Nurses’ Attitudes Towards Ambiguity in Communication with Patients and Families, Emotional Coping Strategies and Attitudes Towards End-Of-Life Care in General Wards

Purpose: We clarified the relationship between attitudes towards ambiguity in nurses’ communication with patients and families, emotional coping strategies and attitudes towards end-of-life care among nurses in general wards. Methods: Requests for participation in a survey were sent to nurses working in general wards with 3 or more years of work experience. The survey was in the form of an online self-administered questionnaire. Results: The responses of the 239 nurses who answered the survey were subject to analysis. Among nurses’ attitudes towards ambiguity, the highest scores were for “control of ambiguity” followed by “enjoyment of ambiguity.” Among emotional coping strategies, the highest scores were for “regulating both patients’ and one’s own emotions.” “Positive attitudes toward caring for dying persons” was most significantly associated with “enjoyment of ambiguity.” “Recognition of caring for the pivot dying persons and his families” was most significantly associated with “regulating both patients’ and one’s own emotions.” Conclusion: The results suggest that nurses working in general wards may need to foster attitudes towards “enjoyment of ambiguity” in communication with patients and families, and also coping abilities “regulating both patients’ and one’s own emotions”, so that they can enhance the attitude toward end-of-life care.

Nurses’ Experience in the Introduction of Palliative Sedation for Patients with Terminal Lung Cancer in Respiratory Medicine Wards

Palliative sedation (PS) is an effective way to alleviate the refractory symptom of terminally ill cancer patients, however it can be ethical. PS is now being implemented in general wards, and there is an urgent need to understand the actual conditions of sedation care for general ward nurses and improve the quality of care. In this study, a semi-structured interview was conducted with nurses working in a respiratory medicine ward of a core cancer treatment hospital. By Krippendorff’s content analysis, 16 categories of nurses’ actions/judgments, 8 categories of positive thoughts, and 5 categories of negative thoughts were extracted. Nurses have always sought the best way to alleviate the pain of patients and their families, and have endeavored to be close to their feelings. However, there was a difference in confidence and positivity regarding multidisciplinary collaboration and sedation discussions. It was suggested that the confident efforts of nurses may support the decision-making of patients and their families and consider methods for pain relief and QOL.

A Prospective Study of the Effects of “Instruction for Near Death” in the End-of-life Period at Acute General Wards

Purposes: We prospectively examined the effects of “instruction for near death” by doctors to improve communication and difficulty in end-of-life care in acute general wards. Methods: A non-randomized controlled trial was conducted to evaluate the communication between pre-treatment group and the group with and without the “instruction for near death” in the end-of-life period by Japanese version of Support Team Assessment Schedule (STAS-J). We also compared the difficulty of end-of-life care before and after the trial. Results: The “communication between professionals” in STAS-J was 0.46±0.53 in pre-treatment group (n=71), 0.18±0.39 in the instruction group (n=34) and 0.66±0.48 in the non-instruction group (n=44) (p<0.001). The “family anxiety”, the “family insight”, “communication between patient and family” and “communication professional to patient and family” in STAS-J were not significantly different between the groups. The questionnaire of difficulty of end-of-life care showed no change in both doctors and nurses. Conclusions: The “communication between professionals” was improved in the group with the “instruction for near death”. The difficulty of end-of-life care was not reduced, and it did not contribute to family anxiety and communications.

Caregiver Burden and self-efficacy: A Hospital- based Comparison between General and Special Ward Patients

India has one of the largest health-care systems in the world, and caregivers play an important role in assisting the patients in seeking services, supporting the patient during treatment and also in recovery, as there is a culturally determined emphasis on kinship

Comparison of antimicrobial resistance of Pseudomonas aeruginosa from intensive care units and general wards in a hospital in 2016 / 中国感染控制杂志

Objective To investigate the distribution and antimicrobial resistance of Pseudomonas aeruginosa (P.aeruginosa) from intensive care units(ICUs) and general wards of a hospital,and provide scientific basis for rational use of antimicrobial agents in clinic.Methods Identification and antimicrobial susceptibility testing of clinically isolated bacteria in this hospital in 2016 were performed by VITEK 2 Compact automatic microbial analysis system,difference in antimicrobial resistance of P.aeruginosa between ICUs and general wards was compared.Results The tested specimens were mainly sputum in both ICUs and general wards,accounting for 78.7％ and 66.5％ respectively.There was no significant difference in the isolation rate of P.aeruginosa between ICUs and general wards (11.7％ vs 11.0％,P＞0.05).P.aeruginosa isolated from ICUs had the highest resistance rate to aztreonam (73.8％),resistance rates to piperacillin/tazobactam,cefoperazone/sulbactam,ceftazidime,imipenem,and meropenem were all up to more than 50％;P.aeruginosa detected in general wards had the highest resistance rate to aztreonam(59.6 ％),followed by piperacillin/tazobactam and imipenem,accounting for 48.0 ％ and 44.3 ％ respectively;resistance rates of P.aeruginosa isolated from ICUs to 12 kinds of antimicrobial agents were all higher thanthose of general wards(P＜0.05).Conclusion Resistance rate of P.aeruginosa from ICUs is higher than that in general wards,which should be paid attention,antimicrobial agents should be selected for clinical treatment of infection according to the results of antimicrobial susceptibility testing result.

Posttraumatic Growth from Bereavement and Other Related Factors among the Family Members of Deceased Cancer Patients at a General Ward

Objective: This study aimed to evaluate posttraumatic growth (PTG) from bereavement and other related factors among family members of deceased cancer patients who had been admitted to a general ward. Methods: A self-administered questionnaire was mailed to 42 bereaved family members who agreed to participate in the present study. The time from the death of their loved ones was between one and four years. Results: Of 42, 37 returned their responses. The average PTGI total score was 2.63, which was consistent with previous studies examined the scores at a general hospital and palliative care units. The PTGI was positively correlated with the emotion focus type coping, the recognition estimating support, and the emotional support. The PTGI of the bereaved whose loved ones underwent medical treatment at home was significantly higher than the score of the bereaved whose loved ones passed away at general ward. Conclusion: It is crucial to evaluate whether or not the bereaved experienced a healthy grieving process, and if they received social support. Moreover, it is important to provide the information regarding where the support is offered to the bereaved. Additionally, clinicians need to improve the support system so that the cancer patients can undergo medical treatment at home.

Participation of the Nurses Who Are Certified Aromatherapist in Palliative Care Team and Their Offering Aromatherapy Massage to Cancer Patients in the General Ward

<p>Purposes: This report describes our activities of performing aromatherapy massage for cancer patients in the general ward. Methods: The number of patients, sex, age, aroma treatment times, outcome, disease type, performance status (PS), treatment phase, symptoms, massage site, and oil type were investigated using the clinical records from March 2014 to March 2016. Results: Aromatherapy massage was performed for 116 patients a total of 301 times. With regard to the final outcome, 50 patients were moved to the palliative care unit (PCU), whereas 49 patients died in the general ward. The main symptoms were general malaise, edema, pain, and anxiety. The popular massage sites were lower limbs, back, and upper limbs. The preferred oils were citrus and relaxation-inducing type. Discussion: By joining the palliative care team, certified aromatherapy nurses were allowed to perform the aromatherapy massage on more patients in the general ward than before. The need for aromatherapy massage was found not only in terminally ill patients but also in chemotherapy patients with good PS. In addition, for patients who were moved to the PCU, aromatherapy massage functioned as bridge between the general ward and PCU because one of the aromatherapy nurses worked in the PCU.</p>

Recognition of General Ward Nurses on Advance Care Planning (ACP) for Cancer Patient in Palliative Care

<p>Backgrounds and Aims: Advance Care Planning (ACP) is necessary for the decision making support of cancer patients. To that end, the truth telling about the diagnosis of cancer, respect for thought, intention, privacy is important. In this study, we investigated the recognition about ACP for cancer patients in general ward nurses to clarify what kind of promotion is necessary to enhance ACP. Methods: Eight hundred nurses who are engaged in nursing cancer patients in the general ward of nationally designated cancer medical collaborating hospital in Hiroshima prefecture were included in this study. Survey was carried out by self-written questionnaire survey by mailing method. Results: Valid responses were 364/800 (46%). The rate of achievement of patients’ advocacy and respect for protection was about 74% and 88%, respectively. That of respect of patients’ privacy was 89%. However, there were variations in recognition when the patient’s condition deteriorated. Only 20% of nurses recognized properly the meaning of ACP. Conclusion: The recognition of ACP in general ward nurses was insufficient. Accordingly, the enlightenment, education, environment maintenance for general ward nurses are urgent themes.</p>

Changes in Nurse Staffing Grades in General Wards and Adult and Neonatal Intensive Care Units / 임상간호연구

PURPOSE: This study aimed to explore the distributions of nurse staffing grades and to report changes in staffing grades in general wards and adult and neonatal intensive care units(ICUs) by hospital type and location. METHODS: Data collected from the Health Insurance Review and Assessment Service were analyzed. Nurse staffing was categorized from grades 1 to 6 or 7 for general wards, 1 to 9 for adult ICUs, and 1 to 4 for neonatal ICUs based on the nurse-to-bed ratio. RESULTS: The staffing grade for the general wards improved during 2008-2016 in 69.8% of the tertiary hospitals, 58.5% of the general hospitals, and 31.7% of the non-general hospitals. The adult ICUs at tertiary hospitals exhibited a greater improvement in staffing grades (48.8%) than did those of general hospitals (44.2%) during 2008-2015. Tertiary hospitals in non-capital regions showed a greater improvement than those in the capital region. The majority of neonatal ICUs (67.1%) had no change in the staffing grade during 2008-2015. CONCLUSION: Improvements in nurse staffing differed by hospital type and location. Government policies to improve nurse staffing in non-tertiary hospitals and those in non-capital regions are required to reduce variations in nurse staffing.

Promoting General Ward Round Actively and Improving Efficiency of Logistics Services / 现代医院

Based on the general ward round and subsequent analysis of various problems during the process, experience-based optimization scheme and measures should be put forward to improve the efficiency of the hospital management, raise the logistic service awareness, appropriately dispose and manage human resources, strengthen skill training and quality education of logistic group and transform the logistic service to a professional, specialized, scientific and socialized one so as to establish a new management system of hospital logistics.

Outcome evaluation of introducing the Japanese version of the Liverpool Care Pathway for patients with cancer in a general ward

This study sought to determine whether the Japanese version of the Liverpool Care Pathway （LCP-J） could improve nurses’ practice in dying-phase and difficulties with palliative care in a general ward. Between July 2014 and June 2015, LCP-J intervention and educational program for nurse were introduced in a general ward. The primary aims of this study were to clarify the changes in self-reported practice and difficulties of nurse before and after the interventions. Self-reported practice and difficulties were measured using Palliative Care Self-Reported Practice Scale （PCPS） and Palliative Care Difficulty Scale （PCDS）, respectively. The secondary aim was to clarify the defference in treatment, care and examination within last 48 hours between LCP-J patients and non-LCP-J patients. We obtained 21 responses in pre-intervention and 22 responses in post-intervention surveys from eligible nurses. Significant improvements were noted on domain of dying-phase care in PCPS and domain of alleviation of symptom in PCDS （3.00±1.16 versus 3.52±0.61 [p=0.042], 3.56±0.78 versus 3.10±0.63 [p=0.015], respectively）. LCP-J was used for 9 dying cancer patients （40%）, and no significant difference in treatment and examination within last 48 hours between LCP-J patients and non-LCP-J patients. LCP-J in general ward may improve nurses’ practice in dying-phase and difficulties with alleviation of symptom. In addition, considering the burden of LCP-J, to develop a useful checklist and educational interventions for dying patients is promising.

Prevalence and characteristics of breakthrough pain in cancer patients: a pilot study

The aim of this study was to clarify the prevalence and characteristics of breakthrough pain in cancer patients. We conducted a cross-sectional survey of consecutive patients older than 20 years of age admitted to a University Hospital with a cancer diagnosis Breakthrough pain was defined as meeting all of the following criteria： Pain 1）with background pain present most of the time, 2）which is well controlled, 3）with short-lived episodes of exacerbation. One hundred and sixty-nine patients were recruited and 118（69.8％）completed the survey. Of these 118 patients, 11％（95％CI：7–18％）had breakthrough pain. Breakthrough pain occurred in 23％（14–35％）of patients with cancer-related pain and 29％（17–45％）of patients with pain from the cancer itself. Patients reported episodes occurring up to three times a day,a time to peak intensity of within 5 minutes, and a duration of untreated episodes of up to 15 minutes are 54％（29–77％）, 54％（29–77％）, 54％（29–77％）, respectively.

The burden of introducing the Japanese language version of the Liverpool Care Pathway（LCP-J）for dying patients in general wards and their families：experience of health care professionals in a university hospital

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

Survey on oral care of terminally ill cancer patients in our hospital

<b>Purpose:</b> Patients with end－stage cancer are prone to various problems in their oral mouth. Survey of nurses’ attitudes regarding oral care in our cancer base hospital was conducted and discussed. <b>Method:</b> 197 nurses working with terminally ill cancer patients in the hospital were involved in the questionnaire survey. <b>Results:</b> 159 nurses completed the questionnaire (81%). 153 nurses responded that oral care was necessary for end－of－life stage (96%) but only 29 nurses responded that adequate oral care was provided (18%). <b>Conclusion:</b> The results showed that the nurses acknowledged of importance of oral care at end－of－life stage but didn’t provide the adequate oral care. The survey found that requesting oral care and relief of symptoms as supportive care are lacking of cooperation with the Dentists. How to share information and work with out－of－hospital dentists will be a challenge in the future.

Neumonía grave del adulto adquirida en la comunidad manejada en sala de cuidados generales en un hospital público / Severe community-acquired pneumonia in adult patients managed in a general ward at a public hospital

Introducción: la neumonía grave del adulto adquirida en la comunidad (NAC grave) se caracteriza por requerir manejo en la unidad de cuidados intensivos (UCI), dado su mayor mortalidad y riesgo de complicaciones, por lo cual se han diseñado distintas escalas de predicción de gravedad. Objetivo: identificar apacientes adultos con NAC grave manejados en la sala de cuidados generales. Pacientes y Métodos: estudio clínico descriptivo retrospectivo, se revisaron las fichas clínicas de 131 pacientes adultos egresados del servicio de medicina del hospital de Quilpué con el diagnóstico de NAC entre el 1 de enero y 31 de diciembre del 2010. Se examinaron los criterios de NAC grave de la Sociedad de Tórax Americana (ATS) y se midió el CURB-65 de 89 pacientes que consignaban esta información. Resultados: en 16 pacientes (18 por ciento) se obtuvo una puntuación del CURB-65 > 3 y en 8 pacientes (9 por ciento) se identificaron > 3 criterios menores de la ATSy en 2 de ellos un criterio mayor. Conclusión: se identificaron pacientes con NAC grave manejados en la sala de cuidados generales de un hospital publico.

Introduction: severe community-acquired pneumonia (severe CAP) is characterized by intensive care unit (ICU) requirement, given its higher mortality and complications rate. Different prediction scales have been designed to assess severity. Objective: identify adult patients with severe CAP managed in the general ward of a public hospital. Patients and Methods: retrospective descriptive study, including all adult patients dischargedfrom hospital with CAP diagnosis, from january 1st to december 31st, 2010, with a total of 131 medical records reviewed. The American Thoracic Society criteria (ATS) of severe CAP and CURB-65 scores from 89 medical records were calculated. Results: 16 patients (18 percent) had CURB-65 score > 3, 8 patients (9 percent) had > 3 minor ATS criteria, and 2 of those patients had a major criterion. Conclusion: a significant number of patients with severe CAP were managed on the general ward of a public hospital.

Implementación de la Lista de verificación de seguridad quirúrgica postoperatoria en la sala general / Post-operative surgical safety checklist implementation in the surgery ward

Introducción: La iniciativa de la OMS ha demostrado que el conocimiento adecuado de los riesgos que pueden llegar a poner en peligro el bienestar y la vida del paciente pueden ser disminuidos a través de la implementación de listas de verificación durante el acto quirúrgico. Objetivos: Identificar las acciones destinadas a brindar mayor seguridad al paciente desde la implementación de listas de verificación en el período postoperatorio. Lugar de Aplicación: Hospital Aeronáutico Central. Diseño: prospectivo, observacional. Población: 200 actos quirúrgicos. Método: Se analizaron las fallas identificadas utilizando Listas de Verificación en 200 actos quirúrgicos entre Abril y Octubre de 2011. Resultados: Se identificaron 20 (57%) partes quirúrgicos incompletos o mal confeccionados, 4 (11%) pacientes con analgesia inadecuada o insuficiente, 4 (11%) con indicación postquirúrgica de oxígeno sin colocar o colocado a flujo inadecuado y 3 (8,6%) pacientes con indicación de faja corporal sin colocar o colocada de forma incorrecta. Conclusiones: La utilización de Listas de Verificación permiten reducir los riesgos y a evitar eventos adversos prevenibles. En este aspecto, es fundamental la educación continua en todas las áreas de trabajo con el fin de lograr una real política de seguridad para el paciente quirúrgico.

Introduction: WHO initiative has shown that adequate knowledge of the risks that may endanger patients’ lives and well-being is essential and they can be diminished by implementing surgical safety checklists during surgery. Objectives: Identify actions aimed at providing better patient safety through the implementation of safety checklists in the postoperative period. Place of implementation: Hospital Aeronáutico Central. Design: prospective, observational. Population: 200 surgeries. Method: Analysis of errors identified using Surgical Safety Checklists in 200 surgeries, between April and October 2011. Results: The following was identified: 20 (57%) incomplete or defective surgery reports, 4 (11%) patients with inadequate or insufficient analgesia, 4 (11%) patients with postoperative indication of oxygen therapy not administered or placed with inadequate flow, and 3 (8.6%) patients with indication to wear abdominal binder were without them or they were wrongly placed. Conclusions: The use of Safety Checklists reduces risks and prevents avoidable adverse events. In this regard, continuing education in all work areas is vital in order to achieve a real safety policy for the surgical patient.

Limitaciones de esfuerzos terapéuticos: Resultados de un registro prospectivo en una sala de clínica médica / Limitation of life-sustaining treatment: A prospective study developed in a clinical ward

El objetivo de este trabajo fue describir el proceso de limitación de los esfuerzos terapéuticos (LET) en los pacientes internados en una sala general. Para ello se realizó un estudio prospectivo descriptivo, desarrollado en la sala de internación general de un hospital universitario. Fueron evaluados pacientes que tuviesen alguna LET, asistidos por el servicio de clínica médica en un período de 60 días consecutivos. Durante el mismo se hospitalizaron 402 pacientes, 62 (15%) tuvieron algún tipo de LET. Este último grupo estaba compuesto por un 66% de mujeres, la mediana de edad fue de 86 años (78-90) y de la duración de hospitalización de 12 días (8-18). La mala calidad de vida fue la causa más frecuente de LET (69%). Se brindó información acerca de las limitaciones a 43 familias (69%) y 8 pacientes (13%). En la decisión participaron el médico de cabecera (50%), médicos de planta (50%), residentes (40%), la familia (42%) y los propios pacientes (11%). En 7 casos hubo constancia en la historia clínica (11%). Diecisiete pacientes (27%) con LET fallecieron durante la internación, mientras que 44 (71%) fueron dados de alta. En conclusión, la limitación de esfuerzos terapéuticos en nuestros pacientes constituyó un hecho frecuente. No se logró identificar un proceso uniforme o sistematizado para la toma de la decisión de LET. Resulta innegable la necesidad de normativas que guíen al equipo de salud en la toma de decisiones, tranquilicen a familiares y acompañen a los pacientes en sus reales necesidades.

The purpose of this study is to describe the limiting life-sustaining treatment process of patients admitted to a general ward. A prospective descriptive study was designed. The setting was the general ward of universitary hospital. Study participants were patients assisted by the internal medicine department during a 60- consecutive days period who had limitations of life sustaining treatments. During the study period, 402 patients were hospitalized, 62 (15%) of them had limitations of life support care. The median patient age of the last group was 86 years (78-90), 66% were women and the length of stay was 12 days (8-18). A low quality of life was the most frequent cause of limitation (69%). Information about the limitations was provided to 43 families (69%) and 8 patients (13%). The primary care physician participated in the decision in 50% of the cases, while the attending physician, the resident in charge, patient's family and patients themselves participated in 50%, 40%, 42% and 11% of the cases respectively. The decision of limiting life-sustaining treatments was recorded in seven patient's charts (11%). Seventeen (27%) patients with limitations died during the hospital stay while 44 (71%) were discharged. In conclusion, we found a frequent life sustaining treatment limitation in our patients. These decisions did not follow a uniform or systemized process. The need of guidelines to sort the medical and ethical challenges imposed to the medical team is undeniable.

Ventilación no invasiva en pacientes con exacerbacion de EPOC / Non invasive positive pressure ventilation in patients with COPD exacerbation

Se realizó un estudio prospectivo sobre la utilización de la ventilación mecánica no invasiva (VNI) en pacientes internados en Clínica Médica Neumonológica por exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC), con el objetivo de evaluar la evolución, los cambios gasométricos, las comorbilidades y la mortalidad de los pacientes internados. Desde enero 2000 a enero 2003 ingresaron al estudio 39 pacientes, evaluados según normas internacionales en 54 internaciones, siendo clasificados como de grado grave y muy grave, dado que la medición del volumen espiratorio forzado en un segundo (VEF1) era del 26%. Veintinueve pacientes (74.4%) presentaron alguna comorbilidad. Como consecuencia de la aplicación de la VNI, el pH se incrementó entre la primera y tercera medición. El pH promedio inicial fue de 7.25 llegando a 7.33 a las 2 horas y a 7.39 al alta, en tanto que la pCO2 con promedio inicial de 83.8 mm Hg llegó a 67.8 mm Hg y 54.2 mm Hg en el mismo período. Treinta y cinco de los 39 pacientes fueron dados de alta con un período de internación promedio de 13.6 días. Cuatro pacientes (10.3%) fallecieron. Se concluye que con la aplicación de la VNI en pacientes con exacerbación de EPOC, el pH y la PaCO2 cambian significativamente en las muestras sucesivas, y que la adecuada capacitación del equipo de salud puede permitir el tratamiento de estos pacientes en áreas de menor complejidad. Deben ser tenidas en cuenta las posibles complicaciones que pueden sufrir los pacientes durante la internación, que pueden requerir la aplicación de ventilación invasiva.

This is a prospective study on the implementation of the non-invasive positive pressure ventilation (NPPV) to treat respiratory failure resulting from exacerbation of chronic obstructive pulmonary disease (COPD) in patients hospitalized in a Pneumological Unit. From January 2000 to January 2003, 39 patients were included during 54 different exacerbation events after being evaluated under international standards. They were classified as severe and very severe patients on the basis of their FEV1 values of 26%. Twenty nine patients presented co-morbidities. As a consequence of the NPPV treatment, the pH values increased between the first and last register as well as the pCO2 dropped in the same period. The initial mean pH values were 7.25 reaching mean values of 7.33 at 2 hours and 7.39 at the discharge; the corresponding pCO2 mean values were 83.8 mmHg, 67.8 mmHg and 54.2 mmHg. Thirty five patients out of 39 were discharged after a mean hospitalization length of 13.6 days. Four patients died. Apropriate training of health care staff in general facilities could allow the implementation of NPPV in addition to usual medical care to treat exacerbation of COPD. High morbidity situations could arise during hospitalization, so invasive ventilation must be necessary.

Recent Progress in Research on Stroke Unit / 国际脑血管病杂志

The article reviews the development of patterns of stroke unit, the roles of different types of stroke unit, the mechanisms of stroke unit in improving prognosis, and the prospect of stroke unit.