Publications

Abstract

Injuries with used needles and other "sharps" put health care workers at risk for serious bloodborne infections, such as HIV and hepatitis B and C. To some extent, this risk can be lessened through safer techniques (such as not recapping needles) and safer devices (such as needleless and self-sheathing equipment). But these injuries occur within a context (often a hospital unit) with organizational features that may themselves contribute to an increased or decreased risk. This Issue Brief summarizes a series of studies that investigate whether workplace aspects of the hospital (such as staffing levels, and organizational structure and climate) affect the risk of needlestick injuries to nurses.

Abstract

Retention rates for 1-year new graduate nurses had fallen to 30% at the author's institution. Upon reviewing feedback, a lack of a new graduate orientation program was determined to be a significant factor. The challenge presented to staff development was to develop a program that would increase 1-year retention rates of new graduate nurses without incurring overtime costs or significant additional expenses. The result was a successful 8-week orientation program using multiple teaching methods. New graduates rated their own progress through the use of a self-assessment questionnaire. One-year retention rates for new graduate nurses increased to 77% after the program was implemented.

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

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

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

New York City and Los Angeles County have the largest health systems in the United States, but they differ significantly in structure. This study compares and analyzes the structural and workforce differences between the two. The health system in New York City is centered around its large hospitals, and as a result New York employs many more health workers than Los Angeles County, where the health system is centered around physician groups. Health care is a significant contributor to the economy of both areas, but a larger contributor to the economy in New York City.

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

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.