Search

During medication preparation, a No Interruption Zone could decrease interruptions and enhance safety. [ABSTRACT FROM AUTHOR]

Relationships between parenting distress, social support, and sense of competence and negative and positive maternal mood were assessed in 162 mothers with twins younger than 2 years. Women with lower satisfaction scores on the sense of competence scale reported higher negative mood (adjusted R(2) = 21.7%, p < .001). Women with lower parenting distress and higher efficacy scores on the sense of competence scale reported higher positive mood (adjusted R(2) = 39.4%, p < .001). Neither instrumental nor subjective social support contributed to variance in maternal mood. Interventions should be aimed at decreasing parenting distress and increasing sense of competence for mothers of twins.Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Health care is rapidly increasing the types of information systems (IS) that are used to manage patient care. The extent to which nurses move to a paperless system will be contingent on their beliefs about IS. The study explores the moderating and mediating effects of nurses' beliefs about IS use on the relationship between IS use and perceived benefits and satisfaction. A descriptive, correlational, cross-sectional design is used, and a random sample of 201 staff nurses working in hospitals was surveyed via a mail questionnaire. Nurses' beliefs have mediating effects on the relationship between nurses' IS use and their perceptions of IS benefits and satisfaction. The results can guide nurse administrators to improve nurses' perceptions about IS by using such methods as providing a training program to increase nurses' computer self-efficacy. Enhancing nurses' use of IS and their perceptions of IS benefits can ultimately improve patient safety and outcomes. [ABSTRACT FROM AUTHOR]

Aim To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. Background The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. Method This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. Results and conclusion Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager's leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. Implications for nursing management Nurse manager's might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to measure coronary heart disease (CHD) knowledge levels in women without a history of CHD and to determine predictors of poor CHD knowledge in these women. Data sources: The sample included 120 women between the ages of 35 and 60, who had no CHD history. Women were asked to complete self-administered surveys including demographic data, personal CHD risk factors, and a CHD Knowledge Test. Conclusions: Women lack CHD knowledge. Low educational level, normal serum lipids, high body mass index (BMI), and lack of access to a nurse practitioner (NP) were predictors of poor CHD knowledge levels in women without CHD history. Implications for practice: Women who had access to an NP were more likely to have higher CHD knowledge. In an attempt to decrease the morbidity and mortality associated with CHD, NPs may be able to improve CHD knowledge in women, particularly in those with lower educational level, normal serum lipids and higher BMI. [ABSTRACT FROM AUTHOR]

Workforce shortages are challenging administrators in the health care environments to examine existing models of providing care. Although characteristics of nursing care delivery contribute in important ways to the success or failure of hospital care, factors common to all practice models have not been identified nor have measurement strategies been designed that assess the impact of care on patient and organizational outcomes. The purpose of this study was to test a measurement model of nursing practice that was developed using multiattribute utility theory. A total of 24 factors identified by expert nurse administrators as being common to all nursing practice models were mathematically formulated into a multidimensional composite index that represented the degree to which a practice model on a nursing unit approached the professional ideal. The index was tested with 298 registered nurses working on 28 medical surgical nursing units in 3 hospitals. The model was evaluated in 2 ways: first by comparing the composite index scores to a qualitative appraisal of the nursing unit's practice model and patient and organizational outcomes. Secondly, individual factors in the model were evaluated in the same manner. While the composite index was not fully validated, there is strength in the evidence of the relationship between individual factors and outcomes. Specifically, factors that addressed interactions among health care team members were most often related to outcomes. [ABSTRACT FROM AUTHOR]

The authors explore the communication role of nurses with respect to the nature of clinical information, environmental variables, communication behaviors, current labor and safety issues, and the effects of delivery models and technology.The dangers inherent in the transmission of information are discussed in terms of the decay and uncertain saliency of information leading to information funneling and ultimately failure to rescue.Factors influencing the sharing of information include the availability of information affecting the likelihood of sharing and the continuity and cohesiveness of work groups.The complexity of the patient and work environment have placed a burden on the nurse's cognitive ability to attend to and recall information.Technology applications have provided mechanisms for prompting and safeguarding information while increasing access to information.Nursing leaders are key to structuring the care environment as well as managing the performance of and resources for systems of communication that enable patient rescue and safety. [ABSTRACT FROM AUTHOR]

The authors revisit the issue of work teams in nursing with the emphasis on common understandings of a unifying nursing model - or lack of same - that influence the practice of RNs and UAP who work together.The purpose of this study was to measure the extent of perceptual congruence between RNs and UAP working on the same clinical unit on aspects of nursing practice.This study focused on the individual attributes of some common nursing practice models and then developed a questionnaire evaluating the level of congruence between RN and UAP co-workers' perceptions of their priorities and practices.Questionnaires were distributed to 647 RNs and 241 non-RN staff on 28 nursing units at three acute care hospitals in the same city.Examined were both RN and UAP perceptions of nurses' role, accountability scope and responsibility, philosophy of care, continuity of care, collaboration, leadership, communication, participation in management/budgeting, learning environment, group commitment, and orientation of temporary unit workers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this paper is to provide a description of Multi-Attribute Utility (MAU) theory and demonstrate its use in creating an index of nursing practice models (NPMs).DESIGN: Delphi.SETTING: Interviews.POPULATION: Five experts in nursing care delivery systems.INTERVENTIONS: A nationally recognized leader in nursing administration was contacted and asked to recommend five nominators. These nominators then were contacted and asked for the names of 3-5 nurses they viewed as experts in nursing care delivery systems. From the 12 nurses nominated, a purposeful sample of five experts were selected and asked to participate. A modified Delphi process followed that refined the attribute hierarchy and tested assumptions. The first two steps resulted in the expression of the MAU model of NPMs in which the experts identified the attributes, and attribute scales, and the weights for each attribute.MAIN OUTCOME MEASURE(S): Evidence from this first stage validation of an MAU model of NPMs indicates that the model performs well. It can be concluded that the mathematical model provides a good representation of the experts' subjective valuation of the extent to which the NPMs evident in the profiles achieve professional ideals. It is possible that the core attributes of an NPM may change over time. Other evidence is needed to determine the usefulness of this measurement scheme.RESULTS/CONCLUSIONS: The NPM developed here is consistent with the essential features found in other NPMs. The attribute hierarchy defined in this exercise expanded the definition of NPM to include the social and interpersonal environment, explicitly addressing components of group dynamics and interprofessional relations. Resolution of the question of the stability of the NPM as a concept, and the NPM MAU model as a marker of that concept, awaits further study. Once validated, the NPM MAU model can serve as a credible benchmark of the nursing practice environment and can be used for self-study and by accreditation bodies such as JCAHO. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to determine if two dimensions of structure: administrative (decentralization) and professional authority (expertise) influence the process of participation in decision making for two kinds of decisions (caregiving and condition-of-work) that nurses make. DESIGN: Correlational, cross-sectional survey. SETTING: Acute care hospitals within two zip codes of metro Cleveland, Ohio. POPULATION: Registered nurses in acute care hospitals who had worked on their current general medical or surgical units for at least 6 months. Almost 95% or responding nurses were female, average age was 39 years. Almost 49% described the nursing care delivery system on the unit in which they worked as team nursing. Primary nursing (35%) was the next most often cited nursing care system. INTERVENTIONS: Using the intrahospital mailing system, staff nurses were sent the questionnaires along with a cover letter. The four-item Job Authority scale was used to measure decentralization (defined as the extent to which staff nurses perceive that they have administrative authority for decision making). Expertise was defined as the extent to which nurses have professional authority for decision making. Expertise was considered both multidimensional and global, and three single-item indicators were developed to measure it. Participation in decision making was assessed by the Participation in Decision Activities Questionnaire (PDAQ). MAIN OUTCOME MEASURE(S): The mean score on the Job Authority Scale was 12.9, indicating that nurses perceived that they had considerable authority. For condition-of-work decisions, full-time nurses participated significantly more in the identification and selection phases than part-time nurses. Nurses working on surgical floors participated more in the identification phase of condition-of-work decisions than nurses on medical floors. Nurses who worked in large hospitals participated more in the selection phase of condition-of-work decisions than nurses working in medium-sized hospitals. RESULTS/CONCLUSIONS: The finding that nurses participated more in caregiving decisions than in condition-of-work decisions is consistent with the findings of others. Although the explanatory power of the model was low, greater decentralization was associated with more participation in decision making. One surprising finding was that expertise did not increase participation in the design phase of caregiving decisions. The findings of this study provide empirical support for others who have suggested that, although nurses express the desire for more authority, some do not use it when they have it. This study further highlights the complexity of participation in decision making, supporting further testing of the conceptual disengagement of having authority for decision making from exercising that authority. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

Interruptions and disruptions in complex healthcare environments, such as trauma rooms, can lead to compromised workflow and safety issues due to the physical environment's characteristics. This scoping review investigated the impact of the physical environment on interruptions and disruptions and the associated outcomes in complex environments, as they relate to the components of the Systems Engineering Initiative for Patient Safety. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct the scoping review. CINAHL, Web of Science, and PubMed databases were searched. After removing duplicates and eligibility screening, quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Of 1,158 articles found, 20 were selected. Poor layout configurations, tripping hazards, and technology integration were common examples. More research must be conducted to unveil the impact of the physical environment on interruptions and disruptions., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To investigate relationships among racial discrimination, explicit racial identity, and obesity in young collegiate African American (AA) women aged 18-25., Design: Researchers recruited 136 women who self-identified as AA from a large Midwestern university. Racial discrimination (RD) was measured using lifetime overt experiences of discrimination, recent microaggressions, and vicarious RD directed towards close others. Explicit racial identity included dimensions of private regard, public regard, and centrality. Generalized obesity (elevated body mass index) and abdominal obesity (increased fat distribution in the midsection) were measured biometrically using kg/m 2 and waist circumference, respectively. Hierarchical multiple regression was employed to explore main and interaction effects., Results: After controlling for adverse life events and income, overt RD, recent microaggressions, and private regard directly accounted for variance in both BMI and waist circumference. Public regard and centrality moderated relationships between RD variables and waist circumference., Conclusions: RD and racial identity accounted for up to 13% of variance in BMI and waist circumference in main effects models among young collegiate AA women. While obesity is a multifactorial phenomenon, racial discrimination and racial identity may affect observed racial disparities in obesity rates among young women., (© 2020. W. Montague Cobb-NMA Health Institute.)

More than 30 million persons in the United States have diagnosed or undiagnosed diabetes. Persons with chronic types of diabetes must learn self-management principles and techniques and perform self-care behaviors to reduce the risk of diabetes-related complications. An electronic personal health record is one type of technology commonly used to support diabetes self-management. This integrative review examines research on how personal health records incorporate or address the American Association of Diabetes Educators self-care behaviors, diabetes-related psychosocial concerns, and the diabetes-related clinical quality-of-care measures of hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure. In the majority of studies reviewed, participants showed improvement in the self-care behavior or physiological outcome examined. Findings were inconclusive about the impact of personal health record use on diabetes distress. Results also revealed a lack evidence of patient specific factors influencing intention to use a personal health record for management of type 2 diabetes mellitus. Despite evidence that personal health record use improves diabetes self-management, they are underutilized. Implications for practice include understanding what influences intention to use a personal health record. Further research is also needed to determine the impact of personal health record use on diabetes distress., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The aim of this study was to describe sleep patterns of adults with traumatic brain injury and examine effects of environmental stressors (patient care activities and light) on patterns of sleep., Design: A descriptive, correlational, explanatory design was used for this study., Methods: Sixty-three subjects with traumatic brain injury (>18 years) on an acute traumatic brain injury rehabilitation unit wore an Actiwatch for 48 hours to collect light and sleep data. Patient care activity data were collected between 11 p.m. and 7 a.m., Findings: Patient care activities and light occurred between 11 p.m. and 7 a.m. Nighttime sleep duration and sleep efficiency were explained by patient care activities, whereas light explained wake time after sleep onset., Conclusion: Patient care activities and light serve as environmental stressors that affect sleep., Clinical Relevance: Results necessitate examining the need and timing of nursing care activities and light during nighttime. Findings provide a basis for policy changes that optimize sleep., (Copyright © 2019 Association of Rehabilitation Nurses.)

Background: Preterm infants' outcomes improve when fed their mothers' milk. Low percentages of neonatal intensive care unit (NICU) nurses support mothers facing barriers to establishing and sustaining adequate milk supplies. Nurses' motivations and attitudes are instrumental, but understudied, factors in their intention to promote maternal lactation., Purpose: Using the Theory of Reasoned Action, this study explored (1) NICU nurses' attitudes, social pressures, feelings of preparedness, perceptions of comfort, and intention to support lactation; and (2) magnitude of relationships among these concepts before and after undertaking an educational module., Methods: A descriptive pre-/postintervention design included a sample of 24 NICU nurses who completed a module, including general lactation and hands-on expressing information. The Nursing Support for Breastfeeding Questionnaire was administered before and after completing the module., Results: Attitudes, social norms, perception of preparedness, and intention were moderate to high before and after completion of the module. Perception of comfort was moderate. When comparing pre- and postintervention, effect sizes for intention and perception of comfort were moderate. Magnitude of the relationship between attitudes and intention was strong before intervention and moderate after intervention. Subjective norms demonstrated stronger relationships with attitudes and intention after intervention. Preparedness and comfort had stronger relationships with attitudes than with intention both before and after intervention., Implications for Practice: Nurses' attitudes, perception of preparedness, and comfort are modifiable considerations in developing strategies to support evidence-based lactation techniques., Implications for Research: Additional studies are needed with fully powered and stronger designs to validate findings to guide interventions for nurse support for NICU mothers to optimize lactation.

Objectives: To examine theoretical and medical variables influencing a patient's intention to perform physical activity during hospitalization for hematopoietic cell transplantation (HCT)., Sample & Setting: 54 patients undergoing HCT at the Seidman Cancer Center in Cleveland, Ohio., Methods & Variables: A longitudinal, prospective cohort design was used. Instruments included the Self-Report Habit Index, tailored to assess exercise habit, the Memorial Symptom Assessment Scale-Short Form, and an investigator-constructed survey of intention, attitude, control, and subjective norm toward physical activity. Descriptive statistics, univariate logistic regression, and linear regression were used., Results: Intention for physical activity remained high at all time points. Previous exercise habits were not related to intention. Inverse relationships between symptom distress and the theoretical constructs that influence intention occurred at the critical time points of nadir and discharge during transplantation., Implications for Nursing: Nurses should reinforce physical activity regardless of exercise habits. Symptom distress may influence physical activity differently during the transplantation trajectory.

When nurses integrate patient expertise, nurse-to-nurse handoff becomes patient-centered (nurse and patient), and the weak link between quality and safety is mitigated. The existing paradigm for handoff is an ineffective measure to minimize errors. This article describes a reimagined bedside handoff-transitioning handoff from its prescriptive nurse-centered interaction to a patient-centered partnership using the principles of complex adaptive systems, simple rules, and partnerships that address the uniqueness of each patient and nurse interaction.

Halobacteriovorax strains are saltwater-adapted predatory bacteria that attack Gram-negative bacteria and may play an important role in shaping microbial communities. To understand how Halobacteriovorax strains impact ecosystems and develop them as biocontrol agents, it is important to characterize variation in predation phenotypes and investigate Halobacteriovorax genome evolution. We isolated Halobacteriovorax marinus BE01 from an estuary in Rhode Island using Vibrio from the same site as prey. Small, fast-moving, attack-phase BE01 cells attach to and invade prey cells, consistent with the intraperiplasmic predation strategy of the H. marinus type strain, SJ. BE01 is a prey generalist, forming plaques on Vibrio strains from the estuary, Pseudomonas from soil, and Escherichia coli . Genome analysis revealed extremely high conservation of gene order and amino acid sequences between BE01 and SJ, suggesting strong selective pressure to maintain the genome in this H. marinus lineage. Despite this, we identified two regions of gene content difference that likely resulted from horizontal gene transfer. Analysis of modal codon usage frequencies supports the hypothesis that these regions were acquired from bacteria with different codon usage biases than H. marinus . In one of these regions, BE01 and SJ carry different genes associated with mobile genetic elements. Acquired functions in BE01 include the dnd operon, which encodes a pathway for DNA modification, and a suite of genes involved in membrane synthesis and regulation of gene expression that was likely acquired from another Halobacteriovorax lineage. This analysis provides further evidence that horizontal gene transfer plays an important role in genome evolution in predatory bacteria. IMPORTANCE Predatory bacteria attack and digest other bacteria and therefore may play a role in shaping microbial communities. To investigate phenotypic and genotypic variation in saltwater-adapted predatory bacteria, we isolated Halobacteriovorax marinus BE01 from an estuary in Rhode Island, assayed whether it could attack different prey bacteria, and sequenced and analyzed its genome. We found that BE01 is a prey generalist, attacking bacteria from different phylogenetic groups and environments. Gene order and amino acid sequences are highly conserved between BE01 and the H. marinus type strain, SJ. By comparative genomics, we detected two regions of gene content difference that likely occurred via horizontal gene transfer events. Acquired genes encode functions such as modification of DNA, membrane synthesis and regulation of gene expression. Understanding genome evolution and variation in predation phenotypes among predatory bacteria will inform their development as biocontrol agents and clarify how they impact microbial communities.

Purpose: Preanesthesia care is a high-risk system where interruptions during the preanesthesia assessment may jeopardize the quality of information obtained. The objective of this study was to (1) identify the number and nature of interruptions occurring during the nursing preanesthesia assessment, (2) evaluate effectiveness of a no interruption zone (NIZ) on the number and nature of interruptions experienced, and (3) determine the frequency with which nurses returned to their original task after interruption., Design: A pre-post, quasi-experimental pilot study design was used., Methods: Study included observational methodology to compare the number and nature of interruptions which occurred during the preanesthesia assessment before and after implementation of a NIZ., Findings: There was a statistically significant decrease in interruptions per observation after implementation of a NIZ with physical and verbal interruptions being the most common. Nurses returned to the original task more often after the implementation of the NIZ., Conclusion: Findings suggest use of a NIZ decreased interruptions experienced by nurses and thereby decreases the potential for workflow fragmentation., (Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices., Background: The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices., Method: This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital., Results: Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices., Conclusion: Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Purpose: To describe work environment characteristics (leadership style and safety climate) of ambulatory surgical settings and to examine the relationship between work environment and nurses' willingness to report medication errors in ambulatory surgical settings., Design: Descriptive correlational design using survey methodology., Methods: The sample of this study consisted of 40 unit-based registered nurses, working as full time, part time, or as needed in four ambulatory surgical settings affiliated with one health care system located in Northeast Ohio., Findings: The results of two separate regression analyses, one with three nurse manager's leadership styles and another with five safety climate dimensions as independent variables, explained 44% and 50%, respectively, on variance of nurses' willingness to report medication errors., Conclusion: To increase nurses' willingness to report medication errors, ambulatory surgical settings administrators should invest in nurse manager leadership training programs and focus on enhancing safety climate aspects, particularly errors feedback and organizational learning., (Published by Elsevier Inc.)

Strategic redirection of a university's mission to focus on research is challenging. This article describes an approach to developing a culture of research in a school of nursing (SON) in a nonacademic health center university. Infrastructure changes and committed mentors were developed to move a dormant research culture into one characterized by a growing dynamism of camaraderie and espirit de corps about research and scholarly productivity. To sustain the momentum, a rapid mentor-faculty feedback loop was created so that within a 48-hour time frame, the mentor provided feedback to the faculty member. Timely and iterative feedback prompted discussions that led to more scientifically rigorous proposals and publications. Tailored approaches were adopted for junior and senior faculty. In the first academic year using this approach, publications increased by 144%, and grant proposal submissions increased by 169%, whereas presentations shifted toward more regional and national venues. The increased productivity was maintained over the next 2 years. Building and sustaining a culture of success in research require leadership and vigilance, infrastructure changes, and process-oriented initiatives., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Information systems (IS) benefits for nurses are outcomes related to the tangible products or improvements that nurses realize from using IS. This study examined the development and psychometric testing of a measure of nurses' benefits from IS. A random sample of 570 nurses working in hospitals, providing direct patient care, and using IS completed the study questionnaire. The internal consistency reliability of the results was .97. Exploratory factor analysis, using principal components extraction and varimax rotation, revealed items loaded on four factors (saving time and efficiency, quality of care, charting, and professional practice) that were confirmed by confirmatory factor analysis. Continued refinement of the instrument is needed with more diverse samples of nurses.

Contemporary forces, including the growing nursing shortage, the aging population, and the emphasis on patient safety, are increasing the pressure on healthcare facilities to use information systems to achieve better outcomes. Use of information systems improves nurses' ability to make decisions in a timely manner; however, nurses are still reluctant about or avoiding using information systems in their daily work. The purpose of this study was to explore the relationships among age, nursing education, computer experience, user involvement in implementation, nursing management support to use information systems, nurses' information system use, and information system outcomes (benefits and satisfaction). The study used an input-process-outcome framework, a descriptive correlational design, and a mailed survey with a random sample of staff nurses. Computer experience, user involvement, and nursing management support were found to significantly explain information system use. In addition, information system use was found to significantly explain nurses' perception of the benefits of using information systems and their satisfaction with using information systems. These results assist nursing administrators and leaders to change and/or restructure the appropriate work environment to enhance nurses' information system use and increase their satisfaction, thereby improving patient outcomes.

No instruments have been located that examine attitudes concerning feeding decisions of mothers of preterm infants. The purpose of this study was to describe the development and psychometric testing of the Preterm Infant Feeding Survey (PIFS). The PIFS was adapted from the Breastfeeding Attrition Prediction Scale. The five-subscale, 78-item PIFS was tested with 105 mothers of preterm infants shortly after hospital admission. Individual subscale Cronbach's alpha values ranged from .75 to .82. Factor analysis demonstrated a five-factor solution. The PIFS is the first instrument to examine factors that contribute to feeding decisions of mothers of high-risk preterm infants; this knowledge will support the planning of interventions to improve breastfeeding outcomes for this population. Further psychometric testing with larger samples is recommended.

As health care costs rise, nurses are increasingly delegating tasks to unlicensed assistive personnel (UAP). The purpose of this phenomenologic study was to describe delegation from the perspective of the acute care nurse. We analyzed interviews with staff nurses, and a description of the meaning of delegation was developed using Donabedian's structure, process, outcome model to organize the findings. The process of delegation centered on communication and on nurse-UAP relationship and was shaped by the structural themes. The outcomes of delegation included nursing and patient outcomes. An enhanced content on communication and interpersonal relations is needed in nursing education.

Introduction: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States, and millions of COPD patients are disabled and unable to work. Pulmonary rehabilitation (PR) programs are available to assist with disability, but it is not clear who is likely to consistently participate in them. The purpose of this study was to determine which participants were likely to consistently attend a PR program., Methods: A retrospective medical record review was used to assess 104 community-dwelling adults with COPD who completed the PR program at a Midwest medical center between 2000 and 2005., Sample: The sample consisted of 32 men and 72 women with a mean age of 59.9 years (±19.10 years), mean predicted one-second forced expiratory volume (FEV(1)) of 46.45% (SD = 20.1), mean percent forced vital capacity (FVC%) of 67.61 (SD = 16.61), mean FEV(1)/FVC% ratio of 51.15% (SD = 18.17), and mean residual volume (RV) of 150.66% (SD = 67.01)., Results: Contextual variables of current smoking (beta = -.36), male sex (beta = .19), not having emphysema (beta = -.27), and FVC% (beta = .32) were significant predictors of attendance at (a dose of) PR. The number of selected comorbidities significantly predicted the dose of PR (beta = -.20)., Conclusion: These findings support the ability to identify factors that predict attendance at a PR program. Nurses can assess patients at risk for lack of consistent PR attendance and implement interventions to improve attendance. Specifically, smoking cessation prior to or as an integral part of PR programs may improve attendance.

Objective: The overall objective of this article was to apply an existing methodology (concept mapping) to a nonstandardized interorganizational data set. The specific aims were to (1) identify, define, and create a map that represented the common conceptual domains of patient satisfaction; (2)validate the relationships among concepts; and (3) use the map by testing the relationships of the patient satisfaction concepts to other patient outcomes., Background: The lack of standardized methodologies for collecting patient outcome data across multiple institutions poses threats to the validity and generalizability of research findings., Methods: The steps in concept mapping were used to explicate the common underlying conceptual dimensions from 3 patient satisfaction tools. The map was then used to evaluate the extent that patient satisfaction was related to outcomes of hospitalized patients. Each of 3 hospitals' measure of patient satisfaction varied in the number and type of items. All items were examined to identify potential areas of conceptual correspondence., Results: Items were grouped into 1 of the 3 identified categories that were consistent across sites: caring, communication, and responsiveness. Moderate correlations were found among the concepts of satisfaction and medication errors, nosocomial infections, and patient falls., Conclusions: Concept mapping-more traditionally used for learning, project planning, and evaluation-is a technique that has demonstrated utility in multi-institutional research.

As the link between executives and bedside nurses, nurse managers assume roles that bridge both organizational and professional goals. Nurse retention is one of the many responsibilities that characterize the nurse manager's work. To better understand the pivotal role of nurse managers, the authors describe the views of 32 nurse managers regarding their roles and the characteristics they need to promote retention.

This methodological study was designed to replicate three previous studies of depressive symptoms, compare assessment of antepartum depressive symptoms among high-risk pregnant women using three standardized instruments, and evaluate the psychometric properties of the instruments. The sample consisted of 89 high-risk pregnant women treated with bed rest, of whom 37 remained hospitalized at 4 weeks. Depressive symptoms were measured by the Multiple Affect Adjective Checklist Revised (MAACL-R) Dysphoria construct, the Profile of Mood States (POMS) Depression scale, and the Center for Epidemiologic Studies Depression Scale (CES-D) across antepartum hospitalization. Internal consistency, test-retest reliability, and convergent validity were high. Depressive symptoms were high on admission as measured by all three instruments and significantly decreased across time when measured by the MAACL-R and POMS., ((c) 2004 Wiley Periodicals, Inc.)

Patient-centered care is a key characteristic of quality health care in the 21st century. Three patient-driven processes of care, characteristic of patient-centered models of care, may be related to improved readiness for discharge: patients' knowledge of their home-going needs, their relative importance, and their active involvement in the discharge process. Forty-four patients having planned abdominal surgery were interviewed at three time points to determine their information needs and preference for involvement. Patients identified 4.74 needs prior to admission, 5.05 needs prior to discharge, and 5.35 needs after discharge. Using Friedman's ANOVA for ranks, the importance of each need did not change over time. Patients expressed a desire for information and preference to be involved. These findings provide initial evidence for the efficacy of future interventions in designing care as seen through the eyes of the patient.

Nursing practice models provide the structure and context to organize the delivery of care. Shared governance is a model of nursing practice designed to integrate core values and beliefs that professional practice embraces, as a means of achieving quality care. Shared governance models were introduced to improve nurses' work environment, satisfaction, and retention. The purpose of this article is to review representative published evidence of shared governance and to evaluate whether shared governance has lived up to its promise and potential. Theoretical and empirical evidence will be examined and discussed in an attempt to answer whether shared governance, as an organizational form of nursing practice, has achieved the positive outcomes it intended.

The purpose of this study was to investigate a reminder to discuss cervical cancer screening with hospitalized females. A quasi-experimental design was used to compare the association of a reminder intervention for nurse practitioners with two outcomes: prevalence of cervical cancer screening as documented in patients' charts and patients' self-report of cervical cancer screening 4 months after discharge. Data were collected by chart review and phone survey. The sample consisted of nurse practitioners caring for eligible female patients at a university teaching hospital. Chi-square was used to test all research questions. The rate of documentation of cervical cancer screening increased from 2% to 69% after implementation of the reminder intervention. The reminder intervention did not impact patients actually receiving Pap smears after discharge. The significant increase in documentation of screening associated with the use of the single reminder in the patients' charts support the use of this low-cost intervention.

Changing models of nursing care have resulted in a more diverse work force composition. Nurses (RNs and licensed practical and vocational nurses) have greater responsibilities for delegation and supervision of unlicensed assistive personnel providing direct nursing care. This study describes nurses' beliefs about their abilities to delegate and supervise direct nursing activities and explores differences based on professional and job-related factors. A national sample of 148 licensed nurses working in three practice settings was surveyed. In general, nurses reported a high level of comfort, frequency, preparedness, confidence, competence, and control. Differences found in nurses' beliefs were based on education, practice setting, and type of work responsibilities.

In this secondary analysis, 890 patients 40 years of age and older were assessed within 24 hours of transfer from intensive care to medical/surgical units. Nursing diagnoses documented in the hospital record were compared to supporting clinical evidence obtained from subjects, the hospital record, and interviews with subjects and nurse caregivers. The congruence, based on the kappa statistic, between the nursing diagnosis and clinical evidence ranged from 0.1% for altered thought processes to 10% for impaired gas exchange, impaired physical mobility, and potential for injury, while no diagnoses were made for self-care deficits or sensory alterations, visual, when clinical evidence for them was available.