நர்சிங்கில் மேம்பட்ட பயிற்சிகளின் இதழ்

Implantable port catheter devices are frequently used to manage patients undergoing long term administration of chemotherapy. Though it has many advantages, they are not free from complications. Nurse's who are knowledgeable and competent in the basic aspects of port-a-cath care able to ensure specific child needs are met and prevent further complications. Aim: was to assess Oncology Critical Care Nurse's Knowledge about insertion, Care and Complications of Venous Port Catheters in Egypt. Research Design: A descriptive design was utilized. Setting: was conducted at critical care units at 57357 hospitals in Egypt. Subject: A convenient sample of 100 oncology nurses who cared for patients undergoing port-a-cath insertion were enrolled in this study. Tools: nurse's background and implantable port catheter care knowledge questionnaire were utilized. Results: In this study, 62% of oncology nurses received in-service training courses about the implantable port catheter. Also, it revealed two thirds of the studied subjects (69%) have got satisfactory knowledge level with the average mean 40.31+2.12 out of 50. Moreover, it showed high significant differences among the oncology nurses level of knowledge by their age and educational qualifications and total knowledge scores (X2=13.17, p=0.001 and X2=7.79, p=0.02 respectively), nurses' years of experience in nursing profession, experience in handling port-a-cath, attending training courses about port-a-cath (X2=23.48, p=0.0001; X2=20.89, p=0.0001 and X2=55.47, p=0.0001 respectively. Conclusion: The majority of the oncology nurses had got satisfactory level and there was significant correlation between the nurses' knowledge level and their demographic characteristics except their gender. Recommendations: periodic consideration of in-service training programs regarding port-a-cath implantation care according to the updated standards and guidelines.

Students face different types of stresses during their study. Stress refers to a dynamic interaction between the individual and the environment. Stress is simply the body's non-specific reaction to any demand made on the body. Stress is a psychological factor that influences the academic performance and welfare of nursing students. Therefore, this study was planned with the objective to identify the major stress factors among nursing students of Allied Hospital, Faisalabad, Punjab, Pakistan. The sample size of 150 female participants was selected through simple random methods. For the purpose descriptive cross sectional study design was used. Results revealed that there are many factors which create stress among nursing students but academic, clinical and environmental factors are the major. The 70%, 75% and 60% participants were agreed and strongly agreed with academic, clinical and environmental factors, respectively, which causes the stress to nursing students. The results of the findings indicate that students experienced mainly academic and clinical stresses which have positive impact on the students learning. The outcomes of the study will be beneficial in designing an accurate stress management package for nursing students of Allied Hospital, Faisalabad.

Aim: This article aims to synthesize evidence from a systematic review on the conceptualization of spirituality related to nursing care.

Background: Over the last few decades, the concept of spirituality has been studied and defined, in relation to illness, and conceptualizations were been formulated from different scientific disciplines and therapeutic fields.

Design: A systematic review with narrative synthesis was performed.

Data sources: First, different concepts of spirit and soul in present Philosophy were exposed. Second, the meaning of spirituality, in dissimilar dictionaries, was interpreted. Third, a literature review of PUBMED, WOS, CUIDEN, and DIALNET was used to discuss the differences among the conceptualizations of spirituality related to nursing care.

Review methods: PRISMA statement was followed, as were established methods for systematic reviews.

Results: In most articles reviewed, methodologies of Walker and Avant Chin and Kramer and Rodgers were stated, for the clarification of this notion. Moreover, it was concluded by different authors that the way it was done was unclear at the present time. No distinction between spirituality, spiritual needs and spiritual care were found.

Conclusions: Spirituality is a difficult term to clarify, because it evolves at the same time as society change and it has been approached from different points of view, related to diverse therapeutic fields and illnesses. Moreover, spirituality is an intimate and subjective experience so nurses should approach it from an ethical and humanistic perspective.

The Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening allergic reactions to medication. They require immediate treatment with the primary goal to prevent infection and encourage healing. This research proposes a specific treatment and care for SJS/TEN patient using sterile banana leaf dressing, which allows the patient to be discharged swiftly and reduces the cost of treatment by 8 times. In conclusion, the case study where specific, supportive therapy using sterilized banana leaf dressing was given the patient can be discharged within 12 days.

Introduction: The purpose of this study was to investigate surface doses of 6 and 10 MV energies of linear accelerator for different clinical setup parameters including (field size, gantry angle, SSD (source skin distance), PW (physical wedge), acrylic block tray and bolus), Comparison between measured surface dose by P.P (parallel plate) and calculated surface dose by TPS (Treatment Planning system). Comparison between surface doses measured by TLD (Thermo luminescence dosimeter) and P.P ion chamber, Comparison between the surface dose of 3DCRT and IMRT techniques.

Materials and Methods: Surface dose measurements were carried out using a (PTW) Markus parallel-plate ion chamber in a plastic water plastic water phantom for various setup parameters using Primus Siemens (6, 10 MV) linear accelerator. For the normalization depth, i.e., the depth of maximum dose 1.5, 2.5 cm were chosen for 6, 10 MV photon beams, respectively.

Results and Discussion: The measured skin dose values for 10 MV were lower than those of 6 MV, the skin dose increased as field size increased. The measured surface dose by P.P for 6 and 10 MV are 16%, 25%, for 10 × 10 cm2 square field size, within the first 2 millimetres of the build-up region, at field size 10 × 10 cm2 the PDD for a 6 and 10 MV photon beam increases from 24% to 62%, 16% to 44% respectively. With increasing the gantry angles (0 to 30) produces a minimal effect of dose, (40-70) gantry angles produce a significant increase. When studying the surface dose with different SSD found that the percentage of surface dose is nearly stable, the absolute surface dose (cGy) increased with decreasing SSD. The absolute skin dose for wedge fields were lower than for open fields, for field size 10 × 10 cm2, while the values of surface dose of wedge 30 are 20% and 14% for 6 and 10 MV respectively. The skin dose for a wedge field increased as field size increased. Bolus 1 cm material increased the surface dose for 10 × 10 cm2 from 24% to 96%, and from 16% to 87%, for 6 and 10 MV respectively. With the use of an acrylic block tray, the surface dose increased to the open fields for all field sizes higher than 10 cm2, but the increase was dominant for large fields, for field size 20 × 20 cm2 the surface dose increased from 29% to 41%, from 22% to 34% for 6 and 10 MV respectively.

Conclusion: Agreement between skin doses calculated by multidata TPS and those measured by P.P ion chamber in water plastic water phantom was better than 20% for 96% of measurement points and this is indicate that the dose calculation in the build-up region using multidata TPS is good. For irregular tumor shape and closed OAR the IMRT is a good solution to cover the tumor and spare the critical organs without increasing the skin dose.

Background: Pain is one of the main symptoms reported in cancer patients which is directly associated with the disease itself or while undergoing treatment. Non-pharmacological interventions are necessary to be included in treatment modalities for pain related to cancer, wherein a variety of options can be used to reduce pain and improve the quality of life Transcutaneous electrical nerve stimulation (TENS) is widely used, despite lacking evidence to confirm effectiveness in any type of chronic pain, including cancer-related pain Purpose: There are limited studies that discussed the uses of TENS. Therefore, the purpose of this paper was to explore the effectiveness of TENS on cancer-related pain. Methodology: Literature review was conducted by searching in PubMed, Science Direct, EBSCO, CINAHL, and google science. 36 articles were found; the review utilized 9 articles despite extensive research which met the selection criteria. The articles regarding TENS is limited, thus the author extends the search for more than five years published articles, which extend between 1997-2013. Conclusion: There is insufficient evidence to ascertain as to whether TENS can be used in adults with cancerrelated pain. After reviewing all the articles, it is evident that there is no significant improvement in pain especially in patients with advanced cancer. The 9 articles which support the use of TENS, still provide inadequate evidence in the effectiveness of TENS to cancer patients. The author believes that TENS is futile to use in the treatment of cancer-related pain.

Purpose: To evaluate the stress level of second-year’s nursing students during their first oncology clinical experience. Methods: The descriptive study in order to determine the stress levels of second-year’s nursing students. This study was conducted with the students of Uludag University. The study population was consisting of 156 nursing students attending second year class in nursing school. Pagana Clinical Stress Questionnaire (PCSQ) was used. Data in analysis of survey’s results was evaluated mean, Pearson's correlation method, t-test was used in statistical analysis percentage. Results: When a comparison is made between the mean score of clinical stress and socio-economic data of the students involved in the study; any meaningful difference has not been observed between the mean scores of stress and the sex, approaches to nursing profession, previous hospital experiences, health status whether having a chronic disease or not. Only meaningful difference (p>0.05) has been observed with family member status whether working as a health worker or not (p<0.05). The mean score of stress of students in the first clinical practice was found as 70 ± 4.15. This result exhibited that the students experienced stress is the average. Conclusions: It was found that the nursing students had a high level of stress during the first clinical practice and experienced the most stress "fighting" dimension from the subscales. So, it was thought that the clinical orientation program must be done before student experience. Because clinical orientation program was effective to reduce the risk.

Inability of clients to pay as low as $ 1.2 to initiate a Family Planning method has contributed to the country’s low Contraceptive Prevalence Rate (CPR) in Nigeria. Until the adoption of free family planning policy in Nigeria, women had to pay fees ranging from about $1 to $3. Considering the fact that abortion is illegal in Nigeria, coupled with the fact that illegal abortion can be expensive, many of these women ended up with unintended pregnancies. The adoption of the policy on free family planning services to women by the Federal Government of Nigeria in 2012 was therefore received positively by civil society organisations. This paper intends to highlight the position before and after the adoption of this policy, by using the ARFH Model Clinic statistics as a primary guideline. In addition, the paper will provide an analysis of how this policy can be better implemented. Findings from this study show that free family planning service influences choice of modern contraceptives as demand for implanon increased when provided free compared to other modern methods. It is therefore, recommended that family planning services for all methods in all public health facilities should be provided free.

Background: The incidence of Diabetes mellitus is increasing rapidly, with type 2 diabetes making up to 90% of the cases. Whether diabetes interferes with lung function is unknown. Aim of this study is to evaluate lung function of diabetic patients.

Materials and Methodology: A cohort of diabetic patients was randomly selected. History and type of diabetes, glycemic control, comorbidities, smoking history was recorded; clinical examination and spirometry was performed.

Results: 62 individuals with type 2 diabetes were enrolled (36 men), aged 64.5 (10.7 Standard Deviation (sd)), Body Mass index 30.1 (6.4 sd), 9.2 years of disease (9.4 sd), HbA1c 7.02% (1.25 sd, 53 mmol/mol, 5.2 sd). 67.7% had arterial hypertension, 14.5% Coronary Heart disease, 54.8% hyperlipidaimia and 16.1% had history of asthmatic symptomatology without any respiratory follow up. 48.3% had smoking history (46.2 pack years) and 20.9% were current smokers. 19.3% had normal spirometry, 30.6% COPD (73.4% mild disease), 6.4% restrictive disorder, 3.2% combined disorder and 40.2% small airway disease (FEF25-75%<60% predicted). In total 74% had obstructive disorder (p<0.001). There was no correlation between sex, smoking, years of diabetes, glycemic control, antidiabetic medications or other comorbidities and obstructive pattern in the spirometry. No patient had evaluated lung function before.

Conclusion: These results prompt to the need of a large cohort study to evaluate the state and evolution of respiratory function in patients with diabetes. The existence of obstructive disorder in the majority of our patients may suggest an endothelial inflammatory process that leads to airway obstruction as a complication of type II diabetes

Background: Little research has been undertaken to explore how Substitute Decision Makers (SDM) are chosen by patients and especially for incompetent adults in an intensive care unit (ICU). Objective: To determine how substitute decision makers are chosen in ICU. Method: A retrospective cohort study using a clinical file audit to appraise socio-demographic and qualitative data from the medical record. The data from the medical record was collected by one researcher and analysed using a de-identified file. Ethics approval was sought and granted by the hospital Ethics Committee and the research was deemed to be low risk due to the nature of the retrospective file audit. Setting/Participants Patients admitted to ICU between July 2010 and June 2011 (n=1500) and died within ICU (n=236). The social demographic features were analysed using descriptive statistics and analysis using SPSS statistical software. Results: Most patients who died in ICU (70%) were aged over 60 years. While most widowed people and some married persons nominated an adult child as next of kin (NOK), 34% of single people nominated someone other than a family member as next of kin. The audit showed key differences between next of kin and the nominated substitute decision maker. For example, in all age groups, for those nominating a partner as next of kin (n=124) over a third had a different person assume the role of substitute decision maker. Conclusion: This retrospective study found that one third of patients preferred another trusted advocate to assume the role of substitute decision maker rather than their next of kin. Hence, the NOK of patients admitted to ICU should not be assumed to be their preferred substitute decision-maker. We recommend a community education program to raise awareness for families to begin conversations about preferences for substitute decision makers especially amongst ageing family members.

The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunication technologies to support long-distance clinical healthcare. Telehealth is becoming one of the disruptive technologies that will transform healthcare in the 21st century. Clinical implementation of telehealth has occurred in nursing and physical therapy. Concurrently, use of health care simulations in academia has occurred recently. The aim of this short communication is provide clinical perspectives from physical therapy and nursing in order to advance telehealth collaborations. One opportunity in academia is to further investigate telehealth healthcare simulation as an interprofessional collaboration between curricula. Future studies must address access, cost, and chronic disease management in telehealth collaborations.

A discussion paper addressing significant issues in the transference of a culture of care and professionalism to nursing students, from their educational schools. The paper argues that the core values and organisational culture of a school of nursing is integral to the professional socialisation of nursing students with particular focus on care. The paper explores the concept of organisational core values, organisational culture, and the characteristics of leadership in change. The importance of core values, and cultural congruence between the organisation/institution and the nurse educators is explored and emphasized; to more effectively facilitate transfer of these values to students. By way of an example, the paper also explores the management of change within schools of nursing and nurse education and the potential impact/impression that this could make to the development of culture and practice of the nursing student.

Background: In reaction to the large increase of migrants in Europe in the year 2015, it was necessary to make some arrangements to reduce the security and social risks possibly ensuing from the migrant inflow into the Czech Republic. The migrant camps were established and several services started to be provided, including common and emergency medical care. The common medical care is provided by medical staff in camps, the ambulance services are provided by the local ambulance service on the basis of a special contract. Because of the increasing number of events when the ambulances were abused, it was necessary to limit the amount of such events. An unusual solution with checking the necessity of ambulance interventions was accepted with good results. Methods: The arrangement of verifying the legitimacy of the ambulance intervention was introduced and accepted after several cases of abusing the ambulance service by people in migrant camps were encountered. The evaluation of the necessity of sending an ambulance car to the camp was made by discussion between the head doctor in the camp and the ambulance service control centre. Results: The experience of doctors in refugee camps shows that the steps taken in order to prevent the abuse of emergency services work well. Simultaneously, no delay in the delivery of acute medical care has been registered after the agreed measures were adopted. Conclusion: This article focuses on the specific aspects of the system of common and acute medical care in the camps for refugees and migrants in the Czech Republic. In reaction to the large increase of migrants in Europe in the last year, it was necessary to make some arrangements to reduce the security and social risks possibly ensuing from the migrant inflow into the Czech Republic. First, it is important to have suitable facilities for migrating people. The fundamental requirement for a human being is medical care. Because of frequent abusing ambulances–where anesthesiologists work-by migrant people in camps, special rules and agreements for acute medical care in migrant camps had to be adopted. Those rules, unusual in the Czech Republic, have already saved a significant number of senseless ambulance interventions