The VA Storybook Program: Humanizing Care With Nurse Stories.

The Veterans Affairs (VA) Storybook Program was developed to enhance nurse-patient relationships and satisfaction with care. Personal stories about nurses were distributed to patients on a medical/surgical unit. Quantitative and qualitative evaluation data were collected from patients and nurses to capture patients' descriptions of nurses and perceptions of program value.

Relationships among types of activity engagement and insomnia symptoms among older adults.

Background: An increasing awareness exists that lack of activity engagement is associated with insomnia symptoms. However, the majority of studies have focused on the association between a single type of activity engagement and insomnia symptoms.

Methods: This is a cross-sectional study using secondary data from the Health and Retirement Study examining the relationships among different types of activity engagement and insomnia symptoms among older adults.

Implementing daily chlorhexidine gluconate treatment for the prevention of healthcare-associated infections in non-intensive care settings: A multiple case analysis.

Introduction: Daily bathing with chlorhexidine gluconate (CHG) in hospitalized patients reduces healthcare-associated bloodstream infections and colonization by multidrug-resistant organisms. Achieving compliance with bathing protocols is challenging. This non-intensive care unit multicenter project evaluated the impact of organizational context on implementation of CHG and assessed compliance with and healthcare workers' perceptions of the intervention.

The My Life, My Story Program: Sustained Impact of Veterans' Personal Narratives on Healthcare Providers 5 Years After Implementation.

Patient-centered care promotes positive patient, staff, and organizational outcomes. Communication is one critical element of patient-centered care. Establishing a patient-provider relationship in which a patient feels comfortable sharing their goals, preferences, and values is important to support patient-centered care and positive health outcomes.

Exploring Patterns in Preferences for Daily Care and Activities Among Nursing Home Residents.

Nursing homes have shifted from task-focused to person-centered care (PCC) environments. Understanding resident preferences for daily care and activities is fundamental to PCC. Examining resident similarities based on preferences may be useful for group or community-wide PCC planning.

Nursing home resident relationship types: What supports close relationships with peers & staff?

Aims And Objectives: To describe from the nursing home resident perspective (a) the types and dimensions of relationships residents develop with others in the nursing home and (b) the conditions that influence the development of close relationships.

Background: Close relationships are considered the fundamental building block of person-centred care. Prior studies have examined the various types of relationships residents develop with peers and staff, but few have focused specifically on articulating the characteristics and dimensions of a close relationship or the factors that can support or detract from their development.

Impact of Hospital Context on Transitioning Patients From Hospital to Skilled Nursing Facility: A Grounded Theory Study.

Background: Twenty-five percentage of patients who are transferred from hospital settings to skilled nursing facilities (SNFs) are rehospitalized within 30 days. One significant factor in poorly executed transitions is the discharge process used by hospital providers.

Objective: The objective of this study was to examine how health care providers in hospitals transition care from hospital to SNF, what actions they took based on their understanding of transitioning care, and what conditions influence provider behavior.

Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents.

Objectives: Person-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.

Exploring Variation in Certified Nursing Assistant Assignments From the Perspective of Nursing Home Residents: A Comparison of Adopters and Nonadopters of Consistent Assignment.

To describe and compare certified nursing assistant (CNA) staffing between adopter and nonadopters of consistent assignment. One month of preexisting CNA assignment and scheduling sheets from a purposive sample of 30 homes. A descriptive comparative study was conducted to calculate and compare numbers of CNAs assigned per resident across homes.

Implementation of daily chlorhexidine bathing to reduce colonization by multidrug-resistant organisms in a critical care unit.

Background: Colonized patients are a reservoir for transmission of multidrug-resistant organisms (MDROs). Not many studies have examined the effectiveness of daily chlorhexidine gluconate (CHG) bathing under routine care conditions. We present a descriptive analysis of the trends of MDRO colonization following implementation of daily CHG bathing under routine clinical conditions in an intensive care unit (ICU).

Analysis of Multidrug-Resistant Organism Susceptibility to Chlorhexidine Under Usual Clinical Care.

Increasing use of daily chlorhexidine gluconate (CHG) bathing can potentially lead to selection for organisms with reduced susceptibility to CHG, limiting the utility of CHG. We examined reduced susceptibility to CHG of fluoroquinolone-resistant gram-negative bacilli and methicillin-resistant Staphylococcus. No evidence suggested reduced susceptibility to CHG.

Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.

Background: Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to reduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project was to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital.

Methods: We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13 registered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU.

Transitions From Hospitals to Skilled Nursing Facilities for Persons With Dementia: A Challenging Convergence of Patient and System-Level Needs.

Purpose Of The Study: To describe skilled nursing facility (SNF) nurses' perspectives on the experiences and needs of persons with dementia (PwD) during hospital-to-SNF transitions and to identify factors related to the quality of these transitions.

Design And Methods: Grounded dimensional analysis study using individual and focus group interviews with nurses (N = 40) from 11 SNFs.

Results: Hospital-to-SNF transitions were largely described as distressing for PwD and their caregivers and dominated by dementia-related behavioral symptoms that were perceived as being purposely under-communicated by hospital personnel in discharge communications.

Rheumatologist and Primary Care Management of Cardiovascular Disease Risk in Rheumatoid Arthritis: Patient and Provider Perspectives.

Objective: Despite increased cardiovascular disease (CVD) risk, rheumatoid arthritis (RA) patients often lack CVD preventive care. We examined CVD preventive care processes from RA patient and provider perspectives to develop a process map for identifying targets for future interventions to improve CVD preventive care.

Methods: Thirty-one participants (15 patients, 7 rheumatologists, and 9 primary care physicians [PCPs]) participated in interviews that were coded using NVivo software and analyzed using grounded theory techniques.

Caregiver Person-Centeredness and Behavioral Symptoms in Nursing Home Residents With Dementia: A Timed-Event Sequential Analysis.

Purpose: Evidence suggests that person-centered caregiving approaches may reduce dementia-related behavioral symptoms; however, little is known about the sequential and temporal associations between specific caregiver actions and behavioral symptoms. The aim of this study was to identify sequential associations between caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and the temporal variation within these associations.

Design And Methods: Videorecorded observations of naturally occurring interactions (N = 33; 724min) between 12 nursing home (NH) residents with dementia and eight certified nursing assistants were coded for caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and analyzed using timed-event sequential analysis.

Nursing student attitudes toward and preferences for working with older adults.

A growing aging population will require nurses who prefer to work with older adults. Schools of nursing have used several strategies to improve students' attitudes, and encourage preferences for working with older adults. However, research on these strategies is inconsistent, with some programs improving students' attitudes whereas others have no effect.

Using latent transition analysis in nursing research to explore change over time.

Background: Latent transition analysis is a method of modeling change over time in categorical variables. It has been used in the social sciences for many years, but not in nursing research.

Objective: The purposes of this study were to illustrate the utility of latent transition analysis for nursing research by presenting a case example (a secondary analysis of data from a previously conducted randomized control trial testing the effectiveness of a tailored psychoeducational intervention to decrease patient-related attitudinal barriers to cancer pain management) and to understand for whom and in what direction the tailored intervention resulted in change with respect to attitudinal barriers and pain symptoms.

Long-term loss of canonical NKT cells following an acute virus infection.

NKT cell activation plays an important role in regulating innate and adaptive immunity during infection. We have previously found that there is a dramatic reduction in the NKT cell population on day 3 after an acute lymphocytic choriomeningitis virus (LCMV) infection. In this study, we report that this loss continued for at least 3 months and was not simply due to internalization of the TCR.

Reduction in CD1d expression on dendritic cells and macrophages by an acute virus infection.

Mice were infected with lymphocytic choriomeningitis virus (LCMV) to determine if changes in CD1d expression occurred during an acute virus infection. It is interesting that a decrease in CD1d expression on splenic dendritic cells (DC) and macrophages (MPhi) was observed for at least 3 months post-LCMV infection, and vaccinia virus and vesicular stomatitis virus induced similar changes in CD1d upon infection with those viruses. The reduction of CD1d cell-surface expression on DC and MPhi was independent of interferon-gamma and interleukin-12 expression but partially recovered in transporter associated with antigen processing-1-deficient mice, suggesting that CD8+ T cells may play a role.

CD1d-mediated antigen presentation to natural killer T (NKT) cells.

CD1d molecules are lipid antigen-presenting molecules. They are involved in presenting these antigens to a unique subpopulation of T cells called natural killer T (NKT) cells, which have the capacity to produce both T helper (Th) 1 and Th2 cytokines. Thus, it is possible that the antigens presented by CD1d and/or the level at which they are presented could have profound effects on the immunoregulation of autoimmune and infectious diseases, as well as cancer.

CD1d1-dependent control of the magnitude of an acute antiviral immune response.

CD1d1-restricted NK T (NKT) cells rapidly secrete both Th1 and Th2 cytokines upon activation and are therefore thought to play a regulatory role during an immune response. In this study we examined the role of CD1d1 molecules and NKT cells in regulating virus-induced cytokine production. CD1d1-deficient (CD1KO) mice, which lack NKT cells, were infected with lymphocytic choriomeningitis virus, and spontaneous cytokine release from splenocytes was measured.

Myeloid marker expression on antiviral CD8+ T cells following an acute virus infection.

CD11b, CD11c, and F4/80 are normally used to define dendritic cell and/or macrophage populations. In this study, the expression of all three markers was observed on CD8(+) T cells following infection of mice with several distinct viruses. Using lymphocytic choriomeningitis virus as a model virus, it was found that relatively more CD11b(+)CD8(+) and CD11c(+)CD8(+) T cells were present in the periphery than in primary lymphoid organs; in contrast, the F4/80(+)CD8(+) T cell population was more prevalent in the spleen.

Recycling CD1d1 molecules present endogenous antigens processed in an endocytic compartment to NKT cells.

Mouse CD1d1 molecules present endogenous glycolipids to NKT cells. Although glycolipid presentation requires CD1d1 transport through the endocytic pathway, the processing requirements for such endogenous Ag presentation by CD1d1 molecules are undefined. We examined CD1d1 Ag presentation to NKT cells by disrupting endocytic trafficking and function in cells expressing normal and mutated CD1d1 expressed by recombinant vaccinia viruses.