Biomedical subjects

C G Rapp

Publications and source records attributed to C G Rapp.

11 recordsLinked to original sources

PubMed2004

Escalation/de-escalation patterns of behavioral symptoms of persons with dementia.

Behavioral and psychological symptoms of dementia (BPSD) may be framed within the Needs Driven Dementia-Compromised Behavior (NBD) Model. Current literature suggests that BPSD may escalate. Several researchers have described a sequence of behavioral escalation that has a clear starting point and ending point. This 'ideal' or concatenated sequence is used to explain behavior that begins with relatively calm behavior and progresses through a prescribed sequence of behaviors that end in violence. This article presents two studies, a descriptive study and an intervention study that examine the escalation and de-escalation patterns of BPSD. Results of the descriptive study indicate a dominant pattern of agitation, aggression, and agitation while results of the intervention study, using sequential analysis indicate persistence of behavior from one 20-minute period to another. The persistence of vocalization at intensity level 2 changed from pre-intervention (mean conditional probability 29%) to post-intervention (mean conditional probability 13%). Taken together these studies shed light on the pattern of escalation and de-escalation of BPSD and suggest an intervention to alter behavior persistence. This article discusses methodological challenges of measuring the escalation and de-escalation of BPSD and offers suggestions for analysis and design such as time series and sequential analysis.

Aged↗

PubMed2001

Acute confusion/delirium protocol.

This abbreviated version of the Acute Confusion/Delirium Research-Based protocol provides clinical guidelines for the assessment and management of acute confusion/delirium in the elderly individual. A screening and ongoing surveillance program that is based on identified risk factors is recommended to prevent or minimize episodes of acute confusion in this age group. This protocol is part of a series of protocols developed to help clinicians use the best evidence available in the care of older adults.

Acute Disease↗

PubMed2001

Training of acute confusion resource nurses. Knowledge, perceived confidence, and role.

Most nurses function as generalists; however, some function in "expert" roles based on informal training as Resource Nurses. Training usually focuses on assessment and management of a specific problem, with the goal of creating a readily available "expert" for every unit. The primary activity of the Resource Nurse is to provide expert care, education, and consultation for patients, families, and staff. The Iowa-Veterans Affairs Nursing Research Consortium (IVANRC) addressed the need to manage acutely confused/delirious clients by training staff nurse volunteers (N = 129) from all units of the four Iowa Veterans Affairs facilities to act as unit-based acute confusion Resource Nurses (ACRNs). A day-long workshop included didactic content addressing etiology and presentation of acute confusion (AC), use of the IVANRC protocol to assess for AC, and basic information on treatment and management of AC. The nurses also participated in an efficacy-based experiential learning program on AC assessment that involved demonstrating assessment of AC and role enactment practice exercises in which ACRNs practiced the assessment. A test of knowledge of AC and perceived level of confidence in assessing acutely confused patients was administered before and after completion of the program. Paired t tests comparing pre- and posttest scores showed that knowledge and confidence significantly increased for the nurses as a result of their participation in the educational program. Eighteen months later, a second program was conducted to update current ACRNs and train additional RNs to enact this role. Pre- and posttest scores were obtained, with paired t tests showing a significant increase in knowledge for the participants. Twenty-four (49%) of the second program attendees had attended the first program. These participants had significantly higher scores on the second program pretest than those participants who had not attended the previous program, indicating a retention of knowledge from the first program.

Acute Disease↗

PubMed2000

Acute confusion assessment instruments: clinical versus research usability.

Acute confusion (AC), also referred to as delirium (AC/delirium), is a common problem seen by health professionals who work in a variety of care settings. This is an evaluative report on the clinical usability of instruments to assess AC/delirium as a part of nursing practice. Specifically, five instruments [the Confusion Assessment Method (CAM), Delirium Rating Scale (DRS), Delirium Symptom Inventory (DSI), Mini-Mental State Examination (MMSE), and Neelon/Champagne (NEECHAM) Confusion Scale] are discussed. The work demonstrates how the cooperation of nurses in practice, education, and research can improve both patient and staff outcomes.

Acute Disease↗

PubMed1998

Unit-based acute confusion resource nurse: an educational program to train staff nurses.

Despite the high prevalence of acute confusion among elders and the importance of its early detection, there are few reports of systematic efforts to increase staff competence. This article describes the development and evaluation of an 8-hour educational program designed to prepare staff nurses to perform in a new role, the unit-based acute confusion Resource Nurse (ACRN). Pre- and posttest scores were obtained for the 80 registered nurses who participated in the program. Paired t tests showed that knowledge and confidence significantly increased for participants as a result of their participation in the educational program. This program can serve as an effective model for geriatric staff education.

Acute Disease↗

PubMed1993

Cognitive impairment in the elderly.

This article reviews research related to assessment and interventions for cognitive impairment conducted by nurses as principal and coinvestigators. It focuses on the broad areas of delirium and dementia, which are divided into assessment and intervention-related research. The intervention research begins with descriptive studies and has subdivisions for primary and secondary symptoms. Ideas for future research follow.

Activities of Daily Living↗

PubMed1990

Clinical trials: the role of the neuroscience nurse.

Participation in clinical drug trials is becoming a common expectation of many neuroscience nurses. Prior to assuming responsibilities associated with a research study, the roles, rights and responsibilities involved must be thoroughly understood. The effective neuroscience nurse brings to the research arena a thorough knowledge of the drug under study, outstanding skills as a clinician and a commitment to ensure the safety and comfort of the participant as the search is made for better and more effective drug regimens.

Clinical Trials as Topic↗

PubMed1990

New drugs for Parkinson's disease.

Parkinson's disease continues to be a tragic debilitator of close to half a million Americans. As more is learned about the disease, pharmacological treatment improves. Just recently, deprenyl became a part of our therapeutic armamentarium, and it appears that Sinemet CR will soon be following. It is hoped that these drugs will improve the quality and quantity of life for patients with PD until the disease can be cured.

Aged↗

PubMedDate not supplied

The nursing outcomes classification: validation by rehabilitation nurses.

Measuring patient outcomes is important to rehabilitation nurses and the patients they serve. This article describes research conducted at the University of Iowa College of Nursing to develop the Nursing Outcomes Classification (NOC) and the validation of this research by surveys conducted through specialty nursing organizations, particularly the Association of Rehabilitation Nurses. Nurses responded to surveys designed to validate (a) the importance of outcome indicators to the achievement of an outcome and (b) nursing's contribution to the achievement of the indicators. The results of the surveys indicated that rehabilitation nurses believe that nursing makes a substantial contribution to most outcomes and indicators.

Activities of Daily Living↗

PubMedDate not supplied

Obtaining and maintaining a research sample with cognitively impaired nursing home residents.

Obtaining and maintaining a research sample of cognitively impaired nursing home residents is a challenging task. One cannot conduct research with this population without the cooperation of the nursing home administration and staff. The initial challenge is identifying and screening potential subjects. The medical record often provides inadequate information, necessitating direct observation and use of screening tools. Once potential subjects have been identified, the researcher must obtain consent. This complicated process may vary from site to site. Because of the potential subjects' cognitive impairment, we must obtain additional consent from a proxy. A variety of persons may function as proxy. Suggested methods of contact include personal contact at the nursing home and phone or written contact. Proxies may raise many issues in deciding whether to consent.

Aged↗

PubMedDate not supplied

Improving dressing behavior in cognitively impaired nursing home residents.

This study tested the extent to which a behavioral intervention, Strategies to Promote Independence in Dressing (SPID), improved dressing independence among 90 cognitively impaired nursing home residents (average score on Mini Mental Status Exam = 7.35 +/- .69). The effect of SPID on caregiving efficiency, the time required for nursing assistants to use the strategies, was also examined. The results showed improved independence (decrease in assistance) from 6.08 +/- .12 at baseline to 4.93 +/- .19 following 6 intervention weeks. This significant improvement in dressing independence occurred without a clinically relevant increase in caregiver time (less than 1 min). Seventy-five percent of the subjects improved one or more levels of dressing independence, and more than 20% achieved their maximum intervention effect during the first week of treatment.

Activities of Daily Living↗