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Supplemental digital content is available in the text. Background: Many patients live with communication disorders that present significant challenges during interactions with health care providers across settings. Yet, nurses receive little to no training in how to communicate with communication impaired patients. Purpose: The purpose of this study was to determine the feasibility and acceptability of delivering the Study of Patient-Nurse Effectiveness With Assistive Communication Strategies (StudentSPEACS) program to prelicensure nursing students and to describe student clinical applications of this content in the year following the communication training. Methods: We used mixed methods to describe student perceptions of StudentSPEACS content and application of content in clinical encounters. Results: Junior nursing students (n = 86, 53.75%) responded to the survey. Students rated content as very valuable and rated their overall ability to communicate with patients after the training program as average. Students provided 48 clinical case application exemplars. Conclusions: The StudentSPEACS program can help prelicensure nursing students acquire and practice communication skills with patients who have communication impairments. [ABSTRACT FROM AUTHOR]

Objectives: Severe infections, often requiring ICU admission, have been associated with persistent cognitive dysfunction. Less severe infections are more common and whether they are associated with an increased risk of dementia is unclear. We determined the association of pneumonia hospitalization with risk of dementia in well-functioning older adults. Design: Secondary analysis of a randomized multicenter trial to determine the effect of Gingko biloba on incident dementia. Setting: Five academic medical centers in the United States. Subjects: Healthy community volunteers (n = 3,069) with a median follow-up of 6.1 years. Interventions: None. Measurement and Main Results: We identified pneumonia hospitalizations using International Classification of Diseases, 9th Edition-Coding Manual codes and validated them in a subset. Less than 3% of pneumonia cases necessitated ICU admission, mechanical ventilation, or vasopressor support. Dementia was adjudicated based on neuropsychological evaluation, neurological examination, and MRI. Two hundred twenty-one participants (7.2%) incurred at least one hospitalization with pneumonia (mean time to pneumonia = 3.5 yr). Of these, dementia was developed in 38 (17%) after pneumonia, with half of these cases occurring 2 years after the pneumonia hospitalization. Hospitalization with pneumonia was associated with increased risk of time to dementia diagnosis (unadjusted hazard ratio = 2.3; CI, 1.6-3.2; p < 0.0001). The association remained significant when adjusted for age, sex, race, study site, education, and baseline mini-mental status examination (hazard ratio = 1.9; CI, 1.4-2.8; p < 0.0001). Results were unchanged when additionally adjusted for smoking, hypertension, diabetes, heart disease, and preinfection functional status. Results were similar using propensity analysis where participants with pneumonia were matched to those without pneumonia based on age, probability of developing pneumonia, and similar trajectories of cognitive and physical function prior to pneumonia (adjusted prevalence rates, 91.7 vs 65 cases per 1,000 person-years; adjusted prevalence rate ratio = 1.6; CI, 1.06-2.7; p = 0.03). Sensitivity analyses showed that the higher risk also occurred among those hospitalized with other infections. Conclusion: Hospitalization with pneumonia is associated with increased risk of dementia. [ABSTRACT FROM AUTHOR]

Critical care researchers, clinicians, and implementation scientists embrace the ABCDEF ("A" for Assessment, Prevention, and Manage Pain; "B" for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; "C" for Choice of Analgesia and Sedation; "D" for Delirium Assess, Prevent, and Manage; "E" for Early Mobility and Exercise; "F" for Family Engagement and Empowerment) bundle as the fundamental regimen for liberation from mechanical ventilation and optimizing ICU patients' neurocognitive and physical functional outcomes. If family engagement is intended to substitute for patient communication or if the family is intended to serve as the patient's interpreter and voice, that is not consistent with evidence from research on both the patient and family experience ([3], [4]). The ABCDEF bundle will be truly patient-centered and best positioned to deliver on its promise when assistive communication strategies tailored to the patient's abilities and preferences are included in bundle implementation. [Extracted from the article]

Event analysis (EA), a qualitative research technique adapted from the fields of anthropology and sociology, can be used to describe and explain social interactions and behaviors associated with complicated clinical situations. Event analysis is useful in limiting the focus of data collection in complex settings and in obtaining and managing multiple perspectives about an event of interest while situating the event within appropriate social and environmental contexts. This article reviews contemporary uses of EA in clinical nursing research, describes the modification and application of EA techniques to common methods of data gathering (observation, interview, and document review) in clinical settings, and presents recommendations for conducting EA in clinical settings by using exemplars from a current study. [ABSTRACT FROM AUTHOR]

Traditionally, the intensive care unit (ICU) has focused on reversal of life-threatening illness. Patients with incurable cancer admitted to the ICU present unique challenges for clinicians when these patients transition to end-of-life (EOL) care. A dimensional analysis of a single case study from a larger 30-case ethnographic study was used to explore the cancer patient's transition to EOL care in the ICU. Family members and clinicians had different expectations of care, which resulted in divergent treatment goals and desires for the patient, a 62-year-old woman with presumed pneumonia and underlying terminal glioblastoma multiforme. The attending physician and palliative care consultant unified family members' and clinicians' divergent goals and desires through a mediating process of probing the family about the patient's wishes. This process unified those involved and brought them to a place of acceptance. This case illustrates the turning point and rationale for the shift to EOL care in the ICU and the important role that communication plays in the transition. Understanding individual and family processes and family members' need for time to adjust to the transition to EOL is an essential element of practice within ICUs that increasingly manage terminally ill cancer patients.

Event analysis (EA), a qualitative research technique adapted from the fields of anthropology and sociology, can be used to describe and explain social interactions and behaviors associated with complicated clinical situations. Event analysis is useful in limiting the focus of data collection in complex settings and in obtaining and managing multiple perspectives about an event of interest while situating the event within appropriate social and environmental contexts. This article reviews contemporary uses of EA in clinical nursing research, describes the modification and application of EA techniques to common methods of data gathering (observation, interview, and document review) in clinical settings, and presents recommendations for conducting EA in clinical settings by using exemplars from a current study.