Comparison of Balance Program Outcomes among Independently Living and Assisted Living Residents.

Falls are a serious health concern for older adults. The purpose of this single group repeated measures intervention was to compare effects of the fall prevention program, A Matter of Balance Volunteer Lay Leader Model (MOB-VLLM), between individuals residing independently in the community (n = 24) and those residing in assisted living (AL) (n = 15). Surveys were completed immediately post intervention and 6 weeks, and 3, 6, 9, 12, and 18 months after. Being younger and living in AL predicted program attendance. Perceived control of fall risk increased post intervention (PS t-test: t = 4.004, df = 38, p<0.001), and the degree fear of falling impacts social activity was lower post intervention (WSR: Z = -3.104, p = 0.002). Current level of exercise was higher post intervention (WSR: Z = -2.099, p = 0.036). Control of falls, impact on social activity, fear of falling, and depression scores remained the same post intervention through follow up for both groups.

Retrospective Evaluation of the Impact of a Geriatric Trauma Institute on Fragility Hip Fracture Patient Outcomes.

BACKGROUND: Fragility hip fractures occur in the older than 65-year population at an alarming rate. It is estimated that 260,000 hip fractures occur annually. Patient outcomes following hip fractures are devastating. One of every 5 patients dies within 1 year of injury, and 1 of 3 remains in a nursing home for years after the injury. Published literature recommends an interdisciplinary approach to caring for hip-fractured patients and expediting surgery to improve outcomes. PURPOSE: The purpose of this study was to retrospectively evaluate the impact of the Geriatric Trauma Institute (GTI) on fragility hip fracture patient outcomes. Specific outcomes included length of stay (LOS), length of time from emergency department (ED) arrival to operating room (OR), complication rate, and discharge destination. METHODS: This study is a single-center pre- and post-retrospective chart review. Data were collected using database queries within the hospital system. Pre-GTI (n = 326) patients older than 65 years with International Classification of Disease, Ninth Revision (ICD-9) codes 820.0-820.9 (hip fractures) admitted to either a primary care physician or orthopaedic surgeon service between April 1, 2011, and April 1, 2013, were compared with post-GTI (n = 245) patients older than 65 years with ICD-9 codes 820.0-820.9 (hip fractures) admitted to trauma services (GTI) between May 1, 2013, and May 1, 2015. Descriptive statistics including demographic data (age, sex) and comparison of outcomes (LOS, ED to OR time, complications, and disposition) across the groups using standard analysis of variance (ANOVA) and correlation techniques. RESULTS: No statistical difference was found between groups for age, sex, or time from ED to OR pre- versus post-time period using one-way ANOVA, F(1,569) = 1.08, p = .30. The complication rate was calculated pre- and post-GTI and compared using the 2-proportion z-test. The difference between the pre-GTI group (16.6%; 54 of 326 patients) and the post-GTI group (9.4%; 23 of 245 patients) was statistically significant, p = .013. Mean LOS was statistically significantly higher in the pre-GTI group (M = 5) than in the post-GTI group (M = 5.2), U = 33,55, z = -3.32, p = .001. No statistical significance was found between pre- and postdischarge destination, χ(4) = .4.82, p = .307; likelihood ratio test, χ(4) = .5.19, p = .269. CONCLUSIONS: This retrospective pre- and post-GTI chart review demonstrates the effectiveness of a multidisciplinary team approach in decreasing complications and LOS for fragility hip-fractured patients. A team approach to the care of these patients improves outcomes and quality of life.

Effects of a video guided T'ai Chi group intervention on center of balance and falls efficacy: a pilot study.

This pilot study evaluated effects of a video-guided T'ai Chi group intervention on center of balance (COB) and falls efficacy, using a one arm, pre/post design. Thirty-two participants began the study, 17 completed pre- and post-testing and 15 were lost to follow-up. Outcomes were compared for the 17 participants who completed pre- and post-testing and subgroups based on session attendance. Irrespective of session attendance, participant COB scores improved. There was a significant negative correlation between number of sessions attended and pre and post scores on the fall efficacy (fear of falling) measure, indicating those with higher fear of falling were less likely to complete the study. Older participants were also less likely to continue participation. Findings indicate potential benefits of T'ai Chi in improving COB (a fall risk factor) among community-dwelling older adults. However, those with greater potential benefit (higher fear scores, older participants) were less likely to continue participation.

Evaluation of a virtual geriatric trauma institute.

Geriatric trauma patients require specialized care. Objective of this study was to compare outcomes for geriatric trauma patients before and after the implementation of a virtual geriatric trauma institute. This is a retrospective chart review of 583 trauma patients older than 65 years admitted to a rural level 1 trauma center before and after the implementation of a geriatric trauma institute. Length of stay was decreased from 4.99 to 3.9 days (P = .0014). Emergency department length of stay was decreased by approximately 10 minutes (P = .059), and time from the emergency department to the operating room was decreased by 470 minutes (P = .262).

Trauma-induced coagulopathy.

Coagulopathy is the inability of blood to coagulate normally; in trauma patients, it is a multifactorial and complex process. Seriously injured trauma patients experience coagulopathies during the acute injury phase. Risk factors for trauma-induced coagulopathy include hypothermia, metabolic acidosis, hypoperfusion, hemodilution, and fluid replacement. In addition to the coagulopathy induced by trauma, many patients may also be taking medications that interfere with hemostasis. Therefore, medication-induced coagulopathy also is a concern. Traditional laboratory-based methods of assessing coagulation are being supported or even replaced by point-of-care tests. The evidence-based management of trauma-induced coagulopathy should address hypothermia, fluid resuscitation, blood components administration, and, if needed, medications to reverse identified coagulation disorders.

Postoperative Ileus.

Postoperative ileus (POI) is a possible complication after abdominal surgery. The exact pathophysiology is unknown. Nurses should be aware of associated symptoms and evidence-based treatments to prevent or reduce the time of POI.

Nursing students with latex allergy.

Latex allergy affects millions of people in the general population and a higher percentage of health care workers. Nursing students with a latex sensitivity pose a unique challenge for the nurse educator. Students may enter the program with pre-existing latex allergy or develop the allergy during the educational process. This manuscript explores the implications of latex allergies exhibited by the nursing student. It addresses the responsibilities of the educator in the skills or simulation laboratory and during clinical learning experiences. It also offers suggestions for ensuring the safety of the student while reducing the legal liabilities of the educational program. The article addresses possible policy ramifications for nursing schools.

Using problem-based learning in staff development: strategies for teaching registered nurses and new graduate nurses.

Problem-based learning, described as an active teaching strategy, provides a framework for the development of self-directed learning, self-evaluation, interpersonal communication, critical thinking, and access and retrieval of information. This teaching method can be modified to fit almost any situation. Problem-based learning provides an opportunity to actively engage staff members in learning situations, making it a great asset for teaching in staff development. This article describes the use of problem-based learning for teaching registered nurses and new graduate nurses. It provides a scenario and facilitator guide pertaining to a real patient situation on an inpatient telemetry unit and offers general tips for implementing problem-based learning in staff education.

Leadership in school nursing.

Whether you are new to school nursing or have been practicing for years, you must be aware that the title of school nurse puts you in a position of leadership. You lead students, faculty and staff in your school; you lead the community in which you live and work. You guide people toward health. They request information when faced with a health crisis. You take control in emergencies. School nurses are at the forefront of developing school health policies and procedures. Do you have the qualities of a leader? "The 21 Indispensable Qualities of a Leader" (Maxwell, 1999) expounds the characteristics of a good leader. This book helps the school nurse in the quest toward leadership. The following is a discussion of the main points of this book and their application to school nursing.

Clean intermittent catheterization in the school setting.

Spina bifida (SB) is a neural tube defect that causes many physical and mental disabilities. Bowel and bladder incontinence is the disability seen most often in these students that requires the school nurse's attention. Clean intermittent catheterization (CIC) provides the student with SB a vehicle to reach a satisfactory level of continence, helps build self-esteem, and allows the student greater independence. The school nurse assists the student with SB with CIC in the school setting and reinforces the importance of correct technique with the student, family, and other personnel caring for the student. The success of a continence management program at school is dependent on all these individuals working together with the common goal of maintaining normal renal function, gaining urinary continence, and promoting independence of the student.