Journal of Vascular Nursing最新文献

Introduction

An evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes.

Aim

This case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress.

Design

Descriptive Observational Case Study.

Clinical care

An evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application ‘Tissue Analytics’, a “purposedesigned digital wound management platform that records, tracks, and analyses wounds”.

Results

Week 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm². The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view.

Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm², a 77% reduction in wound size.

Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm². This represented a 97% reduction in wound size.

Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm². This represented a 99.99% reduction in wound size.

Conclusion

The patient’s treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.

Background

The prevalence of venous thromboembolism is steadily increasing in developing nations including Ethiopia. Nurses play a vital role in the prevention of venous thromboembolism. However, the level of nurses’ knowledge, practice, and associated factors in venous thromboembolism prevention is not well-known across Ethiopia. This study aimed to assess nurses’ knowledge, practice, and associated factors regarding venous-thromboembolism prevention in tertiary Hospitals of Addis Ababa, Ethiopia

Methods

An institutional-based cross-sectional study was conducted among 339 randomly selected nurses working at tertiary hospitals in Addis Ababa, Ethiopia. A validated questionnaire was used to collect data. Data were analyzed with SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables.

Results

Out of the total 339 participants, only (51.6%) and (45.4%) had adequate knowledge and practice towards venous thromboembolism prevention respectively. Attending in-service training (AOR=1.701, p = 0.044) was significantly associated with knowledge of VTE prevention. Educational level (AOR= 3.871, P = 0.048), work experience (AOR=5.207, P<0.001), work location (AOR= 0.507, P = 0.019), working department (AOR= 2.959, P = 0.048), knowledge level (AOR= 0.477, P=0.005) were significantly associated with better preventive practice.

Conclusion

This study suggests that nurses’ level of knowledge and practice towards venous thromboembolism prevention was inadequate. Nurses’ educational level, attending in-service training, work experience, work location, and working department were determinant factors associated with nurses’ knowledge and practice towards venous thromboembolism prevention. Therefore, upgrading nurses’ educational level and providing in-service training on venous thromboembolism prevention is crucial for positive patient outcomes.

Medical decision-making surrounding high risk surgical procedures requires extensive consideration about the potential risks and benefits to the patient, including implications for concomitant medications and therapies. Managing cardiovascular risk in patients undergoing non-cardiac surgery is essential for safe and effective patient care. In instances where cardiac revascularization is needed prior to surgery, antiplatelet medication is also needed which can complicate future surgical procedures. This case report describes a patient who underwent percutaneous coronary intervention with drug eluting stent placement, who also needed urgent treatment for expanding thoracic abdominal aortic aneurysm (TAAA). Standard practice for endovascular repair of a TAAA includes placement of a lumbar drain to decrease the risk of spinal cord ischemia, however dual antiplatelet therapy is contraindicated. Cangrelor is the only intravenous platelet P2Y12 receptor inhibitor currently available. The use of Cangrelor, a short-acting P2Y₁₂ inhibitor, was successfully utilized as a bridge in the setting of a patient requiring dual antiplatelet therapy (DAPT) and further surgical intervention. This medication may improve outcomes for this subset of patients.

Aim

The aim of this study was to explore the experiences of cancer patients regarding venous access ports.

Background

The utilization of intravenous access ports for administering chemotherapy drugs is on the rise. Understanding patients' experiences with these devices can provide valuable insights for nursing managers and nurses.

Methods

A conventional qualitative content analysis approach was employed to explore the experiences of 14 patients who had venous access ports. The participants were selected from patients admitted to the oncology ward of a hospital affiliated with Kermanshah University of Medical Sciences. A purposive sampling method was used for participant selection. Semi-structured in-depth interviews were conducted as the data collection tool. MaxQda-10 software was utilized for data management.

Results

The data analysis yielded three main categories and ten sub-categories. The categories consisted of positive aspects of venous access ports, negative aspects of venous access ports, and barriers to accepting venous access ports.

Conclusions

The participants highlighted both the positive and negative aspects of venous access ports, while also identifying insufficient knowledge and "fear and anxiety" as barriers to accepting these devices. Providing essential training and offering psychological support to newly hospitalized cancer patients could prove beneficial in this regard.

Introduction

Chronic limb threatening ischaemia causes pain, loss of function and complex wounds, necessitating urgent interventions. While growing options for minimally invasive revascularisation make operating on frail and older persons safer, the challenge is knowing when to stop this option and offer amputation. Decisions about amputation are difficult for the person, or for the family who act as substitute decision-makers. Timely treatment decisions are important to optimise clinical outcomes but do not always align with outcomes that are acceptable to patients.

Aim

To provide a philosophically-based understanding of patient/family experiences of making decisions for chronic limb threatening ischaemia.

Methods

Longitudinal qualitative study using Heideggerian phenomenology. Patient and family participants were recruited from three sites. Semi-structured interviews occurred at two time points: soon after advice to consider major amputation, and for those who experienced amputation, six-months post-operatively. The COnsolidated criteria for REporting Qualitative studies (COREQ) checklist guided this report.

Findings

Variable timelines, disease progression, and interventions were encountered prior to confronting the possibility of amputation. Decision-making was interpreted as an initial irresoluteness (neglecting or renouncing decisions). For most, this was eventually followed by a resoluteness where participants either turned away or towards amputation, according to one's preferred mode of suffering, and thus owning the decision to turn. Those who opted for amputation often experienced better-than-anticipated outcomes.

Conclusion

Patients and families had difficulty making decisions about amputation. Clinicians may have been complicit in the neglecting and renouncing of decisions and have an important role in sharing decision-making through their authentic discourse.

Implications

Chronic limb threatening ischaemia requires complex discussions to support decisions and shared decision-making requires clinician presence and engagement in discourse. Patients and family members benefit from more time to experience and process the phenomenon as they move towards owning their decision about amputation.

Aim

To describe healthcare professionals’ experience of needed competence in patient stroke care within specialist and primary healthcare.

Background

Healthcare professionals who provide stroke care need multifaceted, multi-professional skills; ongoing training is important for competent stroke care.

Design

A descriptive qualitative study.

Methods

Six focus group interviews with semi-structured interviews were conducted in October and November 2020. Healthcare professionals (n = 25) working in stroke care units in both specialist and primary healthcare settings were interviewed. The interviews were recorded, transcribed and analyzed inductively by content analysis. The study was conducted, and results were reported according to the Consolidated Criteria for Reporting Qualitative Research.

Results

Five main categories were identified: clinical competence; multiprofessional networking competence; competence in interaction skills; emotional and psychoeducational support competence; and self-management and development competence.

Conclusion

Competence in stroke care includes both in-depth and wide-ranging professional competences that require ongoing development. Utilizing various education models and collaborative learning approaches can help meet the requirements for developing competence in stroke care.

Patient or public contribution

No patient or public contribution