Określenie ryzyka zaparcia u chorych z dolegliwościami neurochirurgicznymi

Background. Preventing constipation is very important for patients in neurosurgery clinics and especially for those who had cerebral hemorrhage and brain tumor surgery as it might lead to elevated intracranial pressure. Therefore, it is necessary to diagnose constipation especially in individuals in neurosurgery clinics.Aim. This study has been designed as a descriptive and a cross-sectional study intending to identify constipation risk and the factors affecting it in neurosurgery patients.Material and methods. The population of the study consists of patients who stayed at a university hospital in Turkey between April 2011 and April 2012, and the sample population consists of 231 people selected by random sampling method. Data were collected using a Patient Information Form, Constipation Severity Instrument (CSI) and Constipation Risk Assessment Scale (CRAS). Data were analyzed using the SPSS version 11.5 for Windows.Results. 55,4% of the patients in the study were women and the average age was 43,80±13,65. CSI Total score average of the patients at admission was low (14,27±11,28). According to CRAS, 14,3% of the patients at admission, 40,7% of the patients on the 3rd day of surgery, and 32,5% of the patients at discharge were in medium and high risk group in terms of constipation. It has been determined that women, old people, people who use analgesics, and people who stay long at a hospital are at higher constipation risk.Conclusions. As result of the data gathered in the study, it has been concluded that nurses working in neurosurgery clinics should not ignore preoperative and postoperative constipation risk in order to be able to give integrated care. (PNN 2013;2(3):96-103)Wprowadzenie.W przypadku pacjentów klinik neurochirurgicznych, a szczególnie po wylewie krwi do mózgu oraz po operacji nowotworu mózgu, zapobieganie zaparciom jest bardzo istotne z uwagi na powodowany przez nie wzrost ciśnienia wewnątrzczaszkowego. Z tego względu koniecznym jest diagnozowanie zaparć szczególnie w przypadku osób przebywających w klinikach neurochirurgicznych.Cel. Niniejsze badanie zostało zaplanowane z zamiarem identyfikacji ryzyka zaparcia i czynników na nie wpływających w sposób diagnostyczny i przekrojowy.Materiał i metody. Populację badania stanowią pacjenci klinicznych szpitali uniwersyteckich w Turcji w okresie od kwietnia 2011 do kwietnia 2012, spośród których losowo wybrano próbę składającą się z 231 osób. Dane zebrane były przy użyciu Formularzy Informacyjnych Pacjenta, Instrumentu Twardości Zaparcia (CSI) oraz Skali Określania Ryzyka Zaparcia (CRAS). Dane były analizowane przy użyciu wersji 11.5 SPSS dla oprogramowania Windows.Wyniki. 55,4% pacjentów poddanych badaniom stanowiły kobiety w wieku średnio 43,80±13,65 lat. Średni wynik CSI dla pacjentów przyjmowanych był niski (14,27±11,28). Natomiast wg CRAS, 14,3% pacjentów przyjmowanych, 40,7% pacjentów na 3 dni po operacji i 32,5% pacjentów wypisywanych, znajdowało się w średniej i wysokiej grupie ryzyka wystąpienia zaparcia.Wnioski. Na podstawie danych zgromadzonych podczas badania wywnioskowano, że pielęgniarki pracujące na oddziałach neurochirurgicznych w celu zapewnienia kompleksowej opieki nie powinny ignorować ryzyka zaparć przedoperacyjnych i pooperacyjnych. (PNN 2013;2(3):96-103

Nöroşirurji Kliniğinde Çalışan Hemşirelerin Beyin Tümörü Olan Hastalar ile Yaşadıkları İletişim Güçlüklerine İlişkin Deneyimleri: Nitel Bir Çalışma

Amaç: Etkili hasta-hemşire iletişimi hemşirelik bakımının kalitesine ilişkin temel bir gösterge ve hasta güvenliği konusudur. Etkili iletişim, özellikle beyin tümörü gibi iletişim sorununa yol açma riski yüksek olan rahatsızlıkları olan veya bu açıdan sınırlılık yaşayan hastalarda daha da önemlidir. Beyin tümörü olan hastaların hemşirelik bakımında bireyselleştirilmiş ve bütüncül bir yaklaşım ile terapötik iletişim sürdürülmelidir. Ancak, bakım sürecini etkileyen çeşitli nedenler bu süreci olumsuz yönde etkileyebilir. Gereç ve Yöntem: Bu araştırma, nöroşirurji hemşirelerinin beyin tümörü olan hastalara bakım verirken yaşadıkları iletişim güçlükleri ve baş etme yöntemlerine ilişkin deneyimlerini belirlemek amacı ile yorumlayıcı fenomenolojik analiz yöntemi ile gerçekleştirilen nitel bir çalışma olarak planlandı. Amaçlı örnekleme yöntemi ile belirlenen 10 hemşire ile derinlemesine, yüz yüze bireysel görüşme yapıldı. Bulgular: Elde edilen bulgular hemşirelerin yaşadıkları iletişim güçlükleri, baş etme yöntemleri ve çözüm önerileri olmak üzere üç grupta ele alındı. Hemşirelerin yaşadıkları iletişim güçlüklerine yönelik hasta ile ilişkili faktörler ve kurum ile ilişkili faktörler ana temaları ve alt temaları belirlendi. Baş etme yöntemleri ile ilişkili olarak; terapötik ve terapötik olmayan yöntemler ana temaları saptandı. Çözüm önerilerinin ise, terapötik bakım ortamının güçlendirilmesi ve hemşirenin güçlendirilmesi temaları altında toplandığı görüldü. Sonuç: Hemşirelerin iletişim güçlüğü yaşadığı durumların ve nedenlerinin çok boyutlu olduğu görüldü. Hemşirelerin iletişim güçlüğü ile baş etmede çoğunlukla terapötik iletişim yöntemlerini kullandığı ve bireyin bakım gereksinimlerini karşılayarak sorunları ile baş ettikleri ancak zaman zaman terapötik olmayan iletişime yöneldikleri belirlendi. Hemşirelerin yaşadığı iletişim güçlüğünü azaltmaya ilişkin önerilerin hayata geçirilmesi için mesleki faaliyetler ile kurumsal düzenlemeler gerektiği saptandı. Araştırmadan elde edilen bulguların, hemşirelerin yaşadıkları iletişim güçlüklerinin azaltılması/ortadan kaldırılmasında hemşirelere ve çözüm stratejilerinin belirlenmesinde yöneticilere rehberlik edeceği düşünülmektedir

Prevalence and Factors Affecting Postoperative Delirium in a Neurosurgical Intensive Care Unit

PURPOSE: The aim of this study was to identify the prevalence of, and factors affecting, postoperative delirium (POD) in patients in the neurosurgical intensive care unit. METHODS: A cross-sectional study of 127 Turkish neurosurgical intensive care unit patients admitted between May 2018 and May 2019 was conducted. Patients were assessed for the development of POD using the Intensive Care Delirium Screening Checklist. We collected other independent data variables daily. Data were analyzed using independent sample t test, chi(2) test, and logistic regression. RESULTS: The prevalence rates of POD on the first and second postoperative days were 18.9% and 8.7%, respectively. Logistic regression analysis showed that the Glasgow Coma Scale score, albumin level, Spo(2) level, hemoglobin values, undergoing cranial surgery, and having intra-arterial catheter were the independent risk factors for POD. CONCLUSION: These findings may contribute to identifying patients at risk for developing POD and developing strategies to improve patient outcomes

Prevalence and Factors Affecting Postoperative Delirium in a Neurosurgical Intensive Care Unit

PURPOSE: The aim of this study was to identify the prevalence of, and factors affecting, postoperative delirium (POD) in patients in the neurosurgical intensive care unit. METHODS: A cross-sectional study of 127 Turkish neurosurgical intensive care unit patients admitted between May 2018 and May 2019 was conducted. Patients were assessed for the development of POD using the Intensive Care Delirium Screening Checklist. We collected other independent data variables daily. Data were analyzed using independent sample t test, chi(2) test, and logistic regression. RESULTS: The prevalence rates of POD on the first and second postoperative days were 18.9% and 8.7%, respectively. Logistic regression analysis showed that the Glasgow Coma Scale score, albumin level, Spo(2) level, hemoglobin values, undergoing cranial surgery, and having intra-arterial catheter were the independent risk factors for POD. CONCLUSION: These findings may contribute to identifying patients at risk for developing POD and developing strategies to improve patient outcomes

Effects of different head-of-bed elevations and body positions on intracranial pressure and cerebral perfusion pressure in neurosurgical patients

The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores. Methods: This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU). Patients’ HOB was elevated (degree of 15,30,45) and the patients were at supine, left lateral and right lateral positions. ICP and CPP were recorded for each patient. Results: It was found that ICP increased and CPP decreased at supine, left and right lateral positions with different HOB elevations, which, however, did not reach statistical significance. When patients with a GCS score of 3Y8 were at degree of 15 right and left lateral positions and 45 right lateral position; and when patients with a GCS score of 13Y15 were positioned at degree of 15 left lateral, ICP and CPP changed significantly. Conclusion: The results of this study showed that different positions the patients’ HOB (degree of 15,30,45) led to slight insignificant changes in ICP and CPP; and these values were maintained within the ranges established by recent guidelines