Factors That Influence NICU Health Care Professionals' Decision Making to Implement Family-Centered Care.

BACKGROUND: Neonatal intensive care unit (NICU) is a multifaceted, technology-driven high stress environment for professionals, infants and families. PURPOSE: Examine healthcare professionals' beliefs and perceptions regarding providing FCC within the context of NICU. METHODS: This exploratory descriptive study used an online-survey format. The survey comprised several instruments including the Perceived Stress Scale, symptoms of burnout subscale from the Professional Quality of Life scale, and the Family Nurse Caring Belief Scale (FNCBS). Demographic and open-ended items were also included. RESULTS: Sample consisted of 115 multidisciplinary participants working in a level IV neonatal intensive care unit. Participants report strong levels of FCC beliefs. Participants strongly agreed (82%) or agreed (18%) that no matter how sick the infant is, he or she needs to be treated as an individual. A significant correlation (r=-0.343, P < .001) exists between participant's stress composite score and FNCBS composite score. There were significant relationships between participant's years of experience (F = 5.35, P < .002) and education levels (F = 2.60, P < .05) and higher FNCBS composite scores. There were also significant relationships between participant's years of experience (F = 4.77, P < .004) and education (F = 2.89, P < .039) with higher Perceived Stress Scale composite scores. IMPLICATIONS FOR PRACTICE: Results suggest that while participants agreed that FCC is important, they also believed that inadequate staffing and inappropriate assignments may lead to rationing of care. IMPLICATIONS FOR RESEARCH: Further research is needed to explore factors that lead to rationing of FCC.

Pruritus in patients with solid tumors: an overlooked supportive care need.

PURPOSE: Pruritus is a common symptom in cutaneous malignancies, but its impact on patients with solid tumors is unclear. We explored the impact and management of pruritus in patients with solid tumors, using patient-reported outcomes (PRO) data from a real-world registry. METHODS: From 2006 to 2011, patients seen in the Duke Cancer Institute reported their symptoms via the Patient Care Monitor v2.0, a validated PRO tool that includes a 0-10-point question about pruritus severity. From > 25,000 encounters, 203 patients reported severe pruritus (> 6/10) on at least one visit and 506 total visits were abstracted where patients reported either moderate or severe pruritus (> 3/10). From this cohort, we abstracted demographics, diagnosis, stage, cancer therapy, anti-pruritic therapy, and clinicians' responses. RESULTS: Mean age was 59.8 (SD 13.3), 134 (66%) were female, 125 (62%) were Caucasian, and 65 (32%) were African American. Breast cancer was the most common tumor (36.5%), followed by lung cancer (23.2%). Mean pruritus severity score was 6.8 (SD 1.8) for patients on chemotherapy, 6.9 (SD 1.8) for patients on targeted therapy alone or in combination, and 7.1(SD 1.8) for patients off treatment. Overall, 67% of patients reported at least two episodes of moderate-severe pruritus (mean # of visits 4.2 (SD 2.7)). Despite frequent report of severe and persistent pruritus, this was mentioned in just 28% of clinician notes and an intervention was recommended/prescribed in only 7% of visits. CONCLUSIONS: Pruritus is an under-addressed symptom in patients with solid tumors. Additional research is needed to understand the burden of pruritus in affected populations.

An MRI investigation of the effects of user anatomy and wheelchair cushion type on tissue deformation.

AIM OF THE STUDY: Tissue deformation is recognized as an important risk factor for pressure injuries. This study investigated the effects of anatomy and wheelchair cushion type on tissue deformation. MATERIALS AND METHODS: Direct 3-dimensional tissue deformation response was measured for six participants sitting on six different wheelchair cushions using MR imaging. Two participants had a traumatic spinal cord injury (SCI) within one year of the assessment, two sustained traumatic SCI at least 13 years prior, and two were without SCI. Tissue deformation was quantified using the difference in volume of tissue beneath the ischial tuberosity (IT) between unloaded and loaded (sitting) conditions. RESULTS: The participants with SCI tended to have less muscle tissue volume beneath their ITs while sitting compared to participants without SCI. Reductions in muscle and fat volumes in the loaded conditions varied depending on both cushion and participant. Higher interface pressures tended to be associated with lower unloaded tissue thicknesses. CONCLUSION: The study showed no single cushion type tested produced the lowest amount of tissue deformation across all participants. Individual anatomy and cushion type affect deformation response of tissue and related pressure injury risk.

Feasibility of freehand ultrasound to measure anatomical features associated with deep tissue injury risk.

Deep tissue injuries (DTI) are severe forms of pressure ulcers that start internally and are difficult to diagnose. Magnetic resonance imaging (MRI) is the currently preferred imaging modality to measure anatomical features associated with DTI, but is not a clinically feasible risk assessment tool. B-mode ultrasound (US) is proposed as a practical, alternative technology suitable for bedside or outpatient clinic use. The goal of this research was to confirm US as an imaging modality for acquiring measurements of anatomical features associated with DTI. Tissue thickness measurements using US were reliable (ICC=.948) and highly correlated with MRI measurements (muscle r=.988, p ≤ .001; adipose r=.894, p ≤ .001; total r=.919; p ≤ .001). US measures of muscle tissue thickness were 5.4mm (34.1%) higher than MRI, adipose tissue thickness measures were 1.6mm (11.9%) lower, and total tissue thickness measures were 3.8mm (12.8%) higher. Given the reliability and ability to identify high-risk anatomies, as well as the cost effectiveness and availability, US measurements show promise for use in future development of a patient-specific, bedside, biomechanical risk assessment tool to guide clinicians in appropriate interventions to prevent DTI.