Publications

Abstract

BACKGROUND: Current evidence suggests that the economic recession has induced retired RNs to reenter nursing and working nurses to work more hours and delay retirement, thus easing the projected RN shortage. We wondered whether the economic downturn had affected new nurses' work attitudes and behaviors, including those related to turnover. OBJECTIVE: The purpose of this study was to compare perceptions about job opportunities, as well as key attitudinal variables (such as job satisfaction and intent to stay), in two cohorts of newly licensed RNs. METHODS: Our data came from two sources: a subset of new RNs licensed between August 1, 2004, and July 31, 2005, who were part of a larger 2006 study on turnover, and a later cohort of new RNs licensed between August 1, 2007, and July 31, 2008. We mailed survey questionnaires to one cohort before the recession in 2006 and to a second cohort during the recession in 2009. RESULTS: We found that RNs' commitment to their current employers was higher in the later cohort than in the earlier one, although neither nurses' incomes nor their reported job satisfaction levels had changed. CONCLUSIONS: Our findings suggest that, despite some improvements in working conditions, newly licensed RNs may just be waiting for the recession to end before changing jobs. Health care organizations' efforts to improve RNs' working conditions and wages, and to implement or support existing programs aimed at increasing retention, should be continued.

Abstract

Parents who are recent immigrants and/or non-native English speakers are at increased risk for poor health literacy. For example, misconceptions regarding treatment for upper respiratory infections (URIs), including nonjudicious use of antibiotics, have been described among Latinos. We sought to assess the influence of health literacy on knowledge and beliefs surrounding URI care and to explore the correlation between two health literacy measures among Latino parents in northern Manhattan. A descriptive survey design was used, and a total of 154 Latino parents were enrolled from four early head start programs between September 2009 and December 2009. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Newest Vital Sign (NVS); parental knowledge and beliefs regarding antibiotic treatment for URIs were also assessed. Analyses were conducted in 2010 with multivariable logistic regression performed to examine predictors of health literacy. Inadequate health literacy was observed in 83.8 % of respondents using NVS and 35.7 % with the S-TOFHLA. College education was significantly associated with adequate health literacy using either the NVS or S-TOFHLA; however, other results varied between measures. Using NVS, there was a greater likelihood of adequate health literacy with US birth status (AOR 13.8; 95 % CI, 1.99-95.1), 95 years US residency (AOR 7.6; 95 % CI, 1.3-43.1) and higher antibiotic knowledge scores (AOR 1.7; 95% CI, 1.2-2.4). Using S-TOFHLA, the odds of adequate health literacy increased with access to a regular care provider (AOR 2.6; 95 % CI, 1.2-5.6). Scores consistent with adequate health literacy on the NVS, but not the S-TOFHLA, were associated with correct beliefs regarding antibiotic use for URIs in comparison to scores of participants with inadequate health literacy. Since health literacy levels were low in this population and the risk of viral URI was high during the first few years of life, targeted education to improve health literacy, knowledge, and beliefs about URI and related antibiotic treatment is needed.

Abstract

Engaging bedside clinicians, especially nurses, is essential for the success of sustainable process improvement programs and thus for improving the quality of health care. Studies have shown that properly implemented professional councils can be effective in engaging and empowering bedside clinicians to create lasting and meaningful improvements. This case study describes a 5-year program to implement and operate staff-led councils to lead evidence-based practice (EBP) quality improvement initiatives at 6 community hospitals. The outcomes presented in this case study demonstrate that staff-led councils have the potential to improve patient safety and quality of care as evidenced by observed reductions in ventilator-associated pneumonias, central line-associated bloodstream infections, and mortality from acute myocardial infarction and severe sepsis.

Abstract

The purpose of this study was to examine patterns and predictors of HIV/STI risk over time among Latino migrant men in a new receiving community. Latino men (N = 125) were interviewed quarterly for 18 months and HIV/STI tested annually. Selected individual, environmental and cultural factors by partner type and condom use were explored longitudinally and in a cross-section. Sex with female sex workers (FSWs) and multiple partners decreased, sex with main partners and abstinence increased, while the number of casual partners remained stable. Consistent condom use was highest with FSWs, lowest with main partners and midrange with casual partners with no trends over time. STI morbidity was low; no HIV was detected. Drug use and high mobility were associated with inconsistent condom use with FSW, whereas having family in the household was protective. HIV/STI prevention efforts should focus on drug using Latino migrants who are highly mobile and should foster healthy social connections.

Abstract

While partner violence and sexual assault are public health concerns affecting college women, most young women do not seek help after the experience. Limited research explores the interpersonal context of help seeking related to violence in young women. The overall purpose of this research was to understand peer factors within a campus culture associated with seeking help in response to violence within a campus environment. Eight focus groups were held with 64 participants representing a broad spectrum of diversity in race and ethnicity. Narrative analysis was the primary method of analysis. Three themes emerged from the data: victim blaming, fear of direct response, and the alcohol factor. The young women's stories demonstrate the effects of friends and campus culture on perceptions of violence and abuse and help seeking. Findings suggest that peers and the social norms of the campus environment influence help-seeking behavior. An understanding of interpersonal level determinants of help seeking is essential for clinically relevant and effective prevention efforts. Nurse practitioners in campus health settings can use this research to guide assessment, intervention, and prevention strategies.

Abstract

Aim. This paper is a report of a study of factors that affect turnover of newly licensed registered nurses in United States hospitals. Background. There is a large body of research related to nursing retention; however, there is little information specific to newly licensed registered nurse turnover. Incidence rates of turnover among new nurses are unknown because most turnover data are not from nationally representative samples of nurses. Method. This study used a longitudinal panel design to obtain data from 1653 registered nurses who were recently licensed by examination for the first time. We mailed surveys to a nationally representative sample of hospital registered nurses 1year apart. The analytic sample consisted of 1653 nurses who responded to both survey mailings in January of 2006 and 2007. Results. Full-time employment and more sprains and strains (including back injuries) result in more turnover. Higher intent to stay and hours of voluntary overtime and more than one job for pay reduces turnover. When we omitted intent to stay from the probit model, less job satisfaction and organizational commitment led to more turnover, confirming their importance to turnover. Magnet Recognition Award ® hospitals and several other work attributes had no effect on turnover. Conclusion. Turnover problems are complex, which means that there is no one solution to decreasing turnover. Multiple points of intervention exist. One specific approach that may improve turnover rates is hospital policies that reduce strains and sprains.

Abstract

Background: Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care. Methods: The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units. Results: The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7611 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations. Discussion: This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.

Abstract

A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Twenty-six percent of the cohort experienced a pregnancy during the study period, with a rate of 125 per 1,000 person years in 2006. The age of first pregnancy ranged from 15-25; 24% were younger than 18. Fourteen pregnancies (42%) were terminated. Nineteen pregnancies resulted in live births, and all infants tested negative for HIV. The success of preventing vertical HIV transmission is attributed to interdisciplinary family-centered services, including reproductive health education, family planning, obstetric-gynecologic services and psychosocial support. Such approach is most likely to be effective at promoting healthy reproductive decisions and reducing morbidity in perinatally infected mothers and their children.

Abstract

Community health worker (CHW) programs have become popular tools in reducing the burden of childhood illnesses. However, the efficacy of CHWs in facilitating behavior change, as a means of preventing waterborne diseases, remains unclear. Using a household survey (n = 225),in rural Tamil Nadu, South India, we assessed the effects of a CHW program on knowledge, attitudes and practices related to diarrheal illness through comparison with a control population that was not enrolled in the program. The CHW program in the experimental village entailed behavior change aimed at preventing diarrheal illness through home visits, community events and health education. Correlates of four key variables on knowledge of drinking water contamination and behavior change were examined by using logistic regression models. We found that while the program was effective in raising awareness of drinking water contamination, it did not significantly increase hygiene and water sanitation practices in the village community in comparison to the control population. Furthermore, villagers enrolled in the CHW program were unable to recognize the connections between contaminated drinking water and disease. The results of our survey indicated the CHW program did not significantly affect behavior in the experimental village. Possible shortcomings in the program are discussed.

Abstract

The public is increasingly inundated with suggestions on how they can reduce their risk of developing cognitive impairment or dementia and are turning to physicians for advice. This study examines physicians' perceptions and practices related to reducing cognitive impairment or dementia risk. Data from Porter Novelli's 2008 DocStyles survey are used to examine physicians' perceptions and practices related to this issue. About 40% of physicians reported discussing concerns about cognitive impairment often or very often with adult patients without dementia. The majority advised patients to reduce risk through physical activity, mental stimulation, and healthy diet. These data shed light on physicians' perceptions and practices related to reducing cognitive impairmentrisk among their patients. Increased information about this issue may inform development of and access to educational materials to meet physicians' needs to address patient concerns related to reducing cognitive impairment or dementia risk.

Abstract

Purpose: Self-management is a dynamic process in which individuals actively manage a chronic illness. Self-management models are limited in their specification of the processes of self-management. The purpose of this article is to delineate processes of self-management in order to help direct interventions and improve health outcomes for individuals with a chronic illness. Design: Qualitative metasynthesis techniques were used to analyze 101 studies published between January 2000 and April 2011 that described processes of self-management in chronic illness. Methods: Self-management processes were extracted from each article and were coded. Similar codes were clustered into categories. The analysis continued until a final categorization was reached. Findings: Three categories of self-management processes were identified: focusing on illness needs; activating resources; and living with a chronic illness. Tasks and skills were delineated for each category. Conclusions: This metasynthesis expands on current descriptions of self-management processes by specifying a more complete spectrum of self-management processes. Clinical Relevance: Healthcare providers can best facilitate self-management by coordinating self-management activities, by recognizing that different self-management processes vary in importance to patients over time, and by having ongoing communication with patients and providers to create appropriate self-management plans.

Abstract

It is estimated that up to 10 percent of the American population is lesbian, gay, bisexual, or transgender (LGBT) and that up to 7 million members of this population are elderly. Both the Institute of Medicine and Healthy People 2020 have addressed the health disparities that affect elderly members of the LGBT community. Nurses are well positioned to bridge health disparities and provide culturally sensitive care across the lifespan, but compared with that of other disciplines, the nursing literature is lacking in content addressing LGBT health. Eliminating health disparities in the care of LGBT elders should be a priority in nursing education.The authors review the issues LGBT elders face and recommend how content related to LGBT aging can be integrated into nursing curricula.

Abstract

Puerto Ricans have been found to have higher asthma prevalence rates than non-Hispanic whites, blacks, and all other Hispanic subgroups. They also have the highest rates of emergency department (ED) use for the management of their asthma. Using a hermeneutic phenomenological approach, the aim of this study was to describe the lived experience of Puerto Rican families caring for their child's asthma and using the ED for asthma care. Six themes were generated from in-depth interviews with 10 Puerto-Rican caregivers: (1) The Folklore of Asthma, (2) Culture and the Medicine Woman, (3) In Awe of Asthma, (4) Praying to God, (5) The Decision-Time to Go, and (6) The ED Environment. The findings emphasize the necessity of establishing and maintaining a therapeutic partnership between primary care providers and families of children with asthma. The results may be used as a foundation for understanding motivations for seeking asthma care in the ED.

Abstract

Purpose/Objectives: To develop a substantive theory of the process of breast cancer survivorship. Research Approach: Grounded theory. Setting: A LISTSERV announcement posted on the SHARE Web site and purposeful recruitment of women known to be diagnosed and treated for breast cancer. Participants: 15 women diagnosed with early-stage breast cancer. Methodologic Approach: Constant comparative analysis. Main Research Variables: Breast cancer survivorship. Findings: The core variable identified was Reclaiming Life on One's Own Terms. The perceptions and experiences of the participants revealed overall that the diagnosis of breast cancer was a turning point in life and the stimulus for change. That was followed by the recognition of breast cancer as now being a part of life, leading to the necessity of learning to live with breast cancer, and finally, creating a new life after breast cancer. Participants revealed that breast cancer survivorship is a process marked and shaped by time, the perception of support, and coming to terms with the trauma of a cancer diagnosis and the aftermath of treatment. The process of survivorship continues by assuming an active role in self-healing, gaining a new perspective and reconciling paradoxes, creating a new mindset and moving to a new normal, developing a new way of being in the world on one's own terms, and experiencing growth through adversity beyond survivorship. Conclusions: The process of survivorship for women with breast cancer is an evolutionary journey with short- and long-term challenges. Interpretation: This study shows the development of an empirically testable theory of survivorship that describes and predicts women's experiences following breast cancer treatment from the initial phase of recovery and beyond. The theory also informs interventions that not only reduce negative outcomes, but promote ongoing healing, adjustment, and resilience over time.

Abstract

UNLABELLED: The PIVENS (Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis [NASH]) trial demonstrated that pioglitazone and vitamin E improved liver histology to varying degrees, but the mechanisms are unknown. We conducted a study to examine the changes in adipose tissue insulin resistance (Adipo-IR) during the PIVENS trial and its relationship to histological endpoints. Adipo-IR (fasting nonesterified fatty acids [NEFAs] × fasting insulin) was calculated at baseline and after 16 and 96 weeks of therapy. Compared to placebo, the baseline Adipo-IR was not different in either the vitamin E group (P = 0.34) or the pioglitazone group (P = 0.29). Baseline Adipo-IR was significantly associated with fibrosis score (P = 0.02), but not with other histological features or nonalcoholic fatty liver disease (NAFLD) activity score (NAS). After 16 weeks, compared to placebo, the pioglitazone group had a significant reduction in Adipo-IR (-15.7 versus -1.91; P = 0.02), but this effect did not persist at 96 weeks (-3.25 versus -4.28; P = 0.31). Compared to placebo, Adipo-IR in the vitamin E group did not change significantly either after 16 weeks (P = 0.70) or after 96 weeks (P = 0.85). Change in Adipo-IR at week 16 was not associated with changes in any histological parameters at week 96, but improvement in Adipo-IR at week 96 was significantly associated with improvement in ballooning (P = 0.03), fibrosis (P = 0.004), and NAS (P = 0.01).CONCLUSION: Vitamin E improved liver histology independent of changes in Adipo-IR, and pioglitazone treatment acutely improved Adipo-IR, but this was not sustained. Changes in Adipo-IR were associated with changes in liver histology, including fibrosis.

Abstract

INTRODUCTION: Although maternal serum α-fetoprotein (AFP), human chorionic gonandotropin (hCG), and estriol play important roles in immunomodulation and immunoregulation during pregnancy, their relationship with the development of bronchopulmonary dysplasia (BPD) in young infants is unknown despite BPD being associated with pre-and postnatal inflammatory factors. RESULTS: We found that these serum biomarkers were associated with an increased risk of BPD. Risks were especially high when AFP and/or hCG levels were above the 95th percentile and/or when unconjugated estriol (uE3) levels were below the 5th percentile (relative risks (RRs) 3.1-6.7). Risks increased substantially when two or more biomarker risks were present (RRs 9.9-75.9). DISCUSSION: Data suggested that pregnancies that had a biomarker risk and yielded an offspring with BPD were more likely to have other factors present that suggested early intrauterine fetal adaptation to stress, including maternal hypertension and asymmetric growth restriction. METHODS: The objective of this population-based study was to examine whether second-trimester levels of AFP, hCG, and uE3 were associated with an increased risk of BPD.

Abstract

Optimal outcomes and quality of life for patients with heart failure depend on engagement in effective self-care activities. Self-care is a complex set of activities and most clinicians are not adequately prepared to assist their patients to engage in effective self-care. In this paper, we provide an overview of self-care that includes definitions, the importance of self-care to outcomes, the physiologic basis for better outcomes with good self-care, cultural perspectives of self-care, and recommendations for the improvement of self-care. Promotion of effective self-care by all clinicians could substantially reduce the economic and personal burden of repeated rehospitalizations among patients with heart failure.

Abstract

The purpose of this study was to establish the feasibility and utility of screening for elder mistreatment in a dental clinic population. We approached older adults in a busy dental clinic and enrolled 139 persons over the age of 65 who completed an Audio Computer Assisted Self Interview (ACASI), which included the Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST). Overall, 48.4% of the participants scored 3 or greater on the HS-EAST, and 28.3% scored 4 or greater. Our study suggests that there is an opportunity to screen in busy dental clinics and to facilitate early detection for those patients who screen positive for elder mistreatment.

Abstract

Objective: Elder mistreatment (EM) is a potentially fatal and largely unrecognised problem in the United States. The purpose of this study was to determine the prevalence of EM in busy clinics and specifically, we report on the feasibility of screening for EM as well as the appropriate instrumentation for screening. Background: Prevalence estimates for elder mistreatment vary, but recent data from a national sample of community-residing adults over 60 years of age indicate that 11.4% of older adults report some form of elder mistreatment. There is a paucity of research related to screening in dental and medical clinics to understand the prevalence in such practice settings. Methods: A cross-sectional study was conducted from January 2008 to March 2009. We enrolled 241 patients at two clinics: a medical clinic (n = 102) and dental clinics (n = 139). A mini-mental status exam was conducted with a minimum of 18 or better for inclusion. An elder mistreatment screen was next used [elder assessment instrument (EAI-R) for medical and Hwalek-Sengstock elder abuse screening test (HS-EAST) for dental]. Results: For the 241 patients, we were able to compare data from the EAI-R with the HS-EAST. This pilot work demonstrates the feasibility of screening for EM in busy clinics since we documented patient enrolment of 20% in the medical clinics and 66% in dental clinics. Patients are willing to answer extremely-sensitive questions related to elder mistreatment and are also willing to use computer technology for interviewing. Conclusion: Dental and medical clinics are important practice venues to screen for elder mistreatment.