Development and initial validation of the Seated Posture Scale

—Literature shows that some health outcomes (e.g., eating, breathing, and speaking) are directly related to posture. Evidence of outcomes mediated by wheelchair seated posture is limited to interface pressure, physical function, and wheelchair skills and safety. This study’s purpose was to develop and validate a rapid, low-burden, paper-pencil assessment of wheelchair seated posture for research use and to test feasibility of its use with a sample of older adults. We used a prospective design and a convenience sample of older adults who were receiving rehabilitation services in a community living center. Forty-nine older wheelchair users participated. Main measures were the Seated Posture Scale (SPS), Modified Ashworth Scale, Barthel Index, Visual Descriptor Scale, scale-content validity index (S-CVI), Cronbach alpha, and test-retest reliability. Rating by six experts yielded the overall content validity score (S-CVI) of 0.744. Total SPS score correlated positively with physical function (Barthel Index, r = 0.46, p \u3c 0.001) and negatively with muscle tone (Modified Ashworth Scale, r = –0.44, p = 0.001), supporting SPS construct validity. Internal consistency was 0.66 (Cronbach alpha). Test-retest reliability yielded Pearson product-moment correlations of 0.89 to 0.99. We conclude that the SPS has sufficient preliminary validity and reliability to support its use as an evaluation of wheelchair seated posture in outcomes research

Effectiveness of an evidence-based curriculum module in nursing schools: Targeting safe patient handling and movement

Nursing schools in the United States have not been teaching evidence-based practices for safe patient handling, putting their graduates at risk for musculoskeletal disorders (MSDs). The specific aim of this study was to translate research related to safe patient handling into the curricula of nursing schools and evaluate the impact on nurse educators and students\u27 intentions to use safe patient handling techniques. Nurse educators at 26 nursing schools received curricular materials and training; nursing students received the evidence-based curriculum module. There were three control sites. Questionnaires were used to collect data on knowledge, attitudes, and beliefs about safe patient handling for both nurse educators and students, pre- and post-training. In this study, we found that nurse educator and student knowledge improved significantly at intervention schools, as did intention to use mechanical lifting devices in the near future. We concluded that the curriculum module is ready for wide dissemination across nursing schools to reduce the risk of MSDs among nurses

Becoming a couple affected by HIV infection

Thesis (Ph. D.)--University of Washington, 1992The purposes of this study were: (1) to describe the experiences of gay couples when at least one was diagnosed with symptomatic HIV infection or AIDS, and (2) to explain couples' experiences in the context of heterosexism. To address the first study purpose, grounded theory provided the methodological basis for data gathering and data analysis. The second study purpose was achieved through a structural analysis that explained the relationship between couples' actions, their acknowledgment, or lack thereof, of heterosexism as an important dimension of their social environment, and the intended and unintended consequences of their actions on heterosexism.The sample consisted of 9 gay couples. Becoming a Couple Affected by HIV Infection was perceived as a major life transition as each individual was challenged with confronting multiple losses including possible death of the PWA, the pre-AIDS lifestyle, relationships with friends and family members, the future, finances, and health. The beginning of this transitional began with "hitting home," or the awareness and subsequent emotional shock that life as the couple knew it before HIV was gone. "Mutual protection" is the mechanism by which individuals in the couple governed their activities toward one another. The major motivation for actions taken by study participants was the protection of the self and the other by forestalling losses such as threats to the relationship, health, and privacy, and preserving important relational characteristics such as independence, social boundaries, and intimacy. "Moving on" marked the end of the transition and included acceptance of a world in which loss and uncertainty were expected, if not commonplace, and moving on with one's life within the relationship, having renegotiated its meaning. Study participants settled on one of two different perspectives for the future: succumbing to AIDS or surviving HIV infection.Structural analysis revealed that although study participants defined their experiences using the term homophobia, their experiences could also be understood in the context of heterosexism, or the socially constructed belief that heterosexuality is superior to homosexuality. Heterosexism asks heterosexuals to consider their privileged position which serves to perpetuate the constraints placed upon gay couples coping with HIV infection. Employing this term helps us to understand the institutionalized and systematic constraints placed upon gay couples, as compared to the concept of homophobia, which tends to focus on the individual personality traits of gays and those who harbor negative feelings toward them

Going public as an AIDS family caregiver

Images of AIDS invoke fears of contagion, disability and formidable death, and moral overtones directed toward drug use, sexuality and sexual identity and freedom. Responses to these images are both private and public, and have profound consequences for individuals whose lives have been touched by the disease, both the person with AIDS and the family caregiver. The purpose of this paper is to analyze in detail 'going public,' one category of a substantive theory of AIDS family caregiving. This category was developed from a grounded theory study of 53 AIDS family members who were asked to describe their experiences as an AIDS family caregiver during an indepth interview. Data were content analyzed using constant comparative analysis. Going public referred to how AIDS family caregivers let others know that they were caring for a PWA. Specifically, going public entailed selecting appropriate persons and audiences to tell, formulating approaches to communicating information, and considering the risks and benefits of the possible choices. The description of going public as an AIDS family caregiver details the assertiveness involved in political action and social change, contrasted with the isolation and secrecy involved in maintaining relationships with others under the condition of a stigmatizing illness. Data revealed a particular emphasis on the phenomenon of 'guilt by association'. Because of their close relationship to a person with AIDS, caregivers were obligated to share the stigma of AIDS and were likewise discredited. Findings from our study emphasize the tremendous personal suffering experienced by caregivers which was associated with AIDS stigma in the form of rejection, loss of friends and harassment. Data also revealed the strong commitment of many caregivers to social activism which ranged from participating in educational efforts to marching in demonstrations. The rationale for the apparent increased activism among AIDS family caregivers compared to other groups of caregivers is explored. Going public highlights both the personal suffering and social manifestations of AIDS, significant issues to consider in planning health services for the second decade of the AIDS epidemic.AIDS family caregiving health care stigma

A framework for managing wandering and preventing elopement

Purpose of the Study: A framework aids choice of interventions to manage wandering and prevent elopement in consideration of associated risks and mobility needs of wanderers. ---------- Design and Methods: A literature review, together with research results, published wandering tools, clinical reports, author clinical experience, and consensus-based judgments was used to build a decision-making framework. Results: Referencing a published definition of wandering and originating a clinical description of problematic wandering, authors introduce a framework comprising (1) wandering and related behaviors; (2) goals of wandering-specific care, (3) interpersonally, technologically, and policy-mediated wandering interventions, and (4) estimates of relative frequencies of wandering behaviors, magnitudes of elopement risk, and restrictiveness of strategies. ---------- Implications: Safeguarding wanderers from elopement risk is rendered person-centered and humane when goals of care guide intervention choice. Despite limitations, a reasoned, systematized approach to wandering management provides a basis for tailoring a specialized program of care. The need for framework refinement and related research is emphasized

The Veterans Health Administration’s Traumatic Brain Injury Screen and Evaluation: Practice Patterns

The goals of this study were to describe clinical practice patterns associated with the Veterans Health Administration’s (VHA’s) Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and determine whether practice patterns vary by patient, provider, or facility characteristics. Veterans (N = 614) who had initial healthcare visits between 2008 and 2011 and who had previously completed the VHA’s traumatic brain injury (TBI) screen and subsequent CTBIE were drawn from a national database. Participants were primarily male (95%) with a mean age of 29.8 yr (standard deviation = 8). Chart reviews were conducted on a random sample of charts with completed CTBIEs from 21 sites. Using a cross-sectional design, patientand facility-specific variables were investigated as potential predictors of practice variation. During the study period, 79% of patients in this national sample were screened within 1 d of their initial healthcare visit and 65% were evaluated via CTBIE within 30 d of screening. Provider and participant characteristics were generally not associated with timeliness. The CTBIE was completed by individuals versus teams at comparable rates. Much of what occurred during the evaluation, beyond TBI-specific procedures, were medical assessments, such as review of medications and other substances