The significant increase in the number of older adults in the USA, particularly in rural areas, has signaled the need for more research to address the health care needs of this complex, heterogeneous, and vulnerable population. However, accessing older adults in rural areas presents an especially difficult challenge for gerontological researchers. Barriers can include the normal physiological changes that accompany aging, prevalence of chronic illness and medication use, lower literacy rates, transportation issues, and a distrust of 'outsiders' and research in general. Specific strategies that may facilitate participation include the use of gatekeepers to gain entry, increased personal contact by researchers sensitive to the unique needs of older adults, and other media approaches tailored to the rural community. Understanding the characteristics of rural older adults, along with careful planning of recruitment strategies, is crucial to obtaining adequate participation and the acceptance of future research efforts.

The ABCDE bundle is an evidence-based, multidisciplinary approach to optimizing patient outcomes in the adult intensive care unit (ICU). The ABCDE bundle incorporates awakening, breathing, coordination, delirium monitoring and management, and early mobility to minimize potentially deleterious effects of prolonged hospitalization, including the development of delirium. Health care organizations that implement the ABCDE bundle have improved patient outcomes such as decreased ICU and hospital lengths of stay, decreased duration of mechanical ventilation, decreased prevalence and duration of delirium, and decreased health care costs. The purpose of this evidence-based practice project was to implement the ABCDE bundle in a six-bed general adult ICU of a rural community hospital. Implementation of the bundle decreased average patient hospital length of stay by 1.8 days, reduced length of mechanical ventilation by an average of 1 day, and established a baseline delirium prevalence of 19% over a 3-month time period. The results of this project indicate that the ABCDE bundle can be implemented in rural, community-based hospitals and provides a safe, cost-effective method for enhancing ICU patient outcomes.

Although researchers have suggested that hardiness is associated with improved outcomes in stressful situations, findings regarding its moderating effects have been mixed. Relationships among hardiness, appraisal, coping, self-perceived health, and other antecedent variables were examined in a convenience sample of 72 community-dwelling spouse caregivers for persons with dementia. In this descriptive correlational design, participants completed a mailed survey. Regression analyses were used to detect main and moderating effects. Antecedent variables predicted 27% of the variance in caregiver appraisal, 23% of the variance in emotion-focused coping, and 22% of the variance in self-perceived health. In addition to its significant main effects, hardiness functioned as a significant moderator between the set of antecedent variables and caregiver appraisal. More research is needed to support the presence of main and moderating effects of hardiness in dementia caregivers.

With economic uncertainty and the worsening of the nursing shortage, interest in accelerated second bachelor's degree programs has skyrocketed. Despite dramatic increases in the number of programs, little has been published about the characteristics of these students. A descriptive study at a mid-Atlantic public comprehensive university examined demographic characteristics and compared academic performance of students in the accelerated and traditional baccalaureate programs. Data and their implications for recruitment, admission, and curricular design are presented.