Clinician assessment of blood alcohol levels among emergency department patients.

INTRODUCTION: Alcohol intoxication is a significant public health concern and is commonly seen among emergency department (ED) patients. This study was undertaken to identify the accuracy of clinician assessment of blood alcohol levels among emergency department patients. METHODS: This prospective survey study was conducted at a Level 1 Trauma Center. Eligible study participants included physicians, nurses, and medical students involved in the care of patients who had BAC. Clinicians estimated the BAC prior to results availability. RESULTS: Among 243 clinicians, the mean difference between the estimated BAC and actual BAC was 17.4 (95% CI: 4.7 to 30.1). Providers tended to overestimate the actual BAC level. The accuracy between roles (attendings, residents, RNs, students) was not significant (ANOVA p-value 0.90). Accuracy was not correlated with age of the patient (Pearson correlation 0.04, p-value 0.54). Accuracy was not associated with the patient's gender (Student's t-test two-tailed p-value 0.90), ethnicity (White versus all others, t-test p-value 0.31), nor insurance (government versus not government, t-test p-value 0.81). The average accuracy value was associated with mode of arrival (t-test p-value 0.003). The average accuracy for walk-in subjects was -14.9 (CI: -32.8 to 3.1) compared to ambulance arrivals 28.3 (CI: 12.7 to 44.0). Providers underestimated BAC for walk-ins and overestimated BAC for ambulance arrivals. Among 107 patients with a BAC of 0, clinician estimates ranged from 0 to 350. Clinicians estimated non-zero BAC levels in 17% of patients with BAC of 0 (N = 18). CONCLUSIONS: Clinicians' estimates of BAC were often inaccurate, and often overestimated the BAC.

Identifying second language speech tasks and ability levels for successful nurse oral interaction with patients in a linguistic minority setting: an instrument development project.

One of the most demanding situations for members of linguistic minorities is a conversation between a health professional and a patient, a situation that frequently arises for linguistic minority groups in North America, Europe, and elsewhere. The present study reports on the construction of an oral interaction scale for nurses serving linguistic minorities in their second language (L2). A mixed methods approach was used to identify and validate a set of speech activities relating to nurse interactions with patients and to derive the L2 ability required to carry out those tasks. The research included an extensive literature review, the development of an initial list of speech tasks, and validation of this list with a nurse focus group. The retained speech tasks were then developed into a questionnaire and administered to 133 Quebec nurses who assessed each speech task for difficulty in an L2 context. Results were submitted to Rasch analysis and calibrated with reference to the Canadian Language Benchmarks, and the constructs underlying the speech tasks were identified through exploratory and confirmatory factor analyses. Results showed that speech tasks dealing with emotional aspects of caregiving and conveying health-specific information were reported as being the most demanding in terms of L2 ability, and the most strongly associated with L2 ability required for nurse-patient interactions. Implications are discussed with respect to the development and use of assessment instruments to facilitate L2 workplace training for health care professionals.

The Eden Alternative: findings after 1 year of implementation.

BACKGROUND: This study examines the effects of the Eden Alternative (EA), a systematic introduction of pets, plants, and children into a nursing home, on the quality of life of nursing home residents. METHODS: Two nursing homes run by the same organization participated. The study site began implementing the EA in November 1998. The control site continued traditional care. Patient-level data from the Minimum Data Set (MDS), Version 2.0, and aggregate data based on staff reports were used to compare the residents at the two sites in terms of cognition, survival, immune function, functional status, and cost of care after 1 year. RESULTS: After adjusting for baseline differences, follow-up MDS data indicated that the Eden site had significantly greater proportions of residents who had fallen within the past 30 days (p =.011) and residents who were experiencing nutritional problems (p <.001). Staff report data indicated that, during the study period, the Eden site had significantly higher rates of residents requiring skilled nursing and hypnotic prescriptions, and more staff terminations and new hires. The control site had significantly higher rates of residents requiring anxiolytic prescriptions. CONCLUSIONS: The findings from this study indicate no beneficial effects of the EA in terms of cognition, functional status, survival, infection rate, or cost of care after 1 year. However, qualitative observations at the Eden site indicated that the change was positive for many staff as well as residents, suggesting that it may take longer than a year to demonstrate improvements attributable to the EA.