Physiological stability: a concept analysis

Wearable wireless continuous vital signs monitoring on the general ward

PURPOSE OF REVIEW

Wearable wireless sensors for continuous vital signs monitoring (CVSM) offer the potential for early identification of patient deterioration, especially in low-intensity care settings like general wards. This study aims to review advances in wearable CVSM - with a focus on the general ward - highlighting the technological characteristics of CVSM systems, user perspectives and impact on patient outcomes by exploring recent evidence.

RECENT FINDINGS

The accuracy of wearable sensors measuring vital signs exhibits variability, especially notable in ambulatory patients within hospital settings, and standard validation protocols are lacking. Usability of CMVS systems is critical for nurses and patients, highlighting the need for easy-to-use wearable sensors, and expansion of the number of measured vital signs. Current software systems lack integration with hospital IT infrastructures and workflow automation. Imperative enhancements involve nurse-friendly, less intrusive alarm strategies, and advanced decision support systems. Despite observed reductions in ICU admissions and Rapid Response Team calls, the impact on patient outcomes lacks robust statistical significance.

SUMMARY

Widespread implementation of CVSM systems on the general ward and potentially outside the hospital seems inevitable. Despite the theoretical benefits of CVSM systems in improving clinical outcomes, and supporting nursing care by optimizing clinical workflow efficiency, the demonstrated effects in clinical practice are mixed. This review highlights the existing challenges related to data quality, usability, implementation, integration, interpretation, and user perspectives, as well as the need for robust evidence to support their impact on patient outcomes, workflow and cost-effectiveness.

Revisiting the Definition of 'Healthy' Participants in Substantiation of Structure/Function Claims for Dietary Supplements

Concepts and definitions of 'healthy' have been evolving within clinical treatment algorithms as well as reference standards such as Body Mass Index and Dietary Reference Intakes. Consumers' perception of the word 'healthy' is also changing to reflect longer life span, need to stay active and in a good state of mental well-being while managing multiple diseases. Guidelines from the US Food and Drug Administration indicate that substantiating evidence for support of Structure/Function (S/F) claims for dietary supplements is best derived from clinical research conducted in a 'healthy' population. S/F claims cannot be represented to diagnose, treat, cure or prevent any disease. However, in this context, the term 'healthy' is non-descriptive and largely interpreted as an absence of disease. Guidelines for treatment of disease have been broadened to include biomarkers of disease risk such that the pool of 'healthy' volunteers eligible to be enrolled in clinical trials for S/F claim substantiation is greatly diminished. This perspective presents the challenges faced by the food and dietary supplement industry and by researcher efforts designed to substantiate S/F claims and suggest the phrase 'physiologically stable' or 'apparently healthy' as descriptions better suited to replace the term 'healthy.'

Being wheelchair-bound and being bedridden: Two concept analyses

AIM

Analysis of the concepts and development of a conceptual definition of being wheelchair-bound and being bedridden.

DESIGN

Concept analysis.

METHODS

Walker and Avant´s concept analysis method was used. A thematic analysis guided the determination of the attributes, antecedents and consequences.

RESULTS

Being wheelchair-bound and being bedridden are defined as permanent states in which people are bound to an object. Being passively bound to a wheelchair and being bedridden both mean an increasing restriction of the life-space. Being passive wheelchair-bound often represents a preliminary stage to being bedridden. Both concepts have six attributes: in need of help, powerlessness, life-space confinement, mobility limitation, endurance and weakness. They differ in the main feature maintaining an independent sitting position. Physical immobility and physiological instability are antecedents with the following influencing factors: illness, complexity, burden, endogenous/exogenous booster. The consequences are the progression of inactivity and all related physical and psycho-social problems.

Homebound: A concept analysis

AIM

Analysis of the concept and development of a conceptual definition of homebound.

BACKGROUND

Homebound persons have a significantly higher mortality risk as well as physical and psychosocial burden. A clarification of the term is necessary to develop preventive measures.

DESIGN

Concept analysis.

DATA SOURCES

Scientific literature from electronic databases (CINAHL, Medline via PubMed, PsycINFO, PsycArticles, and Scopus) and definitions from online dictionaries.

REVIEW METHODS

Walker and Avant's method was applied to guide the concept analysis. To prevent arbitrary and empty results in determining the attributes, antecedents, and consequences a thematic analysis was carried out.

RESULTS

Homebound is defined as an enduring condition in which the life-space is reduced to the home, but moving around in the home is possible (by walking short distances alone or by holding on to furniture, or with the help of a stick, walker, or another person). Homebound has six attributes: in need of help in ADL/IADL and in leaving the life-space, powerlessness, life-space confinement, mobility limitation, endurance, and weakness. Physiological instability and physical immobility are antecedents with wide-ranging influencing factors as illness, complexity, burden, and endogenous/exogenous booster. Homebound has also wide-ranging consequences such as the progression of inactivity, physical, psychosocial, and/or spiritual problems.

CONCLUSIONS

The multidimensional concept of homebound modifies the concepts of mobility and immobility. Given the extensive consequences of homebound nurses play a central role in the prevention.

Ortsfixierung und Bettlägerigkeit im Kontext von Gebundenheit (boundedness). Die Entwicklung einer konzeptuellen Begriffsdefinition auf Grundlage einer integrativen Übersichtsarbeit

Zusammenfassung.Hintergrund: Ortsfixierung und Bettlägerigkeit sind bedeutende Phänomene der Gesundheits- und Krankenpflege. Trotzdem fehlen konzeptuelle Definitionen und entsprechende Pflegediagnosen in den gängigen Pflegeklassifikationssystemen. Ziel: Ziel ist es, die Grundlage für konzeptionelle Definitionen zu schaffen. Dazu wird der aktuelle Stand der deutsch- und englischsprachigen Begriffsverwendungen zu Ortsfixierung und Bettlägerigkeit erfasst. Zugleich werden jene englischsprachigen Begriffsdefinitionen herausgearbeitet, die eine breite internationale Anerkennung finden. Darüber hinaus werden die mit Ortsfixierung und Bettlägerigkeit im Zusammenhang stehenden Phänomene erfasst und voneinander abgegrenzt. Methode: Die Identifizierung deutsch- und englischsprachiger Begriffsverwendungen erfolgt durch eine integrative Übersichtsarbeit für den Zeitraum von 1990 bis 2016. Ergebnisse: Es gibt eine Vielzahl an englischsprachigen Begriffen zu Ortsfixierung und Bettlägerigkeit. Die Begriffe homebound, wheelchairbound und bedridden bilden Ortsfixierung und Bettlägerigkeit am häufigsten ab. Instabilität und Immobilität stehen als Ursachen und Inaktivität als Folge in Verbindung. Gegensätzlich zu betrachten ist Bettruhe (bedrest), die angeordnet und zeitlich befristet ist. Schlussfolgerungen: Ortsfixierung und Bettlägerigkeit sind durch die einheitliche Definition der Gebundenheit (boundedness) zu betrachten. Dabei müssen die Ursachen (Instabilität, Immobilität) diagnostiziert werden, um adäquate Interventionen zur Vermeidung bzw. Linderung der Folgen ableiten zu können.

Evaluating the Use of a Stability Guideline for Long-Term Ventilator-Dependent Children Discharging to Home: A Quality Improvement Project

INTRODUCTION

Defining stability before discharge for children with severe chronic lung disease requiring home ventilation has historically been dependent on an individual provider's opinion.

METHODS

An institutional guideline based on expert opinion was used for patients who were first discharged home on mechanical ventilation. A retrospective review determined if the guideline was used. Electronic medical record changes were initiated to improve compliance with the guideline.

RESULTS

The retrospective review showed that the guideline is documented in less than one third of patients, and 36% of patients met the requirements of the guideline before discharge. Following these results, electronic medical record documentation was changed.

DISCUSSION

Results showed a low utilization rate for the discharge home guideline for patients receiving long-term ventilation. Utilization of electronic medical record charting can improve the tracking of stability guidelines and provide the opportunity to further define stability in ventilator-dependent children.