Perspectives of family caregivers and nurses on hospital discharge transitional care for Muslim older adults living with COPD: a qualitative study

BACKGROUND

The increased number of emergency department visits among older adults living with chronic obstructive pulmonary disease reflects the challenges of hospital discharge transition, especially in those from a cultural minority. The barriers and facilitators of this discharge from the perspective of formal and informal care providers, such as nurses and family caregivers, are important to identify to provide effective symptom management and quality of care. The purpose of this study was to describe the barriers and facilitators in caring for Muslim older adults with chronic obstructive pulmonary disease (COPD) during hospital discharge transitional care.

METHODS

A descriptive qualitative study was conducted in a hospital of Thailand where Muslim people are a cultural minority. Thirteen family caregivers of Muslim older adults living with COPD and seven nurses were purposively recruited and participated in semi-structured interviews and focus group discussions. Content analysis was used to analyze the data.

RESULTS

Five barriers and three facilitating factors of transitional care for Muslim older adults living with COPD were outlined. Barriers included: (1) lack of knowledge about the causes and management of dyspnea, (2) inadequate discharge preparation, (3) language barrier, (4) discontinuity of care, and (5) COVID-19 epidemic. Facilitators included: (1) the ability to understand Malayu language, (2) the presence of healthcare professionals of the same gender, and (3) the presence of Muslim healthcare providers.

CONCLUSION

Family caregivers require more supportive care to meet the care needs of Muslim older adults living with COPD. Alternative nurse-based transitional care programs for these older adult caregivers should be developed.

Predictive factors for community integration among Nepalese persons after traumatic brain injury

Background

Various factors affect the community integration (CI) of persons experiencing traumatic brain injury (TBI). To ensure positive outcomes in terms of life at home, social activities, and productive work among persons suffering TBI, it is necessary to understand the factors that facilitate or impede CI.

Purpose

To compare CI by looking at demographic and clinical characteristics and determine significant predictors of CI among TBI Nepalese persons.

Methods

120 participants were selected using a stratified random sampling technique. A questionnaire was used to identify the participants’ demographic and clinical characteristics, and the Community Integration Questionnaire was used to measure CI. Univariate and multivariate analyses were performed for demographic and clinical factors associated with community integration.

Results

Using univariate analysis, male, employed, living with family, and independence in performing activities of daily living had significantly higher CI scores than female (t = −4.18, p<.000), unemployed (t = −10.52, p<.000), living with friends (t = −3.30, p<.001), and those with moderate to slight dependence (t = −2.83, p<.005). The multivariate analysis revealed that employment status, living with family, and length of hospital stay were significant predictors of CI among TBI Nepalese persons.

Conclusion

Employment status, living with family, and length of hospital stay were significant predictors of CI. These findings suggest that rehabilitation efforts should focus on minimizing hospital stay and promoting both productive and social activities among people surviving TBI.

Prevalence, severity, and self-management of depressive mood among community-dwelling people with spinal cord injury in Nepal

Background

Depression is a common psychological condition after spinal cord injury. There are increased incidences of self-harm, suicidal behavior, and lower quality of life among people with spinal cord injury and depression. However, self-management of depressive symptoms in the community is less explored.

Objective

This study aimed to examine the prevalence, severity, and self-management of depressive mood in community-dwelling people with spinal cord injury.

Methods

A descriptive study was conducted in 2019 among 115 people with spinal cord injury discharged from three health centers and living in the 13 districts of Bagmati Province. Participants were selected using stratified random sampling. Questionnaires were related to demographics, health and environment, depressive mood, and self-management. Descriptive statistics and quantitative content analysis were used to analyze the data.

Results

Ninety-seven (84.3%) people with spinal cord injury had a depressive mood. Of these, 60.8% had moderate to severe depressive moods. They mainly used the internet and social media, shared feelings with family members, and practiced Hindu religious activities for depressive mood management because of the physical barriers to accessing a healthcare facility and easiness to use of non-pharmacological methods. Nearly half of participants who used sharing of feelings felt their depressive mood disappeared when they often used the method.

Conclusion

Depressive mood following initial hospitalization is highly prevalent among people with spinal cord injury in Nepal, most of whom live in rural settings. Therefore, nurses and other health professionals should provide psychoeducation for this population and their family members to better address mental health problems. Facilitating pathways for those in rural areas to engage in social activities and timely treatment access may improve depressive mood. Nurses and other rehabilitation professionals can use social media to assess depressive moods and deliver management approaches in the community.

Knowledge, attitude, and practice of surgical site infection prevention among operating room nurses in southwest China

Background

Surgical site infection has become a problem in the operating room, and the nurses' knowledge, attitude, and practice could impact the incidence of the infection. Unfortunately, there is a dearth of studies on this issue in China. Therefore, determining nurses' knowledge, attitude, and practice of surgical site infection prevention is necessary.

Objectives

This study aimed to examine the knowledge, attitude, and practice of surgical site infection prevention and their relationships, as well as to identify differences in knowledge, attitude, and practice of surgical site infection prevention according to nurses' demographic characteristics.

Methods

A sample of 999 operating room nurses participated in 49 tertiary hospitals and 75 secondary hospitals in Guizhou Province, Southwest China. Data were collected using validated questionnaires through a Chinese survey website. Data were analyzed using descriptive statistics, One-Way Analysis of Variance, and Pearson product-moment correlation.

Results

The knowledge of surgical site infection prevention was at a low level, the attitude was positive, and the practice was at a high level. Approximately 39% of the nurses passed knowledge scores of ≥ 70%, 60% gave a positive attitude score of ≥ 80%, and 76% achieved a practice score of ≥ 80%. The nurses' attitude was positively related to knowledge (p < .01), and practice (p < .01), respectively. However, knowledge and practice did not significantly relate. The age group of 30-39 years old had significant higher knowledge than other age groups. The nurses with working experience of 6-15 years had significant higher knowledge scores than other groups. In addition, the nurses with one time of training frequency had significant lower attitude and practice scores than those with six to ten times of training frequency.

Conclusion

Approximately 60% of operating room nurses still had inadequate knowledge regarding surgical site infection prevention, but they had a positive attitude and high level of practice. The findings of this study might serve as an input for nurse administrators or policymakers to provide updated knowledge or guideline, closed supervision, and in-service training on surgical site infection prevention for operating room nurses.

Predictors of Pressure Injury Prevention Practices Among ICU Nurses in China

OBJECTIVE

To explore the predictors of knowledge of pressure injury (PI) prevention, attitudes on PI prevention, organization support for PI prevention, and the influence of a healthy work environment (HWE) on PI prevention practices among ICU nurses in China.

METHODS

A descriptive, predictive, online survey was conducted among 510 ICU nurses in Guizhou province, China. A PI prevention knowledge questionnaire, PI prevention attitude questionnaire, organizational support for PI prevention questionnaire, HWE assessment tool, and PI prevention practice questionnaire were used for data collection. A hierarchical regression analysis was used to determine the influence of certain predictive factors.

RESULTS

An HWE, organizational support for PI prevention, and positive attitudes toward PI prevention were significant predictors of good practice regarding PI prevention. However, knowledge of PI prevention was not a significant predictor.

CONCLUSIONS

To achieve optimal nursing quality in terms of PI prevention, hospital and nursing administrators should develop strategies or interventions to create and sustain an HWE and supportive organizational culture for ICU nurses and enhance positive attitudes toward PI prevention.

Intensive Care Nurses' Knowledge, Attitude, and Practice of Pressure Injury Prevention in China: A Cross-Sectional Study

Background

Pressure injury (PI) remains a critical health issue worldwide. The global incidence of hospital-acquired PI is 8.4%, and among intensive-care unit (ICU) patients, it is even higher, ranging from 6.60% to 36.80%. It is important to investigate ICU nurses’ PI prevention knowledge, attitudes, and practices (KAP).

Aim

The aim of this study was to describe the level of Chinese ICU nurses’ knowledge, attitudes, and self-reported practices of PI prevention.

Materials and Methods

From March 31 to April 30, 2019, we recruited a total of 510 ICU nurses into the current study using convenience sampling. The Modified Pressure Ulcer Knowledge Assessment Tool version 2.0, Attitudes toward Pressure Ulcer Prevention instrument, and Questionnaire to evaluate nurses’ Adherence to Recommendations for Preventing Pressure Ulcers were used for data collection. We used one-way analysis of variance, Student’s t-test, and the Mann–Whitney U-test to assess differences in knowledge, attitudes, and self-reported practices of PI prevention among ICU nurses, whom we categorized by their demographic characteristics.

Results

Mean scores of participants’ knowledge, attitude, and their self-report practice were 65.82 ± 9.29, 76.65 ± 8.62, and 83.35 ± 13.55, respectively. Participants with bachelor’s degrees or higher, who worked in tertiary hospitals, and who had received training on PI prevention over the last year had higher scored on PI prevention knowledge (all P < 0.05). Participants who had received training on PI prevention over the last year scored higher on attitude than those who had not received such training over the last year (P = 0.001).

Conclusion

ICU nurses surveyed in this study did not demonstrate an acceptable level of knowledge about PI prevention, while their attitudes and self-reported practices were acceptable. Continuing education or in-service training should be provided to enhance ICU nurses’ knowledge of PI prevention.

Effects of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients: A randomized clinical trial

Background & Aim: Most mechanically ventilated patients reported decreasing comfort during their treatments, especially in Muslim patients. Nursing comfort care needs to be addressed by integrating daily Islamic rituals to fulfill the spiritual need and promote holistic comfort of Muslim patients with mechanical ventilation. This study aimed to investigate the effect of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients. Methods & Materials: A pretest-postest with control group design was used. Fifty-six participants recruited from intensive care units of three public hospitals in Indonesia were randomly assigned into either the intervention group (n=28) or control group (n=28) by matching technique based on gender, age, and duration using a ventilator. Those in the intervention group received nursing comfort care developed based on Kolcaba’s Theory of Comfort integrating with the daily Islamic rituals, while those in the control group received usual care. Comfort was measured on the first day before receiving the intervention and on the second day after the intervention was completed by using Comfort Questionnaire for Mechanically Ventilated Patients (CQMVP). Results:  Data analysis using an independent t-test found no significant difference between the intervention and control groups at baseline (t = .134, p .894). The mean of comfort score of patients in the intervention group after receiving the intervention was significantly higher than those in the control group (t=6.70, p< .05).  Conclusion:  Nursing comfort care integrated with daily Islamic rituals increased comfort in Muslim patients while receiving mechanical ventilation. Thus, this nursing comfort care program can be recommended to use in practice.

Community Integration After Traumatic Brain Injury and Related Factors: A Study in the Nepalese Context

Introduction

Community integration is an essential component for rehabilitation among traumatic brain injury (TBI) survivors, which yields positive outcomes in terms of social activities, community participation, and productive work. A factor that usually facilitates community integration among TBI survivors is social support, whereas physical environment and fatigue are most often found as barriers.

Objectives

This study aimed to (1) describe the level of community integration, fatigue, physical environment, and social support of persons after TBI, and (2) examine the relationship between community integration and these three factors.

Methods

This is a descriptive correlational study. One hundred and twenty TBI survivors living in the communities of Province Number Three, Nepal were enrolled using the stratified sampling technique. The data were collected using the Community Integration Questionnaire, Modified Fatigue Impact Scale, Craig Hospital Inventory of Environmental Factors, and the Multidimensional Scale of Perceived Social Support. Descriptive statistics and Pearson's correlation were used to analyze the data.

Results

Community integration, fatigue, and physical environment showed a moderate level, while social support revealed a high level. Fatigue was significantly correlated with overall community integration, whereas physical environment was found to correlate with two subscales of community integration, home integration and productive activities.

Conclusion

To enhance the level of community integration among TBI survivors, health care providers, in particular rehabilitation nurses and community nurses, should plan and implement strategies such as follow-up appointments or continued rehabilitation at home.

Chronic pain experience and pain management in persons with spinal cord injury in Nepal

BACKGROUND AND AIMS

Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal.

METHODS

A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method.

RESULTS

The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs.

CONCLUSIONS

SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal.

IMPLICATIONS

This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.

PAIN INTENSITY AND PAIN INTERFERENCE AMONG TRAUMA PATIENTS: A LITERATURE REVIEW

Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference.Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients.Method: A systematic search of electronic databases (CINHAL, ProQuest, Science Direct, and Google scholar) was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age.Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference was assessed using Brief Pain Inventory (BPI). Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking.Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.

Symptom Experience and Quality of Life of Patients with Breast Cancer Receiving Chemotherapy in Bangladesh

Background: The present study was aimed to the relationships between symptom severity and distress and quality of life (QoL) of patients receiving chemotherapy for breast cancer.Objectives and methodology: A total number of 132 patients, attending both In-patient and Out-patient department and fulfilling the recruitment criteria were included in the study. A self-report questionnaire was used to collect data from the eligible participants by the primary investigator. The data were analyzed by using descriptive and inferential statistical tools. Results: On average, the participants of the study experienced seventeen symptoms with moderate level. The level of QoL of the participants was at moderate level (M=2.02, SD=0.39). Among all the subscales, the physical well-being had the lowest score and social well-being had highest score. Symptom experience and quality of life showed significant negative correlation. Conclusion: The patients with breast cancer would experience high symptoms during a 7-day period after receiving chemotherapy of the previous cycle. Nurses need to perform full measurement of multiple symptoms when care for breast cancer patients after the administration of chemotherapy.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.201-206