The Relationship Between Culture of Safety and Rate of Adverse Events in Long-Term Care Facilities

OBJECTIVE

The aim of the study was to assess the relationship of culture of safety dimensions and the rate of unanticipated care outcomes in long-term care facilities (LTCFs) using the Agency for Healthcare Research and Quality framework of resident safety culture.

METHODS

Cross-sectional survey data were collected on 13 dimensions of culture of safety in five LTCFs from registered nurses, licensed practical nurses (LPNs), nursing assistants, administrators/managers, administrative support, and rehabilitation staff. Secondary data on falls in the five LTCFs from quarters 1 to 3 of 2014 were obtained from the Centers for Medicare and Medicaid Services in February 2015. Spearman's ρ and the Generalized Estimating Equations using a log link (Poisson distribution) were used.

RESULTS

Communication and feedback about incidences reported the highest mean scores (M = 4.35, SD =0.71). Higher rate of falls was associated with a lower level of team work, lower degree of handoffs, and lower levels of organizational learning. The risk for falls increased as the number of residents per facility increased (rate ratio [RR] = 1.02; 95% confidence interval [CI] = 1.01-1.02) and as the number of LPN hours per resident increased (RR = 37.7, 95% CI = 18.5-76.50). Risk for long stay urinary tract infections increased as number of residents increased (RR =1.01, 95% CI =1.01-1.01). Increase in culture of safety score was associated with decrease in risk of falls, long stay urinary tract infections, and short stay ulcers.

CONCLUSIONS

With the shortage of registered nurses in LTCFs and new reimbursement regulations, many LTCFs are hiring LPNs to have full staffing and save money. Licensed practical nurses may lack essential knowledge to decrease the rate of falls.

Mobile App Use in Adults with Comorbid Type 2 Diabetes and Depression

The purpose of this preliminary study was to determine smartphone usage, expressed level of interest, and intent to use mHealth apps among adults with comorbid type 2 diabetes (T2D) and depression. A convenience sample of adults (N=35) completed a Demographic and Mobile App Survey and the CESD-R-10. A majority reported using mobile apps (n=23, 65.7%) and felt comfortable or very comfortable using mobile apps (n=14, 46.7%). However, few respondents used a health app (n=6, 17.1%) or a diabetes-specific app for diabetes management (n=3, 8.6%). Adjusted, age and education were the two variables that independently impacted app use; those aged less than 55 years as well as those with a graduate degree were more likely to use apps. Being younger and having an advanced degree increased the odds of using a diabetes-specific app. The findings suggest that adults with T2D are amenable to using mHealth apps to manage diabetes.

Initiating Telephone Follow Up After Hospital Discharge From an Inpatient Psychiatric Setting to Reduce Recidivism

The purpose of the current evidence-based practice (EBP) project was to reduce recidivism in patients with depression after acute psychiatric hospital discharge through implementation of telephone follow up. Eight patients (intervention group) were called within 72 hours of discharge to reinforce discharge instructions and administer the Patient Health Questionnaire-9 (PHQ-9). The results were compared to 16 patients (control group) who were discharged during the same timeframe 1 year prior. The findings from the control group revealed one (6.25%) patient was readmitted and three (18.75%) patients visited the emergency department (ED) within 30 days of discharge. No one in the intervention group was readmitted or visited the ED within 30 days post discharge. Statistically significant differences were not detected in discharge telephone call status (received or did not receive) and readmissions (p = 1.000) and ED visits (p = 0.526). For six patients in the intervention group, the mean PHQ-9 score was 3.3, which was within a depression severity of none to minimal. This quality improvement project helped address patient lack of knowledge related to discharge instructions after being discharged from the hospital to home. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 25-31.].

Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider

Health care providers (HCPs) face many obstacles as they undertake efforts to meet the challenges of caring for African American patients with comorbid diabetes and depression. This review article discusses the incidence of comorbid diabetes and depression in African Americans, cultural factors affecting diabetes self-management, and clinical practice implications for the HCP. The role of patient-centered care, engagement, and best-practice strategies are discussed to provide the HCP with guidelines regarding the minimal standards that support improved health care outcomes for African Americans with comorbid diabetes and depression.

An organizational process for promoting home fire safety in two community settings

The purpose of this study was to describe the home fire safety quality improvement model designed to aid organizations in achieving institutional program goals. The home fire safety model was developed from community-based participatory research (CBPR) applying training-the-trainer methods and is illustrated by an institutional case study. The model is applicable to other types of organizations to improve home fire safety in vulnerable populations. Utilizing the education model leaves trained employees with guided experience to build upon, adapt, and modify the home fire safety intervention to more effectively serve their clientele, promote safety, and meet organizational objectives.

Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis

This article examines role stress, key psychosocial variables, and well-being in adults recently diagnosed with rheumatoid arthritis. Patients recently diagnosed with rheumatoid arthritis must often learn to balance disease and role-related responsibilities. This was cross-sectional, descriptive study ( N = 80). Data were analyzed using correlation coefficients and linear regression models. Participants were predominantly female (78%), married, and employed. Mean age and disease duration were 54.2 years and 24.2 months, respectively. The findings suggest that well-being is influenced by feelings of being self-efficacious and having balance in their roles and less to do with social support received from others.

Home fire safety beliefs and practices in homes of urban older adults

The purpose of this study is to examine factors influencing urban older adults and develop a thematic analysis of how these factors affect seniors' home fire safety (HFS) beliefs and practices. This was a focused ethnography using participant observation and semi-structured interviews. Additionally, public housing records, cognitive functioning, and general health status were assessed. Individual interviews were transcribed verbatim using a constant comparative analysis. Eight seniors participated in the study. Two main themes described older adults' HFS while aging in place: the risk associated with the living environment and the journey associated with maintaining independence. All participants experienced HFS challenges such as limited mobility and financial constraints. Participants' general health and cognitive status additionally influenced their ability to maintain HFS. The findings suggest that urban seniors may have diverse HFS environment risks compared with the general population, highlighting the need for older adult focused HFS interventions.

Moving healthcare quality forward with nursing-sensitive value-based purchasing

PURPOSE

To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system.

DESIGN AND METHODS

Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP.

FINDINGS

Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing.

CONCLUSIONS

Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs.

CLINICAL RELEVANCE

NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.

Adjusting to recent onset of rheumatoid arthritis: a qualitative study

The purpose of this study was to examine men’s and women’s experiences living with rheumatoid arthritis (RA). Using semi-structured, in-depth telephone interviews, nine women and seven men who were recently diagnosed with RA (disease duration < four years) were interviewed about their experiences adjusting to RA. Line-by-line coding using thematic analysis was used to identify themes. Findings from the qualitative analysis revealed six categories emerging from the data: 1. degree of severity of the impact of the disease, 2. appraisal about what the illness means to me, 3. availability of social support, 4. perception of self-efficacious behaviours, 5. use of coping strategies, and 6. RA’s effect on valued life activities. A number of participants described positive thinking about managing their RA; whereas others described negative thinking. Individuals’ appraisals and perceptions about their illness coupled with how their illness affected their ability to fulfill their role responsibilities were important in their adjustment to RA. Social support was also identified as key in learning to live with RA. For individuals with RA, the impact of the disease on their ability to maintain normal life is important, and as such it is vital that healthcare professionals have a better understanding of the perceptions and experiences that individuals have living with RA.

Patient-centered hand hygiene: the next step in infection prevention

Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients' flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs.

Home health nurses coping with practice care errors

The Institute of Medicine report from 2000 ( To Err Is Human: Building a Safer Health System, National Academy Press, Washington, DC) highlighted the magnitude of practice care errors in the US healthcare system as well as the potentially life-threatening consequences they create. Nurses who make care errors experience a devastating mental and emotional impact and do not know how to deal with the experience. This study assessed how nurses cope with care errors and what strategies they use. A survey design was used for this study and 192 home health nurses completed the survey in a southeastern state. Packets containing sealed surveys, a flier, and a description of the study were mailed to the nurses. Results of the study with home health nurses indicate that nurses felt angry at themselves for making the care errors. Planful problem-solving was the most frequently used coping technique followed by accepting responsibility. The most commonly reported change in practice following a care error experience was paying more attention to detail, followed by personally confirming patient data and changing the organisation of data. Intervention research is needed to help nurses better deal and cope with care errors and to better assess the need for providing such nurses with professional support and counselling after becoming involved in a care error experience.

A Review of Documented Oral Care Practices in an Intensive Care Unit

Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31, 2007. Data were analyzed using bivariate and multivariate analyses to determine the variables related to patients receiving oral care. Frequency of oral care documentation was found to be performed, on average, every 3.17 to 3.51 hr with a range of 1 to 8 hr suggesting inconsistencies in nursing practice. This study found that although oral care is a Center for Disease Control and Prevention (CDC) recommendation for the prevention of hospital-associated infections like ventilator-associated pneumonia (VAP), indication of documentation of the specifics are lacking in the patients’ medical record.

Problematic social support, family functioning, and subjective well-being in women with rheumatoid arthritis

The purpose of this study was to examine the relationship of problematic social support and family functioning to measures of subjective well-being in a sample of women with rheumatoid arthritis. Seventy-three women with rheumatoid arthritis completed questionnaires that assessed problematic support (i.e., negative support, unavailability of emotional support), family functioning, and subjective well-being (i.e., life satisfaction and the absence of negative affect or depressive symptoms). Pearson product moment correlation coefficients and hierarchical multivariable regression analyses were conducted. The latter analyses controlled for age, length of time since diagnosis, education, income, pain and fatigue-two prominent symptoms of rheumatoid arthritis. The two measures of problematic support were significantly inversely related to family functioning (p < 0.01 and p < 0.001) and life satisfaction (p = 0.02 and p < 0.001), but were not significantly related to each other. Family functioning was positively related to life satisfaction (p < 0.001) and inversely related to negative affect (p < 0.001) and depressive symptoms (p < 0.001). In multiple regression analyses higher symptom severity, greater problematic support, and lower family functioning were associated with depressive symptoms (p < 0.001) and negative affect (p < 0.001), while higher family functioning and a decrease in symptom severity were associated with life satisfaction (p < 0.001), above and beyond demographic variables and length of time since diagnosis. Subjective well-being in women with rheumatoid arthritis is related to perceptions of family functioning and the amount and type of support received from others, above and beyond the pain and fatigue that characterizes rheumatoid arthritis and is negatively associated with well-being.

Prenatal and postpartum focus groups with primiparas: breastfeeding attitudes, support, barriers, self-efficacy, and intention

INTRODUCTION

The purpose of this study was to explore women's prenatal attitudes, perception of support, anticipated barriers, facilitators, and breastfeeding self-efficacy beliefs and how their attitudes, beliefs, and perceptions of support changed as a result of their postpartum experiences.

METHODS

A prospective, descriptive design with qualitative data collection methods was used for this study. Eight primiparas participated in prenatal and postpartum focus groups held in the conference room of a local school of nursing. One additional mother participated in individual interviews before and after giving birth at her request.

RESULTS

In the prenatal groups, the major themes included beliefs that breastfeeding benefits both the mother and baby, availability of support, looking toward the future, and uncertainty about what to expect with breastfeeding. In the postpartum groups, the major themes centered around the realization that breastfeeding was both easy and difficult, the importance and role of supportive others, receiving conflicting advice, having validating experiences, and modifying breastfeeding intention based on postpartum experiences.

DISCUSSION

Mothers need to be better educated for breastfeeding prenatally, and the information must be consistent, realistic, and evidence-based.

A comparison of two methods of assessing disease activity in the joints

BACKGROUND

Considerable debate has occurred concerning the utility of different methods of obtaining joint counts and their usefulness in predicting outcomes in persons with rheumatoid arthritis.

OBJECTIVE

The purpose of this study was to compare two methods of assessing disease activity in the joints (clinician joint count, self-reported joint count), and to compare their relative utility in predicting two methods of assessing outcomes (self-reported ratings of impairment and pain, objective performance index) with and without controlling for negative affectivity.

METHOD

Data for this study were obtained during home visits from 185 persons diagnosed with rheumatoid arthritis. Individuals completed a series of self-report measures including the joint count. Trained research assistants completed a 28-joint count and timed participants on a series of measured performance activities (e.g., grip strength, pinch strength, walk time).

RESULTS

The self-report joint count was highly correlated with the clinician joint count and also accounted for as much, if not more, variance in the subjective outcome measures than did clinician assessments. Both types of indicators predicted unique variance in the objective performance index.

CONCLUSIONS

For most research purposes, measures such as self-report joint counts have sufficient validity to be used in place of more costly clinician assessment of joint counts.