Evaluation of Text Messaging Effects on Health Goal Adherence in the Management of Participants With Chronic Diseases.

PURPOSE OF THE STUDY: The study purpose was to determine whether text messaging health-related messages, questions, and reminders to community case management participants with chronic diseases increased health goal adherence. PRIMARY PRACTICE SETTING: This study was conducted by a rural community case management, hospital-affiliated program. METHODOLOGY AND SAMPLE: This pilot, quasiexperimental study measured health goal adherence, the degree to which an individual continues work toward self-identified health goals under limited supervision, before and after a text messaging intervention. All participants were receiving community case management services for chronic disease. Participants completed baseline and follow-up surveys regarding a text messaging intervention. RESULTS: Most participants were African Americans, had diabetes, with equal numbers by gender, an average age of 57.8 years, and had been in the community case management program for 3-5 years. Participants were sent a total of 1,654 messages/questions and 571 reminders. At follow-up, respondents who reported "Did you work on your health goals?" increased significantly (p = .0430). However, no differences were found for "Did you go to your health care appointments?" and "Did you take your medicines as you should?" No differences were noted in reported visits/hospitalizations overall or specifically at the research site. Lastly, study member visit/hospitalization numbers did not change significantly at follow-up. IMPLICATIONS FOR COMMUNITY CASE MANAGEMENT PRACTICE: Although text messaging is not meant to take the place of face-to-face interactions, it does provide community case managers with an additional modality of communication with patients to offer support and important care reminders, and to facilitate patient participation in his or her care.

Effect of ABCDE Bundle Implementation on Prevalence of Delirium in Intensive Care Unit Patients.

BACKGROUND: The ABCDE bundle incorporates multidisciplinary measures to improve and/or preserve patients' physical, functional, and neurocognitive status through awakening and breathing coordination, delirium prevention and management, and early physical mobility. OBJECTIVES: To quantify the prevalence and duration of delirium in patients in the intensive care unit (ICU) before and after implementation of the ABCDE bundle. METHODS: Delirium prevalence was defined as the percentage of patients who had at least 1 positive delirium score on the Intensive Care Delirium Screening Checklist (ICDSC) during the ICU stay; delirium duration was the number of days during the ICU stay that a positive ICDSC score was noted. Retrospective data were collected from before and after implementation of the ABCDE bundle. RESULTS: Of the 159 records reviewed (80 before and 79 after bundle implementation), most were for white men (mean age, 66.3 years). After implementation of the ABCDE bundle, the prevalence of delirium decreased significantly (from 38% to 23%, P = .01) and the mean number of days of delirium decreased significantly (from 3.8 to 1.72 days, P < .001). The number of patients with delirium-free stays increased after bundle implementation. CONCLUSIONS: Implementation of the ABCDE bundle led to significant decreases in the prevalence and duration of delirium in ICU patients.

Timing of Newborn Pulse Oximetry Screenings for Critical Congenital Heart Defects Before Discharge.

OBJECTIVE: To determine if there would be positive results from a second pulse oximetry screening (POS) completed for newborns at discharge at 28 to 48 hours of age in addition to the newborn POS completed at 24 to 25 hours of age. DESIGN: Prospective descriptive research study. SETTING: Rural, mid-Atlantic, 13-bed, level I hospital. PARTICIPANTS: Newborns (N = 1,002) at 35 weeks' gestation or older discharged from the newborn nursery. METHODS: Registered nurses (RNs) performed POS at 24 to 25 hours of age (POS 1) and at discharge but less than 48 hours of age (POS 2). Data related to critical congenital heart defects were collected. RESULTS: There were no positive POS results (O2 saturation ≤ 90%) at POS 1 or POS 2, and no additional diagnostic tests were ordered as a result of POS. Although one full-term newborn had negative results at POS 1 and POS 2, the RN identified a murmur, and a subsequent echocardiogram was used to detect tetralogy of Fallot and pulmonary atresia. The RNs detected concerning conditions in 14 newborns that resulted in 28 additional tests, including echocardiograms (9), chest x-ray imaging (8), laboratory testing (7), electrocardiograms (3), and ultrasound imaging (1). CONCLUSIONS: The POS-positive result rate was 0 for newborns at POS 1 and POS 2. Therefore, our study findings supported Maryland's mandate of one POS completed within 24 to 48 hours of birth. Nurses must continue to be vigilant about assessing newborns, including screening for critical congenital heart defects and congenital heart defects.

A prospective, randomized, single-blind study evaluating the effectiveness, tolerability, and cost of colonoscopy bowel preparations.

Colorectal cancer, the third most common cancer in U.S. adults, can be detected early through colonoscopy. Thorough bowel preparation facilitates successful colonoscopy. Effectiveness, tolerability, and costs of 3 bowel preparations were compared in patients undergoing outpatient screening colonoscopy. In this prospective, randomized, single-blind study, comparing three preparation protocols, 209 of 276 consented subjects completed (Protocol [N = 67] = HalfLytely© 1 L × 2 doses and bisacodyl 5 mg delayed release tablets × 2 tablets; Protocol 2 [N = 74] = MiraLAX® 5 tablespoons × 2 doses and bisacodyl 5 mg tablets × 2 tablets; and Protocol 3 [N = 68] = MoviPrep 1 L × 2 doses). Patients completed symptom diaries and a gastroenterologist rated effectiveness. Most subjects were White females, aged 59 years (mean). Protocol 1 was the most effective regimen, but Protocol 2 was the most tolerable and cost-effective. While the three bowel protocol differences were not statistically significant for all outcomes measured, there were clinically meaningful differences. As Protocol 1 was most effective, HalfLytely© and bisacodyl is recommended for patients prior to colonoscopy. For patients who cannot tolerate HalfLytely© or MoviPrep, or with financial concerns, Protocol 2 (MiraLAX® & bisacodyl) is alternatively recommended.

Evaluation of fall risk assessment tools for psychiatric patient fall prevention: a comparative study.

The Hendrich II Fall Risk Model™ (Hendrich II) is used to determine patient fall risks. However, the WilsonSims Fall Risk Assessment Tool (WSFRAT) is more specific to psychiatric patients. The current study tested the Hendrich II and WSFRAT simultaneously to determine which tool was the most predictive for patient falls in a psychiatric population. Fall risk assessments using the Hendrich II and WSFRAT tools were completed through discharge. Fall risk assessment scores, medications, and falls data were documented. Fifty patients who met eligibility criteria generated 319 observations; of the 50 patients, two (4%) experienced falls. Sensitivity was 100% for the Hendrich II and WSFRAT, with all patients properly categorized as high risk for falling. Both assessments had similar specificity (Hendrich II = 67.8%; WSFRAT = 63.1%). Both tools have similar specificity; thus, additional research is warranted.

Exploring how nurses and managers perceive shared governance.

BACKGROUND: Nurse managers have a pivotal role in the success of unit-based councils, which include direct care nurses. These councils establish shared governance to provide innovative, quality-based, and cost-effective nursing care. PURPOSE: This study explored differences between direct care nurses' and nurse managers' perceptions of factors affecting direct care nurses' participation in unit-based and general shared governance activities and nurse engagement. METHODS: In a survey research study, 425 direct care RNs and nurse managers were asked to complete a 26-item research survey addressing 16 shared governance factors; 144 participated (response rate = 33.8%). RESULTS: Most nurse participants provided direct care (N = 129, 89.6%; nurse managers = 15, 10.4%), were older than 35 (75.6%), had more than 5 years of experience (76.4%), and worked more than 35 hours per week (72.9%). Direct care nurses' and managers' perceptions showed a few significant differences. Factors ranked as very important by direct care nurses and managers included direct care nurses perceiving support from unit manager to participate in shared governance activities (84.0%); unit nurses working as a team (79.0%); direct care nurses participating in shared governance activities won't disrupt patient care (76.9%); and direct care nurses will be paid for participating beyond scheduled shifts (71.3%). Overall, 79.2% had some level of engagement in shared governance activities. Managers reported more engagement than direct care nurses. CONCLUSIONS: Nurse managers and unit-based councils should evaluate nurses' perceptions of manager support, teamwork, lack of disruption to patient care, and payment for participation in shared governance-related activities. These research findings can be used to evaluate hospital practices for direct care nurse participation in unit-based shared governance activities.

Effect of preoperative incentive spirometry patient education on patient outcomes in the knee and hip joint replacement population.

PURPOSE: This study examined the effects of preoperative incentive spirometry (IS) education (POISE) on postoperative outcomes for knee and hip total joint replacement patients. DESIGN: In this prospective study, 140 patients were randomized to Group 1 (POISE intervention = 50 completing) or Group 2 (no intervention = 56 completing) (34 dropped). METHODS: The Group 1 intervention consisted of formal instruction preoperatively for IS home use, postoperative use, and IS volumes documentation. Group 2 patients received no intervention. Patients recorded postoperative IS volumes, which were used to determine return to baseline volume. FINDINGS: One hundred six patients completed the study. Most were Caucasian females averaging 64 years. Although IS return to baseline volume time was not significantly different between groups, POISE patients had fewer postoperative complications, hospital days, and charges. POISE patients ranked the intervention as helpful. CONCLUSIONS: Although IS volumes were not significantly different between groups, POISE patients had better outcomes and ranked the intervention as helpful.

Knowledge and perceptions of prostate cancer among Nigerian male immigrants.

Studies focusing on prostate cancer in the Nigerian population, especially Nigerian male immigrants residing in the United States, are limited. Nigerian immigrants are one of the fastest growing populations of Africans currently residing in the United States. According to a report from Migration Policy Institute in Washington DC, 1.4 million African immigrants live in the United States, of which 13.1% or 185,787 are Nigerian-born individuals (Terrazas, 2009). A great number of these African immigrants (159,928/11.3%) currently reside in the Washington metropolitan area. Similar to African American males in the United States, Nigerian men are at high risk for developing prostate cancer. In Nigeria, prostate cancer constitutes 11% of all male cancers making it the #1 ranking cancer among Nigerian men.

The effect of menstruation on psychiatric hospitalization.

This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission.

Patients' perceptions of patient care providers with tattoos and/or body piercings.

OBJECTIVE: This study evaluated patients' perceptions of patient care providers with visible tattoos and/or body piercings. BACKGROUND: As tattooing and body piercing are increasingly popular, research that informs nursing administrators regarding policies on patient care providers having visible tattoos and body piercings is warranted. METHODS: A total of 150 hospitalized adult patients compared pictures of male and female patient care providers in uniform with and without tattoos and/or nonearlobe body piercings. RESULTS: Patient care providers with visible tattoos and/or body piercings were not perceived by patients in this study as more caring, confident, reliable, attentive, cooperative, professional, efficient, or approachable than nontattooed or nonpierced providers. Tattooed female providers were perceived as less professional than male providers with similar tattoos. Female providers with piercings were perceived as less confident, professional, efficient, and approachable than nonpierced female providers. CONCLUSIONS: Nursing administrators should develop and/or evaluate policies regarding patient care providers with visible tattoos and/or body piercings.

A 2-tier study of direct care providers assessing the effectiveness of the red rule education project and precipitating factors surrounding red rule violations.

As a safety initiative, Inova Loudoun Hospital implemented a Red Rule policy and educated 100% of its staff. The policy consisted of 2 Red Rules: critical requirements for safety associated with an activity or a procedure. The purpose of tier 1 of this 2-tier survey research project was to determine the effectiveness of the educational effort in 13 departments of the hospital. Of the 128 participants, 61% provided a correct or partially correct definition for Red Rule 1 and 12% for Red Rule 2. From an evidence-based practice viewpoint, study results concluded that the Red Rule Education Project required reinforcement. The purpose of tier 2 was to quantify factors that contributed to safety events in the departments of the hospital. Employees violating a Red Rule were asked to complete a survey identifying the factors influencing their behavior. Of the 13 participants (RNs = 100%), the order of frequency of factors influencing errors was interruptions (77%), rushing (69%), inadequate staffing (39%), fatigue (31%), and poor communication (38%). Respondents did not report an awareness of committing an error during the time of the error occurrence. Awareness of specific factors contributing to an error can facilitate process improvement and future counseling and educational efforts.

A comparison of the quality of blood specimens drawn in the field by EMS versus specimens obtained in the emergency department.

INTRODUCTION: Emergency Department (ED) acceptance of blood specimens drawn by Emergency Medical Services (EMS) staff is not a consistent standard of practice across hospitals. The literature does not address acceptance of pre-hospital phlebotomy specimens drawn by EMS staff. The purpose of this study was to compare specimen redraw rates and ED throughput times for specimens drawn by EMS versus ED staff. METHODS: Data was collected on 400 patients regarding phlebotomist type, intravenous (i.v.) site, i.v. angiocatheter size, number of i.v. attempts producing blood specimens, redraw reason, undue blood exposure to phlebotomist, diagnosis, and length of stay. RESULTS: In this study of 400 patients (EMS=200; ED=200), the redraw rate was higher for the ED group (11.5%) than the EMS group (9.5%). The primary reason for redraw in the EMS group was insufficient quantity (52.6%; ED=8.7%, p<.05). The primary reason for redraw in the ED group was hemolysis (52.2%; EMS=31.6%). Median ED throughput time was 17 minutes less for the EMS group (163 minutes) than for ED group (180 minutes). There were no incidences of undue blood exposure in either group. DISCUSSION: Based on no statistically significant differences between the two study groups in redraw rates, a decreased ED patient throughput time, and no undue blood exposure incidences, pre-hospital phlebotomy by EMS in the field and subsequent ED acceptance of samples is a standard of practice that can be implemented.