Abordaje integral de un caso complejo de continuidad de cuidados a un paciente cistectomizado / No disponible

El manejo inefectivo del régimen terapéutico es uno de los diagnósticos que con más frecuencia se le presenta al profesional enfermero durante su desarrollo profesional. Es fundamental que el enfermero desarrolle un plan de cuidados de forma óptima para que el paciente adquiera una correcta adhesión al tratamiento terapéutico y mejore su calidad de vida, así como prevenir las posibles complicaciones ante el no cumplimiento de tal tratamiento. Atendimos en nuestra unidad a un paciente de 56 años con diagnóstico de carcinoma infiltrante de vejiga que iba a ser intervenido de cistectomía. Controla su diabetes sin seguir con el plan terapéutico de su médico de familia, tampoco ha conseguido dejar su hábito tabáquico. Esto nos pone alerta de los posibles problemas posquirúrgicos y al alta

Nursing staff is exposed to ineffective management of therapeutic regimen during their professional development. It is essential for the nursing staff to develop an optimum self-care plan so that the patient can adhere to treatment and improve his quality of life. This will help the patient to anticipate possible complications related to non-compliance for treatment of the disease. A 56 years old patient with an infiltrating bladder cancer was admitted to our unit. The patient poorly controls diabetes, does not follow an appropriate treatment plan and has not stopped smoking. This is putting the patient at great danger due to post-operative complications and problems as a result of discharge from hospital

Postpartum anaemia. Are we vigilant enough?

Anaemia in the immediate postnatal period can manifest itself physically in a number of ways. Amongst these are pallor, tiredness, dizziness, loss of appetite and oedema (Bewley 2004), all of which could be mistaken for commonly observed benign symptoms of the immediate postnatal period. However, left untreated, anaemia can severely impact on both the physical and emotional wellbeing of a woman and dramatically slow down her recovery (Bewley 2004). This altered state of health can also have a detrimental effect on a woman's ability to bond with her new child (Abbott et al 1997) and has been identified as a contributory factor in the initiation of postnatal depression (Corwin et al 2003). It is therefore imperative that, as midwives and student midwives, we take every opportunity to closely monitor the wellbeing of women in our care in order to facilitate their return to a normal haemoglobin level, promote infant bonding and reduce the risk of postnatal depression.

Cultural competency: beyond the vital signs. Delivering holistic care to african americans.

Specific knowledge of African American communities, culture, and history is crucial to achieving culturally competent care. The unique and complex relationship that belief systems have to health care outcomes must be considered for all patients. This is even more apparent in the connection between religion and health outcomes for African Americans. However, as with all ethnic groups, nothing is absolute. Therefore, one must avoid stereotyping and recognize there are differences within each cultural group.

The buck stops here: midwives and maternity care in rural Scotland.

OBJECTIVE: To explore and understand what it means to provide midwifery care in remote and rural Scotland. DESIGN: Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach. SETTING: Remote and rural areas of Scotland. PARTICIPANTS: Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs. FINDINGS: Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence. CONCLUSIONS: This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations. IMPLICATIONS FOR PRACTICE: It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer.

Importance of sexual needs assessment in palliative care.

Sexuality is a fundamental aspect of being human. Guidance states that to support and improve the lives of adults with life-limiting illness, health professionals must address care in the social, psychological, spiritual and physical domains, yet no mention is made of the sexual domain. Palliative care aims to be holistic yet evidence suggests that sexuality is often overlooked when assessing care needs. This literature review will identify the issues that prevent sexual needs assessment in palliative care.

Spirituality. 2: Exploring how to address patients' spiritual needs in practice.

Although meeting patients' spiritual needs is important, many nurses are uncertain about what spiritual care involves and lack confidence in this area. This second article in a two part series on spirituality considers ways of addressing spiritual needs and provides an overview of the principles of assessment and implementation. Part 1 explored definitions of spirituality, the difference between religion and spirituality, and finding meaning in illness.

A holistic approach for planning care of patients with irritable bowel syndrome.

The aims of this study were to determine whether a registered nurse can collect information and plan a holistic and individual strategy for the treatment of patients with irritable bowel syndrome (IBS) and whether this approach can reduce these patients' health aspects. The referrals of 50 Swedish-speaking female patients aged between 18 and 65 years with the preliminary diagnosis of IBS were collected and scrutinized by a gastroenterologist at a university hospital. Of these, 41 patients agreed to participate but 2 did not show up. The 39 patients were randomized into one of two groups: (1) the intervention group (n = 19) where the subjects were interviewed on the basis of the theory of culture care by a nurse before visiting a gastroenterologist and (2) the control group (n = 20) where the subjects first met a gastroenterologist. After the medical examination, 19 subjects were found to have diseases other than IBS. The interview gave a holistic view of the subjects' problems, which could be of use when planning further care. Because subjects sometimes did not receive an accurate diagnosis by their primary care physician, however, the clinic nurse could not give these subjects IBS-specific information because the subjects' diagnosis had not been established. The initial medical assessments based on the primary care doctors' care of many subjects with IBS symptoms were a noted weak point.

A study of the relationship of nursing interventions and cognitions to the physiologic outcomes of care in a simulated task environment.

This study, based on the Expert Performance Approach, examined the clinical nursing performance of participants who were introduced into a simulated task environment requiring them to administer care to a client experiencing an exacerbation of Congestive Heart Failure. This was undertaken to identify cognitive and physiologic variables that differentiate performance levels among participants. Data on participant actions and verbal reports were coded to characterize their relationship with physiologic responses of the Human Patient Simulator. The results demonstrated that physiologic responses to nursing interventions reflect a reliable pattern that can be used to differentiate performance levels.

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis capture nursing practice? A Delphi survey.

BACKGROUND: The "Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA. OBJECTIVES: The objective of this study was to validate this ICF Core Set from the perspective of nurses. METHOD: Nurses experienced in RA treatment were asked about the patients' problems, patients' resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF. RESULTS: 57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA. CONCLUSION: The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like "dry mucous", "risk for decubitus ulcers" and "height" and need to be investigated further.

Nursing management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality, which imposes a major burden on both society and the health service. It is a common condition that is on the increase and predominantly caused by smoking. Progressive damage to the lung tissue renders the patient increasingly breathless resulting in a frightening existence causing varying degrees of disability and handicap. It is therefore essential that healthcare professionals understand how this condition affects patients not only from a physical perspective, but also from a psychological and social perspective to provide effective nursing management. Nursing management of patients suffering from this disease is aimed at helping to control individual patient's symptoms and improve their quality of life.

Putting Evidence into Practice: nursing assessment and interventions to reduce family caregiver strain and burden.

Family caregiving often is associated with multiple rewards, yet the diversity and intensity of caregiving roles also can result in caregiver strain and burden. Using interventions to reduce the strain and burden on caregivers of patients with cancer is an important role nurses play. This article is a critical review and synthesis of the evidence regarding assessment tools and interventions aimed at reducing caregiver strain and burden in the oncology population. Although the striking finding is the limited number of interventions targeted toward oncology caregivers, suggestions from the literature are offered to support and promote healthy outcomes for family caregivers.

Traumatic brain injury: an integrated clinical case presentation and literature review. Part I: assessment and initial management.

Holistic nursing care of critically ill patients continues to be a challenge for all levels of critical care clinicians. Patients with multi-system dysfunction in particular, present complicated clinical challenges that demand care based on sound knowledge and understanding of physiological, psychosocial and spiritual needs. Experiential learning through exposure to a range of patient presentations enables incremental development of professional practice and excellence in nursing care. Case study learning enhances understanding through application of theory to practice in complex clinical presentations. This two-part paper outlines the assessment, interventions and outcome of a person who sustained multiple trauma including severe traumatic brain injury (TBI). Part I explores assessment and initial management from pre-hospital care through to the Emergency Department (ED) and operating theatre. Part II describes the intensive care period as an integral component of the continuum of care. Key issues in the case are presented sequentially with relevant literature integrated and applied to clinical progress, focussing on the complex physiological, psychosocial, spiritual and environmental needs of the patient and his family. The purpose of the paper is to therefore provide a comprehensive learning resource for critical care nurses, particularly for those beginning their practice.