Sherry Robinson

Tangling with the barriers to culture change: creating a resident-centered nursing home environment.

In this study, the author examines the relationship between staff perceptions of organizational culture and their work-related attitudes in assisted living. Data were collected from 317 staff in 61 facilities using self-administered questionnaires. Staff who had more favorable perceptions of organizational culture reported greater job satisfaction, coworker satisfaction, and organizational commitment. Among the dimensions of organizational culture, perceptions of teamwork had the strongest influence on satisfaction with coworkers, and perceptions of organizational morale had the strongest influence on job satisfaction and organizational commitment. Those who want to improve staff attitudes should focus on creating organizational cultures that promote teamwork and high organizational morale.

Delirium Prevention for Cognitive, Sensory, and Mobility Impairments

The purpose of this study was to determine the effectiveness of a protocol designed to prevent delirium in hospitalized elders with the risk factors of dementia and/or vision, hearing, and/or mobility impairments. A group of 80 patients with risk factors hospitalized before the protocol was implemented was matched with a group of 80 patients admitted after the implementation of the protocol. Records of patients in both groups were reviewed to identify patients with delirium. A significant reduction in delirium, from 37.5% to 13.8%, occurred in the elders receiving the protocol.

The Sh-h-h-h Project: nonpharmacological interventions.

Promoting rest and sleep is integral to the profession of nursing. The Sh-h-h-h Project, a nonpharmacological program designed to enhance rest and sleep, was implemented on a hospital medical unit. Nursing assistants provided patients with various modalities to improve sleep, including back rubs, warm drinks, blankets warmed in a blanket warmer, aromatherapy, relaxation music, and earplugs. Additional interventions were taken to reduce noise. The outcomes of the Sh-h-h-h Project are reported here, with patients indicating improved sleep quality and quantity.

Aging and delirium: too much or too little pain medication?

Review of the literature revealed an association of pain and delirium in hip fracture patients. The literature was sparse addressing other types of patients. The purpose of the present study was therefore to examine the association of pain and delirium in medical and surgical patients. A retrospective record review was conducted using records of 100 patients who developed delirium while hospitalized. Data included: age, comorbidities, hospital day when delirium developed, presence of major risk factors for delirium on admission, and amount of medication received in the 24 h before onset of delirium. Descriptive statistics, correlations, and univariate analysis of variance were used to determine association between the variables. The mean age was 76.71 years. The mean number of comorbidities was 2.22. The mean number of risk factors for delirium on admission was 2.26 (range 0 to 5). The mean percentage of total amount of medication ordered that was received was 27.67%. Those individuals admitted with a risk factor of hearing loss received significantly less amount of pain medication than those with other risk factors (p = .023). Nurses should carefully assess pain management in their older patients. If using a PCA pump, the older patients ability to manage the pump should be reassessed often. If a patient is admitted with risk factors for development of delirium, unmanaged pain might be the additional factor that precipitates delirium.

Development of the Edmonson Psychiatric Fall Risk Assessment Tool

The purpose of this study was to develop a fall risk assessment instrument for the inpatient psychiatric population. Nine risk factors were identified through a review of the literature. The instrument was applied retrospectively to patient records, and the percentage of those who fell who triggered each of the items in each domain was calculated. The expected value of the population and weighting system were established. The Morse Fall Scale and Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) were administered simultaneously to inpatient psychiatric patients. Sensitivity of the EPFRAT was 0.63, compared with 0.49 for the Morse Fall Scale; specificity of the EPFRAT was 0.86, compared with 0.85 for the Morse Fall Scale. Initial psychometric testing of the EPFRAT indicates the instrument is more sensitive in assessing fall risk in the acutely ill psychiatric population than those currently available. Additional psychometric testing is needed to determine the reliability and validity of the EPFRAT.

A model of nurse assistant care to promote functional status in hospitalized elders.

After completing 20 hours of classes on promoting the functional status of hospitalized elders, the certified nursing assistants on this medical unit participated in developing a new model of care delivery. Discharge destination (home or nursing home) and length of stay were compared for patients pre- and post-implementation. Length of stay decreased by 2.4 days (p = .0007), and there was a significant increase in the number of elders who were able to return home (p = .024).

THE EDEN ALTERNATIVE: IMPACT ON STUDENT ATTITUDES

ABSTRACT Nursing homes as clinical sites for student learning have the potential to produce negative attitudes toward aging. The purpose of the study reported in this paper was to determine the impact of the Eden Alternative on the attitudes of students toward elders residing in nursing homes. Prior to beginning implementation of the Eden Alternative, 61 students completed the Health Professional Beliefs and Opinions about Elders. At 2 years after implementation of the Eden Alternative, 73 students completed the same survey. The second group reflected significantly more positive attitudes toward elders living in nursing homes.

Systems-based practice assessed with a performance-based examination simulated and scored by standardized participants in the health care system: feasibility and psychometric properties.

Background: Systems-based practice is one of the six general competencies proposed by the Accreditation Council for Graduate Medical Education in their Outcome Project. However, little has been published on its assessment—possibly because the systems-based practice competency has been viewed as difficult to define and measure. Purpose: The purpose of this study was to determine whether a full performance-based examination of systems-based practice cases simulated and scored by standardized participants in the health care system could feasibly be constructed and implemented that would provide reliable and valid measurements. Methods: In the 1st year of the project (2008), four systems-based practice cases were developed and pilot tested with 13 residents. Videotapes of residents were studied to develop an instrument for subsequent assessment of performance by standardized participants. In the 2nd year (2009), the examination was expanded to a full 12 cases, which were completed by 11 second-year residents, and psychometric analyses were performed on the scores. Results: The generalizability coefficient for the full 12-case examination based on scoring by standardized participants was .71, which is nearly equal to that based on scoring by faculty physician observers, which was .78. The correlation between total scores obtained with standardized participants and physician observers was .78. Conclusions: A performance-based examination can provide a feasible and reliable assessment of systems-based practice. However, attempts to evaluate convergent validity and discriminant validity—by correlating systems-based practice performance assessments with mean global ratings of residents on the 6 competencies by faculty throughout training—were unsuccessful, due to a lack of independence between the rated dimensions.

A PROGRAM TO Reduce Fatigue in Convalescing Elderly Adults

This study is an examination of the influence of a fatigue reduction program on the level of fatigue experienced by elderly individuals convalescing in subacute units after lower extremity injury, surgery, or weakness. Fifty participants with a mean age of 81 were divided into two groups of 25 participants. The experimental group received a fatigue reduction program consisting of planned rest periods after bathing and therapy; high-protein, high-carbohydrate liquid supplement; and a 3-minute back rub at bedtime. Each participants level of fatigue was tested soon after admission and 1 week later, and data were analyzed using the paired t test. The difference between the change in pre-test and post-test scores of the two groups was significant in all three measures of fatigue. The experimental group exhibited a significantly greater reduction in fatigue. The outcomes reinforced the value of nursing interventions that have been an integral component of nursing care from its beginning: promoting nutrition, alternating periods of activity and rest, and including a back rub in evening care.

Aging Couple Across the Curriculum

Aging Couple Across the Curriculum is a unique program designed around a couple who “age” a decade with each year of medical school. In these half-day sessions, students encounter the aging couple through a standardized patient experience. Interactive breakout sessions conducted by multidisciplinary professionals enhance student learning and appreciation of the contributions of the team of professionals. A panel of elder specialists provides personal insight into how they have overcome and/or adapted to various health-related problems. Evaluation measures have indicated that students are benefiting from the program and that it is affecting their attitudes in a positive way toward caring for older adults.