Symptom Burden at End of Life in Patients with Terminal and Life-Threatening Illness in Intensive Care Units

The purpose of this study was to examine the symptom burden and severity of symptom distress reported by ICU patients at high-risk for death and to compare patient-rated symptoms and distress for concordance with symptoms reported by a family member. A prospective, correlational design with two data-points was used to study a convenience sample of 80 patients and 53 family members. The Condensed Memorial Symptom Assessment Scale (CMSAS) was used to gain patient/proxy report of symptoms on the first and third day after admission to the ICU. The majority of patients were symptomatic (98%), reporting an average of 10.23 symptoms. Most common symptoms reported on Day-1, were lack of energy (fatigue) and difficulty concentrating, with a mean symptom distress score of 2.96 (SD = 0.70) and 2.79 (SD = 0.84), scored on a scale of 1 = low symptom distress to 4 = high symptom distress, respectively. The CMSAS Total Distress Score was 2.24 (SD=0.66). The Physiological Symptom Distress Subscale (CMSAS-PHYS) score was 2.19 (SD=0.71). Approximately 97.9% of patients reported psychologic symptoms (sadness, worry, nervousness) with a mean symptom distress score of 2.45 (SD=0.66), measured by the Psychological Symptom Distress Subscale (CMSAS-PSYCH). On Day-3, 65 of the patients were still in the ICU. The most prevalent symptom reported was difficulty sleeping (90.8%), with a medium intensity distress score of 3.79 (SD=1.06). Eighty percent of patients reported additional symptoms: lack of energy, lack of appetite, pain, dry mouth, feeling drowsy, shortness of breath, and difficulty concentrating, with a moderate intensity mean score of 3.42. Overall distress increased among all symptoms, as measured by the CMSAS-Total Distress Score of 3.17 (SD=0.44), and the two distress subscales: CMSAS-PHYS mean score of 3.07 (SD=0.46) and CMSAS-PSYCH means score of 3.46 (SD=0.52). Hospital mortality was 17 (21%) during initial hospitalization and 16 (25%) at 3-months follow-up. Family members correctly estimated the presence and absence of symptoms 85.5% of the time, yet rated the patients\u27 physiologic symptoms higher than psychological distress. This study identified ICU patients near death experience a significant burden of multiple symptoms, yet receive limited treatment for significant symptom distress. A need for widespread institution of symptom management strategies with proven effectiveness is indicated. Further research is needed to develop and test new evidence-based interventions to serve as a practice standards in the delivery of consistent, high quality care for all dying patients

Medical device-related pressure ulcers

Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of oxygen delivery devices. A hospital program designed to reduce the number of pressure ulcers from medical devices was successful. The program involved the development of a team that focused on skin, the results were then published for the staff to track their performance, and it was found that using foam dressings helped reduce the pressure from the device. The incidence of ulcers from medical devices has remained at zero at this hospital since this program was implemented. Keywords: pressure ulcer, medical device relate

Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture: A Randomized Controlled Trial

The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures

Involvement of nurses in end-of-life discussions for severely disabled children

In children with profound intellectual and multiple disabilities (PIMD), discussions about end-of-life decisions (EoLDs) are comparatively common. Nurses play a crucial role in the care for these children, yet their involvement in EoLD discussions is largely unknown. The objective of this research was to investigate the involvement in the hospital of nurses in discussions with parents and physicians about EoLDs for children with PIMD. In a retrospective, qualitative study, we conducted semi-structured interviews with the nurses of 12 children with PIMD for whom an EoLD was made within the past 2 years. Parents primarily discuss EoLDs with nurses before and after the meeting with the physician. Nurses who were involved in EoL discussions with parents and physicians assisted them by giving factual information about the child and by providing emotional support. Some nurses, especially nurses from ID-care services, were not involved in EoL discussions, even if they had cared for the child for a long period of time. Some of the nurses had moral or religious objections to carrying out the decisions. Most nurses were not involved in EoL discussions with parents and physicians in the hospital. Excluding nurses from EoL discussions can cause them moral distress. The involvement of nurses in EoL discussions for children with PIMD should be improved, especially by involving nurses from ID-care services. Because these nurses are usually familiar with the child, they can be valuable sources of information about the child's quality of lif