Brief Motivational Intervention to Increase Self-reported Safety Belt Use among Emergency Department Patients

Objectives:  Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients.
Methods:  From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self-reported SBU. Those with SBU other than "always" were asked to participate. At baseline, participants answered a 9-item series of situational SBU questions, each scored on a 5-point Likert scale. SBU was defined as a continuous variable (9-item average) and as a dichotomous variable (response of "always" across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5- to 7-minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3-month follow-up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi-square testing.
Results:  Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] ±11 years; 61% male). At baseline, the intervention and control groups had similar mean (±SD) SBU scores (2.8 [±1.1] vs. 2.6 [±1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow-up. The intervention group had significantly greater improvement in mean (±SD) SBU scores than controls (0.76 [±0.91] vs. 0.34 [±0.88], p < 0.001). Also, SBU prevalence of "always" was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03).
Conclusions:  Participants receiving a brief motivational intervention reported higher SBU at follow-up compared to controls. An ED-based intervention may be useful to increase SBU.     

Is Consent “Informed” When Patients Receive Care from Medical Trainees?

Objectives: Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of “informed” on “consent,” by assessing willingness to be seen by trainees before and after information about trainee’s credentials. Methods: A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar’s test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results: The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of “medical student,” and 35%“intern” and “resident.” In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower‐ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions: Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees’ credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non–English speakers and should address these issues in other medical settings.     

Improving care for orthopaedic patients undergoing surgery for hip fracture and total knee replacement through best practice

As one of Canada’s largest community hospitals with several renowned regional and ambulatory programs, Trillium Health Centre is a leading health care facility in the country. The following article reports the way in which nurses, allied health professionals, managers, and physicians successfully challenged their working practices and achieved greater outcomes for orthopaedic patients, staff and the organization. Two practice improvement studies concerning surgery for hip fracture and total knee replacement are described in essence.     

The last post? Defending nursing against the postmodernist maze

Is postmodernism in many ways the empiricist-liberal tradition at the inevitable end of its intellectual and political tether? Or is postmodernism the ‘laughter of genius’ that art and argument in their traditional forms are dead? Can postmodernism be applied to social and economic issues whilst carrying a denial of the manner by which Western thought has shaped these issues? Can postmodernism provide moral pathways to help us with contemporary ethical issues? How can postmodernist thought encompass the activities of nurses, particularly in the area of psychiatric care? Can nurses afford postmodernist suppositions in the face of suffering and pain? If postmodernism exists, does it exist everywhere (as does nursing) or is it a more localized event?