Mobility Loss in Hospitalized Adults Predicts Poor Clinical Outcomes.

BACKGROUND: The Johns Hopkins Activity and Mobility Program is a systematic approach to measure and improve patient mobility. PURPOSE: The purpose of this study was to evaluate the relationship between mobility loss and quality outcomes. METHODS: A retrospective cohort study design was used. Patients were categorized into 3 groups (gain, loss, no change in mobility) using the Johns Hopkins Highest Level of Mobility (JH-HLM) scores. The association between mobility loss and falls risk, in-hospital mortality, delirium, discharge to a facility, length of stay, and 30 day readmissions were assessed. RESULTS: Those who lost mobility were more at risk of being a high fall risk, in-hospital mortality, delirium, discharging to a facility, and had 48% longer lengths of stay. There was no association between mobility loss and 30-day readmissions. CONCLUSIONS: Loss of mobility assessed using JH-HLM scores is associated with worse patient outcomes.

Development and evaluation of a concise nurse-driven non-pharmacological delirium reduction workflow for hospitalized patients: An interrupted time series study.

We created a concise nurse-driven delirium reduction workflow with the aim of reducing delirium rates and length of stay for hospitalized adults. Our nurse-driven workflow included five evidence-based daytime "sunrise" interventions (patient room lights on, blinds up, mobilization/out-of-bed, water within patient's reach and patient awake) and five nighttime "turndown" interventions (patient room lights off, blinds down, television off, noise reduction and pre-set bedtime). Interventions were also chosen because fidelity could be quickly monitored twice daily without patient interruption from outside the room. To evaluate the workflow, we used an interrupted time series study design between 06/01/17 and 05/30/22 to determine if the workflow significantly reduced the unit's delirium rate and average length of stay. Our workflow is feasible to implement and monitor and initially significantly reduced delirium rates but not length of stay. However, the reduction in delirium rates were not sustained following the emergence of the COVID-19 pandemic.

Role Identity Transition: A Conceptual Framework for Being the Spouse of a Person With Early Onset Dementia.

Informal caregivers of persons with early onset dementia (PWEOD) are usually the spouses of affected individuals. These caregivers face unique challenges related to the unexpected nature of disease onset at this early life stage along with the accompanying symptoms, which can be different from those in late onset dementia. The current study explores the meanings these caregivers make of their situations and actions in response to their experiences. Findings provide a basis for development of a conceptual framework illustrating the basic, psychosocial processes underlying their shared situation. Grounded theory methodology was used. Qualitative data were collected through semi-structured interviews with 15 participants. Data were analyzed using constant comparative techniques and situational analysis. A distinction was made across participants between identifying as spouse versus caregiver for their PWEOD. Each participant had made or was making an identity transition from viewing their role as becoming more caregiver-like toward an eventual, complete shift to that of caregiver in a stepwise fashion. Incremental shifts in identity reflected challenges to the notion held of what it means to be a spouse. Results support prior research highlighting the unique experiences of caregivers of PWEOD while providing a framework for understanding the unique situations of these care-givers. Findings also inform nursing interventions tailored for spouses of PWEOD. [Journal of Gerontological Nursing, 49(8), 27-34.].

Pairing pedagogical and genomic advances to prepare advanced practice nurses for the era of precision health.

BACKGROUND: Broadly accessible curriculum that equips Advanced Practice Nurses (APNs) with knowledge and skills to apply genomics in practice in the era of precision health is needed. Increased accessibility of genomics courses and updated curriculum will prepare APNs to be leaders in the precision health initiative. METHODS: Courses on genomics were redesigned using contemporary pedagogical approaches to online teaching. Content was based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees. RESULTS: The number of students enrolled (n = 10) was comparable to previous years with greater breadth of representation across nursing practice specialty areas (53% vs. 20%). Prior to the first course, students reported agreement with meeting 8% (3/38) of the competencies. By completion of the 3rd course, students reported 100% (38/38) agreement with meeting the competencies. CONCLUSIONS: Content on genomics sufficient to obtain self-perceived attainment of genomics competencies can be successfully delivered using contemporary pedagogical teaching approaches.

Serum BDNF Is Positively Associated With Negative Symptoms in Older Adults With Schizophrenia.

OBJECTIVES: Older adults with chronic schizophrenia are at greater risk for functional disability and poorer health outcomes than those without serious mental illness. These individuals comprise 1-2% of the elderly population in the United States and are projected to number approximately 15 million by 2030. The symptoms of schizophrenia can be disabling for individuals, significantly reducing quality of life. Often, the negative symptoms (NS) are the most resistant to treatment and are considered a marker of illness severity, though they are challenging to measure objectively. Biomarkers can serve as objective indicators of health status. Brain-derived neurotrophic factor (BDNF) is a potential biomarker for schizophrenia and may serve as an important indicator of illness severity. METHODS: A cross-sectional study with 30 older adults with chronic schizophrenia. Participants were assessed on serum levels of BDNF and psychiatric symptoms (Positive and Negative Syndrome Scale). Pearson's bivariate correlations (two-tailed) and linear regression models were used. RESULTS: A significant positive association ( p < .05) was found between higher serum levels of BDNF and greater severity for the NS items of passive, apathetic, social withdrawal, and emotional withdrawal. In multivariate analyses, the association remained significant. CONCLUSIONS: Although the association between BDNF and NS was not in the expected direction, the data corroborate findings from previous work in patients with schizophrenia. It is possible that higher serum levels of BDNF reflect compensatory neuronal mechanisms resulting from neurodevelopmental dysfunction.