Describing the influence of technologies on registered nurses' work.

PURPOSE/OBJECTIVE: The purpose of this study was to describe the influence of technologies on registered nurses' (RNs) work. The study examined the characteristics of technologies that encourage or hinder their correct use and identified RNs' concerns when introduced to new or changed technologies. DESIGN: Four focus group sessions were conducted to collect data describing nurses' concerns as they work with technologies during daily practice and make decisions as to how or how not to use technologies. Transcript content was thematically analyzed, and data were organized to reveal major themes, themes, and subthemes. SETTING: The study was conducted at an urban healthcare network in a large northeastern city. Registered nurses employed at 2 institutions within the network, a general acute care hospital and a tertiary care medical center, participated in the group discussions. SAMPLE: Purposively selected RN participants (N = 31) provided direct care to patients on medical-surgical care units, including telemetry units. Participants had a minimum of 1 year of experience and were employed at least 20 hours weekly. METHODS: Focus group discussions followed a preestablished query path and lasted approximately 90 minutes. Food served as an incentive for participation. Informed consent was obtained. Discussions were audiotape recorded. Discussion data were listed on flip charts during group interviews. The principal investigator served as the group moderator, and a clinical nurse specialist coinvestigator facilitated participation and took notes. Debriefing sessions followed each discussion. FINDINGS: Content analysis revealed that technologies enhanced nursing practice by improving direct care processes, patient outcomes, and work environments. Working with inefficient systems of technology delivery, use, and repair created challenges for nurses and physically unfriendly equipment increased the burden of nurses' work. Nurses bypassed problems rather than proactively solving them, occasionally leading to safety breeches. Technologies led to changing nurse role expectations and altered healthcare team dynamics. CONCLUSIONS: Technology-use systems require monitoring and regular evaluation. System gaps create problems that potentially increase error risk and contribute to nurse dissatisfaction. IMPLICATIONS FOR PRACTICE: Certified nurse specialists may be more accustomed to considering and addressing the front-end needs of new and existing technologies, specifically, in introducing the technology into practice. Study findings suggest that gaps develop throughout the life of technology-use systems. Technologies and their use contexts should be regularly examined so that nurses are less inclined to commit work-arounds or breech established safety measures.

Influence of registered nurses' attitudes toward bariatric patients on educational programming effectiveness.

BACKGROUND AND OBJECTIVE: This study describes registered nurses' (RNs') attitudes toward obese adult patients using the Attitudes Toward Obese Adult Patients Instrument. METHODS: Full-time RNs (N = 119) employed in a medical center, acute rehabilitation institution, and skilled nursing facility participated in the study. RESULTS: Findings revealed that RNs have positive attitudes toward obese adults. RNs were concerned about personal and patient safety. Respondents recognized the complex care needs of bariatric patients and the increased workload associated with meeting these demands. There were differences in attitudes between medical center RNs and acute rehabilitation RNs, possibly related to differences in workload and length of stay. CONCLUSIONS: The effectiveness of bariatric educational programming may be improved if RN attitudes and concerns are measured and addressed.

Clinical nurse specialists' knowledge specific to Medicare structures and processes.

PURPOSE: The purpose of this study was to describe clinical nurse specialists' (CNSs) knowledge of Medicare structures and processes using a multiple-choice examination. DESIGN: This descriptive study used the survey method with a convenient sample. SETTING: Potential subjects received the research study packet at the address designated by them for membership mailings sent from the National Association of Clinical Nurse Specialists (NACNS). SAMPLE: The population of interest was practicing CNSs. The accessible population was NACNS members drawn from the 2002 mailing list organized by zip code. Every third mailing label was skipped. The remaining list members (N = 950) received a study packet. There was a 14.42% response rate with 137 respondents. Eighty-two percent held a master's degree in nursing. METHODS: A 46 item multiple-choice examination was developed based upon a content map established after a review of the available Medicare-related literature and consultation with Medicare advanced practice nurse providers. Content validity was established. Survey packets with the instrument, Scantron answer key, informational letter, and demographic profile were sent to potential subjects. Returned responses were keyed for correct answers. Relationships between demographic variables, raw score, and self-reported Medicare expertise were analyzed. Qualitative data elicited on the demographic form were thematically analyzed. FINDINGS: The examination had a.67 coefficient. Correlation of examination raw score to self-reported Medicare content expertise was 0.982 (P =.000). One third of the examination questions were incorrectly answered by 30% or more of respondents. Percentage correct scores ranged from 60.9 to 95.7 (M = 62.7%; SD = 10.46). Respondents offered 40 comments. Eleven comments related to a self-recognized Medicare knowledge deficit. Four responses highlighted that graduate studies had not provided them with the knowledge necessary for understanding reimbursement issues. Ten respondents expressed an interest in locating some type of educational resource addressing the Medicare system, reimbursement processes, and opportunities. CONCLUSIONS: Findings suggest that NACNS members have Medicare program knowledge deficits. Respondents recognize their deficiencies and are interested in obtaining more information about Medicare but are uncertain as to available resources or networking opportunities that might support them in this process. Graduate nursing programs may need to evaluate the amount of information provided within curriculums specific to insurance reimbursement and Medicare structures and processes. Study limitations include the low response rate and indeterminate sample representativeness. IMPLICATIONS FOR PRACTICE: Educators should examine CNS curriculums to ensure the adequacy of Medicare program information. Continuing education programs and conference workshops addressing Medicare information should be offered to CNSs interested in increasing their expertise or exploring provider opportunities. There may be entrepreneurial opportunities available to CNSs interested in developing an expertise in Medicare programs. Future research studies should quantify potential benefits to Medicare beneficiaries when CNSs participate as providers.