Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Am J Infect Control ; 46(5): 579-580, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29329915

RESUMEN

Video review and scoring was used to evaluate the behaviors of nurses wearing N95 filtering face piece respirators while providing isolation care in a simulated patient care environment. This study yielded a detailed description of behaviors related to N95 respirator use in a health care setting. Developing a more robust and systematic behavior analysis tool for use in demonstration, simulation, and clinical care would allow for improved respiratory protection of health care workers.


Asunto(s)
Adhesión a Directriz , Máscaras , Enfermeras y Enfermeros , Atención de Enfermería/métodos , Aislamiento de Pacientes/métodos , Equipo de Protección Personal , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Grabación en Video , Adulto Joven
2.
Comput Inform Nurs ; 34(9): 387-92, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27232856

RESUMEN

This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an airborne and contact isolation situation. Participants then reviewed their performance with study personnel in a formal, audio-recorded debriefing. Isolation behaviors were scored by an expert panel, and the debriefing sessions were analyzed. Considerable variation was found in behaviors related to using a computer on wheels while caring for a patient in isolation. Currently, no nursing care guidelines exist on the use of computers on wheels in an airborne and contact isolation room. Specific education is needed on nursing care processes for the proper disinfection of computers on wheels and the reduction of the potential for disease transmission from environmental contamination.


Asunto(s)
Competencia Clínica , Computadores/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa/prevención & control , Conductas Relacionadas con la Salud , Enfermeras y Enfermeros , Aislamiento de Pacientes/métodos , Adulto , Actitud del Personal de Salud , Femenino , Adhesión a Directriz/normas , Humanos , Masculino , Persona de Mediana Edad , Simulación de Paciente , Grabación en Video
4.
Am J Nurs ; 115(4): 44-9, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25811520

RESUMEN

OVERVIEW: In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.


Asunto(s)
Infección Hospitalaria/prevención & control , Educación en Enfermería/organización & administración , Hospitales de Aislamiento/métodos , Control de Infecciones/métodos , Control de Infecciones/normas , Personal de Enfermería en Hospital/educación , Equipos de Seguridad , Curriculum , Adhesión a Directriz , Humanos , Guías de Práctica Clínica como Asunto , Estados Unidos
5.
Am J Infect Control ; 42(11): 1152-6, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25444261

RESUMEN

BACKGROUND: Although an emphasis has been placed on protecting patients by improving health care worker compliance with infection control techniques, challenges associated with patient isolation do exist. To address these issues, a more consistent mechanism to evaluate specific clinical behaviors safely is needed. METHODS: The research method described in this study used a high fidelity simulation using a live standardized patient recorded by small cameras. Immediately after the simulation experience, nurses were asked to view and comment on their performance. A demographic survey and a video recorded physical evaluation provided participant description. A questionnaire component 1 month after the simulation experience offered insight into the timing of behavior change in clinical practice. RESULTS: Errors in behaviors related to donning and doffing equipment for isolation care were noted among the nurses in the study despite knowing they were being video recorded. This simulation-based approach to clinical behavior analysis provided rich data on patient care delivery. CONCLUSION: Standard educational techniques have not led to ideal compliance, and this study demonstrated the potential for using video feedback to enhance learning and ultimately reduce behaviors, which routinely increase the likelihood of disease transmission. This educational research method could be applied to many complicated clinical skills.


Asunto(s)
Actitud del Personal de Salud , Transmisión de Enfermedad Infecciosa/prevención & control , Adhesión a Directriz/normas , Enfermeras y Enfermeros , Aislamiento de Pacientes/métodos , Adulto , Terapia Conductista/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
6.
Crit Care Med ; 42(5): 1024-36, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24394627

RESUMEN

OBJECTIVE: The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice. DESIGN: Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. SETTING: Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. PATIENTS: Two hundred ninety-six patients (146 prebundle and 150 postbundle implementation), who are 19 years old or older, managed by the institutions' medical or surgical critical care service. INTERVENTIONS: Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle. MEASUREMENTS AND MAIN RESULTS: For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Patients in the postimplementation period spent three more days breathing without mechanical assistance than did those in the preimplementation period (median [interquartile range], 24 [7-26] vs 21 [0-25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle experienced a near halving of the odds of delirium (odds ratio, 0.55; 95% CI, 0.33-0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29-3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. CONCLUSIONS: Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.


Asunto(s)
Cuidados Críticos/métodos , Delirio/terapia , Hipnóticos y Sedantes/uso terapéutico , Inmovilización/efectos adversos , Respiración Artificial/efectos adversos , Desconexión del Ventilador/métodos , Adulto , Anciano , Protocolos Clínicos , Estudios de Cohortes , Ejercicio , Femenino , Humanos , Inmovilización/fisiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Resultado del Tratamiento
7.
Cancer Nurs ; 37(1): E51-60, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24036438

RESUMEN

BACKGROUND: Although dying children are often aware of their impending death, parents are reluctant to communicate with their dying child about death. OBJECTIVE: The objective of this study was to examine how parents of children in the advanced stage of a life-threatening disease trajectory communicated about death. METHODS: Using grounded theory methods, data were collected via interviews with 18 parents of children who had died of an advanced life-threatening disease. RESULTS: Ways in which parents communicated with their dying child were impacted by the degree of threat to the parental role. From the onset of their child's life-threatening illness, the sense of parental self was threatened, resulting in "Parental Vulnerability." To endure parental vulnerability, parents confronted a process of "Redefining Parenthood." Before the child's death, parents experienced (1) Protecting From Fears, (2) Protecting Normalcy, (3) Protecting Faith, (4) Experiencing Protection From Their Child, and (5) Bookmarking Memories. After the child's death, parents experienced (1) Telling the Story, (2) Making Meaning, (3) Protecting the Child's Memory, (4) Defining a New Normal, and (5) Learning to Live With Regret. CONCLUSIONS: Results provide new information about the experiences of parents of dying children as they communicated with their child during the dying process and as they found ways to go on with life after their child's death. IMPLICATIONS FOR PRACTICE: Findings can be used by healthcare professionals to help support families of dying children. The field of pediatric oncology nursing would benefit from exploration of the dying child's perspective.


Asunto(s)
Adaptación Psicológica , Muerte , Neoplasias/enfermería , Relaciones Padres-Hijo , Responsabilidad Parental , Padres , Cuidado Terminal , Adolescente , Adulto , Actitud Frente a la Muerte , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Neoplasias/terapia , Responsabilidad Parental/psicología , Encuestas y Cuestionarios , Cuidado Terminal/psicología
8.
Pediatr Blood Cancer ; 60(3): 402-8, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22829446

RESUMEN

BACKGROUND: Establishing the ability of children and adolescents with cancer to complete the NIH-sponsored PROMIS pediatric measures electronically and the preliminary validity estimates of the measures (both full item banks and short forms) in pediatric oncology will contribute to our knowledge of the impact of cancer treatment on these young patients. PROCEDURES: A total of 203 8- to 17-year olds were administered eight PROMIS pediatric measures in a cross-sectional study design to establish known-group validity. Of the 200 who completed all or most of the items, a slight majority were male (55.5%) and white (54%). Patients were either undergoing treatment for cancer (n = 93) or in survivorship following treatment for cancer (n = 107). Measures were completed using computer interface during an in-person interaction with researchers. RESULTS: Only 3 of 203 participants did not complete the PROMIS pediatric measures. As hypothesized, participants in treatment were significantly different (worse) on parent-reported clinical indicators (blood counts, fatigue, and appetite) and on seven self-reported measures (depression, anxiety, peer relationships, pain interference, fatigue, upper extremity function, and mobility) from participants in survivorship. Females reported worse fatigue, anger, and pain interference than males. Worse patient-reported outcomes for patients in active treatment persisted after adjusting for potential confounding variables. CONCLUSIONS: Children and adolescents in treatment for cancer or in survivorship and ranging from 8 to 17 years of age can complete multiple PROMIS pediatric measures using a computer interface during an outpatient clinic visit or inpatient admission. Findings establish known-group validity for PROMIS pediatric measures in pediatric oncology.


Asunto(s)
Sistemas de Información en Salud , Oncología Médica , Neoplasias , Pediatría , Autoinforme , Adolescente , Niño , Estudios Transversales , Femenino , Sistemas de Información en Hospital , Humanos , Masculino , Neoplasias/terapia
9.
J Pediatr Oncol Nurs ; 24(2): 106-15, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17332424

RESUMEN

The purpose of this study is to examine the self-reported and parent-reported health-related quality of life (HRQoL) of children (age<19 years) who received a hematopoietic (bone marrow, cord blood, or peripheral blood) stem cell transplant (SCT) at the University of Nebraska Medical Center (UNMC). A total of 35 families participated: 31 SCT recipients, 35 mothers, and 28 fathers. Mean scores were 73.6 child, 71.2 mothers, and 76.2 fathers (range of 0-100, with high scores indicating better HRQoL). No significant overall HRQoL difference between parent and child were reported. Mothers reported significantly lower physical functioning (F2,23=3.509, P=.041) compared to child (P=.041) and fathers (P=.025). Older age at time of transplant was associated with higher procedural anxiety according to child (r=.498, P=.005) and mothers (r=.466, P=.008). Older age at time of transplant was associated with less worry according to fathers (r=-.589, P=.002). Overall, SCT recipients and their parents report moderately high HRQoL.


Asunto(s)
Actitud Frente a la Salud , Estado de Salud , Trasplante de Células Madre Hematopoyéticas/psicología , Padres/psicología , Calidad de Vida/psicología , Sobrevivientes/psicología , Adolescente , Anemia Aplásica/terapia , Ansiedad/etiología , Ansiedad/psicología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Nebraska , Neoplasias/terapia , Investigación Metodológica en Enfermería , Proyectos Piloto , Psicología Infantil , Encuestas y Cuestionarios , Talasemia/terapia , Síndrome de Wiskott-Aldrich/terapia
10.
Oncol Nurs Forum ; 33(2): E36-43, 2006 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-16518436

RESUMEN

PURPOSE/OBJECTIVES: To provide clinical insights into dosing and administration of IV busulfan, a conditioning agent for hematopoietic stem cell transplantation (HSCT). DATA SOURCES: Review of published literature related to busulfan pretransplant conditioning using MEDLINE. Meeting abstracts, investigational protocols, and pharmaceutical manufacturers' package inserts also were reviewed. DATA SYNTHESIS: Busulfan is an effective myeloablative conditioning agent for HSCT. The IV formulation increases dose assurance and the ability to target a therapeutic window. Therapeutic drug monitoring ensures that targeted blood levels are achieved, especially in children, thereby preventing underdosing, which can lead to disease progression or rejection, as well as overdosing, which can cause an increased risk of toxic side effects. CONCLUSIONS: IV busulfan is a convenient, safe, and effective conditioning agent used in HSCT that has a predictable pharmacokinetic profile. IMPLICATIONS FOR NURSING: An understanding of the pharmacokinetic principles underlying the relationship between the therapeutic window for busulfan and optimal HSCT outcomes will facilitate proper dosing and administration of IV busulfan.


Asunto(s)
Busulfano/administración & dosificación , Trasplante de Células Madre Hematopoyéticas , Inmunosupresores/administración & dosificación , Acondicionamiento Pretrasplante/métodos , Administración Oral , Adulto , Busulfano/efectos adversos , Busulfano/sangre , Busulfano/farmacocinética , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Interacciones de Drogas , Monitoreo de Drogas/métodos , Femenino , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/sangre , Inmunosupresores/farmacocinética , Lactante , Infusiones Intravenosas , Convulsiones/inducido químicamente , Convulsiones/prevención & control , Resultado del Tratamiento
11.
Semin Oncol Nurs ; 21(2): 125-34; discussion 134-44, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15991662

RESUMEN

OBJECTIVES: To present an overview of research into end-of-life (EoL) care for pediatric patients with cancer and to describe research completed by a newly formed collaboration of researchers. DATA SOURCES: Professional group position papers and guidelines; research studies. CONCLUSION: Studies to date in pediatric EoL care used retrospective, descriptive, or pilot intervention designs, have been conducted in single-institution settings, and have included small numbers of patients. Most studies have explored perspectives of parents and health care professionals but have omitted the perspective of the dying child. IMPLICATIONS FOR NURSING PRACTICE: Advancing the science of EoL care will depend on intervention-based clinical trials that include the perspective of the dying child in addi tion to parents and health care professionals.


Asunto(s)
Investigación en Enfermería Clínica/organización & administración , Neoplasias/enfermería , Enfermería Oncológica/organización & administración , Enfermería Pediátrica/organización & administración , Cuidado Terminal/organización & administración , Adolescente , Actitud del Personal de Salud , Actitud Frente a la Muerte , Actitud Frente a la Salud , Niño , Comunicación , Conducta Cooperativa , Toma de Decisiones , Predicción , Conocimientos, Actitudes y Práctica en Salud , Prioridades en Salud , Humanos , Modelos de Enfermería , Modelos Psicológicos , Neoplasias/psicología , Padres/psicología , Guías de Práctica Clínica como Asunto , Psicología del Adolescente , Psicología Infantil , Proyectos de Investigación
12.
Cancer Nurs ; 28(2): 148-57, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15815185

RESUMEN

This cross-sectional study used a mailed survey to evaluate the quality of life (QOL) of individuals at least 5 years post-autologous stem cell transplant and to determine instrument preference. Instruments selected were the Medical Outcomes Study-Short Form (MOS-SF-36) as the generic measure and the City of Hope-Quality of Life-Bone Marrow Transplant (COH-BMT) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) as transplant-specific measures. Subjects received the MOS-SF-36 and were randomized to receive (1) COH-BMT, (2) FACT-BMT, or (3) COH-BMT and FACT-BMT. Ninety-two subjects returned completed forms, for a 56% response rate. A study-specific form indicated subjects preferred the BMT-specific instruments. The health of the majority of subjects (85%) was similar to or somewhat better than what it was the previous year. Their MOS-SF-36 scores for physical functioning, role-physical, bodily pain, and general health subscales were lower than the values for the general population, but those for the other subscales were not significantly different. When compared to the data reported by Hann and colleagues for posttransplant in breast cancer, study subjects scored significantly lower on all scales except General Health and Mental Health. COH-BMT scores compared with those reported by Whedon and Ferrel (Semin Oncol Nurs. 1994;10:42-57) were higher for Physical Well-Being, Spiritual Well-Being, and Global QOL. FACT-BMT results compared with those reported by McQuellen et al (Bone Marrow Transplant. 1997;19:357-368) showed that Physical, Social/Family, Emotional, and Functional Scores were similar; only BMT scores were significantly different. Research is needed to determine when QOL plateaus and whether instrument preference changes over time. Awareness of long-term effects that affect QOL can guide program revisions and facilitate decisions regarding the need for supportive rehabilitative services.


Asunto(s)
Estado de Salud , Trasplante de Células Madre Hematopoyéticas/psicología , Calidad de Vida/psicología , Encuestas y Cuestionarios/normas , Actividades Cotidianas , Adaptación Psicológica , Adulto , Anciano , Actitud Frente a la Salud , Estudios Transversales , Femenino , Necesidades y Demandas de Servicios de Salud , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Nebraska , Neoplasias/psicología , Neoplasias/terapia , Dolor Postoperatorio/etiología , Dolor Postoperatorio/psicología , Factores de Tiempo , Trasplante Autólogo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA