Long-Term Effect of a Tablet-Based Cognitive Behavioral Group Intervention on Step Count, Fatigue, Self-Efficacy, and Quality of Life in Older Adults With Arthritis: A Pilot Study.

PURPOSE: To evaluate the long-term effect of a tablet-based, cognitive-behavioral group intervention (Tab-G) to improve daily walking for older adults with arthritis. METHOD: Using an experimental pretest/posttest repeated measure design, long-term effects on step count, fatigue, self-efficacy, and quality of life (QOL) were investigated. RESULTS: Results of repeated measures analysis of variance showed significant improvement in step counts (F[1, 37] = 4.18, p = 0.048), fatigue (F[1, 36] = 9.971, p = 0.003), self-efficacy (F[1,28] = 4.645, p = 0.04), and QOL (F[1, 29] = 6.147, p = 0.019) in the Tab-G group compared to the control group. There were significant time effects across four time points (baseline and Weeks 4, 8, and 10) in fatigue (F[3, 108] = 5.43, p = 0.002), self-efficacy (F[3, 84] = 5.433, p = 0.002), and QOL (F[3, 87] = 3.673, p = 0.015), but not in step counts (F[3, 111] = 0.611, p = 0.609). CONCLUSION: Findings demonstrate positive long-term effects on fatigue in older adults with arthritis. [Journal of Gerontological Nursing, 50(5), 35-42.].

Tablet-based cognitive behavioral intervention to improve arthritis associated fatigue: A pilot study.

This pilot study evaluated the effect of the tablet-based cognitive behavioral intervention ("Tab-CBI") on daily steps, fatigue, and self-efficacy. Tab-CBI combined simple walking and a cognitive behavioral approach. An experimental pretest-posttest repeated measures design was used with 24 older adults. RM-ANOVA results showed a significant group difference (Tab-CBI vs. Comparison), F (1, 22) = 2.25, p =0.048 and time difference (baseline vs. week 4 vs. week 6), F (2, 44) =5.04, p =0.01 in daily steps. There was no significant group difference, F (1, 22) = 2.99, p =0.09, but significant time difference existed, F (2, 44) =2.65, p =0.04 in the PROMIS Fatigue scores. In the PROMIS Self-efficacy scores, no significant group difference, F (1, 22) = 0.02, p =0.90) was found, but significant time difference existed, F (2, 44) =3.27, p = 0.04. The findings provide preliminary evidence for the positive impact of Tab-CBI, but should be interpreted cautiously.

Usability testing of tablet-based cognitive behavioral intervention application to improve a simple walking activity for older adults with arthritis fatigue.

The purpose of this study was to test usability of a tablet-based cognitive behavioral intervention ("Tab-CBI") application. Tab-CBI was designed to improve a simple walking activity for older adults with arthritis fatigue. Two phases of usability evaluation were conducted: phase I with 5 older adults to identify any initial design issues and phase II with 10 older adults to examine if Tab-CBI was seamlessly integrated into their daily living. Participants perceived that Tab-CBI was easy, light, and intuitive to use and helped them walking. They reported two key benefit as a motivator to make more active in walking and improved confidence of self-management of fatigue. They referred video recordings and videoconferencing communications as two preferable features. There were also comments for improvement, for example, a challenge for holding a tablet when videoconferencing communications. Participants comments were incorporated into a final version of Tab-CBI to prepare for a future pilot study.

Developing an Innovative Tablet-Based Walking Program to Improve Arthritis Fatigue.

Fatigue associated with arthritis is highly prevalent and interferes with patients' daily routines. An interdisciplinary research team developed the Tablet-based Cognitive Behavioral Intervention (Tab-CBI) for older adults with arthritis fatigue. The goal of the Tab-CBI is to alleviate fatigue by promoting a simple walking activity. The Tab-CBI application used off-the-shelf technologies and was implemented on a mini-tablet computer. The four key components of Tab-CBI are: (a) multimedia cognitive-behavioral therapy (CBT)-based educational modules; (b) videoconferencing communication; (c) individualized goal setting; and (d) electronic data submission. Experts perceived that the Tab-CBI was engaging and user friendly, and effective in improving simple walking routines and alleviating fatigue. Experts' feedback was incorporated into refining the Tab-CBI. The current study demonstrated that the Tab-CBI has potential to be a useful innovation for fatigue management in older adults. [Journal of Gerontological Nursing, 46(10), 13-18.].

Older adults' experiences with a tablet-based self-management intervention for diabetes mellitus type II: A qualitative study.

Technological interventions to support self-management can potentially help older adults manage their health, live active lives, and maintain their independence. The objective of this study was to assess individuals' experiences and perceptions of using a tablet-based application for 30 days as a component of routine diabetes self-management care in older adults with type 2 diabetes mellitus (T2DM) in the context of daily living. A qualitative research design using semi-structured interviews was used. The participants found the tablet-based application to be a beneficial and valuable component of their routine self-management activities. Five themes emerged from the interviews, namely self-dependence, awareness, positive impact on attitude and behavior, support, and balance. Findings from the individual interviews indicate that technological applications have a unique potential to support the foundations for attitude and behavioral changes toward self-management behaviors and activities, thus improving clinical outcomes.

Evaluating the psychometric properties of the Jacelon Attributed Dignity Scale.

AIM: To develop and psychometrically test the Jacelon Attributed Dignity Scale (JADS). BACKGROUND: The JADS was designed to measure self-perceived attributed dignity in community-dwelling older adults. Attributed dignity was conceived of as a state characteristic of the self. The JADS is a short, positively scored, norm-referenced, evaluation index designed to measure self-perceived attributed dignity during the last week. DESIGN: Instrument development and testing including psychometric properties, internal consistency, factor structure, temporal stability and construct validity. METHOD: Using a quota sample, 289 older adults (65-99 years old) were recruited from senior centres in western New England to complete the JADS, demographic information, the Self-Esteem Scale and the Social Desirability Scale during 2010-2011. Descriptive statistics, exploratory factor analysis, construct validity and temporal stability were evaluated. RESULTS: The resulting positively scored 18-item scale has four factors with high internal consistency for each factor and the entire scale. Construct validity was established by examining correlations with instruments that measured self-esteem and social desirability. Attributed dignity is a unique concept that is stable over time. CONCLUSION: The JADS is an 18-item Likert-scaled instrument designed to measure attributed dignity. Attributed dignity is a concept with four factors and is defined as a cognitive component of the self-connoting self-value, perceived value from others, self in relation to others and behaving with respect. The importance of attributed dignity for older adults in relation to health, function, independence, quality of life and successful ageing can now be evaluated.

Nursing informatics competencies: assessment of undergraduate and graduate nursing students.

AIMS AND OBJECTIVES: To report the informatics competencies of students in selected undergraduate and graduate nursing programmes, to examine whether informatics competencies differed between the different programmes and to suggest competency-based applications that will strengthen informatics courses and informatics-related content throughout the curricula. BACKGROUND: Nursing students in undergraduate and graduate nursing programmes have different educational backgrounds and different practice experience. Thus, their informatics preparation is apt to be varied, and nursing curricula must reflect this variation while advancing students towards informatics proficiency. However, studies on informatics competency assessment in these nursing students are scarce. DESIGN: A descriptive survey design. METHODS: Data were collected from 289 nursing students using a 30-item Self-Assessment of Nursing Informatics Competencies Scale via an email sent to students using a LISTSERV mailing list. The email embedded link to the Internet survey package, SurveyMonkey, which included the Self-Assessment of Nursing Informatics Competencies Scale and demographic questions along with an online consent form. RESULTS: Students in both programmes were competent in three subscale areas: basic computer knowledge and skills, clinical informatics attitude, and wireless device skills. Graduate students reported slightly higher mean competency scores than did undergraduate students in three subscales: clinical informatics role, clinical informatics attitude and wireless device skills. CONCLUSIONS: Findings indicate specific topics for nurse educators to consider when designing informatics curricula. The comparison of undergraduate and graduate students indicates similarities in informatics competencies in terms of areas where students were competent and small mean score differences. Further studies are suggested to examine whether there are differences in informatics competencies between undergraduate and graduate students. RELEVANCE TO CLINICAL PRACTICE: These results assist nurse educators in determining specific areas of informatics content that need greater focus and inclusion in the design of better nursing educational programmes. Examples of integrating competencies into existing curriculum or informatics courses are suggested.

An e-health intervention for increasing diabetes knowledge in African Americans.

An evidence-based e-health program, eCare We Care, was developed to disseminate information on diabetes management through web-based interactive tutorials. This study examined the effect of the eCare We Care program on diabetes knowledge development in African American adults with low diabetes literacy. Forty-six African American adults with type 1 or type 2 diabetes and low diabetes literacy were recruited from two health-care centres in eastern Winston Salem, North Carolina. The eCare We Care program included four weekly sessions: introduction to diabetes; eye complications; foot care; and meal planning. Significant differences in scores on the diabetes knowledge survey were demonstrated between the eCare We Care program participants and the comparison group. Study findings indicate the eCare We Care program is more effective in improving diabetes knowledge of African American adults with low diabetes literacy than paper-based, text-only tutorials. The eCare We Care program can be an effective educational strategy for improving diabetes knowledge and decreasing diabetes disparities among African American adults.

Validation of the self-assessment of nursing informatics competencies scale among undergraduate and graduate nursing students.

This study investigated the psychometrics of the Self-Assessment of Nursing Informatics Competencies Scale for nursing students in undergraduate (n = 131) and graduate (n = 171) programs. The scale had a valid five-factor structure, accounting for 69.38% of the variance, high internal consistency reliabilities (0.96 for the total scale and 0.84 to 0.94 for subscales), and good responsiveness (standardized response mean = 0.99), as well as significantly improved scores in nursing students with diverse demographic and educational backgrounds after taking an informatics course. Our factor structure was similar to the original scale, differing slightly in four items' loadings. This difference may reflect current informatics practice or the greater diversity of our sample. Further research is needed on the factor, data/information management skills, and related item loadings. This scale could be used to assess informatics competencies and develop educational strategies that prepare nursing students as informatics-competent graduates in information technology-rich environments.

Older adults' perceptions of pictograph-based discharge instructions after hip replacement surgery.

Current text-based discharge instructions are unsuitable for low-literate older adults who have difficulty following written action-based instructions. To address this issue, we developed discharge instructions for low-literate older adults after hip replacement surgery using pictographs (i.e., simple line drawings with stick figures showing explicit care actions). The aim of this focus group study was to examine the acceptability and comprehension of these instructions to 15 low-literate older adults. Participants perceived that the pictograph-based discharge instructions helped them understand the intended health care messages, especially for step-by-step procedures of discharge actions. The black-and-white line drawings were well received by all participants of various race/ethnicity. A pictograph-based approach is an effective strategy for developing discharge instructions not only for patients with low literacy skills in acute health care settings, but also for immigrants with significant communication challenges. Future research is suggested to compare the effects of pictograph-based and text-based instructions on adherence to instructions and health outcomes.

Nursing Students' Use of Harm Reduction in the Clinical Setting.

BACKGROUND: The use and awareness of harm reduction education strategies are missing from nursing care of people with substance use disorder (SUD). PURPOSE: To determine whether targeted training improved nursing students' application of harm reduction education in the clinical setting. METHODS: This was an experimental 2-group repeated-measures survey study. Nursing students in a baccalaureate program received targeted training for 3 semesters. Training included presentations by people with lived experience, an addiction-trained physician, and a role-play exercise. Students received harm reduction education and reported on the application of this education. RESULTS: Students in the traditional track cared for more people with SUD than students in the accelerated track. Referral for treatment was the most common education provided, and information related to injection drug use was the least commonly taught education. CONCLUSIONS: Targeted training increased the number of harm reduction options nursing students presented to people with SUD in the clinical setting.

The use of physical restraints and PRN medications in adolescent psychiatric inpatient units.

PROBLEM: Although physical restraint practices and psychotropic/sedative pro re neta (PRN, as needed) medications have been commonly used for managing inpatient aggression, little is known about the characteristics of adolescents who receive them in psychiatric adolescent inpatient units. We aimed to determine the relationship between the use of physical restraints and psychotropic/sedative PRN medications, and to characterize individual attributes, substance use, clinical factors, and time of the first restraint episodes of the use of physical restraints and psychotropic/sedative PRN medications. METHODS: A retrospective case-control study approach was used with the data from electronic health records at a pediatric psychiatric hospital in the United States. Descriptive statistics, χ2 , multivariate logistic regression, and Cox proportional hazard model were used. FINDINGS: Participants of younger age and participants with a longer length of stay were significantly associated with the use of physical restraints and psychotropic/sedative PRN medications, although the substance-related risks were not significantly associated with the use of restraints. Physical restraints were more likely to have occurred soon after the admission and tapered off as the length of stay increased. CONCLUSIONS: This study provides important information in understanding the risk factors of the use of restraints and psychotropic/sedative PRN medications in psychiatric adolescent inpatient units.

Development and pilot test of pictograph-enhanced breast health-care instructions for community-residing immigrant women.

Current written text-based health-care instructions are not suitable for presenting lengthy, complex breast health-care instructions and are difficult for immigrant women with limited literacy skills. The aims of this study were to develop breast health-care instructions enhanced by pictographs (simple line drawings representing health-care actions) and pilot test the instructions in a sample of six immigrant women with limited literacy skills. Based on the Mayer's Cognitive Theory of Multimedia Learning, pictographs were developed in addition to low-literacy text. The text and the pictographs were then pilot tested with six immigrant women in community health centres for clarity, comprehension and acceptability through face-to-face interviews. Participants perceived that the drawings were engaging and enhanced clarity of the intended health-care messages. The black and white simple line drawings were well received by participants of varying race and ethnicity. The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. Future research is needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

Mobile outreach strategies for screening hepatitis and HIV in high-risk populations.

OBJECTIVES: To screen, counsel and offer hepatitis A and B vaccination for subjects at high risk for hepatitis C virus (HCV) and HIV, and determine any relationship between risk factors and HCV positivity. DESIGN AND SAMPLE: A descriptive correlational design. We correlated risk factors and HCV positivity and measured vaccination completion rates. Two hundred and two unduplicated subjects in 4 locations in Western Massachusetts: a walk in substance abuse clinic, a homeless shelter, a county jail, and a community corrections facility. MEASURES: Demographic data and a standard HCV risk- screening survey were used. RESULTS: Significantly higher rates of HCV were found in subjects who were currently using injection drugs (83.3% HCV positive, χ2(1) = 20.85, p<.001), who had a history of sharing needles for drug use (75% HCV positive χ(2) (1)=83.20, p<.001), or a history of receiving treatment for drug abuse/alcoholism (38.4% HCV positive χ2(1) = 12.14, p<.001). Vaccination completion ranged by setting between 18% and 38%. CONCLUSIONS: Targeted outreach to hard to reach groups is effective in providing access for those at high risk for HIV and HCV infection. A mobile outreach strategy can focus needed resources for a variety of groups in a community.

Building Therapeutic Commitment in University Nursing Students.

BACKGROUND: Nurses report feeling unprepared to care for people with a substance use disorder (SUD). PURPOSE: The purpose was to determine whether targeted antistigma interventions improved nursing students' attitudes and perceived stigma toward people with SUD. METHODS: This was a quasi-experimental, repeated-measures survey study. Participants completed the 20-item Drug and Drug Problems Questionnaire (DDPPQ) and the 8-item Perceived Stigma of Substance Abuse Scale (PSAS) at baseline and postintervention in their first clinical semester. Booster sessions were held for 2 additional clinical semesters after the initial intervention in the first clinical semester. The DDPPQ and PSAS were completed at the end of each semester for 3 semesters of the nursing program. RESULTS: After the educational interventions, there was a significant improvement in overall therapeutic attitudes except for 1 sub-scale, role-related self-esteem. CONCLUSIONS: Antistigma interventions led to a decrease in stigma and improved overall therapeutic attitudes toward people with SUD.

Effectiveness of Immersive Virtual Reality in Nursing Education: Systematic Review.

BACKGROUND: Digital education using immersive virtual reality (VR) technology is available in nursing. Evidence of its effectiveness is essential. PURPOSE: This review analyzed the effectiveness of and barriers to using immersive VR in nursing education. METHODS: A structured search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, Web of Science, and ProQuest Nursing & Allied Health Database. The Medical Education Research Study Quality Instrument was used to assess the quality of studies. RESULTS: The final review was composed of 9 studies of moderate to high quality published between 2018 and 2020. The review indicated that immersive VR increased learning, cognitive, and psychomotor performance. Most participants of the studies preferred using immersive VR in education and with a variety of experiential scenarios. Barriers were associated with technological hardware and software (eg, simulation sickness, lack of visual comfort). CONCLUSION: The review supports the viability of immersive VR technology in nursing education.

Literature review: using pictographs in discharge instructions for older adults with low-literacy skills.

AIMS: To evaluate current visual aids used in health education; to explore evidence regarding the use of pictographs (simple line drawings showing explicit health care actions); and to provide suggestions for uses of pictographs in discharge instructions for older adults with low-literacy skills. BACKGROUND: Discharge instructions consist of recommended homecare actions. However, these healthcare actions are provided in text-based discharge instructions, which are often difficult for patients with low-literacy skills to follow precisely at home. Various forms of visual aids are currently used to improve health education; however, the appropriateness of these visual aids for educating discharge instructions for older adults with low-literacy skills is unknown. DESIGN: A narrative literature review. METHODS: Eligible articles were identified via electronic searches of databases. In total, 44 articles were reviewed and analysed. RESULTS: Among various visual aids, pictographs using simple line drawings combined with simplified text are the most efficient and effective tool to improve discharge education. Indeed, pictographs are well suited to show a step-by-step procedure of complex and lengthy discharge instructions consisting of multiple actions, thus making an entire action sequence easier to learn. CONCLUSION: By using pictographs with simplified text, healthcare educators can improve discharge instructions for low-literate older adults. Further research is needed to develop pictographs representing explicit healthcare actions themselves rather than concepts associated with healthcare actions; and to examine the effects of pictographs on adherence and health outcomes. RELEVANCE TO CLINICAL PRACTICE: Healthcare education materials using pictographs provide effective strategies in improving discharge education for low-literate older adults in acute healthcare settings where nurses have primary responsibility as a first line of healthcare providers. It can also serve as an efficient tool to improve health education for immigrants speaking English as a second language.

Pictograph-based discharge instructions for low-literate older adults after hip replacement surgery: development and validation.

Current forms of written text-based discharge instructions are not suitable for presenting lengthy, complex discharge home care actions, and are difficult for low-literate patients to follow precisely at home. The aims of this study were to develop and validate pictograph-based discharge instructions for older adults after hip replacement surgery. Once low-literacy text and pictographs were created, their appropriateness, accuracy, and relevance were reviewed and validated by five experts. The findings show that pictographs (i.e., simple line drawings showing explicit discharge care actions) using stick figures are well suited for presenting action-based discharge instructions. The experts perceived the pictographs as engaging and easy to understand. The pictograph-based approach can be an effective tool in developing health care instructions not only for patients with low-literate skills in acute health care settings, but also for immigrants and refugees who speak English as a second language and present significant communication challenges for health care providers.