Barbara J. Kupferschmid

The effect of natural environments upon agitation and aggression in late stage dementia patients

Agitated aggressive behavior in late stage dementia occurs in 30 to 50 percent of patients. This behavior often results in the use of chemical and physical restraints (which have a high degree of untoward side effects) and caregiver burnout. Interventions for agitated aggressive behavior are needed that do not have these side effects, which are readily available in nursing homes and are effective and acceptable to caregivers. Environmental psychologists have proposed that natural elements within the environment decrease agitation in the nondemented as well as the demented Since the shower bath is often a time of great agitation in dementia patients, natural elements were used to modify care during the shower bath (n = 31). There was a significant decrease in mean difference scores from baseline to treatments one and two, with the treatment group demonstrating an overall decline in agitated aggressive behavior Additional randomized trials of the effects of natural environments upon agitation and aggression in dementia are needed.

Nurse aides' identification of onset and level of agitation in late stage dementia patients

Nurse aides provide the majority of care to patients in nursing homes and thus are vital links in the early identification and treatment of agitation in dementia. Agitation increases in frequency as dementia progresses and unrecognized and untreated agitation may develop into a state of acute aggression (termed catastrophic reaction) in which demented patients become severely disturbed and may harm themselves or others. Nurse aides, however, are sometimes characterized as unable or unwilling to provide accurate observations of demented patients’ behavior, and thus are incapable of assisting with this important research. This study examined a process by which nurse aides were enlisted to identify and rate agitation in late stage dementia patients. Results indicate that nurse aides accurately identified agitation at a high level of agreement (r = >.90), on three occasions, with nurse experts. This high level of agreement was achieved along with a high level of nurse aide participation (75 percent), and with relatively little training time, i.e., approximately one hour per nurse aide. There were no significant differences in the demographic characteristics of aides participating versus those declining participation; likewise, participation rates in unionized versus non-unionized homes were not significantly different. The characteristics of the training program are described and the opinions of both nurse aides and administrators discussed as to why this program was successful.

Families: A Link or a Liability?

Hospitalization in a critical care setting has multiple effects on patients and their families. For patients, it can be a frightening and dehumanizing experience, while families are confronted with stressors that can disrupt normal family functioning. The nurse is the pivotal figure in the health care system who can positively affect family coping through the support offered. With family needs met, they are then strengthened and able to support their family member. This article examines the roles and relationships of families, social support systems, and nurses. Through the framework of social support, nurses provide emotional, instrumental, spiritual, and appraisal assistances to families. This can potentially positively affect the familys adaptation to a stressful situation, and thus the familys ability to provide support to the patient. A case study analysis is described to illustrate the interactions and interventions through a model of family support.

Spatial Learning Responses to Lipopolysaccharide in Adult and Aged Rats

Sickness behaviors, adaptive responses to infections, include lethargy, depression, reduced eating and grooming, and concentration problems resulting from interactions between the immune and neuroendocrine systems. Detecting these responses is especially critical in the elderly, as the infections that cause them can lead to cognitive impairment. While deficits in spatial learning, a hippocampal-dependent form of learning, are part of the sickness response, directional heading errors (DHEs; an indicator of spatial-learning deficits) and their time trajectories need further examination. Therefore, we simultaneously investigated the time trajectory of age-dependent sickness responses and spatial learning over 5 days in adult (5–6 months) and aged (22 months) male Brown-Norway rats injected with 250 μg/kg lipopolysaccharide (LPS; experimental group) or 0.9% sodium chloride (control group). LPS administration resulted in pronounced, age-dependent weight loss and decreased food intake that persisted in the aged group. Animals were tested for 5 days (trial) in the Morris water maze. After 7 days of rest, animals were retested for 2 days (retention). Adult and aged LPS-treated animals displayed greater differences in mean DHE than the control groups, indicating that they exhibited more DHE over the trial days. Experimental groups did not show consistent DHE improvement until Day 4 (adult) or 5 (aged). LPS had no effect on probe or retention trials. We conclude that LPS activation of the immune system results in a selective, age-dependent impairment in spatial learning, decreased food intake, and weight loss. All of these results are prolonged in aged animals.

Improving Patient Education about Tobacco Withdrawal and Nicotine Gum Use by Registered Nurses in Inpatient Psychiatry: A Feasibility Study.

WHAT IS KNOWN ON THE SUBJECT?: Many psychiatric inpatients use tobacco, but most psychiatric hospital units prohibit tobacco use. Psychiatric nurses do not receive adequate education about how to teach patients to best manage tobacco withdrawal symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Psychiatric nurses who receive a brief educational intervention about tobacco withdrawal symptoms and best practices for using nicotine gum may be more prepared to teach patients about these topics. In turn, patients may use nicotine gum more often during their hospitalization, leading to improved outcomes for them as well as for staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A simple educational intervention aimed at psychiatric nurses can result in positive outcomes for psychiatric inpatients who use tobacco. Patients who have a positive experience with stopping tobacco use while hospitalized may be more likely to commit to lifelong tobacco cessation afterwards. The results of this feasibility study demonstrate that additional research that builds on the work presented here is warranted. ABSTRACT Introduction Tobacco use is prohibited in most psychiatric facilities in the United States, yet many psychiatric inpatients are tobacco users. Psychiatric nurses have reported inadequate education about best practices for managing tobacco dependence. Aim To explore the feasibility of an educational intervention for psychiatric nurses designed to improve their ability to educate patients about best practices for managing tobacco dependence, as well as effective use of nicotine gum. Method Fourteen nurses on a psychiatric inpatient unit at a community hospital were educated about the targeted topics. Chart reviews of nonequivalent pre-intervention and post-intervention patient groups were conducted to explore the outcomes of the intervention. Results Patients received more teaching, and used nicotine gum more often, following the intervention. However, no statistically significant differences between the pre-intervention and post-intervention patient groups were found. Discussion Educating nurses about best practices for managing tobacco withdrawal symptoms may have positive outcomes. Existing research suggests that such interventions may be most effective when support and structure are provided to ensure long-term practice changes. Implications for practice This feasibility study demonstrates that a brief nurse education intervention has the potential to improve the experience of tobacco withdrawal for psychiatric inpatients. Future research that expands upon the current project is warranted.

Different Sickness Responses in Adult and Aged Rats Following Lipopolysaccharide Administration

Objective: Immune challenges result in sickness responses such as decreased activity, fever, and spatial learning deficits. While these responses occur simultaneously, they are not usually evaluated concurrently or for an extended time. The purpose of this study was to examine how an immune challenge affected activity and temperature responses in animals tested concurrently in the Morris water maze (MWM) over 5 days and how aging interacts with such responses. Method: An accepted model of aging, adult (n = 10; 5–6 months) and aged (n = 7; 22 months) male Brown-Norway rats were implanted with a telemetry device (Mini Mitter, Oakmont, PA) to continuously monitor temperature and activity following an immune challenge. These animals were injected with either 250 μg/kg lipopolysaccharide (LPS) or 0.9% sodium chloride and then assessed in the MWM for 5 days. Results: Temperature responses varied by age. Initial temperatures decreased in both experimental groups followed by an increase (fever) in the adult group, while the temperatures of the aged animals remained decreased. Although both age groups were sedentary at baseline, activity decreased after LPS only in the adult group. Conclusion: An LPS immune challenge resulted in age-dependent temperature and activity changes. There was an absence of fever and no effect on activity in aged LPS-treated animals. These results may suggest the need to assess a broader spectrum of sickness responses when monitoring elderly individuals for infection and not rely on the presence of fever. Activity may not be a sensitive indicator of sickness in some aging models.

Effects of low-dose lipopolysaccharide and age on spatial learning in different Morris water maze protocols

Objectives: Animals administered lipopolysaccharide exhibit dose-related sickness behaviors (decreased food intake, weight loss, and cognitive changes). While research has demonstrated that spatial learning is impaired following a lipopolysaccharide immune challenge, the results differ depending on the methodology used to evaluate spatial learning. Additionally, few studies have evaluated the effects of low-dose lipopolysaccharide on spatial learning. Therefore, we assessed spatial learning, food intake, and weight changes in adult and aged rats after a low-dose lipopolysaccharide immune challenge in the Morris water maze using two water temperatures. Methods: Adult (5–6 months) and aged (22 months) male Brown-Norway rats were administered either 50 or 100 μg/kg lipopolysaccharide or saline, and then tested in the Morris water maze for 5 days, rested for 7 days, and later underwent 2 days of retention tests. Probe trials were conducted at the end of initial and retention testing. Results: Low-dose lipopolysaccharide administration did not result in food intake or weight changes. While the aged experimental group took longest to improve directional heading error in both cold and warm water, heading error was greater in cold water. Behavioral testing revealed an apparent age and water temperature effect on swim time. Retention and probe trial results showed that aged experimental animals had the worst performance in cold water. Conclusion: We conclude that while low-dose lipopolysaccharide did not result in typical sickness behaviors (decreased food intake or weight), spatial learning and memory were impaired in the aged experimental group. These results have important implications for the care of elderly individuals experiencing mild to moderate infections.

Evaluation of Doctor of Nursing Practice Students' Competencies in an Online Informatics Course

BACKGROUND Doctor of Nursing Practice (DNP) programs have experienced rapid growth across the United States. With the expansion of electronic health records, DNP students are expected to acquire the knowledge and skills needed to manage data and apply informatics concepts. However, little information exists to help faculty evaluate student competency in these areas. METHOD This retrospective analysis evaluated the competencies of a convenience sample of DNP students enrolled in an online informatics course. Two areas were assessed in this study: acquisition of informatics skills, and analysis or application of informatics concepts. RESULTS Regarding informatics skills, postbaccalaureate students performed better than post-masters students. In analysis and application of informatics concepts, post-masters students performed better than postbaccalaureate students. CONCLUSION Different educational strategies may need to be created to meet the varying needs of postbaccalaureate and post-masters students in DNP programs. [J Nurs Educ. 2017;56(6):364-367.].