Creating a Sensory-Friendly Pediatric Emergency Department.

INTRODUCTION: For children with autism spectrum disorder (ASD) and sensory-processing disorder (SPD), an unexpected visit to the emergency department can be an overwhelming experience that creates intensifying behaviors and an unsafe clinical interaction for the child, nurses, and providers. Although resources exist to help nurses work with this specialized group, there are limited examples of the challenges and opportunities of modifying an emergency department to be a place where nurses can provide sensory-informed care. METHODS: Guided by Watson's Theory of Caring, nurses and child life specialists in our pediatric emergency department initiated a practice improvement (PI) project to create a sensory-friendly emergency department. The nurses (1) engaged with community members and families, (2) examined current practices, (3) modified the patient care environment, (4) collaborated in an interprofessional educational session, and (5) created a shared vision for the modified patient-care environment. RESULTS: This article describes the nurse-initiated PI process and the journey to create an evidence-based sensory-friendly pediatric emergency department. A model is presented so that other facilities can embark on their own initiative, and case studies are used to evaluate project outcomes. DISCUSSION: Integrating current evidence, staff suggestions, community input, and expert advice allowed us to find creative solutions to the unique sensory needs of children who visit our emergency department. Modifying both the patient-care environment and the patient-flow process to accommodate for the needs of children with ASD/SPD created a more peaceful and healing environment for children and their families and gave nurses the support they needed to provide sensory-informed care.

Educación para la Salud. Déficit sensoriales en personas mayores / No disponible

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Consistency of breast and arm symptoms during the first two years after breast cancer surgery.

PURPOSE/OBJECTIVES: To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms. DESIGN: Prospective cohort study with two-year follow-up. SETTING: Three institutions in the Stockholm, Sweden, region. SAMPLE: 645 women, aged 20-63 years, enrolled within 12 weeks of surgery for primary breast cancer. METHODS: Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis. MAIN RESEARCH VARIABLES: Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire. FINDINGS: Most participants had undergone breast-conserving surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years. CONCLUSIONS: Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms. IMPLICATIONS FOR NURSING: For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.

Onset aging conditions of adults with an intellectual disability associated with primary caregiver depression.

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p<0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR=3.807, p=0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.

Nursing a sense of family.

Rosemary Jenkinson was named nurse of the year in 1991 in recognition of her work to establish a community home for children with profound sensory disabilities. Winning the award was a confidence booster and a responsibility, she says.

Supporting people with severe myalgic encephalomyelitis.

This article aims to raise nurses' awareness of myalgic encephalomyelitis (ME) also known as chronic fatigue syndrome (CFS). Key symptoms are presented along with possible service responses and treatment options. It emphasises that this condition is often misunderstood but that it can be serious and more research is needed to promote better understanding of the physical symptoms.

'Finding the person the disease has'--the case for multisensory environments.

Education about, and exposure to, the utilization of a multisensory environment (MSE) was provided to clinical staff as a response to findings from the problem identification stage of an action research study. Feedback was obtained about their experience and perceptions of its use. Through the auspices of focus groups and one-to-one interviews, respondents commented on the impact that using the MSE had on their perception of their clients and on subsequent care. The case is made that MSEs afford an opportunity to impact on care through their mediating influence on formal carers' perceptions of their clients and, as such represent a significant but as yet unrealized potential for improving the quality of care of older people with dementia.

Defining and measuring balance in adults.

The ability to maintain balance is often taken for granted, yet it is the foundation for mobility and overall functional independence throughout the life span. The purpose of this article is to define balance, review the components of balance, and describe common instruments used to measure balance. Clinical screening instruments, functional performance tests, and technological measures of balance are reviewed addressing their uses, strengths, and limitations.

Sensory alterations after breast cancer surgery.

Many patients experience a variety of sensory alterations at and around the site of their breast cancer surgery, which they often report as severe and distressing. Prevalence, characteristics, and treatment options associated with these sensory alterations remain understudied, as does the effect they have on patients. This article will review important studies that address these issues and discuss treatment options and nursing implications. With this knowledge, nurses can play an important role in helping patients to understand and manage these sensations.