Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.

BACKGROUND: To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED). AIM: To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors. METHODS: A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed. FINDINGS: The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). CONCLUSIONS: Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level.

[Nurses' experience of violence in psychotic crisis: an example of qualitative research]. / L'esperienza dell'infermiere al contatto con la violenza nella crisi psicotica: un esempio di ricerca qualitativa.

This study indagates into the personal experience of a nurse caring for an aggressive patient in acute psychotic crisis and gives an example of qualitative research.

[The Rosemary Rizzo Theory discusses "developing man" a phenomenologic approach to nursing]. / La teoria di Rosemary Rizzo parse "uomo in divenire" un approccio fenomenologico al nursing.

The Authors discuss the "Human Becoming Theory" by R.R. Parse and main philosophical principles of theory are presented: man as open system in a continuum coostrascendental relationship with the universe. Health is the model of relationship experienced by man to which he gives values for the evolution of model itself. The theory is illustrated and discussed with its structure, research methodology and application for clinical practice.

Long term evaluation of "push down" procedures.

The "push-down" technique for hump removal, or hump elimination, is just one maneuver of a number of surgical steps to obtain a more functionable and esthetic appearing nose. The maxilla-premaxilla Cottle approach to extensive nasal septum surgery is used, using techniques of his to modify the nasal dorsum. The "push-down" procedure usually eliminates the bony hump. The cartilaginous hump, (the upper lateral cartilage area) remains intact, and produces little trauma to the subcutaneous tissue, the mucous membranes, the periosteum, the perichondrium, and preserves the nerves and blood supply of the area. The amount of "push-down" that can be done depends on the nasal septum, which is the key to the surgical procedure. One must know how to handle part or all of the septum; its reconstruction with the patient's own bone and cartilage, so that saddling and deformity of the external pyramid and lobule may not occur later. In the repair of the roof, all anatomic relationships should be restored. The upper lateral area should be spared, however, if modified, very conservatively done and with little or no shortening. If there is partial removal of the hump, there should also be reparation of the nasal dorsum with crushed septal cartilage. Further "push-down" depends upon the width of the nose, the location and number of lateral osteotomies and intra-septal osteotomies, incomplete or complete separation of the upper lateral cartilage, done chiefly through the intra-septum space; thus, the nose becomes narrower, smaller, and the roof remains an unimpaired insulating organ playing its important physiological role. Secondary nasal revisions were minor in nature and were usually performed as outpatient procedures. The hump removal concept of total excision should be changed to "push-down" elimination of the nasal bones with total preservation of the dorsum.