Nursing support in the decision-making process regarding the choice of renal replacement therapy: A scoping review / Accompagnement infirmier dans le processus de prise de décision relatif au choix du mode de suppléance rénale : une revue de la portée

Context: Chronic kidney disease affects 7 to 10 percent of the French population. Entering the end stage of the disease requires a choice to be made between several options. The aim is to document the nursing practices used to support these patients in choosing their renal replacement therapy and to determine the elements that promote decision-making. Method: This is a scoping review based on the methodology of Peters et al. of JBI. Results: The nursing practices identified focus on empowerment, by intervening in: involvement, providing information, clarifying preferences, supporting deliberation, and assessing needs before, during, and after the decision-making process. The key factors identified are: an equal and trusting relationship, the personalization of the process, and emotional support, all provided by trained professionals. Discussion: Several concepts shed light on decision support in a complementary and surprisingly paradoxical way: grief, adaptation, empowerment, and uncertainty. Conclusion: This review shows nursing practices centered on helping the patient to take control of their life decisions. This experience causes a serious upheaval in patients' lives, hence the importance of providing them with support in managing their emotions.

Contexte: L'insuffisance rénale chronique touche 7 à 10 % de la population en France. L'entrée dans le stade terminal de la maladie implique un choix entre plusieurs options. L'objectif est de documenter les pratiques infirmières permettant l'accompagnement de ces patients face à un choix du mode de suppléance et de déterminer les éléments favorisant une prise de décision. Méthode: Il s'agit d'une revue de portée selon Peters et al. du Johanna Briggs Institut. Résultats: Les pratiques infirmières identifiées se centrent sur l'empowerment, en intervenant sur l'engagement, l'apport d'informations, la clarification des préférences, l'accompagnement dans la délibération et l'évaluation des besoins avant, pendant et après le processus décisionnel. Les éléments favorisants identifiés sont la relation de confiance égalitaire, la personnalisation du parcours, l'accompagnement émotionnel, ceci, par des professionnels formés. Discussion: Plusieurs concepts éclairent de façon complémentaire et étonnamment paradoxale l'accompagnement à la décision, comme le deuil, l'adaptation, l'empowerment et l'incertitude. Conclusion: Cette revue montre des pratiques infirmières centrées sur l'acquisition d'un pouvoir d'agir du patient sur sa vie. Cette expérience représente un bouleversement dans la vie des patients et souligne l'importance de l'accompagnement dans la gestion des émotions.

Effect of needle orientation during arteriovenous access puncture on needed compression time after hemodialysis: A randomized controlled trial.

BACKGROUND: There are two techniques for puncturing an arteriovenous fistula: one where the needle is inserted bevel up and then rotated to a bevel down position, and another where the needle is inserted bevel down. The aim of this study was to compare these two methods of needle insertion on minimum compression time required for hemostasis after needle removal. METHODS: This was a prospective, randomized, cross-over, blinded, single-center, routine care study. Each patient's average post-dialysis puncture site compression time was determined during a 2-week baseline period while using bevel-up access puncture. Subsequently, minimum post-dialysis puncture-site compression time was determined during each of two sequential follow-up periods, during which fistula puncture was done with needles inserted bevel up or down, respectively. The order of treatments (bevel up or bevel down insertion) was randomized. During each follow-up period, the minimum compression time necessary to avoid bleeding on needle removal was determined by progressively shortening the compression time. Puncture-associated pain was also assessed as prepump and venous pressures and ability to achieve desired blood flow rate during the dialysis session. RESULTS: Forty-two patients were recruited. The baseline compression time after needle removal averaged 9.99 ± 2.7 min During the intervention periods, the minimum compression time was on average 10.8 min (9.23-12.4) when the access needles had been inserted bevel down versus 11.1 min (9.61-12.5) when the access needles had been inserted bevel up (p = 0.72). There was no difference in puncture-associated pain between the two insertion techniques, and no difference in prepump or venous pressures or ability to achieve the desired blood flow rate during the dialysis session. CONCLUSION: Bevel-up and bevel-down needle orientation during arteriovenous fistula puncture are equivalent techniques in terms of achieving hemostasis on needle removal, and puncture-associated pain.

Exploring Strategies for Developing Enabling Environments for People with Chronic Heart Disease: An Ethnographic Study Protocol.

The impact of chronic diseases on people's daily lives and the exponential number of people affected is a major public health issue. The consequences on individuals and their families is significant, particularly in terms of quality of life. In the literature, this phenomenon is well described in terms of care policy and cost. Although there is a link between a supportive environment and empowerment, there is little literature describing a supportive environment and the daily lives of people living with cardiovascular disease. The objectives of this study are to identify the strategies people use to develop an enabling environment. It will be a qualitative ethnographic study that will address both human behavior and the notion of culture in a broad sense. In the context of this study, an orientation towards critical ethnography will be considered for its particular interest in vulnerable people and in the power relations that may exist in the socio-cultural system. Data will be collected directly in people's homes through observations and interviews with 10 people with cardiovascular disease. For each person, the data collection will take place over three days and will represent approximately 210 h of observation. This protocol was registered in the Research Register on 30 June 2021 and its number is 6933. This study will explore strategies for developing an enabling environment for people living with heart disease and eventually provide recommendations for nursing practices in terms of support.

[The creation of an advanced practice department within a GHT]. / La création d'un département de pratique avancée au sein d'un GHT.

In order to meet the health needs of the population, the joint management of three establishments in the Yvelines Nord territorial hospital group has chosen to deploy advanced nursing practice. To facilitate the implementation of these professionals, an innovative organization has been designed, resulting in the creation of a specific department. The advanced practice nurse is part of a coordinated care pathway where his or her pivotal role in patient care leads him or her to develop numerous partnerships.

Defining an enabling environment for those with chronic disease: an integrative review.

BACKGROUND: Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management. METHODS: An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used. RESULTS: A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment. CONCLUSION: This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.

[Chronic illness and body image construction, the aesthetic concern of the adolescent]. / Maladie chronique et construction de l'image corporelle, le souci esthétique de l'adolescent.

Chronic illnesses, such as diabetes, have an impact on the body, but also on the psyche, disturbing the body image of the child or adolescent. This must be integrated into their"growing up process". To this end, health care professionals specialising in these populations provide the most appropriate support during these periods of doubt and uncertainty.

Perceptions and Experiences of the COVID-19 Pandemic amongst Frontline Nurses and Their Relatives in France in Six Paradoxes: A Qualitative Study.

Due to their frontline position to fight the coronavirus disease 2019 (COVID-19), the professional and personal life of nurses was severely disrupted. To understand and describe their lived experiences and perceptions during the pandemic's first wave in France, we interviewed 49 nurses, including 16 nursing students, and 48 of their family members from June to July 2020. Using a purposeful sampling, the semi-structured interviews were scripted according to Abric's method with probing questions. The interview analysis led to the identification of six paradoxical perceptions concerning the pandemic's consequences: the Silence Paradox, the Hero Paradox, the Workforce Paradox, the Learning Paradox, the Symbolic Exchange Paradox, and the Uncertainty Paradox. However, despite different experiences, the nurses perceived their frontline position both as a burden jeopardizing their safety and well-being and as a spotlight of nurses' tough working conditions. Indeed, because they were in the frontline position, nurses and nursing students were psychologically vulnerable, even more so when they felt alone and inadequately protected. Besides, their families were vulnerable too, as they were also exposed to the consequences of the nurses' frontline engagement. Thus, to preserve their safety and well-being, institutions should also provide them with better organizational support and inclusive leadership, without neglecting their families.

Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial.

BACKGROUND: In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience. OBJECTIVE: Our aim was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children. METHODS: This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal with (intervention group) or without (control group) liniment. Bag removal was recorded on video in such a manner as to permit independent assessments of pain by two evaluators blinded to group allocation. Pain was assessed using the FLACC scale. FINDINGS: 135 patients were analyzed: 70 in the intervention group and 65 in the control group. The median FLACC scores [interquartile range] for the intervention and control groups, respectively 4.0 [2.0-7.0] and 4.0 [3.0-7.0], did not differ significantly (p = 0.5). A FLACC score ≥4 was obtained for 56% of the patients and a score ≥7 for 28%. CONCLUSION: Removal of urine collection bags caused moderate to severe pain in half of the children included. The use of an oleo-calcareous liniment did not reduce this induced pain.

[Intellectual disabitily, challenging behavior, and care: A systematic literature review]. / Déficience intellectuelle, « comportements défis ¼ et soins : une revue systématique de littérature.

Introduction and background : People with intellectual disabilities present difficult behaviors, also called problem behaviors or challenging behaviors.Objective : The objective of this study was to describe the state of knowledge in nursing about challenging behaviors in people with intellectual disabilities.Methodology : We performed a systematic literature review based on the use of the keywords "challenging behavior," "intellectual disability," "nurs*," and "problem behavior" on the PubMed and Web of Science websites between 2008 and 2018.Results : Individuals with intellectual disabilities frequently present challenging behaviors, which can give rise to the abuse of psychotropic medication. These behaviors are also stressful for staff. Solutions in terms of staff training exist, as well as assistance in the identification of associated diagnoses that may sometimes be responsible for challenging behaviors. No publications in French on this topic were found.Conclusion : Nurses who work with people with intellectual disabilities should be encouraged to become involved in research so that they can contribute to developing knowledge on challenging behaviors and improve the quality of their care. This will also enable them to further develop their collaboration within the multidisciplinary team in order to promote good practice in terms of the management of challenging behaviors and in particular in terms of promoting a move away from prescribing psychotropic drugs.

Nurses in France: Between Autonomy and Subordination in Front Line Care.

In France, medical practitioners are aware that the practice of the delivery of primary care by nurses occurs in other countries. However, there is disagreement about how to implement this practice. This aspect of the issue of front line care has not yet been studied in France. In this article, our aim is to identify to what extent the delivery of primary care by nurses is considered acceptable by doctors and nurses working in hospital emergency departments and in public and private health centers. The results of our research provide a picture of opinions that exist among doctors and nurses. These opinions highlight practices that are outside the current regulations and present perspectives, which range from conditionally in favor to unfavorable. Such opinions contribute to our knowledge because they are derived from the professionals directly involved and describe what is acceptable in this particular context.

[Intuition in pediatric care]. / L'intuition dans les soins en pédiatrie.

Caregiver intuition acquired through experience can be considered a form of intelligence in action. It is used in both reflection and field learning and can be mobilised as part of any nurse's clinical context. Transferring knowledge to young professionals should therefore include intuition to help them adapt to each care situation, especially in paediatrics.