Patients and their families weigh in on evidence-based hospital design.

BACKGROUND: In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006. OBJECTIVE: To determine perceptions of patients and their families of evidence-based design features in a new heart center. METHODS: Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients' satisfaction with the environment. Results Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed. CONCLUSIONS: Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients' safety, satisfaction, and quality of care.

Characteristics associated with racial disparities in illness beliefs of patients with heart failure.

African Americans have greater misperceptions about heart failure (HF) than Caucasians. We examined socioeconomic and medical history factors to determine if they explain differences in accuracy of HF illness beliefs by race. 519 patients completed an illness beliefs and socioeconomic status survey. After establishing univariate associations by race, linear regression with backward selection was used to identify factors associated with HF illness beliefs accuracy. HF illness beliefs were less accurate among African Americans (p < .01). In multivariate models, race remained a predictor of HF illness beliefs accuracy, as did education level and living status (all ps < or = .01). Illness beliefs of African Americans were inaccurate and independently associated with social support and education level. Health care providers must consider patient education processes as a possible cause of differences and focus on what and how they teach, literacy level, materials used, and family engagement and education.

Signs and symptoms of heart failure: are you asking the right questions?

BACKGROUND: Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments. OBJECTIVES: To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class. METHODS: A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected. RESULTS: Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P < .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P

Impact of pediatric nurses' uniforms on perceptions of nurse professionalism.

This study examined the impact of nursing pants uniform color and style on perceptions of professionalism. Pediatric patients 7 to 17 years of age and their adult visitors were surveyed at two midwestern health care centers. Participants viewed eight photographs of the same RN in different uniforms. Adult participants rated each photograph for 10 image traits using a modified nurse image scale (MNIS). Pediatric participants rated each photograph for five image traits using the nurse image scale for children (NISC). Pediatric participant median sum scores for the eight uniforms were similar, despite clear preferences for boldly printed top and pressed blue or white-pant uniforms (22% each). Adult participant median sum scores were similar for six of the eight uniforms, but two had significantly lower scores (p < 0.001). Pediatric patients' and visitors' uniform preferences are not related to perceptions of professionalism.

Impact of nurses' uniforms on patient and family perceptions of nurse professionalism.

BACKGROUND: Patients and visitors may perceive nurses as professional based on uniform color and style. Nurse image may affect patient and visitor trust and satisfaction with nursing care. Fitted white dresses have been replaced by loose-fitting or scrub white, colored, or patterned pant sets. OBJECTIVES: This study examines nurse professionalism by assessing the nurse image traits of eight pant uniforms as perceived by pediatric patients, adult patients, and adult visitors. We also examined if uniform preference is congruent with nurse image traits. METHOD: A convenience sample of 499 patients and visitors were surveyed at a large Midwestern tertiary health care center. Subjects viewed photographs of the same registered nurse identically posed in eight uniforms and rated each by image traits. Kruskal-Wallis, Steel-Dwass multiple comparison method, and Wilcoxon signed-rank sum tests were used to test for differences in the Nurse Image Scale (NIS) score by uniform style and color and subject demographics. RESULTS: Subjects were 390 adult patients and visitors (78%) and 109 pediatric patients (21.4%); 66% were female, and 78% were Caucasian. In adults, NIS scores for white uniforms (two styles) were higher than NIS scores for uniforms with small print, bold print, or solid color (all p < .001). White uniform NIS score increased with subject age (all < or = .007). In pediatric patients (7-17 years) and young adults (18-44 years), the highest uniform NIS scores did not differ significantly from the others. Uniform preference was different from NIS score in pediatric and adult subjects, reflecting noncongruence between the perception of nurse professionalism by uniform and uniform preference. DISCUSSION: With aging, adults create perceptions of nurse professionalism based on uniform color and style. Traits of nurse professionalism were highest in white uniforms. Future research is needed to determine if transition to white nurse uniforms improves patient and family satisfaction with nursing care.