% infecciosas e 30,5% cardiovasculares; 46,1% foram submetidos à cirurgia ortopédica; 66,4% sobreviveram ao trauma, 47,3% receberam alta hospitalar com limitações moderadas e 33,6% faleceram, sendo 36,4% por traumatismo cranioencefálico e 22,7% por sepse. Houve associação entre mecanismo do trauma e doença preexistente (p=0,01) e associação entre mecanismo do trauma e sexo (p=0,03); a presença de doenças aumentou em 3,10 a chance para desenvolver complicações em relação aos que não apresentavam doenças (p=0,02); para os internados em CTI, a chance de ter complicações aumenta em 28,2 (p<0,01); conforme aumenta o índice de gravidade do trauma, maiores são as chances de complicações, odds = 3,07 entre ISS 16 e 24 (grave) e odds = 6,50 com ISS 25+ (muito grave) em relação ao ISS 9 a 15 (moderado); para idosos com complicações, a chance de morte aumenta em 5,56, quando comparados com aqueles que não apresentaram (p<0,01); para idosos com TRISS <50% (sobrevida inesperada), a chance de óbito foi de 10,13 em relação àqueles com TRISS >=50% (morte evitável) (p<0,01); a correlação entre os dias de internação no CTI e os escores do ISS foi fraca e positiva (r=0,18), indicando que quanto maior o número de dias de internação no CTI maiores são os índices de gravidade do trauma (p=0,03). O conhecimento das características e da evolução do trauma pode possibilitar aos profissionais de saúde o planejamento de medidas preventivas, além de viabilizar melhor atendimento aos idosos na atenção intra-hospitalar e após a alta, com vistas a melhorar a qualidade de vida.
Trauma emerges as another condition to which elderly individuals are vulnerable. Considering the increase in this population, trauma events are also likely to increase among older individuals. Hence, it is essential that health care providers are aware of changes that may occur with the aging process and the specific characteristics of trauma aiming to better care for this population. This study identifies the sociodemographic profile of elderly trauma victims; characterizes pre-existent diseases and used medications; describes the characteristics of trauma and its progression; verifies potential correlation between days hospitalized in ICU and Injury Severity Score (ISS). This non-experimental, retrospective and exploratory study was based on secondary data collected from a database of the Hospital Epidemiology Center at the Hospital das Clinicas, Medical School, University of São Paulo at Ribeirão Preto concerning reports of elderly trauma victims cared for in the hospital\'s emergency department from 2008 to 2010. Data collection was based on information contained in the database and search on medical charts to identify pre-existent diseases, medication used at home, and clinical complications after the trauma. A total of 131 elderly trauma victims participated in the study: 69.9 years old in average (sd=7.7); 73.3% men; 55.1% married; 54.7% retired; 65.6% with pre-existent diseases: 38.9% systemic arterial hypertension, and 19.8% alcoholism; average of diseases 2.3 (sd=1.4); 48.9% took medication at home, average of 3.2 medications (sd=2.3). In relation to the characteristics of trauma: 31.3% was caused by falls and 28.2% pedestrian; 83.2% was contusion trauma; 59.5% had head and neck injury; 45.8% had limbs and pelvic bones affected, average 1.8 (sd=1.0); 44.3% obtained ISS between 9 and 15 (moderate trauma) and 30.5% ISS was 25 or above (very severe trauma); 80.2% presented Trauma and Injury Severity Score (TRISS) between 51% or above (real conditions to avoid death). In relation to trauma progression, 30.5% was hospitalized in ICU, 4.2 days in average; 62.6% developed clinical complications: 43.5% infections and 30.5% cardiovascular; 46.1% was submitted to orthopedic surgery; 66.4% survived, 47.3% was discharged with moderate impairment and 33.6% died: 36.4% due to brain injury and 22.7% due to sepsis. An association between the mechanism of trauma and pre-existent diseases was found (p=0.01) as well as association between mechanism of trauma and gender (p=0.03). Pre-existent diseases increased 3.10 times the chance of complications comparing to those with no pre-existent diseases (p=0.02). The chances of complications increased 28.2 times for those hospitalized in ICU (p<0.01); the higher the index of trauma severity, the greater the chances of complications, odds = 3.07 between ISS 16 to 24 (severe) and odds = 6.50 with ISS 25+ (very severe) in relation to ISS 9 to 15 (moderate). The chances of dying increased 5.56 times for those with complications compared to those with no complications (p<0.01); chances of death was 10.13 times higher for individuals with TRISS <50% (unexpected survival) in relation to those with TRISS >=50% (evitable death) (p<0.01). Correlation between duration of hospitalization in ICU and ISS scores was weak and positive (r=0.18) indicating that the longer the hospitalization in ICU, the higher the trauma severity index (p=0.03). Knowledge concerning the trauma characteristics and progression can enable health care providers to plan preventive measures and provide better care to elderly individuals both at the hospital and after discharge aiming to improve their quality of life.

Infections are a major cause of morbidity and mortality during the post-operative phase of patients’ recovery. Wound infections are the second most commonly encountered type of nosocomial infection. Because wound infections can be introduced by not applying infection control measures and sterile technique principles in the operating room, the implementation of infection control principles is an imperative. The aim of this study was to explore and describe infection control practices related to the prevention of Surgical site infections in the operating rooms in a public health care sector in the Nelson Mandela Bay Municipality. The findings were compared with practices, as indicated in an evidence-based guideline. The research design was quantitative, explorative, descriptive, comparative-descriptive and contextual in nature. The research sample consisted of all the professional nurses, in the operating room. The data were collected by means of a self-administered questionnaire. Descriptive statistics was used to present the data in the form of tables and graphs. Based on the analysis of the data, some recommendations were made for the implementation of infection control practices, in order to prevent Surgical site infections in the operating room.

This chapter addresses the vital area of wound care, including the impact that wounds can have upon patients and their families, and the nursing management challenges that they present. As a registered nurse caring for patients with wounds, you will be responsible for making a clinical assessment of the patient with a wound, making clinical decisions based on the most appropriate evidence-based, nurse-led interventions, and, crucially, measuring patient outcomes. The latter involves continuous monitoring of how both the patient and his or her wound is responding, or not, to the treatment and care that you give. This chapter presents a generic approach to wound management, and this should help you to deliver high-quality, safe wound care for patients with wounds of differing aetiologies. This includes core components of interventions for acute, chronic, and palliative wound care. Importantly, the chapter has been designed to help you to make the links between assessment, clinical decision-making, nursing interventions, and patient care. Nurses play a key role in the multidisciplinary team in the delivery of wound care, and frequently act as the ‘point of contact’ for the manufacturers and suppliers of wound care products. The approach advocated in this chapter will equip you to make informed assessments and clinical decisions. Wounds are injuries to the body, the skin in particular, causing a breach of the layers of skin (see Chapter 12 Understanding Skin Conditions) and the body boundary. The term ‘wound’ also defines the act of injuring a person’s skin. This may be deliberate, e.g. during a surgical procedure, or deliberate to cause harm, e.g. during warfare, terrorist attacks, or domestic and street violence. Wounding can also occur with accidents (a cut from a kitchen knife), natural disasters (earthquake), and exposure to environmental stresses such as extreme heat (burns, skin cancers), extreme cold (frostbite), excessive pressure, and excessive exposure to water and moisture (trench foot). Wounds also develop because of diseases and conditions such as diabetes, which disrupt the structures of the skin and the normal metabolic processes that maintain skin health (see Chapter 9 Understanding Diabetes Mellitus).

Wound management is an important component of the care for neurosurgical patients. Improper wound management can lead to patient suffering, morbidity, increased length of stay, readmission, increased cost of care, and, in some cases, infection, sepsis, and mortality. The neurosurgeons manage the neurosurgical wounds. In contrast, pressure wounds are usually managed by a team led by the hospitalist. In this chapter, the authors outline the standards of care for management of pressure injuries prior to, during, and after neurosurgery procedures. The focus will be on the role of the hospitalist in this process. The crucial role of the collaboration among hospitalists, nursing staff, neurosurgeons, wound specialists, and general surgeons will be highlighted. The authors emphasize the role of evidence-based management in this process and propose an algorithm for the care of these wounds based on current understanding. Finally, the areas of needed research to achieve the best level of care are explored.