Medicine and Health Sciences Commons^™

Psychogeriatric Outreach To Rural Families: The Iowa And Virginia Models, I. L. Abraham, Kathleen C. Buckwalter, D. G. Snustad, D. E. Smullen, A. A. Thompson-Heisterman, J. B. Neese, Marianne Smith

Kathleen C. Buckwalter

Elderly residents of rural areas are at significant risk for mental health problems, yet have less access to mental health services. Thus, most mental health problems among rural elderly remain either undiagnosed or untreated. We describe two models of mental health outreach programs to rural elderly in Iowa and Virginia, serving demographically, culturally, and epidemiologically different populations in geographically and economically dissimilar regions. Programs are compared on the basis of initiation, community partnerships, target population, target region, clinical disciplines involved, coordinating discipline, referral sources, operational model, initial home assessment, care planning, sustainability, cost, patient demographics, and primary and secondary diagnosed. …

University Of Iowa Hospital And Clinics: Outcomes Management, Mary Berg, M. Dreher, K. Davenport, J. Greiner, R. Howell, A. Mutnick, G. Jensen, Barbara Rakel, F. Johlin, V. Kraus, R. Reiter, K. Leo, J. Ryan, J. Mccloskey

Mary Berg

Delivery of quality patient care and management of patient outcomes is critical to the success of academic medical centers in the ever-changing health care market. The University of Iowa Hospitals and Clinics (UIHC) promotes quality care through the provision of organizational structures and processes that are described in this article. In addition, quality of care and outcomes management are described by members in various roles within the UIHC health care system. It is the authors' belief that understanding quality from these various perspectives helps UIHC work across departments to achieve excellence in patient care.

Pain-Sensitive Temperament And Postoperative Pain, Charmaine Kleiber, M. Suwanraj, L. Dolan, Mary Berg, A. Kleese

Mary Berg

PURPOSE: To describe the relationship between pain-sensitive temperament and self-report of pain intensity following surgery. DESIGN AND METHODS: Fifty-nine adolescents and young adults (average age 14 years) undergoing spinal fusion for adolescent idiopathic scoliosis completed the Sensitivity Temperament Inventory for Pain-Child version (STIP-C). The Pearson correlation between STIP-C scores and the highest pain intensity for each of the first three postoperative days was investigated. RESULTS: There was a small but significant correlation between the Perceptual Sensitivity and Symptom Reporting subscales of the STIP-C and pain intensity measured on the third postoperative day. PRACTICE IMPLICATIONS: Aspects of the pain-sensitive temperament may …

Young Nurse Clinician Programs: Geriatric, Pediatric, And Community Health, Mary Berg, S. Lehmann, Paula Mobily

Mary Berg

In most nursing programs, limited options exist beyond the required nursing curricula for students to continue career growth in a nursing specialty area at the undergraduate level. The authors describe the Young Nurse Clinician Programs, an innovative approach that provides individualized educational opportunities to select nursing students to promote leadership and foster interest in geriatric, pediatric, and community health nursing.

The Meaning Of Breast Cancer Risk For African American Women., Janice Phillips, Marlene Z. Cohen

Journal Articles: College of Nursing

PURPOSE: To describe African American women's experience of being at high risk for breast cancer.

DESIGN: A hermeneutic phenomenological approach was used to guide in-depth interviews and analysis. Methods to ensure trustworthiness and rigor were included.

METHODS: Open interviews were conducted with 20 African American women who were at high risk for breast cancer (family history, personal history, genetic mutation). They were recruited from a cancer risk clinic and community-based settings. Data were transcribed verbatim, and themes were labeled among and between all interviews.

FINDINGS: Five themes were identified: (a) life-changing experience; (b) relationships: fears, support, and concerns; (c) the …

Web-Based Interventions For Weight Loss And Weight Maintenance Among Rural Midlife And Older Women: Protocol For A Randomized Controlled Trial., Patricia A. Hageman, Carol H. Pullen, Melody Hertzog, Linda S, Boeckner, Susan Noble Walker

Journal Articles: Physical Therapy

BACKGROUND: Weight loss is challenging and maintenance of weight loss is problematic among midlife and older rural women. Finding effective interventions using innovative delivery methods that can reach underserved and vulnerable populations of overweight and obese rural women is a public health challenge.

METHODS/DESIGN: This Women Weigh-In for Wellness (The WWW study) randomized-controlled trial is designed to compare the effectiveness of theory-based behavior-change interventions using (1) website only, (2) website with peer-led support, or (3) website with professional email-counseling to facilitate initial weight loss (baseline to 6 months), guided continuing weight loss and maintenance (7-18 months) and self-directed weight maintenance …

Subglottic Secretion Aspiration In The Prevention Of Ventilator-Associated Pneumonia: A Review Of The Literature., Rachel Scherzer

Jefferson Hospital Staff Papers and Presentations

Ventilator-associated pneumonia is a common nosocomial infection that results in both negative patient outcomes and increased health care costs. Recently, many efforts have been targeted at ventilator-associated pneumonia prevention, including the practice of subglottic secretion aspiration. Six randomized control studies examining the effectiveness of subglottic secretion aspiration in the prevention of ventilator-associated pneumonia were reviewed for this article. Results consistently show that subglottic secretion aspiration significantly reduces the incidence of ventilator-associated pneumonia in a variety of patient populations. Despite these findings, this practice is limited in clinical settings. This clinical practice should be implemented in individuals requiring mechanical ventilation to …

Maintenance Of Activity And Eating Change After A Clinical Trial Of Tailored Newsletters With Older Rural Women., Susan Noble Walker, Carol H. Pullen, Patricia A. Hageman, Linda S. Boeckner, Melody A. Hertzog, Maureen K. Oberdorfer, Matthew J. Rutledge

Journal Articles: College of Nursing

BACKGROUND: In the Wellness for Women Project, a randomized-by-site 1-year controlled clinical trial, the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions, eating behavior, and activity behavior were compared among 225 women aged 50 to 69 years.

OBJECTIVES: The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention.

METHODS: Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed using the multivariate approach to repeated measures …

Gis And Injury Prevention And Control: History, Challenges, And Opportunities, Nathaniel Bell, Nadine Schuurman

Faculty Publications

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in industrialized countries around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. Recent evidence has shown that the analytical, data linkage, and mapping tools of geographic information systems (GIS) technology provide can further address these determinants and identify populations in need. This paper traces the history of injury prevention and discusses current and future challenges in furthering our …

Clinical Trial Of Tailored Activity And Eating Newsletters With Older Rural Women., Susan Noble Walker, Carol H. Pullen, Linda Boeckner, Patricia A. Hageman, Melody Hertzog, Maureen K. Oberdorfer, Matthew J. Rutledge

Journal Articles: College of Nursing

BACKGROUND: Unhealthy diet and lack of physical activity increase rural midlife and older women's risk of chronic diseases and premature death, and they are behind urban residents in meeting Healthy People 2010 objectives.

OBJECTIVES: The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity and healthy eating among rural women.

METHODS: In a randomized-by-site, community-based, controlled, clinical trial, Wellness for Women, 225 women aged 50 to 69 years were recruited in two similar rural areas. Over 12 months, women received by mail either 18 generic …

Shift Report And Sbar: Strategies For Clinical Postconference., Fatima Ascano-Martin

Nursing | Faculty Scholarship

Conducting an effective postconference continues to be challenging because of low levels of student participation. Many students are exhausted at the end of the clinical day, which lessens their participation in postconference. In my experience, students often omit important information, such as patients’ age, sex, race, and other medical problems, during initial reports. Some have trouble providing patients’ information in an organized manner as well. The SBAR (situation-background-assessment-recommendation) communication tool can be used as a strategy to conduct clinical postconference.

Using Gis-Based Methods Of Multicriteria Analysis To Construct Socio-Economic Deprivation Indices, Nathaniel Bell, Nadine Schuurman, Michael V. Hayes

Faculty Publications

BACKGROUND: Over the past several decades researchers have produced substantial evidence of a social gradient in a variety of health outcomes, rising from systematic differences in income, education, employment conditions, and family dynamics within the population. Social gradients in health are measured using deprivation indices, which are typically constructed from aggregated socio-economic data taken from the national census--a technique which dates back at least until the early 1970's. The primary method of index construction over the last decade has been a Principal Component Analysis. Seldom are the indices constructed from survey-based data sources due to the inherent difficulty in validating …

Values Of Sleep/Wake, Activity/Rest, Circadian Rhythms, And Fatigue Prior To Adjuvant Breast Cancer Chemotherapy., Ann M. Berger, Lynne A. Farr, Brett R. Kuhn, Patricia Fischer, Sangeeta Agrawal

Journal Articles: College of Nursing

Fatigue is the most prevalent and distressing symptom experienced by patients receiving adjuvant chemotherapy for early stage breast cancer. Higher fatigue levels have been related to sleep maintenance problems and low daytime activity in patients who have received chemotherapy, but knowledge describing these relationships prior to chemotherapy is sparse. The Piper Integrated Fatigue Model guided this study, which describes sleep/wake, activity/rest, circadian rhythms, and fatigue and how they interrelate in women with Stage I, II, or IIIA breast cancer during the 48 hours prior to the first adjuvant chemotherapy treatment. The present report describes these variables in 130 females, mean …

The Impact Of Stress Management On Nurse Productivity And Retention, Tammi F. Milliken, Paul T. Clements, Harry J. Tillman

Counseling & Human Services Faculty Publications

Throughout the history of nursing there is a seeming legacy of personnel shortage, lack of funds, and, based on the nature of the role and related services, heightened levels of stress involved in patient care.

The future of the profession and more imminently, patient care and the health of nurses, may be significantly impacted by repeated challenges where current levels of stress and burnout are contributing to organizational problems, burnout, and attrition.

Employee stress and burn out commonly lead to myriad health-related problems that result in significant organizational consequences.

There are many methods of stress management, and sometimes the best …

Experts Recommend Strategies For Strengthening The Use Of Advanced Practice Nurses In Nursing Homes., Mathy Mezey, Sarah Greene Burger, Harrison G Bloom, Alice Bonner, Mary Bourbonniere, Barbara Bowers, Jeffrey B Burl, Elizabeth Capezuti, Diane Carter, Jacob Dimant, Sarah A Jerro, Susan C Reinhard, Marilyn Ter Maat

College of Nursing Faculty Papers & Presentations

In 2003, The John A. Hartford Foundation Institute for Geriatric Nursing, New York University Division of Nursing, convened an expert panel to explore the potential for developing recommendations for the caseloads of advanced practice nurses (APNs) in nursing homes and to provide substantive and detailed strategies to strengthen the use of APNs in nursing homes. The panel, consisting of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care, developed six recommendations related to caseloads for APNs in nursing homes. The recommendations address educational preparation of APNs; average reimbursable APN visits per day; factors affecting APNs caseload …

Making Tough Decisions, Karen A. Karlowicz

Nursing Faculty Publications

This article focuses on the aspect of critical thinking in making tough decisions in life. Advances in urology have resulted in a range of therapies for many urologic diseases and disorders. Patients need information about each treatment, and the time to fully consider the effect of a given therapy on their overall health. Keep in mind that patients who are empowered to make decisions about their health care are more likely to comply with the treatment plan. Likewise the author urges readers to use their critical thinking skills to solve the clinical problems they are confronted with daily.

Organizational Characteristics And Restraint Use For Hospitalized Nursing Home Residents., Meg Bourbonniere, Neville E. Strumpf, Lois K. Evans, Greg Maislin

College of Nursing Faculty Papers & Presentations

OBJECTIVES: To examine the effect of organizational characteristics on physical restraint use for hospitalized nursing home residents.

DESIGN: Secondary analysis of data obtained between 1994 to 1997 in a prospective phase lag design experiment using an advanced practice nurse (APN) intervention aimed at reducing physical restraint for a group of hospitalized nursing home residents.

SETTING: Eleven medical and surgical units in one 600-bed teaching hospital.

PARTICIPANTS: One hundred seventy-four nursing home residents aged 61 to 100, hospitalized for a total of 1,085 days.

MEASUREMENTS: Physical restraint use, APN intervention, age, perceived fall risk, behavioral phenomena, perceived treatment interference, mental state, …

State Mandated Prenatal Human Immunodeficiency Virus Screening At A Large Community Hospital, William Cusick, Julie G. Stewart, Michael Parry, Gavin Mcleod, Gerald Rakos, Chris Sullivan, John Rodis

Nursing Faculty Publications

Purpose: To describe the initial experience of state mandated prenatal HIV screening at a large community hospital.
Methods: HIV screening was provided to all pregnant women as of October 1, 1999. All HIV-positive women identified received aggressive antiretroviral therapy to reduce the likelihood for vertical transmission. Neonates were screened for HIV at zero, six, and 12 months of age.
Results: Seven pregnant women (0.3%) and two additional family members tested positive for HIV. All seven infants born to the identified HIV-positive women have tested negative for infection. We estimated that six of nine cases of HIV infection identified would have …

Tractor Driving Among Kentucky Farm Youth: Results From The Farm Family Health And Hazard Surveillance Project, Steven R. Browning, Susan C. Westneat, Raeanne Szeluga

Epidemiology and Environmental Health Faculty Publications

This article documents the extent of children's involvement in tractor operations among a representative sample of Kentucky children living and working on family farms. Specifically, we describe children's exposures to tractor-related work activities, profile their use of the tractor (number of days worked), and assess compliance with generally recommended safety measures, such as using tractors equipped with ROPS (rollover protective structures), avoiding riding as passengers on tractors, and operating tractors on public roadways. Data for this study were collected in 1994 and 1995 as part of the NIOSH-sponsored Farm Family Health and Hazard Surveillance Project (FFHHSP). Despite recognition in the …

Basics Of Research (Part 13): Qualitative Research--An Example, Cheryl Thompson, Edward A. Panacek

Journal Articles: College of Nursing

No abstract provided.

Basics Of Research (Part 12): Qualitative Research, Cheryl Thompson, B. Lee Walker

Journal Articles: College of Nursing

Although both the assumptions and methods of qualitative and quantitative approaches in nursing research are different, both have the goal of furthering the scientific basis for practice. A variety of qualitative approaches are available, and which approach to use depends on the purpose of the research. In general, qualitative investigations address broad questions related to description, discovery, or theory building, and, as a consequence, the researcher is concerned with the entire context surrounding the phenomenon of interest rather than concentrating on specific variables thought to influence that phenomenon. The type of data collected and the methods of analysis differ, but …

Basics Of Research (Part 6): Quantitative Data Analysis, Cheryl Thompson, Robert Schwartz, Eric Davis, Edward A. Panacek

Journal Articles: College of Nursing

No abstract provided.

Basics Of Research (Part 5): Ethics And Human Rights, Eric Davis, Edward A. Panacek, Cheryl Thompson

Journal Articles: College of Nursing

No abstract provided.