published_or_final_version / Nursing Studies / Master / Master of Nursing

Intravenous cannulation of pediatric patients is a common procedure in emergency departments. It is a useful tool to facilitate medical investigations and drug administration. However, the pain induced by the procedure can lead to patient distress and bother the nursing and medical procedures afterwards. There are many kinds of topical anesthesia but no relevant evidence-based guideline for their use is available for the emergency departments. This dissertation synthesizes the available evidence in the literature to establish an evidence-based guideline for the use of topical anesthesia to reduce pain caused by pediatric intravenous cannulation in an emergency department. The communication, implementation and evaluation plan are also developed. A systematic literature review was conducted from 30th August to 2nd September, 2011. A number of electronic databases, including PubMed, CINAHL Plus and Embase were searched. Thirteen eligible randomized controlled trials were identified. They were integrated into a table of evidence and were critically appraised by the SIGN Methodology Checklist. After synthesis of evidence, it is suggested that needleless anesthesia with apparatus assistance significantly reduced pain as early as in five minutes. Patients should however be observed for two hours after the administration of anesthesia for signs of adverse effects. The implementation potential, in terms of the transferability, feasibility and cost-benefit ratio, was examined. Among the anesthesia devices, the Jet lidocaine device has satisfactory transferability, feasibility and cost-benefit ratio. The evidence is then translated into a practice guideline with the recommendations scored based on the “SIGN 50: A guideline developer’s handbook”. A fourteen-month implementation plan,including a communication plan, a pilot study and an evaluation plan is developed. The communication phase lasts for three months and the stakeholders including the Chief of Service, Department Operation Manager, Advanced Practice Nurses, frontline healthcare professionals and the pharmacy department are identified. The pilot plan lasts for ten weeks, which includes a two-week training period, a three-week observational period for baseline measurement, a three-week intervention period and an eight-week amendment period. The pilot study collects data regarding the pain level at baseline and identifies unanticipated problems in the guideline. Amendments would be made accordingly and the revised guideline would be sent for ethical approval before the implementation phase. In the evaluation plan, the primary outcome for the innovation is the level of pain. The secondary outcomes are the admission rate and length of hospital stay. Other outcomes are the satisfaction of healthcare professionals, utilization rate and cost. It is expected that the cannulation pain, admission rate and length of hospital stay would be lower with the application of topical anesthesia. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1459945. ProQuest document ID: 1622198801. Includes bibliographical references (p. 41-43)

Thesis (M.S.)--University of Michigan, 1978.

Thesis (M.S.)--University of Michigan, 1978.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Trata-se de uma pesquisa de carÃter descritivo e exploratÃrio, com o objetivo central de analisar os fatores interferentes na realizaÃÃo do cateterismo vesical intermitente limpo na crianÃa portadora de bexiga neurogÃnica, secundÃria à mielomeningocele, sob a percepÃÃo do cuidador. Participaram do estudo 55 cuidadores de crianÃas de 29 dias de vida a 11 anos e 11 meses, vinculadas a um hospital geral infantil do MunicÃpio de Fortaleza-CE, que estivessem realizando o cateterismo vesical intermitente limpo (CIL) assistido e que tenham cumprido programa de reabilitaÃÃo. A maioria das crianÃas era de escolares (74,5%) e pertencia ao sexo feminino (58,2%), possuÃa benefÃcio de renda continuada (78,2%) e a renda familiar era de atà 2 salÃrios mÃnimos. Quanto aos cuidadores, a maioria tinha entre 32 e 39 anos (38,2%), era de mulheres (96,4%), mÃes (94,5%), casadas (69,1%), as quais haviam estudado atà o Ensino MÃdio (58,2%) e nÃo possuÃa ocupaÃÃo fora do domicÃlio (89,1%). Em relaÃÃo à infra-estrutura da casa, a maioria das residÃncias possuÃa Ãgua encanada (90,9%), saneamento bÃsico (69,1%), banheiro (100%), de 4 a 5 cÃmodos (50,9%), porta no local onde o CIL era realizado (63,6%) e de 4 a 5 pessoas coabitando no mesmo ambiente (47,3%). Quanto aos fatores que interferem na realizaÃÃo do CIL, os que apresentaram interferÃncia positiva foram: idade da crianÃa (p=0,047); cuidador sem ocupaÃÃo fora do domicÃlio (p=0,038); recebimento de benefÃcio de renda continuada (p=0,0001); recebimento do material utilizado no CIL do MunicÃpio ou do Estado (p=0,0001); presenÃa de Ãgua encanada (p=0,0001), saneamento bÃsico (p=0,0001) e porta no local onde o CIL à realizado (p=0,0001); boa acuidade visual (p=0,0001) e destreza do cuidador (p=0,0001); aceitaÃÃo da crianÃa (p=0,0001) e do cuidador em relaÃÃo ao procedimento (p=0,0001); ausÃncia de intercorrÃncia durante a realizaÃÃo do CIL (p=0,0001). Quanto aos que apresentaram interferÃncia negativa, tem-se: a presenÃa de sensibilidade uretral (p=0,002), as perdas urinÃrias nos intervalos do CIL e o uso contÃnuo de fraldas (p=0,0001) nessas crianÃas. Dois fatores investigados nÃo interferiram nem positiva nem negativamente: a quantidade de cÃmodos da casa e o nÃmero de pessoas coabitando com a crianÃa: p=0,0001. Esses resultados sugerem que o nÃmero de variÃveis que interferiram positivamente na realizaÃÃo do CIL foi superior ao dos que exerceram interferÃncia negativa. Os achados sÃo de extrema relevÃncia, visto que possibilitam a inferÃncia de que a adesÃo ao CIL à facilitada pela presenÃa desses fatores. / This is an exploratory and descriptive research, primarily aiming at the analysis of factors that interfere in clean intermittent catheterization (CIC) procedure in children with neurogenic bladder, secondary to myelomeningocele (MMC), under caregiverâs perception. Fifty five 29-days-old to 11 years and 11 months-old children participated in the study. They were engaged to a child general hospital in Fortaleza City â CE; they should be using assisted clean intermittent catheterization (CIC) and they had accomplished the rehabilitation program. Most of children were students (74.5%) and female (58.2%), receiving continued social benefit-cost (78.2%) and their family incomes were until 2 minimum wages. Most of caregivers in the study had 32 to 39 years-old (38.2%), were women (96.4%), married (69.1%), had the Mid Level concluded (58.2%) and did not have outdoor occupation (89.1%). Concerning to the house infrastructure, most of residences had treated water (90.9%), basic sanitation (69.1), bathroom (100%), from 4 to 5 rooms (50.9%), door in the place where the CIC was administered (63.6%) and from 4 to 5 people cohabitating the same environment (47.3). Related to the factors that interfere in the CIC procedure, positively interfered: childâs age (p=0.047); caregiver without outdoor occupation (p=0.038); perception of continued social benefit-cost (p=0.0001); reception of material used in CIC from Municipal District or State (p=0.0001); good caregiverâs visual acuity (p=0.0001) and dexterity (p=0.0001); acceptation from child (p=0.0001) and caregiver (p=0.0001) related to the procedure (p=0.0001); absence of intercurrence during CIC administration (p=0.0001). Related to the negative factors, it is related: urethral sensibility (p=0.002), urinary losses in the intervals of CIC; continuous use of diapers and the presence of urethral sensibility in these children (p=0.0001). Two investigated factors did not present any interference: amount of rooms and number of people cohabitating with child in the house (p=0.0001). These results suggest that the number of variables positively interfering in CIC administration was superior to the negative ones. So, findings are extremely relevant so they enable the inference that the adhesion to CIC is made easy by the presence of such factors.

Bakgrund: Perifer venkateter (PVK) är det vanligaste invasiva ingreppet inom vården och något många patienter kan känna obehag inför. Känslor som framkallar obehag kan infinna sig hos patienten röntgensjuksköterskan möter. Syfte: Studien syfte var att sammanställa kunskap om åtgärder röntgensjuksköterskan kan vidta i samband med insättandet av en perifer venkateter för att lindra obehag. Metod: En litteraturöversikt med induktiv ansats. Tio artiklar sammanställdes till ett resultat som kategoriserades efter artiklarnas innehåll. Resultat: Kategoriseringen resulterade i trygghetsskapande-, farmakologiska- samt medicintekniska och distraherande åtgärder. I dessa framgår vilka åtgärder sjuksköterskan kan vidta för att lindra obehaget i samband med insättandet av PVK. Slutsats: Resultatet visar att lindrande av obehag kan ske genom flertalet olika åtgärder. Vissa åtgärder kräver enbart röntgensjuksköterskans personkännedom och lyhördhet medan andra kräver medicinsk utrustning eller teknik. / Background: PVC insertion is the most common invasive procedure in health care and many patients describe feelings of discomfort in connection to the procedure. Feelings of discomfort may appear in this meeting between radiographer and patient. Aim: The aim of the study was to compile the radiographer’s interventions in the procedure of PVC insertion to reduce discomfort. Methods: A general literature review with an inductive approach. Ten articles complied in the result and were categorized from the content of the articles. Results: The categorization resulted in three categories security-, pharmacological- and medically and distraction measures, describing the interventions that the nurse can use to ease the discomfort in the procedure involving a PVC. Conclusions: The results shows that easing the discomfort can be achieved in different ways. Some measures only need the radiographer’s personal knowledge and sensitivity while others require medical devices or technology.

No description available.

No description available.

Bakgrund: Ren intermittent katetrisering (RIK) är en åtgärd som utförs dagligen på ett flertal patienter inom sjukvården, där sjukvårdspersonal tränger innanför patientens integritetssfär. Patienter har olika personliga gränser för när den personliga integriteten hotas och deras upplevelse vid RIK postoperativt, är sparsamt belyst i tidigare forskning.  Syfte: Att beskriva patienters upplevelse av ren intermittent kateterisering postoperativt. Metod: Datainsamlingen genomfördes med semistrukturerade intervjuer där tretton patienter som kateteriserats postoperativt deltog. Data analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visade att patienterna upplevde vårdpersonalen som kompetenta och de förlitade sig på att vårdpersonalen visste vad som var bäst för patienterna som också kände sig omhändertagna. Det upplevdes vara viktigt att bevara den personliga integriteten och de påtalade vikten av tillräckligt insynsskydd vid kateteriseringen vilket inte alltid varit tillfyllest. Patienterna uttryckte också rädsla dels för smärta i samband med kateteriseringen och dels för att de trodde att det var något fel eftersom de inte kunde urinera. Några beskrev det som en lättnad att få hjälp att tömma blåsan, medan andra kände sig utlämnade och upplevde det som att de inte hade något val. Majoriteten av patienterna hade inte fått/kom inte ihåg att de fått adekvat information om att kateterisering kunde komma att behövas postoperativt och de påtalade vikten av att detta gavs innan operationen. Slutsats: Vårdpersonalens bemötande av patienter som behöver genomgå RIK är av största vikt för patientens upplevelse av vårdsituationen. Vikten av att information ges, som är adekvat och lättförståelig, poängteras. Det är en fördel om patienten görs delaktig i sin vård och att hänsyn även tas till speciella önskemål, som t.ex. kön på den som utför kateteriseringen. / Background: Clean intermittent catheterization is an action that is performed daily on several patients in health care, where health care staff penetrates inside the patients privacy sphere. Patients’ have different personal limits when privacy is threatened and research with focus on the patients experience of clean intermittent catheterization postoperatively is limited. Aim: To describe patients’ experience of clean intermittent catheterization postoperatively. Method: Data collection was conducted by using semi-structured interviews with thirteen patients that had been catheterized postoperatively. Data were analysed using qualitative content analysis. Result: The result showed that patients’ experienced health care staff as competent and they relied on that the medical staff knew what was best for the patients who also felt cared for. It felt to be important to preserve privacy and they stressed the importance of sufficient transparency protection during catheterization which had not always been satisfactory. The patients’ expressed fear partly for pain associated with catheterization and partly because they thought there was something wrong since they were unable to urinate. Some described it as a relief to get help emptying the bladder, while others felt vulnerable and felt that they had no choice. The majority of patients’ had not got or could not remember if they had received adequate information that catheterization could be needed postoperatively and they emphasized importance of that this information was given before surgery. Conclusion: Health care staff treatment of patient’s requiring clean intermittent catheterisation is crucial for the patient's experience of the care situation. The importance that the information given is adequate and understandable was emphasized. It is an advantage if the patient is involved in care and that consideration to special requests, such as that the gender of the person performing catheterisation is considered.