Early Cardiac Rehabilitation to Reduce Heart Failure Readmissions.

PURPOSE: This research was conducted to determine whether early participation in cardiac rehabilitation (CR) reduces readmissions following heart failure (HF) hospitalization. METHODS: A retrospective quasiexperimental comparison group design was used. Electronic medical records were abstracted for HF patients discharged between March 2013 and December 2017. The treatment group was defined as patients with HF who attended ≥1 CR session within 6 wk following discharge. The comparison group was defined as patients with HF without additional HF hospitalizations during the previous year, discharged to home/self-care, and did not attend CR within 6 wk. Readmission rates at 30 d and 6 wk were compared between groups using χ 2 analysis and logistic regression. RESULTS: Out of 8613 patients with HF, 205 (2.4%) attended ≥1 CR within 6 wk post-discharge. The treatment group had lower, but not statistically significant, readmission rates than the comparison group for 30-d readmissions for HF ( P = .13), and 6-wk readmission rates for HF ( P = .05). The treatment group had lower all-cause readmissions at 30 d (P < .01) and 6 wk ( P < .01) than the comparison group. Multivariable logistic regression revealed that early CR attendance was associated with reduced 30-d all-cause readmissions (adjusted OR = 0.4: 95% CI, 0.2-0.7) and 6-wk all-cause readmissions (adjusted OR = 0.5: 95% CI, 0.3-0.8). CONCLUSIONS: This study contributes to the existing evidence for allowing early unrestricted CR participation with the aim of improving the health of patients with HF and reducing rehospitalization rates.

Being a Research Mentor: A Qualitative Study.

OBJECTIVES: This qualitative study was designed to describe the experiences of mentors for a nursing research fellowship at a southeastern US academic medical center. BACKGROUND: Mentoring is an important aspect of nursing and is a key strategy to develop nurse leaders and faculty. Research mentors have been identified as essential for novice researchers to be able to complete clinical studies. However, there has been limited research on the experience of nursing research mentors, despite the emphasis on the critical nature of this role. METHODS: Eight mentors for 23 studies over 8 years of a nursing research fellowship participated in a study outlining their experiences as research mentors. RESULTS: Common themes emerged from mentors' identification of key components in the research mentoring process and elements necessary for effective support of frontline nurse researchers. CONCLUSIONS: Recommendations for developing effective, confident research mentors are drawn from the analyses.

Integrating High-Reliability Principles to Transform Access and Throughput by Creating a Centralized Operations Center.

High-reliability organizations (HROs) demonstrate unique and consistent characteristics, including operational sensitivity and control, situational awareness, hyperacute use of technology and data, and actionable process transformation. System complexity and reliance on information-based processes challenge healthcare organizations to replicate HRO processes. This article describes a healthcare organization's 3-year journey to achieve key HRO features to deliver high-quality, patient-centric care via an operations center powered by the principles of high-reliability data and software to impact patient throughput and flow.

A Blended Transfer and Communications Center: Designing a State-of-the-Art Mission Control.

Health systems frequently are challenged by barriers to patient flow and transfer intake processes. To achieve the goals of seamless entry of patients into the health system, coordination of the safest, most appropriate transport of these patients, and efficient management of hospital throughput needs, our tertiary health system created a central transfer and communications center. From the design of the center's physical space to the collaborative education efforts, the immediate synergies created by this new "Mission Control" model impacted throughput and customer service. Achievement of these goals is facilitated with state-of-the-art technology, including an electronic throughput and flow software system, which provides real-time capacity updates and status of confirmed and pending discharges. Because a centralized, information-centered approach to coordination has been such a success, expansion to other departments is underway. We are also finding that our operations center is playing a more central role in emergency operations and disaster management logistics at both the local and regional levels. Centralization of key throughput components of health systems is quickly becoming best practice. Revenue savings can be gained by combining departmental resources as well as supporting throughput efficiencies.

Creating patient-nurse Synergy on a medical-surgical unit.

Medical-surgical nurses care for a complex patient mix. The Synergy Model framed the development of tools to assess nursing competency and patient acuity which yield data for daily staffing assignments. Data support positive outcomes as a result of this model.

Addressing the hidden dimension in nursing education: promoting cultural competence.

The authors describe a cultural competence quality enhancement process to address the retention challenge of students who speak English as second language and international students as part of a school of nursing's continuous program quality improvement to achieve excellence. The process, strategies, outcomes, and evaluation of the training program are detailed within the given geographical, institutional, and curriculum context. Lessons and continuing challenges are also specified.

Motivation for health behaviours: a systematic review of the nursing literature.

UNLABELLED: AIMS AND RATIONALE: This research review examines nursing and allied health studies exploring motivation for health behaviours to identify the state of understanding of this construct within nursing. This review contributes to nursing science by synthesizing nursing research regarding motivation for health behaviour. METHODS: Integrative research review methodology. FINDINGS: Problems of existing research include nonprobability sampling of heterogeneous populations, low statistical power, and colinearity. Studies identifying predictors of motivation explained large proportions of variance using regression. Motivation was not a significant predictor of health behaviours for over one-third of the studies. Overall, the studies suggest that either motivation is not being effectively measured because of a lack of conceptual clarity or that motivation is not an essential determinant of health behaviours. The latter cannot be verified until psychometric research advances current measurement of motivation to a higher level. LIMITATIONS; The literature for this review was accessed through the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Databases for other disciplines were not included in this search. This work represents a first step towards understanding motivation for health behaviour as it is currently defined in the literature. Future studies are necessary to broaden this understanding beyond nursing. CONCLUSIONS: Motivation is a frequently cited rationale underlying the adoption and maintenance of health behaviours in research and practice. Motivation is complex and multidimensional, and clearer definitions for motivation are needed. Populations that have been underrepresented in motivation research need to be targeted in future research. Researchers and practitioners are challenged to examine carefully the role of motivation for health behaviours and explore other factors that may more strongly influence health behaviours.

Knowledge, attitudes, and behavior related to pregnancy in a rural teenage population.

Despite recent declining national trends, teenage pregnancy continues to be a community health problem warranting attention, especially in rural areas of the southern United States. Communities are unique and require assessment of risk populations to develop appropriate initiatives. This pilot study examined consent strategies and survey procedures and tools. Additionally, descriptive statistics related to pregnancy and pregnancy prevention knowledge, attitudes, and behaviors were examined. The study sample consisted of 52 boys and girls who perceived themselves to be in the middle or upper levels of their 9th-grade class and who were predominantly college bound and fairly active in extracurricular activities. Often groups with similar demographics are not perceived as at risk for pregnancy and early sexual intercourse, but the findings suggest otherwise. Many girls were sexually active, several had already experienced pregnancy, and some were at risk for intentional pregnancy. Knowledge regarding pregnancy prevention was modest. School-based and peer-focused programs are promising intervention strategies in response to identified attitudes and reported information sources related to pregnancy and pregnancy prevention.