Improving Nurses' Behavioral Health Knowledge and Skills With Mental Health First Aid.

Given the current professional behavioral health workforce shortage, nursing professional development practitioners require educational resources to fully support registered nurses across settings in responding to patients with behavioral health symptoms. Mental Health First Aid is an 8-hour training to help nonprofessional bystanders assess a mental health crisis, provide initial help, and connect to supports and self-help resources in the local community. Mental Health First Aid was acceptable and useful to 60 RNs and can be supplemented with additional content.

Full-Thickness and Unstageable Pressure Injuries That Develop in Nursing Home Residents Despite Consistently Good Quality Care.

PURPOSE: The purpose of this study was to determine whether stage 3, 4, and unstageable pressure injuries develop despite consistently good quality care (CGQC); ascertain whether these wounds occur without prior recognition of a lower-stage pressure injury; and to describe and analyze characteristics of nursing home residents and their higher-stage pressure injuries. DESIGN: Descriptive, nonexperimental, prospective analysis. SUBJECTS AND SETTING: A convenience sample of 20 residents from facilities participated in the study; research sites were located in 7 counties in Western Washington and Orange County, along with a single site in Wisconsin. METHODS: CGQC facilities were identified using a 3-step incremental approach. Research assistants verified CGQC at the facility level. After data collection was complete, a Longitudinal, Expert, All-Data Panel reviewed cases for a final resident-level validity check for CGQC. Remaining cases were submitted to analysis. RESULTS: Residents who developed advanced stage pressure injuries despite CGQC were older, had limited mobility, dementia, comorbid conditions, urinary or fecal incontinence, and infections. The pressure injuries were relatively small and had little-to-no undermining, exudate, or edema. CONCLUSIONS: Stage 3, 4, and unstageable pressure injuries were observed in nursing home residents despite CGQC. Results from this study may serve as a baseline for further research to evaluate characteristics of these wounds when they develop under settings of poor-quality care. Findings also may be useful in creating evidence-based practice guidelines to support decision making around mandatory reporting, diagnosis, and prosecution.

Defining Unstageable Pressure Ulcers as Full-Thickness Wounds: Are These Wounds Being Misclassified?

PURPOSE: The purpose of this study was to describe the evolution of unstageable pressure ulcers (PUs) over time to determine if their healing trajectory is consistent with full- or partial-thickness wounds. DESIGN: Retrospective review of electronic medical record and a clinical PU database. SUBJECTS AND SETTINGS: Patients with hospital-acquired, unstageable PUs were evaluated. Subjects were cared for at a level 1 trauma/burn center and safety net hospital in the Pacific Northwest between November 2007 and March 2011. METHODS: Electronic medical records and a clinical PU database for 194 unstageable PUs were examined. The PU database is managed by certified wound care nurses; it includes data on all verified hospital-acquired PUs since 2007. The unit of analysis for this study was the individual PU site. RESULTS: Of the initial 194 unstageable PUs identified, 120 were excluded due to lack of data needed to address research questions. Out of the 74 unstageable PUs that remained in the study, approximately one-third (33.8%) were found to follow a healing trajectory consistent with partial-thickness wounds. CONCLUSION: Findings indicate that while approximately two-thirds of unstageable PUs demonstrate healing trajectories consistent with full-thickness wounds, slightly more than a third follow a trajectory consistent with partial-thickness wounds. Additional research is needed to clarify the healing trajectories of unstageable PUs and to determine whether the current definition for unstageable PUs is adequate.

Mortality risk associated with physical and verbal abuse in women aged 50 to 79.

OBJECTIVES: To investigate whether midlife and older women who reported prior-year physical abuse, verbal abuse, or both abuse types had higher mortality risk than peers who did not report prior-year abuse. DESIGN: Retrospective analysis. SETTING: Community. PARTICIPANTS: One hundred sixty-thousand six hundred seventy-six community-dwelling women ages 50 to 79 at baseline enrolled in one of two major Women's Health Initiative (WHI) study components who responded to baseline abuse questions. Observational study enrollment was N=93,676 (1994-1998; 90 months average follow-up). Clinical trial enrollment was N=68,132 (1993-1998; 96 months average follow-up). MEASUREMENTS: Total mortality was measured from 1993 to 2005 using all available data sources. Blinded physician adjudicators measured cause-specific mortality. Ninety-six percent of death records were adjudicated. RESULTS: Prior-year self-reported abuse prevalence was 11.3%. Women who reported physical abuse had the highest age-adjusted mortality rate, followed by women who reported both abuse types. Abuse independently predicted mortality risk after controlling for age, education, ethnicity, and WHI component. High mortality risk remained for physically abused women (hazard ratio (HR)=1.54, 95% confidence interval (CI)=1.09-2.18) after adjusting for demographic and health-related factors. Further adjustment for psychosocial variables diminished this association (HR=1.40, 95% CI=0.93-2.11), but high risk remained. CONCLUSION: Community-dwelling middle-aged and older women who reported prior-year physical, verbal, or both types of abuse had significantly higher adjusted mortality risk than women who did not report abuse. These findings highlight the need for longitudinal research into prevention of abuse in later life and accompanying excess mortality and emphasize the importance of abuse prevention in later life.

Assessment of ovarian reserve with anti-Müllerian hormone: a comparison of the predictive value of anti-Müllerian hormone, follicle-stimulating hormone, inhibin B, and age.

OBJECTIVE: The objective of this study was to evaluate basal anti-Müllerian hormone as a marker for ovarian responsiveness to fertility treatment. STUDY DESIGN: Frozen basal menstrual cycle day 3 serum samples were evaluated retrospectively for anti-Müllerian hormone, inhibin B, and follicle-stimulating hormone levels in 123 in vitro fertilization cycles (93 patients) and compared with in vitro fertilization records. RESULTS: Anti-Müllerian hormone values correlated the best with the number of retrieved oocytes (r = 0.539; P < .001) relative to age (r = -0.323; P < .01), follicle-stimulating hormone (r = -0.317; P < .01), inhibin B (P > .05), luteinizing hormone (P > .05), and estradiol (r = -0.190; P < .05). Receiver operating characteristic curve analysis demonstrated that, for the prediction of <4 oocytes retrieved, anti-Müllerian hormone had the largest area under the curve (AUC = 0.81; P = .0001) relative to age (r = 0.74; P = .005), follicle-stimulating hormone (0.71; P = .02), inhibin B (0.66; P = .03), and estradiol (0.54; P > .05). Similarly, for the prediction of >or=15 retrieved oocytes, anti-Müllerian hormone had the largest area under the curve (0.80; P = .0001) relative to age (0.63; P = .02), follicle-stimulating hormone (0.64; P = .005), inhibin B (r = 0.57; P > .05), and estradiol (0.58; P > .05). CONCLUSION: Anti-Müllerian hormone correlates better than age, follicle-stimulating hormone, luteinizing hormone, inhibin B, and estradiol with the number of retrieved oocytes. Receiver operating characteristic curves estimated that anti-Müllerian hormone accurately predicts ovarian responsiveness to controlled ovarian stimulation with high sensitivity and specificity.

Rural trauma: is trauma designation associated with better hospital outcomes?

CONTEXT: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. PURPOSE: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. METHODS: Analysis of data from the Nationwide Inpatient Sample for discharges between 1998 and 2003 of patients hospitalized with moderate to major traumatic injury in nonfederal, short-stay rural hospitals with annual discharges of 1,500 or fewer patients (N = 9,590). Logistic regression was used to control for patient and hospital characteristics, stratifying by hospital volume. Main outcome measures were in-hospital death and transfer to another acute care facility after initial admission. FINDINGS: A total of 333 patients (3.5%) died in-hospital. After adjusting for patient, injury and hospital characteristics, in-hospital death was more likely among patients treated at the non-designated hospitals with fewer than 500 discharges per year (OR 2.35; 95% CI 1.25-4.41) than among patients treated at similar trauma-designated hospitals. Patients admitted to non-designated hospitals were more likely to be transferred after admission, although this finding was significant only in the larger-volume hospitals with discharges of 500-1,500 per year (OR 1.41, 95% CI 1.08-1.83). CONCLUSIONS: Associations between trauma designation and outcomes in rural hospitals warrant further study to determine whether expanding designation to more rural hospitals might lead to further improvement in trauma outcomes.

Creation of a model of independence for community-dwelling elders in the United States.

BACKGROUND: A goal of many public policies in support of older Americans is independence, but the meaning of independence in the context of community-dwelling elders is not clear. OBJECTIVE: To create a preliminary conceptual model of independence for older, community-dwelling Americans. METHODS: Exploratory factor analysis was used during secondary analysis of a federal dataset, the Second Supplement on Aging (N = 9,447). After preparation of the dataset, 51 variables were selected for possible submission to factor analysis. Initial item reduction resulted in 21 variables for factor structure development. RESULTS: Three factors for a preliminary conceptual model of independence were identified: physical function, social ability, and physical health. Physical function, explaining 29.5% of the variance, included variables related to elders' ability to function in everyday life, such as how well they function in their homes. Social ability variables included items related to social activities, education, driving, and leaving the house, and accounted for 8.6% of the variance. Physical health explained 6.1% of the variance and included variables related to visits to the doctor, prescription drug use, and number of days spent in bed during the past year. DISCUSSION: Findings suggest the importance of physical function for independence and the importance of a physical environment that supports various levels of physical function. Social ability plays a role in independence and may require adequate physical function, financial and material resources, and social support. Physical health may be a component of physical function or reflect access to healthcare. Future studies using primary data are indicated for further development of the concept of independence in the context of community-dwelling elders in the United States. A conceptual model of independence will guide nurses in their assessments of and interventions for older, community-dwelling adults and will help policymakers prioritize spending for programs that have independence as a goal.

The roles of nurses on interprofessional teams to combat elder mistreatment.

Elder mistreatment (EM) is a growing and hidden problem. Nurses have a responsibility to identify potential and actual EM victims. The purpose of this article is to describe the roles of nurses on interprofessional elder mistreatment teams. Current nursing roles in the recognition and management of EM include assessment and screening, mandatory reporting, direct care, and complaint investigation. While the efforts of individual nurses in the detection and management of cases is important, EM is a complex problem that is best approached through interprofessional collaboration. In the greater Seattle area, such collaboration is accomplished through membership on the King County Elder Abuse Project teams. Nurses give expert opinion, educate team members, and provide case consultation. University faculty experience on the teams inspired the start of a Master's pathway in Forensic Nursing, focused nursing research, and increased public policy activity and community service. Nurses on interprofessional teams gain networking opportunities as well as experience with the system that is in place to protect and serve vulnerable adults.