A Scoping Review of Transitions, Stress, and Adaptation Among Emerging Adults.

This scoping review examined research on transitions among emerging adults, 18- to 30-year-olds, to identify designs, populations, frameworks, transition types, and transition outcomes. A librarian conducted the search, yielding 2067 articles. Using predefined criteria, teams screened abstracts and reviewed articles, with 82% to 100% interrater agreement. Data from the final 160 articles were placed in evidence tables and summarized. Most frequently, the studies had exploratory-descriptive designs (69%), nondiagnosed samples (58%), no theoretical frameworks (58%), developmental transitions (34%), and health-related behavior outcomes (34%). This transition research is in an early stage of knowledge development and would benefit from further theory development.

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial.

OBJECTIVES: To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. METHODS: We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. RESULTS: Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). CONCLUSIONS: Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.

Patient handling in the veterans health administration: facilitating change in the health care industry.

OBJECTIVE: To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership. METHODS: Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data. RESULTS: Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors. CONCLUSION: Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.

A comparison of student and faculty perceptions of clinical post-conference learning environment.

The purpose of this study was to repeat a study by Letizia and Jennrich that described and compared perceptions of the clinical post-conference learning environment of undergraduate baccalaureate student nurses (BSN) and faculty. The Clinical Post-Conference Learning Environment Survey (CPCLES) was sent electronically to all traditional and accelerated BSN students and faculty; 178 usable responses were returned. Both faculty and students perceived the environmental characteristics captured by the CPCLES were important, but were used less than expected (p<0.025). No differences were found between faculty and students in perceptions of importance and actual use of the post-conference learning environment. Results showed highest scores for the subscale Teacher Support for both faculty and students. Lowest scores were received for Innovation. The results suggest the important role faculty has in supporting students' efforts to understand and find meaning in clinical experiences. Post-conference learning experiences could be enriched by faculty efforts to increase active learning strategies and innovative experiences. Further research is needed to determine effectiveness of new approaches to the post-conference in facilitating clinical reasoning among student nurses, and promote students' ability to provide safe, high-quality care.

AORN ergonomic tool 7: pushing, pulling, and moving equipment on wheels.

Pushing and pulling equipment in and around the OR can place high shear force demands on perioperative team members' shoulder and back muscles and joints. These high forces may lead to work-related musculoskeletal disorders. AORN Ergonomic Tool 7: Pushing, Pulling, and Moving Equipment on Wheels can help perioperative team members assess the risk of pushing and pulling tasks in the perioperative setting. The tool provides evidence-based suggestions about when assistive devices should be used for these tasks and is based on current ergonomic safety concepts, scientific evidence, and knowledge of effective technology and procedures, including equipment and devices for safe patient handling.

AORN Ergonomic Tool 6: lifting and carrying supplies and equipment in the perioperative setting.

Perioperative team members often are required to lift and carry heavy supplies and equipment into and around the OR; this includes lifting equipment such as hand tables, fluoroscopy boards, stirrups, Wilson frames, irrigation containers for lithotripsy, and heavy instrument pans. Lifting heavy objects creates considerable risk for musculoskeletal injuries to the back and shoulders. AORN Ergonomic Tool 6: Lifting and Carrying Supplies and Equipment in the Perioperative Setting can help caregivers evaluate lifting and carrying tasks and take measures to protect themselves from injury. Caregivers can use the revised National Institute for Occupational Safety and Health lifting equation to assess whether a specific lifting task can be performed safely.

AORN Ergonomic Tool 5: Tissue Retraction in the Perioperative Setting.

Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction. During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction. Ergonomic Tool #5: Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered.

AORN Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings.

Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology.

AORN Ergonomic Tool 3: lifting and holding the patient's legs, arms, and head while prepping.

Lifting the arms, legs, or head of a patient while prepping these areas for surgery can exert strong forces on the muscles and joints of the shoulders and backs of perioperative team members who perform this task, which may lead to work-related musculoskeletal disorders. AORN Ergonomic Tool 3: Lifting and Holding the Patient's Legs, Arms, and Head While Prepping provides scientifically based determinations of the amount of weight perioperative personnel can safely lift and hold manually for up to one, two, and three minutes using one hand or both. If these weight limits are exceeded, additional staff members or assistive devices are needed to help with the task.

AORN ergonomic tool 2: positioning and repositioning the supine patient on the OR bed.

Positioning or repositioning a patient on the OR bed in preparation for a surgical procedure presents a high risk for musculoskeletal disorders, such as low-back and shoulder injuries, for perioperative personnel. Safe patient handling requires knowledge of current ergonomic safety concepts, scientific evidence, and equipment and devices to ensure that neither the patient nor the caregiver is at risk for injury. AORN Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed provides guidelines that enable perioperative personnel to determine safe methods for positioning and repositioning a patient in the semi-Fowler, lateral, or lithotomy position in preparation for surgery.

AORN ergonomic tool 1: Lateral transfer of a patient from a stretcher to an OR bed.

Moving patients can result in injuries to patients and staff members. Lateral patient transfers from a stretcher to an OR bed pose a high risk for musculoskeletal disorders, including lower back, shoulder, and neck injuries for perioperative personnel. AORN Ergonomic Tool 1: Lateral Transfer of a Patient from a Stretcher to an OR Bed helps perioperative staff members determine best practices for safe lateral patient transfers. Safe moving of the patient is determined by the starting and ending position required and the patient's weight. Current ergonomic safety concepts and scientific evidence regarding weight limits help to determine how many caregivers are needed to safely move patients and whether mechanical assistance is needed during lateral transfers.

Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.

OBJECTIVES: (1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment. DESIGN: This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records. SETTING: Three Veterans' Administration hospitals. PARTICIPANTS: Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment. RESULTS: Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls. CONCLUSIONS: This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment.

Longitudinal investigation of wandering behavior in Department of Veterans Affairs nursing home care units.

OBJECTIVES: To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. DESIGN: Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. SETTING: One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. PARTICIPANTS: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. MEASUREMENTS: MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. RESULTS: The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. CONCLUSION: A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.

Using a writing group to promote faculty scholarship.

Writing productivity is an essential component of scholarship. Barriers to writing include intrapersonal characteristics, faculty role complexity, and time constraints. Writing groups can increase faculty members' writing, contributing to dissemination of nursing knowledge and advancement of professional nursing. The authors discuss the structure and processes of a writing group that can be adapted by faculty interested in using comentoring to increase their scholarship.

Patterns of youths' glycemic control with insulin pump therapy.

Youths with type 1 diabetes mellitus may decide to use insulin pump therapy. Limited information describes youths' glycemic control with insulin pump therapy. A repeated-measures design guided data collection at five points from one month before insulin pump therapy through 12 months with insulin pump therapy. The research question was, "How do youths' hemoglobin A(1c) (HbA(1c)) values change with insulin pump therapy?" Glycemic control target was 7.6% HbA(1c) value. Thirty youths (9 to 18 years old) had at least 4 HbA(1c) values. Nineteen youths who achieved glycemic control had three different patterns during 12 months of insulin pump therapy. Eleven youths who did not achieve glycemic control had two different patterns. Multiple factors can influence a youth's glycemic control. Uncontrolled blood glucose levels increase the individual's risk for developing type 1 diabetes complications. Youths and health care providers need to work as a team to identify factors affecting the youth's glycemic control and discuss changes.

Recommendations for vertical transfer of a postoperative total hip replacement patient (bed to chair, chair to toilet, chair to chair, or car to chair).

Vertical transfers of postoperative orthopaedic patients pose a high risk to healthcare workers for developing work-related musculoskeletal disorders. The task is considered high risk based on weight limits and awkward positioning. A task force including representatives from the National Association of Orthopaedic Nurses, the American Nurses Association, the National Institute for Occupational Safety and Health, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Diligent Services, and Guldmann, Inc., developed an ergonomic tool for determining best practices for safe vertical transfers. Current concepts of ergonomic safety, scientific evidence, and safe patient-handling equipment and devices were incorporated into this ergonomic tool.

Development of the National Association of Orthopaedic Nurses guidance statement on safe patient handling and movement in the orthopaedic setting.

High-risk patient-handling tasks lead to work-related musculoskeletal disorders for orthopaedic nurses and other members of the healthcare team who are involved in moving patients with orthopaedic issues. Serious consequences can arise from manually moving/lifting these patients. A task force was organized that included representatives from the National Association of Orthopaedic Nurses, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, the National Institute for Occupational Safety and Health, and the American Nurses Association to identify high-risk tasks performed in the orthopaedic setting and to develop evidence-based solutions to minimize the risk of musculoskeletal disorders. High-risk tasks for moving and lifting orthopaedic patients were identified. Four orthopaedic algorithms and a clinical tool were developed by the task force to direct nurses and healthcare team members caring for orthopaedic patients through the use of scientific evidence and available safe patient-handling equipment and devices.

Safe vertical transfer of patient with extremity cast or splint.

Vertical transfers of patients with a cast/brace or sling on an upper or lower extremity from bed to chair pose a high risk for musculoskeletal injury. A task force was formed, including representatives from National Association of Orthopaedic Nurses, American Nurses Association, National Institute for Occupational Safety and Health, Patient Safety Center of inquiry at the James Haley Veterans Administration Medical Center in Tampa, FL, and related clinical experts. This task force developed an ergonomic decision-making tool (algorithm) to determine best practice for safe vertical transfer of a patient with an upper or lower extremity injury in a sling cast or brace. This tool was designed with current literature review, ergonomic safety concepts, and technology available.

Recommendations for turning patients with orthopaedic impairments.

Nurses and other caregivers face high risk for developing work-related musculoskeletal disorders associated with turning (logrolling) patients with orthopaedic conditions. The task is considered high risk on the basis of weight limits and awkward positioning. A task force including representatives from the National Association of Orthopaedic Nurses the American Nurses Association, the National Institute for Occupational Safety and Health, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Diligent Services, and Guldmann, Inc., developed an ergonomic tool for determining best practices for safe patient turning. Scientific evidence, concepts of ergonomic safety, and safe patient handling equipment were incorporated into this ergonomic tool.