The Influence of Race and Gender on Nursing Care Decisions: A Pain Management Intervention.

BACKGROUND: Understanding whether a patient's race or gender and/or the nurse's race or gender influence how nurses form care decisions can contribute to exploration of methods that can positively affect disparate treatment. AIMS: This research examined how the variables of race and gender of both the nurse and the patient influence nurses' decision making about pain management. DESIGN: A randomized four-group post-test-only experimental design was used to examine the variables and variable interactions. SETTINGS: An investigator-developed case vignette tool hosted online was used to obtain data about nursing pain management decisions. The vignette intervention was developed to simulate four exact patient scenarios that differed only by patient race and gender. Participants/Subjects: A quota sample of 400 nurses was recruited using a self-selected face-to-face recruitment technique. METHODS: A four-way between-groups analysis of variance assessed whether the gender of the nurse, race of the nurse, gender of the patient, or race of the patient made any differences in the dose intensity of pain medications selected by the nurse sample. RESULTS: No significant interactions were noted between any combinations of the four independent variables. A significant main effect was noted in medication intensity for nurse gender (F [1,384] = 9.75, p = .002). CONCLUSIONS: Data trends suggested that gender stereotypes about how patients managed pain played a role in dose intensity decisions because female patients on average were given higher doses of pain medication than male patients were by all the nurses in the study. Further research is needed in this complex area of study.

Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014.

BACKGROUND: Variations in care for pregnant women have been reported to affect pregnancy outcomes. METHODS: This study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored. RESULTS: Medicaid beneficiaries enrolled at AABC sites had diverse socio-behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low-risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery-led prenatal care, and 84% with midwifery- attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4-times greater risk of cesarean birth among medically low-risk childbearing Medicaid beneficiaries. CONCLUSIONS: The birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.

The Influence of Race and Gender on Pain Management: A Systematic Literature Review.

Racial and gender disparities in health are well documented in health science literature. Racial minorities and women are known to receive disproportionately poorer quality of health care when compared to non-Hispanic Whites. It is unknown why women and particular racial and ethnic minorities are more susceptible to experience disparities in patient care. Moreover, with pain being the most common complaint for those entering the healthcare system, gaps in understanding the potential relationship between the nurse provider's gender and/or race and ethnicity and pain management deserve exploration. A systematic literature review has been conducted to explore the current state of knowledge related to providers, health disparities, and pain. Much of the research to date has focused on the provider-patient relationship to health disparities in pain management. Further research is needed to examine how provider-patient interactions may influence patient outcomes, satisfaction, adherence and disparities in health.

Forensic nursing science knowledge and competency: the use of simulation.

Forensic nursing is a nursing specialty that provides services to a variety of patient populations who have experienced violence, including interpersonal violence, sudden or unexpected death, and motor vehicle collisions. However, many critical care nurses have received the background knowledge or practical skills required to provide the level of care required by many forensic patients. The purpose of this study was to determine whether differences in knowledge or practical competence exist between participants using 2 different learning modalities: medium fidelity simulation versus face-to-face lecture. Participants who were enrolled in an elective online forensic nursing science course were randomly assigned to an intervention or control group. The 18 intervention group participants were given three 2-hour forensic simulation sessions in the laboratory. The 17 control group participants attended 3 face-to-face lectures covering forensic science topics. All study participants also received the same forensic course content via the online Blackboard platform. No significant differences were found between the 2 groups in either knowledge or practical competency. The lack of results may have been heavily influenced by the small sample size, which resulted in insufficient power to detect possible differences.

Afghanistan and Iraq war veterans' health care needs and their underuse of health care resources: implications for psychiatric-mental health nurses.

U.S. Veterans who have served in the Afghanistan and Iraq wars have combat-related medical and mental health issues, notably posttraumatic stress disorder and traumatic brain injury, but underuse health care resources. To better understand their health care needs, resource use, and facilitators and barriers to seeking health care, a literature review was conducted. The results suggest high prevalence of mental and medical health issues and disproportionate use of quantitative research design that lacked approaches to understanding the psychosocial, cultural, and contextual factors that affect help-seeking by Veterans. Strategies to increase the likelihood that Veterans will seek needed health care, gaps in the literature, and the need for further research are discussed.

Proof of life: a protocol for pregnant women who experience pre-20-week perinatal loss.

One in 6 pregnancies is lost before the 20th week of gestation and the psychological impacts of this loss are frequently unaddressed while attention is focused on immediate physiological needs. To improve the comprehensive care provided to women experiencing pre-20-week loss, an evidence-based intervention protocol was developed to provide emotional support to these women in the immediate aftermath of the loss. The protocol was tested using a sample of 40 women who experienced a pre-20-week perinatal loss and were being treated in a large county emergency center. Twenty randomly selected women received the intervention protocol while another 20 women received the usual standard of care. Both groups completed the Perinatal Grief Scale during a routine 2-week follow-up visit. The results indicated that the intervention was effective in ameliorating the degree of despair in women experiencing an early pregnancy loss. Women receiving the protocol expressed feelings of being supported and cared for by the staff. Secondary benefits were an increased collaboration among health care professionals, development of an environment of empathy, and a change in the culture of belief that these women needed only physical care. Results indicate a need for a support protocol for all women experiencing loss regardless of gestational age.

Reducing the failure risk of interdisciplinary healthcare teams.

Interdisciplinary healthcare teams have become the new model for patient care delivery in today's complex healthcare environment of increased specialization and disciplinarity of healthcare providers. Research to support the efficacy of this model has been problematic because of poorly conceptualized interdisciplinary teams as well as methodological problems conducting the research. Findings from organizational studies and healthcare interdisciplinary research can be integrated into a theory-based model to design an educational workshop to develop team members. Development of team members is proposed as a means to enhance collaboration among team members and therefore reduce the risk of team failure.

A Randomized Trial of a Bereavement Intervention for Pregnancy Loss.

OBJECTIVE: To examine the effects of a secondary bereavement intervention on grieving in women who experienced a miscarriage (pregnancy loss) at 12-20 weeks gestation. DESIGN: Experimental, posttest only, control group design. SETTING: Obstetric emergency center of a county hospital in a large city. PARTICIPANTS: Forty women who experienced complete spontaneous miscarriages in the first or second trimester (8-20 weeks gestation). METHODS: Participants were randomly assigned to the grief intervention treatment group or usual standard care control group. The Medical Professional Guidelines for Health Care Professionals were used to construct the perinatal grief intervention. The Perinatal Grief Scale (PGS) was completed during a routine follow-up visit 2 weeks postloss. RESULTS: A one-way multiple ANOVA (MANOVA) was used to examine the difference in grieving between the control and experimental groups. Three dependent variables were used: despair, difficulty coping, and active grieving. Analysis revealed a significant difference on the combined dependent variables, F(3, 36) = 22.40, p < .000. When considering the three dependent variables separately, the treatment group displayed significantly lower levels of despair, F(1, 38) = 42.27, p < .001. Active grieving was high in both groups with the treatment group mean higher than the control group. Group means were similar for coping difficulty. CONCLUSION: A bereavement intervention administered immediately after the miscarriage promotes women's ability to cope with early pregnancy loss.

Faculty Experiences Developing and Implementing Policies for Exit Exam Testing.

Nursing schools use standardized exit examinations to determine student readiness for the NCLEX-RN. Yet little is known about how nursing programs develop policies for using the examinations, set benchmarks scores, and implement remediation strategies with their students. In a phenomenological study, faculty identified a testing policy process that fell into the major themes of triggers for change, policy modification, and reactions to change.

Predicting NCLEX-RN success with the HESI Exit Exam: eighth validity study.

Increasingly, Elsevier's HESI Exit Exam (E(2)) is being used to assess students' readiness for the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Seven previously conducted validity studies indicate that the E(2) is 96.36%-99.16% accurate in predicting NCLEX-RN success. Findings of this eighth validity study, which also investigated the predictive accuracy of repeat testing with parallel versions of the E(2), indicated that the E(2) is highly accurate (94.93%-98.32%) in predicting NCLEX-RN success for the initial testing and 2 retests. Of the 66 participating nursing programs, deans and directors from 43 (65.15%) of the programs reported implementing a policy that used E(2) scores as a benchmark for remediation. A score of 850 was the most common E(2) benchmark designated by faculties, and students who failed to achieve the faculty-designated E(2) benchmark score were required to retest with a parallel version of the E(2). Remediation resources used to assist students in achieving faculty-designated E(2) benchmark scores varied widely, with many programs employing multiple remediation methods.

Defragmenting care: testing an intervention to increase the effectiveness of interdisciplinary health care teams.

Few studies in the literature have examined the outcomes of health care interdisciplinary teams. Most existing studies have measured attributes of health care teams; however, none have implemented and examined outcomes of a team development intervention. This study was conducted to determine whether a development intervention used with an existing interdisciplinary team would reduce the length of stay for patients in an acute care setting. A quasi-experimental single-subject time series design was conducted with multiple measures of length of stay collected across baseline, intervention, and reversal phases of the study. Bronstein's Model for Interdisciplinary Collaboration provided the framework for this study. The components of this model were used to guide a team development intervention comprised of 4 consecutive weeks of classroom development sessions and 4 consecutive weeks of booster messaging. Length of stay (LOS) data were collected for each of the study phases to examine preintervention LOS and compare these data with LOS during the intervention and reversal phases. The results of this study revealed that the interdisciplinary team development intervention had no positive effect on the length of stay data. Baseline mean LOS across 12 baseline months was 4.83 days (SD=0.65) with monthly means ranging from 4.1 to 6.3 days. The mean LOS was 5.1 and 4.6 days for the intervention months of May and June and 6.0, 6.5, 5.7, and 5.4 days for the reversal months of July to October, respectively. All means in the intervention and reversal phases were higher than comparable months in the baseline phase. The pattern of the graphed trend was closely aligned with the seasonal variations seen during the baseline months. Although these results showed that the team development intervention provided for this interdisciplinary team had no positive effect on the LOS, there are many factors that may have influenced the results and may provide insights useful for future research. LOS may not be the outcome variable that reflects team effectiveness for this population. It is possible that the interdisciplinary team in this study had well-developed collaborative processes before the intervention. Physicians were not included in the team development intervention yet may be the discipline whose participation may have affected LOS.