Publications

Abstract

MicroRNAs are structural components of an epigenetic mechanism of posttranscriptional regulation of messenger RNA translation. Recently, there has been significant interest in the application of microRNA as a blood-based biomarker of underlying physiological conditions. Dyslipidemia is a complex, heterogeneous condition conferring substantially increased risk for cardiovascular disease. The purpose of this review is to describe the current body of knowledge on the role of microRNA regulation of lipoprotein metabolism in humans and to discuss relevant methodological and study design considerations. We highlight the potential roles for microRNA in geneenvironment interactions.

Abstract

MicroRNAs are structural components of an epigenetic mechanism of post-transcriptional regulation of messenger RNA translation. Recently, there is significant interest in the application of microRNA as a blood-based biomarker of underlying physiologic conditions, and the therapeutic administration of microRNA inhibitors and mimics. The purpose of this review is to describe the current body of knowledge on microRNA regulation of genes involved in lipid metabolism, and to introduce the role of microRNA in development and progression of atherosclerosis.

Abstract

Background: Increasing participation of registered nurses (RNs) in quality improvement (QI) is a promising strategy to close the health care quality chasm. For RNs to participate effectively in hospital QI, they must have adequate QI knowledge and skills. Methods: This descriptive study assessed employersponsored QI education and RNs' preparedness across a wide range of QI steps and processes. RNs from 15 U.S. states who were employed in hospitals and were initially licensed to practice in 2007 to 2008 were surveyed. Results: Fewer than one third of respondents reported being very prepared across all measured QI topics. More than half reported receiving zero hours of training in these same topics in the last year. Lack of educational offerings on the topic was the top reason respondents gave for not obtaining QI training. Conclusion: The QI education offered by employers to RNs could be substantially improved. Nurse educators play a critical role in making these improvements.

Abstract

Background : Most heart failure patients have multiple comorbidities. Objective: This study aims to test the moderating effect of comorbidity on the relationship between self-efficacy and self-care in adults with heart failure. Methods: Secondary analysis of four mixed methods studies (n = 114) was done. Self-care and self-efficacy were measured using the Self-Care of Heart Failure Index. Comorbidity was measured with the Charlson Comorbidity Index. Parametric statistics were used to examine the relationships among self-efficacy, self-care, and the moderating influence of comorbidity. Qualitative data yielded themes about self-efficacy in self-care and explained the influence of comorbidity on self-care. Results: Most (79%) reported two or more comorbidities. There was a significant relationship between self-care and the number of comorbidities (r =-.25; p = .03). There were significant differences in self-care by comorbidity level (self-care maintenance, F[1, 112], 5.96, p = .019, and self-care management, F[1, 72], 4.66, p = .034). Using moderator analysis of the effect of comorbidity on self-efficacy and self-care, a significant effect was found only in self-care maintenance among those who had moderate levels of comorbidity (b = .620, p = .022, Fchange df[6,48], 5.61, p = .022). In the qualitative data, self-efficacy emerged as an important variable influencing self-care by shaping how individuals prioritized and integrated multiple and often competing self-care instructions. Discussion: Comorbidity influences the relationship between self-efficacy and self-care maintenance, but only when levels of comorbidity are moderately high. Methods of improving self-efficacy may improve self-care in those with multiple comorbidities.

Abstract

BACKGROUND:: Surgical stress has been shown to result in immune disturbance. Neuraxial anesthesia (NA) has long been hypothesized to blunt undesired surgical insults and thus limit immune compromise and improve surgical outcomes. We hypothesized that NA would decrease postoperative infectious complications compared with general anesthesia (GA) among knee arthroplasty patients. METHODS:: We studied the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010. There were 16,555 patients included in our final cohort, with 9167 patients receiving GA and 7388 patients receiving spinal or epidural anesthesia.. Outcomes of interest included infection-related 30-day postoperative complications, including surgical site-related infections, pneumonia, urinary tract infection, sepsis, septic shock, and a composite end point of any systemic infection. Multivariable logistic regression was performed to test for effect of anesthesia type while adjusting for the influence of preexisting comorbidities. RESULTS:: The overall mortality was 0.24% and 0.15% among NA and GA subjects, respectively (P = 0.214). NA subjects had fewer unadjusted incidences of pneumonia (P = 0.035) and composite systemic infection (P = 0.006). After risk adjustment for preexisting comorbidities, NA was associated with lower odds of pneumonia (odds ratio = 0.51 [95% confidence interval, 0.29-0.90]) and lower odds of composite systemic infection (odds ratio = 0.77 [95% confidence interval, 0.64-0.92]). CONCLUSIONS:: Our study suggested that NA was associated with lower adjusted odds of both pneumonia and a composite outcome of any systemic infectious complication within 30 days of surgery compared with GA.

Abstract

Aim: To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff. Background: Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied. Design: A cross-sectional design with a survey. Method: A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010-April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables. Results: An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables. Conclusion: In psychiatric hospitals as in general hospitals, nurse-physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers.

Abstract

Objective: To explore maternity nurses' perceptions of women's informed decision making during labor and birth to better understand how interdisciplinary communication challenges might affect patient safety. Design: Constructivist grounded theory. Setting: Four hospitals in the western United States. Participants: Forty-six (46) nurses and physicians practicing in maternity units. Method: Data collection strategies included individual interviews and participant observation. Data were analyzed using the constant comparative method, dimensional analysis, and situational analysis (Charmaz, ; Clarke, ; Schatzman, ). Results: The nurses' central action of holding off harm encompassed three communication strategies: persuading agreement, managing information, and coaching of mothers and physicians. These strategies were executed in a complex, hierarchical context characterized by varied practice patterns and relationships. Nurses' priorities and patient safety goals were sometimes misaligned with those of physicians, resulting in potentially unsafe communication. Conclusions: The communication strategies nurses employed resulted in intended and unintended consequences with safety implications for mothers and providers and had the potential to trap women in the middle of interprofessional conflicts and differences of opinion.

Abstract

Purpose: The purpose of this review is to investigate literature related to organizational climate, define organizational climate, and identify its domains for nurse practitioner (NP) practice in primary care settings. Data sources: A search was conducted using MEDLINE, PubMed, HealthSTAR/Ovid, ISI Web of Science, and several other health policy and nursingy databases. Conclusions: In primary care settings, organizational climate for NPs is a set of organizational attributes, which are perceived by NPs about their practice setting, emerge from the way the organization interacts with NPs, and affect NP behaviors and outcomes. Autonomy, NP-physician relations, and professional visibility were identified as organizational climate domains. Implications for practice: NPs should be encouraged to assess organizational climate in their workplace and choose organizations that promote autonomy, collegiality between NPs and physicians, and encourage professional visibility. Organizational and NP awareness of qualities that foster NP practice will be a first step for developing strategies to creating an optimal organizational climate for NPs to deliver high-quality care. More research is needed to develop a comprehensive conceptual framework for organizational climate and develop new instruments to accurately measure organizational climate and link it to NP and patient outcomes.

Abstract

Background: Deficiencies in the paediatric emergency systems of developing countries may contribute to avoidable paediatric mortality. Studies suggest that nurses and doctors may not be educationally prepared to provide immediate paediatric resuscitative care to acutely ill children. The purpose of this study was to determine if a 1-day World Health Organization (WHO) Emergency Triage and Assessment Treatment (ETAT) Program in paediatric resuscitation would increase Ghanaian nurses' knowledge and self-efficacy of paediatric resuscitation. Methods: A pre-experimental, one-group, pre-test, post-test design was used to assess differences in the nurses' knowledge of paediatric resuscitation, and their perceived self-efficacy of paediatric resuscitation after completing a 1-day educational intervention in paediatric resuscitation. Forty-one nurses from a public teaching hospital in Ghana were recruited and participated in the study. Results: Using a paired samples t-test, there was a statistically significant increase in the nurses' perceived self-efficacy of paediatric resuscitation in general (P<0.000), perceived self-efficacy of bag and mask ventilation (P<0.000), and knowledge of paediatric resuscitation (P<0.000). Conclusions: Findings from this study suggest that a 1-day WHO ETAT Program may increase self-efficacy of paediatric resuscitation and knowledge of paediatric resuscitation. Clinical Relevance: Policy makers in Ghana need to consider implementing education programmes in paediatric resuscitation for nurses as part of a comprehensive strategy to improve emergency systems and address preventable and avoidable infant and child mortality.

Abstract

Objective: This study investigated clinicians' perspectives during a quality improvement project to promote breastmilk feedings in premature infants. Study Design: From 2009 to 2010, 11 hospitals in the California Perinatal Quality Care Collaborative participated in a project to promote breastmilk feedings in premature infants. Audio recordings of monthly meetings held to encourage sharing of ideas were analyzed using qualitative methods to identify common themes related to barriers and solutions to breastmilk feeding promotion. Results: Two broad categories were noted: communication and team composition. Communication subthemes included (1) communication among hospital staff, including consistent documentation, (2) communication with family, and (3) communication between transfer hospitals. Team composition subthemes included (4) importance of physician buy-in and (5) integrated teams designed to empower leaders. Conclusions: Optimizing communication among health professionals and parents and improving team composition may be key components of facilitating breastmilk feeding promotion in premature infants.

Abstract

Background: Intravaginal practices including vaginal washing have been associated with HIV-1 acquisition. This association may be mediated by mucosal disruption, changes in vaginal flora or genital tract inflammatory responses. Reducing vaginal washing could lower women's risk of HIV-1 acquisition. Methods: 23 HIV-1 seronegative women who reported current vaginal washing were recruited from a prospective cohort study of high-risk women in Mombasa, Kenya. A theoretical framework including information-motivation -behavioural skills and harm reduction was implemented to encourage participants to reduce or eliminate vaginal washing. At baseline and after 1 month, we evaluated vaginal epithelial lesions by colposcopy, vaginal microbiota by Nugent 's criteria and vaginal cytokine milieu using ELISA on cervicovaginal lavage specimens. Results: The most commonly reported vaginal washing substance was soap with water (N=14, 60.9%). The median frequency of vaginal washing was 7 (IQR 7-14) times per week. After 1 month, all participants reported cessation of vaginal washing (p=0.01). The probability of detecting cervicovaginal epithelial lesions was lower (OR 0.48; 95% CI 0.20 to 1.16; p=0.10) and the likelihood of detecting Lactobacillus by culture was higher (OR 3.71, 95% CI 0.73 to 18.76, p=0.11) compared with baseline, although these results were not statistically significant. There was no change in the prevalence of bacterial vaginosis. Most cytokine levels were reduced, but these changes were not statistically significant. Conclusions: A theory-based intervention appeared to have a positive effect in reducing vaginal washing over 1 month. Larger studies with longer follow-up are important to further characterise the effects of vaginal washing cessation on biological markers.

Abstract

Background: Verbal abuse in the workplace is experienced by registered nurses (RNs) worldwide; physicians are one of the main sources of verbal abuse. Purpose: To examine the relationship between levels of physician verbal abuse of early-career RNs and demographics, work attributes, and perceived work environment. Method: Fourth wave of a mailed national panel survey of early career RNs begun in2006. Discussion: RNs' perception of verbal abuse by physicians was significantly associated with poor workgroup cohesion, lower supervisory and mentor support, greater quantitative workload, organizational constraints, and nurse-colleague verbal abuse, as well as RNs' lower job satisfaction, organizational commitment, and intent to stay. Conclusion: RNs working in unfavorable work environments experience more physician abuse and have less favorable work attitudes. Causality is unclear: do poor working conditions create an environment in which physicians are more likely to be abusive, or does verbal abuse by physicians create an unfavorable work environment?

Abstract

At a time of profound challenges in health care delivery and professional education characterized by imperatives to improve quality, responsiveness to client needs and efficient use of existing resources, the relationship between nursing education and service is in deep need of reinforcement and rethinking. Important directions for the future include attending to the complementary roles of academia and service in ensuring patient- and family-centered care, building reciprocity in the relationship between clinical agencies and universities, clarifying the intersecting roles of clinical agencies in the generation of various types of research and scholarship, engaging nurses and trainees at all roles within the profession in local- and higher-level health policy, and reinventing joint roles between service and academia.

Abstract

As the American workforce ages, health problems associated with the aging process, like coronary heart disease (CHD) raise new occupational health issues. To date, research on employment among patients with CHD has focused on return to work after an adverse event (e.g., heart attack) as an outcome with little attention paid to how workers function once back at work. The purpose of this integrative literature review was to examine presenteesim among older workers with CHD. The electronic databases that were utilized for this review include: Pubmed, CINAHL, Medline, and PsycInfo with limitations set as published in English from 1992 to 2012 and adults over age 45 (to capture studies focused on older workers). Twelve studies in which presenteeism was measured in older workers with CHD were reviewed. There were 3 key findings: 1) definitions and measurement of presenteeism and CHD diagnosis were inconsistent, 2) the primary focus was on quantifying the economic impact of presenteeism, and 3) job-level and individual-level factors that potentially influence presenteeism were not addressed. Implications for future research include the need for methods that address the gaps identified in this review. Recommendations include the need for longitudinal studies that specifically focus on older workers with CHD and development and testing of theoretical frameworks to guide research design.

Abstract

Background: The purpose of this study was to evaluate the prevalence, patterns and predictors (individual, social, cultural, and environmental) of illicit drug use and binge drinking in a cohort of Latino migrant men (LMM) in a new receiving community. Methods: A cohort of LMM in New Orleans (n= 125) was assembled in 2007 using respondent driven sampling and interviewed quarterly for 18 months regarding past month substance use and other potential covariates. Baseline frequencies were weighted using RDSAT and longitudinal analyses included generalized estimating equations (GEE) and the Cochran-Armitage test for trends. Results: At baseline, substance use behaviors were: drug use 15.0% (range 7.3-25.0%) and binge drinking 58.3% (range 43.6-74.6%). All three of these behaviors decreased over follow-up (P<. 0.01). Baseline alcohol dependence and drug problem were 11.8% (range 5.6-24.3%) and 0.08% (range 0.00-2.7%) and both remained the same over time. Baseline rate of chlamydia was 9% (range 0.00-22.4%); all men tested negative for gonorrhea, HIV, and syphilis. For both binge drinking and drug use, having sex with a female sex worker was associated with increased risk, whereas belonging to a club or organization was associated with less risk. Additional factors associated with increased drug use were: having a friend in New Orleans upon arrival, symptoms of depression, and working in construction. An additional factor associated with less binge drinking was having family in New Orleans upon arrival. Conclusion: Among LMM, substance use is influenced by social and environmental factors. Interventions increase community connectedness may help decrease usage.

Abstract

Although social justice and action for change are among the nursing profession's core values, curricular content on social entrepreneurship for nurses is not as well developed as it is in the educational programs for students in business, engineering, or public policy. This article describes an undergraduate honors elective course in social entrepreneurship offered at New York University College of Nursing. The course uses a seminar format and incorporates content from the humanities, business, and service-learning, with the goal of promoting participants' understanding of the sources of inequality in the United States and providing the requisite skills to promote effective nursing action for social change.