Advancing Nursing Education: BSN Completion Messaging Materials for Associate Degree Program Nursing Faculty.

AIM: This project developed a comprehensive set of bachelor of science in nursing (BSN) completion messaging materials that associate degree in nursing (ADN) faculty can use to advise and encourage students to complete the BSN. BACKGROUND: The Future of Nursing report calls for increasing the proportion of baccalaureate-prepared nurses to 80 percent by 2020. Faculty who teach in ADN programs have opportunities to advise students in advancing their nursing education yet often lack information to guide these conversations. METHOD: After development of BSN completion messaging materials, the products were evaluated by faculty from two Kansas ADN programs. RESULTS: ADN faculty positively evaluated the format and content of the messaging materials. They appreciated having a variety of customizable resources to share with students in group and individual sessions. CONCLUSION: Next steps include disseminating the messaging materials to ADN programs and practice-based nursing leaders to guide education conversations about academic progression of ADN-prepared nurses.

The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation.

UNLABELLED: The abbreviated CGA (aCGA) can be used as a prescreening assessment to identify patients who would most benefit from the complete CGA. OBJECTIVE: To develop cutpoints for scoring the aCGA that are consistent with existing limitations as revealed by the full CGA. DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on cancer patients 70 and over. MEASUREMENTS: Each of the four domains: functional status (activities of daily living (ADL), instrumental activities of daily living (IADL), depression, using the geriatric depression scale (GDS), and cognition using the mini-mental state examination (MMSE)) are scored separately. RESULTS: For the depression domain, a score of 2 or more toward depression indicates that the entire GDS be administered. For the MMSE, a score of 6 or lower indicates necessity of the entire MMSE. For the ADL/IADL, any deficit on either scale (needs assistance or complete assistance) requires further clinical evaluation using the entire instruments. CONCLUSIONS: These guidelines provide the clinician with parameters to target patients most likely to benefit from more intensive geriatric evaluation.

Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial.

BACKGROUND: Family caregivers for cancer patients experience high levels of stress and burden and diminished quality of life (QOL). Interventions to improve coping skills of caregivers have been shown to be effective with other populations, but their impact has not been assessed in the difficult context of hospice care. The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care. METHODS: A three group randomized controlled trial was conducted including baseline, 16 day, and 30 day assessments conducted from March 1999 to May 2003. The sample consisted of 354 family caregivers of community dwelling hospice patients with advanced cancer. Patient/caregiver dyads were randomly divided into three groups, including a control group (n = 109) who received standard hospice care, a group (n = 109) who received standard hospice care plus three supportive visits, and a group (n = 111) who received standard care plus three visits to teach a coping skills intervention. Primary outcomes included caregiver QOL, caregiver burden due to patient symptoms, caregiver burden due to tasks, and caregiver mastery. RESULTS: At the 30-day follow-up, the coping skills intervention led to significantly greater improvement in caregiver QOL (estimate = -0.16, standard error [SE] = 0.07, P = 0.03), burden of patient symptoms (estimate = 0.28, SE = 0.07, P < 0.001), and caregiving task burden (estimate = -0.01, SE = 0.01, P = 0.038) than did the other two conditions. None of the groups showed significant change in overall caregiving mastery, caregiver mastery specific to caregiving tasks, problem-focused or emotion-focused coping. CONCLUSIONS: The coping skills intervention was effective in improving caregiver QOL, reducing burden related to patients' symptoms, and caregiving tasks compared with hospice care alone or hospice plus emotional support. Structured caregiver skill-training interventions for caregivers are promising even in the difficult environment of end-of-life care and for families already receiving benefits of hospice care.

E-health web portals: delivering holistic healthcare and making home the point of care.

E-health delivers healthcare services and education, via a Web portal, to older persons with chronic conditions and their caregivers and enables the patient's home to be the point of care. This growing industry is ripe for exploration by nurses who can empower the patient and caregiver to gain self-care and coping skills. Advances in information technology now make this dream a reality.

Electronic health records documentation in nursing: nurses' perceptions, attitudes, and preferences.

A descriptive study of 100 nursing personnel at a large Magnet hospital in Southwest Florida was conducted to assess their needs, preferences, and perceptions associated with Electronic Health Record (EHR) documentation methods. Nurses' attitudes about the use of EHRs and their perceived effects on patient care were assessed. The five-item, Likert-type attitude scale explained 54% of the variance in attitude scores and demonstrated sound construct validity and internal consistency (r = 0.77). More than one third, 36%, perceived that EHRs had resulted in a decreased workload. The majority of nurses, 64%, preferred bedside documentation but reported that environmental and system barriers often prevent EHR charting at the bedside. Overall, 75% of nurses thought EHRs had improved the quality of documentation and 76% believed electronic charting would lead to improved safety and patient care. Nurses with expertise in computer use, 80%, had a more favorable attitude toward EHRs than those with less expertise. Results have been used to implement clinical system changes.

A focus group for caregivers of hospice patients with severe dyspnea.

The use of focus groups has grown in all aspects of our society, including the areas of politics and business. More recently, clinical research investigators have begun using focus groups to acquire important information from potential study subjects, such as patients and caregivers. Researchers use focus groups to help them design and test data collection measures, assess responses to proposed interventions, and obtain guidance on recruitment and retention methods for clinical trials. This report explains the basic requirements and methods for conducting focus groups. The authors conducted a focus group study based on six former caregivers of hospice patients with severe dyspnea. The paper describes the results of this study and illustrates how caregivers assisted in evaluating potential interventions for dyspnea, which will be tested in a future clinical trial. Subsequently, the researchers used the focus group data to adapt the guided-imagery intervention to the lifestyle and culture of the study subjects and their caregivers.

Dyspnea and quality of life indicators in hospice patients and their caregivers.

This study describe the assessment of dyspnea, symptom distress, and quality of life measures in 163 hospice patients with cancer who reported dyspnea. Mean age of the hospice patient sample was 70.22 years and 61.86 for caregivers (65% were spouses). The majority of patients and caregivers were white: 87%, 63% of the patients were male while 78% of caregivers were female. Mean dyspnea intensity as reported by patients was 4.52 (SD 2.29) and caregivers, 4.39 (SD 2.93). Patients' and caregivers' ratings of the patient's dyspnea intensity revealed no significant differences in ratings thus verifying that caregivers can assess dyspnea severity accurately. Patients' perceived quality of life ratings were not significantly correlated with ratings of their caregivers' perceived quality of life. For patients, symptom distress and education were significant predictors of variance in quality of life (R2 =.35, p =.04). However, mastery, symptom distress, age, and education were found to be significant predictors of variance in quality of life of caregivers (R2 =.40, p =.02).

Hospice patient and caregiver congruence in reporting patients' symptom intensity.

As healthcare increasingly moves out of hospitals, the care of patients with cancer is provided in the community with the help of family caregivers. In many cases, nurses depend on family caregivers to provide assessment data about patients. This makes the accuracy and dependability of the data given by caregivers particularly important. However, it is not clear whether caregivers can accurately and dependably report such subjective data as symptom intensity. The purpose of this project was to evaluate the ability of the primary caregiver to report the symptom intensity of hospice patients with cancer. The sample consisted of 264 newly admitted adult patients with advanced cancer in hospice home care and their primary caregivers. These subjects were part of a large National Institutes of Health (NIH)-funded randomized clinical trial focused on symptom management and quality of life. The patients were alert and oriented. Among the questionnaires completed by both patients and caregivers on admission were numeric rating scales for pain and dyspnea and the Constipation Assessment Scale. All of these scales were designed to describe the patient's symptom intensity. The patient sample was predominantly white (83%) and male (57%), with a mean age of 71.6 years. The caregiver sample was predominantly white (85%) and female (78%), with a mean age of 62 years. The results indicated that caregivers significantly overestimated symptom intensity for all three symptoms (P =.000). Furthermore, the limited variance accounted for by the two sets of scores for each of the symptoms (R2 =.16-.26) indicated much more error in the scores than agreement between patient and caregiver. It appears that family caregivers cannot reliably report patient symptom intensity. Healthcare providers need to train family caregivers in conducting systematic assessments instead of assuming that they understand patient symptoms.

Carpal tunnel syndrome: current theory, treatment, and the use of B6.

PURPOSE: To present the current state of the science of pathophysiology, assessment and treatment of carpal tunnel syndrome, including the use of pyridoxine (B6). DATA SOURCES: Selected research articles, texts, Websites, personal communications with experts, and the authors' own clinical experience. CONCLUSIONS: Much is yet to be learned about carpal tunnel syndrome. While the basic treatment of NSAIDs and nighttime splints seems universally accepted, much controversy remains. The use of vitamin B6 as a treatment is one such controversy requiring further investigation. IMPLICATIONS FOR PRACTICE: Current treatment for carpal tunnel syndrome should include NSAIDs, nighttime splinting, ergonomic workstation review, and vitamin B6 200 mg per day.

Maintaining data integrity in randomized clinical trials.

BACKGROUND: The process of attaining and maintaining data integrity is critical to ensure a successful randomized clinical trial. Methodologic strategies to achieve data integrity when repeated measures are used has not been discussed in detail in the literature. The National Institutes of Health requires that data integrity and safety monitoring boards or plans be established for randomized clinical trials. OBJECTIVES: The objectives of this paper are to (a) examine important data collection issues nurse scientists often encounter in randomized clinical trials and (b) present a process that researchers can apply to achieve data integrity. METHODS: The process to achieve data integrity is based on strategies that were developed by an interdisciplinary hospice research team involved in an ongoing National Institutes of Health-funded clinical trial. The process and key issues are illustrated with methodologic examples from the randomized clinical trial and supporting literature. RESULTS: The process of achieving data integrity involves developing protocols in three key areas: data collection, training of data collectors, and data monitoring. The use of these protocols will increase the rigor of the clinical trial and assist in maintaining study validity. CONCLUSIONS: Investigators conducting clinical trials need to consider all issues involved in achieving data integrity and have tested protocols in place throughout the study. These approaches will not only help maintain study validity but also help ensure data of sufficient quantity and quality to achieve the desired statistical power.