Healthcare2015, 3(3), 659-665; doi:10.3390/healthcare3030659 (registering DOI) - published 30 July 2015 Show/Hide Abstract
Abstract: Background: We examined the agreement over time of the physical functioning domains of the Resident Assessment Instrument: Minimum Data Set Version 2.0 (RAI-MDS) and the Functional Independence Measure (FIM) in nursing home residents with dementia. Methods: We completed a secondary analysis of data from a longitudinal quasi-experimental study ofresidents who could transfer independently or with the assistance of one person.FIM assessments were completed at up to three time points by researchers using interviews. RAI-MDS assessments, completed by nursing home staff, were matched to the FIM assessment by nearest time. FIM and RAI-MDS assessments were correlated based on time between assessments using Pearson’s correlation. Items for activities of daily living (ADL) from the RAI-MDS were rescaled using two previously published crosswalks. Motor and ADL subscales were also used, containing eight and six items, respectively. Results: A total of 362 paired interviews and assessments were collected from 130 residents. The mean scores and standard deviations were as follows: FIM: 19.64 (7.60); William’s RAI-MDS crosswalk: 18.04 (5.25); and Velozo’s RAI-MDS crosswalk: 18.09 (6.50). Using both crosswalks, most items showed medium (r > 0.3) or large (r > 0.5) correlations, even at greater than 41 days between assessments. Subscales showed large correlations for all time intervals for both crosswalks. Conclusions: The RAI-MDS remains stable when data are collected greater than 41 days from the FIM assessment. These findings should add confidence in the RAI-MDS data and its clinical utility.
Healthcare2015, 3(3), 648-658; doi:10.3390/healthcare3030648 (registering DOI) - published 30 July 2015 Show/Hide Abstract
Abstract: The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experience difficulties in meeting their nutritional needs. Malnutrition, encompassing both under and over nutrition increases health risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, now justifies weight management interventions in obese older adults. This growing population group is becoming increasingly diverse in their nutritional requirements. Micro-nutrient status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can impact on well-being and quality of life. Aging presents a number of challenges for the maintenance of good nutritional health in older adults.
Abstract: An effective workforce performing within the context of a positive cultural environment is central to a healthcare organization’s ability to achieve quality outcomes. The Nursing Culture Assessment Tool (NCAT) provides nurses with a valid and reliable tool that captures the general aspects of nursing culture. This study extends earlier work confirming the tool’s construct validity and dimensionality by standardizing the scoring approach and establishing norm-referenced scoring. Scoring standardization provides a reliable point of comparison for NCAT users. NCAT assessments support nursing’s ability to evaluate nursing culture, use results to shape the culture into one that supports change, and advance nursing’s best practices and care outcomes. Registered nurses, licensed practical nurses, and certified nursing assistants from 54 long-term care facilities in Kentucky, Nevada, North Carolina, and Oregon were surveyed. Confirmatory factor analysis yielded six first order factors forming the NCAT’s subscales (Expectations, Behaviors, Teamwork, Communication, Satisfaction, Commitment) (Comparative Fit Index 0.93) and a second order factor—The Total Culture Score. Aggregated facility level comparisons of observed group variance with expected random variance using rwg(J) statistics is presented. Normative scores and cumulative rank percentages and how the NCAT can be used in implementing planned change are provided.
Abstract: Background: Patients with pulmonary hypertension (PH) are often afflicted with the consequences of right heart failure including volume overload. Counseling to assist the patient in the dietary restriction of sodium and fluid may be underutilized. Methods: Consecutive patients seen in the PH Clinic at Mayo Clinic in Florida from June to November 2013. Results: 100 patients were included; 70 were women and most had group 1 PH (n = 69). Patient characteristics using mean (±SD) were: Age 63 ± 13 years, functional class 3 ± 1, brain natriuretic peptide 302 ± 696 pg/mL, 6-min walk 337 ± 116 m, right atrial pressure 8 ± 5 mmHg, and mean pulmonary artery pressure 42 ± 13 mmHg. Overall, 79 had had complete (32) or partial instruction (47) and 21 had no prior counseling to restrict sodium or fluid. Of the 47 with partial instruction, 42 received complete education during the PH Clinic visit. Of the 21 without prior instruction, 19 received complete education during the PH visit. Seven patients with the opportunity to have their education enhanced or provided did not receive any additional counseling during the PH visit. Conclusion: Sodium and fluid restriction is an important but perhaps underutilized strategy to manage volume overload in patients with right heart failure. Focused questioning and education may permit an increase in the patients receiving instruction in this regard.
Abstract: Background: The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provides the most current evidence based strategies to prevent Pressure Ulcer (PU). The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context thus making it culturally acceptable. Aim: To present a protocol detailing the tailoring of international PUPCPG into a care bundle for the Nigerian context. Methods: Guided by the Knowledge to Action (KTA) framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. Results: A PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in selected Nigerian hospitals, is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Conclusion: Using KTA, a knowledge translation framework, to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources.
Abstract: Medical education is continuing to evolve to meet the healthcare needs of the future. The longitudinal integrated clerkship (LIC) model is an important innovation in medical education. It has in its vision and structure “patient- and learner-centered education”, using longitudinal relationships between patients and students as a foundational element in its design. LIC students have shown more patient-centered attitudes and behaviors that persist after medical school. They remain connected with the patient experience of care, which supports empathy and student moral development. The time that LIC students spend acting independently with patients also supports the development of higher order clinical and cognitive skills and professional identity formation. Student participation in a more meaningful way in the care of their patients promotes patient wellbeing, and helps patients with transitions of care, communication and preventative care. Patients report feeling empowered to be more active agents in their own care and feel an accountability and pleasure in the training of new physicians. Focusing on the patient/student relationship as a foundational element of clinical education has meaningful benefits to the patient and student with the potential to improve patient care directly and in the future, as these students become physicians.