Asunto(s)
Sistemas de Administración de Bases de Datos , Sistemas de Registros Médicos Computarizados/normas , Informática Aplicada a la Enfermería , Registros de Enfermería/normas , Enfermería Perioperatoria , Terminología como Asunto , Documentación , Estudios de Factibilidad , Lenguaje , Proyectos Piloto , Calidad de la Atención de SaludRESUMEN
BACKGROUND: Patients receiving long-term home parenteral nutrition (HPN) have catheter-related infections, reactive depression, and other recurrent problems that decrease their quality of life. The aim of this study was to evaluate the Interactive Educational Videotaped Interventions (IEVI) designed to prevent HPN complications of catheter-related bloodstream infection (CR-BSI), to prevent reactive depression (from Diagnostic and Statistical Manual of Mental Disorders, 4th Edition definition), and to increase patients' frequency of problem-solving with professionals. METHODS: A randomized placebo-controlled clinical trial was used to test IEVI that engaged patients in infection and depression prevention and problem-solving activities with professionals. The primary outcome measure was CR-BSIs, while reactive depression and problem solving were secondary outcomes. Quality of life and satisfaction with interventions, also secondary outcomes, were evaluated at 18 months. RESULTS: Compared with controls, there was a lower frequency in the experimental group of CRBSIs (chi2 = 4.82, p = .03), reactive depression (chi2 = 4.50, p = .03), and rehospitalization for CR-BSIs (chi2 = 5.73, p = .01). There was greater use of problem solving in the experimental group (chi2 = 4.33, p = .038). These differences occurred at the primary endpoint of 6 months after administration of the interventions. At the 18-month follow-up, there were fewer CR-BSIs (chi2 = 4.42, p = .035), and fewer hospitalizations for infection (chi2 = 5.729, p = .01). CONCLUSIONS: The IEVI reduced CR-BSIs and reactive depression and increased problem solving with professionals. IEVI use also can result in fewer hospitalizations and improved quality of life. Long-term improvement did not occur for reactive depression and problem-solving outcomes because patients used these less often.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Depresión/prevención & control , Hospitalización , Nutrición Parenteral en el Domicilio , Educación del Paciente como Asunto , Sepsis/prevención & control , Adolescente , Adulto , Catéteres de Permanencia/microbiología , Depresión/etiología , Contaminación de Equipos/prevención & control , Femenino , Humanos , Control de Infecciones , Masculino , Persona de Mediana Edad , Nutrición Parenteral en el Domicilio/efectos adversos , Educación del Paciente como Asunto/métodos , Solución de Problemas , Calidad de Vida , Sepsis/etiología , Resultado del Tratamiento , Grabación de Cinta de VideoRESUMEN
BACKGROUND: For patients receiving home parenteral nutrition (HPN), catheter-related bloodstream infection (CRBSI) and reactive depression may significantly impact quality-of-life. This study evaluated the influence of patient affiliation with a national organization promoting HPN education and peer support on these outcome variables. METHODS: Using a case-control design, we compared 2 groups of affiliated patients with nonaffiliated controls, who were matched for diagnosis, HPN duration, sex, and age. Group 1 data were obtained from patients in large HPN medical practice programs. Group 2 data were obtained from patients in small medical practices with a small number of HPN patients. All participants were evaluated by structured interviews every 6 months over 18 months. RESULTS: In both data collection groups, affiliated patients (A) had significantly higher (mean +/- SD) quality-of-life scores compared with nonaffiliated patients (NA): (Gr 1: A, 19.8 +/- 4.7 versus NA, 17.6 +/- 5.6, p = .05; Gr 2: A, 20.4 +/- 5.2 versus NA, 17.3 +/- 4.8, p = .05). Affiliated patients also had lower depression scores (Gr 1: A, 10.9 +/- 10.4 versus NA, 20.4 +/- 13.6, p = .01; Gr 2: A, 12.5 +/- 9.6 versus NA, 18.5 +/- 10.8, p = .03) and a lower incidence of catheter-related infections (Gr 1: A, 0.10 +/- 0.3 versus NA, 0.60 +/- 0.55, p = .01; Gr 2: A, 0.27 +/- 0.55 versus NA, 0.71 +/- 0.64, p = .02) than nonaffiliated patients. CONCLUSIONS: Affiliation with an organization that provides ongoing HPN education and peer support was associated with significantly better HPN outcomes. Alternative explanations are discussed in relation to limitations of the case-control design.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Depresión/prevención & control , Infecciones/epidemiología , Nutrición Parenteral en el Domicilio , Educación del Paciente como Asunto , Grupos de Autoayuda , Adulto , Anciano , Estudios de Casos y Controles , Catéteres de Permanencia/microbiología , Catéteres de Permanencia/normas , Depresión/etiología , Contaminación de Equipos/prevención & control , Femenino , Humanos , Control de Infecciones/métodos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Nutrición Parenteral en el Domicilio/efectos adversos , Nutrición Parenteral en el Domicilio/psicología , Calidad de Vida , Resultado del TratamientoRESUMEN
The purpose of this study was to determine the feasibility of using home audio/ video telehealth equipment for administering nursing interventions to families, observing the client response, and collecting research data over specific intervals of time. The study design was a descriptive comparison with observational data collection. The subjects were adult patients (n = 5) using nighttime mechanical ventilators for obstructive sleep apnea and their home caregivers (n = 7). Skin color vital signs, spirometry, and pulse oximetry data collected simultaneously through telehealth equipment and through nurse observation in the home were the same. Care and the caregiver's use of the patient equipment were also observed. When nursing interventions, equipment demonstrations, visual illustrations, and audiotaped educational directions were used to facilitate patient care, they were transmitted across telehealth with a few exceptions. Costs of telehealth visits were less than traditional home visits, and client evaluations of telehealth were positive.
Asunto(s)
Cuidadores , Enfermería en Salud Comunitaria , Servicios de Atención de Salud a Domicilio , Investigación Metodológica en Enfermería/métodos , Telemedicina , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración Artificial/enfermeríaAsunto(s)
Diagnóstico de Enfermería , Proceso de Enfermería , Enfermería de Quirófano/organización & administración , Vocabulario Controlado , Benchmarking , Guías como Asunto , Humanos , Perfil Laboral , Rol de la Enfermera , Evaluación de Procesos y Resultados en Atención de Salud , Indicadores de Calidad de la Atención de SaludRESUMEN
A clinically relevant model, grounded in nursing theory, has evolved to become a midrange theory. This article describes the processes used to derive, validate, revise, and test the Caregiving Effectiveness Model. Testing of this midrange theory used prospective longitudinal research with family members caring for patientsrequiring lifelong, complex, technology-based home care. It presents the conceptual critiques and statistical procedures and discusses derivation of model-generated nursing interventions and implications for use of these validation processes in developing nursing knowledge. The article summarizes limitations of the model and presents recommendations for future research.