Randomized Controlled Trial of Acupressure for Perception of Stress and Health-Related Quality of Life Among Health Care Providers During the COVID-19 Pandemic: The Self-Acupressure for Stress (SAS) Trial.

Background: The efficacy of providing self-acupressure educational materials in reducing stress and improving health-related quality of life (HRQOL) is uncertain. Evidence-based data to recommend for or against self-acupressure as an intervention for reducing stress and improving HRQOL is needed. Objective: The Self-Acupressure for Stress (SAS) trial evaluates whether providing self-acupressure educational materials would reduce stress and improve HRQOL among health care providers (HCPs). Design: Randomized behavioral clinical trial. Setting: The entire study took place remotely. Participants: One hundred fifty-nine adult HCPs with no prior experience or training in acupressure. Intervention: The intervention group received self-acupressure educational materials. Measurements: Primary outcomes were perception of stress measured by the Perceived Stress Scale (PSS), as well as scores on the physical and mental components of the 12-item Short Form Health Survey version 2 (SF-12v2). Results: From the baseline to midpoint evaluations, the intervention group significantly reduced their PSS score (P ≤ .001) and increased their SF-12v2 Mental score (P = .002) but not their SF-12v2 Physical score (P = .55). These findings persisted at the final follow-up (both PSS and SF-12v2 Mental changes from baseline P < .001). However the control group also significantly improved their SF-12v2 Mental from baseline to midpoint (P = .01) which was maintained at final follow-up (P = .02), whereas PSS and SF-12v2 Physical did not significantly change from baseline at either mid or final. Finally, the intervention group improved by significantly more than the control group from baseline to final follow-up for both PSS (P = .007) and SF-12v2 Mental (P = .02) HRQOL measures. Limitation: The trial was not blinded. Conclusion: Among HCPs during the coronavirus disease 2019 (COVID-19) pandemic, the provision of self-acupressure educational materials safely improved self-reported assessments of perception of stress and mental health. Self-acupressure represents a promising intervention for other populations. The study findings support the use of self-acupressure to reduce stress and improve HRQOL. Trial Registration: ClinicalTrials.gov: NCT04472559.

Determining care management activities associated with mastery and relationship strain for dementia caregivers.

OBJECTIVES: To identify specific care management activities within a dementia care management intervention that are associated with 18-month change in caregiver mastery and relationship strain. DESIGN: Exploratory analysis, using secondary data (care management processes and caregiver outcomes) from the intervention arm of a clinic-level randomized, controlled trial of a dementia care management quality improvement program. SETTING: Nine primary care clinics in three managed care and fee-for-service southern California healthcare organizations. PARTICIPANTS: Two hundred thirty-eight pairs: individuals with dementia and their informal, nonprofessional caregivers. MEASUREMENTS: Care management activity types extracted from an electronic database were used as predictors of caregiver mastery and relationship strain, which were measured through mailed surveys. Multivariable linear regression models were used to predict caregiver mastery and relationship strain. RESULTS: For each care manager home environment assessment, caregiver mastery increased 4 points (range 0-100, mean+/-standard deviation 57.1+/-26.6, 95% confidence interval (CI)=2.4-5.7; P=.001) between baseline and 18 months. For every action linking caregivers to community agencies for nonspecific needs, caregiver mastery decreased 6.2 points (95% CI=-8.5 to -3.9; P<.001). No other care management activities were significantly associated with this outcome, and no specific activities were associated with a change in caregiver relationship strain. CONCLUSION: Home assessments for specific needs of caregivers and persons with dementia are associated with improvements in caregivers' sense of mastery. Future work is needed to determine whether this increase is sustained over time and decreases the need for institutionalization.

Boron workers in China: exploring work and lifestyle factors related to boron exposure.

This article describes the lifestyle patterns of boron mining and processing workers (N=936) and a comparison group (N=251) in northeast China, and explores relationships between boron exposure and reproductive health. An English version of an interview guide addressing areas of work and lifestyle relevant to boron exposure and metabolism was developed by an occupational health research team, translated to Chinese, and translated back, for clarity. Modifications incorporated suggestions from a local community advisory board and boron industry workers; the translation-back translation process was reapplied, and cultural and semantic equivalence was attained. Results from the interviews showed more than 64% of workers and comparison group participants smoked tobacco and more than 92% reported exposure to environmental tobacco smoke. Boron workers and the comparison group varied in their food intake and alcohol consumption, but not in their smoking habits. Thirty-four percent of boron workers reported eating in the contaminated work area. Nearly all boron workers (99%) showered or bathed after work, although approximately 10% redressed in their contaminated clothes. Reproductive health outcomes were explored, including delayed pregnancy, multiple births, spontaneous miscarriages, induced abortions, stillbirths, and an unusual ratio of male to female offspring. Implications for occupational health nurses and recommendations for future research are provided.

Keeping nursing home residents hydrated.

The purpose of this research is to ascertain nursing home (NH) staffs' perspectives of the problem of dehydration in NHs (skilled nursing facilities) and have them identify clinically practical interventions to ensure that NH residents consistently take adequate fluids. Four focus groups with 28 NH staff members in attendance are held in three NHs in metropolitan Los Angeles. The majority of participants are certified nursing assistants; however, licensed vocational nurses, registered nurses, and other NH staff also attend the groups. Content analytic techniques are used to analyze the data. Three themes emerge focusing on residents' reasons for not drinking, signs and symptoms of dehydration, and strategies for improving hydration in NH residents. NH staff members identify the complexity of providing adequate hydration that was influenced by the resident's relationship with family and NH staff and communication between staff members.

Perceived helpfulness of telephone calls--providing support for caregivers of family members with dementia.

The purpose of this study was to determine the perceived helpfulness of telephone calls to 83 caregivers of family members with dementia. Study participants were assigned by groups to experimental (n = 41) or attention-only control (n = 42) conditions. Initial baseline interview data and narrative transcripts of telephone calls were used in this study. Major perceived reasons for helpfulness were that participants were assisted in sharing thoughts and feelings, expressing feelings of being overwhelmed, discussing physical and psychosocial problems, forgetting the situation, seeking reassurance, and asking for information; several participants perceived the telephone calls to be lacking in helpfulness. Results from this study suggest family caregivers can be helped through a variety of social support mechanisms.

Bridging the digital divide: reaching vulnerable populations.

The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.

Factors influencing health promoting activities of mothers caring for ventilator-assisted children.

The extensive care a ventilator-assisted child (VAC) requires when cared for in the home can impact the mother's ability to participate in health promotion activities. The purpose of this study was to examine health promotion activities and the relationships among functional status of the child, impact of the illness on the family, coping, social support, and health promotion activities of mothers who care for ventilator-assisted children at home. Thirty-eight primary female caregivers, mostly mothers, participated in the study and completed the Personal Lifestyle Questionnaire (PLQ), measures of child's functional status, impact of the illness on the family, coping, social support, and demographic data. Findings revealed that the mothers scored low on the nutrition, exercise, relaxation, and general health promotion subscales of the PLQ. Functional status of the child and coping were positively correlated with participation in health promotion activities, whereas impact of the child's illness on the family was inversely related to health promotion of the mothers. Regression analysis revealed that functional status of the child and coping were significant predictors of mothers' participation in health promotion activities. The high demands associated with caring for a VAC with poor functioning can be a significant risk factor for not participating in health promotion activities. Nurses need to help mothers with coping and finding resources to help mediate the stress related to caring for their child, thereby helping the mothers to maintain their own health.

Variations in nurse practitioner use in Veterans Affairs primary care practices.

BACKGROUND: Increasingly, primary care practices include nurse practitioners (NPs) in their staffing mix to contain costs and expand primary care. To achieve these aims in U.S. Department of Veterans Affairs medical centers (VAMCs), national policy endorsed involvement of NPs as primary care (PC) providers. OBJECTIVES: To evaluate the degree to which VAMCs incorporated NPs into PC practices between 1996 and 1999, and to identify the internal and external practice environment features associated with NP use. STUDY DESIGN: We surveyed 131 PC directors of all VAMCs in 1996 and 1999 to ascertain the staffing and characteristics of the PC practice and parent organization (e.g., academic affiliation, level of physician staffing, use of managed care arrangements), and drew on previously published studies and HRSA State Health Workforce Profiles to characterize each practice's regional health care environment (e.g., geographic region, state NP practice laws, state managed care penetration). Using multivariate linear regression, we evaluate the contribution of these environmental and organizational factors on the number of NPs/10,000 PC patients in 1999, controlling for the rate of NP use in 1996. PRINCIPAL FINDINGS: From 1996-1999, NP use increased from 75 percent to 90 percent in VA PC practices. The mean number of NPs per practice increased by about 60 percent (2.0 versus 3.2; p<.001), while the rate of NPs/10,000 PC patients trended upward (2.2 versus 2.7; p=.09). Staffing of other primary care clinicians (e.g., physicians and physician assistants per practice) remained stable, while the NP-per-physician rate increased (0.2 versus 0.4; p<.001). After multivariate adjustment, greater reliance on managed-care-oriented provider education programs (p=.02), the presence of NP training programs (p=.05), and more specialty-trained physicians/10,000 PC patients (p=.09) were associated with greater NP involvement in primary care. CONCLUSIONS: Staffing models in VA PC practices have, in fact, changed, with NPs having a greater presence. However, we found substantial practice-based variations in their use, suggesting that more research is needed to better understand how they have been integrated into practice and what impact their involvement has had on the VA's ability to achieve its restructuring goals.

Internet intervention for community elders: process and feasibility.

The aim of this report is to describe the process and feasibility of having elders respond to standardized questionnaires in an Internet intervention program for caregivers of persons with dementia. Twenty-one persons with dementia (mean 75 years), and their spouse caregivers (mean age of 65 years) used the intervention program and responded to the questionnaires. Results indicated that with adequate support, elderly caregiver participants were able to provide responses to standardized questionnaires comparable to scores found in other caregiver studies using traditional methods. Suggestions are provided for further testing.

Factors associated with complementary therapy use in people living with HIV/AIDS receiving antiretroviral therapy.

OBJECTIVES: This study examined the extent to which people living with HIV/AIDS (PLWHIV) taking combination antiretroviral therapy used complementary therapy, and the relationship of their reported symptoms to the use of complementary therapy and health-related outcomes. DESIGN: A descriptive design was used in which data were obtained from individual interviews and medical records. SETTINGS: PLWHIV were identified through flyers distributed in five HIV clinics in urban and suburban locations in a Western state of the United States. SUBJECTS: The sample consisted of 182 people living with HIV/AIDS, self-identified as white (24.12%), black (44%), and Hispanic (31.88%) with a mean age of 38 (range, 22-66) years. The majority (n = 160; 87.91%) was using as least one category of complementary therapy. Approximately 56% were experiencing symptoms from HIV or their treatment, and 51% discussed their complementary therapy therapies with their health care providers. OUTCOME MEASURE: Three categories of complementary therapy--physical/body-mind therapies, religion, herbs and supplements--and two health-related outcomes--CD4 count and viral load--were explored. RESULTS: Complementary therapy use was associated with higher education, being Christian, white or black, and working part or full time. Significantly more PLWHIV with symptoms used physical/body-mind therapies than those without symptoms. No differences were found between users and nonusers of complementary therapy with respect to CD4 count and viral load. The use of herbs/supplements was significantly associated with the use of protease inhibitors. Among the categories of complementary therapy, religion, especially prayers, were most frequently used. CONCLUSIONS: A substantial proportion of PLWHIV reported using complementary therapy, most predominantly religion (specifically prayers). Further study is recommended to explore the PLWHIV's perceived benefits of using complementary therapy, and to examine the effect of complementary therapy on the patients' symptoms and disease progression. Health care providers need to be alert to potentials of interactions between combination antiretroviral therapies and specific complementary therapy in PLWHIV.

Use of personal digital assistants by adolescents with severe asthma: can they enhance patient outcomes?

Despite the emphasis placed on asthma education, asthma mortality is on the increase, with rates of disability higher in adolescents. Technology provides unprecedented opportunities for developing means to manage, control, and prevent acute episodes in chronic illnesses. This article describes the use of handheld wireless computer devices (eg, personal digital assistant or pocket personal computer) to prevent emergency department visits and to improve outcomes for patients with severe persistent asthma. The uses of personal digital assistants and challenges encountered in their use are described. Recommendations regarding nurses' contribution in the design, implementation, and evaluation of the program patient outcomes are provided.

Evaluating quality of telehealth advice nursing.

Despite an increased interest in advice nursing, the quality of care has not been addressed. This article examines the quality of the nursing process (including problem identification, care planning, intervention, and evaluation) and its relationship to patient (consumer) outcomes. A sample of 157 nonredundant telephone calls from adults with medical-surgical problems were audiotaped, with providers' and callers' consent, and were rated through an implicit review method by registered nurse raters. The quality of the nursing process was found to be the best in the area of intervention. Patient (consumer) satisfaction was high with 95.4% of the consumers rating the calls as completely or at least somewhat satisfying, and 93.2% stating the advice was very or somewhat helpful. This study pioneers a way to rate the quality of advice nursing and lays the groundwork for further investigations of health care provider behavior and consumer outcomes.

Evaluating quality of nursing care: the gap between theory and practice.

The purpose of this article is to determine whether nursing practice, as judged by nurse peer reviewers, varies by type or location of hospital and to assess which aspects of practice tend to be most at variance with nursing theory. This article provides a framework of continued quality assessment and improvement that is based on prior research. Trained nurse peer reviewers carried out structured implicit review, which utilized their professional judgment to evaluate the process of nursing care for patients admitted to acute hospitals with heart failure or cerebrovascular accident. Findings show significant variations in the quality of nursing care and support the continued development of nursing quality assessment and improvement initiatives directed at reducing the gap between nursing theory and practice.

Use of protocols and guidelines by telephone nurses.

Changes in health care delivery, specifically the addition of telephone advice, affect how nurses work and how patients perceive care. It is important to understand the resources available to these nurses, the process by which they provide care, and patient outcomes. This descriptive study describes one type of resource, the availability and use of protocols. It also describes relationships between protocols and the quality of the nursing process and patient outcomes. Two-hundred-three taped calls to 32 advice RNs and 156 patient follow-up calls were used to measure protocol usage, nursing process quality, and patient outcomes. Although protocols were available for 78.8% of the calls, nurses varied in their extent of use (63.9% not fully used). There was a negative relationship (r = -0.395, p < 0.000) between the availability of protocols and overall quality of the nursing process. Protocol availability and use did not affect patient outcomes.