Family Members' and Intensive Care Unit Nurses' Response to the ECG Memento© During the Bereavement Period.

BACKGROUND: In the United States, 20% of patients die in the intensive care unit (ICU), yet little is known about bereavement strategies to aid grieving families. OBJECTIVE: The primary aim was to study the bereavement experience for families in the ICU; secondary aim was to measure nurses' perception of end-of-life care, and a third was to evaluate the impact of the ECG Memento by families and nurses. METHODS: A prospective, descriptive study design was used, with a postsurvey methodology. Fifty ICU patient families agreed to participate, although only 28 returned the Satisfaction With Bereavement Experience Questionnaire. In addition, 38 of 100 eligible nurses completed the Quality of Dying and Death in the Intensive Care Unit survey. RESULTS: The Satisfaction With Bereavement Experience Questionnaire data showed families as highly satisfied with hospital (mean, 1.5), personal (mean, 1.6), ritual (mean, 1.3), and posthospital experiences (mean, 1.9). Quality of Dying and Death in the Intensive Care Unit results indicated that ideal control of patients' symptoms was reported by only 26% of nurses surveyed. Half of the families reported that the death was unexpected. Families (86%) responded positively to the ECG Memento, and according to 98% of the nurses, the ECG Memento was very well received. DISCUSSION: Despite most families reporting high satisfaction with the bereavement experience, nurses reported a low level of patient symptom control; also, families often found the death to be unexpected. This suggests that the bereavement experience is a complex process requiring nurses to implement various interventions during this vulnerable period. Most families responded positively to this novel bereavement tool, which may aid families as they transition from anticipatory grieving to bereaved status. Further studies are needed to evaluate the ECG Memento as an innovation on a wider scale and to develop additional interventions to positively impact the grieving process for families.

Early malnutrition screening and low cost protein supplementation in elderly patients admitted to a skilled nursing facility.

BACKGROUND: Malnutrition among skilled nursing facility (SNF) patients can lead to hospital readmissions and multiple complications. PURPOSE: To evaluate the effect of an existing malnutrition screening and management program on prealbumin levels of patients in skilled nursing facilities. METHODS: A retrospective design was used to evaluate baseline admission data including a prealbumin level. Patients with malnutrition received an oral protein supplement according to protocol. A comparison prealbumin level was obtained at 30days. RESULTS: Nearly half of the patients were severely malnourished on admission. Patients receiving the prescribed protocol had significantly increased prealbumin levels at 30days than those patients that did not receive the protocol as prescribed. CONCLUSION: A prealbumin level upon admission at a SNF could represent a reliable tool to evaluate malnutrition. Initiation of an early malnutrition screening and protein supplement program in this setting is essential to identifying and treating at-risk patients before complications occur.

Using the Bem and Klein Grid Scores to Predict Health Services Usage by Men.

We examined the association between scores on the Bem Sex Roles Inventory (BSRI), Klein Sexual Orientation Grid, and utilization of hospital inpatient services, emergency departments, and outpatient clinic visits in the past 12 months among 53 men (mean age 39 years). The femininity subscale score on the BSRI, ever having had gonorrhea and age were the three variables identified in a multivariate linear regression significantly predicting use of total health services. This supports the hypothesis that sex roles can assist our understanding of men's use of health services.

Moral distress and intention to leave: A comparison of adult and paediatric nurses by hospital setting.

OBJECTIVES: To assess moral distress intensity and frequency in adult/paediatric nurses in critical care and non-critical care units; and explore relationships of nurse characteristics and moral distress with intention to leave. METHODS/SETTING: A descriptive, correlational design was used to administer an online survey using the Moral Distress Scale to nurses across multiple settings. MAIN OUTCOME MEASURES: Intensity and frequency of moral distress and intention to leave current position. RESULTS: The survey response rate was 43% (n=426/1000). Critical care nurses had the highest levels of moral distress intensity and frequency, compared to non-critical care specialties (M=2.5±0.19, p=0.005 for intensity and M=1.6±0.11, p<0.001 for frequency). Moral distress frequency showed a positive relationship with intention to leave a position of employment. Each unit increase in moral distress frequency doubled the odds of intention to leave when adjusting for age, gender, ethnicity and specialty area (p=0.003). Hispanic nurses had significantly higher levels of moral distress intensity (p=0.01). CONCLUSION: Moral distress is a complex phenomenon requiring further study, particularly with regard to the role of ethnic and cultural differences on perceptions of moral distress.