Does the functional assessment measure (FAM) extend the functional independence measure (FIM) instrument? A rasch analysis of stroke inpatients.

Adding the items of the Functional Assessment Measure (FAM) to the Functional Independence Measure (FIM instrument) has been proposed as a method to extend the range of the FIM, particularly when assessing functional status in rehabilitation patients with brain injury, including stroke. It has been proposed that this approach is especially helpful in ameliorating ceiling effects when brain-injured patients have reached the end of their inpatient rehabilitation stay or are being seen in outpatient settings. In the present study, 376 consecutive stroke patients on a Canadian inpatient rehabilitation unit were concurrently administered the FIM and the FAM. Rasch analysis was used to evaluate how well the FAM items extended the difficulty range of the FIM for both the Motor and Cognitive domains. Within the Motor domain, only the FAM item assessing Community Access was found to be more difficult than extant FIM items, and this item showed some tendency to misfit with the other motor items. In the Cognitive domain, the only FAM item with a higher difficulty level than the FIM items was that assessing Employability. Notably, strict adherence to scoring guidelines for these two FAM items requires taking patients out into the community to evaluate their actual performances, a practice unlikely in the typical inpatient stroke rehabilitation unit. Results indicate that use of the entire FAM as an adjunct to the FIM reduces test efficiency while providing only minimal additional protection against ceiling effects.

Taste, temperature, and presentation predict satisfaction with foodservices in a Canadian continuing-care hospital.

OBJECTIVE: To identify food, service, and patient variables associated with high satisfaction with foodservices in a continuing-care hospital that serves, primarily, geriatric patients and patients undergoing physical rehabilitation. DESIGN: Survey questionnaire concerning eight aspects of food and foodservice as well as type of diet and major patient descriptors. SUBJECTS: All patients from geriatric continuing-care units, geriatric rehabilitation units, and physical rehabilitation units at Saint-Vincent Pavilion were considered potential respondents. A convenience sample of 65 clients met the established inclusion criteria and were willing to participate. Patients had to be able to communicate their views, and the clinical nursing staff judged all respondents to be cognitively able to provide opinions concerning food and foodservice. The mean age of subjects was 67 years, the mean length of stay in the hospital was 2 years, and 60% of the subjects were women (n = 39). STATISTICAL ANALYSES: Spearman rank correlations, univariate analyses (t tests for continuously distributed data, chi 2 tests for categorical data), and multivariate analyses (regular and logistic regression). RESULTS: In general, patients questioned were extremely positive about the quality and quantity of food and foodservices at this continuing-care/rehabilitation hospital. Type of diet and patient characteristics were not differentially associated with high levels of overall satisfaction with foodservices (as assessed by a general satisfaction question). Univariate analyses revealed that all aspects of foodservices (except quantity of food) were significantly correlated with overall satisfaction. Multivariate analyses showed that satisfaction with presentation of meal was the best predictor of overall satisfaction and that clients who were very satisfied with the taste of food and were very satisfied that cold food was cold enough were the most satisfied overall. Knowledge of key variables as assessed by multivariate analyses (ie, taste and coldness) predicted whether clients were very satisfied overall 80% of the time. APPLICATIONS: Surveys are usefull tools for assessing the ways in which clients view the food and services provided by dietitians. Dietitians in continuing-care settings need to focus on a few specific characteristics related to what is eaten and how food is presented, rather than on patient-specific variables, when trying to maximize satisfaction with hospital food. The information in this study can be used as a baseline against which future data can be compared. The survey contributes to a continuing quality assurance process that allows dietitians to track the effect of changes that are made to food and foodservices and to monitor areas that require modification.

Changing bowel hygiene practice successfully: a program to reduce laxative use in a chronic care hospital.

Laxative use was significantly reduced in our long-term care facility when an interdisciplinary program based on a philosophy of prevention and health promotion was implemented. Specifically, increased fluid and fiber intake, timely toileting habits, and regular activity/exercise led to a halving of the number of patients receiving laxatives as required, relative to pre-program levels and relative to a control unit not receiving the program.

Patient death in a long-term care hospital. A study of the effect on nursing staff.

1. The most common ways in which staff were affected by patient death were "low morale" and "loss of efficacy at work." 2. Staff most commonly reported coping with death by "sharing feelings," knowing that their "work contributed to a good death" and by "placing death in a good light," although one in five nurses reported no strategy for dealing with patient death. 3. Nurses who are most affected by patient death have a more difficult time caring for younger patients, tend to "take their stress home" and are more likely to base their nursing care on a personal relationship with the patient, than nurses who are less affected.

Purposes and structures of Canadian hospital-based research: results of a national survey.

Little is known about the current extent, purpose and organization of research within Canadian hospitals. As hospitals face the challenge of reorganization, such information would seem essential. To explore this issue, the authors surveyed Canadian hospitals with more than 100 beds. The results, reported here, reveal that almost all of responding hospitals had engaged in some form of research in the previous 12 months, although the type and number of research projects tended to vary with size of hospital and the status of university affiliation. The study also found that most hospitals have resources specifically dedicated to research, conduct ethical reviews and engage in interdisciplinary research. The vast majority of respondents felt that hospital-based research would assume more importance in the future.

Puréed diet: prevalence and reported reasons for use in a long-term care hospital.

Although puréed diets are thought to be widely used for patients in long-term care facilities, there is little specific information concerning prevalence and reasons for the actual use of this diet texture. At Saint-Vincent Hospital, a 516 bed, long-term care and rehabilitation facility, 25.9% of the chronic-care population (n = 424) were on a puréed diet. Those who received puréed diets tended to be older (83.5 years versus 75.4 years, P < 0.001) and were more likely to be female (82.7% versus 70.8% P < 0.006), than the total population of long-term care patients. A greater percentage of patients receiving a puréed diet had dementia (43.0% versus 30.6%, P < 0.02), and fewer had cerebrovascular accident as a primary diagnosis (22.6% versus 33.9%, P < 0.05), than the total population of long-term care patients at this hospital. Following data collection, reasons for patients being on a puréed diet were grouped into five categories. The most popular categories were "Physiological/Mechanical" and "Cognitive" problems.

Streptokinase use in children undergoing cardiac catheterization.

The development of cardiac catheterization procedures in the pediatric population has evolved from diagnostic in nature to present day advanced technology and interventions. A complication of vessel occlusion secondary to large catheters, length of procedures, and patient size requires immediate intervention. The advent of thrombolytic agents has provided a highly effective mode of treatment in restoring circulation. The use of streptokinase, its efficacy, side effects, and nursing management are discussed.