Using Videoconferencing for Verbal Reports to Improve Clinical Nurse Specialist Student Performance.

PURPOSE: Clear, concise verbal reports are essential to clinical nurse specialists' practice, yet current literature addressing the development of this skill is sparse. The purpose of this study is to determine the effectiveness of using videoconferencing for verbal reports as a learning strategy for improving clinical nurse specialist students' communication competencies and advanced practice decision making. DESCRIPTION OF THE PROJECT: Videoconferencing, using iPad minis issued to faculty and students, was used routinely for verbal reports on clinical cases to faculty, which included immediate faculty feedback. A verbal report template of patient chief complaint, applicable history, review of systems, physical examination/labs, differential diagnoses, and management was developed and provided to students. OUTCOME: Initial student verbal reports were disorganized, lengthy, lacking content, or containing extraneous details. After students routinely gave verbal reports via videoconferencing, verbal report time for the class decreased from more than 20 minutes to 3 to 5 minutes and the accuracy of reports also increased. CONCLUSION: A concise, clinically relevant verbal report template, combined with videoconferencing that allowed for frequent and immediate feedback from faculty, improved student communication competencies. Current technology, such as tablets and smart phones, provide videoconferencing opportunities that can be used to enhance learning for students.

Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure.

BACKGROUND: The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE: The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS: This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS: The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS: An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Explanatory models of heart failure etiology.

Chronic health failure is a leading cause of hospital readmissions and is reaching epidemic proportions in the United States. Explanatory models of illness can provide insight about how people with heart failure perceive their etiology of heart failure. Six themes were found in this descriptive, qualitative study to explore the perceived origin of heart failure in 50 participants. Forty percent of the people were unaware of why they had the diagnosis. Misconceptions and misinformation were common, including confusion about whether the symptoms themselves caused the disease.

Symptom management of affective and cognitive disturbance with a group of cancer survivors.

UNLABELLED: Cancer survivors 65 years of age and older experience treatment-induced memory impairments. However, clinicians do not intervene for these cognitive problems. This article describes the findings from a pilot study of a memory versus health training intervention and its adaptability for cancer survivors for symptom management. DESIGN AND METHODS: A convenience sample of older adults was enrolled in a longitudinal study of a memory and health training intervention and tested on five occasions for 2 years postintervention. The memory training was designed to increase cognitive performance, reduce anxiety, decrease negative attributions, promote health, and increase memory self-efficacy. In this analysis, we included change over time for the first four of the five data collection points. We calculated means and standard deviations on the memory measures for cancer survivors in the intervention (n = 8) and comparison (n = 14) groups. The analysis consisted of a mixed design analysis of variance comparing the two intervention groups across four periods for 12 months. RESULTS: The typical cancer survivor in the sample was a 74-year-old Caucasian female; 14% were minorities. Because of the small sample, some of the effects were not statistically significant. Moderate to large effects were revealed in everyday and verbal memory performance scores, memory self-efficacy, strategy use, and memory complaints. There were also moderate effects for group-by-time interactions on the visual memory performance measure, the memory self-efficacy measure, the depression, the trait anxiety measure, and the complaints subscale. The memory intervention group tended to improve more than the health training group, although this was not always consistent. The results suggested that the participants benefited from the memory training intervention. IMPLICATIONS: Clinicians are often at a loss on how to intervene with cancer survivors who are experiencing cognitive problems following chemotherapy treatment. Evidenced-based interventions for this aspect of symptom management are almost nonexistent. The Cognitive Behavioral Model of Everyday Memory (CBMEM), derived from Self-Efficacy theory provides an evidence-based intervention for symptom management.

The SeniorWISE study: improving everyday memory in older adults.

We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.

Differential benefits of memory training for minority older adults in the SeniorWISE study.

PURPOSE: Cognitive training improves mental abilities in older adults, but the benefit to minority elders is unclear. We conducted a subgroup analysis of subjects in the SeniorWISE (Wisdom Is Simply Exploration) trial to examine this issue. DESIGN AND METHODS: SeniorWISE was a Phase 3 randomized trial that enrolled 265 nondemented community-dwelling older adults aged 65 years and older between 2001 and 2006. Participants were randomly assigned to 12 hr of either memory or health training. RESULTS: The sample was 79% female, 71% Caucasian, 17% Hispanic, and 12% African American. On the Rivermead Behavioural Memory Test (RBMT), 28% of the sample scored normal, 47% scored poor, and 25% impaired. Memory performance changed differently over time depending on the demographic characteristics of participants. Both Hispanics and Blacks performed better than Whites on visual memory, and Blacks performed better over time on instrumental activities of daily living. On all performance measures, lower pretest scores were associated with relatively greater improvements over time. IMPLICATIONS: Our analyses suggested that minority participants received differential benefits from the memory training; however, this remains speculative because the 3 ethnic groups in the sample were not equivalent in size. The question of why Black and Hispanic participants often made greater improvements needs further exploration.

Health-training intervention for community-dwelling elderly in the SeniorWISE Study.

This article describes the outcomes of a psychosocial intervention that tested whether health training could improve health and functional ability in a group of community-residing elderly persons. The health-training intervention consisted of eight 90-minute lecture and discussion classes conducted twice a week for 1 month. In 3 months following the posttest, an additional four booster sessions were delivered once per week for 1 month. Participants received a total of 20 hours of health training. The National Institutes of Health-funded SeniorWISE (Wisdom is Simply Exploration) study was advertised in the community as a program to learn strategies for successful aging. We describe the health curriculum and the health and functional outcomes for a 6-month period at preintervention, postintervention, and postbooster sessions. Complete data were available for 110 individuals. There was a statistically significant change on the Direct Assessment of Functional Status, F(2, 107) = 4.69, P < .012. Health variables remained stable over time. This intervention demonstrated that health training has the potential for noticeable improvement in Instrumental Activities of Daily Living function.

The revised direct assessment of functional status for independent older adults.

PURPOSE: The original version of the Direct Assessment of Functional Status (DAFS), a measure of instrumental activities of daily living (IADLs), was found to have a ceiling effect in older adults living independently in the community. This suggested that the tasks measured, although relevant, do not require full use of this population's abilities, and thus, the instrument may not be sensitive to the early decrements in IADLs that can signal initial cognitive impairment and may not detect improvements in IADLs over time, which is especially important in intervention research. DESIGN AND METHODS: By removing items with little to no variation and adding more difficult subscales that emphasized medication management skills, we designed the DAFS-Extended (Direct Assessment of Functional Status-Revised [DAFS-R]) to be more challenging for elders living independently. RESULTS: Analysis with a sample of 45 older adults suggested that scores on the DAFS-R appear to be more normally distributed than on the original version. The DAFS was able to differentiate individuals with varying standard profile scores on the Rivermead Behavioural Memory Test memory performance instrument (normal, poor, and impaired). In addition, the reliability and validity of the DAFS-R were supported in this sample. IMPLICATIONS: Given the large number of older adults who regularly take multiple prescription medications, deficits in medication management skills can have serious consequences. A performance measure that emphasizes these higher level daily living skills can help providers screen for initial signs of functional decline.

A systematic review of depression in adults with heart failure: instruments and incidence.

Heart failure (HF) is a life-threatening condition affecting 2.5% of Americans. Depression is reported to be present in 9.5% of the general population, but its incidence is higher in individuals with HF. The aims of this systematic review of older adults with HF were to examine the literature to: (1) identify instruments used to evaluate depression/depressive symptoms; and (2) determine the incidence of depression/depressive symptoms reported. Sixteen articles met inclusion criteria. Six self-reporting screening instruments and two diagnostic-interviews for depression were identified. Depression/depressive symptoms were reported in 14-60% of adults with HF. Use of screening instruments resulted in higher frequencies of depression/depressive symptoms (21-60%) than did diagnostic interviews (14-39%). Screening instruments established prior to the 1987 diagnostic guidelines may not reflect the current definition of depression. Depression screening instruments appear to overestimate the incidence of depression in older adults with heart failure. A complete diagnostic interview for depression should be performed prior to the treatment of older adults with HF.

Physiological stress response of young adults exposed to bullying during adolescence.

Peer victimization in the form of bullying is a chronic social stressor experienced by many humans during development. Exposure to bullying has been associated with a variety of mental disorders, such as anxiety and depression. Participants pre-selected for the presence or absence of a history of being bullied were brought into a laboratory and placed in a stressful situation. Blood pressure, heart rate, and salivary cortisol levels were measured before the introduction of the stressor (Time 1), at the end of the stressor (Time 2), and after its removal (Time 3). Men with a history of exposure to frequent bullying showed blunted blood pressure responses at Time 2 compared to control men. Bullied and Non-bullied women did not show any differences in any of the measures. Men and women in both groups showed an increase in heart rate in response to the stressor. There were no significant differences in salivary cortisol levels between Bullied and Non-bullied participants. However, salivary cortisol levels and systolic blood pressure were lower in Bullied male participants who reported having no feelings of anger about their experience compared to controls and those who did report anger. These data show altered sympathetic responses to stress in men with a history of victimization as well as suggesting long-term effects on the HPA axis in the most affected individuals.

Alcohol use and older adults: A little goes a long way.

We examined the relationships between alcohol use, cognitive and affective variables, and the potential differential benefits of training for older adults drinkers and non-drinkers who participated in a randomized trial implemented between 2001-2006. Participants, who were living independently in the community, were randomly assigned to either twelve hours of memory training or health promotion classes. Outcomes included depression, health, cognition, verbal, visual, memory, and performance-based IADLs. The sample was 79% female, 17% Hispanic and 12% African-American. The typical participant had an average age of 75 years with 13 years of education. In the memory intervention group, there were 135 individuals (63 drinkers, 72 non-drinkers). In the health promotion condition, there were 129 individuals (58 drinkers and 71 non-drinkers). At baseline, drinkers scored higher on cognition, verbal memory, and lower on depression than non-drinkers. Alcohol use was positively related to physical health at baseline as measured by the Physical Component Summary Score of the Medical Outcomes Health Scale (SF-36). We found significant effects for the time*drinking*treatment group interaction in the repeated measures ANCOVA for the Mini Mental Status Examination, the Hopkins Verbal Learning Test, and the SF-36 Mental Health sub-scale. The time*drinking*group interactions were not statistically significant for any of the other outcomes; This study demonstrated that older adults benefited from targeted psychosocial interventions on affective, cognitive and functional outcomes. In addition, the SeniorWISE study provides empirical support to the research evidence emphasizing the health benefits of moderate alcohol consumption in older adults.

Health promotion for women with human immunodeficiency virus or acquired immunodeficiency syndrome.

PURPOSE: The purpose of this pilot study was twofold: first, to modify Stuifbergen's health promotion intervention initially developed for women with multiple sclerosis for use among women with human immunodeficiency virus or acquired immunodeficiency syndrome (HIV/AIDS) and to evaluate the feasibility of the newly modified health promotion intervention named "Put Health Into Living" (PHIL). The pilot study was completed in two phases. DATA SOURCES: In phase I, data were derived from a literature review, a focus group of women with HIV/AIDS (n= 7), a panel of experts who reviewed the intervention for content, and three female community workers who evaluated the intervention for the context of living with HIV/AIDS, cultural relevancy, and literacy. During phase II, a pretest/posttest one-group design was used to determine the feasibility of the study methods, content, and format of the health promotion intervention among 10 women with HIV/AIDS. CONCLUSIONS: The pilot study demonstrated the importance of a health promotion intervention for a vulnerable population. Participants verbalized the benefits of attending a health promotion program to gain knowledge and skills to promote their health. One woman said, "I have been positive for 20 years now and no one has talked to me just about my overall health." Participants indicated the PHIL intervention offered a supportive group environment, an overall health focus, and an acceptable format. IMPLICATIONS FOR PRACTICE: Health promotion is a desirable goal for persons living with a chronic disease, and the PHIL intervention has the potential to benefit persons living with HIV/AIDS if subsequent evidence is found in further testing of the intervention.

Health promotion in heart failure--a paradigm shift.

For people living with heart failure, levels of health exist along a continuum in correlation with the illness experience. A focus on health promotion rather than only disease or symptom management expands opportunities for self-care and presents an emerging paradigm shift in the care of people with heart failure. Results from 2 studies revealed that few health-promoting behaviors were reported by patients with heart failure until a focused intervention that emphasized health promotion as part of self-care was implemented.

Cognitive reorganization and stigmatization among persons with HIV.

BACKGROUND: A diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-changing event, where persons must deal with a life-threatening, debilitating disease and its associated stigma and isolation. Studies over the past decade have shown that writing and talking about stressful and traumatic experiences, such as a life-threatening illness, causes emotions surrounding the trauma to change and to become cognitively reorganized. The result is a reduction in inhibition and change in basic cognitive and linguistic processes, which have contributed to meaningful behavioural, psychological, and physical health benefits across a variety of populations. AIMS: To describe the construction of the Integrated Model of Health Promotion for persons with HIV/AIDS, and present initial empirical support of the model from a feasibility pilot study of women with HIV/AIDS. APPROACH: The Integrated Model of Health Promotion is described and relevant literature in the field is reviewed. The model is implemented in a feasibility pilot study utilizing the emotional writing disclosure intervention. RESULTS: Participants in the experimental condition demonstrated a promising pattern of cognitive reorganization, a reduced perception of stigma, and an improvement in mental health scores compared with the control condition. CONCLUSION: Implications of these findings are discussed within the framework of the Integrated Model of Health Promotion. The model explores health and behavioural benefits associated with emotional writing in individuals with HIV/AIDS. The limited sample size of this pilot study precludes testing for significance. Further studies are required prior to the development of practice guidelines.