The holistic nursing competence and transition shock of newly graduated nurses as the determinants of missed nursing care: The mediation analysis.

AIMS AND OBJECTIVE: To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. BACKGROUND: Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. DESIGN: Descriptive and correlational design. METHODS: The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1-12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. RESULTS: The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. CONCLUSIONS: Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. RELEVANCE TO CLINICAL PRACTICE: The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education.

Reframing Holistic Patient Care in Nursing Homes Through the Lens of Relational Autonomy.

In nursing facilities, patient autonomy is more effective when it is reframed under the rubric of relational autonomy. Through this lens, patients, family, and staff, especially nurses, can share conversations that lead to effective decision-making that acknowledges the needs of the whole person within the nexus of the institutional setting.

Advancement of global health: Recommendations from the Global Advisory Panel on the Future of Nursing & Midwifery (GAPFON®).

AIMS: To discuss nurses' contributions to global health through their participation in GAPFON®. DESIGN: Discussion paper that reviews literature related to global health, global nursing and midwifery based on the contributions of the GAPFON® report. DATA SOURCES: A literature search of electronic databases was conducted for published articles during 2014-2018 in English focusing on the main themes of the GAPFON® report. Manual searches of relevant journals and internet sites were also undertaken. RESULTS: Recommendations and strategies were discussed that could have an impact on the advancement of the nursing profession's contribution to global health based on the GAPFON® report outcomes. IMPLICATIONS FOR NURSING: GAPFON® provides a framework to synergize and converge our activities to address professional issues around the globe, through implementation of the suggested strategies identified in the GAPFON® report. GAPFON® has engaged with nursing and midwifery leaders around the globe to determine both the most pressing health issues and professional issues in regions and the report is a synthesis of all the data, reflecting regional and global challenges. This article explores ways of how the report can be used as a basis for engagement with decision makers in global health. CONCLUSION: Advances in the professional areas embedded in the GAPFON® Model are expected to lead to capacity building, evidence-based practice and ultimately improved quality of global health care. The strategies for implementation identified by regional stakeholders can have an impact on the global health agenda by focusing on nurses and midwives as the drivers of this change.

Protocol-based nurse coordinator management of ambulatory tacrolimus dosing in de novo renal transplant recipients-A single-center experience with a large African American population.

INTRODUCTION: Transplant nurse (RN) coordinators review tacrolimus levels frequently and would be capable of making dose adjustments autonomously if not limited by their license. Collaborative practice agreements could be an answer; thus, the aim of this evaluation was to determine if an RN-driven protocol could be used safely and effectively to manage tacrolimus in ambulatory kidney transplant (KTX) recipients. METHODS: This was a retrospective review of all solitary adult KTX recipients between August 1, 2016, and July 29, 2017. The primary objective was to evaluate protocol adherence and frequency of use, and secondary objectives were to evaluate the utility of the protocol both overall and based on ethnicity. RESULTS: A total of 173 patients were included in the evaluation (59% African American [AA], 41% non-African American [non-AA). RN coordinators followed the protocol for 75% of tacrolimus adjustments; however, they only responded to 27% of the overall levels. There was no difference in 180-day tacrolimus-associated readmission (15% AA vs 5% non-AA, P = .06), biopsy-proven acute rejection (4% AA vs 7% non-AA, P = .363), or hyperkalemia (34% AA vs 32% non-AA, P = .87) between groups. CONCLUSIONS: Transplant nurse coordinators are capable of accurately following a protocol for tacrolimus dosage adjustment in a large, racially diverse kidney transplant center.

A Systems Approach to Cultivate a Flourishing Nurse Workforce.

Large integrated health care systems face myriad challenges in bridging national nursing strategy with functional workstream initiatives. The example of a regional Workforce Workstream is outlined to demonstrate how a national nursing agenda may be successfully operationalized to unite and advance an organization's mission, vision, and values. [J Contin Educ Nurs. 2019;50(6):248-251.].

Nursing music intervention: A systematic mapping study.

OBJECTIVE: The present investigation analyses the studies of music intervention carried out by nurse researchers, or a research group including nurses, making use of a systematic mapping method to determine the trends in this field. METHOD: In this study, based on a systematic mapping method, 68 out of the 809 studies published between 2013 and 2017, were evaluated. RESULTS: In 87.7% of the studies, Receptive Music Therapy was used while new age music was listened to in 23.9% of the studies. Music intervention was found to be effective in relieving anxiety and pain in 54% and 34.1% of the 44 studies examining the efficacy of receptive music therapy, respectively. CONCLUSION: This study reveals that nurses use music intervention in all areas of health care services, and that the variables for which the effect of musical intervention is examined are mostly anxiety, vital signs and pain.

Integrating traditional Chinese medicine healthcare into dementia care plan by reducing the need for special nursing care and medical expenses.

Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56-0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.

Implementation of optimized supportive care and hospital needs along the management of patients with advanced lung cancer.

BACKGROUND: Supportive care in cancer (SCC) have been recommended to be integrated in the management of patients with lung cancer all along the course of the disease. We took advantage of a pilot program of early implementation of optimized SCC, to report the feasibility such program in patients with advanced lung cancer, and correlate patient characteristics and outcomes with the actual use of optimized SCC. METHODS: This study is a retrospective analysis of all consecutive patients with lung cancer treated at our center between 2012 and 2016. Optimized SCC included the intervention of a nurse for the home-hospital network coordination, as well as socio-aesthetics, psychomotricity, art-therapy, adapted physical activity, and also establishment of at-home hospitalization. RESULTS: 309 patients were included. Median overall survival was 11.2 months. Unplanned hospitalizations occurred for 276 (89%) patients. The median duration of hospital stay was 19 days. Unplanned hospitalizations more frequently occurred within the first 3 months after the diagnosis of advanced cancer, and in the last 3 months before death. A short - less than 3 months - delay between diagnosis and unplanned hospitalization was associated with poor outcome. 272 (88%) patients received optimized SCC, within a median delay of 8 weeks after diagnosis. Intervention of the nurse for in- and out-patient network coordination was done for 143 (46%) patients, and at-home hospitalization was organized for 78 (25%) patients. The outcome of patients who received optimized SCC was numerically, but not significantly better (median overall survival of 11.8 vs. 6.9 months, p = 0.270). CONCLUSION: Our study provides landmark data to support an early integration of optimized SCC for patients with advanced lung cancer, that includes multimodal supportive care interventions along the course of the disease. This highlights the role of multidisciplinary teams to optimize the management of patients with advanced lung cancer.

Building Specialized Nursing Practice Capacity in Bangladesh: An Educational Program to Prepare Nurses to Care for Oncology and Bone Marrow Transplant Patients in Dhaka, Bangladesh.

In 2012, the Minister of Health and other leaders in the Bangladesh government approached Massachusetts General Hospital to establish the country's first bone marrow transplant program at Dhaka Medical College Hospital to serve the needs of the people of Bangladesh. Stated goals of this collaboration included a broad focus on the care of oncology patients with a specific emphasis on care of patients with hematologic malignancies and of women with gynecologic cancers. The purpose of this article is to describe the international nursing collaboration between Massachusetts General Hospital, Simmons College, the AK Khan Healthcare Trust in Dhaka, and Dhaka Medical College Hospital that was established to share nursing knowledge and to build specialized professional nursing capacities to deliver high-quality cancer care in the public sector. Over the past 3 years, through the educational programs that have been developed within this collaboration-the Enhanced Specialized Nurse Training Program-the Bangladeshi nurses have received continuing professional development based on Western standards of nursing and have been offering nursing care to patients who have undergone chemotherapy and bone marrow transplantation. The challenges, opportunities, and outcomes of this international collaboration have been highly rewarding and mutually beneficial.

Which Complex Patients Should Be Referred for Intensive Care Management? A Mixed-Methods Analysis.

BACKGROUND: A large and increasing proportion of health care costs are spent caring for a small segment of medically and socially complex patients. To date, it has been difficult to identify which patients are best served by intensive care management. OBJECTIVE: To characterize factors that best identify which complex patients are most suited for intensive care management. DESIGN: We conducted a mixed-methods study involving 35 care managers (CMs; 10 licensed social workers and 25 registered nurses) working in intensive care management programs within Kaiser Permanente Northern California (KPNC) outpatient medical centers. We asked CMs to review a randomly selected list of up to 50 patients referred to them in the prior year and to categorize each patient as either (1) "good candidates" for care management, (2) "not needing" intensive care management, or (3) "needing more" than traditional care management could provide. We then conducted semi-structured interviews to understand how CMs separated patients into these three groups. RESULTS: CMs assigned 1178 patients into the 3 referral categories. Less than two thirds (62%, n = 736) of referred patients were considered good candidates, with 18% (n = 216) categorized as not needing care management and 19% (n = 226) as needing more. Compared to the other two categories, good candidates were older (76.2 years vs. 73.2 for not needing and 69.8 for needing more, p < 0.001), prescribed more medications (p = 0.02) and had more prior year outpatient visits (p = 0.04), while the number of prior year hospital and emergency room admissions were greater than not needing but less than needing more (p < 0.001). A logistic regression model using available electronic record data predicted good candidate designation with a c statistic of 0.75. Several qualitative themes emerged that helped define appropriateness for referral, including availability of social support, patient motivation, non-medical transitions, recent trajectory of medical condition, and psychiatric or substance use issues. CONCLUSION: Many apparently complex patients are not good candidates for intensive care management. Current electronic medical records do not capture several of the most salient characteristics that determine appropriateness for care management. Our findings suggest that systematic collection of social support, patient motivation, and recent non-medically related life change information may help identify which complex patients are most likely to benefit from care management.

Terapias alternativas para la recuperación temprana de la continencia urinaria posterior a la prostatectomía: una revisión sistemática / Terapias alternativas para recuperação precoce da continência urinária pós-prostatectomia: revisão sistemática / Alternative therapies for early recovery of post-prostatectomy urinary continence: systematic review

Objetivo: Realizar una revisión sistemática de la evidencia sobre la eficacia de entrenamiento de los músculos del suelo pélvico (EMSP) en el tratamiento de la incontinencia urinaria posterior a la prostatectomía. Métodos: Una revisión sistemática realizada em Ovid MEDLINE, EMBASE y LILACS en Portugués, Inglés y Español, límite de tiempo: 2005-2015. Resultados: 9 estudios examinaron la eficacia de los asociados o no con la biorretroalimentación y la estimulación eléctrica TMAP. Conclusión: El EMSP con o sin biorretroalimentación y la estimulación eléctrica pueden contribuir a la pronta recuperación de la continencia. Los pacientes con dificultad inicial de la identificación de los músculos del suelo pélvico pueden beneficiarse de sesiones de electroestimulación de biofeedback. Una mayor integración de la enfermera es posible en la atención relacionada con el pronto retorno de la continencia en pacientes post-prostatectomía mediante el establecimiento de los ejercicios de fortalecimiento del suelo pélvico y terapia conductual

Objetivo: Conduzir uma revisão sistemática a cerca das evidências da efetividade do Treinamento dos Músculos do Assoalho Pélvico (TMAP) no tratamento da incontinência urinária pós-prostatectomia. Método: Revisão sistemática realizada nas bases de dados MEDLINE/OVID, EMBASE e LILACS nos idiomas português, inglês e espanhol, limite temporal: 2005-2015. Resultados: 9 estudos analisaram a efetividade do TMAP associado ou não ao biofeedback e eletroestimulação. Conclusão: TMAP associados ou não ao biofeedback e eletroestimulação podem contribuir na recuperação precoce da continência. Pacientes com dificuldade inicial de identificação dos músculos do assoalho pélvico podem se beneficiar de sessões de eletroestimulação e biofeedback. É possível uma maior inserção do enfermeiro nos cuidados relacionados ao retorno precoce da continência em pacientes pós-prostatectomizados através da instituição dos exercícios de fortalecimento do assoalho pélvico e terapia comportamental

Aim: To conduct a systematic review of the evidence of the effectiveness of Pelvic Floor Muscle Training (PFMT) in the treatment of post-prostatectomy urinary incontinence. Method: Systematic review conducted in Ovid MEDLINE, EMBASE and LILACS in Portuguese, English and Spanish, with the time limit: 2005-2015. Results: 9 studies analyzed the effectiveness of PFMT associated or not with biofeedback (BFB) and electrical stimulation (ES). Conclusion: PFMT with or without the biofeedback and electrical stimulation may contribute to the early recovery of continence. Patients with initial difficulty of identifying the pelvic floor muscles can benefit from ES followed BFB sessions of structured PFMT. A greater participation of nurses in the care related to the early return of continence in post-prostatectomy patients is possible through the implementation of pelvic floor muscle exercises and behavioral therapy

Satisfacción de pacientes con atención médica en emergencias / Patient satisfaction with medical care emergency

Introducción: al acudir a un centro hospitalario, los usuarios de servicios médicos tienen confianza en que su necesidad de salud será atendida y que al final el proceso sea solventado a cabalidad y eficazmente, es por ello importante conocer la satisfacción que tienen con los servicios. Objetivo: identificar el nivel de satisfacción con la atención médica de los usuarios atendidos en el servicio de emergencia. Métodos: estudio descriptivo de corte transversal en el servicio de emergencia del circuito de salud integral Augusto Egas de la ciudad de Santo Domingo de los Tsáchilas, Ecuador, durante el primer trimestre de 2015, en un universo de 382 pacientes a quienes se aplicó una encuesta validad para obtener la información, el análisis de la información, se realizó mediante el sistema SPSS, al hacer uso de la correlación bivariada de Kendall, los resultados se expresan en tablas de manera porcentual. Resultados: el personal de enfermería predominó como primer contacto con el usuario, brindó un trato agradable, de calidad y calidez, expresado en el 44 por ciento de la muestra, el sexo femenino prevaleció en los encuestados 66 por ciento; un 49 por ciento opinó que fue atendido en los primeros treinta minutos de su llegada al servicio, el 75 por ciento expresó haber recibido una atención médica y de enfermería satisfactoria. Conclusión: los pacientes que acuden al servicio de emergencia reciben una atención satisfactoria por parte del personal de salud(AU)

Introduction: Users of medical services to go to hospital they are confident that their health needs will be taken care of and ultimately the process is solved fully and effectively, it is therefore important to know the satisfaction with the services. Objective: Identify the level of satisfaction with the care of users treated in the emergency service. Methods: A descriptive cross-sectional study was conducted in the emergency circuit holistic health Augusto Egas of Santo Domingo de los Tsáchilas, Ecuador, during the first quarter of 2015, in a universe of 382 patients who applied a validate survey to obtain information, analysis of information, was performed using the SPSS system by making use of bivariate correlation Kendall, the results are expressed in percentage terms tables. Results: The nursing staff prevailed as the first contact with the user friendly service provided, quality and warmth expressed in 44 percent of the sample, the female respondents prevailed in 66 percent; 49 percent felt that it was handled in the first thirty minutes of their arrival at the service, 75 percent said they have received a satisfactory medical care and nursing. Conclusion: Patients who come to the emergency service receive satisfactory attention from health personnel(AU)

Satisfacción de pacientes con atención médica en emergencias / Patient satisfaction with medical care emergency

Introducción: al acudir a un centro hospitalario, los usuarios de servicios médicos tienen confianza en que su necesidad de salud será atendida y que al final el proceso sea solventado a cabalidad y eficazmente, es por ello importante conocer la satisfacción que tienen con los servicios. Objetivo: identificar el nivel de satisfacción con la atención médica de los usuarios atendidos en el servicio de emergencia. Métodos: estudio descriptivo de corte transversal en el servicio de emergencia del circuito de salud integral Augusto Egas de la ciudad de Santo Domingo de los Tsáchilas, Ecuador, durante el primer trimestre de 2015, en un universo de 382 pacientes a quienes se aplicó una encuesta validad para obtener la información, el análisis de la información, se realizó mediante el sistema SPSS, al hacer uso de la correlación bivariada de Kendall, los resultados se expresan en tablas de manera porcentual. Resultados: el personal de enfermería predominó como primer contacto con el usuario, brindó un trato agradable, de calidad y calidez, expresado en el 44 por ciento de la muestra, el sexo femenino prevaleció en los encuestados 66 por ciento; un 49 por ciento opinó que fue atendido en los primeros treinta minutos de su llegada al servicio, el 75 por ciento expresó haber recibido una atención médica y de enfermería satisfactoria. Conclusión: los pacientes que acuden al servicio de emergencia reciben una atención satisfactoria por parte del personal de salud(AU)

Introduction: Users of medical services to go to hospital they are confident that their health needs will be taken care of and ultimately the process is solved fully and effectively, it is therefore important to know the satisfaction with the services. Objective: Identify the level of satisfaction with the care of users treated in the emergency service. Methods: A descriptive cross-sectional study was conducted in the emergency circuit holistic health Augusto Egas of Santo Domingo de los Tsáchilas, Ecuador, during the first quarter of 2015, in a universe of 382 patients who applied a validate survey to obtain information, analysis of information, was performed using the SPSS system by making use of bivariate correlation Kendall, the results are expressed in percentage terms tables. Results: The nursing staff prevailed as the first contact with the user friendly service provided, quality and warmth expressed in 44 percent of the sample, the female respondents prevailed in 66 percent; 49 percent felt that it was handled in the first thirty minutes of their arrival at the service, 75 percent said they have received a satisfactory medical care and nursing. Conclusion: Patients who come to the emergency service receive satisfactory attention from health personnel(AU)

The Veterans Affairs's Corporate Data Warehouse: Uses and Implications for Nursing Research and Practice.

The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA's Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA's transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

Acupuntura como tecnologia aplicada ao cuidado de enfermagem a adultos hipertensos: um estudo experimentl

Estudo sobre a eficácia de um protocolo de acupuntura (AP) como tecnologia aplicada ao cuidado de enfermagem a portadores de hipertensão arterial sistêmic a primária (HAS) em tratamento convencional/medicamentoso. As Práticas Integrativas e Complementares de Saúde (PICS) vêm se constituindo como uma racionalidade em saúde complementar ao modelo biomédico hegemônico. O foco está na atenção primária com vistas à prevenção e tratamento complementar para diversas situações de saúde - doença, entre as quais se incluem as Doenças Crônicas Não Transmissíveis (DCNT), como a HAS, uma patologia de complicações graves a médio e longo praz. Estudos metanalíticos e ensaios clínicos apontam a possibilidade do emprego da AP como terapia não farmacológica associada às demais condutas terapêuticas adotadas para as DCNT cardiovasculares; e sua intervenção em diagnósticos de enfermagem (DE). Mas ainda são incipientes aqueles que destacam quais diagnósticos indicam intervenções pela acupuntura bem como sua eficácia enquanto tecnologia aplicada ao cuidado de enfermagem. Os objetivos foram: identificar os efeitos da AP na pressão arterial e sobre os DE identificados em portadores de HAS; e analisar os efeitos da AP como PICS associada ao tratamento convencional /medicamentoso de portadores de HAS. Adotou - se o conceito de DE na perspectiva da taxionomia II da North American Nursing Diagnosis Association International (NANDA - I). O ptou - se por trabalhar com DE já apontados por expertises como passíveis de intervenção com AP e desenvolveu - se um modelo teórico - experimental de pequeno alcance para validação de PICS como tecnologia aplicada ao cuidado de enfermagem...

Study on the effectiveness of an acupuncture protocol (AP) as technology applied to nursing care of patients with primary arterial hypertension (AH) in conventional / drug treatment. The Complementary and Integrative Practices in Health Care(PICS) are being formed as a health supplement rationality to the hegemonic biomedical model. The focus is on primary care with a view to prevention and complementary treatment for diverse situations of health and illness, among which the Chronic Noncommunicable Diseases (NCDs) are included, such as hypertension, a condition of severe complications in the medium and long term. Studies of meta-analysis and clinical trials indicate the possibility of using the AP as non-pharmacological therapy associated with other clinical strategies for cardiovascular NCDs; and its intervention in nursing diagnostics (DE). But they are still incipient those which highlight which diagnosis indicate acupuncture intervention as well as its efficiency as tecnology applied to the nursing care. The goals were to identify the effects of AP in blood pressure and on the DE identified in patients with hypertension; and analyze the effects of AP as PICS associated with conventional / drug treatment of patients with SAH. The concept of DE on taxonomy II’s perspective of theNorth American Nursing Diagnosis Association International (NANDA-I) was adopted. We chose to work with DE already pointed out by expertise as amenable to intervention with AP and developed a theoretical and experimental model for short-range PICS validation as technology applied to nursing care...

[Morbidity differences according to nursing stage and nursing setting in long-term care patients: Results of a claims data based study]. / Morbiditätsunterschiede bei Pflegebedürftigen in Abhängigkeit von Pflegesektor und Pflegestufe: Eine Untersuchung auf der Basis von Abrechnungsdaten der Gesetzlichen Krankenversicherung.

BACKGROUND: We analyzed the differences in morbidity patterns of chronic diseases between long-term care dependent persons in nursing homes compared to those dwelling in the community. We also investigated morbidity differences between long-term care need stages in Germany. MATERIALS AND METHODS: The study included claims data of one nationwide operating statutory health insurance in 2006. Inclusion criteria were age ≥ 65 years, minimum 1 out of 46 diagnoses in at least 3 quarters of the year (n = 8,670). A comparison population was formed with n = 114,962. Prevalences, relative risks, and odds ratios for the risk of nursing home care were calculated. RESULTS: In the bivariate analysis, only three chronic diseases - dementia, urinary incontinence, and chronic heart failure - showed a higher risk for nursing home care. Regression analysis revealed that only dementia showed higher odds related to the stage of nursing needs. CONCLUSION: Among the chronic diseases, only dementia shows a substantially elevated risk for nursing home care. Risk studies on other chronic diseases associated with higher risks of long-term care dependency and specific intervention strategies aiming at delaying or preventing nursing home admission should be developed.

Proceso de Atención de Enfermeria aplicado a la persona posoperada de trasplante cardiaco / Nursing Care Process applied to the person posoperada heart transplant

Introducción: El trasplante cardiaco es el tratamiento de elección para la insuficiencia cardiaca cuando se estima que la supervivencia y calidad de vida no pueden mejorarse con los tratamientos convencionales; el presente estudio de caso corresponde a una mujer de 56 años con diagnóstico de miocardiopatía restrictiva de tipo fibrosis endomiocárdica inespecífica, a quien se le realiza un trasplante cardiaco en el Instituto Nacional de Cardiología Ignacio Chávez, y se le da seguimiento desde la sala de quirófano, hasta los primeros días posteriores en Terapia Intensiva Quirúrgica. Objetivo: Desarrollar un estudio de caso que promueva los principales cuidados de enfermería que cubran las necesidades de la persona en trasplante cardiaco. Metodología: Con base en el método enfermero se aplica una valoración exhaustiva y una focalizada; se desarrollan las etapas de diagnóstico, planeación, intervención y evaluación, el cual se fundamenta en el Proceso de Atención de Enfermería y en la teoría de las 14 necesidades de Virginia Henderson. Resultados: Se obtienen los diagnósticos enfermeros: disminución del gasto cardiaco, deterioro de intercambio gaseoso y riesgo de lesión; con la ejecución de los planes de cuidados la evolución de la persona es satisfactoria. Conclusión: La aplicación del proceso de atención de enfermería es la metodología idónea para el cuidado holístico de la persona en la fase posoperatoria inmediata de trasplante cardiaco.

Introduction: Heart transplantation is the treatment of choice for heart failure when it is estimated that the survival and quality of life can not be improved with conventional treatments; this case study corresponds to a 56 year old woman diagnosed with restrictive cardiomyopathy fibrosis type nonspecific endomyocardial, to whom it is performed a heart transplant at the National Institute of Cardiology Ignacio Chavez, and are followed up from the operating room until the first days in Surgical Intensive Care. Objective: To develop a case study that promotes the main nursing care to meet the needs of the person in cardiac transplantation. Methodology: Based on a comprehensive assessment method nurse and a focused applies; the stages of diagnosis, planning, intervention and evaluation, which is based on the Nursing Care Process and the theory of Virginia Henderson 14 needs develop. Results: The nursing diagnoses were obtained: decreased cardiac output, impaired gas exchange and risk of injury; the implementation of care plans of the person evolution is satisfactory. Conclusion: The application of the nursing process is the appropriate methodology for the holistic care of the person in the immediate postoperative phase of heart transplantation

Evaluation of special and traditional dementia care in nursing homes: results from a cross-sectional study in Germany.

OBJECTIVE: Two-thirds of all residents in nursing homes in Germany suffer from some type of dementia. We investigated whether or not dementia patients receiving special (segregated or partially segregated) care exhibited a better quality of life than their counterparts residing in traditional nursing homes. METHODS: In a cross-sectional study in 28 special dementia care facilities in the city of Hamburg (admission criterion: mobile dementia patients with behaviour problems) 594 residents were compared to a group of nursing home residents with dementia (n = 573) in 11 randomly selected nursing homes who were receiving traditional integrative care. Primary features such as cognitive and functional impairment, and behaviour problems were assessed by qualified nursing staff. RESULTS: Controlling for confounding variables, for dementia patients in special care units as compared to a reference group in traditional integrative care, the level of volunteer caregiver involvement was higher and there was more social contact to staff, fewer physical restraints, more involvement in home activities, and more frequent use of psychiatrists. There was no significant difference between the two care settings with regard to overall use of psychotropic drugs, however, residents in special dementia care used antipsychotics significantly less often and antidepressants more often. CONCLUSIONS: Significant differences for a number of indicators of the quality of life point in favour of special dementia care. Future evaluation studies ought to examine not only the general efficacy of types of care designed especially for dementia patients but also the efficacy of the respective individual components (i.e. caregiver ratio).