Stories seldom told: paediatric nurses` experiences of caring for hospitalized children with special needs and their families.

Stories seldom told: paediatric nurses' experiences of caring for hospitalized children with special needs and their families

Aims of the study. This study explored paediatric nurses' experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses' experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses' stories.

Study design/methods. Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes.

Findings. The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt.

Conclusions. The study emphasized the context-specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.

A qualitative examination of the experience of 'depression' in hospitalized medically ill patients

Background: Research into depression in the medically ill has progressed without sufficient attention being given to the validity, in this group, of the taxonomic categories. We aimed to describe, using qualitative interviews, the experience of 'being depressed', separating experiences that are unique to depression from experiences that are common to being ill and in hospital.
Method: Forty-nine patients hospitalized for medical illness underwent a 30-min interview in which they were asked to 'Describe how you have been unwell and, in particular, how that has made you feel.' From the transcripts, a 'folk' taxonomy was constructed using a phenomenological framework involving four steps: frame elicitation to identify the important themes, componential analysis to systematically cluster the attributes into domains, a comparison of the experiences of patients screening depressed and  not-depressed, and a theoretical analysis comparing the resulting taxonomy with currently used theoretical constructs.
Results: Experiences common to all patients were being in hospital, being ill or in pain, adjusting to not being able to do things, and having time to think. In addition, all participants described being depressed, down or sad. Patients who were identified by screening as being depressed described unique experiences of depression, which included 'having to think about things' (a forceful intrusive thinking), 'not being able to sleep', 'having to rely on others', 'being a burden' to others (with associated shame and guilt), feelings of 'not getting better' and 'feeling like giving up'. Theoretical analysis suggested that this experience of depression fitted well with the concept of demoralization described by Jerome Frank.
Conclusions: Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients

Influence of health locus of control on recovery of function in recently hospitalized frail older adults

To investigate the influence of health locus of control on physical function, quality of life, depression and satisfaction with care transition in a sample of older adults after a hospital admission.

Evaluation of hospitalized patients in terms of their knowledge related to smoking

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Family visitors and companions of hospitalized elderly and adults: analysis of the experience from the perspective of the nursing working process

Trata-se de estudo qualitativo, utilizando-se como referencial metodológico a Grounded Theory e como referencial teórico o Processo de Trabalho em Enfermagem, para compreender o papel assumido pelo enfermeiro perante as normas e rotinas hospitalares, relativas aos familiares visitantes e acompanhantes de adultos e idosos internados em um Hospital Universitário. A análise dos dados permitiu a identificação do tema: definindo-se a modalidade de apoio familiar durante a hospitalização, que reúne duas categorias principais: tornando-se familiar visitante e tornando-se familiar acompanhante. Por meio da análise, pôde-se aprofundar a compreensão do quanto as regras estabelecidas, com o objetivo de disciplinar e tornar eficiente o trabalho desenvolvido no hospital, podem explicitar o desprovimento de autonomia no processo de trabalho, para modificar as relações nesse contexto e o quanto a apropriação do familiar como parte da equipe de saúde, está distante de ser pensada no concreto das instituições.

Nutritional assessment of hospitalized HIV-infected patients by the phase angle z-score measurement

Background: This study analyzed the phase-angle (PA) values of hospitalized HVI-infected patients by comparing them with those reported for a healthy population and investigated their relation with nutritional parameters.Methods: This is a cross-sectional study including 101 hospitalized patients diagnosed with HIV infection and evaluated by bioimpedance, anthropometry and biochemical tests. The phase angle values, weight loss percentage (%WL), body mass index (BMI), arm muscle circumference (AMC), tricipital skinfold (TSF), body fat percentage (%BF) and albumin were considered. In order to compare with values for the healthy population, the PA z-score of the patients under study was calculated. Spearman's correlation and the multiple linear regression model were used to identify nutritional parameters associated with the PA z-score.Results: The patients showed a mean PA z-score of -2.6 +/- 1.5, and only 6.6% of them with a positive value. The PA z-score values correlated with %WL (r = -0.51; p < 0.0001), albumin (r = 0.49; p < 0.0001), BMI (r = 0.58; p < 0.0001), AMC (r = 0.41; p < 0.0001), TSF (r = 0.47; p < 0.001) and %BF (r = 0.48, p < 0.0001). In multiple analysis %WL (p = 0.008), albumin (p = 0.01), AMC (p < 0.0001) and %BF (p = 0.0003) remained associated with the score.Conclusions: Low PA z-score values were observed, suggesting a worse clinical prognosis for the patients. The inclusion of the PA z-score as a nutritional indicator during care provision to HIV-infected patients is recommended. (Nutr Hosp. 2012;27:771-774) DOI:10.3305/nh.2012.27.3.5684

Human respiratory syncytial virus in children hospitalized for acute lower respiratory infection

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Detection of Altered Risk Factors in Hospitalized Patients with Coronary Artery Disease

OBJECTIVE: To assess biochemical, anthropometric, and dietary variables considered risk factors for coronary artery disease. METHODS: Using anthropometrics, dietary allowance, and blood biochemistry, we assessed 84 patients [54 males (mean age of 55± 8 years) and 30 females (mean age of 57±7 years)], who had severe ( > or =70% coronary artery obstruction) and nonsevere forms of coronary artery disease determined by cardiac catheterization. The severe form of the disease prevailed in 70% of the males and 64% of the females, and a high frequency of familial antecedents (92% ' 88%) and history of acute myocardial infarction (80% ' 70%) were observed. Smoking predominated among males (65%) and diabetes mellitus among females (43%). RESULTS: Males and females had body mass index and body fat above the normal values. Females with nonsevere lesions had HDL > 35 mg/dL, and this constituted a discriminating intergroup indicator. Regardless of the severity of the disease, hyperglycemia and hypertriglyceridemia were found among females, and cholesterolemia > 200 mg/dL in both sexes, but only males had LDL fraction > 160 mg/dL and homocysteine > 11.7 mmol/L. The male dietary allowance was inadequate in nutrients for homocysteine metabolism and in nutrients with an antioxidant action, such as the vitamins B6, C, and folate. Individuals of both sexes had a higher lipid and cholesterol intake and an inadequate consumption of fiber. The diet was classified as high-protein, high-fat, and low-carbohydrate. CONCLUSION: The alterations found had no association with the severity of lesions, indicating the need for more effective nutritional intervention.

Nutritional status and functional capacity of hospitalized elderly

Background: The nutritional status of the aging individual results from a complex interaction between personal and environmental factors. A disease influences and is influenced by the nutritional status and the functional capacity of the individual. We asses the relationship between nutritional status and indicators of functional capacity among recently hospitalized elderly in a general hospital.Methods: A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%.Results: Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition.Conclusion: There is an interrelationship between the nutritional status of the elderly and reduced functional capacity.

Nutritional support and outcome in hospitalized dogs and cats

This study investigated the effect of assisted nutritional support on the outcome and time of hospitalization (TH) of dogs and cats. The study compared two groups of 400 hospitalized animals. The animals in group 1 did not receive assisted nutritional support because they were hospitalized before the clinical nutrition service was implemented; animals in group 2 were nutritionally managed. Animals in group 1 received a low-cost diet with no consumption control. Group 2 animals had their maintenance energy requirement (MER) calculated, received a high-protein and high-energy super-premium diet, had their caloric intake (CI) monitored, and received enteral and parenteral nutritional support when necessary. The statistical analysis of the results included the standard T test (group 1 versus group 2) and chisquare and Spearman's correlation to evaluate group 2 (CI and outcome, body condition score (BCS) and outcome, BCS and CI). For group 2, favorable outcome (FO), defined as the percent responding to therapy and dis-charged from the hospital, was 83%, and the TH was 8.59 days. These values were lower (P < .001) for group 1 (63.2% FO and TH of 5.7 days). For group 2, 65.5% of the animals received voluntary consumption (93.1% outcome), 14.5% received enterai support (67.9% FO), 6.5% received parenteral support (68% FO), and 6.17% did not eat (38.5% FO), demonstrating an association between the type of nutritional support and outcome (P < .01). Group 2 animals that received 0% to 33% of their MER had 62.9% FO, and those receiving more than 67% had 94.3% FO, which shows that lower mortality rates are associated with higher CI (P < .001). TH was higher for animals with higher CI (P < .001). The BCS did not correlate with Cl (P > .05) but did correlate with outcome (P < .01). FO was 68.7% for animals with low BCS, 85.7% for animals with ideal BCS, and 86.6% for overweight animals. Nutritional support could allow for longer therapies, thus increasing the TH and FO rate.

Prevalence of Oral Lesions in Hospitalized Patients with Infectious Diseases in Northern Brazil

The aim of this study was to assess the prevalence of oral lesions in infectious-contagious diseases patients being treated in the University Hospital of the Federal University of Para, northern Brazil. One hundred seven patients with infectious diseases were clinically investigated for oral lesions at the University Hospital of Para, northern Brazil. From total sample, most patients were men (65.7%) with a mean age of 45.4 years. About prevalence of systemic diseases, tuberculosis was the most frequent illness, followed by AIDS, hepatitis types B and C, leishmaniasis, and meningitis. Analyzing oral manifestations, periodontal diseases and candidiasis were the most prevalent diseases in both genders, followed by recurrent aphthous ulcers, saburral tongue, simplex herpes, and squamous cell carcinoma. Of all 107 patients, only 10 males and 6 females did not present any oral manifestation. There was no statistical difference between genders with any systemic condition (P > 0.05). The great prevalence of oral manifestations in hospitalized patients with systemic disorder emphasizes the need of integral dental care in this context, aiming at a multidisciplinary approach of patients. Therefore, presence of some oral conditions, such as candidiasis, should be an alert to different systemic conditions, once in assistance with physicians; dentists can influence the early diagnosis and treatment.

Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital

BACKGROUND: The objective of this study was to estimate the prevalence of depression and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in Sao Paulo, Brazil. OBJECTIVE: To assess the prevalence of mood and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in Sao Paulo. METHOD: A total of 75 patients, men and women, aged between 18 and 76 years, took part in the research. The study employed a descriptive, cross sectional and correlational method. The data was collected by means of a social demographic questionnaire and the PRIME-MD. RESULTS: It was found that 45.3 percent of the subjects presented with depressive symptoms, and 52 percent presented with symptoms of anxiety and that this survey showed moderate and high significant correlations (p<0,01; r= 0,616) for depression and anxiety. CONCLUSION: These facts could evidence the relationship between physical and psyche, just as the literature presents.

Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients

Background: Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Methods: Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. Results: We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. Conclusions: The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in countries with limited resources.

Costs of most frequent nursing activities in highly dependent hospitalized patients

This quantitative study aimed to identify the costs of the most frequent nursing activities in highly dependent hospitalized patients at a medical clinic. The non-probabilistic convenience sample corresponded to 607 observations regarding oral feeding activities (OF), blood pressure verification (BP)/heart rate (HR), body temperature checking (BTC), performance of intimate hygiene and management of feeding probe. The costs identified corresponded to R$2.40 (SD+/-2.64) for OF feeding; R$1.26 (SD+/-0.48) to verify the BP/HR; R$1.17 (SD+/-0.46) for BTC; R$15.59 (SD+/-8.62) to perform intimate hygiene and R$5.95 (SD+/-2.13) for management of feeding probe. This study will facilitate cost management, with a view to avoiding waste related to unnecessary resource consumption and establish a correlation between costs and care delivery results. Supported by Pro-Reitoria de Pesquisa, Universidade de Sao Paulo, Brazil.