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Biomedical subjects

L C Mion

Publications and source records attributed to L C Mion.

At least 19 recordsLinked to original sources
PubMed1998

Prevalence and patterns of physical restraint use in the acute care setting.

Nurse executives usually have the principal responsibility to respond to the national movement to reduce physical restraint use in hospitals. The results of this three-site, interdisciplinary, prospective incidence study (based on more than 49,000 observations collected on 18 randomly selected days) reveal new patterns in the rationale and types of restraints used. The authors discuss how the results can be used in measuring success and allocating resources for restraint reduction programs.

Aged↗
PubMed1998

A nonpharmacologic sleep protocol for hospitalized older patients.

OBJECTIVES: To evaluate the feasibility of and adherence to a nonpharmacologic sleep protocol targeted to nurses for acutely ill older patients and to test the effectiveness of the protocol on enhancing sleep and reducing sedative-hypnotic drug (SHD) use. DESIGN: Prospective cohort study. SETTING: A 34-bed general medical unit in a university-affiliated teaching hospital. PARTICIPANTS: A total of 175 consecutive admissions aged 70 years or older. INTERVENTION: A nonpharmacologic sleep protocol consisting of a back rub, warm drink, and relaxation tapes was administered by nursing personnel to patients who complained of difficulty initiating sleep or who requested a SHD. After 1 hour, if the patient still requested it, the nurse administered the SHD. MEASUREMENTS: The main outcomes of sleep quality and SHD use were measured by patient interview and chart abstraction. Feasibility and adherence to the protocol were tracked daily by patient and nurse interviews and chart abstraction. RESULTS: A cohort of 111 patients, mean age 79.3 (+/- 6.4), 68% women, received the sleep protocol. Patients required the protocol for a mean of 4.9 days per patient, totalling 539 patients-days. The overall adherence rate was 400/539 (74%) patient-days. The rate of complete nonadherence was 139/539 (26%), with reasons for nonadherence including nurse nonadherence in 30 (6%), patient refusal in 104 (19%), and medical contraindications in five (1%). The quality of sleep correlated strongly with the number of parts of the protocol received, suggesting a dose-response relationship, with the highest correlation for receiving two to three parts (p = .64, P < 0.001). The sleep protocol was successful in reducing SHD use from the baseline preintervention rate of 51/94 (54%) to 34/111 (31%) (P < .002). The sleep protocol had a stronger association with quality of sleep (p = .75, P = .001) than did SHDs (p = .07, P = .45). However, chronic SHD users were more likely to refuse the protocol than nonusers (64% vs 41%, P < .03) and received SHDs 4.5 times more often than nonusers (67% vs 15%, P = .001). CONCLUSION: The nonpharmacologic sleep protocol provides a feasible, effective, and nontoxic alternative to SHDs to promote sleep in older hospitalized patients. Use of the protocol can substantially decrease use of SHDs.

Aged↗
PubMed1998

Physical restraints in the acute care setting: issues and future direction.

The pattern and prevalence of physical restraint in hospital settings have changed over the past decade. The challenge to health professionals who wish to reduce or eliminate the use of restraints includes clinical, ethical, and legal concerns. Factors that influence health care providers' decisions regarding whether to use physical restraints include organizational characteristics and systems of care, environmental characteristics, and specific clinical guidelines or protocols, as well as individual patient characteristics. To reduce the incidence of physical restraint, hospital professionals need to develop and test feasible alternative practices using an interdisciplinary approach that addresses organizational, environmental, and patient-specific factors.

Acute Disease↗
PubMed1997

Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study.

OBJECTIVE: To identify factors associated with the occurrence of deliberate self-extubation and to describe associated patient outcomes. DESIGN: Case-control study. SETTING: ICUs of a national referral, tertiary medical center. PARTICIPANTS: Fifty adult, intubated patients who had self-extubated from mechanical ventilatory support. Two control subjects who had not self-extubated were matched to each case based on age, gender, primary discharge diagnosis, and time hospitalized (within same quarter). MEASUREMENTS: Standardized coding of medical record information, including demographic characteristics, clinical information, intubation and mechanical ventilation characteristics, medications, and selected laboratory indexes. RESULTS: As compared to the control subjects, patients who self-extubated were more likely to be medical than surgical patients (p<0.001) and have a current history of smoking (p<0.05). Prior to the self-extubation, patients had a greater likelihood of hospital-acquired infections (p<0.001) or other hospital-acquired adverse events (p<0.001), abnormal (<10, >50 mg/dL) BUN (p<0.05), and abnormal (<20, >50 mm Hg) PaCO2 (p<0.05); they also were more likely to be restless or agitated (p<0.001), and more likely to be physically restrained (p<0.001). A logistic regression model demonstrated that presence of restlessness or agitation and presence of a hospital-acquired adverse event were independently associated with self-extubation from mechanical ventilatory support. In examining outcomes, as compared to the control subjects, those who self-extubated had longer lengths of stay in ICU and hospital, were more likely to need reintubation, and were more likely to suffer complications from intubation. However, none of the cases died within 48 h of self-extubation. CONCLUSION: The results underscore the need for clinical guidelines for weaning and for monitoring patients at risk of self-extubation.

Adult↗
PubMed1997

Improving care givers' satisfaction with information received during hospitalization.

As competition for patient volume escalates among hospital providers, administrators must identify ways to attract new patients and maintain or increase patient volume. Family care givers are known to greatly influence individuals' choices in these matters of selection of healthcare services and providers. The results of a successful nurse-initiated daily phone calls program, designed to improve family care giver satisfaction by enhancing the provision of patient-specific information, are presented. The components of the program, associated costs, and implications on delivery of care are discussed.

Aged↗
PubMed1996

Quantitative and qualitative alterations of acute-phase proteins in healthy elderly persons.

To assess acute-phase proteins in relation to ageing, we measured serum concentrations of C-reactive protein of AGP in 131 healthy elderly individuals (aged >/= 65 years) living independently in the community, and 47 healthy younger individuals. Concentrations of CRP in the older persons (median = 3.0 microg/ml) were significantly greater than in the younger group (median = 0.9 microg/ml, p = 0. 0003). Concentrations of SAA and AGP were similar in the two groups, but AGP glycosylation forms with reduced binding affinity for concanavalin-A (changes that have been observed in chronic inflammatory states) were increased in the elderly sample (p<0.0001). These findings suggest that both quantitative and qualitative alterations of acute-phase proteins occur with physiological ageing in humans.

Activities of Daily Living↗
PubMed1996

Effect of a professional practice model on autonomy, job satisfaction and turnover.

Dissatisfaction and rapid turnover of registered nurses (RNs) challenge nurse administrators. The professional practice model (PPM) can increase the amount of personal control nurses have over their work. Use of a PPM allows innovation, promotes collegial relationships and emphasizes personal responsibility. In this study, facilitating an autonomous climate for RN practice resulted in increased job satisfaction and decreased.

Adult↗
PubMed1996

Establishing alternatives to physical restraints in the acute care setting: a conceptual framework to assist nurses' decision making.

Critical care and acute care nurses must determine ways to deliver optimal patient care without the use of physical restraints. This article explores the application of the clinical decision analysis model to the challenge of finding nonrestraint approaches to care. Clinical decision analysis is a structured, quantified approach for choosing an optimal course of action in a situation that involves tradeoffs among risks and preferences and when outcomes are uncertain. Decision analysis provides a graphic representation of the decision situation that facilitates evaluation of factors relevant to the situation and evaluation of the potential events and outcomes following a chosen strategy. The decision analysis model can be useful for determining guidelines for clinical practices, facilitating discussions among health care providers and patients, and determining areas in need of additional research.

Acute Disease↗
PubMed1996

Neuroleptic therapy. How much do nurses know?

1. Nursing home nurses play an integral and crucial role in neuroleptic therapeutic regimens as they are responsible for administering medications and monitoring for potential side effects. 2. The geriatric population residing in nursing homes is particularly vulnerable to side effects associated with neuroleptics for a variety of reasons including decreased drug distribution/metabolism/excretion, concomitant polypharmacy, and increased prevalence of tardive dyskinesia. 3. Nursing home nurses need to be better informed regarding neuroleptic use; education should be specifically targeted to include changes in pharmacokinetics and pharmacodynamics associated with aging, drug-drug interactions, and ongoing evaluation of side effects. 4. There is a pressing need to continue to examine the judicious use of neuroleptics in nursing home residents.

Adult↗
PubMed1996

Physical restraint use in the hospital setting: unresolved issues and directions for research.

Although the use of physical restraint has declined in nursing homes, the practice remains widespread in hospitals. The use of physical restraint in hospitals was reviewed to identify the current clinical, legal, and ethical issues and the implications for policy and further research. Clinicians use physical restraints to prevent patient falls, to forestall disruption of therapy, or to control disruptive behavior, but they vary in how they determine to institute these restraints. The evidence to support the reasons for their determinations is not compelling. Fear of litigation remains a powerful motivator. The ethical dilemma of autonomy versus beneficence has not been resolved satisfactorily for patients in this setting. The lack of large-scale studies in any of these areas makes it difficult for policy makers to determine whether it is necessary to address hospital physical restraint practices through additional regulation.

Behavior Control↗
PubMed1995

Effectiveness of bran supplement on the bowel management of elderly rehabilitation patients.

1. Constipation is a common problem in the elderly that affects up to 20% of those 65 years and older. 2. Patients receiving the fiber supplement had a significantly lower number of bowel agents per day as compared to the control patients. 3. Side effects from the additional fiber occurred in a subgroup of patients; thus, institution of additional fiber to the diets of ill, physically dependent patients is best done gradually and with close monitoring.

Aged↗
PubMed1994

Nutritional assessment of the elderly in the ambulatory care setting.

Malnutrition is a major risk for morbidity and mortality among elderly hospital and nursing home patients. Moreover, prevalence of malnutrition or inadequate nutrition among the elderly is quite high with 10% to 51% of community-residing elderly, 20% to 60% of hospitalized elderly patients, and up to 85% of nursing home patients showing significant nutritional deficits. Malnutrition in the elderly is a multifactorial problem involving physical, physiological, psychosocial, and economic factors. Because of the many factors that can contribute to inadequate nutrition in the elderly, the clinician needs to assess the elderly individual's physical function, cognition, mood, and alcohol use, socialization and living arrangements, finances, and medications as part of the routine nutrition assessment. Accurate identification of the underlying problems is essential. Interventions are aimed at reducing or alleviating risk factors for inadequate nutrition or at maintaining or promoting nutritional status. Thus, nutrition interventions cover a wide range of activities and can be provided by various social and health professionals. This article provides an overview of the common factors affecting the elderly's nutritional status, recommended assessment techniques, and intervention strategies.

Aged↗
PubMed1993

Alcoholism in the elderly: implications for hospital nurses.

Alcoholism is a major illness that threatens the independent living status in many older persons. Nurses can assist in assuring adequate health care for elderly individuals suffering from alcohol abuse by addressing the social, physical, and psychological needs of this age group.

Age Factors↗
PubMed1993

Comparison of two devices for wound measurement.

Sixty leg ulcers were measured with two techniques, a common paper tape measure and a new technique, a plastic grid device. The plastic grid proved to be a reliable, valid, and feasible method to quickly assess wounds in a busy outpatient setting. The grid was superior to the tape measure in assessing large and/or irregular ulcers.

Clinical Nursing Research↗