Rose Maljanian

Rehabilitation therapy self-efficacy and functional recovery after hip fracture.

Little is known about the role of psychological factors in the functional recovery process of hip fracture patients. This study employed a prospective cohort design to test the hypothesis that hospitalized hip fracture patients with greater reported self-efficacy for conducting rehabilitation therapy would have a greater likelihood of recovering to a pre-fracture level of locomotion function six months after the fracture. This hypothesis was tested controlling for pre-fracture level of function and depressive symptoms reported during hospitalization for surgical repair. An original measure of rehabilitation therapy self-efficacy was evaluated prior to hypothesis testing. Study patients were recruited from two hospitals, interviewed during hospitalization and followed up six months later. Patients included in hypothesis test analyses (n = 24) were mostly women (82%) with a mean age of 79 years. Results showed that patients with higher self-efficacy scores had a greater likelihood of locomotion recovery, controlling for pre-fracture locomotion function level (adjusted odds ratio (AOR) = 1.21; 95% confidence interval (CI) = 1.00–1.45;P  = 0.05). This positive association between rehabilitation therapy self-efficacy and likelihood of locomotion recovery persisted after adding depressive symptoms (the Center for Epidemiological Studies-depression (CES-D) score) to this logistic regression model (AOR for self-efficacy = 1.18; 95% CI = 0.99–1.42;P  = 0.07). It is concluded that rehabilitation therapy self-efficacy is a potentially important psychological factor in helping hip fracture patients recover locomotion functioning.

Evidence-based nursing practice, Part 2: Building skills through research roundtables.

Numerous articles describe barriers to nurses conducting research and achieving evidence-based practice as well as strategies for overcoming barriers. The Research Roundtable format is one such strategy. It is an interactive means for providing novice nurse researchers and nursing students with the skill sets required to drive application of existing evidence to nursing practice and conduct outcome studies to derive new evidence. The authors discuss their Research Roundtable series that addressed a number of barriers to research, research utilization, and evidence-based practice and how the series increased nurses knowledge and skills, demystified the research process, provided role models, demonstrated managerial and collegial support, and provided library, fiscal, and other resource support to complete staff projects. The details of the Research Roundtable series will guide others in replicating the process in their own organizations and academic communities.

Effectiveness of Reminder Systems on Appointment Adherence Rates

The aim of this study was to determine the impact of reminder systems on appointment nonadherence rates in an low-income inner-city clinic population. A total of 2,304 consenting patients were randomly assigned to one of three groups: (1) automated telephone reminder, (2) postcard reminder, or (3) no reminder. In contrast with research on other populations, the results of this study demonstrated no significant difference in appointment adherence rates among the three groups. To aid in the development of more effective interventions in the future, individuals not attending their scheduled appointments were interviewed by telephone to determine reason for nonadherence.

Nurse caring behaviors and patient satisfaction: improvement after a multifaceted staff intervention.

JONA • Vol. 33, No. 9 • September 2003 Nurse caring is a central focus of nursing. Defined as “an interactive and intersubjective process that occurs during moments of shared vulnerability between nurse and patient,” nurse caring has been the subject of considerable research. Recently, researchers have described a link between patients’ judgments of nurse caring and their satisfaction. However, little evidence exists that nurse caring or patient satisfaction can be enhanced through changes in care provision. Carruth et al found no significant difference in the mean caring scores for patients whose care was provided under modular versus primary nursing delivery systems. Dingman et al demonstrated improvements in only two of eight “nurse patient satisfaction attributes” following implementation of a caring model. Had they adjusted their probability level for multiple comparisons, even those two attributes would not have been shown to change significantly. Finnema et al concluded that,“in general,” implementation of emotionally oriented care for demented nursing home residents did not favorably influence family members’ assessment of care quality. Clearly, stronger evidence is required before nursing administrators can advocate the broad use of scarce resources for programs intended to augment nurse caring and patient satisfaction. Satisfaction ratings that were lower than those of patients on other nursing units of our hospital prompted the nursing leadership of the surgical unit to seek ways of improving patient satisfaction. An earlier study on the same unit showed a correlation between patient satisfaction and nurse caring (r = .791); the study also resulted in the adoption of an abbreviated survey of nurse caring. The study described hereafter presents the results of a multifaceted staff intervention aimed at improving patients’ ratings of nurse caring and their satisfaction with the care they received. Two null hypotheses were tested: (1) there will be no significant difference in ratings of nurse caring between patients who are surveyed before and patients who are surveyed after a staff nurse intervention, and (2) there will be no significant difference in ratings of satisfaction between patients who are surveyed before and patients who are surveyed after a staff nurse intervention.

Mortality and readmission of the elderly one year after hospitalization for pneumonia.

Background and aims: Pneumonia, which is common among the elderly, is associated with untoward consequences. We sought, therefore, to describe the incidence of death and readmission, and to determine predictors of these variables during the year subsequent to index hospitalization. Methods: This study involved the follow-up of 153 patients surviving an index hospitalization for pneumonia. Death and readmission were documented, and the relationship of selected variables with these outcomes was determined. Results: Ninety-six (62.6%) of the patients had died or were readmitted. Only a count of comorbidities was correlated significantly with death, readmission, and either death or readmission. Using regression analysis, death alone was predicted by multiple variables. Grip strength and comorbidity counts correctly classified 75.2% of patients relative to that outcome. Conclusions: Untoward outcomes are likely among patients surviving acute hos-pitalization for pneumonia. These outcomes are related to variables that can be targeted in secondary prevention efforts.

Disease-Specific Symptoms and General Quality of Life of Patients with Prostate Carcinoma before and after Primary Three-Dimensional Conformal Radiotherapy

Approximately 189,000 men are diagnosed with prostate carcinoma each year and more than 1 million are living with the disease. Good prognoses and undesirable sequelae accompany each of several available primary and adjuvant treatment options. The current study explored the effects of primary three‐dimensional conformal radiotherapy with or without neoadjuvant hormonal therapy on urinary, bowel, and sexual symptoms and health‐related quality of life (HRQOL).

Evidence-based nursing practice, Part 1: A hospital and university collaborative

This first article in a two-part series describes a collaboration between healthcare and academic organizations that supports evidence-based nursing practice. The multifaceted activities resulting from this collaboration include an annual research and research utilization conference, a series of research roundtables, talks with nurse authors, and a website. Maintaining such a sustained collaboration encourages more rapid dissemination of research findings into practice, enriching nursing practice, and ultimately benefiting patient outcomes.

Improved Diabetes Control Through a Provider-Based Disease Management Program

Objective: The primary aim of this study was to evaluate the effectiveness of a newly implemented hospital-based diabetes mellitus disease management program. A secondary aim was to determine if relationships existed among variables.Design and setting: Effectiveness was evaluated in terms of glycemic control, post-program acute care resource utilization, adherence with American Diabetes Association (ADA) standards of care, and health-related quality of life. Participants in the Diabetes LifeCare program (DLC) received all standards of care which included diabetes self-management education, medical management by a primary care provider (PCP) supported by an evaluation and recommendations by an Advanced Practice Registered Nurse (APRN), nutritional counseling and at minimum, quarterly follow-up appointments for 1 year.Patients: Patients who were aged ≥18 years and referred to the DLC program with new a diagnosis or history of type 1 or 2 diabetes mellitus.Main outcome measures and results: Results demonstrated that at 3 months after enrollment in the DLC, participants in the study with available data (n = 142) had a mean decrease in predominant glycosylated hemoglobin (HbA1c) values from 9.31 to 7.21 (p < 0.001). The HbA1c value for participants with data at the 6-month visit (n = 66) decreased from 9.23 to 7.22 at 3 months and to 6.80 at 6 months (p < 0.001). At baseline, 52 of the 142 participants (36.5%) had HbA1c values less than 8.0, compared with 107 patients (75.4%) at 3 months (p < 0.0001). A total of 185 of 227 patients (81.5%) received eye examinations as per ADA guidelines. A total of 225 of 227 patients (99.1%) were in compliance with the ADA guidelines for nutritional counseling as a result of participation in the program. On the Physical Component Summary, their mean scores were 42.75 [standard deviation (SD) = 11.17] at enrollment, compared with 45.12 (SD = 10.52) at 3 months (p < 0.001). The Mental Component Summary score increased from 47.52 (SD = 11.90) to 50.83 (SD = 10.47) [p < 0.001]. Regarding resource utilization, during the follow-up period only 3 of 227 patients had emergency room visits and there were no inpatient visits for acute problems related to diabetes.Conclusions: Our results show that, in the short term, significant improvement in glycemic control can be achieved through a comprehensive program of patient education and management, that includes collaborative efforts with the patient’s primary care provider. High rates of eye and foot examination can also be attained by reinforcing patient involvement and admissions for acute metabolic complications can be minimized.

Functional gains during acute hospitalization for stroke.

Objectives. 1) Confirm clinimetric suitability of 5 Functional Independence Measure TM (FIM) items for characterizing functional independence. 2) Describe functional changes and relationships between selected variables and functional independence at discharge and functional change. Methods. For 451 patients hospitalized for acute stroke, scores were recorded at admission and discharge for 5 FIM items (transfers, eating, walking, expression, and memory). The sum of the 5 FIM items and functional change between admission and discharge were calculated. Results. The FIM scores were internally consistent (alpha = .894 and .918) and reflected 1 factor. Functional independence increased (t = 17.46, P < .001) over a mean 5.5 days. Regression analysis showed the same variables (admission function, NIHSS score, length of stay, age, and total therapy units) to best predict discharge function (R 2 = .804) and function change (R 2 = .184). Conclusions. Together, 5 easily observed FIM items demonstrated that functional independence increased during hospitalization. Discharge function and functional change were predicted significantly (but weakly) by therapy units.

An Inner-City Asthma Disease Management Initiative: Results of an Outcomes Evaluation

AbstractObjectives: The purpose of this study was to evaluate the effects of a recently implemented disease management programme [Asthma Control and Education Program (ACE)] on patient outcomes (clinical and functional) and on resource utilisation in socio-economically disadvantaged (and largely Hispanic) individuals with asthma treated at Hartford Hospital. Design and Setting: Using standardised measures (i.e. the Health Status Questionnaire [HSQ] and the Center for Epidemiologic Studies Depression Scale) and conducting serial assessments the investigators determined: (i) functional status at intake and follow-up; (ii) change in the level of illness severity over time; (iii) patientss’ acquisition of self-management skills; and (iv) the type and frequency of acute care services utilised pre- and post-enrolment in ACE. Patient Population:The study participants consisted of consenting individuals, aged 18 years or older, enrolled in ACE from 1 January 1997 to 30 September 1998. Each individual had a comprehensive intake interview (data collected included clinical and financial status) followed by 3 educational sessions. Results: While only 34.7% (n = 282) of the 813 patients referred from Hartford Hospital to physicians or emergency department services elected to participate in the programme, 60% of participants completed the educational sessions. 73% of these enrollees returned for the 3-month follow-up.On the HSQ, the mean Physical Composite Summary (PCS) scores increased from 33.3 ± 10.01 at baseline to 41.6 ± 11.48 at the 3-month follow up and 45.3 ± 10.30 at the 6-month follow-up. In an analysis using only those patients (n = 50) with HSQ scores at baseline and 3- and 6-month follow-ups, there were statistically significant increases in both the PCS and the Mental Composite Summary scores (p < 0.001).For the 68 patients with severity data at baseline, 3 months and 6 months there was a statistically significant improvement over time (p < 0.001). For example, 4.4% had severe disease at 6 months versus 69.1% at baseline. A subset of 73 patients for whom pre-ACE data were available realised a 37% reduction in emergency department use and a 52% reduction in in-patient visits. Conclusions: The evaluation of disease management programmes requires outcomes data. The results of this study of an asthma disease management programme indicate there was an improvement in overall functioning, illness severity, self-management, and utilisation of inpatient and emergency department services. Although a cause and effect relationship could not be assumed, the results suggest that the disease management model is an effective one for the studied population of inner-city patients, socioeconomically disadvantaged individuals previously identified as high utilisers of healthcare services and as having significant environmental exposures problematic for patients with asthma. As currently designed, however, this programme does not address the healthcare needs of the large number of referred patients who choose not to enrol or the enrollees (40%) who do not complete the education and follow-up sessions.