Assessment and examination of the respiratory system.

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis.

Registered general nurses' health assessment practices in a tertiary hospital: A focused ethnography study.

AIM: To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards. DESIGN: The study was designed as a focused ethnography. METHODS: A semi-structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method. RESULTS: Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership. IMPLICATION: The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient-centred care delivery and facilitate early recognition of physiological deterioration. PATIENT OR PUBLIC CONTRIBUTION: Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation. CONCLUSION: The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.

The need for acute assessments in home healthcare - Swedish registered nurses' experiences.

PURPOSE: The study aims to describe Swedish RNs' experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare. METHODS: A content analysis of qualitative survey data from RNs (n = 19) working within home healthcare in Sweden. RESULTS: There were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system. CONCLUSION: To increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.

Animal and human bites: Navigating evaluation and care.

ABSTRACT: Patients who have experienced animal or human bites may present for care in a number of settings with a variety of injuries requiring different approaches to treatment and management. Because animal and human bites range in severity and can result in a host of sequelae, their evaluation and management can be complex. In caring for patients with an animal or human bite, NPs must consider the many factors relevant to such an injury.

Daily weight monitoring for inpatients receiving chemotherapy.

ABSTRACT: Unlike intake and output documentation, which is often inaccurate and inconsistent, daily weight measurement is a reliable method to assess fluid volume status. Daily weight assessment and monitoring are crucial for preventing volume overload in patients receiving chemotherapy in the inpatient setting.

[Better assessment, better care: Quetci, a questionnaire for assessing cognitive disorders in nursing practice]. / Mieux évaluer, mieux soigner : le Quetci, un questionnaire d'évaluation des troubles cognitifs IDE.

Cognitive disorders can have significant repercussions on the quality of care and daily life for patients. We have developed a new tool specifically designed for nursing practice to identify these problems in patients with brain tumors. The Cognitive Impairment Assessment Questionnaire for nursing practice is an objective, quick and easy-to-administer tool that is readily accepted by patients.

Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool.

INTRODUCTION: The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. METHODS: This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. RESULTS: With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DISCUSSION: For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.

Blunt mechanism chest wall injury: initial patient assessment and acute care priorities.

Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI.

Nursing assessment and care for a patient with a neurological disorder.

The previous article discussed the pathophysiology involved in disorders of the nervous system. Having considered some of the most prevalent disorders, this second part uses a case study to explore effective patient assessment and emphasise the importance of facilitating patient self-management for improved outcomes. By addressing these key aspects, nursing professionals can enhance the quality of care and the support provided to individuals experiencing neurological disorders.

Femoral fracture in the elderly: dependence on nursing care

Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. The sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization and discharge, according to the SCP. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). With regard to fractures, there was a greater occurrence due to falls from standing height and predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the SCP estimates presented 24.26 in the 1st, 26.12 in the 2nd and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intra-hospital nursing process, thus allowing the systematization of the team's assistance.

Undertaking a neurological assessment.

Neurological observations are an essential aspect of assessment in patients with altered mental status and require the nurse to collect and analyse information using a validated assessment tool. Assessing a patient's pupil size and response is also an important element of a neurological assessment. This article summarises the pathophysiology of raised intracranial pressure and lists some of the conditions that may contribute to an alteration in a patient's mental status. The article details the use of two commonly used neurological assessment tools and the assessment of a patient's pupil size and response. The author also considers the challenges related to accurate recording of neurological observations.

Improving the Use of Subscale-Specific Interventions of the Braden Scale Among Nurses.

BACKGROUND: Pressure injuries (PIs) are costly to hospitals and have a negative impact on patient outcomes. Despite the use of validated tools that describe PI risk, such as the Braden Scale, the incidence of PIs remains high. Studies have shown that Braden Scale subscale scores should be considered when planning care; however, there is a discrepancy between understanding the importance of subscale-specific interventions and implementation. The goal of this study was to test the ability of an educational intervention tailored to specific interventions based on the subscales of the Braden Scale to improve knowledge among nurses. METHOD: This study was a prospective, quasi-experimental, single-group design where nurses (n = 35) from a neurosurgery stepdown unit in a large teaching hospital completed a preintervention survey (T1), attended an educational presentation, and then completed an immediate postintervention survey (T2) and a 2-month postintervention survey (T3). RESULTS: Data analysis compared presurvey scores with postsurvey scores. Nursing comprehension improved from the preintervention survey (T1, M = 5.57) to the postintervention surveys (T2, M = 6.34; T3, M = 6.42) (p = .031). CONCLUSION: Nurses showed increased comprehension after the educational intervention from T1 to T3. [J Contin Educ Nurs. 2024;55(1):42-48.].

Psychometric evaluation of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version / Evaluación psicométrica del instrumento Functional Health Pattern Assessment Screening Tool - Versión modificada para Brasil / Avaliação psicométrica do Functional Health Pattern Assessment Screening Tool - Versão Brasileira Modificada

Objective: to test the factorial structure, reliability and convergent validity of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. Method: this was a psychometric evaluation of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. Seven hundred and seventeen participants answered the data collection instrument consisting of two parts. Part I included a structured questionnaire to collect sociodemographic data and the participants' perceptions and satisfaction with their current health status. Part II consisted of the tool being tested. The internal structure was assessed using Confirmatory Factor Analysis. Convergent validity was evaluated by the correlation of the tool scores with the rates corresponding to self-perception and satisfaction with current health status. Reliability was assessed using Cronbach's alpha. Results: the Confirmatory Factor Analysis confirmed a three-factor solution. The factor loadings were significant and varied from 0.16 to 0.75; the fit indices suggested moderate fit of the model. Internal consistency for all three components varied between 0.779 and 0.919. Conclusion: the findings suggest that the tool is valid and reliable to be used in the Brazilian population, although caution is recommended when interpreting the results due to the moderate fit of the model.

Objetivo: someter a prueba la estructura factorial, confiabilidad y validez convergente del instrumento Functional Health Pattern Assessment Screening Tool - Versión modificada para Brasil. Método: evaluación psicométrica del instrumento Functional Health Pattern Assessment Screening Tool - Versión modificada para Brasil. Setecientos diecisiete participantes respondieron el instrumento de recolección de datos, compuesto por dos partes. La Parte I incluyó un cuestionario estructurado para recopilar datos sociodemográficos y las percepciones y el nivel de satisfacción de los participantes con respecto a su estado de salud actual. La Parte II consistió en la herramienta sometida a prueba. La estructura interna se evaluó empleando Análisis Factorial Confirmatorio. La validez interna se evaluó por medio de la correlación entre las puntuaciones obtenidas en la herramienta y los índices correspondientes a los niveles de autopercepción y satisfacción con respecto al estado de salud actual. La confiabilidad se evaluó utilizando el coeficiente alfa de Cronbach. Resultados: el Análisis Factorial Confirmatorio confirmó una solución con tres factores. Las cargas factoriales fueron significativas y variaron entre 0,16 y 0.75; los índices de ajuste sugirieron ajuste moderado del modelo. La consistencia interna correspondiente a los tres componentes varió entre 0,779 y 0,919. Conclusión: los hallazgos sugieren que la herramienta es válida y confiable para ser usada en la población de Brasil, aunque se recomienda interpretar los resultados con precaución debido al moderado ajuste del modelo.

Objetivo: testar a estrutura fatorial, a confiabilidade e a validade convergente do Functional Health Pattern Assessment Screening Tool - Versão Brasileira Modificada. Método: avaliação psicométrica do Functional Health Pattern Assessment Screening Tool - Versão Brasileira Modificada. Setecentos e dezessete participantes responderam os itens do instrumento de coleta de dados composto por duas partes. A Parte I incluiu um questionário estruturado contendo dados sociodemográficos e a percepção e satisfação dos participantes com seu estado de saúde atual. A Parte II consistiu no instrumento testado. A estrutura interna foi avaliada por meio de Análise Fatorial Confirmatória. A validade convergente foi avaliada pela correlação dos escores do instrumento com os índices correspondentes à autopercepção e à satisfação com o estado de saúde atual. A confiabilidade foi avaliada pelo alfa de Cronbach. Resultados: a Análise Fatorial Confirmatória confirmou uma solução de três fatores. As cargas fatoriais foram significativas e variaram de 0,16 a 0,75; os índices de ajuste sugeriram ajuste moderado do modelo. A consistência interna dos três componentes variou entre 0,779 e 0,919. Conclusión: os achados sugerem que o instrumento é válido e confiável para ser utilizado na população brasileira, embora seja recomendada cautela na interpretação dos resultados devido ao ajuste moderado do modelo.

Design and implementation of an automatic nursing assessment system based on CDSS technology.

BACKGROUND: Various quantitative and quality assessment tools are currently used in nursing to evaluate a patient's physiological, psychological, and socioeconomic status. The results play important roles in evaluating the efficiency of healthcare, improving the treatment plans, and lowing relevant clinical risks. However, the manual process of the assessment imposes a substantial burden and can lead to errors in digitalization. To fill these gaps, we proposed an automatic nursing assessment system based on clinical decision support system (CDSS). The framework underlying the CDSS included experts, evaluation criteria, and voting roles for selecting electronic assessment sheets over paper ones. METHODS: We developed the framework based on an expert voting flow to choose electronic assessment sheets. The CDSS was constructed based on a nursing process workflow model. A multilayer architecture with independent modules was used. The performance of the proposed system was evaluated by comparing the adverse events' incidence and the average time for regular daily assessment before and after the implementation. RESULTS: After implementation of the system, the adverse nursing events' incidence decreased significantly from 0.43 % to 0.37 % in the first year and further to 0.27 % in the second year (p-value: 0.04). Meanwhile, the median time for regular daily assessments further decreased from 63 s to 51 s. CONCLUSIONS: The automatic assessment system helps to reduce nurses' workload and the incidence of adverse nursing events.

Protocolo operacional padrão para o cuidado ao portador de hanseníase pela equipe de enfermagem / Standard operational protocol for the care of leprosy patients by the nursing team

A hanseníase, causada pelo Mycobacterium leprae, um parasita intracelular com tropismo por células cutâneas e do sistema nervoso periférico, é tratável com Poliquimioterapia (PQT) por 6 ou 12 meses, dependendo da classificação clínica em paucibacilares (PB) ou multibacilares (MB). Os casos PB, com baixa carga de bacilos, são menos transmissíveis, enquanto os MB são a principal fonte de transmissão. A excreção do bacilo ocorre principalmente pelas vias aéreas superiores, ou seja, no sistema respiratório. A hanseníase é uma doença com potencial incapacitante, podendo causar deficiências (deformidades) e incapacidades físicas antes do diagnóstico, durante e após o tratamento com a Poliquimioterapia. Nesse contexto, a hanseníase demanda a aplicação de cuidados especializados, se torna evidente a necessidade da adoção dos Protocolos Operacionais Padrão (POP) direcionados a orientações de cuidados, tornando a assistência mais segura e a participação efetiva do paciente em seu tratamento. O objetivo é construir um POP que descreva o processo de aplicação das orientações educativas sobre os cuidados de hanseníase, permitindo assim sua operacionalização efetiva e implantação no serviço. O POP foi desenvolvido em três etapas: levantamento do problema, participação nas reuniões da Comissão de Sistematização da Assistência de Enfermagem (COMSAE) e construção do POP para implantação do material informativo sobre cuidados aos pacientes com hanseníase. Resultou na contribuição para a elaboração do folder da COMSAE e na construção do POP para orientar sua aplicação. Considerou-se que o POP é crucial para padronizar a assistência de enfermagem aos pacientes com hanseníase, fornecendo informações claras sobre a doença, tratamento, controle de comunicantes, cuidados com olhos, nariz, pele, mãos e pés, orientação sobre curativos e estados reacionais.

Leprosy, caused by Mycobacterium leprae, an intracellular parasite with tropism for cells of the skin and the peripheral nervous system, is treatable with Polychemotherapy (MDT) for 6 or 12 months, depending on the clinical classification as paucibacillary (PB) or multibacillary (MB). PB cases, with a low bacilli load, are less transmissible, while MB cases are the main source of transmission. The excretion of the bacillus occurs mainly through the upper airways, that is, in the respiratory system. Leprosy is a disease with disabling potential, which can cause deficiencies (deformities) and physical disabilities before diagnosis, during and after treatment with Polychemotherapy. In this context, leprosy demands the application of specialized care, the need to adopt Standard Operational Protocols (SOP) aimed at care guidelines becomes evident, making assistance safer and the patient's effective participation in their treatment. The objective is to build a SOP that describes the process of applying educational guidelines on leprosy care, thus allowing its effective operation and implementation in the service. The POP was developed in three stages: survey of the problem, participation in meetings of the Nursing Care Systematization Committee (COMSAE) and construction of the SOP to implement informative material on care for patients with leprosy. It resulted in the contribution to the preparation of the COMSAE folder and the construction of the SOP to guide its application. It was considered that the SOP is crucial to standardize nursing care for patients with leprosy, providing clear information about the disease, treatment, control of communicants, care of eyes, nose, skin, hands and feet, guidance on dressings and reaction states

Protocolos gerenciados por enfermeiros para identificação precoce da sepse: revisão de escopo / Nurse-managed protocols for early identification of sepsis: a scoping review / Protocolos administrados por enfermeros para la identificación temprana de la sepsis: revisión del alcance

Objetivo: mapear os protocolos assistenciais utilizados por enfermeiros para identificação precoce da sepse no ambiente hospitalar. Método: trata-se de uma revisão de escopo ancorada nas recomendações do Joanna Briggs Institute, desenvolvida em sete bases de dados. A busca e seleção ocorreu em 17 de julho de 2021, utilizando os descritores: sepse, protocolos de enfermagem, avaliação de enfermagem e cuidados de enfermagem. Resultados: a amostra foi composta de seis estudos, destacaram-se os protocolos implementados por projetos de melhoria de qualidade e utilização sistemas eletrônicos de alerta para deterioração clínica. Conclusão: protocolos assistenciais impulsionam a aderência dos profissionais às recomendações oficiais para o manejo da sepse no ambiente hospitalar e o desenvolvimento de cuidados de enfermagem baseados em evidências, contribuindo para melhorar os indicadores de qualidade e reduzir a mortalidade entre pacientes com sepse(AU)

Objective: to map the care protocols used by nurses for the early identification of sepsis in the hospital environment. Method: this is a scope review anchored in the recommendations of the Joanna Briggs Institute, developed in seven databases. The search and selection took place on July 17, 2021, using the descriptors: sepsis, nursing protocols, nursing assessment and nursing care. Results: the sample consisted of six studies, highlighting the protocols implemented by quality improvement projects and the use of electronic warning systems for clinical deterioration. Conclusion: care protocols boost professionals' adherence to official recommendations for the management of sepsis in the hospital environment and the development of evidence-based nursing care, contributing to improve quality indicators and reduce mortality among patients with sepsis(AU)

Objetivo: mapear los protocolos de atención utilizados por las enfermeras para identificar de forma temprana la sepsis en el ambiente hospitalario. Método: se trata de una revisión de alcance anclada en las recomendaciones del Instituto Joanna Briggs, desarrollada en siete bases de datos. La búsqueda y selección se realizó el 17 de julio de 2021, utilizando los descriptores: sepsis, protocolos de enfermería, evaluación de enfermería y cuidados de enfermería. Resultados: la muestra estuvo compuesta por seis estudios, se destacaron los protocolos implementados por los proyectos de mejora de la calidad y utilización de sistemas electrónicos de alerta con respecto al deterioro clínico. Conclusión: los protocolos asistenciales impulsan la adherencia de los profesionales a las recomendaciones oficiales para el manejo de la sepsis en el ámbito hospitalario y el desarrollo de cuidados de enfermería basados en evidencias, contribuyendo a mejorar los indicadores de calidad y reducir la mortalidad entre los pacientes con sepsis(AU)

Explorando la validez de constructo del índice de Barthel en una muestra de pacientes hospitalizados españoles / Exploring the construct validity of the Barthel index in a sample of Spanish hospitalised patients

Objetivo: Examinar la validez de constructo del índice de Barthel en unidades de hospitalización de adultos. Métodos: Se realizó un análisis secundario en una muestra de 1.342 pacientes adultos ingresados en unidades de hospitalización. El análisis factorial confirmatorio del índice de Barthel no confirma su estructura unidimensional (CFA-1). Se exploraron dos métodos para encontrar una solución con un mejor ajuste. Se realizó la secuencia de los métodos clásicos de análisis factorial exploratorio y confirmatorio (CFA-2). Se realizó un modelo gráfico gaussiano y un análisis factorial confirmatorio (CFA-3). Se compararon tres modelos sobre una base de varios indicadores de bondad de ajuste. Resultados: Los resultados del CFA-1 (χ2 = 161.616; p < 0,001; RMSEA = 0,183) indicaron un mal ajuste entre el modelo y los datos obtenidos. El análisis factorial exploratorio proporcionó un modelo con dos dimensiones que explicaba 86% de la varianza y mejoró el indicador de bondad de ajuste en CFA-2 (χ2 = 846; p < 0,001; RMSEA = 0,133). El modelo gráfico gaussiano ofreció una solución con tres dimensiones que mejoró la bondad de ajuste con respecto a los modelos anteriores al eliminar el ítem continencia vesical (χ2 = 493; p < 0,001; RMSEA = 0,09). Conclusiones: El índice de Barthel no es una medida unidimensional de la capacidad funcional cuando se aplica en unidades de hospitalización de adultos. El modelo que mejor se ajusta tiene una estructura tridimensional (higiene, alimentación y eliminación, movilidad) que se relaciona con los dominios de los cuidados básicos.(AU)

Objective: Examine the construct validity of the Barthel Index in adult inpatient units. Methods: A secondary analysis was performed on a sample of 1342 adult patients admitted to inpatient units. A confirmatory factor analysis of the Barthel Index did not confirm its unidimensional structure (CFA-1). Therefore, two methods were explored to find a solution with a better fit. The sequence of the classical exploratory and confirmatory factor analysis methods was carried out (CFA-2). In contrast, a Gaussian graphical model and confirmatory factor analysis (CFA-3) were performed. Three models were compared on the basis of several goodness-of-fit indicators. Results: CFA-1 results (χ2 = 161616; P < .001; RMSEA = .183) indicated a poor fit between the model and the data. Exploratory factor analysis provided a model with two dimensions that explained 86% of the variance and improved the goodness-of-fit in CFA-2 (χ2 = 846; P < .001; RMSEA = .133). The Gaussian graphical model, by removing the item ‘Bladder’, offered a solution with three dimensions that improved the goodness-of-fit compared to the previous models (χ2 = 492; P < .001; RMSEA = .09). Conclusions: The Barthel Index is not a unidimensional measure of functional capacity when applied to adult inpatient units. The best-fitting model has a three-dimensional structure (Hygiene; Feeding and disposal; Mobility) that relates to the domains of care needs.