Reliability Testing of the Psychosocial Vital Signs Assessment Tool.

The current article describes preliminary psychometric testing of the Psychosocial Vital Signs (PVS) Assessment Tool, a tool for assessing psychosocial variables of health to enhance holistic patient-centered care. The five psychometric measurements of the PVS Assessment Tool include four patient self-reporting items: (a) perception, (b) support, (c) coping, (d) anxiety, and one clinician observation item of (e) anxiety level. A simple psychometric design was used for testing the PVS Assessment Tool for internal reliability among the five measurement items and interrater reliability of the clinician observation item of anxiety level. A convenience sample of nursing students was used to test the tool. Thirty-two tools were used for testing internal reliability and 29 paired tools were used for interrater reliability testing of the clinician observation item. A Cronbach's alpha of 0.806 determined satisfactory internal reliability and a Cohen's kappa of 0.808 determined satisfactory interrater reliability.

The value of staff nurse involvement in decision making.

OBJECTIVES: The objectives of this study were to explore the perceptions of hospital-based staff nurses regarding their involvement in decision making and to gain an understanding of the ways nurses would like to be involved in decision making. BACKGROUND: How nurses want to be involved and the extent to which hospital-based staff nurses are involved in formal and informal structures for decision making remain unknown. METHODS: Stratified cluster random sampling was used to identify hospitals to participate in the study. Staff nurses and chief nursing officers (CNOs) from 10 hospitals in Colorado were invited to participate in this qualitative descriptive study informed by grounded theory. Focus groups with staff nurses and individual interviews with CNOs were also conducted. RESULTS: Safe quality patient care was threaded throughout discussions among the staff nurses and CNOs. CONCLUSIONS: Staff nurses viewed involvement in decision making through the lens of an egalitarian process, whereas administration viewed involvement as soliciting input but making decisions unilaterally.

Investigating pain in heart failure patients: the pain assessment, incidence, and nature in heart failure (PAIN-HF) study.

BACKGROUND: Patients with advanced heart failure (HF) have high rates of pain and other symptoms that diminish quality of life. We know little about the characteristics and correlates of pain in patients with advanced HF. METHODS AND RESULTS: We identified pain prevalence, location, character, severity, frequency, and correlates in 347 outpatients with advanced HF enrolled from hospices and clinics. We evaluated the correlation of pain with HF-related quality of life, mortality, symptoms and health problems, and current treatments for pain. Pain at any site was reported by 293 patients (84.4%), and 138 (39.5%) reported pain at more than one site. The most common site of pain was the legs below the knees (32.3% of subjects). Pain interfered with activity for 70% of patients. Pain was "severe" or "very severe" for 28.6% of subjects with chest pain, and for 38.9% of those with other sites of pain. The only medication reported to provide pain relief was opioids, prescribed for 34.1% of subjects (P = .001). The strongest predictors of pain were degenerative joint disease (DJD) (odds ratio [OR] 14.95, 95% confidence interval [CI] 3.9-56.0; P < .001), other arthritis (OR 2.8, 95% CI 1.20-6.62; P = .017), shortness of breath (OR 3.27, 95% CI 1.47-7.28; P = .004), and angina pectoris (OR 3.38, 95% CI 1.30-8.81; P = .013). CONCLUSIONS: Pain occurred at multiple sites in patients with advanced HF. Pain correlated with DJD or other arthritis, shortness of breath, and angina. Only opioid analgesics provided relief of pain. Future research should evaluate the etiology of and interventions to manage pain in patients with HF.

Psychometric properties of selected tests in patients with lumbar spinal stenosis.

BACKGROUND CONTEXT: The psychometric properties of many outcome tools commonly used with patients with lumbar spinal stenosis have yet to be examined. PURPOSE: Examine the test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences for several outcome measures in a cohort of patients with lumbar spinal stenosis. STUDY DESIGN/SETTING: Cohort secondary analysis of a randomized clinical trial of patients with lumbar spinal stenosis receiving outpatient physical therapy. PATIENT SAMPLE: Fifty-five patients (mean age, 69.5 years; standard deviation, ±7.9 years; 43.1% females) presenting with lumbar spinal stenosis to physical therapy. OUTCOME MEASURES: The Modified Oswestry Disability Index, Modified Swiss Spinal Stenosis Scale (SSS), Patient Specific Functional Scale, and Numeric Pain Rating Scale (NPRS). METHODS: All patients completed the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS at the baseline examination and at a follow-up. In addition, patients completed a 15-point Global Rating of Change at follow-up, which was used to categorize whether patients experienced clinically meaningful change. Changes in the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS were then used to assess test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences. RESULTS: The Oswestry Disability Index was the only outcome measure to exhibit excellent test-retest reliability with an intraclass correlation coefficient of 0.86 (95% confidence interval, 0.63-0.93). All others ranged between fair and moderate. The Oswestry Disability Index, SSS, and Patient Specific Functional Scale exhibited varying levels of responsiveness, each of which was superior to the NPRS. The minimal clinically important difference for the Oswestry Disability Index was five points, the SSS was 0.36 and 0.10 for symptoms subscale and functional subscale, respectively, 1.3 for the Patient Specific Functional Scale, and for the NPRS, 1.25 for back/buttock symptoms and 1.5 for thigh/leg symptoms. CONCLUSIONS: The results of our study indicate that the Oswestry Disability Index, SSS, and Patient Specific Functional Scale possess adequate psychometric properties to be used in the outcome assessment of patients with lumbar spinal stenosis. However, further investigation is needed to validate these findings in other samples of patients with lumbar spinal stenosis and nonspecific low back pain.

Involving nurses in decisions: improving both nurse and patient outcomes.

OBJECTIVE: The objective of this study was to determine the relationship between nurse involvement in decisions and nurse-patient outcomes. BACKGROUND: Evidence demonstrates that nurse involvement is associated with satisfaction, but little evidence exists about patient effects. Because of significant resource expenditure, evidence about expected outcomes is needed. METHODS: Outcomes classified as patient satisfaction, nurse satisfaction, infections, and adverse events were compared between units with high and low levels of involvement from 9 hospitals in Colorado. RESULTS: Involving nurses in outcomes evaluation was associated with better patient outcomes. High involvement units had fewer infections and pressure ulcers. CONCLUSIONS: A formal structure was not required to involve nurses in decisions and is related to nurse and patient satisfaction demonstrating a reduction in adverse events.

Validity and interrater reliability of the Moline-Roberts Pharmacologic Sedation Scale.

PURPOSE: The objective of this study was to determine validity and reliability of the Moline-Roberts Pharmacologic Sedation Scale. DESIGN: A multidisciplinary expert panel was used to establish content validity. Reliability was determined by a prospective, randomized, psychometric evaluation of sedation assignment made by 2 nurse research assistants. SETTING: The study was conducted in a 260-bed nonprofit community hospital. SAMPLE: Eighty-six subjects were enrolled in the study. Inclusion criteria were as follows: receiving opioids, benzodiazepines, or anesthetic agents; ability to understand English; and normal or near-normal hearing. METHODS: Two bachelor of science in nursing-prepared nurses observed each subject and independently documented sedation levels at 3 or 4 points in time for each patient. FINDINGS: Content validity resulted in 100% agreement that the sedation scale reflected the concept of pharmacologic sedation. Internal reliability as measured by Cronbach α was .983 to .996. For each of the scale's components, interrater reliability using Cohen κ ranged from 76.4% to 97.4%. The Cohen κ P value for all components at all points in time was statistically significant at P < .001. CONCLUSION: The Moline-Roberts Pharmacologic Sedation Scale demonstrated content validity and strong reliability. IMPLICATIONS: The sedation scale has clinical value in providing a standardized assessment and quantitative assignment of pharmacologically induced sedation that is reflective of the continuum of sedation. Information obtained regarding the patient's sedation should be documented, trended, and incorporated into the decision-making process regarding additional administration of agents that produce or potentiate sedation. Further research is needed in populations not included in this study.

Maximizing lipophilic efficiency: the use of Free-Wilson analysis in the design of inhibitors of acetyl-CoA carboxylase.

This paper describes the design and synthesis of a novel series of dual inhibitors of acetyl-CoA carboxylase 1 and 2 (ACC1 and ACC2). Key findings include the discovery of an initial lead that was modestly potent and subsequent medicinal chemistry optimization with a focus on lipophilic efficiency (LipE) to balance overall druglike properties. Free-Wilson methodology provided a clear breakdown of the contributions of specific structural elements to the overall LipE, a rationale for prioritization of virtual compounds for synthesis, and a highly successful prediction of the LipE of the resulting analogues. Further preclinical assays, including in vivo malonyl-CoA reduction in both rat liver (ACC1) and rat muscle (ACC2), identified an advanced analogue that progressed to regulatory toxicity studies.

Evaluation of a model for preparing staff nurses to teach clinical groups of nursing students.

Expert staff nurses were identified as Clinical Scholars to teach clinical rotations of nursing students. A 40-hour workshop was developed to present the skills and knowledge necessary to begin as a new clinical faculty member. This article reports the descriptive analysis of the data collected during the life of this funded project. Although this project was undertaken to increase faculty resources, the data also showed increased job satisfaction among Clinical Scholars, increased patient safety, and high student satisfaction.

Discovery of small molecule isozyme non-specific inhibitors of mammalian acetyl-CoA carboxylase 1 and 2.

Screening Pfizer's compound library resulted in the identification of weak acetyl-CoA carboxylase inhibitors, from which were obtained rACC1 CT-domain co-crystal structures. Utilizing HTS hits and structure-based drug discovery, a more rigid inhibitor was designed and led to the discovery of sub-micromolar, spirochromanone non-specific ACC inhibitors. Low nanomolar, non-specific ACC-isozyme inhibitors that exhibited good rat pharmacokinetics were obtained from this chemotype.

Development of a reliable and valid organization-specific professional practice assessment tool.

PURPOSE: This article describes a study to devise an organization-specific professional practice model (PPM) assessment that reflects actual unit involvement. A secondary study goal is the development of a unit-based index that can be used to conduct comparative analyses in an efficient way. DESIGN: Each of the 5 elements of the organization's PPM was represented by 1 or more items on an author-developed instrument. The tool was structured so that item scores could be summed to achieve a single subscale for each PPM element and further aggregated into a total score. METHODS: The instrument was administered to a 40% random sample of all regularly scheduled, full- and part-time registered nurses in an academic, community Magnet hospital in 2003 and 2005. Descriptive statistics were calculated for items, subscales, and summary scores for each patient care unit and overall. A weighted, unit-based index was developed to reflect each unit's score on a scale of 100. FINDINGS: The 2003 assessment response rate was 51% (n = 200); the 2005 response rate was 48% (n = 193). Subscale scores and a total PPM score were calculated by summing the values of each individual item. Submissions enabled calculations of total scores by unit, mean scores by item, and the development of a unit-specific PPM index of performance. CONCLUSIONS: Beyond shared principles of empowerment, the specifics of each organization's PPM may differ in those key components of care delivery nurses are empowered to effect. Thus, fidelity to the organization-specific PPM is not well tested with generic decisional-involvement instruments. An organization-specific assessment such as this one can provide evidence of not only organizational PPM fidelity but a quantitative method to ensure that staff nurse decisional involvement is continuously evolving to an ever higher state.

Sulfoximine-substituted trifluoromethylpyrimidine analogs as inhibitors of proline-rich tyrosine kinase 2 (PYK2) show reduced hERG activity.

The synthesis, in vitro properties, and in vivo pharmacokinetics for a series of sulfoximine-substituted trifluoromethylpyrimidines as inhibitors of proline-rich tyrosine kinase, a target for the possible treatment of osteoporosis, are described. These compounds were prepared as surrogates of the corresponding sulfone compound 1. Sulfone 1 was an attractive PYK2 lead compound; however, subsequent studies determined this compound possessed high dofetilide binding, which is an early indicator of cardiovascular safety. Surprisingly, the corresponding sulfoximine analogs displayed significantly lower dofetilide binding, which, for N-methylsulfoximine (S)-14a, translated to lower activity in a patch clamp hERG K(+) ion channel screen. In addition, compound (S)-14a shows good oral exposure in a rat pharmacokinetic model.

Use of a validated model to evaluate the impact of the work environment on outcomes at a magnet hospital.

Using a structural model, we evaluated the impact of leadership, staff stability, resources, workload, work environment, and staff expertise on nurse-sensitive patient outcomes to determine elements that can be modified.

Barriers to effective symptom management in hospice.

The barriers to effective symptom management in hospice are not well described. We surveyed nurses of hospices affiliated with the Population-based Palliative Care Research Network (PoPCRN) to identify barriers to the effective management of common symptoms in terminally ill patients. 867/1710 (51%) nurses from 67 hospices in 25 U.S. States returned surveys. Of 32 symptoms, nurses reported agitation (45%), pain (40%), and dyspnea (34%) as the 'most difficult to manage.' The most common perceived barriers to effective symptom management were inability of family care providers to implement or maintain recommended treatments (38%), patients or families not wanting recommended treatments (38%), and competing demands from other distressing symptoms (37%). Patterns of barriers varied by symptom. These nurses endorsed multiple barriers contributing to unrelieved symptom distress in patients receiving hospice care. Interventions to improve symptom management in hospice may need to account for these differing barrier patterns.

Retention: it's all about respect.

Retention of employees is often overlooked in developing strategies to deal with worker shortages in health care. Managers mistake requests for more money as the key indicator of job satisfaction. This article examines research conducted by three health service administration graduate students who looked at reasons staff were leaving their jobs or their occupations. Using three different research tools, the students found that job satisfaction is not all about money, or even benefits. Respect, recognition, and organizational commitment are what employees want in their jobs. The article describes the research methods used in the studies and the similarities in results.

A model for evaluating the context of nursing care delivery.

This study used a mixed method to test a model of demands on nurses. Factors were identified that affect demands, and a model was tested using structural equation modeling. Teamwork and expertise had significant effects on nurse-sensitive outcomes. Leadership was a strong determinant of stability and expertise. Workload was not a significant predictor of outcomes, but this is likely due to the difficulty in measuring nursing work. These results provide administrators with actionable recommendations that can be used to reduce the demands on nursing staff.

Confirmation of the "disability paradox" among hospice patients: preservation of quality of life despite physical ailments and psychosocial concerns.

OBJECTIVE: The purpose of this study was to describe quality of life (QOL) and psychosocial and spiritual issues among patients receiving hospice care. METHODS: A questionnaire addressing QOL, spirituality, optimism, loss, fears about the terminal process and death anxiety was administered to 66 adults receiving care from 14 hospices. The physical components of QOL (physical symptoms and physical well-being) were rated lower than the psychosocial and spiritual aspects (support, existential well-being, psychological symptoms). RESULTS: Respondents had a strong spiritual connection and a strong sense of hope. Although these individuals did not express anxiety or fear about death, there were concerns about the dying process itself. Also, although most felt at ease with their current situation, respondents were concerned about how their illness was affecting their family. Financial and legal issues did not concern most of these individuals. SIGNIFICANCE OF RESULTS: There were few significant associations between patient characteristics and the QOL or other psychosocial or spiritual issues addressed. Among this older terminally ill population receiving hospice care, whose functional status was fair and for whom physical symptoms were troublesome, QOL persisted and a positive outlook prevailed.