A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study

<p>Abstract</p> <p>Background</p> <p>Advance Care Planning (ACP) is an emerging strategy to ensure that well-reflected, meaningful and clearly documented treatment preferences are available and respected when critical decisions about life-sustaining treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance directives (AD) have to be followed if they apply to the medical situation, but implementation of ACP has not yet been described.</p> <p>Methods/Design</p> <p>In a longitudinal controlled study, we compare 1 intervention region (4 nursing homes [n/hs], altogether 421 residents) with 2 control regions (10 n/hs, altogether 985 residents). Inclusion went from 01.02.09 to 30.06.09, observation lasted until 30.06.10. Primary endpoint is the prevalence of ADs at follow-up, 17 (12) months after the first (last) possible inclusion. Secondary endpoints compare relevance and validity of ADs, process quality, the rate of life-sustaining interventions and, in deceased residents, location of death and intensity of treatment before death. The regional multifaceted intervention on the basis of the US program Respecting Choices^®comprises training of n/h staff as facilitators, training of General Practitioners, education of hospital and ambulance staff, and development of eligible tools, including Physician Orders for Life-Sustaining Treatment in case of Emergency (POLST-E).</p> <p><it>Participation data: </it>Of 1406 residents reported to live in the 14 n/hs plus an estimated turnover of 176 residents until the last possible inclusion date, 645 (41%) were willing to participate. Response rates were 38% in the intervention region and 42% in the control region. Non-responder analysis shows an equal distribution of sex and age but a bias towards dependency on nursing care in the responder group. <it>Outcome analysis </it>of this study will become available in the course of 2011.</p> <p>Discussion</p> <p>Implementing an ACP program for the n/hs and related health care providers of a region requires a complex community intervention with the effect of nothing less than a cultural shift in this health care sector. This study is to our knowledge the first to develop a strategy for regional implementation of ACP, and to evaluate its feasibility in a controlled design.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN99887420">ISRCTN99887420</a></p

Subjective Distresses of Nasogastric Tube Feeding

Health care professionals assume that tube feeding is an unpleasant, distressing experience for patients, which is only partially substantiated by experience. Thirty patients were interviewed via a tube feeding and hospital experience checklist (a 47–item interview schedule). Common experiences were operationally defined as those felt by at least 50%; subjectively distressful experiences were those identified by patients as causing distress. The most common and most distressful experiences of nasogastric tube feeding were: sensory irritations and sensory deprivation. The psychosensory irritation experiences were: thirst, sore nose or throat, dry mouth, runny nose, a tube in the nose, taking food through a tube, breathing through the mouth, breathing with a tube in the nose, taking food in a treatment type container, and taking food with a different texture and smell than usual. The psychosensory deprivation experiences were: an unsatisfied appetite for certain foods, deprivation of tasting, chewing, swallowing food, and drinking liquids, limited mobility, and deprivation of regular food. Except for burping, gastrointestinal symptoms were not common though they were usually distressful. This information has been used to develop teaching programs which are being tested for effectiveness in reducing distress associated with nasogastric tube feeding.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68702/2/10.1177_014860717900300204.pd

Stress associated with hospitalization in patients with COPD: the role of social support and health related quality of life

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to determine stress levels during hospitalization in patients with Chronic Obstructive Pulmonary Disease (COPD). We wanted to relate stress to previous level of quality of life and patients’ Social Support.</p> <p>Methods</p> <p>80 patients (70.43; SD = 8.13 years old) with COPD were assessed by means of: Hospital Stress Rating Scale, Nottingham Health Profile, St. George’s Respiratory Questionnaire and Social Support Scale.</p> <p>Results</p> <p>COPD patients’ stress levels are lower than expected independently from the severity or number of previous hospitalizations. Linear regression analysis shows the predictive value of Quality of Life and Social Support on stress level during hospitalization (p < 0.0001).</p> <p>Conclusion</p> <p>HRQOL and social support can be associated with stress during hospitalization.</p

Social perception of nursing professional assessed by different scales Percepción social de profesionales de enfermería evaluada mediante diferentes escalas Percepção social de profissionais de enfermagem avaliada por meio de diferentes escalas

The purpose of this experiment was to scale the social perception of nurses through the methods of magnitude estimation, category estimation and cross-modality matching (line lengths). The study participants were high school and undergraduate students, active and retired medicine, psychology, nursing and dentistry professionals. Results revealed that: (1) the characteristics neat, responsible, clean, careful and efficacious occupied the first positions in terms of nurses' social perceptions, while useless, shameful, dishonest, irresponsible and hateful occupied the last positions on all scales obtained by the different direct psychophysics methods; (2) the scale of nurses' social perception is valid, stable and consistent and (3) the rankings resulting from the three methods produce highly concordant positions of perception for the different adjectives.<br>La finalidad de este experimento fue la de escalonar la percepción social del enfermero a través de los métodos de estimación de magnitudes y emparejamiento cruzado (a lo largo de líneas). Participaron del estudio estudiantes de 2º grado y universitarios, profesionales actuantes y jubilados de medicina, psicología, enfermería y odontología. Los resultados mostraron: (1) los trazos aseado, responsable, limpio, cuidadoso y eficaz ocupan las primeras posiciones en términos de percepción social del enfermero, mientras los trazos inútil, deshonroso, deshonesto, irresponsable y odioso ocupan las últimas posiciones en todas las escalas obtenidas por los diferentes métodos psicofísicos directos; (2) la escala de percepción social del enfermero es válida, estable y consistente y (3) las ordenaciones resultantes de los métodos producen posiciones de percepción altamente concordantes para los diferentes adjetivos.<br>O objetivo deste experimento foi escalonar a percepção social do enfermeiro pelos métodos de estimação de magnitudes e de categorias e de emparelhamento intermodal (comprimento de linhas). Participaram estudantes do 2º grau e universitários, profissionais atuantes e aposentados em medicina, psicologia, enfermagem e odontologia. Os resultados mostraram que (1) os traços asseado, responsável, limpo, cuidadoso e eficaz ocupam as primeiras posições em termos da percepção social do enfermeiro, enquanto os traços inútil, desonroso, desonesto, irresponsável e odioso ocupam as últimas posições em todas as escalas obtidas pelos diferentes métodos psicofísicos diretos; (2) a escala de percepção social do enfermeiro é válida, estável e consistente e (3) as ordenações resultantes dos métodos produzem posições de percepção altamente concordantes para os diferentes adjetivos

Estressores em Unidade de Terapia Intensiva: versão brasileira do The Environmental Stressor Questionnaire Estresores en Unidad de Terapia Intensiva: versión brasileña del Environmental Stressor Questionnaire Stressors at the Intensive Care Unit: the Brazilian version of The Environmental Stressor Questionnaire

Este estudo teve como objetivo realizar a adaptação cultural do The Environmental Stressor Questionnaire - (ESQ) para a língua portuguesa do Brasil e verificar sua confiabilidade e validade. Foram empregadas as etapas metodológicas recomendadas pela literatura para adaptação cultural. A versão brasileira do ESQ foi aplicada a 106 pacientes de Unidade de Terapia Intensiva (UTI) de dois hospitais, público e privado, do interior do Estado de São Paulo. A confiabilidade foi avaliada quanto à consistência interna e estabilidade (teste e reteste); a validade convergente foi verificada por meio da correlação entre o ESQ e questão genérica sobre estresse em UTI. A confiabilidade foi satisfatória com Alfa de Crombach=0,94 e Coeficiente de Correlação Intraclasse=0,861 (IC95% 0,723; 0,933). Constatou-se correlação entre o escore total do ESQ e a questão genérica sobre estresse (r=0,70), confirmando a validade convergente. A versão brasileira do ESQ mostrou-se uma ferramenta confiável e válida para avaliação de estressores em UTI.<br>Este estudio tuvo como objetivo realizar la adaptación cultural del Environmental Stressor Questionnaire (ESQ) a la lengua portuguesa de Brasil y verificar su confiabilidad y validez. Fueron empleadas las etapas metodológicas recomendadas por la bibliografía para la adaptación cultural. La versión brasileña del ESQ fue aplicada a 106 pacientes de Unidad de Terapia Intensiva (UTI) de dos hospitales, público y privado, del interior del estado de San Pablo, Brasil. La confiabilidad fue evaluada respecto de la consistencia interna y la estabilidad (test y retest); la validez convergente fue verificada a través de la correlación entre el ESQ y pregunta genérica acerca de estrés en UTI. La confiabilidad fue satisfactoria, con Alfa de Cronbach = 0,94 y Coeficiente de Relación Intraclase = 0,861 (IC 95%; 0,723; 0,933). Se constató correlación entre el puntaje total del ESQ y la pregunta genérica sobre estrés (r = 0,70), confirmado la validez convergente. La versión brasileña del ESQ se mostró como una herramienta confiable y válida para la evaluación de estresores en UTI.<br>The objective of the present study was to perform the cultural adaptation of The Environmental Stressor Questionnaire - ESQ for the Brazilian Portuguese, as well as to verify its reliability and validity. In order to ensure the equivalence between the original instrument and the Brazilian version, all methodological steps recommended in the literature regarding cultural adaptation were followed. The Brazilian version of the ESQ was applied to 106 ICU patients in two hospitals (public and private) in the interior of São Paulo State. Reliability was evaluated in relation to internal consistency and stability (test e retest) and the convergent validity was determined by the correlation between ESQ and generic questions about ICU stress. Reliability was satisfactory with Cronbach's Alfa = 0,94 and stability (ICC=0,861; IC95% 0,723; 0,933). ESQ total score displayed strong correlation with the generic questions about stress (r=0,70; p<0,0001), thus confirming the convergent validity. The conclusion was that the ESQ adapted for Brazilian culture is a reliable instrument for evaluation of stressors in the ICU