RESUMEN
(1) Introduction: Sleep architecture of Intensive Care Unit (ICU) patients is altered, with over 60% of them reporting sleep disorders or even sleep deprivation during their stay. The aim of the study was to describe the experiences related to sleep and nighttime rest of patients hospitalized in the ICU. (2) Method: the study used a qualitative project based on phenomenology as a research method. A semi-structured interview was used as the method to achieve the goal. The patients' answers were recorded and transcribed. The data were coded and cross-processed. (3) Results: twenty-three patients were surveyed, fifteen men and eight women. The average age was 49.7 years. The average time of hospitalization was 34.3 days. During the ICU stay, patients required mechanical ventilation through the tracheostomy tube. Five themes were identified from the interview as factors disturbing sleep: fear, noise, light, medical staff, and at home best. (4) Conclusions: chronic anxiety appears to contribute to sleep disturbances in the ICUs, psychological support, and individualized approach to the hospitalized patient seem necessary. By raising the awareness of the essence of sleep among medical staff, environmental factors can be reduced as disturbing sleep. Based on the participants' comments, it is possible that repeated actions could also increase the patients' sense of security.
RESUMEN
INTRODUCTION: In 2005-2050, the global population of elderly people will increase by 12%. This will lead to increased demand for such healthcare services as hospital care or surgical interventions. Pain in elderly patients is a substantial problem. Insufficiently controlled postoperative pain continues to be a widespread phenomenon. Pain management in Poland is usually based on nursing care supervised by an anesthesiologist or surgeon. The aim of the study was to identify barriers to effective nurse-controlled analgesia in postoperative pain management in elderly patients in hospitals with and without a Hospital Without Pain certificate. MATERIAL AND METHODS: The study was conducted after the approval of the study protocol by the Independent Bioethics Committee for Scientific Research of the Medical University of Gdansk. The study project was multicenter and was conducted from July 2012 to December 2013. The research was questionnaire-based and used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The project included 676 nurses from hospitals awarded the Hospital Without Pain Certificate and 926 respondents from hospitals without the certificate. RESULTS: After calculating the overall average result in particular groups, healthcare system-related problems were first among the barriers hindering pain management in elderly patients M = (C = 3.81, N/C = 3.87). Patient-related barriers were second (M = 3.77). Physician- and nurse-related barriers took the subsequent positions, with very similar scores M = (C = 3.47, N/C = 3.44) and M = (C = 3.46, N/C = 3.44), respectively. CONCLUSIONS: The greatest barriers to pain management in elderly patients are related to the healthcare system. Nurses from Hospital Without Pain certified hospitals devoted significantly more time to relieving pain through non-pharmacological methods.
RESUMEN
INTRODUCTION: Childbirth is an important event, both in a woman's, and in her family's lives, an event which carries a huge emotional charge and influences the functioning of a triad. Labour is a physiological process which may have health (somatic, psychological, mental) and economic consequences. Irrespective of the reasons why it is performed; caesarean section involves surgical, obstetric and anaesthesiological intervention, as well as the necessity for pharmacological agents. Bonding between parents and their children serves as a basis for optimal psychomotor development, and the first year is important for the rest of life. The aim of the study was to assess the influence of the labour mode on the mother's emotional state, mother-child bonding, and the infant's neurobehavioural state. MATERIAL AND METHODS: The plan of this study was approved by the Bioethical Commission of the Pomeranian Medical University in Szczecin (BN-001/108/08). The research material comprised 200 women and their children. The following instruments were used in this study: an original questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), the Mother-Child Relationship FIRST score (MCR FIRST score), the Brazelton Scale, also known as the Neonatal Behavioural Assessment Scale (NBAS). The umbilical blood was used to determine the level of cortisol as a stress marker. Statistical analysis was performed using the Shapiro-Wilk test, the χ2 test, the Mann-Whitney U-test, the Fisher test, and the Spearman rank correlation coefficient. The accepted significance level (p) was equal to 0.05 (the acceptable type I error). RESULTS: Around 35% of the women took part in prenatal education, and 59% of them declared the intention to participate in postnatal education. The respondents wanted someone close to be with them during delivery (65.5%), although only 35% had such a possibility. Women giving birth naturally were more often accompanied by their partners (p = 0.00005). Less than half of the women (35%) had skin-to-skin contact with their babies, and there was a difference between delivery mode (p = 0.01). Attempts at breastfeeding were made by 81.5% of those surveyed. Women after c-section less often tried to breastfeed their babies than their counterparts after natural delivery (p = 0.003). The levels of cortisol in umbilical blood were significantly higher after natural labour than after caesarean section (p < 0.00001). The assessment of the risk of postnatal depression performed with the EPDS did not demonstrate significant differences between women in particular delivery modes (p = 0.82). The percentage of'crying' Children was similar in both modes (12% of naturally born babies and 13% of those born by c-section); the difference was not statistically significant (p = 1.0). Infant examination with the Brazelton Scale revealed differences in babies' behaviour in 30 parameters of the scale in favour of naturally born children. Children born through caesarean section had rarer contact with their mothers after delivery (p = 0.01). CONCLUSIONS: Naturally born babies obtained higher scores on the NBAS, which is an argument for the promotion of this delivery mode. Naturally born babies had significantly higher cortisol levels and more frequent direct contact with their mothers after delivery, which creates favourable conditions for forming bonds. Delivery mode had no influence on the occurrence of postpartum depression, according to the EPDS (p = 0.82).