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Symptom experience has been conceptualized to be multidimensional, but few instruments for use with persons with HIV or AIDS reflect this. The purpose of this study was to develop an instrument to measure the multidimensional nature of symptom experience in persons living with HIV/AIDS. Two scales: the HIV Symptom Experience Assessment Scale (HIV-SEAS) and the HIV Symptom Manageability Scale (HIV-SMS) were developed and tested in 26 patients. Results indicated that the items of HIV-SEAS appropriately assess three dimensions, whereas HIV-SMS covers one dimension. Overall, the HIV-SEAS and the HIV-SMS are promising instruments. Further testing with a larger sample of participants has started. Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

BACKGROUND: Delirium in elderly hip-fracture patients is common and results in negative patient outcomes and increased nursing workload. DESIGN AND OBJECTIVE: The study was part of an evaluation of the interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) in a Swiss university hospital. Nursing workload was compared before and after implementing the program, using a quasi-experimental design. PARTICIPANTS: Included were 200 patients who were 65 years of age or older, recovering from hip-fracture surgery on a trauma ward (intervention) or on the other surgery wards. METHODS: Workload was compared before and after implementing the program on the trauma ward and was also compared on other surgery wards. Nursing workload for each patient was evaluated by means of data obtained from the nursing workload management system. Data were collected in a 4-month timeframe in 2004 and 2005 respectively. Differences for workload in total and workload for day, evening, and night shifts on postoperative days 1-5 were calculated, controlled by co-morbidity. Subgroup analysis was performed for patients categorized by nurses as 'confused'. RESULTS: Total workload decreased slightly from Year 1 to 2 by 6.4% and 4.2% for patients on the trauma ward and other surgery wards. However, workload during night shifts on the trauma ward decreased significantly by 22% (p=.004), while there was not a significant change on the other surgery wards. Sub-analyses for 'confused' patients found that the workload at night on the trauma ward decreased significantly by 23% (p=.01), while it did not change significantly on other surgery wards. Higher co-morbidity and nurses' labelling patients as 'confused' were associated with increased workload (p<.001). CONCLUSIONS: After implementing the program, decreased workload at night was found on the trauma ward. Delirium was detected and treated more quickly which led to less care needed at night. The reason for the slight drop in workload on all wards requires further investigation. [ABSTRACT FROM AUTHOR]

Addressing psychosocial distress is an essential part of cancer care. Therefore, nurses at the University Hospital Zurich have been screening all cancer inpatients with the Distress Thermometer (DT) since 2012. Screening is ineffective without any form of psychosocial intervention. We aimed to identify adherence to the screening protocol and how the reported problems influenced the nursing process. We compared changes in the documentation before and after screening implementation. This retrospective descriptive study used screening data and documentation of psychosocial items in the nursing process of inpatients at an oncologic ward. These data were compared with data obtained before screening implementation and were collected from electronic health records. All data were analyzed descriptively. 65% (N = 1111) of the 2166 inpatients were screened. With the implementation, more psycho-oncological referrals were made (4.5% vs. 11.7%) and more psychosocial issues were described in the nursing process (24.6% vs. 51.2%). Inpatients mentioned emotional problems in 37.5% (N = 353) and physical problems in 47.4% (N = 504) of cases. 15.7% (147) had a psychosocial nursing diagnosis. Only 10.7% (N = 26) of patients who noted anxiety, also had a nursing diagnosis of "anxiety". In contrast, 71.1% (N = 202) of patients who noted pain, had a nursing diagnosis of "pain". Although nurses are more sensitised to psychosocial issues after DT implementation, they do not use screening results to adapt nursing documentation to the psychosocial needs of the patients. Further studies are needed to investigate how distress screening and psychosocial issues can be integrated into nurses' daily work. • With the implementation of the Distress Thermometer nurses are more sensitised to psychosocial issues. • More psychosocial topics are mentioned in the nursing documentation. • Referral rate is higher but still low. • Nurses do not use screening results to adapt the nursing process. • Nursing diagnoses are not congruent with patient reported problems at the problem list. [ABSTRACT FROM AUTHOR]

Background Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear. Aim To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment. Design and methods This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication. Settings The study was conducted within four medical wards of an acute care university hospital in urban Switzerland. Participants A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively. Results Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units. Conclusions The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards. [ABSTRACT FROM AUTHOR]