Publications

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.

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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.

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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.

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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?

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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.

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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.

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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.

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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.

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Objectives: To review the proposed mechanisms of cognitive changes associated with non-central nervous system cancers and cancer treatment. Data Sources: Review and synthesis of databased publications and review articles. Conclusion: Proposed mechanisms include cytokine upregulation, hormonal changes, neurotransmitter dysregulation, attentional fatigue, genetic predisposition, and comorbid symptoms. Implications for Nursing Practice: Oncology nurses need to understand the multiple mechanisms that may contribute to the development of cancer- and treatment-related cognitive changes so that they can identify patients at high risk and help patients understand why these changes occur.

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The development and progression of left ventricular hypertrophy is a consequence of multiple comorbid conditions associated with end-stage renal disease and large variations in interdialytic weight gains. The literature suggests that dietary sodium restriction alone significantly reduces interdialytic weight gains. A total of 124 hemodialysis participants in an ongoing randomized control trial participated in the validation in which psychometric properties of a self-efficacy survey were a secondary analysis. We evaluated the internal consistency, construct validity, and convergent validity of the instrument. The overall Cronbach α was 0.93. Three factors extracted explain 67.8% of the variance of the white and African American participants. The Self-Efficacy Survey has adequate internal consistency and construct and convergent validity. Future research is needed to evaluate the stability and discriminant validity of the instrument.

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BACKGROUND: Self-care of heart failure has been described as a naturalistic decision-making process, but the data available to defend this description are anecdotal. OBJECTIVES: The aim of this study was to explore the process used by adults with chronic heart failure to make decisions about their symptoms. METHODS: This was a secondary analysis of data obtained from four mixed methods studies. The full data set held qualitative data on 120 adults over the age of 18 years. For this analysis, maximum variation sampling was used to purposively select a subset of 36 of the qualitative interviews to reanalyze. RESULTS: In this sample, equally distributed by gender, 56% Caucasian, between 40 and 98 years, the overarching theme was that decisions about self-care reflect a naturalistic decision-making process with components of situation awareness with mental simulation of a plausible course of action and an evaluation of the outcome of the action. In addition to situation awareness and mental simulation, three key factors were identified as influencing self-care decision making: (a) experience; (b) decision characteristics such as uncertainty, ambiguity, high stakes, urgency, illness, and involvement of others in the decision-making process; and (c) personal goals. DISCUSSION: These results support naturalistic decision making as the process used by this sample of adults with heart failure to make decisions about self-care.

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Objective: This study examined recent trends of preventive dental care utilization among Americans aged 50 and above, focusing on variations across racial and ethnic groups including Whites, Blacks, Hispanics, American Indians/Alaska Natives, and Asians. Methods: Self-reported information on oral health behaviors was collected from 644,635 participants in the Behavioral Risk Factor Surveillance System between 1999 and 2008. Results: Despite a significant upward trend of frequency of dental cleaning from 1999 to 2008 (ORD1.02), in 2008 still only 56-77% of any ethnic or racial group reported having had a dental cleaning in the previous 12 months. Relative to Whites, Blacks (ORD0.65) were less likely to have a dental cleaning in the previous 12 months. These variations persisted even when SES, health conditions, health behaviors, and number of permanent teeth were controlled. In contrast, Hispanics, Asians, and American Indians/Alaskan Natives did not differ from Whites in dental cleanings. Discussion: This is the first study to provide national estimates of the frequency of dental cleaning and associated trends over time for five major ethnic groups aged 50 and above in the U.S. simultaneously. Our findings suggest that public health programs with an emphasis on educating middle-aged and older minority populations on the benefits of oral health could have a large impact, as there is much room for improvement. Given the importance of oral health and a population that is rapidly becoming older and more diverse, the need for improved dental care utilization is significant.

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Objectives This study charted the trajectories of dental caries, including decayed teeth, missing teeth and filled teeth among older Americans over a 5-year period. In particular, it focused on racial differences in the levels of and rates of change in dental caries experience. Methods Data came from the Piedmont Dental Study. The sample included 810 older Americans who were dentate at the baseline with up to 4 repeated observations between 1988 and 1994. Hierarchical linear models were employed in depicting intrapersonal and interpersonal differences in dental caries experience. Results Different measures of caries outcomes exhibited distinct trajectories. On average, the number of decayed teeth decreased over time, whereas missing teeth increased. In contrast, the number of filled teeth remained stable during a 5-year period. Relative to their white counterparts, older black Americans had more decayed teeth and missing teeth but fewer filled teeth. Blacks and whites differed in the levels of dental caries but not in their rates of change except for missing teeth. Even when demographic and socioeconomic attributes were adjusted, racial variations in dental caries experience remained significant. Conclusions Although significantly correlated, various dental caries outcomes move along different paths over time. In view of the persistent racial disparities in dental caries trajectories, future interventions to minimize such variations among older Americans in the levels of and the rates of change in dental caries experience are clearly warranted.

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Background. Asthma is the most prevalent chronic illness affecting 10% of the pediatric population. The internet is a useful tool for acquiring information on health topics. In a recent Harris Poll, 154 million adults searched the Internet for health information. The usefulness of asthma materials on the Internet depends on the ability to read and comprehend the information. The goal of this study was to assess the readability of asthma Web sites. Methods. The authors studied the readability of 6 asthma Web sites that have been previously evaluated for quality and accuracy of information. The Flesch/Flesch-Kincaid tools were used to evaluate readability and reading ease of the materials on each of the Web sites with the use of Microsoft Office Word software. Results. Materials included in the 6 Web sites were analyzed. The information included in the Web sites had a readability index between 46.6 and 63.5, with a mean of 54.33 on the Flesch reading ease. The mean Flesch-Kincaid grade level was found to be between 8.0 and 10.3, with an average grade level of 9.73. Conclusions. Findings suggest that readability scores on asthma Web sites are high for the average consumer. Research has shown that patient educational materials should be no higher than a sixth-grade reading level. Practice Implications. Asthma educational materials on the Internet carry the risk of having incomprehensible materials disseminated to patients and their families. Asthma educators need to understand the role of the Internet and health information and guide their patients and their families to accurate, comprehensible, and readable Web sites.

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People with diabetes are at risk of developing complications that contribute to substantial morbidity and mortality. In 2011, the American Association of Diabetes Educators convened an invitational Reducing Risks Symposium, during which an interdisciplinary panel of 11 thought leaders examined current knowledge about the reduction and prevention of diabetes-related risks and translated evidence into diabetes care and self-management education. Symposium participants reviewed findings from the literature and engaged in a moderated roundtable discussion. This report summarizes the discussion and presents recommendations to incorporate into practice to improve outcomes. The objective of the symposium was to develop practical advice for diabetes educators and other members of the diabetes care team regarding the reduction of diabetes-related risks. Optimal diabetes management requires patients to actively participate in their care, which occurs most effectively with a multidisciplinary team. Diabetes education is an integral part of this team approach because it not only helps the patient understand diabetes, its progression, and possible complications, but also provides guidance and encouragement to the patient to engage in proactive risk-reduction decisions for optimal health. A variety of tools are available to help the diabetes educator develop an individualized, patient-centered plan for risk reduction. More research is needed regarding intervention efficacy, best practices to improve adherence, and quantification of benefits from ongoing diabetes support in risk reduction. Diabetes educators are urged to stay abreast of evolving models of care and to build relationships with health care providers both within and beyond the diabetes care team. (Population Health Management 2013;16:74-81).

Abstract

Understanding Mexican American (MA) elders' use of home health care services (HHCS) and elders' reactions to interventions designed to increase HHCS use is vital to address disparities (e.g., MA elders use HHCS less yet have more disabilities with earlier onset than other groups). Dialog notes from a telenovela intervention and interviews with two additional elder-caregiver dyads were content analyzed and revealed ways to improve the telenovela, fitting with Narrative Theory. Further contributions by a community advisory council resulted in a revised script and illustrated how research participants and community members can shape interventions to achieve equity in vulnerable populations' healthcare utilization.

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Young Black males, aged 13 to 29 years, have the highest annual rates of HIV infections in the United States. Young Black men who have sex with men (MSM) are the only subgroup with significant increases in HIV incident infections in recent years. Black men, particularly MSM, are also disproportionately affected by other sexually transmitted infections (STIs). Therefore, we must strengthen HIV and STI prevention opportunities during routine, preventive health care visits and at other, nontraditional venues accessed by young men of color, with inclusive, nonjudgmental approaches. The Affordable Care Act and National HIV/AIDS Strategy present new opportunities to reframe and strengthen sexual health promotion and HIV and STI prevention efforts with young men of color.