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The purpose of this paper is to characterize investigative structures and investigator characteristics for each APS office in all 50 states and the District of Columbia. Through mailed questionnaires and follow-up telephone calls, 1,409 questionnaires were completed for a return rate of 80%. The mean age of respondents was 46.4 years and ninety-nine percent of the respondents worked full-time and has been in his or her current position for an average of nine years. Half of the respondents reported using abuse screen or risk factor instruments when investigating an alleged elder abuse report. Seventy-three percent reported that they investigate only adult and elder allegations. Sixty percent of the respondents reported that a formal training program for elder abuse evaluations was in place for employees with an average length of two to four days. Sixty-nine percent of the investigators consider an elder to be “better off” most of the time following intervention, and that this improved status was a...

Differences in elder abuse definitions hinder the comparison of research and state elder abuse data (Jogerst, Daly, Brinig et al., in press). The purposes of this paper are to describe and summarize the elder abuse definitions in the state statutes and present current definitions used in practice, education, and research. The definitions of elder abuse for the 50 state and District of Columbia laws addressing protective services for domestic elder abuse were analyzed. No one single term describing elder abuse was used uniformly across all statutes. “Abandonment,” “mental anguish,” “exploitation,” “neglect,” “self-neglect,” and “sexual abuse” were predominant terms used in the statutes. It is unlikely that legislation for the 50 states and District of Columbia would be implemented to change the statutes definitions of elder abuse but it is possible to develop a list of definitions that can be used as model definitions for researchers, practitioners, and for future policy changes.

Background: Many adults have not been screened for colon cancer, a potentially preventable cause of death. Methods: This was a randomized controlled trial conducted between December 2008 and April 2011 to improve CRC screening in 16 rural family physician offices. Subjects due for CRC screening were randomized within each practice to 1 of 4 groups: (1) usual care; (2) physician chart reminder; (3) physician chart reminder, mailed education, CRC reminder magnet, and fecal immunochemical test (FIT) (mailed education/FIT); or (4) all the preceding plus a structured telephone call to the patient from project staff to provide education, assess interest in screening, explain the screening tests, and address barriers (mailed education/FIT plus phone call). The main outcome was completion of any CRC screening. Results: This study enrolled 743 patients. CRC screening was completed by 17.8% in the usual care group, 20.5% in the chart reminder group, 56.5% in the mailed education/FIT group, and 57.2% in the mailed education/FIT plus phone call group. We found no effect from the chart reminder compared with usual care (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.7–2.0); and a beneficial effect from the mailed education/FIT (OR, 6.0; 95% CI, 3.7–9.6) and the mailed education/FIT plus phone call (OR, 6.2; 95% CI, 3.8–9.9). Both FIT and colonoscopy rates increased significantly in both mailed education groups. Conclusion: CRC screening rates increased significantly among patients who were overdue for screening after they received mailed educational materials and a FIT. The addition of a phone call did not further increase screening rates.

Patients generally access colorectal cancer (CRC) screening through primary care physicians. National guidelines recommend CRC screening for adults beginning at age 50, yet one-third of Americans are not up to date. Methods: A self-administered questionnaire was administered to family physicians from 16 practices in a Midwestern state who attended an information session for a randomized study to improve CRC screening. The questionnaire assessed CRC screening practices, knowledge of CRC screening guidelines, and office strategies for improving screening. Results: Of 131 health care providers, 85 (65%) completed the questionnaire. Two-thirds were aware of the CRC screening guidelines; 91% knew that the follow-up interval for screening depends on the test chosen. Twenty-five percent incorrectly stated that a single-sample in-office fecal occult blood test is an acceptable screening test. Only 8% had a written policy regarding CRC screening; 18% had offices that used chart reminders; and 32% had charts organized to easily identify patient screening status. Regarding perceptions, those who agreed that they encourage their office staff to participate in screening estimated that they offer screening to more patients than those who disagreed (82.8% vs 70.2%, P < .0001); in addition, those who agreed with and tried to follow the guidelines estimated that they offer screening to more patients than those who disagreed (77.4% vs 60.5%, P = .004). Conclusion: Although physicians were knowledgeable about CRC screening guidelines, 25% mistakenly believed that single-sample in-office fecal testing was appropriate. There was a striking lack of office systems for identifying eligible patients and facilitating CRC screening.

Self-monitoring of blood glucose (SMBG) has been advocated as an integral part of diabetes care that can reassure and empower patients and improve glycosylated hemoglobin, and has been linked to better outcomes.1,2 The purpose of this study was to compare those who conduct SMBG as recommended and those who do not with respect to patient demographics, self-care behaviors, barriers to SMBG, and purchase of blood glucose testing supplies. After institutional review board approval, from four Iowa Research Network rural offices, 48 patients consented to participate and 42 were enrolled in the study, completed a questionnaire, and had medical record and insurance claims reviewed.

Primary care physicians initiate colorectal cencer (CRC) screening and manage health care issues that present from these procedures. Quality of colonoscopy services can be determined by a set of indicators. The purpose of this study was to identify the quality of colonoscopy services provided for patients of family physicians in the Iowa Research Network (IRENE). Quality of services was delineated by (1) presence of a colonoscopy report on the medical record, if the medical record indicated a colonoscopy had been completed, (2) cecal intubation rate, (3) adenoma detection rate, and (4) the content of the colonoscopy report.Medical record review was conducted in 14 IRENE offices.Of 581 medical records indicating a colonoscopy had been completed, 89 (15%) did not have a colonoscopy report. The main reasons for having the colonoscopy were screening and obvious blood in the stool. Polyp detection rate for all colonoscopies was 35%, and the adenoma detction rate for screening colonoscopis for men was 31% and for women was 19%. Depth of insertion to the cecum was reached for 92%. Items least mentioned in the report were the time to complete the procedure and current medications. Only 223 (45%) reports listed the follow-up interval for next colonoscopy. Quality of colonoscopy services for this group of IRENE physicians was comparable to recommended standards of depth of insertion and adenoma detection rate. Improvements are warranted to have all colonoscopy reports and follow-up interval of next colonoscopy on a patient's medical record.

Background: Only about half of eligible Americans are adherent with colorectal cancer (CRC) screening. Because patients generally access CRC screening via their primary care physicians, interventions to improve screening should be tested in the primary care setting. This article describes the recruitment and baseline characteristics of patients from 16 practice-based research network practices for a study to improve CRC screening. Methods: A total of 8327 invitations were mailed to patients of these practices, and 1685 returned consent forms and baseline surveys. Results: Of those who consented, 942 were up to date with screening, which indicates that office databases were unable to provide information about those who were already screened. The 743 due for screening were younger (mean age, 61 vs. 63 years), less likely to have an immediate family member with CRC (11% vs. 19%), less likely to have Medicare (29% vs. 40%), more likely to have no insurance (5% vs. 1%), and less likely to report a physician/nurse recommendation for CRC screening (63% vs. 92%) for all comparisons. Conclusions: Our experiences for this practice-based research network randomized clinical intervention trial may be useful to others. Practice and patient recruitment processes were onerous with institutional review board issues, poorly prepared patient databases, and discarding of mail by the US Postal Service.

Statutes pertinent to elder abuse vary widely. This article provides examples of organizational structure, dependency and age of the victim, definitions of abuse, classification of penalties, and investigation processes. Health care providers must learn their state's elder abuse laws and review any operating manuals produced from the statutes or regulations. All health care workers must know and implement the law to protect the welfare of older persons.

Elder abuse occurs in all practice settings and presents in various forms. The purpose of the current evidence-based practice guideline is to facilitate health care professionals' assessment of older adults in domestic and institutional settings who are at risk for elder abuse, and to recommend interventions to reduce the incidence of mistreatment. Limited research has been conducted on interventions to prevent or reduce elder abuse. Research is available on the prevalence of elder abuse and indicators of individuals who may be more susceptible to harm. The current article summarizes prevalence and risk factors for elder abuse, instruments available to assess individuals at risk for or victims of abuse, and potential interventions to prevent or reduce elder abuse. [Journal of Gerontological Nursing, 44(7), 21-30.].

We discuss colorectal cancer screening with two gastroenterologists, including results from two recently published studies showing long-term effects of screening.

An estimated 95,000 people developed methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005 of which 14% were community-associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year.To explore health care providers' perspectives on management of skin and soft tissue infections to gain a better understanding of the problems faced by busy providers in primary care settings.Focus group meetings were held at 9 family physician offices in the Iowa Research Network. Seventy-eight clinicians including physicians, nurses, nurse practitioners, and house officers attended. Meeting audiotapes were transcribed and coded by 3 investigators, and a MRSA-management taxonomy was developed.The main themes that emerged from the focus groups included epidemiology, diagnosis, treatment, management, prevention, special populations, and public relations. The incidence of MRSA infections was perceived to have increased over the past decade. However, diagnosis and treatment protocols for physicians in the outpatient setting have lagged behind, and no well-accepted diagnostic or treatment algorithms were used by physicians attending the focus groups.The clinicians in this study noted considerable confusion and inconsistency in the management of skin and soft tissue infections, particularly those due to MRSA.

The purpose of this qualitative study was to examine family practice physician and staff views on the benefits of, barriers to, and use of personal health records (PHRs). Four focus groups were conducted at four family medicine practices in Iowa and included a total of 28 providers. Overall, participants seemed to view PHRs as a source of medical information for healthcare providers when the patient's medical record is not available. Providers appeared unaware of the patient-centered features available in many electronic PHRs and how such features might affect patients and their medical practice. While physicians identified numerous patient groups that could benefit from using PHRs, they also perceived several unique barriers, including the potential of PHRs to facilitate narcotic abuse, low levels of patient computer and health literacy, low levels of patient motivation, and difficulties with PHR and electronic medical record interoperability. Physicians' relatively narrow view of PHR functions and benefits and perception of barriers to using PHRs may restrict widespread support of PHR use.

Objective:To implement a colon cancer screening program for uninsured or underinsured Iowans.Methods:All 1995 uninsured patients or patients with Iowa Care insurance aged 50 to 64 years attending the University of Iowa Clinic or the Iowa City Free Medical Clinic were mailed information about the project. Recruitment also took place in person, by having the clinic receptionist hand subjects a research packet, and through community posters. Individuals with colonic symptoms or who were up to date with screening were ineligible. Eligible subjects received a free fecal immunochemical test (FIT), and those with positive FITs were provided with a colonoscopy at no cost to them.Results:Of 449 individuals who completed eligibility forms (23% of the study population), 297 (66%) were eligible and were provided with an FIT. Two-hundred thirty-five (79%) returned a stool sample, with 49 (21%) testing positive. Thirty of the 49 (61%) individuals had a colonoscopy, and 20 individuals had at least 1 polyp biopsied. Thirteen individuals had at least 1 tubular adenoma; 2 had adenomas more than 1 cm in diameter, with no colon cancers identified. Face-to-face recruitment had the highest rate of returned FITs (72%) compared with handing the subject a research packet (3%) or a mailing only (9%) (Chi-square, P < .001).Conclusion:There was high interest in and compliance with colon cancer screening using a FIT among underinsured individuals. Although the FIT positivity rate was higher than expected, many individuals did not complete recommended follow-up colonoscopies. Population-based strategies for offering FIT could significantly increase colon cancer screening among disadvantaged individuals, but programs will have to develop sustainable mechanisms to include the necessary organization and address substantial costs of providing mass screening, as well as facilitating and providing colonoscopies for those who test positive.

Various interventions have been implemented to increase the rate of colon cancer screening. The purpose of this study was to determine if persons who are regular patients of a clinic, ages 50-64 years, and not up-to-date with colon cancer screening will complete the at-home fecal-immunochemical test (FIT) if it is mailed to them. This intervention was designed to have the subject avoid the signing of an informed consent and having to ask for the screening test; and, only one stool specimen was needed. Three hundred and fifty potential subjects were randomly selected from an electronic medical record database after meeting inclusion criteria. Eighty-seven fecal immunochemical tests were returned. Seven of the FIT kit results were positive for occult blood. Each respondent was sent a letter giving them their results. A minimal cue CRC screening intervention, a FIT kit sent in the mail without prerequisite of a signed informed consent, was offered to the study subjects. Twenty-six percent of the eligible persons were screened for colon cancer by this method. A mailed FIT kit or one handed to the patient at an office visit has minimal cost which can be recovered through insurance coverage. Commitment by health care providers is necessary for prevention. This method is one of several that could reach the hard to screen population.

The purpose of this investigation was to determine the site utilized by nurses for administering Diphtheria and Tetanus Toxoids and Pertussis (DPT) injections to infants under 7 months of age. Twenty-six of the 28 agencies identified in a metropolitan area as administering DPT injections chose to participate in the study. Those individuals administering DPT injections in the agencies completed a questionnaire with a return rate of 69% (n = 55). Forty-four participants indicated that they used the anterolateral thigh, the recommended site, 100% of the time. The participants in the study administered a total of 1,453 DPT injections per month. Eighty-seven percent of those injections were administered in the anterolateral thigh, 3.6% were given in the deltoid, 5.1% were given in the dorsal gluteal, and 4% were given in the ventrogluteal. The estimated proportion of DPT injections administered at the correct site was 84.65% which is much lower than the critical value 94.06% for alpha = .05 (p less than .00001).

Background Team-based care is the strategy that has had the greatest effect on improving blood pressure (BP). The purpose of this systematic review was to determine the potency of interventions for BP involving nurses or pharmacists. Methods A MEDLINE search for controlled clinical trials that involved a nurse or pharmacist intervention was conducted. Mean reductions in systolic (S) and diastolic (D) BP were determined by 2 reviewers who independently abstracted data and classified the different intervention components. Results Thirty-seven articles met the inclusion criteria. Education about BP medications was significantly associated with a reduction in mean BP (−8.75/−3.60 mm Hg). Other strategies that had large effect sizes on SBP include pharmacist treatment recommendations (−9.30 mm Hg), intervention by nurses (−4.80 mm Hg), and use of a treatment algorithm (−4.00 mm Hg). The odds ratios (95% confidence intervals) for controlled BP were: nurses, 1.69 (1.48-1.93); pharmacists within primary care clinics, 2.17 (1.75-2.68); and community pharmacists, 2.89 (1.83-4.55). Mean (SD) reductions in SBP were: nursing studies, 5.84 (8.05) mm Hg; pharmacists in clinics, 7.76 (7.81) mm Hg; and community pharmacists, 9.31 (5.00) mm Hg. There were no significant differences between the nursing and pharmacy studies ( P ≥ .19). Conclusions Team-based care was associated with improved BP control, and individual components of the intervention appeared to predict potency. Implementation of new hypertension guidelines should consider changes in health care organizational structure to include important components of team-based care.

Objectives: Patient self-care behaviors, including taking medication, following a meal plan, exercising regularly, and testing blood glucose, influence diabetes control. The purpose of this research was to identify (1) which barriers to diabetes management are associated with problem behaviors and (2) which patient behaviors and barriers are associated with diabetes control. Methods: This was a cross-sectional study of linked medical record and self-reported information from patients with type 2 diabetes. A randomly selected sample of 800 clinic patients was mailed an investigator-developed survey. The study sample consisted of 253 (55%) individuals who had measured glycosylated hemoglobin (HbA1c) within 3 months of the survey date. Results: The barriers to each diabetes self-care behavior differed. Cost was the most common barrier to the 4 self-care behaviors. In a multivariable regression model, the belief that type 2 diabetes is a serious problem and depression were strongly associated with higher HbA1c levels. Lower HbA1c levels were significantly associated with being married and greater self-reported adherence-satisfaction with taking medication and testing blood glucose. Conclusion: This study expanded earlier research by focusing on 4 specific self-care behaviors, their barriers, and their association with HbA1c. Barriers that were significantly associated with HbA1c were specific to the behavior and varied across behaviors.

The purpose of this study was to test the accuracy of patient colorectal cancer (CRC) screening self-report and CRC screening documented in their medical record for those who are cognitively impaired and those who are not based on the clock drawing task. A cross-sectional study where patient survey and medical record information were linked was conducted in 16 primary care offices. Of the 960 patients mailed questionnaires, there were 493 respondents who completed the questionnaire and clock drawing, had a chart review, and had no help in drawing the clock or completing the questionnaire. Chart review was conducted for CRC screening in physician offices. Clock drawings were scored 0–7 according to the Watson method. Accuracy of ever being screened for CRC or being up-to-date for CRC screening was determined by comparing self-report with medical records and calculating sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate. Seventy-five clocks were abnormal, scoring 4 or more. Agreement between self-reported colonoscopy and medical record review was higher in subjects with normal clock drawings than those with abnormal clock drawings. When examining predictors of agreement/disagreement for colonoscopy screening, abnormal clock drawing was the single predictor for higher disagreement.

This study compared two groups of RN students and noted that there is a difference between the profile of the on-campus student and the student in satellite areas. The demographic profile differences revealed that the RN students in satellite centers were slightly older, were employed, and worked more hours each week. They tended to work full-time, traveled farther to attend classes, had more children, and projected a longer time necessary to complete the SCN than their campus counterparts. The academic profile differences revealed that the satellite center RN students had higher ACT-PEP mean scores and transfer GPAs than their on-campus peers. On-campus RN students had higher University of Iowa GPAs and higher grades in the Pathology course and Foundations of Nursing Practice course than satellite center RN students.

Nursing home complaint investigation procedures are established by each state's respective legislation. The purpose of this study was to determine the state statutes that had text addressing nursing home report and investigation of abuse and to describe the content of that text. All states and the District of Columbia have statutes addressing the licensure and re-certification of nursing homes. Fourteen of these licensure and re-certification of nursing home state statutes have text specifically addressing the topic of abuse reports and investigation in the nursing homes. Main concepts discussed in those sections were reporting requirements, mandatory reporting, and definitions.

Background: Global aging may increase the societal burden of providing more resources to augment elders’ disabilities. The implications of functional disabilities can vary depending on the society in which they occur. Objective: To determine differences in US and Russian elder citizens’ function. Research design: Convenience sample of persons 60 years and older were surveyed and evaluated. Subjects: One hundred community dwelling residents, half from Galesburg, Illinois and half from Moscow, Russia. Measurements: An interviewer administered questionnaire and functional assessment examination. Results: The Russian sample was younger than the American sample with a mean age of 67 years versus 78 years, and less likely to be widowed or living alone. Sixty percent of Russians took no medications compared with 14% of Americans, but Russians reported more cardiovascular disease, angina, and hypertension. Forty-four percent of Russians screened as being depressed and only 4% of the Americans. Self-assessed health was good for 77% of Americans and only 6% of Russians. The Medical Outcomes Study SF-36 Health Survey (MOS) eight health concepts showed favorable results for the Americans except for physical functioning, which indicated no difference. Conclusions: Marked health and functional differences exist between our samples. Russians had more cardiovascular disease, took less medication, drank and smoked more and were much more likely to be depressed than the US subjects.

Forty-nine states and the District of Columbia have adult protective services (APS) related statutes that define adult/elder mistreatment found in domestic settings. Institutional adult/elder mistreatment laws are administered by the nursing home licensing agencies and may contain different or duplicate APS-related mistreatment definitions. The purposes of this paper are to describe and summarize the mistreatment definitions in the nursing home licensure statutes and compare those definitions with the definitions found in the APS-related statutes.Westlaw and Lexis-Nexis law database systems were used to retrieve all adult protective services statutes and institutional licensure statutes. Each statute's text was reviewed and coded by two researchers.Institutional mistreatment definitions are addressed in 14 of the states and District of Columbia's nursing home statutes. No one state has a list of the 27 different definitions of mistreatment identified in the literature search. The common types of mistreatment described were physical and emotional abuse, neglect, financial and property exploitation, and sexual abuse.Standardized definitions of resident-to-resident and institutional specific types of mistreatment need to be included in nursing home statutes.

Since elder abuse was first acknowledged as a health care and social problem, incidence and prevalence of mistreatment has been assessed sparingly in the United States and other countries around the world. Standardized instruments for determining the prevalence of elder abuse have not been developed and other instruments measuring a person's function and spousal violence have been adapted for the measurement of elder abuse prevalence. The purposes of this paper are to (1) ascertain the reading grade level of the most frequently used elder abuse prevalence instrument's text and (2) determine the content validity of the instruments with respect to the types of elder abuse included in them. A review of the instruments used to measure elder abuse prevalence was completed and a questionnaire was developed to measure the reading grade level and type of elder abuse content in four instruments. The Fry Readability, Flesch Reading Ease, and McLaughlin Grading formulas were used to determine reading grade level. A questionnaire regarding content validity was sent to 69 faculty and staff in one university department and a 59% return was achieved. The Conflict Tactics Scale and the Hwalek-Sengstock Elder Abuse-Screening Test had the lowest mean score at the 6th grade reading level. Results of content analysis for types of elder abuse demonstrated none of the instruments are comprehensive. Instruments to measure the prevalence are needed which balance readability and content validity.

Live video and detailed images of nursing home residents can be transmitted in real time via the Internet. This telehealth system allows residents and long-term care health professionals to connect with experts not available on-site. Electronic stethoscope, otoscope, dermascope, dentalscope, and electrocardiogram are available for use via the Internet. Impediments to implementing telehealth systems in long-term care include costs and the lack of reimbursement for telehealth services. Reimbursement for telemedicine in nursing homes is limited by originating site, current procedural terminology codes, and facility location.

Sponsored forums were hosted to obtain the opinions of invited professionals on how to create the ideal system for protecting dependent adults in Iowa. The purpose of the study was to determine how the forum participants perceive change in the adult protective service system five years after the forums were held. A mailed sixty-nine-item questionnaire sent to the 1,000 forum participants and professionals in the aging network yielded a 30 percent return rate. Ninety-four percent of the items were ranked by more than half of the respondents as important with abuse awareness items scoring the highest. For each item approximately half of the respondents indicated they did not know if a change had occurred.

Purpose: The purpose of this study is to describe and classify each state's driver's licensing laws and then test whether the licensing laws affect the percentages of over-64 persons licensed and the proportion of older drivers involved in accidents to determine an optimal level of driving. Design and Methods: This paper evaluates state driving rules, obtained from laws, regulations, and driver's manuals, tests, based upon Department of Transportation data, whether the type of laws affects driving and accident rates for those over 64 and suggests a uniform scheme combining self-reporting of driving problems, on-the-road tests of drivers who fall below safe driving standards, and individualized restrictions where these can enable drivers to safely operate vehicles. Results: Rates of licensure for those over 64 years and of the proportion who are involved in traffic accidents vary widely among states. State licensing rules are divided among seven categories. Regression analysis shows a relationship between the licensing category and both rates. Implications: A model (and thus uniform) driving statute is recommended, with final licensing responsibility resting with the Department of Motor Vehicles or equivalent agency and licensing based on an evaluation of actual driving performance.

Objectives. The authors evaluated the impact of state adult protective service legislation on rates of investigated and substantiated domestic elder abuse. Methods. Data were collected on all domestic elder abuse reports, investigations, and substantiations for each US state and the District of Columbia for 1999. State statutes and regulations pertaining to adult protective services were reviewed. Results. There were 190 005 domestic elder abuse reports from 17 states, a rate of 8.6 per 1000 elders; 242 430 domestic elder abuse investigations from 47 states, a rate of 5.9; and 102 879 substantiations from 35 states, a rate of 2.7. Significantly higher investigation rates were found for states requiring mandatory reporting and tracking of numbers of reports. Conclusions. Domestic elder abuse documentation among states shows substantial differences related to specific aspects of state laws. (Am J Public Health. 2003;93:2131–2136)

The purpose of this study was to determine how use of a standardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care (LTC) facility would affect patient outcomes, as well as organizational processes and outcomes. An experimental design was used to compare the effects of two methods of documentation: Computer care plan and paper care plan. Twenty participants (10 in each group) were randomly assigned to either group. No statistically significant differences were found by group for demographic data. Repeated measures ANOVA was computed for each of the study variables with type of care plan, written or computerized, as the independent variable. There were no statistically significant differences between participants, group (care plan), within subjects (across time), or interaction (group and time) effects for the dependent variables: Level of care, activities of daily living, perception of pain, cognitive abilities, number of medications, number of bowel medications, number of constipation episodes, weight, percent of meals eaten, and incidence of alteration in skin integrity. There were significantly more nursing interventions and activities on the computerized care plan, although this care plan took longer to develop at each of the three time periods. Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions, but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting.

City administrators challenged a life-care home's tax-exempt status. A successful, empirically-based case was made based on data collected by gerontological nurses using the Iowa Self-Assessment Inventory (ISAI) and related instruments (Mini-Mental State Examination [MMSE], Instrumental Activities of Daily Living Scale [IADLS], and Physical Self-Maintenance Scale [PSMS]) to describe the life-care population. Testimony by gerontological nurses included comparisons between these life-care residents and statewide data on elderly individuals currently residing in nursing homes and in the community. The data they presented showed not only that this life-care home provided a high quality of life, but also saved society substantial amounts of money in government-funded services that would otherwise be provided to residents of this home. The judge ruled in favor of continuing tax-exempt status for this life-care home because credible evidence clearly demonstrated that taxpayer savings from the services provided to life-care home residents and the life-care commitment dramatically outweighed the taxpayer costs associated with lost tax revenues.

The first year of study in our PhD program has both broadened and intensified our knowledge. We have come to expect ourselves to attain better understandings of any given issue or topic within its attendant context and within the larger context of our profession. We have begun to appreciate and to strive for the clarity, thoroughness, and precision of thought and analysis that typify the nurse scholar. We are beginning to recognize who the nurse scholar is, why we want to emulate this person, and how we can become this person. As members of the fourth generation, we are now beginning, through our doctoral program, to live the vision of scholars who preceded us. To fulfill this vision, we understand that learning is a lifelong process that does not end with achievement of the doctorate or with postdoctoral study, but that it is continually evolving. We recognize the crucial role of research in nursing, but temper this recognition with the knowledge that research must progress in a planned manner dovetailing with existing research lest it fail to strengthen the web of nursing knowledge.

Background: The need for current information on Alzheimer's disease (AD) is apparent as medical research, diagnostic, and treatment guidelines are advancing at a rapid rate. Method: A needs assessment survey determined what educational topics related to dementia nurses perceived they most need, would be most likely to attend, and what information they likely would solicit in a telephone consultation. Results: Nurses in Iowa were interested in continuing education programming and teleconferences on major topics regarding AD provided through the state's fiberoptic system such as: (a) challenging behaviors over the course of illness; (b) family needs such as education, support, respite, referral, and safety; (c) case management services for patients and families; (d) long-term care services from adult care to hospice; and (e) new developments in AD. Conclusion: Rural nurses experiencing professional isolation and lack of resources can access up-to-date information via continuing education programs transmitted by telecommunication strategies.

1. Standardized language for patient assessment, nursing diagnoses and interventions provide a common language for professionals in long-term care. 2. A comprehensive Nursing Interventions Classification (NIC) was first published in 1992 by the Iowa Intervention Project and the North American Nursing Diagnosis Association offers a comprehensive list of nursing diagnoses. 3. Most frequently used nursing diagnoses were: Self Care Deficit: Bathing/Hygiene, Self Care Deficit: Dressing/Grooming, Impaired Physical Mobility, Altered Thought Process, and Potential for Injury.

Objective To determine if there is an association between abuse reporting to state authorities by nursing home administrators and directors of nursing and their characteristics and knowledge of the law. Design Survey. Setting Iowa's 409 Medicare certified nursing homes. Participants Four hundred nine administrators and 409 directors of nursing. Measurements Nursing home abuse incidents, reports, and substantiations, Medicare's Nursing Home Compare Reports, Urban Influence Codes, and county census demographics. Results A single or double response was received from 369 (90%) of the 409 nursing homes. Being a male administrator and having a higher level of education is associated with higher substantiation rates. A greater knowledge of the dependent adult protective services law is associated with higher incident and report rates for directors of nursing. Conclusions Nursing home administrators' and directors of nursing's knowledge of the law and their characteristics are associated with nursing home incident, report, and substantiation of abuse allegations.

Background In average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests. Methods The study was conducted with 954 patients from the University of Iowa Hospital and Clinics during 2010 to 2011. Patients scheduled for a colonoscopy were asked to complete a FIT before the colonoscopy preparation. Following both tests, patients completed a questionnaire which was based on an analytic hierarchy process (AHP) decision-making model. Results In the AHP analysis, the test accuracy was given the highest priority (0.457), followed by complications (0.321), and test preparation (0.223). Patients preferred colonoscopy (0.599) compared with FIT (0.401) when considering accuracy; preferred FIT (0.589) compared with colonoscopy (0.411) when considering avoiding complications; and preferred FIT (0.650) compared with colonoscopy (0.350) when considering test preparation. The overall aggregated priorities were 0.517 for FIT, and 0.483 for colonoscopy, indicating patients slightly preferred FIT over colonoscopy. Patients’ preferences were significantly different before and after provision of detailed information on test features (p

The overall success of the delivery of courses in the nursing major via telecommunication requires careful planning and coordination among the on-campus course faculty, satellite area faculty facilitators, the personnel responsible for the technology, and contact persons in satellite areas responsible for classroom scheduling. Maintaining satellite programs for RN students is a project that requires ongoing evaluation.