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Education in the elderly. Adapting and evaluating teaching tools.

1. The patient's Bill of Rights documents the rights of patients to be informed of their illness, health, and treatment. 2. The use of appropriate teaching tools can significantly increase learning, especially if the tools are modified to accommodate normal aging changes. 3. An appropriate teaching tool is a critical component to the learning success of the elderly. 4. With aging changes that result in loss of short-term memory, a teaching tool may make the difference between short-term learning and long-term success.

Aged↗

[Development of a tool in measuring yangsaeng].

PURPOSE: 'Yangsaeng' is a traditional healthcare regimen for the promotion of health and prevention of illnesses by means of specific principles and methods for the purpose of living a long and healthy life. The purpose of this paper was to develop a tool in measuring Yangsaeng and to verify its reliability and validity. METHOD: Content validity was conducted three times by 8 experts. Factor analysis was conducted to test its construct validity. RESULT: Thirty-one items were selected in 8 factors; Morality Yangsaeng, Mind Yangsaeng, Diet Yangsaeng, Activity & rest Yangsaeng, Exercise Yangsaeng, Seasonal Yangsaeng, Sleep Yangsaeng and Sex life Yangsaeng. The explanatory variance is 61.76%. Cronbach's alpha of the final tool is .89 and that of each factor is .68 approximately .82. The analysis of the items shows that the item-total correlation is .40 or higher. Criterion-related validity was verified with the CMCHS V1.0 and the KoHSME V1.0. CONCLUSION: Since the tool developed in this study was verified in terms of its reliability and validity, it could be utilized as a tool for evaluating the extent of Yangsaeng.

Adult↗

[Development of a nutritional assessment tool for home care centers].

PURPOSE: The purpose of this study was to develop a tool for nutritional assessment, so that home care nurses can make early assessment of patients' nutritional status. METHOD: The study was done in two parts: first a tool was developed to assess nutrition, and second the content validity and clinical validity of the categories and indices were verified. RESULT: The results of this study are summarized in two ways. First, the nutritional assessment tool was classified into 3 areas, physical measurement, nutritional survey and clinical survey, and into 11 categories with 22 indices. Second, when 5 of the 11 categories were positive, nutritional status was considered to be poor. CONCLUSION: By developing a clinically useful nutritional assessment tool for patients receiving home care, which was developed in this study, the quality of life for these patients will improve and contribution to the development of a more effective clinical home nursing practice will occur.

Hemoglobins↗

The Community Adaptive Planning Assessment: a clinical tool for documenting future planning with clients.

OBJECTIVES: The objectives of this article are to (a) identify features needed in a clinical tool in order to organize collaborative planning for the future between therapist and client; (b) describe the structure and procedures for use of the Community Adaptive Planning Assessment (CAPA), which was developed to meet these needs; (c) summarize research on the usability, trustworthiness, and clinical effectiveness of the CAPA; and (d) consider future work to further evaluate qualitative tools like the CAPA for clinical and research purposes. METHOD: Initial and revised versions of the CAPA were evaluated through several studies. Usability was examined through questionnaires completed by therapists who used the CAPA in acute care, rehabilitation, home health, and community programs with a total of 105 clients who had a variety of acute and chronic disabilities. Trustworthiness was evaluated through comparison of information gathered from 21 clients with that from their family members. Clinical effectiveness was evaluated for discharge planning through content analysis of community outcomes of goals and plans established before discharge. RESULTS: Initial studies indicate that the CAPA has sound usability, trustworthiness, and clinical effectiveness for a variety of service delivery systems and with a variety of clients when used by experienced therapists. Findings support use of these three criteria for evaluation of tools designed to document qualitative consultation-based practice. CONCLUSIONS: Results are related to broader issues in the profession, including a need for further study of collaborative planning for the future between clients and therapists, ways in which qualitative aspects of practice can be documented efficiently, ways in which outcomes of consultation-based practice can be evaluated, and establishment of criteria for evaluation of emerging qualitative assessments and intervention tools.

Disability Evaluation↗

Development of a data collecting tool to explore the consuming patterns of Chinese and Western medicines in Hong Kong.

Chinese and Western medicines are both consumed by citizens in Hong Kong. Safe medication practice, however, whether or not it is conducted by Hong Kong citizens, remains unknown. A data collecting tool was developed to explore the consuming patterns of medicines adopted by Hong Kong citizens. It is hoped that by using this tool, baseline information about the ways in which Hong Kong citizens consume their medicines can be explored. It is also hoped that the information will contribute to the educational planning of community-based safe medication practice. The objectives of this paper were thus to report the development of this data collecting tool and to discuss the use of the tool for the promotion of community-based safe medication practice.

Drug Therapy↗

Bone and joint pathology in workers using hand-held vibrating tools. An overview.

A literature evaluation was made with regard to the radiological documentation of bone and joint pathology in the hands and arms of workers using vibrating tools. There is evidence that work with pneumatic percussive tools (such as chipping hammers and scalers) may cause premature elbow and wrist osteoarthrosis, although of very low prevalence. This work-related disorder is not specific to vibration exposure. Instead, it is likely to result from the strong dynamic and static joint loading (often in extreme positions of the joint) and the repetitive hand-arm movements (sometimes also repeated minor traumatization) typical for tool manipulation in any heavy labor. Exposure to low-frequency percussion may, however, play a particular etiologic role: damage to the joint cartilage by repeated shocks from the tool, additional articular load (and consequent strain) associated with a vibration-induced increase in the need for joint stabilization and higher gripping forces, the tonic vibration reflex (which increases muscle contraction), and a stronger grip induced when tactile sensibility is diminished by vibration. So far, no investigations have ventured into the great complexity of possible confounders and effect modifiers. -A constitutional susceptibility may be required to produce osteoarthrosis. -The allegation that hand-arm vibration exposure causes an excess prevalence of bone cysts, vacuoles, Kienböck's disease, or pseudarthrosis of the scaphoid has not been validly documented. -Exposure to vibration of higher frequencies (such as from rotating drills, grinders, and chain saws) does not seem to be associated with excess bone and joint pathology. -The observed large variation in the prevalence of skeletal disorders may be explained by biodynamic and ergonomic differences between various occupations.

Arm↗

Elaboration of a standard procedure for the measurement of vibration emitted by percussive tools--application to breakers.

The Association Française de Normalisation (AFNOR) is preparing a standard on the exposure assessment of vibration from percussive tools. Therefore, a test code was developed for the measurement of vibration from percussive tools under laboratory conditions. The handle vibration from six different breakers, among which three tools were of "antivibration design," was measured with the following energy absorption methods: hydraulic base, steel shot, actual breaking of concrete, AFNOR concrete block, pointed chisel embedded in concrete. The last four methods were applied with breakers held by three successive operators. In addition, the first two were used with tools mounted in a rig which held them vertically and loaded them with a vertical downforce. The results indicated that the steel shot method was preferable although it gave 20% lower vibration results than those recorded for the actual breaking of concrete. It has the advantages of yielding consistent results with low scatter and being simple and cheap. Since difficulties have been experienced during the use of a pneumatic rig with breakers of antivibration design conception, the shot method should be applied with human operators.

Humans↗

Vibration from riveting tools in the frequency range 6 Hz-10 MHz and Raynaud's phenomenon.

The vibration characteristics of hand-held riveting hammers and bucking bars used in the aircraft industry were measured and recorded for frequencies from 6 Hz to 10 MHz. Three different measuring systems had to be used. Up to about 1 kHz a displacement transducer was used, up to about 50 kHz a piezoelectric accelerometer was used, and in the megahertz region an ultrasonic probe was used. The signals were analyzed according to the guidelines of the International Organization for Standardization (ISO/DIS 5349), and also according to methods common in environmental engineering. The weighted acceleration according to ISO/DIS 5349 was between 10 and 11 m/s2 for typical riveting tools. Very high acceleration values were obtained for frequencies above those specified in ISO/DIS 5349. In a group of 288 riveters, about 50% showed symptoms indicating Raynaud's phenomenon after about 10 years of work, although the daily exposure of riveting tools was about 1 min/d. The investigation showed that special precautions must be taken to measure the acceleration of percussion tools and that the risk criteria in ISO/DIS 5349 do not cover all the risks connected with percussion tools.

Aircraft↗

Reliability of a functional mobility assessment tool with application to neurologically impaired patients: a preliminary report.

The purpose of this preliminary study was to examine the intratester and intertester reliability of a functional mobility assessment tool (FMAT). Seven licensed physical therapists with varying amounts of clinical experience served as raters. Twelve patients with neurological deficits were subjects for this study. Raters were asked to provide eight possible ratings for each of eight critical mobility functions. Average weighted kappa coefficients ranged from .82 to .97. Intraclass correlation coefficients ranged from .73 to .97 for the first assessment and from .52 to .97 for the second (retest) assessment. A high degree of agreement between and within seven raters indicated that this tool may provide an effective assessment of stroke, brain injury, and spinal cord injury. Preliminary findings indicate the functional mobility assessment tool is reliable, thereby increasing the usefulness of this method for clinical assessment. The high resolution of the FMAT makes this tool ideally suited for use in future studies focusing on the prediction of mobility function following neurological insult.

Activities of Daily Living↗

HotList. Integration tools.

July's HotList features integration tools. Although many information systems vendors build custom interfaces or provide links to integrated systems, the focus of this Integration Tools HotList is to discover those companies who deliver truly useful tools for integrating disparate systems. All data provided by individual vendors responding to survey questions. Health Management Technology made every effort to contact all vendors within this market. Of 50 vendors contacted, 28 responded as offering integration tools. A full contact list may be requested by calling HMT editorial at (303) 220-0600. See The 1994 Health Management Technology Market Directory for complete listings.

Catalogs, Commercial as Topic↗

Tools for advance directives. American Health Information Management Association.

This issue of the Journal of AHIMA contains a Position Statement on advance directives. Here we have included several "tools" or helpful documents to support your organization's ongoing education regarding advance directives. First, we offer a "Sample Policy and Procedure" addressing the administrative process of advance directives. This sample policy was adapted from a policy shared by Jean Clark, RRA, operations director with Roper Hospital in Charleston, SC, and a director on the AHIMA Board of Directors. Do not automatically accept this policy and procedure for your organization. Instead, the health information management professional could use this sample to write your organization's own, specific policy and procedures that are consistent with your state's law and legal counsel's advice. The second article, "Advance Directives and the New Joint Commission Requirements," compares 1992 Joint Commission standards for Patient Rights and The Patient Self-Determination Act requirements. Selected sections from the Joint Commission chapter on Patient Rights are highlighted and comments added that contrast it with the act. "Common Questions and Answers Related to Advance Directives" is the third tool we offer. These questions and answers may be used for a patient education brochure or staff inservice education program outline. Again, information specific to your own state needs to be added. The fourth tool we offer is miniature "Sample Slides" or overhead transparency copy that can be enlarged and used for a presentation on the basics of advance directives for a community group for staff education. We thank Dee McLane, RRA, director, Medical Information Services at Self Memorial Hospital in Greenwood, SC, who developed these slides for presentations conducted at her hospital. We also thank Jeri Whitworth, RRA, who produced the graphics on these slides. Whitworth is a first year director on the AHIMA Board of Directors this year. Again you can use as is or consider these a model as you develop your own presentation geared for your specific audience. Last, but not least, we include samples of a "Living Will Declaration" and a "Durable Power of Attorney for Health Care" forms reprinted with permission from the American Association of Retired Persons (AARP). We include them here so you can examine the language of each type of advance directive. Copies for your organization should be requested from AARP at 1909 K Street NW, Washington, DC 20049, (202) 662-4895. Forms specific to each state are available from The Society for the Right to Die/Concern for Dying at 250 W. 57th Street, New York, NY 10107, (212) 246-6973. The requirement under The Patient Self-Determination Act became effective December 1, 1991, but the educational requirements of the act are meant to be ongoing. These "tools" are to help you continue to be a regular contributor to the educational process in your organization.

Advance Directives↗

Multidisciplinary patient management by means of a high social risk screening tool.

OBJECTIVE: The long-term goal in this study was for the Memorial Hospital of Salem County, Inc (MHSC), to create a seamless system of continuity of care for patients. This continuity of care begins before patients require acute admission through the hospital course and extends beyond discharge and into the post-hospital setting or alternate care situation. DESIGN: In a retrospective study in 1993, through the first 6 months of 1994, it was discovered that MHSC patients experienced a longer-than-average Medicare length of stay than was seen in other hospitals. MHSC embarked on a program to reduce discharge planning request time to the social work and home care departments by using a patient screening system that began at the time of admission. The nursing, social work, and home care departments collaboratively designed a system that allowed for immediate transfer of vital discharge planning information to the social work and home care departments at the time of the patient's admission. A tool was jointly developed called the multidisciplinary patient management record. RESULTS: The benefits of this process far exceeded the cost of implementing the tool. The average skilled nursing facility length of stay decreased below the national average by almost one full day. Patients experienced earlier access to social service intervention: discharge planning needs were identified more accurately; and the social services and home care departments' productivity rose because they could anticipate problems before a crisis arose. CONCLUSIONS: Critical to the success of this overall effort was not designing the new tool, but integrating the tool into a reengineered multidisciplinary patient management process.

Continuity of Patient Care↗

Home health audit tool--at last!

Dissatisfied with the use of an audit tool not applicable to home health nursing, administrators of the Missoula Home Health Agency formed a special audit committee to review audits used by agencies around the country. After examining 50 audit tools, the committee agreed that the Phaneuf public health nursing audit did not adequately emphasize nursing care and charting specific to home health agencies but did fit most of their criteria. After redesigning the Phaneuf audit and testing it through two quarterly audits, the new Missoula Home Health Audit tool has been found very satisfactory. The Missoula Audit emphasizes: 1. home health's goal of independent living and/or self-care; 2. service provider-family-patient relationship; 3. nurse-physician relationship; 4. charting and recording; 5. coordination of careproviders. Unlike many existing audit tools, the Missoula Audit is specific to home health nursing, covers the spectrum of home health services, has sensitive scoring which reflects true differences in quality of care, and initially, at least, appears to be consistent from audit to audit.

Home Care Services↗

Animated simulation: a valuable decision support tool for practice improvement.

Animated computer simulation is a powerful tool for healthcare operation improvement. As a decision support tool, it offers a systematic method to compare alternative approaches to healthcare operations. Because staff interaction is encouraged by this tool, simulation projects facilitate staff team building and process change ownership. Information that is not used as applied knowledge for the purpose of improvement is worthless. Simulation offers management detailed knowledge of processes, enabling management to make better-informed decisions by providing performance data, such as resource usage rates, patient wait times, capacity rates, and process performance information. Alternatives under consideration can be compared and modified without high financial, personal, and customer costs to the healthcare operation. The knowledge gained from each alternative's simulation response variables can be evaluated against set criteria, the status quo, and each other to determine the best option. Current automation systems and software products allow decision makers to use this tool without investing resources in errant options. A simulation project strategy with examples and a case study of change and renovation of a family practice clinic are provided.

Community Health Services↗

Extending a teleradiology system by tools for 3D-visualization and volumetric analysis through a plug-in mechanism.

This paper describes ongoing research concerning interactive volume visualization coupled with tools for volumetric analysis. To establish an easy to use application, the 3D-visualization has been embedded in a state of the art teleradiology system, where additional functionality is often desired beyond basic image transfer and management. Major clinical requirements for deriving spatial measures are covered by the tools, in order to realize extended diagnosis support and therapy planning. Introducing the general plug-in mechanism this work exemplarily describes the useful extension of an approved application. Interactive visualization was achieved by a hybrid approach taking advantage of both the precise volume visualization based on the Heidelberg Raytracing Model and the graphics acceleration of modern workstations. Several tools for volumetric analysis extend the 3D-viewing. They offer 3D-pointing devices to select locations in the data volume, measure anatomical structures or control segmentation processes. A haptic interface provides a realistic perception while navigating within the 3D-reconstruction. The work is closely related to research work in the field of heart, liver and head surgery. In cooperation with our medical partners the development of tools as presented proceed the integration of image analysis into clinical routine.

Humans↗

A student-developed tool for assessing safety in schizophrenic patients.

Schizophrenia is a chronic, disabling disease of mind and behavior. Since some schizophrenics are prone to violence, nursing students devised a safety risk assessment tool to help health care personnel screen clients in acute care settings who may be at risk for violent behavior. The tool is accurate, quick, and user-friendly, and it enhances communication among members of the multidisciplinary health care team. The results obtained from the assessment tool guide nurses and other health care team members in implementing appropriate interventions. Future research and pilot studies are warranted to increase the reliability and validity of this tool.

Humans↗

Use of and satisfaction with a browser-based nurse teaching tool in a surgical intensive care unit.

Our goal was to determine if a computerized teaching tool is an effective teaching method for nurses in a high-stress fast-paced intensive care unit. We also measured the level of satisfaction with this method of instruction. Thirty-six surgical intensive care nurses used a Web-based Microsoft PowerPoint presentation located on the intranet at nursing stations located on the surgical intensive care unit (SICU). The presentation was designed to provide instruction regarding the methodology and use of APACHE III prior to its implementation. Paired t-tests were performed to compare the results of a pretest and posttest. The questions were divided into two types: methodology and use. After the nurses completed their training sessions, they were asked to complete a questionnaire. The questionnaire questions were rated one a 1 to 5 scale. The average scores were higher on the posttest compared to the pretest (63.2% vs. 69.1%, p = 0.03). The methodology scores were higher on the posttest (74.3% vs. 88.2%, p = 0.001), while the use scores remained the same at 78.1% vs. 75.0%. Our Web-based teaching tool is an effective way to train nurses to understand the APACHE III medical system. The tool was effective at conveying the APACHE III medical systems methodology but was not effective in explaining the usefulness of the system. Most important, the nurses thought the browser-based teaching tool was easily accessible and an effective way to communicate new material to the medical staff.

APACHE↗

[Elaboration of a tool for an audit of radiology reports].

PURPOSE: Elaboration of a tool for an Audit of radiology reports in a department of radiology. Materials and methods. We have made a grid and a guide to evaluate the relevance and the quality of the radiology reports. We have tested this tool on 120 reports from in-patients of the gastroenterology department. The test has been done by two radiologists (blinded test) to verify if the answers were identical. We have calculated for each item the Kappa coefficient (inter-observer agreement). RESULTS: This study has validated most of the items of our grid, some have been deleted, and others modified. CONCLUSION: Our study shows that our tool can evaluate the radiology reports of a radiology department, an audit can thus be conducted using that tool.

Humans↗