Maintaining nutrition in aged care residents with a train-the-trainer intervention and Nutrition Coordinator

OBJECTIVE

To investigate the impact of a train-the-trainer program on the nutritional status of older people in residential care.

DESIGN

Prospective, randomized controlled study.

SETTING

Eight nursing homes in Southeast Queensland, Australia.

PARTICIPANTS

A total of 352 residents participated - 245 were female (69.6%). The mean age was 84.2 years and the majority (79.4%) were classified as high dependency.

INTERVENTION

Residents from four nursing homes were randomly selected for a nutrition education program coordinated by Nutrition Coordinators. Residents from the other four nursing homes (control) received usual care.

MEASUREMENTS

The Subjective Global Assessment was used to determine prevalence of malnutrition at baseline and six months post intervention. The Resident Classification Scale measured functional dependency. Prescribed diet, fluids, oral hygiene status and allied health referrals were obtained by chart audit.

RESULTS

Approximately half the residents were well nourished with 49.4% moderately or severely malnourished. Residents in the intervention group were more likely to maintain or improve their nutritional status compared with the control group who were more likely to experience a deterioration (P=0.027). The odds of the control group being malnourished post test was 1.6 times more likely compared with the intervention group but this did not reach statistical significance (P=0.1).

CONCLUSION

The results of the study encourage the implementation of a Nutrition Coordinator program to maintain nutritional status of aged care residents. Nevertheless, malnutrition rates continue to be unacceptably high. In a rapidly aging society, the aged care sector needs to confront malnutrition and provide better resources for staff to take measures against this problem.

The use of the Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) in clinical practice

Forty-four mental health clients completed the Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS)--a self-rating scale to assess the prevalence and intensity of neuroleptic side-effects. In the month prior to the study, 50% of the clients surveyed had experienced more than half of the side-effects outlined on the 41-item scale. A prevalence profile allowed us to rank the frequency of individual side-effects across the sample. Some side-effects such as 'difficulty concentrating', 'difficulty remembering', 'tiredness' and 'restlessness' were experienced by most of the clients in the study while 'unusual skin marks', 'difficulty passing water', 'rashes' were experienced by a few. A prevalence profile may be a useful guide in developing strategies for managing side-effects more effectively in small groups of clients. In addition, the use of the LUNSERS in clinical practice would enable case managers to establish baseline measures for individual clients and evaluate changes in medication and other non-medical strategies for reducing unwanted side-effects. The identification and assessment of antipsychotic side-effects is an important area for client and professional carer education.

Enhancing case managers' skills in the assessment and management of antipsychotic medication side-effects

OBJECTIVE

Our goal was to reduce the prevalence of antipsychotic medication side-effects by providing a short-term training program on the assessment and management of side-effects to case managers.

METHOD

Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in which they resided. While case managers working with the intervention group attended a short-term training program to improve their assessment and management of neuroleptic side-effects, case managers providing services to the comparison group received no additional training. Side-effects were assessed pre- and postintervention using the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS).

RESULTS

A reduction in the overall prevalence of side-effects in both groups was observed, however, only those patients in the intervention group reported a statistically significant reduction in mean side-effect scores between the pre- and postmeasures (Wilcoxon Matched Pairs Signed-ranks Test, z = -2.8411, two-tailed, p < 0.01). In addition, qualitative data collected during the second survey revealed that patients in the intervention group had acquired some positive management strategies for dealing with unwanted side-effects. The strategies were elicited from eight different patients distributed across six of the 12 case managers who took part in the training program.

CONCLUSIONS

Training cases managers in the assessment and management of side-effects may help to reduce their impact on the lives of people prescribed neuroleptic medication.

Treating skin tears in nursing home residents: a pilot study comparing four types of dressings

A pilot study was conducted to compare four types of dressings used to treat skin tears in nursing home residents. Wounds treated with a non-occlusive dressing healed more quickly than those dressed with occlusive dressings. The results suggest that ease of use and product wastage are important considerations when treating skin tears. The pilot study also highlights the need for further research into skin tear management and the need for ongoing education for nurses regarding skin integrity risk assessment and product information.

Exploring the everyday world of the patient in isolation

PURPOSE/OBJECTIVES

To explore the phenomenon of isolation from the perspective of patients cared for in reverse isolation for bone marrow transplant (BMT).

DESIGN

Interpretive, phenomenologic.

SETTING

Hematology and bone marrow transplant unit of a large teaching hospital in Brisbane, Australia.

SAMPLE

Seven patients undergoing BMT.

METHODS

Phenomenologic interviews and thematic analysis of transcribed data.

MAIN RESEARCH VARIABLE

Patient's day-to-day experiences of reverse isolation.

FINDINGS

Although appreciative of the physical care and attention given to them, participants did not convey a sense that healthcare professionals understood the experience of the BMT recipient's isolation or illness from their perspective. Major themes elicited from analysis of the transcripts included (a) striving to take charge, which refers to participants' attempts to maintain control in a seemingly out-of-control situation. (b) intellectualizing the need for isolation, and (c) being in touch: contact with family and staff.

CONCLUSIONS

Elements of caring for the patient appeared to dominate the comments associated with staff contact. Other forms of care (e.g., caring about) emphasize the importance of nurses understanding and connecting with peoples' meanings and experiences of their illness and treatment.

IMPLICATIONS FOR NURSING PRACTICE

Although all participants were aware that they could ask for information about their diagnosis and treatment at any time, most had not been offered the opportunity to describe their feelings or experiences before. Unless nurses take more initiative to gain insight and a greater appreciation of the patient's understanding of his or her situation, they will continue to focus on unidimensional aspects of care and neglect the multidimensional or holistic nature of nursing care.

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.

Coping with schizophrenia: what does the spouse need to know?

The increasing dependence on community-based care for individuals with major mental health disorders such as schizophrenia has led to concern about the physical, emotional and social effects on the family, however the nature and extent of these effects, particularly for spouses/partners, are not generally known. This paper presents descriptive findings from a pilot study designed to explore the phenomenon of caregiving from the perspective of partners living with a schizophrenia sufferer. Data were collected via in-depth interviews with 14 participants, 12 of whom were still living with their partner. The interviews were tape recorded and subsequently transcribed for thematic analysis with The Ethnograph software. While a number of significant themes were identified, this paper focuses on partners' understanding of schizophrenia and other information needs. It concludes that psychiatric nurses have a significant role to play in educating family members about the illness and its long term consequences.

Nurses' perceptions of their problem-solving ability

A problem-solving approach to nursing practice has been advocated in the nursing literature for some time. However, the extent to which nurses perceive themselves as capable problem solvers or improve their problem-solving ability during their nursing education is not generally known. The purpose of this study was to determine the relationship between nurses' perceptions of their problem-solving ability and their course of study. The Problem-Solving Inventory (PSI) was developed by Heppner and colleagues (1982) to assess attitudes towards and perceptions of problem-solving behaviour. The instrument provides a global appraisal of oneself as a problem solver and assesses perceptions of problem-solving ability. In this study, data were collected from 67 pre and post-registration nursing students in two phases; during their course and on completion of their course. Data from each phase were compared to identify changes in perception of problem-solving behaviour over time. While there was no overall improvement in perceptions of problem-solving ability by phase 2, confidence in problem solving had improved significantly (P less than 0.01). There were improvements according to age, experience, and course being undertaken for the likelihood of approaching rather than avoiding problems, and having personal control over problem solving.

Primary systemic therapy for breast cancer

The use of primary systemic chemotherapy for the treatment of 'operable' breast cancer evolved from the need to improve the outlook of patients with disease that is locally advanced but apparently without metastases. Trials are now showing that this can also be a worthwhile approach to the treatment of primary breast cancer in the elderly.

The use of videotape programs to teach interpersonal skills

Interpersonal skills training evolved rapidly in recent years as teachers began to exploit the distinct advantages of "live" and simulated presentations in videotapes and films as teaching aids. At the same time, psychologists and psychiatrists started to define the basic aspects of interpersonal relations. Many used prepared scripts to produce videotape programs that modeled human interactions. While clinical experience and formal studies clarified some characteristics of effective visual training programs, the impact of dramatic and technical elements in these productions was not fully explored. In the present paper, the authors review the nature of interpersonal skills and the current status of visual aids for teaching human relations and show how videotape productions with characters, a story line, and action sequences can enhance learning. The experience of producing a series of videotapes about prehospital emergency care is used as a paradigm for discussing how theatrical techniques, applied through discrete production steps, can reinforce training goals and appeal to a wide range of students with diverse learning styles.