Adverse effects of non-intubated airway suctioning: a clinical data-based study.

AIMS AND OBJECTIVES: The purpose of this study was to investigate the adverse effects of non-intubated suctioning. BACKGROUND: Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning. DESIGN: A clinical data-based retrospective design. METHOD: Using institutional and clinical databases of three university hospitals in 2008-2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study. RESULTS: Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24-3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26-2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40-6.60). CONCLUSIONS: Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning. RELEVANCE TO CLINICAL PRACTICE: The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.

[Evaluating the Health and Social Care Competences of Nursing Students Using Skills Competition].

BACKGROUND: After graduation, new nurses provide care directly to clients in the health and social care sectors. Nurses with higher levels of health and social care competences have been shown to provide better quality of care. The skills competitions organized and held by the Ministry of Labor follow international standards and address the general roles and functions of care providers worldwide. Using the results of these skills competitions to confirm the health and social care competences of nursing students important for nursing education. PURPOSE: This study was designed to assess the performance of nursing students in the skills competition and to identify the strengths and weaknesses of these students with regard to related competences in the context of current global standards. METHODS: This was a retrospective research study. Data were collected from the results of skills competitions using the Scenario-based Objective Structured Clinical Examination method. Descriptive statistics were used to analysis the data. RESULTS: The mean score for health and social care competence was 67.9 ± 12.9. The score for the home care dimension (65.1 ± 14.1) was the lowest dimension score. The most two improved of the six competence dimensions were problem solving/innovation and creativity (53.7 ± 3.9) and evaluating response to care (55.9 ± 4.0). The lowest health and social care item scores were practicing the five moments of hand hygiene (42.7%) and encouraging patient to discuss health problems (43.1%). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results showed that the competence level of the students was moderate. Nursing educators should develop appropriate education approaches for teaching and evaluation and improve the health and social care competences of nursing students.

[Application of the 6-Minute Walking Test and Shuttle Walking Test in the Exercise Tests of Patients With COPD].

Exercise training improves the management of stable chronic obstructive pulmonary disease (COPD). COPD patients benefit from exercise training programs in terms of improved VO2 peak values and decreased dyspnea, fatigue, hospital admissions, and rates of mortality, increasing exercise capacity and health-related quality of life (HRQOL). COPD is often associated with impairment in exercise tolerance. About 51% of patients have a limited capacity for normal activity, which often further degrades exercise capacity, creating a vicious circle. Exercise testing is highly recommended to assess a patient's individualized functions and limitations in order to determine the optimal level of training intensity prior to initiating an exercise-training regimen. The outcomes of exercise testing provide a powerful indicator of prognosis in COPD patients. The six-minute walking test (6MWT) and the incremental shuttle-walking test (ISWT) are widely used in exercise testing to measure a patient's exercise ability by walking distances. While nursing-related articles published in Taiwan frequently cite and use the 6MWT to assess exercise capacity in COPD patients, the ISWT is rarely used. This paper introduces the testing method, strengths and weaknesses, and application of the two tests in order to provide clinical guidelines for assessing the current exercise capacity of COPD patients.

Effectiveness of paced walking to music at home for patients with COPD.

The use of rhythmic music is beneficial in assisting with the exercise intensity at home. This paper investigated the effects of paced walking to music at home with an 80% VO(2) peak for patients with COPD. A prospective randomized clinical trial consisting of a treatment group (n = 20) assigned to a 12-week period of paced walking to music at home, while the patients in the control group (n = 21) were only given educational information. The treatment response was measured based on the patient's score in the maximal exercise capacity test using the incremental shuttle walking test (ISWT), lung function, health- related quality of life (HRQOL) using the Saint George Respiratory Questionnaire (SGRQ) and their health care utilization during baseline, 4, 8, 12 and 16 weeks. The treatment group increased their distance in the ISWT from 243.5 ± 135.4 at baseline to 16 weeks (306.0 ± 107.3, p < 0.001), Borg RPE-D decreased from 2.2 ± 1.3 at baseline to 0.8 ± 1.1 (p < 0.001) at 16 weeks, and Borg RPE-L decreased from 1.2 ± 1.4 at baseline to 0.3 ± 0.7 (p < 0.05) at 16 weeks, and improved all of the domains of the SGRQ, compared to the control group. The paced walking to music at home program helps patients to achieve a higher-intensity exercise. It is easily incorporated into the care of COPD patients, providing them with a convenient, safe and enjoyable exercise.