Sensing Senses: Tactile Feedback for the Prevention of Decubitus Ulcers

Decubitus ulcers, also known as pressure sores, is a major problem in health care, in particular for patients with spinal cord injuries. These patients cannot feel the discomfort that would urge healthy people to change their posture. We describe a system that uses a sensor mat to detect problematic postures and provides tactile feedback to the user. The results of our preliminary study with healthy subjects show that the tactile feedback is a viable option to spoken feedback. We envision the system being used for rehabilitation games, but also for everyday Decubitus ulcers prevention

Pressure ulcer risk assessment and prevention system design.

Pressure ulcer (PU, bedsore, ischemia, decubitus ulcer) has become a global healthcare problem. In United Kingdom 412,000 people develop pressure ulcer annually and it costs the National Health Service (NHS) £1.4-£2.1 billion pounds (4% of total NHS budget). Pressure ulcers are a combined result of multiple factors such as prolonged external load applied to the skin, reduced blood flow in tissues, the patient’s physiological parameters (body mass index, age, mobility) and body support surface properties. The aetiology of pressure ulcer formation includes both mechanical and biological properties of skin and soft tissues. In order to prevent PU formation in the human body, a new type of risk predicting tool is required where identification of PU risk is based on combined effect of patient’s physiological parameters and support surface properties. Previous research suggests that interface pressure (IP) of 32 mmHg (4.2kPa) can cause PU but there is no strong evidence to show when that pressure is reached. Also IP varies from person to person due to their physiology. There are three risk assessment scales available to predict the occurrence of PU formation; however, none of these scales take interaction of body support surface material into account. Also they do not provide any information at which area a person is at risk of ulceration. In order to identify the harmful IP, biomechanical behaviour of skin and soft tissue is modelled and interaction of body support surface is studied. A mathematical model has been developed to characterise a new type of body support surface material (viscoelastic) and validated by conducting experiments. The relationship between patient’s physiological parameters and surface material are identified along with risk assessment scales for pressure ulcer prediction by conducting experiments. External load at different bony areas are measured using eleven volunteers. By measuring the external load for eleven subjects (age =33±7) and (BMI =25.0±3.01 kg/m2) at different bony areas, the relationship between IP with the total body weight and BMI was developed. A mathematical model is proposed to predict the risk of PU formation combining the Waterlow risk assessment scale and risk prediction algorithms on a user friendly interface

An interpretative phenomenological analysis of spousal carers' experiences of caring for their partner with a long-term, indwelling urinary catheter

This PdD thesis reports an idiographic study employing Interpretative Phenomenological Analysis (IPA) to explore the experiences of spousal carers when their partner has a long-term indwelling urinary catheter (LTIC). The aim was to inform and improve practice.The study was conducted in two parts. In Part I, six spousal carers were interviewed about their experiences when their partner had a LTIC. To further explore their adjusting to the device and to consider the wider impact of a catheter on their relationship, Part II consisted of three dyad case studies. The three 'cases' included LTIC users who had Multiple Sclerosis (MS) and their spousal carers.Findings revealed a continuum of adjusting, with setbacks influenced by external factors such as LTIC problems, poor communication and deterioration in both parties' health. The LTIC users increasingly needed their spouse's support with LTIC care over-time and this necessitated adjustments to their lifestyle. As part of these changes, relationships were renegotiated. Participants incorporated aspects of 'trade-off' within their lives as part of adjusting - what they were willing to adapt, concede or accept in order to adjust to their life now

TIPS, Volume 18, No. 1, 2, & 3, 1998

• The Abortion Scene • Abortion: Deceitful Interpretation as Contraception • Abortion: Other Deceits • Abortion: Prenatal Testing • Abortion: Supporters & Proponents • Abortion: Opposition to It • Abortion: Incoherent Stances • Abortion: Miscellaneous Facts & Developments • Abortion: The Consequences to the Mothers • Abortion: The Societal Consequences • Artificial Baby-Making & Related Deathmaking • Medical Child-Killing • Private Child-Killing & Child-Junking • Progeny-Junking by Multiple Parties • Suicide & Its Promotion • Euthanasia Via Assisted Suicide • The Confusion Among Suicide, Assisted Suicide, Indirect Killing & Direct Killing • Suicide by Proxy: The Step Between Assisted Suicide & Involuntary Euthanasia • Murder-Suicides Interpreted as Suicides • The Promotion or Performance of Euthanasia by Physicians or Under Their Direction • Updates on Euthanasia in the Netherlands • Tissue & Organ Transplanting as a Utilitarian Motive for Euthanasia • Incidences & Issues of Instituting, Terminating or Continuing Treatments & Life Supports • Other Instances of Dangerousness in Hospitals • Deathmaking Service Agencies • Deathmaking In/By Medical Emergency Services • Dangerousness in Nursing Homes & Similar Settings • Danger to Life From Home Care Services • Deathmaking in Hospice Contexts, & Other Hospice News • Dangerousness in Multiple Health Care Contexts • Health Maintenance & Managed Care Organizations as a Major Deathmaking Force • Withdrawal of Medical Care From The Poor & Handicapped • Euthanasia or Other Killings By Other Health Workers • Other Life-Endangerments in Human Service Contexts • Euthanasia, Murder, or Abuse by Private Citizens • Deathmaking by Multiple or Indeterminate Parties • Privatization of Deathmaking • Sympathy for the Deathmakers • More on Advocacy For or Against Deathmaking • Deaths of Vulnerable People from Salmonella & Other Bacteria • Issues of Mortality of Mentally Retarded People • Miscellaneous Other Points Related to Risks to Health or Life of Vulnerable, Devalued &/or Unwanted People • The Danger of Being Marginalized • Dangers From Poverty & Homelessness • Risks From Frailty or Dependency Interacting With Other Factors • Prison Deaths • Unclassified Items Related to Deathmaking • Other Issues of Utilitarianism of Deathmaking • Deathmaking-Related Resources • Postscript from the TIPS Proof-Reader • New SRV Resource • Old SRV Resource Again Available • Miscellaneous News Related to Human Services & Healthhttps://digitalcommons.unmc.edu/wolf_tips/1071/thumbnail.jp

An exploration of the patient and family or carer experience of implementing the pressure ulcer prevention care bundle (known as SSKIN) within a regional quality improvement collaborative

Introduction: Pressure ulcers (PUs) are common, costly and impact negatively on patients’ quality of life. Bearing this in mind, in Ireland, a regional quality improvement collaborative was established within the Health Service Executive entitled ‘Pressure Ulcers to Zero’, utilizing the SSKIN care bundle in pressure ulcer prevention. As the involvement of patient and family/carer is a central component of health care delivery, this study set out to explore the patient and family/carer experiences and involvement within the collaborative including use of the SSKIN care bundle. Methods: A qualitative descriptive approach was adopted. Since there were 3 main healthcare settings involved in the collaborative (acute /specialist, residential and primary care), one unit from each of these settings was purposively selected to participate. Following ethical approval and written informed consent, data were collected over a 6 week period using semi-structured, one to one interviews with patients, and focus group interviews with family members/carers. Twenty five persons agreed to participate; 16 patients, with varying levels of dependency, and 9 family members/carers . Results: Data were analysed using Colaizzi’s Framework, 6 main themes with corresponding subthemes emerged from the analysis: awareness, patient involvement, family/carer involvement, ‘prevention is better than cure’, ‘communication is key’ and resources in prevention. Discussions: Both patients and family/carer had limited involvement in PU prevention within the collaborative. Further, a general lack of awareness of the SSKIN care bundle was identified with some confusion surrounding its acronym. Participants expressed the desire to be more involved in PU prevention and the collaborative processes, henceforth, empowering patients and family/carers through education and communication may increase their level of involvement. This has meaning for future collaboratives, where tools, such as acronyms and activities, for example the design and presentation of visual aids pertaining to the collaborative subject, require a patient as well as a professional focus. Clinical Relevance: Educating patients and families/carers on PU prevention through utilization of the SSKIN care bundle may facilitate a greater willingness of the patient and family/carer to participate in PU prevention. Also informing and including them in collaborative activities may address quality care issues

From start to finish: Examining the interplay of reasoned action theory and constructivism as they mutually inform an instructional development effort

Thesis (PhD) - Indiana University, School of Education, 2007This effort examined the interplay of reasoned action theory and constructivist epistemology as they mutually inform an instructional development effort to decrease the prevalence of pressure ulcers and their associated sequelae in home health care. The effort is framed by the point of view, drawn from health behavior theory, that, barring external barriers, behavior occurs when people know what to do, know how to do it, and, in fact, want to do it. Moreover, in terms of wanting to do something, behavior can be predicted from people's intentions to engage in the behavior, attitudes toward the behavior, perceived norms regarding the behavior, and perceived control over the behavior. This framework becomes richer when behavior and behavioral change are considered from an epistemological perspective that views individuals as active makers of meaning, as creators of personal stories. These dynamic personal narratives are influenced by experience and in turn influence interpretation of experience; they guide behavior, and they provide an explanation for it. From this perspective, for behavior to be understood, and behavior change to be fostered, researchers and developers need to find ways to understand, connect with, and influence personal narratives. Guided by reasoned action theory, beliefs and associated psychosocial constructs regarding pressure ulcer preventive care were determined through elicitation and survey studies among home healthcare providers. This data, along with factual and procedural objectives identified in conjunction with subject matter experts, was used within a constructivist framework to inform the design of an instructional video. The video was evaluated in a between-within design with multiple dependent variables. Significant differences in learning were observed, with those viewing the video demonstrating greater gains on measures of knowledge, on multivariate composite of psychosocial variables, and on perceived control. No differences in intentions, attitudes, or perceived norms were observed. Those viewing the video rated it highly on measures of consumer satisfaction. The results of each stage of the effort are discussed individually and overall. The roles of reasoned action theory and the constructivist epistemological framework are discussed individually and as they mutually affect one another. Implications for other instructional intervention efforts are drawn

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

Why do Patients Develop Severe Pressure Ulcers?

This is a retrospective case study about severe pressure ulcers and why healthcare services may contribute to people developing them. Pressure ulcers are caused when skin and tissues are damaged as a result of pressure. They range in severity from non-blanchable erythema (Category 1), superficial skin loss (Category 2) to large wounds involving fat, muscle and bone (Category 3/4). Category 3 and 4 pressure ulcers are also referred to as severe pressure ulcers (EPUAP/NPUAP, 2009, NHS Improvement, 2018). These can contribute to death. Although there is little known about how patients develop severe pressure ulcers, this study offers possible explanations. As well as the main finding that the health care environment contributes to the development of severe pressure ulcers; four possible explanations are i) patients not being heard, ii) decision making in complex environments, iii) safety culture lacking in mindful awareness and iv) diffusion of responsibility and poor communication between staff, wards and health care services. These also link into a model of intervention. The study’s method offers a way of investigating pressure ulcers retrospectively, which differs from current techniques. The main difference is the focus on the patient’s or carer’s view as the primary source of evidence, in contrast to the current focus on service level investigations. This study offers a ‘Safety III’ approach which combines empirical (correspondence) approaches of investigation with coherent (rational, explanatory) approaches. The study recommends including patients and carers in investigating severe pressure ulcers, empowering nurses to make decisions regarding pressure ulcer care and working towards a ‘mindful’ safety culture

A victimological investigation of farm attacks with specific reference to farmers’ perceptions of their susceptibility, the consequences of attacks for farmers and the coping strategies applied by them after victimisation

Acts of violence on farms and smallholdings are continuing unabated in spite of the efforts of the government and the agricultural unions to quell attacks on members of the farming community. Although research has been done on various aspects of farm attacks, empirical information regarding farmers’ perceptions of their susceptibility to attacks, the consequences that are suffered and the coping strategies that farmers apply after victimisation, is limited to that contained in the Report of the Committee of Inquiry into Farm Attacks. In order to gain first-hand information with regard to this phenomenon, the researcher interviewed 15 direct victims of attacks on a one-on-one basis. All the attacks occurred in the Mpumalanga Province and the adjoining Nokeng Tsa Taemane region in the Gauteng Province. Based on the analysis and interpretation of the data, it was found that most of the respondents felt unsafe on their farms. In spite of this, they were all taken by surprise by their attackers. While the majority of the respondents believed that their homes were reasonably secure, financial and familial constraints prevented some from improving the guardianship on their farms. Those who had good security systems in their homes, were attacked outside or in the early evening before the systems were activated. The findings also revealed that the immediate reactions of victims of farm attacks do not differ fundamentally from those of other victims of crime. Reactions include surprise, fear of being killed, injured and/or raped and powerlessness. After the attacks they often experienced anger and bitterness. Analysis of the data furthermore indicated that physical injuries ranged from minor to serious injuries that necessitated hospitalisation. Emotional and social harm were also experienced by victims, causing them to be fearful and distrustful of black persons, as the attacks were all black on white. Farm attacks also had negative financial consequences for the victims. Capital that might have been used for other purposes had to be used to pay medical and funeral bills and upgrade security, especially since most victims feared re-victimisation. After the attacks some respondents preferred to relocate. While many of the respondents found it too costly to implement the necessary target hardening measures, avoidance behaviour in the form of alertness was identified as the most effective means of preventing victimisation in the future. Other avoidance tactics included feeding dogs in the afternoon when visibility is still good and sending employees out to establish the reason for the visit of black strangers who arrive on the farm without an appointment. Erroneous perceptions with regard to the motives for attacks and the profile of attackers, as well as complacency about security which often sets in because of the routine nature of farmers’ lifestyle, were identified as the main reasons for farmers’ susceptibility to victimisation. It was also found that the respondents’ coping strategies varied. While some relied on their Christian faith and the support of family and friends, others exerted their inner strength to regain their emotional equilibrium. On the basis of the above findings, recommendations were made regarding further research and measures that might be implemented by both the government and farmers to reduce the number of farm attacks. It was highlighted that factors such as hate speech, socio-economic conditions in rural areas, the acceleration of land reform and education deserve further attention. Farmers must guard against complacency and make informed decisions about security on the farms. As coping strategies vary, it was furthermore stated that victimised farmers need to persevere until they have assimilated the negative experience.Dissertation (MA)--University of Pretoria, 2008.Social Work and Criminologyunrestricte

IC 077 Guide to Texas Medical Center Historical Resources Project Records

The Medical World News Photograph Collection (IC 077) predominantly consists of photographic prints, negatives, and transparencies that document the production of a premiere medical news magazine. The collection contains most of the images published in the magazine from 1967-1985. See more at https://archives.library.tmc.edu/ic-077