Familial polyposis: a case study.

This article presents a case study of a patient who was treated for 5 years from the time of diagnosis until his death. The patient was diagnosed with familial polyposis at the age of 35 due to a family history of the same. He suffered from low body image and showed a poor response to treatment, especially regarding nutrition. The period of time related to the presentation of symptoms and the patient's subsequent deterioration was characterized by attempts on the part of nursing staff to improve the patient's quality of life. Treatment of multiple fistulae was employed, while keeping the skin intact, along with the creative development of a unique bandaging method. This article describes the course of the patient's disease and specifies his problems and their solutions. It is hoped that presentation of this case will benefit caregiving staff in dealing with similar cases.

Emergency department staff preparedness for mass casualty events involving children.

BACKGROUND: In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events-a reality that forces hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events. OBJECTIVES: The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel. METHOD: The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's alpha coefficient 0.6 alpha-0.94. RESULTS: The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low. IMPLICATIONS: On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region.

"Between the fixed and the changing": examining and comparing reliability and validity of 3 sedation-agitation measuring scales.

The goal of the study was to compare the reliability and validity of 3 Sedation Agitation Scale. Two nurses and a physician conducted 130 observations simultaneously. They found an excellent interrater reliability in the Richmond Agitation Sedation Scale (r>0.86), and high correlations between the Richmond Agitation Sedation Scale and the Sedation Agitation Scale and Visual Analog Scale scales (r=0.92, r=0.85). The research findings will help to assert Richmond Agitation Sedation Scale as a daily assessment tool in the intensive care unit, and it will pave the way for construction a sedation protocol according to the Richmond Agitation Sedation Scale level.

Personal medical documents management--how patients perceive, keep and manage their medical documents: a qualitative study.

BACKGROUND: Absence of medical documents damages the quality of treatment and service. Despite the computerized medical folder, its use is still limited, and not all countries have a national health communications systems. That is why the patients are asked to bring with them the documents they hold. However, some patients lose the documents and others are uncooperative due to forgetfulness, and a lack of knowledge. OBJECTIVES: To examine how patients perceive, keep and manage medical documents. DESIGN: The research was conducted in the qualitative method. SETTINGS: A cardiology clinic, in a big medical center in Israel. PARTICIPANTS: A total of 28 patients suffering from ischemic heart disease and/or rhythm disorders. The sample was a convenience one, and were taken from the population visiting the Cardiology Clinic from May to October 2003. METHODS: Semi-structured interviews were held with the participants. The data were processed by means of content analysis. RESULTS: The findings indicate that, even though the participants expressed that it is the health system's responsibility to manage medical documents, most of them kept, and some even managed, their medical documents via a personal folder. By keeping documents and deciding to whom and when to show them the patient functions as a self-care manager. This made them more involved in their treatment and, they felt in control and empowered. CONCLUSION: Patient's attention to documents, as keeper and router, results in demonstrations of responsibility and involvement in treatment, consequently empowering the patient.

Caregivers' role in breaking bad news: patients, doctors, and nurses' points of view.

The aim of the research was to identify the caregivers' response patterns when breaking bad news at the first time of cancer diagnosis and their affect on the patient. These issues were examined from 3 points of view: patients, doctors, and nurses. A total of 152 Israelis subjects participated in the research: 51 patients with cancer, 51 nurses, and 50 doctors. They filled out a questionnaire developed for the research that included 35 items. Support patterns identified as effective were as follows: allowing for the expression of emotions, empathetic silence, support through touch, and the use of participatory, commendation, and encouragement statements. The research findings indicate the crucial need in the involvement of a family member and a nurse in the process and in supplying written information for the receiver of the news. Significant differences (P < .05) between patients and caregivers were found in the type of information given, in the timing and quantity, and in the support and communication patterns. The principal emotions professional caregivers experienced were identification and helplessness. Most of them were not trained in this field. The research findings could bridge the gap between what patients want and what caregivers do and would benefit in designing guidelines for breaking bad news and formulating a workshop program for furthering the team skills.

[Caregivers' role in breaking bad news: patients, doctors, and nurses' points of view].

The aim of the research was to identify the behavioral patterns employed by caregivers when breaking bad news, and their affect on the patient. These issues were examined from three points of view: patients, doctors, and nurses. A total of 152 interviewees participated in the research: 51 patients, 51 nurses, and 50 doctors. They completed a constructed questionnaire that included 35 items developed for the research. Support patterns identified as effective were: allowing for the expression of emotions, empathic silence, support through touch, and the use of participatory, commendation, and encouragement statements. The research findings point to the crucial need for the involvement of a family-member and a nurse in the process, and providing written information for the receiver of the news. Significant differences (p < 0.05) between patients and caregivers were found in the type of information given, the timing and quantity, as well as in the support and communication patterns. The principal emotions caregivers experienced were identification and helplessness, and most of them were not trained in this field. The research findings could bridge the gap between what patients want and what caregivers actually do, and would be beneficial in designing guidelines for breaking bad news, as well as formulating a workshop program for furthering the team skills.

The characteristics of self-referrals to ER for non-urgent conditions and comparison of urgency evaluation between patients and nurses.

The aim of the study was to identify the characteristics of self-referrals for non-urgent conditions to the ER, and compare urgency evaluation between patients and nurses. The participants were 73 Israeli clients who arrived at ER without referral from a physician, during the morning shift, and were discharged home after treatment. Their average age was 39.4 years. Most of the visits resulted from orthopedic problems. Over 60% indicated that they had chosen the ER because the treatment there was better, and a third reported that they usually turn to ER when they feel sick. In most cases, the visits were within 3 h of the symptoms emerging, and about a third of the participants indicated that lately they had been under situations of stress and anxiety. Significant differences (p=0.000) were found between nurses and patients, in the urgency evaluation of the visit. While most of the clients (77%), evaluated their condition as urgent to most urgent, most of the nurses (78%) evaluated it as non-urgent. Identifying the characteristics of the non-urgent use of the ER and the differences between caregivers and patients regarding the urgency evaluation of the visit, will provide insights into the population perceived as a burden on the work of the ER as well as benefiting and improving services.

Importance of early referral in sudden loss of hearing.

AIM: To examine the personal and clinical characteristics of patients suffering from sudden hearing loss. METHOD: The participants were 45 Israeli patients, and the data was collected retrospectively from their medical files. RESULTS: In most cases the injury was sensory, and in one ear. The common symptom was tinnitus, followed by vertigo. In 20 per cent of the cases no preliminary signs were documented. As many as 60 per cent of the participants suffered from high levels of cholesterol. This finding might indicate a link between the events of hearing loss and patients' vascular background. A total of 42 per cent of the participants delayed their appeal to treatment, despite the appearance of symptoms. CONCLUSION: A significant link was found between quick referral to treatment and recovery. The nurse holds a central role in identifying this group of patients and ensuring their referral to further treatment.

Chronology of medication errors by nurses: accumulation of stresses and PTSD symptoms.

The aim of this research was to examine the influence of medication errors on the mental state of the erring caregiver. In-depth interviews were conducted with 20 erring nurses. The data were analyzed using content analysis. The following categories were identified: "stress, pressure, and inattention," "responsibility," "the double fear," "I might get fired," "he who works, errs," waiting for the inquiry--"every day is like eternity," "absurdly, it got worse with time," and "following the event I learned my lessons." The emotional distress of several subjects was, across time, reminiscent of PTSD symptoms.

Fear, ambivalence, and liminality: key concepts in refusal to donate an organ after brain death.

The refusal to donate an organ is a phenomenon in need of exploration and explanation. This article refers to the major fear of becoming an organ donor in relation to a global culture perspective and to the Halacha (Jewish law). A theoretical critique about the ambivalence demonstrated by health care providers and families will discuss these concepts in relation to brain death, from the stages of hospitalization, through the period prior to the assertion of brain death, ending with brain death, and its perspective as a liminal situation.Finally, we conclude that nursing practices during the care of the "brain dead" patient, and toward the patient's family, should convey an unequivocal message. That is, brain death describes irreversible cessation of all brain function, and therefore, the patient becomes a dead body and can be treated as a potential organ donor.

Developing a computer game to prepare children for surgery.

Computer games are a major part of the culture of children and teenagers in many developed countries. Research shows that children of the computer age prefer computer-assisted learning to any other teaching strategy. Health care workers traditionally have used dolls, games, drawings, creative arts, and even videotapes to prepare children for surgery. No studies have been conducted in Israel on using computers to help ailing children in general or to help children preparing for surgery in particular. This article discusses the potential for using computers to educate patients based on a review of the literature and interviews with children and describes the process of computer game development.