Older Adults' Perceptions of Their Fall Risk and Prevention Strategies After Transitioning from Hospital to Home.

Falls are common adverse events following hospital discharge. However, prevention programs are not tailored for older patients transitioning home. To inform development of transitional fall prevention programs, nine older adults designated as being at risk of falls during hospitalization who were recently discharged home were asked about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths & Injuries Initiative. Using the constant comparative method, five themes were identified: Sedentary Behaviors and Limited Functioning; Prioritization of Social Involvement; Low Perceived Fall Risk and Attribution of Risk to External Factors; Avoidance and Caution as Fall Prevention; and Limited Falls Prevention Information During Transition from Hospital to Home. Limited awareness of and engagement in effective fall prevention may heighten recently discharged older adults' risks for falls. Prevention programs tailored to the post-discharge period may engage patients in fall prevention, promote well-being and independence, and link hospital and community efforts. [Journal of Gerontological Nursing, 45(1), 23-30.].

Nursing opinion leadership: a preliminary model derived from philosophic theories of rational belief.

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent-based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. The purpose of this paper is to describe the work conducted in preparation for the development of an agent-based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation.

A philosophical analysis of agent-based modelling: a new tool for theory development in nursing.

AIM: In this paper we present a discussion of the nature of agent-based modelling from nursing's philosophical perspectives and truth criteria as a means of evaluating this methodological tool's disciplinary fit. BACKGROUND: Agent-based modelling is a new methodological tool used to study complex systems. Researchers from a multitude of disciplines are using agent-based models to enhance understanding of problems that transcend disciplinary and geographical boundaries. Because of the growing interest in complexity science in the discipline of nursing, this new tool may prove useful for nurses engaged in research and theory development. DATA SOURCES: Electronic indexes and iterative bibliographic searches were used to identify papers, books and abstracts addressing agent-based modelling. In order to trace the emergence of the topic in the literature, date limiting parameters were not used. Selected studies from the international literature were limited to English language reports in the social sciences. The work was completed in 2008. DISCUSSION: Recurrent themes concerning the use of agent-base modelling include heterogeneity, dynamics, adaption, emergence and 'bridging'. The themes were congruent with philosophical views and metanarratives in nursing. IMPLICATIONS FOR NURSING: Agent-based models offer practical advantages in the pursuit of new knowledge, including the ability to pilot research studies using simulation or to visualize potential practice changes prior to implementation. CONCLUSION: The use of agent-based modelling as tool for nursing theory development, should be expanded. As nurses and other researchers become more familiar with the use of these models, methodological critique will contribute to the development of increasingly valid models.

Using bibliometrics to support your selection of a nursing terminology set.

Nurses are being pressured to integrate standardized nursing terminology into the electronic health record to enable the representation and evaluation of nursing practice. Five terminology sets are recognized by the American Nurses Association that contain terms to represent nursing diagnoses, outcomes, and intervention: CCC, ICNP, NANDA/NOC/NIC, Omaha System, and PNDS. Key criteria for choosing the most suitable include demonstrated use and testing under real-time clinical conditions, scope of terms, cost, and the administrative infrastructure to sustain and evolve the terminology. Likelihood of survival is also critical and was evaluated here by examining the diffusion pattern of each terminology set through bibliometric analysis. Each of the five sets had a unique diffusion pattern, with NANDA/NOC/NIC demonstrating the most extensive penetration and author network in the CINAHL literature examined from 1982 to 2006.

Galleria mellonella as a model host to study infection by the Francisella tularensis live vaccine strain.

We used the killing of Galleria mellonella (Lepidoptera: Pyralidae; the greater wax moth) caterpillar by the live vaccine strain (LVS) of Francisella tularensis to develop an invertebrate host system that can be used to study F. tularensis infection and the in vivo effects of antibacterial compounds on F. tularensis LVS. After injection into the insect hemocoel, F. tularensis LVS, killed caterpillars despite the association of LVS with hemocytes. The rate of killing depended on the number of bacteria injected. Antibiotic therapy with ciprofloxacin, levofloxacin or streptomycin administered before or after inoculation prolonged survival and decreased the tissue burden of F. tularensis in the hemocoel. Delayed drug treatment reduced the efficacy of antibacterials and especially streptomycin. The G. mellonella-F. tularensis LVS system may facilitate the in vivo study of F. tularensis, efficacy with antibacterial agents.

Conduits to care: call lights and patients' perceptions of communication.

BACKGROUND: Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients' perceptions concerning call light use and communication. The specific aim of this study was to solicit patients' perceptions regarding their call light use and communication with nursing staff. METHODS: Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. RESULTS: Using qualitative descriptive methods, five major themes emerged from patients' perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants' perceptions of "nurse work"). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. DISCUSSION: Findings from this study extend the knowledge of patients' understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery.

Development and verification of an agent-based model of opinion leadership.

BACKGROUND: The use of opinion leaders is a strategy used to speed the process of translating research into practice. Much is still unknown about opinion leader attributes and activities and the context in which they are most effective. Agent-based modeling is a methodological tool that enables demonstration of the interactive and dynamic effects of individuals and their behaviors on other individuals in the environment. The purpose of this study was to develop and test an agent-based model of opinion leadership. The details of the design and verification of the model are presented. METHODS: The agent-based model was developed by using a software development platform to translate an underlying conceptual model of opinion leadership into a computer model. Individual agent attributes (for example, motives and credibility) and behaviors (seeking or providing an opinion) were specified as variables in the model in the context of a fictitious patient care unit. The verification process was designed to test whether or not the agent-based model was capable of reproducing the conditions of the preliminary conceptual model. The verification methods included iterative programmatic testing ('debugging') and exploratory analysis of simulated data obtained from execution of the model. The simulation tests included a parameter sweep, in which the model input variables were adjusted systematically followed by an individual time series experiment. RESULTS: Statistical analysis of model output for the 288 possible simulation scenarios in the parameter sweep revealed that the agent-based model was performing, consistent with the posited relationships in the underlying model. Nurse opinion leaders act on the strength of their beliefs and as a result, become an opinion resource for their uncertain colleagues, depending on their perceived credibility. Over time, some nurses consistently act as this type of resource and have the potential to emerge as opinion leaders in a context where uncertainty exists. CONCLUSIONS: The development and testing of agent-based models is an iterative process. The opinion leader model presented here provides a basic structure for continued model development, ongoing verification, and the establishment of validation procedures, including empirical data collection.

Sensitivity of Francisella tularensis to ultrapure water and deoxycholate: implications for bacterial intracellular growth assay in macrophages.

The ability of Francisella tularensis to replicate in macrophages is critical for its pathogenesis, therefore intracellular growth assays are important tools for assessing virulence. We show that two lysis solutions commonly used in these assays, deionized water and deoxycholate in PBS, lead to highly inaccurate measurements of intracellular bacterial survival.

Detoxified endotoxin vaccine (J5dLPS/OMP) protects mice against lethal respiratory challenge with Francisella tularensis SchuS4.

Francisella tularensis is a category A select agent. J5dLPS/OMP is a novel vaccine construct consisting of detoxified, O-polysaccharide side chain-deficient, lipopolysaccharide non-covalently complexed with the outer membrane protein of N. meningitidis group B. Immunization elicits high-titer polyclonal antibodies specific for the highly-conserved epitopes expressed within the glycolipid core that constitutes gram-negative bacteria (e.g., F. tularensis). Mice immunized intranasally with J5dLPS/OMP exhibited protective immunity to intratracheal challenge with the live vaccine strain, as well as the highly-virulent SchuS4 strain, of F. tularensis. The efficacy of J5dLPS/OMP vaccine suggests its potential utility in immunizing the general population against several different gram-negative select agents concurrently.

Decontamination of Bacillus anthracis Spores: Evaluation of Various Disinfectants.

The present study compares the efficacy of various disinfectants against Bacillus anthracis spores. While Bleach Rite(®) and 10% bleach reduce spore numbers by 90% within 10 minutes, a long contact time is required for complete disinfection. By contrast, although SporGon(®) did not initially reduce the number of spores as quickly as Bleach Rite or 10% bleach, shorter contact times were required for complete eradication of viable spores.

Capacity for the advancement of nursing science: issues and challenges.

The purpose of this study was to determine whether nursing is meeting its espoused goals of scientific development of the discipline and preparation for academic careers. With a comparative cross-sectional design, data on research funding, faculty number and characteristics, and the published literature across nursing, public health, and medicine were analyzed. Significant differences were found among the groups in terms of the number of National Institutes of Health research grants and the amount of funding awarded, as well as the number of faculty. The number of faculty significantly predicted the number of National Institutes of Health awards for all disciplines (R(2) = .666, P < .000). Within nursing, the number of full-time doctoral faculty was also significant (R(2) = .531, P < .000). The conclusion reached was that the current system for doctoral education in nursing does not prepare the number of graduates necessary to either replace retiring faculty or expand capacity. The lack of nurses with doctoral degrees affects the discipline's ability to generate and use high-impact science. Among the strategies for improvement were leveraging existing research-intensive schools by augmenting doctoral faculty and expanding the capability of nurses to engage in clinical scholarship through the new clinical doctorate, the doctor of nursing practice.