Implementation of a Mental Health Objective Structured Clinical Examination (OSCE) Using Standards of Best Practice.

ABSTRACT: The objective structured clinical examination (OSCE) is effective for the evaluation of clinical competence. Studies examining the use of OSCEs in undergraduate mental health nursing education in the United States are limited. A pilot study and a follow-up study were conducted to establish the reliability and validity of a mental health OSCE to evaluate the clinical competence of prelicensure nursing students. International Nursing Association for Clinical Simulation and Learning Standards of Best Practice were used to guide the design and implementation. Results from both studies provide evidence for the use of OSCE in undergraduate mental health nursing education.

The Scope of LGBTQIA+ Health Content in Prelicensure Nursing Curricula.

BACKGROUND: Little is known about the status of lesbian, gay, bisexual, transgender, queer or questioning, and inter-sex and asexual (LGBTQIA+) health content in prelicensure nursing curricula. This study explored curricular and pedagogical practices of LGBTQIA+ health content in nursing curricula in the United States. DESIGN: A quantitative, cross-sectional comparative descriptive design was implemented. METHOD: Stratified random sampling was used to email a survey to deans and administrators of prelicensure associate degree in nursing (ADN) and baccalaureate nursing (BSN) programs. RESULTS: Private ADN programs included more LGBTQIA+ health content than BSN programs and more LGBTQIA+ health content than public ADN programs in nursing curricula. CONCLUSION: Although progress has been made to include LGBTQIA+ health content in nursing curricula in the U.S., creative educational strategies can be used to help meet the varying needs of different programs. [J Nurs Educ. 2023;62(11):623-630.].

Effects of Medicare wellness visits on health promotion outcomes.

BACKGROUND: The American older adult population has the highest historical prevalence of chronic disease and underuses wellness visit benefits. Little is known about how Medicare wellness visits (MWVs) affect health outcomes. PURPOSE: The aim of this retrospective case-control study was to examine how MWVs affect health outcomes by measuring two kinds of data for case and control groups at baseline versus 15 months: (1) the differences in blood pressure, fasting lipids, and glucose levels and (2) the completion frequencies for seven screenings and vaccinations. METHODOLOGY: Informed by Pender's Health Promotion Model, this design used purposively matched samples from a large American Midwestern Medicare population active between January 2013 and January 2016, with a total sample size of 252, consisting of the case group ( N = 120) and control group ( N = 132). The case and control group samples were matched according to gender, age, marital status, Charlson index scores, smoking status, and pharmaceutical classes. The two groups, case (MWV recipients) and matched control (MWV nonrecipients), were compared at different time points using a doubly multivariate repeated-measures analysis procedure. Descriptive statistics were computed to compare completion frequencies between groups. RESULTS: A doubly repeated multivariate analysis of variance (MANOVA) and descriptive statistics revealed significant differences between the case and control group for three of the four health outcomes. The case group had increased completion frequencies in pneumococcal vaccination. CONCLUSIONS: Additional research controlling for more variables is warranted to better understand MWV efficacy on health outcomes. IMPLICATIONS: Primary care providers need to study how MWVs affect longitudinal health outcomes.

Gerontological nursing competencies: A crosswalk with the 4Ms framework of the age-friendly initiative.

The Age-friendly Health Systems Initiative is a current multidisciplinary movement driving quality improvement across all health care settings. The 4Ms framework (What Matters, Medication, Mobility, and Mentation) provides a common evidence-based language and system of care that can be utilized by all health care providers. Faculty of one nursing program were interested in knowing whether the principles and language of the 4Ms framework align well with the current competencies used to guide undergraduate and beginning level practice for nurses. To answer this question, a crosswalk of curricular and competency guidelines for gerontological nursing was completed to identify how well the competencies aligned with the key concepts of the evidence-based 4Ms framework. Key findings of this crosswalk are being shared with educators for the purpose of describing a systematic way to ensure that the 4Ms are integrated into gerontological curricula and course design. The steps taken to complete the crosswalk are described to guide educators across all disciplines interested in creating curricula that will adequately prepare students to be collaborative partners and leaders in Age-friendly Health Systems.

Accidental Fall Death in McLean County: Examining Variables in Community-Dwelling Older Adults.

Fall risk assessment is a complex phenomenon involving several risk factors, including an individual's balance and mobility status, chronic health conditions, visual impairment, hearing deficits, environmental hazards (e.g., loose rugs, clutter), and being homebound or semi-homebound. Comprehensive fall risk assessment is the cornerstone of fall prevention in older adults throughout the community. The current study was based on secondary data and sought to examine variables associated with death due to accidental fall in a rural, midwestern county in Illinois, and to heighten awareness for consistent screening and risk assessment in older adults residing in the community. Results illustrated that among community-dwelling older adults with accidental falls, blunt injury or subdural hematoma had significantly fewer days until death than a fracture. [Journal of Gerontological Nursing, 48(6), 26-32.].

Are Medicare wellness visits improving outcomes?

BACKGROUND: As the largest and unhealthiest population in American history enrolls as Medicare beneficiaries, it is vital for primary care providers to understand how to maximize Medicare wellness provisions. The Baby Boomer population has been documented to have the highest chronic disease prevalence related to preventable lifestyle behaviors. Perpetual unhealthy lifestyle behaviors associated with chronic disease prevalence are detrimental to life quality and the American Medicare resource structure. Since 2011, the Affordable Care Act provisions have included free wellness visits designed to prevent disease for Medicare beneficiaries, who continue to grossly underuse these services. OBJECTIVES: This systematic review was conducted to evaluate the quality, level, and strength of evidence regarding Medicare wellness service efficacy on related health outcomes. DATA SOURCES: The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for selection of 21 research-based articles included in the analysis. Results from the 21 eligible studies revealed low research quality and vigor; therefore, lacking causality and generalizability of medicare wellness visit (MWV) efficacy on health promotion outcomes. CONCLUSIONS: The evidence is focused on how MWVs are affecting preventive care utilization instead of patient health outcomes. In the interest of reducing chronic disease prevalence and the economic burden on our health care system, it is important to understand how these services affect health promotion outcomes. IMPLICATIONS FOR PRACTICE: The results of this systematic literature review substantiate the need for primary care providers to study MWV efficacy on health promotion outcomes for the Medicare population.

Collaborative student-faculty research to support PhD research education.

This paper describes a three-semester hour applied research course taught over three semesters in a revamped PhD research curriculum at a Midwestern high research activity (R2) university-based nursing program. Faculty developed this strategy to help students become adequately prepared nurse scientists. Students and faculty engaged in a collaborative research project to provide students with opportunities to develop, integrate, and apply research knowledge, skills, and attitudes while concurrently advancing through the related research courses. A summary of these experiences and what was learned is organized within a knowledge, skills, and attitudes (KSA) framework. The collaboration between faculty and student peers was essential to students' success in the course. Student and faculty perspectives were used to describe what was learned during the first year this course was taught, together with future recommendations.

Barriers and Insights in Participant Recruitment in Assisted Living Facilities.

An estimated 1.2 million older adults nationwide currently reside in assisted/supportive living facilities, and research is required to continue to identify best outcomes in for their care. However, challenges exist. The aim of this paper is to address barriers and provide insights related to participant recruitment in assisted and supportive living facilities. Identified barriers included unproductive communication with reception area staff, a perceived lack of interest in research activity, and the inability of Director of Nursing (DON) to provide authorization for research activities. Recruitment insights included productive encounters with gatekeepers, establishing trust with executive administration and healthcare personnel, and research team persistence.

Older people's use of non-pharmacological interventions for chronic, non-cancer pain and comfort.

BACKGROUND: Many older people experience chronic pain, so increased comfort and pain relief are important for older residents in assisted and/or supported-living environments. While several studies have found that people using non-pharmacological interventions without taking pain medication experienced significant differences in pain, the effect of non-pharmacological interventions on comfort and chronic pain in older people has not been studied. AIM: To assess differences in comfort and pain among older people in assisted and supported-living facilities who had chronic, non-cancer pain and who used or did not use non-pharmacological interventions. METHOD: A descriptive, comparative, cross-sectional pilot study with a convenience sample of 82 participants from 11 assisted and supported-living facilities. Three questionnaires were used to obtain data on the independent variable of use/non-use of non-pharmacological interventions and the dependent variables of perceived comfort and pain. Multivariate analyses of variance were computed to measure differences between the use/non-use groups, and Roy-Bargmann stepdown analyses were computed to further subdivide and analyse the groups who were using and not using pain medication. RESULTS: No significant differences were found in chronic pain and perceived comfort between participants who did or did not use non-pharmacological interventions if they were not also taking pain medication. However, when participants were also taking pain medication, chronic pain and perceived comfort scores were significantly affected by the use of non-pharmacological interventions. The most common non-pharmacological interventions were exercise, heat therapy, spiritual activity/religion and listening to music. CONCLUSION: Older people using non-pharmacological interventions and taking pain medication had higher perceived comfort scores and lower pain scores than those using pain medication only. Relationships between non-pharmacological interventions and comfort should be explored further. With minor changes, this pilot study design could be used with a larger sample.

A comparative study of social capital and hospital readmission in older adults.

Numerous factors contribute to hospital readmissions of older adults. The role social capital may play in preventing hospital readmissions is unknown. The aim of this descriptive, cross-sectional study was to determine if levels of personal social capital differ in two groups of patients aged 65 and older, those readmitted to the hospital within 30 days of discharge and those not readmitted. Participants in this study (N = 106) were community-dwelling older adults discharged from 11 hospitals in the Midwestern United States. The Personal Social Capital Scale and a demographic questionnaire were mailed to eligible participants for completion. Multivariate Analysis of Variance (MANOVA) was computed to examine the differences in the dependent variables of bonding and bridging social capital between those patients readmitted within 30 days and those not readmitted within 30 days. No significant differences between the two groups' mean levels of bonding or bridging social capital were identified.

Nonpharmacological interventions for persistent, noncancer pain in elders residing in long-term care facilities: An integrative review of the literature.

Elders residing in long-term care facilities experience ongoing moderate to severe pain, relief from and increased comfort remain relevant healthcare concerns. However, persistent, noncancer pain may not have been properly addressed due to insufficient attention to research that exists to support the utilization and efficacy of nonpharmacological intervention(s) for elders in long-term care facilities. Our aim of this integrated review was to evaluate the current state of the science on nonpharmacological intervention(s) for pain that are currently utilized in elders who reside in long-term care facilities. Exercise, massage, heat therapy, and relaxation/rest were identified as significant nonpharmacological interventions for persistent pain in elder residents living in long-term care facilities.

Social capital, health, health behavior, and utilization of healthcare services among older adults: A conceptual framework.

Meeting the health needs of Americans must change as the population continues to live longer. A strategy that considers social well-being is necessary. One way to improve social well-being is through increased social capital, which includes networks among individuals and norms of reciprocity and trust between them. Supporting attainment of bonding social capital from close-knit groups, such as family, and bridging or linking social capital from those who are dissimilar are vital. Research shows there is a relationship among social capital and self-reported mental and physical health, health behaviors, healthcare utilization, and mortality. Because older adults are often dependent on others for their healthcare needs, it is posited that social capital plays a key role. Nurses can be instrumental in investigating levels of social capital for individuals and determining what type of social support is needed and who in the individual's network will provide that support. When support is absent, the nurse serves as the link between patients and available resources. The purpose of this article is to introduce a conceptual framework that can assist nurses and other healthcare providers to consider social capital in older adults in the context of relationships and the social environments to which they belong.

The effect of first clinical assignments on prelicensure nursing students' attitudes toward older people: an observational study.

BACKGROUND: With the global population growth of older people, health care needs nurses interested in caring for this population. Studies have found a relationship between attitudes toward older people and career choices. AIM: The aim of this study was to determine the effect first clinical experiences had on nursing students' attitudes toward older people. DESIGN/METHOD: Using an observational research design, first-semester nursing students (n = 53) from the United States were assigned to one of two groups based on sequencing of clinical assignments. Participants completed the Refined Aging Semantic Differential scale three times their first semester. RESULTS: Students with exposure to long-term and then the acute care setting showed linear improvement in their attitudes toward older people. In addition, a significant improvement in attitudes over time was found (F[2, 96] = 3.56, p = .032) at two time measurements. CONCLUSION: This study showed that novice students may not recognize the differences in acute and long-term nursing care. Results may assist nursing educators designing curricula.

Continuing Education Preferences, Facilitators, and Barriers for Nursing Home Nurses.

BACKGROUND: The purpose of the study was to determine the continuing education needs for nursing home nurses in rural central Illinois and to determine any potential facilitators or barriers to obtaining continuing education. METHOD: Data were collected using the Educational Needs Assessment questionnaire. Descriptive statistics were computed to examine continuing education preferences, facilitators, and barriers among nursing home nurses. Independent samples t tests were used to compare preferences between administrative and staff nurses. RESULTS: The sample included 317 nurses from 34 facilities. The five top needs were related to clinical problems. Administrative nurses had greater needs for professional issues, managerial skills, and quality improvement than staff nurses. Barriers included rural settings, need for vacation time for programs, and inadequate staffing. CONCLUSION: Continuing education needs of nursing home nurses in Illinois are similar to previous studies conducted in Arizona and North Carolina. Continuing education barriers were mostly organizational, rather than personal. J Contin Nurs Educ. 2018;49(1):26-33.

Nursing students' attitudes toward persons who are aged: An integrative review.

OBJECTIVES: To analyze empirical studies from the United States and Canada to gain an understanding on how nursing education affects nursing students' attitudes toward persons who are aged. DESIGN: An integrative literature review was completed using Garrard's (2011) Matrix Method. DATA SOURCES: Articles were identified through the electronic database search engines of CINAHL, Pub Med, and Academic Search Complete. Only peer reviewed research articles from 2009 to 2015 were reviewed. REVIEW METHODS: A review matrix was created to abstract information from 11 studies so that synthesis could occur. Information in the columns of the review matrix was used to compare the studies. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 27 item check list was used to help with reporting the findings. Studies were graded using the American Association of Critical Care Nurses' (AACN) level of evidence. RESULTS: A key finding is student engagement with gerontological content in the classroom or clinical setting results in improving nursing students' attitudes toward persons who are aged. CONCLUSIONS: Several gaps exist in the literature. Further research including longitudinal studies and large scale, multi-site samples would add to the existing knowledge.

The Influence of X-Factor (Trunk Rotation) and Experience on the Quality of the Badminton Forehand Smash.

No existing studies of badminton technique have used full-body biomechanical modeling based on three-dimensional (3D) motion capture to quantify the kinematics of the sport. The purposes of the current study were to: 1) quantitatively describe kinematic characteristics of the forehand smash using a 15-segment, full-body biomechanical model, 2) examine and compare kinematic differences between novice and skilled players with a focus on trunk rotation (the X-factor), and 3) through this comparison, identify principal parameters that contributed to the quality of the skill. Together, these findings have the potential to assist coaches and players in the teaching and learning of the forehand smash. Twenty-four participants were divided into two groups (novice, n = 10 and skilled, n = 14). A 10-camera VICON MX40 motion capture system (200 frames/s) was used to quantify full-body kinematics, racket movement and the flight of the shuttlecock. Results confirmed that skilled players utilized more trunk rotation than novices. In two ways, trunk rotation (the X-factor) was shown to be vital for maximizing the release speed of the shuttlecock - an important measure of the quality of the forehand smash. First, more trunk rotation invoked greater lengthening in the pectoralis major (PM) during the preparation phase of the stroke which helped generate an explosive muscle contraction. Second, larger range of motion (ROM) induced by trunk rotation facilitated a whip-like (proximal to distal) control sequence among the body segments responsible for increasing racket speed. These results suggest that training intended to increase the efficacy of this skill needs to focus on how the X-factor is incorporated into the kinematic chain of the arm and the racket.

Initial Evidence for the Reliability and Validity of the Educational Needs Assessment Questionnaire.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the reliability and validity of the revised Educational Needs Assessment (ENA) questionnaire, a 32-item questionnaire designed to assess educational needs of nurses. METHODS: Data were obtained from 317 nursing home nurses in central Illinois and underwent testing for psychometric properties. RESULTS: The principal component analysis yielded a 6-factor solution that explained 65.9% of the variance and Cronbach's alpha for each factor was satisfactory. CONCLUSIONS: The revised ENA can be a useful tool to measure and identify in what areas of educational needs nursing home nurses need to develop their skills to help patients more effectively.

Hospital Readmission Rates Following Skills Training for Nurses Employed in Long-term Care Facilities.

Reducing hospital readmissions is a priority for health care providers and affects Medicare reimbursement. The purpose of this study was to determine whether there is a significant difference in readmission rates from long-term care facilities to hospitals with the implementation of a training program for long-term care nurses. The main findings revealed that the training did not significantly affect hospital readmissions; however, the organization saw a significant decrease in hospital readmissions after 24 months of data collection.

Are they family or friends? Social support instrument reliability in studying older lesbians.

We know little about the support needs and health of older lesbians because participant sexual identity has typically not been identified in aging studies. The Lubben Social Network Scale, Revised (LSNS-R) is found widely reliable for testing perceived social support among elders but has never been tested with an exclusively lesbian population. This pilot tested the instrument with an exclusively lesbian population in the Midwest. Our analysis suggests it may not be reliable with this population, even with minor modifications that were made. Further examination adding a category for "family of choice" is warranted and supported by the originator of the tool.