A Scoping Review on Work Experiences of Nurses After Being Diagnosed With Cancer.

PROBLEM IDENTIFICATION: To map key concepts underpinning work-related studies about nurses with cancer and identify knowledge gaps. LITERATURE REVIEW: A search was conducted in the PubMed®, CINAHL®, and PsycINFO® databases for articles about nurses with cancer and work-related topics published through March 2023. DATA EVALUATION: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist was used to report results, and the JBI critical appraisal tools were used to assess the quality of studies. Eleven articles were included. SYNTHESIS: The following four critical concepts were identified: role adjustments at work, cancer impacts on work, organizational support, and translating insights gained from cancer experience into work. Research gaps identified by the scoping review were a lack of theoretical or conceptual frameworks, lack of syntheses of main ideas, and lack of clear data about participants' socioeconomic status across studies. IMPLICATIONS FOR RESEARCH: Minimal research exists to map predictors, outcomes, or intervention targets to guide organizational strategies to support nurses' retention in the nursing workforce. A guiding framework, recruitment of diverse nurses, and focus on the four critical concepts identified in this scoping review are suggested for future research.

Meaningful Engagement as a Predictor of Psychological Well-Being for Adults With Low Income.

IMPORTANCE: The activities that people engage in influence their well-being. Adults with low income have limited resources, which can affect their engagement in meaningful activities. Exploring the connection between meaningful engagement and well-being is an important step in providing occupational justice for this marginalized population. OBJECTIVE: To examine whether engagement in meaningful activities uniquely contributes to well-being for adults with low income after controlling for demographic variables. DESIGN: Cross-sectional exploratory study design. SETTING: Community agencies serving adults with low income, a local library, and a university union hall in northwest Ohio. PARTICIPANTS: Adults with low income (N = 186). OUTCOMES AND MEASURES: Participants completed a demographic questionnaire, the Engagement in Meaningful Activities Survey (EMAS), and the World Health Organization-5 Wellbeing Index (WHO-5). We examined the influence of demographics and EMAS on the WHO-5. RESULTS: We identified a moderate correlation between the EMAS and WHO-5 (r = .52, p ≤ .05). Linear regression revealed an R2 = .27, F(7, 164) = 8.75, p < .001, with the EMAS and participant attributes as predictor variables. The R2 changed to .02 (p = .85) without the EMAS in the model. CONCLUSIONS AND RELEVANCE: Findings support the need for and use of meaningful activities to support well-being and health for adults with low income. What This Article Adds: Findings build on the evidence supporting the role of engagement in meaningful activities by drawing connections to a well-known and widely used measure of subjective psychological well-being and applying these connections to adults with low income. Occupational therapy practitioners can use measures such as the EMAS to strategically infuse aspects of meaning that promote engagement and foster well-being.

An Internet-Based Self-Management Intervention to Reduce Fatigue Among People With Traumatic Brain Injury: A Pilot Randomized Controlled Trial.

IMPORTANCE: Fatigue is a chronic and distressing sequela of traumatic brain injury (TBI). Little evidence exists for the efficacy of interventions that address post-TBI fatigue. OBJECTIVE: To evaluate the preliminary efficacy of a self-management intervention (Maximizing Energy; MAX) for reducing the impact (primary outcome) and severity of fatigue on daily life, improving fatigue experience, and increasing participation compared with a health education (HE) intervention. DESIGN: Pilot randomized controlled trial (RCT). SETTING: Community. PARTICIPANTS: Forty-one participants randomly assigned to the MAX (n = 20) or HE (n = 21) intervention. INTERVENTIONS: The MAX intervention included problem-solving therapy with energy conservation education to teach participants fatigue management. The HE intervention included diet, exercise, and energy conservation education. Both interventions (30 min/day, 2 days/wk for 8 wk) were delivered online by occupational therapists. OUTCOME AND MEASURES: The primary outcome was the modified Fatigue Impact Scale (mFIS). Outcome measures were collected at baseline, postintervention, and 4- and 8-wk postintervention. RESULTS: At 8 wk postintervention, participants in the MAX group reported significantly lower levels of fatigue impact (mFIS) than those in the HE group, F(1, 107) = 29.54, p = .01; Cohen's d = 0.87; 95% confidence interval [0.18, 1.55]. CONCLUSIONS AND RELEVANCE: These findings provide preliminary evidence that the MAX intervention may decrease the impact of fatigue on daily life among people with post-TBI fatigue. What This Article Adds: An internet-based, self-management intervention combining occupational therapy- delivered energy conservation education with cognitive-behavioral therapy seems to reduce fatigue impact and severity among people with post-TBI fatigue. Future appropriately powered RCTs could positively contribute to the evidence available to occupational therapy practitioners for this chronic, debilitating, and often overlooked symptom.

Promoting Routines of Exploration and Play during Mealtime: Estimated Effects and Identified Barriers.

Promoting Routines of Exploration and Play during Mealtime (Mealtime PREP) is an intervention designed to support healthy dietary variety in children. To estimate the effects of this intervention, we recruited 20 parents and children (aged 1-5 years) with sensory food aversions to participate in a pilot study. Parents were coached to enhance daily child meals using Mealtime PREP. Our primary outcome was acceptance of targeted food (number of bites) over time. Descriptive statistics and effect sizes are reported. Moderate effects were observed for acceptance of targeted food. Mealtime PREP warrants additional research to examine effects in larger, more diverse samples.

Behavioral Activation Approach to Parent Training: Feasibility of Promoting Routines of Exploration and Play During Mealtime (Mealtime PREP).

OBJECTIVE: Systematic approaches are needed to help parents with young children adopt healthy routines. This study examined the feasibility (home data collection, protocol adherence, intervention acceptance) of using a behavioral activation (BA) approach to train parents of children with sensory food aversions. METHOD: Parents of young children (18-36 mo) were trained using the novel Promoting Routines of Exploration and Play During Mealtime intervention. Measures included video-recorded meals, Fidelity Checklist, Treatment Acceptability Questionnaire, and Behavioral Pediatrics Feeding Assessment Scale. Descriptive statistics were used. RESULTS: Eleven children and their parents completed the study. Two of three feasibility benchmarks were met. Intervention acceptance was high (mean score = 43/48). On average, parents used three more intervention strategies after training than at baseline. CONCLUSION: Using a BA approach to parent training shows promise for altering daily mealtime routines. Delivering this intervention in the home is feasible and received acceptable ratings among this sample.

Solving fatigue-related problems with cardiac arrest survivors living in the community.

AIM: The aim was to describe fatigue-related problems reported by post-cardiac arrest adults with chronic fatigue and energy conservation strategies generated using an Energy Conservation plus Problem Solving Therapy intervention. METHODS: Following an introduction to the intervention process outlined in a Participant Workbook, participants engaged in the telephone intervention by identifying one to two fatigue-related problems. They then brainstormed with the interventionist to identify potential strategies to reduce fatigue, tested them, and either modified the strategies or moved to the next problem over three to five sessions. RESULTS: Eighteen cardiac arrest survivors with chronic fatigue identified instrumental activities of daily living and leisure activities as fatigue-related activities more frequently than basic activities of daily living. Energy Conservation strategies used most frequently were: plan ahead, pace yourself, delegate to others, and simplify the task. CONCLUSION: Post-cardiac arrest adults living in the community with chronic fatigue can return to previous daily activities by using energy conservation strategies such as planning ahead, pacing tasks, delegating tasks, and simplifying tasks.

An intervention for cardiac arrest survivors with chronic fatigue: A feasibility study with preliminary outcomes.

AIM: The primary aim was to examine the feasibility of recruiting and retaining participants for an Energy Conservation+Problem Solving Therapy (EC+PST) intervention delivered over the telephone, to evaluate the acceptability of the intervention, and to assess the appropriateness of the outcome measures. The secondary aim was to evaluate the preliminary intervention effect on fatigue impact, activity performance, and participation in daily activities in post-cardiac arrest (CA) adults with chronic fatigue. METHODS: This feasibility study used a prospective, pre-post experimental design. Individuals who were at least 3 months post-CA with moderate-to-severe fatigue were eligible to participate. By participating in EC+PST intervention sessions, participants learned how to apply EC strategies to solve their fatigue-related problems. Participants were assessed before and after completing the intervention using outcome measures assessing fatigue, activity performance, and participation in daily activities. RESULTS: Eighteen CA survivors with chronic fatigue successfully completed the intervention and the assessments with high satisfaction. We observed a 15% recruitment rate and ceiling effects on two outcome measures of perceived-performance in daily activities. Significant decreases in the impact of physical (p=.001) and cognitive (p=.006) fatigue of CA survivors were observed with small to moderate effect sizes of r=0.23-0.25 after receiving the EC+PST intervention. CONCLUSION: The delivery of EC+PST intervention over the telephone is feasible, and the intervention is highly acceptable to CA survivors with chronic fatigue. Also, the EC+PST intervention seems promising in reducing the impact of physical and cognitive fatigue of CA survivors.

Feasibility of a Cognitive Behavioral Intervention to Manage Fatigue in Individuals With Traumatic Brain Injury: A Pilot Study.

OBJECTIVE: To evaluate the feasibility of conducting a randomized clinical trial of an Internet-based manualized intervention to teach individuals with traumatic brain injury to manage their fatigue. SETTING: Community dwelling. PARTICIPANTS: Forty-one participants randomized to Maximizing Energy (MAX) intervention group (n = 20) and Health Education group (n = 21). INTERVENTION: The experimental group (MAX intervention) received an 8-week program that combined education and Problem-Solving Therapy to teach individuals to manage fatigue-related problems. The attention control group received health education. MEASURES: Primary outcome measures pertained to the feasibility of conducting the trial. Secondary outcomes were fatigue impact and fatigue severity assessed at baseline and postintervention. RESULTS: Of the 65 participants referred, 41 were enrolled (63% recruitment rate), of which 3 withdrew (92% retention rate). Participants in the experimental and control groups completed their homework 75% and 85% of the time, respectively, and were equally engaged in the sessions. Participants in the experimental group were able to learn and implement the MAX intervention steps. Effect sizes for all measures ranged from small (-0.17) to medium (-0.58) in favor of the intervention group. CONCLUSION: Findings from the study suggest that the MAX intervention is feasible to administer to individuals with post-traumatic brain injury fatigue.

Wheelchair Transfer Simulations to Enhance Procedural Skills and Clinical Reasoning.

OBJECTIVE: We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning. METHOD: Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan(®) and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness. RESULTS: On average, students completed 66%-88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools. CONCLUSION: Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously.

Simulation Strategies to Teach Patient Transfers: Self-Efficacy by Strategy.

OBJECTIVE: We evaluated the effects of transfer training-after training in the classroom and in the high-technology simulation laboratory (WISER Center)-on students' perceptions of their self-efficacy for knowledge, skill, and safety in executing dependent transfers. METHOD: After classroom training, occupational therapy students were randomized to three teaching groups on the basis of the amount of participation and observation opportunities provided at the WISER Center-observation dominant, participation dominant, and participation only. RESULTS: The participation-dominant group reported an increase in knowledge self-efficacy over time compared with the observation-dominant and participation-only groups. Over time, self-efficacy ratings increased for all students, regardless of group. CONCLUSION: Simulation scenarios implemented at the WISER Center provided a useful adjunct to classroom training in transfer skills. Both participatory and observational experiences contributed to the development of students' perceptions of their ability to manage acutely ill and medically complex patients.

Functional Outcomes: One Year after a Cardiac Arrest.

OBJECTIVE: The study aim was to characterize the time-course of recovery in impairments, activity limitations, participation restrictions, disability, and quality of life during the first year after cardiac arrest. Secondarily, the study described the associations between the instruments used to measure each of these domains. METHODS: Measures of global disability (Cerebral Performance Category, CPC, Modified Rankin Scale, mRS), quality of life, activity limitations, participation restrictions, and affective and cognitive impairments were administered to 29 participants 1, 6, and 12 months after cardiac arrest. RESULTS: Global measures of disability indicated recovery between one month and one year after cardiac arrest (mean CPC: 2.1 versus 1.69, P < 0.05; mean mRS: 2.55 versus 1.83, P < 0.05). While global measures of disability were moderately associated with participation, they were poorly associated with other measures. The cohort endorsed depressive symptomatology throughout the year but did not have detectable cognitive impairment. CONCLUSIONS: Recovery from cardiac arrest is multifaceted and recovery continues for months depending upon the measures being used. Measures of global disability, reintegration into the community, and quality of life yield different information. Future clinical trials should include a combination of measures to yield the most complete representation of recovery after cardiac arrest.

Development and validation of the Cerebral Performance Categories-Extended (CPC-E).

BACKGROUND: Optimizing resuscitation efforts after cardiac arrest (CA) requires valid and reliable measurements of functional outcomes. The Cerebral Performance Category (CPC), the historical "gold" standard outcome measure post-CA, lacks psychometric validation. The purpose of this study was to establish the psychometric properties of a revised CPC: the CPC-Extended (CPC-E). METHODS: The study had two phases: We established content validity of the CPC-E by identifying existing domains in the CPC, by adding new domains following a literature review, and iterative input from a panel of CA and rehabilitation experts. We tested the CPC-E's feasibility, intra-rater (IR) reliability and inter-rater reliability (IRR) using retrospective reviews of the electronic medical records (EMR) and "in-person" in-hospital administration. RESULTS: The CPC-E has 10 domains. For both IR and IRR record reviews, 5/10 domains had frequent missing data and in three instances, intraclass correlation coefficients (ICC) could not be calculated. Of the scores that could be calculated, ICC ranged from poor to high (n=30; 0.46-1.0) and poor to high (n=50; -0.16 to 0.93) for IR and IRR, respectively. No data were missing for the "in-person" IRR for the 10 domains and ICC ranged from good to excellent (n=26; 0.79-1.00). In-hospital and post-discharge domains were completed in under 7 min. CONCLUSIONS: The CPC-E is a valid and clinically feasible outcome measure for describing post-CA impairment and disability status. In-person hospital administration of the CPC-E yields more complete data and good to excellent inter-rater reliability compared to retrospective EMR review.

Neurocognitive outcomes following successful resuscitation from cardiac arrest.

INTRODUCTION: Cardiac arrest commonly results in varying degrees of cognitive injury. Standard outcome measures used in the cardiac arrest cohort do not rigorously evaluate for these injury patterns. We examined the utility of the Computerized Assessment for Mild Cognitive Injury (CAMCI) in cardiac arrest (CA) survivors. We hypothesized that cognitive deficits would be more severe in patients who were comatose on hospital arrival. METHODS: Prospective cohort of CA survivors at a single tertiary care facility where participants received neurocognitive testing using CAMCI. CAMCI results were subdivided into memory, attention, and executive functions. Scores between subjects who were initially comatose and were not comatose following resuscitation were compared using the Mann-Whitney test. RESULTS: Of 72 subjects included, the majority (N=44) were initially comatose following resuscitation with mean age of 54 (±14) years. The majority experienced a good neurologic outcome based on Cerebral Performance Category (N=47; 66%) and Modified Rankin Scale (N=38; 53%). Time from resuscitation to CAMCI testing was not associated with total CAMCI score in this cohort (Pearson's r(2) value -0.1941, p=0.20). Initially comatose and not comatose subjects did not differ in their CAMCI overall scores (p=0.33), or in any subtest areas. The not comatose cohort had 1 subtest for which there was a Moderate Risk for mild cognitive impairment (Nonverbal Accuracy), and 2 for which there was a Moderately Low Risk (Verbal Accuracy and Executive Accuracy). The Comatose cohort had 4 subtests, which were deemed Moderately Low Risk for cognitive impairment (Verbal Accuracy, Attention Accuracy, Executive Accuracy and Nonverbal Accuracy). CONCLUSIONS: In-hospital CAMCI testing suggests memory, attention and executive impairment are commonly in patients following resuscitation from cardiac arrest. Outcome evaluations should test for deficits in memory, attention, and executive function.

Evaluating capacity to live independently and safely in the community: Performance Assessment of Self-care Skills.

To determine clients' capacity for community living, occupational therapists must use measures that capture the person-task-environment transaction and compare clients' task performance to a performance standard. The Performance Assessment of Self-care Skills, a performance-based, criterion-referenced, observational tool, fulfills this purpose. In this practice analysis, using data from this tool from multiple clinical studies (N = 941), the authors describe tasks that clients from various diagnostic populations could and could not perform independently and safely. For clinicians, the Performance Assessment of Self-care Skills can be used to identify which daily tasks are compromised and the point of task breakdown, as well as to provide guidance about potential interventions.

Activities and adaptation in late-life depression: a qualitative study.

OBJECTIVE. We sought to understand activity choices of older adults when they were depressed. METHOD. Each community-dwelling participant (n = 27) completed one semistructured interview while in recovery for at least 3 mo. but less than 7 mo. Transcripts were coded to identify relevant themes. RESULTS. Six themes emerged that explained activities participants continued while depressed, and four themes described activities they stopped. CONCLUSION. Older adults maintained many instrumental activities of daily living while depressed, and some actively adapted activities so they could continue them. Some intentionally stopped activities to direct limited energy to their highest priority activities. To guide effective intervention, it is critical for occupational therapy practitioners to complete a client-centered qualitative assessment to understand what and, most important, why activities are continued or stopped. Each theme for activities continued and activities stopped lends itself to intervention strategies.

Affective state and community integration after traumatic brain injury.

Previous studies investigating the relationship between affective state and community integration have focused primarily on the influence of depression and anxiety. In addition, they have focused on frequency of participation in various activities, failing to address an individual's subjective satisfaction with participation. The purpose of this study was to examine how affective state contributes to frequency of participation and satisfaction with participation after traumatic brain injury among participants with and without a current major depressive episode. Sixty-four community-dwelling participants with a history of complicated mild-to-severe traumatic brain injury participated in this cross-sectional cohort study. High positive affect contributed significantly to frequency of participation (ß = 0.401, P = 0.001), and both high positive affect and low negative affect significantly contributed to better satisfaction with participation (F2,61 = 13.63, P < 0.001). Further investigation to assess the direction of these relationships may better inform effective targets for intervention. These findings highlight the importance of assessing affective state after traumatic brain injury and incorporating a subjective measure of participation when considering community integration outcomes.

Unique contribution of fatigue to disability in community-dwelling adults with traumatic brain injury.

OBJECTIVE: To examine the unique contribution of fatigue to self-reported disability in community-dwelling adults with traumatic brain injury (TBI). DESIGN: A cross-sectional cohort design. SETTING: Community dwellings. PARTICIPANTS: Adults (N=50) with a history of mild to severe TBI were assessed. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: This study assessed the contribution of fatigue (Modified Fatigue Impact Scale) to disability (Mayo-Portland Adaptability Inventory), controlling for executive functions (Frontal Systems Behavior Scale), depression status (major depression in partial remission/current major depression/depressive symptoms or no history of depression), and initial injury severity (uncomplicated mild, complicated mild, moderate, or severe). RESULTS: Fatigue was found to contribute uniquely to the variance in self-reported disability (ß=.47, P<.001) after controlling for injury severity, executive functions, and depression status. The overall model was significant (F(4,45)=17.32, P<.001) and explained 61% of the variance in self-reported disability, with fatigue alone accounting for 12% of the variance in self-reported disability (F(1,45)=13.97, P<.001). CONCLUSIONS: Fatigue contributes uniquely to disability status among community-dwelling adults with chronic TBI, independent of injury severity, executive functions, and depression. Addressing fatigue through targeted interventions may help to improve self-perceived disability in this population.

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults.

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.

Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest.

BACKGROUND: Cerebral Performance Category (CPC), Modified Rankin Scale (mRS) and discharge disposition are commonly used to determine outcomes following cardiac arrest. This study tested the association between these outcome measures. METHODS: Retrospective chart review of subjects who survived to hospital discharge between 1/1/2006 and 12/31/2009 was conducted. Charts were reviewed for outcomes (CPC, mRS, and discharge disposition). Discharge disposition was classified in 6 categories: home with no services, home with home healthcare, acute rehabilitation facility, skilled nursing facility, long term acute care facility, and hospice. Intra-and inter-rater reliabilities were calculated for outcome measures. Rates of "good outcome" (defined as a CPC of 1-2, mRS of 0-3, or discharge disposition to home or acute rehabilitation facility) were also determined. Kendall's tau correlation coefficients explored relationships among measures. RESULTS: A total of 211 charts were reviewed. Mean age was 60 years (SD 16), the majority (75%) were white males, in- and out-of hospital cardiac arrests were equally prevalent, and ventricular dysrhythmia was most common (N=109, 52%). Half of the subjects were comatose following resuscitation and 75 (35%) received therapeutic hypothermia. Inter-rater percentage agreement for CPC and mRS abstraction was 95.24% (kappa 0.89, p<0.001) and 95.24% (kappa 0.90, p<0.001) respectively. "Good outcomes" were found in 44 subjects (20%) using the CPC definition, 47 subjects (22%) using the mRS definition, and 129 subjects (61%) subjects using discharge disposition definition. There was fair relationship between the CPC and mRS (tau 0.43) and poor relationships between CPC and discharge disposition (tau 0.23) and between mRS and discharge disposition (tau 0.25). CONCLUSIONS: Determination of the CPC, mRS and discharge disposition at hospital discharge is reliable from chart review. These instruments provide widely differing estimates of "good outcome". Agreement between these measures ranges from poor to fair. A more nuanced outcome measure designed for the post-cardiac arrest population is needed.

Disability in late-life major depression: patterns of self-reported task abilities, task habits, and observed task performance.

This article describes patterns of concordance/discordance between self-reported abilities ("can do") and habits ("does do") and observed task performance of daily living tasks in three groups of older adults: late life depression with mild cognitive impairment (n=53), late life depression without mild cognitive impairment (n=64), and non-depressed, cognitively normal controls (n=31). Self-reported data were gathered by interview in participants' homes, followed by observation of task performance. Significant differences in the patterns of response were found between controls and respondents with both late life depression and mild cognitive impairment for the cognitive instrumental activities, and between the two depressed groups and controls for the physical instrumental activities. For both sets of activities, controls exhibited the greatest overestimation of task performance. No differences were found among the groups for the less complex functional mobility and personal care tasks. However, for the more complex instrumental activities, concordance was close to, or less than, chance. The findings led us to conclude that when performance testing is not feasible, self-reports of functional status that focus on habits may be more accurate than those that focus on abilities.