Catherine Todero

Comparison of Health Buddy with traditional approaches to heart failure management.

The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy®) and (b) compare the effectiveness of the Health Buddy® with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy® issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.

Nurse Residency Programs: An Evidence-Based Review of Theory, Process, and Outcomes

Nursing shortages exist worldwide while job stress, dissatisfaction, lack of peer support and limited professional opportunities still contribute to attrition. The aim of this systematic review is to describe and evaluate the quality of the science, report recommendations and lessons learned about implementing and evaluating nurse residency programs (NRPs) designed to improve new graduate transitioning. Databases were searched between 1980 and 2010 using five search terms: nurse, intern, extern, transition and residency programs. Twenty studies reporting programs for new RNs fit the inclusion criteria. Three major discoveries include: 1. Wide variation in content, teaching and learning strategies make comparison across programs difficult; 2. Lack of theory in designing the educational intervention has limited the selection and development of new instruments to measure program effectiveness; and 3. Well designed quasi-experimental studies are needed. As a major nursing education redesign, NRPs could be used to test the principles, concepts and strategies of organizational transformation and experiential-interactive learning theory. By focusing on fiscal outcomes, current administrators of NRPs are missing the opportunity to implement an organizational strategy that could improve workplace environments. Healthcare organizations need to envision NRPs as a demonstration of positive clinical learning environments that can enhance intra- and interprofessional education and practice.

Mental health and sleep of older wife caregivers for spouses with Alzheimer's disease and related disorders.

This descriptive study examined sleep and mental health variables in 37 older wife caregivers for spouses with dementia compared to 37 age-matched controls. The relationships among selected caregiving variables (behavioral problems, caregiving hours, and years of caregiving), appraisal of burden, self-reported sleep efficiency for the past week, and mental health outcomes were examined. Lazarus and Folkmans stress and coping framework guided the study. Mental health and sleep were poorer for caregivers. Caregiving and appraisal of burden variables showed direct and indirect effects on mental health. However, caregiving and appraisal of burden variables were not significant for predicting sleep efficiency. Sleep efficiency was a good predictor of mental health in this sample of wife caregivers.

Reducing Disruption of Circadian Temperature Rhythm Following Surgery

Temperature and other circadian rhythms are disrupted following surgery and other traumatic events. During recovery, coordination between temperature rhythms and other rhythmic physiologic processes is reduced. Studies of animals and humans have shown that return of synchrony is not immediate, but that it is important in the recovery process. The purpose of this study was to test a combination of cues that have been shown to adjust the timing of circadian temperature rhythm. The combined cues consisted of timed ingestion of caffeine and protein foods and adjustment of the sleep/wake cycle. The intervention was tested in 26 age-and gender-matched maxillofacial surgery patients. Patients were randomly assigned to control or experimental groups. Circadian temperature rhythm was measured by continuous monitoring with axillary probes and miniature recorders before and after surgery. Following surgery, both experimental and control subjects displayed 24-hour circadian temperature rhythms; however, the peak-to-trough difference was decreased more following surgery in the control subjects than in the subjects who had prepared for surgery by practicing the intervention. Control subjects also had less day-to-day stability in the phase of their rhythms following surgery. These results suggest that the intervention reduced circadian disruption following surgery and provides a way for patients to prepare themselves to resist rhythm changes.

The academic‐practice gap: Strategies for an enduring problem

The academic-practice gap in nursing is well documented. Academe is criticized for producing nurses insufficiently prepared to fully participate in patient care. Practice settings are criticized for having unrealistic expectations of new graduates. This article is based on a review of the literature and an exploration of contemporary practices used to bridge academic and practice partnerships. Differences in outcome expectations for new graduates between academe and practice are outlined and consequences of the gap for new graduates, patients, and employers are discussed. Five specific strategies to address the gap are discussed, with the primary realm and responsibility for two falling to education, one to practice, and two to both. Strategies discussed include increased use of simulated learning in nursing education; disruptive innovations in education that promote learner-centered active learning; extended orientation/Transition to Practice Programs for new graduates; dedicated education units; and academic service partnerships. Current literature suggests the viewpoints of academic and practice leaders continue to appear divergent. Closing the gap will require a dedicated and coordinated response from both academe and clinical practice.