How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study.

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

How experienced wound care nurses conceptualize what to do in pressure injury management.

BACKGROUND: Conceptual understanding of the perceptions that wound care nurses use to determine how to manage pressure injuries may provide information for improving their pressure injury care competency. The aim of this study is to explore and describe the way wound care nurses experience and perceive pressure injury management. METHODS: A qualitative, phenomenographic approach, a method designed to explore the different ways in which people comprehend a phenomenon and develop a practical knowledge-based framework, was used in this study. Semi-structured interviews were used for data collection with twenty wound care nurses. All participants were female with a mean age of 38.0, mean total clinical experience of 15.2 years and mean clinical experience as wound care nurse of 7.7 years. The eight steps of qualitative data analysis for a phenomenographic study were employed to develop an understanding of participants' experience of pressure injury management. RESULTS: The analysis resulted in an assessment domain and an intervention domain, each containing three descriptive categories based on five identified conceptions. The categories were as follows: "comparison", "consideration", and "monitoring" in assessment, and "creation", "conversation" and "judgement" in intervention. CONCLUSIONS: This study has created a framework for understanding pressure injury management based on practical knowledge. This framework of the nurses' pressure injury care reflected the need for an awareness of a harmonious approach to patients and wounds. There is a pattern of transcending a reliance on only theoretical knowledge, and this key factor in the framework should be considered when developing education programs and tools for improving nurse pressure injury care competency and patient safety.

For the interprofessional management of the discomfort of long-term care facility residents with dementia.

Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.

How do wound care nurses structure the subjective frame on palliative wound care? A Q-methodology approach.

BACKGROUND: Palliative wound care is important for stability in terminal care. It addresses both the physical and psychological needs of patients and facilitates other aspects of terminal care. Appropriate competencies of nurses regarding palliative wound care can improve patient outcomes and raise their quality of life. The purpose of this study was to identify how wound care nurses structure the subjective frames regarding palliative wound care. METHOD: This study utilized Q-methodology to analyze their subjective viewpoints. Forty nurses experienced in palliative wound care were asked to completely classify 35 Q-statements into a normal distribution shape. The PQ-Method program was used to conduct principal factor analysis and varimax rotation for data analysis. RESULTS: This study revealed 4 Q-factors of palliative wound care: "Focusing on care within the boundary of current patient demands," "Comparing continuously the priorities on wound healing and disease care," "Preparing and preventing from worsening via tracking care in advance," and "Moving forward with a clear direction by confronting the declining condition." CONCLUSION: We hope that the results of this study are used in the development of nursing education that reflects professional perspectives of palliative wound care, thus helping to improve nursing competencies in palliative care.

Highly Hydrophilic Polyurethane Foam Dressing Versus Early Hydrophilic Polyurethane Foam Dressing on Skin Graft Donor Site Healing in Patients with Diabetes: An Exploratory Clinical Trial.

OBJECTIVE: To compare the effects of early hydrophilic polyurethane (EHP) foam dressing and highly hydrophilic polyurethane (HHP) foam dressing on wound healing in patients with diabetes. METHODS: Twenty patients with diabetes with skin graft donor sites on the lateral thigh were enrolled in this study. Each donor site was divided into two equal-sized areas for the application of HHP or EHP foam dressing. The study endpoint was the time required for healing, defined as complete epithelialization of the donor site without discharge. All possible adverse events were also documented. MAIN RESULTS: Donor site healing was faster in 15 patients on the HHP half and 1 patient on the EHP half. In four patients, healing rates were the same between the HHP and EHP areas. Donor sites treated with HHP and EHP foam dressings healed in 17.2 ± 4.4 and 19.6 ± 3.7 days (P = .007), respectively. During the study period, no adverse event associated with the dressings occurred in either group. CONCLUSIONS: The HHP foam dressing might provide faster healing than EHP foam dressing for skin graft donor sites in patients with diabetes.

Measuring the Resilience of Patients on Hemodialysis: Development of a Patient on Hemodialysis Resilience Scale.

The aim of this study was to develop a patient on hemodialysis resilience scale and to verify validity and reliability. This patient on hemodialysis resilience scale (PHRS) was developed according to the scale development process by DeVellis (2017). Thirty-one publications on the subject were reviewed, and in-depth interviews with seven patients on hemodialysis were conducted. Items comprising the scale were reviewed and modified through evaluation by a panel of experts and face validity. For verification of validity, a content validity index for the items, exploratory factor analysis, and confirmatory factor analysis were performed. In the exploratory factor analysis, the PHRS was categorized into three factors: 'pursuing a positive meaning in life,' 'accepting hemodialysis as a part of daily life,' and 'building a willingness to live through meaningful relationships.'

The Impact of Extracorporeal Shock Wave Therapy on Microcirculation in Diabetic Feet: A Pilot Study.

BACKGROUND: Patients with diabetic foot commonly experience vascular insufficiency and compromised tissue perfusion. Extracorporeal shockwave therapy (ESWT) reportedly promotes wound healing and angiogenesis, but clinical studies on the effect of ESWT on angiogenesis are scarce and the exact mechanism remains unclear. OBJECTIVE: To investigate the effect of ESWT on cutaneous microcirculation in diabetic feet. METHODS: Ten patients with diabetic feet received ESWT twice weekly for a total of six sessions. Transcutaneous partial oxygen pressure (TcPO2) and cutaneous blood flow were measured before and after ESWT. MAIN RESULTS: The treated feet showed statistically significant improvements in the mean TcPO2 (P < .01) and cutaneous blood flow level (P < .05) compared with control feet. In treated feet, TcPO2 increased by 19.6%, from 41.4 ± 9.9 to 49.5 ± 8.7 mm Hg (P < .05). In control feet, TcPO2 decreased by 11.6%, from 39.5 ± 14.0 to 34.9 ± 14.5 mm Hg (P = .059). The average cutaneous blood flow level of treated feet before ESWT was 36.9 ± 25.6, which increased to 48.3 ± 32.4 AU after ESWT (30.9% increase; P = .646). In control feet, the cutaneous blood flow level decreased from 80.5 ± 36.7 to 60.4 ± 38.8 AU, a decrease of 25.0% (P = .241). CONCLUSIONS: These results demonstrate that ESWT may have beneficial effects on microcirculation in diabetic feet.

Diabetic Foot Ulcer Patients' Uncertainty Regarding Their Prognosis: A Q-Methodological Study.

PURPOSE: The purpose of this qualitative study was to identify the subjective patient perspectives toward the uncertainty regarding diabetic foot ulcer (DFU) prognosis. DESIGN: Q-methodology, which is a qualitative method for analyzing subjective viewpoints, was used. SUBJECTS AND SETTING: Forty patients with DFUs who were admitted to the diabetic wound center of a university hospital in Seoul, South Korea. METHODS: Data were collected on the subjective viewpoint of patients regarding their DFU prognosis uncertainty and analyzed by the software program PQMethod 2.35 using a principal component analysis and varimax rotation. RESULTS: This study revealed 4 factors characterizing patient subjective experience related to DFU prognosis: confusion from a lack of knowledge, concerns about a negative future, overdependence on information, and expectations for a positive outlook about favorable results. CONCLUSION: The findings of this study suggest various intervention methods for patients with DFU facing uncertainty about their prognosis based on the 4 viewpoints identified. The identification of the factor causing uncertainty and integration of all uncertainty factors are expected to be used as the basis for reducing patients' uncertainty and helping nurses care for patients more effectively.

Translation and validation of the Korean version of the Diabetic Foot Ulcer Scale-Short Form.

The purpose of this study was to translate the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) into Korean and evaluate its psychometric performance in patients with diabetic foot ulcers (DFUs). The DFS-SF was translated into Korean using translation guidelines from the World Health Organization. The Korean version of DFS-SF (DFS-SF-K) went through the full linguistic validation process and was evaluated in 320 Korean patients with DFU. For this study, Cronbach's alpha was used to evaluate the reliability of the DFS-SF-K. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and known-group validity were conducted to examine construct validity. Correlation of the DFS-SF-K with SF-36 was used to test concurrent validity of the DFS-SF-K. Cronbach's alpha was >0.70 for all scales. Factor loadings of the 29 items on the six subscales ranged from 0.82 to 0.95. The six-subscale model was validated by CFA (x2 /df = 4.55, P < 0.001, RMR = 0.06, GFI = 0.73, NFI = 0.90, TLI = 0.91, CFI = 0.92, RMSEA = 0.10). Spearman's correlations and known-groups comparisons supported construct validity. The newly translated DFS-SF-K may be used to assess the impact of QoL with DFUs in Korean patients.

Comparison of perfusion values after percutaneous transluminal angioplasty according to the severity of ischaemia in the diabetic foot.

Percutaneous transluminal angioplasty (PTA) is now more frequently used to improve tissue perfusion in ischemic diabetic feet. However, there are concerns about its feasibility and effectiveness in severely ischaemic feet. This study aimed to compare the perfusion values after PTA according to the ischaemic degree of diabetic feet. This study included 133 ischaemic diabetic feet. The foot transcutaneous oxygen pressure (TcPO2 ) and toe pressure were measured before the procedure and every second postoperative week for 6 weeks. The patients were divided into three groups according to ischaemic severity on the basis of TcPO2 and toe pressures. In the "severely ischaemic" group, the TcPO2 increased from 7.5 ± 4.9 to 40.3 ± 11.3 mm Hg (5.4-fold) 6 weeks after the PTA (P < 0.001). The toe pressure increased from 8.5 ± 8.8 to 42.2 ± 19.3 mm Hg (5.0-fold, P < 0.001). In the "mild" group, the TcPO2 increased from 35.4 ± 2.5 to 41.8 ± 12.4 mm Hg (1.2-fold, P = 0.003), and the toe pressure increased from 45.7 ± 12.3 to 54.3 ± 31.3 mm Hg (1.2-fold, P > 0.05). Results of the "intermediate" group were in between. The most severely ischaemic group had the most dramatic increase of tissue perfusion after PTA. As such, PTA can be an effective method for increasing tissue perfusion even in the severely ischaemic diabetic feet.

How Do Patients on Hemodialysis Perceive and Overcome Hemodialysis?: Concept Development of the Resilience of Patients on Hemodialysis.

This study was conducted to clarify and conceptualize the phenomenon of the resilience of patients on hemodialysis. Three phases of a hybrid model were applied. In the theoretical phase, a working definition of the resilience of patients on hemodialysis was developed via literature review. In the fieldwork phase, in-depth interviews were conducted with 10 patients. Qualitative data from the interviews were analyzed to find attributes of resilience for patients on hemodialysis. The final analytical phase interpreted and compared findings of the theoretical and fieldwork phases. The concept of the resilience of patients on hemodialysis was as a complex phenomenon possessing several dimensions and attributes, delineating how patients on hemodialysis perceive and overcome hemodialysis. This conceptualization could lead to demonstrating a theoretical construct of resilience of patients on hemodialysis.

Exploring Subjective Frames of Patients on Hemodialysis on Acquiring Resilience: A Q Methodology Study.

This study explored subjectivity frames of reference of resilience of patients on hemodialysis by using Q methodology. Participants included 35 patients on hemodialysis. Data were obtained from October to December 2016 and were analyzed by the PQ method. Five factors were identified: 1) finding the value of life by focusing on the meaning of a new life through hemodialysis, 2) compromising actively with the situation of hemodialysis, 3) internalizing sadness and emphasizing the meaning of life itself, 4) finding a support system to help overcome hemodialysis, and 5) building the will to live by getting strength from family. The common theme of the five factors was overcoming hemodialysis and moving forward with their lives. This study can help nurses understand the resilience of patients on hemodialysis and presents strategies that can be used to develop an intervention program to improve the resilience of patients on hemodialysis.

Tissue Oxygenation and Negative-Pressure Wound Therapy When Applied to the Feet of Persons With Diabetes Mellitus: An Observational Study.

PURPOSE: Our group has reported that negative-pressure wound therapy (NPWT) decreases tissue oxygenation by 84% in the foot of diabetic patients because the pad of the connecting drainage tube and foam sponge of the NPWT system compress the wound bed. The purpose of this study was to determine whether an NPWT modified dressing application reduces tissue oxygenation in the feet of persons with diabetes mellitus. DESIGN: A prospective, clinical, observational study. SUBJECTS AND SETTING: We enrolled 30 patients with diabetic mellitus; their mean age was 63.9 ± 11.2 years (mean ± standard deviation). All were cared for at the diabetic wound center at an academic tertiary medical center in South Korea between 2014 and January 2015. METHODS: Transcutaneous partial oxygen pressures (TcpO2) were measured to determine tissue oxygenation levels beneath modified NPWT dressings. A TcpO2 sensor was fixed at the tarsometatarsal area of the contralateral unwounded foot. A negative pressure of -125 mm Hg was applied until TcpO2 reached a plateau state; values were measured before, during, and after the modified NPWT. The Wilcoxon' and Mann-Whitney U tests were used to compare differences between these measurements. RESULTS: TcpO2 levels decreased by 26% during the modified NPWT. Mean TcpO2 values before, during, and after turning off the therapy were 54.3 ± 15.3 mm Hg, 41.6 ± 16.3 mm Hg, and 53.3 ± 15.6 mm Hg (P < .05), respectively. CONCLUSION: Applying NPWT without the pad of the connecting drainage tube significantly reduces the amount of tissue oxygenation loss beneath foam dressings on the skin of the foot dorsum in diabetic patients.

Influence of Negative-Pressure Wound Therapy on Tissue Oxygenation in Diabetic Feet.

OBJECTIVE: Negative-pressure wound therapy (NPWT) has become a common wound care treatment modality for a variety of wounds. Several previous studies have reported that NPWT increases blood flow in the wound bed. However, NPWT might decrease tissue oxygenation in the wound bed because the foam sponge of NPWT compresses the wound bed under the influence of the applied negative pressure. Adequate tissue oxygenation is an essential consideration during diabetic foot management, and the foot is more sensitive to ischemia than any other region. Furthermore, the issue as to whether NPWT reduces or increases tissue oxygenation in diabetic feet has never been correctly addressed. The aim of this study was to evaluate the influence of NPWT on tissue oxygenation in diabetic feet. PARTICIPANTS: Transcutaneous partial oxygen pressures (TcPO2) were measured to determine tissue oxygenation levels beneath NPWT dressings on 21 feet of 21 diabetic foot ulcer patients. DESIGN: A TcPO2 sensor was fixed at the tarsometatarsal area of contralateral unwounded feet. A suction pressure of -125 mm Hg was applied until TcPO2 reached a steady state. The TcPO2 values for diabetic feet were measured before, during, and after NPWT. MAIN RESULTS: The TcPO2 levels decreased significantly after applying NPWT in all patients. Mean TcPO2 values before, during, and after therapy were 44.6 (SD, 15.2), 6.0 (SD, 7.1), and 40.3 (SD, 16.4) mm Hg (P < .01), respectively. CONCLUSION: These results show that NPWT significantly reduces tissue oxygenation levels in diabetic feet.

Can macrocirculation changes predict nonhealing diabetic foot ulcers?

PURPOSE: Transcutaneous partial oxygen tension (TcpO2) is considered the gold standard for assessment of tissue oxygenation, which is an essential factor for wound healing. The purpose of this study was to evaluate the association between macrocirculation and TcpO2 in persons with diabetes mellitus. SUBJECTS AND SETTING: Ninety-eight patients with diabetic foot ulcers participated in the study (61 men and 37 women). The subjects had a mean age of 66.6 years (range, 30-83 years) and were treated at the Diabetic Wound Center of Korea University Guro Hospital, Seoul, Republic of Korea. METHODS: Macrocirculation was evaluated using 2 techniques: computed tomographic angiography and Doppler ultrasound. Macrocirculation scores were based on the patency of the two tibial arteries in 98 patients. Computed tomographic angiography and Doppler ultrasound scores (0-4 points) were given according to intraluminal filling defects and arterial pulse waveform of each vessel, respectively. Tissue oxygenation was measured by TcpO2. Macrocirculation scores were statistically analyzed as a function of the TcpO2. RESULTS: Statistical analysis revealed no significant linear trend between the macrocirculation status and TcpO2. Biavariate analysis using the Fisher exact test, Mantel-Haenszel tests, and McNemar-Bowker tests also found no significant relationship between macrocirculation and TcpO2. CONCLUSIONS: Computed tomographic angiography and Doppler ultrasound are not sufficiently reliable substitutes for TcpO2 measurements in regard to determining the optimal treatment for diabetic patients.

Nurses' Shared Subjectivity on Person-Centered Care for Behavioral and Psychological Symptoms of Dementia in Nursing Homes.

BACKGROUND: Person-centered care (PCC), an approach to healthcare that focuses on the individual needs, preferences, and values of patients, is particularly important in the context of caring for residents of nursing homes (NHs) with the behavioral and psychological symptoms of dementia (BPSD). However, implementing PCC in NHs varies widely due to individual staff, NH environment, and country factors, leading to heterogeneity in person-centered approaches. PURPOSE: This study was designed to explore and gain insight into the shared subjective perspectives of nurses on providing PCC to manage BPSD in NHs in order to elicit a deeper understanding of how nurses interpret and approach the provision of PCC. METHODS: Q methodology was applied to explore the subjective perspectives of nurses. Twenty-nine NH nurses with more than 3 years of experience in managing BPSD completed a Q-sorting task, categorizing 43 Q-samples into a normal distribution shape. Postsorting interviews were conducted after the participants had completed this task. The collected data were analyzed using centroid factor analysis and varimax rotation run within the PQMethod 2.35 program. Interpretation of the resulting factors was based on factor arrays, field notes, and interview data. RESULTS: Four factors from the shared subjective perspectives of nurses related to PCC were identified, including (a) sharing information focused on details to update care strategies, (b) monitoring until the true needs of residents are identified, (c) awareness of interactive cues in relationships, and (d) connecting an individual's life pattern to their current care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings highlight that a one-size-fits-all approach may not be suitable for all nurses and interventions, indicating that nurses should consider the applicable subjective frames to ensure the effectiveness of planned interventions. A need for PCC education that specifically addresses BPSD management is suggested, with the findings implying that a strong organizational climate with respect to PCC in managing BPSD should promote higher job satisfaction and commitment and reduce turnover rates among nurses in NHs. Facilitating the development of PCC interventions appropriate for BPSD management that encompass the various categories and ranges of NH settings and nursing phenomena is thus recommended.

Comparative study between a gravity-based and peristaltic pump for intravenous infusion with respect to the generation of proteinaceous microparticles.

Subvisible particles generated during the preparation or administration of biopharmaceuticals might increase the risk of immunogenicity, inflammation, or organ dysfunction. To investigate the impact of an infusion system on the level of subvisible particles, we compared two types of infusion sets based on peristaltic movement (Medifusion DI-2000 pump) and a gravity-based infusion system (Accu-Drip) using intravenous immunoglobulin (IVIG) as a model drug. The peristaltic pump was found to be more susceptible to particle generation compared to the gravity infusion set owing to the stress generated due to constant peristaltic motion. Moreover, the 5-µm in-line filter integrated into the tubing of the gravity-based infusion set further contributed to the reduction of particles mostly in the range ≥ 10 µm. Furthermore, the filter was also able to maintain the particle level even after the pre-exposure of samples to silicone oil-lubricated syringes, drop shock, or agitation. Overall, this study suggests the need for the selection of an appropriate infusion set equipped with an in-line filter based on the sensitivity of the product.

Coexisting with the Life of Patients with Hemodialysis: Qualitative Meta-Synthesis Study of Life of Caregivers of Patients with Hemodialysis.

As the number of patients with hemodialysis (HD) continues to increase, so too does the number of people depending on caregivers. There is need to pay attention to the lives of caregivers of patients with HD, where sacrifices are forced. This study systematically reviewed and synthesized qualitative studies that explored the experiences of caregivers caring for patients with HD using the meta-synthesis method. We searched literature using four databases (i.e., PubMed, Excerpta Medica dataBASE, Cumulated Index to Nursing and Allied Health Literature, and Web of Science), and finally ten publications were selected. Four themes and nine subtopics were derived from analyzing and synthesizing the research results. The synthesized themes were: "bearing the burden of life as a caregiver," "reconstructing life to maintain hemodialysis", "the fading of caregiver's own life," and "effort to relieve the burden." The results of this study can contribute to the development of interventional studies to improve the quality of life of HD patients. These studies provide an integrated and in-depth perspective on the experiences of caregivers who care for HD patients.

Bridging the Knowledge Gap for Pressure Injury Management in Nursing Homes.

BACKGROUND: Pressure injuries in nursing homes remain a consistent problem. Unfortunately, despite the variety of pressure injury education offered in nursing homes, the knowledge learned cannot be applied in practice, and as a result, the prevalence and incidence of such injuries are consistently high. This study aimed to address those gaps by analyzing the nursing competency for pressure injury management and implementing pressure injury education programs in nursing homes. METHODS: Two phases were conducted based on the action cycle in the knowledge to action model. During the first phase, a framework was constructed by analyzing nursing experience. The second phase consisted of the implementation and monitoring of the program to evaluate the effects of the framework. RESULTS: The main results for nursing competencies for pressure injury management in nursing homes are integrated thinking, understanding in an environmental context, interpersonal relationships for efficient decision making, and meeting any challenges to professional development. The results concerning the program's effects showed significant differences in the participants' knowledge, attitude, stage discrimination ability, and clinical management judgment ability. CONCLUSION: The educational framework and program derived from this study are expected to improve nurses' pressure injury management competency in nursing homes and to contribute to effective pressure injury management and quality of life for residents in nursing homes.

How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?

Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.