Audrey Nelson

Wanderers with Cognitive Impairment in Department of Veterans Affairs Nursing Home Care Units

OBJECTIVES: To explore the extent of and factors associated with male nursing home residents who wander.

A business case for patient care ergonomic interventions.

This article provides a framework for a business case for patient ergonomic programs that accentuates the financial gains to be realized from such programs as compared to meeting safety requirements. An introduction is made to such commonly used measures as payback period, net present value analysis and internal rate of return. Financial measures on a successful patient handling project in the Veterans Health Administration are outlined and policy implications discussed.

A comparison of patient outcomes and quality of life in persons with neurogenic bowel: standard bowel care program vs colostomy.

Abstract Background/Objective: The purpose of this study was to compare patient outcomes and quality of life for people with neurogenic bowel using either a standard bowel care program or colostomy. Methods: We analyzed survey data from a national sample, comparing outcomes between veterans with spinal cord injury (SCI) who perform bowel care programs vs individuals with colostomies. This study is part of a larger study to evaluate clinical practice guideline implementation in SCI. The sample included 1,503 veterans with SCI. The response rate was 58.4%. For comparison, we matched the respondents with colostomies to matched controls from the remainder of the survey cohort. A total of 74 veterans with SCI and colostomies were matched with 296 controls, using propensity scores. Seven items were designed to elicit information about the respondents satisfaction with their bowel care program, whereas 7 other items were designed to measure bowel-related quality of life. Results: No statistically significant differences in satisfaction or quality of life were found between the responses from veterans with colostomies and those with traditional bowel care programs. Both respondents with colostomies and those without colostomies indicated that they had received training for their bowel care program, that they experienced relatively few complications, such as falls as a result of their bowel care program, and that their quality of life related to bowel care was generally good. However, large numbers of respondents with colostomies (n = 39; 55.7%) and without colostomies (n = 113; 41.7%) reported that they were very unsatisfied with their bowel care program. Conclusion: Satisfaction with bowel care is a major problem for veterans with SCI.

Characterizing Wandering Behaviors in Persons With Traumatic Brain Injury Residing in Veterans Health Administration Nursing Homes

OBJECTIVE To examine the prevalence and correlates of wandering in persons with traumatic brain injury (TBI) in nursing homes (NHs). DESIGN Using a cross-sectional design, logistic regression modeling was used to analyze a national database. SETTING One hundred thirty-four NH facilities operated by the Veterans Health Administration. PARTICIPANTS NH residents (N=625) with TBI as well as a sample (n=164) drawn from a larger dataset of NH residents without TBI using 1:K matching on age. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Wandering. RESULTS Wanderers with and without TBI did not differ significantly overall. The prevalence of wandering among patients with TBI was 14%, compared with 6.5% of the general nursing home population. The results of the multivariate logistic regression suggested that wandering was associated with poor memory, poor decision making, behavior problems, independence in locomotion and ambulation, and dependence in activities of daily living related to basic hygiene. CONCLUSIONS Wandering is relatively common in NH residents with TBI. As expected, it is associated with cognitive, social, and physical impairments. Further research with a larger sample should examine those with comorbid dementia and/or psychiatric diagnoses.

Rehabilitation Outcomes for Veterans with Polytrauma Treated at the Tampa VA

&NA; Returning soldiers from Iraq and Afghanistan who have sustained polytrauma have a combination of complex physical and mental morbidities that require extensive therapy and rehabilitation. This study examined the effect of rehabilitation on 116 polytrauma patients with service‐connected injuries treated at the Tampa VA; improvements in functional and cognitive abilities were measured using the Functional Independence Measure (FIM™) scores and healthcare costs for rehabilitation treatment were also assessed. Intensive rehabilitation therapy increased functional ability in this cohort with an average improvement in total FIM scores of 23 points. Total inpatient costs for these patients exceeded

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks

4 million in approximately 3 years. Rehabilitation nurses face challenges providing quality care to this target patient population, including characterizing war‐related polytrauma, providing surveillance, coordinating care, synchronizing care for patients with multiple injuries, and conducting evidence‐based pain management.