Assessment and examination of the respiratory system.

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis.

Nursing terminology for the care of people with respiratory diseases and Covid-19.

OBJECTIVES: To build a specialized nursing terminology for the care of people with respiratory diseases and Covid-19 or who have respiratory diseases after Covid-19, based on ICNP®. METHOD: Methodological study developed in two stages: (1) identification of the relevant concepts for the health priority chosen from the literature; (2) cross-mapping of the identified concepts with the concepts contained in ICNP® version 2019/2020. RESULTS: 9460 terms were extracted from the literature, of which 4065 terms were excluded because they were not related to the object of study and 5395 were submitted to the mapping technique, resulting in 290 constant terms in the ICNP® and 5134 non-constant terms. The constant terms were classified into the following axes: 120 in the Focus axis, 13 in Judgment, 48 in Action, 23 in Location, 38 in Means, eight in Time and one in Client. In addition, 36 nursing diagnoses/outcomes and three nursing interventions were mapped. CONCLUSION: The terminology will support the quality of care provided by the nursing team and the manual and electronic recording of patient data.

Nursing diagnoses and hospital readmission of patients with respiratory diseases: Findings from a case-control study.

AIM: The rate of readmission after hospitalisation for respiratory diseases has become a common and challenging clinical problem. Social and functional patient variables could help identify cases at high risk of readmission. The aim was to identify the nursing diagnoses that were associated with readmission after hospitalisation for respiratory disease in Spain. DESIGN: Case-control study within the cohort of patients admitted for respiratory disease during 2016-19 in a tertiary public hospital in Spain (n = 3781). METHODS: Cases were patients who were readmitted within the first 30 days of discharge, and their controls were the remaining patients. All nursing diagnoses (n = 130) were collected from the electronic health record. They were then grouped into 29 informative diagnostic categories. Clinical confounder-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using logistic regression models. RESULTS: The readmission rate was 13.1%. The nursing diagnoses categories 'knowledge deficit' (OR: 1.61; 95%CI: 1.13-2.31), 'impaired skin integrity and risk of ulcer infection' (OR: 1.45; 95%CI: 1.06-1.97) and 'activity intolerance associated with fatigue' (OR: 1.56; 95%CI: 1.21-2.01) were associated with an increased risk of suffering an episode of hospital readmission rate at 30% after hospital discharge, and this was independent of sociodemographic background, care variables and comorbidity. PATIENT OR PUBLIC CONTRIBUTION: The nursing diagnoses assigned as part of the care plan of patients during hospital admission may be useful for predicting readmissions.

Analysis of the Nursing Effect of Respiratory Critical Illness Based on Refined Nursing Management.

In order to improve the nursing effect of respiratory critical illness, this paper combines the refined nursing method to explore the nursing plan of respiratory critical illness. Moreover, this paper uses the variable control method to explore the effects of nursing management, combines the hospital patient samples to conduct a controlled trial analysis, and conducts sample grouping according to the random grouping method. The patients in the control group are managed by traditional nursing management methods, the patients in the test group are managed by refined nursing management methods, and other conditions are basically the same. In addition, the experiment process variable control is carried out according to the mathematical statistics method, and the reasonable statistics and data processing are carried out. Through the comparison method, we can see that the refined management method proposed in this paper has a good effect in the nursing of respiratory critical illness.

Palliative care for chronic respiratory disease: integrated care in outpatient settings.

Chronic respiratory diseases are progressive and often life-limiting illnesses. Patients experience debilitating and troubling symptoms that impact on their quality of life. Despite this, there is under-recognition of patients who may be entering the final year of their life and require palliative care services. The Royal Wolverhampton NHS Trust in partnership with Compton Care has established chronic respiratory disease multidisciplinary team meetings and a combined respiratory and palliative care outpatient clinic to address these issues. This article presents the impact of this service, now in to its fourth year, of delivering palliative care services to patients with chronic respiratory disease.

A nurse-led critical care outreach program to reduce readmission to the intensive care unit: A quasi-experimental study with a historical control group.

INTRODUCTION: Various critical care outreach services have been developed and evaluated worldwide; however, the conflicting findings indicate the need to strengthen the outreach service research. This study aimed to evaluate the effects of a nurse-led critical care follow-up program on intensive care unit (ICU) readmission and hospital mortality in patients with respiratory problems discharged from the ICU in Hong Kong. METHODS: A quasi-experimental study design, with a historical control and a prospective intervention for 13 months, was used. The intervention group received a nurse-led, multidisciplinary ICU follow-up program in addition to the usual care. The outcome measures included ICU readmission within 72 h after ICU discharge, all ICU readmission (ICU readmission irrespective of the time frame after ICU discharge), hospital mortality, and 90-day mortality rate. Logistic regression analysis was used to determine the predictors for ICU readmission within 72 h. RESULTS: A total of 369 participants (the intervention group: 185; the control group: 184) were recruited. A significant reduction in ICU readmission within 72 h was observed in the intervention group compared to the control group (p = 0.001), even after controlling for confounders (odds ratio: 0.158, p = 0.007). The intervention group also demonstrated a significant reduction in all ICU readmission (p < 0.001) and hospital mortality (p = 0.042), but not on 90-day mortality (p = 0.081), when compared with the control group. This nurse-led ICU follow-up program was shown to be cost-effective, saving an estimated US$ 145,614 for a period of 13 months. CONCLUSION: The findings demonstrated that a nurse-led multidisciplinary ICU follow-up program was a beneficial and cost-saving strategy to avert ICU readmission in patients with respiratory problems after ICU discharge. It also highlighted the competent role of ICU nurses in planning and leading the implementation of a multidisciplinary program. The results contributed to the database of an innovative follow-up program to inform the practice worldwide.

Irish Respiratory Clinical Nurse Specialists' Experiences of Their Role: A Qualitative Exploration.

AIM AND OBJECTIVES: The aim of this study was to explore respiratory clinical nurse specialists' (CNSs') experiences of their role. BACKGROUND: Respiratory illnesses are currently 1 of the top 3 causes of mortality resulting in 1 in 5 deaths and are associated with significant human burden. Respiratory CNSs play a vital role in the management of respiratory disease through supporting improvements in quality of life, reduction of exacerbations, and subsequent hospital admission. While published literature exists regarding the CNS role, there is a dearth of published literature on the respiratory CNS role. DESIGN: A qualitative descriptive design allowed the researcher to elicit respiratory CNSs' experiences of their role. METHODS: Ethical approval was obtained, CNSs were purposively sampled (n = 10), and data were collected by semistructured interviews, transcribed, and analyzed using content thematic analysis. RESULTS: Three themes were identified within the findings: "multidimensional role," "interacting and collaborating," and "advancing the role." CONCLUSIONS: Overall the study highlights that respiratory CNSs are active in the role as clinical experts, advocators, educators, collaborators, consultants, and health promoters. These findings recognize the importance of evaluating and building on the current CNS workforce in respiratory care and evaluating future development of the CNS role in specialized aspects of respiratory care in line with population and service needs.

The experience of palliative care service provision for people with non-malignant respiratory disease and their family carers: An all-Ireland qualitative study.

AIM: To explore specialist and generalist palliative care provision for people with non-malignant respiratory disease, in rural and urban areas in the North and Republic of Ireland. BACKGROUND: Globally, palliative care is recommended as an appropriate healthcare option for people with advanced non-malignant lung disease. Yet, there is limited evidence regarding the integration of palliative care for this client group. DESIGN: Qualitative study. METHODS: Convenience sample of 17 bereaved carers and 18 healthcare professionals recruited from two rural and two urban sites on the Island of Ireland. Data were collected throughout 2012 and 2013 through semi-structured interviews with carers of patients with Chronic Obstructive Pulmonary Disease (N = 12), interstitial lung disease (N = 4) or bronchiectasis (N = 1) who had died 3-18 months previously; and four focus groups with healthcare professionals. Data were analysed using a thematic analysis framework. RESULTS: Carers' interviews yielded three overarching themes: (1) lack of preparedness for death, due to ambiguity regarding disease trajectory; (2) lack of consistency in palliative care delivery, in relation with the receipt of generalist and specialist palliative care; and (3) role ambiguity, related to their caregiving role. Focus groups identified two overarching themes: (1) barriers to appropriate palliative care; and (2) the future direction of palliative care for patient with non-malignant respiratory disease. CONCLUSION: The uncertain disease trajectory was not only experienced by carers but also healthcare professionals. Although referral to specialist palliative care services was perceived as increasing, the availability and coordination of generalist and specialist palliative care services were fragmented and varied dependent on geographical location.

Prevenção da falência respiratória em pediatria: a intervenção especializada em enfermagem de reabilitação / Prevention of respiratory failure in pediatrics: specialized intervention in rehabilitation nursing

Em Portugal, as doenças respiratórias são o principal motivo de recorrência aos Serviços de Urgência e de admissão nas Unidades de Cuidados Intensivos Pediátricos (Palhinha & Carrilho, 2003), pois a deterioração clínica da função respiratória é rápida, progredindo facilmente para falência respiratória; pelo que a sua prevenção, diagnóstico e tratamento precoce são uma prioridade de atuação. Apesar da prevenção da falência respiratória em Pediatria ser amplamente estudada, ainda são poucos os estudos que abordam a intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação (EEER), constituindo uma área emergente de investigação. Por este motivo, o presente Relatório de Estágio visa evidenciar a intervenção do EEER na prevenção da falência respiratória em Pediatria e refletir a aquisição e desenvolvimento de competências do autor (para a atribuição do título de EEER), através da consecução dos seguintes objetivos: [1] Desenvolver competências científicas, técnicas, éticas e relacionais de prestação de cuidados especializados de Enfermagem de Reabilitação (ER); [2] Desenvolver competências no domínio da supervisão, liderança e gestão de cuidados de Enfermagem, promovendo a sua continuidade, qualidade e segurança; [3] Contribuir para a melhoria da qualidade e segurança dos cuidados de Enfermagem através do desenvolvimento de um programa de intervenção de ER direcionado ao cliente pediátrico em risco de falência respiratória. Para tal, o autor baseou-se na sua experiência (profissional e académica) e nas atividades por si desenvolvidas em contexto de Ensino Clínico (EC) numa Equipa de Cuidados Continuados Integrados e no Departamento de Pediatria de um Hospital de Lisboa. A consecução do EC e a realização do presente Relatório de Estágio permitiu ao autor atingir o nível de perito (Benner, 2001) na prestação de cuidados de ER à criança em risco de falência respiratória e atuar como elemento de referência na promoção das boas práticas em Enfermagem, contribuindo para o progresso e afirmação da profissão.

In Portugal, respiratory diseases are the main cause of consulting the Emergency Department and admission to the Pediatric Intensive Care Unit (Palhinha & Carrilho, 2003), as respiratory clinical deterioration is fast, hence easily leading to respiratory failure; making its prevention, diagnose and early onset treatment of prioritary action. Even tough respiratory failure in Paediatrics is troughoutly studied, there are still few studies related to the Nurse Specialist in Rehabilitation role. For this reason, the present internship report aims to support the importance of the Nurse Specialist in Rehabilitation regarding the prevention of respiratory failure in paediatrics, and to reflect on the acquisition of competencies development of its author (leading to the title of nurse specialist in rehabilitation), throught the accomplishment of the following objectives: [1] To develop scientific, technical, ethical and relational competencies of giving specialized care in Rehabilitation Nursing (RN); [2] To develop competencies in the domains of supervision, lidership and care management, promoting its continuity, quality and security; [3] To contribute to a better quality and security of nursing care through the development of a RN programme of ation directed to the paediatric client with risk of respiratory failure. For that, the author has used personal clinical experience (professional and academic) and the activities developed during the internship in a Continuous Care Team and in the Paediatric Department of an Hospital in Lisbon. The accomplishment of the internship and the realization of the present internship report, allowed the author to achieve the level of expert (Benner, 2001) in caring for the child with risk of respiratory failure as a RN and to act as an element of reference in promoting a good practice in Nursing, contributing to the progression and professional affirmation.

Children's respiratory nurse is patient's choice.

A children's respiratory nurse specialist has won one of the most prestigious accolades in nursing, the Patient's Choice category of the RCNi Nurse Award 2017.

Exames realizados para o diagnóstico de tuberculose pulmonar no município de ribeirão preto, brasil / Exámenes realizados para el diagnóstico de tuberculosis pulmonar en la ciudad de ribeirão preto, brasil / Tests performed for pulmonary tuberculosis diagnosis in ribeirao preto city, brazil

Objetivou-se analisar o processo de realização de exames para o diagnóstico da tuberculose pulmonar, no município de Ribeirão Preto. Estudo epidemiológico descritivo do tipo inquérito a partir de uma abordagem quantitativa. A população de estudo foi constituída por 84 doentes de tuberculose pulmonar em tratamento (com idade igual ou superior a 18 anos, residentes em Ribeirão Preto), no período de janeiro a abril de 2009. Os dados foram coletados por meio de entrevistas e para tal utilizou-se um questionário estruturado. De forma complementar, foram levantados todos os exames realizados pelos doentes entrevistados no período do seu diagnóstico no Sistema de Controle de Pacientes com Tuberculose do Estado de São Paulo (TB-WEB). Para análise dos dados, foram utilizadas técnicas de estatística descritiva. Observou-se que a realização de exames no processo de elucidação diagnóstica da tuberculose pulmonar precisa transpor algumas barreiras organizacionais, culturais, geográficas e econômicas, visto que o acesso ao diagnóstico tem ocorrido por meio dos serviços especializados e de referência para controle da doença.

RESUMEN El objetivo fue analizar el proceso de realización de exámenes para el diagnóstico de la tuberculosis pulmonar, en la ciudad de Ribeirão Preto, Brasil. Estudio epidemiológico descriptivo del tipo averiguación a partir de un enfoque cuantitativo. La población estudiada consistió en 84 pacientes en tratamiento de la tuberculosis pulmonar (con edad igual o superior a 18 años, que viven en Ribeirão Preto), en el periodo de enero a abril de 2009. Los datos fueron recolectados a través de entrevistas, utilizando un cuestionario estructurado. Por otra parte, se plantearon todos los exámenes realizados por los enfermos entrevistados en el momento de su diagnóstico en el Sistema de Control de Pacientes con Tuberculosis del Estado de São Paulo (TB-WEB). Para el análisis de los datos, se utilizaron técnicas de estadística descriptiva. Se observó que la realización de exámenes en el proceso de elucidación diagnóstica de la tuberculosis pulmonar necesita superar algunas barreras organizacionales, culturales, geográficas y económicas, ya que el acceso al diagnóstico se ha producido a través de servicios especializados y de referencia para el control de la enfermedad.

ABSTRACT The objective was to analyze the process of examinations for the diagnosis of pulmonary tuberculosis in Ribeirao Preto. This is a survey type study with a quantitative approach. The study population consisted of 84 patients with pulmonary tuberculosis under treatment (aged over 18 years old, living in Ribeirão Preto), from January to April 2009. Data were collected through interviews using a structured questionnaire. Moreover, all tests performed by patients interviewed at the time of diagnosis were raised from the System of Tuberculosis Patients Control of the State of São Paulo (TB-WEB). For data analysis, descriptive statistics were used. It was observed that the performance of tests in the laboratory diagnosis of pulmonary tuberculosis process needs to overcome some organizational, cultural, geographical and economical barriers, since the access to diagnosis has occurred through specialized services, reference for disease control.

Profile of nursing diagnoses in patients with respiratory disorders.

OBJECTIVE: Identify the profile of nursing diagnoses in patients with respiratory disorders. METHODOLOGY: A descriptive and cross-sectional study involving 38 patients with respiratory problems, of referral hospitals, in a city in northeastern Brazil, in the period from August to October, 2012. Data collection was performed using a form and diagnostic inference was made according with the Taxonomy II of NANDA I. RESULTS: The average age of the patients was 46 years and males predominated (60.5%). The most frequent nursing diagnoses were: Risk for infection (97.3%), Acute pain (68.4%), Poor knowledge (68.4%), Sedentary lifestyle (65.7%), Ineffective airway clearance (65.7%), Risk-prone health behavior (63.1%), Activity intolerance (52.6%) and Disturbed sleep pattern (33.3%). Evaluated patients exhibited an average of 8.6 nursing diagnoses (SD = 2.8). With respect to the defining characteristics and related factors the average per person was 7.2 and 9.3, respectively. CONCLUSION: In this group of patients the most frequent diagnoses were the domain activity/rest. Knowledge of nursing diagnoses profile presented by people with respiratory disorders is important, because it is part of the Nursing Process and nurses who take care of such patients should exercise them in their care practice. Knowledge of the mains nursing diagnosis presented by patients with respiratory disorders are important for the practice of nurses who care for these patients, because it allows the choice of responses to problems of their clientele.

Systematic review and meta-analysis of the accuracy of clinical indicators for ineffective airway clearance.

AIM: To report quantitative evidence for the accuracy of the defining characteristics of ineffective airway clearance in different settings and populations. BACKGROUND: Defining characteristics are tests used by nurses to clinically indicate the presence or absence of a particular nursing diagnosis. A few studies have reported the accuracy of certain defining characteristics of ineffective airway clearance, but these studies address specific populations with particular needs. DESIGN: A systematic review with meta-analysis was conducted to provide a synthesis and critical appraisal of the included studies. DATA SOURCES: The electronic databases CINAHL, PubMed, Scopus and LILACS were searched using a systematic search strategy for studies published in any year. The last search was performed on 31 July 2013. REVIEW METHODS: Using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy and the Standards for Reporting of Diagnostic Accuracy (STARD), a systematic review was conducted using studies investigating the presence of ineffective airway clearance and its defining characteristics. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to evaluate the quality of the studies. RESULTS: Seven papers met the search criteria. The studies were developed in different clinical settings and most of them fulfilled QUADAS criteria. Summary measures indicated the following defining characteristics with higher accuracy values: adventitious breath sounds, changes in respiratory rate, difficult vocalizing, diminished breath sounds, dyspnoea, ineffective cough, orthopnoea and restlessness. CONCLUSION: This systematic review showed that the variability in clinical indicators of ineffective airway clearance is related to differences in the clinical settings and patients.

An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England.

BACKGROUND: There is a need to reduce symptoms, exacerbations and improve quality of life for patients with respiratory diseases. Across the world, increasing numbers of nurses are adopting the prescribing role and can potentially enhance service provision. Evidence suggests improved quality of care and efficiencies occur when nurses adopt the prescribing role. No evidence is available on the views of nurse prescribers who care for respiratory patients. The aim was to explore how nurse prescribing is being used for patients with respiratory conditions in different care settings across one strategic health authority, and whether this has benefited patients, healthcare professionals and the National Health Service. METHODS: A qualitative study involving semi-structured interviews with a purposive sample of 40 nurses who prescribed for respiratory patients across the six counties in the East of England Strategic Health Authority. Data were collected in 2011 and subject to thematic analysis. RESULTS: Disease management, including treatment and prevention of exacerbations, emergency episodes and minor illness, optimising and co-ordinating care were key aspects of care provided. Findings are reported under three themes: access, adherence and risk management and impact on nurses. Prescribing enabled nurses overcome existing problems in service provision to improve access, efficiency and patient convenience, reducing hospital admissions and length of stay. It also enabled patient centered consultations, which encouraged self-management, improved adherence, helped manage expectations, and reduced inappropriate service use. While participants experienced increased job satisfaction, knowledge and confidence, concerns were raised about increased responsibility, support, governance and future commissioning of services in line with planned major changes to the National Health Service. CONCLUSIONS: This study provides new knowledge about how nurse prescribers provide care to patients with respiratory diseases. Despite a lack of consensus over the most effective model of respiratory care, prescribing was reported to have improved and extended points of access to treatment, and supported management of complex patients, particularly vulnerable groups. Given the high burden of chronic respiratory disease to patients and families this has important implications that need to be considered by those responsible for commissioning services in the United Kingdom and other countries.