The role of biobehavioral, environmental, and social forces on oral health disparities in frail and functionally dependent nursing home elders

The purpose of this article is to review the literature on and discuss how interactions between bio-behavioral aging, nursing home environments, and social forces shaping current health care policies have contributed to oral health disparities in frail and functionally dependent elders who reside in nursing homes. Emerging empirical evidence suggests links between poor oral health with dental plaque deposition and systemic disease, such as nursing home-acquired pneumonia. The majority of nursing home residents lack either the functional ability or the mental capacity to perform their own mouth care and therefore must rely on others to perform mouth care for them. Certified nursing assistants (CNAs), who provide the majority of care activities, were unsure how to provide care to residents who engaged in care-resistive behaviors. The nurses who supervise the CNAs have limited knowledge regarding the provision of mouth care in general, and they specifically lack knowledge regarding the provision of mouth care to elders exhibiting care-resistant behavior. Elders in nursing homes have limited options when paying for dental care; Medicare does not generally cover routine dental care. Medicaid coverage varies widely between individual states; even when coverage exists, low Medicaid reimbursements discourage dentists from accepting Medicaid patients. The strategies needed to reduce these oral health disparities are complicated but not unrealistic. Investigators willing to embrace this cause will have no shortage of opportunities to test methods to improve the delivery of oral care as well as to monitor and reassess these methods.     

Psychometric properties of a scale to measure investment in the sick role: the Illness Cognitions Scale

Rationale, aims and objectives A person's beliefs about their illness may contribute to recovery and prognosis. Some degree of acceptance of illness and its impact is necessary to integrate the presence of a chronic disorder into one's lifestyle and adhere to necessary components of illness management; however, some individuals can become ‘stuck’ and have difficulty adjusting out of the sick role. Inventories exist to measure illness cognitions, attitudes and behaviours as they relate to hypochondria and psychosomatic illness, but there is no extant measure of sick role inertia. We describe the psychometric properties of a new scale, the Illness Cognitions Scale (ICS), a metric of investment in the sick role. Methods The ICS was administered to 97 individuals with bipolar or schizoaffective disorder, and the psychometric properties of the scale measured. Dimensionality was assessed using Principal Components Analysis with Oblimin rotation. Results The scale has a strong internal consistency, with a Cronbach's alpha of 0.858. Results of a factor analysis suggested the presence of one main factor, with three other smaller, related sub‐factors, capturing aspects of maladaptive illness beliefs. Conclusion The ICS is a 17‐item, internally validated scale measuring difficulty adjusting out of the sick role. The scale predominantly measures a single construct. Further research on external validity of the ICS is required as well as determination of the clinical significance and patient acceptability of the scale.     

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample This study explored the needs of family caregivers during the transition from hospital to home. Data from 37 face-to-face interviews with 16 caregivers before discharge and at 2 weeks and 1 month after discharge were subjected to constant comparative analysis. Findings revealed changes in family caregivers' needs during the discharge transition. While preparing to take caregiving responsibility, caregivers reported a need for various types of information. After the discharge, but before home caregiving settled into a pattern, they needed help with caregiving practices. After reaching a pattern for providing family care, caregivers frequently reported needs for continuous emotional support. These findings provide a basis for transitional care services such as discharge planning and home health care services.     

Construction of a scale to measure load, power, and margin in life

The development of an instrument to measure load, power, and margin in life (MIL) is described. Validity was established through factor analysis and the know-groups approach to construct validity. Stability was tested through a test-retest reliability, and Cronbach alpha reliability coefficients were obtained to test for internal consistency. Subjects consisted of 146 adult men and women volunteers for testing Form 1, later revised to Form 2. Form 2 was given to 103 volunteers; of these 66 were repeaters from the Form 1 testing; 37 were new subjects. Item analyses were performed and used to reduce the original 211 items to 94 for Form 3 of the scale.     

Role perception and role enactment of the nurse and their determinants in a teaching hospital in Nigeria

This study was conducted to compare nurses' perception of their role with the perception which physicians and patients have of the role of nurses in a teaching hospital incorporating a school of nursing and midwifery; to explore the underlying reasons for the discrepancies found; to examine the effects of discrepancies in role perception on the effectiveness of patient care and to discuss the findings in the light of nursing education curricula in Nigeria.

Questionnaires, listing ten technical/instrumental and expressive/humanitarian nursing functions were administered to three groups of respondents (nurses, physicians and patients). They were requested to select any five statements that best described what nurses did, and to rank them according to how often the functions described were seen being practised.

A second questionnaire, administered only to the nurse respondents, elicited a number of background parameters related to nursing career.

The results from the first questionnaire show that nurses did not seem to agree with patients and physicians on the perception and enactment of their role. Nurses saw their role as equally technical/instrumental and expressive/humanitarian, whereas patients and physicians saw it as more expressive/humanitarian, the patients being particularly more inclined to this perception. Most significant was the disagreement between patients and nurses. Nurses whose perception of their role agreed most closely with that of physicians and patients, were found to be older, and to have had longer experience. A significant proportion of them had only basic nursing qualifications, and they perceived their functions to be more appreciated by patients.     

Pain Patient Profile: a scale to measure psychological distress.

OBJECTIVE: To evaluate the construct validity of the Pain Patient Profile (P-3), a brief self-report instrument designed to measure anxiety, depression, and somatization in patients presenting with pain. DESIGN: Comparison of P-3 scores with previously established measures of depression, anxiety, and somatization, and comparison of P-3 scores of pain patients with those of patients with diabetes. SETTINGS: Hospital-based outpatient pain clinic, family practice clinic, diabetes education group. PATIENTS: Seventy pain patients and 40 patients with diabetes. RESULTS: High positive correlations (.69 to .90) were found between the P-3 scales of Depression, Anxiety, and Somatization and the corresponding measures of these constructs, and high intercorrelations were found among the three P-3 scales. Significant differences were found between pain patients and diabetes patients for the P-3 Depression and Somatization scale scores, but not for the P-3 Anxiety scale scores. CONCLUSIONS: The P-3 is a useful instrument for initial screening of psychological distress in pain patients. Some patients may show elevations on more than one of the clinical scales, which either indicates that the P-3 does not distinguish well among these constructs or reflects the well-established comorbidity of these constructs.     

Sexual abuse comfort scale: a scale to measure nurses' comfort to respond to sexual abuse in psychiatric populations

The purpose of the present study was to further contribute to the psychometric evaluation of the Sexual Abuse Comfort Scale (SACS) in order to provide a standardized measure that would assess the impact of educational programmes on nurses' comfort to intervene with psychiatric clients regarding sexual abuse. This study was part of a larger multisite study conducted in four Canadian provinces, designed to assess the attitudes, beliefs, competencies and educational needs of psychiatric nurses who may work with clients who have been sexually abused. As part of the larger study, a self-administered survey was sent to 3532 psychiatric nurses employed in Alberta, Saskatchewan, Ontario and Nova Scotia. The SACS, the Sexual Attitudes Scale (SAS), the Questionnaire Measure of Emotional Empathy (QMEE) and the Marlowe-Crowne Social Desirability Scale (M-CDS) were included in the survey. The SACS was submitted for item analysis, factor analysis, hypothesis testing regarding construct validity and assessment of concurrent validity. Item analysis of the SACS resulted in a 30-item scale with a coefficient of 0.91, indicating an excellent level of reliability. Empirical evidence indicates that the SACS is a reliable and valid instrument that may be used for the effective evaluation of intervention programmes directed towards increasing clinical knowledge and competence related to sexual abuse.     

Home-screen: a short scale to measure fall risk in the home

Community nurses are often the health professionals with whom older Australians living at home have most contact. The home environment has been identified to have a number of hazards associated with falls in older people. The Home-screen scale was specifically designed as a nurse-administered instrument to identify environmental and behavioral risks that alert nurses to the need for action to reduce fall risks in the home. A 14-item scale was administered to 1,165 older people receiving community nursing services. Psychometric investigation confirmed a 10-item scale with construct validity and internal consistency (alpha = 0.86, n = 989), explaining 60% of the construct of home safety (safe home environment and safe home behaviors). In addition, differences in mean scores were found in clients able and unable to transfer independently (t = 4.5 [df = 323.1] p < 0.001 [Group 1: M = 82.14, SD = 15.56; Group 2: M = 75.54, SD = 20.83, n = 989]). Similarly, an association existed between clients with low scores on the Home-screen scale and the perceived need for home modification. A score of 74 on this scale has been identified as a critical point for potential client injury. The use of this scale, both as an initial screening instrument and as a monitoring tool for community nurses working with older people, is recommended.     

How to evaluate the microcirculation: report of a round table conference

Introduction  

Microvascular alterations may play an important role in the development of organ failure in critically ill patients and especially in sepsis. Recent advances in technology have allowed visualization of the microcirculation, but several scoring systems have been used so it is sometimes difficult to compare studies. This paper reports the results of a round table conference that was organized in Amsterdam in November 2006 in order to achieve consensus on image acquisition and analysis.     

Program development and maternal-child health consultation: a conceptual model for role enactment in developing countries

Increasingly, nurses are serving as consultants in designing programs to improve the health of individuals in developing countries. In order to be effective, such programs must reflect the socio-cultural context in which identified health problems occur. This can become problematic when nurses work as consultants in cultures with which they are unfamiliar. This paper proposes the use of the World Health Organization's risk strategy approach as a conceptual framework for developing culture specific programs in maternal-infant health. Suggested consultant role behaviors are articulated with this approach and the various phases of program development using an ongoing project in Juarez, Mexico to which the author has provided nursing consultation as a concrete example.     

Chronic orofacial pain among Korean elders: prevalence, and impact using the graded chronic pain scale

The aims of this study were to investigate the prevalence of orofacial pain symptoms in the Korean elderly population, and to evaluate factors associated with orofacial pain and graded chronic pain. Of 4,342 Korean elders from the cohort of Korean National Interview Survey of Oral Health Status in 2000, telephone interviews were conducted on a stratified random sample of 1,032 people aged 55 years or older. Prevalence of five orofacial pain symptoms (jaw joint pain, face pain, toothache, oral sores, and burning mouth) in the past 6 months along with questions from the graded chronic pain scale were assessed by telephone using a structured questionnaire. The results suggested that the 6-month prevalence of joint pain (15.5%), face pain (9.3%), toothache (26.8%), oral sores (26.2%), and burning mouth (14.2%) in Korean elders were higher than in studies on Caucasian populations. Painful oral sores and burning mouth had higher prevalence for females than for males. Subjects with joint pain, burning mouth or toothache pain were more likely to report high levels of a pain-related disability compared with subjects not reporting those symptoms. There were no age group differences in pain intensity, but the older age group reported a higher number of disability days because of their pain. Chronic orofacial pain is a substantial health problem in the elderly population.     

Barriers to mobility: physically-disabled and frail elderly people in their local outdoor environment.

This paper reports the results of a central government funded two-year project which investigated problems associated with the mobility of physically handicapped people in their external physical environment. Whilst most people who possess below average physical capacity would, even in the most ideal of physical surroundings, experience mobility problems, such inherent personal difficulties are being aggravated by street environments exhibiting symptoms of neglect. Although the difficulties experienced by people in this study can be seen partly as a function of their physical disabilities even elderly people who could be considered as reasonably able-bodied, were reporting difficulty in their local area. A number of the environmental difficulties people reported can be related to existing legislation not being enforced whilst in others to the need for legislation to be entered on to the statute book.