Nursing research
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As many as 50% of total hospital admissions are readmissions. Because the factors contributing to hospital readmission are multiple, and research findings are not conclusive, it is important for clinicians to gain an understanding of the key factors that contribute to readmission. ⋯ The study findings suggest that patients who are frequently readmitted to the hospital are severely ill; are on public assistance; and may need special attention when discharged in order to attenuate repeated hospital readmission.
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Symptoms, a key element in the patient's decision to seek care, are critical to appropriate triage, and influence decisions to pursue further evaluation and initiation of treatment. Although many studies have described symptoms associated with acute coronary syndromes (ACS), few, if any, have examined symptom predictors of ACS and whether they differ by patients' age. ⋯ Typical symptoms are predictive of ACS in younger patients and less predictive in older patients.
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The context of critical care and human phenomena involved in critical illness offer rich opportunity for nursing research. Naturalistic investigation with grounded theory methods can uncover previously unexamined elements and interactions in the critical care setting. This article presents methodological considerations for conducting grounded theory research in fast-paced physiologically and technologically complex critical care settings. ⋯ Given current trends in healthcare treatments and demographics, future research must examine physiological and technological data as integral components of basic social psychological or social structural processes in critical care interactions and should include technology as a component of nurse-patient interaction.
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Randomized Controlled Trial Clinical Trial
Dyspnea and the affective response during exercise training in obstructive pulmonary disease.
Dyspnea (SOB), dyspnea-related anxiety (DA), and exercise performance have been shown to improve after exercise training in patients with Chronic Obstructive Pulmonary Disease (COPD). However, there are no published descriptions of the changes in dyspnea intensity or dyspnea-related anxiety during or across the exercise training sessions. ⋯ As theoretically proposed, both groups significantly decreased their DA over the training sessions. This decrease was early in the sessions and was not accompanied by a decrease in the SOB. In contrast, subjects maintained a nearly constant mean and peak SOB with increasing exercise performance, suggesting that people may have a dyspnea threshold above which they are unable to tolerate greater dyspnea. Description of the changes in dyspnea and the affective response during training need to be expanded, while studying the type and timing of strategies to enhance the improvement in dyspnea and dyspnea-related anxiety.
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With a national trend toward less aggressive treatment of hospitalized terminally ill patients, families increasingly participate in decisions to withdraw life-sustaining treatment. Although prior research indicates decision making is stressful for families, there have been no psychometric reports of actual stress levels and few discussions of the reasoning used by families compared to clinicians in reaching the decision. ⋯ Findings add compelling evidence for the power of advance directives, whether written or verbal, to reduce the stress associated with family decision-making.