Health-Related Quality of Life in Patients With a Left Ventricular Assist Device (QOLVAD) Questionnaire: Initial Psychometrics of a New Instrument.

BACKGROUND: Patients with a left ventricular assist device are a unique and growing population who deserve their own valid, reliable instrument for health-related quality of life. OBJECTIVE: We developed and tested the Health-Related Quality of Life with a Left Ventricular Assist Device (QOLVAD) questionnaire. METHODS: In a prospective, descriptive study, patients from 7 sites completed the QOLVAD and comparator questionnaires. Construct validity was tested using confirmatory factor analysis. Convergent validity was tested using correlations of QOLVAD scores to well-established measures of subjective health status, depression, anxiety, and meaning/faith. Reliability and test-retest reliability were quantified. RESULTS: Patients (n = 213) were 58.7 ± 13.9 years old; 81.0% were male, 73.7% were White, and 48.0% had bridge to transplant. Questionnaires were completed at a median time of 44 weeks post ventricular assist device. The 5 QOLVAD domains had acceptable construct validity (root mean square error of approximation = 0.064, comparative and Tucker-Lewis fit indices > 0.90, weighted root mean square residual = 0.95). The total score and domain-specific scores were significantly correlated with the instruments to which they were compared. Internal consistency reliability was acceptable for all subscales (α = .79-.83) except the cognitive domain (α = .66). Unidimensional reliability for the total score was acceptable (α = .93), as was factor determinacy for multidimensional reliability (0.95). Total test-retest reliability was 0.875 (P < .001). CONCLUSION: Our analysis provided initial support for validity and reliability of the QOLVAD for total score, physical, emotional, social, and meaning/spiritual domains. The QOLVAD has potential in research and clinical settings to guide decision making and referrals; further studies are needed.

Non-Acute-Care Virtual Simulation: Preparing Students to Provide Chronic Illness Care.

This pilot study demonstrated the potential for virtual simulation in nursing education regarding chronic care management in community settings. Observations of faculty characteristics associated with the ability to effectively facilitate simulation experiences and debriefing sessions were consistent with prior studies.

Elder abuse: speak out for justice.

It is estimated that 1 in 10 older adults experience abuse, but only 1 in 5 to as little as 1 in 24 cases are reported. Elder abuse is expected to increase as the population ages. Nurses are in a prime position to identify, assess, manage, and prevent elder abuse. This article explores elder abuse and its prevalence, potential causes, and risk factors offering case studies, assessment tools, resources, and interventions.

A conceptual definition of quality of life with a left ventricular assist device: results from a qualitative study.

OBJECTIVE: To develop a conceptual definition of quality of life (QoL) with a left ventricular assist device (LVAD). BACKGROUND: Conceptual and operational definitions of QoL with an LVAD are lacking. METHODS: A grounded theory method was used. Adult, outpatient LVAD recipients (n = 11) participated twice in individual or paired interviews. RESULTS: A conceptual definition of QoL while living with an LVAD was established as: "Being well enough to do and enjoy day-to-day activities that are important to me." Participants described 5 important life domains consistent with QoL literature: physical, emotional, social, cognitive, and spiritual/meaning. However, participants identified unique concerns not addressed by generic or heart failure disease specific measures typically used in the LVAD population. CONCLUSION: Existing generic and heart-failure specific QoL measures are not adequate for understanding QoL among LVAD patients. Cognition and spiritual/meaning domains were significant; these need inclusion for comprehensive QoL assessment in the LVAD population.

Practicing the Code of Ethics, finding the image of God.

The Code of Ethics for Nurses gives a professional obligation to practice in a compassionate and respectful way that is unaffected by the attributes of the patient. This article explores the concept "made in the image of God" and the complexities inherent in caring for those perceived as exhibiting distorted images of God. While the Code provides a professional standard consistent with a biblical worldview, human nature impacts the ability to consistently act congruently with the Code. Strategies and nursing interventions that support development of practice from a biblical worldview and the Code of Ethics for Nurses are presented.

School wellness policies: opportunities for change.

School districts are required to comply with a 2004 federal mandate to guide nutrition and physical activity environments of schools by developing and implementing wellness policies. The purposes of this article are to (a) discuss the implications of the federal mandate and (b) analyze policies from nine school districts in one large suburban county in Minnesota to assess for compliance, comprehension, and strength. Policy analysis was guided by a coding system that reflected the federal mandate. Only one district met all federal requirements; policy statements from most districts analyzed were nonspecific. Evidence from this analysis supports previous research indicating that many school wellness policies are not comprehensive, lack strength, and do not fully comply with the intent of the federal mandate. School nurses, as stakeholders in school environments, must identify and utilize collaborative opportunities to impact policy development and implementation regarding school nutrition and physical activity environments.