Parente sensitive support by paediatric nurses

Introdução The hospitalization of a child is an experience that causes big changes in child and his family life. The parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can reduce their stress and have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectivos The aim of this study was to define what family-centered care is, to define the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs. It was also a goal to identify and understand the main differences between parental support given by nurses in Belgium and Portugal. Metodologia The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion and exclusion criteria. They had to involve nurses, hospitalized children between 0 and 18 years and their parents. Second part was a focus group. The participants were pediatric nurses from Portugal and Belgium. The goal was to understand different perspectives related to the parental needs of hospitalized children and nursing interventions to answer that needs. Resultados family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parent's participation is important to reduce the parental stress and it is essential for meeting the needs of the children. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. This is crucial to ensure the family's well-being, adaption to hospitalization and the child's recovery. Conclusões Nurses should collect information about the family which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children but they also need to take care of themselves. When nurses have enough information they can use it to the identification of parental needs and the planning of nursing interventions. It is important that nurses create an environment where parents feel safe and that they have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Parente sensitive support by paediatric nurses

Introdução The hospitalization of a child is an experience that causes big changes in child and his family life. The parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can reduce their stress and have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectivos The aim of this study was to define what family-centered care is, to define the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs. It was also a goal to identify and understand the main differences between parental support given by nurses in Belgium and Portugal. Metodologia The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion and exclusion criteria. They had to involve nurses, hospitalized children between 0 and 18 years and their parents. Second part was a focus group. The participants were pediatric nurses from Portugal and Belgium. The goal was to understand different perspectives related to the parental needs of hospitalized children and nursing interventions to answer that needs. Resultados family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parent's participation is important to reduce the parental stress and it is essential for meeting the needs of the children. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. This is crucial to ensure the family's well-being, adaption to hospitalization and the child's recovery. Conclusões Nurses should collect information about the family which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children but they also need to take care of themselves. When nurses have enough information they can use it to the identification of parental needs and the planning of nursing interventions. It is important that nurses create an environment where parents feel safe and that they have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Influence of Cobalt on the Properties of Load-Sensitive Magnesium Alloys

In this study, magnesium is alloyed with varying amounts of the ferromagnetic alloying element cobalt in order to obtain lightweight load-sensitive materials with sensory properties which allow an online-monitoring of mechanical forces applied to components made from Mg-Co alloys. An optimized casting process with the use of extruded Mg-Co powder rods is utilized which enables the production of magnetic magnesium alloys with a reproducible Co concentration. The efficiency of the casting process is confirmed by SEM analyses. Microstructures and Co-rich precipitations of various Mg-Co alloys are investigated by means of EDS and XRD analyses. The Mg-Co alloys' mechanical strengths are determined by tensile tests. Magnetic properties of the Mg-Co sensor alloys depending on the cobalt content and the acting mechanical load are measured utilizing the harmonic analysis of eddy-current signals. Within the scope of this work, the influence of the element cobalt on magnesium is investigated in detail and an optimal cobalt concentration is defined based on the performed examinations.

Determination of ecological sensitive areas of the coastal areas of Caspian Sea (Boujagh Wetland National Park) based on ecological carrying capacity and economical valuation region

The coastal districts, as an intersection of two perfectly different ecosystems of dry land and sea, is one of the most complicated and the richest natural system on earth. Considering these areas are constantly exposed to aggregation of water pollutants and also consequence resulting from construction and development activities, they are very vulnerable. Therefore, "sensitive Coastal areas" has become a common word in the related subjects to marine environment recently. The said title relates to the areas of the coastal lines which are vulnerable to the natural condition or human actions because of ecological, social, economic, educational and research importance, also they need particular supports. The southern coasts of Caspian Sea, In Iran prominent samples are of these sensitive areas which their environment are exposed to demolition and destruction intensely, due to increasing and uncontrolled development. The first stage of protecting and managing the coastal areas is identifying sensitive Coastal areas and broadening the Coasts. In this survey, we attempted to examine a definite area in the southern coasts of Caspian Sea. In Iran, by profiting from the world experiences and concluded researches in Iran especially the concluded studies by marine environment office and the Environment protection organization on the subject of determination criteria of the sensitive ecological districts. For this purpose (In Gilan Province) Boujagh national park district which is located in the mouth of sefidroud river and also is possessed of the special ecological and environmental features and distinctions. In this survey, first they said district is divided proportionally on the basis of using a grid system in order to identify the sensitive ecological districts and broaden the coast, and then the desired indices have been determined and scored by numeral valuation method in each unit and then analysis has been done by using of the geography information system (GIS) and final has estimated economic valuation of sensitive ecological areas that is presented in this essay.

Assessing microvascular function with breathing maneuvers : an oxygenation-sensitive CMR study

Ce projet illustre cinq études, mettant l'emphase sur le développement d'une nouvelle approche diagnostique cardiovasculaire afin d'évaluer le niveau d’oxygène contenu dans le myocarde ainsi que sa fonction microvasculaire. En combinant une séquence de résonance magnétique cardiovasculaire (RMC) pouvant détecter le niveau d’oxygène (OS), des manœuvres respiratoires ainsi que des analyses de gaz artériels peuvent être utilisés comme procédure non invasive destinée à induire une réponse vasoactive afin d’évaluer la réserve d'oxygénation, une mesure clé de la fonction vasculaire. Le nombre de tests diagnostiques cardiaques prescrits ainsi que les interventions, sont en pleine expansion. L'imagerie et tests non invasifs sont souvent effectués avant l’utilisation de procédures invasives. L'imagerie cardiaque permet d’évaluer la présence ou absence de sténoses coronaires, un important facteur économique dans notre système de soins de santé. Les techniques d'imagerie non invasives fournissent de l’information précise afin d’identifier la présence et l’emplacement du déficit de perfusion chez les patients présentant des symptômes d'ischémie myocardique. Néanmoins, plusieurs techniques actuelles requièrent la nécessité de radiation, d’agents de contraste ou traceurs, sans oublier des protocoles de stress pharmacologiques ou physiques. L’imagerie RMC peut identifier une sténose coronaire significative sans radiation. De nouvelles tendances d’utilisation de RMC visent à développer des techniques diagnostiques qui ne requièrent aucun facteur de stress pharmacologiques ou d’agents de contraste. L'objectif principal de ce projet était de développer et tester une nouvelle technique diagnostique afin d’évaluer la fonction vasculaire coronarienne en utilisant l' OS-RMC, en combinaison avec des manœuvres respiratoires comme stimulus vasoactif. Ensuite, les objectifs, secondaires étaient d’utilisés l’OS-RMC pour évaluer l'oxygénation du myocarde et la réponse coronaire en présence de gaz artériels altérés. Suite aux manœuvres respiratoires la réponse vasculaire a été validée chez un modèle animal pour ensuite être utilisé chez deux volontaires sains et finalement dans une population de patients atteints de maladies cardiovasculaires. Chez le modèle animal, les manœuvres respiratoires ont pu induire un changement significatif, mesuré intrusivement par débit sanguin coronaire. Il a été démontré qu’en présence d'une sténose coronarienne hémodynamiquement significative, l’OS-RMC pouvait détecter un déficit en oxygène du myocarde. Chez l’homme sain, l'application de cette technique en comparaison avec l'adénosine (l’agent standard) pour induire une vasodilatation coronarienne et les manœuvres respiratoires ont pu induire une réponse plus significative en oxygénation dans un myocarde sain. Finalement, nous avons utilisé les manœuvres respiratoires parmi un groupe de patients atteint de maladies coronariennes. Leurs myocardes étant altérées par une sténose coronaire, en conséquence modifiant ainsi leur réponse en oxygénation. Par la suite nous avons évalué les effets des gaz artériels sanguins sur l'oxygénation du myocarde. Ils démontrent que la réponse coronarienne est atténuée au cours de l’hyperoxie, suite à un stimuli d’apnée. Ce phénomène provoque une réduction globale du débit sanguin coronaire et un déficit d'oxygénation dans le modèle animal ayant une sténose lorsqu’un supplément en oxygène est donné. En conclusion, ce travail a permis d'améliorer notre compréhension des nouvelles techniques diagnostiques en imagerie cardiovasculaire. Par ailleurs, nous avons démontré que la combinaison de manœuvres respiratoires et l’imagerie OS-RMC peut fournir une méthode non-invasive et rentable pour évaluer la fonction vasculaire coronarienne régionale et globale.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

Cold vapour generation electrothermal atomic absorption spectrometry and solid phase extraction based on a new nanosorbent for sensitive HG determination in environmental samples (sea water and river water)

Mercury is not an essential element for plant or animal life and it is a potential environmental toxic because of its tendency to form covalent bonds with organic molecules and the high stability of the Hg-C bond. Reports estimate a total mercury concentration in natural waters ranging from 0.2 to 100 ng L-1. Due to this fact, highly sensitive methods are required for direct determination of such extremely low levels. In this work, a rapid and simple method was developed for separation and preconcentration of mercury by flow injection solid phase extraction coupled with on-line chemical vapour generation electrothermal atomic absorption spectrometry. The system is based on chelating retention of the analyte onto the mini column filled with a mesoporous silica functionalized with 1,5 bis (di-2-pyridyl) methylene thiocarbohydrazide. The main aim of this work was to develop a precise and accurate method for the determination of the Hg. Under the optima conditions and 120 s preconcentration time, the detection limit obtained was 0.009 μg L-1, with RSDs 3.7 % for 0.2 μg L-1, 4.8 % for 1 μg L-1 and enrichment factor 4, Furthermore, the method proposed has permitted the determination of Hg with a reduction in the analysis time, the sample throughput was about 18 h-1, low consumption of reagents and sample volume. The method was applied to the determination of Hg in sea water and river water. For the quality control of the analytical performance and the validation of the newly developed method, the analysis of two certified samples, TMDA 54.4 Fortified Lake, and LGC6187 River sediment was addressed. The results showed good agreement with the certified values.

Anti-anxiety effect of methanol extract of Pericarpium zanthoxyli using a strychnine-sensitive glycine receptor model

Purpose: To determine if the methanol extract of Pericarpium zanthoxyli exerts anti-anxiety effects and also to explore any probable anti-anxiety mechanism in vivo. Methods: The staircase test, elevated plus maze test, rota-rod treadmill test and convulsions induced by strychnine and picrotoxin on mice were tested to identify potential mechanism of anti-anxiety activity of the plant extract. Results: The plant extract (10 mg/kg, p.o.) significantly reduced rearing numbers in the staircase test while it increased the time spent in the open arms as well as the number of entries to the open arms in the elevated plus maze test, suggesting that it has significant anti-anxiety activity. Furthermore, the extract inhibited strychnine-induced convulsion. However, it had little effect on picrotoxin-induced convulsion, suggesting that its anti-anxiety activity may be linked to strychnine-sensitive glycine receptor and not GABA receptor. Conclusion: These results suggest that the Pericarpium zanthoxyli extract may be beneficial for the control of anxiety.

Light polarization sensitive photodetectors with m- and r-plane homoepitaxial ZnO/ZnMgO quantum wells

Homoepitaxial ZnO/(Zn,Mg)O multiple quantum wells (MQWs) grown with m- and r-plane orientations are used to demonstrate Schottky photodiodes sensitive to the polarization state of light. In both orientations, the spectral photoresponse of the MQW photodiodes shows a sharp excitonic absorption edge at 3.48 eV with a very low Urbach tail, allowing the observation of the absorption from the A, B and C excitonic transitions. The absorption edge energy is shifted by ∼30 and ∼15 meV for the m- and r-plane MQW photodiodes, respectively, in full agreement with the calculated polarization of the A, B, and C excitonic transitions. The best figures of merit are obtained for the m-plane photodiodes, which present a quantum efficiency of ∼11%, and a specific detectivity D* of ∼6.4 × 1010 cm Hz1/2/W. In these photodiodes, the absorption polarization sensitivity contrast between the two orthogonal in-plane axes yields a maximum value of (R⊥/R||)max ∼ 9.9 with a narrow bandwidth of ∼33 meV.

Effect of Arginine and Oscillatory Ca2+ on Vascular Response Mediated Via Nitric Oxide Signaling in Normal and Salt Sensitive Hypertensive Rat Mesenteric Arterioles

Hypertension, a major risk factor in the cardiovascular system, is characterized by an increase in the arterial blood pressure. High dietary sodium is linked to multiple cardiovascular disorders including hypertension. Salt sensitivity, a measure of how the blood pressure responds to salt intake is observed in more than 50% of the hypertension cases. Nitric Oxide (NO), as an endogenous vasodilator serves many important biological roles in the cardiovascular physiology including blood pressure regulation. The physiological concentrations for NO bioactivity are reported to be in 0-500 nM range. Notably, the vascular response to NO is highly regulated within a small concentration spectrum. Hence, much uncertainty surrounds how NO modulates diverse signaling mechanisms to initiate vascular relaxation and alleviate hypertension. Regulating the availability of NO in the vasculature has demonstrated vasoprotective effects. In addition, modulating the NO release by different means has proved to restore endothelial function. In this study we addressed parameters that regulated NO release in the vasculature, in physiology and pathophysiology such as salt sensitive hypertension. We showed that, in the rat mesenteric arterioles, Ca2+ induced rapid relaxation (time constants 20.8 ± 2.2 sec) followed with a much slower constriction after subsequent removal of the stimulus (time constants 104.8 ± 10.0 sec). An interesting observation was that a fourfold increase in the Ca2+ frequency improved the efficacy of arteriolar relaxation by 61.1%. Our results suggested that, Ca2+ frequency-dependent transient release of NO from the endothelium carried encoded information; which could be translated into different steady state vascular tone. Further, Agmatine, a metabolite of L-arginine, as a ligand, was observed to relax the mesenteric arterioles. These relaxations were NO-dependent and occurred via α-2 receptor activity. The observed potency of agmatine (EC50, 138.7 ± 12.1 µM; n=22), was 40 fold higher than L-arginine itself (EC50, 18.3 ± 1.3 mM; n = 5). This suggested us to propose alternative parallel mechanism for L-arginine mediated vascular relaxation via arginine decarboxylase activity. In addition, the biomechanics of rat mesentery is important in regulation of vascular tone. We developed 2D finite element models that described the vascular mechanics of rat mesentery. With an inverse estimation approach, we identified the elasticity parameters characterizing alterations in normotensive and hypertensive Dahl rats. Our efforts were towards guiding current studies that optimized cardiovascular intervention and assisted in the development of new therapeutic strategies. These observations may have significant implications towards alternatives to present methods for NO delivery as a therapeutic target. Our work shall prove to be beneficial in assisting the delivery of NO in the vasculature thus minimizing the cardiovascular risk in handling abnormalities, such as hypertension.

Parent sensitive support by paediatric nurses

Introduction The hospitalization of a child causes big changes in child and his family life. Parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectives: To define what family-centered care is, the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs and to identify the differences between parental support given by nurses in Belgium and Portugal. Methods and procedures The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion criteria. Second part is a focus group. The participants were pediatric nurses from Portugal and Belgium. Results family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. Conclusion Nurses should collect information which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children and take care of themselves. Nurses must create an environment where parents feel safe and have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Parent sensitive support by paediatric nurses

Introduction The hospitalization of a child causes big changes in child and his family life. Parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectives: To define what family-centered care is, the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs and to identify the differences between parental support given by nurses in Belgium and Portugal. Methods and procedures The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion criteria. Second part is a focus group. The participants were pediatric nurses from Portugal and Belgium. Results family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. Conclusion Nurses should collect information which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children and take care of themselves. Nurses must create an environment where parents feel safe and have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Functional defict and sensitive outcomes to nursing care for elderly: Systematic literature review.

ABSTRACT Objective of this study was to determine sensitive outcomes to nursing care in relation to the functional deficit of people aged 65 and older. It is a Systematic Literature Review with qualitative synthesis and meta-analysis. From the qualitative synthesis, it was found that sensitive outcomes to nursing care, observed from structured intervention, were described as improvement of: functional status, self-care, symptom control, safety/adverse events, customer satisfaction, psychological support, decreased healthcare costs, therapeutic system management and quality of life. In meta-analysis we found that there is an improvement of effect on the level of sensitive outcomes to the nursing care between the experimental and control groups. It is noticed that it is necessary to rouse more guided study in clinical practice, to understand the importance of interventions sensitive to nursing care and health outcomes.