Nursing Student Collaborative With Meals on Wheels: Home Visits for At-Risk Senior Adults.

Nursing students at Washington State University Tri-Cities Campus are taking part in a program to provide care for homebound senior adults enrolled in home delivery meal services. Students perform home safety, functional, and cognitive assessments while learning the challenges of meeting nutritional needs of an at-risk senior adult population. This article outlines the program and its outcomes after two years of collaboration. Meals on Wheels is identified as an innovative placement for meeting nursing program outcomes and clinical practice hours. Areas for future growth include interdisciplinary collaboratives and partnering with local hospitals to study the program's impact on hospital readmission.

American Telemedicine Association: Telestroke Guidelines.

The following telestroke guidelines were developed to assist practitioners in providing assessment, diagnosis, management, and/or remote consultative support to patients exhibiting symptoms and signs consistent with an acute stroke syndrome, using telemedicine communication technologies. Although telestroke practices may include the more broad utilization of telemedicine across the entire continuum of stroke care, with some even consulting on all neurologic emergencies, this document focuses on the acute phase of stroke, including both pre- and in-hospital encounters for cerebrovascular neurological emergencies. These guidelines describe a network of audiovisual communication and computer systems for delivery of telestroke clinical services and include operations, management, administration, and economic recommendations. These interactive encounters link patients with acute ischemic and hemorrhagic stroke syndromes with acute care facilities with remote and on-site healthcare practitioners providing access to expertise, enhancing clinical practice, and improving quality outcomes and metrics. These guidelines apply specifically to telestroke services and they do not prescribe or recommend overall clinical protocols for stroke patient care. Rather, the focus is on the unique aspects of delivering collaborative bedside and remote care through the telestroke model.

Prevalence of Complementary and Alternative Medicine Usage in Vietnamese American Asthmatic Children.

This study examined the frequency and type of complementary and alternative medicine (CAM) therapy, as well as characteristics associated with CAM usage. A survey about parental preferences and beliefs regarding CAM usage was distributed to 5 schools with predominantly low socioeconomic Vietnamese children. For the 360 Vietnamese children previously diagnosed with asthma whose families responded, most preferred conventional therapy as prescribed by the physician. The prevalence of CAM usage was 38.1%. Common CAM therapies were steam inhalation, creams/topical oils, foods, prayer, oil inhalation, massage, herbal medication, coining, and cupping. Significant predictors of CAM usage were older age (11-12 years) (P = .038), English language of survey response (P = .001), environmental tobacco smoke exposure (P = .001), fear of long-term medication usage, and perception of asthma as a condition related to genetics (P = .023). These findings suggest that assessing CAM therapy will provide a more holistic approach to asthma therapy.

Parent Perspectives on Appointment Nonattendance: A Descriptive Study.

Appointment nonattendance is a phenomenon that has been studied in a variety of settings. Increased nonattendance rates may result in lost productivity, patient and provider dissatisfaction, and difficulty recruiting staff and physicians. In addition, needed care for patients may be delayed. The purpose of this descriptive study was to examine parental perspectives regarding appointment nonattendance in pediatric specialty care clinics in order to better understand the facilitators and barriers to successful appointment attendance. An exploratory, descriptive approach was chosen for this study. Eight parents of children ages five years and younger were interviewed regarding appointment attendance in specialty care clinics, and conventional content analysis was used to identify themes. Findings suggest that multiple factors are associated with nonattendance, including child/family system and provider/healthcare system factors. Reducing wait times for specialty appointments (from time of scheduling to appointment date), coordinating multiple services, and offering convenient appointment times may be beneficial in optimizing appointment attendance.

The prevalence of asthma risk and contributing factors in underserved Vietnamese children in Orange County, CA.

OBJECTIVES: Vietnamese constitutes one of the fastest growing minority groups in America, with the largest concentration in Orange County (OC), CA. Yet, there are limited data on the prevalence of asthma in Vietnamese children. Our study evaluated the risk of asthma and key contributing factors among these children living in OC, CA. METHOD: Five elementary schools in OC that were predominantly Vietnamese with low socioeconomic status were selected for participation. Validated surveys were sent to parents of all students ages 3-12 in these schools with materials available in English, Vietnamese and Spanish. Surveys included questions to identify the risk of asthma and related key factors. Surveys were completed by parents and returned to schools. RESULTS: There were 1530 participants eligible for analysis. Asthma risk was 30.4%, and of these, 22.6% had no prior diagnosis. Contributing factors to identification of those at risk were male gender (p < 0.001), preferred use of the Vietnamese language (p = 0.004), longer duration in the United States (p = 0.019), and smoker in the household (p = 0.015). CONCLUSIONS: The prevalence of asthma risk in our community of low socioeconomic status Vietnamese children was found to be higher than commonly appreciated. Furthermore, a considerable number of these children had not been previously diagnosed. Given the limited information in this population, our current findings of asthma risk and key contributing factors could affect health care policies that allow appropriate funding for programs dedicated to asthma care in this and other growing population.

Attitudes and preferences on the use of mobile health technology and health games for self-management: interviews with older adults on anticoagulation therapy.

BACKGROUND: Older adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy. OBJECTIVE: The objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management. METHODS: We conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis. RESULTS: The participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology may be helpful for medication management. They also expressed the need for family support in the use of health technology devices. Moreover, the participants discussed concerns and challenges to use health technology and health games, and provided suggestions on ways to make mHealth technology and health games elder-friendly. CONCLUSIONS: These findings indicate that our older adults on warfarin therapy are interested in mHealth technology specific to warfarin medication management and health games. Further research needs to be done to validate these findings. Elder-friendly designs, technology support, and physical safety using mHealth technology may be useful in this population. These findings can be used to inform a larger study to design and test an elder-centered mHealth technology in this target population.

Asthma characteristics among older adults: using the California health interview survey to examine asthma incidence, morbidity and ethnic differences.

OBJECTIVE: The purpose of this study was to examine the incidence, characteristics of asthma morbidity and care, and ethnic differences that exist in older adults with asthma in California. METHODS: Data were from the 2009 California Health Interview Survey (CHIS). Characteristics of older adults (≥65 years) with and without asthma were compared using population-weighted estimates. Asthma-specific variables were compared among different ethnic groups. Multivariate analyses were preformed to determine factors associated with asthma status, asthma episodes/attacks, asthma symptom frequency and emergency department (ED) visits due to asthma. RESULTS: Asthma was present in 8.1% of older adults, among which, 67.3% reported taking medication daily for asthma. Asthma symptoms were experienced every day by almost 20%, with over 34% of seniors with asthma having symptoms at least once per week. Despite having a lower frequency of asthma symptoms, Hispanics were 5.31 times more likely to visit the ED due to asthma than were Caucasians. CONCLUSIONS: The findings from the study showed that older adults with asthma had difficulty with asthma control. We recommend a focus on asthma education so that when symptoms do occur, options are available to avoid costly ED visits. Further research should focus on specific asthma management skills and adherence to asthma treatment regimen among ethnic groups.

Poquito a poquito: how Latino families with children who have asthma make changes in their home.

INTRODUCTION: The purpose of this study was to assess the cultural and environmental barriers to making asthma-focused changes in the homes of Latino families with children who have asthma. METHODS: A descriptive qualitative design guided data collection and analysis in this study. Participating families described their experiences in caring for their children with asthma and the barriers they encountered when trying to modify their home environments and manage their children's asthma symptoms. RESULTS: Families discussed a spectrum of methods to manage their children's asthma symptoms, including barriers they experienced and successful changes they made in their homes. "Little by little" parents made minor adjustments, as they were able, to alleviate their children's asthma symptoms. DISCUSSION: Nurses working with Latino families who experience similar barriers can use these findings to guide inquiries about families' successful changes in their home environment and use them as a starting place to work collaboratively with families to reduce their children's asthma exacerbations. This process will allow nurses to use culturally and family tailored interventions to fit their needs and goals.

Identifying preschool children with asthma in Orange County.

Airway changes related to childhood asthma occur early in the disease process. This pilot study focuses on the validation of the Breathmobile Case Identification Survey (BCIS) in preschool-age children in Orange County, CA. Fifty-two children from low-income Spanish-speaking families participated in the study. Thirteen children were identified as possibly having asthma from the survey results compared with 20 children diagnosed by an asthma specialist. We found that the complete seven-question survey had a sensitivity of 0.65 and a specificity of 0.94. An abbreviated three-question version had a sensitivity of 0.70 and a specificity of 0.84. Our data suggest that the abbreviated BCIS, which is simple and easily analyzed, may be a useful tool in identifying young children who are at risk for asthma and need further evaluation and appropriate therapy.

Efficacy of nurse case-managed intervention for latent tuberculosis among homeless subsamples.

BACKGROUND: The efficacy of a nurse case-managed intervention was evaluated in subsamples of participants with one of the following characteristics: female gender, African American ethnicity, recruited from a homeless shelter, a history of military service, lifetime injection drug use, daily alcohol and drug use, poor physical health, and a history of poor mental health. OBJECTIVE: To determine whether a validated nurse case-managed intervention with incentives and tracking would improve adherence to latent tuberculosis infection treatment in subsamples of homeless persons with characteristics previously identified in the literature as predictive of nonadherence. METHODS: A prospective 2-group site-randomized design was conducted with 520 homeless adults residing in 12 homeless shelters and residential recovery sites in the Skid Row region of Los Angeles from 1998 to 2003. RESULTS: Daily drug users, participants with a history of injection drug use, daily alcohol users, and persons who were not of African American race or ethnicity had particularly poor completion rates, even in the nurse case-managed intervention program (48%, 55%, 54%, and 50%, respectively). However, the intervention achieved a 91% completion rate for homeless shelter residents and significantly improved latent tuberculosis infection treatment adherence in 9 of 12 subgroups tested (odds ratios = 2.51-10.41), including daily alcohol and drug users, when potential confounders were controlled using logistic regression analysis. DISCUSSION: Nurse case management with incentives appears to be a good foundation for increasing adherence to 6-month isoniazid treatment in a variety of homeless subgroups and, in particular, for sheltered homeless populations. However, additional social-structural and environmental strategies are needed to address those at greatest risk of nonadherence.

Rodent allergen in Los Angeles inner city homes of children with asthma.

Recent studies have examined the presence of mouse allergen in inner city children with asthma. Researchers have found high levels of rodent allergen in homes sampled in the northeast and midwest United States, but there has been considerable variation between cities, and there have been few studies conducted in western states. We evaluated the frequency of rodent sightings and detectable mouse allergen and the housing conditions associated with these outcomes in inner city homes in Los Angeles. Two hundred and two families of school children, ages 6-16 living in inner city neighborhoods, participated in the study. Families were predominantly Latino (94%), and Spanish speaking (92%). At study entry, parents completed a home assessment questionnaire, and staff conducted a home evaluation and collected kitchen dust, which was analyzed for the presence of mouse allergen. Fifty-one percent of homes had detectable allergen in kitchen dust. All 33 families who reported the presence of rodents had detectable allergen in the home and were also more likely to have increased levels of allergen compared to those who did not report rodents. Unwashed dishes or food crumbs, lack of a working vacuum, and a caretaker report of a smoker in the home were all significantly associated with a greater risk of rodent sightings or detectable allergen (P<0.05). Detached homes were significantly more likely to have detectable allergen. The prevalence of allergen is common enough that it may have public health implications for asthmatic children, and detectable allergen was not routinely identified based on rodent sightings. Many of the predictors of rodent allergen are amenable to low-cost interventions that can be integrated with other measures to reduce exposure to indoor allergens.

One gets so afraid: Latino families and asthma management--an exploratory study.

INTRODUCTION: This study explored Latino family experiences, issues, and needs in caring for a child with asthma as expressed by Latino parents of children with asthma. METHODS: Eight families represented by 7 women and 2 men, primarily of Mexican descent, participated in the study. All families had at least one child enrolled in preschools in the East Los Angeles area. The study had an exploratory design and used ethnographic group and individual interview techniques to discover the parents' experiences in managing their child's asthma and the meaning asthma has for their families. All interviews were conducted in Spanish. RESULTS: Several common themes emerged from the data: (a) fear, "I got scared"; (b) the acute care experience, "I was not told what to do, nothing"; (c) knowledge, "I did not know anything about asthma"; and (d) parent alternative strategies or strengths, "We want to do what is best. ... we need to be prepared." DISCUSSION: Strength emerged from fear. The parents were resourceful and began developing alternative strategies to assist them in their care for their child with asthma. The findings emphasize the need for more opportunities for culturally sensitive asthma education and community health care resources such as mobile asthma treatment centers and promotora programs.

Communication boards in critical care: patients' views.

BACKGROUND: Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication. OBJECTIVES: The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board. METHODS: Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes. RESULTS: Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication. CONCLUSIONS: Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.

Predictors of perceived health status of tuberculosis-infected homeless.

This study examines the predictors of perceived health status among homeless adults with latent tuberculosis (TB) in Los Angeles, especially in relation to gender differences. Total, 415 men and women enrolled in a TB-adherence trial completed baseline assessments concerning health status. Results indicated that women were more likely than men to report being in fair or poor health and to have experienced health problems. More women than men self-reported daily drug use and poor mental health. Homeless women were also more likely than their male counterparts to receive support from non-drug-users. Homeless adults who reported fair or poor health were also more likely than those who reported better health to have used injection drugs, to report experiencing depressive symptoms and poor mental health, and to have been homeless more than 3 years. Predictors of fair or poor health included being female and experiencing more depressive symptoms.

Predictors of screening results for depressive symptoms among homeless adults in Los Angeles with latent tuberculosis.

The purpose of this study was to examine predictors of screening results for depressive symptoms in a Los Angeles homeless population with latent tuberculosis (TB). Four hundred and fifteen homeless adults participating in a nurse case managed intervention were included in this analysis. Logistic regression results indicated that those who reported a physical health limitation, multiple sex partners, daily drug use, alcohol dependence, or not having completed high school, were more likely to screen positive. Social support from non-drug users was protective. Given the importance of adherence to TB treatment regimens, the high prevalence of a positive screening for depressive symptoms in the homeless and the potential for depression to reduce adherence rates, routine screening and treatment for depression in high risk homeless adults being treated for TB may be warranted.

Self-report INH adherence measures were reliable and valid in Latino adolescents with latent tuberculosis infection.

BACKGROUND AND OBJECTIVE: To test the reliability and validity of 8-day and 30-day self-report measures of adherence to daily isoniazid (INH) for treatment of latent tuberculosis infection (LTBI). METHODS: Participants were 286 Latino adolescents (ages 13-18, 55.6% male) with LTBI recruited from 10 public middle and high schools in San Diego County. INH adherence was measured monthly for up to 9 months by interview and urine specimens at unannounced visits. Reliability and validity analyses were performed within 5 consecutive months. Reliability was assessed by correlating: (1) 8- and 30-day INH adherence measures within each month; and (2) each of the two adherence measures across months. Validity was assessed by correlating reported measures with biological assays within each month. RESULTS: Reliability tests yielded significant correlation coefficients (p < .05 to .001), both across measures (r = 0.71-0.93) and across time (r = 0.29-0.64 for 8-day recall; r = 0.32-0.69 for 30-day recall). Validity tests of both adherence measures were also significant (p < .05 to .001): 8-day recall (r(pb) = 0.52-0.72) and 30-day recall (r(pb) = 0.37-0.71). CONCLUSION: Results suggest that impromptu recall measures of INH adherence, combined with urine collection, are reliable and valid in Latino adolescents.

Tuberculosis knowledge, perceived risk and risk behaviors among homeless adults: effect of ethnicity and injection drug use.

The objectives of this study were to investigate Tuberculosis (TB) knowledge, perceived risk, and risk behaviors in a sample of homeless persons with latent TB in the Skid Row district of Los Angeles. Particular emphasis was given to comparing these variables among homeless persons of varying ethnic backgrounds and among those who did and did not report a history of injection drug use (IDU). Baseline data were collected from 415 homeless individuals recruited to participate in a Tuberculosis chemoprophylaxis intervention. Areas of interest relative to TB knowledge and perceived risk for infection were behavioral factors surrounding substance use and abuse; personal factors measured in terms of current depression; and sociodemographic and situational factors, such as age, ethnicity, history of incarceration, and duration of homelessness. Findings revealed differences in substance abuse. IDUs were more likely to have histories of daily drug use and alcohol dependency, but were less apt to report recent use of crack cocaine. TB knowledge deficits centered on ignorance with respect to modes of transmission and risk factors for TB infection. IDU was also associated with depression. Latinos and IDUs were most likely to lack TB knowledge. There is a pressing need for accessible, available, culturally acceptable and sustained TB screening and intervention programs designed to address multiple risk factors and knowledge deficits with respect to TB infection in homeless populations.

Identification of preschool children with asthma from low-income families in Los Angeles, CA.

BACKGROUND: Few studies have addressed asthma screening in the preschool age group. Early asthma recognition and intervention in preschool children may reduce costs related to unscheduled medical care and missed school and work. OBJECTIVE: To facilitate an early recognition and referral process for asthma in a preschool education program in Los Angeles, CA. METHODS: We administered a 7-question survey to parents and guardians of children aged 12 months to 6 years in the prekindergarten program of a large school district in Southern California. English and Spanish survey questions addressed health care use, school absenteeism, and asthma symptoms. Postsurvey reports to parents recommended clinical evaluation of children who had probable asthma. RESULTS: Of the 609 surveys returned from 8 centers (> or = 80% survey return rate), 12% were positive for probable asthma and only 5.4% of these cases had been previously diagnosed. Of the 12% found to have a high probability of asthma, 3 independent factors were associated with a lower likelihood of prior asthma diagnosis: Hispanic descent; Spanish speaking; and medicine use 2 or more times per week for symptoms such as cough, chest tightness, trouble breathing, or wheezing. Symptoms at play, during the day, and at night were noted in 35% to 44% of the preschoolers. Cough was the most frequently reported symptom (71.9%, n = 424). CONCLUSIONS: A school-based screening process in an early education program can help identify preschool children with a high probability of asthma and offer a basis for early recognition and intervention.

Patients' reports of health care practitioner interventions that are related to communication during mechanical ventilation.

BACKGROUND: The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients' perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients' perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient. OBJECTIVES: This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient. METHODS: A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes. RESULTS: It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r =.109, P =.573) or between the diagnosis and the level of frustration (P =.932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P =.084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and "absent" from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner. CONCLUSIONS: Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient's experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.

Latino children with asthma: rates and risks for medical care utilization.

Latino families have been reported to underutilize health care services compared with families from other ethnic backgrounds. As part of a community trial in a low income Latino population designed to decrease environmental tobacco smoke (ETS) exposure in children with asthma in San Diego, we examined unscheduled medical care for asthma. Latino families (N = 193) reported information about medical care use for their children during the past 12 months. About 23% were hospitalized, 45% used the emergency department, and 60% used urgent care services. About 8.5% of families had two or more hospitalizations in 12 months. Most families were insured by Medicaid or had no insurance. Significant risk factors for a child's hospitalization were age (under age six), failure to use a controller medication, and a parental report of the child's health status as being poor. Risk factors for emergency department use were age (under age six) and male gender. These findings indicate that low-income Latino families with young children with asthma lack the medical resources necessary for good asthma control. Quality and monitored health care with optimization of asthma management could reduce costly acute care services.