Quality Evaluation of Nursing Observation Based on a Survey of Nursing Documents Using NursingNAVI.

We have identified three foci of the nursing observation and nursing action respectively. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions. We developed this structure based NursingNAVI® contents collaborated with some quality centred hospitals. Authors analysed the nursing care documentations of post-gastrectomy patients in light of the standardized nursing care plan in the "NursingNAVI®" developed by ourselves and revealed the "failure to observe" and "failure to document", which leaded to the volatility of the patients' data, conditions and some situation. This phenomenon should have been avoided if nurses had employed a standardized nursing care plan. So, we developed thinking process support system for planning, delivering, recording and evaluating in daily nursing using NursingNAVI® contents. It is important to identify the problem of the volatility of the patients' data, conditions and some situation. We developed a survey tool of nursing documents using NursingNAVI® Content for quality evaluation of nursing observation. We recommended some hospitals to use this survey tool. Fifteen hospitals participated the survey using this tool. It is estimated that the volatilizing situation. A hospital which don't participate this survey, knew the result. So the hospital decided to use NursingNAVI® contents in HIS. It was suggested that the system has availability for nursing OJT and time reduction of planning and recording without volatilizing situation.

Sistematização da assistência de enfermagem no perioperatório de cliente submetido à gastrectomia total: relato de experiência / Systematization of nursing care in the perioperative period client underwent total gastrectomy: experience report

Este estudo descreve a importância da aplicação da Sistematização da Assistência de Enfermagem Perioperatória ao paciente submetido a gastrectomia total. Tratou-se do estudo de um caso realizado durante as aulas práticas da disciplina Saúde do Adulto 11. Os diagnósticos de enfermagem encontrados foram déficit de conhecimento, risco de Infecção, ansiedade, risco de integridade da pele prejudicada, risco de nutrição alterada, dor aguda abdominal, distúrbio no padrão do sono. Esta experiência foi de grande importância para a discente por contribuir para formação da prática científica profissional...

This study describes the importance of applying Systematization of Nursing Perioperative patient underwent total gastrectomy. It was a case study conducted during school discipline practices of Adult Health 11. The nursing diagnoses found were lack of knowledge, risk of infection, anxiety, risk for impaired skin integrity, risk for altered nutrition, acute abdominal pain, disturbed sleep pattern. This experiment was of great importance because it contributes to the student to practice professional scientific training...

Este estudio describe la importancia de la aplicación de Sistematización de Enfermería perioperatoria paciente sufrió una gastrectomía total. Fue un estudio de caso realizado durante las prácticas disciplinarias escolares de Salud del Adulto ll. Los diagnósticos de enfermería encontrados fueron la falta de conocimiento, riesgo de infección, la ansiedad, el riesgo de deterioro de la integridad cutánea, riesgo para la nutrición alterada, dolor abdominal agudo, patrón de sueno alterado. Este experimento fue de gran importancia, ya que contribuye a que el estudiante practique la formación científica profesional...

Problem Solving for Volatilizing Situation in Nursing: Developing Thinking Process Supporting System using NursingNAVI® Contents.

We have identified three foci of the nursing observation and nursing action respectively. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions. We developed this structure based NursingNAVI® contents collaborated with some quality centered hospitals. Authors analysed the nursing care documentations of post-gastrectomy patients in light of the standardized nursing care plan in the "NursingNAVI®" developed by ourselves and revealed the "failure to observe" and "failure to document", which leaded to the volatility of the patients' data, conditions and some situation. This phenomenon should have been avoided if nurses had employed a standardized nursing care plan. So, we developed thinking process support system for planning, delivering, recording and evaluating in daily nursing using NursingNAVI® contents. A hospital decided to use NursingNAVI® contents in HIS. It was suggested that the system has availability for nursing OJT and time reduction of planning and recording without volatilizing situation.

The effects of patient participation-based dietary intervention on nutritional and functional status for patients with gastrectomy: a randomized controlled trial.

BACKGROUND: Patients undergoing gastrectomy because of stomach cancer often face weight loss in the perioperational period, which can lead to malnutrition and negative treatment outcomes. OBJECTIVE: The purpose of this study was to develop a patient participation-based dietary intervention (PPDI) and evaluate its effects on patient outcomes. INTERVENTIONS/METHODS: This was a prospective, randomized controlled trial in which the patients were recruited in a cancer center in South Korea. The participants (N = 56), who underwent gastrectomy with stomach cancer stage I to III, were randomly assigned into either the experimental or the control group. The PPDI, which was given on the day before the hospital discharge, comprised 2 face-to-face and 2 telephone interventions. The outcome variables included body weight, body mass index, muscle mass, the Patient-Generated Subjective Global Assessment, Dietary Symptom Scale, Functional Assessment Cancer Therapy-General, Karnofsky Performance Status, Adherence to Dietary Guidelines Scale, Scale of Dietary Knowledge, Patient Satisfaction Scale, and a 3-day food diary. RESULTS: Participants in the PPDI intervention demonstrated significant (P < .05) reductions in adverse dietary symptoms and significant improvements (P < .05) in functional status, performance status, dietary intake, adherence to dietary guidelines, dietary knowledge, and satisfaction with the intervention as compared with the control group over time. CONCLUSION: The PPDI was an effective dietary intervention for patients undergoing a gastrectomy for gastric cancer and deserves additional study in other populations of patients. IMPLICATIONS FOR PRACTICE: Incorporating patients' perspectives into a dietary intervention after gastrectomy for gastric cancer may contribute to improved patient outcomes and quality care.

Evaluation of the completeness of the nursing process for patients having gastrectomy using electronic nursing records.

The purpose of this study was to evaluate recording completeness of the nursing process. We compared nursing statements documented at the time when the Electronic Nursing Record (ENR) system, based on the ICNP, was implemented in 2004 with those documented in 2007. The ENRs for 35 gastrectomy patients in each year were selected for evaluation. The selected data were 11,822 nursing statements in 2004 and 27,870 in 2007. The results indicated a significant increase in the completeness of the nursing process in 2007. In addition, the number of nursing diagnosis increased by 5.1 times. The most contributing factor for this increase is assumed to be nurse education.

Caso clínico: paciente gastrectomizada en tratamiento con quimioterapia y radioterapia / Case report: a gastrectomized patient under treatment with chemotherapy and radiotherapy

El tratamiento adyuvante del cáncer gástrico incluye radioterapia y quimioterapia. La paciente de este caso fue intervenida de una gastrectomía el 10 de noviembre de 2006. Inició tratamiento de quimioterapia adyuvante esquema McDonald el 2 de enero 2007, finalizando el 1 de junio de 2007. Inició la radioterapia el 6 de febrero 2007 y finalizó el 16 de marzo 2007. El plan de cuidados que se presenta fue diseñado siguiendo el modelo de cuidados de Virginia Henderson vigente en el Hospital Reina Sofía, utilizando las taxonomías NANDA, NOC y NIC a partir de los diagnósticos enfermeros “riesgo de infección”, “temor” y “disposición para mejorar conocimientos”. En la evolución se identificaron2 diagnósticos enfermeros más: “deterioro de la mucosa oral” y “de la integridad cutánea”

The adjuvant treatment of gastric cancer includes radiotherapy and chemotherapy. The patient underwent gastrectomy on November 10, 2006 and began adjuvant chemotherapy (McDonald scheme) on january 2, 2007, finishing on june 1, 2007. Radiotherapy was started on February 6, 2007 and finished on March 16, 2007. The care plan presented was designed following the Virginia Henderson model and is routinely used at the Reina Sofía Hospital. This care plan follows the NANDA, NOC and NIC taxonomies and is based on the following nursing diagnoses: risk of infection, fear, and disposition to improve knowledge. During the clinical course, two new nursing diagnoses were identified: deterioration of oral mucosa and skin integrity

[The effects of enteral nutrition vs parenteral nutrition on gastric motility and gastroenteric hormones after subtotal gastrectomy: a perspective randomized compared clinical trial].

OBJECTIVE: To compare the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy. Try to find the possible prognosticating marks for the postoperative gastroparesis. METHODS: Forty-one patients after gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first day after operation (POD + 1) to the seventh day (POD + 7), patients received either EN (EN group) or PN (PN group) with isocaloric and isonitrogenous intake. Serum gastrin (GAS), plasma motilin (MTL) and plasma cholecystokinin (CCK) were measured on preoperative day, POD + 1 and POD + 7. Electrogastrography (EGG) was measured on preoperative day, and POD + 7. RESULTS: On the seventh day after gastrectomy, plasma MTL and CCK levels in EN group are higher than those in PN group. There is no difference in GAS between two groups. EGG in EN group is better than that in PN group postoperatively. CONCLUSIONS: The level of gastroenteric hormones and the gastric motility are decreased significantly after subtotal gastrectomy. In contrast with PN, EN could accelerate the recovery of some gastroenteric hormones and the gastric motility after subtotal gastrectomy. GAS, MTL, CCK and EGG are not accurate enough as the marks for prognosticating the postoperative gastroparesis.

Análise dos fatores predisponentes à infecção do sítio cirúrgico em gastrectomia / Analysis of predisposing factors for surgical site infection in case of gastrectomy

A infecção do sítio cirúrgico ocupa o segundo lugar em incidência dentro do ambiente hospitalar e está relacionada à vitória do microrganismo sobre a defesa do hospedeiro; envolve, também, interesses econômicos e sociais e se constitui num desafio aos profissionais de saúde. A presente investigação teve como objetivo identificar os fatores de risco relacionados à infecção do sítio cirúrgico, em paciente submetido à cirurgia eletiva de gastrectomia, potencialmente contaminada, na especialidade de Gastrocirurgia, no período compreendido entre 1998 a 2002, em um hospital público do interior paulista. Para tanto, realizou-se um estudo retrospectivo, por meio do levantamento de informações contidas nos prontuários médicos, utilizando-se para a análise estatística dos dados os testes não paramétricos: Mann-Whitney (variáveis quantitativas) e coeficiente de contingência (variáveis qualitativas). Em 181 casos investigados, detectou-se a ocorrência de infecção do sítio cirúrgico em 17 situações (9,4%), sendo 23,5% classificadas como infecção incisional superficial; 52,9%, infecção incisional profunda e 23,5%, infecção de órgão/espaço. Quanto às variáveis referentes ao período de internação pós-operatório, período de internação total, tempo de cirurgia, sondagem vesical de demora foram associadas à presença de infecção do sítio cirúrgico. Neste estudo não se verificou associação entre infecção do sítio cirúrgico e as variáveis referentes à idade, período de internação pré-operatório, utilização de dreno, sexo, raça, diagnóstico etilismo, tabagismo, presença de doenças crônicas, realização de tricotomia, antibioticoprofilaxia, anti-sepsia, tipo de cirurgia, transfusão sangüínea e focos infecciosos à distância.

Long-term quality of life in patients after total gastrectomy.

This study used a questionnaire survey to evaluate the long-term quality of life (QOL) in 51 patients who underwent total gastrectomy. Activities of daily living (ADL) were good in 20, relatively good in 9, relatively poor in 13, and poor in 6 patients. The other 3 patients were treated on an inpatient basis. Of 38 patients who had been employed before surgery, 18 (47%) resumed working. Physically, body weight increased or showed no changes in 38 patients (74%), but decreased in the other 13 patients, of whom 3 showed a 15% or more decrease. Dumping symptoms developed in 13 patients (26%), 2 of whom had a severe condition. Clear decreases in physical strength and mental strength (spiritual energy) were reported by 10 and 8 patients, respectively. Comprehensive QOL was good in 20, slightly poor in 17, and poor in 14 patients. Quality of life was poor in 12 (41%) of the 29 patients with good ADL. The following were suggested as necessary for patients and their families: sufficient preoperative explanation about pathophysiology and nutritional management after total gastrectomy; execution of a continued patient education program until after discharge; and explanations in specific terms about cooking methods, nutritional management, exercise therapy, periodic medical checks, and patients' associations using pamphlets and food models to describe daily living of the patients after discharge.

Gastric cancer.

OBJECTIVES: To review the current status, recent advances, and ongoing research related to screening, diagnosis, staging, and treatment of gastric cancer. DATA SOURCES: Professional journals, research studies, and review articles relating to gastric cancer. CONCLUSIONS: Surgical resection is the gold standard curative treatment for gastric cancer; however, diagnosis is often at later stages of disease, leaving poor long-term survival rates. An emphasis has been placed on developing more effective chemotherapy regimens; currently, fluorouracil is the standard single agent used for gastric cancer. Radiation therapy has been used for palliative symptom management. IMPLICATIONS FOR NURSING PRACTICE: An understanding of current treatment modalities for gastric cancer will help oncology nurses assist their patients throughout their course of treatment with education, nutritional support, and symptom control.

Utilization of the concentric circle model in clinical nursing: a review.

In this article, I review applications of the concentric circle model in clinical nursing. The concentric circle model is based on the cross-sectional shape of the body extremities at several points, and can be used in the areas of both kinesiology and nutritional science. This model makes it possible to calculate the cross-sectional area of muscles from measurement of the circumference of the extremities and the thickness of adipose (fatty) tissue. Then, changes in muscle strength or nutritional status can be inferred or assessed from these data. This model requires only simple and non-invasive measurements, and this is a significant and essential characteristic for its use by nurses, both in clinical and research applications.

Stomach tumors and gastric surgery.

Malignant and benign tumors of the stomach must be resected. Some can be removed endoscopically, but larger lesions must be removed via traditional surgical methods. This article provides an overview of malignant and benign stomach tumors and outlines the determination of diagnosis and the recommended treatment. It describes different types of gastric surgery and the RN first assistant's role in these procedures. A case study of a rare type of benign stomach tumor also is presented.

Esophagogastrectomy.

The diagnosis of esophageal cancer continues to stimulate much research to find the most effective methods of treatment. Combined radiotherapy and chemotherapy may produce results as good as if not better than those with operation plus radiotherapy and chemotherapy. Esophagogastrectomy is performed using any one of several surgical approaches. The individual status of the patient is an important determinant when selecting the surgical approach. There is no clear evidence that one approach is superior to another. Patients should be evaluated appropriately and prepared for operation so that they have the best chance for having a benign postoperative course. Postoperative nursing management requires complex assessment and intervention skills. The optimal approach to the management of esophageal cancer has yet to be defined. Esophagogastrectomy remains primarily a palliative, not curative, approach to patient management. The prevention of postoperative complications through astute assessment and intervention will improve the quality of patient outcomes.