Quality of Life of Sepsis Survivors.

OBJECTIVE: To determine the differences between the quality of life for sepsis and nonsepsis survivors, factors affecting the quality of life for sepsis survivors, and their changes over time. DESIGN: A prospective longitudinal study with a quantitative comparative design. SETTING: A university hospital in the greater Tokyo area of Japan. PATIENTS: The study included 41 and 40 patients in the sepsis and nonsepsis groups, respectively. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Health-related quality of life (HRQOL), independence in activities of daily living (ADL), stress levels, and spirituality were compared between the sepsis and nonsepsis groups at ICU discharge, hospital discharge, and 1 month after discharge. Comparison of HRQOL between the sepsis and nonsepsis groups showed significantly low HRQOL in the sepsis group compared with the nonsepsis group at ICU discharge and hospital discharge. Factors such as stress levels and spirituality affected the HRQOL in the nonsepsis group at ICU discharge. At discharge, stress and spirituality affected HRQOL in both the sepsis and nonsepsis groups. One month after discharge, ADL, stress, and spirituality affected HRQOL in both the sepsis and nonsepsis groups. In terms of changes over time, HRQOL at ICU discharge in the sepsis group was significantly lower than at discharge and 1 month after discharge. The two-way analyses of variance showed no interactions between the groups and time regarding HRQOL. CONCLUSIONS: HRQOL of sepsis survivors was significantly lower than that of nonsepsis survivors. ADL and stress influenced HRQOL. The study suggests the importance of ADL training and stress alleviation during the ICU stay.

Prevalence of and factors associated with physical restraint use in the intensive care unit: a multicenter prospective observational study in Japan.

Physical restraint is widely used in the intensive care unit (ICU) to ensure patient safety despite its ethical implications. We performed a prospective observational study in six ICUs in Japan to determine the prevalence of and factors associated with physical restraint use in the ICU, a phenomenon that has not yet been reported on in Japan. Data were collected on 10 random days between November 2018 and February 2019. We evaluated physical restraint use in ICU patients aged ≥ 20 years during the data collection days. Among the 787 observations, the prevalence of physical restraint use was 32.9%; however, it was 41.5% in patients receiving invasive mechanical ventilation (IMV). The average age of patients was 68.5 years, and the average Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score was 19.4. Among the included patients, 52.1% received IMV, and 17.2% were diagnosed with delirium. Logistic regression analysis revealed that the independent factors [odds ratio (95% confidence interval)] associated with physical restraint use were age [1.02 (1.00-1.05)], APACHE II score [1.05 (1.01-1.09)], IMV [2.15 (1.16-4.01)], central venous catheter indwelling [2.66 (1.46-4.85)], sedative medication [2.98 (1.72-5.17)], agitation [7.83 (2.96-20.8)], and delirium [4.16 (2.37-7.29)]. Approximately one-third of the ICU patients required physical restraint in Japan. In addition, physical restraint use was influenced by disease severity, mental condition, and the medical apparatus used. Based on these findings, further investigations are imperative to develop strategies to reduce physical restraint use.

A Pilot Study on Pain Assessment Using the Japanese Version of the Critical-Care Pain Observation Tool.

BACKGROUND: Critically ill patients experience various types of pain that are difficult to assess because patients cannot communicate verbally due to artificial airways and sustained sedation. The Critical-Care Pain Observation Tool (CPOT) objectively evaluates patients' pain. AIMS: This study aimed to re-assess the reliability and validity of the Japanese version (CPOT-J) and to reveal limitations of behaviors specific to mechanically ventilated patients. DESIGN: Secondary analysis of observational pilot study and case report. PARTICIPANTS:   METHODS: We obtained consent preoperatively from 40 cardiovascular surgery patients. CPOT-J scores were evaluated immediately before, immediately after, and 20 minutes after painful stimulation. Inter-rater reliability was determined by the researcher and 18 ICU nurses (minimum one-year ICU experience). Validity was examined by comparing CPOT-J with vital sign values and patients' self-reports of pain. Two cases revealed the tool's characteristics: one score was consistent with patient reports while the other was not. RESULTS: We evaluated pain in 34 patients (26 men, 8 women; mean age = 66.8 years). Weighted kappa scores ranged from 0.48 to 0.94. The tool only correlated with changes in systolic blood pressure and pulse pressure. Case studies indicated that the tool effectively evaluated mid-sternum-wound pain, but not back pain at rest. CONCLUSIONS: The CPOT-J can assess pain in mechanically ventilated patients, but being immobile results in a score of 0 for body movement (e.g., being immobile while feeling back pain) and is a limitation of the scoring.

Prevalence and retention status of new graduate nurses with special support needs in Japan.

Early resignation of new graduate nurses is a global concern. Tendencies of developmental disorders or special support needs may contribute to the early resignation. A national mail survey about new graduate nurses with special support needs was conducted in Japan in 2013. A modified battery developed for a national survey of school children with special educational needs was used. The questionnaire was completed by the nurse managers of the participating hospitals who supervised the nurses. Among the 500 hospitals invited to participate in the survey, 141 hospitals responded. Sixty-six nurses were identified as having special support needs among the 2,761 nurses who were newly employed at 128 hospitals with 300 or more beds, which comprises 2.39% of the total. The most prevalent need was "social interaction/restricted interest" followed by "inattentiveness." Of these, 40.9% of the nurses left their initial hospital jobs within one year. The need for an individualized support program specific to nurses' needs is implied. Further research studies are warranted to prospectively identify nurses with special support needs and explore their experiences as working nurses.

Behavioral traits of the nursing students with special educational needs in Japan.

Nursing students with tendencies toward developmental disorders or special educational needs could face difficulties while studying nursing. The study examined the behavioral traits of nursing students with special educational needs who graduated in Japan in March 2011. Nurse educators from 341 programs provided information concerning students who had been identified as difficult to teach while enrolled in nursing programs. Behavioral traits were examined in students with special educational needs (n = 139) and those who did not have special needs but were identified as difficult to teach by the nurse educators (n = 84). The most prevalent behaviors in students with special needs were "making excessive excuses" in unstressful situations and "lapsing into silence" under stressful circumstances. The number of students with special needs who were prone to "blaming others" and "disappearing" was higher relative to that of students without special needs under unstressful circumstances. Under stressful circumstances, "blaming others," "disappearing," and "staying at home" were reported more frequently for students with special needs than they were for students without special needs. Nurse educators should pay attention to these behaviors in students facing difficulties while studying nursing.

Nursing students with special educational needs in Japan.

AIM: To reveal the prevalence of nursing students with special educational needs in Japan. METHOD: A mail survey of 833 nursing programs was conducted. Nurse educators were asked to report on their program's profiles and the number of extremely difficult students who belonged to the March 2011 class of graduates. They were also asked to fill a modified questionnaire developed by the Ministry of Education, Culture, Sports, Science and Technology about each extremely difficult student. RESULTS: Among the 14,325 students enrolled the class of 2011, 146 students (1.02%) were identified as having one or more special educational needs for "listening," "speaking," "reading," "writing," "math," "reasoning," "inattentiveness," "hyperactivity/impulsivity," or "social interaction/restricted interests." The most prevalent need was "social interaction/restricted interests," followed by "listening" and "inattentiveness." These students had the most difficulty participating in "nursing care for patients during clinical practicum." CONCLUSION: The proportion of nursing students with special educational needs is small but may have a large impact on the clinical practicum. Evaluation and support systems at multiple levels, including entrance examinations, course placement, and special educational programs, are warranted.

Patients' descriptions of dysphoria associated with cardiac tamponade.

BACKGROUND: Cardiac tamponade is difficult to diagnose. Patients often experience sustained distress. Mood changes in the early stages of cardiac tamponade were previously described. However, precise descriptions of these moods have not been reported. OBJECTIVE: We sought to describe the mood changes specifically referred to as dysphoria in the patients' own words. METHODS: Structured and semistructured interviews were performed with 29 patients who had survived cardiac tamponade. RESULTS: Twenty-six patients (89.6%) affirmed some dysphoric mood. "A bad thing is happening" was most frequently affirmed. "Felt anxious," "could not stay still," and "difficult to settle down" followed. Answers to open-ended questions and free comments were categorized into "fear," "anxiety," "impending doom," "ill feeling," "unusual," "uncertain," "depressed," and "discouraged." CONCLUSION: The majority of patients surviving cardiac tamponade experienced a dysphoric mood. Mood changes may provide a reliable indicator for those at risk for cardiac tamponade.

Incidence and characteristics of dysphoria in patients with cardiac tamponade.

BACKGROUND: The signs and symptoms associated with cardiac tamponade are often nonspecific. Dysphoria associated with cardiac tamponade has been understudied. An understanding of the behavioral traits associated with dysphoria and cardiac tamponade may contribute to early detection. OBJECTIVES: The behavioral traits of dysphoric patients with cardiac tamponade are described. METHODS: A retrospective chart review of 56 adult patients with a diagnosis of cardiac tamponade from 1990 to 1999 at a university hospital in Japan is described. RESULTS: The incidence of dysphoria associated with cardiac tamponade was 17 of 66 events (25.8%) in 56 adult Japanese patients. The most frequent behavioral traits were "body movement," "facial expression," "gets up/tries to get up," and "restlessness." Statements of "somewhat/something strange" and "no place to put (my) body" were documented twice for each category. Subjects verbalized that they were going to "die" in four events. CONCLUSION: Clinicians caring for patients at risk of cardiac tamponade are advised to be sensitive to the patients' restless body movements and unusual facial expressions, and statements indicating restlessness and impending death.