Virpi Hantikainen

Physical Restraint: a descriptive study in swiss nursing homes

This article focuses on the reasons for using physical restraints, their prevalence and nurses’ experiences of their use. The data were collected by means of a questionnaire from nurses, trained nurse’s aids and auxiliary staff (n = 173) in seven Swiss nursing homes. The results showed that physical restraints are used in nursing units, the mean number of restrained residents in each being 3.7 (SD 3.9). However, nursing staff did not necessarily understand and consider the term ‘restraint’ as a restrictive device in its negative sense. The most common reasons indicated for the use of restraint were related to the protection and safety of the residents themselves, the prevention of disturbance of other residents, and the residents’ restlessness and aggressiveness. As for the reasons related to staffing, reference was made to understaffing, a lack of competence on the part of nurses, and the demands of residents, their next of kin and doctors. It was not common practice to inform the elderly residents that they would be restrained, and therefore they were not always aware of what was happening to them and why. Twenty-nine per cent of the respondents reported that the flexibility of their work was affected by the use of physical restraint.

Prevalence of symptoms, with a focus on fatigue, and changes of symptoms over three months in outpatients receiving cancer chemotherapy

QUESTIONS UNDER STUDY Prevalence of symptoms, with a focus on fatigue, and changes of symptoms were explored over three months in outpatients with lymphoma, lung, breast or colorectal cancer, receiving chemotherapy in the oncology outpatient clinic of a Swiss tertiary care hospital. METHODS Prospective, descriptive design; symptom prevalence was measured at start of chemotherapy (T1), and one week prior to the third and fourth cycle (T2, T3). Included were patients starting chemotherapy, with expected survival of >3 months, irrespective of stage of disease. The Memorial Symptom Assessment Scale was used to assess 32 symptoms; fatigue was measured with the FACIT-Fatigue Scale (negative scale). Data were analysed using descriptive statistics and random-intercept regression models. RESULTS 77 patients participated at T1, 58 and 50 at T2 and T3. Patients experienced on average 9.8, 14.4, and 13.7 symptoms, showing a significant increase over time. Lack of energy and feeling drowsy were most frequent. Symptom scores for lack of energy, changes in skin, pain, and feeling drowsy remained >2 over time (scale 0-4, higher scores = more symptoms). Fatigue mean scores were 36.3, 30.2, and 31.3, showing a significant increase of fatigue over time. Individual symptom trajectories varied widely within and among patients. CONCLUSIONS High symptom prevalence at start of chemotherapy as well as over time and great variability in symptom experience call for an individual, systematic symptom assessment and management that does not focus solely on side-effects of therapy but includes disease-related symptoms to achieve satisfactory control of symptoms in outpatients receiving chemotherapy.

Studying feasibility and effects of a two-stage nursing staff training in residential geriatric care using a 30 month mixed-methods design [ISRCTN24344776]

BackgroundTransfer techniques and lifting weights often cause back pain and disorders for nurses in geriatric care. The Kinaesthetics care conception claims to be an alternative, yielding benefits for nurses as well as for clients.Starting a multi-step research program on the effects of Kinaesthetics, we assess the feasibility of a two-stage nursing staff training and a pre-post research design. Using quantitative and qualitative success criteria, we address mobilisation from the bed to a chair and backwards, walking with aid and positioning in bed on the staff level as well as on the resident level. In addition, effect estimates should help to decide on and to prepare a controlled trial.Methods/DesignStandard basic and advanced Kinaesthetics courses (each comprising four subsequent days and an additional counselling day during the following four months) are offered to n = 36 out of 60 nurses in a residential geriatric care home, who are in charge of 76 residents. N = 22 residents needing movement support are participating to this study.On the staff level, measurements include focus group discussions, questionnaires, physical strain self-assessment (Borg scale), video recordings and external observation of patient assistance skills using a specialised instrument (SOPMAS). Questionnaires used on the resident level include safety, comfort, pain, and level of own participation during mobilisation. A functional mobility profile is assessed using a specialised test procedure (MOTPA).Measurements will take place at baseline (T0), after basic training (T1), and after the advanced course (T2). Follow-up focus groups will be offered at T1 and 10 months later (T3).DiscussionTen criteria for feasibility success are established before the trial, assigned to resources (missing data), processes (drop-out of nurses and residents) and science (minimum effects) criteria. This will help to make rational decision on entering the next stage of the research program.Trial RegistrationCurrent Controlled Trials ISRCTN24344776.

Prevalence and contributors to fatigue in individuals hospitalized with advanced cancer: A prospective, observational study

BACKGROUND Although fatigue affects over 75% of patients with advanced cancer, changes over time in symptoms and antecedents have not been described in the acute care setting. OBJECTIVES To determine the prevalence, in patients with advanced cancer, of fatigue and anaemia on admission, describe strategies used to treat anaemia, observe changes in fatigue over ten days, and determine factors associated with fatigue. DESIGN Prospective, observational study. SETTINGS AND PARTICIPANTS In two Swiss tertiary care hospitals, a convenience sample of patients (N=103) was recruited at admission and followed up at days six (n=76) and ten (n=53). Patients were admitted because of new and/or worsening symptoms, deteriorating health status, or complications. They received measures aimed at symptom control and disease modifying interventions. METHODS Clinical and sociodemographic data were collected on selected patients who were able to complete a test battery of validated measures. Assessment was undertaken on hospital admission and on days six and ten post-admission. FINDINGS At admission, according to the suggested cut-off score of 43 for the FACIT-Fatigue scale, 87% of participants were experiencing cancer-related fatigue. Fatigue varied greatly within and among patients. Data on anaemia were available for 100 patients, of whom 62% were anaemic on admission. Severe and life threatening anaemia were mostly treated with red blood cell transfusions. Over time, fatigue decreased for patients who improved enough to be discharged (p<0.001) but not for those who withdrew from the study, most of whom did so due to worsening health. In multiple regression analysis, younger patients and patients with lower functional status, higher scores for depression, and more other anaemia-related symptoms experienced more fatigue. The variables examined explained 62% of variance in fatigue. CONCLUSIONS Fatigue was common in hospitalized patients with advanced cancer and the majority were anaemic. Based on these data, monitoring and treating fatigue and anaemia over a ten-day hospital stay seem to be supported. The variable trajectories call for interventions carefully tailored to individual patients. The results should be considered as a first step to exploring fatigue in these patients.

Entwicklung und testtheoretische Analyse eines Erhebungsinstruments zu Präferenzen und Erleben von Patienten in Bezug auf die Beteiligung an pflegerischen Entscheidungen im Akutspital

Patientenorientierung und Patientenbeteiligung sind wichtige Aspekte der modernen Gesundheitsbetreuung, die im Rahmen der pflegerischen Entscheidungsfindung berucksichtigt werden sollten. Auch im K...

Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

BackgroundModern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older persons experiences later in life. More specific, this study has the following objectives: (1) to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2) to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use), living situation, and survival after discharge and at 6 and 12 months of follow-up.Methods/DesignA prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group). Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group.DiscussionLittle research has focused on long term consequences after ICU admission in older critically ill patients. The present study is specifically focussing on long term consequences of stress factors experienced during ICU admission.Trial RegistrationISRCTN52754370

Die Bewegungsunterstützung nach Kinästhetik® und die Entwicklung und Förderung von Körperwahrnehmung, Bewegungsfähigkeiten und funktioneller Unabhängigkeit bei alten Menschen

Diese Fallstudie untersuchte, ob die Bewegungsunterstutzung nach Kinasthetik® die Korperwahrnehmung, Bewegungsfahigkeiten und funktionelle Unabhangigkeit bei alten Menschen mit Bewegungseinschrankungen fordern kann. Zwei Bewohner eines Altersheims, die nach einem Schlaganfall eine starke Abhangigkeit (Barthel Stufe II; 20–60 Punkte) zeigten und die nicht vorher nach kinasthetischen Prinzipien gepflegt wurden, nahmen an dieser Studie teil. Ein viermonatiger Follow-up mit Einschatzung der Ausgangssituation, Interventionen und monatlichen Evaluationen (n = 4) wurde durchgefuhrt. Funktionelle Unabhangigkeit wurde mittels Barthel-Index bewertet wie auch mittels unstrukturierter Beobachtung zur Erhebung qualitativer Informationen. Eine deutlich beobachtbare Verbesserung der Informationsverarbeitung, der Korperwahrnehmung und der Bewegungsfahigkeiten wurde bei beiden Untersuchungspersonen festgestellt. Die mit dem Barthel-Index erfassten funktionellen Aspekte bei den Alltagsaktivitaten zeigten eine nur wenig erh...

Long-term consequences of pain, anxiety and agitation for critically ill older patients after an intensive care unit stay

AIMS AND OBJECTIVES This study investigated whether an intensive care unit (ICU) stay is associated with persistent pain, anxiety and agitation in critically ill older patients. BACKGROUND Patients hospitalised in the ICU are at risk for experiencing pain, anxiety and agitation, but long-term consequences for older patients have rarely been investigated. DESIGN Prospective nonrandomised longitudinal study. METHODS Pain, anxiety and agitation, measured with a numeric rating scale (0-10), were assessed in older patients (≥65 years) hospitalised in the medical-surgical ICU of a university hospital. Agitation during the ICU was assessed with the Richmond Agitation-Sedation Scale. Data collection occurred during the ICU, one week after the stay and six and 12 months after hospital discharge. Data were collected from an age-matched community-based comparison group at recruitment and after six and 12 months. Study recruitment took place from December 2008-April 2011. RESULTS This study included 145 older patients (ICU group) and 146 comparison group participants. Pain was higher in the ICU group one week after discharge, although pain levels in general were low. Both groups reported no or low levels of pain after six and 12 months. Anxiety levels in general were low, although higher in the ICU group one week after ICU discharge. After six and 12 months, anxiety in both groups was comparable. Throughout the study, levels of agitation were similar in both groups. CONCLUSIONS Critically ill older patients did not experience increased pain, anxiety or agitation 12 months after an ICU stay. RELEVANCE TO CLINICAL PRACTICE This study positively shows that an ICU stay is not associated with persistent pain, anxiety and agitation thus providing additional information to older patients and their families when making intensive care treatment decisions. Adequate management of pain during and after an ICU stay may minimise the suffering of older patients.

Präferenzen und Erleben von Patienten zur Beteiligung an pflegerischen Entscheidungen im Akutspital – Eine Analyse der Übereinstimmung von Präferenz und Erleben sowie der Einflussfaktoren bezogen auf verschiedene Entscheidungstypen

Die Patientenpraferenzen zur Beteiligung an pflegerischen Entscheidungen stellen einen zentralen Aspekt des Konzepts Evidence-based Nursing dar, welcher in der quantitativen Forschungsliteratur noc...

Healthcare resource utilisation by critically ill older patients following an intensive care unit stay.

AIMS AND OBJECTIVES This study examines the utilisation of healthcare resources by critically ill older patients over one year following an intensive care unit stay. BACKGROUND Information on healthcare resource utilisation following intensive care unit treatment is essential during times of limited financial resources. DESIGN Prospective longitudinal nonrandomised study. METHODS Healthcare resource utilisation by critically ill older patients (≥65 years) was recorded during one year following treatment in a medical-surgical intensive care unit. Age-matched community-based participants served as comparison group. Data were collected at one-week following intensive care unit discharge/study recruitment and after 6 and 12 months. Recorded were length of stay, (re)admission to hospital or intensive care unit, general practitioner and medical specialist visits, rehabilitation program participation, medication use, discharge destination, home health care service use and level of dependence for activities of daily living. RESULTS One hundred and forty-five critically ill older patients and 146 age-matched participants were recruited into the study. Overall, critically ill older patients utilised more healthcare resources. After 6 and 12 months, they visited general practitioners six times more frequently, twice as many older patients took medications and only the intensive care unit group patients participated in rehabilitation programs (n = 99, 76%). The older patients were less likely to be hospitalised, very few transferred to nursing homes (n = 3, 2%), and only 7 (6%) continued to use home healthcare services 12 months following the intensive care unit stay. CONCLUSIONS Critically ill older patients utilise more healthcare resources following an intensive care unit stay, however, most are able to live at home with no or minimal assistance after one year. RELEVANCE TO CLINICAL PRACTICE Adequate healthcare resources, such as facilitated access to medical follow-up care, rehabilitation programs and home healthcare services, must be easily accessible for older patients following hospital discharge. Nurses need to be aware of the healthcare services available and advise patients accordingly.