Journal of Nursing Theory and Practice

[Keynote thoughts on nurses’ competence in pain management]

IRINYI Tamás

OCTOBER 30, 2013

Journal of Nursing Theory and Practice - 2013;26(05)

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Journal of Nursing Theory and Practice

[The effects of caring for children who have suffered trauma on pediatric nurses]

PÁLL Nikoletta, FÜLÖP Emőke

[Aim of the study: In case of children suffering trauma immediate care taking psychological aspests into consideration is very important. However, for the caregivers going through these cases cause secondary traumatization and increased mental burden, and they are not provided with professional help to process these, which ultimately may lead to burn-out. Sample and method: The authors have carried out a questionnaire survey among pediatric nurses at Pediatric Surgery Departments (N=90) and as a control group at Internal Medicine Departments (N=90) of five hospitals. Results: Significant differences were found between the two groups, as the nurses working at pediatric trauma departments consider their work as mentally more burdensome, they think the children’s mental care is important and would like to have a full-time psychologist at the ward. Besides they have encountered significantly higher number of cases in which they were unable to respond properly to the children’s psychological reactions. This have ultimately affected their family relations, and they also need trainings and help to mentally process these cases. Significant difference was found in the Secondary Traumatic Stress Scale scores too. Conclusions: In pediatric traumatology departments it would worth greater emphasis on helping nurses with their emotional processing of traumas, on recognizing symptoms of secondary traumatization and on adequate training.]

Journal of Nursing Theory and Practice

[The state of health of Roma in Nagykálló ]

ARATÓ Miklósné

[Aim of the study: To assess the unique lifestyle characteristics and state of health of the Roma minority living in a closed community. The author assumed that the Roma have a different attitude towards their own health and to the healthcare supply system. Sample and method: At the Sántha Kálmán Mental Health Centre and Specialist Hospital, in May 2012 a unique blood donation day was organised for the Roma population. As a part of the program, besides the medical tests, a questionnaire-based survey was conducted. (N=100) The author processed the data using Microsoft Excel, and presented the results with descriptive statistical methods. Results: Of the more than 100 who volunteered, 38 were able to give blood. Among the respondents the majority of women were aged 41-50 years (39%), and most of the men were in the 31-40 age bracket. More than half of the respondents (57%) consume alcohol regularly or occasionally, while 47% of them smoke. Some 39% of those surveyed consider their own state of health to be bad. Some 56% of the respondents are satisfied with the provision of healthcare, despite the fact that almost half of them have experienced some kind of discrimination during their care. Conclusions: The bad state of health of the Roma is related to the lower quality of life, the low level of education, alcohol consumption and smoking. The Roma are aware of the screening tests and consider them important; indeed, some of them also regularly give blood, but the communication targeting them is not effective. The Roma population experience discrimination more frequently then the other members of society. It is imperative that training in tolerance towards the Roma be incorporated into healthcare education. It is also necessary to improve the supportive relationship with healthcare. One means of achieving this could be the inclusion of Roma in healthcare efforts.]

Journal of Nursing Theory and Practice

[Nursing documentation related to attitudes and the management of time spent on administrative activities]

OLÁH Mónika

[Aims of the study: The aim of the study was to explore how did the institutes manage to achieve the legal requirements related to nursing documentation since the introduction of the law. The other aim was to determine the conditions of effective application of the nursing documentation. Sample and methods: Qualitative and quantitative methods were applied as well. In a quantitative, cross-sectional study a questionnaire survey was performed involving 150 nurses. By the means of retrospective data analysis 200 closed nursing documentation were examined. The data analysis was carried out with SPSS 17.0 statistical software. The level of significance was set to p<0.05. Results: The nursing documentation is not personalized (p<0.01) and its information content is not sufficient to learn about the patient’s condition at the time of admission and to evaluate the effects of nursing on the state of the patient. The personalization and information content strongly depends on the nurses’ attitude towards the administration process. Conclusions: As the theory and practice of the nursing documentation are not in accordance, it is necessary to define the principles more precisely and to survey and reorganize the existing documentations. ]

Journal of Nursing Theory and Practice

[Causes of leg problems in chronic kidney failure, and opportunities for prevention]

KRIMMER-S. Tünde

[In patients with chronic kidney failure, especially diabetic haemodialysis patients, the risk of lower-limb complications increases. Through the early recognition of changes in the leg, the definition of risk factors and timely intervention, the prevalence of ulcers and amputations can be reduced. The author aims, through a review of the specialist literature, to provide skills for the recognition of lower-limb complications occurring in chronic kidney patients, and to summarise the most common factors leading to amputation, and the opportunities for prevention. It gives guidance for the definition of risk factors, briefly describes the procedure for assessing the condition of the leg, and the basic principles and options relating to patient education. ]

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Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Lege Artis Medicinae

[Organic and non-organic perspectives in feeding and eating disorders under three years of age]

SCHEURING Noémi, DANIS Ildikó, KAROLINY Anna, SZABÓ László

[Providing optimal nutrition to infants and toddlers is a critical issue for both parents and experts. Besides the quality and quantity of food, indications of feeding behaviour such as feeding method and acceptance by the child are also crucial when determining feeding issues. The development of self-feeding is a significant part of the healthy somatomental development of a toddler between the age of 0-3 years. Efficient treatment of infants and toddlers with feeding disorders is often challenging in clinical practice. These symptoms frequently appear together with additional behaviour disorders, therefore functional reasons have to be taken into consideration in such cases. Due to the complexity of manifestations, applying tools beyond me­dical competence and involvement of special related professions are necessary. The general diagnostic systems of BNO-10 (International Classification of Diseases) and DSM-V (Statistical Manual of Mental Disorders) which are also applied in our country cannot be used appropriately for clear classification of early childhood feeding disorders and for examination of their backgrounds. DC:0-3R (Diagnostic Classi­fication of Mental Health and Develop­men­tal Disorders of Infancy and Early Childhood- Zero to Three), generally used in Anglo-Saxon countries, can be considered as a complex diagnostic system. Using the DC:0-3R classification system (1), we will present six types of feeding disorders affecting children between the age of 0-36 months in which organic and functional origins have been examined as well. In our article we argue for the complex, psychosomatic interpretation and treatments of early childhood feeding disorders.]