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1.
Nurs Adm Q ; 48(3): 237-247, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38848486

RESUMO

Nursing research provides knowledge that advances nursing science, practice, and health care with the vision to optimize the health and well-being of the population. In a medical center setting or health care organization, nurse scientists are needed to demonstrate new knowledge, innovation, and scholarship. Nursing research in health care organizations or medical centers are led mainly by nurse leaders with a Doctorate in Philosophy (PhD) or a Doctorate in Nursing Practice (DNP). The purpose of this report is to provide examples of the role nurse scientists and nursing research plays nationally in Kaiser Permanente, an integrated health care system. In addition, this report will: (1) define the term "research" in the clinical setting and the role of the nurse research scientist in an integrated health care system and impact on the Magnet® Designation journey, and (2) discuss strategies for a successful role as a nurse research scientist in an integrated healthcare system.


Assuntos
Prestação Integrada de Cuidados de Saúde , Papel do Profissional de Enfermagem , Pesquisa em Enfermagem , Humanos , Prestação Integrada de Cuidados de Saúde/tendências , Pesquisa em Enfermagem/tendências , Estados Unidos , Liderança
2.
J Nurs Care Qual ; 39(2): 159-167, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37729001

RESUMO

BACKGROUND: Evidence is limited to the effects of shared governance (SG) and autonomy on nurse-sensitive indicators (NSIs). PURPOSE: To explore the effects of SG, autonomy, and Magnet status on nurse and patient outcomes. METHODS: A cross-sectional survey study was conducted using a convenience sample of 404 nurses from 4 hospitals. Descriptive analyses of variance (ANOVAs), and path analysis were conducted to identify hypothesized associations and predictive pathways among study variables. RESULTS: Nurse managers reported higher perceptions of SG, autonomy, and satisfaction than staff nurses. SG and autonomy were significant predictors of patient falls and hospital-acquired pressure injuries. Nurses' autonomy, SG, and Magnet accreditation were significant predictors of nurse satisfaction. CONCLUSIONS: Leadership support of SG and autonomous practice are key strategies to improve nurse satisfaction and NSI outcomes.


Assuntos
Recursos Humanos de Enfermagem Hospitalar , Humanos , Estudos Transversais , Satisfação no Emprego , Inquéritos e Questionários
3.
Am J Nurs ; 123(11): 58-60, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37882405

RESUMO

ABSTRACT: Nursing research is essential to improving patient care, yet barriers may hinder bedside nurses from participating in research and evidence-based practice (EBP) activities. This article describes a nursing research residency program that aimed to inspire direct care nurses to participate in research and EBP projects. The program described may be a potential solution to bridge the gap between clinical work and research.


Assuntos
Internato e Residência , Pesquisa em Enfermagem , Humanos , Enfermagem Baseada em Evidências , Inquéritos e Questionários
4.
Pediatr Res ; 93(3): 460-462, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35717481

RESUMO

A web-based survey was widely distributed between November 1st-December 27th, 2021, to health care providers and ancillary staff to assess reported COVID-19 vaccination of their children as well as their vaccine concerns. Fewer nurses and laboratory / radiology technicians reported COVID-19 vaccination of their adolescent children and intent to vaccinate their younger children compared to physicians and pharmacists, along with more frequently reported concern about anaphylaxis and infertility. Focused efforts to update ancillary staff as well as all health care providers on emerging COVID-19 vaccine safety information for children is crucial to promote strong COVID-19 vaccine recommendations. IMPACT: Nurses, laboratory technicians and radiology technicians frequently reported concern about anaphylaxis and infertility after COVID-19 vaccination despite reassuring safety data. Education of ancillary staff with emerging safety data is important to strengthen health care provider vaccine recommendations.


Assuntos
Anafilaxia , Vacinas contra COVID-19 , COVID-19 , Vacinas contra Papillomavirus , Adolescente , Criança , Humanos , Anafilaxia/etiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Pessoal de Saúde , Vacinação/efeitos adversos
5.
Worldviews Evid Based Nurs ; 20(1): 27-36, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36464805

RESUMO

BACKGROUND: Organizational supported evidence-based practice (EBP) enables nurses to be change agents and impact patient outcomes. Globally, a multitude of barriers limits EBP implementation, evaluation, and dissemination, which include time constraints, staff, resource access, education, technology, and fiscal support. These barriers and other disenfranchising elements hinder nurses' ability to actualize EBP and change practice within their workplace. AIMS: This study describes the EBP readiness, barriers, and facilitators reported by inpatient registered nurses (RNs) employed in a nationwide healthcare system before COVID-19. METHODS: The study employed a cross-sectional descriptive survey design using the 2005 Nursing EBP Survey for RN EBP readiness. The setting included 14 hospitals in Southern California. The survey was deployed in November 2016 and closed after 23 weeks. Descriptive statistics analyzed demographics and EBP scores, with inferential statistics for associations between demographics and EBP scores. ANOVA examined differences between EBP scores, service lines, years of employment, and education level. A content approach synthesized open-ended barrier and facilitator questions into seven specific themes. RESULTS: Seven hundred and twenty-four nurses completed the survey. Overall, the scores of inpatient RNs were highest scores for Practice Climate, suggesting the health system fosters a climate conducive to EBP. Scores were lowest for Data Collection and Implementation. Qualitative themes were: (1) Everyone Involved in EBP Implementation, (2) Fear and Resistance to Change, (3) Protected Release Time, (4) Knowing EBP Culture Outside of Current Organization, (5) Organizational Communication and Education, (6) Management and Leadership Support, and (7) Pragmatic Solutions to Facilitate EBP. Fear and Resistance to Change cut across all themes. LINKING EVIDENCE TO ACTION: Nurses at all organizational levels from the C-suite to the bedside can create strategies to determine essential EBP readiness components, including EBP mentors to guide knowledge uptake activities. Pragmatic solutions for EBP capacity require frontline nurse feedback, commitment, and partnership with nursing leaders.


Assuntos
COVID-19 , Enfermagem Baseada em Evidências , Humanos , Estudos Transversais , Atenção à Saúde , Escolaridade , Inquéritos e Questionários , Cultura Organizacional , Atitude do Pessoal de Saúde
6.
Workplace Health Saf ; 70(6): 285-297, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35311397

RESUMO

BACKGROUND: There is evidence of disparities in COVID-19 vaccine acceptance among health care providers. The purpose of this study was to examine confidence receiving and recommending COVID-19 vaccines by health care provider type and race/ethnicity. METHODS: This mixed methods study involved a cross-sectional survey and qualitative, semi-structured interviews from March to May 2021 among a sample of physicians, advanced practice providers, nurses, and pharmacists. These workers were recruited through voluntary response sampling from an integrated health system in Southern California. The primary dependent variables were (a) confidence in vaccine safety, (b) confidence in vaccine effectiveness, and (c) intent to recommend the vaccine to others. The primary independent variables were health care provider type and race/ethnicity. FINDINGS: A total of 2,948 providers completed the survey. Nurses relative to physicians were 15% less likely to perceive the COVID-19 vaccine to be safe (risk ratio [RR] = 0.85; 95% confidence interval [CI] = 0.83-0.87); 27% less likely to perceive the vaccine to prevent COVID-19 (RR = 0.73; 95% CI = 0.69-0.76); and 11% less likely to recommend the vaccine to others (RR = 0.89; 95% CI = 0.87-0.91). Hispanic/Latinx providers were 10% less likely to perceive the vaccine to prevent COVID-19 (RR = 0.90; 95% CI = 0.83-0.98) relative to White providers. Qualitative themes included: No need for vaccine; distrusting vaccine research and roll-out; caretaking barriers; uncertainty and potential to change one's mind; framing vaccine decisions around personal beliefs. CONCLUSIONS & APPLICATION TO PRACTICE: Health care workplaces should consider interventions to increase COVID-19 vaccination among their workers, including education and mandatory vaccination policies.


Assuntos
COVID-19 , Vacinas , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Estudos Transversais , Pessoal de Saúde , Humanos , SARS-CoV-2 , Vacinação
7.
J Transcult Nurs ; 33(2): 134-140, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34989259

RESUMO

INTRODUCTION: There is evidence for relatively lower COVID-19 vaccine uptake among people of color in the United States. The purpose of this study was to investigate associations between race/ethnicity and COVID-19 vaccine uptake among nurses. METHODS: Nurses in Southern California (N = 1183) completed a one-time, web-based survey to assess COVID-19 vaccine perceptions and uptake. RESULTS: In all, 82.8% of respondents (N = 979) received at least one COVID-19 vaccine dose. Identifying as East Asian was associated with 14% higher odds of COVID-19 vaccine uptake relative to identifying as White (odds ratio [OR] = 1.14/95% confidence interval [CI] = [1.06, 1.24]); identifying as Filipino was associated with 14% higher odds of uptake (OR = 1.14/95% CI = [1.08, 1.20]); and identifying as Hispanic/Latinx was associated with 6% higher odds of uptake (OR = 1.06/95% CI = [1.00, 1.12]). DISCUSSION: Although nurses and people of color have been identified as groups with low levels of COVID-19 vaccine uptake, this study found that nurses of color received the vaccine at higher levels than their White counterparts.


Assuntos
Vacinas contra COVID-19 , COVID-19 , COVID-19/prevenção & controle , Etnicidade , Hispânico ou Latino , Humanos , SARS-CoV-2 , Estados Unidos
8.
Worldviews Evid Based Nurs ; 17(2): 118-128, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32233058

RESUMO

BACKGROUND: Clinicians' knowledge and skills for evidence-based practice (EBP) and organizational climate are important for science-based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses' (RN) self-reported EBP. AIMS: Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey. METHODS: The study employed a descriptive cross-sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert-type scale. The survey website opened in November 2016 and closed after 23 weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons. RESULTS: One thousand one hundred and eighty-one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p < .001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p = .07). All other covariances and error variances were significant (p < .001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p < .05 level). All factors showed significant differences (p < .05) between inpatient and ambulatory staff, with higher scores for inpatient settings. LINKING EVIDENCE TO ACTION: Nurses' knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence-based outcomes and tailors future EBP initiatives.


Assuntos
Enfermagem Baseada em Evidências/classificação , Inquéritos e Questionários/normas , Adulto , Estudos Transversais , Enfermagem Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos
9.
MCN Am J Matern Child Nurs ; 45(2): 110-115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097223

RESUMO

PURPOSE: The purpose of this study was to determine if changing the timing of the initial newborn bath would have an impact on exclusive breastfeeding during hospitalization. The first newborn bath had been routinely done within 2 hours of age; practice was changed to the first bath being delayed until at least 12 hours of age. A secondary purpose was to examine the nurses' perceived benefits and challenges to such a change. STUDY DESIGN AND METHODS: Through a retrospective design, exclusive breastfeeding rates among mother-infant couplets prepractice change (cohort A) were compared with two postchange cohorts (B and C). Cohorts B and C were from the first 5 months and second 5 months, respectively after the practice change. Demographic information, birth type, bath timing, and feeding data were collected. Comparative statistics were applied to the three cohorts to examine differences in exclusive breastfeeding rates. Postpartum nurses were asked two open-ended questions on concerns and benefits of this change via an anonymous survey. Content analysis was completed on responses. RESULTS: There were 1,463 mother-infant couplets included in three cohorts (A: n = 564; B: n = 468; C: n = 431). There were no significant increases in the exclusive breastfeeding rates (baseline 74.1%) in both the first postimplementation delayed bath cohort (70.1%, p = .207) and the second "sustainability" cohort (79.4%, p = .060). Fifteen of the 60 postpartum nurses completed the survey, for a response rate of 25%. Themes generated from survey responses included concerns (infection control, work distribution), as well as benefits (perceived breastfeeding success, decreased workload) with delaying the first newborn bath. CLINICAL IMPLICATIONS: Delaying the first newborn bath may be one factor that can influence exclusive breastfeeding rates during postpartum hospitalization. Results have been mixed based on recent literature. In our study, the exclusive breastfeeding rate was already above average, as would be expected in a Baby-Friendly designated hospital and may be a reason we did not see a significant change in the rate among mother-infant couplets in our study. Randomized trials are needed for a rigorous evaluation of timing of the newborn bath and possible link to exclusive breastfeeding in the hospital and beyond.


Assuntos
Banhos/métodos , Aleitamento Materno/métodos , Fatores de Tempo , Adulto , Análise de Variância , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Estudos Retrospectivos
10.
Nurs Adm Q ; 43(4): 358-369, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31479058

RESUMO

Compassion fatigue is a phenomenon that might affect nurses of all specialties. Compassion fatigue occurrence could be profound and costly. The immediate impact could be disruption of the unit culture. This study investigated the prevalence and individual-level factors associated with compassion fatigue among nurses. An upsurge in patients' complexity today may leave nurses stressed with increasing practice demands and vulnerable to compassion fatigue. If ignored, compassion fatigue may compromise nurses' health and care outcomes. A sample of 1174 nurses from 2 large Southern California health care organizations completed an online survey measuring compassion fatigue, burnout, and compassion satisfaction. Overall, participants scored moderate to average (23-41) on compassion satisfaction, burnout, and compassion satisfaction. Experienced and working nights nurses experienced higher compassion satisfaction levels. Higher compassion fatigue means were associated with new graduates = 29.5, BSN nurses = 27.2, ICU nurses = 27.4, and working 12-hour shift nurses = 26.9, suggesting higher compassion fatigue vulnerability. Nurse leaders and managers can apply this baseline evidence to create tailored programs for specific nursing specialties and inexperienced nurses to tackle compassion fatigue and reduce related unit disorder. Seasoned nurses' perspective can be of value in enhancing those efforts.


Assuntos
Fadiga de Compaixão/complicações , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Adulto , Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , California , Fadiga de Compaixão/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Qualidade de Vida/psicologia , Inquéritos e Questionários
11.
Nurs Res ; 67(4): 314-323, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29870519

RESUMO

BACKGROUND: Research investigating risk factors for hospital-acquired pressure injury (HAPI) has primarily focused on the characteristics of patients and nursing staff. Limited data are available on the association of hospital characteristics with HAPI. OBJECTIVE: We aimed to quantify the association of hospital characteristics with HAPI and their effect on residual hospital variation in HAPI risk. METHODS: We employed a retrospective cohort study design with split validation using hierarchical survival analysis. This study extends the analysis "Hospital-Acquired Pressure Injury (HAPI): Risk Adjusted Comparisons in an Integrated Healthcare Delivery System" by Rondinelli et al. (2018) to include hospital-level factors. We analyzed 1,661 HAPI episodes among 728,266 adult hospitalization episodes across 35 California Kaiser Permanente hospitals, an integrated healthcare delivery system between January 1, 2013, and June 30, 2015. RESULTS: After adjusting for patient-level and hospital-level variables, 2 out of 12 candidate hospital variables were statistically significant predictors of HAPI. The hazard for HAPI decreased by 4.8% for every 0.1% increase in a hospital's mean mortality ([6.3%, 2.6%], p < .001), whereas every 1% increase in a hospital's proportion of patients with a history of diabetes increased HAPI hazard by 5% ([-0.04%, 10.0%], p = .072). Addition of these hierarchical variables decreased unexplained hospital variation of HAPI risk by 35%. DISCUSSION: We found hospitals with higher patient mortality had lower HAPI risk. Higher patient mortality may decrease the pool of patients who live to HAPI occurrence. Such hospitals may also provide more resources (specialty staff) to care for frail patient populations. Future research should aim to combine hospital data sets to overcome power limitations at the hospital level and should investigate additional measures of structure and process related to HAPI care.


Assuntos
Hospitais/classificação , Indicadores de Qualidade em Assistência à Saúde/normas , Risco Ajustado/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/mortalidade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/classificação , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Risco Ajustado/métodos , Fatores de Risco , Análise de Sobrevida
12.
Nurs Res ; 67(1): 16-25, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29240656

RESUMO

BACKGROUND: Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. OBJECTIVE: The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. METHODS: Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. RESULTS: Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. DISCUSSION: Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.


Assuntos
Úlcera por Pressão/epidemiologia , Úlcera por Pressão/prevenção & controle , Prevenção Primária/métodos , Índice de Gravidade de Doença , Higiene da Pele/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
13.
Int J Nurs Stud ; 71: 97-114, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28384533

RESUMO

OBJECTIVE: To identify risk factors independently predictive of pressure injury (also known as pressure ulcer) development among critical-care patients. DESIGN: We undertook a systematic review of primary research based on standardized criteria set forth by the Institute of Medicine. DATA SOURCES: We searched the following databases: CINAHL (EBSCOhost), the Cochrane Library (Wilson), Dissertations & Theses Global (ProQuest), PubMed (National Library of Medicine), and Scopus. There was no language restriction. METHOD: A research librarian coordinated the search strategy. Articles that potentially met inclusion criteria were screened by two investigators. Among the articles that met selection criteria, one investigator extracted data and a second investigator reviewed the data for accuracy. Based on a literature search, we developed a tool for assessing study quality using a combination of currently available tools and expert input. We used the method developed by Coleman et al. in 2014 to generate evidence tables and a summary narrative synthesis by domain and subdomain. RESULTS: Of 1753 abstracts reviewed, 158 were identified as potentially eligible and 18 fulfilled eligibility criteria. Five studies were classified as high quality, two were moderate quality, nine were low quality, and two were of very low quality. Age, mobility/activity, perfusion, and vasopressor infusion emerged as important risk factors for pressure injury development, whereas results for risk categories that are theoretically important, including nutrition, and skin/pressure injury status, were mixed. Methodological limitations across studies limited the generalizability of the results, and future research is needed, particularly to evaluate risk conferred by altered nutrition and skin/pressure injury status, and to further elucidate the effects of perfusion-related variables. CONCLUSIONS: Results underscore the importance of avoiding overinterpretation of a single study, and the importance of taking study quality into consideration when reviewing risk factors. Maximal pressure injury prevention efforts are particularly important among critical-care patients who are older, have altered mobility, experience poor perfusion, or who are receiving a vasopressor infusion.


Assuntos
Estado Terminal , Úlcera por Pressão/epidemiologia , Humanos , Fatores de Risco
14.
Vaccine ; 34(30): 3515-21, 2016 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-26947497

RESUMO

OBJECTIVE: This qualitative study aimed to identify doctors' and nurses' perceptions of patient-, provider-, and system-level factors associated with human papillomavirus (HPV) vaccine completion that may be targets for intervention. METHODS: We analyzed data from 61 qualitative interviews with pediatricians, family medicine physicians, and immunization nurses at medical centers that had the highest and lowest HPV vaccine completion rates within the same health care system. RESULTS: In both groups, almost all providers reported strong support for the HPV vaccine. In detailing how they talk to parents and patients about the vaccine, more of the providers working at higher completion centers described using effective communication techniques, including engaging parents and patients in two-way conversation and demonstrating awareness of cultural and practical barriers to completion that families may face. Providers at higher completion centers were also more likely to depict a local medical culture supportive of and committed to HPV vaccine completion, with greater levels of proactivity and teamwork. In contrast, providers working at lower completion medical centers described a lack of proactivity, and the strategies they suggested to improve HPV vaccine completion tended to be approaches that someone other than medical providers would implement. The comments made by these providers sometimes reflected a level of negativity and judgment absent from the comments of providers at higher completion centers. CONCLUSION: Interventions to improve HPV vaccination completion rates should address both individual- and system-level factors. Improving communication skills, encouraging a supportive medical culture, and addressing resource issues is likely to improve vaccine adherence.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Papillomavirus/uso terapêutico , Vacinação/estatística & dados numéricos , Adulto , Comunicação , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Cultura Organizacional , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Pais , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Médicos , Pesquisa Qualitativa
15.
J Nurses Prof Dev ; 31(3): 158-63, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25993455

RESUMO

As nurses provide holistic support, their own comfort in caring for parents and families experiencing perinatal loss must be considered. Study results showed that, although education is essential, experience independently predicted comfort in delivering perinatal bereavement care. Evidence from this study promotes the discussion of how nurse educators can structure professional development programs to best transfer the experience and confidence of perinatal nurses who are already comfortable with bereavement care to nurses who are not.


Assuntos
Luto , Recursos Humanos de Enfermagem Hospitalar/educação , Pais/psicologia , Morte Perinatal , Assistência Terminal/psicologia , Adulto , Atitude Frente a Morte , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/psicologia , Gravidez , Desenvolvimento de Pessoal , Inquéritos e Questionários
16.
Respir Med ; 109(2): 238-46, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25559374

RESUMO

BACKGROUND: Efforts to reduce 30-day readmissions are resource intensive. Healthcare systems need to target interventions at patients with the highest risk. Information on physical functioning has been found to increase the performance of previously published risk prediction models. We examined whether functional status documented during routine nursing care in the 24 h prior to discharge was an independent predictor of 30-day readmission risk in patients with COPD. METHODS: Patients from a large integrated healthcare system were included in this retrospective cohort study if they were hospitalized for COPD and discharged between January 1, 2011, and December 31, 2012, age 40+, on a bronchodilator or steroid inhaler, alive at discharge, and continuously enrolled in the health plan 12 months prior to the index admission and at least 30-days post discharge. Our main outcome was 30-day all-cause readmission. Functional status was documented as part of routine nursing care within 24 h prior to discharge as follows: bed bound (Level I), able to sit (Level II), stand next to bed (Level III), walk <50 feet (Level IV), and walk >50 feet (Level V). RESULTS: The sample included 2910 patients (n = 3631 index admissions) with a mean age of 72 ± 11. The 30-day readmission rate was 19%. Multivariate analyses showed that patients who were non-ambulatory at discharge (Levels I-III) were more than twice as likely to be re-admitted within 30-days compared to patients who were able to walk more than 50 feet (RR: 2.14, 95% CI 1.62-2.84, p < .001). There was no significant difference in readmission risk between patients classified as Level IV or V (p > .05). CONCLUSION: Patients with COPD who were non-ambulatory within 24 h prior to discharge were at significantly greater risk of readmission compared to ambulatory patients. Functional status should be used to risk stratify patients for more intensive supportive interventions post discharge.


Assuntos
Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , California , Feminino , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
Perm J ; 18(1): e108-15, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24626081

RESUMO

CONTEXT: Ambulatory care is a growing field of nursing practice. As ambulatory registered nurse (RN) practice grows, there has been an ongoing effort to identify the desired role of the staff RN in outpatient care and to provide linkages to preferred outcomes. OBJECTIVE: This study sought to describe the perceived impact of components of the staff RN role on specific activities and outcomes, as guided by the structures, processes, and outcomes of the Nursing Role Effectiveness Model. DESIGN: This exploratory research study used a descriptive, self-report survey design. RESULTS: Survey respondents were ambulatory care staff RNs from various primary and specialty care clinics (n = 187) in an integrated health care organization in Southern California. The most frequently reported activities included patient assessment, nurse advice during message management, and completion of patient triage. Reported patient outcomes most frequently affected by RN activities were patient satisfaction, normalization of laboratory values, receiving the correct level of medical treatment, and prevention of complications. Respondents expressed that "emergency situations" periodically occur in the ambulatory setting. CONCLUSIONS: This research study supports what ambulatory care RNs say they are doing: daily, diverse, and complex patient care activities that influence multiple relevant patient outcomes. Future research studies could reveal best practices related to message management, in addition to activities and outcomes unique to specialty care populations.


Assuntos
Assistência Ambulatorial/organização & administração , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , California , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Nurs Manage ; 45(4): 36-43, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24662546

RESUMO

Read this article to determine if nursing interventions help prevent hospital-acquired pressure ulcer (HAPU) development.


Assuntos
Cuidados de Enfermagem , Úlcera por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/enfermagem , Estados Unidos
20.
J Nurs Adm ; 42(6): 326-32, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22617698

RESUMO

OBJECTIVE: This study identifies structures, processes, and outcomes associated with hourly nurse rounding. BACKGROUND: Literature supports that nurse rounding every 1 to 2 hours affects quality outcomes. Evidence is lacking regarding the process of successful implementation. METHODS: Using an action research design, project leads implementing hourly rounding at 11 Southern California hospitals agreed to recorded telephone interviews. Transcribed interviews underwent content analysis. RESULTS: Analysis revealed 15 major themes. Structure themes include use of rounding behaviors described through an acronym and collaborative phone call. Processes include a library of tools to use incorporating both patient and staff feedback. Patient satisfaction and patient perception of being well cared for are 2 common outcome themes. CONCLUSIONS: This study provides evidence that frequent reevaluation of structures and processes promote achievement of desired outcomes in relation to hourly rounding. The authors recommend abandonment of routinization and adoption of flexibility to sustain successful implementation of hourly rounding.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Implementação de Plano de Saúde , Cuidados de Enfermagem/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde , Melhoria de Qualidade , Atitude do Pessoal de Saúde , California , Humanos , Segurança do Paciente , Satisfação do Paciente
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