The Role of the Physical Environment in Shaping Interruptions and Disruptions in Complex Health Care Settings: A Scoping Review.

Interruptions and disruptions in complex healthcare environments, such as trauma rooms, can lead to compromised workflow and safety issues due to the physical environment's characteristics. This scoping review investigated the impact of the physical environment on interruptions and disruptions and the associated outcomes in complex environments, as they relate to the components of the Systems Engineering Initiative for Patient Safety. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct the scoping review. CINAHL, Web of Science, and PubMed databases were searched. After removing duplicates and eligibility screening, quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Of 1,158 articles found, 20 were selected. Poor layout configurations, tripping hazards, and technology integration were common examples. More research must be conducted to unveil the impact of the physical environment on interruptions and disruptions.

Racial Discrimination, Racial Identity, and Obesity in Collegiate African American Women.

OBJECTIVE: To investigate relationships among racial discrimination, explicit racial identity, and obesity in young collegiate African American (AA) women aged 18-25. DESIGN: Researchers recruited 136 women who self-identified as AA from a large Midwestern university. Racial discrimination (RD) was measured using lifetime overt experiences of discrimination, recent microaggressions, and vicarious RD directed towards close others. Explicit racial identity included dimensions of private regard, public regard, and centrality. Generalized obesity (elevated body mass index) and abdominal obesity (increased fat distribution in the midsection) were measured biometrically using kg/m2 and waist circumference, respectively. Hierarchical multiple regression was employed to explore main and interaction effects. RESULTS: After controlling for adverse life events and income, overt RD, recent microaggressions, and private regard directly accounted for variance in both BMI and waist circumference. Public regard and centrality moderated relationships between RD variables and waist circumference. CONCLUSIONS: RD and racial identity accounted for up to 13% of variance in BMI and waist circumference in main effects models among young collegiate AA women. While obesity is a multifactorial phenomenon, racial discrimination and racial identity may affect observed racial disparities in obesity rates among young women.

Use of Personal Health Records to Support Diabetes Self-management: An Integrative Review.

More than 30 million persons in the United States have diagnosed or undiagnosed diabetes. Persons with chronic types of diabetes must learn self-management principles and techniques and perform self-care behaviors to reduce the risk of diabetes-related complications. An electronic personal health record is one type of technology commonly used to support diabetes self-management. This integrative review examines research on how personal health records incorporate or address the American Association of Diabetes Educators self-care behaviors, diabetes-related psychosocial concerns, and the diabetes-related clinical quality-of-care measures of hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure. In the majority of studies reviewed, participants showed improvement in the self-care behavior or physiological outcome examined. Findings were inconclusive about the impact of personal health record use on diabetes distress. Results also revealed a lack evidence of patient specific factors influencing intention to use a personal health record for management of type 2 diabetes mellitus. Despite evidence that personal health record use improves diabetes self-management, they are underutilized. Implications for practice include understanding what influences intention to use a personal health record. Further research is also needed to determine the impact of personal health record use on diabetes distress.

Hospital Environmental Effects on Sleep in Adults With Traumatic Brain Injury in Rehabilitation.

PURPOSE: The aim of this study was to describe sleep patterns of adults with traumatic brain injury and examine effects of environmental stressors (patient care activities and light) on patterns of sleep. DESIGN: A descriptive, correlational, explanatory design was used for this study. METHODS: Sixty-three subjects with traumatic brain injury (>18 years) on an acute traumatic brain injury rehabilitation unit wore an Actiwatch for 48 hours to collect light and sleep data. Patient care activity data were collected between 11 p.m. and 7 a.m. FINDINGS: Patient care activities and light occurred between 11 p.m. and 7 a.m. Nighttime sleep duration and sleep efficiency were explained by patient care activities, whereas light explained wake time after sleep onset. CONCLUSION: Patient care activities and light serve as environmental stressors that affect sleep. CLINICAL RELEVANCE: Results necessitate examining the need and timing of nursing care activities and light during nighttime. Findings provide a basis for policy changes that optimize sleep.

Influence of NICU Nurse Education on Intention to Support Lactation Using Tailored Techniques: A Pilot Study.

BACKGROUND: Preterm infants' outcomes improve when fed their mothers' milk. Low percentages of neonatal intensive care unit (NICU) nurses support mothers facing barriers to establishing and sustaining adequate milk supplies. Nurses' motivations and attitudes are instrumental, but understudied, factors in their intention to promote maternal lactation. PURPOSE: Using the Theory of Reasoned Action, this study explored (1) NICU nurses' attitudes, social pressures, feelings of preparedness, perceptions of comfort, and intention to support lactation; and (2) magnitude of relationships among these concepts before and after undertaking an educational module. METHODS: A descriptive pre-/postintervention design included a sample of 24 NICU nurses who completed a module, including general lactation and hands-on expressing information. The Nursing Support for Breastfeeding Questionnaire was administered before and after completing the module. RESULTS: Attitudes, social norms, perception of preparedness, and intention were moderate to high before and after completion of the module. Perception of comfort was moderate. When comparing pre- and postintervention, effect sizes for intention and perception of comfort were moderate. Magnitude of the relationship between attitudes and intention was strong before intervention and moderate after intervention. Subjective norms demonstrated stronger relationships with attitudes and intention after intervention. Preparedness and comfort had stronger relationships with attitudes than with intention both before and after intervention. IMPLICATIONS FOR PRACTICE: Nurses' attitudes, perception of preparedness, and comfort are modifiable considerations in developing strategies to support evidence-based lactation techniques. IMPLICATIONS FOR RESEARCH: Additional studies are needed with fully powered and stronger designs to validate findings to guide interventions for nurse support for NICU mothers to optimize lactation.

Factors Influencing Patients' Intention to Perform Physical Activity During Hematopoietic Cell Transplantation.

OBJECTIVES: To examine theoretical and medical variables influencing a patient's intention to perform physical activity during hospitalization for hematopoietic cell transplantation (HCT). SAMPLE & SETTING: 54 patients undergoing HCT at the Seidman Cancer Center in Cleveland, Ohio. METHODS & VARIABLES: A longitudinal, prospective cohort design was used. Instruments included the Self-Report Habit Index, tailored to assess exercise habit, the Memorial Symptom Assessment Scale-Short Form, and an investigator-constructed survey of intention, attitude, control, and subjective norm toward physical activity. Descriptive statistics, univariate logistic regression, and linear regression were used. RESULTS: Intention for physical activity remained high at all time points. Previous exercise habits were not related to intention. Inverse relationships between symptom distress and the theoretical constructs that influence intention occurred at the critical time points of nadir and discharge during transplantation. IMPLICATIONS FOR NURSING: Nurses should reinforce physical activity regardless of exercise habits. Symptom distress may influence physical activity differently during the transplantation trajectory.

Innovative Approach to Reconstruct Bedside Handoff: Using Simple Rules of Complexity Science to Promote Partnership With Patients.

When nurses integrate patient expertise, nurse-to-nurse handoff becomes patient-centered (nurse and patient), and the weak link between quality and safety is mitigated. The existing paradigm for handoff is an ineffective measure to minimize errors. This article describes a reimagined bedside handoff-transitioning handoff from its prescriptive nurse-centered interaction to a patient-centered partnership using the principles of complex adaptive systems, simple rules, and partnerships that address the uniqueness of each patient and nurse interaction.

Interruptions in Preanesthesia Nursing Workflow: A Pilot Study of Pediatric Patient Safety.

PURPOSE: Preanesthesia care is a high-risk system where interruptions during the preanesthesia assessment may jeopardize the quality of information obtained. The objective of this study was to (1) identify the number and nature of interruptions occurring during the nursing preanesthesia assessment, (2) evaluate effectiveness of a no interruption zone (NIZ) on the number and nature of interruptions experienced, and (3) determine the frequency with which nurses returned to their original task after interruption. DESIGN: A pre-post, quasi-experimental pilot study design was used. METHODS: Study included observational methodology to compare the number and nature of interruptions which occurred during the preanesthesia assessment before and after implementation of a NIZ. FINDINGS: There was a statistically significant decrease in interruptions per observation after implementation of a NIZ with physical and verbal interruptions being the most common. Nurses returned to the original task more often after the implementation of the NIZ. CONCLUSION: Findings suggest use of a NIZ decreased interruptions experienced by nurses and thereby decreases the potential for workflow fragmentation.

Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?

OBJECTIVES: This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices. BACKGROUND: The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices. METHOD: This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital. RESULTS: Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices. CONCLUSION: Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Examining the Relationship Among Ambulatory Surgical Settings Work Environment, Nurses' Characteristics, and Medication Errors Reporting.

PURPOSE: To describe work environment characteristics (leadership style and safety climate) of ambulatory surgical settings and to examine the relationship between work environment and nurses' willingness to report medication errors in ambulatory surgical settings. DESIGN: Descriptive correlational design using survey methodology. METHODS: The sample of this study consisted of 40 unit-based registered nurses, working as full time, part time, or as needed in four ambulatory surgical settings affiliated with one health care system located in Northeast Ohio. FINDINGS: The results of two separate regression analyses, one with three nurse manager's leadership styles and another with five safety climate dimensions as independent variables, explained 44% and 50%, respectively, on variance of nurses' willingness to report medication errors. CONCLUSION: To increase nurses' willingness to report medication errors, ambulatory surgical settings administrators should invest in nurse manager leadership training programs and focus on enhancing safety climate aspects, particularly errors feedback and organizational learning.

Energizing the research enterprise at nonacademic health center schools of nursing.

Strategic redirection of a university's mission to focus on research is challenging. This article describes an approach to developing a culture of research in a school of nursing (SON) in a nonacademic health center university. Infrastructure changes and committed mentors were developed to move a dormant research culture into one characterized by a growing dynamism of camaraderie and espirit de corps about research and scholarly productivity. To sustain the momentum, a rapid mentor-faculty feedback loop was created so that within a 48-hour time frame, the mentor provided feedback to the faculty member. Timely and iterative feedback prompted discussions that led to more scientifically rigorous proposals and publications. Tailored approaches were adopted for junior and senior faculty. In the first academic year using this approach, publications increased by 144%, and grant proposal submissions increased by 169%, whereas presentations shifted toward more regional and national venues. The increased productivity was maintained over the next 2 years. Building and sustaining a culture of success in research require leadership and vigilance, infrastructure changes, and process-oriented initiatives.

Development and testing of a survey instrument to measure benefits of a nursing information system.

Information systems (IS) benefits for nurses are outcomes related to the tangible products or improvements that nurses realize from using IS. This study examined the development and psychometric testing of a measure of nurses' benefits from IS. A random sample of 570 nurses working in hospitals, providing direct patient care, and using IS completed the study questionnaire. The internal consistency reliability of the results was .97. Exploratory factor analysis, using principal components extraction and varimax rotation, revealed items loaded on four factors (saving time and efficiency, quality of care, charting, and professional practice) that were confirmed by confirmatory factor analysis. Continued refinement of the instrument is needed with more diverse samples of nurses.

Information systems use, benefits, and satisfaction among Ohio RNs.

Contemporary forces, including the growing nursing shortage, the aging population, and the emphasis on patient safety, are increasing the pressure on healthcare facilities to use information systems to achieve better outcomes. Use of information systems improves nurses' ability to make decisions in a timely manner; however, nurses are still reluctant about or avoiding using information systems in their daily work. The purpose of this study was to explore the relationships among age, nursing education, computer experience, user involvement in implementation, nursing management support to use information systems, nurses' information system use, and information system outcomes (benefits and satisfaction). The study used an input-process-outcome framework, a descriptive correlational design, and a mailed survey with a random sample of staff nurses. Computer experience, user involvement, and nursing management support were found to significantly explain information system use. In addition, information system use was found to significantly explain nurses' perception of the benefits of using information systems and their satisfaction with using information systems. These results assist nursing administrators and leaders to change and/or restructure the appropriate work environment to enhance nurses' information system use and increase their satisfaction, thereby improving patient outcomes.