Professional values and nursing care quality: A descriptive study.

BACKGROUND: Professional values are important in promoting healthy work environments, patient satisfaction, and quality of care. Magnet® hospitals are recognized for excellence in nursing care and as such, understanding the relationship between nurses' values and Magnet status is essential as healthcare organizations seek to improve patient outcomes. RESEARCH QUESTION/AIM/OBJECTIVES: The research question is: are there differences in individual values, professional values, and nursing care quality for nurses and nurse managers practicing in Magnet, Magnet journey, and non-Magnet direct patient care settings? RESEARCH DESIGN: This descriptive cross-sectional study is guided and informed by the conceptual framework of the Professional Values Model including individual values, professional values, and nursing care quality. PARTICIPANTS AND RESEARCH CONTEXT: Convenience sampling of registered nurses and nurse managers, responsible for direct patient care, was utilized in a non-profit healthcare system in the Midwest region of the United States. ETHICAL CONSIDERATIONS: Institutional review board approval was obtained. Participants were informed about the right to self-determine participation and assurance of anonymity. FINDINGS: 827 (n = 827) nurses and nurse managers responded to the survey. Significant differences were identified in individual values sub-scale: self-enhancement (p = 0.38), professional values (p = 0.037), practice environment: participation in hospital affairs (p = 0.00), foundations for quality care (p = 0.016), and resources adequacy (p = 0.012) and in nurse sensitive HCAHPS questions: nurses explained things understandably (p = 0.00), got help as soon as wanted (p = 0.00), and treated with courtesy and respect (p = 0.00). DISCUSSION/CONCLUSIONS: Findings indicate that fostering individual and professional values may impact nursing practice, regardless of Magnet designation. Promoting professional values may contribute to improved work environments, enhancing patient satisfaction. Study results offer valuable insights for organizations striving to enhance nursing values, impacting quality of care provided to patients. MESH TERMS: Cross-Sectional Studies, Respect, Ethics Committees, Patient Satisfaction, Nurse Administrators, and Personal Satisfaction.

Calcium Carbonate as a Potential Intervention to Prevent Labor Dystocia: Narrative Review of the Literature.

Anecdotally, there are attestations from clinicians of calcium carbonate being used successfully for laboring people experiencing labor dystocia. The goal of this narrative review was to provide a synopsis of pertinent literature on calcium use in obstetrics to explore the potential benefit of calcium carbonate as a simple and low-cost intervention for prevention or treatment of labor dystocia. To answer how calcium and carbonate physiologically contribute to myometrium contractility, we conducted a literature search of English-language peer-reviewed articles, with no year limitation, consisting of the keywords "calcium," "calcium carbonate," "calcium gluconate," "pregnancy," "hemorrhage," and variations of "smooth muscle contractility" and "uterine contractions." Though no overt evidence on calcium carbonate's ability to prevent labor dystocia was identified; relevant information was found regarding smooth muscle contractility, calcium's influence on uterine muscle contractility, and carbonate's potential impact on reducing amniotic fluid lactate levels to restore uterine contractility during labor. Studies reporting the potential effectiveness of calcium gluconate and sodium bicarbonate in preventing labor dystocia offer background, safety information, and rationale for a future randomized control trial to evaluate the ability of calcium carbonate to prevent labor dystocia and reduce rates of cesarean section.

An integrative literature review of barriers and facilitators to cervical cancer screening among refugee women in the United States.

Refugee women experience disproportionally high cervical cancer-related mortality. In this integrative review, we identify and discuss factors related to cervical cancer screening among refugee women in the US according to the Social Ecological Model. Two qualitative and three quantitative studies met inclusion criteria. Individual-level factors include English-language ability, availability, and individual knowledge, attitudes, and beliefs. Interpersonal-level factors include interactions with family/friends, provider, and community health worker. Community-, organization-, and policy-level factors include sociocultural values, transportation, ability to navigate the healthcare system, and health insurance. We discuss findings in the context of related reviews and applicability to other global settings.

Taking Action Together: a YMCA-based protocol to prevent type-2 diabetes in high-BMI inner-city African American children.

BACKGROUND: Associated with a tripling in obesity since 1970, type 2 diabetes mellitus (T2DM) in children has risen 9-10 fold. There is a critical need of protocols for trials to prevent T2DM in children. METHODS/DESIGN: This protocol includes the theory, development, evaluation components and lessons learned from a novel YMCA-based T2DM prevention intervention designed specifically for high-BMI African American children from disadvantaged, inner-city neighborhoods of Oakland, California. The intervention was developed on the basis of: review of epidemiological and intervention studies of pediatric T2DM; a conceptual theory (social cognitive); a comprehensive examination of health promotion curricula designed for children; consultation with research, clinical experts and practitioners and; input from community partners. The intervention, Taking Action Together, included culturally sensitive and age-appropriate programming on: healthy eating; increasing physical activity and, improving self esteem. DISCUSSION: Evaluations completed to date suggest that Taking Action Together may be an effective intervention, and results warrant an expanded evaluation effort. This protocol could be used in other community settings to reduce the risk of children developing T2DM and related health consequences. TRIAL REGISTRATION: ClinicalTrials.gov NCT01039116.

Population-based medical and disease management: an evaluation of cost and quality.

Reports by the Institute of Medicine and the Health Care Financing Administration have emphasized that the integration of medical care delivery, evidence-based medicine, and chronic care disease management may play a significant role in improving the quality of care and reducing medical care costs. The specific aim of this project is to assess the impact of an integrated set of care coordination tools and chronic disease management interventions on utilization, cost, and quality of care for a population of beneficiaries who have complementary health coverage through a plan designed to apply proactive medical and disease management processes. The utilization of health care services by the study population was compared to another population from the same geographic service area and covered by a traditional fee-for-service indemnity insurance plan that provided few medical or disease management services. Evaluation of the difference in utilization was based on the difference in the cost per-member-per-month (PMPM) in a 1-year measurement period, after adjusting for differences in fee schedules, case-mix and healthcare benefit design. After adjustments for both case-mix and benefit differences, the study group is $63 PMPM less costly than the comparison population for all members. Cost differences are largest in the 55-64 and 65 and above age groups. The study group is $115 PMPM lower than the comparison population for the age category of 65 years and older, after adjustments for case-mix and benefits. Health Plan Employer and Data Information Set (HEDIS)-based quality outcomes are near the 90th percentile for most indications. The cost outcomes of a population served by proactive, population-based disease management and complex care management, compared to an unmanaged population, demonstrates the potential of coordinated medical and disease management programs. Further studies utilizing appropriate methodologies would be beneficial.

Self-reported dieting experiences of women with body mass indexes of 30 or more.

Self-reported information on dieting experiences of 149 women with a body mass index (BMI) of 30 to 70 was gathered to refute the notion that obese women have made few serious attempts to lose weight and to see whether women with higher BMIs report more frequent dieting than women with lower BMIs. Participants completed questionnaires about lifetime dieting experiences and provided demographic information, including heights and weights. Statistical comparisons among categorical variables were made using chi(2) tests. Women with higher BMIs tended to start dieting before age 14 (P<.001) and had dieted more frequently (P<.01) than women with lower BMIs. Negative memories of dieting far outnumbered positive or neutral ones. When a patient has a history of dieting failure, dietetics professionals should consider focusing on improvements in metabolic fitness through lifestyle changes for chronic disease risk reduction rather than encouraging continued attempts to lose weight.

Esmolol in acute ischemic syndromes.

BACKGROUND: beta-Blockers have been shown to reduce both morbidity and mortality rates in patients with acute coronary syndromes. However, because of potential side effects, their use is limited in patients who might benefit the most from such therapy. It was thought that the use of an ultra-short-acting intravenous beta-blocker might produce similar results with fewer complications in those patients with relative contraindications to beta-blocker therapy. METHODS: Accordingly, we evaluated the use of esmolol in patients with acute coronary syndromes and relative contraindication to beta-blocker therapy in a prospective randomized trial. One hundred eight patients at 21 sites received an infusion of intravenous esmolol or standard therapy on admission and were followed for 6 weeks from the day of admission. The primary efficacy outcome was a composite event consisting of any of the following that occurred during the index hospitalization: death, myocardial (re)infarction, recurrent ischemia, or arrhythmia as well as silent myocardial ischemia assessed by ambulatory electrocardiographic monitoring. Safety end points including hypotension, bradyarrhythmias, new or worsening congestive heart failure, and bronchospasm were also recorded. RESULTS: Event rates for primary end points were similar in the 2 groups: death (2% in the standard care group vs 4% in the group receiving esmolol), myocardial (re)infarction (4% standard vs 7% esmolol), ischemia (12% vs 13%), arrhythmias (4% vs 2%), and silent ischemia (13% vs 15%). There was a higher incidence of transient hypotension in the group receiving esmolol (2% vs 16%), but all such events were noted to resolve after discontinuation of the esmolol infusion. There were no additional differences in safety end points: bradycardia (2% for those receiving standard care vs 9% receiving esmolol), new congestive heart failure (10% vs 16%), bronchospasm (0% vs 7%), and heart block (2% vs 2%). CONCLUSIONS: The use of an ultra-short-acting beta-blocker such as esmolol might offer an alternative to patients with contraindications to standard beta-blocker therapy. Although this trial had limited power to detect safety and efficacy differences between the 2 therapies, it was observed that safety end points, which occurred during esmolol administration, resolved readily when the infusions were decreased or discontinued. Additional testing is needed to substantiate these findings.

Culturally relevant nutrition education improves dietary quality among WIC-eligible Vietnamese immigrants.

OBJECTIVE: To provide culturally appropriate nutrition education to improve the diets of Vietnamese women. DESIGN: A total of 152 homemakers were recruited to participate in a nutrition education project, with 76 receiving the intervention and 76 serving as the control group. SUBJECTS/SETTING: Non-English-speaking women eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) with incomes below 185% of the poverty level living in 5 California counties. INTERVENTION: Bicultural, bilingual Vietnamese-American nutrition education assistants taught 5 to 7 lessons in the Vietnamese language using nutrition education materials written in the Vietnamese language by 2 bilingual, bicultural nutritionists. MAIN OUTCOME MEASURES: Twenty-four-hour food recalls were obtained before and after the 8-week interval on the treatment and control groups. STATISTICAL ANALYSIS: To examine if there were changes over time in nutrient intake and nutrient density within groups, matched pair t tests were done. Analysis of covariance techniques determined differences between groups. McNemar tests determined if, within groups, there were changes over time in food groups consumed. Chi-square techniques determined changes between groups. RESULTS: Over time, the number of treatment group participants who had at least one serving from each food group (P <.01), and who had the recommended number of servings from each food group (P <.05), significantly increased in comparison to the control group. Over time, the dietary nutrient density of calcium, riboflavin, and vitamin B6 (P <.05), as well as potassium (P <.01), of treatment group participants significantly improved in comparison to the control group. IMPLICATIONS: With training, bilingual, bicultural women can effectively deliver culturally relevant nutrition education to their peers.