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Editor's note: Sigma Theta Tau International Honor Society of Nursing is a global organization focused on leadership and scholarship, with more than 135,000 members from over 100 countries. This first article in a series highlights why global nursing should matter to U.S. nurses and offers an overview of organizations within the global nursing community. [ABSTRACT FROM AUTHOR]

Aims: To discuss nurses' contributions to global health through their participation in GAPFON®. Design: Discussion paper that reviews literature related to global health, global nursing and midwifery based on the contributions of the GAPFON® report. Data sources: A literature search of electronic databases was conducted for published articles during 2014–2018 in English focusing on the main themes of the GAPFON® report. Manual searches of relevant journals and internet sites were also undertaken. Results: Recommendations and strategies were discussed that could have an impact on the advancement of the nursing profession's contribution to global health based on the GAPFON® report outcomes. Implications for Nursing: GAPFON® provides a framework to synergize and converge our activities to address professional issues around the globe, through implementation of the suggested strategies identified in the GAPFON® report. GAPFON® has engaged with nursing and midwifery leaders around the globe to determine both the most pressing health issues and professional issues in regions and the report is a synthesis of all the data, reflecting regional and global challenges. This article explores ways of how the report can be used as a basis for engagement with decision makers in global health. Conclusion: Advances in the professional areas embedded in the GAPFON® Model are expected to lead to capacity building, evidence‐based practice and ultimately improved quality of global health care. The strategies for implementation identified by regional stakeholders can have an impact on the global health agenda by focusing on nurses and midwives as the drivers of this change. [ABSTRACT FROM AUTHOR]

Veracity, one of the five V's used to describe big data, has received attention when it comes to using electronic medical record data for research purposes. In this perspective article, we discuss the idea of data veracity and associated concepts as it relates to the use of electronic medical record data and administrative data in research. We discuss the idea that electronic medical record data are "good enough" for clinical practice and, as such, are "good enough" for certain applications. We then propose three primary issues to attend to when establishing data veracity: data provenance, cross validation, and context. [ABSTRACT FROM AUTHOR]

Fitness bands are widely available and assist with tracking the number of steps taken. However, for older people with slow gaits, shorter step widths and/or use of ambulatory devices, the accuracy of fitness bands for step counting has not been well studied. Using four commercially available fitness bands (Garmin Vivofit2™, Fitbit Flex™, Up3™ and Microsoft Band™), we studied 30 older people with varying ambulatory abilities. We videotaped participants walking and compared the videotaped step count with the fitness band counts. Only 5 of the 30 participants had accurate readings within a ±20 percent accuracy for all four bands. There was no relationship between the step speed and accuracy of the fitness bands. Participants using walkers and walking sticks had none of the bands that met the ±20 percent accuracy. Canes were more variable with accuracy. Fitness band manufacturers may need to tune their algorithms for use by older people. [ABSTRACT FROM AUTHOR]

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. [ABSTRACT FROM AUTHOR]

Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status. [ABSTRACT FROM AUTHOR]

Objective Patients with heart failure ( HF) have high rates of rehospitalization. Home health care ( HHC) patients with HF are not well studied in this regard. The objectives of this study were to determine patient, HHC agency, and geographic (i.e., area variation) factors related to 30-day rehospitalization in a national population of HHC patients with HF, and to describe the extent to which rehospitalizations were potentially avoidable. Data Sources Chronic Condition Warehouse data from the Centers for Medicare & Medicaid Services. Study Design Retrospective cohort design. Data Extraction The 2005 national population of HHC patients was matched with hospital and HHC claims, the Provider of Service file, and the Area Resource File. Principal Findings The 30-day rehospitalization rate was 26 percent with 42 percent of patients having cardiac-related diagnoses for the rehospitalization. Factors with the strongest association with rehospitalization were consistent between the multilevel model and Cox proportional hazard models: number of prior hospital stays, higher HHC visit intensity category, and dyspnea severity at HHC admission. Substantial numbers of rehospitalizations were judged to be potentially avoidable. Conclusions The persistently high rates of rehospitalization have been difficult to address. There are health care-specific actions and policy implications that are worth examining to improve rehospitalization rates. [ABSTRACT FROM AUTHOR]

Opportunities to achieve competency in the psychomotor and cognitive outcomes required of the nursing profession are limited due to shortages of clinical sites and situations. One solution is to use simulation to replicate some of the essential aspects of a clinical situation so it may be readily understood and managed when it occurs in reality. A program developed for sophomore students integrated the pharmacology, health assessment, and pathophysiology theory courses using low-fidelity simulation and computer-assisted instruction. The objectives of the program were based on Quality and Safety Education for Nurses competencies. The simulation strategies were evaluated using the Educational Practice Scale for Simulation, the Student Satisfaction and Self-Confidence in Learning questionnaire, and the Simulation Design Scale. The initial findings are encouraging for promoting active and diverse methods of learning, high and positive expectations for students, self-confidence, and collaborative team-building opportunities. [ABSTRACT FROM AUTHOR]

Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation of functional status were done using ADLs (ambulation, bathing, dressing lower body, dressing upper body, feeding, grooming, toileting, and transferring) scored individually and as indices. Each approach has advantages and disadvantages depending on the research question being asked. The ADL change index score provided the most comprehensive analysis of functional status change although the categorical scores are useful for simple approaches. [ABSTRACT FROM AUTHOR]

A descriptive, comparative study was conducted to examine the attitudes of nurses, physicians and residents towards collaboration and to assess their self-perception of servant leadership characteristics. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration and the Barbuto-Wheeler Servant Leadership Questionnaire were utilized for data collection. Registered nurses (RNs) (n = 2,660), physicians (n = 447) and residents (n = 171) in a Southeastern United States health system were surveyed via the intranet; there were 497 responses for analysis. The response rate should be considered and generalizations made with caution regarding the study results. RN scores were higher for both total scores and subscales as compared to physician/resident groups for collaboration and servant leadership. There was a weak positive correlation between collaboration and servant leadership in the RN group and no significant correlation between the variables in the physician/resident group. Findings from this study have implications for nursing and physician education and practice and may serve as a framework for future studies. Representative samples are needed to gain further insight and to guide future research. [ABSTRACT FROM AUTHOR]

The practice implications of the Centers for Medicare & Medicaid Services hospital payment policy change are likely to influence the relationships between home health care agencies and their referring/receiving hospitals. Maintaining infection control measures can be difficult in the home environment, which was not designed for health care provision and where family members, friends, and pets are present. In addition to the hospital payment changes, there have been epidemiologic changes, with increasing recognition of multidrug resistant organisms and increasing virulence. The purpose of this article is to identify the scope of the practice changes that might be expected in response to epidemiologic and policy changes and activities that home health care agencies can undertake in response. Increased calls for transparency, accountability, and high-quality care, along with threats of denied reimbursement, will force changes across the entire continuum of care. [ABSTRACT FROM AUTHOR]

There is relatively little empirical data on the supply of community-based end-of-life (EOL) providers especially in rural areas despite projections for growth. This study examined the availability of community-based EOL providers in eight states using mapping techniques and statistical approaches. Analysis of variance and geographic information system approaches were used to compare the availability of community-based EOL providers at the county level by degree of rurality. Examining numbers of rural counties by provider, it was found that hospices were the least available community-based EOL providers in rural counties with 62% to 92% of rural counties not having hospice providers (exception: Vermont). When examining the number of providers by population older than 65 years, few differences were found. It is concluded that there are substantially fewer hospice providers in the most rural areas, raising issues of access to care. Examination of both unadjusted and adjusted numbers of providers is important to understand community-based EOL provider supply. [ABSTRACT FROM AUTHOR]

This study evaluated the criterion validity of the Outcome and Assessment Instrument Set (OASIS) items that measure activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive functioning, and depression. A convenience sample of patients (n = 203) from five home care agencies participated in the study. Patient OASIS items were compared to data collected using gold standard instruments. Correlations range from .44 to .69 for ADLs and .20 to .68 for IADLs. A correlation of .62 was found for cognitive functioning while correlations for depressive symptoms are .36 and .26. OASIS ADLs and cognitive status items are sufficiently valid, but the OASIS depression item is not sufficiently sensitive to the prevalence of these conditions. [ABSTRACT FROM AUTHOR]

Rural elders have a disproportionate prevalence of illness and limited access to health services. The purpose of this study is to determine whether degree of rurality and home health care use influences home health care patient outcomes. An adaptation of the Outcomes Model for Health Care Research provided the framework for the study. A stratified random sample was selected from a database of risk-adjusted publicly reported patient outcomes from Medicare-certified home health care agencies and merged with agency factors from Medicare cost reports and U.S. Census data. Path analysis was performed to evaluate the relationships in the model. Hospitalization is the only outcome variable associated with community and agency characteristics or home health care use. Rurality does not have a direct effect on hospitalization; however, increased visits per patient and low-income community status are associated with increased hospitalization. Rurality may not have a direct effect on outcomes but instead acts through health care services. [ABSTRACT FROM AUTHOR]

Rural health care organizations struggle to attract and retain nurses, yet much of the research has focused on characteristics of the nurse work environment or empowerment in urban hospitals. The purpose of this study was to examine the nurse work environment in rural areas across settings by describing the relationship between structural empowerment and characteristics of the nurse work environment. Nurses (N = 97) working in home care agencies and hospitals were surveyed. Significant differences were found between the groups, with home care nurses having significantly higher empowerment scores than medical/surgical nurses. A strong correlation was found between characteristics of the nurse work environment and empowerment. Policy makers are using evidence to guide development of policies, but much of the research has been conducted in urban hospital settings. This study begins to provide evidence that differences exist between urban and rural areas and between practice settings. [ABSTRACT FROM AUTHOR]

Background: The achievement of the Millennium Development Goals (MDGs) depends on sufficient supply of health workforce in each country. Although country-level data support this contention, it has been difficult to evaluate health workforce supply and MDG outcomes at the country level. The purpose of the study was to examine the association between the health workforce, particularly the nursing workforce, and the achievement of the MDGs, taking into account other factors known to influence health status, such as socioeconomic indicators. Methods: A merged data set that includes country-level MDG outcomes, workforce statistics, and general socioeconomic indicators was utilized for the present study. Data were obtained from the Global Human Resources for Health Atlas 2004, the WHO Statistical Information System (WHOSIS) 2000, UN Fund for Development and Population Assistance (UNFDPA) 2000, the International Council of Nurses "Nursing in the World", and the WHO/UNAIDS database. Results: The main factors in understanding HIV/AIDS prevalence rates are physician density followed by female literacy rates and nursing density in the country. Using general linear model approaches, increased physician and nurse density (number of physicians or nurses per population) was associated with lower adult HIV/AIDS prevalence rate, even when controlling for socioeconomic indicators. Conclusion: Increased nurse and physician density are associated with improved health outcomes, suggesting that countries aiming to attain the MDGs related to HIV/AIDS would do well to invest in their health workforce. Implications for international and country level policy are discussed. [ABSTRACT FROM AUTHOR]

Tuberculosis treatment default, missing medical appointments for two consecutive months or more, is a serious problem not only for individuals but also for societies and health-care systems. Most research focuses only on patient factors without considering health-care system factors' effects on treatment default. The study purpose was to examine the influence of process of care on treatment default. Structured interviews and medical chart reviews were conducted in 160 tuberculosis patients receiving care at a tertiary hospital in Thailand. The samples included 54 patients with treatment default and 106 patients with treatment completion. Hierarchical logistic regression was used to examine relationships among the variables. After adjusting for patient factors, having severe medication side-effect and travel time to clinic increased treatment default. The patient factor of being paid on a daily basis was also significantly associated with treatment default. Evidence indicates that some process of care factors influence treatment default. Findings can be applied to practice levels to maintain patients until treatment completion. [ABSTRACT FROM AUTHOR]

Background: The purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. In particular, discharge destination and length of stay have not been studied using a data mining approach which may provide insights not obtained through traditional statistical analyses. Methods: The data were obtained from the 2000 National Home and Hospice Care Survey data for three specific conditions (chronic obstructive pulmonary disease, heart failure and hip replacement), representing nearly 580 patients from across the US. The data mining approach used was CART (Classification and Regression Trees). Our aim was twofold: 1) determining the drivers of home healthcare service outcomes (discharge destination and length of stay) and 2) examining the applicability of induction through data mining to home healthcare data. Results: Patient age (85 and older) was a driving force in discharge destination and length of stay for all three conditions. There were also impacts from the type of agency, type of payment, and ethnicity. Conclusion: Patients over 85 years of age experience differential outcomes depending on the condition. There are also differential effects related to agency type by condition although length of stay was generally lower for hospital-based agencies. The CART procedure was sufficiently accurate in correctly classifying patients in all three conditions which suggests continuing utility in home health care. [ABSTRACT FROM AUTHOR]

The Outcomes and Assessment Information Set (OASIS) is now used extensively for regulatory, reimbursement, research, and clinical purposes in home health care. However, little is known about the interrater reliability of OASIS items based on assessments from home-health-agency clinicians. Therefore, we evaluated OASIS item interrater reliability among 88 patients from 21 agencies. Of 25 items studied, all except 2 had weighted kappa values of κ ⩾ 0.60. We conclude that OASIS item interrater reliability was highly adequate in this study, but we recommend routine interrater-reliabilily evaluation by agencies to maximize the quality of OASIS data nationally. [ABSTRACT FROM AUTHOR]

The complications and management of long-term indwelling catheters used for urinary retention and incontinence were reviewed. Research evidence from 1992 — 2002 was located through searches of CINAHL (38 articles), and Medline (89 articles). Fifty studies were critiqued for this review. The most common complications of long-term indwelling catheters are bacteriuria, encrustation, and blockage. Less common is the prevalence of bacteremia and renal disease. Risk factors for bacteriuria include female gender, older age, and long-term indwelling catheter use. Urinary white blood cells are the best indicator of urinary tract infection. For drainable catheter systems used by community dwelling adults, daily bag cleaning with a diluted bleach solution (1:10) is effective in reducing bacterial counts to negligible numbers. Application of topical antibiotic cream to the meatus around the catheter does not reduce bacteriuria. Silicone catheters and larger lumen size catheters are more resistant to encrustation than other catheter types and smaller lumen size catheters. Acidifying the urine without removing the urease-producing bacteria does not reduce encrustation. Removal of catheter blockage is preventive for renal disease. Because of the complications of long-term indwelling catheter usage, periodic assessment and voiding trials should be used to determine the continued need for a catheter. Evidence-based recommendations for managing indwelling urinary catheters include screening for risk factors and evaluating urinary white blood cell count for infection, and assessment of the continued need for a catheter. Interventions include consideration of closed versus open drainage systems, type of catheter, and size of catheter lumen. [ABSTRACT FROM AUTHOR]

The article provides updates on the Midwest Nursing Research Society (MNRS). These include a message from the president who discussed the 4 goals set by the MNRS Board including securing funding for research, strengthening networking and increasing membership and member retention and a message from the Secretary/Treasurer of MNRS Foundation who stated the opportunity and obligation of members to support the organization's mission of funding and supporting nursing research.

Expected changes in home health care reimbursement will require a shift in focus from a visit-based unit to some other yet-to-be-defined unit of resource consumption. Little research has been done to understand other measures of resource consumption, however, especially those examining disciplinary differences. The purpose of this study was to provide empirical evidence on other measures of resource consumption as a way to frame discussions on alternative measures. Information is presented from a study of 102 home health care patients from 10 agencies in Ohio who completed an episode of care and remained at home. While the mean time per visit was similar for all disciplines (46 to 55 minutes), there were differences in the number of visits provided by various disciplines (home care aide services had the highest mean number of visits with 11.8). The mean cost per day for all services was $43.80 while the mean cost per episode was $1,160. Recommendations for further research include similar examinations using a more rigorous sampling methodology and including disparate populations of patients. [ABSTRACT FROM AUTHOR]

Simulation education is gaining momentum internationally and may provide the opportunity to enhance clinical education while disseminating evidence-based practice standards for clinical simulation and learning. There is a need to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally. The Frances Payne Bolton School of Nursing at Case Western Reserve University has had the unique opportunity to establish academic exchange programs with schools of nursing across five continents. Although the joint and mutual simulation activities have been extensive, each international collaboration has also provided insight into the innovations developed by global partners. [ABSTRACT FROM AUTHOR]

The article examines innovations in home healthcare in the U.S. as of August 2015 that offer opportunities for hospitals and healthcare systems to partner with home healthcare companies. These innovations are remote patient monitoring and telehealth which can be paid by government or private insurance, however most Americans are not aware of this option. Also discussed are the types of patients who can benefit from the technologies as well as the changes in home healthcare.

AIM This article discusses the challenges of international PhD nursing students and recommends strategies to support them. BACKGROUND Approximately 10 percent of the students enrolled in research-focused nursing doctoral programs in the United States are non-US residents, challenging schools of nursing to examine ways to support these students. METHOD We searched five electronic databases using international student* AND doctoral OR graduate as search terms; we integrated the authors' experiences. RESULTS Faculty and peer support can promote a smooth transition into the United States. Participating on research teams or school committees promotes academic socialization. Dissertation work has multiple unique challenges, including international relevance of topics, translation, funding, and location of the research. CONCLUSION Faculty advisers and universities can facilitate student adjustment. Once international students become familiar with the academic requirements and culture, they have the capacity to contribute rich, diverse perspectives that greatly enhance the quality of PhD education. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Functional capacity is widely recognized as a key factor in maintaining the ability of older people to live independently and safely at home. Promoting functional capacity is an important priority particularly in HHC. The purpose of the study was to examine predictors of functional capacity change among HHC patients with HF. Materials and methods: Clinical and administrative data from 2005 from the Medicare Chronic Conditions Warehouse were linked at the population level for HHC patients with a primary diagnosis of HF. The primary outcome was change in functional capacity score from HHC admission to HHC discharge. Results: Over the course of the episode (M =44 days), most (70%) patients improved, 15.6% stayed the same, and 14.4% declined in activities of daily living (ADL) scores. The mean change score was modest (mean=−0.74, SD=1.11) with a median change of −0.58. Multivariate analyses (R 2 =0.23) showed that the largest influence was the admission ADL score followed by receiving any physical therapy (PT), admission ability to manage oral medications, cognitive functioning, rehabilitation prognosis, and urinary incontinence. Discussion: There is a modest rate of improvement from admission to discharge that likely represents the progressive nature of HF and/or the short time frames over which HHC is provided. Providers may want to use the predictive factors to identify patients most at risk for functional decline. [Copyright &y& Elsevier]

Introduction: The proliferation and use of electronic medical records (EMR) in the clinical setting now provide a rich source of clinical data that can be leveraged to support research on patient outcomes, comparative effectiveness, and health systems research. Once the large volume and variety of data that robust clinical EMRs provide is aggregated, the suitability of the data for research purposes must be addressed. Therefore, the purpose of this paper is two-fold. First, we present a stepwise framework capable of guiding initial data quality assessment when matching multiple data sources regardless of context or application. Then, we demonstrate a use case of initial analysis of a longitudinal data repository of electronic health record data that illustrates the first four steps of the framework, and report results.Methods: A six-step data quality assessment framework is proposed and described that includes the following data quality assessment steps: (1) preliminary analysis, (2) documentation-longitudinal concordance, (3) breadth, (4) data element presence, (5) density, and (6) prediction. The six-step framework was applied to the Transport Data Mart-a data repository that contains over 28,000 records for patients that underwent interhospital transfer that includes EMRs from the sending hospitalization, transport, and receiving hospitalization.Results: There were a total of 9557 log entries of which 8139 were successfully matched to corresponding hospital encounters. 2832 were successfully mapped to both the sending and receiving hospital encounters (resulting in a 93% automatic matching rate), with 590 including air medical transport EMR data representing a complete case for testing. Results from Step 2 indicate that once records are identified and matched, there appears to be relatively limited drop-off of additional records when the criteria for matching increases, indicating the a proportion of records consistently contain nearly complete data. Measures of central tendency used in Step 3 and 4 exhibit a right skewness suggesting that a small proportion of records contain the highest number of repeated measures for the measured variables.Conclusions: The proposed six-step data quality assessment framework is useful in establishing the metadata for a longitudinal data repository that can be replicated by other studies. There are practical issues that need to be addressed including the data quality assessments-with the most prescient being the need to establish data quality metrics for benchmarking acceptable levels of EMR data inclusiveness through testing and application. [ABSTRACT FROM AUTHOR]

OBJECTIVE: An educational program including online generic and nursing-specific content was evaluated for self-assessed leadership skill outcomes. BACKGROUND: Leadership development for nurses in direct care positions has not received the same support as for nurses in formal leadership positions. Pandemic and workforce changes make it critical that leadership skills be built at all levels of nursing. METHODS: Early-career nurses (≤10 years of experience) were recruited to participate in an online leadership development program offering 9 LinkedIn Learning courses, 3 leadership courses from Sigma, an e-book, and a discussion board. RESULTS: Most participants who responded to both immediate postsurvey and 3-month follow-up survey (98.6% of n = 69) reported having applied new or improved abilities in their nursing practice to at least a small degree, and the majority reported having done so to a moderate or great degree. CONCLUSION: This online leadership development program was valued and was associated with improved self-assessed leadership. [ABSTRACT FROM AUTHOR]

Purpose: Vacancy rates for nurses in the English-speaking Caribbean are estimated at 30% with turnover typically associated with migration. The purpose of this study was to describe the characteristics of hospital-based registered nurses (RNs) in the sub-region, their practice environment and turnover intention in two and five years, respectively, and to determine the relationships among practice environment characteristics and turnover intention. Design: A descriptive correlational design was used with self-reported questionnaires from a convenience sample of 301 RNs working in hospitals in four English speaking Eastern Caribbean countries. Single-item visual analog scales (VAS) were used to measure turnover intention in 2 years and 5 years. The Practice Environment Scale of the Nursing Work Index (PES-NWI) measured the characteristics in the practice environment. Findings: The mean age of the nurses was 32.5 ( SD= 6.75) years. Most nurses (58.8%) were single and 91.4% had relatives living abroad. Nurses scored three PES-NWI subscales < 2.5, indicating a less positive practice environment: resource adequacy, nurse participation in hospital affairs, and nurse managers' ability, leadership, and support. The subscale for collegial nurse-physician relations received the best rating (mean = 2.61, SD= .62). For 2-year intention to leave, the mean rating on the 100-mm VAS was 63.2, while that for the 5-year intention to leave was 65.6. No significant correlations were found among four of the five PES-NWI subscales and turnover intention in 2 and 5 years. Conclusions: The practice environment, while generally unfavorable, is not associated with the nurses' intention to leave their jobs. These findings support the current policy position that calls for managing turnover among nurses. Nursing and health system administrators should assess, plan, and implement workforce policies to slow the outflow of nurses. Clinical Relevance: Initiatives to improve the work environment and the delivery of high-quality care are important to RNs in the Eastern Caribbean. Managing the negative impact of continuous outflow of nurses through turnover requires long-term coordinated policy and human resource development and management initiatives to sustain the supply of RNs in the subregion. [ABSTRACT FROM AUTHOR]

Background: Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research. Methods: Data come from the Outcomes and Assessment Information Set (OASIS) from a large urban home health care agency and other agency data. Prognostic data yields 49,437 episodes, while follow-up data yields 47,684 episodes. We tested three indices defined as substantial decline in three or more (gt3̱ADLs), two or more (gt2̱ADLs), and one or more (gt1̱ADLs) ADLs. Multivariate logistic regression determines the performance of the models for each index as measured by the c-statistic and Hosmer-Lemeshow chi square (÷2). Results: Frequencies for gt3̱ADLs, gt2̱ADLs, and gt1̱ADLs are 212 (0.43%), 783 (1.58%), and 4,271 (8.64%) respectively. Follow-up results are comparable with frequencies of 218 (0.46%), 763 (1.60%), and 3,949 (8.28%) for each index. Gt3̱ADLs does not produce valid models. The model for gt2̱ADLs consistently yields a higher c-statistic compared to gt1̱ADLs (0.754 vs. 0.679, respectively). Both indices' models yield non-significant Hosmer-Lemeshow chi square indicating reasonable model fit. Findings for gt2̱ADLs and gt1̱ADLs are consistent over time as indicated by follow-up data results. Conclusion: Gt2̱ADLs yields the best models as indicated by a high c-statistic and a nonsignificant Hosmer-Lemeshow ÷2, both of which exhibit exceptional consistency. We conclude that gt2̱ADLs may be preferable in defining ADL adverse events in the context of home health care. [ABSTRACT FROM AUTHOR]

Purpose: To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide. Design: Discussion paper. Methods: Literature review. Findings: Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems. Conclusions: Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels. Clinical Relevance: Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions. [ABSTRACT FROM AUTHOR]

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article highlights SDGs 5 (gender equality), 8 (decent work and economic growth), and 17 (partnerships for the goals), along with the advocacy of these goals by Sigma Theta Tau International Honor Society of Nursing in the UN system. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented discussing the trends in home diagnostic testing for Medicare beneficiaries.

Aim: To evaluate the effectiveness of an online learning, certificate programme for front‐line nurse leaders' sense of empowerment. Background: Front‐line leaders play a crucial role in health care. Current training is often inadequate. The Institute of Medicine report on The Future of Nursing: Leading Change, Advancing Health (2010) recommends nurses at all levels receive training for their role. Methods: A pre‐ to post‐study design was used; instruments included Conditions for Work Effectiveness Questionnaire, Psychological Empowerment Scale, intent to stay, and self‐reported knowledge and effectiveness of intervention questions. This study evaluated the effects of online learning for 29 acute care front‐line leaders in the USA and Australia. Results: Structural empowerment significantly improved, pre‐assessment (M = 18.50, SD = 1.6940) to post‐assessment (M = 19.47, SD = 1.6940). There was no significant difference in intent to stay or overall psychological empowerment. Participants agreed (24/29, 83%) the intervention contributed to their 'sense of empowerment in their role' and 'ability to create an empowering work environment'. Conclusion: Online learning was effective and could be integrated into orientation and/or continuing education plans to develop empowering work environments. Implications for Nursing Management: Online learning may be a means of educating and empowering front‐line leaders for their role. [ABSTRACT FROM AUTHOR]

As the nursing faculty shortage persists, there is an urgent need to develop emerging nurse scholars into research leaders capable of advocating for the profession and expanding on the mission to improve health. To address this need, the Midwest Nursing Research Society (MNRS) commissioned a student task force that led to the development of the Emerging Scholars Network (ESN). The purpose of this article is to describe how the ESN was developed, integrated, and promoted within the MNRS to advance the overall mission and sustainability of the society. The establishment and success of the ESN is described using the Five Developmental Stages of Organization Evolution. These stages include the following: (a) Developing a Concept; (b) Launching a Start-Up; (c) Establishing Credibility; (d) Creating Sustainability; and (e) Road to Maturing and Legacy. Recommendations for continued development of the ESN are provided. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Improving quality performance in home health is an increasingly high priority. The objective of this study was to examine trends in industry performance over time using three quality measures: a composite quality metric (Q index), an infection prevention measure (vaccination verification), and an outcome measure (hospital avoidance). DESIGN/SETTING/PARTICIPANTS/MEASURES: We linked Home Health Compare and Provider of Services data from 2012 to 2016, which included 39 211 observations during the 5‐year study period and 7670 agencies in 2016. The Q index was developed to allow comparability over time, equally weighting the contributions of each element. After examining summary statistics, we developed three regression models stratified by ownership (for‐profit/nonprofit agency) and included two constructs of nurse staffing, in addition to controlling for known confounders. RESULTS: Most agencies (80.4%) were for‐profit agencies. The Q index and vaccination verification improved substantially over time, but there was no change in hospital avoidance. Ownership status was associated with all three measures (P < .001). Registered nurse staffing (relative to licensed practical nurses and home health aides) was associated with higher Q index and vaccination verification (P < .001). CONCLUSION: The Q index allows for assessment of trends over time in home healthcare. Ownership and nurse staffing are important factors in the quality of care. The overall home care market is driven by for‐profit agencies, but their characteristics and outcomes differ from nonprofit agencies. J Am Geriatr Soc 67:1859–1865, 2019 [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Over a million older patients in the United States are admitted yearly for emergency general surgery (EGS) conditions. Seven procedure types dominate: colon, small bowel, gallbladder, ulcer disease, adhesiolysis, appendix, and laparotomy operations. A higher comorbidity burden is known to increase mortality in this population, but the impact of specific comorbidity combinations is unknown. Our objectives were to (1) characterize the distribution of procedures, comorbidities, and outcomes for older patients undergoing EGS; and (2) apply a data‐driven approach (association rule mining) to identify comorbidity combinations associated with disproportionately high mortality. DESIGN, SETTING, AND PARTICIPANTS Cross‐sectional study of patients 65 years and older who underwent one of the seven procedures previously cited, taken from the 2011 Nationwide Inpatient Sample. A total of 280 885 patient encounters were identified. MEASUREMENTS In‐hospital mortality, procedures, and comorbidities based on the Elixhauser Comorbidity Index. RESULTS: Overall mortality was 5.6%. The most common procedures were gallbladder (33.7%), ulcer surgery (21.5%), and adhesiolysis (21.0%). Mortality increased for all procedures as patients aged. Comorbidities associated with the highest mortality included coagulopathy (adjusted odds ratio [aOR] = 3.74; 95% confidence interval [CI] = 3.41–4.11; p <.001), fluid and electrolyte disorders (FED) (aOR = 2.89; 95% CI = 3.66–3.14; p <.001), and liver disease (aOR = 1.89; 95% CI = 1.61–2.22; p <.001). Three‐way comorbidity combinations most highly associated with mortality were coagulopathy, FED, and peripheral vascular disease (aOR = 5.10; 95% CI = 4.17–6.24; p <.001), and coagulopathy, FED, and chronic pulmonary disease (aOR = 4.83; 95% CI = 4.00–5.82; p <.001). CONCLUSION: For older patients, combinations of comorbidities portend additional risk beyond single comorbidities, and the associated risk burden is driven by the specific constellation of comorbidities present. Future work must continue to examine the effect of co‐occurring diseases to provide personalized and realistic prognostication for older patients undergoing EGS. J Am Geriatr Soc 67:503–510, 2019. [ABSTRACT FROM AUTHOR]

Background Underlying psychiatric conditions may affect outcomes of surgical treatment for colorectal cancer (CRC) because of complex clinical presentation and treatment considerations. We hypothesized that patients with psychiatric illness (PSYCH) would have evidence of advanced disease at presentation, as manifested by higher rates of colorectal surgery performed in the presence of obstruction, perforation, and/or peritonitis (OPP-surgery). Materials and methods Using data from the 2007-2011 National Inpatient Sample, we identified patients with a diagnosis of CRC undergoing colorectal surgery. In addition to somatic comorbid conditions flagged in the National Inpatient Sample, we used the Clinical Classification Software to identify patients with PSYCH, including schizophrenia, delirium/dementia, developmental disorders, alcohol/substance abuse, and other psychiatric conditions. Our study outcome was OPP-surgery. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to analyze the independent association between each of the PSYCH conditions and OPP-surgery, after adjusting for patient demographics and somatic comorbidities. Results Our study population included 591,561 patients with CRC and undergoing colorectal cancer surgery, of whom 60.6% were aged 65 years or older, 49.4% were women, and 6.3% had five or more comorbid conditions. Then, 17.9% presented with PSYCH. The percent of patients undergoing OPP-surgery was 13.9% in the study population but was significantly higher for patients with schizophrenia (19.3%), delirium and dementia (18.5%), developmental disorders (19.7%), and alcohol/substance abuse (19.5%). In multivariable analysis, schizophrenia, delirium/dementia, and alcohol/substance abuse were each independently associated with increased rates of OPP-surgery. Conclusions Patients with PSYCH may have obstacles in receiving optimal care for CRC. Those with PSYCH diagnoses had significantly higher rates of OPP-surgery. Additional evaluation is required to further characterize the clinical implications of advanced disease presentation for patients with PSYCH diagnoses and colorectal cancer. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted in an effort to investigate whether the U.S. Agency for Healthcare Research and Quality's evidence-based teamwork training system for healthcare professionals called TeamSTEPPS was effective in enhancing teamwork attitudes among baccalaureate nursing students. Researchers evaluated 21 students. They found that TeamSTEPPS was effective in educating the students about teamwork and in improving their teamwork attitudes.

The aim of this descriptive study was to establish and describe the national incidence, cost, and outcomes of patients that undergo medical transfer. Using discharge data from the Nationwide Inpatient Sample 2011, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, the dataset was analyzed using weighted frequency distribution. Approximately 1.6 million patients are transferred yearly. Transferred patients experience a mean length of stay of 9.3 days (std dv 13.5) versus 4.3 days for patients not transferred (std dv 6.0), and cost more than twice as much (mean $19,234) versus those not transferred (mean $9,469). Additionally, patients who undergo inter-facility transfer cost an additional $15.8 billion annually. Interhospital patient transfers require closer scrutiny regarding appropriateness and future policy implications. [ABSTRACT FROM AUTHOR]

PURPOSE An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life. [ABSTRACT FROM AUTHOR]

We compare the proportion of patients presenting with comorbid conditions among fee-for-service Medicare beneficiaries with heart failure obtained by using (a) home health care claims data, (b) data from the Medicare Provider Analysis and Review (MedPAR), and (c) the Outcome and Assessment Information Set (OASIS), using a unique database developed by linking the records of Medicare administrative data and the OASIS. Data from the MedPAR yielded a higher proportion of patients with comorbid conditions compared to the OASIS or home health care claims data (77%, 51%, and 51%, respectively), leading us to conclude that non-home health care claims data must be used for risk adjustment in studies involving home health care patients. [ABSTRACT FROM AUTHOR]

Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies. In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic. Cross-sectional study. Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019. Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies. 35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique. Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the usefulness of applying supervised machine-learning analyses to identify specific groups of patients that experience high levels of mortality post-interhospital transfer. Methods: This was a cross-sectional analysis of data from the Health Care Utilization Project 2013 National Inpatient Sample, that applied supervised machine-learning approaches that included (1) classification and regression tree to identify mutually exclusive groups of patients and their associated characteristics of those experiencing the highest levels of mortality and (2) random forest to identify the relative importance of each characteristic's contribution to post-transfer mortality. Results: A total of 21 independent groups of patients were identified, with 13 of those groups exhibiting at least double the national average rate of mortality post-transfer. Patient characteristics identified as influencing post-transfer mortality the most included: diagnosis of a circulatory disorder, comorbidity of coagulopathy, diagnosis of cancer, and age. Conclusions: Employing supervised machine-learning analyses enabled the computational feasibility to assess all potential combinations of available patient characteristics to identify groups of patients experiencing the highest rates of mortality post-interhospital transfer, providing potentially useful data to support developing clinical decision support systems in future work. [ABSTRACT FROM AUTHOR]