THRIVE: A Theory-Based Program to Support Hospital Nursing Assistants.

Nursing assistants are vital healthcare team members who often experience personal challenges to professional success. The Transformational Healthcare Readiness through Innovative Vocational Education (THRIVE) program is designed to combat these challenges through coaching and curriculum that is steeped in adult learning and social theories. The program's goal is to increase retention and success of newly hired nursing assistants through personal and professional support. Components of THRIVE can be adapted in a variety of healthcare settings.

Food Insecurity, Neighborhood Disadvantage, and Hospital Readmission in Health System Adults: A Population Health Study.

PURPOSE: The purpose of the study was to examine the relationship between food insecurity, neighborhood disadvantage, and hospital readmission within 90 days of discharge for health system patients. DESIGN: The study used a retrospective, correlational design with a single cohort. METHODS: Records of adult patients with a health system primary care provider and discharged from hospital to home were included. Data were obtained from health system billing database, medical record, and publicly available population databases. A time-to-readmission analysis was conducted with a Kaplan-Meier plot, log-rank test, and Cox regression analysis. RESULTS: The final sample included 41 566 records; the rate of food insecurity was 1.45%, and 90-day readmission rate was 16.7%. The mean area deprivation index score was 54.4 (SD, 26.0). After adjusting for patient demographics, comorbidity, and length of stay, food insecurity resulted in 1.94 times higher risk of readmission (hazard ratio, 1.94; 95% confidence interval, 1.69-2.23; P < .001). Neighborhood disadvantage and lower food access were not significant in final models. CONCLUSIONS: Food insecurity should be identified and addressed as part of transitional care to improve patient outcomes. Future research should focus on models of care that ensure connection to community resources to resolve food insecurity and evaluate the impact on patient outcomes.

An Innovative Assistant Nurse Manager Residency Program Focused on Participation, Satisfaction, Promotion, and Retention.

Assistant nurse managers (ANMs) were asked what they needed to be successful, fully engaged, and equipped to perform in their roles. The ANM Residency Program was created to support development of new ANMs through resources, education, and mentoring. Evaluations were used to guide curriculum enhancements and improve course facilitation. Participation, satisfaction, promotion, and retention were measured. Similar programs may be used to support development for all levels of nurse leaders.

Efficacy of One Dose of Laxative on Postoperative Constipation Following Total Knee Arthroplasty.

Postoperative constipation is a common problem among orthopaedic surgical patients leading to discomfort, increased length of stay, and other complications. The primary purpose of this study was to determine the effectiveness of polyethylene glycol compared with docusate sodium for the prevention of constipation, after total knee arthroplasty. The secondary purpose was to examine the effectiveness of polyethylene glycol on pain and strain with bowel movement. A two-group nonequivalent cohort design was used to evaluate the effect of one 17-g dose of polyethylene glycol by mouth on postoperative day 1 compared with usual care with docusate sodium 100 mg starting the day of surgery and continued twice daily at home. There was no significant difference in the rate of constipation between the two cohorts in the 3 days after surgery. There was no difference in reported pain and strain. Future research should focus on the use of pharmacologic and nursing interventions together for prevention of postoperative constipation in patients with arthroplasty surgery.

Food insecurity, neighborhood, and health care utilization in health system adults.

OBJECTIVES: To (1) explore relationships among food insecurity, neighborhood disadvantage, and health care utilization in adults from a single health system and (2) determine whether food insecurity and neighborhood disadvantage predict acute health care utilization within 90 days of hospital discharge. STUDY DESIGN: A retrospective, correlational design with a single cohort. METHODS: Data were analyzed from health system administrative billing databases, electronic health records, and publicly available population databases. Multivariable negative binomial regression was performed to assess the association between factors of interest and acute health care utilization within 90 days of index hospital discharge. RESULTS: In 41,566 records, 1.45% (n = 601) of patients reported food insecurity. The mean (SD) Area Deprivation Index score was 54.4 (26), indicating that the majority of patients lived in disadvantaged neighborhoods. Patients with food insecurity were less likely to have a provider office visit (P < .001) but were expected to have 2.1 times greater acute health care utilization within 90 days (incidence rate ratio [IRR], 2.12; 95% CI, 1.90-2.37; P < .001) compared with those without food insecurity. Living in a disadvantaged neighborhood had a small effect on acute health care utilization (IRR, 1.12; 95% CI, 1.08-1.17; P < .001). CONCLUSIONS: When considering social determinants of health for health system patients, food insecurity was a stronger predictor of acute health care utilization than was neighborhood disadvantage. Identifying patients with food insecurity and targeting appropriate interventions to high-risk populations may improve provider follow-up and acute health care utilization.

Development and validation of a delirium risk prediction model using a modified version of the Delirium Elderly at Risk (mDEAR) screen in hospitalized patients aged 65 and older: A medical record review.

Most delirium risk prediction models are cumbersome to use, time consuming to complete, and require education ensure accuracy. The purpose of this study was to develop and validate a risk prediction model using routinely assessed risk factors predictive of delirium including: cognitive impairment, ≥80-years old, functional dependence, sensory impairment, and chronic substance use. This retrospective study included 7999 encounters of hospitalized patients aged 65-years or older admitted from 1/1/2019 to 12/31/2019. Various models were compared, with the best tested for validation. A model, where cognitive impairment was worth 2-points and a threshold of 3-points to predict delirium, was determined to be the best model and was validated with an area-under Receiver-Operating-Characteristic curve=0.7126. Management of delirium could be enhanced by integrating a nursing admission delirium risk screening process into the workflow, triggering initiation of prevention interventions and prompt assessment for signs and symptoms of delirium for those at high risk.

Neighborhood matters for transitional care and heart failure hospital readmission in older adults.

A retrospective correlational design with existing data was utilized to examine the relationship between early provider follow-up, nursing care coordination intensity, and 30-day hospital readmission in older adults with heart failure and determine if an interaction exists with neighborhood disadvantage. Forward logistic regression was conducted to determine which variables predicted early provider follow-up and readmission. Ordinary least squares regression, logistic regression, and bootstrap confidence intervals were used to test for mediation and moderation. A direct relationship between early provider follow-up and decreased readmission was identified, but no indirect relationship through care coordination intensity. Neighborhood disadvantage did not moderate the effect of provider follow-up on readmission. Early provider follow-up and care coordination intensity were related and moderated by neighborhood disadvantage, but not for those living in highly disadvantaged neighborhoods. Neighborhood disadvantage is a key factor that may negatively influence participation in transitional care interventions in the elderly heart failure population.

Exploring the Lived Experience of Families Waiting for Surgical Patients: A Qualitative Study.

Family-centered care is an important aspect of perioperative nursing, especially during the perioperative waiting period that separates patients from their families or significant others. However, there is a lack of understanding on what waiting means to family members or significant others. In this hermeneutic phenomenological study, we explored the lived experiences of family members waiting for surgical patients. We identified a shared experience during waiting that we called a "time to focus on self." We identified five supporting themes that shaped this meaning of waiting: the environment, activities, communication, expectations, and feelings. The perioperative waiting experience may be a necessary time of self-reflection and self-care for family members when responsibilities for loved ones are temporarily on hold. Perioperative nurses can provide family-centered interventions to address the physical and emotional needs of individuals who are waiting and improve their experience.

Relationships between physical activity, social isolation, and depression among older adults during COVID-19: A path analysis.

BACKGROUND: There are known significant relationships between greater physical activity and less depression, and greater social isolation and greater depression; therefore, it is important to understand these relationships among older adults during COVID-19. METHODS: The Physical Activity Scale for Elders, Geriatric Depression Scale, and PROMIS Social Isolation were administered. Path analysis was performed to evaluate the relationship between physical activity, social isolation, and depression. RESULTS: Of 803 surveys received, Consistent with our a-priori model, higher social isolation predicted greater depression. (p<0.001). CONCLUSION: Older adults may suffer a high emotional price during times of imposed social distancing.

Upstream Factors in Population Health: A Concept Analysis to Advance Nursing Theory.

The assessment of upstream factors is important in population-based nursing practice. The aim of this concept analysis is to enhance understanding of upstream factors and articulate a definition linked to the Conceptual Model for Nursing and Population Health. Upstream factors are thus defined as established conditions related to economic, social, and physical environments that occur outside the health care system, in the communities where people live, and contribute indirectly to the health outcomes for groups of individuals through multiple causal pathways. This concept analysis highlights the need for middle-range theory to guide nursing assessment and contributes to conceptual model evaluation.

Factors Associated With Predischarge Versus Postdischarge Scheduling for Early Follow-up Appointments.

BACKGROUND: Per national guidelines, early follow-up appointments should be scheduled before discharge, but in previous research, appointments scheduled before discharge were not associated with appointment adherence. OBJECTIVES: The purpose of this study was to determine whether patient, heart failure (HF), and hospital factors were associated with predischarge appointment scheduling. METHODS: A secondary analysis of a medical record review included patients hospitalized for decompensated HF at 3 health system hospitals who had a scheduled office appointment post discharge at 14 days or less. Patient demographics, and social, HF, and hospital factors were studied for association with predischarge scheduling. RESULTS: In multivariable modeling, the odds of having an appointment scheduled predischarge were based on 3 factors: nonwhite race, history of chronic renal insufficiency, and no admission within 14 days before HF hospitalization. CONCLUSIONS: Appointment scheduling may be based on provider perceptions of readmission risk. Follow-up appointment scheduling practices should be based on systematic processes.

Factors Associated With Adherence to 14-Day Office Appointments After Heart Failure Discharge.

BACKGROUND: Follow-up within 14 days after hospital discharge for heart failure (HF) may prevent 30-day hospital readmission, but adherence varies. The purpose of this study was to determine predictors of nonadherence to scheduled appointments. METHODS AND RESULTS: A medical record review included patients hospitalized for decompensated HF at 3 health system hospitals who had a scheduled 14-day office appointment. Patient demographics, and social, HF, and hospital factors were studied for association with appointment adherence. Multivariable modeling was used to determine the odds of missing scheduled appointments. Of 701 cases, mean (standard deviation) age was 73.5 (13.8) years, 46.4% were female and 38.9% were nonwhite. Appointment nonadherence was 16.2%. In multivariate analyses, 4 factors predicted missed appointments: drug use history (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.70-9.20; P < .001), nonwhite race (OR, 1.85; 95% CI, 1.08-3.16; P = .024), pulmonary disease (OR, 1.80; 95% CI, 1.12-2.87; P = .014), and anemia (OR, 1.58; 95% CI, 1.01-2.46; P = .044). Scheduling appointments postdischarge vs predischarge was not associated with missed appointments (OR, 0.72; 95% CI, 0.45-1.15; P = .17). CONCLUSIONS: Findings may help practitioners identify patients who are likely to miss a follow-up visit; all 4 predictors were easily retrievable from medical records during hospitalization.