Recommendations of the Polish Association of Anaesthesia and Intensive Care Nurses on pain monitoring in Intensive Care Units using a Polish version of the behavioural Pain Scale (bPS)

Introduction. In 2018, another update of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/ Sedation, Delirium, Immobilization and Sleep Disorders in Adult Patients Treated in Intensive Care Units (ICUs) was released. Aim. The study is aimed at presenting current recommendations concerning pain management in patients treated in ICU, and presenting the algorithm of pain assessment and monitoring in patients treated in ICU, using a Polish version of the BPS (Behavioural Pain Scale). The guidelines were prepared based on a systematic review of the literature published in the years 2013-2018. Material and methods. The search for scientific publications was carried out using electronic databases in English and Polish. The following keywords and their combinations were used in the searches: pain, assessment, monitoring, nurse, intensive care, adult patient, unable to communicate. Initially, 758 papers were identified with the use of keywords. After excluding duplicates and preliminary checking and selecting the titles of publications and abstracts, 85 papers were qualified for the analysis of full text. Conclusions. Access to effective pain treatment is a fundamental human right. Recommendations of the Polish Association of Anaesthesia and Intensive Care Nurses, concerning pain monitoring in ICU using a Polish version of the Behavioural Pain Scale (BPS), developed by the Task Force for Practice, are intended to provide a specific guideline for developing effective local pain management strategies in ICU.

Effectiveness of selected alternative methods of airway management by the nursing staff

Aim. The aim of the study was to assess the effectiveness of selected methods of alternative airway management by nursing staff. Material and methods. A prospective, pilot observational study was conducted on a group of 51 nurses undergoing specialization training or with specialty. Each nurse managed the airway with a laryngeal mask (LMA-Laryngeal Mask) and a laryngeal tube (LT-D-Laryngeal Tube) on a BT-CSIE trainer, and then carried out one minute ventilation using a bag valve mask, according to possessed knowledge and skills. The obtained parameters (time, pressure on the incisors, head tilt, ventilation quality) were recorded using a dedicated tablet. Statistical analysis was performed using the IBMSPSS Statistics 20 package. Results. No statistically significant differences were observed between the trials to open the airway using LMA and LT-D. Higher efficiency of LMA airway opening was demonstrated in the first trial and the average tidal volume during ventilation in relation to LT-D (LMA 547.84ml vs. LT-D 522.63ml). In addition, there was a significant difference in pressure on the incisors (LMA 6.82N vs. LT-D 4.12N). Conclusions. The effectiveness of LMA and LT-D insertion was assessed at a high level, with no significant differences between them. Variables: age, seniority, education level and type of specialization did not significantly differentiate the results obtained.

Effectiveness of Endotracheal Intubation among system nurses under simulated conditions – pilot studies

Introduction. Endotracheal intubation (ETI) may be a procedure necessary to perform by a nurse in the event of sudden cardiac arrest (SCA). Its correct execution improves the course and organization of a rescue operation and contributes to increased self-confidence in stressful situations. Aim. Assessment of the effectiveness of endotracheal intubation among system nurses under simulated conditions. Material and methods. A pilot study of prospective observational simulation study using advanced evaluation tools for intubation phantom (BT-CSIE, Q’ty model) with a tablet (PC-1EA), IntuBrite laryngoscope with curved handle. The results were analyzed with Statistica PL 12.0 and Microsoft Office Excel 2016, using the Student’s t and chi-square tests. Results. Nurses with specialization intubated twice faster (30.4 s) than nurses during specialization (68.8 s) or without specialization (67.5 s). The shortest time of inserting an endotracheal tube demonstrated subjects with over 10 years of work experience (37.0 s). The mean pressure on the incisors during the procedure was 10.9 N. Ventilation with an average tidal volume of 543 cm3 (p=0.024) was in line with the recommendations of the European Rescue Council (ERC). Conclusions. Work seniority and specialization significantly affected the effectiveness of the intubation procedure in time, while maintaining the recommended frequency and volume of mechanical ventilations.

Motherhood of women with uterine factor infertility

Aim. The aim of this paper is to present alternative ways for women with uterine factor infertility to achieve motherhood. Material and methods. Analysis of professional literature including the issues of surrogate motherhood, uterine transplantation and ectogenesis. Results. The infertility caused by uterine factor affects 3-5% of women in the world. There are also women who wish to conceive a baby out of their own genetic material, despite having a structurally abnormal uterus or lacking this organ altogether. Due to considerable advancements in reproductive medicine, the needs of such women can now be met via extracorporeal fertilisation and embryo implantation into the uterine cavity of another woman – surrogacy, or in special cases, via uterus transplantation. Another controversial concept is ectogenesis, i.e. technology which would allow for the growth of human embryos outside the mother’s body in an artificial uterus. The surrogate is considered when treatment and other reproduction methods have not worked well. This procedure is legal and accepted in some countries, while in others it is strongly opposed. Summary. There is growing demand for accurate and modern diagnostic and therapeutic methods allowing for successful reproduction. The proposed solutions may seem unreal, but the results of the research carried out to embody them seem to be promising.

The occurrence of ovarian cancer in the population of urban and rural women, BRCA1 and BRCA2 genes mutation testing and the general rules on the patient’s consent to treatment

Introduction. The BRCA1 and BRCA2 genes belong to suppressor genes that control the mechanisms of repairing various damages of the DNA double helix, regulate cell division, and the cell cycle. Mutations within these genes are associated with the hereditary ovarian and breast cancers. Aim. Assessment of the frequency of testing BRCA1 and BRCA2 gene mutation in the population of women living in urban and rural environments with diagnosed ovarian cancer. Material and methods. The study was conducted among 300 women seeking treatment or consulting a doctor from the Wielkopolska Oncology Center in Poznań, and patients treated in a home hospice in the Rawicz district in Wielkopolska province over the period 2016-2018. Results. Among the respondents, the most were women aged from 36 to 40 (53.3%). The age of developing ovarian cancer for the women from cities is between 41 and 45. In the vast majority of women, i.e. 247 (82.3%), epithelial cancer was diagnosed. A marker that could indicate ovarian cancer, i.e. CA 125 antigen, was determined in more than half of 165 (55.0%). However, only in a few cases, in a total of 25 (8.3%) patients a test confirming the presence of BRCA1 and BRCA2 gene mutation was performed. Conclusions. The possibility of testing for BRCA1 and BRCA2 gene mutation in all sick women and their closest family should be considered. Regardless of the age of women, it is important to raise awareness of the risk of ovarian cancer, encourage them to keep regular medical appointments, and perform diagnostic tests.

Documenting patient’s violent behavior by medical staff of hospital emergency departments

Introduction. Hospital emergency departments (ED) are places of the highest aggression rates towards staff. In Poland, in the case of violent behavior personnel can exercise the right to legal protection reserved to public officials. To be able to exercise it, personnel should document the course of violent behavior they were subject to. Aim. The aim of the study was to examine whether the staff of ED document violent behavior they are subject to in the workplace and to answer the question: what factors are they taking into account while reporting or not violent behavior incidents. Methods. The study was conducted among medical personnel of six hospital ED in Poland. A total of 282 health care professionals took part in the study. The diagnostic survey method was applied. The data was compiled using Statistica PL and Microsoft Excel software. Results. 43.3% of respondents always document cases of violent behavior and 5.3% never do it. The personnel document aggression mainly for the purpose of their own safety - 44.8%. 40% of respondents who do not document acts of aggression consider it pointless. Conclusions. Cases of aggression are registered in medical records by nearly every second person of medical professional. The reasons for documenting cases of aggression include: concern for own safety, procedures in force in the unit, fear of further consequences.

An outline of the problem of pelvic organ prolapse, including dietary and physical activity prophylaxis

Introduction. In gynecology, the proper selection of diagnostic and therapeutic methods, including conservative and/or surgical procedures, plays an important role. An outline of these issues is presented in the context of static disorders of female genital organs. The period of a woman’s life predisposing to pelvic organ prolapse is menopause, especially the period of senium, which is associated with hypoestrogenism. An analysis of the factors affecting the risk of disorders of genital statics indicates that pelvic floor exercises and a proper diet, which does not lead to constipation or obesity, are important in the prevention of genital static disorders. Aim. The aim of the study is to analyze the problem of disorders of the statics of genital organs, which is significant in nursing and medicine, in the light of the literature data.

Life satisfaction among women after vaginal delivery and caesarian section according to selected socio-demographic characteristics

Introduction. The multitude of changes taking place in the female body in terms of the physiological aspect as well as in the psychological well-being in the perinatal period has become the motivation to fi nd an answer to the question: what is the women’s satisfaction with life (SWL) after childbirth. Aim. The aim of the study was to analyse the level of SWL among women after vaginal delivery and caesarian section according to selected socio-demographic characteristics. Material and methods. The study included 128 females after vaginal delivery (n=58) and caesarian section (n=70) hospitalized at the maternity units in Lublin. The study was voluntary and anonymous. It was conducted in 2020 with the use of survey method and utilized two research tools: the Satisfaction With Life Scale (SWLS) and a questionnaire designed by the author in order to collect socio-demographic data. Results. The mean SWL were 26.12±4.78 in women after vaginal delivery and 24.60±6.17 after cesarean section. Selected socio-demographic factors (age, education, marital status, place of residence, professional status) are signifi cantly related to the satisfaction with life of women after cesarean section; while the material situation and living together with the family among women with vaginal delivery. Conclusions. Analysis of the results obtained indicated that actions aimed at the improvement of SWL should be directed to young, unemployed, with primary and vocational education, unmarried women and with poor fi nancial situation.

Models of care for people with dementia applied in practice

Aim. The study highlights the different concepts of dementia care models which are used in different care settings and determine the effectiveness and contribute to a better quality of life for people with dementia. Methods. This literature review use PRISMA process for data collection and analysis. Scientific and professional publications in English were searched through international specialized databases; EBSCO HOST, CINAHL, MEDLINE, PubMed and Wiley Online Library. The review results were founded by key words and then selected according to the publication time frame and other shaped criteria. Results. In total 1998 references were identified for the thematic content analysis, in the final review we included 29 studies. Two thematic areas were identified according to the keywords and literature search strategy: dementia care models and geriatric models of care. Further, we formed four concepts highlighted in models that reflect the specific characteristics and principles of care: biopsychosocial approach, person-centred care practice, environment of care, and Montessori for dementia care. Conclusions. Most of featured models advocated the implementation of comprehensive, integrated and person-centred care, focused to honour and integrate an individual’s life story with their needs into daily care as much as possible in an appropriate and customized environment. Currently the most innovative model is based on implementation of Montessori approach into person’s daily activities.

Personal wellbeing and stress coping strategies among nurses working at the departments of anesthesiology and intensive care

Aim. To investigate the personal wellbeing of nurses in relation to selected variables. Then to explore whether personal wellbeing has any impact on preference for stress coping strategies. Material and methods. The sample consisted of 509 nurses working at the Department of Anaesthesiology and Intensive Medicine. We used the Personal Wellbeing Index – Adult (PWI – A) scale and coping strategies (Brief COPE) questionnaire. Data were analyzed using the methods of descriptive and inductive statistics. Results. Subjective perception of personal wellbeing was assessed at the score 60-70% (60.85; SD±12.47). The research revealed that age and marital status had no significant impact on wellbeing in contrast to the length of work experience and education level. The lowest scores of personal wellbeing among nurses were detected in connection with their concerns regarding their future security. Nurses utilized both adaptive and maladaptive coping strategies. The study pinpointed the connection between coping strategies and personal wellbeing, in particular, in the domain of satisfaction with personal relationships and satisfaction with community connectedness. Conclusions. Monitoring the personal wellbeing of nurses and utilizing stress coping strategies proved to be important, because these may have an impact on the work performance of nurses, personal safety, and quality of health work experiences they provide.