Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
The medically underserved: who is likely to exercise and why?
Adult; Female; Male; Ohio; Aged; Motivation; Exercise; Health Promotion; Counseling; Human; Convenience Sample; Questionnaires; Chi Square Test; Descriptive Statistics; Funding Source; Data Analysis Software; Interviews; Middle Age; Correlation Coefficient; Adolescence; Summated Rating Scaling; Whites; Preventive Health Care; Medically Underserved – Ohio
Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates. This study investigates the rate at which medically underserved patients receive exercise counseling from health care providers, characteristics of those who exercise, and barriers and motivations to exercise. The convenience sample was predominantly female and White and exclusively low-income and uninsured or underinsured. On average, participants were obese, by Federal Obesity Guidelines; 43% smoked. Although 60% of 126 patients reported that providers discussed exercise with them, the discussions had no relationship with patients' engagement in exercise. Women and those with lung problems, diabetes, or children in the home were less likely than others surveyed to exercise. The highest rated motivations included body image and health issues. The most important barriers were time, cost, and access to exercise facilities and equipment. In order for exercise counseling to be more effective, health care providers' interventions must consider patients' personal characteristics, health status, readiness to engage in an exercise program, and motivations and barriers to exercise.
Schrop S L; Pendleton BF; McCord G; Gil K M; Stockton L; McNatt J; Gilchrist V J
Journal of Health Care for the Poor & Underserved
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1353/hpu.2006.0069" target="_blank" rel="noreferrer noopener">10.1353/hpu.2006.0069</a>
The effect of a 12-month longitudinal long-term care rotation on knowledge and attitudes of internal medicine residents about geriatrics.
Ohio; Aged; Curriculum; Prospective Studies; Attitude of Health Personnel; Educational Measurement; Clinical Competence; Education; Internship and Residency; Geriatric Assessment; Nursing Homes; Confidence Intervals; Internal Medicine; Human; Questionnaires; P-Value; Scales; Data Analysis Software; Pretest-Posttest Design; Professional Knowledge; Summated Rating Scaling; Interns and Residents; Internal Consistency; Attitude Measures; Wilcoxon Signed Rank Test; Paired T-Tests; Medical; Geriatrics – Education; Long Term Care – Education; Terminal Care – Education
OBJECTIVE: To determine if participation in a 12-month longitudinal long-term care (LTC) rotation resulted in improved knowledge and attitudes about geriatrics. DESIGN: Longitudinal study with paired measurements. SETTING: A community LTC facility and a university-affiliated, community-based internal medicine residency program. PARTICIPANTS: Sixty-seven internal medicine residents who participated in the rotation from 1997 through 2004. INTERVENTION: The internal medicine residents attended nursing home (NH) rounds one half day per month for 1 year, during which time they participated in a case-based interactive lecture on a core geriatric topic and rounded on their assigned patients. MEASUREMENTS: Knowledge was assessed using a 70-item test. Attitudes were evaluated with a 28-item, 5-point Likert scale (1 = least positive, 5 = most positive). RESULTS: The percent correct responses on geriatric knowledge pretest was 47% (95% CI = 45.2% to 48.8%) and on the posttest it was 57.5% (95% CI = 55.3% to 59.6%) (t = 8.180, df = 67, P \textless .001). The pretest total attitude score was 3.6 (95% CI = 3.6 to 3.7), with a posttest score of 3.7 (95% CI = 3.7 to 3.8) (P \textless .001). The difference in this total was accounted for mainly by the significant changes in the attitude subscales in educational preparation (pretest 3.6 [95% CI = 3.5 to 3.8]; posttest 3.8 [95% CI = 3.7 to 3.9] [P \textless .001]), general attitudes (pretest 4.0 [95% CI = 3.9 to 4.1]; posttest 4.2 [95% CI = 4.0 to 4.3] [P = .006]), and therapeutic potential (pretest 3.7 [95% CI = 3.5 to 3.8]; posttest 3.8 [95% CI = 3.7 to 3.9] [P = .048]). CONCLUSION: A longitudinal LTC rotation is an efficient and effective way to systematically provide internal medicine residents their core knowledge and experience in geriatrics.
Baum EE; Nelson KM
Journal of the American Medical Directors Association
2007
2007-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jamda.2006.05.009" target="_blank" rel="noreferrer noopener">10.1016/j.jamda.2006.05.009</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
A sexual history-taking curriculum for second year medical students.
Female; Male; Curriculum; Educational Measurement; Students; Clinical Competence; Education; Human; Summated Rating Scaling; Medical; Patient History Taking; Attitude to Sexuality; Sexuality; Step-Wise Multiple Regression
The purpose of this study is to describe the evaluation of a sexual history-taking curriculum and correlates of student performance during a Clinical Skills Assessment. Reading assignments, small group discussions, a Saturday Sex workshop and performance on a Clinical Skills Assessment were evaluated. Students most favorably rated the workshop and least favorably rated the reading assignments. Eighty-four percent of students asked at least one sexual history question on the Clinical Skills Assessment. We were unable to identify any independent predictors of sexual history-taking behavior.
Wagner E; McCord G; Stockton L; Gilchrist V J; Fedyna D; Schroeder L; Sheth S
Medical teacher
2006
2006-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/01421590500271274" target="_blank" rel="noreferrer noopener">10.1080/01421590500271274</a>
Providing Nutrition Support in the Electronic Health Record Era: The Good, the Bad, and the Ugly.
Time Factors; Health Personnel; Nutritional Support; Safety; Human; Questionnaires; Descriptive Statistics; Summated Rating Scaling; Documentation; Electronic Order Entry; Product Evaluation; Acute Care; America; Electronic Health Records – Methods
Vanek Vincent W
Nutrition in Clinical Practice
2012
2012-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0884533612463440" target="_blank" rel="noreferrer noopener">10.1177/0884533612463440</a>
Patient Awareness and Expectations of Pharmacist Services During Hospital Stay.
*Anticipation; *Awareness; *Health Knowledge; 80 and over; Adolescent; Adult; Aged; Attitudes; Descriptive Statistics; Female; Health Services Accessibility; hospital; Hospital/methods/*statistics & numerical data; Human; Humans; Inpatients; Inpatients/*psychology; Male; marketing; Marketing/methods; Middle Aged; Patient Attitudes; patient awareness; Patient Education; patient expectations; Pharmacists/*statistics & numerical data; Pharmacy Service; pharmacy services; Practice; Pretest-Posttest Design; Professional Role; Professional-Patient Relations; Psychological; Social Marketing; Summated Rating Scaling; Surveys; Surveys and Questionnaires; United States; Young Adult
BACKGROUND: There are insufficient data in the United States regarding patient awareness and expectations of hospital pharmacist availability and services. OBJECTIVE: The objective of this research is to assess patient awareness and expectations of hospital pharmacist services and to determine whether a marketing campaign for pharmacist services increases patient awareness and expectations. METHODS: Eligible inpatients were surveyed before and after implementation of a hospital-wide pharmacist services marketing campaign (12 items; Likert scale of 1 [strongly disagree] to 4 [strongly agree]; maximum total score of 48) regarding awareness of pharmacist services. The primary outcome was the change in median total survey scores from baseline. Other outcomes included the frequency of patient requests for pharmacists. RESULTS: Similar numbers of patients completed the survey before and after the campaign (intervention, n = 140, vs control, n = 147). Awareness of pharmacist availability and services was increased (41 [interquartile ranges, IQRs: 36-46] vs 37 [IQR 31-43]; P \textless .001). Patients were 7 times more likely to request a pharmacist following the marketing campaign implementation. CONCLUSION: Awareness among inpatients of pharmacist services is low. Marketing pharmacist availability and services to patients in the hospital improves awareness and expectations for pharmacist-provided care and increases the frequency of patient-initiated interaction between pharmacists and patients. This could improve patient outcomes as pharmacists become more integrally involved in direct patient care.
King Philip K; Martin Steven J; Betka Eric M
Journal of pharmacy practice
2017
2017-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0897190016665541" target="_blank" rel="noreferrer noopener">10.1177/0897190016665541</a>
Surveying the hidden attitudes of hospital nurses' towards poverty.
*Attitude of Health Personnel; *Healthcare Disparities; *Poverty; Adult; Age Factors; Attitude Measures; attitudes; Coefficient Alpha; Convenience Sample; Cross Sectional Studies; Cross-Sectional Studies; Descriptive Research; Descriptive Statistics; Educational Status; Female; health disparities; health inequities; Health Status Disparities; Hospital; Hospital/*psychology; Human; Humans; Income; Job Experience; Male; Middle Age; Middle Aged; Multivariate Analysis; Nurse Attitudes – Evaluation; nurses; Nursing Staff; Ohio; Politics; poverty; Poverty; Registered Nurses; Regression; Regression Analysis; Summated Rating Scaling; Surveys and Questionnaires; Young Adult
AIMS AND OBJECTIVES: To explore the attitudes held by registered nurses about persons living in poverty. BACKGROUND: As a profession, nursing has strong commitment to advocating for the socioeconomically disadvantaged. The links among poverty and health disparities are well established and research demonstrates that attitudes of providers can influence how those in poverty use health services. Although nurses are the largest sector of healthcare providers globally, little research has been published on their attitudes towards patients they care for who live in poverty. DESIGN: Cross-sectional survey. METHODS: Used a convenience sample of 117 registered nurses who completed the Attitudes Towards Poverty Short Form that contained three subscales. Regression analysis was used to examine the associations between the nurses' age, education, and years of experience, political views and financial security with their total score and subscale scores. RESULTS: Nurses were more likely to agree with stigmatising statements than statements that attributed poverty to personal deficiency or structural factors. In the multivariate analysis, years of experience were associated with more positive attitudes towards those living in poverty. Nurses with the most experience had less stigmatising beliefs about poverty and were more likely to endorse structural explanations. Those with a baccalaureate education were also more likely to endorse structural explanations for poverty. CONCLUSIONS: Gaining knowledge about attitudes towards and the factors influencing those attitudes, for example, education, are important in helping combat the disparities associated with poverty. RELEVANCE TO CLINICAL PRACTICE: Nurses have a duty to evaluate their individual attitudes and biases towards those living in poverty and how those attitudes and biases may influence daily practice. Assessing nurses' attitudes towards poverty may aid in better means of empowering nurses to seek solutions that will improve health conditions for those living in poverty.
Wittenauer James; Ludwick Ruth; Baughman Kristin; Fishbein Rebecca
Journal of clinical nursing
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jocn.12794" target="_blank" rel="noreferrer noopener">10.1111/jocn.12794</a>
Willingness and Ability of Older Adults in the Emergency Department to Provide Clinical Information Using a Tablet Computer.
*aged; *Attitude to Computers; *Computers; *data collection; *elderly; *emergency department; *Emergency Service; 80 and over; 80 and Over; ACADEMIC medical centers; Academic Medical Centers – North Carolina; Aged; Computers; Confidence Intervals; CONFIDENCE intervals; Convenience Sample; Cross Sectional Studies; CROSS-sectional method; Cross-Sectional Studies; Descriptive Statistics; DESCRIPTIVE statistics; Emergency Care – In Old Age; EMERGENCY medical services; Emergency Service; Female; Handheld; Hospital; HOSPITAL emergency services; Human; Humans; LONGITUDINAL method; Male; Mass Screening/*instrumentation; MEDICAL cooperation; Multicenter Studies; New Jersey; NEW Jersey; North Carolina; NORTH Carolina; OLD age; Patient Attitudes – Evaluation – In Old Age; PATIENTS' attitudes; Portable – Utilization – In Old Age; PORTABLE computers; Prospective Studies; RESEARCH; SCALE analysis (Psychology); Scales; STATISTICAL sampling; Summated Rating Scaling; Surveys and Questionnaires; United States; User-Computer Interface
OBJECTIVES: To estimate the proportion of older adults in the emergency department (ED) who are willing and able to use a tablet computer to answer questions. DESIGN: Prospective, ED-based cross-sectional study. SETTING: Two U.S. academic EDs. PARTICIPANTS: Individuals aged 65 and older. MEASUREMENTS: As part of screening for another study, potential study participants were asked whether they would be willing to use a tablet computer to answer eight questions instead of answering questions orally. A custom user interface optimized for older adults was used. Trained research assistants observed study participants as they used the tablets. Ability to use the tablet was assessed based on need for assistance and number of questions answered correctly. RESULTS: Of 365 individuals approached, 248 (68%) were willing to answer screening questions, 121 of these (49%) were willing to use a tablet computer; of these, 91 (75%) were able to answer at least six questions correctly, and 35 (29%) did not require assistance. Only 14 (12%) were able to answer all eight questions correctly without assistance. Individuals aged 65 to 74 and those reporting use of a touchscreen device at least weekly were more likely to be willing and able to use the tablet computer. Of individuals with no or mild cognitive impairment, the percentage willing to use the tablet was 45%, and the percentage answering all questions correctly was 32%. CONCLUSION: Approximately half of this sample of older adults in the ED was willing to provide information using a tablet computer, but only a small minority of these were able to enter all information correctly without assistance. Tablet computers may provide an efficient means of collecting clinical information from some older adults in the ED, but at present, it will be ineffective for a significant portion of this population.
Brahmandam Sruti; Holland Wesley C; Mangipudi Sowmya A; Braz Valerie A; Medlin Richard P; Hunold Katherine M; Jones Christopher W; Platts-Mills Timothy F
Journal of the American Geriatrics Society
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jgs.14366" target="_blank" rel="noreferrer noopener">10.1111/jgs.14366</a>
Short-term functional decline and service use in older emergency department patients with blunt injuries.
*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
Workplace Violence Training Using Simulation.
Attitude of Health Personnel; Chi Square Test; Clinical Assessment Tools; Descriptive Statistics; Disaster Planning; Fisher's Exact Test; Health Personnel; Human; Learning Environment; Literature Review; McNemar's Test; Multidisciplinary Care Team; Nonverbal Communication; Nursing; Ohio; Qualitative Studies; Quantitative Studies; Role Playing; Self Assessment; Self Defense; Simulations; Students; Summated Rating Scaling; Validity; Videorecording; Weapons; Workplace Violence – Education
: Workplace violence in health care settings is increasing dramatically nationwide. In response, an interdisciplinary team at an Ohio health system developed and piloted a model of training to address workplace violence. The model included classroom learning, a code silver (person with a weapon or a hostage situation) simulation training, and hands-on self-defense techniques. Based on data collected in the pilot, the team revised the model to offer a more comprehensive approach; the new, revised training program is known as Violence: enABLE Yourself to Respond. The team designed four distinct five-minute simulation scenarios depicting a range of threats from "escalating behavior" to "active shooter" and enacted them with standardized participants (health care personnel trained to perform specific behaviors in educational scenarios). Immediately after each simulation, the instructors facilitated a debriefing of the participants. Participants' pre- and post-training program self-evaluations of how prepared they felt to react to violent situations, as well as experts' evaluations of the participants' performance in simulations, provided evidence of the effectiveness of the model. Analysis of the data demonstrated a statistically significant positive difference in both participants' perception of their preparedness and experts' evaluation of their performance. The combination of classroom learning and simulation training is an effective, evidence-based method to prepare employees to respond when a situation escalates to violence, including the use of a weapon. This approach was designed for acute care but can be adapted to other settings. Skills learned can be used in both personal and professional life.
Brown Robin G; Anderson Shauna; Brunt Barbara; Enos Trish; Blough Keith; Kropp Denise
The American journal of nursing
2018
2018-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.NAJ.0000546382.12045.54" target="_blank" rel="noreferrer noopener">10.1097/01.NAJ.0000546382.12045.54</a>
Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain.
*Cardiovascular; *Cortisol; *Epinephrine; *Post-operative Pain; *Severity of Illness Index; *Stress; *Surgery; 80 and over; 80 and Over; Aged; Arthroplasty; Catecholamines – Urine; Center for Epidemiological Studies Depression Scale; Cohort Studies; Data Analysis Software; Descriptive Statistics; Effect Size; Female; Human; Humans; Hydrocortisone – Urine; Knee; Knee/*adverse effects/psychology; Male; Middle Age; Middle Aged; Nonexperimental Studies; Ohio; Pain; Pain Measurement/methods; Physiological; Postoperative Pain – Risk Factors; Postoperative/*diagnosis/etiology/*psychology; Predictive Value of Tests; Prospective Studies; Psychological/complications/*diagnosis/*psychology; Regression; Replacement; Scales; Stress; Summated Rating Scaling; Treatment Outcome
OBJECTIVE: The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. SUBJECTS: Participants included 110 patients undergoing total knee arthroplasty. METHODS: Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1: , 95 (1988)] 2.5 weeks prior to surgery and at a
Cremeans-Smith Julie K; Greene Kenneth; Delahanty Douglas L
Pain medicine (Malden, Mass.)
2016
2016-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/pm/pnv043" target="_blank" rel="noreferrer noopener">10.1093/pm/pnv043</a>
Mindfulness as a predictor of positive reappraisal and burnout in standardized patients.
*Adaptation; *Emotions; *Patient Satisfaction; 80 and over; Adult; Aged; Burnout; Clinical Assessment Tools; Coefficient Alpha; Convenience Sample; Descriptive Statistics; Education; Female; Human; Humans; Job Characteristics; Male; Medical; Middle Aged; Mind Body Techniques; Models; Multiple Regression; Ohio; Patient Simulation; Professional – Risk Factors; Psychological; Psychological/*complications/psychology; Psychometrics; Questionnaires; Regression Analysis; Risk Assessment; Statistics as Topic; Stress; Summated Rating Scaling
BACKGROUND: Standardized patients (SPs) portray emotionally intense roles that can have unintended deleterious effects including burnout. PURPOSE: This study explored SP characteristics that could serve as protective factors against these adverse effects. The literature suggests that positive reappraisal and mindfulness are protective factors, with positive reappraisal mediating the relationship between mindfulness and burnout. METHODS: Seventy-six SPs completed an instrument measuring burnout, positive reappraisal, and mindfulness. Multiple regression was performed to test the hypothesized mediator model. RESULTS: The results revealed that mindfulness and positive reappraisal explained a meaningful portion of SP burnout variance (R (2) = .31 p \textless .01). Germane to the mediator model, all correlations were significant: mindfulness and positive reappraisal (a) r = .668; positive reappraisal and burnout (b) r = -.527; and mindfulness and burnout (c) r = -.496, p \textless 01. When positive reappraisal and mindfulness were included in the model, the previously significant relationship c was no longer statistically significant. The combination of these three relationships supports a mediator model. CONCLUSIONS: Education to enhance mindfulness and positive reappraisal offers a way to offset the adverse effects of portraying intense emotional patient experiences.
Gerzina Holly A; Porfeli Erik J
Teaching and learning in medicine
2012
2012
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/10401334.2012.715255" target="_blank" rel="noreferrer noopener">10.1080/10401334.2012.715255</a>