[Quality of life after multiple trauma]. / Lebensqualität nach Polytrauma.

BACKGROUND: Multiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life. OBJECTIVES: The aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified. MATERIALS AND METHODS: A MedLine search was performed to identify studies dealing with the outcome after multiple trauma. RESULTS: In addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities. CONCLUSION: The fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.

Nurturing and caring for self.

As instruments of healing, nurses commonly provide therapeutic counseling, but often do not heed their own advice for self-care. To give to others, nurses need to nourish all aspects of self. The self extends far beyond the needs of the physical body. Therefore, giving of the self requires self-nurturance of the physical, mental, emotional, and spiritual aspects. This article describes how to nurture and care for the self.

Healing relationships with nature.

Our health is intimately connected to the health of our environment. The contemporary world view which sees a radical distinction between humans as subjects and world as object can obscure our recognition of how much we rely on nature for health and survival. Indigenous traditions and contemporary scholars remind us that we live in a universe in which all things are connected, and in which nature continues to offer its gifts in co-creative partnership for the health and wellbeing of all. Living in awareness of our relationship with nature enables us to open more to the experience of nature's nurturing. Many complementary therapies derive from ancient practices that involve nature in healing partnership. As nurses and midwives we must learn to expand our boundaries to encompass the many ways that nature partners with us for healing.

Viewing persons as stories: a perspective for holistic care.

In our increasingly hurried and high-tech society, patients and families hope that those who care for them are interested in the depth and uniqueness of their lives. Viewing persons as stories enables the understanding that events and experiences in life occur within a unique context for each individual. This article considers the healing potential of story within the healthcare milieu. Story involves an interpretation of events and experiences, and may communicate more truth about the patient than extracted data from traditional history taking. Viewing persons as ongoing and unfolding stories provides a perspective from which healthcare providers intentionally seek and listen for story. This article presents examples of stories encountered in research and clinical practice, the value of story and metaphor in the clinical setting, ways of attending to one's own story, and ways of encouraging and hearing the stories of others.

Becoming and connecting: elements of spirituality for women.

This study explored women's understandings of spirituality through in-depth, face-to-face interviews with 12 adult women in Appalachia. Data were analyzed utilizing the constant comparative processes of naturalistic inquiry and grounded theory. The results revealed spirituality as a unifying force permeating all of life, and manifested through one's becoming and connecting. Women indicated that spirituality shapes and gives meaning to life, is expressed in one's being, knowing, and doing, and is experienced within caring connections with Self, Others, Nature, and Ultimate Other. Spirituality was related to an inner knowing and source of strength. This study contributes to understanding the concept of spirituality for nursing, affirming the importance of women's stories.

Reawakening spirit in clinical practice.

This article describes processes for incorporating spirituality into clinical nursing practice. Spirituality is viewed as a unifying force manifested in the Self, which is expressed and experienced in the context of caring connections with oneself, others, nature, and God/life force. Spirituality relates to an inner knowing and source of strength reflected in one's being, one's knowing, and one's doing. The nurse's intentional, caring presence with clients makes possible the speaking and hearing of spiritual concerns. Such concerns are revealed in the context of one's life story. Nurturing the nurse's own spirit is essential for responding to the spirit in any interaction. Nurses frequently deal with issues of spirituality but may not label them as such. This article suggests processes through which nurses may more clearly identify spiritual issues. Spirit is understood to be both the source of and a manifestation of one's spirituality. By reawakening spirit in clinical practice, nurses will be more effective providers of holistic nursing care.

Characteristics of spirituality in the lives of women in a rural Appalachian community.

The aim of this study was to add to nursing's knowledge base relative to spirituality by exploring how women in rural Appalachia experience and describe spirituality in their daily lives. Data was gathered through participant observation in a small rural community in West Virginia, including in-depth interviews of five women from the community. Characteristics of spirituality included belief in God or Greater Source, prayer/meditation, and a sense of relationship or connectedness with others, nature and oneself. The dominant theme which emerged relative to these relationships was that of self-reliance or inner strength. Spirituality for these women relates to the whole of life and is relational.

5-hydroxytryptamine1A agonists. A new therapeutic principle for stroke treatment.

We conducted the present study to investigate the effects of 5-hydroxytryptamine agonists on brain morphology after the induction of focal cerebral ischemia by permanent occlusion of the left middle cerebral artery in rats and mice. Forty-eight hours after vessel occlusion, the damage was quantified in rats by planimetry and subsequent integration on cresyl violet-stained serial sections and in mice by planimetric analysis of the damaged cortical surface after counterstaining with carbon black. All 5-HT1A agonists investigated substantially decreased cortical infarct size in the rat focal ischemia model (p less than 0.05). Drugs were applied 30 minutes before the induction of ischemia, and efficacy was demonstrated for 8-OH-DPAT (1 mg/kg s.c.), buspirone (10 mg/kg i.p.), gepirone (10 mg/kg i.p.), ipsapirone (10 or 30 mg/kg i.p.), and Bay R 1531 (1 mg/kg i.p.). The most pronounced effects were seen with the higher dose of ipsapirone and Bay R 1531, both compounds reducing cortical infarct size by more than 60%. Except for 8-OH-DPAT, the 5-HT1A agonists also caused a reduction in total infarct volumes. In a separate series, ipsapirone (30 mg/kg i.p.), applied 1 hour after vessel occlusion, led to a reduction in cortical and total infarct volumes by about 50% compared with corresponding controls (p less than 0.05). In neither series was striatal damage influenced. We tested the compounds in the mouse ischemia model over a broad dose range.(ABSTRACT TRUNCATED AT 250 WORDS)

Spirituality: cornerstone of holistic nursing practice.

Practitioners of holistic nursing seek to be part of an environment that is healing, recognizing that healing occurs on many levels. Suffering and pain are viewed as part of larger life experience and may be sources of growth and transformation. Understanding that spirituality has to do with all of life and is expressed in a variety of ways, the practitioner of holistic nursing is open to the spirituality of self and others, as manifested in the ordinary as well as the dramatic, and in gentle ways encourages its experience and expression.

Spirituality: an analysis of the concept.

Learning to listen for indications of significant relationships and experience of connection is an important skill for the nurse. The nurse needs to be aware of the variety of expressions of spiriting, recognizing that it is often not expressed in traditional religious language. Dealing effectively with spiriting with clients requires an investment of the self, which is an intentional way of being with the client and can be a part of every nurse-client relationship.