[Life quality of patients with muscular failure, using permanent respiratory support, seen from their point of view. 2. Practical requirements and problems connected with respirator treatment]

Sixteen patients with neuromuscular disease receiving long-term assisted ventilation participated in a combined questionnaire/interview investigation with the purpose of illustrating their situation as regards appropriate personal attention, technical aids, knowledge of respirator-technique, illness and regular hospital examinations, multidisciplinary conferences, adapted housing and speech problems connected with tracheostomy. Generally, we conclude that these practical factors and arrangements, enabling the patient to manage everyday life, were, on the whole, satisfactorily settled. Compliance with the patient's desires to the utmost extent is recommended and achievement of the optimal solutions for him, by means of teamwork. Thus one must always bear in mind that the goal of these practical arrangements for the patient (such as personal attention, technical assistance, hospital examinations etc.) apart from optimal maintenance of daily activities should be to keep the patient independent of residential care.

Outcome of home care for technology-dependent children: success of an independent, community-based case management model

Case management is important for successful home care of technology-dependent, respiratory-disabled children. Traditionally, the medical model of hospital-based home care and case management has been used for these children. The outcome may be different from when using independent, community-based home care and case management. We evaluated the results of 28 technology-dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, community-based, case management group to coordinate home care. After 26.3 +/- 20.6 months of follow-up, 13 children (46%) remained technology-dependent, 10 (36%) were technology-independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies (n = 4), primary pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology-dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community-based home care and case management is a reasonable alternative to the hospital-based model.

[Neuromuscular disorders]

In this study, the author focuses on three neuromuscular disorders that have historically been isolated to a specific region in Québec. The author is convinced that appropriate nursing interventions can help in the detection of these disorders and can, using data on social behavior, help eliminate harmful genetic mutations.

Ineffective airway clearance related to neuromuscular dysfunction

Individuals with neuromuscular dysfunction are at increased risk for secretion retention. Their underlying disease process compromises or prevents ability to cough effectively. Although their lung function may remain normal, neuromuscular disease predisposes to breathing at low lung volumes and to elimination of sighing respirations, a breathing pattern which predisposes to development of airway and alveolar collapse. As ventilatory reserve decreases, risk of progressive atelectasis and secretion retention is increased. Prompt recognition of the signs and symptoms of this nursing diagnosis can prevent or reverse problems relating to ineffective airway clearance. Nursing management thus becomes the cornerstone of the individual's regimen of care.

Rehabilitation of the adult with head trauma

The changes incurred as a result of brain injury are often devastating. The approaches outlined in this article merely scratch the surface because the list of possible deficits is inexhaustible. The behavioral and cognitive capacity during the various phases of recovery dictate the intervention method that will be appropriate and successful, with concepts and tasks progressing from the simple to the more complex. When confusion, agitation, and inappropriate behavior are evident, safety is a prime concern. Some individuals do not progress beyond this stage. Placement and appropriate future planning are major issues in this situation. When behavior becomes more appropriate, inpatient rehabilitation efforts will be most beneficial and successful, with the focus on helping the individual regain functional skills. Improvement may be rather dramatic during this time, especially when compared with previous stages. Recovery beyond this point, with intact memory, goal-directed behavior, adequate socialization skills, and vocational rehabilitation, occurs over an extended period of time, perhaps years. With discharge, new concerns for the individual and family emerge as the reality of the situation becomes clearer. Health care providers in the community setting must recognize the effects of injury on the individual and the resulting psychosocial stresses and strains on the individual and family. Adequate neuromedical and neuropsychological follow-up are essential during the outpatient recovery phase to monitor progress and provide input for future plans.

Validating the nursing diagnosis of impaired physical mobility

The lack of research-based literature and of research models for validating nursing diagnoses results in some ambiguity in research efforts. Research must, however, move forward if there is to be progress in differentiating nursing and medical diagnostic models and use of nursing diagnoses to improve communication among nurses. Operational definitions of nursing diagnosis terminology are essential to continue work in validating nursing diagnoses, particularly in the clinical setting. The diagnosis impaired physical mobility was found to be an appropriate diagnosis for rehabilitation patients. Continued study and refinement of etiologies and defining characteristics is needed.

Alterations in movement: nursing assessment and implications

Physical assessment for nursing purposes is necessarily different from that of medicine because the focus of nursing is to diagnose and treat human responses to disease rather than the disease itself. This article will consider nursing assessment, pathophysiology, implications for daily living, and nursing implications for selected functional aspects of movement, namely seeing, eating, expressing (facially), speaking, moving, and walking.