Palliation of Thirst in Intensive Care Unit Patients: Translating Research Into Practice.

BACKGROUND: Thirst is prevalent among patients in intensive care units. A research-based "thirst bundle" was shown to significantly decrease thirst in these patients. OBJECTIVE: To implement a research-based thirst intervention performed by intensive care unit nurses and patients' family members. METHODS: Nurses and family members were taught the thirst intervention through video training and project team reinforcement. The intervention was performed by nurses for 123 patients and by family members for 13 patients. Thirst was measured with a numeric rating scale of 0 to 10, a word scale of 0 to 3, or "yes/no" answers, whichever was easiest for the patient. Inferential statistics were used to assess changes in thirst scores over time. Also assessed were nurse and family member burden levels, family level of satisfaction, and patient enjoyment. RESULTS: Thirst scores on the numeric rating scale decreased significantly: from a mean (SD) of 7.9 (2.0) before to 3.9 (2.7) after the intervention for nurses (P < .001); and from 9.2 (1.5) to 5.3 (2.6) for family members (n = 13; P = .002). Word scale scores also decreased significantly, from a median (interquartile range) of 3 (3-3) before to 2 (1-2) after the intervention for nurses (P < .001). Most patients (96%) reported enjoying the procedure. Median burden levels were less than 2 on a numeric rating scale of 0 to 10. CONCLUSIONS: The palliative "thirst bundle" significantly alleviated patients' thirst and resulted in little caregiver burden. Further efforts are warranted to incorporate this intervention into intensive care unit practice.

Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study.

AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer. BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life. DESIGN: This was a qualitative descriptive study. METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data. RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems. CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

Examining the links between hydration, nutrition and mouth health.

Hydration, nutrition and mouth health have historically been overlooked and considered in isolation when, in reality, they are interlinked and interdependent. Not only do these health factors greatly influence each other, but also they have a significant effect on general health and wellbeing. By viewing each of these areas in isolation, health professionals risk missing opportunities to maximise patients' health and quality of life. Collaboration between health professions will also maximise benefits to patients. This article aims to explain the health effects of hydration, nutrition and mouth health and the links between them so practitioners consider how they can make positive changes in these areas for their patients and how they can promote collaboration with other health professionals.

Part 3: Impact of systemic conditions and medications on oral health.

The people who are treated in the community setting will often have multiple comorbidities. Systemic medical conditions can have a negative impact on oral health. In addition, the medications used to treat systemic conditions may also themselves cause oral symptoms. As a large proportion of patients treated by the community nursing team will be elderly, this paper will focus on common geriatric conditions that can display oral or dental symptoms. The effects of medications will be discussed and linked to oral complaints patients may express. The primary aims are to give a broad overview of the oral effects of ageing, of illness and of polypharmacy and advise on how these can be best managed by the nursing team.

Manejo enfermero del paciente con xerostomía / Nursing management of the patient from xerostomia

La salud oral es un componente fundamental de la salud de las personas, siendo el cuidado de la boca un aspecto vital de la enfermería. Un problema de salud oral frecuente y desconocido es la xerostomía, una condición que afecta a entre el 10 % y el 38 % de la población y se define como la sensación subjetiva de boca seca. Con este artículo se busca conocer las distintas intervenciones basadas en la evidencia que como profesionales de enfermería podemos efectuar en el cuidado del paciente que sufre xerostomía. El manejo de la misma se basa en el diagnóstico, seguimiento y tratamiento de la enfermedad, mediante el empleo de diversas medidas farmacológicas y no farmacológicas, como son los estimulantes y sustitutos de la saliva y los fármacos con efecto colinérgicos. La xerostomía tiene un gran impacto en la persona que la sufre, siendo aún necesario mayor investigación, en la que la enfermería ha de jugar un papel protagonista (AU)

The oral healh is a fundamental component of the health of the people, being its care a vital aspect of nursing. A frequent and unknown oral health problem is xerostomia, a condition that affects between 10 % and 38 % of the population and which is defined as the subjetive experience of dry mouth. With this article we are looking forward to learn the different based on evidence-interventions that as nurses we can perform in the care of the patient suffering from xersotomia. The management of xerostomia is based in the diagnosis, monitoring and treatment of the disease, using diverse farmalogical and no farmalogical measures, like salivary stimulants and substitutes and colinergic drugs. The xerostomia has a big impact in the pacient, being necessary a bigger research of the subject, in which the nursing has to play a lead role (AU)

[Nursing Management of the Patient Suffering from Xerostomia]. / Manejo enfermero del paciente con xerostomía.

The oral health is a fundamental component of the health of the people, being its care a vital aspect of nursing. A frequent and unknown oral health problem is xerostomia, a condition that affects between 10% and 38% of the population and which is defined as the subjective experience of dry mouth. With this article we are looking forward to learn the difference based on evidence-interventions that as nurses we can perform in the care of the patient suffering from xersotomia. The management of xerostomia is based in the diagnosis, monitoring and treatment of the disease, using diverse farmalogical and no farmalogical measures, like salivary stimulants and substitutes and cholinergic drugs. The xerostomia has a big impact in the patient, being necessary a bigger research of the subject, in which the nursing has to play a lead role.

[Post-radiotherapy care and monitoring of head and neck cancers]. / Soins et surveillance post-radiothérapie des cancers ORL.

Radiotherapy performed to treat head and neck cancer results in considerable side effects and the patient must be provided with all the necessary information and regular monitoring. From the announcement of the diagnosis, during and after the radiotherapy, the nurse coordinator identifies and assesses the needs, expectations and concerns of the patients. Their role helps to simplify and personalise the care pathway, providing a liaison between the different professionals and offering support for the patient.

Saliva composition and upper gastrointestinal symptoms in chronic kidney disease.

OBJECTIVE: To investigate self-reported upper gastric symptoms experienced by patients with chronic kidney disease (CKD) and compare associations between uraemic symptoms and saliva composition. METHODS: In a cross-sectional observational study, 30 patients with Stages 4 and 5 CKD were selected from a tertiary hospital renal outpatient clinic. Subjects answered a questionnaire to assess upper gastrointestinal (GI) symptoms. A saliva sample was collected to determine biochemical composition. Possible associations between saliva composition and uraemic upper GI symptoms were assessed. RESULTS: Only 3 (10%) patients reported no upper GI symptoms whilst 19 (63%) complained of a dry mouth, 16 (56%) had a change in taste, 9 (30%) had nausea, 7 (23%) vomited and 7 (23%) dry retched. Lower saliva bicarbonate concentration related to both dry mouth (p < 0.003) and dry retching (p < 0.01). An elevated level of saliva calcium was also implicated in a dry mouth sensation (p < 0.01). Nausea was associated with higher saliva sodium levels (p < 0.03) and a higher saliva sodium/potassium ratio (p < 0.02). CONCLUSION: Altered saliva composition in patients with Stages 4 and 5 CKD may be associated with uraemic upper GI symptoms. In particular, lower saliva concentrations of bicarbonate are associated with dry mouth and retching. Higher saliva calcium levels are also related to a dry mouth whilst higher saliva sodium levels and a greater sodium/potassium ratio are associated with nausea. Further studies investigating strategies to improve uraemic symptoms via changes in saliva are required.

Adverse effects and appetite suppression associated with particle beam therapy in patients with head and neck cancer.

AIM: This purpose of this study was to investigate the relationship between the appetite and various factors that are associated with particle beam therapy, including the adverse effects of radiation, dry-mouth period, analgesic medication use, frequency of oral care, and participants' characteristics, in 121 patients with head and neck cancer. METHODS: A path analysis was used to evaluate the causal relationship of the factors that affected the participants' appetite. RESULTS: At a cumulative dose of 40 GyE, the factors that impacted the participants' appetite included xerostomia, oral mucositis, age, frequency of oral care, and analgesic medication use. At a cumulative dose of 50 GyE, the factors that affected the participants' appetite were xerostomia, sensitivity to taste, oral mucositis, dry-mouth period (in the morning), frequency of oral care, number of artificial teeth, and analgesic medication use. The results indicate that interventions to avoid appetite suppression during particle beam therapy will differ according to a radiation schedule of 40 GyE, compared to 50 GyE. CONCLUSIONS: These results are important to consider when deciding how best to maintain the dietary intake of patients who are receiving particle beam therapy.

Oral health of psychiatric patients: the nurse's perspective.

OBJECTIVE: To assess nurses' perspectives on character, prevalence and cause of oral diseases among psychiatric patients and also their approach and suggestions in relation to the care of oral problems. MATERIALS AND METHODS: A questionnaire-based cross-sectional survey of all cadres of nurses (n = 136) at the Federal Psychiatric Hospital, Benin City, Nigeria, was conducted between December 2010 and January 2011. RESULTS: Two-thirds (67.6%) of the respondents reported that psychiatric in-patients in comparison with the general population have a higher occurrence of oral and dental problems. Commonly cited reasons for the poor oral health of patients included as follows: sedation for long periods, lack of care by family, psychopathological symptoms, poor access to dentists and lack of oral hygiene advice. The common oral health complaints received by the respondents included toothache, pain from the gums and inability to open the mouth. Majority (91.4%) of respondents claimed to be presently involved with oral care of psychiatric in-patients but oral care delivery is however bedevilled with lot of barriers like uncooperativeness of patients and lack of oral care materials. CONCLUSION: Oral complaints received are frequent and numerate with limited palliative action rendered. Attaching dentists to psychiatric hospitals and regular training of psychiatric nurses on oral care delivery are recommended to comprehensively cater for the oral health problems of psychiatric in-patients.

Oral health in hospitalised patients: assessment and hygiene.

Maintaining oral health is an essential aspect of patient care. Good oral hygiene can reduce the risk of infection and improve patients' quality of life. This article provides an overview of oral care to enable nurses to undertake assessment of the mouth and deliver appropriate care as part of the patient's hygiene routine.

Views of xerostomia among health care professionals: a qualitative study.

AIM: To explore and describe views of xerostomia among health care professionals. BACKGROUND: Xerostomia (dry mouth) is caused by changes in quality and quantity of saliva due to poor health, certain drugs and radiation therapy. It is a common symptom, particularly among older people and has devastating consequences with regard to oral health and general well-being. METHODS: Data were obtained and categorised by interviewing 16 health care professionals. Qualitative content analysis was chosen as the method of analysis. DESIGN: Qualitative. RESULTS: The latent content was formulated into a theme: xerostomia is a well-known problem, yet there is inadequate management of patients with xerostomia. The findings identified three categories expressing the manifest content: awareness of xerostomia, indifferent attitude and insufficient support. CONCLUSIONS: Although xerostomia was recognised as commonly occurring, it was considered to be an underestimated and an ignored problem. Proper attention to conditions of xerostomia and subsequent patient management were viewed as fragmentary and inadequate. Additional qualitative studies among patients with xerostomia would be desirable to gain further understanding of the problems with xerostomia, its professional recognition and management. RELEVANCE TO CLINICAL PRACTICE: A holistic view, positive professional attitudes and enhanced knowledge of xerostomia seem essential to augment collaboration among health care professionals and to improve compassion for and support of patients with xerostomia.

[Comprehensive nursing care of the terminally ill and the dying patient. Selected symptoms and interventions]. / Umfassende Pflege und Betreuung Schwerkranker und Sterbender am Beispiel ausgewählter Symptome und Interventionen.

The special care and attention due to terminally ill and dying patients will be demonstrated in this contribution with the help of specifically chosen paradigm cases and examples. The paper focuses on the needs of dying patients and their (nurs ing) relatives during the last days/hours of life (48-72 hours). Noisy, rattling breathing (death-rattle) and dry mouth (xerostomia) will be introduced as selected symptoms and phenomena together with basic stimulation and subcutaneous therapy as corresponding nursing interventions. Especially subcutaneous therapy has been shown to be a simple, non-invasive, and outstandingly effective option for easing symptoms and suffering of terminally ill people. Furthermore, this contribution wants to stimulate the critical reflection of carers within their own organizational structure in order to foster patient focused, competent, and comprehensive therapy, care, and attention of terminally ill and dying patients during their last days of life.

A survey of the oral care practices of intensive care nurses.

BACKGROUND: Intensive care unit (ICU) patients have complex oral care needs. Inadequate oral care may predispose ICU patients to nosocomial infections. Recent initiatives have sought to improve the quality and evidence base of ICU oral care provision. OBJECTIVES: To describe the current priority given to oral care, the knowledge and practice of oral needs assessment and oral care methods, and adherence to the local ICU oral care protocol of ICU nurses working in one hospital. METHOD: Self-administered questionnaire survey of all nurses working in adult ICU ( n = 160 ). RESULTS: Replies were received from 103 (response rate 64.5%). On average, oral care was given a similar priority to other aspects of personal care. 13.5% nurses rated oral care as a low priority. Whilst 98% nurses routinely performed an oral needs assessment, only 26% used a written assessment tool. Toothbrushes were used at least once a day by 85.5% nurses and chlorhexidine products were routinely used by 50.5% nurses. The oral care practices of most nurses matched the local ICU protocol. 23.5% nurses had received no training in oral care and 58% nurses requested initial/further training. CONCLUSIONS: Most oral care methods were appropriate, based on the available evidence. A small minority of nurses gave oral care a low priority and were not using evidence-based oral care methods recommended in the local ICU protocol. Encouraging the general use of oral needs assessment tools is a priority, and further oral care training is required.

Radiation-induced xerostomia: how dry is your patient?

Most patients receiving radiation therapy to the head and neck region will experience some type of oral complication. Xerostomia is one of the most severe symptoms that patients experience and may become a lifelong problem. This article reviews normal salivary function, effects of radiation therapy on oral mucosa, impact of xerostomia on quality of life, and current treatment strategies used to manage this debilitating side effect. Oncology nurses can have a significant impact on patient outcomes through diligent assessment and ongoing education regarding symptom management.