How to creatively meet care needs of the morbidly obese.
Discover how nursing staff on a medical unit initiated inventive care and discharge planning to meet the needs of a morbidly obese patient with mobility problems.
Activities of Daily Living↗
Biomedical subjects
D E Holland
Publications and source records attributed to D E Holland.
Modeling nursing scientific inquiry. The University of Iowa Hospitals and Clinics Research Utilization Residency Program for Geriatric Nurse Practitioners and Gerontological Clinical Nurse Specialists.
The application of research findings to achieve nursing outcomes sensitive to the effects of nursing care remains a challenge for the nursing profession. The Research Utilization Nursing Residency Program is a project implemented by the University of Iowa Gerontological Nursing Interventions Research Center. For a discharge planning coordinator serving a largely geriatric patient population, the residency experience provided support to apply scientific nursing knowledge to outcomes. Resources from both clinical and academic settings are discussed within the context of the resident's experience.
Aged↗
Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up.
The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.
Adolescent↗
Determining the relevance of a certification exam to home health care nursing practice.
Home health care is enjoying increased use and popularity. Unfortunately, in today's cost-cutting environment, home healthcare is also subject to increased scrutiny and inevitable reimbursement limitations. This is borne out by the impact on home healthcare as a result of the Balanced Budget Act of 1997. Berke (1998) reports that those at greatest risk for cutbacks in care are those that can least afford it--the oldest, sickest, poorest, and most frail. Compounding the financial dilemma that home health care clients face are multiple providers of care, an unrealistic media presentation of health care, and less time for anyone to provide psychosocial-focused care (Simmons, 1990). Home health care clients have a desperate need for an advocate to provide expert navigation through the health care system. Home health care providers are aware of and often responsible for bridging gaps in health, medical benefits, and social services. This article describes a process for determining the relevance of a certification to community nursing clinical practice--using the Advanced Certification in Continuity of Care (A-CCC) exam as the example.
Certification↗
Testing the Uniform Needs Assessment Instrument for hospital discharge planning with older adults.
The Uniform Needs Assessment Instrument (UNAI) was developed to systematically assess the continuing care needs of high-risk older adults in response to the 1986 Omnibus Budget Reconciliation Act. Based on previous studies, a revised UNAI was tested with 103 hospitalized older adults, comparing usual discharge planning with the UNAI. High interrater reliability was obtained. The UNAI had high (> or = 85%) sensitivity and specificity when comparing needs identification on the UNAI with subjects' reported needs at 10 to 14 days after discharge. Overall, the UNAI was more effective (sensitive and specific).
Aftercare↗
Prevention and early intervention for anxiety disorders: a controlled trial.
The Queensland Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of anxiety problems in children. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After recruitment and diagnostic interviews, 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group. Both groups showed improvements immediately postintervention. At 6 months follow-up, the improvement maintained in the intervention group only, reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. Overall, the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program.
Adolescent↗
Propofol infusion and the suppression of consciousness: dose requirements to induce loss of consciousness and to suppress response to noxious and non-noxious stimuli.
We have defined the infusion dose requirements of propofol to suppress consciousness and response to a variety of graded non-noxious and noxious stimuli in 52 unpremedicated patients aged 16-40 yr and 32 patients aged 41-65 yr. They were allocated to receive one of five loading dose-infusion schemes designed to establish stable conditions covering the range from wakefulness, through sedation, to loss of consciousness and anaesthesia. At 10 and 20 min after the loading dose, each patient's response to a graded series of stimuli was recorded. Probit analysis was used to derive mean values (95% confidence interval) for the ED50 and ED95 (as final infusion rate) for loss of response to verbal command at 4.9 (4.7-5.1) mg kg-1 h-1 and 7.9 (7.3-8.8) mg kg-1 h-1, respectively, in the young group and 4.2 (4.0-4.4) mg kg-1 h-1 and 5.8 (5.4-6.4) mg kg-1 h-1, respectively, in the older group. In both groups the dose-response curves for suppression of proprioception, finger counting and perception of light touch in conscious patients were shifted to the left of the curves for loss of consciousness and eyelash reflex. Dose-response curves for noxious stimuli were shifted to the right of those for loss of consciousness.
Adolescent↗
Continuity of care: a nursing needs assessment instrument.
Based on testing of the Uniform Needs Assessment Instrument (UNAI), a nursing needs assessment tool for adult hospitalized patients was integrated into nursing practice. Some content and format changes to the UNAI occurred as a result of the research process. The revised assessment form is called the Nursing Needs Assessment Instrument (NNAI). Community providers, including nursing home and home health care personnel, use the NNAI to derive necessary admission data for assessing patients, planning care, and communicating with other staff regarding patient needs. Instituting an evidence-based practice change in hospital discharge forms enables the next care provider to consistently meet the patient's continuing needs.
Adult↗
A discharge planning program in orthopaedics: experiences in implementation and evaluation.
The acute care orthopaedic registered nurse plays a key role in assessing and communicating the continuing care needs of patient's and their families, coordinating community resources, and formulating a timely discharge plan to maximize rehabilitation and recovery. Developing and maintaining a staff nurse's discharge planning knowledge and skills can be a challenging endeavor. Discharge Planning Coordinators at a tertiary medical center developed and implemented a Discharge Planning Mentorship Program, an educational pilot program designed to enhance the knowledge and skill level of select nurses in the orthopaedic specialty practice, thus maximizing expert resources at the bedside. Program implementation and evaluation of role preparation, practice changes, and actualization challenges are discussed in this article. Overall, participants demonstrated increased skill in articulating and problem solving a patient's postdischarge needs, devised creative strategies to enhance communication between multiple levels of care, and developed a greater knowledge of community resources and reimbursement mechanisms for continuing care.
Clinical Competence↗
Development of a discharge planning mentorship program.
Discharge planning coordinators at a tertiary medical center developed a Discharge Planning Mentorship Program. The group established the educational program to support the autonomy of the staff primary nurse in the discharge planning component of professional practice. To establish the program, the discharge planning coordinators used the underlying principle of "CollaMentoach." The term is an acronym combining the three core concepts of collaboration, mentoring, and coaching. Program planning and marketing, participant selection, curriculum development, and curriculum evaluation are included to guide staff development specialists and nurse managers in the formulation of a program to enhance staff nurse discharge planning skills.
Curriculum↗