Implementation of Trauma-Informed Care and Brief Solution-Focused Therapy: A Quality Improvement Project Aimed at Increasing Engagement on an Inpatient Psychiatric Unit.

Addressing tense and escalating situations with noncoercive measures is an important element of inpatient psychiatric treatment. Although restraint rates are frequently monitored, the use of pro re nata (PRN) intramuscular (IM) injections to address agitation is also an important indicator. In 2015, at the current study site, a significant increase was noted in PRN IM medication use despite unit leadership's efforts to build a culture of trauma-informed care (TIC). The purpose of the current quality improvement project was to educate staff on methods to incorporate TIC into daily practice and the use of brief solution-focused therapy techniques in escalating situations. Measurement of attitudes toward patient aggression and engagement with patients followed two waves of staff education. Upon completion of the project, a decrease in PRN IM medications, improvement in staff attitudes toward patient aggression, and improved sense of staff competency in handling tense situations were noted. [Journal of Psychosocial Nursing and Mental Health Services, 56(8), 16-22.].

Women's perceptions of childbirth experience at a hospital in rural Tanzania.

Tanzania's health care provider shortage, especially in rural areas, makes it challenging to meet women's support needs in hospitals. We describe women's perceptions of childbirth support at a hospital in rural Tanzania. We interviewed 25 women within 24 hours after delivery using semistructured interviews. Most women sought life-saving technological support in case of complications. They also valued having family present to provide care and affection. Women's needs, however, were difficult to fulfill at this busy facility. Increasing women-centered childbirth support and recognizing family as important contributors may provide a strategy to meet the needs of both women and providers.

Risk of breastfeeding cessation among low-income women, infants, and children: a discrete time survival analysis.

BACKGROUND: Women who receive services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) often stop breastfeeding earlier than recommended. Little is known about maternal background and intrapersonal variables that predict the timing of breastfeeding cessation over the 12-month postpartum period. OBJECTIVES: The aim of this study was to identify the maternal background and intrapersonal predictors associated with the timing of breastfeeding cessation in WIC participants over the course of the 12-month postpartum period. METHOD: Existing longitudinal survey and administrative data from low-income breastfeeding WIC recipients (n = 309) were analyzed using discrete time survival analysis. Risk of breastfeeding cessation was the outcome, and self-reported items were used to derive predictor variables that corresponded to the background and intrapersonal variables of the Interaction Model of Client Health Behavior. RESULTS: Rates of breastfeeding were low (31% at 6 months and 6% at 12 months). In the best fitting discrete time survival analysis model, women who were older and of Mexican ethnicity, who had previous breastfeeding experience, and who had breastfeeding support from family or friends were at lowest risk for breastfeeding cessation at each monthly interval. DISCUSSION: Breastfeeding duration rates were lower than Healthy People 2020 benchmarks of 61% at 6 months and 34% at 12 months. Clinicians and researchers can use the findings from this study to develop interventions that are targeted to periods of greatest risk of premature breastfeeding cessation to prolong breastfeeding duration in this vulnerable population.

What level of knowledge do elementary school teachers possess concerning the care of children with asthma? A pilot study.

A self-report questionnaire was used to assess the level of knowledge among a convenience sample of 34 elementary school teachers in a rural school district in Illinois. The questionnaire addressed general asthma knowledge and management, including signs and symptoms, triggers, and treatment. The results suggest a knowledge deficit among this sample of elementary school teachers; the average score was 75%. Teachers with an increased exposure/experience with asthma scored significantly higher than did those with limited exposure. Implications of these findings for schools in rural areas are discussed.

Evaluation of the Tiredness Management Guide: a pilot study.

The Tiredness Management Guide (TMG), developed by N. W. Troy and P. Dialgas-Pelish (1995), consists of 59 interventions that may be helpful in decreasing maternal fatigue in the postpartum period. The purpose of this pilot study was to evaluate which interventions mothers perceived as most helpful and thus reduce the length of the TMG and update its relevance. A convenience sample of 30 Women, Infants, and Children Program (WIC) participants between the ages of 18 and 35 years completed a demographic tool and the TMG. The 25 most helpful interventions can be placed into the following broad categories: rest and relaxation, time management, rearranging usual activities, relief/prevention of hemorrhoids/constipation, signs of infection, and emotional support.

Comparison of pulse oximetry measures in a healthy population.

In this study finger and ear oximetry readings of 89 healthy persons were compared. The findings do not support the common nursing practice of using a finger sensor to obtain a pulse oximetry reading from an individual's ear if the finger is not usable.

Nurses' knowledge and attitudes regarding pain assessment and intervention.

Registered nurses were queried about their knowledge and attitudes regarding pain management. Results suggest knowledge of pain management principles and interventions is insufficient.

Comparison of nurse workload approaches.

BACKGROUND: For hospitals in the United States, the number of patients who lie in beds at midnight is considered to be the standard indicator of nursing workload; relatively little attention is given to the total number of patients cared for in a 24-hour day. Staffing decisions are related to cost of care. Such decisions are made on a per-shift basis, calculating hours per patient day (HPPD) based upon midnight census provides little decision-making support about variable staffing needs over a 24-hour period. The discrepancy between nurse managers' staffing based on real-time patient needs and financial analysts looking only at units of service captured at midnight clearly speaks to the need for a new metric of measurement. OBJECTIVE: To describe the variations in nursing workload across two medical units using a comparison of intra-day census recommendations for staffing and those projected based on the midnight census alone. METHODS: Data were retrieved from a primary data set that included: (1) the number of patients lying in beds at four different times during a 24-hour period: 06.00, 14.00, 22.00 hours and at midnight; (2) projected nursing hours needed based on the numbers of patients lying in beds at different times during the 24-hour period; and (3) the number of projected nursing hours needed for the numbers of patients lying in bed and those who were admitted and discharged in an 8-hour period of time. RESULTS: Statistically significant increases in 06.00 hour patient counts were found with statistically lower patient counts at both 14.00 and 22.00 hours compared with the midnight census alone. Nursing hour projections per day did not show any significance when projected based on intra day vs. midnight census alone. Statistically significant increases in nursing hour projections were seen on all three shifts when admissions and discharges and the nursing workload associated with those procedures were calculated. CONCLUSIONS: Findings suggest that the midnight census alone may well not be the most precise measure to predict nursing workload or to cost out nursing care. To accurately capture the realities of a 24-hour nursing workload, the nursing work associated with patient admissions and discharges has to be a part of the equation. IMPLICATIONS FOR NURSING MANAGEMENT: The tradition of using the midnight census to budget 24 hours of nursing services in the hospital setting does not capture the totality of nursing workload. A model that costs out direct nursing care in the hospital and ultimately bills separately for that care is needed to reflect the realities of hospital nursing workload.

Job embeddedness and nurse retention.

BACKGROUND: Nurse retention is a different way of conceptualizing the employer-employee relationship when compared with turnover. Job embeddedness (JE), a construct based on retention, represents the sum of reasons why employees remain at their jobs. However, JE has not been investigated in relation to locale (urban or rural) or exclusively with a sample of registered nurses (RNs). The purpose of this study was to determine what factors (JE, age, gender, locale, and income) help predict nurse retention. METHODS: A cross-sectional mailed survey design was used with RNs in different locales (urban or rural). Job embeddedness was measured by the score on the composite, standardized instrument. Nurse retention was measured by self-report items concerning intent to stay. RESULTS: A response rate of 49.3% was obtained. The typical respondent was female (96.1%), white, non-Hispanic (87.4%), and married (74.9%). Age and JE were predictive of nurse retention and accounted for 26% of the explained variance in intent to stay. Although age was a significant predictor of intent to stay, it accounted for only 1.4% of the variance while JE accounted for 24.6% of the variance of nurse retention (as measured by intent to stay). CONCLUSIONS: Older, more "embedded" nurses are more likely to remain employed in their current organization. Based on these findings, JE may form the basis for the development of an effective nurse retention program.

Location of blood pressure measurement.

Health care workers in a rural community hospital were queried about factors associated with blood pressure (BP) accuracy. Results suggest remedial education regarding cuff size, patient position, arm position, and location for accurate BP measurement is needed.

Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants.

The present study was designed to compare milk production and hormone responses (prolactin [PRL], oxytocin [OT]) and to determine associations of hormone levels with milk production in mothers of preterm (PT) and term (TM) infants during the first 6 weeks postpartum. Mothers of PT infants (n = 95) were all pump dependent; mothers of TM infants (n = 98) were all feeding their infant at breast. Mothers of nonnursing PT infants produced less milk over time compared to mothers of TM infants. A higher proportion of PT mothers had lower basal PRL levels compared with TM mothers. PRL and frequency of breast stimulation combined positively influenced milk production in PT mothers. OT levels were higher in PT versus TM mothers, but OT was not related to milk production. Further study is warranted regarding interventions to enhance milk production, particularly in pump-dependent mothers of PT infants.

Intuition in Clinical Decision Making: Differences Among Practicing Nurses.

PURPOSE: To examine the relationships and differences in the use of intuition among three categories of practicing nurses from various clinical units at a medical center in the Midwest. DESIGN: Descriptive, correlational, cross-sectional, prospective design. METHOD: Three categories of nurses were based on the clinical unit: medical/surgical nurses ( n = 42), step-down/progressive care nurses ( n = 32), and critical care nurses ( n = 24). Participants were e-mailed the Rew Intuitive Judgment Scale (RIJS) via their employee e-mail to measure intuition in clinical practice. Participants were also asked to rate themselves according to Benner's (novice to expert) proficiency levels. FINDINGS: Nurses practicing at higher self-reported proficiency levels, as defined by Benner, scored higher on the RIJS. More years of clinical experience were associated with higher self-reported levels of nursing proficiency and higher scores on the RIJS. There were no differences in intuition scores among the three categories of nurses. CONCLUSION: Nurses have many options, such as the nursing process, evidence-based clinical decision-making pathways, protocols, and intuition to aid them in the clinical decision-making process. Nurse educators and development professionals have a responsibility to recognize and embrace the multiple thought processes used by the nurse to better the nursing profession and positively affect patient outcomes.

Predictors of preterm infant feeding methods and perceived insufficient milk supply at week 12 postpartum.

As part of a large, nonexperimental, prospective, longitudinal study, 94 pump-dependent mothers of a nonnursing preterm infant were queried via telephone at weeks 8 to 12 post-partum about their infant feeding method. At week 12, 44.6% provided own mother's milk, 26.6% provided own mother's milk + artificial milk, and 28.7% provided artificial milk only. Logistic regression analyses identified the following predictors for risk of artificial milk at week 12 postpartum: multiple birth, week 6 inadequate milk supply, maternal age younger than 29 years, and intended length of lactation less than 34 weeks. Predictors for risk of maternal perceived insufficient milk supply for weeks 8 to 12 postpartum included week 6 inadequate milk supply, unemployment, and infant hospital discharge after postpartum day 42. Further research is needed to assist pump-dependent mothers of preterm infants with sustaining their milk supply.

Comparison of milk output between breasts in pump-dependent mothers.

This article reports the naturally occurring pattern of milk output beginning day 6 through day 42 postpartum from each individual breast in 95 pump-dependent mothers of a non-nursing preterm infant. Of the 3488 study days, milk output was greater from the left breast on 51.6% (n = 1800) of the study days, from the right breast 45.8% (n = 1598) of the study days, and equal 2.6% (n = 90) of the study days. Overall, total left and right breast milk output for the entire study (37 days) was 52.6% and 47.4%, respectively. There was no significant relationship between individual breast milk output and maternal handedness, parity, or breastfeeding experience. Clinicians need to assess the total milk output as well as individual breast output in lactating mothers, as there may be significant disparities in milk production.

Maternal perceived quality of life following childbirth.

OBJECTIVE: To examine preterm, near-term, and term mothers' self-reported quality of life in the early postpartum period. DESIGN: Prospective, longitudinal repeated measures design. SETTING: Four medical centers in the Midwest. PATIENTS/PARTICIPANTS: A convenience sample of 184 mothers of either a preterm, near-term, or term infant. MAIN OUTCOME MEASURE: Maternal Postpartum Quality of Life tool. RESULTS: Mothers of preterm infants scored significantly lower on the subscale psychological/baby of the Maternal Postpartum Quality of Life tool compared to mothers of near-term and term infants. CONCLUSIONS: Infant gestational age at birth has relevance for maternal quality of life during the postpartum period. Health care professionals need to be cognizant relative to infant gestational age and individualize nursing care.

Medication errors in a rural hospital.

The purpose of this investigation was to compare and contrast three nursing shifts in a small rural Midwestern hospital with regard to the number of reported medication errors, the units on which they occurred, and the types and severity of errors. Results can be beneficial in planning and implementing a quality improvement program in the area of medication administration with the nursing staff.

Mood states and milk output in lactating mothers of preterm and term infants.

The purpose of this study is to compare psychological distress via both negative and positive mood states between 2 different groups of lactating mothers during the first 6 weeks postpartum with a large sample. Mood states were measured using the Multiple Affect Adjective Check List-Revised by a convenience sample of newly delivered mothers from 4 tertiary care units in Illinois. Preterm mothers' negative mood states of anxiety, depression, hostility, and dysphoria were significantly greater than those reported for term mothers. For the positive mood states of positive affect and PASS (positive affect + sensation seeking), preterm mothers had significantly lower scores than term mothers; there were no differences for the positive mood state, Sensation Seeking. Maternal perceived mood states had no apparent effect upon lactation as measured by milk volume produced. Further study is warranted to determine what factors influence milk output in mothers of preterm and term infants who are at risk for lactation failure.

Cultural sensitivity education for nurses: a pilot study.

Health professionals need to be responsive to changing demographics, especially the growing Hispanic American population. This pilot project explored the effect that an education program about selected Hispanic health beliefs and practices had on nurses who provide care to this population. Seven white registered nurses employed at a small, rural health department completed a 10-item, researcher-designed instrument, termed the Lee Cultural Sensitivity Tool: Hispanic Version, before and after an educational intervention. Findings showed that the intervention increased knowledge of selected Hispanic health beliefs and practices.

Maternal Postpartum Quality of Life Questionnaire.

This article summarizes the development and psychometric properties of the first self-administered, paper-and-pencil instrument that measures maternal quality of life during the early postpartum period. The definition, domains, and conceptual model by Ferrans and Powers (QLI) were used to develop the Maternal Postpartum Quality of Life (MAPP-QOL) tool. A convenience sample of 184 mothers completed the MAPP-QOL at week 1 and 3 postpartum. Component analysis revealed five domains: psychological/baby; socioeconomic; relational/spouse-partner; relational/family-friends; and health & functioning. Internal consistency reliability for the five subscales resulted in Cronbach's alpha coefficients ranging from .82 to .96. Stability reliability ranged from .66 to .76. The MAPP-QOL and a single-item measure of life satisfaction correlated (r = .69), suggesting convergent validity; discriminant validity was supported by negative correlations with the three negative mood states of the Multiple Affect Adjective Check List-Revised (MAACL-R) as well as poor sleep and fatigue scores. Acceptable reliability and construct validity suggest that the MAPP-QOL may be used in research. Further testing with larger and more diverse samples is recommended.

Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth.

This study reports the temporal pattern of milk output in 2 groups of lactating mothers during the first 6 weeks postpartum. A study aim was to examine if the average milk output for postpartum days 6 and 7 (baseline) predicts milk adequacy at week 6 postpartum. Mothers of preterm (< or = 31 weeks) infants (n = 95) used mechanical expression to initiate and maintain their milk supply; mothers of a singleton healthy term infant (n = 98) fed their infant at the breast. Baseline milk output was predictive of milk adequacy, defined as > or = 500 mL/d at week 6 (P = .000). Preterm mothers were 2.81 times more at risk of not producing adequately than term mothers were. Study findings suggest that interventions that promote the initiation and maintenance of an adequate milk supply during the first week postbirth are critical.