Background Each Emergency Room (ER) across the USA provides every patient with paperwork upon discharge, which commonly includes information about the patient’s diagnosis. This information will briefly describe the condition, provide information on treatment outside the ER, and possibly more, depending on the document and source. These documents are not made by hospital staff, but are generally purchased from outside providers who mass market such documents as resources for hospitals to use to educate patients. One issue with these documents lies in their mass usage, which is not necessarily designed to target the general population’s reading and educational levels. Purpose The purpose of this research was to investigate currently used discharge education materials and evaluate them for their readability and content. From this investigation, recommendations were made and adjustments to the documents were applied in order to increase understanding for the general population. Results The documents ranged in Flesch-Kincaid grade level rankings from 7.8 to 3.6, and with Flesch Reading Ease scores of 54.7 to 85.3. The entirety of the standard documents were ranked at a minimum of 7th grade equivalents, and are, at the hardest rank, ranked at a 54.7 by the Reading Ease score. In comparison, the ‘easy to read’ documents were ranked all below 5th grade level, and at the hardest rank, ranked at a 69.0 with the Flesch Reading Ease calculation. At a minimum, all documents included condition information and home care guidelines. The major obvious difference between the documents considered ‘easy to read’ and the standard documents are that those considered easy to read typically had sections found on the standard document removed, and have the same overall content as the standard version remaining, only in a simpler vocabulary. Conclusions In order to provide the best educational materials to the general public, it would be in the best interest of companies manufacturing these documents to produce only one version, which would be at a level around the 6th grade or below. A document slightly below the 6th grade level would be more ideal, as the simpler the document is, the more patients it will be accessible for overall, accounting for those who are below the national standards. It is not truly necessary to separate the documents into two forms, and it helps to prevent confusion or offense by doing so.

‎Nursing is a trusted profession aimed at delivering quality, patient-centered care perceived by patients as caring and satisfactory. While empiric care components are measurable as associated with clinical outcomes, patients’ perceptions of care are increasingly important in determining satisfaction with the patient care experience. Not clearly defined, nor empirically measurable, the “art” of nursing is taking on increasing importance as a component of satisfaction with the patient experience. The purpose of this integrative literature review was to review the literature in order to find common themes influencing determination of the art of nursing on patient satisfaction in acute care settings. Fourteen studies were selected and reviewed after a search of CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PsycARTICLES, and PsycINFOCINAHL databases. Four themes that emerged: building a relationship with the patient; conducting a thorough assessment of the patient; meaningful communication with the patient, and availability of nurses for their patients. The findings suggest that the art of nursing, as grounded in the demonstration of nursing care behaviors, is a component of patients’ satisfaction with the provision of care. This evidence-based knowledge is transferable to efforts in modifying nursing practices that exemplify patient-centered care.

Introduction: Oral hygiene is a significant aspect of nursing care. Endocarditis, stroke, lung cancer, and hypertension have been associated with poor oral hygiene. Research exploring oral care practices for mechanically ventilated patients is well documented. In contrast, oral hygiene for the non-mechanically ventilated acute care population remains underestimated. The purpose of this study was to establish a baseline of the type, frequency, and consistency of oral hygiene being performed on non-mechanically ventilated ICU patients and explore how the oral care provided was documented. Methodology: A literature search was conducted and reported as a literature review. The databases CINAHL Plus with Full Text, MEDLINE, PsychINFO, Academic Search Premier, and Cochrane Database of Systematic Reviews were searched. Key terms used were "oral hygiene," "oral care," "oral intensity," "mouth rinse," "mouth care," chlorhexidine rinse and ICU, "intensive care unit," "critical care" and infection*, pneumonia*, NV, non-ventilat*, and nonventilat*. The articles' selection addressed type, frequency, consistency, and/or documentation of oral hygiene in ICU patients, particularly non-mechanically ventilated patients, if available. Inclusion criteria consisted of English language, and academic journal articles. No specified publication date was placed as a restriction. The results were limited to English language, academic journal articles, peer reviewed research articles, evidence-based articles or practices, and articles published within the last ten years (2006 to 2016). All articles on oral hygiene practices in the ICU or critical care population were included. Articles that did not relate to oral hygiene practices in acute care, ICU patients, or critically ill hospitalized patients were excluded. Articles focused solely on the mechanically ventilated or intubated population were also excluded. Results: The review yielded very few articles focusing solely on non-mechanically ventilated ICU patients. Nevertheless, resulting data showed four areas common to oral hygiene practices in non-mechanically ventilated patients in the ICU: type of documentation, type of products, frequency of care, and personnel providing care. Documentation was found to be lacking compared to personnel's self-reported frequency of oral care. Oral hygiene products were found to be consistent in non-mechanically ventilated patients, while there was no consistency of products used in the general acute care population. Oral hygiene was self-reported by staff members to have been performed an average of two to three times per day for non-mechanically ventilated patients. Oral hygiene self-reported frequency was found to be inconsistent among the general acute care population. Lastly, registered nurses (RNs) were the primary providers of oral hygiene to patients. Conclusions: Findings support the existing gap in the literature on oral hygiene practices in non-mechanically ventilated patients in the ICU. Despite evidence documenting the impact of oral hygiene on health, further research is guaranteed.

Social support is the collection of tangible and intangible experiences that surround people as they cope with daily stressors. High quality social support is important among patients with cardiovascular disease (CVD) because it has positive effects on social, psychological and physical well-being, and those with good social support cope better with the travails of CVD. Although there are many studies of social support in CVD, little work has been done on the topic of discrepancies between desired and received social support in the context of gender. The purpose of this dissertation was to determine if there are gender differences in the discrepancies between CVD patients’ desired and received social support. If gender differences exist in desired and received needs for social support, it is necessary to identify how these differences might affect rehospitalization and mortality rates. Three manuscripts are included in this dissertation: 1) a comprehensive review of the literature to examine gender differences in CVD patients’ perception of the concordance between desired and received social support and if gender differences in patients’ perception of concordance are associated with differences in health outcomes; 2) a secondary analysis of a cross-sectional observational study to determine whether there is a differential relationship between perceived social support and depression in African American and Caucasian patients with heart failure (HF), and 3) a longitudinal observational study to determine if the discrepancy between desired and received support for individuals hospitalized with an exacerbation of HF is associated all-cause event-free survival. I identified a gap in the literature regarding the differences in received and desired levels of social support between genders that warrants further investigation. In the secondary analysis, I found that race moderates the relationship between perceived social support and depressive symptoms. Higher levels of perceived social support were associated with lower levels of depressive symptoms among Caucasians who had higher levels of depression. Among African Americans, depression levels were lower and were unaffected by level of social support. In the longitudinal observational study, 157 participants identified desired and received support upon enrollment. The participants had follow-up at one- and three-month post discharge intervals to determine if they had experienced rehospitalization or mortality during the period. In unadjusted and adjusted analyses neither gender nor social support congruency score group were predictive of all-cause event-free survival. This finding belies the common belief that too much support will smother the patient, causing cardiac invalidism. Despite this, further research is needed to continue to evaluate ongoing discrepancies between genders of desired and received support and their impact on health outcomes. Further research is also needed to establish accuracy in more appropriately matching social support received with the social support desired.

No description available.

Introdução: No âmbito da assistência ao paciente crítico, ainda persiste uma intensa e controversa discussão acerca da dificuldade da manutenção da normoglicemia, especialmente a fim de evitar episódios hipoglicêmicos. A hipoglicemia consiste em importante evento adverso e fator limitante para o controle glicêmico (CG) ideal. Objetivo: Este trabalho teve por objetivo analisar a hipoglicemia e os fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes críticos internados nas unidades de terapia intensiva, e clínica semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 106 adultos, que apresentaram CG, por, pelo menos, 48 h, e cujo seguimento foi de 72 h. A variável dependente foi hipoglicemia (70mg/dl) e independentes foram idade, dieta, uso de insulina, catecolaminas, hemodiálise, carga de trabalho de enfermagem e SAPSII. Na análise dos dados utilizaram-se os testes t de student, Exato de Fisher e regressão logística, com significância de p 0,05. Resultados: A incidência de hipoglicemia 70mg/dl foi de 14,2%. A média de idade foi 63,3 anos, com internação clínica em 67% dos casos, cerca de 40% dos pacientes tinham diabetes mellitus 39% insuficiência renal e 8% insuficiência hepática. A hipoglicemia foi associada a média da glicemia (p=0,013) variabilidade glicêmica (p=0,000), uso de catecolaminas (p=0,040), óbito na UTI (p=0,008). Foram fatores de risco a ausência de dieta via oral, OR 5,11; IC 1,04 -25,10, e a realização de hemodiálise OR 4,28; IC 1,16-15,76. O intervalo de medida glicêmica mais frequente foi de 6/6h, com poucas medidas em horários de troca de turno de trabalho e no período das 4 h às 7 h. A correlação entre medidas glicêmicas prescritas e realizadas foi de 0,880 (p=0,000). Conclusão: A hipoglicemia persiste como evento adverso no contexto das unidades críticas. A prescrição do CG, com maior ênfase na monitorização nos grupos de risco, ou seja, nos pacientes submetidos a hemodiálise e aqueles que não recebem dieta VO, pode ajudar a prevenir episódios hipoglicêmicos / Introduction: Within the context of critical patients care, there remains an intense and controversial discussion over the difficulty of maintaining normoglycemia, especially to avoid hypoglycemic episodes. Hypoglycemia is an important adverse event and a limiting factor for an ideal glycemic control (GC). Objective: This study aimed to analyze the factors associated to hypoglycemia in critically ill patients. Methods: Retrospective cohort study conducted in critically ill patients from intensive and semi-intensive care units, of the University Hospital University of São Paulo. The sample consisted of 106 adults who had GC, for at least 48 h, and whose follow-up was 72 h. The dependent variable was hypoglycemia (70mg / dl) and independent variables were age, diet, insulin, catecholamines, hemodialysis, nursing workload and SAPSII. In the data analysis we used Students t and Fishers Exact tests and logistic regression, with significance of p 0,05. Results: The incidence of hypoglycemia 70mg / dl was 14.2%. The average age was 63.3 years, 67% were clinical patients, about 40% had diabetes mellitus, 39% had renal failure and 8% liver failure. Hypoglycemia was associated with mean blood glucose (p = 0.013) glycemic variability (p = 0.000), use of catecholamines (p = 0.040), and death in the ICU (p = 0.008). Risk factors were the absence of oral diet, OR 5.11; CI 1.04 -25.10, and hemodialysis OR 4.28; CI 1.16 to 15.76. The most frequent range of glucose measurement was 6 / 6 h, with few readings in the hours of the nursing work shift change, and from 4 h to 7 h am. The correlation between prescribed and performed glucose measurements was 0.880 (p = 0.000). Conclusion: Hypoglycemia persists as an adverse event in the context of critical units. Prescription of GC, with greater emphasis on monitoring in risk groups, namely, patients undergoing hemodialysis and those not receiving VO diet, can help prevent hypoglycemic episodes

Introdução: A assistência hospitalar a pacientes portadores de queimaduras é altamente dispendiosa devido aos recursos humanos, materiais e estruturais necessários à sua viabilização. O conhecimento financeiro relativo a essa temática ainda é escasso, especialmente no que tange aos custos dos procedimentos executados por profissionais de enfermagem a pacientes, grandes queimados, em condições críticas. Objetivo: Identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, a pacientes grandes queimados internados em uma Unidade de Terapia Intensiva de Queimaduras (UTIQ). Método: Esta pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, foi conduzida na UTIQ da Unidade de Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: A partir de 1354 observações, relativas a 12 procedimentos frequentemente realizados na UTIQ, obteve-se o CDM de R$ 1,88 (DP=1,04) para controle dos sinais vitais; R$ 28,78 (DP=69,74) para administração de medicamentos via intravenosa; R$ 16,97 (DP=7,92) para mensuração de diurese; R$ 2,68 (DP=1,20) para verificação de glicemia capilar; R$ 6,71(DP=2,20) para administração de medicamentos via sonda nasoenteral; R$ 50,07 (DP=11,89) para higiene íntima no leito; R$ 3,64 (DP=2,01) para auxílio alimentação; R$ 55,88 (DP=18,98) para banho no leito/arrumação da cama; R$ 287,11 (DP=372,87) para curativo; R$ 6,65 (DP=2,09) para higiene oral; R$ 3,13 (DP=1,08) para administração de medicamentos via oral e R$ 8,51 (DP=1,79) para administração de medicamentos via subcutânea. Conclusão: A apuração dos custos dos recursos consumidos nos procedimentos requeridos pelos pacientes, grandes queimados, em UTI, pode fundamentar as tomadas de decisão gerenciais subsidiando a sua eficiência alocativa, evitando a ocorrência de desperdícios e, quando possível, indicando estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem. / Introduction: Hospital care for critical burn patients is highly costly due to human, material and structural resources required for its viability. The financial knowledge concerning this subject is still scarce, especially in regard to the cost of procedures performed by nurses in critical burn patients. Objective: To identify the average direct cost (ADC) of the nursing procedures carried out with greater frequency for burn patients admitted into the burn intensive care unit (BICU). Methodology: This quantitative exploratory and descriptive single case study was conducted in BICU at the Burn Unit of the Hospital das Clinicas of the Faculty of Medicine, Universidade de Sao Paulo. The ADC was calculated by multiplying the time (chronometering) spent by nursing professionals in procedures, object of this study, by the unit cost of direct labor adding to the cost of materials and solutions/drugs. For the purposes of the calculation, the Brazilian currency (R$) was used. Results: Based on 1354 observations related to 12 procedures often performed in BICU, it was obtained the ADC of R$ 1.88 (SD=1.04) for \"control the vital signs\"; R$ 28.78 (SD=69.74) for \"administering medication intravenously\"; R$ 16.97 (SD=7.92) for \"measurement of diuresis\"; R$ 2.68 (SD=1.20) to \"check Capillary Blood Glucose\"; R$ 6.71 (SD=2.20) for \"drug administration via nasogastric tube\"; R$ 50.07 (SD=11.89) for \"patient intimate hygiene; R$ 3.64 (SD=2.01) for \"food aid\"; R$ 55.88 (SD=18.98) for \"bed bathing/make the bed\"; R$ 287.11 (SD=372.87) for \"dressing\"; R$ 6.65 (SD=2.09) for \"oral hygiene\"; R$ 3.13 (SD=1.08) for \"oral drug administration\" and R$ 8.51 (SD=1.79) for \"drug administration subcutaneously\". Conclusion: The calculation of the resource costs spent in the procedures required by critical burn patients, in ICU, justify the decision making of subsidizing its allocative efficiency, avoiding the occurrence of waste and, when possible, indicating control strategies/minimizing strategy costs without impairing the quality of nursing care

The purpose of this dissertation was to examine the associations among social support, gender, relationship quality, and self-care behaviors in patients with heart failure (HF). Specific aims were to: 1) compare the psychometric properties of the 12-item and the 9-item European Heart Failure Self-Care Behavior Scale (EHFScBS) when used to measure self-care behaviors in patients with HF in the United States; 2) determine whether gender moderated the association between perceived social support and daily sodium intake in patients with HF; and 3) determine whether a patient’s gender and relationship with the primary family caregiver (spousal or non-spousal) moderated the association between relationship quality and HF self-care. For the first specific aim, reliability and validity of the 12-item and the 9-item EHFScBS were compared by measures of internal consistency of reliability, item analysis, exploratory factor analysis, and hypothesis testing. The 12-item and the 9-item EHFScBS were valid and reliable when used to measure self-care behaviors in the United States. The 9-item EHFScBS was more homogenous with dimensions closer to the originally proposed dimensions when compared to the 12-item EHFScBS. The second specific aim was addressed by secondary analysis of data from The RICH Heart Program HF Registry. A hierarchical multiple regression model was used to determine whether gender moderated the association between social support and daily sodium intake. In our study, gender did not moderate the association between social support and daily sodium intake. The third specific aim was addressed using hierarchical multiple regression analyses to determine whether gender or relationship type moderated the association between relationship quality and HF self-care. Baseline data from an ongoing longitudinal, randomized controlled trial of a patient-caregiver dyadic intervention program were used in the analysis. Relationship quality was measured using the patient version of the Dyadic Relationship Scale, which consists of two subscales: positive dyadic interaction and negative dyadic strain. Heart failure self-care was measured using the 9-item EHFScBS. Positive dyadic interaction was associated with better HF self-care in female patients or patients with a non-spousal relationship with their family caregiver. This dissertation has fulfilled important gaps in the evidence base for the self-care of patients with HF. The findings from this dissertation provided evidence for the validity and reliability of the 9-item EHFScBS when used to measure HF self-care behaviors. It also provided recommendations for future research to measure directed social support to adopt a specific behavior, such as eating low sodium diet, instead of measuring the social support in general. It also emphasized the importance of examining the quality of the relationship between patients and their family caregivers. The findings also pointed to the need for interventions targeting the relationship quality to be tailored according to the patients’ gender or their relationship type with their family caregiver (spousal or non-spousal). A better understanding of how social factors can impact self-care behaviors in patients with HF is essential, as it gives researchers and healthcare providers the prospect of developing effective interventions to improve HF self-care.

Utgångspunkten för denna litteraturstudie är att ventilatorassocierad pneumoni (VAP) går att förebygga. Syftet med detta arbete var att kartlägga olika evidensbaserade munvårdsmetoder som används av intensivvårdssjuksköterskor för att förebygga VAP hos ventilatorbehandlade patienter. Syftet var också att belysa vilka faktorer som påverkar intensivvårdssjuksköterskans utförande av evidensbaserad munvård till ventilatorbehandlade patienter. Studien utfördes som en systematisk litteraturstudie. Till resultatet användes 16 vetenskapliga artiklar. För att kunna bedöma artiklarnas vetenskapliga kvalitet granskades artiklarna utifrån en modifierad granskningsmall. Samtliga artiklar fick höga kvalitetspoäng, vilket innebär hög vetenskaplig relevans. Resultatet av litteraturstudien visar att i flera av de evidensbaserade munvårdsprotokoll som publicerats den senaste tiden finns några återkommande punkter. Dessa punkter är; bedömning av munhålans status, tandborstning med barntandborste, munsköljmedel och att munnen fuktas med ett intervall av två till sex timmar. Flera faktorer påverkar intensivvårdssjuksköterskans utförande av evidensbaserad munvård. Genom att införa ett evidensbaserat munvårdsprotokoll för ventilatorbehandlade intensivvårdspatienter och ge personalen utbildning i munvård kan incidensen av VAP minska. Resultatet visar också att generellt sett är kunskapsnivån låg hos intensivvårdssjuksköterskor gällande förebyggande åtgärder för att förhindra VAP. Om sjuksköterskan anser att hon/han har tid att utföra munvård blir resultatet av högre kvalitet och hon/han upplever också åtgärden som mindre obehaglig. Detta innebär att försök att förbättra omvårdnaden och därmed minska antalet vårdrelaterade infektioner även är en organisatorisk fråga.

Introdução: No âmbito da assistência ao paciente crítico, ainda persiste uma intensa e controversa discussão acerca da dificuldade da manutenção da normoglicemia, especialmente a fim de evitar episódios hipoglicêmicos. A hipoglicemia consiste em importante evento adverso e fator limitante para o controle glicêmico (CG) ideal. Objetivo: Este trabalho teve por objetivo analisar a hipoglicemia e os fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes críticos internados nas unidades de terapia intensiva, e clínica semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 106 adultos, que apresentaram CG, por, pelo menos, 48 h, e cujo seguimento foi de 72 h. A variável dependente foi hipoglicemia (70mg/dl) e independentes foram idade, dieta, uso de insulina, catecolaminas, hemodiálise, carga de trabalho de enfermagem e SAPSII. Na análise dos dados utilizaram-se os testes t de student, Exato de Fisher e regressão logística, com significância de p 0,05. Resultados: A incidência de hipoglicemia 70mg/dl foi de 14,2%. A média de idade foi 63,3 anos, com internação clínica em 67% dos casos, cerca de 40% dos pacientes tinham diabetes mellitus 39% insuficiência renal e 8% insuficiência hepática. A hipoglicemia foi associada a média da glicemia (p=0,013) variabilidade glicêmica (p=0,000), uso de catecolaminas (p=0,040), óbito na UTI (p=0,008). Foram fatores de risco a ausência de dieta via oral, OR 5,11; IC 1,04 -25,10, e a realização de hemodiálise OR 4,28; IC 1,16-15,76. O intervalo de medida glicêmica mais frequente foi de 6/6h, com poucas medidas em horários de troca de turno de trabalho e no período das 4 h às 7 h. A correlação entre medidas glicêmicas prescritas e realizadas foi de 0,880 (p=0,000). Conclusão: A hipoglicemia persiste como evento adverso no contexto das unidades críticas. A prescrição do CG, com maior ênfase na monitorização nos grupos de risco, ou seja, nos pacientes submetidos a hemodiálise e aqueles que não recebem dieta VO, pode ajudar a prevenir episódios hipoglicêmicos / Introduction: Within the context of critical patients care, there remains an intense and controversial discussion over the difficulty of maintaining normoglycemia, especially to avoid hypoglycemic episodes. Hypoglycemia is an important adverse event and a limiting factor for an ideal glycemic control (GC). Objective: This study aimed to analyze the factors associated to hypoglycemia in critically ill patients. Methods: Retrospective cohort study conducted in critically ill patients from intensive and semi-intensive care units, of the University Hospital University of São Paulo. The sample consisted of 106 adults who had GC, for at least 48 h, and whose follow-up was 72 h. The dependent variable was hypoglycemia (70mg / dl) and independent variables were age, diet, insulin, catecholamines, hemodialysis, nursing workload and SAPSII. In the data analysis we used Students t and Fishers Exact tests and logistic regression, with significance of p 0,05. Results: The incidence of hypoglycemia 70mg / dl was 14.2%. The average age was 63.3 years, 67% were clinical patients, about 40% had diabetes mellitus, 39% had renal failure and 8% liver failure. Hypoglycemia was associated with mean blood glucose (p = 0.013) glycemic variability (p = 0.000), use of catecholamines (p = 0.040), and death in the ICU (p = 0.008). Risk factors were the absence of oral diet, OR 5.11; CI 1.04 -25.10, and hemodialysis OR 4.28; CI 1.16 to 15.76. The most frequent range of glucose measurement was 6 / 6 h, with few readings in the hours of the nursing work shift change, and from 4 h to 7 h am. The correlation between prescribed and performed glucose measurements was 0.880 (p = 0.000). Conclusion: Hypoglycemia persists as an adverse event in the context of critical units. Prescription of GC, with greater emphasis on monitoring in risk groups, namely, patients undergoing hemodialysis and those not receiving VO diet, can help prevent hypoglycemic episodes