Leader Influence, the Professional Practice Environment, and Nurse Engagement in Essential Nursing Practice.

OBJECTIVE: The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice. BACKGROUND: There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making. METHODS: A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated. RESULTS: Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC. CONCLUSIONS: Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.

Prevention of Medical Device-Related Pressure Injuries Associated With Respiratory Equipment Use in a Critical Care Unit: A Quality Improvement Project.

Medical devices have been identified as an extrinsic risk factor for development of pressure injuries, with as many as 30% to 70% of medical device-related pressure injuries resulting from respiratory equipment. This article describes a quality improvement project undertaken to reduce the occurrence of respiratory device-related pressure injuries in a critically care unit. Multiple actions were implemented to achieve this goal. Respiratory therapists were trained to document occurrences on a daily basis, and apparent cause analyses were conducted on each occurrence. An interdisciplinary team conducted biweekly rounds on patients with respiratory devices and consulted other professionals as indicated. Nurses and respiratory therapists attended an evidence-based, collaborative, educational offering and completed a measure of team functioning before the program and at the end of the study period. The occurrence rates of respiratory device-related pressure injuries were reduced over the project period, and these changes were sustained over the subsequent 12 months.

Impact of lower extremity strengthening exercises and mobility on fall rates in hospitalized adults.

Preventing falls in acute care hospitals is a major challenge, and achieving positive outcomes has remained elusive. The purpose of this study was to examine the impact of lower extremity strengthening exercises and mobility on fall rates and fall rates with injury. A nonequivalent control group design was used. Subjects on the intervention unit received targeted lower extremity strengthening exercises and ambulation using a nurse-driven mobility protocol; subjects on the control unit received ambulation alone. One assisted fall occurred on the intervention unit.

Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults.

The purpose of the study was to determine the impact of a nurse-driven mobility protocol on functional decline. A nonequivalent control group design was used; the independent variable was mobility protocol and dependent variables were functional status and length of stay. Older adults who participated in a mobility protocol maintained or improved functional status and had a reduced length of stay. Practice implications include an emphasis on ambulation in hospitalized older adults.

A home-based nurse-coached inspiratory muscle training intervention in heart failure.

People with heart failure (HF) are living longer but with disabling dyspnea that erodes quality of life (QOL). Decreased strength of inspiratory muscles (IMs) may contribute to dyspnea in HF, and inspiratory muscle training (IMT) has been shown to improve the strength of IMs. The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program. Bandura's Self-Efficacy Theory directed nursing interventions. This randomized controlled trial employed an experimental group (IMT) and a control group (education). Data were collected during six home visits. Outcome measures included maximal inspiratory pressure, perceived dyspnea, self-efficacy, and health-related QOL. Significant differences in PI(max), dyspnea, and respiratory rate were found. Implications for further research and practice are discussed.

Inspiratory muscle training: integrative review of use in conditions other than COPD.

Inspiratory muscle training (IM training) is a technique that is designed to improve the performance of the respiratory muscles (RMs) that may be impaired in a variety of conditions. Interest in IM training has expanded over the past two decades, and IM training has been used in an increasingly wide range of clinical conditions. However, the benefits of IM training continue to be debated, primarily because of methodological limitations of studies conducted to date. The focus of this article is to provide a critical review of IM training research in conditions other than chronic obstructive pulmonary disease for which it has been used, including asthma, bronchiectasis, cystic fibrosis, pre- and postsurgery, ventilator weaning, neuromuscular diseases, and chronic heart failure. Emphasis is placed on what has been learned, remaining questions, future applications, and significance to practice.

Inspiratory muscle training: integrative review.

This article provides a critical review of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD). Although extensive research on IMT has accumulated, its benefits have been debated, primarily because of methodological limitations of studies. Using relevant key words, multiple databases were searched from 1966. Selected studies used PImax (maximal inspiratory pressure) as an outcome variable. Overall, research demonstrated that a standard protocol of 30% or higher for a duration of 20 to 30 minutes per day for 10 to 12 weeks improves dyspnea and inspiratory strength and endurance with either inspiratory resistive or inspiratory threshold training. Regardless of method, IMT protocols for people with COPD and inspiratory muscle weakness and dyspnea are generally safe, feasible, and effective. Patient selectivity and study of subgroups are recommended.

Long-term married couples' health promotion behaviors: identifying factors that impact decision-making.

Knowledge about health promotion behaviors and their determinants in older individuals is scant. Even less is known about persons in long-term marriages, although a growing interdependence in health decision-making has been suggested. The purpose of this study was to identify determinants of health promotion activities in older adults who were in long-term marriages. Pender's Health Promotion Model and a proposed re-conceptualization of Pender's interpersonal influences were used to guide selection of study variables. Perceived barriers and perceived self-efficacy, two behavior-specific cognitions, and relationship quality and social support, proposed interpersonal influences, were hypothesized to predict participation in health promotion behaviors. A convenience sample of 80 individuals in long-term marriages was recruited. Regression analysis identified four predictor variables as explaining 31% of the participation in health promotion behaviors: relationship quality, perceived barriers, perceived self-efficacy, and social support. Implications for nursing practice and for further research are discussed.

Older married couples and health promotion: joint decision-making process for long-term spouses.

The purpose of this study was to explore communication patterns between long-term married couples to better understand the process by which later-life couples participate in health promotion. Forty community-residing couples married for 30 years or longer were asked to respond to open-ended questions and to participate in a decision-making activity. The majority of couples made health decisions jointly, with wives acting as the final deciders 54% of the time. Most couples used positive communication strategies during a structured scenario. Findings highlight the importance of expanding beyond traditional individual-focused models to include joint decision-making processes. Implications for future research and for nursing practice are discussed.

An exploration of health concerns & health-promotion behaviors in pregnant women over age 35.

PURPOSE: To explore the specific health concerns and health-promotion behaviors of childbearing women 35 years of age or older. STUDY DESIGN AND METHODS: Semistructured interviews with women ( = 50) ages > or =35 in their third trimester of pregnancy. Interviews lasted approximately 1 hour, were conducted by two nursing faculty, and were scheduled to accommodate participant needs. Process recording was used to document participant responses. Verbatim statements were recorded, and subjects were redirected to clarify responses when necessary. Content analysis and coding were completed by an independent researcher, based upon techniques derived from Miles and Huberman (1994). Data reduction was accomplished by the identification of categories of responses that described the participants' meaning. RESULTS: Study participants reported concerns reflecting both fetal well-being and maternal health-related issues. The majority of childbearing women (86%) reported engaging in multiple health-promotion behaviors focusing on daily nutritional intake, lifestyle activities, and rest patterns. Participants reported conscientious decisions to eliminate substances recognized as harmful, and to alter exercise, employment, or daily responsibilities to accommodate physical changes during pregnancy. Participants were "proactive healthcare seekers," accessing information from a variety of sources and seeking services to meet their individualized needs. CLINICAL IMPLICATIONS: The multitude and frequency of health-promotion behaviors adopted by those > or =35 years of age during pregnancy is indicative of this group's ability to independently initiate change, and exceeds the percentages previously reported. The nurse can be influential in supporting lifestyle modifications adopted during the childbearing period as permanent health-promotion behaviors.

Exercise and older adults: changing behavior with the transtheoretical model.

The loss of muscle strength, decreased flexibility and range of motion, and decreased sense of balance that frequently accompany aging contribute to falls and functional decline. Even in advanced old age, one can improve strength, decrease the risk of falls, improve cardiorespiratory fitness, and improve ability to live independently. The Transtheoretical Model (TTM) of behavior change is an internationally recognized model that holds much promise for health behavior changes of all types. This article outlines the effects of exercise on age-related changes in the musculoskeletal system and describes the TTM as a model useful to help older adults change their exercise behavior. Research studies are documented that support the effectiveness of the TTM in changing behavior. Application of the model is described with specific examples illustrated in two case studies.