Exergames-based intervention for assisted living residents: a pilot study.

The physical and psychosocial benefits of exergames have been reported in various literature. A pre-posttest, single-group design was used to test the effects of an exergames-based intervention on cognition, depression, and health-related quality of life (QOL) in assisted living residents. Bandura's self-efficacy theory was applied. Seven residents (mean age = 86, SD = 5 years) participated in the program two times per week for 8 weeks. Outcome measures included cognition, depression, and health-related QOL. No statistically significant differences were found in any of the outcomes after the intervention. A tendency toward improved cognition occurred, but the outcomes of depression and health-related QOL did not follow a similar trend. However, improved socialization and motivation to exercise were reported. Continued research is needed to investigate the cognitive and psychosocial effects of exergames on this population. Nurses can collaborate with other health care professionals to engage residents in exercise and thus improve residents' QOL.

The feasibility of an intervention combining self-efficacy theory and Wii Fit exergames in assisted living residents: A pilot study.

The purpose of this study was to examine the feasibility of a self-efficacy based intervention using Wii exergames in assisted living residents. The study was a single-group pre- and post-test design. Seven older adults (aged 80-94 years) were instructed to engage in exergames twice a week for 8 weeks. Physical function (balance, mobility, and walking distance), fear of falling, self-efficacy for exercise, and outcome expectations for exercise were evaluated. All participants had enjoyable experiences and no serious adverse events were reported. Participants had significant improvement on balance. Although not significant, there were trends indicating that participants improved mobility, walking endurance, and decreased fear of falling. The use of Wii exergames was an acceptable, safe, and potentially effective approach to promote physical activity in older adults. Findings provide support for the applications of integrating self-efficacy theory into exergames as a mechanism to encourage older adults to engage in exercise.

Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction.

PURPOSE: To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI). DESIGN: The study was a cross-sectional descriptive survey. A convenience sample of Jordanians with AMI were interviewed at the coronary care units of two teaching hospitals in Jordan. METHODS: The Arabic version of the modified Response to Symptom Questionnaire was used to assess predictors of decision delay and patterns of health care-seeking behaviors. Decision delay was evaluated by assisting patients to triangulate time of symptom onset and time of decision to seek professional health care by placing both times in context of daily activities that participants could easily remember. Regression analysis was conducted to elicit predictors of decision delay. FINDINGS: Decision delay time among Jordanian men (n=110) and women (n=24) with AMI was alarmingly long (medians 3.5 and 3.6 hours, respectively). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others' responses to patients' symptoms. While 16 other variables (cognitive, emotional, and clinical) independently predicted delay among men, equivalent evidence was not established among women due to the relatively small sample size. CONCLUSIONS: Similarities and differences existed between Jordanian men's and women's decision delay to seek health care for AMI. Decision delay time among Jordanians with AMI requires intervention that incorporates awareness of delay predictors. Future research needs to utilize adequate sample sizes of both sexes to obtain a better understanding of sex differences. CLINICAL RELEVANCE: To reduce decision delay among Jordanians, health educators should emphasize early symptom recognition and the value of prompt health care-seeking behaviors.

A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest.

Faculty at the University at Buffalo designed and implemented a mock cardiac arrest that involved joint participation by both undergraduate and graduate students. Various instruments were developed to evaluate the effectiveness of this teaching modality, including scales that measured pre- and postsimulation knowledge and confidence. Students were also asked to evaluate the strengths and weaknesses of the experience especially regarding teamwork during an emergency situation. Management of the arrest by the graduate students was evaluated using a scale that included competency criteria related to assessment, diagnosis, treatment, and resource management. Undergraduate students' performance was also evaluated. Using paired t-test statistics, postsimulation knowledge scores were significantly higher than presimulation scores (p = .000), while postsimulation confidence scores were not statistically significant (p = .177). Students at both levels reported high satisfaction with the experience and with the opportunity to participate in a simulated cardiac arrest as a member of the health team. The use of a computer-assisted human patient simulator involving different levels of nursing students appears to be an effective teaching method; more investigation into specific outcomes is needed.

A comparison of clinical simulation and case study presentation on nurse practitioner students' knowledge and confidence in managing a cardiac event.

The study was designed to compare the efficacy of controlled simulation mannequin (SM) assisted learning and case study presentation on knowledge and confidence of nurse practitioner (NP) students in managing a cardiac event. Twenty-three volunteer students were randomly assigned to the experimental (simulation) or control (case study presentation) group. All participants were instructed on atrial arrhythmias, were pre- and post-tested on knowledge and confidence, and completed an evaluation of the experience. There were no statistically significant differences in knowledge test scores, although the control group scored significantly higher on post- test confidence (p=.040). Both groups rated their experience as valuable. The simulation and case study presentation had similar outcomes. Additional research is needed to determine the effectiveness of this teaching modality.

Understanding the Wii Exergames Use: Voices from Assisted Living Residents.

PURPOSE: The study was to understand the facilitators and barriers to exercise using exergames among assisted living residents, particularly in the area of cognitive, physical, and psychosocial effects. DESIGN: Self-efficacy theory was incorporated into the design of the Wii Fit exergaming program. METHOD: Fifteen participants (mean age: 87.07 ± 3.92) received the program twice a week for 4 weeks. Semi-structural individual interview was conducted after the program. Interview responses were analyzed using basic content analysis methods. FINDINGS: Five themes emerged that facilitated participants? desire to exercise: (1) health and mobility; (2) increased alertness; (3) elevated mindset; (4) social interaction; and (5) structured program. Barriers to engage in exercise included: (1) age- or health-related impairments to exercise; and (2) unpleasant experiences related to exercise. CONCLUSIONS: An intervention incorporating self-efficacy and Wii exergames did result in the identification of cognitive, physical, and psychosocial benefits and barriers to exercise.

Evaluating Simulation Methodologies to Determine Best Strategies to Maximize Student Learning.

Limited evidence exists as to the most effective ways to provide simulation experiences to maximize student learning. This quasi-experimental study investigated 2 different strategies repeated versus 1 exposure and participation versus observation on student outcomes following exposure to a high-fidelity acute asthma exacerbation of asthma scenario. Immediate repeated exposure resulted in significantly higher scores on knowledge, student satisfaction and self-confidence, and clinical performance measures than a single exposure. Significant intergroup differences were found on participants' satisfaction and self-confidence as compared with observers. Implications for nurse educators include expanding the observer role when designing repeated exposure to simulations and integrating technical, cognitive, and behavioral outcomes as a way for faculty to evaluate students' clinical performance.

Effects of using Nintendo Wii™ exergames in older adults: a review of the literature.

OBJECTIVE: The purpose of this review is to summarize and synthesize the impact of using the Nintendo Wii™ exergames in older adults. METHOD: A database search was conducted to identify relevant studies. The search was limited to empirical studies, with particular attention paid to the effects of Wii exergames intervention on cognition, physical function, and psychosocial outcomes in older adults. RESULTS: A total of 22 empirical studies met inclusion criteria and were included in this review. Positive effects included improving physical function, decreasing depression, and increasing cognition and quality of life in older adults. Improved socialization and motivation to exercise were also reported. DISCUSSION: Using Wii exergames does show promise as an intervention to improve physical function, cognition, and psychosocial outcomes in older adults. Evidence supports that Wii exergames is a safe and feasible tool to encourage older adults to engage in exercise.

Physical and psychosocial effects of Wii Fit exergames use in assisted living residents: a pilot study.

The purpose of this study was to investigate the physical and psychosocial effects of the Wii Fit exergames incorporating self-efficacy theory on assisted living residents. The study was a quasi-experimental pre/post-test design. Thirty-two participants were recruited from two assisted living facilities. Sixteen participants received the Wii Fit exergames incorporating self-efficacy theory twice a week for 4 weeks. The other participants received a health education program. Physical function, fear of falling, depression, and quality of life were evaluated. T tests were used for data analysis. After the 4-week intervention, the Wii Fit group showed significant improvements in balance (p < .01), mobility (p < .01), and depression (p < .05). The education group showed no significant improvement in any of the outcomes. Integrating concepts of self-efficacy theory with the exergames show promise as a potential tool to improve and maintain physical and psychosocial health for older adults.

Patient-surrogate agreement of predictors of decision delay among patients with acute myocardial infarction: a questionnaire survey.

BACKGROUND: Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events. OBJECTIVES: To evaluate utility of using surrogates to proxy patients who cannot be interviewed and to examine patients-surrogate agreement. DESIGN: A cross-sectional descriptive survey study. The cognitive and emotional domains of the modified Response to Symptoms Questionnaire were used to interview participants. PARTICIPANTS AND SETTINGS: A convenient sample of patient-surrogate pairs was collected (n=109). Hospitalized patients with acute myocardial infarction were eligible if they were at least 18 years old, hemodynamically stable, pain free or controlled pain during interview, and could identify a surrogate. Exclusions (n=45) were patients transferred from other hospitals or those who had acquired heart attack following their admission. A surrogate was defined as an individual who witnessed the onset of symptoms and whom the patient has articulated symptoms with prior to admission. METHODS: Patient and surrogate were interviewed independently. Decision delay time was assessed by assisting participants and surrogates to triangulate the time of symptom onset and time of decision to seek help by placing it in the context of events that they would remember. The intraclass correlation coefficient was used to assess agreement. RESULTS: Patients were mainly men (81%), married (79%) and ranged in age from 39 to 78 years while surrogates were mostly women (74%) and 55% of them were patients' spouses. Surrogates ranged in age from 18 to 75 years. Intraclass correlation coefficients levels varied across different variables ranging from lack of agreement (p>0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (86%, p<0.05). Cognitive variables had higher agreement than emotional variables. Significant emotional variables' agreement ranged form 28% to 39% and significant cognitive variables' agreement ranged form 64% to 68%. Female surrogates (n=81) had higher agreement levels with their respective patients than male surrogates (n=28). CONCLUSIONS: Utilizing surrogates to proxy patients' account of decision delay time and its cognitive predictors is practical and feasible.

A challenge in academia: meeting the healthcare needs of the growing number of older adults.

PURPOSE: The purposes of this study were to survey nurse practitioners (NPs) to determine their comfort level with knowledge about caring for individuals aged 65 years and older and to obtain their input on enhancing geriatric content in the educational preparation of advanced practice nurses who provide care to older adults but are not specialists in gerontology. DATA SOURCES: The sample consisted of 500 randomly selected NPs who were certified to practice in New York State. The Geriatric Curriculum Survey designed by the researchers was based on the 47 "Older Adult Care" competencies developed by the American Association of Colleges of Nursing. The survey was mailed to the subjects along with a stamped self-addressed envelope to facilitate its return. Two hundred and twenty-two surveys (44%) were returned. CONCLUSIONS: A majority of the respondents were comfortable with their assessment skill knowledge of individuals aged 65 years and older in all areas except those related to cultural/ethnic items. Over half of the respondents were only "somewhat comfortable" with knowledge of management of Alzheimer's disease, delirium, dementia, neurological problems, polypharmacy, and sleep issues. Finally, respondents were asked to rate their knowledge comfort level on topics relevant to physical and psychosocial issues of individuals aged 65 years and older. The majority of respondents only felt "somewhat comfortable" with their knowledge on all but one of the nine items in this category. Health promotion and disease prevention was the only item that over 50% of the respondents felt "very knowledgeable" about. Ninety-five percent indicated they would be better prepared to care for individuals aged 65 years and older if a didactic course in geriatrics was required in their program of study. Seventy percent indicated they would consider taking an online course in geriatrics. IMPLICATIONS FOR PRACTICE: Based on the results of this study, an online, four-credit geriatric-focused course "Issues in Geriatric Management" was developed. The course is required in the acute care and adult NP programs. Eventually, this course will be offered as continuing education credit for practicing NPs. The offering of a course focused on geriatrics will help to better prepare NPs to care for the growing number of elderly in this country.

Acute care nurse practitioner education: enhancing performance through the use of clinical simulation.

Full-body patient simulators have been used for a number of years to educate nurse anesthetists and anesthesiologists. These lifelike mannequins operate from a sophisticated computerized system with the ability to generate multiple physiologic events and respond to numerous pharmacologic stimuli. The authors recently integrated the use of the patient simulator into the curriculum to educate their acute care nurse practitioner students. The learning process was divided into three steps: the presimulation experience, the simulation experience, and the postsimulation experience. These steps are described as well as important principles that need to be integrated into each phase of the process. A case scenario on respiratory failure provides an example of the simulation experience. In addition, the advantages and disadvantages of this teaching method, as identified by faculty and students, are discussed.