Research in the Rehabilitation Unit Presents Challenges to Nurse Researchers.

PURPOSE: Gathering data from patients on a rehabilitation unit poses challenges for nurse researchers. DESIGN: A case study is presented that describes ways the researchers attempted to meet these challenges while conducting their study. METHODS: The case study presents the approaches that the investigators took to undertake the study and then described the ways in which these approaches could have been improved. FINDINGS: Their successes and failures are described. CONCLUSIONS: Suggestions are made for future investigators. CLINICAL RELEVANCE: Clinical nursing research is required to develop an evidence base for practice in the rehabilitation unit. An analysis of the challenges and possible methods of overcoming these challenges is useful to both future investigators and nurses in practice to insure that studies can be carried out effectively.

The relationship between pressure ulcer prevalence, body mass index, and Braden scales and subscales: a further analysis.

The purpose of this study was to evaluate whether any of the Braden subscales were more strongly related to pressure ulcer occurrence than the Braden total score in obese and nonobese hospitalized patients. The authors investigated whether defining high risk for the total Braden score of 16 or less was associated with pressure ulcer occurrence.

Pilot testing the augmentech body position sensor on the morbidly obese patient.

The Augmentech Body Position Sensor (ABPS), a device for monitoring patient repositioning, was tested for use in morbidly obese patients. Specific aims were to: determine whether there was correspondence between data on patient turning and repositioning from the ABPS and data gathered through human observation; determine whether the ABPS is an acceptable instrument for measuring body movements in morbidly obese patients in terms of ease of use, comfort and ability to stay in place. A descriptive study was conducted. Data from the ABPS recording patients' body positions were compared with data from videotapes taken of the same patients during the same time period. The sleep center of a tertiary care facility in the southeastern United States was used. Ten participants with BMI ≥30 were selected from patients referred to the sleep center for polysomnography. Positioning the device on the patient's thigh, data were collected from midnight until discharge. Videotapes taken of the same patient during the same time period were examined for changes in body position over time. There was a strong correspondence between the videotaped data and the ABPS data. The device was comfortable and not irritating to the patient. The APBS can be a useful measure for determining changes in body position but further study should be undertaken to test other sites for placement.

Experiences of military CRNAs with service personnel who are emerging from general anesthesia.

We conducted this qualitative study to understand the experiences of military Certified Registered Nurse Anesthetists (CRNAs) working with service personnel who have traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) and are emerging from general anesthesia. This study is important because there are no studies in the literature that describe the experiences of anesthetists working with patients with these specific problems. The leading questions were: "Out of all the anesthesia cases both abroad and stateside (post 9/11/2001), have you noticed service members wake from general anesthesia (not utilizing total intravenous anesthesia (TIVA), in a state of delirium? If so, can you tell me your experiences and thought processes as to why it was occurring?" Five themes emerged: (1) Emergence delirium (ED) exists and to a much higher degree in the military than in the general population. (2) ED was much more prevalent in the younger military population. (3) TIVA was a superior anesthetic for patients thought to have TBI and/or PTSD. (4) Talking to all patients suspected of having TBI and/or PTSD before surgery and on emergence was vital for a smooth emergence. (5) There is something profound happening in regard to ketamine and PTSD and TBI.

Living with diabetes: what patients are saying.

The purpose of this study was to explore the thoughts and feelings of patients with diabetes. The study analyzed the responses to an open-ended question, which was the last item (Question 43) on a diabetes survey that was mailed to 2,615 persons, 534 (22%) with diabetes in eastern North Carolina. Content analysis of the data revealed the following themes: coping/prayer, support, effects of diabetes, metaphors, controlling comorbidities, and appreciation/thankfulness.

Barriers to transition of obese patients from hospital to community.

OBJECTIVES: To identify barriers encountered by case managers in hospitals, home care agencies, and nursing homes in the transition of the obese patient from the hospital to the community. STUDY DESIGN: Exploratory descriptive design was used. Hospital case managers, nursing home administrators, and Medicare-certified home healthcare agency administrators were surveyed to identify barriers. METHODS: Hospital case managers in each licensed acute care hospital, directors of licensed nursing homes, and administrators of the Medicarecertified home healthcare agencies in 1 southern state were surveyed. The survey instrument was designed by the investigators based on variables identified in the literature or encountered within their practice. Instruments consisted of items related to the respondent's experience with barriers such as patient size, degree of patient independence, patient care requirements, staffing levels, and the need for assistive equipment, as well as items used to collect basic demographic information. RESULTS: Both hospital case managers and nursing home directors reported as major barriers the equipment, the size of the patient, patient independence, and finances. Home care agency directors reported that the presence or absence of a competent caregiver was the major factor in the decision to accept or not accept an obese patient. CONCLUSIONS: Transition of the obese patient presents major challenges. Further exploration is needed to identify the extent of problems and make policy recommendations toward a solution.

The association of BMI and Braden total score on the occurrence of pressure ulcers.

PURPOSE: We compared pressure ulcer (PU) prevalence patients with a body mass index (BMI) of 40 or more, and Braden Scale scores of 16 or more to patients with lower BMI. METHODS: A cross-sectional study by using existing data was conducted combining patient skin status with BMI. Subjects underwent skin assessment for evidence of skin breakdown by nurses trained in PU assessment. Data from this assessment were combined with historic data gathered from review of medical records and BMI. SUBJECTS AND SETTING: The study was carried out in a tertiary medical center in Eastern North Carolina. Three hundred sixty-two patients were included in the prevalence study. RESULTS: Fourteen percent of all patients had at least 1 PU. The prevalence among patients with a BMI of less than 40 was 12.5% as compared to 26% in patients with a BMI of more than 40 (P 5 .01). When controlling for the effects of BMI, patients with a Braden Scale score of 16 or less were almost 6 times more likely to have a PU as compared to those with Braden Scale scores of more than 16 (P, .001). Body mass index had an independent association with the probability of PU occurrence. Patients with BMIs of more than 40 were almost 3 times more likely to have a PU compared to those with BMIs of 40 or less, after controlling for Braden risk (P 5 .01). CONCLUSION: A BMI of more than 40 and Braden Scale score of 16 or less were found to have an independent and statistically significant association with PU occurrence. Future studies should investigate the predictive validity of BMI along with individual Braden subscales.

Learner-centered characteristics of nurse educators.

The purpose of this study was to describe the learner-centered teaching characteristics of nurse faculty who report using contemporary pedagogy. A secondary analysis of data collected by an international survey of nurse educators regarding pedagogical teaching approaches and strategies was used to answer the research questions. The study sought to: 1) describe characteristics emerging from faculty response, 2) make inferences from faculty responses regarding meaning, and 3) make inferences regarding the importance of the meaning to nursing. A qualitative research design was used to address the research question. Themes that emerged were placed under the concepts of power, role of teacher, responsibility of learner, and philosophy of evaluation guided by Weimer's (2002) conceptual framework of a learner-centered philosophy of teaching. Themes and meaning units derived from the study helped to generate textual and structure statements that represent the characterizations of learner-centered nurse educators.

A dialogal investigation of "Who am I as a teacher?".

Women health professionals who join academe reformulate their identities as they become professors and teachers. Teacher inquiry is a systematic intentional study of one's own professional teaching practice that framed the question "Who am I as a teacher?" Using a process of dialogal research, we explored our biases and assumptions about teaching, which served as the source for our data. We discovered that our teaching included being a "judge," "lifelong learner," "bridge to learning," and "researcher," and that our teaching was "affected by temporality" and "the environment." As teachers, we are "someone who works through challenges." We suggest that teacher inquiry can empower allied health educators, change educational practice, and provide meaningful opportunities for the professional development of faculty.

The experience of teaching in a diabetes program.

Diabetes care accounts for $132 billion of total health care expenditures, and the prevalence of diabetes is increasing. Preparing and managing diabetes educators are a serious challenge for health care managers. A phenomenological approach was used to explore the teaching experiences of 3 diabetes program staff members. Data were collected through 3 face-to-face interviews and 20 e-mail messages over a 6-week period. The individuals included 2 second year marriage and family therapist doctoral students and 1 certified diabetes educator. Reflexivity, triangulation by peers, and member checks were used to ensure trustworthiness. The 4 themes found in this study were roles, awareness, sense of importance, and challenges and frustrations.

Challenges in caring for morbidly obese patients.

This study aimed to determine how morbidly obese patients and their families manage activities of daily living (ADLs) at home. A survey design was used for this descriptive study. Home healthcare professionals identified both challenges and innovations in managing the ADLs of the morbidly obese in the home.

Skin care intervention for patients having cardiac surgery.

BACKGROUND: Pressure ulcers are a major problem after cardiovascular surgery, occurring in 9.2% to 38% of patients. OBJECTIVES: To determine the effectiveness of a skin care intervention program in preventing development of ulcers or progression from one stage to another and to determine the extent to which selected risk factors were associated with development and progression of pressure ulcers. METHODS: A simple interrupted time series design was used. The protocol involved interrelated assessment, staging, and type of intervention provided. The Braden Scale was used to determine risk for skin breakdown. RESULTS: Of the 351 patients in the study, 327 (93%) maintained skin integrity and 24 (7%) had skin breakdown. Breakdown by stages was as follows: stage 1, 62% (n = 15); stage 2, 29% (n = 7); stage 3, 4% (n = 1); and stage 4, 4% (n = 1). Age, sex (female), and heart failure were statistically significant risk factors for breakdown (P = < .001, .02, and .02, respectively). The mean scores on the Braden Scale of the breakdown group differed significantly from those of the skin integrity group from days 2 through 5 after surgery (P = .01). Seventeen (71%) of the breakdowns occurred during the first 4 days after surgery. CONCLUSIONS: Skin assessments and nursing interventions should be increased on the day of surgery and the first to fifth postoperative days, including multiple assessments and skin care focused on maintaining skin integrity.