Characteristics and functional outcomes of elderly rehabilitation patients.
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Activities of Daily Living↗
Biomedical subjects
L C Mion
Publications and source records attributed to L C Mion.
Falls in the rehabilitation setting: incidence and characteristics.
A prospective six-month study was conducted to determine a high-risk index for medical rehabilitation patients who fall. Variables studied for all patients included demographics, medical conditions, associated symptoms, orthostatic blood pressure measurements, physical function, posture control, proprioception, use of physical restraints, and medications, A detailed examination of the fall events was also conducted. Of the 143 patients studied, 46 (32%) fell at least once, making a total of 84 falls. Impaired ability to follow directions, impaired judgment, impaired proprioception, presence of physical restraints, use of major tranquilizers, use of sedatives, and presence of psychiatric diagnosis were all individually associated with patients who fell. Males fell more than females. Logistic regression identified altered proprioception as the only major predictor of falling. Of those who fell, only 26% called for assistance prior to the fall. Sixty-eight percent of the falls were from wheelchairs. Importantly, no patients had serious injury or morbidity from the falls.
Accidental Falls↗
Rehabilitation nursing approaches to cerebrovascular accident: a comparison of two approaches.
The purpose of this study was to compare patients receiving neurodevelopmental therapy (NDT) to patients receiving a traditional approach. The study took place on two separate medical rehabilitation units, each using just one approach. Patients were assigned to each unit based upon bed availability. The charts of 43 cerebral vascular accident (CVA) patients who received the traditional approach and of 37 CVA patients who received NDT were audited for demographic, functional, and disposition data. No significant differences at admission were found between the two groups, except that the NDT group had higher scores in dressing (p = .04) and toileting (p = .02). At discharge, the NDT group had higher functioning scores on toileting only (p = .03). Length of stay was almost identical between the two groups. Eighty-six percent of the NDT sample were discharged home compared to 78% of the traditional sample, but this was not statistically significant. Thus, the NDT approach does not appear to be superior to the traditional approach. These results imply that there needs to be more careful study of rehabilitation approaches before committing to one specific approach in the nursing care of CVA patients.
Activities of Daily Living↗
Use of physical restraints in the hospital setting: implications for the nurse.
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Accidental Falls↗
Pain management protocol. NICHE Faculty.
Pain management for the elderly person is complex, challenging, but ultimately rewarding for the nurse who learns the core knowledge for assisting the older individual who is in pain.
Aged↗
Standard of practice protocol: acute confusion/delirium. NICHE Faculty.
Acute confusion, also known as delirium, is a prevalent disorder that contributes to poor outcomes of care. Because of their inability to think clearly, delirious patients are unable to care for themselves and often exhibit unsafe behaviors, resulting in an increased use of physical and pharmacologic restraints. Consequently, the goal of this article is to delineate prevention and treatment guidelines for acutely confused patients and thereby improve nursing care for this vulnerable patient population.
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Developing better critical paths in healthcare: combining 'best practice' and the quantitative approach.
Critical paths are tools to manage healthcare delivery and ensure favorable patient outcomes. Unfortunately, many of these paths are not evaluated or revised after their initial development. One potential problem faced by nursing managers is that critical paths may lose relevance in a rapidly changing healthcare environment. The authors suggest one strategy to strengthen existing critical paths in a way that is responsive to these changes.
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Substance abuse and the hospitalized elderly.
Health care professionals frequently fail to recognize and address the misuse and abuse of alcohol and drugs in the elderly. Estimates of alcohol abuse in the older adult population range from 4% to 20% in the community dwelling elderly and up to approximately 25% among hospitalized older adults (Adams & Cox, 1995; Adams & Kinney, 1995; Beresford et al., 1990). In addition, the present population of older adults consumes 2-3 times more psychoactive medications than younger age groups (Sheahan et al., 1995). The effects of alcohol and substance abuse in older adults are influenced by physical, developmental, and psychosocial changes that occur with aging. Identification of alcohol and substance abuse presents a challenge for health care providers as older adults often present with atypical symptoms. Accurate diagnosis allows for the initiation of interventions for both immediate and long-term treatment.
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Evaluation of an orientation system for newly employed registered nurses.
In this article, the authors discussed the successful evaluation of an orientation system for newly employed registered nurses in a large teaching hospital using the IOP model. This methodology can be successfully applied to any educational program that is consolidated into an organization's goals. Although not well examined, orientation has been reported to be costly (Bethel, 1992; del Bueno, Weeks, Brown-Stewart, 1987). The system presently used at this hospital uses at least 1 week of a nurse educator's time, 3-10 weeks for a newly employed registered nurse, and 3-10 weeks for a preceptor RN. Such an investment of personnel resources mandates examination of the processes and outcomes of the program to ensure newly employed RNs become competent practitioners as efficiently as possible. The use of the IOP model particularly was useful in examining a complex orientation system in a multicentered hospital. Use of this systematic program evaluation separated the overall orientation process into workable components. Tools, such as the algorithm, allowed for easy visualization and comprehension of the process steps. This was indispensable because of the number and scope of people involved in the orientation program. The evaluation process was impartial and focused on the program steps, not on the individuals. Because of this impartiality, people were able to gather and work cohesively to improve the overall program. Use of the IOP model assisted the nurse educators in determining that PBDS was not achieving the goal of identifying individual learning needs. Rather, PBDS was a useful tool in establishing baseline competency of newly employed RNs. The system clearly identified those individuals who had above average knowledge bases and those individuals who had more learning needs. For those with more learning needs, PBDS provides a starting point for planning a structured orientation. Thus, a Phase II PBDS assessment could be used as a more unit-specific assessment to validate whether the RN has achieved the orientation objectives. Although the IOP model is not a strict research methodology, it is appropriate for examination of a program as fluid and ongoing as this. Finally, ongoing run charts or statistical trends will assist the nurse educators in monitoring the quality and effectiveness of the orientation program.
Adult↗