Hydration Status of Assisted Living Memory Care Residents.

Water intake and hydration status of assisted living memory care (ALMC) residents were evaluated. Thirty-two residents (eight men; mean age 86.5 years; Global Deterioration Scale [GDS] 3 to 7) from four ALMC units participated. Ingested food and fluid amount, type, and time, and ingestion behaviors were observed from 7:00 a.m. to 7:00 p.m. Related factors were obtained from chart review/participant survey. Mean fluid intake was 1,160.16 mL; mean water intake from food and fluid was 56.55% (SD = 23.4%) of recommended water intake (RWI). Only one participant met 100% RWI. Using osmolality laboratory results (available for 21 participants), five participants were hydrated, whereas eight (38.1%) participants were in impending dehydration and dehydration categories, respectively. Fluid intake, GDS, and level of assistance during meals predicted RWI. Water intake of ALMC residents is inadequate, placing them at risk for dehydration, and justifies development and implementation of care standards for increasing water intake. [Journal of Gerontological Nursing, 45(4), 21-29.].

Leadership Strategies, An Interdisciplinary Team, and Ongoing Nurse Feedback: Ingredients For a Successful BCMA Project.

Barcode medication administration (BCMA) implementation represents a change in a complex process requiring significant modifications in the work of nurses. Nurses' voices are critical for successfully implementing BCMA technology to support this change in nursing practice. Feedback from nurses who administered medications was critical to selecting and refining a BCMA system that supported their practice needs. Feedback regarding implementation status was critical for keeping key stakeholders across the institution informed of the progress and initial impact of the implementation. Nursing leadership engagement throughout the process supported the successful adoption of new workflow processes and technology.

The relationship between RN job satisfaction and accountability.

The purpose of this descriptive correlational secondary data analysis is to describe the relationship between job satisfaction and accountability among registered nurses with clinical responsibilities employed by a rural health care network in the Midwest. The response rate from the primary study is 39%, with 337 RN respondents. The sample for this secondary analysis is 299. The instruments used to measure accountability and job satisfaction are the Specht and Ramler Accountability Index-Individual Referent and the McCloskey-Mueller Satisfaction Scale (MMSS). The results indicate that accountability is perceived to be relatively high and job satisfaction is moderate. Accountability and job satisfaction are significantly correlated at a moderate level. The correlations between the subscales of the MMSS and accountability are all statistically significant but low. The subscales with the highest correlations (e.g., control and responsibility, praise and recognition, professional opportunities, scheduling) provide direction for nurse administrators about important target areas for improvement.

Work complexity assessment, nursing interventions classification, and nursing outcomes classification: making connections.

When nurses understand what interventions are needed to achieve desired patient outcomes, they can more easily define their practice. Work Complexity Assessment (WCA) is a process that helps nurses to identify interventions performed on a routine basis for their specific patient population. This article describes the WCA process and links it to the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). WCA, NIC, and NOC are all tools that help nurses understand the work they do and the outcomes they achieve, and that thereby acknowledge and validate nursing's contribution to patient care.

Staff Nurse Decisional Involvement in the United States and Turkey.

The purpose of this descriptive comparative study is to compare the levels of decisional involvement of staff nurses between one Midwestern health care system in the United States with a nongovernmental University hospital in Turkey. The Decisional Involvement Scale was used for data collection. U.S. ( n = 163) and Turkey ( n = 50) staff nurses were included in the study. Both samples preferred more decisional involvement than they currently experienced. However, Turkish nurses experienced and preferred lower levels of decisional involvement than the U.S. SAMPLE: Shared governance structures may be a strategy used to enhance staff nurse decisional involvement.

Decisional involvement among staff nurses based on educational level and certification status.

Mechanisms to enhance the work environment are nurse decisional involvement (DI), obtainment of a baccalaureate or higher degree, and specialty certification. The purpose of this descriptive comparative study was to determine the difference between actual and preferred DI of staff nurses on the overall Decisional Involvement Scale (DIS), the differences based on its subscales, and those based on education level and certification. The sample included 163 staff nurses from a Midwestern health care organization. A statistically significant difference was found between actual and preferred DI, but no difference was found based on educational level and certification. There is a need to focus on nurses with a BSN/master's degree or specialty certification and to conduct comprehensive studies to address the effects of education and certification on DI. An additional strategy that can be useful for organizations is to provide nurses with the empowerment structures, expectations, and mentoring/coaching to become involved in the process of decision making.

Using the nursing interventions classification to describe the work of the nurse practitioner.

PURPOSE: To extend the specialty use research based on the Iowa Intervention Project using the Nursing Interventions Classification (NIC) and identify and the 20 most prevalent interventions described by practicing nurse practitioners (NPs). DATA SOURCES: A descriptive survey using a mailed questionnaire was sent to 1,190 NPs with prescriptive authority in Minnesota. Results are based on 414 (37%) useable responses. CONCLUSIONS: Of the 486 NIC interventions on the questionnaire, NPs reported using an average of 120 at least once per month. The 20 most frequently selected were reported by 71%-90% of respondents as being used at least once per month. Four core interventions (documentation, telephone consultation, teaching: prescribed medication, and emotional support) were common to NPs in all specialties. IMPLICATIONS FOR PRACTICE: Common medical coding does not reflect the nursing aspects of NP practice. As NPs attempt to define what is different about NP practice, the use of a standardized nursing language such as the NIC may facilitate this process. One clarification that needs to be made with regard to the NIC in future research with NPs is the distinction between prescribing and performing the interventions.

Decisional involvement: actual and preferred involvement in decision-making among registered nurses.

Enhancing nurse involvement in decision-making is a starting point in addressing the nursing shortage, recruitment, and retention. The purpose of this descriptive comparative secondary data analysis was to describe the level of registered nurses' actual and preferred decisional involvement (DI) in two studies carried out during 2004 and 2010 and to describe the difference in the levels of actual and preferred DI between the 2004 study (N = 290) and the 2010 (N = 111) study in a Midwestern medical center after a new shared governance structure was implemented. In the 2004 and 2010 studies, there were statistically significant differences between actual and preferred levels of DI. A statistically significant decrease in means occurred in actual and preferred DI in 2010 as compared with that in 2004. A concerted effort must be made by nursing leaders to enhance DI, offer adequate resources, promote learning and growth, and recognize nursing contributions within a shared governance.

Implications of electronic health record meaningful use legislation for nursing clinical information system development and refinement.

PURPOSE: To describe what electronic health record meaningful use requirements mean for nursing clinical information system (CIS) development. CONCLUSIONS: The nursing CIS in many, if not most hospitals, has a number of critical design inadequacies that constrain the meaningful use of nursing data to ensure quality outcomes for patients and data-based maturing of the nursing profession. IMPLICATIONS: It is the responsibility and obligation of nurses to ensure that CISs are designed for the meaningful use of nursing clinical data. To accomplish these ends, interoperable clinical nursing data must be documented in a properly integrated operational CIS, and must be retrievable and stored in data repositories for analysis and reports.

Evaluation of outcome change scores for patients with pneumonia or heart failure.

This study was conducted to describe the variance in selected Nursing Outcomes Classification (NOC) outcome change scores of hospitalized older patients with pneumonia (n = 216) or heart failure (HF; n = 67) that could be explained by age, length of stay (LOS), number of comorbid conditions, number of nursing diagnoses, and number of nursing interventions. Investigators used a descriptive correlational design to analyze data sets from three U.S. community hospitals. Study participants had at least two ratings on one of nine outcomes selected for their frequency and use across the three hospitals. A significant portion of the variance in the outcomes Knowledge: Illness Care and Fall Prevention Behavior was explained for pneumonia patients. None of the regression models for HF patients showed significance. Individual independent variables were significant in some of the models (i.e., LOS [pneumonia], number of nursing diagnoses [pneumonia and HF]). Implications for research and clinical practice are discussed.

Decisional involvement: staff nurse and nurse manager perceptions.

Enhancing involvement in organizational decisions is one strategy to improve the work environment of registered nurses and to increase their recruitment and retention. Little is known about the type of decision making and the level of involvement nurses desire. This was a descriptive study exploring staff nurse and nurse manager ratings of actual and preferred decisional involvement and differences between staff nurses and nurse managers. A sample of 320 RNs from a Midwestern health care network was surveyed using the Decisional Involvement Scale. Nurse managers and staff nurses had statistically significant differences in their perceptions of who was involved in actual decision making in the areas of unit governance and leadership and collaboration or liaison activities. There were statistically significant differences in preferred decisional involvement between staff nurses and nurse managers in the overall DIS scale and the subscales of unit governance and leadership and quality of support staff practice.

Most frequent nursing diagnoses, nursing interventions, and nursing-sensitive patient outcomes of hospitalized older adults with heart failure: part 1.

PURPOSE: Rank and compare the 10 most frequently documented nursing diagnoses, interventions, and patient outcomes using NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification for care of patients with heart failure (HF). METHODS: A descriptive comparative multisite study of documented care for 302 older adults with HF. FINDINGS: There were four common nursing diagnoses, two interventions, and only three common outcomes across three sites. CONCLUSIONS: This and similar analyses of clinical nursing data can be used by nursing administrators and clinicians to monitor the quality and effectiveness of nursing care. IMPLICATIONS: Similar analyses may be used for continuing education, quality improvement, and documentation system refinement. Part 2 will discuss data retrieval and implications for building a multiorganizational data warehouse.

Minnesota nurses' perceptions of nursing diagnoses.

PURPOSE: The study aims to identify Minnesota nurses' perceptions regarding nursing diagnoses and to examine how these perceptions have changed over time. METHODS: Five hundred sixty-four out of 2,000 randomly selected registered nurses in Minnesota responded to the Perceptions of Nursing Diagnosis Survey. FINDINGS: Nurses have neutral to slightly negative perceptions of nursing diagnoses. These results differ slightly from the results of the original study which demonstrated neutral to slightly positive perceptions. IMPLICATIONS: After 30 years of use, it is concerning that more than half of nurses surveyed have a negative perception of nursing diagnosis. Consideration should be given to methods that facilitate the use of nursing diagnoses in practice, improvement of diagnostic language, or a more accepted method of planning patient care.

Nursing clinical documentation data retrieval for hospitalized older adults with heart failure: part 2.

PURPOSE: The study aims to discuss the implications for retrieval of nursing data and building a multiorganizational data warehouse. METHODS: The method used was a descriptive comparative multisite study of documented care for 302 older adults with heart failure. Unit and patient level variables were retrieved. FINDINGS: Data regarding the most identified variables were retrievable electronically. Important linkages among nursing data elements were not present. CONCLUSIONS: Data were retrievable and the building of a data warehouse was possible and lessons were learned. IMPLICATIONS: When clinical information systems (CISs) are developed, developers and nurses must discuss how standardized data will be entered to ensure retrieval and usefulness in evaluating nursing care. For nursing effectiveness research, CISs must also provide linkages among nursing diagnoses and specific interventions, and nursing-sensitive patient outcomes.

Nursing diagnoses, interventions, and patient outcomes for hospitalized older adults with pneumonia.

A study was conducted by academic and community hospital partners with clinical information systems that included the standardized nursing language classifications of the North American Nursing Diagnosis Association International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). The aim of the study was to determine the frequency of NANDA-I, NIC, and NOC (NNN) terms documented for older adults with pneumonia who were discharged from three hospitals during a 1-year period. NNN terms were ranked according to frequency for each hospital, and then the rankings were compared with previous studies. Similarity was greater across hospitals in rankings of NANDA-I and NOC terms than in rankings of NIC terms. NANDA-I and NIC terms are influenced by reimbursement and regulatory factors as well as patient condition. The 10 most frequent NNN terms for each hospital accounted only for a small to moderate percentage of the terms selected.

Outcomes related to dehydration in the pediatric population.

The purpose of this pilot study was twofold: 1) to determine whether there was a statistically significant difference in nursing-sensitive patient outcome ratings from admission to discharge, and 2) to describe nursing interventions used to care for children admitted with a primary diagnosis of dehydration to a 272-bed Midwestern community hospital. Twenty-nine patient care records meeting study criteria were extracted from all pediatric admission records during the study period. The patient care records are part of a computerized clinical documentation system using the standardized nursing languages of the North American Nursing Diagnosis Association, the Nursing Interventions Classification, and the Nursing Outcomes Classification (NOC). A statistically significant improvement in outcome ratings from admission to discharge was demonstrated for seven of eight NOC outcomes.

Perceptions and characteristics of registered nurses' involvement in decision making.

PURPOSE: This study aimed to determine the level of actual and preferred decisional involvement and ascertain whether there is decisional dissonance among registered nurses (RNs). SUBJECTS AND METHODS: A convenience sample of 196 RNs completed a demographic form and the Decisional Involvement Scale, a tool that measures actual and preferred decisional involvement for RNs in 6 categories: unit staffing, quality of professional practice, professional recruitment, unit governance and leadership, quality of support staff practice, and collaboration/liaison activities. From these data, the level of and difference between RN's actual and preferred decisional involvement was analyzed. In addition, the impact of level of education, years of experience, hours worked per pay period, and work setting on actual and preferred decisional involvement were measured. RESULTS AND CONCLUSIONS: A statistically significant difference was found between RNs' actual and preferred decisional involvement, with RNs preferring more decisional involvement than they actually experienced. Work setting was the only variable to which a difference could be attributed. Further study is warranted to find causes of decisional dissonance and interventions that could help alleviate the problem and potentially increase job satisfaction.

Outcomes research: making a difference in practice.

The purpose of this pilot study was to determine whether a significant difference in outcome ratings exists from admission to discharge for selected populations. Two acute care sites that have standardized nursing languages in their computerized clinical documentation systems participated. These data are an important start in using patient outcomes to determine the effect of nursing interventions. These data clearly suggest that nursing care did make a difference in patient outcomes.