Elizabeth A. Swanson

Effects of individualized music on confused and agitated elderly patients

The Progressively Lowered Stress Threshold Model in conjunction with an identified theoretical basis provides a framework for the use of individualized music in individuals with Dementia of the Alzheimers Type (DAT). The effects of individualized music is explored in five elderly patients who are confused and agitated and residing in a long-term care facility. The Modified Cohen-Mansfield Agitation Inventory is used to measure the outcome. The immediate and 1-hour residual effects suggest the potential of individualized music as an alternative approach to the management of agitation in confused elderly patients.

Catastrophic reactions and other behaviors of Alzheimer's residents: Special unit compared with traditional units

Using a quasi-experimental pretest/posttest design, the effects of a Special Care Unit (SCU) on the incidence of catastrophic reactions and other behaviors of nursing home residents with Alzheimers disease (AD) were examined. Findings indicate significantly fewer catastrophic reactions and other selected behavior changes occurred during the posttest period for subjects in the experimental group compared with the subjects in the control group. Implications for psychiatric consultation/liaison nurses (PCLNs) working with this vulnerable population are discussed.

The caring partnership: Staff and families of persons institutionalized with Alzheimer's disease

This article has set forth a strategy to increase family/staff cooperation in the care of persons institutionalized with AD. The FIC program was developed as an outgrowth of research that demonstrated family member dissatisfaction with their roles. It is specifically designed to provide a partnership role with staff for families whose relatives with AD are institutionalized. Hypothesized outcomes include the reduction of stress in caregiving, increased satisfaction in role and improved patient cognitive and functional outcomes. Testing of the FIC is currently underway.

Most frequent nursing diagnoses, nursing interventions, and nursing-sensitive patient outcomes of hospitalized older adults with heart failure: part 1

PURPOSE Rank and compare the 10 most frequently documented nursing diagnoses, interventions, and patient outcomes using NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification for care of patients with heart failure (HF). METHODS A descriptive comparative multisite study of documented care for 302 older adults with HF. FINDINGS There were four common nursing diagnoses, two interventions, and only three common outcomes across three sites. CONCLUSIONS This and similar analyses of clinical nursing data can be used by nursing administrators and clinicians to monitor the quality and effectiveness of nursing care. IMPLICATIONS Similar analyses may be used for continuing education, quality improvement, and documentation system refinement. Part 2 will discuss data retrieval and implications for building a multiorganizational data warehouse.

Outcome indicators for direct and indirect caregiving

Informal caregiving and outcomes for caregiving are an important part of health care and of particular importance in nursing. The purpose of this research is to report the results of a survey mailed to nursing experts for validation of the outcome labels Caregiver Role Performance: Direct Care and Caregiver Role Performance: Indirect Care and their accompanying indicators. Experts were asked to rate how important the identified indicators were for assessing those two outcomes. In addition, the respondents were asked to what extent nursing interventions influence the achievement of each identified indicator for Caregiver Role Performance: Direct Care and Caregiver Role Performance: Indirect Care. In general, the validity of the concept analysis work by the caregiver focus group was supported. Ten indicators for Caregiver Performance: Direct Care were retained, 1 was dropped that was considered most appropriate for indirect care, and 3 new indicators were added to reflect the nurse experts surveyed. For Caregiver Performance: Indirect Care, all of the indicators were retained.

Nursing clinical documentation data retrieval for hospitalized older adults with heart failure: part 2

PURPOSE The study aims to discuss the implications for retrieval of nursing data and building a multiorganizational data warehouse. METHODS The method used was a descriptive comparative multisite study of documented care for 302 older adults with heart failure. Unit and patient level variables were retrieved. FINDINGS Data regarding the most identified variables were retrievable electronically. Important linkages among nursing data elements were not present. CONCLUSIONS Data were retrievable and the building of a data warehouse was possible and lessons were learned. IMPLICATIONS When clinical information systems (CISs) are developed, developers and nurses must discuss how standardized data will be entered to ensure retrieval and usefulness in evaluating nursing care. For nursing effectiveness research, CISs must also provide linkages among nursing diagnoses and specific interventions, and nursing-sensitive patient outcomes.

Evaluation of Outcome Change Scores for Patients With Pneumonia or Heart Failure

This study was conducted to describe the variance in selected Nursing Outcomes Classification (NOC) outcome change scores of hospitalized older patients with pneumonia (n = 216) or heart failure (HF; n = 67) that could be explained by age, length of stay (LOS), number of comorbid conditions, number of nursing diagnoses, and number of nursing interventions. Investigators used a descriptive correlational design to analyze data sets from three U.S. community hospitals. Study participants had at least two ratings on one of nine outcomes selected for their frequency and use across the three hospitals. A significant portion of the variance in the outcomes Knowledge: Illness Care and Fall Prevention Behavior was explained for pneumonia patients. None of the regression models for HF patients showed significance. Individual independent variables were significant in some of the models (i.e., LOS [pneumonia], number of nursing diagnoses [pneumonia and HF]). Implications for research and clinical practice are discussed.

Implications of electronic health record meaningful use legislation for nursing clinical information system development and refinement.

PURPOSE  To describe what electronic health record meaningful use requirements mean for nursing clinical information system (CIS) development. CONCLUSIONS  The nursing CIS in many, if not most hospitals, has a number of critical design inadequacies that constrain the meaningful use of nursing data to ensure quality outcomes for patients and data-based maturing of the nursing profession. IMPLICATIONS  It is the responsibility and obligation of nurses to ensure that CISs are designed for the meaningful use of nursing clinical data. To accomplish these ends, interoperable clinical nursing data must be documented in a properly integrated operational CIS, and must be retrievable and stored in data repositories for analysis and reports.

Interventions for residents with dementia and their family and staff caregivers: evaluating the effectiveness of measures of outcomes in long-term care

This article describes six instruments developed for programs of research testing nursing interventions for individuals with dementia in Special Care Units and their family and staff caregivers. The Functional Abilities Checklist measures the functional abilities of residents with dementia. The Family Perceptions of Care Tool assesses family member satisfaction with care of the institutionalized relative with dementia. The Family Perceptions of Caregiving Role instrument evaluates stress experienced by family members of individuals with dementia related to their caregiving roles in long-term care settings. The Caregiver Stress Inventory and Staff Perceptions of Caregiving Role tools measure staff stress related to caring for residents with dementia. Finally, the Attitudes About Families Checklist assesses general staff attitudes about families of residents with dementia. Each instrument and its psychometric properties are described. The advantages of these instruments for research and clinical use with individuals with dementia are discussed.

Degree of Closeness: Does it Affect the Bereaved's Attitudes toward Selected Funeral Practices?

This research project investigated the attitudes of bereaved individuals toward selected funeral practices. Six selected variables (three characteristics of the bereaved and three conditions of the death situation) were correlated to nineteen components of the funeral. The characteristics were sex, closeness to the deceased, and religious preference; the conditions were timing of the death, viewing at the funeral home and location of the funeral service. In this study, closeness of relationship to the deceased emerged as a significant variable in assessing attitudes toward certain funeral practices. The intent of this article is to present and discuss the empirical data related to this variable.