Monthly Archives: July 2011

What is the evidence for best practices in caring for patients with dementia?

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For an overview of caring for patients with dementia:
Dementia, Care of Patient.  In:  Lippincott’s Nursing Procedures and Skills.
Provides overview with references to the literature for care of the patient with dementia.  Also includes a list of additional references that you may find helpful.

For guidelines
Alzheimer disease and Dememtia with Lewy Bodies.  In:  DynaMed.
Go to the Guidelines and Resources Section in each of these entries to see a list of US guidelines. Also, the Treatment Sections include reviews of evidence for management strategies, such as diet, as well as medical therapy.

Reviewed and updated 4/30/2014 ldt

 

Does nonsurgical pain interfere with rehabilitation activities in patients who’ve had total knee arthroplasty?

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Search Method

Searched PubMed, CINAHL, and EMBASE for combinations of these concepts:

  • Pain – etiology, drug therapy, prevention and control
  • Postoperative period or postoperative care
  • Rehabilitation OR physical therapy OR physiotherapy
  • Factors that interfere with rehabilitation (looked for these terms:  interfere* OR delay* OR prohibit*)
  • Arthroplasty/rehabilitation
  • Comparative study or clinical trial or cohort study or prospective study

Search Results
One article differentiated between pain associated with surgery and other pain:
Wittig Wells, Deborah R, Susan EShapiro, and Melinda KHiggins. “Patients’ experiences of pain in the 48 hours following total knee arthroplasty.” Orthopedic nursing 32.1 (2013):39-44.

View a selected collection of other studies on postoperative care of arthroplasty patients in this PubMed collection.

Reviewed and updated 4/30/2014 ldt

What effect does standard clinical attire to help patients recognize different caregivers have on patient satisfaction?

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Search Methods
Searched PubMed and CINAHL for combinations of the following concepts:
dress OR attire OR uniforms
patient satisfaction
patient attitudes or perception
allied health personnel
patient care team
identification
nurse’s role

Search Results
Below are selected studies applying mostly to a general patient population. There are also studies about specific patient populations, such as behavioral health units.

PubMed
Relevant studies are in this PubMed collection.
These are observational studies of patient’s perception of nursing attire.

CINAHL
Title: An evidence-based approach to creating a new nursing dress code: a survey of patients reveal what nurses should — and shouldn’t — wear.
Authors: Windle L ; Halbert K ; Dumont C ; Tagnesi K ; Johnson K
Source: American Nurse Today (AM NURSE TODAY), 2008 Jan; 3(1): 17-9

Title: Dress code debate.
Authors: Kaser M ; Bugle LW ; Jackson E
Source: Nursing Management (NURS MANAGE), 2009 Jan; 40(1): 33-8
COMMENT: This small study included 20 patients and their family members and 12 nurses who represented children’s units. The preference of being able to distinguish nurses from other healthcare staff did come up in this study.

Title: Use of non-conventional nurses’ attire in a paediatric hospital: a quasi-experimental study.
Authors: Festini F ; Occhipinti V ; Cocco M ; Biermann K ; Neri S ; Giannini C ; Galici V ; de Martino M ; Caprilli S
Source: Journal of Clinical Nursing (J CLIN NURS), 2009 Apr; 18(7): 1018-26
COMMENT: Investigates parents and children’s (N=112) attitudes toward multi-colored v. white uniforms for nurses. Parents expressed preference for being able to distinguish nurses from other staff.

Title: True colors: more hospitals turn to standardized attire for nurses to better identify them to patients and to polish their professional image.
Authors: Gaskill M
Source: NurseWeek (15475131) (NURSEWEEK (S CENTRAL)), 2004 Oct 4; 11(21): 20-1

Reviewed and updated 4/16/2014

Are there studies on management of pain not related to surgery in postoperative patients?

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There are no studies addressing management of pain not related to surgery in postoperative patients.

Search Method

Searched PubMed, CINAHL, and EMBASE for different combinations of these concepts:

  • Pain – etiology, drug therapy, prevention and control
  • Postoperative period or postoperative care
  • Rehabilitation OR physical therapy OR physiotherapy
  • Factors that interfere with rehabilitation (looked for these terms:  interfere* OR delay* OR prohibit*)
  • Arthroplasty/rehabilitation
  • Comparative study or clinical trial or cohort study or prospective study

Reviewed 4/29/2014 ldt

 

In taking a blood sample from a central venous catheter for evaluating a catheter-related infection, does discarding initial blood make a difference in contamination of the sample?

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Bottom line: In samples drawn from central venous catheters, there may not be much difference between the contamination rate of the discard and that of the blood drawn after the discard.

Summary: Dwivedi S, Bhalla R, Hoover DR, Weinstein MP.  Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures. J Clin Microbiol. 2009 Sep;47(9):2950-1.
This prospective study compared contamination rates of cultures of the discards to cultures of the sample taken after the discard for 653 consecutive samples on three oncology nursing units. RESULTS: Overall contamination rate was 10.9% for the discard vial versus 10.5% for the standard vial (p=0.90).

Reviewed 4/15/2014 ldt

What is the procedure for draining cerebrospinal fluid?

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Lumbar drains are used to drain cerebrospinal fluid in patients with postoperative or traumatic dural fistulae, shunt infections, hydrocephalus, or increased intracranial pressure from a head injury.

Thompson HJ. Managing patients with lumbar drainage devices. Crit Care Care. 2000;20(5):59-68.
Provides detailed instructions.

Overstreet M. How do I manage a lumbar drain? Nursing. 2003;33(3):74-75.
The author responds to a question about how to maintain an output of 15 to 20 ml/hour when the patient changes position.

Khan MH, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine. 2006;31(22):2609-2613.
Provides guidance on how long to drain fluids.

Reviewed and updated 4/15/2014 ldt