Nonsuicidal Self-Injury.

ABSTRACT: Nonsuicidal self-injury (NSSI) is an area of growing concern for the health care community, as evidenced by its identification as a Healthy People 2030 objective and as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In the past, nurses may have identified patients who cut or harmed themselves as having suicidal intent, yet NSSI is increasingly recognized and investigated as a separate disorder. This article provides an overview of NSSI, including information about risk factors, clinical assessment, and preventive efforts.

Sensitivity and Specificity of a Nurse Dysphagia Screen in Stroke Patients.

PURPOSE: To determine how well an institutionally developed nurse dysphagia screening tool correctly identified the presence (sensitivity) or absence (specificity) of dysphagia in patients following acute stroke. METHODS: A method-comparison design was used to compare results of the Nurse Dysphagia Screen to the dysphagia evaluation by a speech and language pathologist (SLP). Each newly diagnosed participant served as his or her control, with both dysphagia evaluations (nurse, SLP) occurring within 2 hours of each other. Sensitivity and specificity of the Nurse Dysphagia Screen was calculated using standard formulas. RESULTS: For 49 patients evaluated following stroke, average age was 71.7 (SD +/- 13.5). Twenty-five subjects were female and 24 were male. The majority of the participants had strokes identified as ischemic in origin (n=35). The SLP found 18 (37%) participants had a positive dysphagia assessment. The Nurse Dysphagia Screen was positive in 16 of 18 participants screened positive by SLP, resulting in some type of dietary restriction. The Nurse Dysphagia Screen was negative in 28 of the 31 patients screened as negative by SLP. Sensitivity and specificity of the Nurse Dysphagia Screen were 89% and 90%, respectively. CONCLUSIONS: An easy-to-use, institutionally developed nurse dysphagia screening tool successfully identified patients with swallowing difficulties after stroke later diagnosed by SLP.

Pediatric procedural pain: how far have we come? An ethnographic account.

The aim of this ethnographic study was to explore the pediatric procedural pain management practice of health care providers in a non-pediatric emergency department. Data were collected for 5 months and included more than 100 hours of observation. Six key informants were interviewed, and 44 pediatric procedural interactions with 27 health care providers during the treatment of children aged 2 to 8 years undergoing procedures were observed. Other information gathered included documents from the institution, and pain-related information from the patient's medical record. Two major themes with categories are discussed, the treatment of pain, and procedural pain. The findings of this study provide insight into the everyday practice of emergency department health care providers for pediatric pain in a non-pediatric setting, and identify practice issues that may adversely affect the management of pediatric procedural pain, notably the nonuse of pharmacologic techniques for simple needle procedures and the common use of physical restraint during painful procedures.