Standardized Spiritual Screening Increases Chaplain Referrals Through the EMR: A Nurse-Chaplain Collaboration for Holistic Acute Healthcare.

The use of a concise standardized spiritual screening process to identify spiritual practices and needs of patients is essential for holistic nursing care. This interprofessional initiative resulted in the development of a spiritual screening tool that substantially increased Pastoral Services referrals to the patients who needed them and represents a significant opportunity in the delivery of holistic nursing care. Acute care settings may benefit from the adoption of a standardized chaplain referral process housed in the EMR and completed on the frontlines by trusted nursing staff providing patient and family centered care. This standardized spiritual screening process not only triggered essential services of Pastoral Services, but also helped identify and address important spiritual needs of hospitalized patients.The ability to design a tool responsive to the evolving, spiritual needs of patients can be challenging. Through collaboration with chaplains, nurses can be instrumental in creating instruments informed by available evidence in the empirical literature. Furthermore, engaging patients as a source of data during instrument design helps to ensure the content validity and practical usefulness of an instrument. Healthcare organizations might choose to implement and further evaluate/refine the new Spiritual Screening Tool and referral process developed as a result of this initiative.

El proceso de duelo en un paciente con lesión medular / The grieving process in a patient with spinal injury

Para la mayoría de las lesiones medulares no hay ningún tratamiento curativo, y dado el gran impacto que ocasiona en la calidad de vida de estas personas, las intervenciones van orientadas, entre otras, a la adaptación del nuevo estado de salud y a la obtención de la mayor independencia y autonomía posible en las necesidades del individuo. Además, después de la lesión se experimenta ansiedad y preocupación extrema que impide el manejo adecuado de las emociones, por lo que será necesario un seguimiento adecuado del proceso de duelo para la pronta recuperación psicológica. Dada la relevancia del abordaje adecuado en el proceso de duelo en el paciente lesionado medular se propone la exposición de un caso clínico de un paciente joven con dicha situación y experiencia, que pueda ayudar a otros profesionales. Para ello se elabora un plan de atención enfermero siguiendo el modelo teórico de Virginia Henderson y la taxonomía NANDA, NOC y NIC

There is no curative treatment for the majority of spinal cord injuries, and given their major impact on the quality of life of these patients, interventions are targeted, among other things, to adaptation to their new health status and achieving the highest independency and autonomy possible for their individual needs. Besides, patients will experience anxiety and extreme concern after the injury, which prevents an adequate management of emotions; therefore, an adequate follow-up will be required for the grieving process, in order to achieve an early psychological recovery. Given the relevance of an adequate approach for the grieving process in a patient with spinal injury, we hereby present the case record of a young patient with said situation and experience, which can be helpful for other professionals. To this aim, a nursing care plan was prepared, following the theoretical model by Virginia Henderson, and the NANDA, NOC and NIC taxonomy

La teoría del confort en los cuidados enfermeros / Comfort theory in nursing care

Introducción: Etimológicamente, el concepto de «confort» deriva de la palabra inglesa comfort y se refiere a todo aquello que produce comodidad y genera bienestar a la persona. Una de las personas que más ha estudiado en profundidad esta idea es la enfermera gerontológica Katherine Kolcaba, que la definió como la experiencia inmediata y holística de la persona de fortalecerse cuando se abordan las necesidades para tres tipos de confort: alivio, tranquilidad y trascendencia. Además, es importante tener en cuenta los contextos donde este confort se puede aplicar: físico, psicoespiritual, ambiental y social. Los preceptos teóricos de Katherine Kolcaba reafirman la idea de que las intervenciones de confort no suelen ser intervenciones técnicas, sino que complementan la asistencia clínica, a la vez que abogan por satisfacer las necesidades humanas básicas. En este sentido, la disciplina enfermera tiene un papel relevante. Discusión y conclusiones: Como consecuencia de este concepto de subjetividad, el confort es difícil de valorar y objetivar, por lo que, dentro de su determinación, se han de tener en consideración el empleo de diversos instrumentos objetivos validados como el Comfort Questionnaire, desarrollado por Katherine Kolcaba. El confort debe valorarse y considerarse desde una perspectiva humanística, holística, multidimensional e interdisciplinar resultado de las interacciones de la persona con percepciones, situaciones y objetos modificables a lo largo del tiempo y el espacio. Dentro de esta inclusión del confort en el cuidado del paciente, la enfermera juega un papel importante

Introduction: Etymologically, «comfort» concept is derived from English language and it refers to everything that produces ease and generates welfare. One of the most important people in the study of comfort from a nursing perspective was the gerontolist Katherine Kolcaba who defined it as the immediate holistic experience of being strengthened through addressing the three types of comfort: relief, ease, and transcendence. At the same time we should also consider the four contexts in which comfort can be attained: the physical, the psychospiritual, sociocultural and environmental. Katherine Kolcaba theorical precepts reinforce the notion that comfort interventions are not related to technical interventions, but rather to clinical assistance, at the same time that it advocates for meeting basic human needs. Accordingly, nursing field has an important role. Discussion and conclusions: Comfort is a subjective concept that is very difficult to assess and objectify. Because of this subjectivity, comfort should be assessed using different tools like the comfort questionnaire developed by Katherine Kolcaba. Comfort, as a result of interactions between people, situations and objects developed over time, should be valued and considered from an humanistic, holistic, multidimensional and interdisciplinary perspective, in which the nurse plays an essential role

Perspectiva de género en páginas webs españolas de salud sexual para la población joven / Gender perspective on Spanish websites addressed to young people's sexual health

Introducción. El desarrollo imparable de las nuevas tecnologías y su uso creciente como fuente de información en salud sexual por parte de la población más joven nos hace replantearnos si la información que los jóvenes están recibiendo a través de estas páginas web es objetiva y fiable, y si refleja un modelo de sexualidad integral y con perspectiva de género. Objetivos. Analizar el contenido visual y escrito del Portal de Salud Sexual de población joven de Castilla y León desde una visión holística de la sexualidad y contrastar las páginas web de salud sexual joven de instituciones oficiales de las diferentes comunidades autónomas de España. Material y método. Se ha realizado una evaluación del diseño y de los contenidos de la página de la web de Salud Sexual Joven de Castilla y León mediante una matriz de análisis que respondía a las necesidades y objetivos del estudio. Resultados y conclusiones. El modelo de salud sexual que promueve el portal estudiado, a través de sus contenidos e imágenes, es un modelo heterosexista basado en la prevención de riesgos, cuyo eje central está sustentado en la reducción de riesgos de contraer infecciones de trasmisión sexual (ITS) o embarazos no planificados, lo cual fomenta por tanto una visión de la sexualidad limitada y coitocéntrica. Su abordaje se plantea ciego al género, omitiendo los factores sociales, culturales e individuales que interactúan en mujeres y hombres a la hora de vivir su sexualidad

Introduction. The unstoppable development of new technologies and their increasing use as a source of information on sexual health by the younger population, makes us wonder whether the information they are receiving through websites is objective and reliable; and whether it reflects a model of comprehensive sexuality with a gender perspective. Objectives. To analyze the visual and written content of the Sexual Health Portal for young people of Castilla y León from a holistic sexual perspective and to compare the websites for young people’s sexual health from official institutions of Spain’s different autonomous communities. Materials and method. The design and contents of the website for Young People’s Sexual Health of Castilla y León were analyzed using a matrix that met the study’s needs and objectives. Results and conclusions. The sexual health model promoted by the portal, through its contents and images, follows a heteronormative model based on risk prevention, whose central axis is based on the reduction of risks of sexually transmitted infections (STIs) or unplanned pregnancies, thus promoting a vision of a limited and coitocentric sexuality. The website’s approach to sexuality is gender blind, omitting the social, cultural and individual factors present in women and men's sexual experiences

Enhancing Spiritually Based Care Through Gratitude Practices: A Health-Care Improvement Project.

BACKGROUND: Addressing spirituality in health care is important as it improves health outcomes; however, several provider barriers exist to providing spiritually based care. Local problem: A chart audit at a multidisciplinary wellness center serving a population with chronic mental health problems identified a need to improve the number of spiritually based interventions provided to clients by the nurse practitioner. DESIGN: A quasi-experimental design and pre- and post-test questionnaire were used to measure outcomes including the number of spiritually based interventions and provider attitudes. INTERVENTION: Providers, including a nutritionist, exercise physiologist, pharmacist, acupuncturist, and nurse practitioner, participated in two, 1-hour interactive educational sessions on providing spiritually based care, emphasizing the use of gratitude practices. RESULTS: The mean number of spiritually based interventions charted per visit by the nurse practitioner increased from 0.4 pre-implementation to 1.1 post-implementation (rate ratio = 2.57, with 95% CI [1.75, 3.87]; p < .001). Descriptive statistics from all providers show improvements in attitudes and comfort level in addressing spiritually based care. Several intervention areas documented by the nurse practitioner decreased significantly, including mind/body, which may be related to the study, as many spiritually based interventions are also mind/body interventions. CONCLUSION: Interactive educational sessions on spirituality can improve a health-care team's attitudes, comfort level, and practice of providing spiritually based care. Generalizability is limited to the project site, but the process could be implemented in other facilities to determine if similar results can be achieved.

Plan de cuidados a un paciente portador de una sonda de gastrostomía / Plan of care for a patient with a gastrostomy catheter

Se expone el caso de un paciente portador de sonda de gastrostomía por presentar neoplasia del seno piriforme que impide la deglución. Cuando el paciente fue derivado a la consulta presentaba irritación importante de la piel que rodeaba la sonda de gastrostomía debido a la emisión continua de jugos gástricos, así como por pérdidas de alimentación provocadas por la holgura excesiva del estoma y dolor continuo en la zona. Dicha situación no permitía descansar al paciente, generándole sentimientos de preocupación y desánimo. Utilizando los patrones de Marjory Gordon se valoró al sujeto, identificando los diagnósticos enfermeros según la taxonomía de la North American Nursing Diagnosis Association (NANDA), los resultados según la Nursing Outcomes Classification (NOC) y las intervenciones enfermeras oportunas, siguiendo la Nursing Intervention Classification (NIC), para que el paciente adquiriera las habilidades necesarias para el manejo de su sonda de gastrostomía, supiera cómo administrar adecuadamente la alimentación y los medicamentos a través de la misma y mantuviera la integridad de la piel periestomal (AU)

We present the case of a patient with gastrostomy due to neoplasia in the pyriform sinus that prevented swallowing. When the patient was referred, he presented a major irritation of the skin around the gastrostomy catheter, due to the continuous production of gastric juices, as well as food losses caused by the excessive width of the ostomy and continuous pain in the area. Said situation prevented the patient from resting, and generated feelings of concern and discouragement. The patient was assessed using Marjory Gordon's patterns, identifying nursing diagnoses according to the taxonomy by the North American Nursing Diagnosis Association (NANDA), outcomes according to the Nursing Outcomes Classification (NOC), and the adequate nursing interventions, following the Nursing Intervention Classification (NIC), so that the patient acquired the skills needed to manage his gastrostomy catheter, learning how to administer adequately food and medications through it, and maintaining the integrity of peristomal skin (AU)

Transformational Leadership: A Model for Advanced Practice Holistic Nurses.

Advanced Practice Holistic Nurse (APHN) leaders could provide a model of leadership to advance value based health care systems in the United States. The American Nurses Association has recognized Holistic Nursing as a specialty because of the emphasis placed on patient-centered care, the development of therapeutic relationships, interconnection, and holism. Transformational leadership is a framework that uses vision, inspiration and intellectual stimulation to motivate people toward needed change. The APHN is well positioned to use transformational leadership methods to lead teams placing the patient at the center of health care decision making and bring the essence of holism to the forefront of health care. Highlighted are methods for positive communication, inspiration, negotiation, and conflict resolution as tools the APHN could use to become a transformational leader. The purpose of this article is to discuss a framework for transformational leadership development and implementation to establish the holistic ideals of APHNs in the health care system.

All patients deserve holistic care.

Towards the end of my first year of training, I was on placement on a hospital ward when I heard the alarm bell go off in a bathroom.