Jakość życia zależna od stanu zdrowia u chorych na astmę oskrzelową

A patient is not, or at least should not be, a passive subject, but the active participant of the process of asthma treatment. This naturally imposes covering patients with bronchial asthma with a holistic model of care. Assessment of health-related quality of life (HRQoL) is one component of this model. HRQoL of asthma patients can be determined with an array of generic instruments, e.g. Medical Outcomes Survey Short Form 36 (SF-36), EuroQoL questionnaire (EQ-5D) or World Health Organization Quality of Life Questionnaire (WHOQOL), as well as with the specific tools, among which Saint George’s Respiratory Questionnaire (SGRO) and Asthma Quality of Life Questionnaire (AQLQ) belong to the most widely used. HRQoL is significantly associated with the degree of asthma control. However, literature data suggest that a determination of HRQoL alone, with either specific or generic instrument, can be insufficient, as the level of health-related quality of life turned out to be modulated by three groups of factors: 1) demographic characteristics of patients, 2) clinical parameters, and 3) personality traits of respondents. Due to particularly strong effect of psychological characteristics on the quality of life of patients with bronchial asthma, also the level of depressiveness should be examined along with the HRQoL determination. Furthermore, complex assessment of the quality of life and its determinants should be conducted longitudinally, either in individual patients or in epidemiological studies.W procesie terapii astmy pacjent nie jest — a przynajmniej nie powinien być — biernym podmiotem, lecz aktywnym uczestnikiem. W sposób naturalny narzuca to objęcie chorych na astmę oskrzelową holistycznym modelem opieki. Jednym z jego elementów jest ocena jakości życia związanej ze stanem zdrowia (HRQoL). Do oceny HRQoL u chorych na astmę oskrzelową można wykorzystać wiele instrumentów generycznych, na przykład Medical Outcomes Survey Short Form 36 (SF-36), kwestionariusz EuroQoL (EQ-5D) czy World Health Organization Quality of Life Questionnaire (WHOQOL), a także specyficzne narzędzia, spośród których najczęściej stosuje się Kwestionariusz Szpitala Św. Jerzego (SGRO) oraz Asthma Quality of Life Questionnaire (AQLQ). HRQoL jest czynnikiem związanym istotnie ze stopniem kontroli astmy. W świetle danych literaturowych wydaje się jednak, że samo określenie HRQoL za pomocą specyficznego lub generycznego instrumentu nie jest wystarczające. Wykazano bowiem, że na poziom jakości życia związanej ze stanem zdrowia wpływają trzy grupy czynników: 1) charakterystyki demograficzne chorych, 2) parametry kliniczne, oraz 3) cechy osobowości badanych. Z uwagi na szczególnie istotny wpływ charakterystyk psychologicznych na jakość życia pacjentów z astmą oskrzelową, równolegle z oceną HRQoL należy określić także poziom depresyjności. Co więcej, kompleksowa ocena jakości życia i jej determinant psychologicznych powinna być prowadzona w sposób ciągły — zarówno u indywidualnych pacjentów, jak i w badaniach epidemiologicznych

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

Job satisfaction among school nurses

Introduction Job satisfaction among Polish nurses is a significant predictor of the quality of health care provided. A school nurse is a specialist who improves student well-being, promotes health behaviours, advances academic and life success, thus, high levels of motivation and job satisfaction are indispensable to manage this role. Aim The aim of the research was to assess the factors affecting job satisfaction among school nurses. Material and methods The study was conducted among 125 nurses working in Polish schools. Sociodemographic data were obtained using an original questionnaire developed by the authors. The level of job satisfaction was assessed on the basis of the Satisfaction with Work Questionnaire (SPP). Results The mean age of the group studied was 52.7±7.2 years. 93.6% of the respondents had a work experience exceeding 15 years, 42.3% were medical vocational college graduates. Analysis of the SPP questionnaire showed that the group surveyed obtained an average of 5.0±1.0 points (min.2.8, max.7.0). Higher SPP scores were observed in the group of nurses with shorter job seniority (

Validation of the Numerical Anxiety Rating Scale in postpartum females: a prospective observational study

Objectives: Perinatal anxiety is important for the quality of life of mothers and their offspring. The Numerical Anxiety Rating Scale (NRS-A) allows the level of anxiety in patients to be quickly assessed. Until now, the NRS-A has not been validated in the postpartum female population. The aim of this study was to assess the accuracy and reliability of the NRS-A when compared with the reference methods for measuring anxiety. Material and methods: The observational prospective study included a group of 200 adult postpartum females of a hospital maternity ward. The validity between the Numerical Rating Scale for Anxiety (NRS-A) and the State and Trait Anxiety Inventory (STAI), and between the NRS-A and the Hospital Anxiety and Depression Scale (HADS-A), was determined. The detection thresholds for high anxiety were examined. Results: Both measurements showed a positive high correlation between the NRS and STAI-S (in T1 rho = 0.807, in T2 rho = 0.778; p < 0.001), and a comparable relationship of both scales (STAI-S and NRS-A) with the STAI-T and HADS-A. The analysis of the ROC curve indicated that the value of the NRS-A equal to 3.5/10 can be considered the threshold that allows for a differentiation of patients with high anxiety from those without high anxiety in the studied population. Conclusions: The NRS-A is an accurate tool for measuring anxiety in Polish postpartum females. Routine anxiety measurements using the NRS-A can be used to identify people with high anxiety in order to provide emotional support to patients in the early postpartum period

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

Adherence and compliance in the treatment of hypertension

Nadciśnienie tętnicze (NT) uznawane jest za schorzenie występujące najczęściej w populacji ogólnej. Stanowi problem zdrowotny i ekonomiczny na całym świecie. Mimo dostępnej wiedzy oraz rozwoju medycyny w kierunku farmakoterapii i leków hipotensyjnych, w Polsce skuteczność leczenia NT wynosi zaledwie 5–15%. Kluczowym elementem każdej terapii jest przestrzeganie zaleceń lekarskich oraz odpowiednia współpraca chorego z personelem medycznym. Zadawalający poziom adherence i compliance przyczynia się do osiągnięcia odpowiednich wartości ciśnienia tętniczego. Z powodu dużej liczby chorych niestosujących się do zaleceń lekarskich oraz niesystematycznego przyjmowania leków od kilkunastu lat podejmuje się próby naukowego uzasadnienia tego zjawiska. Wysoki poziom compliance i adherence zmniejsza ryzyka wystąpienia powikłań sercowo-naczyniowych, koszty związane z leczeniem oraz poprawia jakość życia chorego.The hypertension is considered to be a disease occurring most frequently in the general population. Is a health and ecologic problem around the world. Despite the available knowledge and the development of medicine in the direction of Pharmacotherapy and antihypertensive medications, the efficiency of the treatment of hypertension in Poland is only on the level 5–15%. A key element in the therapy is the medical adherence and appropriate cooperation of the patient with medical staff. A satisfactory level of adherence and compliance contributes to achieving the appropriate values of the blood pressure. There is a large number of patients who do not adhere to medical recommendations and thus do not take prescribed medications systematically, scientific justification of this phenomenon has been attempted for several year. A high level of the compliance and adherence decreases the risk of cardiovascular complications and the costs associated with treatment. It also improves the quality of patiens’ lives