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- ItemInfant feeding decision: What new mothers have told us(2007-11-04) Agostino, Margaret-Rose; Salisbury University, Salisbury, Maryland, USA
Objective: To explore the infant feeding decision of new mothers and elicit their perspective regarding breastfeeding.
Design: Descriptive exploratory.
Setting: Postpartum units at seven birthing hospitals, including two tertiary perinatal centers in New Jersey and thirteen participant home telephone interviews.
Participants: 394 new mothers prior to hospital discharge; 13 interviewees including a total of eight African-American women, five who were non-WIC eligible and a total of five White women, three who were non-WIC eligible.
Main Outcome Measures: Central Jersey New Mother Survey, semi structured home telephone interviews.
Results: Knowledge regarding the health benefits of breastfeeding by the mother both during pregnancy and immediately following the birth of her baby does not necessarily reflect the mother's choice to breastfeed. Inconsistent health promotion messages from providers compounds the issue. Women indicated that they relied on printed information rather than provider based discussions as their primary source. Additionally, women indicated that they considered themselves to have the most influence with regard to their infant feeding choice.
Conclusions: By finding pathways into the lives and decisions of new mothers, health promotion education with regard to breastfeeding may be better identified. This can lead to the development of programs that have a greater cultural congruence and thus a greater impact on the infant feeding choice made by new mothers. Additional research is needed that reflects the emic perspective of women of childbearing age and their health decisions and behaviors.
- ItemKeeping women and their infants together during the recovery phase following cesarean section(2011-10-17) Clegg, Leeann; Madsen, Jaclyn; Snethen, Julia; Langley Memorial Hospital, Langley Township, British Columbia, Canada
[Invited Poster or Paper Session] (Please contact the primary investigator for more information about this study.)
- ItemHIV risk reduction behaviors in adolescent females: The influence of mastery and self-esteem(2001-11-10) Long-Middleton, Ellen R.
AIDS is a leading cause of death in adolescent and young adult populations. Heterosexual transmission of HIV is the fastest growing mode of infection among women, and minority populations are affected disproportionately. It is important to identify and assess psychological determinants of HIV risk reduction behaviors, in order that health care interventions may be tailored to maximize a client's preventive efforts. Hence, the concepts of mastery and self-esteem were investigated in relationship to HIV risk reduction behaviors in a culturally diverse group of adolescent females. Mastery is a global sense of control over one's life, and self-esteem is the value placed on oneself. HIV risk reduction behaviors were conceptualized as the actions taken by an individual to diminish the chance of acquiring heterosexually transmitted HIV. The objective of the study was to test the moderator effect of mastery on the relationship between self-esteem and HIV risk reduction behaviors. A purposive sample of 224 black, Latina and white adolescent females was recruited from an urban primary care setting in a tertiary care center. A cross-sectional, correlational design was utilized, and measures included the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, and Metzger High Risk Sexual Relationships Subscale of the Adolescent Problem Severity Index. Using hierarchical multiple regression, no moderator effect of mastery on self-esteem and HIV risk reduction behaviors was found. Mastery and self-esteem did not predict HIV risk reduction behaviors in the total sample or in the cultural subgroups. Age was inversely related to HIV risk reduction behaviors in the total sample and in the black group of participants; household income was positively associated with HIV risk reduction behaviors in only the black group. Age and number of hours worked were inversely related to HIV risk reduction behaviors in white adolescent females who worked. Despite non-significant moderation relationships, there is enhanced understanding of what did not provide explanatory value relative to HIV risk reduction behaviors. Further study is needed to determine significant predictors of HIV risk reduction in these cultural groups.
- ItemDifferences in mastery and self-esteem in culturally diverse adolescent females(2011-10-17) Long-Middleton, Ellen R.
Purpose: Mastery, a global sense of control over one's life, and self-esteem, the value placed on oneself, are psychological characteristics associated with numerous health-enhancing behaviors. Developing interventions to fortify and enhance an individual's sense of mastery and self-esteem may serve to promote health-enhancing behaviors. Yet, differences in mastery and self-esteem among individuals of diverse cultures are not well understood, nor are the ways in which mastery and self-esteem impact health-enhancing behaviors. This is particularly so in adolescent females. Hence, the purpose of this investigation was to determine if differences existed in mastery and self-esteem levels in diverse cultural groups of adolescent females.
Methods: As part of cross-sectional, correlational study investigating predictors of HIV risk reduction behaviors, Pearlin Mastery Scale and Rosenberg Self-Esteem Scale scores among black, Latina and white adolescent females were examined to determine if significant differences existed across groups. A purposive sample of 224 black, Latina, and white adolescent females was recruited from an urban adolescent primary care setting. Analysis of variance was utilized to determine if significant differences existed across cultural groups.
Results: Black participants had significantly higher mastery scores than the Latina participants. Black participants had significantly higher self-esteem scores than both Latina and white participants. No significant differences in HIV risk reduction behavior scores existed among the three cultural groups.
Implications for practice: A better understanding of cultural differences in mastery and self-esteem in this group of adolescent females may serve to guide the development of interventions to promote health-enhancing behaviors associated with mastery and self-esteem in culturally-diverse groups of adolescent females.
- ItemTelephone support for first-time breastfeeding mothers: Building a foundation for healthier tomorrows(2011-10-17) Agostino, Margaret-Rose; Delaware State University, Dover, Delaware, USA
Objective: To assess the effect of post-discharge telephone breastfeeding support on reducing the risk of early weaning from mother's stated goal.
Literature Review: Data Sources: Cochrane Pregnancy and Childbirth Group trials register; PubMed; Med Line; CINAHL; Proquest; Ovid; Academic Search Premier: Health Source: Nursing/Academic Edition; Library, Information Science & Technology Abstracts; PsychARTICLES; PsychINFO. Search terms: breastfeeding, lactation, support, duration, cessation, weaning, and telephone support. Restricted to English, full text, published January 1997-December 2008. Study Selection: 78 articles met the inclusion criteria: peer review, journal articles, human subject, clinical trial, meta-analysis, practice guideline, and review.
Data extraction: Quality review conducted utilizing the Johns Hopkins Nursing Evidence-Based Practice Research and Non-Research Appraisal methodology (Newhouse, et al 2007). Data Synthesis: The positive effect of post-discharge breastfeeding support on increasing the duration of breastfeeding is well documented in the literature.?
Methods: Pre-intervention base-line data obtained via: brief telephone survey conducted with breastfeeding mothers 6 months prior to intervention and data obtained regarding breastfeeding duration and perception of breastfeeding support; telephone survey of local pediatric practices was conducted and breastfeeding initiation and 6 month duration data obtained for babies born in January 2009; WIC breastfeeding data for January-July 2009 obtained. Intervention: first-time breastfeeding mothers meeting the eligibility criteria, self-selected by completing the enrollment form [N= 34]; telephone support included weekly calls for three months, then monthly calls for three months, or until the mother weaned. Data obtained from the mothers were analyzed utilizing Ethnonursing methodology and descriptive statistics.
Results: The provisions of a structured telephone support decreased the relative risk of early weaning, empowered participants to meet/ overcome challenges, and meet their stated goal.
Reference: Newhouse, R., Dearholt, S., Poe, S., Pugh, L., & White, K. (2007) Johns Hopkins Evidence-Based Practice Model and Guidelines.
- ItemInformation literacy: A prerequisite to evidence-based nursing(2011-10-17) Belcik, Kimberly Dawn; Texas State University, Round Rock, Texas, USA; Chi Psi
Purpose: Information literacy is an ambiguous term that many professionals in various fields, including nursing, have attempted to define. It is emphasized as a skill nurses should have yet it has not been conceptualized within nursing. The purpose of this paper is to analyze the concept of information literacy. This analysis emphasizes information literacy in the context of nursing as a prerequisite to evidence-based nursing practice.
Methods: The method used to analyze the concept is the Walker and Avant method. All steps of the Walker and Avant method are used with the exemption of the invented and illegitimate cases in line with the philosophy of Rodgers. The invented and illegitimate cases are addressed in the form of a related case. The social context of the concept is addressed in implications for theory, research, and practice.
Findings: A theoretical definition of information literacy was derived from the literature. It is a self-directed, independent ability to locate access and/or retrieve information efficiently from available sources, evaluating the quality of the information and managing and organizing the information while understanding the implications of doing so. Seven antecedents and eight consequences of the concept were identified. A model case describes a nurse using the Internet to help her patient make a decision about diagnostic testing. A contrary case describes a nurse attempting to find information on medications. The related case presents a nurse using critical thinking skills to care for a post-operative patient. The Information and Communications Technology (ICT) Literacy Assessment by the Educational Testing Service is presented as an empirical referent.
Conclusions: Considering the findings, information literacy is a skill nurses should have as a prerequisite to evidence-based nursing practice.
- ItemRapid intraosseous vascular access while wearing personal protective equipment(2011-10-17) Borron, Stephen W.; Montez, Diana F.; Haas, Patti; Philbeck, Thomas; Arias, Juan C.
Purpose: The ability to obtain rapid vascular access for fluid or medication administration is standard of care when working in emergency conditions. Hazardous material incidents require more sophisticated levels of personal protective equipment (PPE) that can interfere with fine motor skills needed for intravenous line placement. This study included participants representing a variety of clinical professions who could potentially face that challenge. Participants were tested for their ability to place intraosseous (IO) lines for quick antidote administration wearing various levels of PPE.
Design: This was an experimental study utilizing live anesthetized goats. Setting: The study was conducted in the lab animal research/experimental surgery center at a large university medical school facility in Texas.
Participants: A total of 18 volunteers were recruited, representing both prehospital and emergency department practice. The participants included six first responders (fire department paramedics and one physician with incident response training) and twelve first receivers (emergency department nurses, physicians, and physician assistants).
Methods: Approval from the Institutional Animal Care and Use Committee was obtained. Each subject completed a questionnaire prior to participation to quantify their previous experience with hazardous materials incidents, and use of the intraosseous device utilized in the study. The participants were designated to wear one of four levels of personal protective equipment in accordance with the US Environmental Protection Agency nomenclature. All operators were given brief (~10 minutes) instruction and an hour to practice with the intraosseous device. Operators were then randomized to a particular animal and to the order of level of personal protective equipment worn for each intraosseous attempt. Study subjects sequentially donned each level of PPE and placed intraosseous lines in one of four anatomical sites in twelve anesthetized goats. Placements were timed from the moment of touching equipment until a bolus injection of normal saline was delivered. Intraosseous placements were verified by aspiration of bone marrow and ability to flush the needle and the final insertion was additionally confirmed by fluoroscopy.
Results/Outcomes: First responders placed 100% of the intraosseous lines successfully. The median (interquartile range) times to completion (secs) were level A: 43.5 (23.0); B: 45.0 (29.0); C: 40.0 (15.0); D: 30.0 (17.0). First receivers placed IO lines successfully in 91% of the cases. Their median times to completion (secs) were level C: 42.0 (19.5); D: 37.0 (11.0). Differences in time to completion among PPE levels or between operator groups were statistically insignificant. Two placements resulted in extravasation. All infusions were completed successfully.
Implications: Placement of intraosseous lines for vascular access and early administration of antidotes can be accomplished rapidly and effectively while wearing PPE in a goat model. Similar success in humans in a clinical setting seems likely. Intraosseous access may make it possible to administer antidotes and other medications early in the resuscitation process of victims of hazardous materials incidents.
- ItemTriage space redesign to facilitate application of relationship based care(2011-10-17) Barnard, Amy G.
Purpose: The previous Emergency Department triage space was inadequate to meet the hospital's mission and vision to provide a patient centered focus of care. The Goal established for this project was to create an environment conducive to care which would place the patient and family at the center of triage activity, and facilitate assessment of all patients within the ED scope of service including those with special needs.
Design: This is an Evidence-Based project designed to apply principles of Relationship Based Care¬, the hospitalÆs selected professional practice model.
Setting: A community based, level II trauma center in the Midwest with 32,000 annual visits.
Participants: A convenience sample of Emergency Department patients who had experienced both the old and the new triage space were requested to voluntarily complete a survey which compared perceptions of the old and new triage designs. Additionally, ED patients are mailed Press-Ganey surveys to assess dimensions of patient satisfaction using the sampling processes established by that company, with results benchmarked against national comparison groups.
Methods: Project Procedures: The project was developed by a member of the Emergency Department Unit Operations Council, with input provided by direct-care nurse members, as well as architectural, engineering, and design experts.Evaluation Methods: Methods to evaluate the effectiveness of this project included development and utilization of a tool to assess goal achievement, and measurement of patient satisfaction scores pre and post project implementation. The instrument created by the Project Leader was a ten question Likert scale survey which compared patient perceptions of the previous and redesigned space, which was based on care delivery and the patient and family dimensions extracted from concepts of Relationship Based Care. No validity or reliability for this instrument has been established.
Results and Outcomes: The Likert scale survey results showed the new triage room was more spacious, more accommodating, provided more privacy, and most importantly provided an environment of caring. 100% of patients were both completely satisfied and found the new room accommodating, compared to 15% with the old room. 100% of patients found the room to provide more privacy and was more spacious, compared to 45% and 15% respectively. 85% of patients found the new room to provide an environment of caring compared to 28% with the old room. Press Ganey scores showed drastic improvement post implementation from the 65th percentile in 3rd quarter 2008 to the 93rd percentile in 1st quarter 2009 when compared to the large database. It must be recognized that change in the triage environment is not the only variable that may have influenced patient satisfaction during this period of time.
Implications: The physical environment in which care is provided can facilitate the implementation and use of models of care. Leadership support is instrumental to obtain the funding necessary to drive structural changes. - ItemObservation Assistants: Sitter Effectiveness and Industry Measures(2011-10-17) Harding, Andrew D.[ENA Leadership Conference] Evidence-based Practice Presentation: Observation Assistants: Sitter Effectiveness and Industry Measures
Purpose: The use of observation assistants (sitters) is a means for direct observation of patients for the purpose of providing a safer environment for the patient. There are no defined industry standards for the use, efficiency, or financial measure of sitters. This project sought to improve the effectiveness, utilization and financial costs of sitters.
Design: Performance improvement project prospective is designed to study and improve the processes of providing healthcare services to meet the needs of patients and stakeholders.
Setting: This performance improvement project occurred in a free standing 140 bed acute care hospital that receives 54,000 emergency department visits annually, in suburban Massachusetts.
Participants / Subjects: The subject was the process of sitter requests and utilization. The registered nurses with a bachelor of science in nursing or masters' degrees were only 31% of the active staff and 96% female.
Methods: Data were collected related to the unique patient visit requests for sitters per shift, the indication for the sitter request, the patient and hospital unit demographics, the financial costs of using sitters by patients visiting the emergency department (ED) and inpatient units (except the nursery). Interventions were implemented in March 2009 allowing comparisons between the first 5 months and the last 7 months of fiscal year 2009 (FY '09). After reviewing the literature and first five months data the project's interventions were selected. Comparisons of the data before and after intervention implementation were completed.
Eight interventions were implemented including an electronic intranet based requisition system for direct care providers. Indications for sitter use were limited to patients at risk to harm themselves or others and patients at high right to fall, per the SAD PERSON tool & Morse Fall Score respectively. Nurse manager & nurse supervisor in-person clinical review of patients prior to the next shift helped to identify alternative interventions. A sitter education program was provided. Increased hiring and use of per diem for all employees acting in the role was instituted. Scrutiny increased for using overtime. The construct of average daily census (ADC) was used to present the data in all forums and reports.
Results / Outcomes: No elopement or assaultive behaviors were documented for patients with a sitter. The fall rate had no relationship to sitter use. Actual sitter ADC increased 17% monthly on average in the last 7 months of FY æ09. The average hourly rate paid to sitters was reduced by $1.89 or 12.4%. The percent of overtime of monthly total dollars was reduced from 26.8 % to 15.6%. Average daily census is a useful construct for displaying the data about sitters for internal and external stakeholders.
Implications: The use of sitters had no relationship to fall rate, assaultive behaviors or self harm. There were no relationships between ED or inpatient volume and actual sitter use. The interventions used to reduce the cost of sitters were effective. The ADC construct is suggested for comparison and industry standardization. Research is needed to determine the effectiveness of sitters. - ItemHemolysis of Blood Specimens: Increasing Time in the Emergency Department(2011-10-17) Young, Sherry; Hiles, Julie[ENA Leadership Conference] Evidence-based Practice Presentation: Hemolysis of Blood Specimens: Increasing Time In The Emergency Department
Purpose: The nurses in a rural Emergency Department (ED) noted an increased incidence of hemolysis of blood specimens after adopting the practice of nurses obtaining blood specimens via a newly established intravenous site (IV), increasing throughput time in the ED. The purpose of this study was to determine if there was a significant difference in the proportion of hemolysis of blood specimens obtained from a newly inserted IV using a 20g Advant IV safety catheter and blood specimens obtained from a 21g-23g straight needle venipuncture.
Design: Non-experimental descriptive quantitative retrospective design was selected to compare hemolysis of blood drawn via newly established IV site and the venipuncture site.
Setting: This study was conducted in a Level 2 ED of a 220-bed non-profit, community teaching Appalachian hospital. The ED volume was approximately 53,000 visits for fiscal year 2009.
Participants/Subjects: A convenience sample of 101 hemolyzed blood specimens drawn in the ED January, 2009- November, 2009 were included in this study, excluding specimens collected from minors, mastectomy, and dialysis patients.
Methods: IV site blood specimens were collected by randomly selected ED nurses with 2 or more years of ED experience, and the venipuncture specimens were collected by randomly selected ED technicians with 2 or more years of ED experience. Blood specimens were analyzed for hemolysis using a Hitachi automated spectrophotometer and visual inspection by the lab technologist. Hemolyzed specimens were stratified according to method of specimen retrieval: Group A = venipuncture and Group B= IV site. Using SPSS, Chi-Square was used to compare the groups.
Results/Outcomes: Of the 101 hemolyzed specimens, 65 (64.4%) were drawn by newly placed 20g IV catheter, while 36 (35.6%) were drawn by 21-23g venipuncture needle. There was a significant difference in the proportion of hemolysis in the two specimen collection methods, x2 (1, N= 101) =8.327; p<.01.
Implications: A decreased hemolysis rate would result in improved ED throughput, reduced length of stay for the patient, and improved patient satisfaction. Based on these results and review of evidence from other sources, a policy was developed describing the process for obtaining blood specimens for laboratory patient testing in the ED. All blood obtained for laboratory specimens will be drawn from peripheral site using straight needle venipuncture to decrease the rate of hemolysis. The rate of hemolysis will be monitored in the future to determine the effectiveness of this policy change. - ItemRetrieving a Reputation: A Story of an ED Turnaround(2011-10-17) Montesino, BeckyPurpose: The Emergency Department of a large suburban, level 2 hospital has been associated with very long waiting times (an average of 18 hours from presentation to disposition), hallway beds as regular treatment areas and a 13% left without being seen rate. Staff morale was low; turnover was high and all ED functions were dysfunctional. A decision was made to turn the ED around from all facets--administrative, physician and staff. The process started with the appointment of a new ED Director and quickly there were expectations of high standards and an atmosphere of nurse empowerment that could lead to change. The journey began with the collection of data, the readjusting of hardwired behaviors and the holding of all staff members accountable for patient satisfaction scores (6th percentile) and the very negative reputation in the community. Instead of hiding what was wrong in the department, transparency was in vogue and the mission of upper and middle management was now to tell the story of the department as it progressed in the quest for excellence. This ED achieved all goals and today enjoys a fully staffed ED, without travelers, patient satisfaction above the 90th percentile, left without being seen below 2% and a renewed reputation. It also now sees 33% more patients per month. This is truly a story of a planned ED turnaround that has many lessons for ED's in similar conditions.
Design: This was a collaborative, realistic goal setting effort. That would have reliable measures, accountability of its team members.
Setting: This ongoing project is being carried out at a level 2 suburban community hospital in the Deep South.
Participants: All staff and physicians within the adult ED.
Methods: The Press Ganey surveys were used. Data was compared to other hospitals with similar volume. Studer rounding tools; staff engagement; physician partnership and research data are among the methods used for overall improvement. Outcomes are evaluated using Length Of Stay (LOS), Left Without Being Seen (LWBS) and patients leaving Against Medical Advice, (AMA); data is collected monthly.
Results: Data was measured from June 2008 to June 2009. In June 2008 Visits were 4,679 compared to 6,200 in June 09. LWBS was 5.1% compared to 2.0% in June ô09. AMA was 0.7% in June 08 vs 0.6 in Æ09, the admission rate dropped from 39% in 08 to 35% in Æ09. However patient satisfaction went up significantly from the 33rd% to 95th% in spite of increased volume.
Conclusions: Leadership had to be held accountable for consistently engaging tools that are evidence-based. Management championing of hourly rounding and other methods that increased patient and staff satisfaction, had to be consistent and sustainable in order to improve staff and patient satisfaction while decreasing AMA and LWBS. Staff had to be presented with data, and the rationale for hardwiring rounding, which entailed both the management team and staff rounding on patients daily and hourly respectively. - ItemHIV risk reduction behaviors in adolescent females; The influence of mastery and self-esteem(10/27/2011) Long-Middleton, Ellen R.; MGH Institute of Health Professions, Boston, Massachusetts, USA
Purpose. The purpose of the study was to test the moderator effect of mastery on the relationship between self-esteem and HIV risk reduction behaviors.
Aims. The aims of this study were to: 1) examine the relationships among mastery, self-esteem and HIV risk reduction behaviors in a culturally-diverse group of adolescent females, and 2) determine if differences exist in relationships among mastery, self-esteem and HIV risk reduction behaviors among three cultural groups. Framework. AIDS is a leading cause of death in adolescent and young adult populations. Heterosexual transmission of HIV is the fastest growing mode of infection among women, and minority populations are affected disproportionately. It is important to identify and assess psychological determinants of HIV risk reduction behaviors, in order that health care interventions may be tailored to maximize a client's preventive efforts. The psychological characteristics of self-esteem and mastery were examined in this study. Mastery, a global sense of control over one's life, and self-esteem, the value placed on oneself, work together to provide formidable barriers to the stressful consequences of social strain. It was theorized that mastery would potentate self-esteem, and would moderate the influence of self-esteem on HIV risk reduction behaviors through the strengthening of this relationship.
Methods. An urban primary care setting in a tertiary care center served as the site for this study, in which a cross-sectional, correlational design was used. The sample consisted of 224 adolescent females 15-19 years of age. Of the 224 participants, 109 identified themselves as black, 58 as Latina, and 57 as white. Participants completed the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, Metzger High Risk Sexual Relationships Subscale of the Adolescent Problem Severity Index, and a demographic data form. All scales had demonstrated psychometric evidence. Hierarchical multiple regression was used to test the research hypotheses.
Results & Conclusions. No moderator effect of mastery on self-esteem and HIV risk reduction behaviors was found. Mastery and self-esteem did not predict HIV risk reduction behaviors in the total sample or in the cultural subgroups. Age was inversely related to HIV risk reduction behaviors in the total sample and in the black group of participants; household income was positively associated with HIV risk reduction behaviors in only the black group. Age and number of hours worked were inversely related to HIV risk reduction behaviors in white adolescent females who had jobs. Despite non-significant moderation relationships, there is enhanced understanding of what did not provide explanatory value.
Implications for Nursing Practice & Knowledge Development in Nursing. Further study is needed to determine significant predictors of HIV risk reduction behaviors in these cultural groups.
- ItemIncreasing the Compliance of Suicidal and Homicidal Ideation Assessment in the Emergency Center(2011-12-21T12:45:27Z) Alford, Dorothy[ENA Annual Conference 2011 - Evidence-based Practice Presentation]Increasing the Compliance of Suicidal and Homicidal Ideation Assessment in the Emergency Center
Purpose: National Patient Safety Goal 15 A focuses on identification of individuals at risk for suicide and aims to increase use of a screening assessment tool to identify risks of suicide and/or homicide. The compliance rate for initial assessment of suicide risk during triage in an adult emergency center (EC) at a large hospital in the Southwest was 84% in the last quarter of 2009. When screening was performed, primary nurses were not conducting more in-depth assessments for patients who screened positive for suicidal and homicidal ideation. Regulatory standards require rates of 90% or more for initial risk assessment as well as more in-depth assessment of patients who screen positive for risks. The purpose of this project was to improve initial screening rates and to meet standards of practice for more detailed assessment of patients identified at risk for suicide or homicide.
Design: A quality improvement project was conducted. Daily medical record reviews were performed on all charts of patients seen in EC triage. Data were gathered from the electronic medical record. Open record reviews were conducted for all patients who screened positive on initial assessment of suicidal and homicidal ideation to evaluate compliance with in-depth assessment of suicide risk. Coaching was provided for registered nurses who were non-compliant.
Setting: The project was implemented at the Adult Emergency Center of a large county hospital system in the Southwest. The county hospital is a level one trauma center located in the Texas Medical Center of Houston Texas.
Participants: Documentation by registered nurses in medical records of all patients seen in emergency center triage was reviewed.
Methods: Education was provided for the emergency center staff with emphasis on the National Patient Safety Goal standard 15A, the hospital policy for Suicide Risk Assessment and the instrument used for Assessment of Risk Factors. Continuous chart reviews were performed to evaluate nurses’ compliance with the safety standard. Open medical records review provided opportunities for just-in-time education for registered nurses who were not meeting the practice standard.
Results: After providing education, reviewing medical records, and providing individual coaching the compliance rate increased from 84% to 94% for the initial risk assessment at triage. In-depth assessments of suicide risk were performed by primary nurses at a 95% rate.
Implications: Using the quality improvement process to evaluate compliance with regulatory standards supports identification of educational needs, intervention with process barriers, and implementation of appropriate measures to assure patient safety. - ItemFactors affecting nurse migration for nursing leaders to consider to improve nurse retention(2012-01-04) Cameron, Sheila; Freeman, Michelle A.; Wolfe, Barat J.; Rajacich, Dale Lynn
Purpose: Migration of nurses continues to concern global nursing leaders in this time of nursing shortage (Kingma, 2008). The purpose of this study was to examine factors influencing nurse migration in a sample of Canadian nurses in an attempt to determine what influenced their decisions about working in Ontario or Michigan.
Design: This was a cross-sectional, exploratory study conducted with nurses living in Ontario who either worked in Ontario or commuted daily to Michigan.
Methods: Nurses were recruited through the nursing registries in Ontario and Michigan and completed a mailed questionnaire exploring several selected stressors, including staffing adequacy, safety, commute strain, time-based work interference with family life, strain-based work interference with family life, and a range of demographic variables.
Findings: Logistic regression was used and all five predictors were statistically significant (p < .001), indicating that they reliably distinguished between nurses working in Ontario and Michigan. Individually, commute strain, safety, and time-based work interference with family life were identified as reliable predictors of working in either Ontario or Michigan.
Conclusions: Understanding nursing stressors is critical for providing healthy work environments and promoting well-being of nurses. In this study these factors were reliable predictors of whether a nurse worked in Ontario or Michigan. Global nursing leaders should incorporate knowledge of stressors experienced by nurses if they hope to keep pace with the demands of nurses considering moving from their home countries for better opportunities. Further, nurse recruitment and retention efforts are critical in response to the projected nursing shortage and must be tailored to the specific needs and values of nurses working within each system. Focusing on these stressor variables has the potential to enhance healthy work environments for nurses, aid in recruitment and retention, and support the provision of safe health care.
- ItemSurprise findings from pediatric medication administration OSCE research: It's not only about the 5 rights!(2012-01-04) Cazzell, Mary A.
One in ten patients is harmed while receiving health care in hospital settings (World Health Organization [WHO], 2008). The WHO has highlighted patient safety research as essential toward identifying major modifiable factors leading to unsafe care and patient harm globally. The Objective Structured Clinical Evaluation (OSCE) allows nurse educators an opportunity to evaluate skills important to patient safety, teamwork, and communication. Nursing literature discusses problems seen when nursing students administer medications: incorrect calculations, poor hand hygiene, not checking patient identification, and not completely addressing the 5 rights of medication administration. Not all pediatric hospitals allow nursing students to administer medications during clinical experiences. The purpose is to evaluate undergraduate nursing students' skills and competencies in pediatric medication administration during an OSCE performance. Upon completion of a 7-hour pediatric medication administration simulation lab and within the first four weeks of pediatrics, all Senior 1 nursing students completed a videotaped solo OSCE performance of medication administration to an infant manikin (two oral and one intravenous medication). This study analyzes data from two semesters (N = 210). Quantitative data was obtained from performance rubric scores (0-not done; 1-done) while viewing OSCE videos; lists of common psychomotor errors were compiled. Data collection will be completed by May, 2011; data analysis by August, 2011. Data from one semester (N=105) shows that most students checked patient ID and allergies, performed accurate calculations, communicated well to parent and infant, and administered oral meds appropriately. Common student errors/omissions were: poor hand hygiene and/or gloving, poor cleansing of IV port with alcohol, administration of heparin as pre-med flush, giving IV infusion med as IV push, giving an oral med IV. Implications for nursing and patient safety include: repetition of foundational nursing skills throughout curriculum, early use of OSCEs in nursing programs, and use of reflective writing immediately following OSCE.
- ItemHandwashing: What is Staff Using?(2012-01-04) Cedeno, Denise P.(41st Biennial Convention) Handwashing is a simple process to decrease nosocomial infections in the hospital and all staff are expected to comply with hand-washing guidelines. I hypothesized that if staff is provided with what they prefer to use to wash their hands, compliance will increase.� Having several alternatives to use, also will increase compliance. Regardless of what is provided, heightening staff awareness of the importance of this simple procedure is vital.� I surveyed 31 hospital staff, 5 males and 26 females, including registered nurses, patient care assistants, rehabilitation therapists, respiratory therapists, physicians, unit secretaries, Environmental Services staff, and nursing students by asking three questions: (1) What product do you use to wash your hands (soap and water, waterless foam or your own product); (2) What product do you prefer to use to wash your hands on Seton 1 (soap and water, waterless foam or your own product); and (3) What product do you mostly use to wash your hands on Seton1 (soap and water, waterless foam or your own product)?� At a different time, I randomly observed 31 staff to see what they actually used. Twelve (12) used soap and water, while 19 used the waterless foam. Their reasons for selecting a specific method for washing their hands are as follows: accessibility; feeling cleaner; less harshness with soap and water; and being able to use waterless foam on the run. The findings showed congruence between what staff reported using and what they were observed using. In conclusion, the products made available to staff for washing their hands are used to reduce the incidence of nosocomial infections.
- ItemPhysical health of community-dwelling older adults: Live longer and stay healthier?(2012-01-04) Chen, Kuei-Min; Huang, Hsin-Ting; Li, Chun-Huw; Lin, Mei-Hui; Hsu, Pei-Chi; Wang, Yueh-Chin
Background: Physical health of older adults is the major concern in health promotion of this age group. Having better comprehension about older adults' physical health can better design activities to maintain and promote their health.
Aims: This study aimed to: 1) investigate the physical health of community-dwelling older adults; and 2) compare the differences of physical health among different age groups and gender. Design: Survey research.
Methods: Using stratified random sampling, 384 community-dwelling older adults, equally represented from 11 districts in Kaohsiung city, southern Taiwan, were recruited. Based on the Health Model of Older Adults, three constructs with 28 indicators were measured through face-to-face structured interviews: 1) activities of daily living (6 indicators), 2) physical status (14 indicators), and 3) functional fitness (8 indicators). Descriptive and inferential statistics (ANOVA and independent t-test) were applied to analyze the data.
Results: With an average age of 79.24 + 8.50 years, participants were independent in activities of daily living (M = 96.45, SD = 11.29). Most physical health indicators were within normal range, except problems of central obesity (male: 42.90%; female: 80.30%), abnormal blood pressure (systolic: 47.10%; diastolic: 7%), and deteriorated lung capacity (male: 59.30%; female: 70.70%). Young-old older adults had better conditions in all physical health indicators than the middle-old and old-old older adults (all p < .05). Male older adults had better body composition, cardio-pulmonary fitness, hand-grip strength, and lower-limb muscle endurance than female older adults; however, less body flexibility than the female older adults (all p < .05).
Conclusions: Encouraging community-dwelling older adults to do volunteer works and keep them active would be essential to delay or prevent the deteriorations of nature aging. With an understanding of the physical health of older adults, exercise programs could be specifically designed to reflect those weak points and promote their physical health.
- ItemPrenatal fatigue and quality of life of pregnant women over 26 weeks of gestation(2012-01-04) Cheng, Ching-Yu; Liou, Shwu-Ru; Wang, Panchalli
Pregnant women have high rate of experiencing fatigue, which may impact women's quality of life (QoL). The purposes of his study were to examine relationship between fatigue and QoL (general, physical, mental, and social health) of women in the third trimester. The study was a cross-sectional design with snowball sampling. Data from 128 pregnant women without pregnancy-related physical/mental complications in Taiwan were analyzed. They were at 32.66 (SD=3.76) gestational weeks and were 40.41 (SD=4.30) years old. About half of them were primiparous (55%) and employed (57%); had an education higher than high school (59%) and planned for the pregnancy (51%). The 16-item Multidimensional Assessment of Fatigue (MAFS, scores 1-50, high score indicates higher level of fatigue) and the 17-item Duke Health Profile (DHP, scores 0-100 on each dimension of health, higher score indicates healthier) were used. Cronbach's alphas for the MAFS and DHP were .96 and .80, respectively. Descriptive statistics, ANOVA, Pearson correlation, and regression were used. Participants did not have very high score on the MAFS (M=20.56) and physical (M=52.97), mental (M=64.61), social (M=63.71), and general (M=60.43) health of the DHP. Fatigue was correlated with physical (r=-.68), mental (r=-.53), social (r=-.45), and general (r=-.70) health. Fatigue could explain 47% of the variance of physical, 28% of mental, 20% of social, and 49% of general health. Fatigue and dimensions of QoL did not differ by gestational groups (<32, 32-36, and >36 weeks), educational level (college or higher and lower than college), or happy about pregnancy (happy, unhappy, and uncertain). Employed pregnant women had better mental (t=2.14, p=0.04) and social (t=2.81, p=0.01) health than unemployed women. Strategies to manage fatigue such as time management, may improve maternal QoL. Helping pregnant women to be employed may increase their QoL. Longitudinal study can help to understand patterns of fatigue and QoL during pregnancy.
- ItemPostpartum weight retention and its related factors in Taiwanese women: A preliminary study(2012-01-04) Cheng, Hsiu-Rong
Purpose: Childbearing is a significant contributor to the increase of body weight and body fat, and waist circumference is an effective measurement to predict the risk of obesity-related diseases. Few studies have explored postpartum weight retention, and none have measured waist circumference in Taiwanese postpartum women. Hence, the purpose of this study is to examine the current magnitude of postpartum weight retention, waist circumference, and related factors of postpartum weight retention in Taiwanese women.
Methods: A cross-sectional design was used. A convenience sample of Taiwanese women was recruited from two health centers in southern Taiwan. Women's body weights and waist circumferences were measured. Structured questionnaires were used to collect explanatory factors of postpartum weight retention. Independent t-test and Pearson correlation test were used for data analysis.
Findings: The sample (N = 30) were all married, with mean age 31.93 years, at 2 weeks to 28 weeks postpartum (mean = 11.50), and 53% of them were primiparas. Their average gestational weight gain, average postpartum weight retention, and average increase in waist circumference were 12.61 4.23 Kg, 4.24 2.03 Kg, and 8.72 5.64 cm, respectively. The prevalence of overweight increased from 21.4% before pregnancy to 32.1% postpartum. Higher gestational weight gain was related to postpartum weight gain (r = 0.331). Primiparas increased their waist circumferences more than multiparas did (t = 2.22, p = 0.037). Postpartum weight retention and snack eating during doing the month are related to increases in waist circumference (r = .625 and r = .435). In addition, total hours of sleep was negatively associated with increases in waist circumference (r = .40).
Conclusions: There is significant postpartum weight retention and increase in waist circumference in Taiwanese women. Gestational weight gain, lifestyle changes, and the custom of doing the month have important effects on women's bodies.
- ItemAssessment of educational effectiveness of applying Nightingale's concept of "disease" to promote the reflection of life style of nursing students(2012-01-04) Chien, Shu Chun; Nagata, Akiko; Saito, Shinobu; Nitta, Natsuko; Yamamoto, Toshie; Wazumi, Yoshiko; Tsubaki, Sachiko; Yamagishi, Hitomi
Purpose: This study is to assess the educational effectiveness of applying Nightingale's concept of "Disease" to promote the reflection of life styles of nursing students. Nightingale descripted disease as, "a reparative process." She went on to say, "The reparative process which Nature has instituted, and which we call disease, has been hindered by some want of knowledge or attention, in one or in all of these things and pain, suffering, or interruption of the whole process sets in". According to the above concept we can find one very important principle hidden in Nightingale's thinking. That is, if we know what living processes causes people to become ill, we can help them to arrange their life style to prevent recurrences or onset of the illness.
Methods: The subject of "Medical and Nursing Information" was organized the concept into lectures to instruct nursing students how to apply the concept to reflect the relations between their life styles namely their continued 24 hours lives and health conditions. 102 nursing students who attended the lectures were enrolled for assessing the educational effectiveness. After the lectures students keyed in their fundamental daily living information using the software which developed based on the Nightingale's concept of "Disease" and minimal period two weeks of their daily lives as time of sleeping, contents of meals and exercises, schedules etc. and their health conditions. Researchers analyzed the data with 4 ranks of criterions.
Results and conclusions: We found that 98% of students could identified the relations between their life styles and their health conditions, 69% of students could make concrete plans for changing the patterns of daily lives to improve the health conditions. Nightingale's concept of "Disease" is useful to promote students' reflection and it is also could be recognized as the nursing strategy of preventive medicine.