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Presbyphagia is age-related changes in swallowing function, which imposes a high risk of aspiration in older adults. Considering olfactory stimulation (OS) can influence behavioral activities by modulating neuronal excitability, the present study aims to determine whether OS could improve the swallowing function of aged rats through activating the central neuronal networks and downstream muscular activities participated in the control of swallowing. Aged male Wistar rats received OS by inhaling a mixture of plant-based volatile molecules twice a day for 12 days were subjected to functional magnetic resonance imaging (fMRI) and c-fos, choline acetyltransferase (ChAT) immunostaining to detect the neuronal activities of the orbitofrontal cortex (OFC) and medullary nuclei engaged in swallowing control, respectively. The functional effects of OS on downstream pharyngeal muscle activity were examined by evaluating the dihydropyridine receptor–ryanodine receptor (DHPR–RyR)-mediated intramuscular Ca2+ expression, and analyzing the amplitude/frequency of muscle contraction, respectively. In untreated rats, only moderate signal of fMRI and mild c-fos/ChAT expression was detected in the OFC and medullary nuclei, respectively. However, following OS, intense signals of fMRI and immunostaining were clearly expressed in the orbitofronto-medullary networks. Functional data corresponded well with above findings in which OS significantly enhanced DHPR–RyR-mediated intramuscular Ca2+ expression, effectively facilitated a larger amplitude of pharyngeal muscle contraction, and exhibited better performance in consuming larger amounts of daily dietary. As OS successfully activates the neuromuscular activities participated in the control of swallowing, applying OS may serve as an effective, easy, and safe strategy to greatly improve the swallow function of aging populations.

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

This pilot study explored whether Reiki delivered by family caregivers to cancer patients in a home setting was feasible in reducing cancer symptoms and enhancing health-related outcomes. An explanatory sequential mixed-methods study design was applied using pre-/post-Reiki questionnaires and post-Reiki interviews. Six patient-caregiver dyads from an outpatient clinic and cancer support facilities in northeast America performed daily Reiki at home for 3 weeks. Differences with symptoms, mental well-being, health-related quality of life, and satisfaction with at-home Reiki as well as qualitative content analyses were evaluated. Positive feedback was reported after at-home Reiki practice. Large statistical effects were identified for improving fatigue, memory, mood, nausea, and emotional well-being (P < .10, r = 0.51-0.59). All participants were satisfied and 83.3% of them would recommend self-practice home Reiki. High involvement and adherence to the intervention protocol illustrated intervention fidelity. The qualitative data revealed 2 major categories, perceived benefits and barriers. Overall Reiki benefits outweighed barriers in relation to time commitment and place distractions/positioning. Our preliminary findings support that the at-home Reiki protocol had potential benefits and was feasible and acceptable by both community-dwelling patients and their family caregivers in promoting cancer-related outcomes. Further studies with larger samples are warranted to examine the effectiveness of home-based Reiki for a patient-centered cancer care modality.

This pretest-posttest pilot study was to examine the effects of how olfactory stimulation (OS) influenced swallowing function in older adults. Forty-four community-dwelling older residents (24 OS & 20 control) from southern Taiwan were recruited. Participants in the intervention group administered pre-meal OS using odor and flavor inhalation. The study found that physiological responses for different food textures significantly differed between groups at post-test ( p ≤ .02). Within the experimental group, swallowing function, and individual satisfaction showed significant differences before and after the odor inhalation over time ( p

Background Online teaching has expanded over the past few decades, particularly during the COVID-19 pandemic. However, characteristics of online teaching effectiveness and quality remain understudied. Purpose This study examined perceptions of online teaching effectiveness from nursing faculty and student perspectives. Methods The findings presented are from phase 1 of a three-phase, mixed methods research project. In this phase, a qualitative descriptive design was used to analyze data obtained from focus group interview sessions. A purposive sampling of faculty (N = 15) and students (N = 17) from one midwestern, public university participated in five focus groups. Results Seven themes emerged through qualitative data analysis of faculty focus group data. Student focus groups yielded six themes. Faculty and students identified challenges and strategies for effective online teaching. Student and faculty perceptions of online teaching effectiveness aligned for many themes. Conclusion Study findings have distinct implications for nursing education. Identifying the characteristics of online teaching effectiveness provides the foundation for establishing tangible constructs and robust evaluation, broadening the impact on learning outcomes, faculty development, and educational practice.

Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. Educational aims To explain the basic domains of palliative care applicable to chronic respiratory diseases. To review palliative care interventions for patients with chronic respiratory diseases. To outline a checklist for clinicians to use in practice, based on the domains of palliative care. To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases., Early palliative care can relieve suffering and provide support for people with respiratory diseases http://ow.ly/bEmW30fQw8l

Benefits of home-telemonitoring for rural dwelling cancer patients are largely unknown. This study examined the effectiveness of home-telemonitoring surveillance with nurse coaching for self-management to improve lung cancer outcomes in mountainous Appalachia where health care access/ service is limited. This randomized clinical trial pilot study compared patient outcomes for telemonitoring versus routine care. A convenience sample (N = 47) was enrolled/ randomized (Telemonitored: 26/ Control: 21) from a university hospital and cancer center. Physiologic parameters and symptoms were collected in the telemonitored group for two weeks; all participants were studied for 60 days after the index treatment/ discharge. The telemonitored group showed greater improvement for both functional status (Wald X2 = 3.78, p = .05) and quality of life (QOL) (Wald X2 = 7.25, p = .007) from baseline to 60 days post-discharge. Compared to controls, telemonitored patients survived longer; had more scheduled medical visits (96% vs. 75%); made more unplanned calls to doctors/ nurses (32% vs. 30% & 64% vs. 50%); had fewer rehospitalizations (28% vs. 40%); and had more ER utilization (36% vs. 30%). The telemonitored group had relative improvements for health utility (.09 on a scale where 0 = death/ 1= perfect health) and QOL (15 on 0-100 VAS). Differences in health care utilization and cost were not significantly different (p > .05), likely due to the sample size. Telemonitoring group satisfaction with care was high and recommended by patients and caregivers. Results suggest that it is possible to improve patient outcomes with home-telemonitoring for self-management in rural areas. Short-term, telemonitoring-based coaching is feasible and offers a promising option to develop patient self-management knowledge and skills.

Introduction: Lung cancer is the leading cause of cancer death worldwide with poor survival rates. However, the prognostic factors for survival of patients with lung cancer are not well-established. In this study, we examined the impact of routine laboratory biomarkers and traditional factors on survival of patients with non-small cell lung cancer (NSCLC). Method: Secondary data analysis was conducted from a retrospective study of 404 patients with newly diag-nosed lung cancer in 2005-2007 in Taiwan. There were eight routine laboratory biomarkers and eight traditional factors investigated in the analyses. Cox proportional hazards model was used to assess the hazard ratios for the association between risk factors and patient overall survival. The Kaplan-Meier method was used to compare survival curves for each prognostic indicator. Results: High WBC counts (HR = 1.798, 95%CI: 1.225 - 2.639), low Hgb level (HR = 1.437, 95%CI: 1.085 - 1.903), and low serum albumin level (HR = 2.049, 95%CI: 1.376 - 3.052) were significant laboratory prognostic biomarkers for poor NSCLC survival. Additionally we confirmed the traditional prognostic factors for poor overall survival among NSCLC patients, including older age, comorbidity conditions, advanced cancer stage, and non-surgical treatment. Conclusions: This study identified three available laboratory biomarkers, high WBC counts, low Hgb level, and low serum albumin level, to be significant prognostic factors for poorer overall survival in NSCLC patients. Further prognostic evaluation studies are warranted to compare different ethnic groups on the prognostic values of these clinical parameters in NSCLC survival outcomes. These identified prognostic biomarkers should be included in early risk screening of hospitalized lung cancer patient population.

87 Background: Reiki is a complementary therapy that has been reported to decrease symptoms of stress and promote relaxation. Standards for administrating Reiki have not been established. Additionally, patients with advanced cancer and their family caregivers (FCGs) encounter challenges during the illness experience that preclude them from participating in stress reducing therapies offered outside the home. The purpose of this study was to evaluate the feasibility and fidelity of an “at-home” reiki intervention performed by the FCG of patients with cancer. Methods: Twelve cancer patients and their FCGs were recruited from oncology outpatient facilities in the Greater Cleveland area. A certified Reiki educator provided two 4-hour courses for the FCGs to learn the basics and practice. To develop and promote intervention fidelity, the FCG maintained a daily diary recording frequency, interval, time of day, and position of Reiki practice. The Reiki educator called the FCG weekly to monitor usage, protocol adherence (60-minutues daily practice for three weeks) and answer questions. Satisfaction with the intervention was measured on completion of the study. Results: Compliance to the study protocol was high in this sample. The majority of day-to-day practice episodes (110/126; 87%) were delivered and completed by FCGs over a three week period. Diary entries indicated FCGs were prone to practice Reiki 45 minutes (72%) per day, once daily (79-93%), in a lying position (82%) and in the evening (61%). Deterioration in a patients’ health was most frequently cited for lack of adherence to daily Reiki practice. A few patients and FCGs reported practice time duration as a barrier. Both patients and FCGs reported a high satisfaction with the Reiki intervention. Follow-up phone calls by a Reiki educator were described as supportive by the FCGs. Conclusions: At-home Reiki was reported as feasible with high compliance and satisfaction to the study protocol. Findings will inform protocol refinement to address the limitations of Reiki practice barriers. This study provides initial support for the administration of an “at home” Reiki intervention in a larger sample to further validate fidelity criteria and treatment effects.

Background: Inconsistent, costly ICU orientation with low retention/RN dissatisfaction are problems. A research approach transformed ICU orientation into a 5-level Competency-based Orientation for Retention Enhancement (CORE-ICU) program. RN vacancies were 33% in 2007 due to rapid expansion in MICU/SICU. Aims: To assess the CORE-ICU program in improving nurse retention/satisfaction, decreasing vacancies below 12%, & improving clinical outcomes in ICUs in an AMC. Methods: Pre-post evaluation. CORE-ICU tested Knowledge (BKAT), Skill (Simulation), and Attitude (Critical Thinking), with mentor development in cultural competence (IACCP-R) and coaching. In 2011, we added mentors/nurses in Pediatric/Neonatal ICUs with curricula paralleling the adult CORE-ICU program. Outcome data were pre-post RN vacancy/retention rates, ICU hospital acquired events (ICU-HAE), and nurse satisfaction. Results: A partnership with WVU hospitals & SON/HSC educated 80 CCRNs, 48 mentors and 5 clinical preceptors. By 2009, vacancy was Conclusion: Graduated leveling by competencies supported 94% completion of CORE-ICU programs; committed preceptor educators & RN mentors have made the program sustainable. Mentor coaching skills were incorporated best practice outcomes for orientation.

This study examines the relationships among physiological, psychological, and social factors and hospital readmission to develop a model predicting chronic obstructive pulmonary disease (COPD) readmission for 145 patients with COPD following hospital discharge at 14 days and 90 days in Taiwan. Daily functioning, comorbidity, severity of illness, self-efficacy, depressive symptoms, and perceived informal support were regressed on hospital readmission. Daily functioning was the only significant variable to predict COPD readmission at 90 days in the Taiwan population living in a rural area. Age was significantly correlated with 14 days readmission. Post hoc analyses examined differences in three ethnic groups. Mainlanders perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens and Hakkas, or the Aborigines. The study reinforced the need for identification of cultural differences and low functioning as risk factors for early readmission so they can be addressed in discharge planning.

174 Background: Complementary care modalities are needed for residential patients and family caregivers, in addition to traditional cancer treatments, to effectively alleviate associated symptoms. Reiki is one of the biofield energy modalities which is generally known to provide non-invasive, non-pharmacological, and beneficial relaxation. It has been commonly practiced to cancer patients in clinical and cancer support facilities. However, little is known about providing Reiki at home especially by informal caregivers. This study aims to describe and understand the perceptions of an in-home Reiki practice as experienced by patients with cancer and their family caregivers. Research Question: What are the perceptions of patients and caregivers of their experiences with an in-home Reiki practice? Methods: A descriptive phenomenological approach (Husserl) was used to explore the perceptions of cancer patients and family caregivers of an in-home Reiki practice through narratives of six dyads of participants; six patients with active cancer and six family caregivers were interviewed. Participants were recruited at three sites in Northeast Ohio. Participants’ narratives were analysed according to Colaizzi’s thematic analysis method. Bracketing, peer debriefing, and external audits were performed to enhance the trustworthiness of findings. Results: Seven major themes were identified: 1) exchange of emotional energies, 2) sensory experiences of energy exchange, 3) physical symptom relief, 4) detachment from stressful circumstances, 5) restoration of spiritual wellbeing, 6) recognition of a valued technique, and 7) lifestyle accommodation. Conclusions: Study participants perceived that in-home Reiki was a beneficial self-care practice that improved the health of patients with cancer. An understanding of patient and caregiver perceptions of Reiki practice in home settings may lead to the development of stand practice and guidelines for a successful patient–caregiver intervention, suitable for a daily schedule or lifestyle. Further study is needed to understand the process underlying in-home Reiki in connection with health outcomes related to cancer.

Purpose/objectives To explore the feasibility of rural home telemonitoring for patients with lung cancer. Design Exploratory, descriptive, observational. Setting Patient homes within a 75-mile radius of the study hospital in West Virginia. Sample 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis. Methods Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months. Main research variables Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction. Findings Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer. Conclusions Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact. Implications for nursing Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.

Purpose/objectives To examine how routine laboratory biomarkers and clinical parameters available within medical records related to overall survival in patients with non-small cell lung cancer (NSCLC). Design Retrospective chart review. Setting University-based cancer center in rural West Virginia. Sample 110 patients from the U.S. Appalachian region with a primary diagnosis of NSCLC at initial hospitalization. Methods Electronic medical records were reviewed for one year after discharge or until death. The Kaplan-Meier method was used to compare survival curves for each prognostic factor. Cox proportional hazards model was used for multivariate analyses. Main research variables Total white blood cell, neutrophil, lymphocyte, and platelet counts; hemoglobin level; body mass index (BMI); performance status; and cancer stage. Findings Low BMI (lower than 18.5 lb/in2), advanced cancer stage (IIIB or IV), and elevated neutrophil (higher than 8 x 103/mcl) and platelet (300-826 x 1012/L) counts were significant, independent prognostic factors for shorter survival time in NSCLC. BMI (hazard ratio [HR] = 2.15, 95% confidence interval [CI] [0.94, 4.9]) and neutrophil (HR = 2.93, 95% CI [1.53, 5.59]) and platelet (HR = 2.65, 95% CI [1.25, 5.62]) counts were overall prognostic predictors for patients with advanced NSCLC and remained in the multivariate survival model. Conclusions This study detected two known clinical parameters, cancer stage and nutritional status (i.e., BMI and neutrophil and platelet counts), as having independent prognostic significance for shorter survival in NSCLC. Research on survival in patients with NSCLC should include those identified laboratory biomarkers and clinical parameters for screening patients at risk for shorter survival time following hospitalization. Investigation of whether treatments tailored to address neutrophil and platelet counts and BMI can improve survival outcomes also is warranted. Implications for nursing Attention to common biomarkers recorded in patient charts (e.g., neutrophil and platelet counts) as well as BMI could allow nurses to identify patients at risk for low survival. Interventions should be identified and initiated. Longitudinal studies in clinical settings that follow the survival of patients with NSCLC are essential.

Diabetes has been consistently linked to many forms of cancers, such as liver, colorectal, pancreatic, and breast cancer, however, the role of diabetes in outcome among cancer patients remains unclear. In this study, we retrospectively reviewed electronic medical records of 342 inpatients newly diagnosed with NSCLC referred by a teaching hospital cancer center in southern Taiwan between 2005 and 2007 to examine the effects of fasting glucose levels at time of cancer diagnosis on overall survival in patients with non-small cell lung cancer (NSCLC). All patients were followed up until the end of 2010. The Kaplan–Meier method was used to compare survival curves for patients with and without diabetes. The Cox proportional hazards model was used to estimate hazard ratios for the association between diabetes, other prognostic factors and patient survival. We observed that significant prognostic factors for poor overall survival in patients with NSCLC included older age, smoking, poor performance status, advanced stage (stage IIIB or IV), and no cancer-directed surgery treatment. Particularly, we identified that diabetic state defined by fasting blood glucose level ≥126 mg/dl was another independent prognostic factor for these patients. Compared with those who had normal range of fasting glucose level (70–99 mg/dl), patients with high fasting glucose level (≥126 mg/dl) had 69% excess risk of all-cause mortality in patients with NSCLC. In conclusion: Diabetes as indicated by elevated fasting blood glucose was independently associated with a significantly higher risk of all-cause mortality in patients with NSCLC, indicating that diabetes or hyperglycemia effectively controlled may present an opportunity for improving prognosis in NSCLS patients with abnormal glucose level.

This article describes the development and psychometric evaluation of the short-form Pulmonary Functional Status Scale (PFSS-11©) derived from the previously validated 35-item PFSS, using data from 179 subjects (120 Chronic Obstructive Pulmonary Disease [COPD]/59 normative, non-COPD). Items were extracted based on item-response distribution and commonality >.60. Factor analysis yielded a three-factor solution, accounting for 65.6% of total variance. Construct validity was supported by PFSS-11© scores for COPD versus norms (p

This study examined factors that predicted depressed mood at discharge and 3 months after discharge for 124 elders with chronic obstructive pulmonary disease (COPD). After the use of control for physiologic status (forced expiratory volume in 1 second percent predicted), the factors of anxiety, perceived health competence, daily functioning, and family emotional coping predicted depressed mood. Discharge referrals for home care services could be used to assess the 4 factors with the potential for the healthcare team to intervene. Interventions could include anxiety reduction through music or other therapies, education to enhance perceived health competence, oxygen use with activities to improve functioning, and integration of informal caregiving support from the community to increase family emotional support.

Community engagement through service-learning was introduced into a graduate program in nursing education to develop student leadership skills, interest in learning, and social responsibility. With faculty expertise and guidance, students worked in partnership with underserved community agencies. The goal of sustainability was accomplished by developing faculty expertise in service-learning as a method of instruction and integrating community engagement into academic assignments within existing courses. Opportunities to reflect on the benefits of the experiences were considered crucial to bridging service to learning in the community. Evaluation findings indicate that students gained insight into community needs and resources as they moved outside traditional health care settings. Graduates increased their understanding of their role as a resource to the community, and community agencies saw the value of a nurse educated at an advanced practice level.