Evaluation of an Organizational Intervention to Improve Osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a serious public health problem that affects millions in the United States (Hootman & Helmick, 2006). National health objectives indicate an urgent need to increase the number of people educated about the causes, prevention, and treatment of OA (Sleath, Cahoon, Sloane, & Callahan, 2008). The most effective OA reduction strategies include health education, health promotion, and self-management education (Schulz, et al., 2015). Studies examining the design and implementation of education are limited. Researchers have established the a link between improving knowledge and improved health outcomes; reduced pain, increased mobility, improved joint health, and delayed surgery (Szychlinska, Leonardi, Al-Qahtani, M., Mobasheri, & Musumeci, 2016). Beneficial interventions may decrease the disability associated with OA and the need for more invasive treatments (Sharma, 2016). In our previous article titled Components of an Effective Osteoarthritis Self-Management Program, provided components needed for program implementation and how to measure the program's success by using the nursing Health Belief Model. OBJECTIVE: The purpose of this program evaluation is to improve program information and increase patient knowledge. METHOD: This evaluation used two mixed methods: (a) standardized survey (Figure 1), (b) instructor interview (Figure 2). Both evaluations were conducted by the authors with defined methods and conditions discussed under sections Participant Survey Method and Instructor Interview Method. RESULTS: The program evaluation goal was met with positive reviews from all 67 participants who attended the program. Instructor interviews uncovered reasons for volunteering and gathered data used for future recommendations. CONCLUSION: This program evaluation will provide tools for program implementation and evaluation by health organizations with the long-term aim of reducing the burden of OA and healthcare costs.

Fetal alcohol spectrum disorders: Prevention, identification, and intervention.

Fetal alcohol spectrum disorders (FASD) remain a common cause of intellectual disability in infants and children, with an estimated incidence of 9.1 out of every 1,000 U.S. live births. This article discusses methods for identifying and assisting women who consume alcohol prenatally and referring infants and children with FASD for intervention.

Human touch effectively and safely reduces pain in the newborn intensive care unit.

This was a feasibility pilot study to evaluate the efficacy of the nonpharmacologic pain management technique of gentle human touch (GHT) in reducing pain response to heel stick in premature infants in the neonatal intensive care unit (NICU). Eleven premature infants ranging from 27 to 34 weeks' gestational age, in a level III NICU in a teaching hospital, were recruited and randomized to order of treatment in this repeated-measures crossover-design experiment. Containment with GHT during heel stick was compared with traditional nursery care (side lying and "nested" in an incubator). Heart rate, respiratory rate, oxygen saturation, and cry were measured continuously beginning at baseline and continuing through heel warming, heel stick, and recovery following the heel stick. Infants who did not receive GHT had decreased respiration, increased heart rate, and increased cry time during the heel stick. In contrast, infants who received GHT did not have decreased respirations, elevated heart rates, or increased cry time during the heel stick. No significant differences were noted in oxygen saturation in either group. GHT is a simple nonpharmacologic therapy that can be used by nurses and families to reduce pain of heel stick in premature infants in the NICU.

Salivary cortisol as indicators of pain in preterm infants: a pilot study.

Assessment and management of pain in preterm infants is critical and complicated. The addition of salivary cortisol measurement may improve the specificity of assessment and guide care to alleviate pain. The purpose of this study was fourfold: (a) assess the feasibility of a method of saliva collection in premature infants, (b) assess reliability of a method of measuring salivary cortisol in response to heelstick, (c) identify relationships between salivary cortisol and a measure of pain behavior (using CRIES) following heelstick, and (d) identify peak response times for elevations of salivary cortisol following heelstick in preterm infants. This was a prospective, descriptive pilot study. Serial saliva samples were collected from eight healthy infants 30 to 36 weeks' gestational age in a Newborn Intensive Care Unit. Cortisol levels were determined using enzyme-immune assay. Samples were collected without use of stimulants. Sample means supported peak and trough patterns previously described in the literature. Behavioral measures of pain did not correlate well with peak cortisol levels.