The need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge.

BACKGROUND: Many patients who receive steroid pulse therapy go home the same day or the day after steroid administration. Nursing instructions are important for improving patient knowledge related to their diseases and treatments, but the short hospital stay often prevents complete education and guidance regarding the given therapy. The purpose of this study was to investigate the need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge of their disease and treatment. METHODS: Patients with systemic lupus erythematosus (SLE) and systemic sclerosis receiving steroid pulse therapy (N = 63) were recruited from a medical center in Taipei. A structured questionnaire was used for data collection before and after nursing instruction, and 1 week as well as 2 weeks after therapy. The need for nursing instruction and knowledge levels were validated using Cronbach's α reliability test. RESULTS: There was a significant difference (P < 0.001) in the need for nursing instruction among the 4 time points. There was a positive correlation between the need for nursing instruction and body weight change, frequency of treatment, and distress, but there was a negative correlation with knowledge level (ß = -0.012, P = 0.003) regarding symptoms. The knowledge level of subjects after nursing instruction was significantly higher than before nursing instruction (80 ± 14.31 vs. 70.06 ± 17.23, P < 0.001). CONCLUSIONS: This study indicates that nursing instruction is needed by patients receiving steroid pulse therapy, and that by designing and administering nursing instructions according to the priority of patient symptoms, nurses can improve patient knowledge related to their diseases and treatments. In addition, the need for nursing instruction can be affected by patient characteristics.

Assistência de enfermagem ao paciente em pulsoterapia com corticosteróide / Nursing care of patients on corticosteroid pulse therapy

Introdução: A pulsoterapia com corticosteróide endovenoso consistena administração de corticosteróides em altas doses (a partir de 1 g/dia), por três dias ou mais, ou em dias alternados. A necessidade de hospitalização ocorre devido aos possíveis efeitos colaterais que o paciente pode apresentar durante a infusão da droga; para tanto a monitorização dos parâmetros vitais, além de identificar precocementeos efeitos, possibilita intervenção adequada, garantindo a segurança do paciente. A uniformização dos cuidados prestados é necessária devido à responsabilidade da equipe de enfermagem na administração da droga e o acompanhamento destes pacientes. Objetivo: Identificar os principais cuidados na assistência de enfermagem durante a administração do corticosteróide em uma unidade hospitalar. Métodos: Pesquisa bibliográfica em base de dados, livros e revistas científicas nas áreas de endocrinologia, farmácia e enfermagem; discussão com especialistas em neurologia, transplante e farmácia. Resultados: Os efeitos colaterais durante a pulsoterapia com corticosteróides podem ocorrer logo no início da infusão da droga. Para monitorar estas alterações foi elaborado um instrumento para sistematizar a assistência de enfermagem prestada a estes pacientes. Conclusões: A assistência de enfermagem sistematizada durante a pulsoterapia com corticosteróide promove a identificação precoce das possíveis complicações e, conseqüentemente, intervenção paraminimizá-las.