Screening for Risk of Fall-Related Inpatient Trauma in a US Acute Care Setting.

Introduction Falls during hospitalization are a leading cause of preventable trauma-related injuries. Factors associated with fall risk include an unfamiliar environment, changes in health status, and efficacy based on the home environment. Assessing fall efficacy with an individualized prevention plan can decrease falls. The primary aim of this study was to estimate the effect of implementing a fall efficacy screening and intervention on reducing patient falls. Methods The study utilized a quasi-experimental, cross-sectional design with a convenience sample of patients admitted to an in-patient adult medical unit within a community hospital over a twelve-month period. Sampling times included pre-implementation, immediately post-implementation, and a second post-implementation phase. The intervention consisted of an admission fall efficacy screening tool and an individualized educational initiative. Statistical analysis included descriptive statistics of central tendency and dispersion, along with inferential statistics using independent sample t-tests, chi-square tests, correlations, and binary logistic regression. Results Among the study participants (n=2,074), the total sample had an average age of 67.7 (+/- 17.4) years and had mean scores of 13.3 (6.9) on the Short Falls Efficacy Scale-International and 51.8 (20.3) on the Morse Fall Scale. Fifty-two percent of the study population were female; 16.2% of the patients were diagnosed with cerebrovascular accident (CVA) or CVA-like symptoms. Fall rates decreased with a rate of change of -4.15% after efficacy screening and intervention. Males demonstrated higher efficacy in avoiding falls compared to females (t(828) = 3.369, p <0.001). Patients with a CVA diagnosis demonstrated higher efficacy scores compared to non-CVA patients (t(2071) = -3.348, p <0.001). FES risk groups (OR of 5.632, 95% CI (2.171-7.892)) and age over 65 (OR 1.21, 95% CI (1.006-1.442)) were significant predictors of a fall when patients with a primary CVA diagnosis were omitted from the sample (p= 0.022 and 0.046 respectively). Conclusion The findings suggest that efficacy screening may be associated with decreased falls for acute care non-CVA inpatient populations over 65 years of age. Further research into the predictive utility of fall efficacy screening in acute care CVA and non-CVA hospitalized patient populations aged 65 years and above is recommended.

Retrospective Analysis of Risk Factors in Geriatric Hip Fracture Patients Predictive of Surgical Intensive Care Unit Admission.

INTRODUCTION: Although numerous risk factors and prediction models affecting morbidity and mortality in geriatric hip fracture patients have been previously identified, there are scant published data on predictors for perioperative Surgical Intensive Care Unit (SICU) admission in this patient population. Determining if a patient will need an SICU admission would not only allow for the appropriate allocation of resources and personnel but also permit targeted clinical management of these patients with the goal of improving morbidity and mortality outcomes. The purpose of this study was to identify specific risk factors predictive of SICU admission in a population of geriatric hip fracture patients. Unlike previous studies which have investigated predominantly demographic, comorbidity, and laboratory data, the present study also considered a frailty index and length of time from injury to presentation in the Emergency Department (ED). METHODS: A total of 501 geriatric hip fracture patients admitted to a Level 1 trauma center were included in this retrospective, single-center, quantitative study from January 1, 2019, to December 31, 2022. Using a logistical regression analysis, more than 25 different variables were included in the regression model to identify values predictive of SICU admission. Predictive models of planned versus unplanned SICU admissions were also estimated. The discriminative ability of variables in the final models to predict SICU admission was assessed with receiver operating characteristic curves' area under the curve estimates. RESULTS:  Frailty, serum lactate > 2, and presentation to the ED > 12 hours after injury were significant predictors of SICU admission overall (P = 0.03, 0.038, and 0.05 respectively). Additionally, the predictive model for planned SICU admission had no common significant predictors with unplanned SICU admission. Planned SICU admission significant predictors included an Injury Severity Score (ISS) of 15 and greater, a higher total serum protein, serum sodium <135, systolic blood pressure (BP) under 100, increased heart rate on admission to ED, thrombocytopenia (<120), and higher Anesthesia Society Association physical status classification (ASA) score (P = 0.007, 0.04, 0.05, 0.002, 0.041, 0.05, and 0.005 respectively). Each SICU prediction model (overall, planned, and unplanned) demonstrated sufficient discriminative ability with the area under the curve (AUC) values of 0.869, 0.601, and 0.866 respectively. Finally, mean hospital Length of Stay (LOS) and mortality were increased in SICU admissions when compared to non-SICU admissions. CONCLUSION: Of the three risk factors predictive of SICU admission identified in this study, two have not been extensively studied previously in this patient population. Frailty has been associated with increased mortality and postoperative complications in hip fracture patients, but this is the first study to date to use a novel frailty index specifically designed and validated for use in hip fracture patients. The other risk factor, time from injury to presentation to the ED serves as an indicator for time a hip fracture patient spent without receiving medical attention. This risk factor has not been investigated heavily in the past as a predictor of SICU admissions in this patient population.

Resource Deployment in Response to Trauma Patients.

Background Variance in the deployment of the trauma team to the emergency department (ED) can result in patient treatment delays and excess burden on ED personnel. Characteristics of trauma patients, including mechanism of injury, injury type, and age, have been associated with differences in trauma resource deployment. Therefore, this retrospective, single-site study aimed to examine the deployment patterns of trauma resources, the characteristics of the trauma patients associated with levels of trauma resource deployment, and the deployment impact on ED workforce utilization and non-trauma ED patients. Methodology This was an investigator-initiated, single-institution, retrospective cohort study of all patients designated as a trauma response and admitted to a community hospital's ED from July 01, 2019, through July 01, 2022. Results Resource deployment for trauma patients varied by mechanism of injury (p < 0.001), injury type (p < 0.001), and patient age groups (p < 0.001). Specifically, there was a lower average trauma activation for geriatric trauma patients with a fall as a mechanism of injury compared to all younger patient groups with any mechanism of injury (F(5) = 234.49, p < 0.001). In the subsample, there was an average of 3.35 ED registered nurses (RNs) allocated to each trauma patient. Additionally, the ED RNs were temporarily reallocated from an average of 4.09 non-trauma patients to respond to trauma patients, despite over a third of the trauma patients in the subsample being the trauma patients being discharged home from the ED. Conclusions Trauma activation responses need to be standardized with a specific plan for geriatric fall patients to ensure efficient use of trauma and ED personnel resources.

Perceptions of Authentic Nurse Leader Attributes Among Clinical Nurses and Nurse Leaders.

OBJECTIVE: This study aimed to develop and validate a tool to measure authentic nurse leadership (ANL) from the perspective of nurse leaders. BACKGROUND: The COVID-19 pandemic heightened the need for ANL to establish healthy work environments (HWE) that promote positive outcomes. METHODS: A nonexperimental design and exploratory psychometric analysis developed and validated the Authentic Nurse Leadership Questionnaire for Nurse Leaders (ANLQ-NL) instrument. Relationships were explored between ANLQ-NL and HWE, as measured by the Areas of Worklife Survey (AWS). The Marlowe-Crowne Social Desirability Scale (MC-SDS) was used to measure the nurse leaders' tendency to produce socially desirable responses. The sample consisted of 188 nurse leaders from several US hospitals. RESULTS: The ANLQ-NL instrument was found to be valid and highly reliable. Each of the constructs aligned with the ANL conceptual framework. CONCLUSION: The ANL conceptual framework and instruments (ANLQ and ANLQ-NL) can be used for educational programs aimed at developing ANL attributes among nurses.

Expression pattern of CAPA/pyrokinin neuropeptide genes in Remipedia and silverfish: Rapid differentiation after gene duplication in early Hexapoda, followed by strong conservation of newly established features in insects.

Only few genes are known from insects that encode multiple neuropeptides, i.e., peptides that activate different receptors. Among those are the capa and pk genes, which differentiated within Hexapoda following gene duplication. In our study, we focus on the early stages of differentiation of these genes. Specifically: (1) What was the expression pattern of the ancestral capa/pk gene, i.e., prior to gene duplication? (2) What is the expression pattern of capa and pk in silverfish, whose ancestors diverged from Pterygota more than 400 mya? Our results suggest the location and projection of CAPA immunoreactive Va cells in abdominal ganglia (trunk ganglia in Remipedia) are a plesiomorphic trait that was already present in the ancestor of Remipedia and Hexapoda. General features of serial homology such as location of cells bodies, contralateral projection of primary neurites, and presumed peripheral peptide release from segmentally arranged neurohemal release sites could be observed in Remipedia and silverfish, but also in all Pterygota studied so far. Differences are mainly in the specific location of these peripheral release sites. This hypothetical basic pattern of capa/pk neurons underwent modifications in the anterior ganglia of the ventral nerve cord already in Remipedia. In silverfish, as in all Pterygota studied so far, pk expression in the CNS is apparently restricted to the gnathal ganglia, whereas capa expression is typical of abdominal Va cells. Thus, differentiation in the expression pattern of capa and pk genes occurred early in the evolution of Hexapoda; likely soon after the appearance of two separate genes.

Evaluating mental illness-substance abuse stigmatic perceptions through education: A library-nursing initiative.

In this library-nursing initiative, the goal was to identify any changes in stigmatic perceptions among public library staff regarding mental health and substance abuse, post 3-day educational sessions. A total of n = 37 library staff participated in this project and attended all three educational sessions and completed a pre- and postquestionnaire designed to address common mental health and substance abuse-related stigmatic perceptions among public library staff. Upon analysis of the pre- and postresponses, we identified that there were statistically significant changes in two perceptions, namely; "embarrassed to disclose mental illness" and "commonality of substance abuse" (p ≤ .05). Therefore, it is essential that behavioral health nurses engage and collaborate with local public libraries to educate and build a safe environment for vulnerable populations like those affected with mental illness and substance abuse in the community settings.

Making Fall Risk Assessment Clinically Relevant in an Adult Psychiatric Setting.

The purpose of this non-experimental descriptive study was to measure psychiatric clinical nurses' (N = 25) perceptions of the Edmonson Psychiatric Falls Risk Assessment Tool© (EPFRAT) compared to the Morse Fall Scale (MFS) and to evaluate patient falls with injury rates 12 months before and after the study. The setting was a 27-bed, adult psychiatric unit in a community-based teaching hospital located in the Northeast region of the United States. The EPFRAT and MFS were used to assess fall risk in 216 patients over 3 months. Findings indicated that the EPFRAT was more user-friendly and relevant; improved nurses' clinical judgment in identifying high-risk patients; and nurses were supportive toward changing practice from using the MFS to EPFRAT for fall risk assessment. Falls with injury rates decreased by 0.52 per 1,000 patient care days post-implementation of the EPFRAT. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 21-26.].

Effects of Animal-Assisted Activity on Mood States and Feelings in a Psychiatric Setting.

BACKGROUND: Research has shown that animal-assisted activity (AAA) effectively improves physiological, psychological, emotional, and social well-being in various environments. AIMS: To identify how AAA affects mood states and feelings among both patients and staff on inpatient psychiatric units. METHODS: This study used a quasi-experimental, pre-/posttest design with nonequivalent comparison groups. Quantitative data were collected using the Visual Analog Mood Scale. Demographic data, with an open-ended question, were obtained postsessions. RESULTS: Significant changes were observed pre- and postexposure to AAA sessions with a therapy dog. Negative moods decreased, and positive moods increased as measured by the Visual Analog Mood Scale. Content analysis identified themes of feeling happy, feeling relaxed, and feeling calm. CONCLUSIONS: This research expands scientific evidence associated with AAA by identifying changes in mood states and feelings among individuals in a psychiatric setting.

Authentic Nurse Leadership Conceptual Framework: Nurses' Perception of Authentic Nurse Leader Attributes.

Today's nurse leaders are challenged to successfully implement and sustain healthy work environments and promote staff engagement. Authentic leaders possess inner core values that are consistent with the nursing profession. Authentic nurse leaders are able to create a healthy work environment that leads to engaged nurses. The first aim of this study was to develop the authentic nurse leadership conceptual framework and instrument. The second was to identify nurses' perception of authentic nurse leader attributes, grounded in the nursing discipline, that support a healthy work environment and promote nurse engagement. A crossover design was employed to compare the Authentic Nurse Leadership Questionnaire (ANLQ) with the Authentic Leadership Questionnaire, which has been used for leaders from multiple disciplines. The study sample consisted of 309 registered nurses, whose work includes at least 50% direct patient care. Results of the study indicate that the ANLQ is valid and reliable; ANLQ concepts were statistically supported by both exploratory and confirmatory factor analyses. The ANLQ better identified nursing values, as indicated by a stronger relationship with nurse work-life and nurse engagement.

Prevalence of Dumping Syndrome After Laparoscopic Sleeve Gastrectomy and Comparison with Laparoscopic Roux-en-Y Gastric Bypass.

BACKGROUND: Dumping syndrome is a well-known side effect of laparoscopic gastric bypass (LRYGB), and it is commonly believed that dumping syndrome is less likely to occur after laparoscopic sleeve gastrectomy (LSG), due to the preservation of the pyloric sphincter. However, it is not uncommon for patients undergoing LSG at our center to report symptoms suggestive of dumping syndrome. OBJECTIVE: To assess the prevalence of symptoms of dumping syndrome after LSG compared with LRYGB. SETTING: A single surgical group at a high-volume (700 cases per year) Bariatric and Metabolic Surgery Center of Excellence. METHODS: One thousand four hundred seventy-one LRYGB (366) and LSG (1105) patients received a questionnaire to assess symptoms of dumping syndrome, utilizing a modified version of the Sigstad scoring system. Dumping syndrome was considered to be present when the questionnaire score exceeded a threshold value. RESULTS: A total of 360 responses were received (249 LSG, 111 LRYGB). 26.5% (66) LSG and 41.4% (46) LRYGB exceeded the threshold for dumping syndrome (p < 0.01). 84.8% (56) LSG and 84.7% (39) LRYGB reported early dumping syndrome (p > 0.05). Thirty-six percent (24) LSG and 28% (13) LRYGB reported late dumping syndrome (p > 0.05). Twenty-seven percent (62) LSG and 44.4% (44) LRYGB reported at least one symptom of dumping syndrome with sweets (p < 0.05). 34.3% (85) LSG and 35.5% (39) LRYGB reported symptoms when drinking with or within 30 min of a meal (p > 0.05). 14.5% (36) LSG and 17.3% (19) LRYGB reported symptoms after alcohol consumption (p > 0.05). CONCLUSION: Dumping syndrome after LSG is prevalent but has not been widely reported. This finding may impact clinicians and patients in their choice of procedure and has relevance in post-operative education and care.

Instrument Development of Integrative Health and Wellness Assessment™.

The nurse coach role was developed to address the needs of our nation and the world for health and wellbeing. The Theory of Integrative Nurse Coaching provides a foundation for coaching interventions supporting health promotion, and a framework for the development of the Integrative Health and Wellness Assessment (IHWA) short form. This 36-question Likert-type scale self-reporting tool assists participants in assessing healthy behaviors through a self-reflection process, provides information for the coaching relationship, and may be an outcome measurement. This article describes the history of the IHWA tool and the development and pilot testing of the IHWA short form using guidelines provided by DeVellis. Results of the Kaiser-Meyer-Olkin test yielded a value of .520, and the Bartlett's test of sphericity was significant. Cronbach's alpha overall scale internal consistency was .88 ( n = 36). Pilot study results indicate that the scale could be improved through additional revision, and an ongoing study is in progress.

Implantable cardioverter defibrillators and permanent pacemakers: prevalence and patient outcomes after trauma.

BACKGROUND: The prevalence and outcomes of older trauma patients with implantable cardioverter defibrillators (ICDs) or permanent pacemakers (PPMs) is unknown. METHODS: The trauma registry at a regional trauma center was reviewed for blunt trauma patients, aged ≥ 60 years, admitted between 2007 and 2014. Medical records of cardiac devices patients were reviewed. RESULTS: Of 4,193 admissions, there were 146 ICD, 233 PPM, and 3,814 no device patients; median Injury Severity Score was 9. Most cardiac device patients had substantial underlying heart disease. Patients with ICDs (13.0%) and PPMs (8.6%) had higher mortality rates than no device patients (5.6%, P = .0002). Among cardiac device patients who died, the device was functioning properly in all that were interrogated; the most common cause of death was intracranial hemorrhage. On propensity score analysis, cardiac devices were not independent predictors of mortality but rather surrogate variables associated with other predictors of mortality. CONCLUSIONS: Approximately 9.0% of admitted older patients had cardiac devices. Their presence identified patients who had higher mortality rates, likely because of their underlying comorbidities, including cardiac dysfunction.