Medicine and Health Sciences Commons^™

The Rbans Effort Index: Base Rates In Geriatric Samples, K. Duff, C. Spering, S. O'Bryant, L. Beglinger, D. Moser, J. Bayless, Kennith Culp, J. Mold, R. Adams, J. Scott

Kennith R. Culp

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more …

Twelve-Month Mortality Among Delirium Subtypes, S. Decrane, Kennith Culp, B. Wakefield

Kennith R. Culp

This study used data from the Delirium Among the Elderly in Rural Long-Term Care Facilities Study and data from the National Death Index (NDI) to examine mortality among 320 individuals. Individuals were grouped into noncases, subsyndromal cases, hypoactive delirium, hyperactive delirium, and mixed delirium on the basis of scoring using the Confusion Assessment Method (CAM), NEECHAM Scale, Mini-Mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Risk ratios of mortality using "days of survival" did not reach statistical significance (alpha = .05) for any subgroup. Underlying cause of death (UCD) using International Classification of Disease, 10th …

Sleeplessness, Deborah Schoenfelder, Keela Herr

Deborah P. Schoenfelder

This article identifies and reviews research related to sleeplessness reported by nurses in the literature. The current state of clinical nursing research as it relates to sleep is evaluated, including the content, methodology, and implications for further research. Although the review indicates current interest in sleep by clinical nurse researchers, the number of nursing studies in the literature is limited, especially within specific areas, such as age groups and setting. Also, directions for future nursing research on sleep are recommended.

Innovations In Long-Term Care. Homesafe: Supportive Assistance For Elderly Individuals Through A Nurse-Managed Plan, Deborah Schoenfelder, Meridean Maas, Janet Specht

Deborah P. Schoenfelder

A lack of quality, cost-effective alternatives to nursing home care for community-dwelling older adults exists. The evidence suggests that case management provides quality care in a cost-efficient manner to help older adults remain at home safely and as independently as possible. This article describes HomeSafe, a nurse-managed membership plan that assists older individuals to enhance their health and quality of life, and to age in place in their homes and communities. HomeSafe serves as an innovative model of care and a teaching site for undergraduate and graduate nursing students and nursing faculty at The University of Iowa.

An Exercise Program To Improve Fall-Related Outcomes In Elderly Nursing Home Residents, Deborah Schoenfelder, L. Rubenstein

Deborah P. Schoenfelder

This study tested a 3-month ankle-strengthening and walking program designed to improve or maintain the fall-related outcomes of balance, ankle strength, walking speed, risk of falling, fear of falling, and confidence to perform daily activities without falling (falls efficacy) in elderly nursing home residents. Nursing home residents (N = 81) between the ages of 64 and 100 years participated in the study. Two of the fall-related outcomes, balance and fear of falling, were maintained or improved for the exercise group in comparison to the control group.

Evidence-Based Guideline. Individualized Music For Elders With Dementia, L. Gerdner, Deborah Schoenfelder

Deborah P. Schoenfelder

No abstract provided.

Evidence-Based Guideline. Wandering, M. Futrell, K. Melillo, R. Remington, Deborah Schoenfelder

Deborah P. Schoenfelder

No abstract provided.

The Independent Nurse Role In Community Care Gerontological Nursing, Deborah Schoenfelder, Janet Specht, Meridean Maas

Deborah P. Schoenfelder

No abstract provided.

A Fall Prevention Educational Program For Community Dwelling Seniors, Deborah Schoenfelder, K. Van Why

Deborah P. Schoenfelder

The purpose of this research was to assess participants' responses to a fall prevention educational program. Fourteen persons volunteered to participate in the study conducted at a large senior center. Descriptive statistics were used to characterize the sample and to assess subjects' awareness about falls, attitudes about fall risk, fall prevention behaviors, and incidence of falls before the fall prevention program and again at one month and three months after the program. Forty-six percent of the sample had fallen in the previous year. In general, subjects' perceptions that their risk of falling was lower than others of the same age …

Healthy People 2000. A Fall Prevention Program For Elderly Individuals: Exercise In Long-Term Care Settings, Deborah Schoenfelder

Deborah P. Schoenfelder

No abstract provided.

Homesafe: Supportive Assistance For Elderly Individuals Through A Nurse-Managed Plan, Deborah Schoenfelder, Meridean Maas, Janet Specht

Deborah P. Schoenfelder

A lack of quality, cost-effective alternatives to nursing home care for community-dwelling older adults exists. The evidence suggests that case management provides quality care in a cost-efficient manner to help older adults remain at home safely and as independently as possible. This article describes HomeSafe, a nurse-managed membership plan that assists older individuals to enhance their health and quality of life, and to age in place in their homes and communities. HomeSafe serves as an innovative model of care and a teaching site for undergraduate and graduate nursing students and nursing faculty at The University of Iowa.

Literacy-Appropriate Educational Materials And Brief Counseling Improve Diabetes Self-Management, Andrea Wallace, H. Seligman, T. Davis, D. Schillinger, C. Arnold, B. Bryant-Shilliday, J. Freburger, D. Dewalt

Andrea S. Wallace

OBJECTIVE: In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care. METHODS: We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients' activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up. RESULTS: Statistically significant (p

Milwaukee Police Department Retirees: Cardiovascular Disease Risk And Morbidity Among Aging Law Enforcement Officers, Sandra Ramey, Nancy Downing, W. Franke

Nancy R Downing

This study explored the self-reported prevalence of cardiovascular disease (CVD) and accompanying risk factors among 165 male retirees 43 years and older (M = 56.2, SD = 7.1) from the Milwaukee Police Department (MPD) compared to 671 individuals of similar age and income who responded to the 2005 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS). CVD and other risk factors were more prevalent in the MPD retirees than the general population (CVD 15.2% vs. 9.5%, p = .036; hypertension 51.5% vs. 36.2%, p = .001; hypercholesterolemia 62.4% vs. 44.4%, p = .001; overweight and obesity 85.1% vs. 74.7%, p = …

Sisters Of The Yam: African American Women's Healing And Self-Recovery From Intimate Male Partner Violence, Janette Taylor

Janette Y. Taylor

In this womanist ethnographic investigation African American women (N = 21) survivors of intimate male partner violence were interviewed about their resilience-recovering experiences. This article foregrounds the role of therapeutic support groups in African American women's healing experience and addresses how race and ethnicity shape the lives and the recovering process for many African American women. The findings are important to practitioners who strive to provide assistance and interventions for African American women as well as other women of color.

No Resting Place: African American Women At The Crossroads Of Violence, Janette Taylor

Janette Y. Taylor

Seeking safe places after leaving abusive relationships is often an intricate process for African American women. Survivor-victims of gender violence frequently experience ongoing trauma because of race, ethnicity, class, sexual orientation, and other stigmatizing social identities. All too often, women of color must handle leaving the gender violence simultaneously with the ongoing threat of cultural violence. The intersection of gender and cultural violence (e.g., racism, discrimination) complicate African American women's ability to obtain and sustain safe environments. These intersections are critical crossroads in African American women's lives. The results of this womanist and Black feminist study are presented in an …

Talking Back: Research As An Act Of Resistance And Healing For African American Women Survivors Of Intimate Male Partner Violence, Janette Taylor

Janette Y. Taylor

The purpose of this article is to use a Black feminist/ womanist framework to: (a) explore the historical factors that discourage Black women's participation in the research process; (b) demonstrate how research can be a potential avenue of resistance and healing for African American women survivors of intimate male partner violence; and (c) suggest ways for practitioners and researchers to encourage the participation of this population. Benefits from the research process emerged as three themes: (a) healing the self, (b) helping others, and (c) envisioning new life directions.

Moving From Surviving To Thriving: African American Women Recovering From Intimate Male Partner Abuse, Janette Taylor

Janette Y. Taylor

In this ethnographic study, a womanist framework was used to investigate the process of recovery from domestic violence. A purposive sample of African American women (N = 21) was interviewed to gain understanding of their recovery process. Survivorship-thriving was the overarching process. Six themes related to survivorship-thriving were identified: (a) Sharing secrets/Shattering silences--sharing information about the abuse with others; (b) Reclaiming the Self-defining oneself separate from abuser and society; (c) Renewing the Spirit-nurturing and restoring the spiritual and emotional self; (d) Self-healing through Forgiveness--forgiving their partners for the abuse and violence; (e) Finding inspiration in the Future-looking to the future …

The Influence Of Cognitive-Perceptual Variables On Patterns Of Change Over Time In Rural Midlife And Older Women's Healthy Eating., Bernice C, Yates, Carol H. Pullen, Jonathan Bruce Santo, Linda Boeckner, Patricia A. Hageman, Paul J. Dizona, Susan Noble Walker

Journal Articles: College of Nursing

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = …

The Six Dimensions Of Wellness And Cognition In Aging Adults, Kelley A. Strout, Elizabeth P. Howard

Nursing Faculty Scholarship

Objective: Examine how wellness in six dimensions (occupational, social, intellectual, physical, emotional, and spiritual) protects cognition in aging adults. Background: cognitive impairment increases with age. Baby boomers represent a significant percent of the population at risk for cognitive impairment. Cognitive impairment has a negative impact on nursing resources, health care finances, patient mortality, and quality of life. Wellness and prevention is one focus of Institute of Medicine’s vision for the future of nursing. Method: Literature was retrieved from Cumulative Index to Nursing and Allied Health Literature and MEDLINE. Research that examined the affect of wellness in each of the six …

Safe Prescribing For The Elderly, Brenda Hoskins

Brenda L. Hoskins DNP, ARNP

Prescribing for older adults is a complex and high-risk process. Age-related changes produce differences in the way lderly patients respond to and process medication. This article discusses age-related changes, common problems that increase risk for older adults, strategies for improving adherence, and models for safe and effective prescribing.

Saitohin And Apoe Polymorphisms Influence Cognition And Function In Persons With Advanced Alzheimer Disease, D. Schutte, D. Reed, S. Decrane, Anne Ersig

Anne L. Ersig

BACKGROUND/AIMS: Alzheimer disease (AD) is characterized by variability in the onset and progression of cognitive, functional and behavioral symptoms. The purpose of this study was to identify genetic correlates of symptom variability in persons with moderate-to-advanced AD. METHODS: Repeated measures of cognition, function and behavior were collected from institutionalized persons with AD over 12 months. Candidate genes were assayed. RESULTS: Single polymorphisms within the saitohin and APOE genes were associated with increased cognitive impairment and functional dependence. The APOE-epsilon4 allele was associated with increased baseline physical agitation. CONCLUSION: The development of predictive profiles for the clinical symptoms of AD may …

Effectiveness Of Transcutaneous Electrical Nerve Stimulation On Postoperative Pain With Movement, Barbara Rakel, Rita Frantz

Barbara A. Rakel

This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in …

From Book To Bedside: Putting Evidence To Use In The Care Of The Elderly, M. Titler, J. Mentes, Barbara Rakel, L. Abbott, S. Baumler

Barbara A. Rakel

BACKGROUND: Infusion of research findings into clinical practice is a challenging part of the research process. Because the length of time between discovery and use of knowledge averages 20 years, methods are needed to speed translation of research findings into practice. Few efforts have been made to coordinate the generation of new knowledge with the dissemination of findings from research to improve care of the elderly. RESEARCH-BASED PRACTICE PROTOCOLS: The Research Development and Dissemination Core (RDDC) of the Gerontological Nursing Interventions Research Center (GNIRC) at the University of Iowa emphasizes development of research-based (RB) protocols, which requires collecting relevant literature, …

Clinical Outcome Of Emergency Repeat Coronary Artery Bypass Surgery, J. Lemmer, D. Ferguson, Barbara Rakel, N. Rossi

Barbara A. Rakel

To determine the clinical outcome of patients requiring emergency repeat coronary artery bypass graft (CABG) procedures, we reviewed 23 such procedures performed for ongoing myocardial ischemia refractory to medical management. The operative mortality was 17%. On follow-up, an average of 24.9 months after emergency reoperation, 14 of the 19 survivors (74%) had recurrent angina. As compared to a randomly selected group of 25 patients who underwent elective repeat CABG procedures during the same time period, the incidence of late cardiac events was significantly higher (79% in the emergency group, 30% in the elective surgery group) and fewer patients had received …

Physical Modalities In Chronic Pain Management, Barbara Rakel, J. Barr

Barbara A. Rakel

The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness …

Development Of Alterations In Learning: Situational Learning Disabilities, Barbara Rakel, G. Bulechek

Barbara A. Rakel

Until now the nursing diagnosis knowledge deficit has served as a label for all teaching/learning situations. This is inadequate and does not effectively give direction to correct intervention(s). The purpose of this article is to present the diagnostic concept, situational learning disability (SLD), a component of Alterations in Learning, which has been identified as an area to be developed in the Knowing pattern of the NANDA taxonomy. A thorough review of the literature and empirical support involving 20 cardiology patients on a 27-bed telemetry step-down unit is provided. The data support the development of two nursing diagnoses: (1) situational learning …

The Meaning Of Parenteral Hydration To Family Caregivers And Patients With Advanced Cancer Receiving Hospice Care., Marlene Z. Cohen, Isabel Torres-Vigil, Beth E. Burbach, Allison De La Rosa, Eduardo Bruera

Journal Articles: College of Nursing

CONTEXT: In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake almost always receive parenteral hydration in acute care facilities but rarely in the hospice setting.

OBJECTIVES: To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers.

METHODS: Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research …

Reliability Of The 60+ Functional Fitness Test Battery For Older Adults, K. E. Mobily, Paula R. Mobily

Paula Mobily

The primary purpose of this investigation was to determine the internal consistency of the 60+ functional fitness test battery for older adults. A secondary purpose was to determine whether the number of trials recommended in the testing manual was optimal. Subjects were used from an ongoing study of a fitness program for community-dwelling older adults. Internal consistency coefficients for subtests of flexibility, agility, coordination, and strength were excellent. Post hoc analysis across trials indicated significant differences in means between early trials and later trials. Mean scores stabilized after two or three trials, depending on the subtest of interest. Data provided …

Associations Of Cardiorespiratory Fitness And Fatness With Metabolic Syndrome In Rural Women With Prehypertension., Patricia A. Hageman, Carol H. Pullen, Melody A. Hertzog, Linda S. Boeckner, Susan Noble Walker

Journal Articles: Physical Therapy

BACKGROUND: This study investigated the associations of fitness and fatness with metabolic syndrome in rural women, part of a recognized US health disparities group.

METHODS: Fitness, percentage body fat, BMI, and metabolic syndrome criteria were assessed at baseline in 289 rural women with prehypertension, ages 40-69, enrolled in a healthy eating and activity community-based clinical trial for reducing blood pressure.

RESULTS: Ninety (31%) women had metabolic syndrome, of which 70% were obese by BMI (≥30 kg/m²), 100% by percentage body fat (≥30%), and 100% by revised BMI standards (≥25 kg/m²) cited in current literature. Hierarchical logistic regression models, adjusted for …