The Practice of Sputum Aspiration and Tube Feeding by Nurses and Caregivers of Special Nursing Homes for the Elderly.

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(1)PB7 469. The Practice of Sputum Aspiration and Tube Feeding by Nurses and Caregivers at Special Nursing Homes for the Elderly TOSHIKO MIZUNO＊, TOMOKO KAMEI＊＊, MOMOE KONAGAYA＊, SHIMA SAKAI＊,YUKIKO LAU＊, REINA IZAWA＊, KATUKO KANAGAWA＊＊＊＊＊ St. Luke’s College of Nursing ＊＊＊ Kobe City College of Nursing ＊Tokyo Women’s Medical University School of Nursing. 2. Objectives. 1. Background. The information in this presentation advances medical care by providing survey about patients in special nursing homes for the elderly who receive a substantial number of sputum aspirations. Japan has a total population of 127,648,000 in 2008 22% of Japan’s population were elderly（ 27,464,000 senior citizens ） 790,000 elderly people live in nursing facilities 400,241 people are residents of special nursing homes for the elderly. 3. Methodology. It has been hard to place elders who need medical care into special nursing homes for the elderly, and a large rise in this group is forecast for the future Night time medical care is not available in special nursing homes for the elderly because doctors and nurses are not on duty and medical care system is ill equipped. We explain about only the practice of sputum aspiration here. ・Personal connections were used to select special nursing home facilities throughout Japan that care for patients needing sputum aspiration ・With permission, we conducted interviews to survey one nurse and one caregiver from each of 38 different facilities ・The data was classified according to content and counted for frequency. It included a few cases that we summarized and depicted because the content was worthy of special mention.. 4-2） Time and Performance of Sputum Aspiration. ・Average age of patients: 84.2 (SD =6.9)old (66-99 years old) Sex：11 men, 26 women ・Each facility (average size: 100 patients) had an average of 7.6 patients who needed aspiration (SD =7.0) (range 0-32) ・Self-sufficiency: each patient was fully bedridden and needed assistance with elimination, meals and change of clothing. ・Cognitive functioning: 82.1% had severe cognitive impairment. ・ 32 patients (86.4%) required tube feeding.. The average number of per-person aspirations in 24 hours was 7.0 (range 1-24, mode 5). During the 9-hour period between 9:00 a.m. to 6:00 p.m., 125 aspirations were performed (48.6%). The hourly average was13.9 35.0. 30.0. 25.0. 20.0. %. 4. Results 4-1） Patients who require sputum aspiration. 33.3. 33.3. 15.0 27.3 24.2 21.2. 10.0. 18.2 15.2. 4-3 Sputum Aspiration Preventative Care. 18.218.2 15.2 15.2 12.1 12.1. 15.2 12.1. 5.0. 9.1. 9.1 9.1. 6.1. 24.2 21.2. 21.2. 24.2 21.2. 24.224.2 21.2. 24.2. 18.2. 21.2 18.218.2. 18.2 15.2. 12.1. 12.1. 15.215.2. 12.1. 12.112.1. 9.1. 9.1. 6.1. 6.1. 6.1. 3.0. 6.1. 3.0. 3/day 73.0%. Nurses(n= 37). 3/day, 56.7%. 2/day, 14.3% 1/day, 8.6%. 0%. Weekly Swallowing Exercises Most nurses and caregivers did not provide swallowing exercises.. 40%. 7/day, 2.7%. 6/day, 11.4%. 60%. 80%. 30%. The stethoscope picks up the sound of too much sputum. 40%. 24 :0 0. 22 :3 0. 23 :0 0. 23 :3 0. 21 :0 0. 21 :3 0. 22 :0 0. 19 :3 0. 20 :0 0. 20 :3 0. 18 :0 0. 18 :3 0. 19 :0 0. 21.6%. 13.5% 11.4% 18.9% 22.9% 24.3% 5.7%. 50%. 10.8%. Having Disease that causes sputum disorder. 0.0% 5.4% 2.9%. The patient wants to be aspirated. 40.5%. The family wants aspiration. 5.4% 0.0%. 10.8%. 32.4%. Sputum usually increases during and after meals, after a bath, etc.. 2.9%. 25.7% 2.7%. 0.0%. Vibration. 16 :3 0. 5.7%. 0.0%. look distressed. 5.4%. Huffing. 17 :0 0. 5.4%. Their respiratory condition is bad. 34.3%. The nurse is away on a break or off-duty, etc. 24.3%. Percussion. 17 :3 0. 21.6% 20.0%. 100%. 5.4% 2.9%. Postural drainage. Squeezing. 15 :0 0. 5.4% 0.0%. Their coloring looks bad. Low saturation. Endotracheal heat. 15 :3 0. 25.7% 16.2% 8.6%. The sputum is dark. 7/day, 2.9%. Nurses perform exercises such as postural drainage, percussion and squeezing. Caregivers perform postural drainage and percussion, etc. 20%. 16 :0 0. 74.3% 32.4%. Sputum and saliva escape from the mouth. Encouraging Patient Self-Expectoration (multiple responses). 10%. 100%. 34.3%. Their respiration is fast. 0%. 80%. 17.1%. The sputum is usually viscous. 2/day, 2.9% 20%. 60%. .2%16. The rattle of sputum and saliva can 2/day , 2.7%. no, 80.0%. 0%. 40%. 54.1%. Cough with sputum and saliva. 6/day, 8.1%. 1/day, 2.9% Caregivers(n=35). 20%. Self expectoration is difficult. 78.4%. no, 83.8%. Nurses(n=37). 14 :0 0. Nurses and caregivers are most likely to decide on aspiration when the noise of sputum and saliva can be heard and when the patient has trouble with self-expectoration.. 40% 60% 80% 100% Daily performance of oral care. 1/day 2.7%. 14 :3 0. 12 :3 0. 13 :0 0. 13 :3 0. 11 :0 0. 11 :3 0. 12 :0 0. 9:3 0. 10 :0 0. 10 :3 0. 8:0 0. 8:3 0. 9:0 0. 6:3 0. 7:0 0. 7:3 0. 5:0 0. 5:3 0. 6:0 0. 3:3 0. 4:0 0. 4:3 0. 2:0 0. 2:3 0. 3:0 0. 0:3 0. 4-4. Assessing the Need for Sputum Aspiration. unrecorded, 2.9% 20%. 1:0 0. 0:0 0. 4/day, 5.7%. Caregivers(n=35). 時間. Some patients were aspirated at a frequency of 24, 22, 17, 16, etc. , times per day. At night, certain patients were aspirated once or more per hour. The amount of daily tube feedings and sputum aspirations was statistically significant (rs = .47, p<.05) This includes a small but discernible number of cases where commencement of tube feeding made it necessary to perform aspirations.. unrecorded, 0.0%. 1/day, 8.1%. 0%. Fig.1 Percent of Patient Aspirations by Time Period. 4/day 8.1%. 2/day, 8.1%. 1:3 0. 0.0. Both nurses and caregivers usually provided oral care three times a day. 5.4% 2.9% Nurses (n=37). Caregivers (n=35). 20.0% 8.1%. instructions for regular aspiration. 17.1%. 5. CONCLUSIONS. 14.3%. Nurses (n=37). Caregivers (n=35)). 4) It is necessary to study assessment of methods and results of manual techniques for 1) Aspiration was conducted and approved on a 24-hour basis. manipulative bronchial drainage, ways to encourage sputum self-expectoration for patients Reassessment of comfort and safety is necessary because of the frequency with diminished cognitive functions, and aspiration methods. of aspiration, and, in particular, the frequency of nighttime aspiration. 2) The nursing facilities actively implemented oral care, but few performed 5) t is necessary to clarify the standard techniques that must be known by nursing facility swallowing exercises. employees when they perform sputum aspiration. It is also necessary to designate 3) Assessment of appropriate tube feeding procedure is needed. specific educational goals and content. This study was carried out according to the Ministry of Health, Labor and Welfare, elderly health and health promotion projects subsidy in 2008.

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