Factors influencing peritoneal dialysis patients’ psychosocial adjustment

[[abstract]]Aims and objectives The specific aims of this study were as follows: (1) to describe psychosocial adjustment in adults with end-stage renal disease who underwent maintenance peritoneal dialysis; (2) to explore the influence of demographics, clinical variables, symptom distress and social support on psychosocial adjustment and (3) to determine predictive factors of psychosocial adjustment. Background Proper psychosocial adjustment is important for patients with end-stage renal disease to cope with multiple stressors of their disease and to balance their lives within the restrictions imposed by peritoneal dialysis treatment. Knowledge on psychosocial adjustment in patients receiving long-term peritoneal dialysis has been limited. Design The study was based on a predictive correlational design. Method One hundred peritoneal dialysis patients were recruited from outpatient peritoneal dialysis clinics of a general hospital in Taipei, Taiwan. Data were collected with the study questionnaires, including the Physical Symptom Distress Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale – self-report. Results The mean score on the Psychosocial Adjustment to Illness Scale was 359·7 (SD = 40·0), indicating that these participants were moderately struggling in adjusting to their illness. Symptom distress, family social support and financial status explained 38·3% of the variance in psychosocial adjustment (F3,96 = 21·5, p < 0·001). Conclusions The level of psychosocial adjustment in peritoneal dialysis patients is suboptimal. Overall, the patients with high physical symptom distress, weak family social support and poor financial status reported deficient psychosocial adjustment to their illness. Implications for practice The findings of this study are relevant to the understanding of preconditions that enable peritoneal dialysis patients to successfully adjust to the disease and its diverse consequences. Patients with insufficient income, higher symptom distress and less family social support have a greater risk of psychosocial maladjustment. Medical professionals may use these variables to identify higher risk groups for early intensive intervention

The Efficacy of Abdominal Massage for Reducing Ascites Associated Symptoms in Cancer Patients

[[abstract]]Introduction Patients with advanced cancer often experience a number of distressing symptoms. Approximately 15-50% of end stage cancer patients will develop malignant ascites and related symptom cluster, including distention, pain, activity decrease, fatigue, dyspnea, appetite loss, nausea, and hypoactive bowel movement. It is a great challenge for nurses to manage ascites related symptoms. The purpose of this study is to test the efficacy of abdominal massage in reducing ascites-related symptom cluster. Methods The study was based on a quasi-experimental design using repeated measures. A convenient sample of 80 cancer patients with ascites was recruited from a medical center in Taiwan. Participants were randomly assigned to the intervention or control group. The intervention participants received 15-minute gentle abdominal massage twice a day for three days. The control participants received social attention only. Data were collected from 2010 to 2011. Participants' ascites-related symptom cluster, body weights, and abdomen girths of paunch were measured at morning for 4 consecutive days from pre to post test by one of the researchers. The instruments included the Edmonton Symptom Assessment System-Ascites Modification questionnaire, a body weight scale, and a measuring tape. Descriptive statistics were used to describe participants' demographics, disease profiles, and outcome variables. Chi-Square, t-test, and Generalized Estimating Equations were used to examine group difference in terms of ascites-related symptom cluster, body weight, and abdomen girth of paunch. Results The average age of the study participants was 59.1 (SD=1.1); ranging from 35 to 82. Majority of them were male (n=53), married and living with a spouse (n=65), and had an elementary (n=28) to middle school (n=25) education level. The average duration of diagnosed with cancer were 13.2 months (SD=15.4); ranging from one to 64 months. 54 patients had liver or gallbladder cancer, 20 patients had cancer in other parts of the gastrointestinal system, and 6 patients had cancer outside the GI system. The demographics, disease profile, and measures of outcome variables were equivalent between the two study groups at baseline. Results of GEE showed significant group by time interactions in ascites-related symptom cluster (Wald X2=4187.01, p<0.001), and body weight (Wald X2=2827.3, p<0.001), indicating that abdomen massage improved ascites-related symptom cluster and reduced ascites-associated weight gain. Conclusion The results of the study showed that 15-minute gentle abdomen massage twice a day can improve ascites-related symptoms in patients with end stage cancer

A theoretical model for preventing osteoarthritis-related disability

[[abstract]]Osteoarthritis (OA) affects many aspects of life for affected individuals. Effective interventions to prevent and restore function must be based upon an understanding of what contributes to OA and its associated disabilities. A hypothetical OA disability model built upon the previous work of Nagi (1991), Verbrugge and Jette (1994), the International Classification of Functioning of World Health Organization (World Health Organization, 2001), and other scientific findings is proposed. The model includes a main disease pathway, which describes the sequence of events from OA-associated impairments to disabilities. Contextual factors influencing the process include individual characteristics, psychological state, coping style, comorbidities, social support, and physical environment. The model provides a useful conceptual framework for understanding the OA disability process from a biopsychosocial perspective and for guiding rehabilitation nursing interventions in OA care

Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty

[[abstract]]Abstract: Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f ¼ 29.70, p < 0.001). The study results provide preliminary support for biofeedback relaxation, a noninvasive and non-pharmacological intervention, as a complementary treatment option for pain management in this populatio

Concept analysis of functional status

[[abstract]]Nursing as a discipline is striving toward evidence-based practice whose foundation is built upon clarity of concepts and theories and appropriate measures. The objectives of the paper are to clarify an overused and vague concept and to provide a precise operational definition of functional status. By following the Walker and Avant concept analysis guidelines, the concept, functional status, can best be defined as the level of activities performed by an individual to realize needs of daily living in many aspects of life including physical, psychological, social, spiritual, intellectual, and roles. Level of performance is expected to correspond to normal expectation in the individual's nature, structure, and conditions

Effects of aquatic exercise on flexibility, strength, and aerobic fitness in adults with osteoarthritis of the hip or knee

[[abstract]]Title. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Aim.  This paper reports a study of the effects of aquatic exercise on physical fitness (flexibility, strength and aerobic fitness), self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee. Background.  Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement. Exercise is important for preventing and/or managing the functional limitations associated with joint disease. Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis; however, few studies have examined the effects on people with osteoarthritis, and these have yielded inconsistent results. Methods.  A two-group randomized controlled trial with a convenience sample was used. Participants were recruited from community sources and randomly assigned to a 12-week aquatic programme or a non-exercise control condition. Data for 38 participants were collected at baseline, week 6, and week 12 during 2003 and 2004. Instruments were a standard plastic goniometer, a handheld dynamometer, the 6-minute walk test, the multidimensional Health Assessment Questionnaire, and a visual analogue scale for pain. Results.  Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility, strength and aerobic fitness, but had no effect on self-reported physical functioning and pain. The exercise adherence rate was 81·7%, and no exercise-related adverse effect was observed or reported. Conclusions.  Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee. Although the programme may not offer pain relief or self-reported improvements in physical functioning, results suggest that aquatic exercise does not worsen the joint condition or result in injury. Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients

Efficacy of narrowband ultraviolet phototherapy on renal pruritus

[[abstract]]Aims and objectives To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus. Background Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition. Design The study was based on a quasi-experimental design with repeated measures. Methods A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008. Results The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 (p < 0·001) at time seven, 1·71 (p < 0·001) at time six and 1·24 at time five (p < 0·001). The group-by-time interactions were statistically significant after four sessions of narrowband-UVB irradiation. Conclusion The study findings support the efficacy of narrowband ultraviolet B phototherapy in alleviating renal pruritus. Relevance to clinical practice Clinicians may consider prescribing phototherapy for haemodialysis patients who have intractable renal pruritus and do not respond to conventional treatments

Influences of facial disfigurement and social support for psychosocial adjustment among patients with oral cancer in Taiwan: a cross-sectional study

[[abstract]]Objective To explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer. Design A cross-sectional design was used for the study. Participants and setting A convenience sample of 77 patients with oral cancer was recruited from the otolaryngology and oral and maxillofacial surgery outpatient clinics of three general hospitals in Taiwan. Measures Data were collected using the study questionnaires, including the Facial Disfigurement Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale. Results The mean score on the Psychosocial Adjustment to Illness Scale was 413.01 (SD=32.32); 71.4% of the participants were maladjusted. Results of multiple regression analysis showed statistically significant main effects of tumour site (beta=0.37), facial disfigurement (beta=0.35) and social support (beta=−1.01), and the interaction effect of facial disfigurement and social support (beta=0.79) (all p<0.05) on psychosocial adjustment after controlling for other sociodemographic and clinical variables. All variables together explained 62% of the variance in psychosocial adjustment (F(16, 55)=14.98, p<0.001). Conclusions The level of psychosocial adjustment in patients with oral cancer was suboptimal. Poorer psychosocial adjustment was reported by patients with more severe facial disfigurement and less social support. Patients with cancers in other areas of the oral cavity also reported poorer psychosocial adjustment than patients with cancers in the buccal mucosa. Medical professionals may use these variables to identify higher risk groups for early intensive intervention

[[alternative]]Preventing Common Enteral Feeding Complications in Critically Ill Adult Patients

[[abstract]]營養支持是提供重症病人在面對疾病壓力與氧合所需能量的一種輔助性治療，可經由腸胃道管灌或非腸胃道方式提供給無法主動維持適當營養攝取的重症病人。腸胃道管灌比靜脈營養更能維持腸道完整性、有較低的感染併發症風險及營養治療費用，而早期的腸道營養支持，更被認為是一種可以減輕疾病嚴重度、減少合併症、縮短加護病房住院天數以及改善病人治療成效的積極治療策略，故重症病人之營養支持以腸胃道管灌為優先考量。然而，就像其他的治療一樣，腸胃道管灌也有其相關的危險性。護理人員應具備相關知識，以提供接受腸胃道管灌之重症病人適當的照護，因此，本文就腸胃道管灌臨床適應症、照護注意事項、常見合併症之評估與預防作深入介紹。其中照護注意事項包括：開始灌食的時機、確認灌食管路插入的位置、胃殘餘量的監測以及管路阻塞的預防與處置，而常見合併症主要介紹肺吸入、腹瀉、嘔吐、低血鈉與高血糖的評估與預防，上述實證知識可作為重症照護單位制訂灌食管路照護標準與規範及人員訓練之參考，並藉以提供病人適當的營養支持，進而促進病人的預後。[[abstract]]Nutritional support provides critically ill patients with energy and nutrients required to face the demands of their illness and stress. For those unable to ingest orally, enteral feeding rather than parenteral feeding is recommended, as the former better preserves gut integrity, reduces risk of infection, and costs less. Early enteral feeding in critically ill patients is also associated with decreased disease severity, reduced complications, and shortened length of stay. Risks associated with enteral feeding include aspiration, diarrhea, vomiting, hyponatremia, and hyperglycemia. This article reviews current knowledge on enteral feeding and addresses correct feeding tube placement, proper feeding sites, assessing and managing gastric residual volume, and preventing feeding tube occultation. We also review information related to identifying and controlling risk factors for enteral feeding complications such as aspiration, diarrhea, vomiting, hyponatremia, and hyperglycemia. Nurses can use this information to provide high quality care for enteral feeding patients and develop institutional protocols, guidelines, and standards of care for such patients in intensive care units

Factors influencing heart failure patients’ sleep quality

[[abstract]]Title. Factors influencing heart failure patients’ sleep quality. Aim.  The aim of the study was to describe the factors influencing the sleep quality of patients with heart failure. Background.  Sleep problems are common in patients with heart failure, and have a negative impact on their quality of life. Patients with heart failure often have difficulties in lying supine to sleep, falling asleep, and maintaining sleep, as well as waking up too early. Methods.  A predictive correlational design was used, with 101 patients with heart failure recruited from cardiology clinics in Taiwan. Patients completed questionnaires, and data were collected in 2007. Statistical analyses included descriptive statistics, t-tests, analysis of variance, Pearson product moment correlation coefficients, and multiple regression. Results.  The mean score for sleep quality was 10·78 (sd = 4·78), as measured by the Pittsburgh Sleep Quality Index. Overall, 81% of participants reported poor sleep quality, and 31% were unsatisfied with the quality of their sleep. Sleep efficacy and hours of sleep during the night were rated as the lowest among the dimensions of sleep quality. The most common reason for interruption of sleep was getting up to urinate at night. Stepwise multiple regression analysis showed that the factors related to sleep quality were gender, perceived health, depressive mood, and the number of comorbidities. These four variables explained 31% of the variance in the sleep quality of these patients. Conclusion.  Patients with heart failure should be taught sleep hygiene and to increase leisure time activities, disease self-management, and emotional adjustment skills to improve their sleep quality. These patients should also be observed for night time safety risk due to nocturia