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  • ISSN: 2379-9501
    Volume 3 Issue 5
    Research Article
    Beth Quatrara*, Melanie Turner, Nancy Pitts, Cherie Parks, Felicia Murphy, and Mark Conaway
    Administering intramuscular (IM) vaccinations is a basic nursing skill. Yet, there is debate among clinicians regarding the necessity of aspirating to assess for blood return prior to IM vaccine administration. The debate is further complicated by inconsistencies in procedural manuals and guidelines regarding the recommendation of whether or not to aspirate for potential blood return. Underlying these uncertainties is the question of how often blood return occurs with aspiration and the risk of inadvertently administering the vaccine intravenously.
    The goal of the observational study was to identify how often blood return occurs with aspiration in adult patients.
    Registered Nurses who regularly performed aspiration for potential blood return were observed by a study team member when they administered an IM vaccination. The team member recorded the presence of blood return as well as size of needle, injection site and type of solution injected.
    A total of 318 IM injections with 10 second aspiration events were observed. Fifteen different RNs were observed. The majority of patients were female (57%) and the mean age was 64.6 years. The pneumonia vaccine was given to 57% of the patients and the influenza vaccine to 43%. The 23 gauge needle was used for the majority (98%) and the left arm deltoid was the most common injection site (66%). No blood return was identified with any of the IM aspirations.
    This study provides insight to the chance of blood return with aspiration and scientifically points to the limited benefits of IM blood aspiration assessment prior to vaccination in the adult population. The results support the recommendations to eliminate the step of aspiration prior to IM vaccine administration in the deltoid of adults.
    Fabio da Costa Carbogim, Denise Barbosa de Castro Friedrich*, Katiusse Rezende Alves, Flavia Batista Barbosa de Sa Dias, Luana Vieira Toledo, Larissa Bertacchine de Oliveira, and Vilanice Alves de Araujo Puschel
    Background: critical thinking (CT) is a practical activity based on the balanced search for reason through skills and dispositions. Purpose: To analyze the perceptions of students on an educational intervention focusing on First Aid for the development of skills and CT dispositions.
    Method: this was a qualitative, exploratory, and descriptive study based on the historical-cultural theory and activity, performed on 28 first- to third-year students of an undergraduate program in nursing. Interviews were conducted after a first aid course using an assessment portfolio. Data was analyzed using the content analysis proposed by Bardin.
    Results: students reported acquiring CT skills throughout the course, despite their initial insecurity. The results confirm and find support in the cultural-historical theory and activity, indicating that the most fruitful learning is the one that precedes development, through clear definitions of teaching and learning activities.
    Conclusions: based on the results, the teaching activity should not be limited to the assimilation of content to achieve skills and attitudes, but should also promote CT.
    Shrestha BK*, Rajbanshi L, and Lopchan M
    Background: Chronic kidney disease is a common and rapidly increasing public health problem all over the world, both in developed and developing countries. Majority of the patients with chronic kidney disease on maintenance hemodialysis are not aware of self care management such as fistula care, diet, weight monitoring, blood pressure monitoring and exercise as well as complications.
    Objective: To evaluate self care knowledge among patients with chronic kidney disease undergoing maintenance hemodialysis.
    Methods: A descriptive exploratory design was used including 100 patients undergoing hemodialysis at National Kidney Center, Balaju Kathmadu from 29th Sep to 30th October 2011. Semi structured interview schedule was developed and data collected using face to face interview method.
    Results: Male predominance was seen with 63%, 78% were literate and 88% were married. Average episode of the dialysis was 216±2.2 with a mean duration of 2.42±2.20 years. Majority of the patients (54%) had poor and 46% had good knowledge about self care management. Mean knowledge score on weight monitoring was 90%, fistula care was 86.36%, diet was 80%, and blood pressure monitoring and exercise were 75%. No association was seen between respondent’s level of self care knowledge regarding haemodialysis and demographic variables. Similarly no association was seen regarding hemodialysis related variables.
    Conclusion: Patients with chronic kidney disease on maintenance hemodialysis require knowledge on fistula care, exercise, diet, blood pressure and weight monitoring. An educational program for hemodialysis patient on self care definitely reduces the morbidity.
    Short Communication
    Helene van Berge-Landry RN, Ph.D.*
    The purpose of this commentary arises from thematic concerns related to where we are with hospice and palliative nursing care today. Recent calls for changes in undergraduate nursing education to include a broader context for end-of-life care by the American Colleges of Nursing and concerns by the Hospice and Palliative Nurses Association (HPNA) reflect broader concerns. This commentary also includes personal anecdotal experiences for reflection. Very little quality palliative care evidenced-base research is available and the HPNA research agenda 2015-18 reflects this. The hospice movement in the United States has been around for more than four decades, but over the last 16 years the hospice and palliative care industry has basically quadrupled in size. Nearly half of all Medicare recipients who die now do so as a hospice patient. It is incumbent upon Nurses everywhere to take heed.
    Review Article
    Chipping J*, Mooney J, and Macgregor AJ
    Rheumatology deals with the investigation, diagnosis and management of patients with musculoskeletal conditions. It is a multidisciplinary complex specialty incorporating over 200 disorders affecting joints, bones, muscles and soft tissues, including inflammatory arthritis and systemic autoimmune disorders.
    Musculoskeletal conditions can be debilitating and socio-economic consequences severe: 20% of people with chronic physical health problems have depression known to be associated with poor treatment adherence and diagnostic overshadowing, adversely affecting treatment and health status. Diseases are often treated in isolation but there is increasing recognition of the complex relationships between diseases and treatments in patients with multiple chronic diseases, and growing evidence of the detrimental effect poor mental health can have on physical health outcomes.
    There is little formal acknowledgement of the impact of mental health on those with musculoskeletal conditions. With the management of arthritides largely based in secondary care, the rheumatology team could be best positioned to provide psychological support for those with mental health issues as co-morbidities. The European League against Rheumatism (EULAR) recommends that the role of the rheumatology practitioners should include provision of psychosocial and self-management support for patients with inflammatory arthritis (IA). This discussion advocates syndication of a registered mental health nurse (RMN) embedded within the Rheumatology outpatient department (OPD). This will require the support of clinical leaders and policy makers but could bring significant patient benefit.
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