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

[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

[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

[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

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.

Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine

DEMIR Fıgen Ulku, BOZKURT Oya

Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

Clinical Oncology

[Complications of infusion treatment with emphasis on extravasation of cytostatics]

HARISI Revekka

[The extravasation of cytostatics is the most signifi cant complication of infusion therapy in cancer treatment. Extravasation refers to the inadvertent infi ltration of cytostatic drugs into subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. According to literature data incidence estimates between 0,01-7%. Extravasated drugs are classifi ed according to their potential for causing damage as vesicant, irritant and nonvesicant. Knowledge of risk factors, the patientrelated and treatment-related ones is important to minimize the occurrence of extravasation. In order to reduce the risk of extravasation, the staff involved in the tumor infusion therapy must be specially trained to implement several preventive and therapeutical protocols. In 2012, ESMO-EONS has put together a new comprehensive treatment protocol on the topic of cytostatics extravasation. Protocol recommended that every oncological department, who administers chemotherapy have to have extravasation trained team and a standby extravasation kit. According to the new ESMO-EONS guideline subcutaneous corticoids are not recommended, anymore. In case of mechloretamine extravasation the recommendation is immediate subcutaneous injection of sodium thiosulfate. After extravasation of anthracyclines, mitomycin C and platin salts the best treatment opportunity is subcutan dimethyl sulfoxide administration. In case of anthracyclines’ extravasation intravenous dexrazoxane treatment is also effective. Hyaluronidase, injected into or under the skin, facilitates absorption of extravasated drugs because of increases connective tissue permeability, promotes the spreading and reduces the local concentration of the extravasated citostatic agents. Hyaluronidase might be effi cacious in preventing skin necrosis by extravasation due to vinca alkaloids. The treatment of unresolved tissue necrosis or pain lasting more than 10 days is surgical debridement. Because of the medical and juristic importance of the extravasation event, it is necessary to establish uniform guidelines for treatment of extravasation, in all Hungarian Oncological Centers.]

LAM KID

[New findings in the cortical bone biology and its role in bone fractures]

BALOGH Ádám, BHATTOA Harjit Pál

[The authors surveyed the already known factors responsible for the osteoporotic bone fragility. Then the results of using modern imaging techniques (micro-CT, high-resolution peripheral computed quantitative tomograph - HR-pQCT) and advanced computer analytic methods (finite element analysis, FEA) are presented. These data - beyond the already known fracture risk factors (age, risk of falling, bone mineral density - BMD, and fine structure damage of trabecular bone) are stressing the importance of the (micro)damage of cortical bone as a fracture risk factor, which has been still underrated. The cortical thickening and increased porosity - verified on various population samples - are increasing the risk of fractures in certain subgroups of subjects having identical BMD values, even among those, who are considered only osteopenic by the earlier classification based on BMD values. Backed with modern software batteries, the new imaging techniques are expected to enter clinical application in the near future. Pharmacologic agents with stronger cortical effect are already available and research is continuing to find new drugs to use in the management of osteoporotic patients of high fracture risk.]