Development and Implementation of a Procedural Sedation Course for Registered Nurses.

Procedural sedation is the administration of medication to obtund, dull, or reduce the intensity of pain or awareness associated with a therapeutic or diagnostic procedure. Because registered nurses play a key role in ensuring patient safety during procedural sedation, it is essential they have the requisite knowledge and skills to provide safe, quality care. This paper describes the development, implementation, and outcomes of a course designed for nurses providing care to patients undergoing procedural sedation.

Assessing Nutrition Status in an Outpatient Wound Center: A Feasibility Study.

OBJECTIVE: To explore the feasibility of using the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutrition status of patients with chronic wounds receiving care in an outpatient wound clinic. METHODS: The PG-SGA was administered to a single cohort convenience sample of adults with chronic wounds who presented to an outpatient wound clinic. The authors performed univariate descriptive analyses and calculated interrater reliability. RESULTS: Nutrition assessments were completed with 15 clinic patients. Patients required an average of 6.5 minutes (range, 3.5-10 minutes) to complete their component of the PG-SGA, exceeding the target goal of 5 minutes or fewer. Dietitians required an average of 2 minutes per patient to complete the professional component of the PG-SGA (physical examination). The nutrition assessment process was rated highly favorable. Resources to conduct the study at the site were available 100% of the time. CONCLUSIONS: The PG-SGA demonstrates promise for use in the chronic wound population and could be incorporated into clinical care in settings equipped with appropriate and adequate resources. The complexities of workforce stability and resource availability, in addition to the ongoing need to be responsive to patient challenges, must be acknowledged in the planning of future studies.

Effect of a QI Intervention on Nursing Assistants' Pain Knowledge and Reporting Behavior.

BACKGROUND: Pain among long-term care residents is often underdiagnosed and inadequately treated. We examined the effect of a multimodal intervention on certified nursing assistants' pain recognition knowledge and verbal reporting behavior. Secondarily, we examined pain documentation in a newly established pain log compared with pain verbally reported to nurses and documented in the electronic health record (EHR). DESIGN: Quality improvement project using a pretest-posttest design. SETTING: A skilled nursing and rehabilitation facility in Southwestern Pennsylvania including two long-term care units and one transitional rehabilitation unit. PARTICIPANTS/SUBJECTS: Fifty-six nursing assistants. METHODS: The intervention was a face-to-face educational session with a training video and introduction of a new pain log used to document residents' pain. Pain knowledge was measured before and after the educational intervention. Multiple measures were used to examine nursing assistants' pain reporting. RESULTS: Nursing assistants' pain knowledge improved (p < .001). There was no change in verbal pain reporting behaviors. The percent of pain episodes documented in the electronic health record that were reported to nurses varied by unit type (45% on the long-term care units vs. 100% on the rehabilitation unit) but remained unchanged postintervention. Pain logs were used more often on the rehabilitation than the long-term care units; use was low overall. Nursing assistant reports that nurses provided feedback on their reports of resident pain increased from 45% in week 1 to 75% in week 4. CONCLUSIONS: Although the multimodal intervention improved nursing assistants' pain knowledge and their perceptions of the feedback they received from nurses when they reported pain, it had no effect on certified nursing assistants reporting of pain to nurses (per nurse report).

A scoping review of nurse practitioner workforce data: Part two of a four-part series on critical topics identified by the 2015 Research Agenda Roundtable.

BACKGROUND AND PURPOSE: There is no single comprehensive data source for conducting nurse practitioner (NP)-focused workforce and outcomes research. The 2015 Research Agenda Roundtable of the Fellows of the American Association of Nurse Practitioners supports the development of a national NP data source. A scoping review was conducted to provide an overview of data being used in NP-focused research and to identify key issues relevant to making progress toward a national NP database. METHODS: PubMed, CINAHL, and EMBASE were searched for English-language articles published within the past 10 years (2007-2017). Twenty-one articles were included for review and categorized into three themes: 1) NP Workforce Data Collection and Availability; 2) Using Data to Identify NPs; and 3) Minimum Data Sets and Key Variables. CONCLUSIONS: General consensus among workforce experts suggests that rich sources of NP data exist. However, challenges include a lack of a national data source for studying the NP workforce and outcomes; the inability to identify individual NP providers within existing data; and variations in how different sources of data are collected. IMPLICATIONS FOR PRACTICE: Improved NP workforce data collection is vital for workforce planning and forecasting and has implications for outcomes research and NP workforce distribution and employment.

Obesity and disability in older adults.

The prevalence of obesity and disability in older adults has significant public health implications. This case review discusses the benefits and risks of weight loss in older adults and outlines treatment options available to Medicare beneficiaries. The importance of preserving lean muscle mass in weight management is emphasized.

Older Rural- and Urban-Dwelling Appalachian Adults With Mild Cognitive Impairment.

PURPOSE: Mild cognitive impairment (MCI) is a well-recognized risk state for Alzheimer's disease and other dementias. MCI is rapidly increasing among older adults in general and has not yet been examined in older adults within the Appalachian region. Our objective was to compare MCI symptom severity among older rural and urban Appalachian adults with MCI at an initial neuropsychological testing visit. METHODS: A cross-sectional, descriptive study of older Appalachian adults with MCI was conducted using data from the National Alzheimer's Coordinating Center Uniform Data Set. Symptom severity was conceptualized as neuropsychological composite scores across 4 cognitive domains and Clinical Dementia Rating-Sum of Boxes (CDR-SOB) score. For group comparisons, MANCOVA was used for cognitive domains and ANCOVA for CDR-SOB. RESULTS: The sample (N = 289) was about half male (54.3%), predominantly white (91.7%), and living with others (83.5%), with a mean (±SD) 74.6 ± 6.2 years of age and 15.4 ± 3.0 years of education. Rural and urban groups differed significantly in years since onset of cognitive symptoms (2.98 ± 1.91 in rural and 3.89 ± 2.70 in urban adults, t[260] = -2.23, P = .03), but they did not differ across sociodemographic features or comorbid conditions. Rural and urban participants were similar across the 4 cognitive domains and CDR-SOB (P ≥ .05). DISCUSSION: No differences were found between rural and urban Appalachian residents on MCI symptom severity. However, urban residents reported a longer time lapse from symptom identification to diagnosis than their rural counterparts. Future studies using more representative population samples of Appalachian and non-Appalachian adults will provide an important next step to identifying disparate cognitive health outcomes in this traditionally underserved region.

Improvement in colon cancer screening through use of a multilevel intervention: A QI initiative.

BACKGROUND AND PURPOSE: Colon cancer is the second leading cause of cancer-related deaths in the United States but is highly treatable when diagnosed early. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate a multilevel intervention to raise colon cancer screening rates. METHODS: A pre- and postintervention design was used with patients who were largely Caucasian and English speaking. Patients were mailed information about the importance of screening, and a phone line was created for patients to select a colonoscopy, fecal immunochemical test, or decline screening. Patients not responding via the phone line received an e-mail or postcard about the importance of screening. Electronic flags were sent to providers on the day of the visit to remind staff to address screening. Uninsured patients received free screening. CONCLUSIONS: Across three clinics, colon cancer screening rates increased by 6.3%-6.9% through use of a multilevel intervention. Staff satisfaction was moderately high for ease of use, staff education, and perceived success of the QI initiative. IMPLICATIONS FOR PRACTICE: Patient education, decision support tools, outreach to patients by mail, phone, e-mail, electronic flags, and free screening for uninsured patients collectively can increase colon cancer screening rates in an at-risk population.

Baccalaureate Nursing Students' Knowledge of and Attitudes Toward Older Adults.

Preparing nurses to care for a growing population of older adults is one of the most significant challenges for nursing education. The purpose of the current study was to describe baccalaureate nursing students' knowledge of and attitudes toward older adults, and explore the impact of a gerontological nursing course on their knowledge and attitudes. Results showed that students who had prior experience with older adults had significantly more positive attitudes toward them. Although students who participated in a gerontological nursing course had significantly higher knowledge scores than the comparison group, no significant difierence was noted in overall attitude. In addition, students who were enrolled in the gerontological nursing course or had prior experience with older adults were more likely to report plans to work with this population after graduation. Students who participated in interviews with older adults found the experience meaningful and their attitudes regarding older adults were largely positive.