ABSTRACT
OBJECTIVE: This study aimed to describe registered nurses' (RNs) experiences of providing respiratory care in relation to hospital acquired pneumonia (HAP), specifically among patients with acute stroke being cared for at in-patient stroke units. BACKGROUND: One of the most common and serious respiratory complications associated with acute stroke is HAP. Respiratory care is among the fundamentals of patient care, and thus competency in this field is expected as part of nursing training. However, there is a paucity of literature detailing RNs' experiences with respiratory care in relation to HAP, specifically among patients with acute stroke, in the context of stroke units. As such, there is a need to expand the knowledge base relating to respiratory care focusing on HAP, to assist with evidence-based nursing. DESIGN: A qualitative descriptive study. METHOD: Eleven RNs working in four different acute stroke units in Southern Sweden participated in the current study. The data were collected through semi-structured interviews, and the transcribed interviews were analysed using inductive content analysis. RESULTS: Three overarching categories were identified: (1), awareness of risk assessments and risk factors for HAP (2) targeting HAP through multiple nursing care actions, and (3) challenges in providing respiratory care to patients in risk of HAP. These reflected the similarities and differences in the experiences that RNs had with providing respiratory care in relation to HAP among in-patients with acute stroke. CONCLUSIONS: The findings from this study suggest that the RNs experience organisational challenges in providing respiratory care for HAP among patients with acute stroke. Respiratory care plays a vital role in the identification and prevention of HAP, but our findings imply that RNs' knowledge needs to be improved, the fundamentals of nursing care need to be prioritised, and evidence-based guidelines must be implemented. RNs would also benefit from further education and support, in order to lead point-of-care nursing in multidisciplinary stroke teams.
ABSTRACT
Glycosaminoglycans (GAGs) are linear carbohydrate polymers containing repetitive sequences of differently sulfated uronic acid and glycosamine residues that are recognized by antibodies raised against proteoglycans. We have developed a method to demonstrate such repetitive sequence motifs in isolated GAG chains immobilized on hydrophobic membranes derivatized with cationic detergents. Six monoclonal antibodies directed against Cs (2B6, 3B3, Cs56, and 1B5), Hs (HepSS), and Ks (5D4) were used to detect native and chondroitinase-generated epitopes in the immobilized GAGs. All antibodies, except 1B5, were able to detect epitopes in both proteoglycans and isolated GAGs. Type of detergent and buffer composition affected the accessibility and the retention of immobilized GAGs. The epitope density, i.e., the number of repetitive epitopes per GAG mass, was estimated as the ratio between antibody (epitope) and Alcian blue (mass) staining measured simultaneously. The epitope profiles, using six antibodies, were different for each sample (CsA, CsC, Ds, Hs, intact cartilage, and human serum). The epitope profile may be used as a structural characteristic of a GAG population. Electrophoretic separation of GAGs based on their glucuronic/ioduronic acid content and O-sulfate/N-sulfate ratio was performed using a diethylene glycol-diaminobutanol agarose gel. The electrophoretic populations were characterized by immunoblotting to detergent-treated membranes.