Cases reported "Confusion"

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1/6. Governing the conduct of conduct: are restraints inevitable?

    BACKGROUND: The purpose of this article is to provide an interpretation of how restraint use is maintained and legitimized despite negative reports on its efficacy and questions about its ethicality. My research examined the use of restraint on a patient requiring care in an acute teaching hospital in australia. This article examines one case study that was part of a PhD research project. The literature reveals evidence of the harm that restraints cause, as well as their ineffectiveness as a safety measure. In addition, it indicates that the prevalence of restraint use is high. methods: The study is framed by a Foucauldian approach to discourse analysis. This report is an in-depth case study including observations of the patient, interviews with members of the multidisciplinary team and analysis of medical, physiotherapy and nursing notation. FINDINGS: Discourses from the health care team are identified by which restraint use is justified, and legitimized by staff. An important discursive practice is 'constituting the patient's inability to self govern' and their resulting marginalization from the services provided by the team. LIMITATIONS: There are certain philosophical limitations including classical arguments about the position of postmodernism and specifically the ideas of Michel Foucault as opposed to other philosophy's ability to make sense of a phenomenon. The study was carried out in australia and thus the discursive practices may be dissimilar in other countries. CONCLUSIONS: Through these discursive practices we can understand how staff maintain a monopoly over the truth and perpetuate claims about the inevitability of restraint use.
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2/6. Lucidity in a woman with severe dementia related to conversation. a case study.

    AIMS AND OBJECTIVES: The aim of this study was to explore the presence of lucidity in a woman with severe dementia during conversations and whether it occurred when conversational partners or the woman with severe dementia initiated the conversation topics about the present, past or future time and whether she was presented with support or demands during the conversation. BACKGROUND: communication problems as well as episodes of lucidity in people with dementia are reported in the literature. DESIGN: A researcher held 20 hours of conversation with a woman with severe dementia. A daughter participated for about three and a half hours. The conversation was tape-recorded and transcribed verbatim. methods: The text was divided into units of analysis. Each unit of analysis was then assessed separately and discussed among the authors. Chi-square tests and logistic regression analysis were performed. An ethics committee approved the study. RESULTS: The woman as initiator of the conversation topic and support to the women during conversation from the conversation partner were found to be the most significant factors explaining lucidity, while conversation about the present or past time showed no connection with lucidity. Very few topics (n = 7) concerned future time and they were not used in the statistical analysis. The researcher initiated 41%, the woman 43% and the daughter 16% of the topics. Support was registered in 49%, demands in 15% and both support and demands in 16% of the units of analysis. There were 58% topics about present and 40% about the past time. CONCLUSIONS: The presented study is a case study and the results cannot be generalized. For the woman with severe dementia, lucidity was promoted by the conversational parties carefully focusing on conversation topics initiated by the woman while supporting her during conversation. RELEVANCE TO CLINICAL PRACTICE: To share the same perception of reality, focusing on the topics initiated by the patient with severe dementia and a supporting attitude to what the patient tells, will hopefully give more episodes of lucidity in the patient. This approach in caring for patients with severe dementia might give more meaning and well-being to the conversational partners in daily care.
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3/6. Potential perils of the demonstration-consultation interview in family therapy: a case study of contextual confusion.

    This article focuses on a specific aspect of consultation in contemporary family therapy, namely, problems that arise in the context of a consultation that simultaneously serves as a demonstration of a particular model of therapy. The demonstration-consultation interview is used widely in family therapy, but has received little attention in the literature. We use a case example of the apparent persistent deterioration in the clinical state of a patient following such a family interview with a visiting expert, and examine the possible contribution to the patient's deterioration that the demonstration-consultation context creates for the various participants. We offer provisional guidelines to minimize the risk of negative effects of the demonstration-consultation interview, pending empirical research into this phenomenon.
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4/6. Wandering: a proposed definition.

    1. Two typologies of wandering behavior, "continuous" and "sporadic" can be distinguished when time-in-motion is used as a criteria. 2. Interventions for "continuous wanderers" should emphasize modification of the environment while organized activities and verbal communication techniques should be stressed for the "sporadic wanderer." 3. empirical research is needed that studies the different needs of wanderers based on the percentage of time spent in motion.
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5/6. The emotional experience of caregivers to relatives who are chronically confused--implications for community mental health nursing.

    This paper examines the emotional experience of informal caregivers to family members who are chronically confused. Six informal caregivers were taken from the caseloads of community mental health nurses working with elderly people. Data were collected by means of a daily diary and in-depth interviews relating to their emotional experience as caregivers. The data are presented in the form of six vignettes and the implications for theory, practice and research in community mental health nursing are examined.
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6/6. Transient global amnesia: a complication of incremental exercise testing.

    Incremental exercise testing is routinely used for diagnosis, rehabilitation, health screening, and research. We report the case of a 71-yr-old patient with chronic obstructive pulmonary disease (COPD) who suffered an episode of transient global amnesia (TGA) several minutes after successfully completing an incremental exercise test on a cycle ergometer. TGA, which is known to be precipitated by physical or emotional stress in about one-third of cases, is a transient neurological disorder in which memory impairment is the prominent deficit. TGA has a benign course and requires no treatment although 24-h observation is recommended. Recognition of TGA as a potential complication of incremental graded exercise testing is important to both aid diagnosis of the amnesia and to spare a patient unnecessary evaluation.
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