Creating a positive work environment: implementation of the nurse-friendly hospital criteria.

The nursing shortage is negatively affecting the quality, effectiveness, and timeliness of patient care, which warrants a transformation of the nursing work environment. The Nurse-Friendly (NF) Hospital Project assisted 30 rural or small hospitals implement 12 NF criteria into hospital policies to create a positive work environment. The NF criteria represent organizational attributes necessary for ensuring quality patient care, positive work environment, professional development, and nurse satisfaction. The authors discuss nurses' perception of presence of NF criteria before and after they were incorporated at each hospital and the implementation outcomes.

Perception of practice environment, organizational commitment, and intention to leave among Asian nurses working in U.S. hospitals.

Asian nurses who are collectivist oriented have become the majority of international nurses working in U.S. hospitals. Collectivists view themselves as members of a group. It is important for administrators to understand workplace-related factors that encourage these nurses to stay. This study examined the relationships among collectivist orientation, perception of practice environment, organizational commitment, and intention to leave. Results demonstrated that organizational commitment is a mediator of perception of practice environment and intention to leave. Implications for administrators are discussed.

Nurse-Friendly Hospital Project: enhancing nurse retention and quality of care.

The present shortage of nurses in the United States is expected to continue. Nurse shortage, the nature of the work environment, and employers' expectations and attitudes, among other factors, influence both nurse retention and quality of patient care. The Nurse-Friendly Hospital Project was designed to improve nurses' work environment in rural and small hospitals in Texas. Findings demonstrate improvements in nurse retention, nurse staffing, and quality of care.

Living with chronic obstructive pulmonary disease (COPD): part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status.

This study is the second part of a project with the main purpose of obtaining a deeper understanding of the consequences of living with chronic obstructive pulmonary disease (COPD) concerning meal-related situations and an impaired nutritional status. COPD is a slowly progressive lung disease that results in several complications, including malnutrition. Nutritional status is an important part of COPD treatment, and there are criteria recommended for nutritional assessment and interventions among patients with COPD. Despite this, patients with extreme malnutrition and unnoticed weight loss are reported. The aim of the study was to investigate how Registered Nurses (RNs) in primary care describe nutritional assessment practices and interventions in COPD patients with impaired nutritional status. An interview approach using semistructured questions and case vignettes was chosen. The sample included 19 RNs working specifically with COPD patients. Data from interviews were analysed using qualitative content analysis, and nine categories corresponding to the aim were identified. The RNs reported that their assessment of nutritional status was based largely on intuition. Assessment also included detection of the patients' current beliefs and being sensible about information provision - When and How. Interventions were supportive eating interventions, practical and cognitive participation, and making patients aware of the illness trajectory. An overall category that influenced nursing was respecting patients' feelings of shame and guilt about a self-inflicted disease. It seems that RNs use intuition because of a lack of knowledge of systematic methods of nutritional assessment. The findings also indicate that the RNs attempted to build a relationship of trust with the patients rather than provide early information on sensitive topics (e.g. nutritional information). The study reports areas of nursing care for COPD patients that must be improved in the future.

Casting light on the concept of patient satisfaction by studying the construct validity and the sensitivity of a questionnaire.

PURPOSE: This study aims to explore the construct validity and the sensitivity of a patient satisfaction questionnaire for the purpose of gaining a better understanding of the concept, and of issues surrounding its measurements. DESIGN/METHODOLOGY/APPROACH: Several statistical analyses were used to study the reliability, construct validity, and the sensitivity of a patient satisfaction questionnaire. FINDINGS: The study supported the construct validity, high internal consistency, and homogeneity of the instrument. Two factors were found; one consisted of negatively worded items and the other of positively worded items. The negatively worded items contributed more than the positively worded items to the sensitivity of the instrument. Items were identified that contribute little or nothing to the construct validity and/or the sensitivity of the questionnaire. RESEARCH LIMITATIONS/IMPLICATIONS: The effect of wording on the variability and sensitivity of the instrument can be explained both as a consequence of response set bias and with regard to the theories against which two phenomena were being measured - patient satisfaction and patient dissatisfaction. The development of two kinds of instruments is proposed: those that measure patient dissatisfaction and are sensitive to minute changes in nursing care and those that measure both concepts and capture what patients find important in their care. ORIGINALITY/VALUE: The paper demonstrates how an analysis of the construct validity and the sensitivity of patient satisfaction instrument, can enhance understanding of the concept. It contributes to the debate about whether patient satisfaction and dissatisfaction are opposite ends of the same continuum or two different phenomena that require two different definitions.

Living with chronic obstructive pulmonary disease: part I. Struggling with meal-related situations: experiences among persons with COPD.

Reduced nutritional intake with low and decreased body weight can be a component of normal ageing. There is, however, also a greater risk for reduced nutritional intake within certain diagnoses, especially for chronic diseases. Malnutrition in chronic obstructive pulmonary disease (COPD) is caused by many factors. The relationship between COPD and low values of body mass index (BMI) is a known independent risk for mortality. For optimal support and care with special focus on nutritional status and interventions, caregivers need more knowledge about the meal-related situations (i.e. shopping for food, cooking and eating) of COPD patients. The aim of this study was to describe experiences of meal-related situations as viewed from the individual's perspective. The sample included eight women and five men with COPD recruited from five primary health clinics. The participants' average age was 68.9 years, with values of forced expiratory volume in 1 second (FEV(1) percentage) ranging from 18 to 69 and BMI values from 15 to 40. A descriptive design with qualitative interviews and self-reported diaries were used and the data were later analysed using content analysis. Findings showed consistency between informants' COPD, nutritional status and descriptions of experiences in meal-related situations. Findings were disease-specific but were also found to be general- and age-related. Respondents described physical influences and positive and negative feelings in their meal-related situations. Feelings of dependence, level of activity, transport of food, having company or being alone, appetite, hunger and need of time were also mentioned. Most research reports reduced nutritional status from a medical perspective. To our knowledge, no study has reported the positive and negative feelings that arise when eating in persons with COPD. Malnutrition for persons with COPD is not only caused by eating difficulties: eating is an integral part of social situations as shown in this study.

Nursing curriculum and continuing education: future directions.

Redefinition of roles and functions in the healthcare systems of the future requires embracing to the value of continuing education. Within this framework healthcare professional education and continuing education, there are several core competencies described by Institute of Medicine (IOM) [A.C. Greiner, E. Knebel (Eds.), Health Professionals Education: Bridge to Quality, IOM, available at, May 2003] that form the foundation for practice for nurses and other healthcare professionals. An overarching sentence in the document says "All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics" (p. 45). These IOM core competencies are: (1) Common value for respecting patients' differences, values, preferences and expressed needs. (2) Ability to cooperate, collaborate, communicate and integrate care using interdisciplinary teams. (3) Knowledge of and willingness to employ evidence-based practice principles. (4) Capability to apply quality and safety improvement approaches in care. (5) Understand, value and use informatics to all areas of health care, to reduce errors, manage knowledge and information, and make decisions and communicate. In enveloping these core competencies in basic and continuing education, it is necessary to build an evidence base for education itself, demand that faculty are prepared for the future. A crucial need is for healthcare professional students (including nursing students) learn interdisciplinary collaboration in the education of patients. A global strategy, using these competencies for preparing faculty is necessary; and some models already exist that can be further developed to meet future needs that are informatics driven in our increasingly technological future care systems.

Modeling nursing interventions in the act class of HL7 RIM Version 3.

The proposed Health Level 7 Reference Information Model (HL7 RIM) Version 3 is the foundation for expressing data to be communicated across health care information systems. The general objective of this analysis was to examine whether the RIM supports the expression of nursing interventions, considering both terminological and structural perspectives. The Nursing Terminology Summit Interventions Group focused on patient education about breast cancer, an intervention that differs sufficiently from other medical processes already considered by HL7 and represents issues surrounding both definition and execution of nursing process. Relevant actors, actions, and action relationships were culled from use cases and modeled into the proposed RIM structure and attributes by using modified instance diagrams. This method was effective and reproducible, and the RIM proved to be an adequate model for supporting breast cancer education. Additional interventions must be studied to fully assess the adequacy of the model to support all aspects of nursing process and terminology.

Describing an episode of home nursing care for elderly postsurgical cancer patients.

BACKGROUND: While studies have documented the beneficial effect of home care for cancer patients, the actual interventions implemented during these studies have not been well described. OBJECTIVES: Purposes of this study were to analyze interventions documented in narrative form by advanced practice nurses during a four-week episode of home care and describe intervention type, frequency, range, and variation over time in intervention emphasis and dose intensity. METHODS: Chart audits were performed on records kept for 148 postsurgical cancer patients who were assigned to the experimental group in a randomized clinical trial to evaluate the effect of home care on quality of life outcomes (McCorkle et al., 2000). Interventions statements (N = 7,275) were analyzed using Grobe's (1996) Nursing Intervention Lexicon and Taxonomy. RESULTS: Teaching accounted for the highest percentage of interventions documented, followed by provision of psychological support and reassurance, determination of patient needs and nursing care requirements, assessment of current status, and indirect care. Physical care and actions to promote self-care independence were documented least frequently. Differences in nursing care were found by cancer site with the greatest diversity of interventions documented for breast cancer patients. Intervention emphasis and dose intensity varied over time, suggesting that these nurses altered their care in response to the changing needs of their patients. CONCLUSIONS: These nurses responded to complex problems and used a variety of interventions to assist patients and families in management of the illness experience. They also tailored their care to each patient's location along the illness trajectory. These findings provide beginning support for the clinical utility of Nursing Intervention Lexicon and Taxonomy as a way to quantify an episode of nursing care.

Maintenance of skin integrity as a clinical indicator of nursing care.

OBJECTIVE: To assess maintenance of skin integrity in hospitalized patients as a clinical indicator of quality nursing care. DESIGN: Descriptive correlational study. SETTING: 17 acute care urban and rural hospitals in Texas. PARTICIPANTS: 723 hospitalized patients from 33 medical-surgical units. MAIN OUTCOME MEASURES: Pressure ulcers since admission and nursing care practices per unit. MAIN RESULTS: Overall prevalence of pressure ulcers since admission (4.7%) was lower than previously reported for acute care settings. Prevalence of pressure ulcers in hospitalized patients (10%) was higher than found in the Texas Nurses Association feasibility study (3.7%). The skin integrity ratio was strongly correlated for several unit variables, including number of beds per unit (r = 0.623) and average daily census per unit (r = 0.909). Benchmarking data across units showed that units with subjects that maintained skin integrity had a lower percentage of patients assessed on admission and performed daily assessments less frequently than did the units with subjects that did not maintain skin integrity. In addition, the units with subjects that maintained skin integrity classified fewer patients as at risk for pressure ulcer development and did not implement a skin care protocol for these patients. CONCLUSION: Patients who developed a pressure ulcer after admission were older and had more risk for pressure ulcers than those who maintained skin integrity. Benchmarking data detected various differences in nursing care. Significant relationships between study variables demonstrate the importance of assessing clinical indicators to monitor nursing care. Outcomes such as skin integrity, pressure ulcer since admission, and nosocomial ratio represent the quality of nursing care.