Hospital-Based Nursing Research: Clinical and Economic Outcomes.

We surveyed 181 nursing research leaders from Magnet® hospitals, using mixed methods with the online Hospital-Based Nursing Research Clinical and Economic Outcomes survey, to describe the clinical and economic outcomes of nursing research conducted in hospital settings. We used descriptive statistics to analyze the quantitative findings and a qualitative descriptive approach to study the open-ended responses. Most respondents reported that findings from their hospital-based studies were implemented on their units (88.2%), improved health care processes (88.2%), and reduced hospital costs (79%). Over 50% reported positive impacts on core quality measures, including improving patient/family satisfaction (76.8%), nurse satisfaction (65%), length of stay (59.1%), and infection rates (56.5%). Four themes were identified: study evaluation, improvements in care delivery/clinical outcomes, economic impact, and intrinsic and extrinsic rewards. Much of the research reported by respondents focused on quality measures with findings that resulted in improved clinical and economic outcomes.

Interprofessional care of people with multiple chronic conditions: An open-access resource for nursing educators.

Nurses, nurse practitioners, and other healthcare professionals must be prepared to care for the growing population of patients with multiple chronic conditions, to promote patient engagement, patient self-management, and for interprofessional collaboration. Interprofessional Care of Individuals with Multiple Chronic Conditions is an open-access eLearning course designed to prepare students with these skills. The course features multimedia presentations, interactive exercises, and an immersive "day in the life of a patient-centered medical home" in which learners make decisions, receive feedback, and experience consequences in the context of real-world video scenarios. Three hundred thirty-four nurse practitioner students participated in the educational program. To evaluate the program, we conducted a paired-samples t-test to compare scores on pre and posttest evaluation surveys. There was a significant difference in the scores for applying the Chronic Care Model t (df) = 15.99; p < 0.001, coaching for self-management t (df) = 11.04; p < 0.001 and interprofessional collaboration t (df) = 3.86; p < 0.00. The majority of students were satisfied or very satisfied with the modules. Students found the immersive video scenarios to be the best feature of the course. The course is available to assist students in gaining the ability to care for patients with chronic illnesses within interprofessional practice settings.

Reducing Unnecessary Phlebotomy Testing Using a Clinical Decision Support System.

INTRODUCTION: Reducing unnecessary tests reduces costs without compromising quality. We report here the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests and describe, estimated costs, and unnecessary provider ordering. METHODS: We used a pretest posttest design to examine unnecessary type and screen tests 3 months before and after CDSS implementation in a large academic medical center. The clinical decision support system appears when the test order is initiated and indicates when the last test was ordered and expires. Cost savings was estimated using time-driven activity-based costing. Provider ordering before and after the CDSS was described. RESULTS: There were 26,206 preintervention and 25,053 postintervention specimens. Significantly fewer unnecessary type and screen tests were ordered after the intervention (12.3%, n = 3,073) than before (14.1%, n = 3,691; p < .001) representing a 12.8% overall reduction and producing an estimated yearly savings of $142,612. Physicians had the largest weighted percentage of unnecessary orders (31.5%) followed by physician assistants (28.5%) and advanced practice nurses (11.9%). CONCLUSIONS: The CDSS reduced unnecessary type and screen tests and annual costs. Additional interventions directed at providers are recommended. The clinical decision support system can be used to guide all providers to make judicious decisions at the time of care.

Effectiveness of early identification and electronic interventions for teens with risk factors for the development of heart disease and diabetes: Phase II findings.

BACKGROUND AND PURPOSE: Serum and physical risk factors for the development of heart disease and diabetes are detectable long before adulthood. The purpose of this two-part study was to assess the prevalence and associations of these risk factors in teens and determine the effectiveness of a customizable two-part electronic education program on minimizing identified risks. METHODS: Data were collected from teens (n = 168) from two high schools (one urban and one rural) in the mid-Atlantic region. After baseline data were collected, the two-part electronic education program was initiated. Serum and physical risk factors were rechecked at 12-week intervals, and results were analyzed. CONCLUSIONS: Significant serum and physical risk factor associations were identified and remained present among teens over the course of the study. High-density lipoproteins showed significant, steady improvement. Low-density lipoproteins were positively associated with body mass index, diastolic blood pressure, and thyroid-stimulating hormone level. IMPLICATIONS FOR PRACTICE: Although serum and physical risk factors are identifiable in teens, routine screening of this age group and younger is not an established standard of care. Health care providers need effective, innovative methods to counteract these risks. Through increased awareness of the presence of risk factors in young patients, advanced nurse practitioners may implement earlier interventions to counteract these risks.

National Study of Nursing Research Characteristics at Magnet®-Designated Hospitals.

OBJECTIVE: To describe the research infrastructure, culture, and characteristics of building a nursing research program in Magnet®-designated hospitals. BACKGROUND: Magnet recognition requires hospitals to conduct research and implement evidence-based practice (EBP). Yet, the essential characteristics of productive nursing research programs are not well described. METHODS: We surveyed 181 nursing research leaders at Magnet-designated hospitals to assess the characteristics in their hospitals associated with research infrastructure, research culture, and building a nursing research program. RESULTS: Magnet hospitals provide most of the needed research infrastructure and have a culture that support nursing research. Higher scores for the 3 categories were found when hospitals had a nursing research director, a research department, and more than 10 nurse-led research studies in the past 5 years. CONCLUSIONS: While some respondents indicated their nurse executives and leaders support the enculturation of EBP and research, there continue to be barriers to full implementation of these characteristics in practice.

Development and Preliminary Testing of the Perceived Benefit and Burden Scales for Cancer Clinical Trial Participation.

We developed measures of benefits and burdens of research participation in cancer clinical trials using a sequential mixed methods design with a qualitative ( n = 32) and quantitative sample ( n = 110) of cancer clinical trial participants. Benefit-burden items (22 for benefits, 23 for burdens) were subsequently developed and assessed through cognitive interviewing for content, clarity, and meaning. Preliminary psychometric analyses support the internal consistency reliability and construct validity of Benefit (α = .90) and Burden (α = .87) research participation scales. Item response theory models supported the discrimination ability of the items on the scales. Participants who had thoughts of dropping out had lower Benefit scale scores ( p < .001) and higher Burden scores ( p < .001) than those who had no thoughts of dropping out, supporting construct validity. With further psychometric testing, the scale can be used to develop appropriate interventions to address recruitment and retention of human participants in clinical research.

Cancer clinical trial participants' assessment of risk and benefit.

BACKGROUND: The purpose of this article is to examine the extent to which cancer clinical trial participants assess the benefits and risks of research participation before enrollment. METHODS: One hundred and ten oncology research participants enrolled in cancer clinical research in a large Northeastern cancer center responded to a self-administered questionnaire on perceptions about cancer clinical trials. RESULTS: Of the participants, 51.6% reported they did not directly assess the benefits or risks. Educational level, age, employment, treatment options, insurance, and spiritual-religious beliefs were significantly associated with whether participants assessed risk and benefits. Those who felt well informed were more likely to have assessed the benefits and risks at enrollment than those who did not feel well informed (odds ratio [OR] = 3.92, p = .014); of those who did not assess the risks and benefits, 21% did not feel well informed at enrollment (p = .001). Those who agreed that the clinical trial helped pay the costs of the care had nearly three times the odds of not assessing risks and benefits compared to those who disagreed. CONCLUSION: Our findings have important implications for understanding the role of assessing risks and benefits in the research participation decisions of patients with cancer and call for further understanding of why participants are not assessing information believed to be essential for autonomous informed decisions.

The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States.

PURPOSE: Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. METHODS: This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. RESULTS: Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors. CONCLUSIONS: Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care.

The influences of immigration on health information seeking behaviors among Korean Americans and Native Koreans.

Korean Americans (KAs) have low screening rates for cancer and are often not well informed about their chronic diseases. Reduced access to health-related information is one reason for gaps in knowledge and the widening health disparities among minority populations. However, little research exists about KAs' health information seeking behaviors. Guided by the Structural Influence Model, this study examines the influence of immigration status on KAs' trust in health information sources and health information seeking behaviors. Cross-sectional surveys were conducted in the Washington, D.C., metropolitan area as well as in the Gwangju metropolitan city in South Korea during 2006-2007. Two hundred and fifty-four KAs and 208 native Koreans who were 40 years of age or older completed the surveys. When comparing native Koreans to KAs, we found KAs were 3 times more likely to trust health information from newspapers or magazines (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.49-6.54) and 11 times more likely to read the health sections of newspapers or magazines (OR = 11.35; 95% CI = 3.92-32.91) in multivariate adjusted models. However, they were less likely to look for health information from TV (OR = 0.29; 95% CI = 0.12-0.72) than native Koreans. Our results indicate that immigration status has profound influences on KAs' health information seeking behaviors. Increasing the availability of reliable and valid health information from printed Korean language magazines or newspapers could have a positive influence on increasing awareness and promoting screening behaviors among KAs.

Breast cancer screening practices among Asian Americans and Pacific Islanders.

OBJECTIVE: To compare the breast cancer screening practices and related factors between Asian Americans and Pacific Islanders (PIs) and non-Hispanic whites. METHODS: Using 2008 Behavioral Risk Factor Surveillance System data, reported mammogram usage among women aged 40+ were compared. Covariates included demographics, risk behaviors, health perception, care access, and general health practice behavior. RESULTS: PIs had higher rates of screening mammogram usage than did Asian Americans. Most covariates had different levels of influence on mammogram screening for the 2 groups, with a few in opposite directions. CONCLUSION: Understanding the magnitude and predictors of these disparities for racial/ethnic groups can help inform targeted interventions.

Lifestyle behaviors, chronic diseases, and ratings of health between black and white adults with pre-diabetes.

PURPOSES: The purposes of this study were to assess differences in lifestyle behaviors and other health-related factors between black and white adults with pre-diabetes and to identify predictors for lifestyle behaviors. METHODS: Using the 2007 and 2009 data from the Behavioral Risk Factor Surveillance System (BRFSS), an annual cross-sectional survey of randomly selected samples from each state, black (n = 1156) and white (n = 9539) adults with pre-diabetes were compared on lifestyle behaviors, general health practices, perceptions of health, chronic diseases, and access to care. Predictors for participating in regular physical activity and adequate intake of fruits and vegetables were identified for each racial and gender group using multiple regression procedures. RESULTS: Less than 40% of the adults with pre-diabetes participated in regular physical activity, and less than a quarter had adequate intake of fruits and vegetables; only 20% met the body weight recommendations. Compared to whites, blacks were more likely to be overweight/obese (86% vs 79%) and less likely to engage in regular physical activity (29% vs 40%). Except for adequate intake of fruits and vegetables, each racial and gender group had different predictors for regular physical activity. For black males, the predictors included impaired physical health and coronary heart disease/stroke. For black females, the predictors were younger age and routine checkup. CONCLUSIONS: Significant disparities exist between blacks and whites in lifestyle behaviors and other health-related factors. Targeted intervention strategies are needed to motivate blacks to modify behaviors to prevent or delay the development of diabetes.

The management of sleep and circadian disturbance in patients with dementia.

Sleep and circadian disturbances are common among patients with dementia. Symptomatic manifestations vary according to dementia subtype, with one commonly shared pattern--the irregular sleep-wake rhythm (ISWR), a circadian disorder characterized by an absence of the sleepwake cycle's circadian synchronization. Hypothesized mechanisms of circadian rhythm disturbance include suprachiasmatic nucleus (SCN) circadian pacemaker damage, pineal gland and melatonin secretion alterations, and reduced zeitbeigers and decreased input to the SCN. Management options include prescribed sleep/wake scheduling, light therapy, melatonin, physical and social activity, and mixed modality. The mixed-modality approach is the most effective method in treating ISWR. Pharmacologic interventions are controversial, with no evidence supporting their effectiveness while associated with multiple side effects. They should be used with caution and only be considered as short-term therapy. All treatment strategies should be individualized to achieve the best outcomes.

Comparison of lifestyle behaviors and related factors between Asian American and white adults with prediabetes.

This study compares lifestyle behaviors and related factors between Asian American and white adults with self-reported prediabetes and identifies covariates/predictors for regular physical activity and adequate intake of fruits/vegetables. Using data from the United States of America Behavioral Risk Factor Surveillance System, 302 Asian Americans and 9558 white adults were analyzed. There were no significant differences for participating in regular physical activity or consumption of adequate fruits/vegetables between the two groups. Overall, 40% of the respondents engaged in regular physical activity, whereas less than 25% reported an adequate intake of fruits/vegetables. In the adjusted models, compared to white, Asian Americans were less likely to have impaired physical (OR = 0.54, 95% CI: 0.36 0.80) or mental health (OR = 0.36, 95% CI: 0.21, 0.61), or cardiovascular diseases (OR = 0.59, 95% CI: 0.41, 0.87). The covariates/predictors that relate to the behaviors differed between the groups. We conclude that interventions to increase physical activity and healthy eating for Asian American and white adults with prediabetes should address the different covariates/predictors for each group.

New-onset constipation at acute stage after first stroke: incidence, risk factors, and impact on the stroke outcome.

BACKGROUND AND PURPOSE: The prevalence of constipation after stroke varies from 30% to 60%. The incidence of new-onset constipation during the early stage of stroke remains uncertain. The present study was designed to investigate the prevalence of new-onset constipation, its risk factors, and its impact on stroke outcome in patients with their first stroke at acute stage. METHODS: This is a prospective cohort study of 154 patients admitted with their first stroke. New-onset constipation during the first 4 weeks of stroke was recorded, using the Rome II criteria for constipation. Demographics, characteristics of the stroke, laboratory parameters, and use of medications were evaluated as risk factors for constipation. Death, recurrent stroke, and handicap at 12 weeks were regarded as poor outcome. The impact of constipation on poor outcome was also studied. RESULTS: The cumulative incidence of new-onset constipation was 55.2% at 4 weeks poststroke. The occurrence of constipation was associated with dependence (P<0.01) and use of bedpan for defecation (P<0.05). Among patients with moderate stroke severity (NIHSS 4 to 11) at baseline, constipation at 4 weeks was associated with a poor outcome at 12 weeks. CONCLUSIONS: New-onset constipation is a common complication of acute stroke. Its occurrence is associated with dependence and use of bedpan for defecation. Its development may predict a poor outcome at 12 weeks in patients with moderately severe stroke.