Sonya R. Hardin

The quality of life of hospice patients: Patient and provider perceptions

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients’ symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients’ levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support. The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure. The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.

Urinary incontinence and overactive bladder in patients with heart failure.

PURPOSE We explored the nature of the relationship between heart failure and urinary symptoms, specifically urinary incontinence and overactive bladder. MATERIALS AND METHODS An 81-item written survey about urinary incontinence, urgency, frequency, nocturia and other symptoms was administered to hospitalized and clinic patients with heart failure. A medical records review was also conducted to determine types of medications, body mass index and documentation of the New York Heart Association Classification of heart failure. RESULTS Of 408 respondents 296 (average age 62.2 years) had information about heart failure stage and urinary symptoms. Of these respondents 45% and 57% reported urinary incontinence and overactive bladder, respectively. Adjusted odds ratio for having overactive bladder over no symptoms for respondents with New York Heart Association Class III or Class IV heart failure was 2.9 (95% CI 1.344-6.250) and for higher fatigue-depression composite was 2.155 (95% CI 1.206-3.860). Adjusted odds ratio for having overactive bladder over frequency/nocturia for respondents with higher body mass index was 1.458 (95% CI 1.087-1.953) and for higher fatigue-depression composite was 1.629 (95% CI 1.038-2.550). CONCLUSIONS Urinary incontinence and overactive bladder are prevalent in patients with heart failure. Evidence of late stage heart failure, higher fatigue-depression composite and higher body mass index were associated with overactive bladder. Sex, age and diuretic use were not associated with urinary incontinence and overactive bladder.

Distance Learning: Issues Emerging as the Paradigm Shifts

The resurgence in popularity of complementary and alternative therapies in the United States in the late 20th century is an issue to be recognized and discussed. At the beginning of this century, complementary and alternative therapies were the rule rather than the exception. As Western medicine grew throughout this century, there was less reliance on folk healing therapies. People seem to be seeking a simpler, less complex way of handling life events. To this end, alternative therapies such as acupuncture, chiropractic, and homeopathy are more available and are used by more people. Complementary therapies of massage, relaxation, meditation, and imagery are accepted as useful healing aids. Within this issue, there is an exploration of alternativelcomplementary therapies and the relationship to four nursing theories.

Atrial fibrillation among older adults: pathophysiology, symptoms, and treatment.

Atrial fibrillation is the most common arrhythmia among older adults. Valvular heart disease, dilated cardiomyopathy, aortic stenosis, hypertension, coronary artery disease, pericarditis, thyrotoxicosis, pulmonary disease, cardiac surgery, alcohol excess, and alcohol withdrawal are associated with atrial fibrillation. Nurses caring for older adults need to understand the conditions pathophysiology, signs and symptoms, diagnostic data and treatment protocols, and adherence issues to prevent the formation of emboli in chronic atrial fibrillation and to understand treatment of this common arrhythmia. This article presents an individual example of an elderly man exhibiting a new onset of atrial fibrillation and the interventions required to manage the associated complications. Atrial fibrillation places patients at risk for stroke from a thromboembolism; thus, pharmacological and nonpharmocological care strategies for managing patients with atrial fibrillation are discussed.

Advanced practice nursing: playing a vital role.

To clarify the education preparation of advanced practice nurses, a survey of all 50 states was performed. Results show a high degree of variability from state to state in tracking advanced practice nurses. Standardizing the educational preparation for the nurse practitioner, clinical nurse specialist, certified nurse midwife and the certified registered nurse anesthetist will clarify advanced practice nursing.

Comparison of characteristics of heart failure by race and gender.

Heart failure (HF) affects almost 4.8 million Americans, occurring in men and women of all races. Half of those with HF are women; of the African Amercian population, almost 3% are affected by HF. Although recent HF research has focused on women and minorities, information is still needed regarding differences by race and gender. The purpose of this study was to compare risk factors and physiologic differences by race (African American and Caucasian) and gender that exist in those with HF.

Sex-related differences in heart failure

Heart failure (HF) is a complex syndrome that is generally defined as cardiac output not adequate to meet the circulatory demands of the body. HF is at the end of the continuum of cardiovascular disease and preceded by an initiating event such as myocardial infarction, untreated hypertension, idiopathic cause, congenital heart disease, or pulmonary hypertension. In recent years, research has revealed differences in various aspects of HF between men and women including risk factors, pathophysiology, clinical manifestations, and response to treatment. Therefore, the purpose of this review is to review these sex-related differences between men and women who live with HF.

Inpatient Fall Prevention: Use of In-room Webcams

Objectives Patient falls are a challenging safety and quality issue in acute care settings. This study compared inpatient falls on medical-surgical units with and without Webcams and assessed the Morse Risk Assessment (MRA) for effectiveness in identifying fall risk. Methods Ten hospitals in one health system that exceeded the benchmark for falls were chosen for a 6-month study. One medical-surgical unit in each of the 10 hospitals was randomly assigned to an intervention or control group. The intervention group used Webcams that viewed the bed with a central monitoring system. A “virtual bed rail” function was used for those patients with a Morse Risk Assessment (MRA) of greater than 25. Results Consent rate was 20.7% for the intervention group. A significant difference (P ⩽ 0.05) between groups was found in fall rate per 1000 admissions, but no significant difference was found in fall rate per 1000 patient days. The Morse Risk Assessment was a significant predictor of risk. Conclusions Webcams are one option to increase surveillance for high-risk patients. The use of the MRA with a 50+ score for high risk is recommended. More research is needed on patient acceptance of this form of intervention and effectiveness in preventing falls on various inpatient units or with specific age groups.

Engaging Families to Participate in Care of Older Critical Care Patients

Provision of optimal outcomes for older adults can be understood through the use of the American Association for Critical-Care Nurses Synergy Model. These outcomes can be enhanced if strategies are designed to improve the characteristics of patients and families as described in the Synergy Model. When older adults are admitted to critical care units, spouses, children, and friends are in a position to participate in care. This column examines the Synergy Models patient characteristic of participation in care relative to involvement of the family and significant others of the older patient as a method of enhancing optimal outcomes.

A story of Pick's disease: A rare form of dementia

&NA; Picks disease is a progressive illness that affects brain function, eventually causing loss of verbal skills and problem‐solving abilities. Picks disease accounts for 5% of all dementias. The most common symptoms involve personality, behavior, and language changes. Diagnosis can be difficult; a differential diagnosis often requires several years. Frequently, the disorder is initially diagnosed as stress, depression, or Alzheimers disease. A magnetic resonance imaging scan will show atrophied portions of the frontal and temporal lobes. One of the most difficult aspects of care for someone with Picks disease is communication. The communication styles of nurses can alleviate the anxiety experienced by a person with Picks disease. Nurses should try different strategies as an approach to communicating and caring for someone with Picks disease, remembering that each person suffering from dementia is different. Picks disease can be emotionally devastating to the families of those who develop this disease. Working with families confronting the disability of a loved one is perhaps the greatest challenge for nurses. Nurses have the responsibility of educating the primary caregiver about nutrition, skin protection, incontinence care, safety, and end‐of‐life decisions.