Candidate name order effects in New Hampshire: Evidence from primaries and from general elections with party column ballots.

Research in a few U.S. states has shown that candidates listed first on ballots gain extra votes as a result. This study explored name order effects for the first time in New Hampshire, where such effects might be weak or entirely absent because of high political engagement and the use of party column ballots. In general elections (in 2012 and 2016) for federal offices and the governorship and in primaries (in 2000, 2002, and 2004), evidence of primacy effects appeared in 86% of the 84 tests, including the 2016 presidential race, when Donald Trump gained 1.7 percentage points from first listing, and Hillary Clinton gained 1.5 percentage points. Consistent with theoretical predictions, primacy effects were larger in primaries and for major-party candidates in general elections than for non-major-party candidates in general elections, more pronounced in less publicized contests, and stronger in contests without an incumbent running. All of this constitutes evidence of the reliability and generalizability of evidence on candidate name order effects and their moderators.

CE: Acute Care for Patients with Dementia.

Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.

Framing the Opioid Crisis: Do Racial Frames Shape Beliefs of Whites Losing Ground?

CONTEXT: Although research has begun to examine perceptions of being on the losing side of politics, it has been confined to electoral politics. The context of health disparities, and particularly the opioid crisis, offers a case to explore whether frames that emphasize racial disadvantage activate loser perceptions and the political consequences of such beliefs. METHODS: White survey participants (N = 1,549) were randomized into three groups: a control which saw no news article, or one of two treatment groups which saw a news article about the opioid crisis framed to emphasize either the absolute rates of opioid mortality among whites or the comparative rates of opioid mortality among whites compared to blacks. FINDINGS: Among control group participants, perceiving oneself a political loser was unrelated to attitudes about addressing opioids, whereas those who perceived whites to be on the losing side of public health had a less empathetic response to the opioid crisis. The comparative frame led to greater beliefs that whites are on the losing side of public health, whereas the absolute frame led to more empathetic policy opinions. CONCLUSIONS: Perceptions that one's racial group has lost ground in the public health context could have political consequences that future research should explore.

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention.

PURPOSE: Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction. METHODS: Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016. Patient interviews determined reasons for not attending appointments, involvement in goal setting, engagement in pain management planning, and satisfaction with postoperative pain management. RESULTS: Retrospective chart reviews and interviews were conducted after the intervention (May-July 2017). Scheduling changes increased attendance at preoperative pain consultations by 14 percentage points (50% vs 64%). Those who attended consultations were more involved in goal setting and decisions and were more satisfied. CONCLUSIONS: Preoperative pain consultations with opioid-tolerant patients can increase satisfaction through realistic goal setting and involvement in the pain management plan.

An innovative course to prepare advanced practice registered nurses to spearhead quality and safety initiatives for older adults.

ABSTRACT: Current trends dictate that advanced practice registered nurses (APRNs) must be competent to address quality/safety issues specific to older adults. A gap analysis and review of key competencies in an adult-gerontology APRN-Doctorate of Nursing Practice (DNP) curriculum prompted the design and evaluation of an innovative online course, Quality and Safety for the Aging Adult. Course objectives align with key competencies, including graduate-level Quality and Safety Education for Nurses (QSEN) and the DNP Essentials. The course purpose was to prepare adult-gerontology APRN-DNP students as leaders to promote quality/safety outcomes for aging adults. The six-step Knowledge-to-Action Framework guided course development and evaluation. Select graduate-level QSEN competencies were used to construct a 20-item Quality and Safety Survey (4-point Likert scale) (Cronbach's alpha, 0.916). This survey was used during week 1 (pre) and week 15 (post) of the semester to evaluate students' preparation and confidence to perform key QSEN competencies. Significant improvements (p < .000) between pre/post scores on the Quality and Safety Survey were found across five classes. Students felt more prepared and confident to apply selected QSEN competencies on course completion. Moreover, nearly 60% (primary care) and nearly 35% (acute care) adult-gerontology APRN students selected the older adult population for their DNP projects. The Quality and Safety for the Aging Adult course positively influenced five classes of adult-gerontology APRN-DNP students. Integrating QSEN competencies with gerontology and quality/safety content is an effective strategy to prepare APRNs to lead quality/safety initiatives in aging adults. This innovative online course offers a successful model for innovative DNP education of adult-gerontology APRNs.

Promoting Older Adult Physical Activity Throughout Care Transitions Using an Interprofessional Approach.

The nurse practitioner plays a key role in monitoring and improving physical activity and function of older adults. Physical activity is an essential component of care management for all older adults, even those who are frail with multimorbidities. All physical activity, no matter how small, has the potential to impact functional independence and quality of life. Partnering with the older adult and caregivers along with interprofessional providers, such as a physical therapist or occupational therapist and community-based resources, facilitates the development of successful goals and plans and the implementation of activities to promote physical activity across the continuum of care.

Integrating gerontological content across advanced practice registered nurse programs.

PURPOSE: Faculty members across the country are faced with integrating gerontological content and competencies across advanced practice registered nurse (APRN) programs that focus on the adult-gerontology population. The purpose of this initiative was to effectively and efficiently integrate gerontological content into the adult management courses for several APRN programs in acute and primary care at one university's college of nursing. DATA SOURCES: Current literature, resources for integrating adult-gerontology content, course evaluations, and end of program surveys were used in this project. CONCLUSION: This curricular update effectively utilized resources and engaged faculty across programs to infuse gerontological content into the adult management courses. Students from multiple programs sharing these courses benefited from gerontological lecturers, content, and learning activities. The content gaps were integrated into existing courses rather than developing a new course. Current outcome data reflect this was an effective curricular change. IMPLICATIONS FOR PRACTICE: In conjunction with meeting national requirements for integrating adult-gerontology content into APRN curriculum, APRNs prepared with enhanced gerontological knowledge and skills build a workforce that is competent to improve care for older adults across the continuum of care.

Reluctant gerontologists: integrating gerontological nursing content into a prelicensure program.

Integration of readily available resources on care of older adults increased student and faculty interest and knowledge of gerontological nursing. The authors describe their use of these practical and easy-to-implement resources.

Optimizing evaluation of nursing education programs.

Program evaluation data must be meaningful, credible, objective, and responsive. The content, inputs, process, and product model provides an effective and useful framework for organizing the evaluation process. The model is a decision/accountability-oriented approach that emphasizes both proactive and retroactive evaluation to assess program improvement and quality. The authors describe the steps used in developing an evaluation plan to address undergraduate, graduate, and specialty standards and to serve as a framework for data collection, decision-making, continuous quality improvement, and demonstration of outcomes.

The effect of adult day care services on time to nursing home placement in older adults with Alzheimer's disease.

PURPOSE: This longitudinal study examined whether the use of adult day care services delayed time to nursing home placement in persons with Alzheimer's disease. DESIGN AND METHODS: Two hundred and eighteen adult day care clients with Alzheimer's disease were recruited from 16 adult day programs in a large metropolitan area. Two hundred and ninety eight persons with Alzheimer's disease but not using adult day care were recruited from a federally funded Alzheimer's diagnostic center and frequency matched to adult day care users on age, gender, race, and level of cognitive impairment. Participants were followed at 3-month intervals for up to 48 months. Cox proportional hazards models were used to examine the effects of adult day care and other fixed and time-varying factors on risk of nursing home placement. RESULTS: Risk of nursing home placement increased significantly with the number of days of adult day care attendance, with this effect being substantially greater for men (hazard ratio or HR = 1.33; confidence interval or CI = 1.18-1.49) than for women (HR = 1.09; CI = 1.00-1.18). Participant disability and hospitalizations and caregiver age and burden were independent predictors, but their inclusion in the model did not alter the risk associated with adult day care. IMPLICATIONS: More severe disease and greater caregiver burden did not explain the increased risk of nursing home placement among adult day care users with Alzheimer's disease. Rather, it appears that other unmeasured factors, such as a proclivity to institutionalize, may account for the association of adult day care to nursing home risk.