Karen Devereaux Melillo

Providing universal location services using a wireless E911 location network

This article reviews the issues associated with the development of an E911 location network in light of the desire to leverage the E911 location network to provide universal non-cellular location-based services. The key issues are illustrated with a system originally developed for locating elderly patients with Alzheimers disease.

Conducting interdisciplinary research to promote healthy and safe employment in health care: promises and pitfalls.

Due to the complexity of human health, emphasis is increasingly being placed on the need for and conduct of multidisciplinary and/or interdisciplinary health research. Yet many academic and research organizations—and the discipline-specific associations and journals—may not yet be prepared to adopt changes necessary to optimally support interdisciplinary work. This article presents an ongoing interdisciplinary research projects efforts to investigate mechanisms and pathways that lead to occupational health disparities among healthcare workers. It describes the promises and pitfalls encountered during the research, and outlines effective strategies that emerged as a result. Lessons learned include: conflict resolution regarding theoretical and methodological differences; establishing a sense of intellectual ownership of the research, as well as guidelines for multiple authorship; and development and utilization of protocols, communication systems, and tools. This experience suggests a need for the establishment of supportive structures and processes to promote successful interdisciplinary research.

Caring for an aging population: review of policy initiatives.

Due to the aging population in the United States, there will be a need for a larger workforce that is prepared to provide care to an older adult population. The Institute of Medicine has noted challenges related to the preparation of a geriatric workforce due to lack of faculty, inconsistent curricula, and few training opportunities, and has made recommendations to increase the geriatric workforce. In this article, several policy initiatives are discussed that address the shortage of health professionals prepared to care for older adults. Initiatives by professional nursing organizations to improve the gerontological nursing workforce are also reviewed.

Dehydration Reduction in the Community Dwelling Older Adult: Perspectives of Community Health Care Providers

Dehydration is a common problem among older adults and can negatively affect their health. This cross-sectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participants identify dehydration as a problem affecting older adults, and 94% noted the need for a public campaign on dehydration awareness and reduction. Four major themes emerged: Intentional Avoidance and Caution, Lack of Awareness/Education/Understanding, Poor Access to Fluids, and Social and Environmental Influences. Strategies identified to promote hydration in community-dwelling older adults included community partnerships, community education, community engagement, and interdisciplinary approaches. This study provides useful information and detailed strategies recommended by health care providers for designing interventions to promote hydration for community-dwelling older adults.

Physical activity and exercise counseling in primary care.

Despite the known health benefits of regular physical activity and exercise, physical inactivity is prevalent among American adults. The primary care provider is in an optimal position to provide physical activity and exercise counseling. The Physician-based Assessment and Counseling for Exercise (PACE) program, which utilizes the stages of change theory, provides a valuable framework for exercise counseling. This article discusses exercise counseling theories and research and provides an overview of the PACE program, including the PACE protocols and the models utility in primary care.

Asymptomatic bacteriuria in older adults: when is it necessary to screen and treat?

The incidence of asymptomatic bacteriuria increases with age, and thus it is a common finding in older adults, especially the very old and the institutionalized. Bacteriuria in most older adults, while common, is often transient. The clinical significance is generally minor and the treatment yields very little benefit, is expensive, and may cause substantial drug toxicity. Guidelines to help determine which patients may benefit from treatment are included. Primary care providers for older adults in ambulatory, home, hospital, or institutional settings, should recognize asymptomatic bacteriuria and know when and when not to treat. This management decision will become an increasingly important aspect of gerontological health care.

Bedside coaching to improve nurses' recognition of delirium.

ABSTRACT Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses’ knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses’ recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse’s Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

Making healthy connections: introducing nursing as a career choice to middle school students

The current economic climate has resulted in many experienced nurses returning to the workforce. Despite this, the nursing shortage is looming in our future and the recruitment of a diverse nursing workforce reflective of the population remains a high priority. The Merrimack Valley in northeastern Massachusetts has two large cities, Lawrence and Lowell, in which the Hispanic and the Southeast Asian populations are disproportionately higher than state and national levels. Through the University of Massachusetts Lowells Bring Diversity to Nursing Project, partnerships with both city school systems were developed and after-school programs aimed at highlighting nursing as a career choice were initiated. Mr. Thompsons Heart is the focus of a middle school, pre-entry program developed by faculty. Introducing career choices in middle school gives students fundamental information about careers and how to begin investigating them. Mr. Thompsons Heart introduces nursing as a career choice combining career information with a focus on developing healthy lifestyle habits. Multiple hands on activities create excitement and interest in the nursing profession.

Health Disparities Among Health Care Workers

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

A guide for assessing caregiver needs: determining a health history database for family caregivers.

The complex issue of combining caregiving and employment requires an awareness on the part of primary care providers of the health and social impact these responsibilities have on clients. Failure to consider the psychosocial and health-related consequences of caregiving for individuals with dual roles could result in greater health care costs, jeopardize the health of the caregiver, and place the care recipient at risk of institutionalization. The purpose of this article is to offer a guide that can be used as part of a comprehensive health history to assess the caregiving situation and provide a database on which to establish a plan of action. The caregiver assessment guide can be inserted in the clients health record and periodically reviewed during primary care visits.