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- Allemann, Hanna, et al.
(author)
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Nurses' actions in response to nursing assistants' observations of signs and symptoms of infections among nursing home residents
- 2015
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In: Nursing Open. - : Wiley-Blackwell. - 2054-1058. ; 2:3, s. 97-104
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Journal article (peer-reviewed)abstract
- AimsTo describe what nurses do during episodes of suspected infection in elderly nursing home residents and if these actions are linked to who is initiating an episode and whether the episode is considered an infection or not.DesignProspective descriptive study. Data were collected in 2008–2010.MethodsSummarized and categorized documentation by nursing assistants and nurses was used for summative content analysis.ResultsNurses' actions seem to be related to who initiated the episode and if the episodes are categorized as ‘non-infection’, ‘possible infection’ or ‘infection’. Actions could be ‘observation’, ‘screenings’, ‘engaged in waiting’, ‘follow-ups’, ‘nurse-prescribed actions’, ‘diagnosing’, ‘contacting the physician’, ‘carrying out an action prescribed by the physician’, ‘contacting an ambulance or arranging an emergency visit to the hospital’ and ‘prescribing screening’. As NAs often initiate episodes of suspected infection by observing changed conditions, it seems important to include the NA in the decision-making process as these observations could detect possible early signs and symptoms of infections.
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| 2. |
- Johansson, Rose-Marie, et al.
(author)
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Guidelines for preventing urinary retention and bladder damage during hospital care
- 2013
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In: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 22:3-4, s. 347-355
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES:To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection.BACKGROUND:Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs.DESIGN:An expert group was established, and a literature review was performed.METHODS:On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed.RESULTS:The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information.CONCLUSION:Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak.RELEVANCE TO CLINICAL PRACTICE:These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.
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| 3. |
- Sund Levander, Märta Helena, et al.
(author)
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Fever or not fever - that's the question : A cohort study of simultaneously measured rectal and ear temperatures in febrile patients with suspected infection
- 2018
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In: Clinical Nursing Studies. - Toronto, Canada : Sciedu Press. - 2324-7940 .- 2324-7959. ; 6:2, s. 47-54
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Journal article (peer-reviewed)abstract
- Objective: To study how ear and rectal body temperatures relate to each other over time in febrile patients.Methods: Descriptive cohort study with repeated measurements. The setting was a Unit for Infectious Diseases at a county hospital in Sweden. Patients, ≥ 18 years, admitted for suspected infection and with a rectal or ear temperature of ≥ 37.5°C were invited. 16 females and 24 men, 19 to 94 years were included. Ear and rectal temperature was measured simultaneously every two hours for one day.Results: Mean rectal temperature was higher, compared to both ear sites. Ninety-five percent of the differences between the rectal and ear sites were within 0.6°C to 1.1°C. Changes in rectal temperature were smaller and slower than in ear temperature, especially when patients were given temperature-lowering drugs.Conclusions: Adjustments from one temperature site to another is a risk of diagnostic error affecting clinical decision-making. Ear temperature reacts faster than the rectal site to body temperature changes and antipyretics, and is therefore more reliable in the assessment of the patient’s condition. Traditional paradigm for temperature measurement and assessment needs to be replaced with evidence-based science to improve patient safety.
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| 4. |
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| 5. |
- Sund-Levander, Märta, et al.
(author)
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The Challenge of Infections in Frail Elderly : The Story of Mr. Nilsson
- 2015
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In: Clinical Medical Reviews and Case Reports. - : ClinMed International Library. - 2378-3656. ; 2:9
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Journal article (peer-reviewed)abstract
- Signs and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. The case of Mr. Nilsson illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. What we can learn from this case is to reflect on changed behavior from habitual status and/or non-specific symptoms as possible suspected infection, and to consider a rise from individual baseline temperature, so called DiffTemp™, instead of traditional decided cut-off values for fever.
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| 6. |
- Toros, Andrew, et al.
(author)
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Use of temperature changes and pro-inflammatory biomarkers to diagnose bacterial infections in patients with severe cerebral trauma
- 2022
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In: Journal of Neurocritical Care. - : Korean Neurocritical Care Society. - 2508-1349. ; 15:1, s. 21-31
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Journal article (peer-reviewed)abstract
- BackgroundIn patients undergoing neurosurgeries, inflammation and infection are strongly related; however, inflammation can be present without infection. Midregional proadrenomedullin (MR-proADM) is a relatively new sepsis biomarker that is rarely used clinically. Recently, the concept of DiffTemp was introduced, that is, a >1°C rise from individual normal temperature accompanied by malaise, as a more accurate definition of temperature assessed as fever. The aim of the present study was to examine the importance of C-reactive protein (CRP), white blood cells, procalcitonin, and MR-proADM levels and DiffTemp.MethodsThis prospective, comparative study had a quantitative approach. Forty-two patients, aged >18 years and presenting with severe cerebral trauma were included from a neurosurgical intensive care unit. The outcome variable was infection; group 0, no infection (n=11); group 1, suspected infection (n=15); and, group 2, confirmed infection (n=16). Group assignments were performed using biomarkers, medical records, bacterial cultures, and International Classification of Diseases-10, and by the clinical assessment of criteria for nosocomial infections by a neurosurgeon.ResultsOn comparing groups 1 and 2, MR-proADM and DiffTemp were associated with a higher risk of confirmed infection (odds ratio, 5.41 and 17.14, respectively). Additionally, DiffTemp had a 90.9% specificity in patients with no infection and a 93.8% sensitivity in patients with confirmed infections. CRP and procalcitonin levels were not associated with an increased risk of confirmed infection.ConclusionIncreased levels of MR-proADM were associated with a higher risk of confirmed infection. DiffTemp was associated with a higher risk of having a confirmed infection.
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