Improving Quality Through Nursing Participation at Bedside Rounds in a Pediatric Acute Care Unit: A Pilot Project.

PROBLEM: Implementation of bedside rounds enhances communication and collaboration between physicians and nurses, resulting in improved clinical outcomes. Yet, the literature demonstrates that it remains difficult for nurses to attend rounds if they don't know when they are happening. PURPOSE: This project aimed to increase nurses' presence and participation at bedside rounds in a pediatric acute care unit, enhance teamwork and collaboration, and improve quality outcomes. DESIGN AND METHODS: Nurses carried a pager so that physicians could alert them of rounds. Perception of teamwork and collaboration was assessed via surveys pre- and post-intervention as well as the annual survey evaluating RN and MD interactions from the National Database of Nursing Quality Indicators™ (NDNQI®). Other quality outcome measures included length of stay and patient satisfaction through Press Ganey™ surveys. RESULTS: Findings demonstrated that when nurses were notified in advance, their participation in rounds increased from 44.4 to 73%. Length of stay decreased from 2.5 days prior to the project to an average of 2.10 days during the project. Scores on inpatient satisfaction surveys increased from 82.4 to 92.2%, and nursing communication improved from 83.3 to 95.65%. CONCLUSION: Interprofessional collaboration as reflected by the inclusion of nurses at bedside rounds led to positive outcomes in patient care. IMPLICATIONS: Increasing nurses' presence and providing them with a role at rounds is an important step towards fostering teamwork and collaboration with physicians and enhancing team-based care in a pediatric inpatient setting. Further research measuring the impact of interprofessional collaboration in healthcare is needed.

Interprofessional student experiences on the HAVEN free clinic leadership board.

In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.

Characterizing nurse practitioner practice by sampling patient encounters: an APRNet study.

PURPOSE: The purpose of this study was to characterize nurse practitioners' (NPs') practice by using reports of patient encounters to more accurately reflect practice patterns than has been previously performed. This study was part of a larger primary care practice survey by a consortium of 20 practice-based research networks (PBRNs). Therefore, comparisons, when appropriate, were also made between this network of NPs (Advanced Practice Registered Nurse Network, APRNet) and the other 19 physician-run research networks. DATA SOURCES: A descriptive survey was developed by the 20 PBRN consortium under grants from the Agency for Healthcare Research and Quality. The consortium's goal was to collect primary care data over a 6-month period and to document and compare primary care practice in the United States. The data were collected immediately following members' encounters with patients rather than from billing spreadsheets. Nineteen PBRNs may have had NPs in the practices that comprised their networks. However, the data from these NPs were collected under the study ID numbers of the physician owners of each practice. APRNet, therefore, was the sole research network comprised exclusively of NPs who collected and reported data under their own study ID numbers. CONCLUSIONS: Acute health problems comprised 45% of all episodes treated by NPs compared to 30% of episodes for exacerbations of chronic conditions and 24.5% for nonillness and health promotion visits. In addition, our findings suggest that NPs provide counseling in 84% (vs. 61% for physicians) of their primary care visits, regardless of the reason for visit, and the type of counseling varies by the type of NP. IMPLICATIONS FOR PRACTICE: Despite many studies on the comparability and outcomes of NP practice, the need to identify, clarify, and document the practices of NPs in primary care settings remains. The present survey provides an important and useful first step in providing a systematic way to characterize these practices through a survey of APRNs immediately following their patient encounters.

Promising outcomes in teen mothers enrolled in a school-based parent support program and child care center.

BACKGROUND: This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes. METHODS: A volunteer sample of 65 adolescent mothers enrolled in the parent support program and their children were interviewed, surveyed, and assessed. Fifty-three mothers had children enrolled in the school-based child care center and 12 mothers had their children cared for by family members. Maternal characteristics assessed included self-esteem and depressive symptoms, social stressors and support, self-perceived parental competence, parent-child teaching interactions, and subsequent childbearing and maternal educational outcomes. Child outcomes included child developmental assessments and health outcomes. RESULTS: About 33% of teen mothers were mildly to moderately depressed and 39% of the sample had experienced transitional homelessness. Social support networks were small; in the past 12 months, mothers experienced a mean number of 13.2 +/- 11.9 negative life events. Maternal self-report measures and mother-child observation measures indicated positive levels of parental competence. Maternal educational outcomes were positive, and only 6% of mothers had subsequent childbirths within 2 years. The mean scores on developmental assessments of children fell within the normal range, although there were 7 children identified with developmental delays. CONCLUSIONS: For at-risk teen mothers, this parent support program and school-based child care setting appears to offer promising opportunities to help young mothers with parenting, avoid rapid subsequent pregnancies, and stay engaged with school, while their children are cared for in a close and safe environment.

Sources of stress and support and maternal resources of homeless teenage mothers.

PROBLEM: Homeless families headed by young mothers are increasing. This preliminary study describes the characteristics of 17 homeless teenage mothers (HTM). METHODS: HTMs completed questionnaires researching depression, self-esteem, maternal competence, and sources of stress and support. FINDINGS: HTMs had positive maternal competence and self-esteem scores. When compared to housed mothers, HTMs were younger, had more depressive symptoms and negative life events, and fewer social supports. CONCLUSIONS: HTMs represent a high-risk group with fewer available supports and many complex life stressors. School-based programs can benefit HTMs by offering support, helping them continue their education, and assisting with on-site school-based childcare.

HLA Alleles Associated with Delayed Progression to AIDS Contribute Strongly to the Initial CD8(+) T Cell Response against HIV-1.

BACKGROUND: Very little is known about the immunodominance patterns of HIV-1-specific T cell responses during primary HIV-1 infection and the reasons for human lymphocyte antigen (HLA) modulation of disease progression. METHODS AND FINDINGS: In a cohort of 104 individuals with primary HIV-1 infection, we demonstrate that a subset of CD8(+) T cell epitopes within HIV-1 are consistently targeted early after infection, while other epitopes subsequently targeted through the same HLA class I alleles are rarely recognized. Certain HLA alleles consistently contributed more than others to the total virus-specific CD8(+) T cell response during primary infection, and also reduced the absolute magnitude of responses restricted by other alleles if coexpressed in the same individual, consistent with immunodomination. Furthermore, individual HLA class I alleles that have been associated with slower HIV-1 disease progression contributed strongly to the total HIV-1-specific CD8(+) T cell response during primary infection. CONCLUSIONS: These data demonstrate consistent immunodominance patterns of HIV-1-specific CD8(+) T cell responses during primary infection and provide a mechanistic explanation for the protective effect of specific HLA class I alleles on HIV-1 disease progression.

Barriers to effective pediatric asthma care.

Although progress has been made in understanding the pathophysiology of asthma and identifying key features of quality asthma care, the prevalence of childhood asthma remains high. Barriers to effective asthma care that currently exist include the persistence of environmental risk factors, disparities in care that stem from poverty and cultural differences, and inconsistencies in the quality of asthma care provided by clinicians. Pediatric nurse practitioners at Yale New Haven Children's Hospital have actively implemented the recommended guidelines for asthma care and addressed causes for some of the disparities in asthma health care. Two major initiatives are described: the Asthma Care Coordination Project at Yale New Haven Hospital Pediatric Primary Care Center, and the establishment of an Asthma Outreach Program. Recommended resources and Web sites for the practitioner are also provided.

Parenting preterm infants: a meta-synthesis.

PURPOSE: To synthesize the findings of qualitative studies on parenting preterm infants and present a framework that will enable clinical nurses to provide better care. STUDY DESIGN AND METHODS: A meta-ethnographic approach was used to synthesize the findings of 10 qualitative research studies that focused on parenting the preterm infant upon hospital discharge and on into the toddler years. RESULTS: Five themes of parenting preterm infants emerged: adapting to risk, protecting fragility, preserving the family, compensating for the past, and cautiously affirming the future. CLINICAL IMPLICATIONS: Nurses provide expert care, anticipatory guidance, and education for NICU babies and families, but should also foster the inclusion of all family members in the NICU setting, provide opportunities for parental peer support, establish effective systems of continuity of care, and advocate for parents of preterms in policy-making arenas.

An XML standard for the dissemination of annotated 2D gel electrophoresis data complemented with mass spectrometry results.

BACKGROUND: Many proteomics initiatives require a seamless bioinformatics integration of a range of analytical steps between sample collection and systems modeling immediately assessable to the participants involved in the process. Proteomics profiling by 2D gel electrophoresis to the putative identification of differentially expressed proteins by comparison of mass spectrometry results with reference databases, includes many components of sample processing, not just analysis and interpretation, are regularly revisited and updated. In order for such updates and dissemination of data, a suitable data structure is needed. However, there are no such data structures currently available for the storing of data for multiple gels generated through a single proteomic experiments in a single XML file. This paper proposes a data structure based on XML standards to fill the void that exists between data generated by proteomics experiments and storing of data. RESULTS: In order to address the resulting procedural fluidity we have adopted and implemented a data model centered on the concept of annotated gel (AG) as the format for delivery and management of 2D Gel electrophoresis results. An eXtensible Markup Language (XML) schema is proposed to manage, analyze and disseminate annotated 2D Gel electrophoresis results. The structure of AG objects is formally represented using XML, resulting in the definition of the AGML syntax presented here. CONCLUSION: The proposed schema accommodates data on the electrophoresis results as well as the mass-spectrometry analysis of selected gel spots. A web-based software library is being developed to handle data storage, analysis and graphic representation. Computational tools described will be made available at http://bioinformatics.musc.edu/agml. Our development of AGML provides a simple data structure for storing 2D gel electrophoresis data.