Verpleegkunde最新文献

The purpose of this literature study is to gain an insight into the information available on epidemiological aspects, specific factors of risk, risk assessment instruments and preventive measures with respect to pressure sores with adult ICU patients. There are indications that the incidence of pressure sores in the ICU is higher than the average incidence of 3-10% in hospital populations. This higher incidence may be accounted for by specific risk factors, such as history before admission to the ICU, severity of the disease, the risk of prevention measures, the use of special medicine and the nutritional state. Also structural factors, such as the accessibility of prevention means and the unambiguous usage of the registration of pressure sores, play a part. Risk assessment instruments are used to quantify the risk of pressure sores in order to support or evaluate the decision concerning preventive measures. For the ICU risk assessment instruments have to be developed, in which the specific factors of risk are processed. Related to preventive measures the effect of turning and re-positioning the patient on the vital functions should further be investigated. If turning and re-positioning could be started as early as possible and in a responsible way, the demand for expensive measures, like special beds en special mattresses, will possibly decrease. The positive effect of these special beds on the prevention of pressure sores seams to be irrefutable.

Nurses' daily care for patients is imbued with moral questions. Ethics distinguish various movements that intend to solve the problem of how to deal with such questions. This article discusses two variants, namely ethics of rules and ethics of care. Ethics of rules present a rational model of thinking in which universal principles are applied to practical moral problems. According to ethics of care, an attitude of responsibility and involvement and, accordingly, the attention to the complex situation of a patient is considered moral. Both kinds of ethics are attached to a case from the practice of nursing care for oncology patients. The thinking of the nurses concerned is in line with ethics of care. It also involves principles of ethics of rules. These principles, however, only make sense in the complex situation of the patient. By virtue of this quality they are taken into consideration by nurses as one of the details from the context. This makes ethics of care function as a kind of 'breeding ground' for ethics of rules.

Research into nursing problems related to breathing that can occur by pulmonary patients and their relationship with literature on Nursing Diagnoses (further referred to as diagnoses) on this subject has been done on two nursing wards. Interviews have been held with eleven nurses working in direct patient care. From the acquired data twelve problems with their signs and symptoms as well as the possible etiology were found, each showing one or more similarities with diagnoses from the North American Nursing Diagnosis Association (NANDA). Similarities and differences between the NANDA diagnoses and the acquired data have been analysed.

In this article the results of explorative research into the validity and reliability of a Dutch version of the Bradenscale are described. The Bradenscale is a risk assessment tool for measuring the risk of developing pressure sores. With a prospective longitudinal design the Bradenscale has been investigated in a hospital and a community setting in Belgium and the Netherlands. Results of the research in hospital indicate a fair to moderate agreement with respect to interraterreliability and a reasonable amount of predictive validity. In the community care setting interraterreliability indicates slight to fair agreement while predictive validity could not be established due to several reasons. Further research into the Bradenscale is recommended considering the limited research population in both studies and the results in community care.

This article concerns one of the research questions in the project on 'Terminology in Dutch Nursing: Towards clarification, classification and standardization of nursing concepts', i.c. related to the conceptual definition of nursing diagnosis. On the one hand those parts are reported on which agreement was reached, by means of literature research and analysis of documents, interviews with key-informants and group discussions and through a Delphi research. On the other hand, those aspects of the proposed conceptual definition are elucidated on which discussions seem not to be closed yet or that are missing in the definition for lack of agreement. These discussion points are explored, thus following one of the recommendations of the research project on 'Terminology in Dutch Nursing', namely for further refinement of the proposed working definition of the concept nursing diagnosis. Finally some suggestions are made to realize this solicited refinement.

Methodological quality of scientific research is argumentative persuasiveness of the conclusions of the research. Aspects of methodological quality are: methodological objectivity (including reliability, validity, subjectivity and intersubjectivity), generalizability, and, regarding action-oriented research, action-rationality. Values, which are only partly of a methodological nature, are: transferability, utilization-value, implementary value and participatory value. Concerning each of these norms and values a variety of measures to promote methodological quality in qualitative inquiry are discussed.

The present article explores the significance of prodromal symptoms in the prevention of psychotic relapse in schizophrenic patients. Prodromal symptoms are changes in patient's subjective perception and observable behavior which may signal the onset of psychosis. The article first describes the process of psychotic decompensation and continues with the description of the most common prodromes, the situation in which they may be observed and who may observe them. The discussion also touches on the predictive value of prodromal symptoms, i.e. their ability to predict an impending psychosis correctly. Finally, the article discusses the various interventions available to nurses, focusing in particular on two aspects. The first aspect is the drafting of observation plans aimed at recognizing prodromal symptoms at an early stage. The second describes how such plans can be linked to the education and information provided to patients and to others in the patient's environment.