Biomedical subjects
Publications and source records attributed to J Colling.
Pulmonary pneumatoceles are a rare complication of nosocomial pneumonia. They occur most often in staphylococcal infections and are hence more frequent in children. We report the case of an immunocompromised adult who shortly after digestive surgery developed Escherichia coli pneumonia which evolved rapidly towards pneumatocele formation revealed by pneumothorax.
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Medication consumption patterns among community-dwelling elderly persons with chronic urinary incontinence were examined. All health professionals, including nurses, should be knowledgeable of the potential for adverse drug reactions. Continuing education and establishment of routine monitoring systems could help to reduce the risk of potential for adverse drug reactions and prevent drug-induced UI in patients.
Approximately half of the nursing home residents in the United States are incontinent of urine, and the prevalence rates among community-dwelling elderly persons are significant. Behavioral treatments are first-line management for most cases of urinary incontinence, and these techniques are recommended in the urinary incontinence guidelines published in 1996 by the Agency for Health Care Policy and Research. This article emphasizes assessment and treatments for persons in whom urinary incontinence has been detected and who are cognitively or physically impaired that are appropriately performed by nurses with no special expertise in or knowledge of urinary incontinence.
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Publication in 1992 of national Clinical Practice Guidelines for Urinary Incontinence in Adults by the US Department of Health and Human Services, Agency for Health Care Policy and Research (AHCPR) brought together in one document, for the first time, all the relevant material on the diagnosis and treatment of urinary incontinence. These guidelines also provided data about the effectiveness of various treatment options. Dissemination has been enhanced through massive distribution to professional and lay groups as well as making copies available at no charge by telephone (1-800-358-9295). Because of the volume of new research on incontinence, the guidelines are now being revised and updated with publication expected in 1995. This guideline is especially relevant for nursing because nurses are often the first, and may be the only, health professional with whom patients will discuss this embarrassing problem.
Nursing home units are subcultures of the entire facility, with values, attitudes and norms that are passed from aide to aide. Changes in work routines may threaten your workers' effectiveness. Helping your nursing staff adapt will always remain a challenge.
OBJECTIVE: To test an individualized form of habit training for urinary incontinence (UI) among long-stay cognitively and/or physically impaired elderly nursing home residents over time. DESIGN: Randomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24-hour period at 3-week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12-week intervention period was administered by indigenous staff after they attended a 4-hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects. SETTING: Four non-profit nursing homes; west, mid-west, east coast. PATIENTS: Consent was obtained from 154 (71%) who met primary inclusion criteria. Forty-one failed the secondary inclusion criteria leaving 113 who entered the 37-week study. Eighty-eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI. RESULTS: UI was significantly decreased during the 3-month period (P less than 0.001). Eighty-six percent showed improvement over baseline while one-third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P less than 0.005) while the control group's UI volume increased. CONCLUSIONS: The training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy.
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To test a behavioral approach for urinary incontinence (UI), 166 staff in four nursing homes participated in a quasi-experimental study that measured knowledge and attitudes about UI and compliance with toileting protocols. The intervention group (N = 96) showed a slight increase in knowledge; their attitudes remained positive over the four testing times. Compliance with the more critical component of the toileting protocol was only 72%, although evidence existed that the protocol reduced UI. Results are discussed in terms of the sociocultural environment of nursing homes.
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Researchers at four nursing home sites experienced similar problems in the informed consent process when they attempted to access a frail, cognitively impaired population to conduct a collaborative, quasi-experimental two year clinical trials study on urinary incontinence. In addition, similar institutional barriers were experienced in these geographically distant and dissimilar nursing homes. The study involved working closely with indigenous licensed nursing and nurse aide staff to implement the independent variable, an individualized toileting prescription. Successful strategies used to overcome barriers in conducting the research will be described.
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Urinary incontinence among nursing home patients is a very common problem. Until quite recently, incontinence was believed to be impossible or unnecessary to treat except through the use of absorbent pads and diapers. The cost of this type of management to the facility in terms of laundry, labor, and supplies, as well as to patients' well-being, is very high. Recent data suggest that at least some incontinent nursing home patients can benefit from treatment programs that can be taught to the nurse's aide staff and that, at the very least, will reduce laundry and supply costs. The significance of an improvement in patient morale or a decrease in the incidence of complications resulting from incontinence has yet to be assessed, but should be considered. In addition, even a partially successful treatment program may be helpful to the nurses caring for these patients as the nurses' sense of hopelessness and frustration about managing incontinent patients may be reduced. Finally, an active treatment program for continence, instituted by nurses, advances the nursing care of these patients from custodial nursing care to therapeutic nursing care.
Empirical evidence suggests that elderly persons experience more frequent qualitative and quantitative sleep disturbances than persons of other age groups. These disruptions may be particularly detrimental to the elderly since their physiological tolerance for disequilibrium is more limited than that of younger persons. Some sleep changes, however, appear to be physiologically beneficial and adaptive and should not be inadvertently dampened with drugs or other measures. Considerably more research is needed to allow nurses to assess sleep problems and intervene to achieve the intended therapeutic effect with greater precision.