The Baptist Health High-Risk Falls Assessment: One Assessment Fits All.

Assessing high risk for falling among psychiatric inpatients is particularly challenging in that assessments with strong sensitivity and specificity are not available. The purpose of this study was to determine the sensitivity, specificity, and diagnostic odds ratio of the Baptist Health High Risk Falls Assessment (BHHRFA), a medical-surgical fall risk assessment, in a psychiatric inpatient population. Data collected on 5910 psychiatric inpatients using the BHHRFA showed acceptable sensitivity, specificity, and diagnostic odds ratio (0.68/0.70/4.964).

Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings.

Overcoming barriers to effective pain management: the use of professionally directed small group discussions.

Inadequate assessment and management of pain among critical care patients can lead to ineffective care delivery and an increased length of stay. Nurses' lack of knowledge regarding appropriate assessment and treatment, as well as negative biases toward specific patient populations, can lead to poor pain control. Our aim was to evaluate the effectiveness of professionally directed small group discussions on critical care nurses' knowledge and biases related to pain management. A quasi-experiment was conducted at a 383-bed Magnet(®) redesignated hospital in the southeastern United States. Critical care nurses (N = 32) participated in the study. A modified Brockopp and Warden Pain Knowledge Questionnaire was administered before and after the small group sessions. These sessions were 45 minutes in length, consisted of two to six nurses per group, and focused on effective pain management strategies. Results indicated that mean knowledge scores differed significantly and in a positive direction after intervention [preintervention mean = 18.28, standard deviation = 2.33; postintervention mean = 22.16, standard deviation = 1.70; t(31) = -8.87, p < .001]. Post-bias scores (amount of time and energy nurses would spend attending to patients' pain) were significantly higher for 6 of 15 patient populations. The strongest bias against treating patients' pain was toward unconscious and mechanically ventilated individuals. After the implementation of professionally directed small group discussions with critical care nurses, knowledge levels related to pain management increased and biases toward specific patient populations decreased.

Major Predictors of Inpatient Falls: A Multisite Study.

OBJECTIVE: The purpose of this secondary data analysis was to identify key factors predictive of falls in hospitals. BACKGROUND: Patient falls remain a major concern for hospitals. Falls can increase patient morbidity/mortality and increase legal risk/cost for institutions. While a number of high-risk falls assessments are available, key predictors of falls have not been identified. METHODS: A secondary data analysis was performed on 281,865 high-risk falls assessments collected in a multisite study. RESULTS: For the total sample, logistic regression analyses demonstrated that 3 factors, falls within the past 6 months (OR=2.98), confusion (odds ratio, 2.05), taking a laxative (odds ratio, 1.54), are strong predictors of falling. Similar results were found for individual hospitals, different units within hospitals, and urban versus rural hospital locations. CONCLUSION: Findings suggest that assessments of fall risk should heavily weigh the 3 predictors identified in this study. Another approach would be to intervene based on these predictors.

Improving knowledge, assessment, and attitudes related to pain management: evaluation of an intervention.

Pain control in the acute care setting is repeatedly described in the literature as problematic. The purpose of this clinical research project was to evaluate an educational intervention designed to improve the management of pain in an acute care setting. A quasi-experimental pre- and post-intervention design was used. Three hundred and forty-one medical-surgical and critical care nurses completed the Brockopp-Warden Pain Knowledge/Bias Questionnaire (2004) (203 pre, 138 post). Data were collected before the intervention and 3 months following the educational experience. Sixty patients (30 pre, 30 post) recorded numerical assessments of their pain every 2 hours in a pain diary. Patient charts were reviewed to compare patients' pain assessments with nurses' documentation. A 50% decrease in the mean difference between patients' assessment of pain and nurses' documentation (p < .04) was found post-intervention. Although no significant differences were found on total knowledge or bias scores, 20% of nurses who participated responded incorrectly to six of 21 knowledge items both pre- and post-intervention. In keeping with earlier research on bias regarding pain management, patients with non-physiological conditions were not attended to as well as patients who had clearly defined physical problems. Results of this project have precipitated major changes regarding the management of pain in this institution. A pain steering committee has been formed and additional unit-based projects have been conducted. The challenge of finding the most effective method for changing biases toward specific patient populations and increasing knowledge regarding pain management remains.

The Baptist Health High Risk Falls Assessment: a methodological study.

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the Baptist Health High Risk Falls Assessment (BHHRFA). BACKGROUND: The cost of falls and the potential for increased patient morbidity and mortality necessitate the development of a psychometrically sound assessment. METHODS: Based on pilot data, a multisite study was conducted. Assessments were collected on 21 medical-surgical units, 1 rehabilitation unit, 1 psychiatric unit, and 3 critical care units (N = 241599). Sensitivity, specificity, and diagnostic odds ratios (DORs) were calculated. Clinical usefulness in terms of assessment performance time was addressed. RESULTS: Psychometric properties were within a desirable range for each site, critical care patients, and all participants (sensitivity, 0.64-1.00; specificity, 0.50-0.70; and DOR, 4.73-7.0). Although sensitivity at 1 site was high (0.84), specificity was low (0.37). CONCLUSIONS: Results suggest that the BHHRFA is clinically useful for adult inpatients across acute care settings.

Suspected deep tissue injury profile: a pilot study.

PURPOSE: To enhance the learner's competence with knowledge of the results of research examining suspected deep tissue injury profiles. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: OBJECTIVE: : The purpose of this study was to examine (1) the incidence of potential precipitating events of suspected deep tissue injuries (SDTIs) identified over a 7-day period prior to cutaneous manifestation, (2) physiological variables related to the formation of SDTIs, and (3) the time since precipitating events and the occurrence of the SDTI. DESIGN: A descriptive exploratory study. A retrospective chart review was conducted. SETTING: A 348-bed community Magnet-redesignated hospital, Baptist Health Lexington Kentucky PARTICPANTS:: Eighty-five participants with SDTIs identified between January 2008 and March 2010. MAIN OUTCOME MEASURES: Precipitating events evaluated were tissue perfusion, surgery, transfers, mobility, and falls. Physiological variables included anticoagulation, albumin/prealbumin, hemoglobin, partial thromboplastin time, and hemoglobin A1c. Timeline differences between precipitating events and SDTI were measured. MAIN RESULTS: Precipitating events identified from most to least frequent were transfers = 67 (78.8%), tissue perfusion = 36 (42.5%), surgery = 33 (40.2%), mobility = 26 (30.9%), and falls = 14 (16.9%). Of the 85 charts reviewed, 69 of the charts met the criteria for timeline difference between precipitating event and SDTI manifestation. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) years. Meaningful physiological variables noted were anticoagulation 52 (61.2%), anemia (hemoglobin 6-9 g/dL) 53 (67.1%), and hemoglobin A1c less than 7.5 mmol/L 29 (74.4%). CONCLUSIONS: This exploratory pilot study evaluating patients with SDTI revealed the most common precipitating event was transfers. In addition, the physiological variables that appeared to contribute to the development of SDTIs were anticoagulation and anemia. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) days.

Development and psychometric testing of the Honaker suspected deep tissue injury severity scale.

PURPOSE: This article describes the development of the Honaker Suspected Deep Tissue Injury Severity Scale (HSDTISS). The aims of the instrument are to (a) accurately evaluate the severity of the suspected deep tissue injury (SDTI), (b) determine progression of SDTI, and (c) demonstrate utility of the instrument in the clinical setting. INSTRUMENT: The HSDTISS contains 3 items: total surface area size, skin integrity, and wound color/tissue assessment. The total surface area size item is scored on a scale of 1 to 8, the skin integrity item is scored on a scale from 1 to 3, and the wound color/tissue assessment item is scored on a scale of 1 to 7. A cumulative score is calculated for the HSDTISS; it ranges from 3 to 18. METHODS: Content validity and interrater reliability testing were calculated. Content validity was evaluated by reviewing the items and scorings of the HSDTISS. Validation was derived from 10 content experts who participated in 2 rounds of evaluation and feedback. Intraclass correlation was used to evaluate the interrater reliability of the HSDTISS in a group of 21 clinicians (6 physical therapists and 15 RNs) by using the HSDTISS to evaluate photographs of 3 patients with SDTIs upon initial assessment and at discharge. The clinical utility of the instrument was determined by evaluation and subsequent comments received from 10 staff nurses within the hospital. RESULTS: Feedback from content experts supported content validity of the instrument. Calculation of an intraclass correlation coefficient showed strong interrater reliability (r = 0.997, P < .001). The time involved to complete assessment of 6 photographs was 8.2 ± 2.3 minutes, suggesting that the HSDTISS is straightforward and easy to use. CONCLUSION: Findings from this study suggest that the HSDTISS accurately diagnoses wound severity among patients with SDTI. Further testing is needed to confirm these results in a larger group of clinicians with variable expertise in wound care. Further testing is needed to confirm these results among a larger group of clinicians.

The Baptist Health Lexington evidence-based practice model: a 5-year journey.

There are numerous advantages to basing nursing practice on evidence. Improvements in the quality of patient care, better patient outcomes, decreased healthcare costs, and enhanced work satisfaction for nurses have been described in the literature. Baptist Health Lexington, a community hospital, has experienced a successful 5-year journey integrating evidence-based practice as a result of the development of the Baptist Health Lexington Evidence-Based Practice Model. This journey is described below. Yearly activities, examples of projects, and clinical outcomes are presented.

A pilot project to evaluate the academic performance, abilities, and satisfaction of second-degree students.

The literature on students matriculated in the growing number of second-degree nursing programs in the United States typically describes them as exceptional on many parameters of interest. The experience at the authors' university in an integrated second-degree baccalaureate nursing program did not support prevailing notions regarding these students. The purpose of this pilot project was to evaluate the performance and satisfaction of second-degree students in comparison to traditional students. The Learning and Study Strategies Inventory, a standardized exit examination, the nursing grade point average (GPA), and focus groups were used in the evaluation. Findings showed little difference between second-degree students and traditional students on the Learning and Study Strategies Inventory and no difference in exit examination scores and nursing GPA. Social and learning differences were apparent as a result of the focus group experience.

Exploring the Lived Experience of Women Immediately Following Mastectomy: A Phenomenological Study.

BACKGROUND: In 2014, it is estimated that 232,670 new cases of breast cancer occurred in the United States. Unilateral or bilateral mastectomy is a frequently chosen option for treating this disease. OBJECTIVE: The purpose of this study was to explore, through an in-depth interview process, the lived experience of women immediately following mastectomy when they see their scars for the first time. METHODS: Purposeful sampling was used until saturation was reached. In-depth interviews were conducted with 10 women related to their mastectomy experience. The data were analyzed using a phenomenological approach. RESULTS: The following 8 themes emerged from the data; lasting impact, personal impact, relational impact, gratitude, support system, coping strategies, timing, and discomfort. CONCLUSIONS: The results of the study provide evidence that women face ongoing challenges following seeing their mastectomy scars for the first time that is not adequately addressed by healthcare professionals. IMPLICATIONS FOR PRACTICE: Nurses and other healthcare professionals need to gain a better understanding of the difficulties perceived by women following seeing the scars from mastectomy and implement strategies to assist in successful adaptation to the experience.

Effects of naltrexone on repressive coping and disclosure of emotional material: a test of the opioid-peptide hypothesis of repression and hypertension.

OBJECTIVE: The present study was designed to assess the role of endogenous opioids in the relationship of hypertension to repressive coping. METHODS: Ten hypertensive and 8 normotensive males were given either the opioid antagonist naltrexone or placebo in a randomized, double-blind fashion over the course of four laboratory sessions. Measures of repression and disclosure were completed and blood pressure was assessed during a laboratory stressor protocol. RESULTS: Opioid antagonism reduced repression and increased disclosure only in the hypertensive group. Also, opioid antagonism increased stress-related systolic blood pressure only in the hypertensive group. CONCLUSION: The results support the hypothesis that endogenous opioid dysregulation underlies both hypertension and repressive phenomena.

Astym therapy improves function and range of motion following mastectomy.

Hypersensitive scar tissue formation along the incision line and drain site is a common side effect following mastectomy. If this scar tissue is not addressed, it can lead to decreased flexibility and function in the involved upper quadrant. Astym(®) treatment is a new approach to soft tissue injuries, and is evidenced in animal studies to promote the healing and regeneration of soft tissues. It has also been found to reduce pain and increase function in people with soft tissue dysfunction. The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. Handheld instrumentation is applied topically to locate and treat the underlying dysfunctional soft tissue through specific protocols for the application of particular pressures and shear forces. The purpose of this study was to examine the effects of Astym treatment on activities of daily living in women who had undergone a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, following a mastectomy, evaluated five outcome measures pre- and post-Astym treatment. All five measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active range of motion of shoulder flexion; and active range of motion of abduction were also measured and all demonstrated significant changes. In this study, Astym treatment improved active range of motion in the involved quadrant and also improved function in patients following a mastectomy.

Understanding colorectal screening behaviors and factors associated with screening in a community hospital setting.

BACKGROUND: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death in the United States. More than 2,000 Kentuckians are diagnosed with CRC annually, and more than 800 die from the disease. Little research has been conducted in Kentucky to better understand why individuals are not screened for CRC and what strategies might encourage them to do so. OBJECTIVES: The purpose of this study was to evaluate the efficacy of educational materials mailed to participants supporting the need for CRC screening on the decision to complete screening post-hospital discharge. An additional focus was to identify the characteristics of individuals screened and not screened. METHODS: A quasi-experimental study was conducted on 167 adult patients discharged from a 383-bed Magnet-designated hospital. An investigator-designed, semistructured telephone interview was conducted to collect data on research-based factors identified to influence CRC screening rates. FINDINGS: Although not statistically significant, slightly more patients who remembered receiving educational materials in the mail completed screening. Future educational efforts should focus on the importance of screening and financial resource availability.

Evaluating preceptors: a methodological study.

The purpose of this study was to develop and test the Baptist Health Lexington Performance and Proficiency Assessment for validity and reliability. Twelve expert nurse educators evaluated the instrument for content validity. The sample for test-retest included nurse administrators (5), preceptors (9), and new graduates (10). To evaluate internal consistency, administrators (12), preceptors (66), and new graduates (43) responded. Strong validity and reliability were found for all subscales on the preceptor and new graduate versions.

Does the type of sleep surface influence infant wellbeing in the NICU?

PURPOSE: To evaluate whether different mattress surfaces (standard vinyl-covered foam mattress [SFM] versus viscoelastic polyurethane mattress [VPM]) are associated with differences in nurses' perceptions of infant sleep/restfulness, nurses' assessment of infant pain, parents' perceptions of infant comfort/crying, infant weight, and vital signs among babies with birthweights <1,700 grams or gestational ages <35 weeks in a NICU. STUDY DESIGN AND METHODS: A quasi-experiment was conducted in which a control group of 40 babies admitted to the NICU over a 7-month period were placed on SFMs and an experimental group of 40 babies admitted in the next 7 months were placed on VPMs. Data were collected in 72 hours immediately following infant placement on the mattresses. RESULTS: There were no differences between groups based on gender, gestational age, and birthweight. Babies in the SFM group were an average of 15 hours older when placed on the mattress and had lower Day 1 acuity. There were no differences between groups on nurses' perceptions of infant sleep/restfulness, nurses' assessment of infant pain, parents' perceptions of comfort/crying, and infant vital signs. Weight loss for babies in the VPM group was more than twice that of infants on the SFM; however, the loss was clinically within normal limits. Vital signs of babies in both groups were largely within normal ranges and perceptions of sleep/restfulness and comfort/crying levels were positive. CLINICAL IMPLICATIONS: Both mattresses seem to be effective for babies in the NICU. More data are needed on the potential relationships between the VPM mattress and neonatal weight loss.