ORCID Profile
0000-0002-2766-8727
Current Organisation
University of Calgary
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Publisher: Springer Science and Business Media LLC
Date: 02-01-2018
Publisher: SLACK, Inc.
Date: 10-2013
DOI: 10.3928/00220124-20130716-33
Abstract: Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at ev_students.asp?action=browse& main=Nursing+Journals& misc=564 . In order to obtain contact hours you must: 1. Read the article, “Practice Uncertainty: Changing Perceptions,” found on pages 439–444, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2015. This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Review factors leading to practice change. Describe actions that can be taken to reduce negative consequences of practice uncertainty. Neither the planners nor the authors have any conflicts of interest to disclose. Practice uncertainty occurs when health care providers feel uncomfortable in response to unfamiliar or challenging patient care situations. Practice uncertainty is inevitable in health care, and there are many contextual factors that can lead to either good or bad outcomes for patients and health care providers. Practice uncertainty is not a well-established concept in the literature, perhaps because of the predominant empirical paradigm and the high value placed on certainty within current health care culture. This study was conducted to explore practice uncertainty and bring this topic into the foreground as a first step toward practice evolution. A shift in the perception of practice uncertainty may change the way in which practitioners experience this phenomenon. This process must start with nursing educators recognizing and acknowledging this phenomenon when it occurs. J Contin Educ Nur s 2013 (10):439–444.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
DOI: 10.1097/RNJ.0000000000000214
Abstract: Potential nurse authors may find writing a challenge, including managing the publication process from getting started through submission to revision of the work and its acceptance. This special article presents strategies to help inexperienced writers develop and hone skills for journal publication. Tips discussed here that may lead to manuscript acceptance include selecting a topic of interest, using motivational self-talk approaches and structuring time to write, choosing coauthors, targeting a journal for submission, writing strong sentences in active voice, developing a structured abstract, using correct citation and reference formats, understanding reviews and resubmitting the manuscript, and keeping momentum to produce continued writing results. Practical writing hints are also suggested for inexperienced writers. These strategies can help guide nurse writers in planning, navigating the system, and finding success as a published author.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.PMN.2016.01.003
Abstract: Managing acute-on-chronic pain in opioid-tolerant in iduals is complex and challenging exploring new analgesia regimens for this population is essential. Ketamine is an N-methyl D-aspartate antagonist that blocks transmission of painful stimuli and could be a useful medication for this patient population. A new low-dose ketamine protocol as an adjunct to conventional pain therapy was implemented in a major urban Level 1 trauma center in Canada. A retrospective before-and-after chart review was conducted to explore the research question, "What is the effect of low-dose ketamine continuous intravenous infusions on pain of highly opioid-tolerant adults following spinal surgery?". All patients had spine surgery, used a minimum of 100 mg daily oral morphine equivalent preoperatively and were followed postoperatively by the hospital's Acute Pain Service. Data from in iduals treated with conventional therapy during the year prior to protocol implementation were compared with data from patients who received conventional therapy plus ketamine post implementation. Outcome measures included pain scores and daily opioid consumption on postoperative days 0 through 5, time to ambulation, time to discharge, and adverse effects. There were no statistically significant differences between conventional therapy and conventional therapy plus ketamine. Ketamine may still be of benefit to patients with acute-on-chronic pain, although this was not evident in this study. Future research using more robust assessment tools to determine effectiveness of ketamine is required.
Publisher: SAGE Publications
Date: 29-06-2015
DOI: 10.1111/IJS.12557
Abstract: Every year, approximately 62 000 people with stroke and transient ischemic attack are treated in Canadian hospitals, and the evidence suggests one-third or more will experience vascular-cognitive impairment, and/or intractable fatigue, either alone or in combination. The 2015 update of the Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue Module guideline is a comprehensive summary of current evidence-based recommendations for clinicians in a range of settings, who provide care to patients following stroke. The three consequences of stroke that are the focus of the this guideline (poststroke depression, vascular cognitive impairment, and fatigue) have high incidence rates and significant impact on the lives of people who have had a stroke, impede recovery, and result in worse long-term outcomes. Significant practice variations and gaps in the research evidence have been reported for initial screening and in-depth assessment of stroke patients for these conditions. Also of concern, an increased number of family members and informal caregivers may also experience depressive symptoms in the poststroke recovery phase which further impact patient recovery. These factors emphasize the need for a system of care that ensures screening occurs as a standard and consistent component of clinical practice across settings as stroke patients transition from acute care to active rehabilitation and reintegration into their community. Additionally, building system capacity to ensure access to appropriate specialists for treatment and ongoing management of stroke survivors with these conditions is another great challenge.
Publisher: SAGE Publications
Date: 11-05-2020
Abstract: The aims of this study were to describe patterns and dose of rehabilitation received following stroke and to investigate their relationship with outcomes. This was a prospective observational cohort study. A total of seven public hospitals and all subsequent rehabilitation services in Queensland, Australia, participated in the study. Participants were consecutive patients surviving acute stroke between July 2016 and January 2017. We tracked rehabilitation for six months following stroke and obtained 90- to 180-day outcomes from the Australian Stroke Clinical Registry. Dose of rehabilitation – time in therapy by physiotherapy, occupational therapy and speech pathology modified Rankin Scale (mRS)- premorbid, acute care discharge and 90- to 180-day follow-up. We recruited 504 patients, of whom 337 (median age = 73 years, 41% female) received 643 episodes of rehabilitation in 83 different services. Initial rehabilitation was predominantly inpatient (260/337, 77%) versus community-based (77/337, 21%). Therapy time was greater within inpatient services (median = 29 hours) compared to community-based (6 hours) or transition care (16 hours). Median (Quartile 1, Quartile 3) six-month cumulative therapy time was 73 hours (40, 130) when rehabilitation commenced in stroke units and continued in inpatient rehabilitation units 43 hours (23, 78) when commenced in inpatient rehabilitation units and 5 hours (2, 9) with only community rehabilitation. In 317 of 504 (63%) with follow-up data, improvement in mRS was most likely with inpatient rehabilitation (OR = 3.6, 95% CI = 1.7–7.7), lower with community rehabilitation (OR = 1.6, 95% CI = 0.7–3.8) compared to no rehabilitation, after adjustment for baseline factors. Amount of therapy varied widely between rehabilitation pathways. Amount of therapy and chance of improvement in function were highest with inpatient rehabilitation.
Publisher: SAGE Publications
Date: 18-01-2016
Publisher: SAGE Publications
Date: 06-07-2015
DOI: 10.1111/IJS.12551
Abstract: The 2015 update of the Canadian Stroke Best Practice Recommendations Hyperacute Stroke Care guideline highlights key elements involved in the initial assessment, stabilization, and treatment of patients with transient ischemic attack (TIA), ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and acute venous sinus thrombosis. The most notable change in this 5th edition is the addition of new recommendations for the use of endovascular therapy for patients with acute ischemic stroke and proximal intracranial arterial occlusion. This includes an overview of the infrastructure and resources required for stroke centers that will provide endovascular therapy as well as regional structures needed to ensure that all patients with acute ischemic stroke that are eligible for endovascular therapy will be able to access this newly approved therapy recommendations for hyperacute brain and enhanced vascular imaging using computed tomography angiography and computed tomography perfusion patient selection criteria based on the five trials of endovascular therapy published in early 2015, and performance metric targets for important time-points involved in endovascular therapy, including computed tomography-to-groin puncture and computed tomography-to-reperfusion times. Other updates in this guideline include recommendations for improved time efficiencies for all aspects of hyperacute stroke care with a movement toward a new median target door-to-needle time of 30 min, with the 90th percentile being 60 min. A stronger emphasis is placed on increasing public awareness of stroke with the recent launch of the Heart and Stroke Foundation of Canada FAST signs of stroke c aign reinforcing the public need to seek immediate medical attention by calling 911 further engagement of paramedics in the prehospital phase with prehospital notification to the receiving emergency department, as well as the stroke team, including neuroradiology updates to the triage and same-day assessment of patients with transient ischemic attack updates to blood pressure recommendations for the hyperacute phase of care for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The goal of these recommendations and supporting materials is to improve efficiencies and minimize the absolute time lapse between stroke symptom onset and reperfusion therapy, which in turn leads to better outcomes and potentially shorter recovery times.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
DOI: 10.1161/CIRCOUTCOMES.113.000375
Abstract: Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in in iduals with first mild stroke. This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92 YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9±1.3 [95% confidence interval, 0.1–0.7] effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used. URL: www.controlled-trials.com . Unique identifier: ISRCTN95662526.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.IJNURSTU.2009.02.008
Abstract: Most patients with minor stroke are discharged directly home from acute care, under the assumption that little will be required in the way of adaptation and adjustment because informal caregivers will manage the stroke recovery process. We explored male patients with minor stroke and their wife-caregivers' perceptions of factors affecting quality of life and caregiver strain encountered during the first year post-discharge. Data were obtained from responses to two open-ended questions, part of quality of life and caregiver strain scales administered to participants in a larger descriptive study. Conventional content analysis was used to assess narrative accounts of living with minor stroke provided by 26 male patients and their wife-caregivers over a period of 1-year post-discharge. Two major themes that emerged from these data were 'being vulnerable' and 'realization'. Subthemes that arose within the vulnerability theme included changes to patients' masculine image and wife-caregivers' assumption of a hyper-vigilance role. In terms of 'realization' patients and their wife-caregivers shared 'loss' as well as 'changing self and relationships'. Patients in this study focused primarily on their physical recovery and their perceptions of necessary changes. Wife-caregivers were actively involved in managing the day-to-day demands that stroke placed on in idual, family and social roles. We conclude that patients and wife-caregivers expend considerable time and energy reestablishing control of their lives following minor stroke in an attempt to incorporate changes to self and their relationship into the fabric of their lives.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2021
DOI: 10.1161/STR.0000000000000357
Abstract: In 2009, the American Heart Association/American Stroke Association published a comprehensive scientific statement detailing the nursing care of the patient with an acute ischemic stroke through all phases of hospitalization. The purpose of this statement is to provide an update to the 2009 document by summarizing and incorporating current best practice evidence relevant to the provision of nursing and interprofessional care to patients with ischemic stroke and their families during the acute (posthyperacute phase) inpatient admission phase of recovery. Many of the nursing care elements are informed by nurse-led research to embed best practices in the provision and standard of care for patients with stroke. The writing group comprised members of the Stroke Nursing Committee of the Council on Cardiovascular and Stroke Nursing and the Stroke Council. A literature review was undertaken to examine the best practices in the care of the patient with acute ischemic stroke. The drafts were circulated and reviewed by all committee members. This statement provides a summary of best practices based on available evidence to guide nurses caring for adult patients with acute ischemic stroke in the hospital posthyperacute/intensive care unit. In many instances, however, knowledge gaps exist, demonstrating the need for continued nurse-led research on care of the patient with acute ischemic stroke.
Publisher: RCN Publishing Ltd.
Date: 03-09-2014
Abstract: Phantom limb pain (PLP) is a neuropathic pain condition occurring after utation of a limb. PLP affects utees' quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions.
Publisher: SAGE Publications
Date: 31-12-2014
Abstract: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. Multi-site mixed method randomized controlled trial. Acute and community care in three Canadian cities. Caregivers were family members or friends providing care to in iduals who experienced their first stroke. The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. Thirty-one caregivers received standard care ( n=10), self-directed ( n=10), or stroke support person-directed ( n=11) interventions. We retained 77% of the s le through 6-months. Key areas of support derived from intervention records ( n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews ( n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial.
Publisher: Wiley
Date: 09-01-2021
DOI: 10.1111/JORC.12360
Abstract: Sexual health, wellbeing, and function are important parts of a person's identity. Chronic diseases, such as kidney failure can alter, impair, and profoundly, affect sexual wellbeing and function. To conduct a scoping review of studies about renal nurses’ practice and attitudes towards sexual health, wellbeing, and function in people with kidney failure receiving haemodialysis. Using Arksey and O'Malley's framework, seven databases were searched (CINAHL, MEDLINE, EMBASE, OvidPsycINFO, Scopus, Cochrane library, and JBI library). The search included studies published in English from January 2009 to January 2020. Four studies met the review criteria (two cross‐sectional surveys and two qualitative). Role confusion in discussing sexual issues, lack of training, and education in addressing sexual concerns, personal, and workplace related barriers were four factors that emerged from the review of the studies. This review identified that renal nurses were uncomfortable and hesitant in initiating discussions about sexual health, wellbeing, and function with people receiving haemodialysis. Renal nurses experience role confusion about whose responsibility it is to initiate and discuss sexual concerns with patients, as well as who's role is it to conduct sexual health assessments. Work related and personal barriers impeded nurses’ practice regarding sexual health, wellbeing, and function. Nurses working in renal units need knowledge and practical training about how to initiate and address sexual concerns in those affected by kidney disease.
Publisher: Wiley
Date: 11-07-2019
DOI: 10.1111/JORC.12280
Abstract: Recent studies indicate that informal caregivers provide support to family members who are undergoing haemodialysis although the amount and type of activities provided and the burden of this is not well-known. To analyse the burden and support activities of informal caregivers caring for adults receiving haemodialysis. A cross-sectional study recruited 178 adult informal caregivers (family members or close friends) of patients who had been undergoing haemodialysis for more than three months. Caregiver burden was measured by the Zarit Caregiver Burden Scale (ZCBS). Difficulty and time-spent on caring tasks were assessed using the Oberst Caregiver Burden Scale (OCBS). Demographic characteristics were also collected. Most informal caregivers were female (55.6%) between 30 and 60 years of age (66%) and were a spouse of the person receiving haemodialysis. Overall, informal caregivers reported a high level of burden in caring (M = 40.15, standard deviation [SD] = 10.46) with 80.9% identifying the level as severe. However, the caring activities were perceived as slightly difficult (M = 24.5, SD = 8.81) and not requiring much time (M = 29.47, SD = 8.75). Predictors of greater informal caregiver burden were having their own health problems, greater time required to provide care, and doing more difficult tasks (R While the caregiving activities were not reported to take much time, there was a high level of burden on informal caregivers. Renal nurses are ideally placed to assess for caregiver burden and to provide education and support to them.
Publisher: Wiley
Date: 26-05-2021
DOI: 10.1111/JORC.12380
Abstract: Being on haemodialysis can lead to many burdens on patients' lives. Social support for patients is crucial however, whether social support affects health outcomes including both depression, anxiety and health‐related quality of life is not well understood. To explore the relationship between social support, psychological status and health‐related quality of life of people undergoing haemodialysis. A cross‐sectional study. Convenience s ling recruited 388 patients from one dialysis centre. Survey data collected included demographic and clinical data, the Medical Outcomes Social Support Survey, Depression Anxiety Stress Scales and Short‐Form Health Survey 36. Multiple linear regression was used to determine the direct and mediation effects of social support on health outcomes. Participants' ages ranged from 19 to 84 years and most had undergone haemodialysis for more than 5 years (53.2%). Overall, there was a moderate level of social support, and although tangible support was high, emotional‐oriented support functions were missing. Participants reported a high level of anxiety, moderate levels of depression, mild levels of stress and impaired physical and mental health. Greater social support independently and positively affected mental health, and also reduced the negative influences of depression on the mental health component but not the physical health component. Social support, depression, anxiety and participation in social groups explained 48% of the variance in mental health. People undergoing haemodialysis require both tangible and emotional social support. When there is enough social support, there are positive effects on reducing depression and improving mental, but not physical health.
Publisher: Elsevier
Date: 2018
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.IJNURSTU.2008.08.001
Abstract: Internationally the stroke unit is recognised as the evidence-based model for patient management, although clarity about the effective components of stroke units is lacking. Whilst skilled nursing care has been proposed as one component, the theoretical and empirical basis for stroke nursing is limited. We attempted to explore the organisational context of stroke unit nursing, to determine those features that staff perceived to be important in facilitating high quality care. A case study approach was used, that included interviews with nurses and members of the multidisciplinary teams in two Canadian acute stroke units. A total of 20 interviews were completed, transcribed and analysed thematically using the Framework Approach. Trustworthiness was established through the review of themes and their interpretation by members of the stroke units. Nine themes that comprised an organisational context that supported the delivery of high quality nursing care in acute stroke units were identified, and provide a framework for organisational development. The study highlighted the importance of an overarching service model to guide the organisation of care and the development of specialist and advanced nursing roles. Whilst multidisciplinary working appears to be a key component of stroke unit nursing, various organisational challenges to its successful implementation were highlighted. In particular the consequence of differences in the therapeutic approach of nurses and therapy staff needs to be explored in greater depth. Successful teamwork appears to depend on opportunities for the development of relationships between team members as much as the use of formal communication systems and structures. A co-ordinated approach to education and training, clinical leadership, a commitment to research, and opportunities for role and practice development also appear to be key organisational features of stroke unit nursing. Recommendations for the development of stroke nursing leadership and future research into teamwork in stroke settings are made.
Publisher: SAGE Publications
Date: 28-03-2019
Abstract: To describe current practice and investigate factors associated with selection for rehabilitation following acute stroke. Prospective observational cohort study. Seven public hospitals in Queensland, Australia. Consecutive patients surviving acute stroke. Rehabilitation selection processes are assessment for rehabilitation needs, referral for rehabilitation and receipt of rehabilitation. Functional impairment following stroke is modified Rankin Scale (mRS). We recruited 504 patients, median age 73 years (interquartile range (IQR) = 62-82), between July 2016 and January 2017. Of these, 90% (454/504) were assessed for rehabilitation needs, 76% (381/504) referred for rehabilitation, and 72% (363/504) received any rehabilitation. There was significant variation in all rehabilitation selection processes across sites ( There was significant inter-site variation in rehabilitation selection processes. The major factors influencing rehabilitation access were assessment for rehabilitation needs, co-morbidities and post-stroke functional impairment. Gaps in access to rehabilitation were found in those with mild to moderate functional impairment.
Publisher: BMJ
Date: 23-09-2019
DOI: 10.1136/BMJQS-2019-009570
Abstract: Experience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study. We identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity. EBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner. CRD42018105879.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-05-2021
DOI: 10.1097/JNN.0000000000000585
Abstract: INTRODUCTION: In August of 2020, the 4th International Neuroscience Nursing Research Symposium was held. The purpose of the symposium was to share neuroscience nursing research from around the world. One of the topics thought most notable that stimulated a crucial conversation was how different countries assessed pain and their use of opioids for pain management. BACKGROUND: Neuroscience nurses are global. What is not known is their experience with and what challenges exist with pain management for human beings in their country. Crossing geographic and cultural boundaries, pain affects all human beings. Each culture has unique values and beliefs regarding pain. Patient barriers, pivotal in this article, included poverty, poor health literacy, opioid phobia, and cultural as well as social beliefs. RESULTS: Neuroscience nurses from Australia, Brazil, Germany, Singapore, India, Ghana, Kenya, Philippines, South Africa, and the United States each collaborated to provide a short summary of assessing pain and use of opioids for pain management for the neuroscience patient. CONCLUSION: Neuroscience patients have varying degrees of pain based on many factors. Various countries have religious, spiritual, and cultural traditions that influence the reporting and management of pain. Pain assessment and management can be challenging, especially for the neuroscience nurses around the world.
Publisher: Informa UK Limited
Date: 2014
DOI: 10.2147/PPA.S54822
Publisher: Wiley
Date: 22-04-2020
DOI: 10.1111/JORC.12329
Publisher: SAGE Publications
Date: 27-03-2019
Abstract: The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial interobserver variability impairs outcome assessment as well as reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health, we developed a comprehensive, hierarchical assessment tool (miFUNCTION) to address the shortcomings of the modified Rankin Scale and deliver a more thorough understanding of disability following stroke. The initial construct validity of miFUNCTION was established in a pilot study of patients at an outpatient stroke prevention clinic that had been diagnosed with stroke within 60 days. To further assess criterion validity, miFUNCTION was compared against the modified Rankin Scale and other outcome measures within the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial. Logistic regression analysis with miFUNCTION as an outcome was used to demonstrate the beneficial effect of endovascular treatment. The pilot study showed moderate inter-observer agreement (k = 0.585, p 0.005) but near perfect correlation between miFUNCTION and modified Rankin Scale (ρ = 0.821, p 0.05). The correlation of miFUNCTION and modified Rankin Scale was near perfect again in the ESCAPE trial (ρ = 0.944). Effect size of the multivariable models using modified Rankin Scale (adjusted odds ratio: 3.45, 95% confidence interval: 2.05–5.78) and miFUNCTION (adjusted odds ratio: 3.32, 95% confidence interval: 1.99–5.55) as an outcome measure for the ESCAPE trial patients was similar. miFUNCTION is strongly associated with the degree of disability following stroke both in an outpatient setting and a clinical trial. Further work remains to assess sensitivity to change and to improve the inter-observer reliability of the scale.
Publisher: Oxford University Press (OUP)
Date: 12-07-2013
Abstract: This paper is a report of a narrative review examining the current state of knowledge regarding adherence with cardiac medication among South Asian cardiac patients. South Asians experience higher rates of cardiovascular disease than any other ethnic group. South Asians may be less adherent with a cardiac medication regimen than Caucasians. The factors contributing to adherence are important to discover to assist South Asians to optimize their cardiac health. CINAHL, Medline (Ovid), PsychINFO, EMB Reviews-(Cochrane), and EMBASE were accessed using the key words: 'South Asian', 'Asia', 'East India', 'India', 'Pakistan', 'Bangladesh', 'Sri Lanka', 'medication compliance', 'medication noncompliance' and 'medication adherence'. English language papers published from January 1980 to January 2013 were eligible for inclusion. Abstracts were reviewed for redundancy and eligibility by the primary author. Manuscripts were then retrieved and reviewed for eligibility and validity by the first and last authors. Content analysis strategies were used for the synthesis. Thirteen papers were in the final data set most were conducted in India and Pakistan. Medication side-effects, cost, forgetfulness and higher frequency of dosing contributed to non-adherence. South Asian immigrants also faced language barriers, which contributed to non-adherence. Knowledge regarding the medications prescribed was a factor that increased adherence. South Asians' non-adherence to cardiac medications is multifaceted. How South Asians who newly immigrate to Western countries make decisions regarding their cardiac medication adherence ought to be explored in greater detail.
Publisher: ACM
Date: 28-11-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
DOI: 10.1161/STROKEAHA.108.527606
Abstract: Background and Purpose— Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods— A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results— Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4% P .0001). The adjusted odds of a length of stay days was reduced by 30% ( P .0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care. Conclusions— We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Cambridge University Press (CUP)
Date: 12-03-2020
DOI: 10.1017/CJN.2020.53
Abstract: Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation. Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination. Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM n = 1155), moderate (FIM 40–80 n = 994), or severe (FIM n = 117). Fifty-five percent of males (45.7% females) had mild stroke 39.5% of males (49.5% females) had moderate stroke and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males ( p = 2.4 × 10 −4 ). No sex difference existed in time from acute care to rehabilitation admission ( p = 0.73) or in mean FIM change ( p = 0.294). Mean LOS was longer for females than males ( p =0.018). Males were more likely than females to be discharged home ( p = 1.8 × 10 −13 ). Further, male patients ( p = 6.4 × 10 −7 ) and those 65 years ( p = 1.4 × 10 −23 ) were more likely to be discharged home without homecare. There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2017
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2009.02.005
Abstract: Mild stroke survivors are generally discharged from acute care within a few days of the stroke event, often without rehabilitation follow-up. We aimed to examine the recovery trajectory for male patients and their wife-caregivers during the 12 months postdischarge. A descriptive study was undertaken to examine functional outcomes, quality of life (QOL), depression, caregiver strain, and marital function in a prospective cohort of male survivors of mild stroke and their wife-caregivers during the 12 months postdischarge. Data from each point in time were summarized and repeated measures analyses undertaken. Logistic regression was used to determine which baseline demographic and biopsychosocial variables influenced or predicted marital functioning 1 year postdischarge. A total of 38 male patients (mean age 63.4 years) and their wife-caregivers (mean age 58.5 years) were examined. The median discharge National Institutes of Health Stroke Scale score was 1.5, modified Rankin Scale score was 1.0, Barthel Index was 100.0, and Stroke Impact Scale-16v2 score was 78.5. The patients' modified Rankin Scale (function) and QOL scores improved significantly over time (F (2) = 4.583, P = .017 and F (6) = 5.632, P < .001, respectively). However, the wife-caregiver QOL scores did not change. Multivariate analysis revealed overall worsening of depression for both the patient and wife-caregivers (F (6, 32) = 3.087, P = .017) and marital function (F (6, 32) = 3.961, P = .004), although the wife-caregivers' perceptions of caregiver strain improved (F (6, 32) = 3.923, P = .007). None of the measured variables were associated with marital functioning 1 year postdischarge. Despite improvement in patients' functional status, other patient and wife-caregiver psychosocial outcomes during the 12 months postdischarge may be negatively affected. Thus, attention needs to focus on recovery beyond functional outcomes.
Publisher: RCN Publishing Ltd.
Date: 07-10-2015
Abstract: This article provides an overview of the care of patients undergoing limb utation. Absence of a limb can be congenital or the result of trauma or complications of chronic diseases. While the economic burden of limb utation is significant, nurses have an important role in limiting other losses attributable to limb loss, such as long-term disability leading to loss of employment and delayed return to work or school. Comprehensive nursing assessments and appropriate interventions, pre and post-operatively, as well as early discharge planning and community reintegration can help avoid some of these losses. Nurses should be aware of the resources available in communities and work in multidisciplinary teams to ensure optimal outcomes for patients following limb utation and their families.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JVN.2019.07.002
Abstract: Improving poststroke outcomes is contingent on early symptom recognition and timely access to life-saving interventions. Several studies have reported differences in access to care among stroke patients from different ethnic/racial backgrounds, although some of the findings present contrasting results. A 2011 AHA/ASA Scientific Statement noted ethnic/racial disparities in access and receipt of stroke care. The aim of this systematic review was to comprehensively identify and describe the impact of ethnic/racial status on access to care after onset of stroke symptoms. We undertook a systematic search of the following databases: Cochrane, JBI, Trove, ProQuest, Ethos, CINAHL, MEDLINE, Embase, PsycINFO, Academic Search Elite, and Scopus to find relevant qualitative, quantitative, or mixed-method studies focused on ethnicity/race, stroke, and access to health care services in adult (≥18 years) stroke patients. A narrative synthesis approach was used to generate key themes describing the impact of ethnic/racial differences in stroke-related care. Twenty-five studies were included in this systematic review. Narrative synthesis yielded 4 key themes related to differences in 1) transportation to hospital, emergency wait time, hospital admission, and length of stay 2) receipt of intravenous thrombolysis 3) receipt of mechanical-reperfusion therapies and imaging procedures and 4) risk of death, based on ethnicity/race. Generally, but not universally, ethnic/racial minorities (particularly black patients) had lower access to poststroke care, but no greater mortality risk. Reducing health-related disparities will improve treatment outcomes among ethnic stroke patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2003
Publisher: Informa UK Limited
Date: 04-2022
DOI: 10.2147/JMDH.S342197
Publisher: ACM
Date: 29-11-2022
Publisher: Cambridge University Press (CUP)
Date: 22-08-2019
DOI: 10.1017/CJN.2019.276
Abstract: We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination. Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors. The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild ( M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10 –9 ) from moderate ( M = 30.4, 16.4 SD) and severe ( M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke ( M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10 –9 ) different from moderate stroke ( M = 86.8, 76.4 SD) and severe stroke ( M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10 –9 , partial η 2 0.022) and LOS (p = 1.1 × 10 –19 , partial η 2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare. Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 29-05-2007
DOI: 10.1111/J.1365-2648.2007.04321.X
Abstract: This paper is a report of a narrative review to examine the current state of knowledge regarding the impact of minor stroke on male patients and their female spousal caregivers' recovery trajectory and quality of life. Minor stroke survivors are often discharged early in the recovery process. The perception of the healthcare community that these patients and their female spousal caregivers will experience an uneventful recovery may lead to inadequate preparation for the postdischarge period. A range of databases was searched to identify papers addressing 'minor stroke', 'transitions', 'quality of life', 'chronic disease', 'caregivers' and 'spouse caregivers', including AARP Ageline, AMED, CINAHL, Evidence Based Medicine Reviews, MEDLINE and PsychInfo. Papers published in English from 1990 to December 2006 were included. Thirty-four papers were in the final data set. Minor stroke survivors and their female spousal caregivers may experience major challenges in adaptations postdischarge. The trajectory of minor stroke recovery may necessitate a re-evaluation of life plans, rethinking of priorities and integration of resulting disabilities into current and emerging life situations for both stroke survivors and their female spousal caregivers. In many cases these adaptations are compounded by transitions associated with the normal ageing process. While there is extensive literature on stroke recovery and the role of caregivers in general, there is little available describing the recovery of minor stroke survivors in relation to the normal ageing process. Further research is needed examining recovery from a transitional perspective, to support nurses and other health professionals discharge planning.
Publisher: Wiley
Date: 22-01-2018
DOI: 10.1111/JORC.12235
Abstract: Living with end stage kidney disease and having dialysis is burdensome, and there is a need for support from informal caregivers (i.e. family members and friends). Renal health professionals readily acknowledge and value the support provided by caregivers although the activities and experiences of caring for a loved-one who is receiving dialysis is less well understood. To review studies about the perspectives and experiences of family members and friends who provide support for adults receiving either haemodialysis or peritoneal dialysis. A mixed-methods systematic review was conducted. Eight databases (Medline, CINAHL, EMBASE, PsycINFO, Proquest, Web of Science, Cochrane Library and JBI library) were comprehensively searched using relevant key words for studies regardless of design published in English from January 2006 to July 2017. Twenty studies were included in this review. Informal caregivers undertake many everyday activities as well as a range of dialysis-specific activities, report an elevated level of burden, feel overwhelmed, experience social isolation, and also need to consider their own health. A unique finding was that caregivers also experienced personal growth that may defuse the impact of caregiving burden and to help them develop a sense of resilience to sustain the support through the tough times and for many years. This review substantiates that caregiver burden is due to the unrelenting nature of complex dialysis-specific activities although resilience often develops. Additional research is necessary to understand social support in this context and how health teams can assist caregivers further.
No related grants have been discovered for Theresa Green.