Evaluation of Sensor Technology to Detect Fall Risk and Prevent Falls in Acute Care.

BACKGROUND: Sensor technology that dynamically identifies hospitalized patients' fall risk and detects and alerts nurses of high-risk patients' early exits out of bed has potential for reducing fall rates and preventing patient harm. During Phase 1 (August 2014-January 2015) of a previously reported performance improvement project, an innovative depth sensor was evaluated on two inpatient medical units to study fall characteristics. In Phase 2 (April 2015-January 2016), a combined depth and bed sensor system designed to assign patient fall probability, detect patient bed exits, and subsequently prevent falls was evaluated. METHODS: Fall detection depth sensors remained in place on two medicine units; bed sensors used to detect patient bed exits were added on only one of the medicine units. Fall rates and fall with injury rates were evaluated on both units. RESULTS: During Phase 2, the designated evaluation unit had 14 falls, for a fall rate of 2.22 per 1,000 patient-days-a 54.1% reduction compared with the Phase 1 fall rate. The difference in rates from Phase 1 to Phase 2 was statistically significant (z = 2.20; p = 0.0297). The comparison medicine unit had 30 falls-a fall rate of 4.69 per 1,000 patient-days, representing a 57.9% increase as compared with Phase 1. CONCLUSION: A fall detection sensor system affords a level of surveillance that standard fall alert systems do not have. Fall prevention remains a complex issue, but sensor technology is a viable fall prevention option.

Validity of the Johns Hopkins Fall Risk Assessment Tool for Predicting Falls on Inpatient Medicine Services.

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is widely used but few studies have examined its psychometric properties. We examined the predictive validity of the JHFRAT for 13 574 patient admissions to medicine units at a large academic medical center in 2014. There were 204 patient falls reported. While patients who fell had higher JHFRAT total scores, a majority of patients who fell were classified by the JHFRAT as moderate or low risk.

Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients.

PURPOSE: Identification of modifiable risk factors for falling is paramount in reducing the incidence and morbidity of falling. Peroneal neuropathy with an overt foot drop is a known risk factor for falling, but research into subclinical peroneal neuropathy (SCPN) resulting from compression at the fibular head is lacking. The purpose of our study was to determine the prevalence of SCPN in hospitalized patients and establish whether it is associated with a recent history of falling. METHODS: We conducted a cross-sectional study of 100 medical inpatients at a large academic tertiary care hospital in St Louis, Missouri. General medical inpatients deemed at moderate to high risk for falling were enrolled in the summer of 2013. Patients were examined for findings that suggest peroneal neuropathy, fall risk, and a history of falling. Multivariate logistic regression was used to correlate SCPN with fall risk and a history of falls in the past year. RESULTS: The mean patient age was 53 years (SD = 13 years), and 59 patients (59%) were female. Thirty-one patients had examination findings consistent with SCPN. After accounting for various confounding variables within a multivariate logistic regression model, patients with SCPN were 4.7 times (95% CI, 1.4-15.9) more likely to report having fallen 1 or more times in the past year. CONCLUSIONS: Subclinical peroneal neuropathy is common in medical inpatients and is associated with a recent history of falling. Preventing or identifying SCPN in hospitalized patients provides an opportunity to modify activity and therapy, potentially reducing risk.

Anatomy of Inpatient Falls: Examining Fall Events Captured by Depth-Sensor Technology.

BACKGROUND: Sensor technology offers a new way to identify patient movement, detect falls, and automatically alert health care staff when falls occur. The information gained from analyzing actual fall events can be beneficial in developing individualized fall prevention strategies, informing nursing staff about the nature of falls, and identifying opportunities to make the patient care environment safer. METHODS: A six-month performance improvement pilot was conducted at Barnes-Jewish Hospital (St. Louis) to assess the ability of a depth-sensor system to capture inpatient fall events within patient hospital rooms. Depth sensors were installed on two inpatient medicine units with a history of high fall rates. The depth sensors captured actual fall events on video. Video clips were reviewed and analyzed to identify the characteristics of patient falls, staff response times, and environmental conditions contributing to falls. RESULTS: A total of 16 falls involving 13 patients were recorded by depth sensors. Six of the 13 patients who fell were classified as high risk on the basis of the hospital's fall rating tool. Common contributing factors included difficulty rising from their bed, weakened lower extremities, and unsteady or slow gait. Eleven of the falls involved patients reaching for objects in their path in an effort to achieve stability. Nurses had less than two minutes from the time a patient began to exit a bed to the time a fall occurred. Patients expressed few complaints with depth sensors installed in rooms. CONCLUSION: Fall-detection sensor systems offer valuable data for analyzing the nature of patient falls, with the potential promise of prescribing specific fall interventions for patients and to identify staff development opportunities. Hospitals should understand these devices' benefits and limitations and how they affect nursing practice.

Compassion fatigue resiliency training: the experience of facilitators.

This qualitative evaluation examined compassion fatigue facilitators' perceptions of the effects of a compassion fatigue resiliency training program in an urban medical center in the midwestern United States. Nine months after completing a compassion fatigue resiliency facilitator training program, 15 participants wrote short narratives describing how the program affected them. Participants described how the training program benefited them both personally and professionally. Two main themes were identified from the narrative analysis: self-improvement and application of resiliency. All of the participants described one or more self-improvements as a result of the program, particularly in regard to emotional health. All of the participants also described how they regularly applied one or more of the resiliency skills taught in the class to improve their ability to manage stress and prevent compassion fatigue. This program shows promise in ameliorating compassion fatigue and burnout in health care providers.

The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year.

PURPOSE: The purpose of this longitudinal study was to track the symptom experience in a sample of cancer patients, determine the persistence of cancer symptoms and symptom burden, and examine the relationship between symptoms and QOL over time. METHODS: Five hundred forty-two patients provided longitudinal data, completing surveys over a 12-month period. Patients had breast, colorectal, gynecologic, lung, or prostate cancer with stage 1, 2, or 3 disease. Surveys included the Memorial Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General Scale and were administered every 3 months. Demographic and clinical information and comorbidities were collected from the tumor registry. RESULTS: The number and type of symptoms experienced by patients varied by cancer type, but about 90% of patients reported one or more symptoms--with prostate cancer patients reporting fewer symptoms and colorectal patients, more symptoms. Prostate patients also had the lowest symptom burden at every time point. Overall, symptom burden decreased over time, as did the Physical subscale for the MSAS. Quality of life was stable over time, except for physical well-being, which improved. Quality of life was negatively correlated with symptom burden at every time point. CONCLUSIONS: The differences in symptom experience by cancer type suggest that assessment and management of symptoms must be individually tailored or at least adjusted by cancer type. While symptom burden decreased over time, residual symptom burden was still noteworthy. As quality of life was persistently negatively correlated with symptom burden, the results suggest the need for comprehensive symptom assessment and management.

The benefits of integrating a statistician into a nursing research department.

In today's competitive healthcare market, more hospitals are seeking Magnet® designation. To meet the expectations for evidence-based practice and research, many organizations are considering the addition of statistical expertise to their team. The authors discuss the benefits of analytical support and integration of a statistician on the team.

Developing a systemic program for compassion fatigue.

The effort in hospitals to improve the patient experience has yielded a new impetus to address compassion fatigue (CF), a combination of secondary traumatic stress and burnout. Over the last 3 years, Barnes-Jewish Hospital has developed a systemic program for CF resiliency. An initial evaluation of the extent to which CF was affecting the hospital's oncology staff led to the formal implementation of a resiliency program for oncology registered nurses. The success of that program ultimately led to the implementation of a hospital-wide resiliency program, designed to help professional caregivers understand CF, recognize the physical, mental, and emotional effects of stress, and adopt resiliency strategies. The voluntary program has been very well received by participants, and a formal evaluation shows promising results with a decline in secondary traumatic stress and burnout among participants. Developing an institutional culture of recognition and support for CF is critical for health care organizations. Establishing such a culture may help managers proactively create work environments that provide opportunities for connection and support among staff. Compassion fatigue training allows professional caregivers to reconnect to their personal mission and then truly begin to connect with an organization's values and mission.

Psychosocial aspects of caregiving: perceptions of cancer patients and family caregivers.

PURPOSE: The care of cancer patients involves collaboration among health care professionals, patients, and family caregivers. As health care has evolved, more complex and challenging care is provided in the home, usually with the support of family members or friends. The aim of the study was to examine perceived needs regarding the psychosocial tasks of caregiving as reported by patients and caregivers. We also evaluated the association of demographic and clinical variables with self-reported caregiving needs. METHODS: Convenience samples of 100 cancer patients and 100 family caregivers were recruited in outpatient medical and radiation oncology waiting areas-the patients and caregivers were not matched dyads. Both groups completed a survey about their perceptions of caregiving tasks, including how difficult the tasks were for them to do. Demographic information was also provided by participants. RESULTS: Caregivers reported providing more help in dealing with feelings than patients endorsed needing. Caregivers were also more likely than patients to report the psychosocial aspects of caregiving were more difficult for them. Lastly, caregivers were more likely to report helping with logistical issues in comparison with patients expressing this need. Race, length of time since diagnosis, and age were associated with patients' expressed needs, while only number of hours spent providing care was associated with the caregivers' reporting of care activities. CONCLUSIONS: Our results suggest that patients may underestimate how difficult caregivers perceive the psychosocial aspects of caregiving to be. Also, it seems that caregivers tend to take on the psychosocial aspects of caregiving, although patients do not tend to report this need. Caregiving needs were only minimally associated with demographic variables, as was participation in caregiving tasks.

A DVD program on fall prevention skills training for cancer family caregivers.

This feasibility study tested an instructional DVD program for improving cancer family caregivers' knowledge and preparedness in fall prevention and reducing fall occurrence among the patients they care for at home. DVD program features included training caregivers on safe mobility skills. Family caregivers of cancer patients were surveyed before and after viewing the DVD program on "Moving Safely" in the home. Cancer patients were followed 4 months postintervention to determine if fall occurrence was reduced. There was a decrease in the number of patients who fell postintervention compared with those who fell preintervention. Caregivers' perceptions of knowledge about fall prevention improved significantly after viewing the DVD. An instructional DVD program is an effective educational tool for preparing family caregivers with the knowledge and skills needed to reduce the incidence of falls in the home setting. Educators must develop programs for preparing family caregivers to perform nursing skills within the home.

Documenting the symptom experience of cancer patients.

BACKGROUND: Cancer patients experience symptoms associated with their disease, treatment, and comorbidities. Symptom experience is complicated, reflecting symptom prevalence, frequency, and severity. Symptom burden is associated with treatment tolerance as well as patients' quality of life (QOL). OBJECTIVES: The purpose of this study was to document the symptom experience and QOL of patients with commonly diagnosed cancers. The relationship between symptoms and QOL was also explored. METHODS: A convenience sample of patients with the five most common cancers at a comprehensive cancer center completed surveys assessing symptom experience (Memorial Symptom Assessment Survey) and QOL (Functional Assessment of Cancer Therapy). Patients completed surveys at baseline and at 3, 6, 9, and 12 months thereafter. This article describes the study's baseline findings. RESULTS: Surveys were completed by 558 cancer patients with breast, colorectal, gynecologic, lung, or prostate cancer. Patients reported an average of 9.1 symptoms, with symptom experience varying by cancer type. The mean overall QOL for the total sample was 85.1, with results differing by cancer type. Prostate cancer patients reported the lowest symptom burden and the highest QOL. LIMITATIONS: The sample was limited in terms of racial diversity. Because of the method of recruitment, baseline data were collected 6-8 months after diagnosis, meaning that participants were at various stages of treatment. CONCLUSIONS: The symptom experience of cancer patients varies widely depending on cancer type. Nevertheless, most patients report symptoms, regardless of whether or not they are currently receiving treatment. Patients' QOL is inversely related to their symptom burden.

An analysis of educational and learning needs of cancer patients and unrelated family caregivers.

Family caregiving involves the provision of care by family members and self-care by patients, with the two groups participating together in illness-related care. A convenience sample of 100 patients and 100 unrelated family caregivers were surveyed to examine their perceptions of the caregiving skills they perform, the difficulty they experience in performing certain skills, and their associated learning needs. Descriptive analysis of data revealed differences in the type of activities patients and caregivers perform, the perceived difficulty of caregiving tasks, and their need for assistance. Uncertainty about disease stage poses important implications for educators.

Delegation practices between registered nurses and nursing assistive personnel.

AIM: To understand registered nurses' (RNs) and nursing assistive personnel's (NAP) perceptions of delegation practices in delivery of oncology patient care. BACKGROUND: No research to date describes how RNs and NAP communicate and interact during the delegation process. An understanding of the nature of communication during delegation offers direction for how RNs and NAP can improve collaboration. METHOD: Qualitative descriptive study. RESULTS: Participants described conflict as a central theme during delegation. Sources of conflict varied between RNs and NAP. Successful delegation is characterised by effective communication, teamwork and initiative. CONCLUSION: Successful delegation depends on the quality of RN and NAP working relationships, timely ongoing communication, initiative and a willingness to collaborate. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers play a key role in the facilitation of delegation practices. Developing clear guidelines for RN and NAP patient reporting and providing opportunities to discuss conflict-related issues is essential. RNs would benefit from acquiring competency in how to conduct reports, resolve conflicts, and how to convey their role in patient care management. Nursing assistive personnel would benefit from developing competency in using effective communication skills for giving feedback, clarifying tasks and patient status and resolving conflict.

Identification of pre-operative and intra-operative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures.

This study examined variables predictive of pressure ulcers among patients undergoing urologic surgical procedures. Anesthesia duration and total time of the diastolic blood pressure was less than 50 Hgmm were statistically significant predictors. Dynamic pressure-relieving devices are recommended to reduce incidences of pressure ulcer incidence.

Evidence Equals Excellence: The application of an evidence-based practice model in an academic medical center.

An evidence-based practice (EBP) program that is designed to develop mentors in both clinical and academic settings has the potential for transforming a health care organization. This article describes an innovative program, Evidence Equals Excellence, which consists of two components: a clinical practice component for health care clinicians and an academic program for baccalaureate and graduate nursing students. The development of EBP mentors creates a core group of clinicians who can assist fellow staff members apply evidence at the bedside. An academic program prepares new graduates to partner easily with clinical mentors to support and initiate successful practice changes.

Persuasion and licensure: a randomized controlled intervention trial to increase licensure rates among Maryland motorcycle owners.

OBJECTIVE: This study aimed to determine whether a persuasive educational intervention could increase licensure among motorcycle owners. Unlicensed motorcycle operators appear to be disproportionately involved in police-reported motorcycle crashes in Maryland, accounting for about 27% of motorcycle operators in police-reported crashes, although unlicensed owners comprise 17% of primary motorcycle owners. METHODS: A randomized controlled trial was conducted among unlicensed owners. Linking Maryland records of registered motorcycles with license files, 8,499 unlicensed owners who had no licensed co-owners were identified. Half were randomized to receive a persuasive educational mailing in early June 2005 from Maryland Motor Vehicle Administration (MVA). Motorcycle licenses can be attained by passing an accredited motorcycle training class or passing knowledge and skills tests administered by the state driver licensing agency. Licensure rates and motorcycle class enrollment were followed for 6 months post-intervention. RESULTS: As of December 16, 2005, 280 intervention group owners had obtained Class M motorcycle licenses and 158 had obtained Class R motorcycle learner's permits. The comparison group obtained 209 M licenses and 122 R permits. The overall success rate in the intervention group, defined as obtaining Class M or R, was 10.4% compared with 7.9% in the comparison group (licensure ratio (LR) = 1.33; 95% confidence interval (CI) = 1.16-1.52). The intervention was most successful among men, whose LR for obtaining M licenses was 1.45 (95% CI = 1.21-1.75). LRs were higher among owners ages 40-48 and 49+ receiving the intervention compared with younger groups. Motorcycle training class enrollment rates were higher in the intervention group, particularly among those taking a course for riders with intermediate skills (enrollment ratio = 2.24; 95% CI = 1.41-3.55). CONCLUSION: The intervention appeared to increase licensure, yet the licensure rate remained low among the intervention group. Potential risks and benefits of increasing the percentage of motorcyclists who are licensed need to be studied.

Evaluation of chemical dot thermometers for measuring body temperature of orally intubated patients.

BACKGROUND: Recent research indicates that oral measurement of body temperature is a reliable option in orally intubated patients. In situations such as protective isolation, where dedicated electronic thermometers are not available, are single-use chemical dot thermometers an acceptable alternative? OBJECTIVE: To determine the accuracy of single-use chemical dot thermometers in orally intubated adult patients. METHODS: Subjects included a convenience sample of 85 adult patients admitted to 1 of 2 intensive care units (surgical trauma and neuroscience). For each patient, oral temperatures were measured concurrently (within 5 minutes) with a chemical dot thermometer and an electronic thermometer. The sequence of temperature measurements was alternated with each subsequent patient. Both thermometers were placed in the same posterior sublingual pocket opposite the side of the endotracheal tube. RESULTS: Measurements obtained with electronic and single-use chemical dot thermometers correlated strongly (r = 0.937). With the chemical dot thermometer, body temperature was overestimated in 11.8% of the measurements and underestimated in 10.8% of the measurements by 0.4 degree C or more. The difference between oral temperatures measured with the 2 different thermometers was not related to the patient's age, sex, or sublingual pocket location or to the order of thermometer use. CONCLUSION: The chemical dot thermometer is useful and reliable for measuring body temperature of orally intubated patients. When measurements of body temperature have important consequences for decisions about treatment, clinicians should use an electronic thermometer to confirm measurements made with a chemical dot thermometer.

Compassion, compassion fatigue, and burnout: key insights for oncology professionals.

When cancer care clinicians become stressed, sad, isolated--and unaware of this--they are placing themselves at risk for burnout and their patients at risk for suboptimal care. Despite their best intentions, clinicians can sink from a healthy work state of compassion, empathy, and well-being into compassion fatigue and burnout. Lessons from first responders demonstrate the importance for clinicians to recognize the warning signs of compassion and fatigue and burnout, as this recognition can enable them to take action towards prevention and/or recovery. The recognition of these issues as a threat to clinician performance has outstripped the development of evidence-based interventions, but interventions tested to date are effective, feasible, and scalable. These interventions could be incorporated systematically into cancer care.

Patient and provider concordance on symptoms during the oncology outpatient clinic visit.

BACKGROUND: Cancer patients experience multiple symptoms, with specific symptoms varying by cancer type. Problems in communication between patients and health care providers (HCPs) can interfere with effective symptom assessment and management. OBJECTIVE: To address gaps in previous research by prospectively examining concordance between HCPs and patients on identifying patients' symptoms by using an identical tool for patients and HCPs at the time of the oncology clinic visit. METHODS: 94 patients completed measures of symptom experience and medical comorbidities before seeing their oncology medical team. HCPs were informed of a patient's participation in the study before seeing the patient in clinic. Immediately after the clinic visit, HCPs completed a symptom survey in which they noted the patient's symptoms. RESULTS: Patients reported more symptoms than the HCPs endorsed. The highest level of concordance for any symptom fell in the moderate agreement range. Kappa values reflecting concordance between patients and HCPs were not significantly different between the various patient-HCP pairs. No demographic or clinical variables for patients were found to be statistically related to the level of agreement on patients' symptoms. LIMITATIONS: The use of a small convenience sample size drawn from 3 specialty oncology outpatient clinics may limit the generalizability of the results to other types of cancer. The distribution of cancer stage was weighted toward stages III and IV, likely contributing to the number of symptoms. CONCLUSIONS: The level of agreement between HCPs and oncology patients on patient symptoms is weak. Concordance levels were similar, regardless of the type of HCP.

An instructional DVD fall-prevention program for patients with cancer and family caregivers.

PURPOSE/OBJECTIVES: Determine the efficacy of a fall-prevention skills training program for patients with cancer and family caregivers. DESIGN: Randomized, controlled trial with repeated measures and postintervention measure of fall occurrence. SETTING: A comprehensive cancer center in the midwestern United States. SAMPLE: 132 patient and family caregiver dyads. METHODS: Dyads were randomly assigned to one of two groups: a control group that received standard fall-prevention education or a treatment group that received standard education and a fall-prevention DVD program to view at home. Participants completed surveys at baseline, one week, one month, and three months. Follow-up phone calls were made at three months. MAIN RESEARCH VARIABLES: Fall occurrence, perceptions of fall risks, and fall-prevention knowledge. FINDINGS: Patients in the treatment group were significantly more likely to report not falling at three months than patients in the control group. The number of falls was lower for the treatment group. The difference was not statistically significant. Dyads in the treatment group showed significantly greater improvement over time in fall risk awareness and fall-prevention knowledge. CONCLUSIONS: Mobility skills training is a promising educational intervention for reducing fall occurrences in the home for patients with cancer. IMPLICATIONS FOR NURSING: Efforts are needed for improving the knowledge and skills of cancer survivors and their family members in recognizing patient fall risks, making home adjustments, and performing mobility skills competently.