Development and Pilot of the Caregiver Strategies Inventory.

Children with autism spectrum disorder often demonstrate unusual behavioral responses to sensory stimuli (i.e., sensory features). To manage everyday activities, caregivers may implement strategies to address these features during family routines. However, investigation of specific strategies used by caregivers is limited by the lack of empirically developed measures. In this study, we describe the development and pilot results of the Caregiver Strategies Inventory (CSI), a supplement to the Sensory Experiences Questionnaire Version 3.0 (SEQ 3.0; Baranek, 2009) that measures caregivers' strategies in response to their children's sensory features. Three conceptually derived and empirically grounded strategy types were tested: cognitive-behavioral, sensory-perceptual, and avoidance. Results indicated that the CSI demonstrated good internal consistency and that strategy use was related to child age and cognition. Moreover, parent feedback after completing the CSI supported its utility and social validity. The CSI may be used alongside the SEQ 3.0 to facilitate a family-centered approach to assessment and intervention planning.

[Nursing care of unilateral neglect patients].

The prevalence of unilateral neglect among stroke patients has risen to 82% and 69%, respectively, in acute wards and rehabilitation units. Neglect may restrict the activities of patients and reduce their quality of life. Patients are often unaware of their neglect behavior and of their inability to see or feel persons or objects on their affected side. Healthcare providers should pay greater attention to the signs of neglect behavior in patients. Neglect is a silent syndrome for both patients and healthcare providers. This article reviews the definition of unilateral neglect as well as its associated characteristics, theoretical interpretations, rehabilitation, and nursing care. The authors hope that the contents of this article may help healthcare professionals assess and provide care to patients with neglect problems in order to decrease the negative impacts of neglect on patients and improve their daily functions.

Unilateral neglect: assessment in nursing practice.

The North American Nursing Diagnosis Association has recognized unilateral neglect (UN) as a nursing diagnosis for more than 2 decades. Such a designation implies that nurses primarily are responsible for assessing, treating, and researching the disorder. However, nurses have made few documented contributions toward this responsibility. Although UN is a complex problem that requires attention from several specialties, there is room for nurses to substantially increase their role. Nurses are uniquely positioned to assess and treat UN by virtue of their interaction with patients in a variety of times, settings, and activities. Nurses need to develop quantifiable measures of clinical observation that are reliable and valid in nursing practice. This article reviews the literature to examine the impact of UN, existing assessment methods, and nursing involvement in assessment and treatment. Potential nursing contributions in practice and research are featured as well.

Chronic unilateral neglect from focal meningoencephalitis lesions in an immune-compromised hemodialysis patient.

Unilateral neglect (UN) is a disorder associated primarily with right-brain damage; it causes individuals to behave as if the contralesional half of their world has become unimportant or has simply ceased to exist. This is the first known case study to describe and measure UN caused by an infectious process, meningoencephalitis. The patient was immune compromised as a result of antirejection drugs following a kidney and pancreas transplant, as well as from a baseline vulnerability common to patients with hemodialysis. She was reassessed serially during hemodialysis treatments over 12 months and demonstrated improvement in some measures of UN but not in others. UN is a recognized nursing diagnosis and can be assessed, treated, and researched by nurses. Neuroscience nurses need to better understand and investigate UN to improve their own practice and the practice of other specialties.

Assessments and nursing care for right brain-damaged stroke patients: focusing on neglect and related symptoms.

The purpose of present study was to identify the behavioural characteristics and examine assessments of nursing care among right brain-damaged stroke patients with neglect within 1 year following initial onset. Characteristics related to higher cerebral dysfunction were extracted and patient grouping was attempted through cognition (Mini-Mental State Examination) and physical function (Barthel Index) plots. The characteristics and implications for nursing care for each group were analyzed. Twelve patients were classified into four groups using cognitive-physical function evaluations together with subjective and objective data associated with neglect. 'Neglect' has been regarded as a disorder of spatial perception. However, the characteristics observed in Group 2 suggest that 'neglect' may have another facet, manifesting as disorders in perceiving continuous spatio-temporal changes of an action and comprehending the context of a situation. In these patients, although 'by calling attention' is the conventional care, more appropriate care should be provided based on an assessment of cognitive-physical function and spatio-temporal recognition of an action.

A communication protocol to help patients with sensory impairment.

Patients with sight, hearing and speech impairment are entitled in law to equal access to health care according to the Disabilities Discrimination Act. More and more patients experience these problems as the population grows older. This paper reports on how a group of staff in one trust helped set up a protocol to ensure that this group's communication needs are tackled.

Phantom bladder sensations: a new concern for stoma care workers.

The phenomena of phantom limb pain and sensations are well recognized in the medical literature. However, historically, there has been little more than passing reference to phantom pain and sensations of visceral organs. In particular, phantom bladder pain has been barely recognized. This article describes the result of a small survey of urostomists (n=50) who experienced bladder pain and sensations that were described by the respondents as being a perpetuation of the pain and sensations that they experienced before cystectomy or urinary bladder diversion surgery. Respondents reported a varied frequency of sensations, unhelpful healthcare professional responses and a range of strategies that they employed to deal successfully with the pain and sensations. The findings of this study are important because they have identified significant issues for stoma care patients that need to be addressed by those involved in stoma care and which could lead to significant quality of life improvements. This research has shown that stoma care workers need to include the possibility of the occurrence of phantom bladder sensations in preoperative counselling, acknowledge and support postoperative patients by confirming the validity of their experience and by using interventions, identified in this study, that can minimize the effects.

Managing agitation in critically ill patients.

Managing agitation in critically ill patients is challenging and complex. Advances in the field of critical care impose strains on patients that can lead to disorientation and agitation, especially as more severe illnesses are treated successfully. Although the adverse effects of agitation are well-known, their impact on morbidity, mortality, length of stay, and cost are only beginning to be addressed. Meeting these challenges requires an understanding of the potential adverse effects of agitation, its causes and contributing factors, the advantages and limitations of available pharmacologic agents, and the role of nonpharmacologic interventions. This article reviews each of these issues, with a focus on clinical applications and strategies.

Altered thought processes and sensory/perceptual alterations: a critique.

Concerns about the clinical usefulness of altered thought processes and sensory/perceptual alterations--and the resulting avoidance of these two diagnoses--led to a study to determine how expert nurses differentiate between the diagnoses and how the diagnoses are used in practice. The authors developed a questionnaire and mailed it to 128 members of NANDA who had identified themselves as experts in the diagnoses; sixty-six (52%) responded. Conclusions were that the defining characteristics for altered thought processes were cognitively oriented and those for sensory/perceptual alterations were perceptually oriented. The overlap of defining characteristics, such as change in problem-solving ability, makes differential diagnosis a difficult task.

The effects of sensory changes in older persons.

An increasing proportion of persons encountered in professional nursing practice are older. This paper discusses the effects of sensory changes in older persons, specifically, the visual, auditory, olfactory, and gustatory effects. Nursing interventions aimed at assisting older persons to cope with or more effectively adapt to these potentially disabling alterations are explained, and some guidelines for nursing care are discussed.

Nursing diagnoses and interventions for the rehabilitation of the stroke patient.

The nurse has many opportunities and interventions with which to facilitate rehabilitation for the patient with a stroke. The most effective interventions are those related to helping the patient become as independent as possible and to increasing feelings of self-worth and dignity, which in turn has a positive impact on the resocialization of the patient in the family and community.

Perceptual dysfunction: nursing assessment and management.

Perceptual dysfunction is a complex problem and can be a serious barrier to the patient's recovery of independence. Nurses play a significant role in the identification of a possible perceptual deficit and in the use of nursing interventions that complement and are coordinated with the work of the occupational therapist. Four common categories of perceptual dysfunction are identified. One-sided neglect and apraxia are emphasized and specific assessment data and nursing interventions for these two problems are discussed. Agnosia and visual-spatial relationship problems are described briefly. The related problem of visual deficits is outlined and discussed with reference to perceptual dysfunction.