RESUMO
Mindfulness is useful for some psychiatric illnesses, but limited research exists among persons with anorexia nervosa (AN). This study aimed to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in women with AN (n = 59) entering residential treatment. Participants completed a self-administered survey, including the Cognitive Affective Mindfulness Scale and other measures. Additional data from medical records were collected. Greater mindfulness was associated with less eating disorder symptoms (p = .049). This relationship was most profound in individuals with AN, including restrictive and binge-purge subtypes compared to individuals with atypical AN (interaction p-value = 0.044). Greater mindfulness was significantly associated with less shape (p = .023) and weight concern (p = .047). Expectedly, anxiety was inversely associated with eating disorder symptoms (p = .001). Greater pain was associated with less eating disorder symptoms (p = .024). Overall, mindfulness may be a protective factor against some eating disorder symptomology.
Assuntos
Anorexia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos , Atenção Plena , Ansiedade , Feminino , Humanos , DorRESUMO
Publicly available data from the Centers for Medicaid & Medicare Services were used to analyze factors associated with removal of the urinary catheter within 48 hours after surgery in 59 Massachusetts hospitals. Three factors explained 36% of the variance in postoperative urinary catheter removal: fewer falls per 1000 discharges, better nurse-patient communication, and higher percentage of Medicare patients. Timely urinary catheter removal was significantly greater in hospitals with more licensed nursing hours per patient day.
Assuntos
Remoção de Dispositivo/estatística & dados numéricos , Cateteres Urinários/estatística & dados numéricos , Cateteres de Demora/efeitos adversos , Centers for Medicare and Medicaid Services, U.S./economia , Comunicação , Estudos Transversais , Remoção de Dispositivo/economia , Feminino , Hospitais , Humanos , Masculino , Massachusetts , Complicações Pós-Operatórias/economia , Fatores de Tempo , Estados Unidos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Infecções Urinárias/economia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controleRESUMO
This paper examined hospital characteristics, staffing, and nursing care factors associated with patient perception of poor pain control by conducting a secondary analysis of the Hospital Consumer Assessment of Health Care Providers Systems (HCAHPS) survey in California, Massachusetts, and New York hospitals. Analysis of variance was used to analyze the relationship between nurse, hospitalist, physician, and resident staffing and patients' perception of pain control. Twenty-one factors correlated with patients' reports of pain control were included in the stepwise linear regression analysis. Patients' perception of pain control significantly improved with higher numbers of registered nurses (p = .045), nursing staff (p = .005), and hospitalists (p = .035) and worsened with higher numbers of residents or interns (p = .010). Six predictors explained 79% of the variance in patients' self-reports of pain control. Four factors increased the likelihood that patients reported their pain was poorly controlled: (1) patients did not receive help as soon as they wanted (p < .001), (2) poor nurse communication (p < .001), (3) poor medication education (p < .001), and (4) teaching hospitals (p < .001). Two factors decreased the likelihood that patients reported their pain was poorly controlled: (1) higher numbers of nursing staff (p = .001) and (2) nonprofit hospitals (p = .001). Nurse staffing and nurse-patient communication are highly predictive of patients' perception of pain management. In teaching hospitals, with rotating intern/resident assignments, patients reported less satisfaction with pain management. This study provides new evidence for the importance of continuity of care in controlling the pain of hospitalized patients.
Assuntos
Manejo da Dor/normas , Medição da Dor/instrumentação , Satisfação do Paciente , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Análise de Variância , California , Comunicação , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Massachusetts , New York , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
In the 2014 Emergency Department Benchmarking Alliance Summit, for the first time, participants recommended tracking nursing and advanced practice nurse hours. Performance data from the Centers for Medicare and Medicaid Services provides an opportunity to analyze factors associated with delays in emergency care. The purpose of this study was to investigate hospital characteristics associated with time to a diagnostic evaluation in 67 Massachusetts emergency departments from 2013 to 2014. METHODS: Covariates significantly correlated with time to diagnostic evaluation, and factors associated with timely care in emergency departments were included in the stepwise linear regression analysis. Differences in nurse staffing and performance measures in trauma and nontrauma emergency departments were examined with analysis of variance and t tests. RESULTS: Two predictors explained 38% of the variance in time a diagnostic evaluation (1): nurse staffing (P < .001) and (2) trauma centers (P <.001). In trauma centers, the time to a diagnostic evaluation significantly increased (P = .042) from 30.2 minutes when a nurse cared for fewer than 11.32 patients in 24 hours to 61.4 minutes when a nurse cared for 14.85 or more patients in 24 hours. DISCUSSION: Efforts to improve patient flow often focus on process interventions such as improved utilization of observation beds or transfers of patients to inpatient units. In this study, time to diagnostic evaluation significantly increased when emergency nurses care for higher numbers of patients. The findings present new evidence identifying the relationship of specific nurse to patient ratios to wait time in emergency departments.
Assuntos
Tomada de Decisão Clínica , Enfermagem em Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Transversais , Humanos , Massachusetts , Fatores de TempoRESUMO
In this study of California, Massachusetts, and New York hospitals, 6 factors predicted 27.6% of readmissions for patients with heart failure (HF). We found that higher admissions per bed, teaching hospitals, and poor nurse-patient communication increased HF readmissions. Conversely, the HF readmissions were lower when nurse staffing was greater, more patients reported receiving discharge information, and among hospitals in California. The implications for nursing practice in the delivery of care to patients with HF are discussed.
Assuntos
Insuficiência Cardíaca/epidemiologia , Hospitais/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , American Hospital Association , California/epidemiologia , Centers for Medicare and Medicaid Services, U.S. , Comunicação , Bases de Dados Factuais , Humanos , Massachusetts/epidemiologia , New York/epidemiologia , Relações Enfermeiro-Paciente , Valor Preditivo dos Testes , Fatores de Risco , Estados UnidosRESUMO
The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (p<.001) than that in California and New York (p=.007). The rate of change in registered nurses full-time equivalent hours per patient day was significantly less (p=.02) in Massachusetts than that in California and was not different from zero. The rate of change in admissions to registered nurses full-time equivalent hours per patient day was significantly greater in Massachusetts than California (p=.001) and New York (p<.01). Nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Seguro Saúde/organização & administração , Tempo de Internação/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Patient Protection and Affordable Care Act/organização & administração , Patient Protection and Affordable Care Act/estatística & dados numéricos , California , Emprego/estatística & dados numéricos , Feminino , Reforma dos Serviços de Saúde/economia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Massachusetts , New York , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Formulação de PolíticasRESUMO
BACKGROUND: Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE. OBJECTIVES: The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors. METHODS: A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy-General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS. RESULTS: The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001). CONCLUSIONS: Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE. IMPLICATIONS FOR PRACTICE: Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.
Assuntos
Neoplasias da Mama , Participação do Paciente , Neoplasias da Mama/terapia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , SobrevivênciaRESUMO
BACKGROUND: Sepsis is a critical illness that requires early detection and intervention to prevent disability and/or death. OBJECTIVE: To analyze the association between various hospital-related factors and rates of sepsis after surgery in Massachusetts hospitals. METHODS: The sample consisted of 53 hospitals with intensive or critical care units and 25 hospitals with step-down units. Hospital characteristics, staffing levels, and health care-acquired conditions were examined using publicly available data. Analysis of variance and linear regression were performed to explore the relationship between nurse and physician staffing levels and sepsis rates. RESULTS: Sepsis rates were significantly lower when nurses cared for fewer patients (P < .001) and when intensivist hours were greater (P = .03). Linear regression for nurse staffing revealed that higher rates of catheter-associated urinary tract infection (P = .001) and higher numbers of step-down patients cared for by nurses (P = .001) were associated with a significantly higher rate of sepsis (P < .001). Linear regression for physician staffing revealed that higher rates of catheter-associated urinary tract infection (P < .001) and wound dehiscence after surgery (P < .001), greater hospitalist hours (P = .001), and greater physician hours (P = .05) were associated with a significantly higher sepsis rate, while greater intensivist hours were associated with a lower sepsis rate (P = .002). CONCLUSION: In this study, greater nurse staffing and intensivist hours were associated with significantly lower rates of sepsis, whereas greater physician staffing and hospitalist hours were associated with significantly higher rates. Further research is needed to understand the roles of the various types of providers and the reasons for their differing effects on sepsis rates.
Assuntos
Mortalidade Hospitalar , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Médicos/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Sepse/mortalidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Massachusetts , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Complicações Pós-Operatórias/etiologia , Sepse/etiologia , Recursos Humanos/estatística & dados numéricosRESUMO
This paper describes the process of expanding the knowledge base and clinical practice for students in professional preparation programs in social work, nursing and education. Through a partnership of university faculty and administrators of a private school for students with learning and behavior problems, a transdisciplinary course was designed to address the need for providing future professionals an opportunity to understand multiple perspectives in the design of clinical interventions.The process of defining the course content, identifying appropriate required reading, and building connections to field work was a collaborative effort and less problematic than the logistics of implementation. Negotiating the administrative barriers to interprofessional collaboration involving curriculum innovation was more challenging. Discussion also includes the need for a shared vision and responsibility for improving practice, the practical implications of university funding and the benefits and challenges of transforming current treatment paradigms into one focused on interprofessional care.