Effectiveness of synchronous action observation and mental practice on upper extremity motor recovery after stroke.

The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.

Implementation of Interprofessional Meetings Preparing Caregivers of Patients With Brain Injury for Discharge: A Pilot Study.

PURPOSE OF STUDY: Caregivers are often unprepared to care for patients discharged with brain injury. Interprofessional team meetings with the caregiver used in some specialties improve discharge planning. The purpose of this study was to evaluate the effect of a standardized interprofessional caregiver meeting on caregiver readiness for caregiving. PRIMARY PRACTICE SETTING: The study was implemented on an eight-bed brain injury unit within a 73-bed Magnet-designated surgery and rehabilitation hospital in south central Pennsylvania. METHODOLOGY AND SAMPLE: This study used a pre-/post-quasi-experimental retrospective design. Caregivers of patients admitted to the brain injury unit completed the Preparedness for Caregiving Scale at admission and discharge. The intervention group received an interprofessional team meeting focused on the needs of the caregiver in preparation for caregiving within 3-4 days of admission compared with unscheduled meetings as needed. RESULTS: Scores improved significantly from admission to discharge in usual care and intervention groups. Sample size was insufficient to detect differences between groups. Health care providers and caregivers expressed improvement in communication and readiness for discharge. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Early interprofessional meetings with the purpose of getting to know and understanding the needs of caregivers of patients with brain injury could guide us to better prepare the caregiver for caregiving at home. The Preparedness for Caregiving Scale can be useful to assess multiple domains of caregiving. This proactive approach may improve communication and discharge readiness for patients with brain injury.

ECMO survivors' quality of life and needs after discharge: A descriptive, comparative cross-sectional pilot study.

OBJECTIVES: To describe gender differences in health-related quality of life and characterise discharged patients' perceptions of follow-up needs after extracorporeal membrane oxygenation. RESEARCH METHODOLOGY/DESIGN: A descriptive, comparative cross-sectional pilot design was used. Adult patients receiving extracorporeal membrane oxygenation discharged between January 1, 2016 and March 31, 2018 participated in telephone interviews. SETTING: A 580-bed community teaching hospital in south central Pennsylvania. MAIN OUTCOME MEASURES: Health-related quality of life was measured with the Rand 36-item Short Form Health Survey. Open-ended questions identified post-discharge healthcare services and perceived follow-up needs. RESULTS: Of 30 eligible patients, 24 completed a telephone interview. All health-related quality of life dimensions, except for role-emotional and mental health, were lower in post- extracorporeal membrane oxygenation patients at follow-up compared to national norms. Women scored lower than men in all health-related quality of life dimensions. The most frequent post-discharge services used were physical therapy (66.7%), rehabilitation (62.5%) and occupational therapy (54.2%). The need for coordination of care post-discharge was identified. CONCLUSIONS: Given long-term sequelae of extracorporeal membrane oxygenation on health-related quality of life and gender differences in health-related quality of life outcomes, ongoing interdisciplinary follow-up is imperative to ensure comprehensive patient management across the continuum of care.

Effect of a Scheduled Nurse Intervention on Thirst and Dry Mouth in Intensive Care Patients.

BACKGROUND: Thirst is a common, intense symptom reported by hospitalized patients. No studies indicate frequency of use of ice water and lip moisturizer with menthol to ameliorate thirst and dry mouth. In an audit of 30 intensive care unit patients at a 580-bed community teaching hospital, 66% reported dry mouth with higher thirst distress and intensity scores than in published studies. OBJECTIVES: To evaluate the effectiveness of scheduled use of ice water oral swabs and lip moisturizer with menthol compared with unscheduled use in relieving thirst and dry mouth for intensive care unit patients. METHODS: In a quasi-experimental design, adult patients admitted to 2 intensive care units at a community hospital were provided with ice water oral swabs and lip moisturizer with menthol upon request. The intervention was unscheduled in 1 unit and scheduled in the other unit. The scheduled intervention was provided hourly during a 7-hour period (n = 62 participants). The unscheduled intervention consisted of usual care (n = 41 participants). A numeric rating scale (0-10) was used to measure thirst intensity, thirst distress, and dry mouth before and after 7 hours in both groups. RESULTS: The scheduled-use group had significant lessening of thirst intensity (P = .02) and dry mouth (P = .008). Thirst distress in the scheduled-use group did not differ from that in the unscheduled-use group (P = .07). CONCLUSION: Scheduled use of ice water oral swabs and lip moisturizer with menthol may lessen thirst intensity and dry mouth in critical care patients.

Effect of the Salary Model on Sustainability of a Professional Practice Environment.

OBJECTIVE: This replication study examined differences in RN perception of the professional practice environment (PPE) between salary- and hourly-wage compensation models over time. BACKGROUND: A previous study demonstrated that nurses in a salary-wage model had a significantly higher perception of the PPE compared with their peers receiving hourly wages. METHODS: A descriptive, comparative design was used to examine the Revised Professional Practice Environment (RPPE) scale of nurses in the same units surveyed in the previous study 2 years later. RESULTS: Mean scores on the RPPE continued to be significantly lower for hourly-wage RNs compared with the RNs in the salary-wage model. CONCLUSIONS: Nurses in an hourly-wage unit have significantly lower perceptions of the clinical practice environment than their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit were sustained for a 2-year period and may provide a more effective PPE.

Parent reported outcomes of quality care and satisfaction in the context of a life-limiting fetal diagnosis.

OBJECTIVE: To identify which quality indicators (QI) predict patient satisfaction. METHODS: A cross-sectional design using a validated tool was administered using a Web-based platform. Parents (n = 405) who experienced a life-limiting fetal diagnosis and opted to continue their pregnancy provided feedback on 37 QI and satisfaction with prenatal care. Descriptive analyses and logistic regression identified relationships among variables. RESULTS: Parental satisfaction with care was 75.6%. Statistically significant differences in mean scores were reported with satisfied patients reporting higher agreement with quality indicators. Parents who were satisfied with their care had 1.9 times the odds of reporting that consistent care was provided (CI: 1.4-2.4, p < 0.01), 1.8 times the odds of reporting compassionate care (CI: 1.4-2.5, p < 0.01) and 1.8 times the odds that they received help to cope with their emotions (CI: 1.4-2.3, p < 0.01). The model correctly predicted parent satisfaction 92% of the time. CONCLUSION: Provision of consistent prenatal care is an important quality indicator for this population of parents. The odds of securing satisfied parents increase when families are treated with compassion and given resources to help them cope with the emotionally devastating experiences associated with a life-limiting fetal diagnosis.

Quality Indicators and Parental Satisfaction With Perinatal Palliative Care in the Intrapartum Setting After Diagnosis of a Life-Limiting Fetal Condition.

Measurement of quality indicators (QIs) in perinatal palliative care has not been addressed. Parents who chose to continue pregnancy after a diagnosis of a life-limiting fetal condition described perceptions of quality care and their satisfaction with care. This research identified which QIs explained parental satisfaction. High QI scores are associated with parental satisfaction. Parents who were satisfied reported 2.9 times the odds that their baby was treated with dignity and respect and 3.4 times the odds their medical care was addressed. This research is a first step in developing a robust measure of QIs in perinatal palliative care.

A comparison of salary-wage and hourly-wage acute care nursing units: a pilot study.

OBJECTIVE: This pilot study examined differences in RN perception of the professional practice environment and financial indicators between salary-wage and hourly-wage compensation models. BACKGROUND: There is a dearth of current information regarding use of salary-wage models for compensation for direct care nurses. METHODS: A descriptive, comparative design was used to examine the Revised Professional Practice Environment Scale (RPPE) and financial indicators of nurses in a nonprofit healthcare system over a 6-month period. RESULTS: Mean scores on the RPPE were significantly lower for hourly-wage RNs, and the hourly-wage model resulted in a 1.2% additional cost for overtime hours compared with the fixed cost of the salary-wage model. CONCLUSIONS: Nurses in an hourly-wage unit reported a significantly lower perception of the clinical practice environment than did their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit may provide a more effective professional practice environment. Financial analysis resulted in a budget-neutral impact.

Traditional classroom education versus computer-based learning: how nurses learn about pressure ulcers.

The goal of the Nurse Professional Development specialist is to utilize the most effective educational strategies when educating staff nurses about pressure ulcer prevention. More information is needed about the effect of computer-based learning and traditional classroom learning on pressure ulcer education for the staff nurse. This study compares computer-based learning and traditional classroom learning on immediate and long-term knowledge while evaluating the impact of education on pressure ulcer risk assessment, staging, and documentation.

A cross-sectional analysis of the effect of patient-controlled epidural analgesia versus patient controlled analgesia on postcesarean pain and breastfeeding.

OBJECTIVE: To assess patient controlled epidural analgesia (PCEA) versus patient controlled analgesia (PCA) for postcesarean analgesia and to determine the impact of analgesic modality on breastfeeding in the first 24 hours postpartum. DESIGN: A retrospective, descriptive, comparative, correlational design. SETTING: A metropolitan, community, teaching hospital in the northeast United States. PARTICIPANTS: Medical records for all women with cesarean births in 2007 of at least 34 weeks gestational age (N = 621). METHODS: Following Institutional Review Board approval, electronic medical records and clinical charts were reviewed by the study team. Data were analyzed with PASW version 18.0. RESULTS: Women with PCEA reported significantly less average pain (p = .000) and required significantly less analgesic adjuvant medication doses (p = .038) than women with PCA. Statistically significant negative correlations were found for average total pain score with number of breastfeeding sessions (p = .023). Controlling for confounders, women with PCEA had 2.2 times the odds of mild pain compared to PCA (p = .03). Women with mild pain (adjusted odds ratio [aOR] = 2.4, p = .03), term neonate (aOR = 3.2, p = .006), breastfeeding within 2 hours (aOR = 3.2, p = .000), and no supplemental feedings (aOR = 6.9, p = .002) had significantly greater odds of breastfeeding 6+ times in the first 24 hours. CONCLUSION: Patient-controlled epidural anesthesia confers greater pain control postcesarean than PCA. Women with greater pain are less likely to breastfeed six or more times within the first 24 hours. This could potentially affect duration of breastfeeding. Intraprofessional measures to improve pain management are warranted.

The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women.

Maternal-fetal attachment (MFA) has been associated with health practices during pregnancy, but less is known about this relationship in low-income women, and no identified studies have examined this relationship to neonatal outcomes. This longitudinal descriptive study was conducted to examine the relationships among MFA, health practices during pregnancy, and neonatal outcomes in a sample of low-income, predominantly African-American women and their neonates. MFA was associated with health practices during pregnancy and adverse neonatal outcomes. Health practices during pregnancy mediated the relationships of MFA and adverse neonatal outcomes. The results support the importance of examining MFA in our efforts to better understand the etiology of health disparities in neonatal outcomes.

Can a health clinic-based intervention increase safety in abused women? Results from a pilot study.

BACKGROUND: Intimate partner violence (IPV) has been related to a number of adverse physical and mental health consequences. Research has identified relatively high IPV victimization rates among women seeking care in primary healthcare and emergency department settings. Studies have shown the potential usefulness of screening and intervention in these settings. METHODS: This article reports results from a pilot study designed to assess the effect of a clinic-based intervention on women's engagement in safety-promoting behaviors. This study was conducted in a primary healthcare clinic for the uninsured in Baltimore, Maryland. Women who screened positive for recent IPV were randomly assigned to an intervention or control group. The intervention consisted of an on-site counseling session and six telephone counseling sessions over a 3-month period. Women in the control group received health information brochures, a list of community resources, and a monthly telephone call to confirm contact information. RESULTS: A total of 41 women participated in the study. Results demonstrated that women who received the clinic-based intervention engaged in significantly more safety-promoting behaviors than did women in the control group. CONCLUSIONS: The results of this study and others indicate the potential usefulness of screening and intervention in a medical setting.

The mediation effect of posttraumatic stress disorder symptoms on the relationship of intimate partner violence and IFN-gamma levels.

BACKGROUND: Women who experience intimate partner violence (IPV) report greater stress and negative health consequences than nonabused women. Although an association between psychological stress and altered immune function has been shown, IPV studies have not investigated this relationship. OBJECTIVE: This study explored the association of IPV with mental health symptoms and an immune marker to determine if posttraumatic stress disorder (PTSD) symptoms mediate the effect of IPV on pro-inflammatory (IFN-gamma) cytokine levels. METHODS: A cross-sectional, comparative design was used to compare 62 women with IPV and 39 nonabused women. RESULTS: Mean IFN-gamma values were higher in abused women and in women with current PTSD symptoms. There were no significant relationships with potential confounding variables that could provide an alternative explanation for the increase in production of proinflammatory cytokines. CONCLUSIONS: PTSD symptoms mediate the association between IPV and IFN-gamma levels and may partially explain the association of mental health symptoms with physical health sequelae in IPV.