Volume 36, Issue 3 ,2014

Development of clinical practice guidelines for urinary continence care of adult stroke survivors in acute and rehabilitation settings
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By Andrea R. Fisher, RN, MSN, MSc, CNN(C), Toba Miller, RN, MScN, MHA, & Susan Draper, RN, MScN


Abstract

This study developed evidence-based clinical practice guidelines for the urinary continence care of adult stroke survivors in acute and rehabilitation settings. The research team conducted a comprehensive review of the literature on urinary continence interventions and outcomes. The team then developed a set of recommendations outlined in the resulting clinical practice guidelines titled Clinical Practice Guidelines (CPGs) for the Urinary Continence Care of Stroke Survivors in Acute and Rehabilitation Settings.

The evaluation of the CPGs consisted of a two-part assessment and pilot implementation. An expert panel of 25 local and regional experts in stroke and continence care assessed the proposed CPGs. This assessment consisted of two stages: a) evaluating the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) Instrument (http://www.agreetrust.org); and, b) conducting focus groups to identify barriers and facilitators to the implementation of the guidelines using the Ottawa Model of Research Use (OMRU). Results from the expert panel assessments/feedback contributed to the refinement of the CPGs as well as identification and construction of implementation strategies.

Two sites conducted a three-month pilot implementation of three recommendations from the CPGs as selected by each site. The two inpatient sites were a rehabilitation setting and a mixed acute and rehabilitation setting. The implementation of the CPGs included the development of learning strategies tailored to the needs of each site and in addition to the creation of an online self-learning portal. This study assessed nurses’ knowledge, attitudes, and beliefs regarding urinary continence challenges using a survey before and after the pilot. Chart reviews before and after the pilot implementation audited the nurses’ urinary continence practices for patients and uptake of the selected guidelines’ recommendations. Study findings suggested the implementation of the CPGs’ recommendations improved nurses’ knowledge of the continence needs of stroke survivors.



Clustered stroke patients on a general medical unit: What nursing skills and knowledge contribute to optimal patient outcomes?
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By Brenda Clayton, RN, MN, CNN(C)


Abstract

The purpose of this paper is to explore the nurse’s role in caring for adult stroke patients, both ischemic and hemorrhagic, who are clustered on general medical units. There is evidence in the literature that having patients cared for in a dedicated stroke unit improves patient outcomes by decreasing disability and mortality rates for stroke survivors. However, having a dedicated stroke unit may not be practical or feasible because of the population distribution, particularly for smaller urban and rural communities. Therefore, training nurses on the general medical units to provide care to clustered stroke patients requires specific skill training. This will decrease hospital stays and improve patient outcomes, as a result of specialized trained health care workers. A review of the literature indicates that there are specific skills and knowledge the nurse requires to perform evidence-based best practice therapy and have optimal patient outcomes when caring for patients on general medical units.

Key words: organized stroke units, nursing care, acute stroke care, clustered stroke care



Retrospective analysis of phone queries to an epilepsy clinic hotline
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By Anny Laforme, RN, BNI, Suzie Jubinville, RN, Micheline Gravel, RN, BScN, Patrick Cossette, MD, PhD, FRCPC, and Dang K.

Nguyen, MD, PhD, FRCPC


Abstract

We undertook a retrospective study of 5,189 telephone calls made between January 2004 and June 2011 through our adult epilepsy clinic hotline to a single epileptologist initially and two epileptologists from June 2010 onwards. The majority of calls were made by patients themselves (72%), followed by family members (16%) and health care providers (11%). Half of the calls originated from outside the city limits. Most were related to medication (25%), notification of seizures (23%), appointments or tests (12%), and side effects (9%). Half of the workload was generated by 10% of patients. The hotline service appears to respond to needs, with most calls requiring rapid intervention. It is desirable to develop novel approaches to address the needs of high-frequency callers.

Key words: epilepsy, clinic, nursing, telephone, hotline



Promoting rest using a quiet time innovation in an adult neuroscience step down unit
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By Tara Bergner, RN, BN, MHS, CNN(c)


Abstract

Sleep and rest are fundamental for the restoration of energy needed to recuperate from illness, trauma and surgery. At present hospitals are too noisy to promote rest for patients. A literature search produced research that described how quiet time interventions addressing noise levels have met with positive patient and staff satisfaction, as well as creating a more peaceful and healing environment. In this paper, a description of the importance of quiet time and how a small but feasible innovation was carried out in an adult neuroscience step down unit in a large tertiary health care facility in Canada is provided. Anecdotal evidence from patients, families, and staff suggests that quiet time may have positive effects for patients, their families, and the adult neuroscience step down unit staff. Future research examining the effect of quiet time on patient, family and staff satisfaction and patient healing is necessary.

Keywords: noise, hospital, quiet time, rest, patient satisfaction



CLINICAL CORNER Promoting rest using a quiet time innovation in an adult neuroscience step down unit
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By Tara Bergner, RN, BN, MHS, CNN(c)


Abstract

Sleep and rest are fundamental for the restoration of energy needed to recuperate from illness, trauma and surgery. At present hospitals are too noisy to promote rest for patients. A literature search produced research that described how quiet time interventions addressing noise levels have met with positive patient and staff satisfaction, as well as creating a more peaceful and healing environment. In this paper, a description of the importance of quiet time and how a small but feasible innovation was carried out in an adult neuroscience step down unit in a large tertiary health care facility in Canada is provided. Anecdotal evidence from patients, families, and staff suggests that quiet time may have positive effects for patients, their families, and the adult neuroscience step down unit staff. Future research examining the effect of quiet time on patient, family and staff satisfaction and patient healing is necessary.

Keywords: noise, hospital, quiet time, rest, patient satisfaction



2014 CANN Conference Brain Tumour Foundation Award Primary malignant brain tumours, psychosocial distress and the intimate partner experience: What do we know?
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By Dr. Brenda Sabo, RN, PhD


Abstract

From the time of diagnosis of a primary malignant brain tumour (PMBT) and throughout the illness trajectory, the patient and intimate partner face many psychosocial challenges ranging from fear and uncertainty to hope and loss (Fox & Lantz, 1998; Janda et al., 2007; Kvale, Murthy, Taylor, Lee, & Nabors, 2009). While many patients diagnosed with cancer may go on to live with cancer as a chronic illness, this may not be said of individuals diagnosed with a PMBT, in particular those diagnosed with a glioma, the most common form of brain tumour (Gupta & Sarin, 2002). Gliomas are associated with a short disease trajectory and multiple deficits (functional, cognitive and psychiatric). What makes the PMBT experience unique from other cancers is that the intimate partner must not only deal with the diagnosis of cancer in their spouse, but also the accompanying personality, functional and behavioural changes wrought by the disease, as well as grieve the loss of the person they once knew (Sherwood et al., 2004). These multi-dimensional deficits are thought to place the intimate partner, as caregiver, at greater risk for adverse psychosocial effects such as anxiety, depression and post traumatic stress (Goebel, von Harscher, & Mehdorn, 2011; Keir, Farland, Lipp, & Friedman, 2009). The following discussion will provide an overview of the extant literature on the experience of living with a PMBT from the intimate partner (spouse) perspective with a particular emphasis on how intimate partners cope. The intimate partner is considered to be the heterosexual or same-sex, married or common-law partner of the patient. Highlights from the psychotherapy practice of the author will be used to further strengthen the need for more research, education and enhanced practice to more effectively meet the unique needs of this underresearched and supported population.