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Biomedical subjects

K Dracup

Publications and source records attributed to K Dracup.

At least 37 records · Page 2Linked to original sources

Creating a healing environment for elders.

The number of elderly, both in society at large and in the critical care population, is increasing at an unprecedented rate. Critical care nurses must address how best to provide care to these elders. The authors focus on physiologic, cognitive, and psychosocial characteristics of the elderly that place them at risk for complications during their stay in critical care. The critical care environment also contributes to complications such as sleep deprivation, sensory deprivation or overload, painful procedures, and decreased social support. The critical care environment may also be a factor in facilitating delirium, common in critically ill elders. Critical care nurses can proactively help to create a healing environment for these elders by facilitating sleep, implementing strategies to reduce delirium, preventing or minimizing painful experiences, and liberalizing family visitations.

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A closer look at compliance research in heart failure patients in the last decade.

Compliance with a complex healthcare regimen is required of most patients with heart failure. Noncompliance with even some aspects of the recommended treatment can lead to repeated and preventable hospitalizations, or even death. This paper reviews the extent of noncompliance for general health-seeking behavior and recommended lifestyle modifications in the general population, as well as the research on compliance conducted specifically in patients with heart failure. Research findings are reviewed in three areas: the extent and predictors of compliance, the relationship of compliance and clinical outcomes, and interventions designed to increase compliance in heart failure patients. Based on research findings to date, strategies to enhance compliance are offered.

Heart Failure↗

Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants.

PURPOSE: The birth of a premature or critically ill infant can result in debilitating parental responses. This study identifies correlates of parental anxiety, hostility, depression, and psychosocial adjustment so that nurses can identify parents likely to need special attention or intervention. DESIGN: An explanatory, correlational design was used. SAMPLE: The study involved 469 parents (mothers = 299, 65 percent; mean age 29.1 +/- 6.8 years) of infants hospitalized in five Level III NICUs. MAIN OUTCOME VARIABLE: The main outcomes were those variables which correlated with the independent variables and included: parent status (mother or father), ethnicity, employment status, and education. RESULTS: Parents experienced high levels of anxiety, hostility, and depression. Poorer family functioning, lower levels of social support, and lower perceived control were associated with higher levels of anxiety, hostility, and depression and with poorer adjustment. Parental status (mother or father), ethnicity, employment status, and education were significantly related to parental responses.

Adaptation, Psychological↗

Heroic nurses.

Explore the source record for details and available documents.

England↗

One size fits all?

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Critical Care↗

Self-care behaviour of patients with heart failure.

Heart failure-related self-care behaviour is important to optimize outcomes for patients with heart failure. Such behaviours include adherence to medication, diet and exercise, but self-care also refers to such things as seeking assistance when symptoms occur, and daily weighing. The study aim was to describe heart failure-related self-care behaviour, to test the effect of education and support on self-care behaviour and to discuss limitations. Data were collected from 128 heart failure patients during their hospital stay and at 1-, 3-, and 9-month follow-ups. Concepts from Orem's general theory of nursing were used to describe heart failure-related self-care behaviour and its limitations. The effects of intensive systematized and planned education from a nurse in hospital and at home were evaluated in an experimental design. Results showed that education enhanced self-care behaviour significantly at 1 and 3 months after discharge. Despite intensive education and support, patients did not manifest all self-care behaviours that might be expected. Patients in both the intervention and control groups described limitations in knowledge, judgement/decision-making and skills. It can be concluded that supportive-educative intervention is effective in enhancing heart failure-related self-care behaviour early after discharge. To optimize such intervention, more emphasis must be placed on behavioural strategies (e.g. self-medication), social support (e.g. from family members) and reinforcement (e.g. home visits).

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Sexuality of patients with advanced heart failure and their spouses or partners.

BACKGROUND: Sexuality is an important aspect of quality of life for patients with advanced heart failure and their spouses or partners. Therefore, we conducted a study to determine the types of sexual problems and concerns of patients and their spouses/partners, their level of interest in receiving information on this topic, and the relationship between their need for information and the degree of sexual problems. METHODS: Sixty-three couples were recruited from a university-affiliated, outpatient, heart failure program during their initial visit. RESULTS: The most important sexual relationship issue of both patients and spouses/partners was related to decreased frequency in sexual relations. They reported the need to receive specific information about sexual activity as moderate to very high, but it was unrelated to the level of need for education and counseling. CONCLUSIONS: Nurses and physicians need to assume interest and provide instruction related to the sexual activity needs of patients and their spouses/partners.

Adolescent↗

Quality of life in older patients with systolic and diastolic heart failure.

AIMS: To get insight into the quality of life of a clinical practice sample of patients with heart failure that are admitted to the hospital. Secondly to determine differences between patients with systolic and diastolic dysfunction and finally to describe factors relating to quality of life. METHODS: Three dimensions of quality of life (functional capabilities, symptoms and psychosocial adjustment to illness) were assessed during interviews of 186 patients with chronic heart failure. In addition, data on demographic, clinical and self-care characteristics were collected and patients completed a 6-min walk. RESULTS: On average patients walked 172 m in 6 min and reported functioning in daily life at a mean level of 4.5 MET. Patients experienced four different symptoms of heart failure. Most of them described dyspnea, fatigue, sleep disturbance and ankle oedema. Problems with psychosocial adaptation occurred mostly in social and vocational domains. Overall well-being of patients was rated as 6.4 on a 10-point scale. In regard to quality of life, the only differences between patients with systolic and diastolic heart failure was the occurrence of ankle oedema and health-care orientation. The variance in components of quality of life were partly explained by demographics and clinical characteristics. All three dimensions of quality of life were related to ability for self-care. CONCLUSION: Patients with heart failure seen in clinical practice are often not comparable to patients described in major clinical trials or patients that are admitted for transplant evaluation. Their functional capabilities are more compromised, but they may have fewer problems with psychosocial adjustment. Patients with normal systolic dysfunction also report a low quality of life. It could be important to enhance self-care abilities of patients to improve psychosocial adaptation to illness.

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Comparison of psychosocial adjustment of mothers and fathers of high-risk infants in the neonatal intensive care unit.

OBJECTIVE: To compare the psychosocial adjustment of mothers and fathers to the birth of a premature or critically ill infant hospitalized in the neonatal intensive care unit (NICU). STUDY DESIGN: Using a comparative design, we studied 165 mothers and father pairs of high-risk neonates. Mothers were 29.1 +/- 6.7 and fathers were 30.7 +/- 6.8 years old. All infants were hospitalized in the NICU. Couples completed questionnaires in either English or Spanish during the infant's NICU stay. RESULTS: Mothers were more poorly adjusted and were more anxious, hostile, and depressed than fathers, but both parents experienced levels of emotional distress significantly above normative values. Mothers and fathers reported equal levels of family functioning and social support and shared similar feelings of control related to the health status of their infant. CONCLUSION: The birth of an infant who requires care in the NICU environment is highly stressful for both parents. Physicians, nurses, and other health professionals working in the NICU should assess the psychosocial adjustment in both parents, but mothers may require more intense education and counseling to reduce the distress they experience.

Adaptation, Psychological↗

Effects of education and support on self-care and resource utilization in patients with heart failure.

AIMS: To test the effect of education and support by a nurse on self-care and resource utilization in patients with heart failure. METHODS: A total of 179 patients (mean age 73, 58% male, NYHA III-IV) hospitalized with heart failure were evaluated prospectively. Patients were randomized to the study intervention or to 'care as usual'. The supportive educative intervention consisted of intensive, systematic and planned education by a study nurse about the consequences of heart failure in daily life, using a standard nursing care plan developed by the researchers for older patients with heart failure. Education and support took place during the hospital stay and at a home visit within a week of discharge. Data were collected on self-care abilities, self-care behaviour, readmissions, visits to the emergency heart centre and use of other health care resources. RESULTS: Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure. Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge, but the increase in the intervention group was significantly more after 1 month. Although self-care behaviour in both groups decreased during the following 8 months, the increase from baseline remained statistically significant in the intervention group, but not in the control group. No significant effects on resource utilization were found. CONCLUSIONS: Intensive, systematic, tailored and planned education and support by a nurse results in an increase in patients' self-care behaviour. No significant effects were found on use of health care resources. Additional organisational changes, such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support.

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