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Newly arrived immigrant and refugee children are faced with significant physical and mental health issues and often rely on school nurses for care and connection to healthcare. The purpose of this qualitative phenomenological study was to explore urban public school nurses’ experiences caring for newly arrived children. Data were collected through one-time in-depth semistructured interviews with school nurses ( n = 20). Three relational themes were identified: (1) Trials and Triumphs: Telling Stories About Newly Arrived Children; (2) Walk a Mile in My Shoes; and, (3) Being a Trusted Health Navigator. The Role of School Nurses in the Context of Trauma emerged as the constitutive pattern. The current study enhances our understanding of the unique role played by school nurses as they address the profound needs of newly arrived children and their families, many of whom have survived trauma and face a number of barriers to accessing care.

The Demands of Immigration (DI) scale consists of six subscales and is designed to measure demands that negatively affect emotional health of immigrants.The purpose of this review is to (a) examine the DI scale's language versions and translation procedures; and (b) evaluate reliability and validity of the DI scale based on studies subsequent to its initial development.Published studies were identified through CINAHL Complete, MEDLINE, Social Sciences Premium Collection and PsycInfo.Seventeen quantitative studies reported the DI scale's reliability (internal consistency and test-retest) and/or validity (content and construct). Correlations among the DI subscales and key variables (e.g., job satisfaction, acculturation, depression, perceived support, and resilience) support its construct validity.The DI scale is a reliable and valid tool for measuring demands or challenges that immigrants face.

For long-term care (LTC) residents, multiple barriers impede access to formal museum-based participa-tory art programming. Capitalizing on available technologies may circumvent common barriers and improve quality of life for those older adults even in the presence of dementia. Targets: A convenience sample of 31 older adults was recruited from the population of residents in one LTC facility. Intervention: ArtontheBrain, a web-based program, engages participants in activities centered on visual artwork, enabling users to learn about artists through activities, such as puzzles, storytelling, and group discussions. Mechanisms of Action: Researchers hypothesized that engagement with ArtontheBrain would benefit perceived quality of life in the domains of meaningful activity engagement and personal relationships and secondarily, improvements in functional performance, mood state, and cognitive performance may occur. Outcomes: Application of a quality of life survey pre and post ArtontheBrain intervention revealed significant improvements within the individual subsample for two activity options: engagement in enjoyable activities on weekends and evenings and explore new skills and interests. Total scores for the personal relationship scale had significant improvements post-intervention for the individual and group subsamples. The individual subsample demonstrated improvement in cognitive performance, which worsened for the group subsample. Mood and functional ability worsened for the entire sample.[ Research in Gerontological Nursing, 14 (5), 235–243.]

Military to civilian reintegration is a complex, multidimensional phenomenon warranting holistic perspectives. Complex phenomena require theory to understand and interpret relationships among concepts. Despite the need for theory-driven research, recent nursing reports often lack a theoretical structure. We extracted relevant concepts from the Neuman's Systems Model (stressors, environment, and person) and the Transactional Model of Stress and Coping (primary and secondary appraisal, coping, and adaptation) to form a Conceptual-Theoretical-Empirical model. Exemplar empirical instruments are presented, along with their conceptual and theoretical dimensions. An integrated System Theory of Stress, Resilience, and Reintegration is presented with its utility demonstrated through a research application.

Lack of physical activity is particularly problematic among U.S. Latino older adults. There is substantial evidence linking physical activity and well-being. However, associations between physical activity and positive psychological well-being among this population have never been studied or measured. Physical activity was compared to five positive psychological well-being measures based on the PERMA model. Secondary data analysis was completed on a sample of 68 Latino American individuals, age 60 and older, compared to 72 non-Hispanic White older adults. Overall, physical activity was positively associated with positive psychological well-being despite race. Pain, functional limitations, and physical restrictions did not moderate the relationship between physical activity and positive psychological well-being among Latino and non-Hispanic White older adults. Further research is needed to clarify whether physical activity and psychological well-being are perceived similarly or differently within various cultures. [ Journal of Gerontological Nursing, 45 (6), 44–56.]

Context Adequate self-management could minimize the impact of falls in older adults. The efficacy of fall prevention self-management interventions has been widely studied, yet little is known about why some older adults engage in fall prevention self-management actions and behaviors, whereas others do not. Through a systematic review of fall prevention self-management studies, this study identified characteristics and the personal, social, and environmental factors of older adults who engage in self-management actions and behaviors. Evidence acquisition Medical and nursing literature related to fall prevention self-management was searched in PubMed, Embase, and CINAHL (1997–2017), and relevant publications were selected by three researchers to assess whether the papers included subject characteristics and their fall prevention self-management actions and behaviors. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used by the researchers to assess the quality of the included studies and to determine the significance of the extracted characteristics. Evidence synthesis Searching literature through 2017, a total of 972 papers were identified, and 28 papers remained after removing those that did not meet inclusion criteria. Nine papers that addressed subject characteristics in relation to the study outcomes were included in a sub-analysis. The authors identified the following characteristics of older adults who participated in fall prevention self-management actions and behaviors: younger males, not living alone and with self-reported good health, having greater fear of falling and high fall prevention self-efficacy, and possessing high motivation for engagement with self-management activities. Conclusions The systematic literature review revealed the personal characteristics of older adults who engage in fall prevention self-management actions and behaviors.

Religion is a consistent, positive predictor of health in older adults. Studies focused on religion and spirituality as a coping mechanism find significant positive effects on the lives of older adults. This study investigated how an older person's living situation influences his or her access to spiritual and religious resources and, consequently, his or her health. Utilizing existing data, this pilot project examined the relationship between visits from a chaplain and the mood, pain level, functional ability, and/or discharge status of elders residing in the rehabilitation unit of one long-term care facility. Samples of patients who did and did not have chaplaincy visits were matched based on their level of frailty. Analytic comparisons revealed no significantly different outcomes in terms of mood, pain level, functional ability, or discharge status for patients visited by a chaplain. The outcomes suggest future hypotheses and offer a model for outcomes-based chaplaincy research.

Post-9/11 veterans exhibit high prevalence of deployment stress, psychological conditions, and traumatic brain injury (TBI) which impact reintegration, especially among those with a history of interpersonal early life trauma (I-ELT). The relative importance of each risk factor is unclear.We examined major deployment and clinical exposures of reintegration challenges among veterans with and without I-ELT.We analyzed cross-sectional data of 155 post-9/11 veterans from the Translational Research Center for TBI and Stress Disorders study.Depression severity had the strongest association with reintegration challenges, followed by posttraumatic stress disorder (PTSD) severity, post-deployment stress, and deployment safety concerns. Deployment safety concerns had a stronger, significant association among veterans with I-ELT. In nearly every model, PTSD and depression severities were weaker for veterans with I-ELT, compared to those without.Clinicians should consider the relative risk of concurrent clinical conditions and trauma histories when considering veterans' reintegration needs.

Background: An increase in both the complexity of nursing home case-mix and corresponding challenges faced by staff in planning for the care of these individuals are notable outcomes from the growth in residential and service alternatives. The purpose of this project was to identify, among long-term care nursing home residents, those personal characteristics that indicate one’s risk of dying and then summarize these items in a Risk of Death Scale. In addition, an assessment of how possible confounding facility-level characteristics might impact on the risk of death model was completed. Methods: The design of the study was a longitudinal analysis of a national cohort of US nursing home admissions from 2011 to 2012, followed over 2 years and a validation study using 2013 data The 2011-2012 sample included 1,536,842 nursing home admissions and the 2013 validation sample consisted of 769,148 admissions We based the Risk of Death Scale on resident characteristics. While it is based on death status at 12 months, we describe death rates under the model from one-month post-admission to two years post-admission. Results: The Risk of Death Scale has seventeen graded levels. The lowest four scale categories (0-3) represent half the cohort with one-year death rates from 2% to 13.8%, whereas the mean of the entire cohort is 24.1% at one year. The top nine categories represent approximately 9% and have one-year death rates ranging from 51.7% to 95.7%. Conclusions/Implications: The Risk of Death Scale includes a broad spectrum of 30 independent variables, including measures of prognosis, treatments, diagnoses, clinical status, function, cognitive status, and age.

The efficacy of a technology-driven visual arts recreation activity, delivered virtually, was evaluated for its potential to achieve positive impacts, similar to traditional arts-interventions, on wellbeing in long-term care residents. Thirty-one residents (average age 86.8 years; SD = 9.4) engaged with the arts-intervention for 30-minutes, twice weekly, for 6 weeks with either a partner or as part of a group. Wellbeing indicators included self-reported psychological and health-related wellness, and attention capacity. Binomial tests of postintervention change revealed a significant above-chance probability of improvement in one or more wellbeing indicators ( p < .05). Postparticipation feedback survey scores were positive ( p < .05). Cognitive status did not influence outcome; however, other participant characteristics such as younger age, higher openness-to-experience (personality trait), and lower baseline mood were significantly associated with positive response to the intervention ( p < .05). Findings demonstrate technology may be an effective platform for promoting accessibility to beneficial arts-interventions for older adults.

Background and purposeTo measure wellness interventions, researchers need valid and reliable tools to measure the concept of wellness. The purpose of this study is to examine the validity and reliability of the Lifestyle Survey instrument.MethodsCommunity-dwelling older adults were recruited and asked to evaluate the reliability by engaging in a test retest reliability. Observer agreement was measured by calculating a kappa score for each item. Content validity was evaluated with a focus group session.Results(n = 56) older adults completed the survey on time one and time two. Of 115 items, 77.39% demonstrated moderate or higher kappa agreement. Focus group respondents identified rewording a few items.ConclusionWith refinement, the Lifestyle Survey is a valid and reliable measure of wellness among community-dwelling older adults.

Objectives Primary purpose was to generate a model to identify key factors relevant to acute care hospital readmission within 90 days from 3 types of post-acute care (PAC) sites: home with home care services (HC), skilled nursing facility (SNF), and inpatient rehabilitation facility (IRF). Specific aims were to (1) examine demographic characteristics of adults discharged to 3 types of PAC sites and (2) compare 90-day acute hospital readmission rate across PAC sites and risk levels. Design Retrospective, secondary analysis design was used to examine hospital readmissions within 90 days for persons discharged from hospital to SNF, IRF, or HC. Settings and Participants Cohort sample was composed of 2015 assessment data from 3,592,995 Medicare beneficiaries, including 1,536,908 from SNFs, 306,878 from IRFs, and 1,749,209 patients receiving HC services. Measures Initial level of analysis created multiple patient profiles based on predictive patient characteristics. Second level of analysis consisted of multiple logistic regressions within each profile to create predictive algorithms for likelihood of readmission within 90 days, based on risk profile and PAC site. Results Total sample 90-day hospital readmission rate was 27.48%. Patients discharged to IRF had the lowest readmission rate (23.34%); those receiving HC services had the highest rate (31.33%). Creation of model risk subgroups, however, revealed alternative outcomes. Patients seem to do best (i.e., lowest readmission rates) when discharged to SNF with one exception, those in the very high risk group. Among all patients in the low-, intermediate-, and high-risk groups, the lowest readmission rates occurred among SNF patients. Conclusions and Implications The proposed model has potential use to stratify patients’ potential risk for readmission as well as optimal PAC destination. Machine-learning modeling with large data sets is a useful strategy to increase the precision accuracy in predicting outcomes among patients who have nonhome discharges from the hospital.

Despite the documented and well-publicized health and well-being benefits of regular physical activity (PA), low rates of participation have persisted among American older adults. Peer-based intervention strategies may be an important component of PA interventions, yet there is inconsistent and overlapping terminology and a lack of clear frameworks to provide a general understanding of what peer-based programs are exactly and what they aim to accomplish in the current gerontological, health promotion literature. Therefore, a group of researchers from the Boston Roybal Center for Active Lifestyle Interventions (RALI) collaborated on this paper with the goals to: (a) propose a typology of peer-based intervention strategies for use in the PA promotion literature and a variety of modifiable design characteristics, (b) situate peer-based strategies within a broader conceptual framework, and (c) provide practice guidelines for designing, implementing, and reporting peer-based PA programs with older adults. We advance clarity and a common terminology and highlight key decision points that offer guidance for researchers and practitioners in using peers in their health promotions efforts, and anticipate that it will facilitate appropriate selection, application, and reporting of relevant approaches in future research and implementation work.

BACKGROUND: Spiritual well-being enhances older persons’ health status. Factors that optimize their spiritual well-being are not well-established. OBJECTIVE: To describe spiritual needs attainment and identify factors associated with such attainment among community-dwelling older persons. DESIGN: Cross-sectional SETTING: Sixty-five U.S. continuing care retirement communities or independent housing facilities SUBJECTS: 4077 persons entering the facilities between January 1, 2007 and November 30, 2016 METHODS: Standardized Community Health Assessment and Wellness Survey instruments were used to determine the proportion of subjects reporting their spiritual needs were met. Multivariate logistic regression identified characteristics independently associated with this outcome. RESULTS: Among the 4077 subjects (mean age 81.6 ± 7.5; female, 71.2%; and White race, 70.7%), 93.4% stated their spiritual needs were met. Factors independently associated with a greater likelihood of spiritual needs attainment were: satisfaction with life (adjusted odds ratio (AOR) 2.81, 95% confidence interval (CI) 2.00, 3.96; p

Patients with heart failure (HF) are at risk for frequent readmission potentially due to self-care deficits. Medical doctors (MDs) and nurse practitioners (NPs) both provide discharge instructions. However, each type of provider may emphasize different elements of care. The aim of this study was to analyze and compare the content of the documentation of 50 discharge instructions of heart failure patients written by NPs and MDs. Compared with MDs, NPs placed greater emphasis on symptom identification, and were more likely to advise and schedule follow-up appointments with primary care and cardiology providers rather than advising an appointment was needed without scheduling one.

Self-care and self-management programs are touted as a means to age successfully. Yet, these programs pay little regard to a critical first step—the personal goals of older adults. The capacity to self-identify goals and pursue actions toward goal achievement transcends age. An examination of life goals identified by community-dwelling, low-income older adults indicates that functional performance mechanisms are valued. Maintenance of health and increased physical activity were the two most commonly identified personal goals within a sample of 161 community-dwelling older adults residing in subsidized housing. A third goal, increased socialization, aligns with relevant psychosocial factors and reflects the need to engage with others. The preferences of the older adult placed at the center of the care planning process strategically support goal attainment. Providing an opportunity to create and pursue self-selected life goals of older adults is worth consideration when developing and testing interventions designed to support successful aging. [Res Gerontol Nurs. 2017; 10(5):205–214.]

Increased attention to post-acute care (PAC) settings and available services to meet patients’ needs following acute hospital discharge is needed as these settings are being utilized increasingly in models of care delivery. The primary purpose was to generate a model to identify the most predictive factors relevant to hospital readmission within 90 days following discharge to one of three types of PAC sites: home with home care services (HC), skilled nursing facility (SNF), in-patient rehabilitation facility (IRF). Specific aims were to (1) examine number and characteristics of older adults discharged to the 3 PAC sites; (2) compare 90 day hospital readmission rate across sites and acuity level; and (3) examine assessment items across population and subgroups to identify variables most predictive of hospital readmission. 2015 assessment data from 3,592,995 Medicare beneficiaries were analyzed representing 1,536,908 from SNFs, 306,878 from IRFs, and 1,749,209 receiving HC services. Total sample 90-day readmission was 25.8 % . Patients discharged to IRF had lowest readmission rate (23.34%), and those receiving HC services had highest readmission rate (29.34%). Creation of risk subgroups however, revealed alternative outcomes. Among all patients in the low, intermediate and high risk groups, the lowest readmission rates occurred among SNF patients. Factor analysis of assessment variables indicated bladder and bowel incontinence and functional limitations were the most distinguishing factors between the very low and very high risk subgroups.

Publisher's version (útgefin grein), Objective: To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. Design: Retrospective longitudinal analysis of an international home care database. Setting and participants: 523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. Measures: Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. Results: The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. Conclusions/Implications: The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery., The authors remain grateful to interRAI.org and specifically the home care clients whose assessments provided the data for this project.

Military to civilian reintegration is a complex, multidimensional phenomenon warranting holistic perspectives. Complex phenomena require theory to understand and interpret relationships among concepts. Despite the need for theory-driven research, recent nursing reports often lack a theoretical structure. We extracted relevant concepts from the Neuman's Systems Model (stressors, environment, and person) and the Transactional Model of Stress and Coping (primary and secondary appraisal, coping, and adaptation) to form a Conceptual-Theoretical-Empirical model. Exemplar empirical instruments are presented, along with their conceptual and theoretical dimensions. An integrated System Theory of Stress, Resilience, and Reintegration is presented with its utility demonstrated through a research application.

Peer-based intervention strategies may be an important component of physical activity interventions, yet there is inconsistent and overlapping terminology and a lack of a clear framework to provide a general understanding of what peer-based programs are exactly and what they aim to accomplish in the current literature. Therefore, a group of researchers from the Boston Roybal Center for Active Lifestyle Interventions (RALI) collaborated on this paper to propose a typology of peer-based intervention strategies, situate peer-based strategies within a broader conceptual framework, and provide practice guidelines for designing, implementing and reporting peer-based programs with older adults. We advance clarity and a common terminology and highlight key decision points that offer guidance for researchers and practitioners in using peers in their health promotions efforts, and anticipate that it will facilitate appropriate selection, application, and reporting of relevant approaches in future research and implementation work.

Cognitive decline impacts older adults, particularly their independence. The goal of this project was to increase understanding of how short-term, everyday lifestyle options, including physical activity, help an older adult sustain cognitive independence. Using a secondary analysis of lifestyle choices, we drew on a dataset of 4,620 community-dwelling elders in the US, assessed at baseline and one year later using 2 valid and reliable tools, the interRAI Community Health Assessment and the interRAI Wellness tool. Decline or no decline on the Cognitive Performance Scale was the dependent variable. We examined sustaining one’s status on this measure over a one-year period in relation to key dimensions of wellness through intellectual, physical, emotional, social, and spiritual variables. Engaging in physical activity, formal exercise, and specific recreational activities had a favorable effect on short-term cognitive decline. Involvement with computers, crossword puzzles, handicrafts, and formal education courses also were protective factors. The physical and intellectual domains of wellness are prominent aspects in protection from cognitive decline. Inherent in these two domains are mutable factors suitable for targeted efforts to promote older adult health and well-being.

Innovative, community-based interventions that promote behavioral wellness are critical to engaging older adults in improving personal health. The objective of this qualitative content review was to develop an understanding of older adults’ wellness priorities. A random sample of 128 male and female

The purpose of this study was to develop a prediction model of demographic and sociobehavioral characteristics common among older adults with hypertension (HTN) who engage in self-management behavior. A descriptive, correlational predictive design was used to collect data at 14 faith-based and senior citizen organizations in a major urban northeastern city. Participants ranged in age from 63 to 96 with a mean age of 77 (SD 6.9). A 33-item questionnaire was used to gather data on 15 explanatory and 5 outcome variables. Instruments were the Perceived Stress Scale, the Duke Social Support Index, the stage of change for physical activity scale, and the DASH Food Frequency Questionnaire. Correlation and regression analyses were used to test the hypothesis. Results indicate there is a common set of characteristics such as higher stage of change, reading food labels, and higher self-rated health that can predict the older adult’s likelihood to engage in hypertension self-management behavior. The significant correlations found in this preliminary study warrant further study and validation. Findings are clinically relevant as knowledge of demographic and sociobehavioral characteristics associated with engagement in self-management behavior enables health care clinicians to support and encourage older adults to improve management of this common, chronic condition.

The purpose of this study was to assess the relationship between diabetes self-care, diabetes-specific emotional distress, and social support and glycemic control (hemoglobin A1C levels: HbA1c) among a sample of Lebanese adults with type 2 diabetes. A descriptive correlational design was adapted with descriptive statistics and multiple logistic regressions for analyses. A convenience sample of 140 adults diagnosed with type 2 diabetes was recruited from 2 diabetes clinics in Greater Beirut. Participants were asked to complete 4 questionnaires in Arabic. Significant associations (P < .05) were found between following a general diet for more than 3.5 days per week and higher social support and HbA1c levels of 7% or more. Social support was positively associated with HbA1c levels such that participants with uncontrolled glycemic levels, as evidenced by higher values for HbA1c, received more support from their social network.

The purpose of this research was to examine the psychometric properties of the Lifestyle Survey (LS), a wellness instrument designed for community dwelling older adults. The LS contains 109 items measuring wellness in six domains: physical fitness, recreation, nutrition, social relationships, emotionality, and spirituality. A two-part study was conducted using a sample of community dwelling adults 65 and older. Reliability was assessed using a timed series administration of the LS with a two-week interval between survey administrations. Forty-four individuals returned both pre and post surveys. Participants ranged in age from 66 to 91 years (M=75 years), were largely low income (62% earning under $14,999), and female (84%). Based on kappa agreement statistics, LS items demonstrated reliability over time with 63% of the items maintaining a moderate or near perfect agreement and 22% maintaining fair to poor agreement over two weeks. A follow-up focus group (N=9) was conducted to assess LS face validity using a group debrief format exploring clarity of item wording, evaluating question response options, assessing older adult views of wellness concepts, and identifying areas for improving the instrument overall. Results indicate overall face validity of LS items with additional suggestions for improving validity including clarifying certain wellness terms (i.e. homeopathy, reiki, aromatherapy), parceling larger questions into smaller components (such as fluid intake types), and further clarifying terms that leave leeway for interpretation such as “healthy diet.” Formatting feedback included using words over numbers for rating scales and use of “don’t know” response options.

The purpose of this project was to develop and test the interRAI-based Nursing Home (NH) Frailty Scale so as to enhance our understanding of this age-related concept. Study cohort consisted of US nursing home residents for year 2012 with a baseline sample of 1,097,189 assessments and a quarterly follow-up sample of 1,007,450. Using a secondary analysis approach, a subset of items in both the interRAI Long-term Care Facilities assessment system and Minimum Data Set (MDS) version 3.0 nursing home assessment system were examined. Logistic regression was used to evaluate items for inclusion and subsequent analyses validated the scale. The interRAI-based NH Frailty Scale was developed from an analysis of more than 100 items from the MDS, with death, hospitalization, and clinical judgment being close to death as dependent measures. The resulting 21-item frailty scale represents domains of function, cognition/communication, clinical symptoms, medical diagnoses, and treatments. Scale scores extended from zero to 14 with the average frailty score of 4.45. Incidence of death within the 120-day follow-up period increased steadily for those with a frailty score of 6 and above. When we saw an improvement on the NH Frailty Scale, we also found lower distress rates on each measure, serving to validate the scale. Because of the large number of frail elders within their facility, US nursing homes are best positioned to assume the leadership and implement routine frailty screening and assessment, based on the MDS, a tool currently in use in nursing homes.

ArtOn the Brain is a mobile application that incorporates art history education, play and socialization for older adults. This pilot project examined its health and social impact among long term care residents. A convenience sample of 48 residents, 60+ years, with borderline intact to moderate cognitive impairment were recruited. Residents with mild or better cognitive status used the app individually on a tablet while the remaining participated in therapist-led group sessions. One-hour intervention occurred twice weekly. Primary outcomes, health and well-being, were measured with 5Q-5D-5L and Warwick-Edinburgh Mental Well-being tools at baseline and after 6 weeks. Secondary outcomes were mood, cognition, function and overall satisfaction with activity options and personal relationships. Pre-post paired t-test analyses of data from EQ-5D-5L and Warwick tools did not show a significant difference. There were no notable declines with cognitive performance, functional ability and depression post-intervention. Four activity options and three personal relationship items had statistically significant improvements post-intervention. Activity options addressed engagement in enjoyable activities on weekends and evenings, and opportunity to, spend time with other like-minded residents and explore new skills, interests. Personal relationships items included engagement in activities helpful to others and having people to do things with. ArtOn the Brain is a novel application suitable for long term care residents. While 6 week intervention did not show improvement in overall health and well-being, there were significant improvements with residents’ reported engagement in activity options and improvement of personal relationships. Longitudinal evaluations are needed to examine changes in health status and well-being.

Background and Purpose: Nurse researchers and practicing nurses need reliable and valid instruments to measure key clinical concepts. The purpose of this research was to develop an innovative method to measure dimensions of wellness among older adults. Method: A sample of 5,604 community-dwelling older adults was drawn from members of the COLLAGE consortium. The Wellness Assessment Tool (WEL) of the COLLAGE assessment system provided the data used to create the scores. Application of the Rasch analysis and Masters' partial credit method resulted in logit values for each item within the five dimensions of wellness as well as logit values for each person in the sample. Results: The items fit the Rasch model, and the composite scores for each dimension demonstrated high reliability (1.00). The person reliability was low: social (.19), intellectual (.33), physical (.29), emotional (.20), and spiritual (.29). The small number of items within each dimension and the homogenous sample appear to have contributed to this low reliability. Conclusion: Ongoing research using multidimensional tools to measure dimensions of wellness among older adults is needed to advance wellness science and wellness promotion in nursing practice.Keywords: wellness; multidimensional wellness; holistic; aging adults; older adults(ProQuest: ... denotes formulae omitted.)Promoting wellness among aging adults needs to be a priority for nurses both today and in the future (Institute of Medicine [IOM], 2011). Testing interventions designed to promote wellness among older adults is becoming increasingly impor- tant as the number of adults entering old age is growing exponentially. Baby boomers, those born between 1946 and 1964, started turning 65 years old in 2011; they represent 20% of the United States population (Federal Interagency Forum on Aging-Related Statistics, 2010; Hartman-Stein & Potkanowicz, 2003). As adults age, their risk for chronic disease, functional decline, and cognitive decline increases (Federal Interagency Forum on Aging-Related Statistics, 2010). These increased risks affect quality of life, increase health care costs, and limit older adults' ability to remain living independently in the community (Federal Interagency Forum on Aging-Related Statistics, 2010). The recent Future of Nursing Report for the IOM (2011) expects a transformed health care system where nurses intentionally promote wellness and disease prevention, reliably improve health outcomes, and provide compassionate care across the life span (IOM, 2011, para. 1).Promoting wellness among older adult populations forces a paradigm shift in health care delivery from disease-focused or deficit-based care to well-focused or asset-based care. The goal for the future of nursing is to shift sick-focused care to wellness care through creative, innovative, holistic, and multidimensional wellness interventions in the community (IOM, 2011). Nurses play a critical role in wellness program development, evaluation, and education (IOM, 2011). Before nurses can design effective wellness inter- ventions for America's aging adults, they need valid and reliable methods to measure the multidimensional concept of wellness. The purpose of this article is to present a multidi- mensional wellness measurement tool and scoring method designed specifically for older adults.BACKGROUNDThe concept of wellness is not universally defined (Mackey, 2009). Theorists, however, agree that wellness is a complex and holistic state of being that innately strives to expand and achieve one's full potential (Adams, Bezner, Steinhardt, 1997; Hattie, Myers, & Sweeney, 2004; Hettler, 1976; National Wellness Institute, 2010; Nenn & Vaisberg, 2010; Witmer & Sweeney, 1992). Wellness is a multidimensional structure encompass- ing five to seven dimensions: social, occupational, spiritual, physical, intellectual, envi- ronmental, and psychological (Adams et al., 1997; Becker, Dolbier, Durham, Glascoff, & Adams, 2008; Hattie et al. …

Objectives To systematically identify, appraise, and summarize research on the effects of behavioral interventions to prevent cognitive decline in community-dwelling older adults using a holistic wellness framework. Design Systematic review of randomized controlled trials that tested the effectiveness of behavioral interventions within each of the six dimensions of wellness: occupational, social, intellectual, physical, emotional and spiritual. Databases searched included PubMed MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, ALOIS, and The Grey Literature Report through July 1, 2014. Setting Community. Participants Individuals aged 60 and older (N = 6,254). Measurements Consolidated Standards of Reporting Trials Checklist. Results Eighteen studies met the inclusion criteria. Interventions in the physical dimension of wellness were most common (11 studies); interventions in the spiritual dimension were least common (0 studies). Fifty-nine different measures were used to measure multiple cognitive domains, with memory being the most commonly measured (17 studies) and language being the least commonly measured (5 studies). Fifty percent of the interventions examined in the 18 studies demonstrated statistically significant outcomes on at least one cognitive measure. Interventions in the intellectual dimension that examined cognitively stimulating activities using pen and paper or a computer represented the greatest percentage of statistically significant outcomes. Conclusion Intellectual and physical interventions were most studied, with varied results. Future research is needed using more-consistent methods to measure cognition. Researchers should include the National Institutes of Health Toolbox Cognition Battery among measurement tools to facilitate effective data harmonization, pooling, and comparison.

Translation of instruments needs to ensure equivalence between the source and the target language to establish the psychometric properties of the translated version. The purpose of this study was to examine the psychometric properties of the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA) instrument. The 12-item English version of the SDSCA was translated into Arabic using back translation on a sample of 140 Lebanese participants with Type 2 diabetes. Construct validity was measured using exploratory factor analysis with varimax rotation. Multitrait scaling analysis was used to test for item convergent and discriminant validity based on item–scale correlations. Conceptual and content validity were examined by an expert panel in diabetes. Internal consistency reliability R was assessed using interitem correlations. The average interitem correlation for the four subscales ranged between –.05 for Diet and .66 for Glucose Testing. Factor analysis identified four factors which accounted for 60% of the variance. The preliminary results of Summary of Diabetes Self-Care Activities-Arabic Version (SDSCA-Ar) are comparable to the psychometric properties the original SDSCA. SDSCA-Ar is a valid measure of diabetes self-care in Lebanese patients with diabetes.

Objective: Examine how wellness in six dimensions (occupational, social, intellectual, physical, emotional, and spiritual) protects cognition in aging adults. Background: cognitive impairment increases with age. Baby boomers represent a significant percent of the population at risk for cognitive impairment. Cognitive impairment has a negative impact on nursing resources, health care finances, patient mortality, and quality of life. Wellness and prevention is one focus of Institute of Medicine’s vision for the future of nursing. Method: Literature was retrieved from Cumulative Index to Nursing and Allied Health Literature and MEDLINE. Research that examined the affect of wellness in each of the six dimensions on cognition in older adults was included. Results: One or more of the following may protect cognition in aging: midlife occupation complexity, marriage, social networks, formal education, intellectual activities, physical activity, healthy nutrition, motivational ability, purpose in life, and spirituality. Conclusion: Wellness in one or more of the six dimensions may protect cognition in aging. The cognitive protective benefits may increase when wellness in more than one dimension is demonstrated. High wellness in one dimension may protect cognition by compensating for low wellness in another dimension. The interconnectedness of each of the dimensions signifies the importance of evaluating older adults holistically. Wellness throughout the life span may result in improved cognition in aging. Application: Future research is needed to examine the relationship between the six dimensions of wellness and cognition, and to determine if one dimension of wellness is a significant predictor of cognitive health in aging adults.

Background Despite practice guidelines promoting delirium assessment in intensive care, few data exist regarding current delirium assessment practices among nurses and how these practices compare with those for sedation assessment. Objectives To identify current practices and perceptions of intensive care nurses regarding delirium assessment and to compare practices for assessing delirium with practices for assessing sedation. Methods A paper/Web-based survey was administered to 601 staff nurses working in 16 intensive care units at 5 acute care hospitals with sedation guidelines specifying delirium assessment in the Boston, Massachusetts area. Results Overall, 331 nurses (55%) responded. Only 3% ranked delirium as the most important condition to evaluate, compared with altered level of consciousness (44%), presence of pain (23%), or improper placement of an invasive device (21%). Delirium assessment was less common than sedation assessment (47% vs 98%, P < .001) and was more common among nurses who worked in medical intensive care units (55% vs 40%, P = .03) and at academic centers (53% vs 13%, P < .001). Preferred methods for assessing delirium included assessing ability to follow commands (78%), checking for agitation-related events (71%), the Confusion Assessment Method for the Intensive Care Unit (36%), the Intensive Care Delirium Screening Checklist (11%), and psychiatric consultation (9%). Barriers to assessment included intubation (38%), complexity of the tool for assessing delirium (34%), and sedation level (13%). Conclusions Practice and perceptions of delirium assessment vary widely among critical care nurses despite the presence of institutional sedation guidelines that promote delirium assessment.

This study presents the first update of the Cognitive Performance Scale (CPS) in 20 years. Its goals are 3-fold: extend category options; characterize how the new scale variant tracks with the Mini-Mental State Examination; and present a series of associative findings. Secondary analysis of data from 3733 older adults from 8 countries was completed. Examination of scale dimensions using older and new items was completed using a forward-entry stepwise regression. The revised scale was validated by examining the scale’s distribution with a self-reported dementia diagnosis, functional problems, living status, and distress measures. Cognitive Performance Scale 2 extends the measurement metric from a range of 0 to 6 for the original CPS, to 0 to 8. Relating CPS2 to other measures of function, living status, and distress showed that changes in these external measures correspond with increased challenges in cognitive performance. Cognitive Performance Scale 2 enables repeated assessments, sensitive to detect changes particularly in early levels of cognitive decline.

Background According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult’s risk of falling and if it does, will the relationship hold as the count of risk factors increases? Methods Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment. Results For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls. Conclusions The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

Background: As adults age, there is a greater risk of cognitive health decline, and thus protecting cognitive health is a public health priority. Negative mood is a risk factor for losing cognitive abilities among aging adults. The Broaden and Build Theory of Positive Emotion suggests that activities that build positive emotion may mediate the negative effects of negative mood. This theory guided an examination of the relationship between mood and activities that promote positive emotions and their effects on cognitive decline among aging adults. Methods: The sample included 492 community-dwelling adults 60 years and older who completed a Community Health Assessment (CHA) and a COLLAGE Wellness Assessment (WEL) twice between the years 2007 and 2013. Cognition was measured using items from the CHA that formed the Cognitive Performance Scale (CPS) and activities that promote positive emotions was measured using items from the WEL. Negative mood was measured using items from the CHA. Logistic regression was used to associate CPS, mood, and positive emotion activities at baseline and after at least one year. Results: All three of the negative mood variables were statistically significant predictors of a poor CPS score. The presence of negative statements (p=0.036), anger (p=0.017), and withdrawal (p=0.009) were statistically significant. Conclusions: None of the activities that cultivate positive emotions were significantly associated with changes in CPS score. Future research should examine interventions to reduce negative mood and determine if they mediate the risk of cognitive decline among aging adults.

Background Older adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals. Methods A secondary analysis of data from a cross-national sample of community residing elderly, 60 years of age or older, and most of whom received services from a local home-care program was conducted. The assessment instrument used in this study is the interRAI HC (home care), designed for use in assessing elderly home care recipients. The model specification stage of the study identified the baseline independent variables that do and do not predict the follow-up measure of hospitalization and ED use. Stepwise logistic regression was used next to identify characteristics that best identified elders who subsequently entered a hospital or visited an ED. The items generated from the final multivariate logistic equation using the interRAI home care measures comprise the interRAI Hospital-ED Risk Index. Results Independent measures in three key domains of clinical complications, disease diagnoses and specialized treatments were related to subsequent hospitalization or ED use. Among the eighteen clinical complication measures with higher, meaningful odds ratios are pneumonia, urinary tract infection, fever, chest pain, diarrhea, unintended weight loss, a variety of skin conditions, and subject self-reported poor health. Disease diagnoses with a meaningful relationship with hospital/ED use include coronary artery disease, congestive heart failure, cancer, emphysema and renal failure. Specialized treatments with the highest odds ratios were blood transfusion, IV infusion, wound treatment, radiation and dialysis. Two measures, Alzheimer’s disease and day care appear to have a protective effect for hospitalization/ED use with lower odds ratios. Conclusions Examination into “preventable” hospitalizations and re-hospitalizations for older adults who have the highest rates of utilization are occurring beneath an umbrella of assuring the highest quality of care and controlling costs. The interRAI Hospitalization-ED Risk Index offers an effective approach to predicting hospitalization utilization among community dwelling older adults.

Wellness is associated with cognitive health protection; however, findings are limited because they only examine variable(s) within one dimension of wellness. This research examined the association between multiple dimensions of wellness and cognition among aging adults. The sample included 5,605 male and female community-dwelling adults 60 years and older. Four dimensions of wellness demonstrated a statistically significant higher mean difference in cognitively healthy older adults compared to cognitively impaired older adults, F(4, 5,595) = 47.57, p < .001. Emotional wellness demonstrated the strongest association with cognitive health, followed by physical and spiritual wellness, F(5, 5,372) = 50.35, p < .001. Future research is needed to examine the cognitive protective benefits of wellness using longitudinal, prospective designs that control for the potential temporal relationship between wellness and cognition.

This project used the interRAI based, community health assessment (CHA) to develop a model for identifying current elder drivers whose driving behavior should be reviewed. The assessments were completed by independent housing sites in COLLAGE, a non-profit, national senior housing consortium. Secondary analysis of data drawn from older adults in COLLAGE sites in the United States was conducted using a baseline assessment with 8042 subjects and an annual follow-up assessment with 3840 subjects. Logistic regression was used to develop a Driving Review Index (DRI) based on the most useful items from among the many measures available in the CHA assessment. Thirteen items were identified by the logistic regression to predict drivers whose driving behavior was questioned by others. In particular, three variables reference compromised decision-making abilities: general daily decisions, a recent decline in ability to make daily decisions, and ability to manage medications. Two additional measures assess cognitive status: short-term memory problem and a diagnosis of non-Alzheimers dementia. Functional measures reflect restrictions and general frailty, including receiving help in transportation, use of a locomotion appliance, having an unsteady gait, fatigue, and not going out on most days. The final three clinical measures reflect compromised vision, little interest or pleasure in things normally enjoyed, and diarrhea. The DRI focuses the review process on drivers with multiple cognitive and functional problems, including a significant segment of potentially troubled drivers who had not yet been publicly identified by others. There is a need for simple and quickly identified screening tools to identify those older adults whose driving should be reviewed. The DRI, based on the interRAI CHA, fills this void. Assessment at the individual level needs to be part of the backdrop of science as society seeks to target policy to identify high risk drivers instead of simply age-based testing.

The purpose of this study was to determine whether a nursing intensity system could be used as a valid and reliable measure of patient function (ability to perform activities of daily living). Eighty seven patients on the medical service were randomly selected for inclusion in the study. Functional status assessment was obtained by the Katz Index and compared with functional status data obtained from the nursing intensity system. Correlation between the two measures was high (r = .71, p < .001). The nursing intensity system was also found to have high internal consistency (alpha = .85). It was concluded that such systems have the potential to provide useful measures of function.

To remain viable, academic institutions preparing the future workforce need to be attentive and responsive to changes in the social environment. This is particularly true when considering the preparation of a health care workforce for the field of geriatrics. An Interdisciplinary Geriatric Education Center is an innovative, deliberate, institutional strategy to prepare and deliver an effective healthcare workforce for the future geriatric population. The model and processes for the implementation of such a center are presented.

TOPIC Clinical learning in a managed-care environment. PURPOSE To obtain evaluative data about clinical learning experiences for graduate nursing students based on the domains of competence for successful practice in managed-care organizations. METHODS A survey of 42 nurses (20 graduate students, 22 nurse practitioner preceptors) self-reported on two questionnaires. FINDINGS Both the students and preceptors reported that there were learning opportunities for research utilization, the development of clinical competence, the identification of group dynamics, the development of leadership skills. In addition, the respondents reported learning opportunities to examine the financial impact on healthcare delivery and clinician decision making. The area of ethics and its impact on clinical decision making is an apparent void, as reported by the respondents. CONCLUSIONS A managed care environment does provide an effective learning environment for nurse practitioner students.