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Background: Patient safety is a priority in health care systems. Nurses' safety competence along with environmental and personal factors plays a role in patient safety. Purpose: The purpose of this study was to explore the relationships among safety competency, structural empowerment, systems thinking, level of education, and certification. Methods: A cross-sectional exploratory design was used to collect data from nurses (n = 163) practicing in a large Midwestern hospital system. Results: There were significant positive correlations between safety competency and (a) structural empowerment, (b) systems thinking, and (c) certification. Systems thinking explained 12.9% of the variance in the knowledge component of safety competency and 6.8% of the variance in the skill component of safety competency. Certification explained 2.4% of the variance in the skill component of safety competency. Conclusions: Understanding factors that affect safety competency supports the development of effective interventions that may improve safety. [ABSTRACT FROM AUTHOR]

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]

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.

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

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., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

A comparative descriptive study was conducted to determine the effectiveness of text messages with pictures compared with plain text messages or verbal reminders in improving measles, mumps, and rubella immunization compliance in the rural areas of the Philippines. We found that text messaging with or without pictures is a feasible and useful tool in measles, mumps, rubella immunization compliance for childhood immunization. Texting with pictures (n = 23), however, was no more effective than plain text messaging (n = 19) or verbal reminder (n = 17) in improving measles, mumps, and rubella immunization compliance. Compared with parents who received verbal reminders alone, either type of text reminders was linked to parents bringing their child for measles, mumps, and rubella immunization on a timelier basis, as defined by the difference between the scheduled visit and the actual visit, although this was not statistically significant. Mobile technology that uses text reminders for immunization can potentially improve the communication process between parent, the public health nurse, and healthcare provider. Future studies can explore the application of plain text messages or text messages with pictures to improve compliance more broadly for maternal and child healthcare especially in rural areas of developing countries and may be a helpful tool for health promotion for this population.

"The Future of Nursing: Leading Change, Advancing Health" from the Institute of Medicine () has created a long-overdue national discussion about nursing's role in the healthcare delivery system and what it will take for nurses to address these possibilities. For home healthcare nurses in particular, the next 10 years are going to result in drastic changes in practice and operations in home healthcare nursing practice. Most of these changes are going to be positive from the home healthcare nurse's perspective. However, I am concerned that home healthcare nurses are not ready for the extent of these drastic changes, and I present several scenarios that could occur, based on the IOM report and existing research.

The Outcomes and ASsessment Information Set Version C (OASIS-C) is the most comprehensive update to OASIS since its inception. This article describes the background and rationale for the changes, the testing process, an overview of the changes, and a description of the quality measures that will be generated from the use of OASIS-C.

Work structures that empower nurses contribute to a healthy work environment yet there are few studies that have looked at the relationship between nurse participation in formal work structures and their perception of empowerment. Nurses involved in power-sharing activities demonstrate a greater commitment to the organization and have improved job satisfaction. To measure the perception of structural empowerment by nurses and examine the relationship between staff registered nurse participation in organizational structures and perceived structural empowerment. A descriptive correlational survey design was used to measure staff nurses' perception of structural empowerment, using the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II). A purposive sample of staff registered nurses (N = 122) at a large Veterans Affairs urban teaching hospital was recruited to complete an online survey. The response rate was 33%. Nurses perceived a moderate amount of structural empowerment and a greater sense of empowerment in the areas of opportunity, support, and collaboration on the CWEQ-II. The total mean score for the CWEQ-II (M = 18.50, SD = 3.63) indicated a moderate amount of perceived structural empowerment. Of the 4 CWEQ-II subscales, opportunity (M = 3.78, SD = 0.87) was moderately high. Resources (M = 3.04, SD = 0.72) and support (M = 2.92, SD = 0.94) were rated as moderate, and participants rated information moderately low (M = 2.75, SD = 0.88). On 2 scales that measured sources of organizational power, informal power was moderately high (M = 3.37, SD = 0.79) compared with formal power (M = 2.64, SD = 0.81), which scored moderately low. In comparing nurses who participated in councils with those who did not, there were no significant differences in their total or subscale scores on the CWEQ-II. Of those who did participate in councils (n = 48, 39.3%), the number of council meetings nurses attended correlated significantly with support (r = 0.37, P = .009). The percentage of time council members communicated information to their peers at the unit level correlated positively with informal power (r = 0.30, P = .04). Organizational structures that provide opportunities for nurses to participate in professional matters that are important to them support empowerment that is essential for a healthy work environment.

Patient safety has taken on increasing importance in the American healthcare system, yet there is little information on patient safety in home healthcare. The current study aimed to describe the most frequent adverse events defined by the Centers for Medicare & Medicaid Services among the national population of patients receiving home healthcare in 2003, and to compare characteristics between patients who experience adverse events and those who do not. The findings show that 13% of all home healthcare patients had an adverse event, with 80% experiencing only 1 adverse event. More than three fourths of the adverse events were associated with discharge to the community and required continued assistance. Patients who experienced adverse events were older, had more depressive symptoms and behavioral problems, and were more functionally impaired. Women had a slightly lower relative risk of an adverse event (.98), whereas patients of minority ethnicity had a slightly higher relative risk (1.06). These findings suggest that home healthcare agencies may need to spend more time on discharge planning after home healthcare and work with existing community providers. The findings also raise questions regarding the appropriateness of these adverse events and whether there are additional adverse events that warrant monitoring and follow-up evaluation.

Frontloading, providing 60% of planned visits in the first 2 weeks of the home healthcare episode, was tested in two groups of patients: insulin-dependent patients with diabetes and patients with a primary diagnosis of heart failure. Frontloading was effective for patients with heart failure, decreasing rehospitalization by more than half (39.4-16%), with fewer visits (15.5 vs. 9.5) and equal clinical outcomes and patient satisfaction. There were no significant differences in outcomes for patients with diabetes.

This study examined how the value of autonomy is reflected in home healthcare agencies' practice models and how staff registered nurse (RN) characteristics (education, experience, certification) relate to the RNs' perception of their ability to exercise autonomous practice: control over practice decisions (clinical autonomy) and control over practice setting decisions (organizational autonomy). RNs (N = 82) from 11 agencies were found to have more control over practice decisions than practice setting decisions. No significant relationship was found between RN characteristics of education, RN experience, home healthcare experience, and specialty certification.

Background: The Outcome and Assessment Information Set (OASIS) is the universal clinical assessment tool for adult nonmaternity patients receiving skilled care at home from Medicare-certified home health agencies in the United States. Anticipating increased use of OASIS data for research purposes, this article explored the usefulness of Rasch modeling to address disability measurement challenges presented by the unique response category structure of the seven activities of daily living (ADL) and eight instrumental ADL (IADL) items in the OASIS., Objectives: To illustrate how Rasch model statistics can be used to evaluate OASIS ADL and IADL item unidimensionality and model fit; to illustrate how Rasch modeling simultaneously estimates ADL and IADL item difficulty, thresholds between item response categories, and person disability; and to compare Rasch estimates of item difficulty and person disability scores to estimates based on more conventional Likert scoring techniques., Subjects: Medicare-eligible home health care patients (n = 583) served by one of 12 home care agencies in Ohio between November 1999 and September 2000., Measures: ADL and IADL items were measured three ways: according to the original OASIS scoring (raw Likert); transformed raw Likert scores accounting for the nonuniform item structure (corrected Likert); and Rasch Partial Credit model scores., Results: The items bathing and telephone use showed evidence of unexpected response patterns; recoding of these items was necessary for good Rasch model fit. Partial Credit model results revealed that interval distances between response categories varied widely across the 15 ADL and IADL items. When ADL and IADL items were ranked by level of difficulty, results were similar between Rasch and corrected Likert measurement approaches; however, corrected Likert person scores were found to be nonlinear at highest and lowest disability levels when plotted against Rasch person scores., Conclusions: Rasch modeling can help improve the precision of disability measurement in Medicare home care patients when using ADL and IADL items from the OASIS instrument.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in this country, with a total annual cost of approximately $23 billion. This study examined the impact on total resource utilization when a pulmonary specialty team manages the in-home healthcare of the patient suffering from advanced COPD. Following implementation of the pulmonary specialty team, the use of hospital, emergency department, and skilled nursing facility resources decreased while home healthcare resource use increased. The overall costs were reduced on average by more than $13,000 per patient.