Safe-patient-handling equipment in therapy practice: implications for rehabilitation.

OBJECTIVE: To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice. METHOD: We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study. RESULTS: Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety. CONCLUSION: SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary.

Wii-hab for pre-frail older adults.

PURPOSE: To examine the effectiveness of a novel intervention aimed at decreasing indices related to frailty through systematic, Progressive Functional Rehabilitation (PFR). METHODS: Pre-frail volunteers were recruited to participate in a 15 week exercise intervention or control group. Those who met study criteria and consented were randomized into one of three groups: control, seated exercise, or Wii(®) -fit. Test measures were completed before and after the 15 week intervention period on all participants. Measures included: Senior Fitness Test, Body Weight, Balance Efficacy Scale, CHAMPS, Late-Life Function and Disability Index, MOS SF-36. Attendance was also recorded. RESULTS: There were improvements on several of the measures included in the Senior Fitness Test including chair stands, arm curls, step 2, six minute walk, sit and reach, and the timed up and go. A few participants did lose weight. All of the differences reflected improved physical functional status in the seated exercise or Wii-fit groups compared with the control group. DISCUSSION: Increased physical activity was beneficial for all who participated. There were improvements in physical performance scores on several of the measures on the senior fitness test in both the seated exercise and Wii-fit groups. Participants in the Wii-fit group also showed improvement in their reported caloric expenditure and balance confidence. CONCLUSION: This pilot study suggests a rehabilitation effect that was similar to the effect of community based senior fitness classes. A home video game console system with weight vest could be an effective alternative for pre-frail senior adults to group exercise classes.

Is harmonica playing an effective adjunct therapy to pulmonary rehabilitation?

PURPOSE: This randomized controlled trial examined the effect harmonica playing has on various clinical, psychosocial, and functional outcomes among chronic obstructive pulmonary disease (COPD) patients in pulmonary rehabilitation (PR). METHOD: Twenty-eight participants (Age 69.9 ± 1.8; FEV1 Predicted 41.9 ± 2.0%) were recruited from an outpatient PR program. Participants were randomly assigned to one of two groups, traditional PR (C; n = 16) or traditional PR plus harmonica playing (HT; n = 9). The HT group was provided a harmonica and one-on-one instruction by PR staff. Patients were given practice exercises to perform for at least 5 minutes, but not exceeding 20 minutes twice/day, 5 days/week. RESULTS: No significant differences were found between groups. The combined sample improved significantly in their perception of shortness of breath, quality of life, and distance walked in 6 minutes. CONCLUSION: Harmonica playing does not significantly affect the clinical, psychosocial, or functional status of COPD patients enrolled in PR.

Tradução e adaptação transcultural do instrumento Edmonton Symptom Assessment System para uso em cuidados paliativos / Translation and cultural adaptation of the instrument Edmonton Symptom Assessment System for use in palliative care

O objetivo deste estudo foi realizar a tradução e adaptação transcultural, para o português do Brasil, do instrumento Edmonton Symptom Assessment System (ESAS-r) para uso em Cuidados Paliativos. A ESAS-r é uma versão revisada do instrumento ESAS e foi desenvolvida no Canadá por pesquisadoras que estudam a temática dos Cuidados Paliativos. A ESAS-r consiste de uma escala visual numérica, com gradação de zero a 10, para avaliar nove sintomas (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, shortness of breath, wellbeing) e um sintoma adicional considerado relevante para o paciente. Utilizou-se o referencial metodológico de Beaton et al (2000) para realização do estudo, composto de seis etapas: tradução, realizada por dois tradutores independentes; síntese das duas traduções; retrotradução, por outros dois tradutores; revisão por comitê de especialistas, com a intenção de avaliar as equivalências semântica, idiomática, experimental e conceitual; pré-teste, composto por 30 participantes, sendo eles 10 pacientes, 10 familiares e 10 enfermeiras; e submissão da versão traduzida aos autores do instrumento original. Como resultado foram realizadas algumas alterações no título, enunciado e em determinados termos do instrumento para adequação da gramática e vocabulário brasileiros. De forma geral, a maioria dos participantes entendeu o significado das palavras referidas na versão traduzida da ESAS-r. Houve somente uma dúvida com relação ao termo náusea. Foi sugerida a inserção de uma explicação sobre o significado da palavra náusea, assim como recomendada a padronização do termo Sem na coluna à esquerda do instrumento e a substituição da palavra depressão por tristeza. Esta Escala poderá ser utilizada tanto por pacientes, quanto por familiares e profissionais da saúde. Entretanto, para que isso ocorra, é necessária a validação do instrumento com a verificação das propriedades psicométricas.

Opportunities for people with disabilities in the virtual world of Second Life.

The virtual world of Second Life (SL) offers people with disabilities a chance to explore new worlds without being limited by their disabilities. Many people with disabilities use SL for information, support, and entertainment. SL is a computer-based simulated environment in which participants are represented by a human-like avatar. The avatar can move through the environment, manipulate objects, and participate in day-to-day activities that most people take for granted, such as walking, dancing, and communicating. In this article, the authors focus on the benefits that information, socialization, and community membership can offer people with disabilities and some of the resources that are available for them in SL. SL communities, groups, and activities also help increase self-worth and empower people with disabilities. Participating in a virtual world enriches the overall quality of life of people with disabilities and may enhance their physical, emotional, and social adjustment.

Using technology to promote safe patient handling and rehabilitation.

Technology has improved and expanded the equipment options for use in patient handling. There is substantial evidence that these activities expose healthcare professionals, including nurses and physical therapists, to risk for work-related musculoskeletal disorders. There is also evidence that ergonomic use of equipment to assist with patient handling is associated with decreases in injuries among healthcare providers. The use of patient-handling equipment has additional potential for facilitating the goals of rehabilitation and improving patient outcomes. This article presents an overview of new research areas and a discussion of these topics.

Proper sling selection and application while using patient lifts.

In response to staff shortages, an aging clinical workforce, and research on safe patient handling, manufacturers have provided an extensive array of patient-lifting technology, including ceiling, floor-based, and sit-to-stand lifts as well as slings that are required for their use. Expanded choice, however, may pose challenges to both healthcare facilities and individual clinicians. These challenges, if not successfully resolved, can preclude the consistent, safe, and efficient use of patient-handling devices. This article provides nurses and other direct patient care providers with a heightened awareness of the challenges to appropriate sling and lift use in rehabilitation and other clinical settings. A new way to categorize slings is introduced, and guidelines for safely evaluating and using slings for different patient-handling tasks are offered.

The impact of the implementation of a rehabilitation tool on the contents of the communication during multidisciplinary team conferences in rheumatology.

OBJECTIVE: Problems with multidisciplinary team conferences in health care include the exchange of too much (discipline-specific) information. The aim of this study was to investigate the effect of the implementation of a rehabilitation tool on the contents of communication during multidisciplinary team conferences in a rheumatology setting. METHODS: All initial and follow-up team conferences of 25 consecutive patients with rheumatoid arthritis admitted to a day patient care ward were videotaped during a period before (period I) and after (period II) the introduction of a rehabilitation tool. The aims of the rehabilitation tool were to enhance discussions on the co-ordination of care rather than merely exchange of information. This was achieved by providing a framework for the setting and evaluation of common treatment goals and management strategies as well as accompanying electronic and printed records. For every team conference, the duration of time spent on three types of communication was recorded: (1) grounding regarding the patient's health status, (2) the making of practical arrangements by no more than two health professionals, and (3) the co-ordination of common treatment goals or management strategies. Comparisons of the proportions of time spent on the different types of communication between the two periods were done by means of the Mann-Whitney U-test. RESULTS: Apart from the 25 initial team conferences in both periods, 86 and 71 follow-up team conferences were available in periods I and II, respectively. Regarding the initial team conferences, the proportion of time spent on grounding and practical arrangements was significantly smaller in period II than in period I. In addition, the proportion of time spent on common goals or management strategies was significantly greater in period II than in period I. For the follow-up team conferences, the proportion of time spent on practical arrangements was significantly smaller in period II, than in period I. Moreover, the proportions of time spent on the other types of communication did not differ significantly between the two periods. CONCLUSION: The implementation of a rehabilitation tool including a computer application increased the proportion of time spent on the discussion of common treatment goals or management strategies during initial but not during follow-up team conferences in a day patient rheumatology clinic.

Using the Cancer Rehabilitation Questionnaire in patients with colorectal cancer.

This article describes the development and testing of the Cancer Rehabilitation Questionnaire (CRQ) in patients with colorectal cancer. A descriptive, correlational survey was conducted in a sample of patients with colon or rectal cancer who received care at an outpatient cancer clinic at a large, northeastern U.S. academic medical center. Patients were identified from the Tumor Registry (N = 327) and received a mailed questionnaire. One hundred and three patients with colorectal cancer completed the demographic questionnaire, the CRQ developed by the investigators, and the Quality of Life Index (QLI). Significant differences were found between individuals with colon cancer and individuals with rectal cancer on the total CRQ (p < .005) and the physical, future orientation, and role-relationship subscales. For the QLI, significantly lower scores were reported on the family subscale for patients with rectal cancer in comparison with those with colon cancer. More attention to rehabilitation issues and quality of life is required across the trajectory of the cancer experience. With the increasing incidence of colorectal cancer, nurses in rehabilitation practice must address the issues affecting patients with this disease as they progress from diagnosis to treatment and rehabilitation.

Evaluating functional activity in older Thai adults.

The purpose of this study was to translate the original English version of the Self-Efficacy and Outcome Expectations Scales for Exercise and Functional Activity and to establish their reliability in older Thai adults in geriatric rehabilitation. This study used a correlational design with repeated measures. Reliability of the Self-Efficacy for Exercise Scale (SEES), the Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES), and the Outcome Expectations for Functional Activity Scale (OEFAS) developed by Resnick was measured in 20 older adults aged 60 years or older after hip or knee replacement or another orthopedic surgery of their lower extremity. All scales were translated into Thai and back translated into English according to the process described by Marin and Marin. The instruments were administered twice--the 1st and 2nd day in the participants' geriatric rehabilitation program (i.e., the 4th and 5th postoperative day). Results indicated that there was sufficient evidence for internal consistency of the SEES, SEFAS, OEES, and OEFAS with alpha coefficients of 0.84, 0.86, 0.70, and 0.86 respectively. Test-retest reliability of the tools was also demonstrated with Spearman correlation coefficients of 0.84 for the SEES, 0.87 for the SEFAS, 0.61 for the OEES, and 0.54 for the OEFAS. The findings from this study provide important information for instrument adaptation and the applicability of these scales for further studies of older Thai adults.

Monitoring pressure ulcer healing in persons with disabilities.

Pressure ulcers are a high-risk, high-volume, and high-cost problem for persons with disabilities. This article describes four tools published in the literature and reports the validity, reliability, strengths, and limitations of each. These tools include the Pressure Ulcer Scale for Healing (PUSH), the Pressure Sore Status Tool (PSST), the Sussman Wound Healing Tool (SWHT), and the Sessing Scale. Rehabilitation nurses should use a consistent framework with accurate quantification to assess, document, and monitor changes in pressure ulcers over time. Such a measurement tool must prove valid for the disabled population in which the tool is used. This will enable healthcare providers to communicate more effectively and evaluate the therapeutic plan of care.

Wound care for burn patients in acute rehabilitation settings.

Caring for patients who are recovering from severe burns is not common in most inpatient rehabilitation settings. Nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center (HMC), a regional Level 1 burn and trauma center in Seattle, WA, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes HMC's nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve burn patients. Says one burn survivor: "Nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aids the patient in his journey from fire victim to burn survivor."

The ethics of using cybernetics and cyborg technologies: what every rehabilitation nurse should know.

Cybernetics and cyborg technologies are rapidly developing in the field of biotechnology. Such developments have yielded a wide variety of devices and prosthetics that have promoted the quality of life for many individuals with physical limitations and generally have been applauded by society and the rehabilitation field. However, such rapid developments have given rise to multiple ethical concerns. Understanding these ethical concerns and the implications they have for rehabilitation nurses is imperative. While the potential benefits of advances in technology are great for those with disabilities and chronic conditions, ethicists suggest that skepticism must be balanced with the zeal that often accompanies cutting-edge developments. As Hook notes, "We must show not a fear of technology, but a courageous control of technology, and refuse to let technology control us" (2002, p. 67).

Psychometric evaluation of selected pain intensity scales for use with cognitively impaired and cognitively intact older adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales such as the Faces Pain Scale (FPS), the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) to assess pain in cognitively impaired older adults. A descriptive correlational design was used, and a convenience sample of 66 volunteers age 60 and older residing in assisted living facilities in the South was recruited for this study. The sample included 22 (33%) men and 44 (67%) women, with a mean age of 76. Ninety-eight percent (65) of the sample comprised Caucasian participants, with the exception of 1 African-American man. Seventy percent (47) completed high school and/or college. The mean Mini Mental State Exam (MMSE) score was 16, with a range of 1 to 29. Eighty-five percent scored 24 or lower, indicating some degree of cognitive impairment. The remaining 15% were cognitively intact. All but one participant could use each scale to rate their pain. Concurrent validity of the VDS, NRS, and IPT was supported with Spearman rank correlation coefficients ranging from .78 to .86 in the cognitively impaired group. The FPS, however, demonstrated weak correlations with other scales when used with the impaired group, ranging from .48 to .53. In the cognitively intact group, strong correlations ranging from .96 to .97 were found among all of the scales. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from .67 to .85) and unacceptable for most scales in the cognitively impaired group (correlations ranged from .26 to .67). When asked about scale preference, both the cognitively impaired and the intact groups preferred the IPT and the VDS. This study revealed that cognitive impairment did not inhibit participants' ability to use a variety of pain intensity scales, but the stability issue must be considered.

Modification of bed systems and use of accessories to reduce the risk of hospital-bed entrapment.

Despite the long history of hospital-bed use, only in the past decade have bed-related patient-safety hazards, including falls and life-threatening entrapment, been discussed publicly. Entrapment is an event in which a patient is caught, trapped, or entangled in hospital-bed components, including the bed rail, mattress, or hospital-bed frame. Since 1995, the Food and Drug Administration and the Joint Commission on Accreditation of Healthcare Organizations have issued patient-safety alerts about entrapment. While new beds are being manufactured without large gaps that would allow an individual's head, neck, or chest to become entrapped, it is incumbent upon healthcare providers, including rehabilitation nurses, to ensure the safety of older beds in use. This article describes a facility-based approach for identifying and managing risk related to hospital bed-entrapment to be used in rehabilitation settings.

Effects of wheelchair posture on patient safety.

Wheelchairs originally were designed to transport people from one place to another quickly and easily. They have evolved to rank among the most important therapeutic devices used in rehabilitation. Currently, an estimated 2.2 million people who use wheelchairs generally are living longer and moving about more. However, the increased use of wheelchairs has been accompanied by many types of adverse events and repetitive stress injuries. Wheelchair prescription, posture, training, and maintenance are critical components of safety in this population, and may be enhanced through increased awareness and education. Since nurses and nursing staff are most often involved directly with wheelchair users (particularly in long-term-care settings), providing specialized programs for adaptive wheelchair fitting allows for a proactive approach to seating problems.

Fear of falling in older adults: a guide to its prevalence, risk factors, and consequences.

Fear of falling, defined as a lack of self-confidence that one may avoid falls while doing everyday activities, may have serious consequences for elderly people. This article examines the prevalence, risk factors, and consequences of fear of falling in the elderly population; methods for assessing those fears; and suggests evidence-based interventions. Incorporating successful strategies into programs to reduce falling can result in improved patient outcomes as well as decreased healthcare utilization and costs.

Reducing employee slips, trips, and falls during employee-assisted patient activities.

Following a remodeling of patient care rooms at Mary Free Bed Rehabilitation Hospital, the nursing staff reported frequent slipping in patient care areas. Data were analyzed and revealed that most slips were occurring during transfer of patients from shower chairs. An extensive literature review was done, and solutions to slipping were sought from areas outside of the healthcare industry. Specifically, ideas were borrowed from the commercial fishing industry and the restaurant industry. Both industries rely heavily on footwear to reduce slipping in the workplace. A trial was initiated with nursing staff members wearing positive-grip shoe covers that can be worn over regular footwear. No slips occurred during the trial. The purpose of this article is to motivate nurses who are involved in transferring patients from shower chairs (often used in rehabilitation settings) to consider the role their footwear has in reducing slips and potential injury.