Risk Factors Associated with Patient Assaults of Home Healthcare Workers

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47‐12.67), routinely handling patients (OR = 8.48, 95% CI 1.89‐37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75‐11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.     

Safe Patient Handling for Rehabilitation Professionals

Every day, thousands of physical therapists and rehabilitation nurses are required to perform physically demanding therapeutic patient handling tasks that are stressful to the caregiver and increase his or her risk of developing work‐related musculoskeletal disorders (MSDs). In rehabilitation, patient handling tasks might be classified as “traditional” or “therapeutic.” Traditional tasks have a practical goal, such as transferring a patient from bed to a wheelchair, and therapeutic tasks have more targeted goals such as facilitating patient function and independence. Therapeutic patient handling tasks present a greater risk for caregivers to sustain work‐related MSDs than typical patient handling tasks do because caregivers are exposed to high mechanical loads on the spinal tissues for longer amounts of time. The Veterans Health Administration, Association of Rehabilitation Nurses, and the American Physical Therapy Association endorse the use of modern patient handling technology as part of a comprehensive safe patient handling program for providing therapy in rehabilitation settings. Information about patient handling technology that is effective in reducing the risk of work‐related MSDs from performing therapeutic patient handling and movement tasks is also presented and discussed in this article.     

Using the Functional Independence Measure Instrument to Predict Stroke Rehabilitation Outcomes

The purpose of the study described in this article was to identify the factors that have an impact on stroke patients' discharge destination. Two hundred thirty-four stroke patients admitted to a rehabilitation facility over a 2-year period were examined. Functional Independence Measure (FIM?) data were used to examine functional status, demographic characteristics, and the discharge destination of patients admitted to the facility's program. The relationship between patients' FIM scores at discharge and their discharge locations was analyzed using the chi-square statistic. The results showed that a discharge FIM score of 80 or above had a high specificity and sensitivity with patients' discharge to their homes. In addition, outliers were analyzed, and the results showed that family members of only 20% of the patients who were discharged to their homes were working, in contrast to 65% of the family members of patients who were discharged to a skilled nursing facility. The availability of a nonworking family member and the ability of a family to provide supervision and physical assistance were more likely to be factors related to discharge of patients to their homes. Ninety percent of the families of patients discharged to their homes were able to provide supervision and to provide physical assistance. Thus, both functional status and social factors, such as family availability and support, are critical elements in predicting the discharge destination of this patient population.     

应用功能独立性评测评定脑卒中患者的残疾

对３３例脑卒中患者应用功能独立性评测（ＦＩＭ）评定其残疾及残疾严重程度以确定年龄、登工症及偏瘫侧对残疾有无影响。结果：所有患者的日常生活活动均需帮助,最在或完全需要寿命的活动评级１－２分）是上下楼梯（７５．８％）,浴盆／淋浴转移（６９．７％,行走（６６．７％）、穿下衣（６３．６％）、洗澡（６０．６％）;基本独立或需较少帮助的活动（ＦＩＭ评级６－７分）是进食（４８．５％）、修饰（２７．３％）、膀胱和     

Using technology to promote safe patient handling and rehabilitation.

Technology has improved and expanded the equipment options for use in patient handling. There is substantial evidence that these activities expose healthcare professionals, including nurses and physical therapists, to risk for work-related musculoskeletal disorders. There is also evidence that ergonomic use of equipment to assist with patient handling is associated with decreases in injuries among healthcare providers. The use of patient-handling equipment has additional potential for facilitating the goals of rehabilitation and improving patient outcomes. This article presents an overview of new research areas and a discussion of these topics.     

Use of the Functional Independence Measure for Outcomes Measurement in Acute Inpatient Rehabilitation

Assessment of functional status is a major responsibility for professionals practicing in rehabilitation facilities. Functional assessment tools have been created to meet this need. One of the most widely used tools is the Functional Independence Measure (FIM). Data from the FIM are used to examine patient outcomes for several purposes. This article explores the rationale for use of the FIM as an outcomes measure and research regarding the validity, reliability, responsiveness, and utility of this tool. Limitations of this instrument, future research needs, and implications for rehabilitation professionals also are discussed.     

Patient Safety: Perianesthesia Nursing''s Essential Role in Safe Practice

A safety culture that promotes best practices and best outcomes is important in today's healthcare environment. The perianesthesia environment of care is constantly challenged with the introduction of new technologies, improved medications, and advances in surgical and nonsurgical procedures. This practice is also marked by fast turnover, increasing volume, and, often, high-acuity patients. The integration of principles of safety and evidence-based principles is a core value of perianesthesia practice. The American Society of PeriAnesthesia Nurses (ASPAN) is committed to providing the foundation to support a culture of perianesthesia safety. This article will discuss the development of the ASPAN Safety Model by the ASPAN Safety Committee.     

Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke

Purpose: To translate and cross-culturally adapt the Functional Independence Measure (FIM) into the Persian language and to test the reliability and validity of the Persian FIM (PFIM) in patients with stroke. Method: In this cross-sectional study carried out in an outpatient stroke rehabilitation center, 40 patients with stroke (mean age 60 years) were participated. A standard forward–backward translation method and expert panel validation was followed to develop the PFIM. Two experienced occupational therapists (OTs) assessed the patients independently in all items of the PFIM in a single session for inter-rater reliability. One of the OTs reassessed the patients after 1 week for intra-rater reliability. Results: There were no floor or ceiling effects for the PFIM. Excellent inter-rater and intra-rater reliability was noted for the PFIM total score, motor and cognitive subscales (ICC_agreement 0.88–0.98). According to the Bland–Altman agreement analysis, there was no systematic bias between raters and within raters. The internal consistency of the PFIM was with Cronbach's alpha from 0.70 to 0.96. The principal component analysis with varimax rotation indicated a three-factor structure: (1) self-care and mobility; (2) sphincter control and (3) cognitive that jointly accounted for 74.8% of the total variance. Construct validity was supported by a significant Pearson correlation between the PFIM and the Persian Barthel Index (r?=?0.95; p?Conclusions: The PFIM is a highly reliable and valid instrument for measuring functional status of Persian patients with stroke.

• Implications for Rehabilitation

• The Functional Independence Measure (FIM) is an outcome measure for disability based on the International Classification of Functioning, Disability and Health (ICF).

• The FIM was cross-culturally adapted and validated into Persian language.

• The Persian version of the FIM (PFIM) is reliable and valid for assessing functional status of patients with stroke.

• The PFIM can be used in Persian speaking countries to assess the limitations in activities of daily living of patients with stroke.

     

Myths and facts about safe patient handling in rehabilitation.

As the incidence of injuries associated with patient-handling tasks remains high in the rehabilitation community, interdisciplinary discussions on optimal methods for preventing injuries and ensuring good care continue. A national task force consisting of representatives from the Association of Rehabilitation Nurses, the American Physical Therapy Association, and the Veterans Health Administration identified myths that have been promulgated on both sides of the discussion, focusing especially on rehabilitation practices. The purpose of this article is to dispel these myths by using evidence-based methods. Evidence should be applied in discussions of safe patient handling, and although concern about patient outcomes is critical, there is no evidence that the use of patient-handling technology undermines rehabilitation goals and strong evidence that these practices enhance the safety of rehabilitation care providers. Further research on the impact of safe patient-handling practices on rehabilitation goals and continued communication between rehabilitation providers are recommended.     

Link between safe patient handling and patient outcomes in long-term care.

This study examined the relationship between safe patient handling and quality of care measures. A comprehensive patient care ergonomics program included six elements. Using a retrospective observational design, 10 quality domains were compared before and after implementation of the program for 111 residents living on 24 units in six Veterans Administration nursing homes using a general linear regression model with repeated measures clustered within time and adjusted for age. After implementation, we found lower levels of depression, improved urinary continence, higher engagement in activities, lower fall risk, and higher levels of alertness during the day. Additionally, four areas showed a decline in function: pain, combativeness, locomotion, and cognition. Findings from this study may be useful in enhancing organizational support for safe patient-handling programs and could be used to build a business case for improving caregiver safety.     

Equating activities of daily living outcome measures: the Functional Independence Measure and the Korean version of Modified Barthel Index

Purpose: To create a crosswalk between the Functional Independence Measure (FIM) motor items and the Korean version of the Modified Barthel Index (K-MBI).

Method: Korean community-dwelling adult patients (n?=?276) completed the FIM and K-MBI on the same day in outpatient rehabilitation hospitals. We used a single group design with the Rasch common person equating and conducted a factor analysis of the co-calibrated item pool using the two measures. Rasch analysis was used to investigate the psychometrics of the equated test items in the identified factor structure(s). The correlation between FIM raw scores and converted K-MBI scores was examined.

Results: Three measurement constructs were identified: self-care, mobility, involuntary movement. The equated test items in the three constructs demonstrated good person separation reliability (r?=?0.94–0.96) and good internal consistency (Cronbach’s alpha =0.93–0.97). The three crosswalks between the FIM raw scores and converted K-MBI scores demonstrated good correlations (r?=?0.91–0.93, all p?Conclusions: The Rasch equating method successfully created three crosswalks between the FIM motor items and K-MBI, with the equated test items demonstrating good psychometrics. The crosswalks would address the incomparable scoring systems between the FIM motor items and K-MBI.

• Implications for Rehabilitation

• The three crosswalk tables (scoring tables) would allow clinicians to compare or translate a patient’s motor scores between the FIM and K-MBI.

• The crosswalk tables would allow health-care administrators to track patients’ functional status across various rehabilitation facilities that exclusively use the FIM or K-MBI.

     

Patient transfers in Australia: implications for nursing workload and patient outcomes

blay n., duffield c.m. & gallagher r. (2012) Journal of Nursing Management 20, 302–310
Patient transfers in Australia: implications for nursing workload and patient outcomes Aim To discuss the impact of patient transfers on patient outcomes and nursing workload. Background Many patient transfers are essential and occur in response to patients’ clinical changes. However, increasingly within Australia transfers are performed in response to reductions in bed numbers, resulting in ‘bed block’. Evaluation A discussion of the literature related to inpatient transfers, nursing workload and patient safety. Key issues Measures to increase patient flow such as short-stay units may result in an increase in patient transfers and nursing workload. Frequent patient transfers may also increase the risk of medication incidents, health-care acquired infections and patient falls. Conclusions The continuing demand for health care has led to a reactionary bed management system that, in an attempt to accommodate patients, has resulted in increased transfers between wards. This can have a negative effect on nursing workload and affect patient outcomes. Implications for nursing management High nursing workload is cited as one reason for nurses leaving the profession. Reductions in non-essential transfers may reduce nurse workload, improve patient outcomes and enhance continuity of patient care.