Intergenerational Influence of African American, Caribbean and Hispanic/Latino Adults Regarding Decision to Participate in Health-Related Research

Introduction: Identifying effective strategies to enroll African American, Caribbean, and Hispanic/Latino adults ≥65 years of age in health research is a public health priority. This study aimed to explore intergenerational influence (IGI) among these populations living throughout Florida. Methods: African American, Caribbean, and Hispanic/Latino adults ≥65 years of age and a trusted family member/friend between 25-64 years participated in virtual listening sessions (LS). Culturally matched facilitators used a semi-structured guide to lead LS that was recorded, transcribed, and uploaded into NVivo©. The constant comparative method was used for analysis. Results: 363 African American, Caribbean, and Hispanic/Latino participated in LS. Five (5) themes relate to IGI emerged: (1) parent-child relationships; (2) family caregiving/parental illness experiences; (3) historical research maltreatment; (4) transfer of cultural knowledge; and (5) future generations. Discussion: Our findings support that IGI can be leveraged to increase the participation of African American, Caribbean, and Hispanic/Latino older adults in health research.

Emergence Delirium With Post-traumatic Stress Disorder Among Military Veterans

The clinical characteristics of emergence delirium (ED) associated with post-traumatic stress disorder (PTSD) among military veterans encompass transient agitation, restlessness, disorientation, and violent verbal and physical behaviors due to re-experiencing of PTSD-related incidents. Two cases of ED after general anesthesia associated with PTSD are presented. Different anesthesia methods were applied for the two cases. A traditional medical approach appeared not to prevent the incidence of ED. In the second case, dexmedetomidine infusion along with verbal coaching was effective in preventing ED for a veteran known to have “wild wake-ups” with prior anesthetics. Further clinical studies in effectively utilizing dexmedetomidine in this population with PTSD at high risk for ED are warranted.

Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics

BACKGROUND

Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time.

PURPOSE

The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups.

METHODOLOGY/APPROACH

We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression.

FINDINGS

A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group.

PRACTICE IMPLICATIONS

Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able to reduce fall rates by maintaining greater nurse staffing ratios as well as fostering an environment consistent with that of Magnet hospitals.

Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments

CONTEXT

Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.

OBJECTIVE

To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS

Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data.

MAIN OUTCOME MEASURES

A 30-day inpatient mortality and failure-to-rescue.

RESULTS

The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%.

CONCLUSIONS

Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs

OBJECTIVE

To examine prenatal, maternal, and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birth-weight infants in which half of the prenatal care was provided in women's homes by nurse specialists with master's degrees.

STUDY DESIGN

Randomized clinical trial.

PATIENTS AND METHODS

A sample of 173 women (and 194 infants) with high-risk pregnancies (gestational or pregestational diabetes mellitus, chronic hypertension, preterm labor, or high risk of preterm labor) were randomly assigned to the intervention group (85 women and 94 infants) or the control group (88 women and 100 infants). Control women received usual prenatal care. Intervention women received half of their prenatal care in their homes, with teaching, counseling, telephone outreach, daily telephone availability, and a postpartum home visit by nurse specialists with physician backup.

RESULTS

For the full sample, mean maternal age was 27 years; 85.5% of women were single mothers, 36.4% had less than a high school education, 93.6% were African American, and 93.6% had public health insurance, with no differences between groups on these variables. The intervention group had lower fetal/infant mortality vs the control group (2 vs 9), 11 fewer preterm infants, more twin pregnancies carried to term (77.7% vs 33.3%), fewer prenatal hospitalizations (41 vs 49), fewer infant rehospitalizations (18 vs 24), and a savings of more than 750 total hospital days and $2,496,145 [corrected].

CONCLUSION

This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs.

Employment patterns and timing of birth in women with high-risk pregnancies

OBJECTIVE

To describe the characteristics of employed women with high-risk pregnancies, their pattern of employment prenatally and postpartum, and the relationship of prenatal employment to preterm or full-term birth.

DESIGN

Secondary analysis with a sample of 171 women with high-risk pregnancies.

SETTING

Women's homes and a tertiary care hospital.

PARTICIPANTS

Women who were primarily single, African American, and poor; 33% worked or attended school during their pregnancies.

MAIN OUTCOME MEASURES

Gestational age at birth, employment, and school attendance.

RESULTS

Preterm delivery was not related to when the women stopped working or attending school or were prescribed bed rest. Women employed prenatally were older, had higher incomes, and were more likely to be white or of ethnicity other than African American. Fifty-seven percent of women with a history of prenatal employment and 85% of the women who intended to work after delivery returned to work during the first postpartum year.

CONCLUSIONS

Women employed during high-risk pregnancies are similar demographically to women with low-risk pregnancies in other studies. Most of the women stopped working or attending school because of prescribed bed rest. Bed rest, however, was not related to preterm delivery. Most women who planned to return to work did so. Factors other than the women's high-risk pregnancies, such as attitudes toward employment, employability, and family circumstances, most likely influenced their employment status. Current welfare reform initiatives will increase the number of women working while pregnant. This article provides pre-welfare-reform baseline data concerning patterns and effects of employment for women with high-risk pregnancies. These data will enable nurses to examine the effects of welfare reform on employment during pregnancy and preterm birth.

Psychological changes associated with self-regulatory treatments of irritable bowel syndrome

The psychological "side effects" of self-regulatory treatment (a combination of relaxation, thermal biofeedback, and cognitive therapy) for irritable bowel syndrome (IBS) were compared among 20 "successfully" treated patients, 12 "unsuccessfully" treated patients, and 9 patients who merely monitored symptoms for 12 weeks. Pretreatment and posttreatment scores on the Beck Depression Inventory, State-Trait Anxiety Inventory, and Psychosomatic Symptom Checklist were examined. "Successfully" treated patients had significant (p less than .01) reductions on all measures and significantly greater reductions on depression and state anxiety than the symptom monitoring group. Interestingly, the failures also showed a significant (p = .027) reduction in trait anxiety and no significant increases on other measures.

Behavioral treatment of irritable bowel syndrome: a 1-year follow-up study

Sixteen clients afflicted with irritable bowel syndrome (IBS) were reassessed 1 year following completion of a multicomponent treatment package incorporating progressive muscle relaxation, thermal biofeedback, cognitive therapy, and IBS education. For the 14 patients who kept a 2-week symptom diary, significant reductions in ratings of abdominal pain and tenderness, diarrhea, and flatulence were obtained comparing pretreatment and follow-up symptom-diary ratings. Eleven of 14 clients were improved over pretreatment levels, 57% met the criteria for clinical improvement of at least a 50% reduction in major symptom scores, and all but 1 of 16 rated themselves as subjectively improved.

Psychological comparisons of irritable bowel syndrome to chronic tension and migraine headache and nonpatient controls

Comparisons were made among patients with IBS (n = 55), tension headache (n = 69), or migraine headache (n = 68) and nonpatient controls (n = 64) on the MMPI and several other psychological tests, including BDI, STAI, Life Events, and Psychosomatic Symptom Checklist. With two nonsignificant exceptions (MMPI scale F and Life Events) the groups were consistently ordered, in terms of increasing psychological distress: Normals less than Migraine Headache less than Tension Headache less than IBS. The IBS patients were more like the tension headache patients than any other group. Subgroups of IBS patients, on the basis of presence or absence of diarrhea or constipation in addition to abdominal pain, were generally not significantly different on the psychological tests.

Nonpharmacologic treatment of chronic headache: prediction of outcome

We studied the ability of headache history, a 4-week headache diary, standard psychological tests, and laboratory measures of psychophysiologic responses to stress to predict the outcome of relaxation therapy and biofeedback for three types of chronic headache. Using canonical discriminant function analyses, each potential predictor set was tested separately, and all four were tested together. Information from the headache history alone correctly classified 89 to 95% of patients as improved or unimproved. No other single predictor set was consistently better than headache history. When all four predictor sets were combined, prediction improved; 93 to 100% of patients were correctly classified.

The relationship between capacity for absorption and chronic headache patients' response to relaxation and biofeedback treatment

A sample of 49 chronic headache patients (35 vascular and 14 tension) was separated according to capacity for absorption (as measured by Tellegen & Atkinson's 1974 scale) into groups high in absorption and groups low in absorption, with patients in the middle range being excluded. Absorption capacity was found to affect response to treatment in complex ways. Vascular headache patients high in absorption were significantly improved following relaxation training, but not after biofeedback training. Vascular headache patients low in absorption were significantly improved after biofeedback training. Tension headache patients low in absorption did not respond significantly to either form of treatment, while those high in absorption responded significantly to biofeedback training. Reasons for these differences in response to treatment were discussed.

Smoking and carbon monoxide levels during pregnancy

Self-reports of smoking status and breath tests for carbon monoxide were collected in prenatal outpatients. The breath test for carbon monoxide appeared to be a valid and specific measure of smoking status during pregnancy. Of the 179 patients surveyed, 99 reported they had smoked during the present pregnancy. Nineteen of the smokers reported they had quit during the present pregnancy and 46 reported that they smoked fewer cigarettes than at the beginning of their pregnancy. Most of the quitters and reducers stated that they had stopped or reduced their intake early in pregnancy and for pregnancy-related reasons; however, neither parity, nausea or vomiting, marital status, nor requests of physicians or family were associated with higher rates of smoking cessation or reduction. Most of the pregnant smokers were interested in stopping smoking, but few attended a free treatment program.