Hierarchical regression and structural equation modeling: two useful analyses for life course research.

This article reviews the life course perspective and considers various life course hypotheses such as trajectories, transitions, critical periods, sequencing, duration, and cumulative effects. Hierarchical regression and structural equation modeling are suggested as analyses to use in life course research. Secondary analysis was performed on the Early Head Start Research and Evaluation Study, 1996-2010, to illustrate their strengths and challenges. Models investigated the influence of mother and infant characteristics and of parent-child dysfunction at 14 and 24 months to children's cognitive outcomes at 36 months. Findings were interpreted and discussed in the context of life course hypotheses.

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation.

OBJECTIVE: To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses. METHODS: We used a Diagnostic content validation using an online survey of expert clinical nurses. RESULTS: 195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively. CONCLUSION: The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

Sampling Methods.

Knowledge of sampling methods is essential to design quality research. Critical questions are provided to help researchers choose a sampling method. This article reviews probability and non-probability sampling methods, lists and defines specific sampling techniques, and provides pros and cons for consideration. In addition, issues related to sampling methods are described to highlight potential problems.

Nurse Competence on Physiologic Monitors Use: Toward Eliminating Alarm Fatigue in Intensive Care Units.

BACKGROUND: Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses' perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose. METHODS: This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors' features. Thirty nurses from 4 adult ICUs were invited to respond to the survey. RESULTS: Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales' scores and demographic characteristics (p > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users' needs. CONCLUSION: This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all necessary skills and should not assume proficiency on basic skills. Special attention should be focused on managing technical alarms. Increasing the number of super users is a recommended strategy for individualized and unit-specific training. There is a need for a usability testing of complex IT-equipped medical devices, such as physiologic monitors, for effective, efficient and safe navigation of the monitors.

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation / Diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos: validação de conteúdo diagnóstico / Diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores: validación del contenido diagnóstico

ABSTRACT Objective: To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses. Methods: We used a Diagnostic content validation using an online survey of expert clinical nurses. Results: 195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively. Conclusion: The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

RESUMO Objetivo: Validar as características definidoras dos diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos, testando as definições dos diagnósticos entre enfermeiros especialistas. Método: Validação de conteúdo diagnóstico utilizando um questionário online para enfermeiros clínicos especialistas. Resultados: 195 enfermeiras especialistas realizaram as validações diagnósticas. Os resultados demonstraram a validade de memória prejudicada com 11 características definidoras principais, e confusão crônica com 11 características definidoras principais e uma secundária. Em ambos os diagnósticos, o índice de validade de conteúdo foi de 0,85. A análise fatorial forneceu quatro para memória prejudicada e cinco fatores para confusão crônica. Conclusão: O estudo forneceu evidências de validade dos dois diagnósticos, tornando-os mais claros. Por meio do uso desses diagnósticos de enfermagem atualizados, os enfermeiros podem melhorar a precisão e a qualidade do atendimento a pacientes idosos, contribuindo para um cuidado gerontológico de enfermagem mais preciso.

RESUMEN Objetivo: Validar las características que definen los diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores, testeando las definiciones de los diagnósticos entre enfermeros especialistas. Método: Se trata de una validación del contenido diagnóstico realizado mediante un cuestionario en línea para enfermeros clínicos especialistas. Resultados: Las validaciones de diagnóstico las llevaron a cabo 195 enfermeras especialistas. Los resultados demostraron la validez del deterioro de la memoria con 11 características principales definidoras y la confusión crónica, con 11 principales definidoras y una secundaria. En ambos diagnósticos, la tasa de validez del contenido fue de 0,85. El análisis factorial proporcionó cuatro factores para el deterioro de la memoria y cinco para la confusión crónica. Conclusión: El estudio trajo evidencias de la validez de los dos diagnósticos y los dejó más claros. Al valerse de estos diagnósticos actualizados, los enfermeros pueden mejorar la precisión y la calidad de la atención de los pacientes adultos mayores y contribuir aún más con el cuidado gerontológico de enfermería.

Improving glycemic control with the adjunct use of a data management software program.

BACKGROUND: Published studies have supported the implementation of tight glucose control (TGC) programs to improve patient outcomes and reduce mortality rates. However, measuring a program's efficiency is challenging, because of a lack of systems that capture data, allow access to data, and support analysis and interpretation in a near prospective time frame. We hypothesized that providing clinicians access to real-time blood glucose (BG) results reports could improve the efficacy of our TGC program. METHODS: We performed a retrospective review of BG data during a 12-month period in a surgical trauma intensive care unit at a level I trauma center. A unit-specific insulin algorithm was used throughout the study. We compared BG values before and after the implementation of a data management software program that allowed clinicians access to real-time BG results reports. Reports were run daily and weekly to monitor the unit's TGC program. RESULTS: A total of 70 616 BG values from 1044 patients were analyzed. An overall decrease was observed in the BG level mean, from 121 mg/dL to 112 mg/dL (P < .001), as well as a decrease in the aggregated mean across patients, from 132 mg/dL to 119 mg/dL (P < .001), after implementation of the software. The percentage of values within the target range of 80 to 110 mg/dL increased from 38.9% to 50.4% (P < .001). The percentage of BG values less than 70 increased from 2.7% to 3.4% (P < .001). However, the percentage of severe hypoglyce-mic episodes (≤ 40 mg/dL) remained unchanged. CONCLUSIONS: Access to real-time aggregated BG data reports through the use of a data management software program improved the efficacy of our TGC program.