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Biomedical subjects

B J Daly

Publications and source records attributed to B J Daly.

At least 19 recordsLinked to original sources
PubMed2001

Relationship of empathy to appraisal, depression, life satisfaction, and physical health in informal caregivers of older adults.

The relationship between empathy and caregiving appraisal and outcomes was examined among 140 informal caregivers of older adults. Caregivers with high cognitive empathy appraised the caregiving situation as less stressful and less threatening, were less depressed, and reported higher life satisfaction than did caregivers with low cognitive empathy. The caregivers' appraisal, along with educational levels and total household income, significantly predicted individual differences in caregiver depression, life satisfaction, and perceived physical health. Emotional empathy was negatively related to life satisfaction. There appeared to be distinct roles for emotional and cognitive empathy in informal caregiving outcomes. The study supported the important role of caregiving appraisal and resources in caregiving outcomes.

Adaptation, Psychological↗
PubMed2001

Prevention in the inpatient setting.

PURPOSE: To review the literature on and describe approaches to implementing health promotion and disease prevention practices in the inpatient setting. DATA SOURCES: Comprehensive review of nursing and medical literature, clinical practice guidelines, and U.S. government documents. CONCLUSIONS: Preventive screening has been shown to reduce morbidity and mortality from many diseases. Health promotion and disease prevention activities form the foundation of practice for many nurse practitioners (NPs). As increasing numbers of NPs begin to practice in the acute care setting, it is important they incorporate prevention into the inpatient setting. IMPLICATIONS FOR PRACTICE: Because there are many barriers that impact appropriate preventive screening, health care providers must take advantage of every patient encounter including those in the inpatient setting. Although it may not be feasible to actually perform certain screening exams while a patient is hospitalized, it is feasible in many cases to take a few minutes to review recommended preventive screening.

Health Promotion↗
PubMed2001

Hospital readmission among long-term ventilator patients.

STUDY OBJECTIVES: Patients experiencing prolonged periods of in-hospital mechanical ventilation have been described as long-term ventilator (LTV) patients. The purpose of this study was to document the incidence of hospital readmission and to identify risk factors for readmission for LTV patients up to 6 months after hospital discharge. DESIGN: This study was part of a larger prospective longitudinal descriptive study of posthospital outcomes for LTV patients. SETTING AND PARTICIPANTS: One hundred ninety-nine ICU patients admitted to a university medical center, Veterans Administration hospital, or small community hospital who required > 96 h of continuous in-hospital mechanical ventilation were enrolled. MEASUREMENTS AND RESULTS: Descriptive statistics, logistic regression, and survival analytic techniques were used. The 6-month hospital readmission rate was 38%. Readmission occurred most often within days 1 to 60 days (mean, 39.2 days) posthospital discharge. Predictive variables for readmission were the following: length of the index hospital stay; length of the index mechanical ventilation; and the need for oxygen at hospital discharge. Using survival analysis, the age category of 66 to 71 years was statistically significant for the relative risk of readmission within the first 30 days of the index hospital discharge. CONCLUSIONS: LTV patients should be considered at risk for hospital readmission. Further study examining the impact of closer follow-up in the first 60 days posthospital discharge is necessary in order to determine whether there is a more effective way of reducing the risk of readmission for LTV patients.

Aged↗
PubMed2000

Special challenges of withholding artificial nutrition and hydration.

Despite society's increasing understanding of and comfort with end-of-life decision-making, questions about the appropriate use of artificial hydration and nutrition remain particularly challenging to both professional and family members. These decisions are complicated by misunderstandings about likely benefits and burdens, concern about patient suffering, and ambivalence regarding the moral status of feeding. Data regarding the effectiveness of tube feedings in terms of prolonging survival, improving wound healing, or preventing aspiration do not support the widespread use of this intervention in states of severe dementia or end-stage disease. Further, there is evidence that withholding feeding is not associated with suffering, so long as adequate mouth care and desired sips of water are provided. Nonetheless, surveys of both long-term care residents and family members of persons with dementia indicate that at least 30% to 50% of those queried expresses a preference for artificial feeding if they (or their relative) could not eat. Given the absence of conclusive data about the efficacy of feeding and the apparent plurality of values surrounding the provision of this intervention, health professional must focus efforts on using a careful, deliberate approach to decision-making that involves all interested parties and make use of valid empirical data.

Aged↗
PubMed2000

Hastening death.

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Aged↗
PubMed1999

Research methodology issues related to interviewing the mechanically ventilated patient.

Difficulties conducting research in vulnerable or frail patient populations limit the data-based information on which to base practice in these populations. Although there are many challenges in this type of research, they are not insurmountable, and, in an effort to encourage others interested in studying vulnerable patient populations, we discuss the methodological process used to prospectively study one vulnerable group. Interviews about perceptions of weaning, fatigue, mood, and sleep/rest states were conducted with 20 patients who were chronically critically ill and required long-term mechanical ventilation. Illness severity and communication difficulties were primary considerations in the design, development, and implementation of the study. Ethical considerations, informed consent, sample representation, and data collection issues are discussed.

Adult↗
PubMed1999

Why a new Code?

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American Nurses' Association↗
PubMed1997

Nurses' job satisfaction, absenteeism, and turnover after implementing a special care unit practice model.

The purpose of the study was to compare job satisfaction, absenteeism, and turnover between nurses working in a nurse-managed special care unit (SCU) and those working in traditional intensive care units (ICU). A case management practice model with a shared governance management model and minimal technology was implemented in the SCU while contrasting features of a primary nursing practice model with a bureaucratic management model and high technology already in place in the traditional ICU. Individual nurses' perceptions of and their preferences for the SCU practice model also were examined related to job satisfaction. Using analysis of covariance, greater satisfaction with a lower absenteeism rate was found in nurses working in the SCU. Nurses' perceptions and preferences for the SCU practice model were closely related to their job satisfaction and growth satisfaction. The findings suggest that individual perception and preference should be taken into account before implementing autonomy, authority, and responsibility at the organizational level to lead to the desired nurse outcomes in a given working environment.

Absenteeism↗
PubMed1997

Acute-care nurse practitioners: 'strangers in a strange land'.

In 1961, Heinlein described a "stranger" from another planet struggling to comprehend and integrate the cultural idiosyncracies of earthlings in his adopted land. One could compare that situation with what confronts acute-care nurse practitioners (ACNPs) as they embark into the practitioner's world of acute care. Rather than embrace the expensive and fragmented patient-care world through collaboration with its "strangers," ACNPs would benefit from clinging to elements of their own native nursing culture and become "nesters" rather than "perchers" in the quest for improved health care.

Acute Disease↗
PubMed1997

Outcomes of long-term ventilator patients: a descriptive study.

BACKGROUND: Long-term ICU patients who require prolonged mechanical ventilation are a growing segment of the in-hospital population. Despite recognition that this population is costly to care for no systematic research has been done on the characteristics, outcomes, and disposition of these patients after they leave the hospital. OBJECTIVE: To describe clinical and sociodemographic characteristics and outcomes of ICU patients who require long-term (5 days or more) mechanical ventilation while in the hospital. METHODS: A prospective, longitudinal descriptive design was used to study 57 ICU patients who required 5 days or more of continuous mechanical ventilation while in the hospital. Clinical and sociodemographic data were collected at the time of enrollment. Patients were followed up for up to 6 months after discharge from the hospital to ascertain disposition and morality. RESULTS: On average, patients had a hospital stay of almost 6 weeks and required mechanical ventilation for approximately 4 weeks; 43.9% of the patients died in the hospital. None of the patients discharged from the hospital were able to return home initially without assistance. By 6 months after discharge, more than 50% of the original sample and died, 9% resided in an institution, and 33% were living at home. CONCLUSIONS: A large percentage of ICU patients who require 5 days or more of mechanical ventilation die in the hospital, and many of those who live spend considerable time in an extended-care facility before they are discharged to their homes. These likely outcomes of patients who require long-term ventilation should be discussed with patients and their families to assist them in making informed decisions.

Aged↗
PubMed1996

Procedures used in withdrawal of mechanical ventilation.

OBJECTIVE: The purpose of this study was to describe ways in which withdrawal of mechanical ventilation is carried out in one institution, patient responses to the various methods of withdrawal, and nurses' perceptions of the methods and morality of ventilator withdrawal. METHOD: A retrospective descriptive study was used with a convenience sample of adult patients who underwent terminal weaning at University Hospitals of Cleveland. Demographic and clinical data, and descriptions of the exact method of ventilator withdrawal were collected from the medical records of these patients. The nurse caring for the patient was interviewed about his or her perceptions, within 7 days of the withdrawal. RESULTS: Data were obtained on 42 subjects. There were no differences in mental status, ventilatory status, age, or duration of survival between the patients who had support removed gradually and those from whom it was abruptly removed. Morphine was administered to 88% of the sample during withdrawal. Survival duration was unrelated to morphine dosage, but did correlate with ventilatory status at the time of withdrawal. Every nurse interviewed reported that he or she believed the act of withdrawal for that patient was morally correct, although only 85% were completely comfortable with carrying out the procedure. CONCLUSIONS: These results provide a foundation for preliminary recommendations about the most humane form of ventilator withdrawal and the appropriate use of narcotics and sedatives during withdrawal.

Adult↗
PubMed1996

Information requirements of advanced practice nurses.

To insure the availability of effective computer systems, advanced practice nurses (APNs) must first identify information required for practice. Fifteen APNs who worked in a local hospital participated in a focus group. The APNs included nurse practitioners and certified nurse midwives. All APNs carried individual caseloads and practiced collaboratively with both nurses and physicians. The most important information need expressed by the APNs was for current, clinical information about specific patients. Also desirable were computer tools that supported communication, documentation, and billing.

Computer Systems↗
PubMed1995

Withholding nutrition and hydration revisited.

The concerns Hall raises in her article, "Caring for Corpses or Killing Patients" (October 1994) are reasonable points to consider but careful examination suggests that this form of treatment limitation is not prohibited by moral, legal or professional principles. In fact, in situations in which we have reliable information about what the patient's preferences were, we may have a very strong obligation to cease this unwanted intervention. In situations of uncertainty because of lack of data, lack of confidence in the information or sincere philosophical differences, we must hesitate before acting, calling upon whatever ethical, legal and professional resources can shed light on the issues at hand and lead us to consensus.

Coma↗