Assessment of the Psychosocial Adjustment of Well Elderly Residing in Retirement Communities.

Moving to a retirement community involves a major life transition that requires adjustment to a new way of life. The purpose of this study was to develop a tool to assess the psychosocial adjustment of residents. Using the Life Patterns Model as a conceptual framework, residents of 3 retirement communities (n = 240 residents) were surveyed. Median ages were ∼84 years, Nearly 85% (202) reported that they feel good about themselves and most (92.5%; n = 221) have things to do that they enjoy. Health status was strongly associated with having nearby relatives (rs = -.232, p > .000, n = 239). A factor analysis supported the use of the conceptual framework. Findings indicate that the tool can used for the designed purpose.

Catheter-Related Bloodstream Infections (CR-BSI) in Geriatric Patients in Intensive Care Units.

Catheter-related bloodstream infections (CR-BSIs) are bloodstream infections that, through specific laboratory testing, identify the intravascular catheter as the source of the bloodstream infection. By 2015, the rate of elderly patients 80 years of age and older admitted to the intensive care unit (ICU) will represent 1 in 4 admissions. Approximately 80 000 CR-BSIs occur in ICUs annually, potentially resulting in as many as 56 000 CR-BSIs occurring in the geriatric ICU patient, with 20% of these cases resulting in death. To minimize the occurrence of CR-BSIs in these patients, specific knowledge about the geriatric patient will have to be factored into the ICU health care professional's practice, including the development of a vascular access plan, which includes selection of the correct device and proper insertion of that device along with an evidence-based care and maintenance program. Intensive care unit health care professionals may be at a loss when it comes to navigating the vast array of vascular access medical devices available today. The Healthcare and Technology Synergy framework can assist the ICU health care professional to logically review each vascular access device and select those devices that best meet patient needs.

Comparison of central line-associated bloodstream infection rates when changing to a zero fluid displacement intravenous needleless connector in acute care settings.

This was a multicenter, quasiexperimental, 140-month, acute care study comparing central line-associated bloodstream infection rates associated with positive or negative intravenous connectors to a zero fluid displacement connector. A decrease in central line-associated bloodstream infections was found after changing from either negative or positive intravenous connectors to the zero fluid displacement connector (P = .004) with total cost savings of over $3 million.

In vitro study assessing the antibacterial activity of three silver-impregnated/coated mechanical valve needleless connectors after blood exposure.

This in vitro study's purpose was to assess antibacterial activity of 3 different connectors: V-Link (Baxter, Deerfield, IL), Ultrasite Ag (B. Braun, Bethlehem, PA), and MaxGuard (CareFusion, Ontario, CA), impregnated with silver nanoparticles after blood exposure. All 3 silver-coated/impregnated connectors grew Staphylococcus aureus and Staphylococcus epidermidis. Log reduction of bacteria was not significant (range, +0.19 to -1.82). There was substantial bacterial recovery from all 3 connectors (mean ranges, 2.09 × 10 to 4.00 × 10) indicating that, once blood comes in contact with silver-coated/impregnated needleless connectors, their antibacterial activity is significantly reduced.

A symptom cluster and sentinel symptom experienced by women with lung cancer.

PURPOSE/OBJECTIVES: To determine the symptom experience and a sentinel symptom and to describe the relationship of participant characteristics with symptom clusters. DESIGN: Prospective, correlational study. SETTING: Clinical sites in five U.S. states. SAMPLE: 196 women six months to five years after non-small cell lung cancer diagnosis. METHODS: Symptoms were measured during the past day and past four weeks. Symptom clusters were described using a novel dummy coding approach. MAIN RESEARCH VARIABLES: Symptom occurrence and severity, demographic and clinical characteristics, health status factors, and meaning of illness. FINDINGS: About 98% of women experienced three or more symptoms in the past day. The most common symptoms reported by more than 80% of the women were fatigue, shortness of breath, anorexia, cough, and pain, with fatigue and shortness of breath rated as most severe. Sleep problems, concentration problems, and weight loss also were reported during the past four weeks. A five-symptom cluster including fatigue, shortness of breath, cough, pain, and anorexia was reported by 64% of women. Pain was identified as a sentinel symptom for that cluster. CONCLUSIONS: Most women experienced at least three symptoms in the past day, and a five-symptom cluster occurred frequently and continued post-treatment. IMPLICATIONS FOR NURSING: Women who participated in the study were, on average, two years postdiagnosis, but most experienced three or more symptoms well past treatment; therefore, vigilant ongoing clinical assessment of these women is essential. A co-occurring sentinel symptom used as a clinical indicator for the presence of a symptom cluster may be useful for clinical assessment.

Comparative evaluation of five needleless intravenous connectors.

AIM: The purpose of this study was to evaluate in vitro differences of colony forming units (CFUs), of four different bacteria (Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli), over 4 days, using bovine blood, in five intravenous needleless connectors (three negative, one positive, one zero). BACKGROUND: Availability of colony forming units creates a definitive environment for bloodstream infections and occlusions. Protection of the intraluminal pathway is one important way to help eliminate occlusions and catheter-related bloodstream infections and utilization of best available product(s) will aid in best patient outcomes. METHODS: Five different connectors evaluated in 2009 by an independent laboratory for in vitro differences about colony forming units of four different organisms over 4 days. RESULTS: The Q-Syte™ performed poorly on all organisms (P<0·0001). The MaxPlus(®) Clear and MicroCLAVE(®) fluctuated between high colony forming units (28·15 & 56·55 respectively) and zero colony forming units. The TKO™Clave(®) stayed increased (high of 50·8 colony forming units). The RyMed-5001(®) performed the best with very low colony forming units (2·25 CFUs to zero). CONCLUSIONS: Non-antimicrobial connectors differ on colony forming unit counts in vitro for four types of bacteria. Connectors with most colony forming units to least colony forming units included the Q-Syte™, TKO™Clave(®), MicroCLAVE(®), MaxPlus(®) Clear and RyMed-5001(®). Connectors are one statistically significant variable (50%) in the development of occlusions and infections. Staff nurses, managers, infection control specialists and vascular access specialists in all settings need to use technologies that invoke the least patient harm. The RyMed-5001(®) connector best protects the intraluminal pathway from bacteria compared with four other commonly used connectors in vitro.

In vitro comparisons of two antimicrobial intravenous connectors.

Fifty percent of catheter-related bloodstream infections (CR-BSI) caused by organism migration through the fluid pathway (intraluminal) via a connector can be colonized within 24 hr. With a mean hospital stay of 4.8 days, intraluminal contamination is a primary source of CR-BSI. Purpose of this research was to determine which antimicrobial needleless connector produced the least bacterial colony-forming units (CFUs) in vitro and to compare these CFUs to the leading nonantimicrobial connector shown in previous research to have the lowest CFUs. Independent laboratory tested 2 antimicrobial (Baxter V-Link™, RyMed-7001 Nano(®)) and 1 nonantimicrobial (RyMed-5001) connector, 20 connectors each, 3 controls, each of 4 days, 4 organisms, under the same laboratory conditions. Baxter V-Link™ produced 2.0 to 8.8 times more bacteria than the RYM-5001( ®) and RYM-7001(®) connectors, regardless of bacteria type. The antimicrobial connector with the most and consistent bacteria (13, 675 CFUs) over 4 days was the V-Link™ and the connector with no consistent bacteria was the RyMed-7001(®). Nurses and researchers must include technological design, connector types, and methods of coating/ impregnating connectors as factors in evaluation.

Comparison of bacterial CFUs in five intravenous connectors.

This study determines if there are differences in colony forming units (CFU) of bacteria between five different needleless intravenous connectors. CFUs create environments for bloodstream infections with 1 CFU to begin an infection and 15 to develop infection. Intraluminal pathway protection is a most significant way to eliminate 50% bloodstream infections. Five different connectors were evaluated by independent laboratory in vitro regarding ≥15 CFUs, 4 organisms over 4 days. Q-Syte™ had significantly higher mean number days CFUs ≥15 than all other devices, Rymed-5001(®) having the least (p < .0001). Q-Syte™ and TKO+Clave(®) had significantly more CFUs ≥15 on one or more days. Nonantimicrobial connectors differ on CFU counts in vitro. CFUs are ranked highest to lowest CFUs as follows: Q-Syte™, TKO™Clave(®), MicroCLAVE(®), MaxPlus(®) Clear, and Rymed-5001(®). Best nonantimicrobial connector products for intraluminal protection are Rymed-5001(®) followed by MaxPlus(®) Clear. Using the best connector can significantly prevent infections as part of nursing care.

Women with lung cancer: quality of life after thoracotomy: a 6-month prospective study.

BACKGROUND: Data about health-related quality of life (QOL) after surgical treatment for lung cancer are limited. Such information can be valuable in developing appropriate nursing interventions for follow-up care for survivors. OBJECTIVES: The purposes of this study were to describe physical and emotional QOL of disease-free female non-small cell lung cancer (NSCLC) survivors and to determine characteristics associated with greater risk for disruptions. METHODS: One-hundred-nineteen women surgically treated for NSCLC completed the Short-Form 36 (as a measure of physical and mental QOL) along with health status assessments (including comorbidity, depression, Center for Epidemiologic Studies-Depression Scale, smoking status, and body mass index), dyspnea (Dyspnea Index), meaning of illness, and demographic and clinical information at baseline and 3 and 6 months. RESULTS: On average, the women were 68 years of age, diagnosed 2 years previously, had adenocarcinoma, and were treated surgically with lobectomy. The majority (66%) had comorbid disease, 29% had depressed mood (Center for Epidemiologic Studies-Depression Scale score > or =16), 8% were current smokers, 62% were overweight, 22% had dyspnea (scores > or =2), and 24% had a negative meaning of illness. Physical and emotional QOL scores were comparable to Short-Form 36 norms for older adults and exhibited little change over time. Controlling for time since diagnosis, dyspnea, and depressed mood were strongly related to disruptions in physical and emotional QOL, respectively, across the 6-month study period, with comorbid disease contributing to both models. CONCLUSION: Depressed mood, comorbidities, and dyspnea were factors related to poorer physical and emotional QOL. Survivors with these characteristics might benefit from greater supportive care. IMPLICATIONS FOR PRACTICE: Screening for dyspnea, depressed mood, and comorbid illness can identify female survivors at-risk for poorer QOL after surgery.

Caring for patients with cancer through nursing knowledge of IV connectors.

Knowledge about the three different types of IV connectors (negative, positive, and neutral) is imperative to cancer care as specific and distinct interventions can help prevent occlusions and catheter-related bloodstream infections that can lead to increased morbidity with infections and loss of treatment time and mortality. Nurses have responsibilities associated with nursing research, education, and evidence-based practice that should support the outcomes of best patient care when using IV connectors.

Symptom severity 1 to 4 months after thoracotomy for lung cancer.

BACKGROUND: Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery. OBJECTIVES: To describe symptom severity during the first 4 months after thoracotomy for non-small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months. METHODS: Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies-Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms. RESULTS: Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months. CONCLUSIONS: Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

Implementation of an intravenous medication infusion pump system: implications for nursing.

AIM: To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. BACKGROUND: Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. METHODS: Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. RESULTS: Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. CONCLUSIONS: It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. IMPLICATIONS FOR NURSING MANAGEMENT: Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses.

Tobacco use in women with lung cancer.

BACKGROUND: Smoking cessation after a cancer diagnosis is associated with improved clinical outcomes. PURPOSE: The aims of this study are to determine smoking prevalence, describe patterns of smoking, identify readiness to quit and cessation strategies, identify factors associated with continued smoking among women with lung cancer, and determine smoking prevalence among household members. METHODS: Data were collected through questionnaires and medical record review from 230 women. Smoking was determined through self-report and biochemical verification with urinary cotinine. RESULTS: Eighty-seven percent of women reported ever-smoking, and 37% reported smoking at the time of diagnosis. Ten percent of women were smoking at entry to the study, 13% were smoking at 3 months, and 11% at 6 months. Fifty-five percent of smokers planned a quit attempt within the next month. One third of smokers received cessation assistance at diagnosis, and pharmacotherapy was the most common strategy. Significant factors associated with continued smoking included younger age, depression, and household member smoking. Continued smoking among household members was 21%. Twelve percent of household members changed their smoking behavior; 77% quit smoking, but 12% started smoking. CONCLUSIONS: The diagnosis of cancer is a strong motivator for behavioral change, and some patients need additional support to quit smoking. Family members should also be targeted for cessation interventions.

Use of complementary and alternative medicine therapies to control symptoms in women living with lung cancer.

Complementary and alternative medicine (CAM) use by cancer patients, especially women, is increasing. However, CAM use among patients with lung cancer, who have been reported to have the highest symptom burden, is poorly documented. This study describes types and frequencies of specific CAM therapies used by women with lung cancer to manage symptoms, and examines differences in demographic and clinical characteristics between CAM users and non-CAM users. Participants included 189 women with non-small cell lung cancer and > or =1 of 8 symptoms. Six CAM therapies, used to control symptoms, were assessed, including herbs, tea, acupuncture, massage, meditation, and prayer. Forty-four percent (84 women) used CAM therapies, including prayer (34.9%), meditation (11.6%), tea (11.6%), herbs (9.0%), massage (6.9%), and acupuncture (2.6%). Complementary and alternative medicine use was greatest for difficulty breathing and pain (54.8% each), with prayer the most commonly used CAM for all symptoms. Significant differences (P < .05) were found for age (t = 2.24), symptom frequency (t = -3.02), and geographic location (chi = 7.51). Women who were younger, experienced more symptoms, and lived on the West Coast or South (vs Northeast) were more likely to use CAM. We found that CAM use is variable by symptom and may be an indicator of symptom burden. Our results provide important initial data regarding CAM use for managing symptoms by women with lung cancer.

Quality of life and health status of dyads of women with lung cancer and family members.

PURPOSE/OBJECTIVES: To describe and compare the quality of life (QOL) and health status of dyads of women with lung cancer and their family members and to explore the correlates of family members' QOL. RESEARCH APPROACH: Descriptive, cross-sectional. SETTING: Interview, self-report. PARTICIPANTS: 51 dyads consisting of women with lung cancer and their family members. METHODOLOGIC APPROACH: One-time assessment of family members' and patients' QOL, health status, and demographics and patients' clinical characteristics. MAIN RESEARCH VARIABLES: Family and patient QOL and health status. FINDINGS: QOL of the dyads was not significantly related. Poorer physical QOL of family members was associated with older age, comorbid conditions, less education, and alcohol use. Poorer emotional QOL of family members was associated with younger age, depressed mood, and not being a spouse. Fifty-nine percent of family members had comorbid conditions. Significantly more family members continued to smoke and use alcohol. CONCLUSIONS: The QOL of family members of patients with lung cancer is diminished when their own health status is compromised. Further study is needed. INTERPRETATION: Additional study is needed to identify family members at risk for diminished QOL and with compromised health status because these factors might affect ability to support patients with lung cancer.

Internet design preferences of patients with cancer.

PURPOSE/OBJECTIVES: To describe computer experience and preferences for multimedia design. DESIGN: Prospective, descriptive. SETTING: Physician office and outpatient cancer centers in an urban area in the southeastern United States. SAMPLE: Convenience sample of 22 volunteer patients with cancer from four racial groups. METHODS: A questionnaire on computer experiences was followed by a hands-on computer session with questions regarding preferences for seven interface items. Data termination occurred when sample size was obtained. MAIN RESEARCH VARIABLES: Design of Internet education site for patients. Variables include preferences, computer, cancer, multimedia, and education. FINDINGS: Eighty-two percent had personal computers, 41% used a computer daily, and 95% believed that computers would be a good avenue for learning about cancer care. Preferences included display colors in blue and green hues; colored buttons; easy-to-read text; graphics with a simple design and large, clear pictures; serif font in dark type; light-colored background; and larger photo size in a rectangle shape. Most popular graphic icons as metaphors were 911 for emergency, picture of skull and crossbones for danger, and a picture of a string on an index finger representing reminder. The simple layout most preferred for appearances was one that included text and pictures, read from left to right, and was symmetrical in its placement of pictures and text on the page. CONCLUSIONS: Preferences are necessary to maintain interest and support navigation through computer designs to enhance the translation of knowledge to patients. IMPLICATIONS FOR NURSING: Development of multimedia based on patient preferences will enhance education, learning, and, ultimately, quality patient care.

Quality of life and meaning of illness of women with lung cancer.

PURPOSE/OBJECTIVES: To describe the quality of life (QOL) of women with non-small cell lung cancer (NSCLC) and examine relationships of demographic, clinical, health status, and meaning of illness (MOI) characteristics to QOL. DESIGN: Descriptive, cross-sectional survey. SETTING: In-person interviews in homes or research offices. SAMPLE: 217 women with NSCLC (greater than 6 months and less than 5 years since diagnosis, mean = 2 years); 19% of the women had advanced disease. The mean age was 65 years. METHODS: Assessments of QOL with cancer-specific (QOL Scale-Patient Version) and generic (Short Form-36) self-reports, health status (i.e., number and type of comorbid conditions, presence of depressed mood using the Center for Epidemiologic Studies Depression Scale, smoking status), and MOI (positive and negative perceptions). MAIN RESEARCH VARIABLES: QOL, health status, MOI, and demographic and clinical characteristics. FINDINGS: Serious disruptions in psychological and social aspects of QOL were common. Depressed mood, negative conceptualizations of MOI, and younger age explained 37% of the variance of global QOL and were correlated with poorer physical, psychological, and social dimensions of QOL. Thirty-six percent reported negative ascriptions of MOI; 35% experienced depressed mood; more than 75% reported distress with their diagnosis, family distress, and impact of sexual function as lowering their QOL; and 67% reported comorbid conditions, the most common being chronic obstructive pulmonary disease (31%). CONCLUSIONS: Women with lung cancer experience a range of disruptions in QOL, and more than a third associate lung cancer with negative meaning. Younger age, depressed mood, and number of comorbid diseases are risk factors for negative QOL. IMPLICATIONS FOR NURSING: These findings support the importance of assessing the QOL, MOI, and health status of women with lung cancer even after treatment is completed. Younger women may be at higher risk for disruptions.

Assessing coughing and wheezing in lung cancer: a pilot study.

PURPOSE/OBJECTIVES: To establish reliability and validity of two self-report questionnaires, the Lung Cancer Cough Questionnaire and the Lung Cancer Wheezing Questionnaire. DESIGN: Prospective, exploratory pilot study. SETTING: Clinical oncology settings in the southern United States. SAMPLE: 31 adult women with lung cancer. METHODS: Content validity of both questionnaires was assessed through a comprehensive literature review and an expert judge panel. Concurrent validity was established by Spearman rank correlation coefficients and Wil-coxon Rank Sum tests with items from other valid tools. Test-retest reliability was assessed by percent agreement, kappa, paired t tests, and correlations. Internal consistency was determined by Cronbach's alpha. MAIN RESEARCH VARIABLES: Cough, wheeze. FINDINGS: Cronbach's alpha showed excellent internal consistency and percent agreement, and kappa showed similarity of item responses across test-retest administrations. Nonsignificant paired t tests indicated similar mean scores, and significant test-retest correlations supported test-retest reliability. CONCLUSIONS: Preliminary testing indicates good reliability and validity for both questionnaires. Both instruments can identify people with problems of coughing and wheezing and have the potential for monitoring these symptoms over time and determining effectiveness of interventions. IMPLICATIONS FOR NURSING: Assessment of coughing and wheezing is an important component of monitoring respiratory symptoms of lung cancer. Both of these symptoms can be amenable to interventions. Further research is needed to confirm psychometrics and sensitivity of these tools.