Kathleen E Krichbaum

Predictors of nursing home admission for persons with dementia

Objective:The objective of this systematic review was to identify factors that consistently predict nursing home admission (NHA) in persons with dementia. Methods:Studies published in English were retrieved by searching the MEDLINE (1966–2006), PSYCINFO (1950–2006), CINAHL (1982–2006), and Digital Dissertations (1950–2006) databases. Bibliographies of retrieved studies were also searched. Information on study characteristics and empirical results were extracted using a standardized protocol. Results:Of 782 relevant studies identified 80 were selected for review based upon eligibility criteria. The most consistent predictors of NHA in persons with dementia included severity of cognitive impairment, Alzheimer disease diagnosis, basic activity of daily living dependencies, behavioral symptoms, and depression. Caregivers who indicated greater emotional stress, a desire to institutionalize the care recipient, and feelings of being “trapped” in care responsibilities were more likely to admit persons with dementia to nursing homes. Demographic variables, incontinence, and service use did not consistently predict NHA. Conclusions:Several results seemed to challenge conventional assumptions of what precipitates NHA among persons with dementia. Caregiver stressors in conjunction with care recipient characteristics are important to consider when assessing NHA risk. The findings emphasize the need to construct more complex models of institutionalization when designing risk measures to target interventions.

Exploring the Connection Between Self-Efficacy and Effective Diabetes Self-f Management

PURPOSE the purpose of this study was to review the existing empirical evidence about factors that contribute to effective diabetes self-management as indicated by healthy outcomes in persons with the disease, with a specific focus on self-efficacy, to determine the link between learned self-efficacy and effective diabetes self-management in adults. METHODS A systematic review was conducted of the extant literature from 1985-2001 that described factors related to effective self-management of diabetes. The review included theoretical and empirical articles. The search engines included CINAHL, MEDLINE, PUBMED, and COCHRANE. RESULTS Empirical evidence supports the following factors to improve the education outcomes for adults with diabetes: involve people with diabetes in their own care, guide them in actively learning about the disease, explore their feelings about having the disease, and teach them the skills necessary to adjust their behavior to control their own health outcomes. Thus, the goal for educating people with diabetes is to improve their individual self-efficacy and, accordingly, their self-management ability. CONCLUSIONS Education sessions need to involve fewer lectures and more practical, interactive exercises that focus on developing specific skills. Follow-up contact is a valuable method for helping people make a healthy adjustment to living with diabetes.

Progress in the Moral Reasoning of Baccalaureate Nursing Students between Program Entry and Exit

Changes in moral reasoning between entry into and exit from a baccalaureate nursing program and the relationship between student characteristics and moral reasoning at entry and exit were explored in this descriptive study. The moral reasoning of four cohorts of students was measured using the Defining Issues Test (DIT). Admission grade point average, prior college credits, and gender accounted for 10% of the variance in DIT P% scores at entry and 14% of the variance at exit from the program. Female students had significantly higher moral reasoning scores than men. Age did not contribute significantly to explaining DIT score variance. DIT P% scores at entry for all four cohorts were within the range of reported norms for college students. Exit scores for all four cohorts were between the normative means for undergraduate students and graduate students. DIT P% score gains between entry and exit were significant for all four cohorts. Students whose entry scores were in the lowest categories had the greatest mean gains.

Improving resident outcomes with GAPN organization level interventions

This research tested the effectiveness of the second tier of interventions in a two-tiered nursing intervention model designed to improve quality of care for residents in long-term care facilities (LTCFs). The first tier of the model called for gerontological advanced practice nurses (GAPNs) to provide direct care and to teach staff to implement care protocols for residents with incontinence, pressure ulcers, depression, and aggression. Results of the first-tier study indicated significant improvement in resident outcomes in incontinence, pressure ulcers, and aggression. In the second tier, GAPNs added a set of organization-level (OL) interventions including membership on the LTCF quality assurance committee and collaborating with staff on problem-solving teams. Analysis following the addition of OL interventions revealed significant improvement in both depression scores and in the trajectory of depression in residents of the LTCF where OL interventions were used.

The interplay of institution and family caregiving: relations between patient hassles, nursing home hassles and caregivers' burnout

This population‐based study investigated the relationship between stresses (hassles) and burnout for 30 family caregivers and their institutionalized demented elderly. The Burnout Measure, the Patient Hassles Scales and the Nursing Home Hassles Scale were used. Hassles included: patient hassles (cognitive, behavior, basic ADL) and nursing home hassles (caregiver – staff, patient – staff, practical/logistical). The caregivers characteristics are described in relation to burnout and the caregivers most frequent hassles are discussed. All subscales except basic ADL were correlated to burnout. However, regression analysis showed the nursing home hassles to be the most important stresses explaining variance in burnout among family caregivers. Copyright

Development of a measure of resident satisfaction with the nursing home.

A satisfaction instrument specifically designed for use with nursing home residents, the Satisfaction with the Nursing Home Instrument (SNHI), was developed and tested with a sample of 110 nursing home residents from three proprietary facilities in Minnesota. As hypothesized, significant relationships were found between SNHI scores and measures of affect (negatively associated with depression and positively associated with morale), providing support for the construct validity of the scale. The lack of a significant relationship between SNHI scores and both age and mental status confirmed the predicted divergent validity of the instrument. The alpha coefficient for the 29-item scale was 0.81.

Clinical Teaching Effectiveness Described in Relation to Learning Outcomes of Baccalaureate Nursing Students

Grounded in cumulative findings on teaching effectiveness from K-12 education, higher education, and professional education, this process-product study empirically explored the relationship between 24 specific teacher behaviors generally thought to be effective for student learning and learning outcomes of baccalaureate nursing students. Two measures of learning in a critical care practicum taught by staff nurse preceptors were used: performance in the practicum as assessed on a clinical evaluation instrument developed by faculty, and performance on a standardized test of knowledge in critical care. Important aspects of clinical teaching effectiveness included the ability to set clear objectives to help students organize their learning, to ask appropriate questions, to provide specific and timely feedback to students, and to convey a positive, concerned attitude. Certain teaching behaviors showed significant relationships with cognitive learning outcomes, while others were tied to performance outcomes.

Tai Chi and well-being of Taiwanese community-dwelling elders

Abstract Tai Chi has been widely practiced by elders in Taiwan and other countries. Yet, there is limited scientific evidence to demonstrate its effects on the well-being of elders. The purpose of this cross-sectional, comparative study was to compare the differences on physical well-being (physical health status, blood pressure, and the occurrence of falls) and psychological well-being (mental health status and mood states) of Taiwanese community-dwelling elders who had practiced Tai Chi for one year or longer and those who did not practice Tai Chi or exercise. Eighty Taiwanese community-dwelling elders (40 of whom practiced Tai Chi and 40 who did not), aged 65 and over, matched on age, gender, and reported number and types of chronic illnesses, were recruited. Results showed that subjects who practiced Tai Chi had better physical and mental health statuses, lower blood pressure, fewer falls within the past year, less mood disturbance, and more positive mood states than those who did not practice Tai Chi (all pvalues < .05). Findings provide a basis for using Tai Chi as a therapeutic intervention and incorporating Tai Chi into community programs to promote well-being of community-dwelling elders.

Development and validation of a screen for specialized discharge planning services.

Background: There is no rigorously developed and empirically validated screening tool to identify, early in the hospital stay, those adults who will use specialized hospital discharge planning services. Objectives: To develop and validate a screen using hospital admission clinical data that discriminates between adults who use and do not use specialized discharge planning services. Methods: Subjects consisted of prospectively sampled adult patients admitted to two hospitals located in a Midwestern United States city in 1998 (tool development sample, n = 991) and 2002 (validation sample, n = 303). Variables suggestive of being predictive of use of specialized hospital discharge planning services were identified from the literature and were obtained from direct participant interviews, record review, and administrative databases. The outcome was a documented referral for involvement of specialized discharge planning personnel with the patients plan of care and was identified from review of hospital records. Results: Of 24 variables examined, only age, disability, living alone, and self-rated walking limitation were jointly predictive of use of specialized discharge planning services in the development sample. Standardized coefficients from the joint model were used to estimate a screening score. A cut-point was derived and had a sensitivity of 75% and specificity of 78% in the development sample. The screen performed equally well in the validation sample and the development sample. Conclusion: A screening tool consisting of a limited number of characteristics readily available early in the hospital stay that were shown to be highly predictive of the use of specialized discharge planning services was developed. The application of such a tool will hopefully assist providers to deploy services appropriately and in a timely fashion.

GAPN Postacute Care Coordination Improves Hip Fracture Outcomes

We tested the effectiveness of a nursing intervention model to improve health, function, and return-home outcomes in elders with hip fracture via a 2-year randomized clinical trial. Thirty three elders (age > 65 years) were tracked from hospital discharge to 12 months postfracture. The treatment group had a gerontologic advanced practice nurse as postacute care coordinator for 6 months who intervened with each elder regardless of the postacute care setting, making biweekly visits and/or phone calls. The coordinator assessed health and function, and informed elders, families, long-term care staff, and physicians of the patients progress. The control group had care based on postacute facility protocols. Nonnormal distribution of data led to nonparametric analysis using Freidmans test with post hoc comparisons (Mann—Whitney U tests, Bonferroni adjustment). The treatment group had better function at 12 months on several activities and instrumental activities of daily living, and no differences in health, depression, or living situation.