Achieving eating independence in an acute stroke ward : Developing a collaborative care plan

Aim: This article outlines the development and implementation of a collaborative feeding care plan (FCP) for stroke patients in an acute stroke ward. The aim of this pilot study was to evaluate the impact of an ecological intervention to improve eating independence in an acute stroke ward environment. Methods: An action research approach comprising seven stages—determine the initial problem, develop the care plan, act, reflect and monitor progress, evaluate, reflect, and refine plan—was used to track environmental changes during the development and implementation of the FCP in an acute stroke ward in an Australian regional hospital. During the evaluation phase, six allied health staff completed a survey on the FCP. The staff also completed an observation assessment integrating the Eating Disability Scale, Functional Independence Measure and Canadian Occupational Performance Measure with 12 participants with acute stoke (participants with FCP=6; participants without FCP=6). Results: The FCP group showed significant improvements in upper limb independence (p=0.046), when comparing mean admission scores (3.5±0.97) with discharge scores (4.17±2.14). Clinically significant improvements in levels of collaboration between health professionals were also demonstrated. Conclusions: The changes in team collaboration and the patient’s upper limb independence indicate how environmental change can influence acute stroke patient outcomes. It is recommended that this study be expanded to further explore the effect of ecological interventions and change.

Repeated acute activation of the hypothalamo-pituitary adrenal axis prior to and during estrus did not affect reproductive performance in gilts

We investigated the effects of repeated acute activation of the hypothalamo-pituitary adrenal axis, prior to and during estrus, on reproduction in gilts. Individual gilts (n = 24 per treatment) either served as controls or were subjected to daily acute stress ("negative handling," brief electric shock with a battery-operated prodder during confinement with the experimenter) commencing, on average, 8 days prior to estrus. Gilts subjected to negative handling had a significant elevation in plasma concentrations of cortisol that lasted at least 3-4 h, and these gilts were slower than control gilts to approach and interact with the experimenter in a standard test. Nevertheless, reproductive performance--as measured by sexual receptivity and proceptivity, ovulation, the percentage of gilts that became pregnant, the number of embryos 20-21 days after insemination, and the weight of embryos--was not affected by repeated acute activation of the hypothalamo-pituitary adrenal axis. Our results suggest that repeated acute activation of the hypothalamo-pituitary adrenal axis prior to and during estrus does not affect the factors that control estrus and ovulation in gilts.

Sustained but not repeated acute elevation of cortisol impaired the luteinizing hormone surge, estrus, and ovulation in gilts

We tested the hypothesis that sustained and repeated acute elevation of cortisol would impair the LH surge, estrus, and ovulation in gilts. Cortisol was injected intramuscularly, to achieve a sustained elevation of plasma concentrations of cortisol, or intravenously, to achieve an acute elevation of plasma concentrations of cortisol. Control gilts received i.m. injections of oil and i.v. injections of saline. These treatments were administered to gilts (n = 6 per treatment) at 12-h intervals from Days 7 to 11 of the estrous cycle until after estrus ceased or until Day 27 or 28 of the estrous cycle, whichever came first. The repeated acute elevation of cortisol had no effect on the LH surge, estrus, or ovulation. In contrast, when the elevation of cortisol was sustained, the LH surge, estrus, and ovulation were inhibited. We conclude that cortisol is capable of direct actions to impair reproductive processes in female pigs but that plasma concentrations of cortisol need to be elevated for a substantial period for this to occur.

Inhibition of the secretion of LH in ovariectomised pigs by sustained but not repeated acute elevation of cortisol in the absence but not the presence of oestradiol

Prolonged stress is known to impair reproduction. It has been proposed that reproduction will also be impaired when a severe acute stress occurs during a period of elevated plasma concentrations of oestradiol, such as during the follicular phase of the oestrous cycle. In this experiment, we hypothesised that repeated acute and sustained elevation of cortisol would suppress the secretion of LH in ovariectomised pigs and that these effects would be enhanced in the presence of oestradiol negative feedback. Cortisol (or vehicle) was administered 12 hourly to ovariectomised pigs (n=6/treatment) for 8 days in the absence of oestradiol treatment and for a further 8 days during treatment with oestradiol. Vehicle was administered to 'control' pigs, 10 or 20 mg cortisol was administered i.v. to pigs to produce 'repeated acute' elevation of cortisol and 250 mg cortisol was administered i.m. to pigs to give a 'sustained' elevation of cortisol. Both before and during treatment with oestradiol, plasma concentrations of LH were monitored on the day before treatment, on the 4th and 8th days of treatment and following an i.v. injection of GnRH at the end of the 8th day of treatment. The repeated acute elevation of cortisol did not impair any parameters of LH secretion (i.e. mean plasma concentrations of LH, pulse amplitude or frequency, pre-LH pulse nadir or the LH response to GnRH) in the absence or in the presence of oestradiol. In contrast, when the elevation of cortisol was sustained, the mean plasma concentrations of LH and the pre-LH pulse nadir were significantly (P<0.05) lower on the 8th day of treatment than on the day before treatment and on the 4th day of treatment. Nevertheless, no other parameters of LH secretion were affected and these effects only occurred in the absence (not in the presence) of oestradiol. In conclusion, cortisol needed to be elevated for more than 4 days to impair the secretion of LH, and oestradiol did not enhance the impact of cortisol on LH secretion in ovariectomised pigs.

Transferring from an acute hospital and settling into a subacute facility: the experience of patients with dementia

Background.  In a Melbourne metropolitan health network, patients with dementia can have difficulty settling into a subacute rehabilitation facility after transfer from the acute hospital.

Aims and objectives.  To understand how older patients with mild to moderate dementia experienced the transfer from acute to subacute care and settling-in period.

Design.  A descriptive design was used. Eight patients with mild to moderate dementia were recruited, one to 5 days after transfer.

Method.  A qualitative method using in-depth interviews was used. The data were analysed using content analysis.

Results.  Four main themes were identified: ‘Settling into a new environment’, ‘staff attitudes to people with dementia’, ‘loss of control’ and ‘family support’.

Conclusions.  Person-centred care that comes from the perspective of respect for the individual transcends all these issues. People with dementia require more support to settle after transfer. Family involvement can assist in facilitating a smooth transition.

Implications for practice.  Nurses who understand the specific needs of patients with dementia can develop ways of working with patients to ensure person-centred care. More conversations with people with dementia are needed to investigate how this can be achieved. Orientation procedures should ensure that support for people with dementia is optimized during the settling-in phase.

Recognising dying in acute care

The article reports on terminal care services which are offered to patients in Australia and discusses a terminal care program called the Liverpool Care Pathway which was implemented in Great Britain and is being tested in Australia. In the article the author offers her opinions on terminal care in Australia, on the Liverpool Care Pathway and on the education that Australian nurses receive the dying phase of the human life cycle.