Ethical issues concerning cardiac surgery in elderly patients — the nurse’s role as a patient advocate: A case report

Introduction: Frailty syndrome (FS) is one of the well-known risk factors for cardiac surgical treatment. Moreover, older patients are more likely to suffer from various comorbidities. Ethical issues that arise in patient care should be considered, including their identification, analysis, and appropriate resolution. The study aimed to present the nurse’s role in the therapeutic team, which should take the floor as a patientadvocate representing her/his interest.Case presentation: An 82-year-old patient was admitted to the Cardiac Surgery Clinic and was discussed in the context of emerging ethical dilemmas in clinical practice. The peri-operative risk was assessed as high; the nurse identified both frailty phenotype and FS. Currently, at postoperative day 40, the patient remains sedated, haemodynamically unstable, and has a poor long-term prognosis.Summary: If the patient is not presented with a risk assessment that includes FS assessment during the qualification process, it can be concluded that this omission violates the information component of informed consent. Nurses must speak out in those patients’ interests in order to preclude actions that may increase their vulnerability during cardiac surgery

Zastosowanie modelu adaptacyjnego Callisty Roy w opiece nad chorym ze stwardnieniem rozsianym – opis przypadku

Introduction. Multiple sclerosis (Sclerosis Multiplex — MS) is a chronic disease of the central nervous system characterized by inflammation and the loss of myelin sheath surrounding the axon. A result of disseminated demyelination process in patients suffering from MS, is a wide variety of symptoms that lead to changes in terms of functioning both in biological and psychosocial aspects. The skilful preparation of a patient to find the optimal way of dealing with the disease, as well as maintaining independence and joy of life is an essential part of the therapeutic process in patients with MS.Aim. The aim of this study was to use the Callista Roy adaptation model in the care of a patient suffering from multiple sclerosis, namely:— demonstrate the usefulness of the holistic Callista Roy adaptation model in the care of chronically ill patients,— prepare a patient to cope with the problems induced by the disease, based on the nursing process developed in line ith the guidlines of C. Roy model.Case Report. A case study of a 69 year old patient with multiple sclerosis (SM) was prepared on the basis of medical documentation (personal information forms from hospitals), an interview with the patient and direct observations.Discussion. The nursing care model based on the theory by Callista Roy proved to be very useful in the process of taking care of a patient chronically ill with SM, as it guaranteed satisfying the needs of a patient in terms of bio-psychosocial aspect, but it also gave the opportunity to acquire skills to cope with problems resulting from the disease.Conclusions. The nursing process based on the theory by Callista Roy requires from a nurse an individual and holistic approach to a patient and patient’s problems. The model structure provides a comprehensive delivery of nursing care and ensures continuous contact with a patient. This is particularly important in the era of technology development in modern medicine.(JNNN 2015;4(3):121–129)Wstęp. Stwardnienie rozsiane (Sclerosis Multiplex — SM) jest przewlekłą chorobą centralnego układu nerwowego, która charakteryzuje się stanem zapalnym i utratą osłonki mielinowej wokół aksonu. W wyniku rozsianego procesu demielinizacyjnego u pacjentów chorujących na SM obserwuje się wiele różnorodnych objawów prowadzących do zmian w funkcjonowaniu zarówno w aspekcie biologicznym, jak i psychospołecznym. Umiejętne przygotowaniepacjenta do znalezienia optymalnego sposobu radzenia sobie z chorobą, a także zachowania samodzielności i radości życia jest niezbędnym elementem procesu terapeutycznego chorych na SM.Cel. Próba zastosowania modelu adaptacyjnego Callisty Roy w opiece nad pacjentką chorującą na stwardnienie rozsiane, czyli:— wykazanie przydatności holistycznego modelu adaptacyjnego Callisty Roy w opiece nad przewlekle chorym,— przygotowanie pacjenta do radzenia sobie z problemami wynikającymi z choroby w oparciu o proces pielęgnowania opracowany zgodnie z założeniami modelu C. Roy.Opis przypadku. Studium przypadku 69-letniej pacjentki ze stwardnieniem rozsianym zostało opracowane na podstawie analizy dokumentacji medycznej (kart informacyjnych ze szpitali), przeprowadzonego wywiadu z pacjentką oraz bezpośredniej obserwacji.Dyskusja. Model pielęgnowania oparty na teorii Callisty Roy okazał się bardzo przydatny w procesie pielęgnowania przewlekle chorego z SM, ponieważ zagwarantował pacjentce zaspokojenie jej potrzeb bio-psycho-społecznych, aletakże dał możliwość nabycia umiejętności radzenia sobie z problemami wynikającymi z choroby.Wnioski. Proces pielęgnowania oparty na teorii Callisty Roy wymaga od pielęgniarki rozpatrywania pacjenta i jego problemów w sposób zindywidualizowany i całościowy. Struktura modelu zapewnia kompleksowe świadczenie usług pielęgniarskich i gwarantuje ciągły kontakt z pacjentem. Jest to szczególnie ważne w dobie technicyzacji we współczesnej medycynie.(PNN 2015;4(3):121–129

Stosowanie się do zaleceń terapeutycznych w niewydolności serca

Despite the efforts to increase the efficacy of the treatment of heart failure, readmission frequency still remains high. The most common reason of readmissions is exacerbation of heart failure. Among the factors contributing to the deterioration of udder health concomitant disease, treatment nonadherence lack of self-control and the lack of optimal treatment. Nonadherence includes mostly too small or too large dosages medication, interruptions in medication, and taking drugs without a prescription. Among the reasons impeding adherence the recommendations mentioned pharmacological age, cognitive impairment, physical and depressive disorders, lack of social support, low socioeconomic status, a large number of comorbidites, side effects and interactions of drugs, long period of treatment time, polypharmacy, frequent administration several doses per day, and malfunctioning health care system. It is considered that 23% -31% readmission could have been avoided if the adaptation of the recommendations was more respected, and that patients able to access and opportunities for collaboration with a multidisciplinary team suitably prepared. Improvement strategies cooperation should be targeted especially at-risk patients. Increasing patients' knowledge through well scheduled education, reducing the number of drugs used and simplifying dosing regimens and to facilitate contact and communication capabilities with specialist multidisciplinary team is one of the most important strategies to improve and conscious participation of the patient in the therapeutic processMimo wysiłków zwiększających skuteczność leczenia niewydolności serca (HF), częstość rehospitalizacji pozostaje wysoka. Najczęstszą przyczyną ponownych hospitalizacji jest zaostrzenie HF. Wśród czynników przyczyniających się do pogorszenia stanu zdrowia wymienia się choroby towarzyszące, nieprzestrzeganie zaleceń terapeutycznych, brak samokontroli i brak optymalnego leczenia. Nieprzestrzeganie dotyczy najczęściej przyjmowania zbyt małych lub zbyt dużych dawek leków, przerw w przyjmowaniu leków oraz zażywaniu leków bez recepty. Wśród przyczyn utrudniających dostosowanie się do zaleceń farmakologicznych wymienia się podeszły wiek, zaburzenia poznawcze, fizyczne i depresyjne, brak wsparcia socjalnego, niski status socjoekonomiczny, dużą liczbę chorób towarzyszących, działania niepożądane i wzajemne interakcje stosowanych leków, długi okres leczenia, wielolekowość, częste przyjmowanie kilku dawek leku w ciągu dnia oraz źle działający system opieki zdrowotnej. Uważa się, że 23–31% rehospitalizacji można by uniknąć, gdyby dostosowanie do zaleceń było bardziej przestrzegane, a pacjenci mieli dostęp i możliwość współpracy z odpowiednio przygotowanym zespołem wielodyscyplinarnym. Strategie poprawy współpracy powinny być ukierunkowane szczególnie na pacjentów z grupy ryzyka. Pogłębianie wiedzy pacjentów dzięki dobrze zaplanowanej edukacji, ograniczanie liczby stosowanych leków i uproszczenie schematów dawkowania oraz ułatwienie kontaktu i możliwość komunikacji ze specjalistycznym zespołem wielodyscyplinarnym należy do najważniejszych strategii poprawy i świadomego udziału chorego w procesie terapeutycznym

Self-Reported Medication Adherence Measured With Morisky Medication Adherence Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic Review and Meta-Analysis

Background: The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with antihypertensive treatment in this age group.Methods: A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded.Results: Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80–79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs.Conclusion: Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors

Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults.

Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard "forward-backward" procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach's α) and test-retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); and 8 (high). Complete questionnaires were returned by 110 respondents (mean age: 60.7 years ±12.6; 54.6% were female). The mean number of pills taken daily was 3.61±4.31. The mean adherence score was 6.42± 2.0. Moderate internal consistency was found (Cronbach's α=0.81), and test-retest reliability was satisfactory (r=0.461-0.905; P<0.001). Reproducibility expressed by Cohen's κ coefficient =0.61 was good. In high-adherent patients, the percentage of well-controlled blood pressure was higher than in low-adherent patients (33.3% vs 19.1%, χ (2)=0.87, P=0.648). Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may be routinely used to support communication about the medication-taking behavior in hypertensive patients

Przestrzeganie i zastosowanie się do leczenia antykoagulacyjnego oraz antyarytmicznego pacjentów z migotaniem przedsionków

Atrial fibrillation (AF) is considered to be the most frequently occurring arrhythmic, especially in the elderly. Despite the progress of diagnostic and therapeutic ,there has been a continuous increase in morbidity. It is estimated that because of the AF suffers 1.5–2% of the general population. The occurrence of cardiac arrhythmias can contribute to a number of complications, of which the most life-threatening of the patientis considered to be an instance of the stroke. An integral part of the treatment is the patient’s compliance with the therapeutic recommendations and cooperation with medical staff — compliance and adherence. Regular intake of medication, reasonable understanding of the substance of the proceedings in accordance with the prescribed therapy by the physician patterns significantly contributes to the prevention of incidents of secondary thrombotic episodes of urgency among arrhythmias of patients with AF. In this paper we wanted to point out that the lack of proper compliance and adherence is one of the main factors of the failure of anticoagulant and antiarrhythmic therapy of patients with AF.Migotanie przedsionków (AF) uznaje się za najczęściej występującą arytmię, zwłaszcza u osób w podeszłym wieku. Mimo postępów diagnostycznych i terapeutycznych obserwuje się ciągły wzrost zachorowalności. Szacuje się, że na AF cierpi 1,5–2% populacji ogólnej. Występowanie arytmii może się przyczyniać do wystąpienia wielu powikłań, z których za najbardziej zagrażające życiu chorego uznaje się wystąpienie udaru. Nieodłącznym elementem leczenia jest przestrzeganie przez chorego zaleceń terapeutycznych oraz współpraca z personelem medycznym, tak zwane compliance i adherence. Regularne przyjmowanie leków, zrozumienie istoty terapii oraz postępowanie zgodne z przepisanymi przez lekarza schematami w istotny sposób przyczyniają się do profilaktyki incydentów zatorowo-zakrzepowych oraz nagłych epizodów arytmii wśród chorych z AF. Celem autorów niniejszej pracy było wykazanie, że brak prawidłowego compliance i adherence jest jednym z głównych czynników niepowodzenia terapii antykoagulacyjnej oraz antyarytmicznej u pacjentów z AF

Quality of life and health behaviours of patients with tuberculosis — sex differences

Introduction: Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publications indicate an increase of tuberculosis cases among smokers, diabetics, malnurished subjects and those abusing alcohol and drugs. In the literature, there are only few studies raising the topic of the quality of life (QoL), stress management and health behaviour among patients with tuberculosis. The aim of this study was to evaluate QoL of patients with tuberculosis taking into account gender differences. In the study, the analysis of knowledge, health behaviour and stress management among TB patients depending on sex was carried out. Material and methods: The study included 80 subjects diagnosed with TB (including 38 females) who were hospitalised at the Regional Hospital Centre of Kotlina Jeleniogórska, Medical Unit Wysoka Łąka, Pulmonology and Phthisiology Department in Kowary between August 2012 and January 2013. The following questionnaires were used in the study: Mini-COPE — evaluating stress management, WHOQoL — assessing the quality of life of patients, IZZ — assessing health behaviour. Results: A difference with regards to sociodemographic profile between females and males was observed. Half of the women surveyed were working (50% vs 19% of men), whereas half of men were entitled to unemployment benefit (50% vs 18.4% of women). More than half of women lived with their family (55.3%), whereas 47.6% of men lived alone. The majority of the subjects consumed alcohol occasionally (60.2% of women vs 45.2% of men), but as many as 31% of male patients vs 7.9% of females admitted that they consumed alcohol frequently. Among the respondents, people who consumed alcohol occasionally dominated (60.2% women vs. 45.2% of men), but as many as 31% of male patients vs. 7.9% of women admitted to consume alcohol frequently. Quality of life (QoL) assessment has shown no statistically significant differences between the sexes in this field. The respondents rated lowest their QoL in the physical domain, 12.4 ± 3.1 (12.9 ± 3.0 women vs. 11.8 ± 3.1 men) and 12.6 ± 2.4 in the environmental domain (13.1 ± 2.3 women vs 12.1± 2.4 men). Women received a higher rating of health behaviour on all subscales of the IZZ questionnaire, with the highest score in the prevention behaviour subscale (3.6 ± 0.7) and the lowest in the subscale of proper eating habits (3.1 ± 0.8). In men the highest score of health behaviour was observed in the subscale of positive mental attitude (3.1 ± 1.0) and the lowest in the subscale of proper eating habits (2.5 ± 0.8). Conclusions: 1. There are differences between sociodemographic profile of TB patients: women are younger, better educated, economically active and more likely to remain in relationships; 2. There is no difference in QoL of TB patients between the sexes, whereas there are differences in the strategies of stress management and in applied health behavior; 3. Differences between genders indicate the need for matching treatment and preventive action for different patients profiles based on the cooperation of doctors, social workers, therapists, and psychologists.Introduction: Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publications indicate an increase of tuberculosis cases among smokers, diabetics, malnurished subjects and those abusing alcohol and drugs. In the literature, there are only few studies raising the topic of the quality of life (QoL), stress management and health behaviour among patients with tuberculosis. The aim of this study was to evaluate QoL of patients with tuberculosis taking into account gender differences. In the study, the analysis of knowledge, health behaviour and stress management among TB patients depending on sex was carried out. Material and methods: The study included 80 subjects diagnosed with TB (including 38 females) who were hospitalised at the Regional Hospital Centre of Kotlina Jeleniogórska, Medical Unit Wysoka Łąka, Pulmonology and Phthisiology Department in Kowary between August 2012 and January 2013. The following questionnaires were used in the study: Mini-COPE — evaluating stress management, WHOQoL — assessing the quality of life of patients, IZZ — assessing health behaviour. Results: A difference with regards to sociodemographic profile between females and males was observed. Half of the women surveyed were working (50% vs 19% of men), whereas half of men were entitled to unemployment benefit (50% vs 18.4% of women). More than half of women lived with their family (55.3%), whereas 47.6% of men lived alone. The majority of the subjects consumed alcohol occasionally (60.2% of women vs 45.2% of men), but as many as 31% of male patients vs 7.9% of females admitted that they consumed alcohol frequently. Among the respondents, people who consumed alcohol occasionally dominated (60.2% women vs. 45.2% of men), but as many as 31% of male patients vs. 7.9% of women admitted to consume alcohol frequently. Quality of life (QoL) assessment has shown no statistically significant differences between the sexes in this field. The respondents rated lowest their QoL in the physical domain, 12.4 ± 3.1 (12.9 ± 3.0 women vs. 11.8 ± 3.1 men) and 12.6 ± 2.4 in the environmental domain (13.1 ± 2.3 women vs 12.1± 2.4 men). Women received a higher rating of health behaviour on all subscales of the IZZ questionnaire, with the highest score in the prevention behaviour subscale (3.6 ± 0.7) and the lowest in the subscale of proper eating habits (3.1 ± 0.8). In men the highest score of health behaviour was observed in the subscale of positive mental attitude (3.1 ± 1.0) and the lowest in the subscale of proper eating habits (2.5 ± 0.8). Conclusions: 1. There are differences between sociodemographic profile of TB patients: women are younger, better educated, economically active and more likely to remain in relationships; 2. There is no difference in QoL of TB patients between the sexes, whereas there are differences in the strategies of stress management and in applied health behavior; 3. Differences between genders indicate the need for matching treatment and preventive action for different patients profiles based on the cooperation of doctors, social workers, therapists, and psychologists