Roxanne Pickett Hauber

Telehealth: reaching out to newly injured spinal cord patients.

Objectives. The authors present preliminary results on health-related outcomes of a randomized trial of telehealth interventions designed to reduce the incidence of secondary conditions among people with mobility impairment resulting from spinal cord injury (SCI). Methods. Patients with spinal cord injuries were recruited during their initial stay at a rehabilitation facility in Atlanta, They received a video-based intervention for nine weeks, a telephone-based intervention for nine weeks, or standard follow-up care. Participants are followed for at least one year, to monitor days of hospitalization, depressive symptoms, and health-related quality of life. Results. Health-related quality of life was measured using the Quality of Well-Being (QWB) scale. QWB scores (n = 111) did not differ significantly between the three intervention groups at the end of the intervention period. At year one post discharge, however, scores for those completing one year of enrollment (n = 47) were significantly higher for the intervention groups compared to standard care. Mean annual hospital days were 3.00 for the video group, 5.22 for the telephone group, and 7.95 for the standard care group. Conclusions. Preliminary evidence suggests that in-home telephone or video-based interventions do improve health-related outcomes for newly injured SCI patients. Telehealth interventions may be cost-saving if program costs are more than offset by a reduction in rehospitalization costs, but differential advantages of video-based interventions versus telephone alone warrant further examination.

Telerehabilitation support for families at home caring for individuals in prolonged states of reduced consciousness.

Objective:To investigate the use of telerehabilitation to support families caring at home for individuals with prolonged states of reduced consciousness. Design:A comparison group approach. Participants:Participants were recruited from a special program that is part of a Model Systems brain injury program located in the Southeast. Five patients, ranging from Rancho 1 to Rancho 3 were discharged home with family members as the primary caregivers. Procedures:Participant families were followed for 4 to 8 weeks via videophone. Follow-up telephone surveys were conducted with a family member 6 to 9 months after discharge and compared with a similar group that had not received the videophone follow-up. Main Outcome Measures:Present living status, number of emergency room visits, number of hospitalizations, the caregivers perceptions of functional status and care needs, readmission for rehabilitation and perceived family needs as measured by the Family Needs Questionnaire (FNQ). Results:More patients in the videoconferencing group were still living at home and had returned for rehabilitation. On the FNQ, families in the videophone group reported more of their needs met than families in the comparison group. Conclusions:The use of videoconferencing to bridge the transition to home for families caring for a family member at the Rancho 1 to Rancho 3 level may assist families in successfully caring for the individual in the home and reducing the number of perceived family needs.

An Exploration of the Relationship Between Knowledge and performance-Related Variables in High-Fidelity Simulation: Designing Instruction That Promotes Expertise in Practice

ABSTRACT Increasingly, high‐fidelity patient simulation (HFPS) is becoming essential to nursing education. Much remains unknown about how classroom learning is connected to student decision‐making in simulation scenarios and the degree to which transference takes place between the classroom setting and actual practice. The present study was part of a larger pilot study aimed at determining the relationship between nursing students clinical ability to prioritize their actions and the associated cognitions and physiologic outcomes of care using HFPS. In an effort to better explain the knowledge base being used by nursing students in HFPS, the investigators explored the relationship between common measures of knowledge and performance‐related variables. Findings are discussed within the context of the expert performance approach and concepts from cognitive psychology, such as cognitive architecture, cognitive load, memory, and transference.

Factors associated with closed head injury in a pediatric population

&NA; The purpose of this study was to identify characteristic factors in children who sustained closed head injury (CHI) between birth and less than 15 years of age. A two‐year retrospective audit of charts from a large metropolitan pediatric hospital with a trauma center yielded a sample of 138 charts that met the established criteria for inclusion in the study. Using a descriptive design, data were gathered on age, sex, race, cause of injury, severity of injury, season of accident, time of accident and length of hospital stay. Data analysis revealed that males were 1.5 times more likely to sustain CHI than females. Both sexes showed the highest incidence of CHI during the first year with a second less dramatic peak at around 6 years of age. Transportation‐related causes accounted for 57.2% of the injuries with falls accounting for another 22.5%. Of the transportation‐related injuries, 27.5% were associated with motor vehicle accidents. The lack of restraint use for subjects in the motor vehicle accident group was associated with 5 deaths as opposed to no deaths in subjects who were restrained. Over 70% of the injuries occurred in the time periods of 2:00–6:00 p.m. (31.9%) and 6:00–10.00 p.m. (40.7%). CHI occurred less frequently in the winter (13.8%) than any other season. Using the Glasgow Coma Scale scores, 56.5% of the injuries were categorized as mild, 17.4% were moderate and 26.1% were severe. There was an 8% mortality rate secondary to injury in the sample.

Living in limbo: the low-level brain-injured patient and the patient's family.

&NA; One ballmark of severe traumatic brain injury (TBI) is a loss of consciousness followed by varying states of consciousness. Estimates suggest that 30–40% of individuals who survive severe TBI will stay in low‐level or reduced states of consciousness for prolonged periods. The state of coma is relatively easy to diagnose; however, differential diagnosis of other states of reduced consciousness have proven to be much more difficult, precipitating a number of problems related to prognosis, treatment, and rehabilitation. Accurate diagnosis is critical in determining the prognosis for persons with severe TBI because it has significant implications for the patient, family, clinician, and payer. Studies have shown that prognosis directly influences numbers and types of treatments recommended. Often, families find themselves being forced to make critical decisions with little knowledge and a great deal of uncertainty. Understanding reduced states of consciousness and facilitating accurate evaluation of such states allow neuroscience nurses to help families effectively cope during this difficult time.

Extending the Continuum of Care After Spinal Cord Injury Through Telerehabilitation

Spinal cord injury is life altering. Individuals and their families must deal with life long changes in physical abilities, vocational goals, social roles, and other basic aspects of life. Managed care has had a profound effect on the length of stay in acute and rehabilitation settings and on the availability of long-term services and support for people with spinal cord injury. Technological developments that bridge geographic distance offer new possibilities for meeting this challenge. This article describes Shepherd Centers development of telerehabilitation as a means of providing support and continued rehabilitation to patients and families after discharge. The article covers uses of telerehabilitation, lessons learned from this work, unresolved issues, and future applications.

Using Telecommunication Technologies to Change the World for People with Disabilities Related to Catastrophic Neurological Impairment

Telecommunications and information technology is rapidly becoming a part of health care delivery. For people with disabilities resulting from catastrophic injury, this technology is becoming an effective way to bridge the gap between their specialized care needs and the sources of this specialty care. The cyber environment lends itself to modification, even customization, to the user. It can make resources and services readily available and accessible. Therefore, cyber environments have tremendous potential for changing the world for people with disabilities. This article is a discussion of one institutions application of telecommunication and information technology to provide support and services to people with disabilities resulting from catastrophic injury. There is a focus on the human issues and challenges associated with this mode of health care delivery.

Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study

BACKGROUNDnEvidence suggests that a significant number of children receive less than optimal management of procedure-related pain.nnnOBJECTIVESnTo determine if there was a difference in the perceived pain associated with a venipuncture procedure in a group of pediatric patients based on the preparatory intervention used during the procedure and, to determine if age, sex, or ethnic group were associated with the effectiveness of the preparatory interventions used.nnnDESIGNnA quasi-experimental, 3×4 factorial design was used.nnnSETTINGnParticipants were recruited from a non-profit, regional hospital in the southeast United States.nnnPARTICIPANTSnParticipants were recruited from children between the ages of 18 months and 17 years who were admitted to the facility. Criteria for inclusion was the first needle stick during admission with a parent or guardian present, English as the primary language. Potential participants were excluded if they had previous experience with any of the preparatory interventions, were sedated, unconscious, hemodynamically unstable, developmentally delayed for their age, or had a known chronic condition. Of the 285 participants consented to participate, 173 children completed the process including 35 (20.2%) toddlers, 34(19.7%) preschool and 65 (37.6%) school age children, and 39 (22.5%) adolescents. There were 77 (44.5%) females and 96 (55.5%) males; and 101 (58.4%) non-Hispanic white children and 72 (41.6%) minority children.nnnMETHODSnChildren were randomized to one of three treatment interventions. There was a purposeful effort to include representative numbers of each age group, ethnic group, and sex and in each treatment group. Measures of pain before and after the procedure included an observational measure completed by the parent/guardian and a self-report measure completed by the two older age groups.nnnFINDINGSnThere were no statistically significant differences among treatment groups based on the observational measures of pain or the self-report measures of pain. There was a statistically significant interaction between ethnic group and treatment group (p=0.006) based on the observational measure of pain which was also found between ethnic group and treatment group (p=.04) based on self-report scores in school age children and adolescents.nnnCONCLUSIONnFindings support the use of both mechanical vibration and topical anesthetic as effective in children regardless of age group or sex. Further, the interaction between ethnic group and treatment contributes to a growing body of knowledge that suggests ethnic group is an important factor in the pain response and requires further study in an effort to better customize approaches to pain management in children.

Better care for low-level brain-injured patients and their families

&NA; Persons who sustain severe traumatic brain injury often have prolonged periods of impaired consciousness. During this period, patients and families are suspended in a world of uncertainty. A unique rehabilitation program can provide for better monitoring and evaluation of patients with low‐level brain injury during this period. Included in the program are education and training sessions for family members and caregivers. Telecommunications technology to extend the nursing continuum of care beyond discharge also can be used.

Educating Parents on Sports-Related Concussions.

ABSTRACT Purpose: Approximately 30 million children and adolescents in the United States participate in various forms of organized sports, and incidents of traumatic brain injuries in emergency departments have increased to 62% from 2001 to 2009. Knowledge, information, and preventive interventions appear to have been well disseminated among athletic personnel at the professional, collegiate, and high school levels. Research regarding parents’ perceptions and knowledge of sports-related concussions (SRCs) however is lacking. This project aims to determine the impact of interventions designed to improve parental awareness of SRCs. Methods: The study used a demographic information sheet and a postintervention survey design. These surveys were to determine the impact of three distinct educational tools presented on the perceptions and knowledge of SRCs in a group of parents with children actively involved in sports. Results: Forty-seven participants completed the demographic information sheet, most of them African American and have at least one child competing in high school contact sports. Furthermore, 85.1% of the parents felt that SRCs are a critical issue, although only 46.8% of the parents have ever sought out information to learn more about SRC. Twenty-nine individuals participated in the posteducational survey after the intervention, and most parents perceived that all three educational tools were written and presented in a fashion that changed their perception, awareness, and knowledge base of SRCs. These parents however stated that none of the interventions captured their attention enough to want to go to a professional for further information. Conclusions: Findings from this study suggest that parents know what educational approaches work best for them. However, it also suggests that a one-time educational intervention is not sufficient to move many parents to be proactive. The scarcity of published studies speaks to the need for further research to determine the most effective approaches to engage all involved groups in an integrated approach to ensure that children can be safely involved in sports without jeopardizing their future.