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Overseeing medication-taking is a critical aspect of dementia caregiving. This randomized controlled trial examined the efficacy of a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basic aspects of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had decreases in medication management problems as measured by the MedMaIDE (F=6.91, p

Purpose . Interprofessional collaborative practice (IPCP) has been advocated to overcome challenges related to rural healthcare and substance abuse. The investigators evaluated the effectiveness of an online interprofessional education (IPE) program to improve health care professionals’ perceptions in treating people with substance use and identified the challenges of conducting IPE. Sample . Sample included 106 healthcare professionals (nurses, behavioral health counselors, and public health workers) from rural areas in Pennsylvania, Ohio, and West Virginia. Method. This prospective study utilized a quasi-experimental design with healthcare professionals who received a 6-hour online IPE regarding substance abuse. Measures were the Alcohol & Alcohol Problems Perception Questionnaire (AAPPQ) and the Drug & Drug Problems Perception Questionnaire (DDPPQ). Findings. Perceptions of alcohol (i.e., role adequacy and role support) and drug (i.e., role adequacy, role legitimacy, sole support, and work satisfaction) problems were improved after training (Ps < .05). Competing priorities, leadership support, technology, rural culture, and fiscal consequences were addressed as challenges during project implementation. Conclusion. The IPE program improved the participants’ attitudes and perceptions toward working with patients who struggle with substance abuse. Rural nurse managers can influence professionals in a range of clinical team settings to improve safety and quality of health care through IPCP. Challenges experienced by rural healthcare professionals can be resolved by the leadership support. Consequently, the leadership of nurse management can favorably impact patient healthcare outcomes by reinforcing IPE. DOI: http://dx.doi.org/10.14574/ojrnhc.v16i1.385

Purpose Nocturia, a common cause of disturbed sleep quality and next-day fatigue, may contribute to difficulty with diabetes self-management. The purpose of this study was to examine the effect nocturia has on next-day subjectively measured mental and physical energy and objectively measured physical activity. Methods This secondary analysis utilized sleep diaries over one week which measured nocturia frequency and other sleep quality indicators (wake after sleep onset, sleep quality and sleep duration) along with next-day reports of mental and physical energy. Next-day physical activity was measured with the BodyMedia Sensewear armband. Results Sleep quality and sleep duration were associated with next-day physical and mental energy. Nocturia frequency (≥2 times per night) was associated with increased next-day sedentary activity. Conclusion These results suggest that nocturia could negatively affect next-day physical activity in people with diabetes.

Objective To examine the prevalence of symptom-related mobility disability and identify specific symptoms and other factors associated with mobility disability among a national sample of ovarian cancer (OC) survivors. Methods Descriptive, correlational secondary analysis of a National Ovarian Cancer Coalition mailed survey of women with a history of OC ( n =713). We used the Symptom Representation Questionnaire (SRQ), the MD Anderson Symptom Inventory (MDASI) Interference Scale, and medical and demographic information to determine prevalence of symptom-related mobility disability. We constructed a multiple linear regression model to determine the relative contributions of specific symptoms and other factors to mobility disability. Results A majority of the sample (60.0%) reported symptom-related mobility disability. Independent predictors included: > one comorbidity (β=0.112, p =0.001), active OC (β=0.111, p =0.037), abdominal bloating (β=0.097, p =0.006), fatigue (β=0.314, p p =0.045), numbness/tingling (β=0.134, p p 2 =0.415). Unexpectedly, age (β=−0.028, p =0.412) and current chemotherapy (β=0.107, p =0.118) were not significant predictors. Conclusions Symptom-related mobility disability is common among women with OC and is associated with medical comorbidities, abdominal bloating, fatigue, lack of appetite, numbness/tingling, and pain. Longitudinal research should clarify the relationship of these symptoms to mobility disability and determine whether effective symptom management minimizes disability.

Although substance use is prevalent in the United States, the majority of people who misuse substances do not receive appropriate treatment. This paper describes, (1) an interprofessional education (IPE) program for health professionals to provide Screening Brief Intervention and Referral to Treatment to rural substance use patients, and (2) compares registered nurses' [RNs] and behavioral health professionals' [BHPs] attitudes to work with those patients and their perceptions on IPE. A data analysis of 62 RNs and 36 BHPs shows statistically significant increases in both attitudes and perceptions. This paper discusses the implications of the IPE program vis-a-vis substance use treatment.

The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured.To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit.Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication.Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards).Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.

Objective To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients. Design Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurse–patient dyad for communication frequency, quality and success. Patients self-rated communication ease. Setting Two ICUs in a university-affiliated medical center. Participants 89 intubated patients awake, responsive and unable to speak and 30 ICU nurses. Main results Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC + SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p Conclusions This study provides support for the feasibility, utility and efficacy of a multi-level communication skills training, materials and SLP consultation intervention in the ICU.

This study examined the concordance between multiple measures of adherence, as well as sensitivity to detection of poor adherers, specificity, and predictive validity using a daily cholesterol-lowering regimen. Participants ( N = 180) aged 24 to 60 years participated in an adherence ancillary study in a clinical trial. Males constituted 53.9% of this well-educated, community sample. Data on adherence were collected over a 6-month period, using electronic monitoring, self-report, specific recall, and pill counts. Electronically monitored (odds ratio [OR] = 5.348) and Shea self-report (OR = 2.678) predicted cholesterol lowering. Days (78.9%) and intervals (84.2%) adherent and the Shea (73.7%) were sensitive to the detection of poor adherers. Moderate associations were found between measures of the same type. Low correlations were found otherwise. The electronic monitor was the most accurate and informative measure. The Shea self-report was the most accurate brief, global estimate of adherence. Other measures were not associated with clinical outcome or sensitive to poor adherence.

Objective.This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity.Setting.Subjects (N=37) being evaluated for OSA were recruited from a sleep clinic.Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD=7.35;median BMI=32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr).Measurements.Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity.Results.Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patient's age, sex, and ESS.Conclusion.Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

Much of the research of the past few decades has approached adherence from a global perspective. The multiple processes underlying adherence to medical advice have not been examined for the identification of phase-specific covariates or for the identification of phase-specific interventions. This chapter reviews the multiple processes that underlie adherence including the phases of adoption through continuance, the influence of measurement and analysis strategies, as well as the impact of a global approach on the identification of predictors and interventions. It is recommended that future research examine more specifically each phase in the process of adhering using sensitive measures and analytic approaches appropriate to the measures and the distribution of data.

Purpose/Objectives—To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. Design—Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. Setting—School of Nursing at the University of Pittsburgh. Sample—The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. Methods—Analysis of existing comorbidity and symptom data collected from both studies. Main Research Variables—Symptom clusters, chronic disease, and cancer as a comorbidity. Findings—Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. Conclusions—The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. Implications for Nursing—Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical.

Objectives Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS). Background SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown. Methods Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated ≥2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009–2011 with blinded retrospective medical record abstraction. Main results 323/383 (84%) nurses completed training; their communication knowledge ( p p p = .44), heavy sedation ( p = .73), pain score documentation ( p = .97), presence of ICU-acquired pressure ulcers ( p = .78), coma-free days ( p = .76), ventilator-free days ( p = .83), ICU length of stay ( p = .77), hospital length of stay ( p = .22), and median costs ( p = .07) did not change. Conclusions SPEACS improved ICU nurses' knowledge, satisfaction and comfort in communicating with nonvocal MV patients but did not impact patient care quality or resource use.