The adapted model of institutional support for Hispanic student degree completion: revisions and recommendations.

This article describes the historical development of the adapted model of institutional support (AMIS) for Hispanic student degree completion. The model was developed using 6 major categories of support: financial support, emotional and moral support, mentoring, professional socialization, academic advising, and technical support. Studies used to validate the inclusion of each of the components are presented. Two self-assessment instruments based on the model, the Institutional Self-Assessment for Factors Supporting Hispanic Student Recruitment and Persistence and the Healthcare Professions Education Program Self-Assessment (PSA), used to evaluate institutional supports for Hispanic student degree completion are described. This article describes the results of 2 studies using the PSA. The findings from these studies provide support for the AMIS. Limitations of the model and recommendations for further research are presented.

Institutional support for diverse populations: perceptions of Hispanic and african american students and program faculty.

Using the Adapted Model of Institutional Support as a framework, data were collected from 90 minority students, 80 faculty members, and 31 administrators from schools of nursing in Texas to determine perceived barriers and needed supports for program completion. Findings illustrate similar and differing perceptions of Hispanic and African American students, faculty, and program administrators. The data provide a baseline for making improvements and establishing "best practices" for minority recruitment and retention.

Assessing institutional support for Hispanic nursing student retention: a study to evaluate the psychometric properties of two self-assessment inventories.

AIM: To assess the content validity and internal consistency reliability of the Healthcare Professions Education Program Self-Assessment (PSA) and the Institutional Self-Assessment for Factors Supporting Hispanic Student Retention (ISA). BACKGROUND: Health disparities among vulnerable populations are among the top priorities demanding attention in the United States. Efforts to recruit and retain Hispanic nursing students are essential. METHOD: Based on a sample of provosts, deans/directors, and an author of the Model of Institutional Support, participants commented on the perceived validity and usefulness of each item of the PSA and ISA. Internal consistency reliability was calculated by Cronbach's alpha using responses from nursing schools in states with large Hispanic populations. RESULTS: The ISA and PSA were found to be reliable and valid tools for assessing institutional friendliness. CONCLUSION: The instruments highlight strengths and identify potential areas of improvement at institutional and program levels.

The biomechanics of patient room standardization.

BACKGROUND: The prevailing focus on cognitive load reduction in healthcare environment standardization excludes a domain of healthcare delivery that could contribute significantly to safety and efficiency through standardization, but it has escaped discussion in the context of the biomechanics of care delivery. Inappropriate biomechanics not only can harm caregivers but compromise care delivery. Little, however, is known regarding the biomechanics of patient care and the way it interacts with the configurational issues typically targeted in healthcare environment standardization. OBJECTIVES: Examine the types of potentially harmful or stressful actions exhibited by nurses during patient care delivery in an acute medical/surgical setting. Examine the sources influencing unsafe actions. METHOD: Twenty nurses provided three types of simulated care in an experimental setting involving nine care configurations that were systematically manipulated. A kinesiology expert coded 80 simulation segments representing two types of task and two levels of environmental challenge to identify potentially stressful and harmful actions. Exploratory and regression analyses were conducted on the data. RESULTS: Analysis suggests that a considerable proportion of potentially harmful and stressful actions are associated with the design of the physical elements as opposed to the configurational factors typically addressed in standardization. Both of these factors interact to produce work-arounds that result in unsafe actions. CONCLUSION: The standardization of healthcare environments needs a larger framework to address both cognitive lapses and the biomechanics of care delivery.

A comparison of glomerular filtration rate estimating equation performance in an older adult population sample.

The purpose of this study was to compare the performance of four commonly used glomerular filtration rate (GFR) estimating equations in an older, ethnically diverse sample using a descriptive correlational design. A convenience sample of 495 ethnically diverse adults aged 65 or older were observed via a retrospective record review. Average age was 73 years, and 76% were female. They were 58% African-American and 23% Latino. The estimated GFRs by the various equations were highly correlated MANOVA revealed significant differences between the equations. Chronic kidney disease (CKD) stage distribution was significantly different when examined by the equations. Because pharmacokinetic studies are based on creatinine clearance, the Cockcroft-Gault equation is more appropriate for calculating drug dosages. However, because the CKD Epidemiology Collaboration equation was derived from the most similar and representative sample, and currently offers the greatest discrimination at all levels, it should be used in preference to other equations for the classification and trending of renal function in older minority patients.

A counterbalanced cross-over study of the effects of visual, auditory and no feedback on performance measures in a simulated cardiopulmonary resuscitation.

BACKGROUND: Previous research has demonstrated that trained rescuers have difficulties achieving and maintaining the correct depth and rate of chest compressions during both in and out of hospital cardiopulmonary resuscitation (CPR). Feedback on rate and depth mitigate decline in performance quality but not completely with the residual performance decline attributed to rescuer fatigue. The purpose of this study was to examine the effects of feedback (none, auditory only and visual only) on the quality of CPR and rescuer fatigue. METHODS: Fifteen female volunteers performed 10 minutes of 30:2 CPR in each of three feedback conditions: none, auditory only, and visual only. Visual feedback was displayed continuously in graphic form. Auditory feedback was error correcting and provided by a voice assisted CPR manikin. CPR quality measures were collected using SkillReporter® software. Blood lactate (mmol/dl) and perceived exertion served as indices of fatigue. One-way and two way repeated measures analyses of variance were used with alpha set a priori at 0.05. RESULTS: Visual feedback yielded a greater percentage of correct compressions (78.1 ± 8.2%) than did auditory (65.4 ± 7.6%) or no feedback (44.5 ± 8.1%). Compression rate with auditory feedback (87.9 ± 0.5 compressions per minute) was less than it was with both visual and no feedback (p < 0.05). CPR performed with no feedback (39.2 ± 0.5 mm) yielded a shallower average depth of compression and a lower percentage (55 ± 8.9%) of compressions within the accepted 38-50 mm range than did auditory or visual feedback (p < 0.05). The duty cycle for auditory feedback (39.4 ± 1.6%) was less than it was with no feedback (p < 0.05). Auditory feedback produced lower lactate concentrations than did visual feedback (p < 0.05) but there were no differences in perceived exertion. CONCLUSIONS: In this study feedback mitigated the negative effects of fatigue on CPR performance and visual feedback yielded better CPR performance than did no feedback or auditory feedback. The perfect confounding of sensory modality and periodicity of feedback (visual feedback provided continuously and auditory feedback provided to correct error) leaves unanswered the question of optimal form and timing of feedback.

Literature review: instructional design and pedagogy science in healthcare simulation.

This article is a review of the literature focused on simulation as an educational intervention in healthcare. The authors examined the literature based on four key levels: (1) the validity and reliability of the simulator, (2) the validity and reliability of the performance evaluation tool, (3) the study design, and (4) the translational impact. The authors found that the majority of research literature in healthcare simulation does not address the validity and reliability of the simulator or the performance evaluation tool. However, there are well-designed research studies that address the translation into clinical settings and have positive patient safety outcomes.

An empirical examination of patient room handedness in acute medical-surgical settings.

OBJECTIVE: The study objective was to examine whether standardized same-handed room configurations contribute more to operational performance in comparison to standardized mirror-image room configurations. Based on a framework that physical environment standardization supports process and workflow standardization, thus contributing to safety and efficiency, the study examined the comparative effectiveness of the standardized same-handed configuration and the standardized mirror-image configuration. BACKGROUND: Patient room handedness has emerged as an important issue in inpatient unit design, with many hospitals adopting the standardized same-handed room concept at all levels of patient acuity. Although it is argued that standardized same-handed rooms offer greater levels of safety and efficiency in comparison to standardized mirror-image rooms, there is little empirical evidence either to support or refute these contentions. METHOD: An experimental setting was developed where elements of the physical environment and approach to the caregiver zone were systematically manipulated. Twenty registered nurses (10 left-handed and 10 right-handed) provided three types of care to a patient-actor across nine physical design configurations, which were videotaped in 540 separate segments. Structured interviews of the subjects were conducted at the end of each individual set of simulation runs to obtain triangulation data. Video segments were coded by nursing experts. Statistical and content analyses of the data were conducted. RESULTS: Study data show that standardized same-handed configurations may not contribute to process and workflow standardization--hence, to safety and efficiency--any more than standardized mirror-image configurations in acute medical-surgical settings. Data suggest that a global view of the patient care environment upon entry is the most sought-after familiarization factor to reduce cognitive load.

Cultural competency of graduating BSN nursing students.

Providing culturally appropriate care is an essential nursing competency for new graduates. Multiple curricular approaches are being used to achieve this end. When measured by Campinha-Bacote's Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals-R, graduating students (n = 515) from six different BSN programs scored, on average, in the culturally aware range. These results suggest that no one curricular approach is proving to be more effective than another in achieving essential cultural competency.

Emerging technologies to enhance the safety of older people in their homes.

As more and more Baby Boomers are growing into their senior years, technology applications are being developed and marketed to increase their ability to remain independent in their own homes for as long as possible. This article reviews currently available devices and products that are intended to meet home safety needs of the elderly. The purpose of the article to share with nurses who care for elderly patients and their families some of the products and services that are currently available. Data regarding acceptability and efficacy of these products are still needed.

A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation.

BACKGROUND: Hands-Only cardiopulmonary resuscitation (CPR) is recommended for use on adult victims of witnessed out-of-hospital (OOH) sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2) CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR. METHODS: Twenty healthy female volunteers certified in basic life support performed Hands-Only CPR and 30:2 CPR on a manikin. A mixed model repeated measures cross-over design evaluated chest compression rate and depth, changes in fatigue (chest compression force, perceived exertion, and blood lactate level), and changes in electromyography and joint kinetics and kinematics. RESULTS: All subjects completed 10 minutes of 30:2 CPR; but, only 17 completed 10 minutes of Hands-Only CPR. Rate, average depth, percentage at least 38 millimeters deep, and force of compressions were significantly lower in Hands-Only CPR than in 30:2 CPR. Rates were maintained; but, compression depth and force declined significantly from beginning to end CPR with most decrement occurring in the first two minutes. Perceived effort and joint torque changes were significantly greater in Hands-Only CPR. Performance was not influenced by age. CONCLUSION: Hands-Only CPR required greater effort and was harder to sustain than 30:2 CPR. It is not known whether the observed greater decrement in chest compression depth associated with Hands-Only CPR would offset the potential physiological benefit of having fewer interruptions in compressions during an actual resuscitation. The dramatic decrease in compression depth in the first two minutes reinforces current recommendations that rescuers take turns performing compressions, switching every two minutes or less. Further study is recommended to determine the impact of real-time feedback and dispatcher coaching on rescuer performance.

Innovations in basic life support education for healthcare providers: improving competence in cardiopulmonary resuscitation through self-directed learning.

Providing cardiopulmonary resuscitation is an essential competency for nurses. Nurse educators involved in staff development and continuing education spend numerous hours offering basic life support courses and conducting performance improvement activities such as mock codes. This study provides evidence that cardiopulmonary resuscitation performance skills using self-directed learning methods are as good as or, on a number of parameters, better than those achieved with a more resource- and time-intensive traditional approach.

Improving workplace safety training using a self-directed CPR-AED learning program.

Adequate training in cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) is an important component of a workplace safety training program. Barriers to traditional in-classroom CPR-AED training programs include time away from work to complete training, logistics, learner discomfort over being in a classroom setting, and instructors who include information irrelevant to CPR. This study evaluated differences in CPR skills performance between employees who learned CPR using a self-directed learning (SDL) kit and employees who attended a traditional instructor-led course. The results suggest that the SDL kit yields learning outcomes comparable to those obtained with traditional instructor-led courses and is a more time-efficient tool for CPR-AED training. Furthermore, the SDL kit overcomes many of the barriers that keep individuals from learning CPR and appears to contribute to bystanders' confidently attempting resuscitation.

Voices of Hispanic students in baccalaureate nursing programs: are we listening?

Hispanics have been described as the "missing persons" in the health professions at a time when a lack of cultural diversity in the workforce has been linked to health disparities. The shortage of Hispanic nurses cannot be addressed effectively without understanding their perspectives on nursing and nursing education. The adapted Model of Institutional Support served as a framework to describe perceived barriers and supports to retention among Hispanic students in baccalaureate nursing programs. Focus groups were used to allow the voices of Hispanic students to emerge; 14 Mexican American nursing students from two liberal arts universities participated. Theory-guided content analysis of focus group transcripts revealed themes congruent with the model components of finances, emotional and moral support, professional socialization, mentoring, academic advising, and technical support. Personal determination emerged as a theme not identified in the model. The prominence of the personal determination theme among these students warrants further study, but suggests that success may be enhanced by helping students capitalize on their personal determination.

Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention.

BACKGROUND: Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. OBJECTIVE: To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. METHODS: Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. RESULTS: Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. CONCLUSIONS: The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

Cultural attitudes, knowledge, and skills of nursing faculty toward patients from four diverse cultures.

This study used a convenience sample of 94 nursing faculty recruited among attendees of two professional conferences to describe faculty attitudes toward and perceived level of confidence in cultural knowledge of patients representing four ethnic groups. The study also explored relationships between these variables and the respondents' demographic characteristics. Respondents completed the Cultural Attitudes Scale, the Cultural Self-efficacy Scale, and a demographic survey and wrote a response to an open-ended question. Mean scores indicated moderately positive attitudes toward and moderate-to-high confidence levels in cultural knowledge related to caring for four ethnic groups. Three variables accounted for 33% of the variability in level of confidence in skill in transcultural care: cultural content was included in the curriculum of the employing nursing school, education courses in culture, and the predominant ethnicity of the patients for whom care was provided. Repeated exposure to persons from other cultures was the most frequently cited means of increasing personal comfort in caring for ethnically diverse patients. Only 53% of the respondents remembered cultural content in their own academic preparation. Findings suggest that cultural exposure opportunities enhance faculty-perceived confidence in knowledge and attitudes toward people from other cultures.

Cultural attitudes, knowledge, and skills of a health workforce.

This study describes cultural attitudes, knowledge, and skill of 409 health care workers using the Ethnic Attitude Scale, the Cultural Self-Efficacy Scale, and a demographic inventory. Findings suggest cultural knowledge and educational preparation of the health worker may influence cultural skills. Workers that were most confident in their cultural skills in working with other cultural groups were more confident in knowledge of cultural concepts and had higher education levels. The results also suggest gaps in workers' knowledge of other cultures and how to care for them in culturally sensitive ways. Educational interventions may enhance workers' knowledge. Whether such enhanced knowledge yields improved patient care outcomes remains to be answered.

Mastery over stress among women with HIV/AIDS.

To better understand how women with HIV infection deal with the stress of their disease, the authors explored the relationships between stressors, resources for managing stress, and mastery over stress in 80 HIV-positive women. Nurses and other professionals recruited participants in a variety of settings in 10 states. Participants completed a packet of research instruments that measured the stressors of perceived stress intensity, interpersonal conflict, and severity of illness; the resources of social support, support networks, and spiritual perspective; and the outcome of mastery over stress. Participants reported high levels of social support, spiritual perspective, interpersonal conflict, and perceived stress intensity. Twenty-nine women (36%) had achieved mastery over stress. Mastery over stress was significantly and positively correlated with social support, spiritual perspective, and physical functioning, a measure of severity of illness. Mastery over stress was significantly and negatively correlated with interpersonal conflict. An exploratory stepwise multiple regression analysis yielded two predictors of mastery over stress: social support and spiritual perspective. Although a comparison of these results with those reported in the literature for men suggests that men and women differ in how they respond to stressors, further research will be needed to enhance our understanding of these gender differences. Stress management training, especially related to interpersonal conflict, may be an effective intervention to facilitate mastery. Other potential interventions include assessing social support and spiritual perspective, discussing the potential benefit of these resources, and making referrals for psychosocial services as needed.

Access to preventive health care: is method of payment a barrier for immigrant Hispanic women?

This study describes the payment category of 397 low-income Hispanic women and the relationship to compliance with family planning visits the first year postbirth. Only one-fourth of the women returned for the one-year family planning visit, when they would have received well-woman care. Pay category was not a factor in identifying those who returned. Health system barriers, patient cultural beliefs, and life circumstance may explain why women enter and then leave apparently seamless systems of care. To increase preventive care, more study is needed of interventions that build on women's existing cultural prescriptions for health behavior by health professionals who portray postbirth checks as wellness checks.

Evaluating nurse competency: evidence of validity for a skills recredentialing program.

A multitrait, multimethod approach was used to evaluate the validity of a hospital-based nurse competency assessment program as a mechanism for assuring compliance with the three standards for competence established by the National Council of State Boards of Nursing, Inc. For selected competencies, both knowledge and skill performance were evaluated under simulated conditions and under routine patient care conditions. Under simulated conditions, pass rates on first attempts among the 368 participating nurses were high as expected (82 per cent to 94 per cent on knowledge and 75 per cent to 99 per cent on performance). Offering immediate educational feedback followed by second attempts yielded a 97 per cent overall pass rate. Competencies assessed under both simulated and patient care conditions (35 sets of observations) revealed no differences in assessed competence. The equivalence of assessments made under simulated and patient care conditions supports the validity of competency assessment programs currently in use in many large health care settings.