Jeanne Flannery

Meeting the needs of rural families during critical illness: the APN's role.

Family needs during critical illness have been a major focus of nursing research, yet the unique needs of families living in rural America still need to be investigated. This study sought to identify the needs of families in rural southern Appalachia and compare these findings to those from a study that identified the needs of families in a large metropolitan medical center. We found 13 needs to be significantly different between the rural and urban samples and suggest strategies that rural and urban critical care nurses and advanced practices nurses can use to care for families of critically ill patients from rural areas.

Limb loss: Alterations in body image

An estimated 10% of persons older than 70 years have peripheral vascular disease. Peripheral vascular disease includes venous and arterial medical conditions. Peripheral arterial disease (PAD) is a major concern in assessment of patients for loss of limb. With the ever increasing numbers of senior citizens in the United States today, a major public health concern is the management of chronic health problems. Many persons who have progressive PAD as a result of circulatory changes eventually are forced to have a limb amputated. This amputation triggers the realization of the loss of the limb, which directly influences body image. Therefore, management of the effect of limb loss on body image becomes a major nursing consideration in health promotion/health maintenance endeavors by health care professionals. This article explores the concepts of limb loss and body image. The relationship between PAD and limb loss is established. The conceptual link between limb loss and body image alteration is described, with emphasis on the importance of nursing interventions to manage body image alterations. Pathophysiologic conditions leading to PAD and limb loss are reviewed. Nursing implications for management of body image alterations with limb loss are summarized.

Cognitive-behavioural stimulation protocol for severely brain-damaged patients in the post-acute stage in developmental age.

Purpose. To present a cognitive-behavioural stimulation (CBS) protocol designed to help severely damaged patients in the early post-acute stage by describing the underlying methodology and assessing its efficacy compared to traditional rehabilitation methods. This protocol combines multisensory stimulation and cognitive-behavioural techniques to elicit and intensify the occurrence of adaptive responses and reduce maladaptive behavioural patterns. Methods. A control group and an experimental group – both evaluated with the Levels of Cognitive Functioning Assessment Scale (LOCFAS) – were compared at the beginning of the rehabilitation programme and at the end of it. The control group consisting of patients assessed and treated before receiving the CBS protocol was enrolled in a traditional rehabilitation programme (only physical therapy and speech therapy). Besides the traditional therapy, the experimental group also received the CBS protocol. Results. Patients on the CBS protocol show a greater improvement and are therefore more responsive than the control group after the 16-week remediation programme. The mean LOCFAS improvement of the experimental group is more marked during the first month of rehabilitation and is associated to the entry LOCFAS level, while in the control group the improvement on LOCFAS is considered to be ‘spontaneous’ and is associated to the aetiology of the brain damage. Conclusions. Our results show a better initial outcome for patients receiving the CBS protocol.

coping Strategies of Rural Families of Critically Ill Patients

ABSTRACT This study explored the coping strategies of families of critically ill patients in a rural Southern Appalachian setting. A convenience sample of 30 family members of 22 critically ill patients in two rural hospitals completed the Jaloweic Coping Scale. The five most frequently used coping methods were helping, thinking positively, worrying about the problem, trying to find out more about the problem and trying to handle things one step at a time. The five most effective coping strategies were talking the problem over with friends, praying, thinking about the good things in life, trying to handle things one step at a time and trying to see the good side of the situation. Findings contradicted many of the more “negative” descriptions of Appalachian people in the literature. Similarities outweighed differences when comparing the coping styles of rural and urban populations. Findings suggest that coping strategies must be considered for positive outcomes in the delivery of care to such a rural population.

Pharmacologic Prophylaxis and Treatment of Stress Ulcers in Critically Ill Patients

Most clinicians agree that critically ill patients are at significant risk of developing stress-related ulcers and may have already developed mucosal lesions even if they are asymptomatic. Many options, including new pharmacologic advances, are available for the treatment and prophylaxis of stress-related ulcers; therefore, all critically ill patients should receive prophylaxis, even if they do not require treatment. Nutrition may play a significant role in the future in preventing stress-related ulcers. By improving stores of critical elements such as antioxidants, vitamins, and minerals before surgery, patients may lower the risk of developing stress ulcers. Critical care clinicians are critical in preventing and treating stress-related ulcers and should be vigilant in their patient care.

The student process for success: the nursing care plan.

Written nursing care plans are designed to focus students on individualizing nursing care, which promotes critical thinking and decision making. In actual practice, emphasis has shifted from care plans toward standards of care. The authors discuss a concise, simplified care plan format that includes both standards of care and collaborative problems. This plan of care is compatible with healthcare regulations and requires less time to produce and evaluate.

Hypercholesterolemia: A Look at Low-Cost Treatment and Treatment Adherence

PURPOSE To determine whether a positive cholesterol-lowering effect could be achieved with a psyllium dose of 6 grams per day instead of the usual 10 grams per day as advocated by other researchers. DATA SOURCES Randomized trial of 46 males and females with hypercholesterolemia; multivariate analysis of variance with repeated measures on 1 factor done on 28 subjects (18 in treatment group, 10 in control group) remaining after 16 weeks of treatment. CONCLUSIONS Lipoprotein analysis at 2, 8, and 16 weeks indicated that a daily dose of 6 grams of psyllium hydrophilic mucilloid did not significantly affect serum total cholesterol nor low-density lipoproteins in either men or women with hypercholesterolemia. The effects of psyllium on hypercholesterolemia appear to be dose dependent. PRACTICE IMPLICATIONS Although it is a low cost option, the addition of psyllium to the diet has unpleasant side-effects, including abdominal distention, flatulence, and discomfort. Because these side effects are troublesome, the lowest effective dose of psyllium may be an important factor in improving treatment adherence.

Undertreatment of women with heart failure: a reversible outcome on hospital readmission.

Heart Failure (HF) is now an epidemiologic nightmare, with a higher prevalence in older women. Overall, within the population, more women have HF even with age-adjusted rates for both sexes. There is evidence that men and women with HF differ with respect to epidemiology, etiology, diagnosis, prognosis, and treatment. Yet, current diagnosis and treatment do not address the gender differences, resulting in the clinical instability of women after discharge and the high rate of unnecessary hospital readmissions within 90 days. Clinical nurse specialist case managers (CNSCMs) are integral in closing the gap for quality outcomes for this population. With patient advocacy, comprehensive monitoring and postdischarge follow-up, and utilization of current research to establish evidence-based practice, outcomes can be markedly improved.

Reflex sympathetic dystrophy syndrome: An update

RSDS is a complicated condition that requires early diagnosis and treatment for a favorable prognosis. The nurse should be alert to clinical signs in a patient with a traumatized area and report them to the physician as soon as possible. Management of the pain and establishment of trust will help promote successful physical therapy for the patient. The nurse should coordinate and manage the total care of the patient so that emotional and physical care can be at an optimum level for the patient and the patients family.

Focus on Excellence: Decision Making in Rehabilitation Nursing

&NA; This article describes the conceptual framework, design, implementation, and evaluation of a series of workshops for rehabilitation nurses in which the Decision Profile, a practical model for clinical decision making, was used. Evaluations confirmed that the approach was exceptionally effective, not only in engaging the audience and presenting information that would assist in continued professional development, but also in validating and supporting the participants’ intuitive processes and decision‐making patterns through analyses presented by experts.