Predicting posthospital recovery of physical function among older adults after lower extremity surgery in a short-stay skilled nursing facility

This study describes the posthospital recovery of physical function among 131 older adults after lower extremity surgery in a short-stay skilled nursing facility (SNF), and identifies admission factors predicting physical function at discharge. Multiple regression analyses found that older adults with low baseline physical function, pressure ulcer, malnutrition, memory loss upon admission, and not enough physical therapy had poor physical function at the time of discharge from the facility. This study generated the following recommendations for nurses working in short-stay SNFs: (1) screen all posthospital residents at admission with predictors to identify people at risk for physical functional decline, (2) design and implement targeted nursing and rehabilitation interventions to improve physical function, and (3) develop discharge plans that provide ongoing monitoring and interventions for community or nursing home nurses.     

Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo

Purpose: To describe the novel BrightArm Duo bimanual upper extremity (UE) rehabilitation system; to determine its technology acceptance and clinical benefit for older hemiplegic participants. Methods: The system table tilted to adjust arm gravity loading. Participants wore arm supports that sensed grasp strength and wrist position on the table. Wrist weights further increased shoulder exertion. Games were designed to improve UE strength, motor function, cognition and emotive state and adapted automatically to each participant. The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities (SNFs). Participants were evaluated pre-therapy and post-therapy using standardized clinical measures. Computerized measures of supported arm reach, table tilt and number of arm repetitions were stored on a remote server. Outcomes: Seven participants had significant improvements in their active range of shoulder movement, supported arm reach, shoulder strength, grasp strength and their ability to focus. The group demonstrated higher arm function measured with FMA (p?=?0.01) and CAHAI (p?=?0.05), and had an improvement in depression (Becks Depression Inventory, II). BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points. Conclusions: Given these findings, it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs.

• Implications for Rehabilitation

• Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities.

• Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke.

• Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly.

     

Prevalence and characteristics of nursing homes residents requiring light-care

Rising nursing home (NH) costs and the poor quality of NH care make it important to recognize elders for whom NH care may be inappropriate. As a first step in developing a method to identify these elders, we examined the characteristics of NH residents requiring light-care and changes in their care level from NH admission to 12-months. Using data from the Missouri Minimal Data Set electronic database, we developed three care-level categories based on Resource Use Groups, Version III (RUG-III) and defined light-care NH residents as those requiring minimal assistance with late-loss ADLs (bed mobility, transfer, toilet use, or eating) and having no complex clinical problems. Approximately 16% of Missouri NH residents met the criteria for light-care. They had few functional problems with mobility, personal care, communication, or incontinence; approximately 33% had difficulty maintaining balance without assistance; and 50% of those admitted as light-care were still light-care at 12-months. Findings suggest that many NH residents classified as light-care by these criteria could be cared for in community settings offering fewer services than NHs.     

A longitudinal study of cognition in nursing home residents with multiple sclerosis

Purpose. Examine cognitive change in nursing home residents with multiple sclerosis (MS) over the first 4 years of their nursing home stay.

Method. Nine hundred and twenty-four individuals with MS in nursing homes were longitudinally studied. Of these, 121 had MS but no psychiatric or neurological co-morbidities, 169 had MS plus another neurological disorder (MS-Neuro), 269 had MS plus a psychiatric disorder (MS-Psych) and 365 had MS plus both psychiatric and neurological disorders (MS-Comb). Data were obtained from a large government data-set, the minimum data set (MDS), and cognition was rated on the MDS-Cognition Scale.

Results. Data were analysed using a mixed-model ANOVA with a repeated factor of time and a fixed factor Group. We found a significant time effect with declines in cognition between each assessment, except 2000 and 2001, and a significant group effect so that the MS-Neuro and the MS-Comb groups had worse cognition than the MS-Psyc and the MS groups. A significant time × group interaction indicated differences in how the groups declined over time.

Conclusions. Over the first 4 years of a nursing home stay, cognition deteriorates in individuals with MS. Though there are not different rates of decline, residents with MS-Neuro and MS-Comb perform worse than residents with MS or MS-Psyc.     

Validity of functional independence staging in patients receiving rehabilitation in skilled nursing facilities

OBJECTIVES: To determine the psychometric performance and clinical applicability of the Functional Independence Staging (FIS) system for activities of daily living (ADLs), sphincter management, mobility, and executive function in patients receiving rehabilitation in the skilled nursing facility (SNF) setting. DESIGN: A retrospective analysis of secondary data using data from a privately owned administrative dataset. Setting Seventy SNFs under contract with SeniorMetrix Inc health plan clients. PARTICIPANTS: Patients (N=7526) covered by Medicare+Choice plans and admitted to an SNF in 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Analysis of construct validity, sensitivity to change, and predictive validity. RESULTS: The FIS score in each domain except mobility at admission was higher for patients with no concomitant disease than for patients classified as moribund ( P <.001). The odds of being discharged to the community were consistently greater for patients with higher discharge FIS scores in sphincter management (odds ratio [OR] range, 1.32-1.76), mobility (OR range, 1.93-4.66), and executive function (OR range, 1.50-4.15). Discharge FIS score was greater than admission FIS score for all domains ( P <.001). The odds of being discharged to the community were fairly consistently predicted by admission FIS score in ADLs (OR range, 1.26-3.73) and executive function (OR range, 1.60-5.05). CONCLUSIONS: The FIS system has reasonable psychometric properties that suggest it may be applied to the assessment and monitoring of functional status in patients admitted for rehabilitation in SNF settings. The system may be useful for determining the type of therapy that might be required or to predict the likely discharge needs of the patient.     

Functional independence domains in patients receiving rehabilitation in skilled nursing facilities: evaluation of psychometric properties

OBJECTIVE: To provide evidence for the validity of using FIM items to derive 4 domains of functional independence (mobility, activities of daily living [ADLs], sphincter management, executive function) in patients receiving rehabilitation in skilled nursing facilities (SNFs). DESIGN: A retrospective analysis of secondary data using data from a privately owned administrative dataset. Setting Seventy SNFs under contract with SeniorMetrix Inc health plan clients. PARTICIPANTS: Patients (N=7536) with a variety of conditions, covered by Medicare+Choice plans, and admitted to an SNF in 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Item score distributions, corrected item-total correlations, factor correlations, internal consistency, and stage ceiling and floor effects for each hypothesized functional independence domain. RESULTS: With the exception of 2 items, the items within a domain had similar standard deviations and distributions of items were not highly skewed. Four factors accounted for 73.4% of the variance in functional independence. Corrected item-total correlations ranged from .58 to .80 for the ADL domain, from .23 to .71 for the mobility domain, and from .78 to .88 for the executive function domain. The correlation between bowel and bladder management items was .84. Cronbach alpha coefficients ranged from .76 for the mobility domain to .96 for the executive function domain. At admission, there were substantial floor effects for the sphincter management (34.4%) and mobility domains (43.1%) and ceiling effects for the executive function domain (26.7%). CONCLUSIONS: With a few exceptions, the items proposed for each functional independence domain met the criteria for supporting the validity of the domains.     

Mexican American elders' use of skilled home care nursing services

Hispanic elders use skilled home care nursing (SHCN) services less often than Anglo elders. The purpose of this study was to identify factors that influence whether disabled Mexican American elders decide to use SHCN services. The research process included reviewing the historical context in one Mexican American community, interviewing key and primary informants, presenting a report to the community and getting feedback, and assessing whether the community perceived a need for increased use of SHCN services by their disabled elders. Seven barriers to the use of SHCN services were identified: expectations of discrimination, lack of knowledge about services, expectations embedded in familism, lack of sense of prevention, lack of health insurance, preference for traditional remedies, and neglect/abuse. A community advisory committee validated the barriers identified during interviews and the need for increased use of SHCN services. Results provide new insight into the sociopolitical and cultural complexities that influence health care utilization decisions by Mexican American elders and their families and uncover traditional, oversimplified beliefs and practices by mainstream professionals and policymakers. Interventions that decrease inequities in a southern Arizona community may be transferable to other vulnerable populations in the United States and globally.     

Symptom occurrence and associated clinical factors in nursing home residents with cancer

Little is known about the factors that contribute to symptoms in nursing home residents with cancer. We compared rates of symptoms in residents with (n = 1,022) and without cancer (n = 9,910) and examined physiologic, psychologic and situational factors potentially related to symptoms in residents with cancer. Pain, shortness of breath, vomiting, weight loss, and diarrhea were significantly (p < .05) more prevalent in residents with cancer. Cancer treatments, comorbid illnesses, and situational factors were not consistently correlated with symptoms. Improved symptom control was especially needed for the 30% of residents with cancer who clinically deteriorated within 3 months of admission; physical dependence and deteriorating clinical status were associated with pain, shortness of breath, and weight loss. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32: 453–464, 2009     

An imperative to improve discharge planning: predictors of physical function among residents of a medicare skilled nursing facility

Given the pressure to effects of shorter length of stay among older adults, it is important to understand factors that predict trajectories of physical function in a posthospital recovery period. Data were collected from the medical records of 131 older adults following lower extremity surgery to identify admission factors that predict physical function at discharge, length of stay, and discharge disposition in a Medicare skilled nursing facility. Knowing on admission those who are most at risk for poor physical function at discharge can arm nurse administrators with critical information for better discharge planning for continuing services.     

Usefulness of the nursing home quality measures and quality indicators for assessing skilled nursing facility rehabilitation outcomes

OBJECTIVE: To examine the usefulness of the nursing home quality indicators and nursing home quality measures for differentiating among providers from a rehabilitation outcomes perspective. DESIGN: Retrospective. SETTING: Skilled nursing facilities (SNFs) across the United States. PARTICIPANTS: A total of 211 SNFs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All quality indicators, all quality measures except for CWLS01 (residents who lose too much weight), and a set of rehabilitation outcomes including residualized FIM motor gain, the percentage of patients discharged to community, and the percentage of patients reporting "quite a lot" or "completely" prepared to manage their care at discharge from SNF-based rehabilitation. RESULTS: No quality measures correlated with any rehabilitation outcomes. Residualized FIM motor gain did not correlate with any quality indicators or quality measures. Only 1 quality indicator-prevalence of daily use of restraints (QI 22)-correlated with the rehabilitation indicator community discharge percentage. The third rehabilitation indicator, prepared to manage care at discharge, correlated (negatively) only with QI 18 incidence of decrease in range of motion. Among the rehabilitation outcomes, residualized FIM motor gain correlated significantly with both community discharge percentage and prepared to manage care at discharge. CONCLUSIONS: Patients and referrers choosing SNF-based medical rehabilitation need tools that differentiate among prospective providers from a rehabilitation outcomes perspective. Data in this study indicate that nursing home quality indicators and quality measures are inadequate for this purpose.     

Use of physical restraints with cognitively impaired nursing home residents

AIM: The aim of the study was to examine the prevalence of physical restraint use in cognitively impaired nursing home residents, the manner in which restraints are used, reasons for using them, and relationships between residents' characteristics and use of physical restraints. METHODS: A point prevalence study was conducted on the use of physical restraints among all residents cared for in two Dutch nursing homes and one nursing home unit (n = 265). Data about the nursing home residents and the use of restraints were collected by means of a questionnaire, which was filled in by the nurses. The response rate was 98%. The mean age of residents was 81 years (sd = 8.6), 74% of whom were female. RESULTS: One or more restraints were used with 49% of the residents. The most frequently used physical restraints were bed rails, a waist belt, and a chair with a table. In almost all situations (90%), residents were continuously restrained and restraints were used for longer than 3 months. The most common reason (90%) for use of restraints was to prevent falls. Logistic regression analysis revealed that use of restraints was highly associated with poor mobility, care dependency and risk of falling in the opinion of nursing staff. CONCLUSIONS: The results of this study are comparable with those of other studies. However, since recent studies have reported that physical restraints are inadequate to prevent falls, recommendations are made to re-evaluate critically the use of restraints and to conduct future research into a responsible and safe way of decreasing the use of physical restraints.     

Measuring the intensity of nursing care: making use of the Belgian Nursing Minimum Data Set

BACKGROUND: The Belgian Nursing Minimum Data Set (B-NMDS) is a nationwide registration of 23 nursing activities. It was developed for the measurement of nursing care in acute hospitals. It is used to support healthcare management & policy decision making such as hospital financing and nurse staffing decisions. OBJECTIVE: To develop a measure of the intensity of nursing care based on information that is available in the B-NMDS. DESIGN-SETTING-PARTICIPANTS: Retrospective analysis of the B-NMDS from all Belgian acute hospitals (n=115) for the year 2003. The sample included 690,258 inpatient days for 298,691 patients that were recorded from 1637 acute care nursing units. METHODS: The 23 nursing activities were synthesized into one new latent variable by PRINQUAL analysis. This variable was evaluated as a measure of nursing care intensity using key characteristics of the San Joaquin patient classification system, which was designed to measure the intensity of nursing care. RESULTS: The main NMDS component from the PRINQUAL analysis accounted for 26.8% of the variance. The distribution of inpatient days over all four San Joaquin categories is: 11.1% (self-care); 40.4% (average care); 30.8% (above average care); 17.7% (intensive care). In 97.5% of the nursing units the intensity of nursing care score of the B-NMDS (main NMDS component) followed the ordinality of the San Joaquin classification system. Furthermore, the San Joaquin categories alone explained more variability--70.2% in the intensity of nursing care measure (main NMDS component) than did other determinants, such as department type, age, diagnostic-related groups (DRG) and severity of illness, hospital type and hospital size together. CONCLUSION: The B-NMDS is an instrument that produces a measure of the intensity of nursing care in acute hospitals.     

人文关怀在护理中的作用与实践

文章分析了人文关怀在护理中的作用,认为其可以提高患者生活质量,提升医院形象,建立良好的护患关系;同时指出临床工作中应在几个环节做好人文关怀的实践,如细心沟通、热情关怀、耐心谈话等。     

身体约束在老年病人护理中使用的研究进展

综述了老年护理中身体约束的使用情况,使用身体约束对被约束者的影响,影响老年护理中身体约束使用的因素以及减少身体约束使用的方法。     

身体约束在老年病人护理中使用的研究进展

综述了老年护理中身体约束的使用情况，使用身体约束对被约束者的影响，影响老年护理中身体约束使用的因素以及减少身体约束使用的方法。