Journal of Nursing Theory and Practice

[Surgical isolation protocol and cost-effectiveness]

PÉCZELI András

APRIL 30, 2012

Journal of Nursing Theory and Practice - 2012;25(02)

[A fundamental prerequisite for surgical procedure is full compliance with the rules on ensuring asepsis and antisepsis. The isolation and special clothing of the patient and surgical team has a long history. The doctors of our grandfathers’ generation donned white, and those of our fathers’ generation green clothing, while we now live in the age of the disposable isolation attire. The author aims was to demonstrate, through the work conducted at the central operating theatre of a county hospital, how a disposable isolation solution - used properly - is more cost-effective than a textile-based isolation system. The author introduces the professional guidelines for the use of a disposable isolation system, and the phases in its implementation and application. Through a cost analysis he proves that a properly used disposable isolation system represents a smaller financial burden for the given institution than the textile isolation systems used previously. Disposable isolation systems have lived up to expectations in day-to-day use, and there is demand for their use. ]

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Further articles in this publication

Journal of Nursing Theory and Practice

[The specialities and competencies of nurse-level triage in paediatric emergency care ]

NAGY Gábor, PÁPAI Tibor

[A part of the emergency patient care system is paediatric emergency care, the organisation and management of which must take place in accordance with the same guiding principles and consensuses as adult emergency care. Owing to the special requirements stemming from the children’s age, anatomy and physiology, the assessment, categorisation, diagnostics, therapeutic interventions and implementation of the nursing process require special knowledge, skills and competencies in comparison to adult emergency care. The paper describes the process of patient admission and triage in intra-hospital paediatric emergency care in Hungary, with regard to the related nursing competencies. ]

Journal of Nursing Theory and Practice

[The importance of patient education and ILCO clubs in the rehabilitation of stoma patients]

VARGÁNÉ TERHES Anita

[Aim of the study: The author aims to reveal and propose a solution for the flaws in the education of stoma patients, especially with regard to patient education at the Department of Surgery in Szeged. She examined the opinions, attitudes and knowledge of stoma patients regarding patient information, rehabilitation, and the extent to which they participated in the self-help groups. Methodology and sample: In the course of the quantitative descriptive research a questionnaire-based survey was conducted among the stoma patients treated and cared for at the institute (N=96). The data was processed using mathematical statistical methods. Results: 83% of the patients received lifestyle information at the institute, which helped them to accept their illness, and 99% of them were taught about stoma care at the clinic. The patients that participated in the training course, with the assistance of the stomal therapy nurse, were better able to accept their disease. The proportion of those participating in the self-help group was 51%, despite the fact that 65% of those asked regarded the ILCO club as useful. Conclusions: The provision of lifestyle information and the development of patient education at the department have an important role, because the majority of the patients express no demand for club membership. The author also takes the opportunity to highlight the importance of a holistic and multidisciplinary approach to the nursing of stoma patients. ]

Journal of Nursing Theory and Practice

[The situation of healthcare vocational training and nurse training at the Ferenczi Sándor Healthcare Vocational School, Miskolc]

KONCZNÉ KISS Krisztina

[Aim of the study: The author aims to examine the opinions of healthcare vocational school students participating in the survey, with regard to further education and working abroad. The study also examines how attractive nursing training is to the students, and whether the student scholarship program has any effect on their choice of major. She attempts to assess the extent to which the place of nursing in the employment hierarchy, and the dimension of prestige, influence the value that society places on nursing. Methodology and sample: The descriptive, prospective research was conducted by means of a questionnaire-based survey of 12-year students prior to taking their general secondary school examinations (n=106), and year 14-15 students in vocational training (n=137), at Ferenczi Sándor Healthcare Vocational School, Miskolc. The data was collated using the SPSS program, and the processing of the results thus obtained took place using statistical mathematical (frequency, correlative coefficient) techniques. Results: Some 58% of the students about to sit their general secondary school examinations would enrol for nurse training at the school if they received a monthly scholarship grant. A total of 83% of the students in vocational training would like to find work that matches their acquired qualification, 63% would like to remain in education, while 35% would like to start work immediately after sitting the examination. More than 80% of the students are attracted by the opportunity to work abroad. In their opinion the social perception of nursing is lower than that of the other occupations. Conclusions: Due to the low prestige of the nursing profession and the low pay, students are not inclined to choose nurse training; however, the system of scholarship grants, as a motivational force, serves as a positive incentive to continue studying. The lack of financial rewards, however, prompts many of them consider migration.]

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

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Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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[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.]