Wheelchair Seated Posture and Health Outcomes of Older Veterans in Community Living Centers.

PURPOSE: Nursing home residents sit in wheelchairs (WCs) for extended periods, often with slumped posture. They often experience pneumonia, pressure ulcers, and pain. This study described WC seated posture with its selected predictors and outcomes in the nursing home environment, throughout the daytime hours of 1 day. DESIGN AND METHODS: This observational study (n = 45) in two Veterans Administration Community Living Centers introduced a new measure of WC fit and described WC seated posture of older Veterans, with selected predictors and outcomes. FINDINGS: Wheelchair seated posture was predicted by cognitive status, WC fit, WC skills, and duration of sitting, but not by level of sitting ability. Poor posture measured by the Seated Posture Scale was associated with pain. Highest interface pressures measurable were seen in peak pressure index (PPI = 200 mm Hg), indicating risk of pressure injury. Veterans often denied discomfort, possibly lowering overall pain scores, while reporting severe pain in specific body parts. CONCLUSIONS: Wheelchair seated posture was predicted by cognitive status, WC fit, WC skills, and duration of sitting. Poor posture was associated with pain, and poor posture was an outcome of poor WC fit. Poor WC fit in this study supported earlier findings in non-Veterans Administration nursing homes.

Pressure Ulcer Prevalence by Level of Paralysis in Patients With Spinal Cord Injury in Long-term Care.

OBJECTIVE: Scientific literature suggests pressure ulcer (PU) risk increases as immobility increases, indicating that more extensive paralysis confers a greater risk of PU. Yet the specific level of paralysis (ie, hemiplegia vs paraplegia vs quadriplegia), apart from neurodegenerative diagnoses, has never been examined in the long-term care (LTC) population. This study examined the prevalence of PU among LTC residents with different paralysis levels. METHODS: The authors conducted a secondary data analysis of the 2012 US Minimum Data Set of LTC facilities (n = 51,664 residents). Measures included PU stage, level of paralysis, functional impairments, comorbidities, and sociodemographic factors. After removing residents with neurodegenerative disease, comatose patients, and those with hip fractures from the analysis, logistic regressions were used to examine the association of risk factors and sociodemographic characteristics with the presence of PU. MAIN RESULTS: The sample included 7,540 patients with quadriplegia, 11,614 patients with paraplegia, and 32,510 patients with hemiplegia in LTC facilities. The PU prevalence in the sample (stages 2, 3, and 4; suspected deep-tissue injury; and unstageable PUs) was 33.9% for patients with quadriplegia, 47.4% for patients with paraplegia, and 9.6% for patients with hemiplegia. CONCLUSIONS: Within paralysis groups (quadriplegic, paraplegic, hemiplegic), risk factors for PU differed in type and magnitude. The PU rates associated with quadriplegia and paraplegia are much higher than LTC residents without paralysis, and PU prevalence for hemiplegia is similar to the rate in LTC residents without paralysis. When the risk factor of paraplegia versus quadriplegia was isolated, PU prevalence for patients with paraplegia was significantly higher.

Nurse Author: Who Me? Yes, You!

BACKGROUND AND PURPOSE: Potential nurse authors may find writing a challenge, including managing the publication process from getting started through submission to revision of the work and its acceptance. This special article presents strategies to help inexperienced writers develop and hone skills for journal publication. POTENTIAL PUBLICATION STRATEGIES: Tips discussed here that may lead to manuscript acceptance include selecting a topic of interest, using motivational self-talk approaches and structuring time to write, choosing coauthors, targeting a journal for submission, writing strong sentences in active voice, developing a structured abstract, using correct citation and reference formats, understanding reviews and resubmitting the manuscript, and keeping momentum to produce continued writing results. Practical writing hints are also suggested for inexperienced writers. RELEVANCE AND CONCLUSION: These strategies can help guide nurse writers in planning, navigating the system, and finding success as a published author.

Reliability and Criterion-Related Validity of the Seated Posture Scale.

PURPOSE: Earlier, we reported development and initial testing of a rapid, low burden measure of wheelchair seated posture (the Seated Posture Scale [SPS]) for research and clinical use. The purpose of this study was to test the intrarater reliability, interrater reliability, and criterion related validity of the SPS. DESIGN: We used a descriptive design to test and develop the instrument. METHODS: We used the method described by Walter, Donner, and Eliasziw to determine 46 participants were needed, from two Veterans Administration nursing homes or CLCs (community living centers). Using a digital goniometer to score rapidly and with two trained raters, we scored individual participants simultaneously and again in succession. For criterion related concurrent validity, we also scored each participant with Section 2 of the Seated Postural Control Measure for Adults. Intrarater reliability, interrater reliability, and criterion related, concurrent validity were assessed using kappa statistics for individual instrument items (and corresponding 95% confidence intervals where appropriate) and intraclass correlation coefficients (ICC) for total scores. FINDINGS: The intrarater intraclass correlation coefficient (ICC) was .995; interrater ICC was .80; interrater reliability kappas ranged from -.03 to .80. Criterion-related, concurrent validity kappas ranged from .13 to .91. ICC for total scores was .85. CONCLUSION: The SPS has sufficient preliminary validity and reliability to support measurement of wheelchair-seated posture in outcomes research and clinical use. CLINICAL RELEVANCE: In the future, rehabilitation nurses may use the SPS to improve management of wheelchair seated posture, to improve clinical outcomes, particularly for those who do not reposition themselves.

Pressure Injury Education in the Department of Veterans Affairs: Results of a National Wound Provider Cross-sectional Survey.

PURPOSE: The aim of this study was to describe experience, training, educational needs and preferences, and perceptions of pressure injury (PI) prevention education of wound care providers in the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) as an indicator of effectiveness of the mandated VHA PI Prevention Program. SUBJECTS AND SETTING: A convenience sample of national VHA wound care providers practicing in VHA facilities was compiled from members of special interest groups and committees and by referrals from known wound care specialists and clinicians (N = 1726). The response rate was 24% (n = 410). DESIGN: Cross-sectional, descriptive study. METHODS: A 42-item online cross-sectional survey was administered via a blast-email of the survey link to the sample. The survey link was active for 1 month (March 3-31, 2014). The survey queried demographic data, PI experience and education, and their perceptions and preferences for PI education. Quantitative responses underwent descriptive analyses, and responses to open-ended questions were analyzed by content analysis. RESULTS: The majority of the 415 respondents completed most of the questionnaire (n = 310, 74%). Half were board-certified providers with a mean wound care experience of 14.2 years (standard deviation = 9.8 years). Preference for type of wound training ranged from 17% for online gaming to 82% for face-to-face training. Training provided by facilities was perceived to be inadequate for wound care by 60% (n = 175) and inadequate for PI care by 49% (n = 142). CONCLUSIONS: The 2 greatest areas of need in PI care identified by wound care providers were education and documentation. These same issues were identified as problematic by an audit of PI prevention and management at 47 VHA facilities that was conducted by the VA Office of Inspector General.

Development and initial validation of the Seated Posture Scale.

Literature shows that some health outcomes (e.g., eating, breathing, and speaking) are directly related to posture. Evidence of outcomes mediated by wheelchair seated posture is limited to interface pressure, physical function, and wheelchair skills and safety. This study's purpose was to develop and validate a rapid, low-burden, paper-pencil assessment of wheelchair seated posture for research use and to test feasibility of its use with a sample of older adults. We used a prospective design and a convenience sample of older adults who were receiving rehabilitation services in a community living center. Forty-nine older wheelchair users participated. Main measures were the Seated Posture Scale (SPS), Modified Ashworth Scale, Barthel Index, Visual Descriptor Scale, scale-content validity index (S-CVI), Cronbach alpha, and test-retest reliability. Rating by six experts yielded the overall content validity score (S-CVI) of 0.744. Total SPS score correlated positively with physical function (Barthel Index, r = 0.46, p < 0.001) and negatively with muscle tone (Modified Ashworth Scale, r = -0.44, p = 0.001), supporting SPS construct validity. Internal consistency was 0.66 (Cronbach alpha). Test-retest reliability yielded Pearson product-moment correlations of 0.89 to 0.99. We conclude that the SPS has sufficient preliminary validity and reliability to support its use as an evaluation of wheelchair seated posture in outcomes research.

Wheelchair components and pulmonary function in children with cerebral palsy.

OBJECTIVE: This study investigates the effects of four individual wheelchair components (upper extremity supports, lateral trunk supports, anterior pelvic belt, and 30 degree posterior seat tilt), on pulmonary function in prepubertal children with cerebral palsy (CP). METHODS: Participants who range in age from 5-10 years were evaluated using four wheelchair components in six configurations (conditions 1-6) using a planar seating simulator. The Respironics Non Invasive Cardiac Output monitor (NICO) and MasterScreen Impulse Oscillometry System (IOS) measured pulmonary function parameters. Repeated measures ANOVA was used to analyze effect of wheelchair conditions on total airway resistance (R(AW)). RESULTS: Eight participants completed the protocol. R(AW) and minute ventilation (MV) varied with wheelchair condition. Lowest R(AW) was seen with two upper extremity supports or two lateral trunk supports. Differences were not significant (p = 0.253). CONCLUSIONS: The NICO and IOS, independent of participant effort, measured R(AW) and MV, which varied by wheelchair seating condition. More research is needed with a larger sample to determine seating components' impact on pulmonary function. These methods objectively measured pulmonary function of young children with CP in wheelchairs and could facilitate further research into benefits of wheelchair postural support components.