Aplicação do Nursing Activities Score em unidade semi-intensiva especializada: construção e validação de um tutorial / Application of the Nursing Cctivities Score in specialized semi-intensive unit: construction and validation of a tutorial

Objetivo: apresentar a validação de um tutorial referente à aplicação do Nursing Activities Score (NAS) emUnidade de Cuidado Semi-intensivo especializada. Método: estudo descritivo, de validação, realizado porjuízes por meio da Técnica Delphi quanto à abrangência, clareza e pertinência. Para avaliar a concordânciaentre os juízes foi utilizado o Índice de Validade de Conteúdo de 90%. Resultados: participaram sete juízes ea validação do tutorial compreendeu dois ciclos. Em relação à avaliação dos itens, os Índices de Validade deConteúdo referentes à abrangência, clareza e pertinência foram respectivamente de: primeira avaliação -0,78; 0,79 e 0,89; segunda avaliação - 0,98; 0,97 e 1,00. O percentual de concordância foi de 82% na primeiraavaliação e 98% na segunda avaliação. Conclusão: a construção e validação do tutorial contribuíram parauniformizar e facilitar a aplicação do instrumento, tornando mais fidedigna à mensuração da carga detrabalho de enfermagem.(AU)

Objective: to present the validation of a tutorial on the application of the Nursing Activities Score (NAS) in specialized Semi-Intensive Care Unit. Method: a descriptive study, of validation, conducted by judges through the Delphi Technique regarding the comprehensiveness, clarity and relevance. For evaluating the agreement among the judges, a 90% Content Validity Index was used. Results: seven judges participated and the tutorial validation comprised two cycles. Regarding the assessment of the items, the Content Validity Indices relating to the scope, clarity and relevance were respectively: first assessment - 0.78, 0.79 and 0.89; second evaluation - 0.98, 0.97 and 1.00. The percentage of agreement was 82% in the first evaluation and 98% in the second evaluation. Conclusion: the tutorial construction and validation contributed to standardize and facilitate the implementation of the instrument, making it more reliable to measure the nursing workload. (AU)

Objetivo: presentar la validación de un tutorial sobre la aplicación del Nursing Activities Score (NAS) en la Unidad de Cuidado Semi-Intensivo especializada. Método: estudio descriptivo, de validación, llevado a cabo por los jueces a través de la técnica Delphi cuanto al alcance, claridad y relevancia. Para evaluar el acuerdo entre los jueces se utilizó el Índice de Validez de Contenido de 90%. Resultados: participaron siete jueces y la validación del tutorial fue compuesto por dos ciclos. En cuanto a la evaluación de los artículos, los índices de validez de contenido relacionados con el alcance, claridad y relevancia fueron, respectivamente: primera evaluación - 0,78, 0,79 y 0,89; segunda evaluación - 0,98, 0.97 y 1.00. El porcentaje de acuerdo fue del 82% en la primera evaluación y el 98% en la segunda evaluación. Conclusión: la construcción y validación del tutorial contribuyeron a normalizar y facilitar la aplicación del instrumento, por lo que es más fiable para medir la carga de trabajo de enfermería.(AU)

Nursing care system development for patients with cleft lip-palate and craniofacial deformities at Srinagarind Hospital.

BACKGROUND: A holistic nursing care system for patients with cleft lip-palate (CLP) and/or craniofacial deformities was arranged by the Nursing Department, Srinagarind Hospital, which provides tertiary nursing care. The nursing care system was developed as per system theory via participating management with action research following the Deming Cycle (PDCA) divided into 3 phases. Participants included 117 nurses from 8 divisions caring for patients with CLP and 128 parent caregivers. The research instruments included: 1) situation analysis, 2) meeting and planning and 3) self-administered questionnaire. Groups were divided according to the age, physical and mental aspects of the patients. RESULTS: 1) The nursing care system under study comprised psychosocial care, breastfeeding, counseling, providing assistance in various ways in order to respond to problems of patients/families by the multidisciplinary team. There was also follow-up to evaluate the results and in order to give patients/families longitudinal and continuing care. 2) Minor research of 4 nursing sections was initiated. 3) Nursing care standards, manuals, regulations and innovations for the organization of eight nursing sections were created and implemented. CONCLUSION: The present study on developing a nursing care system for patients with CLP helped the team to (a) understand the overall nursing care system (b) to develop the organization of nurses by conducting research and (c) to create 12 works for developing care. The latter aimed to establish or create standards, nursing manuals, caring manuals, regulations, innovations, CDs, portfolios and informative cartoons to be applied systematically and shared across and between communities. The model for nursing care for patients with CLP in tertiary hospitals was clearly demonstrated.

The development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital, Khon Kaen, Thailand.

BACKGROUND: The highest incidence of cleft lip-palate and craniofacial deformities in Thailand occur in the Northeastern Region. There is the necessity for an interdisciplinary care team as well as the specialized care center with systematic coordinated care, thus "Tawanchai Cleft Center" is becoming a superior medical center for patients with cleft lip-palate and craniofacial deformities. Therefore, the development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital is extremely important and necessary. OBJECTIVE: To develop the nursing care system appropriate for a super tertiary hospital (Tawanchai Cleft Center). MATERIAL AND METHOD: It is a participation study which has 3 steps as follows, 1) Analyzing the situations and collecting the opinions of the 22 Out-patient Surgery Department staff and Tawanchai Cleft Center staff by using 6 questions, 2) Summarizing of the situation analysis from the meetings and the questionnaires, then using such summary as the guidelines for developing the nursing care system from January 2011 onwards, 3) evaluating the satisfaction after the 4 month development period (May-August 2011) with 106 caregivers by using 8 questions and being analyzed by the average value, percentage and standard deviation. RESULTS: 1) The nursing care system consisted of psychosocial care, breast feeding, counseling and other assistance as required. This various assistance responded to the patient/family problems by following the treatment guideline of the multidisciplinary team which uses the continuous evaluation processes for the holistic patient/family care. 2) The patients with complete cleft lip-palate were the most common type, found in 44 cases or 41.53 percent. The highest number of caregivers were mothers which were 68 percent; the average age of those mothers was 36 years old. The highest number of them finished elementary school at 43 percent and 40 percent were farmers. The satisfaction for the services of Tawanchai Cleft Center showed the average for each satisfaction subject all at very good level (x = 3.56, SD = 0.13). CONCLUSION: The care for patients with CLP and craniofacial deformities at Tawanchai Cleft Center Srinagarind Hospital has been developed in order to have the appropriate nursing care system to provide superior quality care, which provides patient-holistic care, as well as improving effective accessibility to the services. Thus, the patients/caregivers who are satisfied with given services, get continuing monitoring and treatment and are able to live their lives in the society happily.

Nursing outcome in patients with craniofacial anomalies who underwent operation.

BACKGROUND: The Northeast of Thailand has patients with craniofacial anomalies about 2.5: 1,000 children birth. Ward 3C Srinagarind Hospital has about 150-200 cases of patients with craniofacial anomalies each year. Some of them have an operation about 10 times. When the patients go to hospital to undergo operation, patients and families experience fear and anxiety. They need information about their disease, operation, feeding and wound care. Nurses who work continuously and closely with the patients need to have ability to support patients needs by using nursing process. Nursing outcome will help nurses to measure the quality of nursing care. OBJECTIVE: To study nursing outcome in the patients with craniofacial anomalies who were admitted in 3C ward. MATERIAL AND METHOD: The present study is retrospective descriptive study. Data was collected from medical records of 27 patients with craniofacial anomalies who were admitted in 3C ward Srinagarind Hospital between June 2010 to May 2011. Medical records were purposively selected for the study and recorded with a data collection form. RESULTS: The authors found that 2.36% of patients had wound infection. 100% of parents received information about disease, medication, self care but some information was not received or was received but not understand. 1 case of patients unplanned readmit. Length of stay of patient 2.74 days. Parents satisfaction is 91.81%. CONCLUSION: Patients had wound infection when back home because care giver cannot clean patients wound correctly, parents and care giver did not receive enough information or did not understand all information.

Measuring health and well-being effects in family caregivers of children with craniofacial malformations.

PURPOSE: This research explores the sensitivity of three generic instruments for preference-weighting health states of family caregivers of children with craniofacial malformations (CFM). We also examine the construct validity of the new CarerQol instrument measuring caregiver burden and general quality of life. METHODS: Caregivers of children born with CFM were identified through the Arkansas Reproductive Health Monitoring System. A mailed survey included the HUI3, the SF-6D, the QWB-SA to measure health-related quality of life; the CES-D measuring depressive symptoms as well as the SRB scale, and the CarerQol. The HUI3, the SF-6D, and the QWB-SA were examined in relation to the CES-D the SRB, the CarerQol, and each other. RESULTS: A total of 65 (63%) parents of children (≤17 years) responded. The mean SF-6D, HUI3, and QWB-SA scores were 0.81 (SD = 0.13), 0.84 (SD = 0.23), and 0.67 (SD = 0.14), respectively. The mean CES-D score was 13.3 (SD = 13.4) and 28.6% of the sample met a threshold for depressive symptoms (CES-D ≥ 16). The mean CarerQol-VAS and SRB scores were 7.5 (SD = 2.3) and 15.1 (SD = 23.5), respectively. The Spearman correlations (ρ) of the HUI3 and the SF-6D with the CES-D were similar (-0.81 and -0.76) while the ρ was lower (-0.57) for the QWB-SA. Preference-weighted scores of caregivers with CES-D scores ≥ 16 differed significantly for both the SF-6D and the HUI3, but not the QWB-SA. All three generic instruments showed moderate to strong relationships with the CarerQol. CONCLUSIONS: The HUI3 and SF-6D were more sensitive predictors of depressive symptoms in this caregiver sample than was the QWB-SA. The CarerQol showed good construct validity and may be useful for measuring well-being effects associated with caregiving.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities in Srinagarind Hospital: pre-post operation.

BACKGROUND: Cleft lip and palate are the most common craniofacial anomalies. Srinagarind Hospital has 150-200 cases each year. The operating process of care requires continuity of care involving a multidisciplinary team. When the patients go to hospital to have operation, pain, limited activity and food are very different from normal life. During pre and post operative care nurses who work continuously and closely with the patients should have knowledge, experience and ability to take excellent care of their patients and families. This can prevent complications and help their decision process, decrease parents stress and encourage better co-operation. OBJECTIVE: To develop a nursing care system for patients with cleft lip-palate undergoing operation. MATERIAL AND METHOD: This is an action research divided into 3 phases. Phase 1, situation review: review of nursing care process by interview, focus group, observation and nursing documents. Phase 2, nursing system management: developing guidelines, composing nursing manual, handbook for parents, VCD for patients and family and story telling. Following that announcement and implementation. Phase 3: evaluation. RESULT: The authors found that guidelines, nursing manual, handbook for parents, VCD for patients and family and story telling are appropriate and have good utilization, but the pictures in handbook for parents and storytelling were not clear, too small and not attractive. CONCLUSION: Nursing manual for giving information about pre-post operative care, handbook for parents, story telling and VCD about pre-post operative care provide optimal care for patients and family with cleft lip and palate, but need to evaluate further the nursing outcome after this nursing system development.

Focus on the physical assessment of the infant with Stickler syndrome.

Stickler syndrome is an autosomal dominant, genetic connective tissue disorder characterized by ocular, orofacial, auditory, and skeletal anomalies. The diagnosis of Stickler syndrome is often missed in the newborn period and diagnosed as simply Pierre Robin sequence. For these patients, complications and disabilities could be lessened by further analysis of the family history.Neonatal caregivers are responsible for the immediate care of the newborn with Pierre Robin sequence. The prudent healthcare profession will explore the origin of the condition to provide optimal comprehensive care to the infant and family. This article reviews the physical findings of Stickler syndrome including differentiation between similar syndromes. A systematic review of physical findings is included along with treatment options.

Human becoming theory with children.

As a nurse practitioner, I am often challenged with providing care for children in the traditional medical model. Struggling with these challenges has created new ways of being with patients and their families. Working with children is gratifying, stimulating, and life changing. Living true presence with children as they draw images of their realities gives rise to a powerful interconnectedness that facilitates greater understanding of their meaning about what is important to them as they create new ways of seeing health opportunities. Bearing witness to children as they use art and words to describe their feelings encourages and fosters new ways of becoming for the nurse and the child and the child's family. This column describes a dialogical-engagement of this nurse practitioner and a young child and how this process transformed the nurse practitioner as she moves to be with children and families in new ways.

What to do about flat heads: preventing and treating positional occipital flattening.

Across Canada there has been an increasing incidence of positional occipital flattening. This increase appears to be related to the recent change in infant sleep position to supine. In this paper, two patterns of positional occipital flattening, positional plagiocephaly and positional brachycephaly, are outlined. While there is no evidence of long-term developmental or neurological problems that result from positional occipital flattening, the infant's appearance can be distressing to parents who will then seek treatment. Prevention of positional occipital flattening requires a community approach with timely screening and early intervention should the infant's skull appear flat. Treatment involves repositioning the infant coupled with physiotherapy if there is neck muscle involvement. Should repositioning alone be ineffective, a helmet or headband program may be implemented. Neuroscience nurses can work in partnership with the community to ensure prevention strategies are implemented and timely interventions initiated.

Assessment of the newborn with dysmorphic features.

Accurate assessment of all newborns is essential for identifying those who will need more thorough examination, medical or support services, or family counseling. External assessment of dysmorphic features offers clues to the presence of internal anomalies. This article describes a systematic approach to the assessment of dysmorphic features in the newborn.

Rare facial clefts: craniofacial anomalies.

Craniofacial surgery is an integrated approach to correct anomalies that include a range of deformities in the growth of the cranium and facial bones. The goal of surgery is to achieve a maximum result with the best possible functional and aesthetic results with minimal scarring in the least amount of time.

Disostosis craneofacial: enfermedad de crouzzon / Craneofacial disostosis: Crouzon disease

La disistosis cráneo faciales si bien son enfermedades muy excepcionales en la gran variedad de presentaciones que tienn, son asimismo cuadros que requieren un estudio minucioso, clínico y radiológico que apoyen el diagnóstico planteado para poder de este modo realizar el manejo quirúrgico inmediato destinado a la sobrevida del paciente y evita las futuras ealteraciones estéticas y fundamentalmente somáticas del individuo, es po ello que los autores presentan este caso clínico por considerarlo de nterés profesional.