Long-Term Effect of a Tablet-Based Cognitive Behavioral Group Intervention on Step Count, Fatigue, Self-Efficacy, and Quality of Life in Older Adults With Arthritis: A Pilot Study

PURPOSE

To evaluate the long-term effect of a tablet-based, cognitive-behavioral group intervention (Tab-G) to improve daily walking for older adults with arthritis.

METHOD

Using an experimental pretest/posttest repeated measure design, long-term effects on step count, fatigue, self-efficacy, and quality of life (QOL) were investigated.

RESULTS

Results of repeated measures analysis of variance showed significant improvement in step counts (F[1, 37] = 4.18, p = 0.048), fatigue (F[1, 36] = 9.971, p = 0.003), self-efficacy (F[1,28] = 4.645, p = 0.04), and QOL (F[1, 29] = 6.147, p = 0.019) in the Tab-G group compared to the control group. There were significant time effects across four time points (baseline and Weeks 4, 8, and 10) in fatigue (F[3, 108] = 5.43, p = 0.002), self-efficacy (F[3, 84] = 5.433, p = 0.002), and QOL (F[3, 87] = 3.673, p = 0.015), but not in step counts (F[3, 111] = 0.611, p = 0.609).

CONCLUSION

Findings demonstrate positive long-term effects on fatigue in older adults with arthritis. [Journal of Gerontological Nursing, 50(5), 35-42.].

SLEEP CHARACTERISTIC OF AN OLDER END OF LIFE (EOL) CAREGIVER: A SINGLE CASE STUDY

Background

Extensive caregiving work, psychological distress, and caregiving burdens put end of life (EOL) caregivers at great risk of sleep disturbances.

Methods

A single case mixed method design was used to explore older EOL caregivers’ sleep characteristics. Multi-dimensional data was collected through a series of methods including questionnaires (caregiver and care recipient demographics, care recipient symptom severity, caregiver caregiving strain, depressive symptoms, and sleep quality), 14 days of National Sleep Foundation (NSF) sleep diary, 28 days of daily sleep and activity measured by wearable personal sleep monitoring devices (Garmin vivofit 4), and a semi-structured interview. Data was analyzed using thematic content analysis. Findings: A 60 year old female taking care of her 85 years old mother with dementia, kidney cancer, and several other illnesses was recruited for this case study. She showed overall poor sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI, total score: 8), and she slept 6.73 (±1.27) hours per day on average with 52.96% of deep sleep, 41.63% of light sleep, and 5.41% awake times. The caregiver reported that her daily sleep quality depended on her care recipient’s health condition each night. She also described others supporting for her caregiving work as a “double-edged sword,” because she needed to trade some privacy for the additional help.

Conclusion

Further study is needed for EOL caregivers’ poor sleep quality considering external factors and sleep intervention for EOL caregivers should be developed considering these external caregiving contexts.

OLDER DYADS USING A WEARABLE PERSONAL SLEEP MONITORING DEVICE FOR SLEEP SELF-MANAGEMENT

Normally occurring changes in sleep patterns can affect behavior, safety, and function in older individuals. In addition, altered sleep of one partner can affect the functioning of the other. We tested a novel intervention using an off the shelf, wrist-worn actigraph as a personal sleep monitoring device (PSMD) with dyads comprised of individuals who were 70 years old or older, and slept in the same house. Aims included: 1) Establish the feasibility of sleep self-monitoring using PSMDs, as a self-management strategy. 2) Establish the feasibility of PSMD data sharing among members of the dyad to improve sleep self-management and improve sleep quality; and 3) Evaluate the usability of PSMDs and data sharing for dyads of older individuals. Over the course of a five-week trial, we used a mixed methods approach. Data were comprised of daily sleep diaries, data from the PSMD, weekly questionnaires regarding sleep patterns and function, and qualitative interviews focused on sleep, self-management within the dyad, and the usability of the PSMD. Data were analyzed using qualitative or statistical methods. The use of the PSMD increased awareness of sleep patterns at the individual and dyadic levels, but the limitations of the PSMD were frustrating. Participants valued having a graphic image of how their daily activities affected their sleep patterns. The dyadic approach was effective in improving sleep patterns for older individuals, and using over the counter activity monitoring devices provide a relatively inexpensive way to assist older adults to improve their sleep self-management.

Motivational Interviewing, Readiness for Change, Walking, and Functional Ability in Older Adults

Regular exercise in older adults can slow the physical, psychological, and functional decline that is associated with aging. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might help identify interventions that would successfully increase physical activity. The purpose of the current study was to determine if motivational interviewing would increase readiness for change, daily steps, and functional ability among older adult participants. The Senior Fitness Test (SFT) and pedometers were used to assess functional ability and daily steps within two groups of older adults. All participants who completed the 8-week study, on average, demonstrated an increase in daily steps as well as overall fitness. Posttest analyses revealed that the outcome for the intervention group did not exceed the control group, with the exception of the 8-foot up-and-go test, a test within the SFT that measures agility and dynamic balance (p = 0.035). One-on-one, individualized socialization sessions may have contributed to the overall improvement noted in both groups. [Journal of Gerontological Nursing, 48(3), 23-29.].

An analysis of the concept of patient flow management

AIM

To analyze the concept of patient flow management.

BACKGROUND

Patient flow has a significant impact on the provision of patient care. The term "patient flow" is widely used, but the related concept of "patient flow management" has been poorly defined. The ability to differentiate and clarify the term patient flow management has implications on strategies to improve patient flow.

DESIGN

Rodgers evolutionary method of concept analysis.

DATA SOURCE

Literature published between 2000 and 2021 in the PubMed, CINAHL, and Business Source databases.

REVIEW METHODS

Inductive analysis of the literature was performed to identify the usage and features of the concept.

RESULTS

Patient flow management is defined as the application of holistic perspectives, dynamic data, and complex considerations of multiple priorities to enable timely, efficient, and high-quality patient care. Patient flow management requires the identification of a patient, care processes, a flow manager, and frontline staff. It has profound consequences on patient, staff, and hospital system outcomes.

CONCLUSIONS

Literature should more carefully delineate between "patient flow" and "patient flow management." Effective patient flow management increases the speed and quality of patient care, improves employee satisfaction, and reduces healthcare costs. Strategies to improve patient flow management should focus on understanding the role and interventions of flow management nurses.

"A Little Bit of Their Souls": Investigating the Concept of Dignity for People Living With Dementia Using Caregivers' Blogs

Dignity is an important component of quality of life and a core value of family nursing care. Few studies have explored dignity in community-dwelling adults with dementia. This study used blogs written by caregivers to explore the concept of dignity in dementia caregiving. A template analysis of blogs written by family caregivers of people with dementia was conducted. Four themes were defined a priori in relation to Jacelon's model of dignity: perceived value from others, self in relation to others, behavioral respect, and self-value. Caregivers wrote about experiences that related to each of the four a priori themes from Jacelon's model. In addition, the theme of dignity by proxy was derived from the analysis. By understanding the concept of dignity in the context of dementia family caregiving, interventions and services can be developed to improve family quality of life through dignifying, family-focused care.

Developing the Concept of Adverse Childhood Experiences: A Global Perspective

BACKGROUND

The relationship between health and adverse childhood experiences (ACEs) has been a major topic in the field of healthcare. In recent years, the study ACEs and health has expanded internationally.

PURPOSE

The purpose of this study was to further develop the concept of ACEs using a global perspective.

METHOD

Rodgers' Evolutionary Model guided the study. PubMed, CINAHL, and PsychINFO databases were searched. A total of 39 publications were selected for review.

FINDINGS

Development of the concept was achieved using a wide global lens. ACEs are influenced by diverse cultural, social, environmental, and economic factors that affect individuals' health worldwide.

DISCUSSION

The developed ACEs concept described in this paper includes a global perspective, adding context to the existing definition, thus broadening its application, and expanding its usefulness in international research. A clear concept for ACEs is valuable to nurses who care for children, adolescents and young adults around the world, who have suffered from ACEs and seek health care.

SOCIAL NETWORK STRENGTHS: AN EXPLORATORY ANALYSIS OF A MEASURE OF TIES AMONG OLDER PEOPLE

Purpose: To explore a self-report measure of social network features among a sample of older people living with multiple chronic conditions based on the conceptual model of Social Network Influences on Health. Design: A cross-sectional descriptive study design using a telephone survey methodology was used. Methods: An exploratory principle component analysis with a varimax rotation was performed on items that measured the identified components (reciprocity, size, proximity, density, general activation, activation when sick, duration, closeness, involvement in health, interaction frequency) of social networks. All items were standardized prior to analyses. Results: Self-report social network data were collected from eighty-four older people living in the community and managing multiple chronic conditions. The principal components model, operationalized as tie strength, contained six items based on factorability: reciprocity, social network size, proximity, density and perception of the activation in general and when sick of close social network members. Results yielded acceptable factorability (KMO = 0.781, Bartlett p 0.70). Two components that had eigenvalues greater than 1.0, explained 61.7% of the total variance. The first factor was interpreted as total social network resources, while the second factor was identified as social network availability. Conclusion: Exploratory principal component analysis supports a measure of social network features, tie strength, that can be tested in future studies. Assessing these variables is useful in identifying specific relationship features critical to managing chronic conditions in older age and advances current measurement of social networks important to living well in older age.

CHRONIC ILLNESSES AND FATIGUE IN OLDER INDIVIDUALS: A LITERATURE REVIEW

In the United states, 60% of adults have one chronic disease and 40% have at least two chronic diseases. Fatigue is a commonly reported symptom in individuals with chronic illnesses, the prevalence of which ranges between 40-74%. It is associated with multiple risk factors and has a tremendous impact on quality of life, social functioning, mood, motivation and cognition. Despite its high prevalence, the relationship between fatigue and chronic illness has not been well explored. Accordingly, the focus of this synthesis of literature is to explore fatigue-associated factors and their relation to chronic disease. The databases searched were CINAHL, PubMed, PsychInfo and Web of Science, where the following keywords were used: “Chronic disease” OR “Chronic illness” OR “Chronic conditions”, “Fatigue”, “Elderly” OR “Older adults” OR “Seniors” OR “Geriatrics”. The synthesis resulted in four themes: understanding the concept of fatigue, factors related to fatigue, activity and fatigue, and self-management of fatigue. There were some inconsistencies in the findings among research studies which were addressed, in addition to the strengths and weaknesses of some of the fatigue measurement scales used. This literature review integrates findings about fatigue in chronic illnesses in various aspects, in the population of individuals who are of 65 age or older. The four emerged themes are of value to individuals with similar characteristics as the selected population, as well as to health care providers and researchers who may address the inconsistent findings and provide a strong evidence for best practice.

SOCIAL NETWORK INFLUENCES ON SENSE OF CONTROL AND ATTRIBUTED DIGNITY IN OLDER AGE: RESEARCH RESULTS

The purpose of this study was to explore the relationship between the functions of individual social networks, defined here as social support, and the outcomes of sense of control and attributed dignity among a sample of older people living with multiple chronic conditions. This study integrated an explanatory sequential (Quan/Qual) mixed methods design. Descriptive statistics were used to describe social networks. Bivariate correlations and regression statistics were used to examine the relationships of social network support (MOS-Social Support Scale) with the dependent variables of sense of control (Wallhagen Revised PCQ Questionnaire) and attributed dignity (Jacelon Attributed Dignity Scale). Open-ended interviews and thematic analysis were used to expand understanding of the quantitative findings. A cross-sectional sample of eighty-nine community dwelling older people living with multiple chronic health conditions participated. Social support, as a function of one’s social network, predicted the outcome of sense of control (β = .33, p ≤ .01) and attributed dignity (β = .44, p ≤ .001). Correlation statistics and regression models substantiated positive relationships of social supports’ influence on perceived sense of control and attributed dignity. Thematic analysis, based on open-ended interviews (n=12), expanded on the nuances of social influences on sense of control and attributed dignity in managing chronic health conditions through the themes “learning to ask for help”, “only a phone call away” and “smaller circles”. This research proposes new ways of understanding the relationships between perceptions of social support, sense of control and attributed dignity in later life in managing health.

A usability study to test the effectiveness, efficiency and simplicity of a newly developed Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE): Protocol paper

The Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE) is a mobile web app being developed to provide lung cancer survivors with an algorithm-based, tailor-made, self-management programme to inform their exercise choices and improve symptom severity. The aim of this protocol paper is to detail the plan for conducting the usability study to test the effectiveness, efficiency and simplicity of an exercise-focused self-management mobile web app for lung cancer survivors. The mixed methods study will consist of three consecutive phases, each interspersed with elements of data analysis and app prototype redevelopment. The study will take place in Oxford, United Kingdom. Ethical approvals have been obtained. The study will contribute to lung cancer survivorship research and is important in the app developmental process. This study contributes to the international forum for the exchange of practice, innovation and research, increases transparency in mobile health developmental processes and contributes to the methodological evidence base.

Dying with dignity: The good patient versus the good death

Death is a unique experience for each human being, yet there is tremendous societal pressure on a dying person to be a “good patient” while trying to experience the “good death.” These pressures shape patient, caregiver, and family choices in end-of-life situations.

The purpose of this literature review was twofold: first, to develop an understanding of “dying with dignity” to enhance the end-of-life care received by dying patients, and second, to contribute to a concept analysis of dignity to improve the clarity and consistency of future research related to dignity in aging individuals. Articles pertaining to dying with dignity from the disciplines of nursing, medicine, ethics, psychology, and sociology were reviewed using a matrix method. 1

A dichotomy surrounding dying with dignity emerged from this review. The definition of dignity in dying identifies not only an intrinsic, unconditional quality of human worth, but also the external qualities of physical comfort, autonomy, meaningfulness, usefulness, preparedness, and interpersonal connection. For many elderly individuals, death is a process, rather than a moment in time, resting on a need for balance between the technology of science and the transcendence of spirituality.

Reducing the rate of rehospitalization from postacute care: a quality improvement project

PURPOSE

To evaluate rehospitalizations and develop a strategy to reduce the number of individuals sent back to the hospital within 30 days of admission from postacute care services including skilled care, long-term care, and home care.

DESIGN

Using the Plan, Do, Study, Act (PDSA) format outlined by the Institute for Healthcare Improvement, we implemented and evaluated a quality improvement project.

METHODS

The number of rehospitalizations was calculated and chart audit was used to determine the reasons. Interventions were designed to decrease the number of reasons individuals had to return to the hospital.

FINDINGS

Five rehospitalizations were deemed preventable. Interventions were designed to improve staff knowledge.

CONCLUSIONS

The effectiveness of interventions and rehospitalization rates continue to be monitored. The rehospitalization rates from these agencies are low. Low rehospitalization rates are good for clients and improve desirability as a source for care posthospitalization.

CLINICAL RELEVANCE

Understanding causes for rehospitalization, providing skills and knowledge aimed at the root causes of hospitalization, and reducing the rate of rehospitalization improves nursing practice and reimbursement.

Perceptions on the Use of Telehealth by Homecare Nurses and Patients With Heart Failure

The purpose of this study was to explore perceptions on effectiveness of telehealth for Heart Failure (HF) management beyond the initial acceptance phase in a home care setting. Participants included 31 home care nurses for surveys, 9 nurses for focus groups and 4 patients with HF and the telehealth nurse for interviews. Telehealth was perceived to benefit by contributing objective assessments, timely information regarding patient status, a sense of security, and patient accountability. However, barriers to use of telehealth included inadequate staff training, lack of guidelines for client referrals and integration of telehealth in nursing workflow, lack of trust in equipment’s accuracy, and certain patient characteristics. The study exposed the role played by inadequate systemic guidelines and patient characteristics as factors affecting long-term use of telehealth for HF.

Designing and evaluating an electronic patient falls reporting system: perspectives for the implementation of health information technology in long-term residential care facilities

BACKGROUND AND PURPOSE

Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT.

METHODS

In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders' perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users' physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder.

RESULTS AND CONCLUSIONS

The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings. The usability analysis revealed several fixable design flaws and demonstrated the importance of scenario-based user training. The technology acceptance model showed that users perceived the reporting system to be useful and easy to use, even more so after implementation. Finally, the holistic human factors evaluation identified challenges encountered when nurses used the system as a part of their daily work, guiding further system redesign. The four-pronged evaluation framework accounted for varied stakeholder perspectives and goals and is a highly scalable framework that can be easily applied to health IT implementations in other LTRCFs.

'I'd rather just go on as I am'--pelvic floor care preferences of frail, elderly women in residential care

Little is known about how frail, elderly women in assisted living and long-term care facilities view pelvic floor dysfunctions and treatments. Twenty-five residents reflect on these issues, and quality of life.

Making meaning: the creative component in qualitative research

Findings in qualitative research are often wondrous and exciting, expounding new knowledge and perceptions previously unknown. Qualitative research requires the researcher to ponder and reflect on the data collected so as to find the meaning within. Helping researchers learn how to perform this step is not well discussed in the qualitative literature, yet this is one of the more crucial components of this type of research. In this article, the incubation, the meaning-making phase of qualitative research, is discussed in relation to the experiences of five researchers who have used traditional processes, models, metaphors, plays, pastiche, poetry, and quilt making and design to help them make meaning.