Nursing Deans on Self-Care: The Case for a Trauma-Informed Approach.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic turned the world upside down and highlighted multiple sources of trauma inherent in the role of dean or director of an academic nursing unit. METHOD: Experienced nursing deans (n = 3) identify common sources of trauma for nursing deans and directors, including a case example of traumatizing events and circumstances triggered by the pandemic. The concept of trauma-informed self-care is introduced and explored as an approach to achieving the goal of resilience and posttraumatic growth. RESULTS: Based on the Trauma-Informed Self-Care Measure-Revised, specific strategies for nursing deans and directors are recommended in three broad categories: (1) use of organizational resources; (2) observance of organizational protocols for employee support; and (3) dedication to stress management and work-life balance activities. CONCLUSION: To be a positive role model for faculty, staff, and students, nursing deans and directors would benefit from taking a trauma-informed approach to caring for themselves and others. [J Nurs Educ. 2023;62(8):450-453.].

The Experience of Women Who Care for Spouses With Parkinson's Disease and Lower Urinary Tract Symptoms.

OBJECTIVE: To describe the symptoms, bother, impact, and attribution of lower urinary tract symptoms (LUTS) and management strategies from the perspective of the spouse caregiver. DESIGN: A qualitative descriptive design with semistructured interviews was guided by the Theory of Unpleasant Symptoms and family systems theory. SETTING: Women were recruited from a Parkinson's Center at a Veterans Affairs hospital in the northeastern part of the United States. Their veteran husbands received care for Parkinson's disease at the center. PARTICIPANTS: Participants were 15 female spouse caregivers of men with Parkinson's disease and associated LUTS. METHODS: Purposive sampling was used to select caregiver participants for audiotaped interviews. Semistructured interviews were conducted with the participants. A directed content analysis was used to code transcribed interviews and field notes. RESULTS: The cognitive, affective, and behavioral dimensions of caring for a spouse with LUTS were identified. Participants were knowledgeable about the direct effect of Parkinson's disease on the bladder. Their affective responses included experiencing bother, emotional distress from the impact of LUTS on their lives, and empathy for their husbands. Participants tried many behavioral strategies to manage LUTS but received limited professional assistance for daily LUTS management. CONCLUSION: Multidisciplinary, patient- and family-centered approaches that provide education, treatment, and support are needed to promote better management of LUTS, maintain patient dignity, and reduce burden for the patient and family.

Cognitive, Affective, and Behavioral Dimensions of the Lower Urinary Tract Symptom Experience in Men With Parkinson's Disease.

OBJECTIVE: Lower urinary tract symptoms (LUTS) in persons with Parkinson's disease (PD) have received little research attention. To address this gap in our knowledge, we examined the LUTS experience in men with PD, guided by The Theory of Unpleasant Symptoms. METHODS: A qualitative design was used to explore the LUTS experience in this population. Participants were recruited from a Veterans' Affairs PD Center. Maximum variation sampling was used to select diverse participants for audiotaped open-ended interviews. Additional data sources included field notes collected during interviews and observation of a PD support group. The template organizing analytic approach was used to code transcribed interviews and field notes. RESULTS: Cognitive, affective, and behavioral dimensions of the LUTS experience were identified. Participants attributed LUTS to aging, medications, and effects of motor symptoms on their ability to respond to the urge to void. There was little awareness of the neurologic contributions of PD to LUTS, and most viewed LUTS as "something that you have to put up with." Negative effects of LUTS on self-identity were noted, which jeopardized relationships, intimacy, participation in social activities, and travel. Affective responses to LUTS, particularly embarrassment, had a profound impact on quality of life. Behavioral strategies to manage LUTS focused on "being prepared to go when you need to go" and consisted mostly of trial-and-error efforts. CONCLUSION: Misconceptions about LUTS among men with PD may result in underreporting, missed opportunities for professional assistance, and diminished health-related quality of life. Future research should focus on developing and testing nursing interventions to address cognitive, affective, and behavioral aspects of the LUTS experience in men with PD.

Lower urinary tract symptoms in men with Parkinson disease.

PURPOSE: The aim of this study was to examine the prevalence, presentation, and predictors of lower urinary tract symptoms (LUTS) in men with idiopathic Parkinson disease (PD). METHODS: Guided by the Theory of Unpleasant Symptoms, this retrospective exploratory study used data abstracted from admission clinical records of 271 male patients with idiopathic PD enrolled in a movement disorders clinic at a large metropolitan Veterans Affairs Medical Center in the eastern region of the United States. Data from the admission questionnaire, Unified Parkinson's Disease Rating Scale, and Mini Mental State Examination were abstracted by trained research assistants. Interrater reliability for the abstraction process was 0.99 in a randomly selected 10% sample of records. Descriptive statistics were used to determine the prevalence of LUTS. Logistic regression was used to determine LUTS risk factors and predictors. RESULTS: At least one LUTS was reported by 40.2% of participants. Incontinence was the most prevalent symptom, affecting almost 25% of participants, followed by nocturia (14.8%) and frequency (13.7%). Of the 10 identified risk factors for LUTS, four significant predictors were discovered: number of non-PD medications (p < .05), PD duration (p < .05), number of comorbidities (p < .05), and history of a hernia diagnosis (p < .05). CONCLUSIONS: Assessment for LUTS should be a component of every evaluation of a patient with PD. Our findings offer a preliminary profile of the male PD patient with LUTS, which is an important step toward effective screening, detection, and access to care and treatment. Next steps in research include further work to identify predictors of LUTS in both male and female PD populations, explore patient perspectives, begin trials of interventions for LUTS in the PD population, and analyze the economic impact.

Validity testing of the stopwatch urine stream interruption test in radical prostatectomy patients.

OBJECTIVE: To assess convergent validity of the stopwatch urine stream interruption test (UST). Specific aims were to describe relationships among stopwatch UST scores and 4 common clinical indices of pelvic floor muscle strength: 24-hour urine leakage, confidence in performing pelvic muscle exercise, 24-hour pad count, and daily pelvic muscle exercise count. DESIGN: Secondary analysis; instrumentation study. METHODS: The final sample consisted of baseline stopwatch UST scores and measurements of comparison variables from 47 participants in a randomized clinical trial of 3 approaches to pelvic floor training for patients with urinary incontinence following radical prostatectomy. The sample size provided 80% power to detect correlations of moderate strength or higher. The stopwatch UST was conducted in an examination room at the study site by trained study personnel (MP, ADC, JP, SM). Measurements of comparison variables were obtained from 3 instruments: 24-hour pad test, Broome pelvic muscle self-efficacy scale, and 3-day bladder diary. Relationships among study variables were evaluated with Pearson correlation coefficients. RESULTS: Stopwatch UST scores were moderately correlated with 24-hour urine leakage on the 24-hour pad test (r = 0.35, P < .05), the most robust comparison measure. Correlations between stopwatch UST scores and all other comparison measures were in the appropriate direction, although weak, and did not reach statistical significance. CONCLUSION: Findings suggest that the stopwatch UST may be a valid index of pelvic floor muscle strength in men following radical prostatectomy. With further testing, the stopwatch UST could become a valuable clinical tool for assessing pelvic floor muscle strength in radical prostatectomy patients with urinary incontinence.

Effects of advanced practice nursing on patient and spouse depressive symptoms, sexual function, and marital interaction after radical prostatectomy.

A secondary analysis of a prospective randomized clinical trial with repeated measures was conducted to examine the effects of a standardized nursing intervention on patient and spouse depressive symptoms, sexual function, and marital interaction. Another purpose of this study was to determine if, over time, differences existed in men and their spouses' levels of depressive symptoms, sexual function, and marital interaction following radical prostatectomy. Spouses reported significantly higher levels of depressive symptoms and significantly more marital interaction distress compared to patients. Patients reported significantly more distress pertaining to sexual function than their spouses.

Psychometric properties of the Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ) in patients following radical prostatectomy.

INTRODUCTION: Research instruments can be used to assess the impact of lower urinary tract symptoms on health-related quality of life. Evaluating the reliability, validity, and sensitivity of two of these instruments provides evidence concerning their readiness for use in research and clinical settings. OBJECTIVE: The researchers evaluated psychometric properties of the Male Urogenital Distress Inventory and Male Urinary Symptom Impact Questionnaire in men suffering from lower urinary tract symptoms following radical prostatectomy. METHOD: The internal consistency reliability, concurrent validity, construct validity, and sensitivity of both instruments were evaluated in a cohort of men who participated in a larger study of nursing's impact on quality of life post-prostatectomy. RESULTS: The reliability, validity, and sensitivity of both instruments were supported in this population. CONCLUSIONS: Initial support is provided for use of the instruments to measure the effect of interventions for lower urinary tract symptoms and urine leakage on health-related quality of life during the first 6 months of recovery from radical prostatectomy; however, further research with a larger and more diverse sample is needed prior to using the instruments in clinical settings.

Continuous quality improvement as an innovation: which nursing facilities adopt it?

PURPOSE: We identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI. DESIGN AND METHODS: We performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey ( Zinn, Weech, & Brannon, 1998) and The New Jersey NH Profiles Chart. We also performed a discriminant analysis. Of 350 NHs, 46% returned completed questionnaires. RESULTS: Using variance innovation, resource dependence, and institutional perspectives for our framework, we found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters. IMPLICATIONS: Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.

Pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction and postmicturition dribble: three case studies.

Three successful case studies of men receiving treatment for erectile dysfunction and postmicturition dribble are presented to alert nurses to the possible benefits of pelvic floor muscle exercises.

Consumer satisfaction in long-term care: state initiatives in nursing homes and assisted living facilities.

PURPOSE: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. DESIGN AND METHODS: Data on state initiatives and programs were collected during March and April 2000 through a mailed questionnaire and follow-up telephone interviews and were current as of September 2002. RESULTS: Of the 50 states surveyed, 50 responses were received (response rate = 100%); 12 states (24%) reported the use of consumer satisfaction measures, and 7 (Florida, Iowa, Ohio, Oregon, Texas, Vermont, and Wisconsin) reported using resident satisfaction data within their consumer information systems for nursing homes or assisted living facilities. Additionally, 2 states (Iowa and Wisconsin) use resident satisfaction data for facility licensing and recertification. The design of the instruments and collection methods vary in these states, as do the reported response rates, per-resident cost, and the purpose for satisfaction data collection. IMPLICATIONS: State satisfaction efforts are in an early stage of development. Well-produced, easily understandable reports on nursing home and assisted living quality could provide information and guidance for patients and families contemplating the utilization of long-term care services. Dissemination of quality information may also facilitate sustained quality and efficiency improvements in long-term care facilities and thus enhance the quality of care for and quality of life of long-term care residents.

Development and testing of a measure of health-related quality of life for men with urinary incontinence.

OBJECTIVES: To describe the development and psychometric testing of male versions of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). DESIGN: Instrument development. SETTING: Urology clinic at a large urban Veterans Affairs Medical Center. PARTICIPANTS: Convenience sample of English-speaking community-dwelling male urology clinic patients who acknowledged concerns about urine leakage. MEASUREMENTS: Content experts and male clinic patients evaluated items for clarity and fit. Revised instruments were administered to 153 participants. Data were analyzed to examine issues of feasibility of administration, internal consistency reliability, and validity. RESULTS: Modal completion time for the Male Urogenital Distress Inventory (MUDI) (27 items) and Male Urinary Symptom Impact Questionnaire (MUSIQ) (32 items) was 20 minutes. Cronbach's coefficients were.89 for the MUDI and.95 for the MUSIQ. Total MUDI and MUSIQ scores were moderately correlated (r =.59, P <.001). Mean MUDI and MUSIQ scores varied significantly with self-reported desire for socialization, urine leakage, and depression. Principal components analyses suggested the presence of seven factors accounting for 65.4% of the variance in the MUDI and six factors accounting for 72.9% of the variance in the MUSIQ. CONCLUSIONS: It is feasible to use the MUDI and MUSIQ to measure health-related quality of life in men with continence problems. The scores appeared to be reliable and valid in this racially and educationally diverse sample. Use of the MUDI and MUSIQ may provide more sensitive measurement of the specific effect of urinary incontinence and related symptoms on health-related quality of life in men. Future research should determine reproducibility and responsivity and reexamine the construct validity of these instruments.