Patients' Perceptions of Nurses' Behaviour That Influence Patient Participation in Nursing Care: A Critical Incident Study

Patient participation is an important basis for nursing care and medical treatment and is a legal right in many Western countries. Studies have established that patients consider participation to be both obvious and important, but there are also findings showing the opposite and patients often prefer a passive recipient role. Knowledge of what may influence patients' participation is thus of great importance. The aim was to identify incidents and nurses' behaviours that influence patients' participation in nursing care based on patients' experiences from inpatient somatic care. The Critical Incident Technique (CIT) was employed. Interviews were performed with patients (n = 17), recruited from somatic inpatient care at an internal medical clinic in West Sweden. This study provided a picture of incidents, nurses' behaviours that stimulate or inhibit patients' participation, and patient reactions on nurses' behaviours. Incidents took place during medical ward round, nursing ward round, information session, nursing documentation, drug administration, and meal

After colonic surgery: The lived experience of participating in a fast-track programme

Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients' perspective lacks documentation. This study describes the lived experience of participating in a fast-track programme after colonic surgery. Sixteen patients were interviewed twice. The interviews were analysed using a descriptive phenomenological approach. Participating in a fast-track programme is characterized by a process where patients experience how the daily regimen works both with them and against them. To succeed in the overall goal of recovering fast according to the evidence-based care plan involves facing dilemmas and mobilizing courage and will to follow the regimen. Support from the professionals is crucial. The participants had a strong desire to comply and regain health; but this role of being a good and cooperative patient had a built-in asymmetric power relationship favouring the professionals' expectations. The complexities of this power relationship were related to both patient factors and contextual factors, e.g. the daily regimen and hospital norms. Although patient participation in care is an accepted ideal, it is demanding and difficult to accomplish. More studies on fast-track programmes are needed, with special attention to patient autonomy and partnership

Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study

Objective: Repetitive transcranial magnetic stimulation (rTMS) may alleviate tinnitus. We evaluated effects of electric field (E-field) navigated rTMS targeted according to tinnitus pitch. No controlled studies have investigated anatomically accurate E-field-rTMS for tinnitus. Design: Effects of E-field-rTMS were evaluated in a prospective randomised placebo-controlled 6-month follow-up study on parallel groups. Patients received 10 sessions of 1Hz rTMS or placebo targeted to the left auditory cortex corresponding to tonotopic representation of tinnitus pitch. Effects were evaluated immediately after treatment and at 1, 3 and 6 months. Primary outcome measures were visual analogue scores (VAS 0-100) for tinnitus intensity, annoyance and distress, and the Tinnitus Handicap Inventory (THI). Study sample: Thirty-nine patients (mean age 50.3 years). Results: The mean tinnitus intensity (F-3=15.7, p<0.0001), annoyance (F-3=8.8, p=0.0002), distress (F-3=9.1, p=0.0002) and THI scores (F-4=13.8, p<0.0001) decreased in both groups over time with non-significant differences between the groups. After active rTMS, 42% and 37% of the patients showed excellent response at 1 and 3 months against 15% and 10% in the placebo group (p=0.082 and p=0.065). Conclusions: Despite the significant effects of rTMS on tinnitus, differences between active and placebo groups remained non-significant, due to large placebo-effect and wide inter-individual variation

Chemical aspects of ocean acidification monitoring in the ICES marine area

It is estimated that oceans absorb approximately a quarter of the total anthropogenic releases of carbon dioxide to the atmosphere each year. This is leading to acidification of the oceans, which has already been observed through direct measurements. These changes in the ocean carbon system are a cause for concern for the future health of marine ecosystems. A coordinated ocean acidification (OA) monitoring programme is needed that integrates physical, biogeochemical, and biological measurements to concurrently observe the variability and trends in ocean carbon chemistry and evaluate species and ecosystems response to these changes. This report arises from an OSPAR request to ICES for advice on this matter. It considers the approach and tools available to achieve coordinated monitoring of changes in the carbon system in the ICES marine area, i.e. the Northeast Atlantic and Baltic Sea. An objective is to measure long-term changes in pH, carbonate parameters, and saturation states (Ωaragonite and Ωcalcite) in support of assessment of risks to and impacts on marine ecosystems. Painstaking and sensitive methods are necessary to measure changes in the ocean carbonate system over a long period of time (decades) against a background of high natural variability. Information on this variability is detailed in this report. Monitoring needs to start with a research phase, which assesses the scale of short-term variability in different regions. Measurements need to cover a range of waters from estuaries and coastal waters, shelf seas and ocean-mode waters, and abyssal waters where sensitive ecosystems may be present. Emphasis should be placed on key areas at risk, for example high latitudes where ocean acidification will be most rapid, and areas identified as containing ecosystems and habitats that may be vulnerable, e.g. cold-water corals. In nearshore environments, increased production resulting from eutrophication has probably driven larger changes in acidity than CO2 uptake. Although the cause is different, data are equally required from these regions to assess potential ecosystem impact. Analytical methods to support coordinated monitoring are in place. Monitoring of at least two of the four carbonate system parameters (dissolved inorganic carbon (DIC), total alkalinity (TA), pCO2, and pH) alongside other parameters is sufficient to describe the carbon system. There are technological limitations to direct measurement of pH at present, which is likely to change in the next five years. DIC and TA are the most widely measured parameters in discrete samples. The parameter pCO2 is the most common measurement made underway. Widely accepted procedures are available, although further development of quality assurance tools (e.g. proficiency testing) is required. Monitoring is foreseen as a combination of low-frequency, repeat, ship-based surveys enabling collection of extended high quality datasets on horizontal and vertical scales, and high-frequency autonomous measurements for more limited parameter sets using instrumentation deployed on ships of opportunity and moorings. Monitoring of ocean acidification can build on existing activities summarized in this report, e.g. OSPAR eutrophication monitoring. This would be a cost-effective approach to monitoring, although a commitment to sustained funding is required. Data should be reported to the ICES data repository as the primary data centre for OSPAR and HELCOM, thus enabling linkages to other related datasets, e.g. nutrients and integrated ecosystem data. The global ocean carbon measurement community reports to the Carbon Dioxide Information Analysis Center (CDIAC), and it is imperative that monitoring data are also reported to this database. Dialogue between data centres to facilitate an efficient “Report-Once” system is necessary

Psychiatric (Axis I) and personality (Axis II) disorders and subjective psychiatric symptoms in chronic tinnitus

Objective: Chronic tinnitus has been associated with several psychiatric disorders. Only few studies have investigated these disorders using validated diagnostic interviews. The aims were to diagnose psychiatric and personality disorders with structured interviews, to assess self-rated psychiatric symptoms and elucidate temporal relations between psychiatric disorders and tinnitus. Design: Current and lifetime DSM-IV diagnoses of axis-I (psychiatric disorders) and axis-II (personality disorders) were assessed using structured clinical interviews (SCID-I and -II). Current subjective psychiatric symptoms were evaluated via self-rating instruments: the Symptom Check List-90 (SCL-90), the Beck Depression Inventory, and the Dissociative Experiences Scale (DES). Study sample: 83 patients (mean age 51.7, 59% men) with chronic, disturbing tinnitus and a median Tinnitus Handicap Inventory score of 32. Results: The rates of lifetime and current major depression were 26.5% and 2.4%. The lifetime rate of obsessive-compulsive personality disorder (type C) was 8.4%. None of the patients had cluster B personality disorder or psychotic symptoms. The SCL-90 subscales did not differ from the general population, and median DES score was low, 2.4. Conclusions: Tinnitus patients are prone to episodes of major depression and often also have obsessive-compulsive personality features. Psychiatric disorders seem to be comorbid or predisposing conditions rather than consequences of tinnitus.Clinical trial reference: ClinicalTrials.gov (ID NCT 01929837).</p

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018)

A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance

Dynamics of primary production as measuredby the ISIS in situ technique

The ISIS in situ incubator was used to evaluate the dynamics of a phytoplankton bloom in the Kattegat in late October 1979. The nutrient status of the water column indicated a typical fall regenerative situation with relatively high concentrations of ammonium and phosphate and only low concentrations of nitrate. The photic zone was well mixed during the bloom due to preceding rough weather. Clear, sunny and calm conditions prevailed the day prior to and during the bloom. Primary production was measured at four depths and amounted to 90.4 mg C m-2 h-1 integrated from the surface to 12 m. The highest fixation rate occurred at 1 m depth and was 16.4 mg C m-3 h-1. The productivity index was 3.7 mg C (mg chlorophyll a)-1 h-1 at 1 m and 5.3 mg C (mg chlorophyll a)-1 h-1 at 4 m depth. The light response relationship showed light saturation at about 3.8·1023 quanta m-2 h-1. It is concluded that primary production during this experiment was controlled by a combination of excess light energy and temperature but not by nutrient limitation

The Staff Nurse Clinical Leader at the Bedside : Swedish Registered Nurses' Perceptions

Registered nurses at the bedside are accountable for and oversee completion of patient care as well as directly leading and managing the provision of safe patient care. These nurses have an informal leadership role that is not associated with any given position. Leadership is a complex and multifaceted concept and its meaning is unclear, especially in the staff nurse context. The aim was to describe registered nurses’ perceptions of what it entails to be the leader at the bedside in inpatient physical care. A phenomenographic approach was employed. Interviews were performed with Swedish registered nurses (n=15). Five descriptive categories were identified: demonstrating clinical knowledge, establishing a good atmosphere of collaboration, consciously structuring the work in order to ensure patients’ best possible nursing care, customized presence in the practical work with patients according to predetermined prerequisites, and monitoring coworkers’ professional practice. Registered nurses informal role as leader necessitates a social process of deliberate effort to attain and maintain leader status and authority. Participants used deliberate communicative approaches and interactive procedures. Leader principles grounded in the core values of the nursing profession that ensure nursing values and person-centered attributes were a key aspect.CC BY 4.0</p