Components and Indicators of Frailty Measures: A Literature Review.

BACKGROUND: Frailty is a debilitating condition in older adults that is associated with increased risks for adverse outcomes. However, the issue of quantifying frailty remains elusive. There is a lack of consistency in the frailty components and the corresponding indicators used to quantify these components. OBJECTIVE: 1) to describe the components of frailty and examine the existing measures of frailty; and 2) to identify current gaps in knowledge of frailty measures. METHODS: The PubMed, CINAHL, and Web of Science databases were searched. Each study was reviewed to determine its fit with inclusion/exclusion criteria. RESULTS: A total of 49 studies were identified and comprised the sample. Each study described one unique measure of frailty. The frailty components and corresponding indicators within three domains (physical, psychological, and social) were described. The most frequently reported components of frailty were mobility and balance, nutrition, and cognitive function. Fifteen of 49 frailty measures included components across all three domains. Current frailty measures were critiqued and important areas for future study are identified. CONCLUSIONS: The frailty components and corresponding indicators vary considerably across different frailty measures. Future studies are needed to address inconsistences in frailty measures and models.

Gender and age differences in nurses' triage decisions using vignette patients.

BACKGROUND: Although evidence indicates that women who suffer a myocardial infarction (MI) are less likely than men to be diagnosed based on their presenting symptoms, to receive aggressive treatment, and to survive an acute cardiac event, most studies conducted to date are retrospective chart reviews that examine the triage decision-making practices of physicians. OBJECTIVES: This study examined whether emergency department (ED) nurses' triage decisions were different when the nurse was presented with similar cues for MI, but different patient gender. METHOD: A nonexperimental, descriptive study was conducted. Five hundred ED nurses were randomly selected to receive a mailed clinical vignette questionnaire. Data analysis included descriptive, bivariate, and multivariate analyses. RESULTS: ED nurses perceived the middle-aged male vignette patient to be in need of more urgent triage (t = 2.58; df = 207; p = 0.01) and an admission to an intensive care unit bed (chi2 = 10.43; df = 1; p = 0.001) and were more likely to consider a cardiac diagnosis in the male than the age-matched female (chi2= 37.49; df = 1; p < 0.0001) with identical presentation. However, no such differences were noted in the elderly vignette patients. CONCLUSIONS: The findings of this study suggest that gender bias and ageism may account for the disparities in triage decisions for middle-aged women with complaints suggestive of coronary artery disease. Although middle-aged women may have a lower incidence of MIs than middle-aged men, their increased morbidity and mortality warrants its consideration.

Gender and age bias in triage decisions.

INTRODUCTION: Recently it has been recognized that women are less likely than men to be diagnosed with a myocardial infarction (MI) or to receive early or aggressive treatment and are more likely than men to die of an MI. The purpose of this qualitative study was to examine the triage decisions made by ED nurses for persons with symptoms suggestive of MI. The theoretical framework for this investigation was Hammond's lens model for clinical inference and Evan's two-stage reasoning model. METHOD: Four focus group sessions were conducted. The participant's oral descriptions were tape-recorded, transcribed verbatim, and analyzed using the Krueger method. RESULTS: Content analysis revealed several important issues influencing triage decisions: patient presentation, nursing knowledge and experience, practice environment, intuition, the fear of liability, and gender-specific behaviors. ED nurses held different perceptions regarding the significance and likelihood of MI for male and female patients seeking evaluation and treatment. In addition, ED nurses admitted that MI is not the first diagnosis considered for middle-aged women. DISCUSSION: The inability of ED nurses to associate middle-aged women's presenting symptoms with MI may contribute to the increased morbidity and mortality experienced by this population. The findings of this study have implications for nursing research, education, and practice.

Balancing calcium and phosphorus levels in chronic renal failure patients.

Patients with chronic renal failure (CRF) can develop problems such as lethargy, tetany, and muscle spasms, which can increase their morbidity and mortality. Because of their non-functioning kidneys, patients with CRF require in-depth and comprehensive monitoring of calcium (Ca) and phosphorus (P) levels. This article presents advanced nursing actions and critical thinking strategies for use by the critical care nurse when caring for patients with CRF.

Lived experiences of CNSs who collaborate with physicians: a phenomenological study.

Collaborative relationships with other disciplines is an important component of the CNS role. Literature is scant about CNS/physician collaboration. The purpose of this phenomenological qualitative study was to discover the lived experience of CNSs who experienced physician collaboration. Four CNSs described their experiences. Their oral descriptions were tape-recorded and transcribed verbatim. These descriptions were analyzed for meaning using the Giorgi method. Five themes emerged: (1) experiences mutual trust and respect, (2) maintains a nursing perspective, (3) establishes collegial relationships, (4) defines a practice role, and (5) lives a positive experience. The synthesized structural description of the collaboration emerged as a process of relationship building based on mutual respect, trust, and commitment to actualize this collegial manner of practice. CNSs can use information from this research to develop strategies to establish collaborative relationships with physicians.