Evaluation of a Stress, Coping, and Resourcefulness Program for VA Nurses During the COVID-19 Pandemic.

Background: The COVID-19 pandemic, combined with the shortage of nursing staff, contributed to higher levels of stress. Sustained stress has been associated with burnout. However, nurses have traditionally demonstrated resourcefulness skills that resulted in building resilience.

Needs assessment survey of healthcare providers' perceptions and practices regarding delirium prevention at a university medical center.

Despite the high prevalence and serious implications of delirium, identification, tracking, and documentation of the condition remain a challenge for the health care team, impeding management of patients. This survey is the first phase of a qualitative study to build a conversational agent-based tool for screening and managing delirium-prone patients. To assess healthcare providers' perceptions of delirium management, focusing on patient assessment, therapeutic interventions, and subsequent communication and documentation.

The Effects of Osteoarthritis on Depressive Symptomatology Among Older U.S. Military Veterans.

Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.

Assessment and Management of Delirium in Critically Ill Veterans.

Background: Delirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality.

Objective: To describe a nurse-led interdisciplinary quality improvement initiative to increase nurses' knowledge of delirium, documentation of delirium assessment, and patient mobility.

Malnutrition as a Fall Risk Factor.

Examining various aspects of malnutrition in elderly patients may be helpful in determining the risk of falls.

Simulation Training, Coaching, and Cue Cards Improve Delirium Care.

A quality improvement study supports the use of multimodal education to enhance clinical practice for care of patients with delirium.

Is a behavioral treatment for urinary incontinence beneficial to prostate cancer survivors as a follow-up care?

Purpose: The American Cancer Society (ACS) recommends a follow-up care plan for urinary incontinence of prostate cancer survivors that includes pelvic floor muscle exercise (PFME). We examined potential impacts and access barriers of this recommendation with consideration of patients who normally do not seek such care.

Methods: We compared 267 participants of a clinical trial that tested a PFME-based treatment of urinary incontinence and 69 nonparticipants who declined the trial.

Racial Difference in Response to Vitamin D Supplementation.

Unlabelled: This manuscript is the result of work supported by the use of resources and facilities at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, specifically, the Geriatric Research Education and Clinical Center (GRECC).

Background: Deficiency in 25-hydroxyvitamin D (25[OH]D) is common, especially in the elderly and African Americans (AA). While 25(OH) D deficiency is associated with multiple negative health outcomes, current recommendations for supplementation of this deficiency may be insufficient.

Patterns of Benign Prostatic Hyperplasia Associated Urinary Retention: Indwelling Urinary Catheter Use and Clinical Sequelae.

Introduction: Current clinical practice guidelines aim to decrease the use of unnecessary indwelling urinary catheters to prevent catheter associated urinary tract infections. Patients with benign prostatic hyperplasia often experience increased post-void residual urine volume and subsequent bladder catheterization to prevent complications such as urinary tract infections or hydronephrosis. However, the management of urinary retention in patients with benign prostatic hyperplasia varies and clinical guidelines are lacking.

Impacting the Trajectory of Chronic Kidney Disease With ARPN-Led Renal Teams.

Health care reform demands improvements in population health and the patient experience while reducing costs. This demand is referred to as The Triple Aim of Improvement. A sense of urgency must be created for development of new models of care that impact outcomes earlier in the disease process.

Effects of Patient Centered Interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment: A Randomized, Controlled Trial.

Purpose: We examined whether an intervention combining pelvic floor muscle exercise and symptom self-management would improve urinary continence and quality of life in patients with prostate cancer.

Materials And Methods: In a randomized, controlled, longitudinal clinical trial 279 patients with prostate cancer with persistent urinary incontinence were randomized to 1 of 3 groups, including biofeedback pelvic floor muscle exercise plus a support group, the biofeedback exercise plus telephone contact and usual care without intervention. The biofeedback plus support and plus telephone groups received 1 session of biofeedback assisted exercise and 6 biweekly sessions of problem solving therapy.

Willingness and access to joint replacement among African American patients with knee osteoarthritis: a randomized, controlled intervention.

Objective: African American patients are significantly less likely to undergo knee replacement for the management of knee osteoarthritis (OA). Racial difference in preference (willingness) has emerged as a key factor. This study was undertaken to examine the efficacy of a patient-centered educational intervention on patient willingness and the likelihood of receiving a referral to an orthopedic clinic.

Acute care for elders units produced shorter hospital stays at lower cost while maintaining patients' functional status.

Acute Care for Elders Units offer enhanced care for older adults in specially designed hospital units. The care is delivered by interdisciplinary teams, which can include geriatricians, advanced practice nurses, social workers, pharmacists, and physical therapists. In a randomized controlled trial of 1,632 elderly patients, length-of-stay was significantly shorter-6.

Impact of perceived discrimination in healthcare on patient-provider communication.

Background: The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown.

Objective: To examine association of past perceived discrimination with subsequent patient-provider communication.

Research Design: Observational cross-sectional study.

The use of multimodal strategies for distance education in the GRECCs.

The Department of Veterans Affairs (VA) has found distance education to be particularly valuable as a means to disseminate information to large numbers of busy learners in geographically diverse settings. Specifically, Geriatric Research, Education and Clinical Centers (GRECCs) of the VA have used various forms of distance learning to provide geriatrics-focused education to diverse health care providers. Such formats allow programs to be available to audiences regardless of distance or time.

Orthopedic communication about osteoarthritis treatment: Does patient race matter?

Objective: To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee and hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs orthopedic clinics.

Methods: Audio recorded visits between patients and orthopedic surgeons were coded using the Roter Interaction Analysis System and the Informed Decision-Making model. Racial differences in communication outcomes were assessed using linear regression models adjusted for study design, patient characteristics, and clustering by provider.

The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting.

Background: The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.

Objective: To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.

Design: Prospective, observational study.

Recovery of activities of daily living in older adults after hospitalization for acute medical illness.

Objectives: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge.

Design: Observational.

Setting: Tertiary care hospital, community teaching hospital.

Emerging nurse-sensitive outcomes and evidence-based practice in postoperative cardiac patients.

Outcomes continue to be one of the most powerful measures of quality care in all health care settings for all caregivers. Nurse-sensitive outcome measurement is one of the most promising strategies that can enhance patient care and satisfaction of patients, families, and caregivers. The purpose of this article is to assist intensive care unit nurses with identification and implementation of current evidence-based nursing interventions for the critically ill patients undergoing cardiac surgery.

The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients.

Objectives: To determine the association between indwelling urinary catheterization without a specific medical indication and adverse outcomes.

Design: Prospective cohort.

Setting: General medical inpatient services at a teaching hospital.

The use of guided imagery to manage pain in an elderly orthopaedic population.

Background: The management of postoperative pain in elderly orthopaedic patients is critical for advancing patient outcomes and improving the use of healthcare resources. Adequate pain control without adverse side effects, such as confusion and sedation, is crucial to promote comfort and participation in rehabilitation therapies among all patients but particularly among elderly joint replacement patients. Without adequate pain control, physical therapy is delayed and the risk of complications increases.

Unsteadiness reported by older hospitalized patients predicts functional decline.

Objectives: To determine whether a simple question about steadiness at admission predicts in-hospital functional decline and whether unsteadiness at admission predicts failure of in-hospital functional recovery of patients who have declined immediately before hospitalization.

Design: Prospective cohort study.

Setting: One university hospital and one community teaching hospital.