[Work after brain damage: unpredictability of outcomes]

The Unit for Evaluation, Re-Education and Socio-Professional Orientation (UEROS) is a bridge between the hospital environment and professional life. It assists brain-damaged patients with their social and professional reintegration while taking into account their specific needs.

How do you know when your patient is "waking up": coma recovery assessment in a complex continuing care setting

Coma, vegetative state (VS) and minimally conscious state (MCS) are disastrous outcomes following severe traumatic brain injury. Due to the extent of the resultant neurological deficits including hemisphere damage, loss of cellular integrity, altered and abnormal movements such as flexor and extensor patterns, and alterations in cranial nerve function, it can become difficult for the interprofessional team to identify when a patient is emerging from their coma. The Glasgow Coma Scale (GCS), commonly used to assess patients with traumatic brain injury (TBI) is not comprehensive or sensitive enough to provide concrete evidence that a patient is emerging from VS to an MCS. The purpose of this paper is to present a case study of a patient who has emerged from a persistent VS to promote a deeper understanding of what is involved when working with this clientele. Challenges in assessment of cognitive functioning, the development of successful communication through the use of technology and the goals of therapy amongst the various health team members will be provided. Collaborative support with the family will also be discussed. Members of the interprofessional team explored the literature to determine coma recovery assessment tools and best evidence guidelines to direct their interventions with this patient.

[Burden of primary caregivers of young patients with brain damage]

OBJECTIVES

The objective of this study was to shed light on (1) the extent to which primary caregivers of patients with brain damage feel nursing-care burden, and (2) the relationship between such burden and other attributes in a cross-sectional manner.

METHODS

We conducted an anonymous questionnaire survey of primary caregivers of young patients with brain damage. The survey was conducted between November 2008 and March 2009. The number of valid responses was 53 (response rate 56%). To assess burden of caregivers, we used the Short Version of the Japanese Version of the Zarit Caregiver Burden Interview (J-ZBI_8).

RESULTS

With regard to burden felt by primary caregivers "concerns about excretion" and "problematic behavior" were stressed. Individuals who were less than 50 in age most strongly felt burden. Moreover, burden was greater for spouses than for guardians.

CONCLUSION

In order to reduce the burden of caregivers in case of primary caregivers, rehabilitation concerning young patients with brain damage and efforts to enhance their capabilities are important. In addition, it is also necessary to provide social resources so that primary caregivers can rely on other persons without worry.

Northwick Park Care Needs Assessment: adaptation for inpatient neurological rehabilitation settings

AIM

This paper is a report of a study to establish which timings and assumptions of the Northwick Park Dependency Scale and Care Needs Assessment are appropriate to the inpatient rehabilitation setting and which, if any, require adjustment.

BACKGROUND

Cost-effective provision of nursing care relies on being able to adjust staffing levels in accordance with patient dependency. The Northwick Park Dependency Scale and Care Needs Assessment enables direct assessment of nursing care needs in community settings.

METHOD

An observational study was conducted in 2004 to record the time taken to complete direct nursing care interventions in a rehabilitation ward and to compare these times with simultaneously recorded time-estimates provided by the Care Needs Assessment. A total of 1168 nursing interactions were timed for 50 care episodes.

RESULTS

There was considerable variation in the time taken for each nursing intervention, depending on overall patient dependency and the number of nurses required. Although there was good correlation between observed care times and those estimated by the Care Needs Assessment, observation confirmed that most interventions took substantially less time than the estimates. There was also a very different pattern of care in hospital compared with the community, with shorter, more frequent interactions as nurses distribute their time between different patients, and activities other than direct patient care.

CONCLUSION

The Northwick Park Care Needs Assessment tool already has widespread application in other countries and its continued use for estimating community care needs remains relevant. The tool, once fully developed, will have the potential to contribute to international rehabilitation nursing workforce planning and research.

Reliabilität und Validität der deutschsprachigen «NCCPC-R» Eine Pilotstudie zu den psychometrischen Eigenschaften eines Schmerzassessmentinstrumentes bei kognitiv beeinträchtigten Kindern und Jugendlichen

Die «Non-Communicating Children’s Pain Checklist – Revised» (NCCPC-R) ist für das Schmerzassessment bei kognitiv beeinträchtigten Kindern und Jugendlichen, die Schmerzen weder verbal noch mit Mimik oder Gestik bewusst und angemessen äußern können, entwickelt worden. Ziel dieser nicht-experimentellen Pilotstudie war es, eine Aussage über die psychometrische Güte der deutschsprachigen Version der NCCPC-R zu machen. Bei 24 Kindern und Jugendlichen, die in einem in der deutschsprachigen Schweiz gelegenen Rehabilitationszentrum hospitalisiert waren, wurden von 42 Pflegefachfrauen insgesamt 187 schmerzfreie Situationen und 62 Schmerzepisoden gemessen. Die Gesamtscores der NCCPC-R waren intern konsistent, über die Zeit stabil und korrelierten mit der von den beurteilenden Pflegefachfrauen vorgenommenen subjektiven Einschätzung und der bei den Studienteilnehmenden vermuteten Schmerzintensität substanziell. Die Gesamtscores zwischen Messungen schmerzvoller und schmerzfreier Episoden differierten deutlich. Bei einem Gesamtscore von 5 als Cut-off-point beträgt die Sensitivität 84% und die Spezifizität 78%. Unter Berücksichtigung der Tatsache, dass die Resultate auf einer schlanken Datenbasis beruhen, kann angenommen werden, dass die deutschsprachige NCCPC-R eine für die alltägliche Handhabung in der Pflegepraxis ausreichende Güte hinsichtlich der untersuchten Reliabilitätaspekte und Validitätsformen aufweist. Ihre Eignung für das Schmerzassessment bei kognitiv beeinträchtigten Kindern und Jugendlichen sollte in weiteren Studien noch breiter und vertiefter untersucht werden.

[Aspiration of milk in healthy infant--cause of acute respiratory arrest?]

We present the case of 4month old female infant, who obviously suffered from a respiratory arrest during bottle-feed ing. After primary successful resuscitation the baby died after 49 days due to large intracranial hemorrages. The diagnosis of shaking trauma was based on the detailed medical examinations and on the case history taken from the police file. The life-threatening shaking trauma is rare as an emergency. Therefore every doctor should be aware of a potential victim in cases of infants who are normal developed without signs of injuries, have no history of a severe disease and show life-threatening symptomes.

[Stroke in nursing care--regarding the need for a neurogeriatric management process]

In Austria every year approximately 15,000 people are suffering the fate of stroke. A permanent handicap remains in about 60 percents. Many of the patients need permanent assistance and admittance to a nursing home is often required. The clinical picture of stroke makes it necessary that even in nursing homes a qualified and professional care is offered to the patients to satisfy their needs. In such stroke care specialized nursing homes an extensive multiprofessional assessment is useful to determine and to quantify the deficits but even the abilities of stroke victims. The results are the basis for further treatment and planning of nursing care. More and more modern and progressive nursing concepts are used emphasizing the special clinical situation. The goal is to establish an extensive concept of stroke care that is realized not only in stroke units but even in long term care institutions. A modern long term management of stroke patients exceeds the term "Pflegefall" by far. It is a multiprofessional challenge.