Barbara L. Drew

Trauma in the very elderly: A community-based study of outcomes at trauma and nontrauma centers

BACKGROUND Little research has examined trauma outcomes in the very elderly (>80 years), the fastest growing subset of our geriatric population. Our objective was to describe demographics, mechanism of injury and injury severity of very elderly trauma patients and examine the association between trauma center (TC) verification and hospital mortality in this age group. METHODS Retrospective cohort study. Database consisted of a 1996 countywide trauma registry. Subjects consisted of patients > 80 years of age. The setting consisted of Level I (TCI) and Level II (TCII) trauma centers, and acute care (AC) hospitals. The z score analysis was performed using the Major Trauma Outcome Study and a county-specific risk/outcome equation. In addition, a logistic regression model examined hospital mortality (outcome variable) using age, ISS, arrival GCS, and TC verification as predictor variables. Statistical analysis included descriptive statistics; ANOVA; and forward stepwise logistic regression model (OR; 95% CI). RESULTS Four hundred fifty-five patients with a mean age of 85.9 (+/-4.8) years (range 80-101). Overall mortality was 9.9%. Using z score analysis, survival at TCII performed as predicted (-1.59), while AC performed less than predicted (-3.41). In the regression model, GCS (OR 0.68; CI 0.57-0.79), ISS (OR 1.1; CI 1.05-1.2) and AC setting (OR 3.2; CI 1.1-9.5) predicted hospital mortality. TCs had significantly better outcomes than AC hospitals in a subset of severely injured patients (ISS 21-45) (56% v 8% survival; p < 0.01). CONCLUSION Risk-adjusted outcomes, in this population, differed between TC and AC settings. Head injury, injury severity, and lack of TC verification are associated with hospital mortality in very elderly trauma patients.

National Survey of Psychiatric Mental Health Advanced Practice Nursing: Development, Process, and Finding

A survey was sent to all Psychiatric Mental Health (PMH) Advanced Practice Registered Nurses (APRNs) who had a registered e-mail address with the American Nurses Credentialing Center, resulting in 1,899 usable surveys. The practice of two groups of APRNs was examined and contrasted: those certified to treat children and adolescents and PMH-APRNs certified only to treat adults. Our findings raise concerns about the numbers of PMH-APRNs treating children. Considering the national demand for mental health professionals prepared to treat children, the specialty must move to increase the number of qualified APRN child providers.

National Survey of Psychiatric Mental Health Advanced Practice Nursing: The Adequacy of Educational Preparation: Voices of Our Graduates:

BACKGROUND: Little is known about the fit between practice and graduate education from the perspective of psychiatric mental health advanced practice registered nurses (PMH APRNs). OBJECTIVE: With the purpose of addressing this gap in our knowledge, an e-mail survey that was sent to certified PMH APRNs included a query “Did your program prepare you for your role?” and an open-ended follow-up question: “Please explain how your graduate program did not prepare you adequately for your role?” DESIGN: Descriptive survey. RESULTS: Although 70% of respondents reported satisfaction with their educational programs, content analysis of the comments indicated that the most pressing concerns related to instructional content about psychopharmacology, the practice of prescribing and psychiatric diagnosing, and that there was a perception of a disconnect between the role they were prepared for and their role in the present-day world of work. CONCLUSIONS: The findings reinforce the need for the PMH nursing specialty to further define the optimal methods for preparing APRNs for the full scope of psychiatric services they are licensed to provide as the size of the PMH APRN workforce increases.

HIV Disclosure by Perinatal Women in Thailand

Little is known about HIV disclosure among perinatal women, although we do know that disclosure can facilitate timely initiation of appropriate interventions for infected individuals and their families. This study, therefore, examined predictors of HIV disclosure among perinatal Thai women. Data (N = 207) were extracted from two larger studies of depressive symptoms in HIV-positive pregnant or postpartum women in Thailand in which participants completed questionnaires. Most participants had low socioeconomic status. Logistic regression indicated that significant predictors of disclosure included older age, employment, and high family support. Psychiatric mental health nursing interventions to promote family support are critical during this time.

The Effect of Telephone Support on Depressive Symptoms Among HIV-Infected Pregnant Women in Thailand: An Embedded Mixed Methods Study

&NA; Depressive symptoms negatively impact the lives of HIV‐infected individuals and are correlated with faster progression to AIDS. Our embedded mixed methods study examined and described the effects of telephone support on depressive symptoms in a sample of HIV‐infected pregnant Thai women. HIV‐infected pregnant Thai women (n = 40) were randomly assigned to either the control or the intervention group. A registered nurse provided telephone support to the intervention group. Depressive symptoms were measured at three points in both groups. In‐depth interviews were conducted at Time 2 and Time 3. Results show that depressive symptoms in the intervention group decreased over time. Qualitative results describe how telephone support can work, but also reveal that telephone support did not work for everyone. We recommend that a larger mixed methods study be conducted to examine the effects of telephone support on depressive symptoms among HIV‐infected women, including the costs and benefits of such support.

Effect of Environment and Research Participant Characteristics on Data Quality

The purpose of this study, a component of a randomized clinical trial, was to assess the influence of the emergency department environment and participant characteristics on the accuracy of self-reported health care utilization. Interviews of 612 seniors aged 65 to 93 were conducted in two emergency departments. The research assistant, upon completion of each interview, rated characteristics of the emergency department and compared participants’ self-reports of emergency department use and hospitalization during the previous 4 weeks with data from hospital records: 3.6% overreported and 2.2% underreported visits to the emergency department. Regarding hospitalizations, 2.6% overreported and 1.2% underreported. Discrepancies were associated with male gender, cognitive deficits, and risk status. Inconsistencies were not related to any of the environmental variables. These findings suggest that seniors without cognitive decline report reliable data even in a potentially challenging environment.

Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey

BACKGROUND: Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted. OBJECTIVE: In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs. DESIGN: The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers. RESULTS: The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy. CONCLUSION: PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.