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Biomedical subjects

Barbara Pieper

Publications and source records attributed to Barbara Pieper.

16 recordsLinked to original sources
PubMed2006

Bariatric surgery: patient incision care and discharge concerns.

Because it provides greater and more durable weight reduction than behavioral and pharmacological interventions for the morbidly obese, the number of bariatric surgeries is increasing - one such procedure is the Roux-en-Y gastric bypass. A cross-sectional study was conducted to examine incision care knowledge and discharge concerns of patients who had undergone this type of gastric bypass bariatric surgery. Participants (N = 31; 28 women, three men; mean age 45 years), recruited from a bariatric surgery center in a large, urban teaching hospital, had undergone a Roux-en-Y gastric bypass by either the open (n = 29) or laparoscopic (n = 2) method. Patients scheduled to be discharged home, 21 years of age or older, and able to understand and respond in English were eligible to participate. Participants completed questionnaires that included demographic information and rating scales regarding incision care knowledge, fears, and discharge concerns. Mean time from hospital admission to study participation was 1.1 days (SD = 3 days). Knowledge of incision care and amount of information received about incision care were rated low. The five most frequently mentioned postdischarge concerns included bowel trouble at home, wound pain at home, looking for wound complications, watching for wound infection, and activity limitations. The higher the amount of information received about incision care, the higher the patient's knowledge (r = .57, P <.001). Lower incision care knowledge scores were correlated with a higher fear of incision care (r = .46, P = .008) and patients reporting greater pain had more concerns about discharge (r = .49, P <.005). Little is known about preparing the bariatric surgery patient for discharge home. To improve outcomes, research that examines issues including discharge teaching methods, patient concerns, and information for persons undergoing bariatric surgery is needed.

Activities of Daily Living↗
PubMed2005

Injection drug use and wound care.

Persons who have injected drugs present challenges to providing wound care. They tend to have multiple physical and psychosocial problems and abuse many substances. They may mistrust health care providers because of past experiences and their perceived negative attitude toward providers. Because they often self-treat abscesses and wounds before seeking care, the infection or wound can be large. A complete history and physical examination should be obtained. All aspects of the person's background will have an impact on wound healing. Wounds need careful assessment and diagnosis. Correct diagnosis of the wound is critical for the proper treatment. Treatment decisions must also include pain control, financial concerns, living arrangements, insurance, and the person's ability to perform the care. Patient education is a critical link in enhancing positive wound healing outcomes.

Abscess↗
PubMed2003

Lower extremity changes, pain, and function in injection drug users.

Persons who have injected drugs are highly susceptible to a life-long, debilitating condition of the legs called chronic venous insufficiency (CVI). CVI may affect a person's ability to function. The purposes of this study were to examine (a) the functional relationship between CVI severity, pain, and behavior; and (b) the extent to which pain mediates the relationship between CVI severity and functional behavior for persons with a history of injection drug use. The 100 participants had a history of injection drug use and were recruited from a medical clinic and a methadone treatment clinic. Participants responded to a questionnaire that contained demographic, health history, drug history, pain and functioning components. Their legs were examined from the knees to the feet for clinical manifestations of CVI. Pain and functional behavior were monotonically related to severity of CVI. Path analysis showed leg pain as a mediator of the relationship between CVI and behavioral functioning controlling for the effects of other chronic diseases. Treatment center counselors need to be aware of leg changes that occur with injected drugs, realize these changes may affect many aspects of functioning and cause pain, and encourage clients to obtain medical assistance for treatment of their legs.

Activities of Daily Living↗
PubMed2003

Nontraditional wound care: A review of the evidence for the use of sugar, papaya/papain, and fatty acids.

With global travel and immigration, WOC nurses may see or be asked questions about wound care practices that are different from those traditionally taught in their educational programs. The purpose of this article is to review the evidence about 3 commonly used wound products, namely, sugar, papaya/papain, and essential fatty acids. Although these products are used in numerous countries, their application in Brazil will provide the examples of use in this article. Nontraditional wound care is still frequently practiced even in countries where access to evidence-based products is fairly good. Research studies about sugar, papain/papaya, and essential fatty acids generally are case reports/studies and descriptive. Protocols in the use of the products varied. Use of these products is often based on tradition and economics. WOC nurses need to be knowledgeable regarding nonstandard wound care products and procedures so they can respond appropriately in situations where these products are used.

Brazil↗
PubMed2003

Knowledge of pressure ulcers by undergraduate nursing students in Brazil.

The purpose of this study was to examine Brazilian nursing students knowledge of pressure ulcers. Third- and fourth-year undergraduate baccalaureate students at a public university in Brazil (N = 83) were asked to provide demographic information, identify extracurricular activities (eg, reading journals and articles and using the Internet to enhance comprehension of pressure ulcer care), and complete the Pressure Ulcer Knowledge Test. Students correctly answered 67.7% of the Pressure Ulcer Knowledge Test items. Students who participated in extracurricular activities and used the Internet had significantly higher Knowledge Test scores than those who did not. Readings did not significantly impact the Knowledge Test score. Generally, the students were found to have low pressure ulcer knowledge, but that educational programs and the Internet have the potential to positively impact nursing students knowledge of pressure ulcers.

Adult↗
PubMed2002

Skin and soft tissue infections in injection drug users.

Skin and soft tissue infections are the most common cause for hospital admission of injection drug users. Cutaneous and subcutaneous abscesses are the most frequent type of SSTI and occur most commonly when drug users are no longer able to inject intravenously and resort to injection directly into skin or muscle. Abscesses may be difficult to differentiate from uncomplicated cellulitis or may be confused with pseudoaneurysms, hematoma, phlegmon, or thrombosed vein. Special studies, including ultrasonography; CT scans, and MR imaging; or careful incision and inspection may be necessary to clarify the extent of infection and the presence of abscess. These procedures may also help differentiate a subcutaneous abscess from a vascular structure. Uncomplicated cellulitis most commonly responds to antibiotic therapy directed toward Staphylococcus aureus and Streptococcus spp. In several recent studies, cutaneous and subcutaneous abscesses have been found to be caused by polymicrobial infections and to include anaerobic organisms as well as aerobic gram-positive cocci in a little more than 50% of cases. Complete, often repeated, incision and drainage is a prerequisite for successful outcome in these cases. Complications of SSTI are many and are potentially life threatening. They include direct extension of subcutaneous abscess into vital areas or structures, necrotizing fasciitis and myositis, bacteremia, and sepsis. An outbreak of a highly lethal SSTI that recently occurred in Scotland, Ireland, and England seems to have resulted from infection with Clostridia spp, including C. novyi and C. perfringens. A rare but well-documented SSTI in injection drug users is pyomyositis, an abscess-forming infection of skeletal muscle. More than 20 cases have been reported in temperate climates to date. Although not life-threatening, chronic cutaneous venous ulcers of the lower extremities are common and debilitating, requiring long-term multidisciplinary care for successful healing.

Humans↗
PubMed2002

Home care nurses' ratings of appropriateness of wound treatments and wound healing.

PURPOSE: The purpose of this study was to examine nurses' ratings of appropriateness of wound treatments and wound healing for patients in home care in relation to patient demographic and visit variables. DESIGN: A cross-sectional design was used. SETTING AND SUBJECTS: Data were collected about patients with wounds by 281 nurses from 13 home care agencies located throughout lower Michigan. Patients with wounds (n = 881) ranged in age from 21 to 100 years. They included 492 women and 383 men who were white (72.4%) or African-American (26%). INSTRUMENTS: The Community Wound Assessment Tool was developed for the study and was used to obtain demographic and wound data. The demographic section contained information about the patient's age, sex, reason for the visit, length of visit, and time the case was opened. The wound section included the wound type, treatments, presence of incontinence, nutritional supplementation, and adverse home environmental factors. Nurses rated wounds as healing or not healing. Wound treatments were rated as all appropriate, some appropriate/inappropriate, and all inappropriate. METHODS: Nurses were systematically selected from each agency and collected data about each patient visited on one occasion. MAIN OUTCOME MEASUREMENTS The main outcome measurements were the relationship of patient demographic variables and visit variables to the appropriateness of wound treatments and wound healing. RESULTS: The nurses' rating of wound treatments as appropriate was significantly related to younger patient age and a shorter time for the case to be open. Wound healing was initially associated with younger patient age, continence of urine or stool, shorter home visits, shorter time for the case to be open, and fewer reasons for the visit. When wound healing was controlled for the type of wound in path analysis, the patient's age was no longer significant and incontinence appeared to impair healing of nonsurgical wounds. The appropriateness of the wound treatments was significantly related to wound healing. CONCLUSIONS: Nurses' ratings of appropriateness of wound treatments and healing are significantly related to factors that affect length of service and complexity of care for the home care patient with a wound. Decisions nurses make about wound treatments and healing are important for the patient as well as for the agency.

Adult↗
PubMed2002

An international partnership: impacting wound care in Brazil.

The purpose of this article is to review nursing literature about international partnerships, describe nursing and nursing education in Brazil, and describe an international partnership about chronic wound prevention and treatment in Brazil. Because countries often share health care concerns, nursing knowledge is greater than any one country's health care trends or clinical issues. Although the literature has numerous articles about pressure ulcers and other chronic wounds, much of this information is lacking for nurses in Brazil because it is primarily written in English. This project provided educational programs in Portuguese to nurses and nursing students in Brazil, involved them in the development of wound care protocols, allowed practice with dressings, and stimulated discussions on improvement of home care to patients and families. WOC nurses have a critical global role in sharing wound care knowledge.

Brazil↗
PubMedDate not supplied

Wound management in vulnerable populations.

While wound management is a significant challenge for many rehabilitation patients, vulnerable populations are at particular risk. In addition, considerable focus is being placed on vulnerable populations within health care. Rehabilitation nurses should understand issues related to working with vulnerable patients with wounds, including poverty and payment for care, culture, and literacy. Nursing research to advance the care of individuals from vulnerable populations requires a special approach designed to establish the integrity of the research and gain the trust of potential participants.

Culture↗
PubMedDate not supplied

Chronic venous insufficiency in HIV-positive persons with and without a history of injection drug use.

OBJECTIVE: To examine chronic venous insufficiency in human immunodeficiency virus-positive persons with and without a history of injection drug use and to examine the extent to which neuropathy further increased the risk of chronic venous insufficiency. DESIGN: Cross-sectional stratified design with quota sampling. SETTING: Infectious diseases clinic in a large, urban midwestern city. PARTICIPANTS: Human immunodeficiency virus-positive persons, 27 with no history of injection drug use and 46 with a history of injection drug use, who met the inclusion criteria, including being 30 to 65 years of age, not pregnant, and willing to respond to a questionnaire and have their lower legs examined, were enrolled until the quota for each stratum (no injection drug use and injection drug use) was filled. MAIN OUTCOME MEASURES: Chronic venous insufficiency clinical classification, injection drug use history, and presence of peripheral neuropathy. MAIN RESULTS: Sixty-one percent of injection drug users (28/46) presented with severe chronic venous insufficiency compared with 11% (3/27) of noninjection drug users (P< .001). The presence of lower extremity neuropathy was not significantly related to chronic venous insufficiency classification. CONCLUSIONS: This is the first study to report the high risk of chronic venous insufficiency in human immunodeficiency virus-infected persons who inject drugs. Chronic venous insufficiency should be assessed in human immunodeficiency virus-positive persons when there is a history of injection drug use, and measures to protect the legs should be implemented.

Adult↗
PubMedDate not supplied

A retrospective chart review of risk factors for extravasation among neonates receiving peripheral intravascular fluids.

PURPOSE: To identify variables associated with extravasation and resulting tissue damage in neonates with peripheral intravascular therapy. DESIGN: A retrospective chart review was completed. SETTING AND SUBJECTS: Randomly selected medical records of 25 neonates admitted to a neonatal intensive care unit from January 2003 through April 2004 and who experienced peripheral intravascular infiltration were examined. INSTRUMENTS: The Neonatal Tissue Extravasation Tool was created to reflect common descriptive variables of the neonatal population and infused solutions used in their care. Tissue damage was classified with the scale from the Task Force of Pediatric Nursing Research Committee, 1994. RESULTS: Charts of 15 female and 10 male infants 24 to 39.6 weeks old were reviewed. Extravasation was not significantly related to age, weight, or sex. The most common intravenous medications were total parenteral nutrition (n = 19) and calcium (n = 18). Peripheral intravenous sites were secured with tape. The sites of the infiltrate were the arm (n = 16), foot/leg (n = 5), and scalp (n = 3) (one not recorded). Stages 0 (absence of redness, pain, swelling; flushes with ease) (n = 11) and 4 (severe swelling; blanching, pain, skin breakdown, etc.) (n = 6) were the most common stages. The site of the infiltrate was measured and care described in only 9 neonates. CONCLUSIONS: The intravascular solutions causing the most extensive damage from extravasation were similar to those reported in other studies. No other potential risk factors were identified, but poor documentation about the extravasation site and management of skin damage hampered data collection via retrospective chart review.

Extravasation of Diagnostic and Therapeutic Materi↗
PubMedDate not supplied

Discharge information needs of patients after surgery.

Patients who have undergone surgical procedures often have self-care concerns in their preparation for discharge from the hospital. This article examines the research literature about information needs of postoperative patients prior to their discharge. The most common concerns were the incision/wound care, pain management, activity level, monitoring for complications, symptom management, elimination, and quality of life. Because of their clinical knowledge of the perioperative experience, wound, ostomy, and continence nurses and other advanced practice nurses have a critical role in the development of discharge-educational programs for postoperative patients and caregivers. Because unmet discharge needs can contribute to poor patient outcomes and readmission, it is critical that wound, ostomy, and continence nurses, advanced practice nurses, and clinical staff nurses accurately identify patients' informational needs and find ways to meet these needs especially with the aging population, new/advanced surgical procedures, vulnerability/poverty, and literacy level of patients.

Attitude to Health↗