The Doctor-Patient Relationship, Partnership Theory, and the Patient as Partner: Finding a Balance Between Domination and Partnership.

It is perhaps most useful to approach the Doctor-Patient relationship (DPR) by admitting that it's complicated. We review some of the strategies that have been employed to mitigate this complexity, zeroing in on one that promises to capture the main features of the DPR without eliminating some of its more important, existential components; pieces of the puzzle that must be retained if we are to avoid oversimplification and the errors that can arise by ignoring important foundational properties. We believe that a useful way to look at the DPR and to capture essential features that must be balanced in the process is provided by Partnership Theory and its definition in terms of the so-called domination and partnership systems. We apply this theory to the DPR and investigate the implications of this application to health care. We see that in the absence of mitigating circumstances, adoption of the patient-as-partner model serves healthcare well and is flexible enough to accommodate circumstances that dictate modifications.

Predictors of Turnover Among Asian Foreign-Educated Nurses in Their 1st Year of US Employment.

OBJECTIVE: The aim of this study was to investigate factors affecting turnover of Asian foreign-educated nurses (FENs), which may lead to improvements in retention strategies. BACKGROUND: Asian FENs working in the United States have considerable rates of turnover. Little is known about which factors are related. METHODS: A cross-sectional design was used. A convenience sample (n = 201) of Asian FENs completed surveys by regular mail and through a website. Backward multivariable logistic regression was performed to identify factors associated with turnover in their 1st year of employment. RESULTS: Most participants were from the Philippines and Korea. Perceived quality of orientation predicted organizational-level turnover and trended toward predicting unit-level turnover. CONCLUSIONS: Healthcare institutions may benefit from developing organizational programs for FENs that are sensitive to their unique needs, in the interest of reducing rapid or early turnover and accompanying negative effects on hospital finances and patient care.

Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions. 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.].

Turnover and Associated Factors in Asian Foreign-Educated Nurses.

OBJECTIVES: The purposes of this study are to (1) describe the gap between expected and perceived organizational experiences among Asian foreign-educated nurses (FENs) in the United States and (2) to examine factors associated with turnover in their 1st year of employment. BACKGROUND: Little is known about factors associated with turnover among Asian FENs. METHODS: A cross-sectional design with a convenience sampling was conducted. Subjects (n = 201) responded either via Web-based or mail survey. A series of simple and multivariable logistic regressions were used. RESULTS: Expectations of FENs before organizational entry were significantly higher than their experiences. The FENs who reported less organizational responsibility than expected were more likely to leave their 1st employment to move to another organization or unit. CONCLUSION: This study may contribute to our understanding of the potential factors that assist or interfere with the organization's administrative retention plan for Asian FENs.

Perception of Jordanian nurses regarding involvement in decision-making.

BACKGROUND: Nurses in any organizational context are members of a team and cannot work independently. Teamwork requires making decisions frequently, and these decisions affect team performance on a regular basis. Ultimately, the team shapes the quality of patient care. AIM: This study examines nurse decision-making related to patient care, self-management and the work environment. METHOD: Qualitative descriptive design was used to collect data. Eighteen staff nurses participated in semi-structured interviews to explore the perception of Jordanian staff nurses regarding their participation in decision-making. RESULTS: Variation in decision-making involvement was found to exist across unit types and from hospital to hospital. In general, the participants were not satisfied with their level of decision-making involvement and believed that they could participate more. CONCLUSION: The results have implications for nurse managers in facilitating the engagement of staff nurses in decision-making and creating an organizational culture to facilitate this engagement.

Nurses in the United States with a practice doctorate: implications for leading in the current context of health care.

The Institute of Medicine has recommended doubling the number of nurses with doctorates by 2020. The National Research Council has recommended a clearer distinction between doctoral preparation for a practice profession and that for the preparation of scientists. To support the central premise that both the research-oriented doctorate (PhD) and the practice-oriented doctorate, the doctor of nursing practice (DNP), are critical to achieve and expand doctoral education, we present current information regarding the impact of DNP programs, including enrollments, scholarly productivity of DNP graduates, and the employment setting of DNP scholars. Scholarly productivity was estimated by searching publication databases between 2005 and 2012 using three strategies to estimate the publication record of nurses who had earned a DNP degree. The large numbers of nurses receiving the DNP are helping to fulfill the Institute of Medicine's recommendation and are increasingly contributing to the scholarly output in the field, especially related to clinical practice.

Factors associated with sleep quality among operating engineers.

Blue collar workers generally report high job stress and are exposed to loud noises at work and engage in many of risky health behavioral factors, all of which have been associated with poor sleep quality. However, sleep quality of blue collar workers has not been studied extensively, and no studies have focused Operating Engineers (heavy equipment operators) among whom daytime fatigue would place them at high risk for accidents. Therefore, the purpose of this study was to determine variables associated with sleep quality among Operating Engineers. This was a cross-sectional survey design with a dependent variable of sleep quality and independent variables of personal and related health behavioral factors. A convenience sample of 498 Operating Engineers was recruited from approximately 16,000 Operating Engineers from entire State of Michigan in 2008. Linear regression was used to determine personal and related health behavior factors associated with sleep quality. Multivariate analyses showed that personal factors related to poor sleep quality were younger age, female sex, higher pain, more medical comorbidities and depressive symptoms and behavioral factors related to poor sleep quality were nicotine dependence. While sleep scores were similar to population norms, approximately 34 % (n = 143) showed interest in health services for sleep problems. While many personal factors are not changeable, interventions to improve sleep hygiene as well as interventions to treat pain, depression and smoking may improve sleep quality resulting in less absenteeism, fatal work accidents, use of sick leave, work disability, medical comorbidities, as well as subsequent mortality.

Factors influencing functional recovery in patients with acute ischemic stroke.

AIM: This study examined factors influencing functional recovery, including neurological and psychological function and activity of daily Living (ADL), in individuals hospitalized with acute ischemic stroke. METHODS: A prospective observational study was undertaken in a sample of 141 hospitalized adults with acute ischemic stroke in three hospitals in metropolitan Bangkok and one in regional Thailand. Sociodemographic and clinical data were collected using a standardized questionnaire. Co-morbidity burden was assessed using the Charlson Co-morbidity Index-Modified-Thai version (CCI-T) and acute stroke care services usage using the Measurement of Acute Stroke Care Services Received form. Recovery of neurological function was measured by the National Institutes of Health Stroke Scale-Thai (NIHSS-T), and ADL function was measured by the Modified Barthel Index Measurement-Thai Version (BI-T). Psychological function was assessed using the Center for Epidemiologic Studies Depression Scale-Thai version (CES-D-T). Multivariate Logistic regression was used to analyze the predictive ability of pre-specified variables. RESULTS: Receiving thrombolytic therapy was a significant predictor of functional recovery in terms of neurological (OR=4.714; P=.004) and ADL functions on the day of discharge (OR= 5.408; P=.002). Accessing acute stroke care service was the only factor predicting improved psychological function on hospital discharge (OR=1.312; P=.049).

The transition from inquiry to evidence to actionable clinical knowledge: A proposed roadmap.

RATIONALE, AIMS, AND OBJECTIVES: We consider the question "What should we do?" in the context of clinical research/practice. There are several steps along the way to providing a satisfactory answer, many of which have received considerable attention in the literature. We aim to provide a unified summary and explication of these "steps along the way". The result will be an increased appreciation for the meaning and structure of "actionable clinical knowledge". METHODS: We review the literature to identify pertinent works dealing with evidence production and translation into actionable clinical knowledge. We draw from insights in this literature about various aspects of reasoning relevant to clinical questions and integrate these into a unified approach to the processes that lead to actionable clinical knowledge. RESULTS: We collect, collate, and integrate some of the work by Bauer, Carper, Goldman, Haack, McHugh and Walker, and Upshur and colleagues and obtain guidelines to aid in the evidence-to-actionable-clinical- knowledge transition. CONCLUSIONS: Clinical decision-making is not infallible, and the steps we can take to minimize error are context dependent. Medical evidence, produced as it is by human effort, can never be perfect. We will be doing well by assuring that the evidence we use has been produced by a reliable process and is relevant to the question posed.

Scientism recognizes evidence only of the quantitative/general variety.

RATIONALE, AIMS AND OBJECTIVES: McHugh and Walker introduced a model of knowledge to demonstrate that EBM is a form of scientism that ignores important sources of knowledge thereby impairing the practice of medicine. We study the development of this model and explore additional applications. METHODS: Review of the relevant literature and identification of possible areas for fruitful application. RESULTS: We show that the McHugh and Walker model is closely related to the model of evidence considered earlier by Upshur et al. We also indicate that the utility of this model is not limited to showing scientism distorts clinical practice. Several representative applications are identified, including psychotherapy, the Salk polio vaccine trial, and the placebo effect. CONCLUSIONS: Priority should be given to Upshur et al for the development of a model that has far-reaching application to medical epistemology. It is shown that all four of the types of evidence considered-qualitative/personal, qualitative/general, quantitative/general, and quantitative/personal-are required to adequately characterize epistemology in medical research and practice.

Human resources in nursing education: a worldwide crisis.

The global shortage of nurses is escalating. A key contributing factor to the production of new nurses is the growing shortage of qualified faculty. This paper explores the forces influencing the global faculty shortage, including those that increase demand and those that limit the supply of nursing faculty. The authors discuss potential solutions to the shortage, placing particular emphasis on leveraging the strengths of the profession to accelerate the progression of nurses to graduate school, the enhancement of funding for graduate education, changing the paradigm of clinical education, and the expansion of the science base for practice.

Mexican immigrant mothers' expectations for children's health services.

Women of Mexican descent living in the United States raise children who use health care services. What do immigrant Mexican mothers expect from children's health care services? And how do their expectations for children's health services compare to acculturated Mexican American mothers' expectations? This focused ethnographic study, based on repeated interviews with 28 mothers of varying acculturation levels, describes their expectations and experiences with children's health care services in the United States. Findings support a shared core of expectations for both Mexican immigrant and Mexican American mothers, and differences in health care access and financing, time spent in health care encounters, and cultural and linguistic expectations for care. Health care providers can use this information to approach Mexican-descent mothers and children with their expectations in mind, and craft a negotiated plan of care congruent with their expectations.

Staff nurses and their solutions to the nursing shortage.

Nurses in acute care hospitals report that situations in their work setting and profession are in dire need of repair. Although they waiver on their intention to remain in their institution and nursing, they do not waiver on their selected resolution to nursing's shortage. A total of 787 staff nurses in eight geographically and demographically diverse states responded and were asked to select the "Top 5" actions they thought would improve nursing and decrease the shortage. Creating career ladders was endorsed by most respondents (85%) with increasing pay endorsed by the fewest (33%). When selecting the single most important action, they reversed the order--increased pay was the most endorsed (26%), and creating career ladders and increased educational opportunities were endorsed by less than 1%. Nurses appeared to be concerned about the profession in general; however, when asked the "most important" thing to do, an age-old action was selected--increase pay.

Parents' Analgesic Trade-Off Dilemmas: How Analgesic Knowledge Influences Their Decisions to Give Opioids.

OBJECTIVES: Ineffective analgesic decisions in the home may jeopardize the safety and comfort of children, yet little is known about factors influencing parental decisions. This study explored how parents' analgesic understanding influenced their hypothetical decisions to give opioids when faced with important trade-off dilemmas where pain and adverse drug event (ADE) symptoms were both present. METHODS: A total of 514 parents whose children required opioids after discharge completed surveys assessing their Gist ADE Understanding (ie, knowledge of opioid-related ADEs and their seriousness) and other comparative analgesic perceptions. Parents then made hypothetical decisions to give or withhold prescribed opioids to a postoperative child with varying pain levels and serious (oversedation) and nonserious (nausea) ADE symptoms. RESULTS: Gist ADE Understanding influenced decisions to withhold opioids for a child with nausea/vomiting (ß=0.85 [95% confidence interval (CI), 0.74-0.98]) or oversedation (ß=0.86 [95% CI, 0.77-0.97]), but not for one with no ADE (ß=1.00 [95% CI, 0.98-1.02]). However, while perceived higher seriousness of oversedation influenced withholding opioids when this ADE was present (mean difference=0.36 [95% CI, 0.11-0.61], P=0.005), knowledge that oversedation was possible did not by itself affect behavior (odds ratio=0.80 [95% CI, 0.50-1.29], P=0.362). DISCUSSION: These data suggest that gist understanding of ADE seriousness, not just its possible presence, is needed to facilitate safe analgesic decisions. Importantly, higher overall ADE understanding did not influence parents' opioid decisions in the presence of high pain and absence of ADEs. Thus, risk information about specific ADEs is unlikely to dissuade parents from efforts to manage pain but may improve their decisions if ADEs should occur.

Preventing violence in an academic setting: one school of nursing's approach.

Workplace violence occurs in many different contexts, including academic settings. However, the types of violence that make headlines are less common than the everyday behaviors that, left unchecked, may lead to extreme situations. This article describes how a school of nursing developed a program of workplace violence prevention, intervention, and response. Descriptions of the program, definitions, and workplace violence resources are included.

A critical examination of developments in nursing doctoral education in the United States.

UNLABELLED: Graduate nursing education in the United States is undergoing major transformations, as a result of factors both within nursing and in the larger society. OBJECTIVE: In this paper the authors examine the trends and factors that are influencing the changes, especially in doctoral education, for both nurse scientist and advanced practice preparation. CONCLUSION: The paper provides a background that serves as context, it gives an overview of the PhD and the DNP degrees, focusing on the recent changes and identifying the most compelling issues and concerns, ending with a series of recommendations.

Demographic and Socioenvironmental Characteristics of Black and White Community-Dwelling Caregivers and Care Recipients' Behavioral and Psychological Symptoms of Dementia.

The purpose of the current study was to compare the association between caregiver background characteristics and care recipients' behavioral and psychological symptoms of dementia (BPSD) in Black and White community-dwelling family caregivers. Using logistic regression models, caregiver/care recipient dyad data from the Aging Demographics and Memory Study were used to describe associations between caregiver background characteristics (i.e., demographic and socioenvironmental variables) and care recipients' BPSD (i.e., hallucinations, delusions, agitation, depression) (N = 755). Results showed that Black caregivers were more likely to be female, younger, an adult child, have less education, and live in the South (p ≤ 0.05); they were less likely to be married. Several caregiver background characteristics were associated with care recipients' depression and agitation, but not with other BPSD. Caregiver background characteristics may play a role in the recognition and reporting of BPSD and should be considered when working with families of individuals with dementia.

Advancing patient-centred care through knowledge development.

The call for health-care services that are patient-centred raises the need for knowledge development in both the conceptual and empirical domains. The definitions and operational elements of patient-centred care present a variety of conceptual issues. A common element in all definitions is accommodation of patient wants, preferences, and expectations. In the research domain, intervention studies face both design and measurement challenges. These include the development of interventions that are patient-centred or tailored for both patient characteristics and the environment in which they will be delivered. By addressing these critical issues, nursing can play a key role in advancing intervention science and knowledge development in the domain of patient-centred care.

Relationship of nurses' assessment of organizational culture, job satisfaction, and patient satisfaction with nursing care.

This exploratory study investigated the relationship among staff nurses' assessment of organizational culture, job satisfaction, inpatient satisfaction with information about home care and follow-up, and general inpatient satisfaction with nursing care. A conceptual path model was tested using a secondary data analysis research design. Staff nurses and inpatients were sampled from inpatient units. The unit of analysis was patient care units. Pearson correlation and regression analyses were used. We found that strength of organizational culture predicted job satisfaction well and positively; job satisfaction predicted inpatient satisfaction significantly and positively; and inpatient satisfaction predicted general inpatient satisfaction well and positively. Methodological challenges of this study are discussed.

The impact of Sun Solutions educational interventions on select health belief model constructs.

The purpose of this study was to offer the Sun Solutions intervention to operating engineers (N = 232) to decrease sun exposure and skin cancer. The majority (82%) of the engineers worked outside between 10 a.m. and 3 p.m., 4 to 5 hours a day; 81.4% reported more than one sunburn during the past year and 70% sometimes or never used sunscreen compared to 30% who wore sunscreen approximately 50% or more of the time. Most reported that the intervention was helpful (97%), most were satisfied (96%) with the intervention, and 84% expressed a future intention to use sunscreen. Regarding sun protective behaviors, the intervention significantly improved perceived self-efficacy (p < .05) and increased perceived barriers (p < .05). Regarding sunburn and skin cancer, the intervention increased perceived benefits (p < .05), susceptibility (p < .05), and severity (p < .05) for sunburning, but not skin cancer (p > .10). The Sun Solutions intervention showed the potential to increase sunscreen use and decrease the risk of sunburn and skin cancer among operating engineers.