The use of autologous platelet-rich plasma (platelet gel) and autologous platelet-poor plasma (fibrin glue) in cosmetic surgery.

The purpose of this study was to evaluate a new technique of harvesting and preparing autologous platelet gel and autologous fibrin glue (body glue) and to evaluate their effectiveness in stopping capillary bleeding in the surgical flaps of patients undergoing cosmetic surgery. A convenience sample of 20 patients ranging from 25 to 76 years of age undergoing cosmetic surgery involving the creation of a surgical flap were included in the study. The types of surgical procedures included face lifts, breast augmentations, breast reductions, and neck lifts. Platelet-poor and platelet-rich plasma were prepared during the procedure from autologous blood using a compact, tabletop, automated autologous platelet concentrate system (SmartPReP, Harvest Autologous Hemobiologics, Norwell, Mass.). The platelet-poor and platelet-rich plasma were combined with a thrombin-calcium chloride solution to produce autologous fibrin glue and autologous platelet gel, respectively. Capillary bed bleeding was present in all cases and effectively sealed within 3 minutes following the application of platelet gel and fibrin glue. The technique for making the solution and for evaluating its effectiveness in achieving and maintaining hemostasis during cosmetic surgical procedures is described. Autologous platelet gel and fibrin glue prepared by the automated concentrate system are compared with autotransfusor-prepared platelet gel and Tisseel (Baxter Healthcare Corp.), a commercially prepared fibrin sealant preparation.

Effectiveness of different medication management approaches on elders' medication adherence.

This pilot study investigated the effects of three different medication management approaches on medication adherence and resource utilization. Sixty-one participants living in an independent elder community in South Florida were randomly assigned to one of the three medication management approaches: (1) a pillbox method, (2) a voice-activated method, and (3) self-administration of medications as they had in the past. One outcome was measured by recording the number of doses of medications ingested over a 1-, 3-, and 6-month period. Adherence to medications also was measured by the impact on the medical diagnosis. For example, the hypertensive group was defined adherent by a sustained normotensive pressure. Participants' medical records were examined as to the number of physician office visits, hospitalizations, and home health visits. There were significant differences in the mean number of doses missed, with the fewest in the voice-activated group to the highest in the self-administration (control) group. Additionally, the group that self-administered their own medications had more frequent physician office visits and increased hospitalizations. Because the elder population is prone to medication mismanagement for a variety of reasons, nurses are in a unique position to identify populations at risk and suggest interventions that may improve medication adherence.

The circle of caring: a transformative model of advanced practice nursing.

This article presents a new and original approach to advanced practice nursing. A transformative model, the Circle of Caring is described. Using a template that builds on both nursing and medicine, this model provides a synthesized approach to practice. The traditional medical model is reviewed, as well as the evolution of the nursing process. In response to changing societal need, the scope of nursing practice is constantly challenged and expanded. New elements of practice emerge. In an effort to clarify and elaborate the current realities of advanced practice nursing, the Circle of Caring was conceptualized. Components of traditional medical practice are combined with elements of traditional nursing practice; both are situated in an elemental nursing model of caring. Although a linear representation, the Circle of Caring encompasses process pieces taken in part from a theory of caring (Boykin & Schoenhofer, 1993; Mayerhoff, 1971). An underlying purpose of this model is to highlight in a concrete way the inclusion of nursing's voice in the new and emerging--and rapidly changing--healthcare system. It is theorized that this approach to practice will yield more positive outcomes for patients, families, and communities.

Death, denial, and defeat: older patients and advance directives.

This article describes a phenomenological study involving 17 older persons who shared their reasons for not having formalized their end-of-life decisions. The study found they vacillated between fear and acceptance of death, trust and mistrust that others would or would not act according to their wishes, the assumption of immortality or the inevitability of death, and the denial or lack of knowledge of the necessity for legalizing their wishes. A discussion of the implications of these findings for nurse practitioners is presented.

Can caring for critically ill patients be taught by reading a novel?

Just before graduating, nursing students read Bed Number 10, a reflective account of an author's experience of being hospitalized with Guillain-Barre syndrome, which left every muscle in her body paralyzed. Students' wrote about the meaning of the story to their practice. The findings are heartwarming and remind us why we chose nursing. They also lead one to believe that caring for critically ill patients can be taught, in part, by reading a novel.

The dark side of caring: challenges of caregiving.

1. Because of the subtleness of the progressin of Alzheimer's disease, caregivers found themselves gradually allocating increased amounts of time and energy to the care of their loved ones. 2. All of the relatives mentioned the need to share the experience either formally with support groups for caregivers, or informally with relatives and friends. 3. Nurses' support of caregivers may prevent them from viewing their loved one as an object and prevent some of the prevailing guilt expressed by participants in this study.

The meaning of disability in a caring environment.

The meaning of disability on perception of self-worth as a nurse was identified through this qualitative study of disabled registered nurses. A metaphor emerged depicting the phenomena of the lived experience of disabled nurses. The results indicate that by creating a caring environment, nurse administrators can encourage disabled RNs to return to nursing practice.

Using intuition to define homesickness at summer camp.

Camp nurses are in a unique position to assist in the study of homesickness because they are living the situation. This descriptive study was undertaken because homesickness has not been defined operationally, and nurses do not have a documented set of "defining characteristics" that might be used to make a diagnosis. Twelve camp nurses from eight states completed a questionnaire on homesickness. The nurses surveyed had a consistent set of defining characteristics regarding homesickness. Intuition is reported to play a significant part in the camp nurses's diagnosis of homesickness. Symptoms of homesickness and recommended interventions are included that will ultimately help to promote a more positive camp experience for the camper.

Administrators' attitudes toward hiring disabled nurses.

An accessible but previously untapped market for staff is disabled registered nurses. The authors report the results of a survey sent to nursing home and hospital administrators assessing their attitudes toward hiring disabled RNs. The differences between nurse administrators and non-nurse administrators were significant. The authors suggest strategies to incorporate disabled nurses into the work force.