Publications

Abstract

A serious shortage of hospital nurses in the U.S., evident in the past decade, is expected to continue and worsen in the next 15 years. Increasingly, the public and the health professions are acknowledging that nurse understaffing represents a serious threat to patient safety in U.S. hospitals. Although anecdotal evidence has linked patient deaths to inadequate nurse staffing, the numbers and kinds of nurses needed for patient safety is unknown. This Issue Brief highlights two studies that clarify the impact of nurse staffing levels on surgical patient outcomes, and examine the effect of nurses' experience and educational level on patient mortality in the 30 days after a surgical admission.

Abstract

The Maryland Perinatal Education Consortium (MPEC), a 12-hospital education initiative, provides basic didactic education for perinatal nurses. The MPEC core curriculum integrates patient-specific cultural and age-related considerations for both the novice and experienced perinatal nurse. While the primary goal for developing the consortium was to maximize use of the nurse educator's time by pooling educational resources between participating hospitals, member hospitals have discovered that it also resulted in advantageous positioning for recruitment and retention of nursing staff. MPEC's pooled turnover rate of 14% is below the national average of 16%, resulting in important cost savings and additional staff for participating hospitals. This article describes the development of the MPEC and uses the Nursing Executive Center's model of turnover costs to describe the cost savings and retention impact for various-sized hospitals achieved through MPEC's multihospital collaboration in staff development.

Abstract

Medical interns, residents, and fellows are heavily involved in caring for dying patients and interacting with their families. Due to a lack of formal medical education in the area, these house staff often have a limited knowledge of palliative care. The purpose of this study was to determine how, given inadequate formal education, house staff learn to provide palliative care. Specifically, this study sought to explore the extent to which physicians learn to provide palliative care through formal medical education, from physicians and other hospital staff, and by on-the-job learning. Twenty physicians were interviewed about their medical education and other learning experiences in palliative care. ATLAS/ti software was used for data coding and analysis. Analysis of transcripts indicated that house staff learn little to nothing through formal education, to varying degrees from attending physicians and hospital staff, and mostly on the job and by making mistakes.

Abstract

As part of a system-wide initiative to advance evidence-based practice among clinicians, graduate students, and educators, the New York University Division of Nursing embarked on a curricular initiative to integrate components of information literacy in all core courses of the master's program. Increasing competency in information literacy is the foundation for evidence-based practice and provides nursing professionals with the skills to be literate consumers of information in an electronic environment. Competency in information literacy includes an understanding of the architecture of information and the scholarly process; the ability to navigate among a variety of print and electronic tools to effectively access, search, and critically evaluate appropriate resources; synthesize accumulated information into an existing body of knowledge; communicate research results clearly and effectively; and appreciate the social issues and ethical concerns related to the provision, dissemination, and sharing of information. In collaboration with the New York University Division of Libraries' Health Sciences Librarian, instructional modules in information literacy relevant to each of the 5 core nursing master's courses were developed, complemented by a Web-based tutorial: http://library.nyu.edu/research/health/tutorial. The Web site is multifaceted, with fundamentals for the beginner, as well as more complex content for the advanced user. Course assignments were designed to promote specific competencies in information literacy and strategies for evaluating the strength of the evidence found. A survey of information literacy competencies, which assessed students' knowledge, misconceptions, and use of electronic information resources, was administered when students entered the program and at 1-year intervals thereafter.

Abstract

A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996-2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.

Abstract

Recent advances in telecommunications technology have created opportunities to enhance the quality of health care services through telehealth, the use of telecommunications and information technologies to deliver health care. However, the diverse technologies and applications encompassed by telehealth have tended to confuse discussions of the effectiveness of these programs. An interactive voice response system (IVRS) is a simple, yet effective telehealth application that improves access to health care by continuing care beyond the hospital setting, with specially tailored programs that are easily accessible to patients around the clock. Often described as a telephone connected to a "talking computer," an IVRS allows patient interaction for data collection or to deliver recorded telephone messages related to medication compliance or behavior modification. Despite easy access to touchtone telephone services and growing familiarity with IVRS, many health care providers are unaware of these programs. This paper reviews the infrastructure of IVRS technology and its uses in health care.

Abstract

A review of the literature reveals few studies that focus on the challenge of language barriers in primary care settings. Recognizing the need for a national consensus on cultural and linguistic standards for health care in the United States, the Office of Minority Health recently released a set of standards for culturally and linguistically appropriate services (CLAS). These standards were utilized to examine the linguistic services available at eight ambulatory care centers in a small New England state in an effort to determine compliance with recommended national standards. Although myriad studies have focused on provision of linguistically appropriate care in emergency rooms (ERs), few studies have specifically examined ambulatory care settings. Numerous strategies have been adopted by individual clinics in an attempt to deal effectively with linguistic barriers. Yet without clear national regulations and dedicated funding for interpreter services, a large spectrum of services exists. Survey data were obtained from on-site visits at select community health clinics to ascertain availability, need, and utilization of linguistic services for patients with limited English proficiency. The majority of patients served by the clinics surveyed were predominantly Spanish-speaking. Results reveal that although most of the clinics provided informal mechanisms of interpreter services, few directly addressed linguistic services as a component of culturally competent care.

Abstract

ISSUES AND PURPOSE: The purpose of this paper is to synthesize the current qualitative literature on homeless women with children living in shelters. METHODS: Eighteen qualitative studies on homeless women with children living in shelters were included in the synthesis. The meta-synthesis was conducted using the meta-ethnographic approach of Noblit and Hare (1988). RESULTS: Six reciprocal translations (themes) of homeless mothers caring for their children in shelters emerged: On becoming homeless, protective mothering, loss, stressed and depressed, survival strategies, and strategies for resolution. PRACTICE IMPLICATIONS: The results may be used by healthcare workers as a framework for developing intervention strategies directed toward helping mothers find new solutions to dealing with shelter living and innovative ways to resolve their homelessness.

Abstract

Objective. Residential drug treatment units are uniquely situated to provide HIV testing and counseling to their patients. This article examines the extent to which residential drug treatment units in the United States provide HIV testing on-site, and identifies organizational and institutional characteristics that differentiate units in which on-site HIV testing is available from those in which it is not. Methods. The analyses use data collected in telephone interviews with unit managers from a random nationwide sample (N=138) of residential drug treatment units in 2001. Results. About half (48.6%) of the residential drug treatment units made HIV testing available to their patients on-site. Residential units were significantly more likely to make on-site testing available if they were larger (i.e., had a greater number of patients treated each month or had a greater number of staff that provided direct patient services) and if they were publicly rather than privately owned. Provision of on-site HIV testing was significantly correlated with having a medical orientation, i.e., with being operated by a hospital, with the unit viewing itself as patients' primary medical provider, or with providing medical care to the patients either on-site or at another part of the same treatment agency. Conclusion. In view of the critical importance of HIV testing for individuals who use illicit drugs and the existence of a simplified testing protocol involving saliva samples (eliminating the need for phlebotomy), units that do not have a medical orientation should be encouraged to make HIV testing available on-site.

Abstract

Objective: To determine strategies to overcome barriers to HIV testing among persons at risk. Methods: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Results: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home selftesting (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. Conclusions: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.

Abstract

PURPOSE: To present the theoretical background for lifestyle change interventions in the prevention and management of type 2 diabetes and to provide pragmatic strategies for advanced practice nurses (APNs) to incorporate such interventions into their practices. DATA SOURCES: Selected scientific literature and the Internet. CONCLUSIONS: There is an epidemic of obesity and type 2 diabetes among adults in the United States. Preventing or managing these health conditions requires significant lifestyle changes by individuals. IMPLICATIONS FOR PRACTICE: APNs are in a key role to deliver lifestyle change interventions, particularly in the primary care setting. Strategies to assist APNs with lifestyle change counseling include (a) assessment, (b) mutual decision making, (c) referral to education programs, (d) individualized treatment goals, (e) strategies to assist with problem solving, (f) continuing support and encouragement, (g) relapse prevention, and (h) ongoing follow-up.

Abstract

Hepatitis C virus (HCV) has reached epidemic proportions among drug users, and drug programs are in a unique position to provide each of their patients with HCV education. Using a nationwide sample (N= 434) of drug treatment programs, we report the results of a logistic regression analysis that differentiates programs providing HCV education to all of their patients versus programs that do not. Fifty-four percent of the programs provide HCV education to all of their patients. Programs are about four and a half times as likely to provide HCV education to all patients if they dispense methadone; almost four times as likely to provide this service if they educate most of their staff about HCV; twice as likely if they are residential; and almost twice as likely if they conduct HIV testing on-site. Our findings indicate that there is a need to increase HCV educational services in drug treatment programs.

Abstract

Psychosocial issues are a major part of palliative treatment, yet, due to inadequate training, physicians are often ill-prepared to address them. Twenty physicians were interviewed about the importance they placed on psychosocial issues and the perceptions they had of their role in addressing them. Several respondents felt psychosocial issues were important because they affect physical issues, enable holistic care, enhance relationships, impact care decisions, and can reduce patient and family stress. Other respondents did not feel psychosocial issues were their responsibility due to time constraints, their focus on physical care, their lack of expertise in this area, the patients' preferences for attending physicians, and a sense on the part of house staff physicians of not yet being "real" doctors. Collaboration with other hospital staff helped overcome some of these obstacles. Since physicians must often provide psychosocial care, improved training in addressing psychosocial issues is indicated.

Abstract

The authors’ research group published a major article in October 2002 showing a strong effect of nurse staffing on both patient outcomes and factors related to nurse turnover in 168 Pennsylvania hospitals. This article reviews major design elements and findings of the study and discusses policy implications of this research. Even though evidence is mounting that hospital staffing is a public health issue, regulation of staffing levels remains controversial. Higher quality staffing data that incorporate information about patients’ needs for nursing care are required for better administrative decision-making and research purposes. That the current nurse shortage is occurring in an era of renewed concerns about safety in hospitals offers unique opportunities for developing public policy to remedy problems with staffing and other long-standing workplace environment issues in hospital nursing.

Abstract

The purpose of this pilot study was to explore the relationships between spiritual well-being, emotional distress, HbA1c values, and blood pressure levels in a convenience sample of 22 Black women with type 2 diabetes. Results revealed significant inverse correlations between diastolic blood pressure (BP) and both total spiritual well-being (r=-.51, P=.02) and religious well-being (RWB) (r=-.55, P=.01). Women with higher RWB scores tended to have lower diastolic BP, as compared to their counterparts with lower RWB scores (z=2.78, P=.005). Emotional distress was positively related to systolic BP (r=.48, P=.03). These findings suggest that holistic care, addressing the spiritual and emotional dimensions, may foster improved BP levels among Black women with type 2 diabetes, thereby potentially reducing their high risk for secondary complications.

Abstract

Background: A paucity of epidemiologic research exists concerning the co-occurrence of birth defects and mental retardation (MR). Study of this co-occurrence may yield important clues about the causes of both. Objective: To examine the co-occurrence of birth defects and MR, taking into consideration the type of birth defect, level of MR, co-occurrence of MR with other developmental disabilities, and individual and maternal factors. Design: A retrospective cohort study of infants born in the California Central Valley with and without a structural birth defect by 1 year of age, and with or without MR by 7 to 9 years of age. Setting and Participants: One-year survivors (N = 119556) born in nonmilitary hospitals in 8 California counties between January 1, 1992, and December 31, 1993, for whom information about birth defects was recorded within the first year of life. Main Outcome Measure: Diagnosis of MR by age 7 years considered as being mild or severe and as occurring without other developmental disabilities (isolated MR) or as occurring with other developmental disabilities, including cerebral palsy, epilepsy, or a pervasive developmental disorder. Results: Children with birth defects were nearly 27 times more likely to have MR by 7 years of age compared with children without a diagnosed birth defect regardless of type of defect (prevalence ratio, 26.8; 95% confidence interval, 22.7-31.7). Among those with birth defects, children with Down syndrome (prevalence ratio, 211.7; 95% confidence interval, 171.3-261.5) and children with sex chromosomal defects (prevalence ratio, 57.4; 95% confidence interval, 23.7-138.6) were at the highest risk for MR. Children with nonchromosomal defects, including central nervous system defects and all types of organ and system defects, were at substantially increased risk for all levels of MR. Risks of MR among children with Down syndrome and nonchromosomal defects were not substantially altered when adjusted for individual and maternal factors. Conclusions: Children with chromosomal and other structural birth defects are at a substantially increased risk for having MR by 7 years of age compared with children born without a birth defect. Children with birth defects are at an especially increased risk for having severe MR and MR occurring independently of other developmental disabilities.