An interprofessional team was established to prevent tracheostomy-related acquired pressure injuries. The team performed an in-depth analysis of practice from tracheostomy insertion through ...postinsertion care. A literature evaluation identified best practices, and a root cause analysis for all tracheostomy-related pressure injury cases identified common causes. Lessons learned from the practice and literature reviews drove care standardization and reduced variation. Preimplementation and postimplementation data were analyzed to determine the effectiveness of improvement interventions. Improvement strategies included use of a more flexible tracheostomy tube, standardization of suturing, timing of suture removal, application of a hydrocolloid dressing at time of insertion and a foam dressing after suture removal, and caregiver education regarding early identification of and interventions for complications related to sutures and swelling. The result has been an 80% reduction of tracheostomy-related acquired pressure injuries systemwide.
TOPIC: Hyperactivity, a persistent, severe pattern of inattention or impulsivity, places children at risk for impaired functioning in many developmental areas. This behavior is characterized by ...short attention span, low frustration tolerance, impulsivity, distractibility, and increased physical activity. Responses from multiple sources in the child's environment must be monitored to manage childhood hyperactivity.
PURPOSE: Success at school, in peer relationships, and parent‐child interactions is frequently affected by hyperactivity. Using a focus group approach, a Nursing Outcomes Classification (NOC) label, definition, and indicators were developed for Hyperactivity Level.
SOURCES: Review of the literature allowed for a content analysis approach and conceptualization of hyperactivity at several levels.
CONCLUSION: Twenty three (23) measurable indicators were formulated and refined into conceptually and clinically coherent outcomes. Clinical relevance and utility were presented through a case study approach.
Evidence-based practice drives nursing procedures and standards of care. Supporting practice with valid research can be a challenge. After identifying a knowledge- and problem-focused trigger, a ...group of WOC nurses began a research journey. Our purpose was to determine the effectiveness of the rectal trumpet compared to the fecal collector in maintaining skin integrity in patients with fecal incontinence. The methodology included a convenience sample of 100 patients randomized to rectal trumpet or fecal collector versus standard care. Data were collected on signs of increased skin breakdown or healing, stool leakage around device, dislodgement, and discomfort from device. This article will reveal our journey in conducting this clinical research. After many challenges, the study was terminated, but the experiences and lessons learned during our efforts were invaluable. Even well-planned studies can encounter problems that prevent completion. It is important to evaluate these problems so that lessons can be learned and shared. This is our roller coaster ride in the research world.
Drawing on their considerable experiences of the syndrome, as well as current research findings, the authors help teachers and other education professionals to better understand the needs of a ...dyspraxic child. Through practical strategies, they show how teachers can make all the difference to a child's ability to succeed in the classroom, and case studies show how parents, teachers and therapists can work together to facilitate learning.
Whilst providing a unique insight and approach to the complex condition of dyspraxia, this lively, informative text also examines specific cases and scenarios, considering the perspectives of teachers and parents. It handles a range of crucial topics such as:
issues surrounding diagnosis
the developmental differences and characteristics of dyspraxia
conventional and alternative intervention strategies
an exploration of the pressure of families
ways of improving home/school liaison.
Teachers, SENCOs and other educational professionals will find this book provides a wealth of essential information and guidance, whilst parents will also find much to support them in the daily care and welfare of their child.
Eight retarded adolescents were trained to select one (a trained S+) of two visual stimuli in response to a spoken word (a trained word). Two different visual stimuli alternated randomly as the S-. ...To determine if the spoken work was merely a temporal discriminative stimulus for when to respond, or if it also specified which visual stimulus to select, the subjects were given intermittent presentations of untrained (novel) spoken words. All subjects consistently selected the trained S+ in response to the trained spoken word and selected the previous S- in response to the untrained spoken words. It was hypothesized that the subjects were responding away from the trained S+ in response to untrained spoken words, and control by untrained spoken words would not be observed when the trained S+ was not present. The two visual S- stimuli selected on trials of untrained spoken words were presented simultaneously. The untrained spoken words presented on these trials no longer controlled stimulus selections for seven subjects. The results supported the hypothesis that previous control by spoken words was due to responding away from the trained S+ in response to untrained spoken words.
In Experiment I, six preschool-aged children were given matching-to-sample training with two figures in which they were required to choose one of two comparison stimuli that was identical in shape to ...the standard stimulus. Following this training, they were given intermittent test trials in which a novel stimulus figure was substituted for the previously correct comparison stimulus. Five of the six subjects consistently chose the substituted stimulus during test trials. Experiment II replicated the findings of Experiment I with three other preschool-aged children. Experiment II also provided controls for the possibility that the subjects of Experiment I were selecting the substituted stimulus because of its novelty. The investigators concluded that eight of the nine subjects were exhibiting the type of control described by Berryman, Cumming, Cohen, and Johnson (1965) as S-delta responding.
Autonomy is defined as having control over one's life, not being subject to the will of another, the right of self-determination, and the right to decide, or freedom of choice. An autonomous ...individual is protected from unwanted interference. There is a consistent theme running through the literature of nursing, medicine, and ethics that assumes that the autonomous individual is sufficiently competent to receive, understand, and make choices based on information available. Using a focus group approach, a Nursing Outcomes Classification label, a definition, and indicators were developed for
personal autonomy. The definition and indicators were refined into a conceptually and clinically coherent outcome. Findings include the definition and 11 measurable indicators. Clinical relevance and utility are currently under investigation.
The nurse plays an important part in the preoperative and postoperative management of the patient with a urinary diversion. Although urinary diversion as a surgical alternative has been performed ...since the mid 1800s, improvements in technique and management over the past 10 years warrant discussion. Three types of urinary diversion procedures are discussed along with suggestions for optimal nursing management during the postoperative period.
A needs assessment was done to objectively evaluate client need and determine gaps between these needs and the services provided by mental health services. The services included were standard case ...management, assertive case management and residential care across the Fraser Health Region in British Columbia, Canada. Assessments involved collection of data on current symptoms, functioning, and service use and needs. Results showed many specific areas where client needs were under met. A level-of-care planning model was applied to the data and results suggest that a high percentage of clients may be in fact receiving too high or too low a level of care for their needs. This method of performing a population-based needs assessment provided findings that have proved useful for planning purposes in order to ensure that community mental health services better match client need.
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