Care Requirements (care + requirement)

Distribution by Scientific Domains

Selected Abstracts

Autonomy through identification: a qualitative study of the process of identification used by people with type 2 diabetes

Albine Moser MPH
Aims and objectives., The aim of this study is to clarify the process of identification with diabetes as a dimension of autonomy as described by people with type 2 diabetes. Background., People with type 2 diabetes view autonomy as competency in shaping one's life. This concept of autonomy has seven dimensions, which emerged as categories in prior research. Dynamic processes shape these dimensions of autonomy. One of the dimensions of autonomy is identification. Method., This study has a qualitative descriptive and exploratory design and an inductive approach as described in grounded theory. Data were collected by means of in-depth interviews. The sample consisted of 15 people with type 2 diabetes mellitus in a nurse-led, shared-care setting in the Netherlands. Results., The phases of identification are comprehending, struggling, evaluating and mastering. Each phase has its own characteristics. Identifying with the diabetes is a non-linear, cyclical and continuous process because people with diabetes have to deal with changing conditions. Conclusion., The dynamics of identification is directed to a process of identifying with diabetes and its care requirement. Recognizing identification as an element of autonomy enables nurses to adopt a more patient-oriented view of autonomy. Relevance to clinical practice., Nursing that fosters the process of identification promotes autonomy. This implies that a person with diabetes should be able to identify with the nurse's interventions. Hence it is vital that nurses build supportive partnerships when providing care for such a patient. [source]

Quantifying Dementia Care in Japan: A Discussion on the Long-Term Care Insurance

Shivani Nandi PhD
Abstract: The Japanese government mandated the kaigohoken, or Long Term Care Insurance (LTCI) in December 1997. In view of the pressures faced by Japan as an aged society, the aim of the LTCI is to alleviate the burden of providing care for frail older people by ensuring good quality and readily available services to everyone over 65. The LTCI is thus a high profile, age-based entitlement program,age based for persons 65 years of age and above, and age related disability based for ages 40 to 64. Individuals 40 years and above, including foreigners living in Japan for more than a year, are responsible in bearing a part of the financial responsibility by having to pay the mandatory premium. The benefits that the insured person receives are decided after evaluating the care requirement. Care is quantified by being categorized into six levels of increasing requirement, starting from support required, through five levels of increasing care. As is well known, caring for a person with dementia is further complicated by accompanying psychiatric disturbances which in turn increase caregiver burden. Thus the fundamental difficulty in dealing with the care of persons with dementia such as Alzheimer's disease, which is the most common form of dementia, is the evaluation procedure preceding entitlement. We find that the statistical program of the LTCI employed in the initial stage of the evaluation contains discrepancies, and tends to overemphasize bed ridden patients over people with dementia. This paper is a study of the status of people with dementia in Japan, the mechanism of the assessment method, and the problems associated with it. [source]

Comparison of the Medical Priority Dispatch System to an Out-of-hospital Patient Acuity Score

Michael J. Feldman MD
Abstract Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. Methods: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. Results: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. Conclusions: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements. [source]

Postpartum/newborn patients: who are they and do they all need the same amount of nursing care?

Christiane Raby RN
Aim, To obtain a quantitative description of mother,newborn presentations and to identify their nursing care requirements while in hospital. Background, Recommendations on minimum staffing levels are broad based with implications that all new mothers and newborns are normal without complications. However, in a large tertiary centre, mother,newborn dyads do present with complications, suggesting variation in nursing care requirements. Method, Two studies were conducted: (1) a cross-sectional retrospective, descriptive study; and (2) a convenience sampling survey professional nurses' expert opinions. Results, A sample of 1224 mother and/or newborn presentations was retrospectively classified. Almost half of the patient presentations were classified as having complications. Nursing care ratios required for postpartum ranged from 1:1 to 9:1. Conclusion, An objective classification system was obtained from nursing experts in caring for mother and newborn with variable needs, in a hospitalized setting. Implications for nursing management This comprehensive classification system can be used to objectively align nursing resources to mother/newborn care needs. [source]

Management of HIV and AIDS in the African context

R Wood
The initial response to the African HIV epidemic was to concentrate on the prevention of new infections. There is now an urgent need to address the health care requirements of large numbers of already infected individuals. The spectrum of disease in the African setting is dominated by tuberculosis, bacterial and protozoan infections. In much of Africa, health services are overwhelmed by the care of terminally ill AIDS patients. In the absence of specific HIV therapy, health care resources are being increasingly utilised, but with little survival benefit for the individual. Resources available for treating patients vary considerably between the richer and poorer countries of the continent. Primary prevention of opportunistic infections and maternal child transmission are at present affordable and cost-effective interventions. Whilst antiretroviral therapies may presently be unaffordable in much of Africa, they represent a modality that can have a major effect on HIV survival. The challenge is to improve the health and longevity of HIV-infected individuals with the rational use of the limited health resources available in Africa today. [source]