Breastfeeding Assessment Score: Systematic Review and Meta-analysis.

BACKGROUND: Previous studies have revealed conflicting results for the Breastfeeding Assessment Score (BAS) in predicting early breastfeeding cessation. Our objective was to externally validate the BAS and provide summary accuracy estimates for this clinical prediction model. METHODS: We used the original data from a prospective cohort study. Additional studies were identified by searching electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane) from 2002 to 2013 and contacting research groups that had derived or validated the BAS. Prospective cohort studies were eligible if the BAS was computed at baseline and mothers were followed up for breastfeeding cessation. Two physicians extracted relevant information and independently assessed the methodological quality for the included studies. RESULTS: In the external validation cohort, 22 of 424 mothers (5.2%) discontinued breastfeeding within 14 days of infant age. The BAS predicted early breastfeeding cessation with an area under the curve of 0.70 (95% confidence interval [CI]: 0.65 to 0.74) and inadequate calibration. When restricting the meta-analysis to 3169 mother-infant pairs enrolled in 4 higher-quality studies, a BAS value <8 predicted early cessation with 0.80 sensitivity (95% CI: 0.69 to 0.91) and 0.51 specificity (95% CI: 0.32 to 0.70) summary estimates. CONCLUSIONS: Substantial between-study heterogeneity limited the interpretation of summary accuracy estimates. The BAS predicts early breastfeeding cessation with moderate accuracy, although local recalibration is advised before implementation. Further study is warranted to determine whether the BAS can help pediatricians in identifying mother-infant pairs that may benefit from more extensive breastfeeding assessment and support.

Developing and testing a clinical information system evaluation tool: prioritizing modifications through end-user input.

OBJECTIVE: The objectives were to develop and validate the Information System Evaluation Tool (ISET), use feedback to modify the institution's clinical information system (CIS), and determine the modifications' success. BACKGROUND: The ability of a CIS to increase patient safety and care quality is dependent on its systems and processes. A survey was needed to provide the specificity necessary to make meaningful system improvements. METHODS: The ISET was pilot tested and revised before being administered before implementation of the CIS. It was administered at 2 times after implementation. The ISET was revised after analysis of the results, and comparisons were made between the times. RESULTS: The ISET is a valid and reliable instrument. Perceptions of the CIS initially decreased, but had significantly improved by 16 months after implementation. CONCLUSIONS: End-users must be convinced that the CIS supports their practice and improves care for adoption to be successful. The ISET measures these perceptions and highlights areas for improvement.

Development and testing of an organizational job satisfaction tool: increasing precision for strategic improvements.

OBJECTIVE: This article describes the development and testing of a new instrument that measures organizational job satisfaction (OJS). BACKGROUND: Nurse satisfaction includes 2 different types of satisfaction: OJS and professional work satisfaction. To obtain valid results, each type must be measured correctly. METHODS: A metasynthesis of OJS was conducted from 3 sources: nurse satisfaction instruments, attributes present in recruitment advertisements, and nursing comments from a national survey. A cross-walk of these sources provided 17 consistent OJS satisfiers. A survey of 10,000 nurses identified the importance of these satisfiers. RESULTS: Cronbach α for the scale was .85. The satisfiers were grouped into 3 categories: universally important, moderately important, and unimportant. CONCLUSIONS: A synthesis from 3 sources, including identification of important satisfiers, provides validity for the OJS scale. The scale is a reliable and valid tool used to assess and evaluate strategies to improve the nurses' work environment.

Evaluation of a breastfeeding assessment score in a diverse population.

A previous study performed in a predominately suburban population developed a breastfeeding assessment score (BAS) that was designed to predict, prior to hospital discharge, those mothers who would discontinue breastfeeding within the first 10 days of age. The purpose of the present study was to assess the BAS in a more diverse population. Patients were solicited from 3 urban hospitals serving patients primarily supported by public funding. Results of the present study with 1182 mother-infant pairs confirmed that 5 variables scored on a 0-2 scale (maternal age, previous breastfeeding experience, latching difficulty, breastfeeding interval, number bottles) remained highly significant for predicting discontinuation of breastfeeding. The data also demonstrate that the BAS is inversely related to the risk of cessation of breastfeeding at 7 to 10 days of age. Those at an early risk of cessation of breastfeeding, identified by the BAS, may benefit from early identification and a lactation consultation.

Differences between pediatric registered nurses' perception of organizational support, intent to stay, workload, and overall satisfaction, and years employed as a nurse in magnet and non-magnet pediatric hospitals: implications for administrators.

Much is understood about the issues that nurses believe impact their work environment and how Magnet hospitals have better organizational and patient outcomes. The majority of these large-scale studies have not included large numbers of nurses who care for children. In addition, we know little about how nurses perceive their work environment as their years in nursing increase. This study used a secondary analysis of survey responses from pediatric staff nurses to determine (1) whether there were differences in nurses' perceptions of organizational support, workload, intent to stay, and overall satisfaction within Magnet and non-Magnet hospitals, and (2) whether there were differences in these responses as the years in nursing increased. Findings indicate that Magnet nurses perceive a better work environment than do nurses from non-Magnet hospitals, and that for nurses in their first year as a nurse and for those nurses who have been a nurse for 15 years or longer believe their work environment is more supportive. The implications for nurse administrators include finding ways to keep new nurses engaged and satisfied after that initial "honeymoon" feeling about their new profession as well as providing further evidence of the value Magnet provides an institution.

Enhancing the work environment of staff nurses using targeted interventions of support.

Nurse executives continue to search for ways to support their staff nurses through enhancing their work environment to promote professional practice environments. Given that not all hospitals have the intensive resources necessary to pursue Magnet Recognition certification or the Texas Nurses Association's Texas Nurse-Friendly Hospital program designation, this does not prohibit them from pursuing specific components adapted for their own institution. The authors discuss 3 programs to enhance the work environment through increased professional practice. The rationale for these programs, preimplementation and postimplementation are explained.

Differentiating the workplace needs of nurses by academic preparation and years in nursing.

Questions surrounding the optimal level of academic preparation for nurses entering the workforce appear to be nearing consensus. However, in most organizations, the existing nursing workforce includes nurses of various ages, amounts of experience, and levels of academic preparation. All nurses serve an important role in caring for patients. The objective of this study was to determine if differences in work environment perceptions exist for nurses with different levels of academic preparation but similar years of experience in nursing. Mean values of work environment perceptions were compared between associate degree nurses and bachelor of science nurses with equivalent years in clinical practice using univariate statistics. Bachelor of science nurses reported similar or more positive work environment perceptions across all levels of professional experience as compared with associate degree nurses. The largest difference in perceptions between the two groups was seen in nurses with more than 15 years of professional experience. In this group, bachelor of science nurses reported more positive perceptions of peer support, unit support, workload, and overall nursing satisfaction. Intent to stay was not different between the groups considered. The results of this study suggest that efforts to expand nurses' access to baccalaureate programs may have positive implications for professional nursing and the work environment.

Nursing support, workload, and intent to stay in Magnet, Magnet-aspiring, and non-Magnet hospitals.

This study examined the differences between nurses' (N = 3,337) scores on organizational support, workload, satisfaction, and intent to stay between Magnet, Magnet-aspiring, and non-Magnet hospitals. The study was conducted using the Individual Workload Perception Scale, a valid and reliable tool with 32 Likert scale items, with nurses from 11 states, 15 institutions, and 292 diverse units. Results indicate that nurses at Magnet hospitals had significantly better scores on all subscales. Furthermore, nurses from Magnet-aspiring hospitals had better scores than did nurses from non-Magnet facilities. Conclusions of the study indicate that the Magnet program is meeting its intended goal: to provide a professional practice environment for staff nurses. Nurse executives may consider using the Individual Workload Perception Scale as a way to assess their organization's culture as it relates to professional practice of the registered nurse.

United States operating room nurses: work environment perceptions.

Concerns about pending retirement of nurses working in the operating room (OR) are undeniable. The nurses' work environment and level of perceived support is part of the equation of why a nurse may choose to retire or stay in the workforce. This study compares nurses' perceptions of the work environment between OR nurses and nurses who work in other type units; and compares the work environment perceptions of OR nurses between institutions of two sizes (<300 beds and >300 beds). Findings include: OR nurses have better perceptions of their work environment than nurses in other type units and OR nurses in smaller hospitals are more satisfied with their work environment, workload and perceptions of organisational support. Implications for OR work environments are discussed.

Improving work environment perceptions for nurses employed in a rural setting.

CONTEXT: Effective recruitment and retention of professional nurses is a survival strategy for health care facilities, especially in rural areas. PURPOSE: This study examines the use of the Individual Workload Perception Scale to measure nurse satisfaction by a small rural hospital in order to make positive changes in the work environment for nurses. METHODS: Baseline work environment perceptions of nurses employed in a rural Kentucky hospital were assessed using the Individual Workload Perception Scale, a validated 38-item instrument. Nurses reviewed the results and brainstormed on potential interventions to address areas of concern. The 4 interventions selected for implementation by the nursing staff included (1) implementation of a shared decision making or governance model; (2) enhanced role of licensed practical nurses within the organization; (3) augmentation of administrative support on night and weekend shifts; and (4) utilization of wireless communication devices. After implementation of the interventions, staff nurse perceptions were reassessed using the same tool. FINDINGS: The follow-up survey revealed improvements in all areas measured by the Individual Workload Perception Scale, with the greatest improvement in the perception of the work environment noted among night nurses. The increase in positive work environment perception among these nurses, with greater than or equal to 11 years of professional experience, was statistically significant. CONCLUSIONS: Tools exist to support the development and evaluation of interventions to improve the work environment for nurses practicing in rural health care settings. By addressing issues of specific concern, both job satisfaction and retention of this talented pool of professionals can be enhanced.

Work environment perceptions of pediatric nurses.

This study assessed whether pediatric nurse perceptions of the work environment differed (1) from nurses employed in nonpediatric settings, (2) by the type of pediatric practice setting, or (3) by year of birth. The results of the study suggested that pediatric nurses had more positive perceptions of unit support, workload, and overall nurse satisfaction than their colleagues working in nonpediatric facilities. Specific to pediatrics, younger nurses and those working in critical care settings seemed to be the happiest with their work environment.

Nurses' work environment perceptions when employed in states with and without mandatory staffing ratios and/or mandatory staffing plans.

Multiple stakeholders have sought regulatory and nonregulatory strategies to address nursing workforce and patient safety concerns. This study examines differences in nurses' work environment perceptions. Approximately 4,000 nurses employed in 10 states provided their perceptions of key characteristics of their work environment using the Individual Workload Perception Scale. Univariate statistics were used to characterize mean values of the nurses' work environment perceptions by state of employment and whether these perceptions changed if employed in states with versus without mandatory staffing ratios and/or mandatory staffing plans. This study provides preliminary evidence that mandatory staffing plan legislation may be linked with the most positive nurse work environment perceptions when compared with implementation of mandatory staffing ratios or no workforce regulation. Based on this preliminary observation, further analysis comparing the relative benefits and costs of workforce regulation may be warranted.

An infrastructure for organizational support of research.

Nurses are well suited to develop, implement, and disseminate research initiatives. However, most nurses need assistance to translate the idea behind the initiative into reality. This process requires resources and support. The authors outline one organization's infrastructure by which support is provided. Collaboration between a hospital-based research team and bedside nurses has produced a successful, funded program of research that has led to dissemination of findings.

Neonatal outcomes and quality of care in level II perinatal centers supported by a children's hospital-medical school level III program.

OBJECTIVE: Eight Level II perinatal centers developed contracts with the children's hospital to provide consultative neonatal patient care, education, and administrative support. The purpose of the present study was to evaluate infant outcomes and quality of care during a 3-year period of the program, 1994 to 1996. STUDY DESIGN: Neonatal mortality rates were determined for the 18,703 live births. Quality of care was assessed for 30 infants who died at the Level II centers and 315 infants transferred to the children's hospital. RESULTS: The neonatal mortality rate was 2.2/1000 live births. Quality-of-care issues primarily involved 80 "drop-in" deliveries

Baby boomer nurses bearing the burden of care: A four-site study of stress, strain, and coping for inpatient registered nurses.

OBJECTIVE: Because today's nursing workforce faces a multitude of stressors, the objective of this study was to describe stress, strain, and coping across institution types for inpatient registered nurses (n = 694), and to identify the influence of age on these findings. METHODS: This study, using a multi-site, mixed methods approach, provides data to support more focused interventions that address the challenges of specific types of stressors and age cohort needs. RESULTS: The worst scores for sub-scales addressing stress and strain for this sample of inpatient nurses were problems associated with physical environment and responsibility. Consistency was found across the four institutions for the sub scale of responsibility. Baby Boomer nurses (born between 1946 and 1964) had significantly worse scores than other age cohorts, specifically with the stress and strain sub-scales of role overload, role insufficiency, role ambiguity, role boundary, and interpersonal strain. CONCLUSION: The authors outline specific ways to support registered nurses by using staffing metrics that factor in unit activity as well as supporting the Baby Boomer nurse, both physically and psychosocially.

Perinatal outcomes in a school-based program for pregnant teen-agers.

Teen-age pregnancy constitutes a high-risk factor for prematurity, low birth weight, intrauterine growth retardation, infant mortality, and later health, behavioral, developmental, and educational disadvantages. A case-controlled study was performed to evaluate the influence of the Teen-age Parent Center on pregnancy outcomes. Improved outcomes were identified for low-birth-weight rate, high school graduation rate, smoking during pregnancy, and prenatal care. These results indicate that a comprehensive, school-based program can enhance perinatal outcomes.

A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age.

OBJECTIVES: To develop a succinct and comprehensive breast-feeding assessment score (BAS) to accurately identify infants at risk for early cessation of breast-feeding before initial hospital discharge. STUDY DESIGN: Mothers who intended to breast-feed their infants were solicited from 9 suburban hospitals. Two detailed data forms covering 107 items were completed before hospital discharge. A third form was completed at 7 to 10 days of age after telephone contact with the mother. RESULTS: Cessation of breast-feeding occurred in 113 of 1075 infants (10.5%). A multiple logistic regression analysis revealed 8 variables that were significant (P <.05) in predicting breast feeding cessation. A BAS was developed based on the odds ratios and relative risks of breast-feeding cessation for these 8 variables. CONCLUSIONS: The BAS was easily and quickly performed before hospital discharge for near term and term infants, which accurately predicted the risk of breast-feeding cessation within 7 to 10 days of age in the population studied.