California story book.

Printed by Stanley-Taylor. Cf. Barr p.159.

Extending the human life span : social policy and social ethics /

"NSF/RA 770123."

California older adult Stroop test (COAST): Development of a Stroop test adapted for geriatric populations

An adaptation of the traditional Stroop test, the California Older Adult Stroop Test (COAST) (Pachana, Marcopulos, Yoash-Gantz & Thompson, 1995), has been developed specifically for use with a geriatric population, utilizing larger typeface, fewer items (50) per task, and more easily distinguished colors (red, yellow and green). Test-retest reliability and validity data are reviewed for both control and clinical populations. Increased error rates on the Stroop test compared to the COAST were found for the color and color/word interference tasks. These results are discussed in terms of changes in the visual system with increasing age. The implications for better test sensitivity with the COAST for older adult populations are discussed.

Assessment of social cognition in bipolar disorder

Background: Impairment in social cognition may contribute to deficits in social functioning in patients with bipolar disorder (BD). In this study, a complex social cognition task was administered during a neuroimaging session. The behavioral and neural correlates of social cogniton in patients with BD were compared to healthy comparison (HC) subjects. Methods: The task was administered to 25 HC and 25 patients with depression scores ranging from euthymic to depressed at the time of assessment. The task required participants to evaluate situations that were “enhancing” or “threatening” to self-esteem, directed at both oneself, and at other people. For instance, self-esteem enhancing scenarios involved vignettes of activities such as receiving praise during a sports game, while a threatening scenario involved, for example, receiving criticism at a party. Participants were then required to evaluate characters in the scenarios on the basis of positive (“kind”) or negative (“mean”) descriptors. Evaluations were classified from extremely negative to extremely positive. The frequencies of behavioral responses were analyzed using chi-square tests and fMRI data were analyzed using Statistical Parametric Mapping software. Results: Patients differed significantly from HCs in their evaluation of threatening scenarios, directed at both oneself and at other people (p<0.001). Patients had a lower proportion of responses in the neutral category, and more responses in the positive and negative categories, relative to HCs. Neuroimaging results reveal differential patterns of prefrontal-cortical and limbic-subcortical activation in BDs throughout the task [p<0.05 (unc.)]. Conclusions: Findings will contribute to understanding difficulty in interpersonal functioning in patients with BD.

An examination of attitude toward change as a predictor of policy/program implementation

Policy/program implementation, e.g., the process of fulfilling policy/program directives, is fundamentally tied to change. Implementation studies have examined the process, identifying many critical organizational variables although individuals perform the activities.^ Many of the studies are predicated on the rational, goal oriented model of organizations and examine implementation, presenting only the goal-oriented view. Organizational change and its resistance, however, are not fully explained by the rational model of organizations. There are other schools of thought providing different views of organizations from which explanation may emerge. Bolman and Deal (1984, 1991a, 1994) provide a different perspective for examining organizations Bolman and Deal argue organizations should be viewed through four different frames or lenses. Framing and reframing organizational action captures the complexity of action and provides better understanding of organizational processes. Understanding of implementation of policies/programs also will benefit from the use of the four-frame approach.^ The goal of this research is to provide a better understanding of the implementation process by examining individual attitudes toward change, the dependent variable of this research, and studying the relationship between the dependent variable and frame. The research was conducted in two phases. In Phase One, a survey was sent to 306 school administrators and teachers in magnet programs in Dade County, Florida. The survey instrument was composed of 55 questions including six from Bolman and Deal's Leadership Orientation Survey (1988) and 38 questions about organizational change. In Phase Two, more in-depth analysis of four school was conducted, to further explore the relationship between frame and attitude toward change.^ The results revealed that frame was a factor in explaining differences in personal Attitude Toward Change and Comfort Level with Change. Individuals using the symbolic frame had more positive attitudes toward change and were also more comfortable with change. The results of Phase Two of the research partially supported this finding in that the most fully implemented program was the product of an administrator who had chosen the symbolic frame. ^

Family needs of critically ill patients in the emergency department

INTRODUCTION: Family members' experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses. METHODS: A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory. RESULTS: Family members ranked needs related to 'communication with family members,' as most important, followed by 'family member participation in emergency department care', 'family member support' and 'organizational comfort'; rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to 'communication with family members' and 'family members' participation in emergency department care'. CONCLUSIONS: Family members place greater importance than emergency nurses on the need for effective communication.

Assuaging death anxiety in older overseas-born Australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care

BACKGROUND: Death anxiety is a known phenomenon in older people of culturally and linguistically diverse backgrounds (CALD) hospitalised for end-of-life (EOL) care . Little is known about how nurses assuage death anxiety in this population. AIMS: To investigate strategies used by nurses to assuage death anxiety and facilitate a good death in older CALD Australians hospitalised for EOL care.

METHODS: Advanced as a qualitative descriptive inquiry, a purposeful sample of 22 nurses was recruited from four Victorian healthcare services. Interviews were transcribed verbatim and analysed using thematic analysis processes.

FINDINGS: Nurses used three key strategies: recognising death anxiety; delineating its dimensions; and initiating conventional nursingcaring behaviours to help contain it. Contrary to expectations, cultural similarities rather than differences were found in the strategies used.

CONCLUSIONS: Nursing strategies for recognising, delineating, and managing death anxiety in older CALD people hospitalised at the EOL is an important component of quality EOL care.

The acceptance of nursing information systems: an analysis using UTAUT

Nurses are the largest group of health-care professionals in hospitals providing 24-h care to patients. Hence, nurses are pivotal in coordinating and communicating patient care information in the complex network of health-care professionals, services, and other care processes. Further, surveillance and timely interventions by nurses impact quality of care, reduce errors, and decrease health-care costs. Information communication technologies (ICTs) provide the capabilities to support many aspects of nursing care. However, within the context of acute nursing care, there is a lack of integrated technology solutions to support the complex interactions associated with nursing activities and thereby the delivery of high-quality and safe care. Generally, to date, the literature reports low levels of acceptance of ICT solutions by nurses. To address this, the following discussion serves to examine nurses’ acceptance of an integrated point-of-care solution for acute nursing contexts. The ICT was specifically designed to be sensitive to nurses’ needs with the expectation that this will lead to high levels of user acceptance. An evaluation of the acceptability of the proposed solution is presented using unified theory of acceptance and use of technology (UTAUT). Through the UTAUT lens, initial reactions of the participating nurses were examined. The findings provided us with feedback to redesign the solution to better fit with the dynamics and complexity of nursing care. The study has implications for theory, including using UTAUT in health-care contexts, and for practice, including recommendations for the design and development of ICT solutions suitable for nursing contexts.

Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety

OBJECTIVES: To examine quality and safety in inter-professional clinical handovers in Post Anaesthetic Care Units (PACUs) and make recommendations for tools to standardize handover processes.
DESIGN: Mixed methods combining data from observations and focus groups.
SETTING: Three PACUs, one public tertiary hospital and two private hospitals.
PARTICIPANTS: Observations were made of 185 patient handovers from anaesthetists to nurses. Eight focus groups were conducted with 62 staff (15 anaesthetists and 47 nurses) across the study sites.
INTERVENTION: Inter-professional clinical handovers in PACU's.
MAIN OUTCOME MEASURES: Characteristics of the structure and processes that support safe inter-professional PACU handover practice.
RESULTS: Characteristics of the process, content, activities and risks during anaesthetist to nurse patient handover into the PACU were integrated into four steps in the PACU handover process summarized by the acronym COLD (Connect, Observe, Listen and Delegate), a verbal communication tool (ISoBAR), a checklist of critical information for safe patient transfer into PACU and a matrix of factors perceived to increase handover risk.
CONCLUSIONS: The standard structure and checklists for optimal content of patient handovers were derived from existing practices and consensus, hence, expected to provide ecologically valid and practical resources to improve quality and safety during clinical handovers in the PACU.

Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: multimedia intervention for managing patient experience (MIME). Study protocol for a cluster randomised crossover trial

BACKGROUND: Patient participation is an important indicator of quality care. Currently, there is little evidence to support the belief that participation in care is possible for patients during the acute postoperative period. Previous work indicates that there is very little opportunity for patients to participate in care in the acute context. Patients require both capability, in terms of having the required knowledge and understanding of how they can be involved in their care, and the opportunity, facilitated by clinicians, to engage in their acute postoperative care. This cluster randomised crossover trial aims to test whether a multimedia intervention improves patient participation in the acute postoperative context, as determined by pain intensity and recovery outcomes.

METHODS/DESIGN: A total of 240 patients admitted for primary total knee replacement surgery will be invited to participate in a cluster randomised, crossover trial and concurrent process evaluation in at least two wards at a major non-profit private hospital in Melbourne, Australia. Patients admitted to the intervention ward will receive the multimedia intervention daily from Day 1 to Day 5 (or day of discharge, if prior). The intervention will be delivered by nurses via an iPad™, comprising information on the goals of care for each day following surgery. Patients admitted to the control ward will receive usual care as determined by care pathways currently in use across the organization. The primary endpoint is the "worst pain experienced in the past 24 h" on Day 3 following TKR surgery. Pain intensity will be measured using the numerical rating scale. Secondary outcomes are interference of pain on activities of daily living, length of stay in hospital, function and pain following TKR surgery, overall satisfaction with hospitalisation, postoperative complications and hospital readmission.

DISCUSSION: The results of this study will contribute to our understanding of the effectiveness of interventions that provide knowledge and opportunity for patient participation during postoperative in-hospital care in actually increasing participation, and the impact of participation on patient outcomes. The results of this study will also provide data about the barriers and enablers to participation in the acute care context.

The first year: the support needs of parents caring for a child with an intellectual disability

AIM: To describe the support needs of parents caring for a child with an intellectual disability in the first year of life. BACKGROUND: Parents of children with intellectual disabilities face significant challenges during the first year of their child's life which is an important developmental period not previously addressed in the literature. The provision of support by health professionals, particularly nurses and midwives, during this crucial period can impact on parental well-being and on the health and developmental outcomes of their children. However, parents often feel unsupported. DESIGN: The study used a qualitative descriptive methodology. METHODS: Semi-structured interviews were conducted with parents of eleven children with an intellectual disability in Victoria, Australia, during 2014. Interviews were digitally recorded, transcribed verbatim and analysed using thematic data analysis. FINDINGS: Three key areas of support need were identified to assist parents to provide effective care for their child with an intellectual disability in the first year of life: (1) emotional support as parents adjusted to their role of caring for a child with an intellectual disability; (2) information support as they embarked on a quest for knowledge; and (3) support to facilitate their connection to peer networks. The findings highlighted inconsistent provision of support for parents. CONCLUSION: This study informs health professionals about how to provide holistic, timely support to parents of children with intellectual disabilities in the first year of life. There is an urgent need to review how nurses and midwives can provide relevant support that is responsive to parents' needs.