Exploring the Associations Between Patient Affect, Self-Care Actions, and Emergency Department Use for Community-Dwelling Adults.

BACKGROUND: Nurses and other health care providers need to ensure that patients receive care that addresses their specific needs and wants. PURPOSE: This exploratory study examined the associations between patients' self-reported positive and negative affect, the perceived importance of 57 self-care actions, the desire and ability to perform them, and emergency department use in the past 3 months. METHODS: A secondary analysis from a cross-sectional survey project that surveyed 250 community-dwelling adults living in the southern United States, 2015-2016. Independent t tests and the χ test were used. RESULTS: Positive affect was associated with positive perceptions of self-care actions and having no emergency department visit. Patients with a more negative affect perceived finding and using services that support their health behaviors as being important and expressed a desire to participate in local health screening or wellness events. CONCLUSIONS: Patients' perceptions of their self-care actions could lead to better outcomes.

Do patients' demographic characteristics affect their perceptions of self-care actions to find safe and decent care?

AIM(S): This exploratory study examined the relationship of five patient demographic characteristics (residence in an urban or rural site, gender, age group, marital status, and education level) with the patients' (1) perceived importance of, (2) desire to, (3) ability to perform four patient engagement self-care actions that result in finding safe and decent care. BACKGROUND: Equitable access to health care is essential in a humanized health care system. Healthcare providers must engage patients in discussions about their desires for their care to create person-centered care plans reflecting patient values and wishes. METHODS: This secondary data analysis from a cross-sectional survey project surveyed community-dwelling adults living in the southern United States, 2015-2016. This paper only includes responses of participants aged 65 years and older (N = 123). Data collected in The Patient Action Inventory for Self-Care and demographic questions were used. Chi-square tests and multiple logistic regression analyses were used. RESULTS: As revealed in the Chi-square and logistic regression findings, self-care actions of "finding a doctor or practitioner who meets your needs," "using available information to choose a doctor or practitioner," and "using data to choose a hospital or clinic" showed some associations with whether seniors resided in an urban or rural community, age group, and marital status (P < 0.05). No significant associations between these four self-care actions with gender or education were found. CONCLUSIONS: A community-based solution is warranted to leverage between patient demographic characteristics and their perceived self-care actions by harnessing local factors in collaboration with identified patient needs.

Perceived top 10 highly effective interventions to prevent adult inpatient fall injuries by specialty area: a multihospital nurse survey.

PURPOSE: This study identified the perceived top 10 highly effective interventions to prevent fall injuries of adult inpatients based on the perceptions of RN staff by specialty area in acute hospital settings. BACKGROUND: The fall prevention precautions to focus on may vary by patients' medical problems and thus by specialty area. METHODS: This cross-sectional nurse survey was conducted at five U.S. health systems (July 2011-February 2012, 68 study units, 10 specialty areas). 560 staff participants completed the survey, yielding an overall response rate of 25.81%. This work is part of a larger project. Descriptive statistics were used. RESULTS: Each specialty area had its own top 10 effective interventions identified by RNs. The complexity and differences in the top 10 highly effective interventions by the 10 included specialty areas are apparent. For example, only one common intervention (keeping hospital bed brakes locked) appeared in the lists from the medical units and surgical units. CONCLUSION: Addressing the unique needs of the patient population by specialty area is essential. Adopting the perceived top 10 highly effective interventions for preventing injurious falls by specialty area with staff consensus might be more feasible for staff buy-in and compliance in inpatient acute care settings. Since patients' characteristics may change over time and the science in fall prevention is advancing, re-prioritizing effective interventions as needed every 2 years is recommended.

i Engaging user testing: lessons learned from inpatients and health care providers.

This user-testing study assessed the feasibility of the functional prototype of an innovative fall prevention intervention, i Engaging, to engage patients in their own fall prevention care during hospital stays. The i Engaging application as well as its approaches to engage patients in fall prevention care during hospital stays was perceived as being easy to use, effective, and practical. The user-testing study consisted of adults 65 years of age or older and health care providers.

Patient Engagement in Hospital Fall Prevention.

Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input).

Frequently observed risk factors for fall-related injuries and effective preventive interventions: a multihospital survey of nurses' perceptions.

There is an urgent need to prioritize the risk factors for injurious falls and effective interventions in nursing practice. Registered nurses perceived that the most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions. The most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards.

Medication error-related issues in nursing practice.

Professional nurses are more exposed to civil claims for negligence than in the past. Issues related to medication errors, and strategies to decrease them, are addressed.

Staff response time to call lights and unit-acquired pressure ulcer rates in adult in-patient acute care units.

The US National Pressure Ulcer Advisory Panel claimed that most pressure ulcers are avoidable (2007). Identifying nursing-process indicators that are objective and associated with pressure ulcer rates is desperately needed. As a result, the purpose of this exploratory study was to examine the relationship between staff response time to call lights and the rate for unit-acquired pressure ulcers stage II and greater, in adult in-patient acute care units. We used archived data of one Michigan hospital located in the United States from July 2005 to December 2008 for analyses. The unit of analysis was the patient care unit-month. Pearson product-moment correlation analyses were used. The results showed that a faster staff response time to call lights was found to be associated with a lower percentage of unit-acquired pressure ulcers stage II and greater among surveyed patients. Staff response time is a significant process indicator to predict unit-acquired pressure ulcer rates.

The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four US hospitals using archived hospital data.

BACKGROUND: Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. METHODS: We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063). Hierarchical multiple regression analyses were used. RESULTS: Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. CONCLUSIONS: Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider strategizing fall and injurious fall prevention efforts by aiming for a decrease in staff response time to call lights. Monitoring call light response time on a regular basis is recommended and could be incorporated into evidence-based practice guidelines for fall prevention.

Relationship of actual response time to call lights and patient satisfaction at 4 US hospitals.

This multihospital study examined patient satisfaction with items of "received help as soon as possible" and "help to the bathroom" and their relationship to the actual response time to call lights. We found that faster actual response time to call lights contributed to higher patient satisfaction with "received help as soon as possible." The relationship between response time and patient satisfaction with "help to the bathroom" was not supported.

Toileting-related inpatient falls in adult acute care settings.

A toileting-related fall was associated with history of a previous fall, use of physical restraints, and risk for falling in hospital settings. This study provided insights to be used to prioritize patient fall prevention strategies.

Nursing staff's awareness of keeping beds in the lowest position to prevent falls and fall injuries in an adult acute surgical inpatient care setting.

High beds are a safety concern. This qualitative study used pre-existing nurse interview data and confirmed nurses' awareness of the importance of keeping patient beds in the lowest position. Lowering the bed helps promote patient safety and prevent falls.

Keeping patient beds in a low position: an exploratory descriptive study to continuously monitor the height of patient beds in an adult acute surgical inpatient care setting.

This descriptive study was intended to measure the percentage of the time that patient beds were kept in high position in an adult acute inpatient surgical unit with medical overflow in a community hospital in Michigan, United States. The percentage of the time was calculated for morning, evening, and night shifts. The results showed that overall, occupied beds were in a high position 5.6% of the time: 5.40% in the day shift, 6.88% in the evening shift, and 4.38% in the night shift. It is recognized that this study was unable to differentiate whether those times patient beds being kept in a high position were appropriate for an elevated bed height (e.g., staff were working with the patient). Further research is warranted. Falls committees may conduct high-bed prevalence surveys in a regular basis as a proxy to monitor staff members' behaviors in keeping beds in a high position.

Is there a link between the hospital-acquired injurious fall rates in US acute care hospitals and these institutions' implementation levels of computerized systems?

Medicare no longer reimburses acute care hospitals for the costs of additional care required due to hospital-acquired injuries. Consequently, this study explored the effective computerized systems to inform practice for better interventions to reduce fall risk. It provided a correlation between type of computerized system and hospital-acquired injurious fall rates at acute care hospitals in California, Florida, and New York. It used multiple publicly available data sets, with the hospital as the unit of analysis. Descriptive and Pearson correlation analyses were used. The analysis included 462 hospitals. Significant correlations could be categorized into two groups: (1) meaningful computerized systems that were associated with lower injurious fall rates: the decision support systems for drug allergy alerts, drug-drug interaction alerts, and drug-laboratory interaction alerts; and (2) computerized systems that were associated with higher injurious fall rates: the decision support system for drug-drug interaction alerts and the computerized provider order entry system for radiology tests. Future research may include additional states, multiple years of data, and patient-level data to validate this study's findings. This effort may further inform policy makers and the public about effective clinical computerized systems provided to clinicians to improve their practice decisions and care outcomes.

Link between patients' perceptions of their acute care hospital experience and institutions' injurious fall rates.

This exploratory study used 4 publicly available large data sets to determine whether significant correlations exist between patients' perceptions of their acute care hospital experience and hospital-acquired injurious fall rates at their hospitals in the states of California, Florida, and New York in 2007. The results showed that the higher the inpatient satisfaction levels with the responsiveness of hospital staff and cleanliness and quietness of the hospital environment, the lower were the injurious fall rates.

The relationship of the hospital-acquired injurious fall rates with the quality profile of a hospital's care delivery and nursing staff patterns.

Fall occurrence during hospital stays is a well-recognized nursing-sensitive outcome indicator. This study was intended to determine the unique contributions of three inpatient satisfaction measures on the hospital-acquired injurious fall rates. Study results demonstrated the higher the inpatient satisfaction levels with the quietness of hospital environment, the lower the injurious fall rates. The physical environment (quietness) of the acute inpatient care settings was a significant and meaningful determinant of the prevalence of injurious falls. Additionally, more total nursing personnel FTEs per 1,000 discharges and a higher percentage of RN FTEs by total nursing personnel FTEs would not result in better patient outcomes.

Predicting patient satisfaction with nurses' call light responsiveness in 4 US hospitals.

OBJECTIVE: This multihospital study determined the contributors to patient/family satisfaction levels with nurses' call light responsiveness and compared the reasons for call light usage as perceived by patients and nurses. BACKGROUND: Delayed responses to answering call lights may result in a patient falling and can affect patient satisfaction. METHODS: This cross-sectional survey study was conducted from September 2008 to November 2009 in 4 US hospitals; 1,253 patients/family participants and 988 nurses were surveyed. Descriptive and multiple regression analyses were conducted. RESULTS: Women, older patient/family participants, and those who perceived that nurses often answered call lights in person, that their problems were resolved after pushing the call light, and that their call lights less frequently involved safety issues were more satisfied with nurses' responsiveness. The top 5 reasons for using call lights were the same for patients and nurses. CONCLUSION: Nursing administrators should emphasize increasing staff's call light responsiveness.

Adding additional grab bars as a possible strategy for safer hospital stays.

Patient room design should fulfill the safety needs of most patients. This article addresses the safety concerns related to grab bars and handrails (a United States-based review) and describes our proposed innovative approaches to promote safer hospital stays. The fixed augmentation of high-low grab bars and handrails can economically prevent inpatient falls in the areas commonly used by patients (e.g., patient rooms, patients' bathrooms, and hallways). The optimum grab bar and handrail configurations require further research. Revisions to guidelines for health care facilities related to grab bars and handrails should allow a range that respond to age- and disability-specific needs.

Nurses' response time to call lights and fall occurrences.

Nurses respond to fallers' call lights more quickly than they do to lights initiated by non-fallers. The nurses' responsiveness to call lights could be a compensatory mechanism in responding to the fall prevalence on the unit.