Multicenter study of nursing role complexity on environmental stressors and emotional exhaustion.

Among nurses, work and cognitive complexity patterns of care were previously associated with environmental stressors, but it is unknown if complexity patterns are also associated with emotional exhaustion. A multicenter sample of hospital nurses (N=281) completed valid, reliable questionnaires. Data were analyzed using multivariable modeling. Registered nurse characteristics did not vary by work setting. Overall mean (standard deviation [SD]) standardized complexity of care score was 45.82 (13.73), reflecting moderate complexity during 3-hour work periods. Nurses experienced greater cognitive complexity patterns than work complexity patterns (p<0.001). In multivariable analyses, overall complexity of care and work and cognitive complexity patterns were not associated with high emotional exhaustion. Higher work complexity pattern score was associated with more environmental stressors (p=0.009), but there was no association between overall complexity of care or cognitive complexity pattern and environmental stressors. Interventions that reduce environmental stressors might reduce work complexity of care.

Psychosocial impact of anterior dental esthetics on periodontal health, dental caries, and oral hygiene practices in young adults.

This study sought to determine whether the self-perceived image of a young adult's anterior dental esthetics is linked with periodontal health, dental caries, and oral hygiene practices. Two hundred subjects were assessed via a clinical examination, including intraoral photographs. The subjects were questioned about their demographics and oral hygiene practices and given the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) to measure their self-perceived variables related to dental esthetics. A high PIDAQ score indicates a negative image of one's own dental esthetics, while a low PIDAQ score indicates a positive outlook. A self-perceived negative psychosocial impact of anterior dental esthetics was detected in subjects with higher levels of dental caries and visible gingival inflammation in the anterior region of the mouth.

Multidrug-Resistant Salmonella Heidelberg Associated with Mechanically Separated Chicken at a Correctional Facility.

We describe multidrug-resistant (MDR) Salmonella Heidelberg infections associated with mechanically separated chicken (MSC) served at a county correctional facility. Twenty-three inmates met the case definition. All reported diarrhea, 19 (83%) reported fever, 16 (70%) reported vomiting, 4 (17%) had fever ≥103°F, and 3 (13%) were hospitalized. A case-control study found no single food item significantly associated with illness. Salmonella Heidelberg with an indistinguishable pulsed-field gel electrophoresis pattern was isolated from nine stool specimens; two isolates displayed resistance to a total of five drug classes, including the third-generation cephalosporin, ceftriaxone. MDR Salmonella Heidelberg might have contributed to the severity of illness. Salmonella Heidelberg indistinguishable from the outbreak subtype was isolated from unopened MSC. The environmental health assessment identified cross-contamination through poor food-handling practices as a possible contributing factor. Proper hand-washing techniques and safe food-handling practices were reviewed with the kitchen supervisor.

Capture of knowledge work of clinical nurse specialists using a role tracking tool.

PURPOSE: The aim of this study was to quantify clinical nurse specialist (CNS) work and determine if competencies are associated with personal characteristics, priorities, and quality outcomes. BACKGROUND: The work of a CNS is difficult to quantify. Nurse leaders need quantifiable data to understand the impact of CNS work. DESIGN: A prospective, single-center, correlational study with a convenience sample was conducted. SETTING AND SAMPLE: The study was conducted in a 1200-bed quaternary care medical center in Northeast Ohio, using CNSs. METHODS: The investigator-developed Role Tracker Tool (software) and a CNS questionnaire were used to collect baseline and monthly data for 5 months. Characteristics of the CNSs were summarized using descriptive statistics. Correlational statistics were used to measure associations. After mutually exclusive groups were created, tests for differences were completed using a Welch 2-sample t test and analysis of variance. Regression models were used to determine if relationships existed over time between competencies, priority ranking of competencies, and nursing characteristics. FINDINGS: Among 14 CNSs, mean (SD) age was 45 (10.11) years; mean (SD) CNS experience was 5.57 (7.87) years. Of 6 competencies, CNSs ranked quality as most important, followed by clinical work. Research ranked low. Mean (SD) time spent in hours/8.5-hour workday over 5 months was highest for clinical work, at 1.9 (1) hours, and lowest for professional self-development, at 0.4 (0.4) hours. Time spent on specific competencies varied by specialty, years as a CNS and at current employer, and comfort in competencies and spheres after controlling for nurse characteristics and monthly trends. Of 9 quality initiative focuses, mean (SD) time in hours/8.5-hour workday was highest for heart failure, with 0.7(0.8) hours. Time spent on quality initiatives was not associated with changes in quality improvement outcomes. Clinical nurse specialist competency priorities, quality initiative focuses, and quality outcomes varied over time. IMPLICATIONS: The work of CNSs can be captured and analyzed to enhance understanding of unique and varied CNS contributions in the healthcare matrix.

Complexity of care is associated with distressing environmental factors.

PURPOSE: The purpose of this study was to describe work and cognitive complexity patterns and assess predictors of increased complexity of care. DESIGN: Prospective, cross-sectional, correlational design, using a convenience sample and survey method. SETTING: Four nursing units at a large, Midwest tertiary-care medical center. SAMPLE: Participants were 38 nurses. METHODS: A 3-part survey included nurse caregiving complexity, environmental (unit) stress factors, and nurse/work characteristics (including role responsibility level). FINDINGS: Standardized sum score for work complexity was higher than cognitive complexity (P < .001). Nurses with more role responsibilities and environmental stressors had higher work (ρ = 0.37, P = .009) and cognitive complexity scores (ρ = 0.54, P < .001). After controlling for the number of role responsibilities, environmental stressors, and nurse/work characteristics, work complexity pattern scores were higher for breakdown in communication processes in nurses working off-shifts (P = .013) and interruptions in tasks on typical/busy workdays (P < .001). After controlling for nurse/work characteristics, work complexity patterns were not associated with role responsibilities, and cognitive complexity patterns were not associated with role responsibilities or environmental distress. In multivariable analysis, work complexity pattern scores remained associated with environmental distress scores (P = .024) and with 3 work complexity pattern factors: items placed in separate areas (P = .007), waiting for nonavailable systems (P = .010), and difficulty assessing proper resources (P = .015). CONCLUSIONS: After controlling for nurse/work characteristics, role responsibilities, and environmental stressors, work complexity was associated with environmental distress. IMPLICATIONS: Future research may increase understanding of relationships found in this study, and process improvement initiatives may provide targets for decreasing complexity of work patterns.

Waterborne outbreak of Salmonella I 4,[5],12:i:-.

Salmonella I 4,[5],12:i:- is an emerging serotype, and little information regarding attribution or risk factors for infection has been documented. We investigated an outbreak of Salmonella I 4,[5],12:i:- infections in a rural community and identified the community's private water system as the source of infection. Five people were ill with gastroenteritis. Water testing identified Salmonella. Contamination of the unprotected spring from an environmental source was suspected.