[The development of the multifunctional automatic rotating bed with process-monitoring]

We have developed a new rotating bed for the old and the paralised people. This rotating bed is composed of two bed heads at front and at end, bed boards, guardrails, an electric motor, a reducer, an induction locator and a set of electronic controls. With the preestablished program, the angle between the left/right bed board and the middle board is changed by rotating the left/right board around the rotation axis, and the gravity direction between the human body and the ground is changed by the rotation of the middle board as a whole, so that the middle bed board and the left and right ones will act respectively as supporters of weight of the person who is lying on his back or on his side. In this way, a person can turn over automatically, comfortably and naturally when he/she is asleep. This rotating bed meets the physiological needs of a sleeping person, and people with turning over problems can turn over in a comfortable and natural way by means of biotechnology. It can also improve the quality of sleep and help avoid decubitus. In addition, it can be used to promote the rehabilitation of those who are paralysed by reason of its passive exercising function.

A prospective study of early ambulation 90 minutes post-left heart catheterization using a retrospective comparison group

BACKGROUND

Despite a trend toward a reduction in bedrest time after left heart catheterization (LHC) in many Canadian centres, an evidence-based standard of practice has not been established. Canadian bedrest times range from two to four hours post-LHC. Two recent prospective non-randomized studies (n = 1,000) indicate safety of ambulation at 60 and 90 minutes post-LHC.

PURPOSE

The purpose of this study was to determine safety of ambulating patients at 90 minutes post-LHC sheath removal compared to the current practice of ambulation at three to four hours post-sheath removal.

DESIGN

The study was a prospective non-concurrent design with a retrospective control. METHOD/SAMPLE: Retrospective data from the APPROACH database and chart reviews were analyzed for a period of six months for the control group on the traditional three- to four-hour ambulation protocol (n = 402). Prospective data were gathered for six months for the experimental group (n = 193).

RESULTS

There was no difference in complication rates for the two groups.

CONCLUSIONS

The results suggest that early ambulation for selected patients at 90 minutes is safe and has the potential to increase both patient comfort and quality of care.

A mobility protocol for critically ill adults

Although the complications of immobility are well-described in the literature, critically ill patients are often subjected to prolonged periods of bed rest. Nurses, by virtue of their expertise in preventing iatrogenic complications, are in an ideal position to prevent the adverse outcomes associated with immobility. This article describes how nurses can use a mobility protocol to increase the activity of critically ill patients in a timely manner that may prevent the infirmity and suffering that is caused by unnecessarily long periods of bed rest.

Patient handling tasks with high risk for musculoskeletal disorders in critical care

Critical care nurses are at high risk for development of work-related musculoskeletal disorders (WMSDs). Many patient handling tasks in critical care require physical demands that may result in excessive internal forces, increasing the risk for WMSDs. There are solutions for performing these tasks safely, using technology. This article describes risk factors associated with high-risk patient handling tasks and presents solutions for reducing risk for WMSDs. Studies show that implementing a safe patient handling and movement program that incorporates new technology can pay for itself in a short period of time and provide long-term benefit for health care facilities and nursing staff.

Technology solutions for high-risk tasks in critical care

There are several high-risk nursing tasks in the critical care environment discussed in this article. These tasks include lateral transfers, repositioning patients up or side to side in bed, bed-to-chair or -wheelchair transfers, pericare of bariatric patients, toileting in bed, sustained limb holding for dressing wounds, and patient transport. Although many, if not all, of these tasks currently are performed manually, there are technological solutions available that undoubtedly can reduce the risks for caregiver and patient injuries. These solutions should be implemented in critical care to promote the safety of all involved in patient care.

Listening to the Voices of Hospitalized High-Risk Antepartum Patient

OBJECTIVE

To explore the needs of high-risk antepartum patients while hospitalized and to generate recommendations from the patients' perspective.

DESIGN

Qualitative descriptive.

PARTICIPANTS/SETTING

Thirteen female patients in a high-risk antepartum unit of a large tertiary hospital, Edmonton, Alberta.

DATA ANALYSIS

A qualitative data analysis process was followed.

RESULTS

The major themes and subthemes that emerged from interviews with participants included stressors associated with loss of control and feelings of being a burden. The need for privacy and sensitivity to family members was expressed. Participants' recommendations included being treated as a family unit, setting up accommodation for visiting family members, and wanting more organized activities to relieve boredom.

CONCLUSIONS

An understanding of the needs of high-risk antepartum patients while hospitalized from their perspective will help the primary caregiver such as the registered nurse improve the quality of the women's care, provide guidance about the management of stressors, and plan interventions to reduce stress and to involve their families.

Exploring the effects of wound dressings and patient positioning on skin integrity in a pediatric burn facility

Although literature on the subject is scant, in practice, pressure ulcers in the pediatric burn population remain a challenge. An interdisciplinary team at an urban pediatric burn institution treats a population (average age 8 years, range 1 month to 21 years) that includes children too young or unable to articulate pressure-related pain from dressings or positioning techniques. After pressure ulcer data collection procedures were instituted, it was observed that elastic bandages, wet operating room dressings, and positioning appeared to contribute to pressure ulcer occurrence. To better understand the patient's experience and educate staff, an informal study was conducted by an interdisciplinary committee of clinicians to assess the amount of pressure in mm Hg created on bony prominences by care procedures. Three staff members volunteered and were placed in elastic dressings and various commonly used positions for several minutes and three pressure measurements were obtained. Pressure readings of 40 and 56 mm Hg were common, causing pain and placing a person at risk for skin ulceration. The information was used to educate staff on how to maintain therapeutic efficacy without compromising skin integrity and causing pain. Lectures and hands-on demonstrations elucidated correct dressing application. The committee continues to provide education to all staff members on methods to prevent pressure ulcers from occurring in the high-risk burn patient population and ways to reduce the use of elastic wraps and improve patient positioning.

Handling of the Bariatric Patient in Critical Care: A Case Study of Lessons Learned

Bariatric admissions across the United States (US) are increasing at an alarming rate. The obesity epidemic costs the US health care system $70 billion per year. Many bariatric surgical and medical patients are admitted to critical care units. The mortality risks for these patients compared with non-bariatric patients is up to 2:1. Managing these patients is a challenge to health care nursing personnel. Patient size, care required, equipment technology, availability, and environmental space can increase risk for injury for nursing personnel and patients. The Health Sciences Center in Winnipeg shares a case study of an admission of a 697-lb patient, reviewing lessons learned, techniques, equipment, and difficulties.

Clinical skills: bed making and patient positioning

Providing a clean, comfortable bed and positioning a patient in the optimum posture for prevention of complications and to enable maximum independence are fundamental nursing skills. Bed-making is a daily routine that requires practical and technical skills. Selecting the correct posture for a patient in bed or in a chair is essential for physiological functioning and recovery. In this article bed-making is described, as are positioning and re-positioning in relation to patients in bed, armchairs and wheelchairs. Infection control and moving and handling issues are also considered.

Ventilator-associated pneumonia and pressure ulcer prevention as targets for quality improvement in the ICU

The health care culture must change. Florence Nightingale wrote [8] "deep-rooted and universal is the conviction that to give a medicine is to be doing something, or rather everything and to give air, warmth, cleanliness etc. is to do nothing." Hygiene care practices and mobility activities are fundamental and independent care components in the nursing profession. When implemented using available evidence, they can significantly improve patient outcomes. It is time to claim and demonstrate the importance of consistent delivery of the fundamentals of basic nursing care. Interventional patient hygiene is an effective framework to ensure the the basics of nursing care are consistently applied to improve patient outcomes.

Positioning practices for ventilated intensive care patients: current practice, indications and contraindications

To investigate the process of providing patient positioning in intensive care units (ICUs), a self-reported survey was distributed to a senior physiotherapist and a nurse in each of the 38 Level 3 Australian ICUs. The survey explored the rationales, aims, type, frequency and duration of directed patient positioning used, and perceived risks that may impede the implementation of an effective positioning regime. The response rate was 93%. Fifty nine respondents (83%) agreed that there is an accepted standard of care for the duration of a position change with ventilated patients. Of these respondents, 51 (86%) agreed that the standard is to turn patients every 2 hours, but this was only achievable "more than 50% of the time" in 47% (n=34) of ICUs. Educational and environmental issues were found to impact on positioning practices. Semi-recumbent and full side-lie positions were recommended in the management of a range of patient conditions. However, full side-lie was less commonly used than supine positioning. The prone and head down tilt positions were the least frequently utilised. Levels of agreement for precautions and contraindications to positioning patients into full side-lie and sitting were high. We conclude that, in Australia, experienced ICU physiotherapy and nursing staff are aware of evidence-based positioning practices and agree on indications and potential risk factors associated with positioning. However, educational and environmental resources are needed to improve the frequency and type of positioning used. Results from this survey can now be incorporated into educational tools to facilitate the safe use of positioning.

Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial

AIMS AND OBJECTIVES

To evaluate whether postponing preventive measures until non-blanchable erythema appears will actually lead to an increase in incidence of pressure ulcers (grades 2-4) when compared with the standard risk assessment method.

BACKGROUND

To distinguish patients at risk for pressure ulcers from those not at risk, risk assessment scales are recommended. These scales have limited predictive validity. The prevention of further deterioration of non-blanchable erythema (grade 1 pressure ulcer) instead of the standard way of assigning prevention could be a possible new approach.

DESIGN

Randomized-controlled trial.

METHODS

Patients admitted to surgical, internal or geriatric wards (n = 1617) were included. They were randomly assigned to an experimental and a control group. In the experimental group (n = 826), prevention was started when non-blanchable erythema appeared, in the control group (n = 791) when the Braden score was <17 or when non-blanchable erythema appeared. In both groups, patients received identical prevention, either by using a polyethylene-urethane mattress in combination with turning every four hours or by using an alternating pressure air mattress. Pressure points were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. The Braden scale was scored every three days.

RESULTS

In the experimental group, 16% of patients received preventive measures, in the control group 32%. The pressure ulcer incidence (grades 2-4) was not significantly different between the experimental (6.8%) and control group (6.7%).

CONCLUSION

Significantly fewer patients need preventive measures when prevention is postponed until non-blanchable erythema appears and those patients did not develop more pressure ulcers than patients who received prevention based on the standard risk assessment method.

RELEVANCE TO CLINICAL PRACTICE

Using the appearance of non-blanchable erythema to allocate preventive measures leads to a considerable reduction of patients in need of prevention without resulting in an increase in pressure ulcers.

Nursing care of the mechanically ventilated patient: what does the evidence say? Part one

The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.

Raising awareness of pressure ulcer prevention and treatment

PURPOSE

To provide the practitioner with updated information about pressure ulcers and their management.

TARGET AUDIENCE

This continuing education activity is intended for physicians and nurses with an interest in better understanding the scientific principles governing pressure ulcer development and treatment.

OBJECTIVES

After reading this article and taking this test, the participant should be able to: 1. Discuss the etiology and assessment of pressure ulcers. 2. Describe treatment options for pressure ulcers.

While You Are Waiting: a family-focused antepartum support program

While You Are Waiting is an antepartum support program developed for hospitalized, high-risk pregnant women. The goal of the program is to provide an atmosphere for the mother that will minimize the adverse effects of long-term activity restrictions and prolonged hospitalization. The program focuses on 4 key opportunities to promote optimal outcomes: education, support, recreation, and outreach. Details of the program and preliminary outcome data are provided.

When the goal is palliative care

OBJECTIVE

An analysis of the literature regarding palliative care of patients with wounds.

DATA SOURCES

Health care literature, including national and international reports, focusing on enhancing quality of life for individuals with wounds who are receiving palliative care.

CONCLUSION

The literature on palliative care of patients with wounds is limited. Integration of palliative care concepts and chronic wound management is challenging; however, palliative care, which focuses on comfort and symptom management for quality of life, can provide the best quality care within the parameters of disease and individual patient wishes.

NICE pressure ulcer guideline: summary and implications for practice

This article outlines the principle areas for consideration form the NICE (2005) guideline for pressure ulcer prevention and treatment. All key areas are included and recommendations made for their implementation into clinical practice. A conclusion is made that pressure ulcer prevention is a key indicator of quality care and that all professionals have a responsibility for its implementation.

Direct observations of nursing home care quality: Does care change when observed?

OBJECTIVES

Recent research demonstrates that care recorded by nursing home (NH) staff is often inaccurate. Direct observations of care may therefore be of critical importance in assessing and improving care in this setting. Unfortunately, despite their apparent use in several types of quality assurance activities, there is little written information about the reliability or accuracy of observational procedures in NHs. This paper provides information about one important measurement issue (reactivity) that is often cited as a limitation of observational procedures in measuring usual care practices accurately.

DESIGN

Descriptive.

SETTING

Seven nursing homes.

PARTICIPANTS

Staff and residents.

MEASUREMENTS

Direct observational time in bed; repositioning and feeding assistance.

RESULTS

Observational measures of care quality were stable over multiple observation periods and consistently detected quality problems even on the first and last days of observation.

CONCLUSION

Direct observations of care provided to residents do not appear to change provider behavior.

[Effects of backrest position on central venous pressure and intracranial pressure in brain surgery patients]

PURPOSE

This study was done to investigate the effects of backrest elevation of 0 degree and 30 degrees that minimize the risk of increasing ICP when CVP is measured.

METHODS

Subjects were sixty-four patients who stayed in the neurosurgical intensive care unit after brain surgery at two university-based hospitals. CVP, blood pressure, heart rate and ICP were measured along with position changes in order of backrest position with primary 30 degrees backrest position, 0 degree backrest position and secondary 30 degrees backrest position. For data analysis, one-group, repeated-measures analysis of variance design was used in SAS program.

RESULTS

Backrest elevations from 0 degree to 30 degrees did not alter the CVP without increasing the ICP. Therefore, 30 degrees backrest position is a preventive position without increasing ICP.

CONCLUSION

30 degrees backrest position might be appropriate for brain injury patients when CVP is measured.

Embracing technology? Using change management strategies to improve the use of continuous lateral rotation therapy

The purpose of this quality improvement initiative was to improve the utilization of continuous lateral rotation therapy (CLRT) in a nine-bed community hospital ICU within the context of a nurse-driven protocol. Nursing focus groups, analyzed using a strength, weakness, opportunity, threat (SWOT) approach, resulted in the implementation of four interventions over seven weeks. Change management strategies guided all aspects of the project. Results showed a modest increase in the utilization of CLRT. This initiative demonstrates that change management strategies may assist with the incorporation of technology into nursing practice by increasing empowerment and creating an attachment to and responsibility for outcomes.

Reduction of musculoskeletal injuries in intensive care nurses using ceiling-mounted patient lifts

The musculoskeletal injury (MSI) rate in the Richmond Hospital Intensive Care Unit (ICU) increased significantly in 2000 and 2001 by 130%. As part of a quality initiative program, the problem was identified, assessed, and a plan was developed that involved the installation of ceiling-mounted patient lifts (CMPL) and the incorporation of a patient positioning sling. The evaluation process included a survey given to the ICU nursing staff prior to the implementation of the CMPL and repeated three, six, and 18 months after implementation. The survey included questions about discomfort, fatigue, and frustration levels before and after a 12-hour shift, as well as any medical interventions such as use of medications, physician visits, physiotherapy, and massage therapy for work-related issues. The use of the lifts contributed to lower scores in fatigue, pain and frustration in addition to a reduction in medical visits. The results also demonstrated a significant reduction in work-related time loss claims while promoting a positive workplace environment.

Cost of hospital care for elderly at risk of falling

The variables that relate to cost of hospital care for a large sample of elderly patients at risk for falling are examined. The chief predictors of cost of hospitalization were medical, pharmacy, and nursing interventions. Use of nursing interventions, on average, raised the median hospital cost less than use of medical or pharmacy interventions. Using a standardized nursing language with the hospital's information system can provide nurses with information that demonstrates the cost effectiveness of their interventions.

Activity in the chronically critically ill

Although therapeutic activity prevents functional decline and reduces mortality, little is known about typical levels of activity among intensive care unit (ICU) patients. This report of a preliminary study describes typical therapeutic activity and compares the use of two measures of activity in a small sample of chronically critically ill adults. Type, frequency, and duration of therapeutic activity were measured simultaneously with direct observation and actigraphy. The only consistent activity documented was turning (frequency: 3 turns/8 hours; duration: mean average of 11 minutes). Analysis demonstrated acceptable agreement between the two measures of activity for both frequency and duration of therapeutic but not for type of activity. Congruence between measures for duration of activity was also supported. This study provides information for investigators and practitioners who are interested in measuring or implementing therapeutic activity in selected critically ill adults.

Positioning critically ill patients in hospital

Although moving and handling is an important aspect of nurse training, the emphasis is often more on the health and safety of the nurse than on the importance of the correct therapeutic positioning of patients. This article outlines optimum patient positioning in different critical care settings and for different medical conditions.

Bed-rest post-femoral arterial sheath removal - What is safe practice? A clinical audit

Numbers of patients undergoing coronary angiography and angioplasty procedures have increased in England due to targets within the National Service Framework for Coronary Heart Disease. Little evidence is available regarding optimal bed-rest duration for patients post-femoral arterial sheath removal following these procedures. Through literature review and clinical benchmarking, we aimed to identify what best practice was in the UK and whether bed rest times at our centre could be reduced without increasing complications to enable increased day case procedures. An audit tool was designed to collect data regarding method of obtaining haemostasis, length of bed-rest post-sheath removal and any post-procedural complications experienced by the patient. From a convenience sample of consecutive patients, 195 complete sets of baseline data revealed an average (median) period of 6-h bed rest. This was reduced to 3h and audit repeated yielding 176 complete data sets using the same audit tool. Femoral wound site complication rates were not significantly affected by reducing bed-rest time for diagnostic or interventional procedures. These findings contributed to an important change in practice, reducing length of stay post-procedure and should be re-explored due to increased use of femoral arterial closure devices.

Differences in European critical care nursing practice: a pilot study

The purpose of this pilot study was to determine if there are differences in nursing practice between critical care units across Europe, if these practices are related to the perceived level of incorporation of evidence into nursing practice and/or to regional differences. Nurses attending the nursing session of the bi-annual conference of the European Society of Intensive Care Medicine were asked to fill out a two page questionnaire which addressed five areas of practice: physical care, pain management, monitoring, weaning and ethical issues. Some differences were found between regions although there were no differences in the perception of whether these protocols were evidence-based.

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

AIMS AND OBJECTIVES

To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers.

BACKGROUND

The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress.

DESIGN

A prospective randomized pre/post-test experimental design.

METHODS

Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards.

RESULTS

Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi2 = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi2 = 0, P = 0.987).

CONCLUSIONS

Clear, concise written instruction improved practice but verbal education was not additionally beneficial.

RELEVANCE TO CLINICAL PRACTICE

Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Help! My Orthopaedic Patient is Pregnant!

Caring for a pregnant patient is a possibility in every field of nursing. Understanding the effects various illnesses may have on pregnancy and vice versa is important in preventing damage to the fetus and/or complications for the pregnant woman. This article assists orthopaedic nurses to practice proactively and anticipate problems during the care of the pregnant patient and avoid undesirable outcomes. Selected physiologic changes in pregnancy and their implications of orthopaedic conditions are described. Implications for nursing care with pregnant women with an orthopaedic condition are also discussed.