Publications

Abstract

Objective. To examine the impact of nurse staffing on selected adverse events hypothesized to be sensitive to nursing care between 1990 and 1996, after controlling for hospital characteristics. Data Sources/Study Setting. The yearly cross-sectional samples of hospital discharges for states participating in the National Inpatient Sample (NIS) from 1990-1996 were combined to form the analytic sample. Six states were included for 1990-1992, four states were added for the period 1993-1994, and three additional states were added in 1995-1996. Study Design. The study design was cross-sectional descriptive. Data Collection/Extraction Methods. Data for patients aged 18 years and older who were discharged between 1990 and 1996 were used to create hospital-level adverse event indicators. Hospital-level adverse event data were defined by quality indicators developed by the Health Care Utilization Project (HCUP). These data were matched to American Hospital Association (AHA) data on community hospital characteristics, including registered nurse (RN) and licensed practical/vocational nurse (LPN) staffing hours, to examine the relationship between nurse staffing and four postsurgical adverse events: venous thrombosis/pulmonary embolism, pulmonary compromise after surgery, urinary tract infection, and pneumonia. Multivariate modeling using Poisson regression techniques was used. Principal Findings. An inverse relationship was found between RN hours per adjusted inpatient day and pneumonia (p < .05) for routine and emergency patient admissions. Conclusions. The inverse relationship between pneumonia and nurse staffing are consistent with previous findings in the literature. The results provide additional evidence for health policy makers to consider when making decisions about required staffing levels to minimize adverse events.

Abstract

Background: Recently passed federal legislation requires institutions to adopt safety equipment to prevent needlesticks, but there is little empirical evidence of the effectiveness of specific types of safety devices or the contribution of safety devices to reducing needlesticks relative to the contributions of staffing, organizational climate, and clinicians’ experience. Method: In 1998, 2287 medical-surgical unit nurses in 22 US hospitals were surveyed in regard to staffing and organizational climate in their hospitals and about patient and nurse outcomes, including needlestick injuries. Hospitals provided information about available protective devices at the time of the survey. Relationships between nurse and hospital characteristics and protective equipment and the likelihood of needlestick injuries and near-miss incidents were examined. Results: Poor organizational climate and high workloads were associated with 50% to 2-fold increases in the likelihood of needlestick injuries and near-misses to hospital nurses. Capless-valve secondary intravenous set systems and use of any type of protective equipment for IV starts or blood draws were associated with 20% to 30% lowered risks of both event types. Conclusions: Nurse staffing and organizational climate are key determinants of needlestick risk and must be considered with the adoption of safety equipment to effectively reduce sharps injuries.

Abstract

We examined physical restraint use among 1856 nursing home residents hospitalized with hip fracture using a data set of hip fracture patients in 20 U. S. hospitals from 1983-1993. Mean age of patients was 85.2 years, 81.7% were women, and 91.3% were white. Rate of physical restraint use was 59.4%. Pre-operative physical restraint use was predicted by younger age, confusion, dementia, and needing assistance or dependency in activities of daily living (ADL). Physical restraint use following surgery was predicted by pre-operative physical restraint use, confusion, dementia, and lower co-morbidity of illness. At hospital discharge, restrained patients were more likely to be dependent in ADL and continence. The reduction of physical restraints among hospitalized nursing home residents will require attention to a multiplicity of factors that contribute to restraint use.

Abstract

A policy analysis of access to health care was undertaken using a review of current studies and proposals for health care reform in order to uncover the issues of cost, quality, and scope of services that would be required to realize health care coverage for the 38.7 million Americans who remain uncovered. This national issue was explored at the state level, and it was also explored at the individual level by a description of those affected by age, race, ethnicity, health status, and gender. Finally, the author looks at health care reform as one of many other issues affecting the American citizen as choices are made about how to utilize limited resources.

Abstract

PURPOSE: To determine the frequency with which Black women with type 2 diabetes receive routine primary health care screening for cancer and diabetes complications. DATA SOURCES: Pilot study data from a convenience sample of 21 Black women (mean age 46.8 years) with type 2 diabetes. CONCLUSIONS: Cancer screening consisted of Pap smear, mammography, and colon cancer screening consistent with current American Cancer Society recommendations. Ninety percent reported having had a Pap smear, 86% mammogram and 33% colon cancer screening. Diabetes complications screening was based on the American Diabetes Association care recommendations. Fifty-five percent received screening eye exams, 40% were screened for renal proteinuria, and 50% received foot examinations and diabetes foot care instruction. IMPLICATIONS FOR PRACTICE: This sample of mid-life, Black, educated, working women with type 2 diabetes utilize healthcare services and have high rates of primary care cancer screening. Rates of diabetes complications screening are less than optimal. Because Black American women suffer disproportionately high rates of diabetes and related complications, it is imperative that they receive quality diabetes care in an effort to improve health outcomes and decrease premature mortality.

Abstract

This study investigates the relationship between substance use and partner abuse among women (N = 1,025) who entered drug-treatment programs through the criminal justice systems in New York City and Portland, Oregon. Self-report data on substance use and partner abuse indicate that although the rate of partner abuse in both cities is well above the national average, the less substance-involved women in Portland reported more abuse than their New York counterparts. Our analyses suggest that the relationship between partner abuse and substance use during conflicts varies within the population of women offenders who are heavily drug-involved, with women in Portland reporting a greater direct link between partner abuse and substance use. The findings indicate that there is a need for drug-treatment providers to understand their clients' victimization histories and the relationship between partner abuse and substance use in order to engage clients in the treatment process and help them learn how to avoid being victimized in the future.

Abstract

A burgeoning aging population, the desire of elders to “age in place,” and changes in family structure that leave elders with limited family supports have generated great interest in assisted living. Many baby boomers have the means to afford assisted living either for themselves or their aging family members. Additionally, in an effort to contain skyrocketing Medicaid expenditures, policy makers are interested in alternatives to nursing home care. As the number of assisted living facilities soars, calls for regulation are growing. Nurses have much to contribute to the formation of federal, state, and local assisted living policies. In particular, knowledge of regulatory issues and the agenda-setting process can enhance nursing’s influence in assisted living policy making. This article describes the issues surrounding policy making for assisted living with an eye toward promoting the role of nurses in this important policy area.

Abstract

Purpose: The aim of this article was to identify major research needs related to quality of life at the end of life and quality of the dying process for vulnerable older people at home, in assisted living facilities, in skilled nursing facilities, and in prisons. Design and Methods: Review and analysis of the literature was used. Results: The science is generally weak in relationship to what is known about quality of life at the end of life and quality of dying for vulnerable older adults in different settings. Few studies address actively dying patients and the reasons for transfers between home and other settings. Existing studies are primarily anecdotal, descriptive, have small samples, and involve a single setting. Participant decisional capacity is a barrier to conducting research in these settings. Implications: Research recommendations for each setting and across settings are provided. The National Institutes of Health should clarify criteria for enrollment of persons with diminished, fluctuating, and absent decisional capacity in research.

Abstract

There is a critical shortage of geriatrics-prepared health care professionals. In 2002 more than thirty-five million people were age sixty-five and older, and 23 percent of them reported poor or fair health. Older adults use 23 percent of ambulatory care visits and 48 percent of hospital days, and they represent 83 percent of nursing facility residents. Yet 58 percent of baccalaureate nursing programs have no full-time faculty certified in geriatric nursing. Only three of the nation's 145 medical schools have geriatrics departments, and less than 10 percent of these require a geriatrics course. We argue that every health care worker must have some education in geriatrics and access to geriatrics care experts.

Abstract

Restraint-free care has emerged as an indicator of quality care for older adults in all settings. The most difficult challenges to achieving this goal are care of hospitalized older adults who are functionally dependent and cognitively impaired. The purpose of this article is to report findings from a descriptive study of restrained hip fracture patients, and discuss approaches to achieving restraint-free care. Rate of restraint use was 33.2% among hospitalized hip fracture patients during an 11-year period in 20 metropolitan teaching hospitals. Restrained patients were older men who resided in nursing homes prior to hospitalization. Clinically, restrained patients had a diagnosis of dementia, were noted to be confused or disoriented by nursing staff, and were dependent in activities of daily living. An individualized approach to care is the best method to avoid use of physical restraints for patients with acute confusion and cognitive impairment.