A Qualitative Exploration of Nurse Faculty Experiences Related to the Sudden Unanticipated Death of a Nursing Student.

BACKGROUND: Nurse faculty serve as teachers, role models, and mentors to nursing students. This unique relationship results in a myriad of feelings when a student dies. Limited research exists in examining faculty grief related to the sudden unanticipated death of a nursing student. PURPOSE: To explore the experiences of nurse faculty following the sudden unanticipated death of a nursing student. METHODS: Researchers conducted a phenomenological qualitative study. The source of qualitative data included a demographic questionnaire and in-depth interviews with 13 participants throughout the geographical regions of the United States. RESULTS: Six following themes emerged: (1) leadership response, (2) grief experience, (3) role uncertainty, (4) grief triggers, (5) cannot help but think what if, and (6) acknowledging a life unfulfilled. CONCLUSION: This study yields a rich understanding of the unique grief experiences of nurse faculty, warranting the need for further dialogue, faculty education, policy development, and supportive interventions for faculty and administrative leaders.

Work-life balance and professional quality of life among nurse faculty during the COVID-19 pandemic.

BACKGROUND: The rapid transition to online teaching during the COVID-19 pandemic created additional stress and workload issues for nurse faculty. Burnout has been reported in nurse faculty who cite workplace factors that influence satisfaction and work-life balance as major contributing factors. PURPOSE: The purpose of this study was to examine life balance and professional quality of life among nurse faculty (N = 216) in 2021 during the first year of the COVID-19 pandemic and to describe the challenges of delivering virtual learning experiences. METHODS: A cross-sectional design was utilized to survey nurse faculty using the Life Balance Inventory and the Professional Quality of Life Scale. Descriptive statistics and correlations were calculated. RESULTS: Nurse faculty reported an unbalanced life balance (median = 1.76), average compassion satisfaction (median = 40.00), average burnout (median = 24.00), and low secondary traumatic stress (median = 21.00). Narrative themes included (1) COVID-19 pandemic has made balance nearly impossible, (2) Intentional disconnection from work activities, (3) Challenging/changing priorities, (4) Promoting a healthy work environment, and (5) Moral distress and exhaustion. DISCUSSION: Understanding the factors that influence nurse faculty delivery of virtual learning experiences during the COVID-19 pandemic may provide opportunities to improve nurse faculty work-life balance and professional quality of life.

Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients with Delirium Superimposed on Dementia.

OBJECTIVES: We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure. DESIGN: In this secondary analysis we used control group data from an ongoing randomized clinical trial. SETTING/PARTICIPANTS: Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (±6.83) years; 67.6% were women; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele. MEASURES: We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; the Confusion Assessment Method; and the Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale. RESULTS: Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition. CONCLUSIONS: For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function, and greater length of stay during rehabilitation.

Feasibility study of an attention training application for older adults.

BACKGROUND: Technology-based attention training has demonstrated promise in its potential to improve cognitive functioning in older people. Developing mobile applications, with older users specifically in mind, may support future dissemination of these interventions and integration into daily life. AIMS AND OBJECTIVES: The purpose of this pilot study was to test the feasibility of an Attention Training Application (ATA) for community-dwelling older adults using mobile technology. DESIGN: A descriptive, mixed-methods design was used to capture older adults' feedback on the usability and acceptability of the ATA. METHODS: A convenience sample of older adults (n = 9) from two independent living facilities participated in a 2-hour training and practice session with the ATA. Participants were given personally tailored instructions for using the mobile device and the ATA specifically. Following a practice session, participants provided ratings on multiple components of the ATA and completed an audio-recorded, semi-structured interview to provide detailed descriptions of their experience and perceptions. An iterative process of content analysis was used to characterise the open-ended responses. RESULTS: Participants rated the ATA favourably overall on several 0-10 scales including likeability [8.5 (1.6)], interest [8.8 (2.3)] and satisfaction [8.2 (1.9)]. The qualitative analyses revealed several issues relevant to the feasibility of the ATA among older people including the importance of the technological background of the user, limiting negative feedback, challenges with the touch screen interface, personal preferences for challenge, extending the practice period and the difficulty of the dual-task condition. CONCLUSIONS: The use of the ATA is feasible in the older adult population. Future development should specifically consider personal characteristics as well as preferences to maximise usability and acceptability among older people. IMPLICATIONS FOR PRACTICE: Older adults enjoyed the ATA. This opens doors to user-friendly technological interventions that may be effective in assisting older adults maintain and possibly even improve their cognitive function.

Assessment of subjective cognitive impairment among older adults.

Subjective cognitive impairment (SCI) refers to an individual's everyday concerns related to cognitive functioning, which can exist even in the absence of objectively assessed impairment. SCI is common among older adults, and although symptoms may be mild, SCI is associated with subsequent cognitive decline as well as significant negative effects on everyday functional ability, mood, and social engagement. Despite the potential consequences, SCI is often underreported and undetected. Thus, it is critical to consider assessing for SCI among older adults to determine cognitive impairment risk and support early intervention to promote functional well-being and health management. The current article reviews factors related to SCI, evaluates existing methods for the assessment of SCI, and proposes a person-centered framework for enhancing assessment. Application of the framework is further illustrated through the use of clinical examples.

Licensed Nurse and Nursing Assistant Recognition of Delirium in Nursing Home Residents With Dementia.

Many nursing home residents experience delirium. Nursing home personnel, especially nursing assistants, have the opportunity to become familiar with residents' normal cognitive function and to recognize changes in a resident's cognitive function over time. The purpose of this study was to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Participants were asked to complete five case vignette assessments at three different time points (in 6-month intervals) to test their ability to identify different subtypes of delirium and delirium superimposed on dementia (DSD). A total of 760 case vignettes were completed across the different time points. Findings reveal that staff recognition of delirium was poor. The case vignette describing hyperactive DSD was correctly identified by the greatest number participants, and the case vignette describing hypoactive DSD was correctly identified by the least number of participants. Recognition of the case vignette describing hypoactive delirium improved over time. Nursing assistants performed similarly to the licensed nurses, indicating that all licensed nursing home staff require further education to correctly recognize delirium in older adults.

Pain, delirium, and physical function in skilled nursing home patients with dementia.

OBJECTIVE: Skilled nursing facilities (SNFs) are major sites of postacute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are suboptimal because of poor-quality treatment, including the failure to provide needed care. Pain is frequently unrecognized and untreated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. DESIGN: Secondary analysis of data from an on-going randomized clinical trial. SETTING: Eight SNFs located in central and northeast Pennsylvania. PARTICIPANTS: A total of 103 SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were women (66%) and white (98%). MEASUREMENTS: Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. RESULTS: On days when participants experienced greater than their average level of pain, they also experienced more delirium symptoms (P < .001) and lower physical function (P < .001). Participants with higher levels of average daily pain were more likely to die (odds ratio [OR] 6.306, 95% confidence interval [CI] 1.914-20.771, P = .003) or be placed in a nursing home (OR 4.77, 95% CI 1.7-13.2, P = .003) compared with returning to the community at 3-month follow-up. CONCLUSION: Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs.