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Introduction Reminiscence therapy has been shown to improve mental health and quality of life in dementia; however, reminiscence therapy is often delivered by therapists instead of being technology-enabled. This study evaluated the preliminary efficacy of Memory Matters (MM), an iPad reminiscence game on mood, social interaction, quality of life, and behavioral and psychological symptoms of dementia. Methods This pilot study used an experimental design where participants were randomized on a 2:2:1 ratio to three arms: individual MM (one-on-one with an interventionist), group MM (2–3 participants per session), or waitlist control. MM was delivered for 30 minutes a session, twice a week for six weeks, followed by six-week self-play. Outcomes were assessed at the baseline, six weeks, and 12 weeks by data collectors blinded to group allocation. Data were analyzed using intention-to-treat analysis and analysis of covariance. Results The sample (n = 80) was 82.1 ± 7.8 years in age with 58% female, 15.3 ± 3.3 years of education. Mood did not differ, except for apathetic mood between group MM and control arm at 12 weeks (P = .051). Social interaction improved for individual MM compared with group MM (t = 2.38, P = .017) and control (t = 2.84, P = .005) at six weeks, but not 12 weeks. Other outcomes did not differ. Discussion MM improved social interaction and possibly mood. Future studies are needed to evaluate the efficacy of MM with a sufficient sample size.

Background Optimizing early education in gynecological procedures utilizing an Enhanced Recovery after Surgery (ERAS) program and a bundle concept may optimize patient outcomes after surgery. Purpose Evaluate whether an ERAS bundle compared to standard education can affect length of stay, 30 day readmission, and patient satisfaction among patients undergoing gynecologic surgery. Design Prospective, comparative, randomized design Setting 28 bed Medical Surgical Unit Sample/Intervention 50 patients undergoing hysterectomy, 25 who received post-operative evidence based bundle/standard education, and 25 who received standard education packet. Bundle components included 1) early mobilization, 2) early transition to oral pain medication, 3) early feeding, and 4) chewing gum. A follow-up phone call was made in two to three days following discharge for both groups utilizing teach-back. Results 84% (n = 21) patients in the bundle group were discharged in one day. There were no 30 day readmissions for both groups. Twenty two (88%) participants met the bundle components 100% of the time. For the indicator “walking helped with recovery” 100% (n = 25) responded “very good to excellent” for bundle group and 96% (n = 24) responded “very good to excellent” for standard group. Twenty three (92%) of the bundle group felt that that overall nursing care received was very good to excellent and 24 (96%) of the general group felt that overall nursing care received was very good to excellent. Conclusion Optimizing peri-operative education using a bundle approach to provide evidence based interventions can minimize risk and enhance early recovery for females undergoing gynecological surgery.

Background Workplace stress can affect nurse satisfaction. Aroma therapy as a therapeutic use of essential oil can be beneficial in reducing stress. Purpose Assess perceived stress pre-post introduction of Essential Oil Lavender among registered nurses, charge nurses, and patient care technicians in a trauma intensive care unit, surgical specialty care unit and an orthopedic trauma unit. Methods Pre-post intervention with a quasi-experimental design. After a pre-survey, Essential Oil Lavender was diffused 24 h per day over 30 days in a designated nursing area that all nurses were not required to enter on each unit. Results Dependent sample t-test for “how often do nurses feel stressed a work in a typical week” revealed pre-survey mean 2.97 (SD = 0.99) which was significantly higher than post-survey mean 2.70 (SD = 0.92) with significance, t(69) = 2.36, p = 0.021, suggesting a difference in how often staff felt stressed at work in a typical week, trending down from “feeling stressed half of time” to “once in a while”. There were no statistically significant differences in pre-post survey scores for TICU, TOU, or SSC as separate units. Relevance Use of essential oils to decrease work-related stress among nursing staff may improve retention, workplace environment, and increase nurse satisfaction.

Purpose Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. Methods Randomised controlled trial, 40 patients aged 55 and older. Intervention Participants randomly assigned to receive music listening or usual care for 60 minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses. Outcomes Heart rate, respiratory rate, systolic and diastolic blood pressure, confusion assessment method. Results Repeated measures ANOVA, F(4, 134) = 4.75, p = .001, suggested statistically significant differences in heart rate pre/post music listening, and F(1, 37) = 10.44, p = .003 in systolic blood pressure pre/post music listening. Post-hoc analysis reported changes at three time periods of statistical significance; (p = .010), (p = .005) and (p = .039) and a change in systolic blood pressure pre/post music listening; (p = .001) of statistical significance. All participants screened negative for delirium. Conclusion Music addresses pathophysiologic mechanisms that contribute to delirium; neurotransmitter imbalance, inflammation and acute physiologic stressors. Music to prevent delirium is one of few that provide support in a critical care setting.

Summary Objective Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. Methodology/design/setting Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. Outcome measures Change in practice and beliefs regarding delirium. Results McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction. Changes in "Delirium is largely preventable", were statistically significant ( p =0.035). Haldol was the medication of choice for treating delirium, with an increase in use ( p =0.062) post-intervention. The majority of participants believed a high percentage of patients experience delirium in a trauma intensive care. The two most frequent medical complications associated with delirium pre-questionnaire was over sedation 8 (22%) and falls 9 (24%) and in post-questionnaire, over sedation 12 (26%) and falls 13 (28%). Conclusions An educational intervention emphasising the importance of screening for delirium, risk factors for delirium and approaches to decrease the incidence of delirium can improve identifying and correctly treating delirium in a critical care setting. An educational program had concrete results in respondents' knowledge about delirium.

Three captive-born (5-day-old, 8-day-old, and 4-yr-old) Asian elephants (Elephas maximus) and one captive-born 22-yr-old African elephant (Loxodonta africana) from three private elephant facilities and one zoo in the United States presented with depression, anorexia, and tachycardia as well as gastrointestinal signs of disease including abdominal distention, decreased borborygmi, tenesmus, hematochezia, or diarrhea. All elephants showed some evidence of discomfort including agitation, vocalization, or postural changes. One animal had abnormal rectal findings. Nonmotile bowel loops were seen on transabdominal ultrasound in another case. Duration of signs ranged from 6 to 36 hr. All elephants received analgesics and were given oral or rectal fluids. Other treatments included warm-water enemas or walking. One elephant underwent exploratory celiotomy. Three animals died, and the elephant taken to surgery was euthanized prior to anesthetic recovery. At necropsy, all animals had severe, strangulating intestinal lesions.

Summary Objectives Evaluate change in ventilator associated pneumonia (VAP) and nurse's attitudes, beliefs post implementation of an evidence based practice (EBP) oral hygiene protocol. Methodology/design/setting Descriptive pre and post test design in two critical care units in a Level One Trauma Community Hospital. Oral hygiene protocol data was reanalysed to examine effects in medical surgical and trauma subgroups. Outcome measures Oral care practices, attitudes and beliefs among nurses, and VAP rates according to Centers for Disease Control and Prevention guidelines. Results Trauma rates increased from 6.4% to 10.0% ( p = 0.346), and medical/surgical rates decreased from 3.3% to 1.0% ( p = 0.042). Results revealed changes in nurses’ beliefs regarding pre-admission colonisation ( p = 0.027) and having adequate training. Nurses’ perception of facility support improved, by having suitable equipment and readily available supplies. Foam swabs with moisture agents at 4 hours or less was 88.6% and toothbrush use at 12 hours or less was 71%, with significant changes in frequency of oral care post intervention. Conclusions Trauma patients present with unique characteristics which compromise oral care. Understanding risk and prognostic factors, mechanisms of transmission and systemic inflammatory response are important when implementing EBP protocols. Nurses’ attitudes, beliefs are important, and staff adherence considered when initiating EBP changes.