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Montgomery AP, Sullivan C, Dick T, Roberson C, Harris LM, Patrician PA. Comparison of Alabama Nurse Experiences Between Practice Areas During the Early COVID-19 Pandemic. Workplace Health Saf 2024:21650799241247077. [PMID: 38660753 DOI: 10.1177/21650799241247077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND According to the Total Worker Health® framework, safety culture including a reasonable workload among healthcare workers is essential to the security and well-being of patients, staff, and healthcare organizations. Evaluating the impact of the pandemic on the nursing workforce in different practice areas is critical for addressing workforce health and sustainability. The purpose of this study was to compare work and selfcare experiences among Alabama nurses between practice areas and the early pandemic years (2020 vs. 2021). METHODS A secondary analysis of cross-sectional Alabama State Nurses Association (ASNA) survey data was conducted. Kruskal-Wallis analysis of variance, Wilcoxon rank, and false discovery rates were examined. RESULTS There were 1,369 and 2,458 nurse survey responses in 2020 and 2021, respectively. By 2021, nurses reported worsening staff shortages, a greater need for retired and new graduate nurses to help with the workload burden, and perceptions of heavier emergency department workloads. Lower proportions of nurses reported the ability to engage in self-care activities and satisfaction with state and federal crisis management. Intensive care nurses were more likely to report staffing shortages while also reporting the lowest ability to engage in self-care. CONCLUSIONS Overall, the Alabama nursing workforce perceived worsening work conditions in 2021 compared to when the pandemic began. Practice areas varied greatly in their responses, with acute and intensive care areas perceiving more difficult work conditions. Total Worker Health® programs should be designed to promote and support nurses' well-being based on their experience and the needs of specific practice areas.
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Affiliation(s)
- Aoyjai P Montgomery
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | | | - Tracey Dick
- School of Nursing, University of Alabama at Birmingham
- Birmingham VA Health Care System
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Patrician PA, Travis JR, Blackburn C, Carter JL, Hall AG, Meese KA, Miltner RS, Montgomery AP, Stewart J, Ruffin A, Morson DM, Polancich S. Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program. Nurs Adm Q 2024; 48:165-179. [PMID: 38564727 DOI: 10.1097/naq.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.
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Affiliation(s)
- Patricia A Patrician
- Author Affiliations: University of Alabama at Birmingham School of Nursing, Birmingham (Drs Patrician, Miltner, and Polancich, Mr Travis, and Mss Blackburn, Carter, Ruffin, and Morson); Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham (Drs Hall and Meese); Center for Healthcare Management and Leadership, and Office of Wellness, University of Alabama at Birmingham, Birmingham (Dr Meese); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham (Dr Montgomery); and UAB Medical Center, University of Alabama atBirmingham, Birmingham (Dr Stewart)
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Campbell CM, Warshawsky N, Swiger PA, Li P, Olds D, Patrician PA. Evolution of an Instrument: Measuring the Nursing Work Environment: A Scoping Review. J Nurs Meas 2024; 32:47-57. [PMID: 37348888 DOI: 10.1891/jnm-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: The Nursing Work Index (NWI) was developed in the 1980s to measure the nursing work environment (NWE). Instruments descended from the NWI continue to measure the NWE today. The purpose of this review was to identify instruments derived from the NWI, examine how they have been used and revised, and evaluate their ability to capture elements of the current work environment. Methods: A scoping literature review. Results: Forty articles were included. Instruments developed from the NWI have been translated into numerous languages and administered to hundreds of thousands of nurses globally. Conclusions: The study of the NWE remains extensive throughout the world. Future research should examine the factorial structure of instrument adaptions and ensure that items are relevant to contemporary nursing practice.
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Affiliation(s)
| | | | | | - Peng Li
- University of Alabama, Birmingham, AL, USA
| | - Danielle Olds
- University of Missouri - Kansas City, School of Medicine & Saint Luke's Hospital, Kansas City, MO, USA
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Xiao C, Patrician PA, Montgomery AP, Wang Y, Jablonski R, Markaki A. Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis. BMC Nurs 2024; 23:115. [PMID: 38347512 PMCID: PMC10863110 DOI: 10.1186/s12912-024-01789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs. PURPOSE To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework. METHODS A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis. FINDINGS Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity. CONCLUSION Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.
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Affiliation(s)
- Chunhong Xiao
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA.
| | - Patricia A Patrician
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Aoyjai P Montgomery
- University of Alabama at Birmingham School of Public Health, 1665, 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Youhua Wang
- College of State Governance, Southwest University, No. 2 Tianshen Road, Chongqing, 400715, Beibei District, China
| | - Rita Jablonski
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Adelais Markaki
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Hock KM, Gist K, Fazeli PL, Zaccagni HJ, Sorabella RA, Patrician PA. A descriptive assessment of the informed consent document used by congenital cardiac surgery centres. Cardiol Young 2023:1-6. [PMID: 38044661 DOI: 10.1017/s1047951123004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Informed consent for surgery is a complex process particularly in paediatrics. Complexity increases with procedures such as CHD surgery. Regulatory agencies outline informed consent contents for surgery. We assessed and described CHD surgical informed consent contents through survey dissemination to paediatric CHD centres across United States of America. METHODS Publicly available email addresses for 125 paediatric cardiac clinicians at 70 CHD surgical centres were obtained. Nine-item de-identified survey assessing adherence to The Joint Commission informed consent standards was created and distributed via RedCap® 14 March, 2023. A follow-up email was sent 29 March, 2023. Survey link was closed 18 April, 2023. RESULTS Thirty-seven surveys were completed. Results showed informed consent documents were available in both paper (25, 68%) and electronic (3, 8%) format. When both (9, 24%) formats were available, decision on which format to use was based on centre protocols (1, 11%), clinician personal preference (3, 33%), procedure being performed (1, 11%), or other (4, 45%). Five (13%) centres' informed consent documents were available only in English, with 32 (87%) centres also having a Spanish version. Review of informed consent documents demonstrated missing The Joint Commission elements including procedure specific risks, benefits, treatment alternatives, and expected outcomes. CONCLUSIONS Informed consent for CHD surgery is a complex process with multiple factors involved. Majority of paediatric CHD surgical centres in the United States of America used a generic informed consent document which did not uniformly contain The Joint Commission specified information nor reflect time spent in discussion with families. Further research is needed on parental comprehension during the informed consent process.
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Affiliation(s)
- Kristal M Hock
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katja Gist
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hayden J Zaccagni
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Sorabella
- Department of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Foots L, Swiger PA, Orina J, Campbell CM, Javed M, Hodson P, Patrician PA. Recommendations From a Systematic Review of Leadership Development to Support a New Nursing Practice Model. J Nurs Adm 2023; 53:661-667. [PMID: 37983605 DOI: 10.1097/nna.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To develop a new nursing practice model for use within the US military, researchers aimed to create evidence-based recommendations for nursing leadership development based on current literature. BACKGROUND The role of nursing leadership has many implications, including better nurse and patient outcomes. Therefore, an actionable compilation of recommendations informing how to develop effective nurse leaders could be helpful for current and aspiring nurse leaders. METHODS Researchers conducted a systematic literature review of 5 databases searching for relevant articles published from 2001 to 2020. RESULTS Seventy-eight articles were synthesized to develop a list of 5 broad yet actionable recommendations for leadership development. CONCLUSIONS Leadership development is essential for current and future nurse leaders. The recommendations identified from this review can assist in developing leaders. Leaders can use these recommendations to guide leadership training initiatives, engage in self-development, or begin succession planning.
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Affiliation(s)
- Lozay Foots
- Author Affiliations: Contractor and Retired Army Colonel (Dr Foots), Defense Health Agency, San Antonio, Texas; Colonel (Dr Swiger), US Army Nurse Corps, Madigan Army Medical Center, Joint Base Lewis-McChord; and Program Manager (Orina), Geneva Foundation, Tacoma, Washington; Research Assistant (Drs Campbell and Javed) and Professor and Rachel Z. Booth Endowed Chair (Dr Patrician), University of Alabama at Birmingham; and Lieutenant Colonel (Dr Hodson), US Army Nurse Corps, Fort Sam Houston, Texas
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Campbell CM, Li P, Warshawsky N, Swiger PA, Olds D, Cramer E, Patrician PA. Modernizing Measure of the Nurse Work Environment. West J Nurs Res 2023; 45:932-941. [PMID: 37599466 DOI: 10.1177/01939459231194132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s. OBJECTIVE We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability. METHODS We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument. RESULTS While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary. CONCLUSIONS With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes.
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Affiliation(s)
| | - Peng Li
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Danielle Olds
- Saint Luke's Hospital, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Emily Cramer
- Health Outcomes and Health Services Research, Children's Mercy Kansas City, Kansas City, MO, USA
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Imes CC, Tucker SJ, Trinkoff AM, Chasens ER, Weinstein SM, Dunbar-Jacob J, Patrician PA, Redeker NS, Baldwin CM. Wake-up Call: Night Shifts Adversely Affect Nurse Health and Retention, Patient and Public Safety, and Costs. Nurs Adm Q 2023; 47:E38-E53. [PMID: 37643236 DOI: 10.1097/naq.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The purpose of this mini review is to (1) summarize the findings on the impact of night shift on nurses' health and wellness, patient and public safety, and implications on organizational costs and (2) provide strategies to promote night shift nurses' health and improve organizational costs. The night shift, compared with day shift, results in poorer physical and mental health through its adverse effects on sleep, circadian rhythms, and dietary and beverage consumption, along with impaired cognitive function that increases nurse errors. Nurse administrators and health care organizations have opportunities to improve nurse and patient safety on night shifts. Low-, moderate-, and higher-cost measures that promote night nurses' health and well-being can help mitigate these negative outcomes. The provided individual and organizational recommendations and innovations support night shift nurses' health, patient and public safety, and organizational success.
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Affiliation(s)
- Christopher C Imes
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Imes, Chasens, and Dunbar-Jacob); College of Nursing, The Ohio State University, Columbus (Dr Tucker); School of Nursing, University of Maryland, Baltimore (Dr Trinkoff); School of Nursing, Purdue University Global, West Lafayette, Indiana (Ms Weinstein); School of Nursing, The University of Alabama at Birmingham (Dr Patrician); School of Nursing, University of Connecticut, Storrs (Dr Redeker); and Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Dr Baldwin)
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Poe AA, Vance DE, Patrician PA, Dick TK, Puga F. Resilience in the context of dementia family caregiver mental health: A concept analysis. Arch Psychiatr Nurs 2023; 45:143-151. [PMID: 37544690 DOI: 10.1016/j.apnu.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/31/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
Resilience has been identified as a key concept for dementia family caregiver mental health; however, the concept is not well defined. A concept analysis examining dementia caregiver resilience was conducted using Rodger's Evolutionary Method. The aim of this concept analysis was to describe the historical perspective, attributes, antecedents, and consequences of resilience as it relates to dementia caregiver mental health. Key attributes of dementia caregiver resilience were acceptance, coping strategies, social support, self-appraisal, and spirituality. The results from this concept analysis provide the foundation for the development of resilience-based interventions to support the well-being of dementia family caregivers.
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Affiliation(s)
- Abigail A Poe
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Tracey K Dick
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
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Montgomery AP, Campbell CM, Azuero A, Swiger PA, Patrician PA. Using item response theory to develop a shortened practice environment scale of the nursing work index. Res Nurs Health 2023. [PMID: 37249126 DOI: 10.1002/nur.22324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
The 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) has been frequently used globally to measure the nurse work environment. However, due to its length and subsequent respondent burden, a more parsimonious version of the PES-NWI may be desirable. Item response theory (IRT) is a statistical technique that assists in decreasing the number of items in an instrument without sacrificing reliability and validity. Two separate samples of nurses in the United States (one called the "internal data source" and the other called "external data source"; sample sizes = 843 and 722, respectively) were analyzed. The internal data source was randomly split into training (n = 531) and validating data sets (n = 312), while a separate whole external data source was used as the final validating data set. Using IRT with training data, we removed nine items; two additional items were removed based on recommendations from a previous study. Confirmatory factor analyses supported the validity of the measurement model with the 20-item of PES-NWI in both internal and external validation data sources. The correlations among subscales between 31- and 20-item versions were high magnitude for five subscales in both validation data sets (τ = 0.84-0.89). Ultimately, we identified a 20-item version of the PES-NWI which demonstrated adequate validity and reliability properties while decreasing data collection burden yet maintaining a similar factor structure to the original instrument. Additional research may be necessary to update the items themselves on the PES-NWI.
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Affiliation(s)
- Aoyjai P Montgomery
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin M Campbell
- Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pauline A Swiger
- Center for Nursing Science and Clinical Inqiury, US Army Nurse Corps, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Patricia A Patrician
- Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ruffin A, Shirey MR, Dick T, Fazeli PL, Patrician PA. Understanding the Impact of Span of Control on Nurse Managers and Hospital Outcomes. J Healthc Manag 2023; 68:158-173. [PMID: 37159015 DOI: 10.1097/jhm-d-22-00191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL Span of control is a multidimensional concept requiring a comprehensive definition that captures the complexities of the nurse manager's role in acute care settings. This concept analysis aimed to identify factors associated with span of control and provide a comprehensive definition outlining the breadth of this concept. METHODS ProQuest, PubMed, and Scopus databases were used to search peer-reviewed literature addressing the span of control in acute care nurse management. The search produced 185 articles; 177 titles and abstracts were screened for eligibility. Data from 22 articles were included in this analysis. PRINCIPAL FINDINGS This analysis includes antecedents, attributes, and consequences of expanded nurse manager spans of control. Work-related factors such as staff and manager experience levels, work complexity, and patient acuity are attributes of a nurse manager's span of control. Our findings suggest that expanded spans of control can have negative consequences on nurse managers such as role overload and burnout. Low satisfaction among staff and patients can result from excessive spans of control. PRACTICAL IMPLICATIONS An awareness of span of control can promote sustainable nursing practices by improving workplace conditions, staff satisfaction, and patient care quality. Our findings may translate across other health disciplines and thus contribute to scientific knowledge that can support changes in job designs and encourage more manageable workloads.
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Polancich S, Miltner R, Montgomery A, Dick T, Poe T, Brown D, Patrician PA. Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes. J Healthc Manag 2023; 68:174-186. [PMID: 37159016 DOI: 10.1097/jhm-d-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.
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Affiliation(s)
- Shea Polancich
- University of Alabama at Birmingham School of Nursing and University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | | | | | - Tracey Dick
- University of Alabama at Birmingham School of Nursing
| | - Terri Poe
- University of Alabama at Birmingham Hospital
| | - Daran Brown
- University of Alabama at Birmingham Hospital
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Sullivan CE, Day SW, Ivankova N, Markaki A, Patrician PA, Landier W. Establishing nursing-sensitive quality indicators for pediatric oncology: An international mixed methods Delphi study. J Nurs Scholarsh 2023; 55:388-400. [PMID: 35790072 PMCID: PMC9946155 DOI: 10.1111/jnu.12798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries. DESIGN/METHODS A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings. RESULTS Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas. CONCLUSION Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement. CLINICAL RELEVANCE NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.
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Affiliation(s)
- Courtney E. Sullivan
- School of Nursing, University of Alabama at Birmingham
- Center for Outcomes and Effectiveness Research, School of Medicine, University of Alabama at Birmingham
| | - Sara W. Day
- College of Nursing, University of Tennessee Health Science Center
| | | | | | | | - Wendy Landier
- School of Nursing, University of Alabama at Birmingham
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
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Siaki LA, Patrician PA, Loan LA, Matlock AM, Start RE, Gardner CL, McCarthy MS. Ambulatory Care Nurse-Sensitive Indicators: A Scoping Review of the Literature 2006-2021. J Nurs Care Qual 2023; 38:76-81. [PMID: 36166653 DOI: 10.1097/ncq.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Meeting recommendations that nurses should partner in leading health care change is hampered by the lack of ambulatory care nurse-sensitive indicators (ACNSIs). This scoping review was conducted to identify evidence regarding ACNSI identification, development, implementation, and benchmarking. METHODS Following the PRISMA-ScR reporting guide, we performed PubMed/MEDLINE, CINAHL, and Cochrane Library searches for the period January 2006 to March 2021. RESULTS Twelve of the 1984 articles from 6 countries met inclusion criteria. All focused on identifying, developing/pilot testing indicators, and included structure, process, and outcome indicators. Seven articles were level II and all were at least grade B quality. Leverage points involved leadership support, automated data extraction infrastructure, and validating links between nurses' roles/actions and patient outcomes. CONCLUSIONS While high-quality work is ongoing to identify clinically meaningful and feasible ACNSIs, knowledge in this field remains underdeveloped. Prioritizing this work is imperative to address gaps and facilitate national strategic health care goals.
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Affiliation(s)
- Leilani A Siaki
- Tripler Army Medical Center, Honolulu, Hawaii (Dr Siaki); School of Nursing, University of Alabama at Birmingham, Birmingham (Drs Patrician and Loan); National Institutes of Health Clinical Center, Bethesda, Maryland (Dr Matlock); Rush University Medical Center, Chicago, Illinois (Ms Start); Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Gardner); and Madigan Army Medical Center, Tacoma, Washington (Dr McCarthy)
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Montgomery AP, Patrician PA. Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross-sectional study. J Nurs Manag 2022; 30:4015-4023. [PMID: 36190507 PMCID: PMC9874867 DOI: 10.1111/jonm.13831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
AIMS The aims of this work are to (1) investigate the work environment, resilience, burnout, and turnover intention and (2) examine how work environment and personal resilience impact burnout and turnover intention among nurse leaders in the midst of the COVID-19 crisis. BACKGROUND The COVID-19 pandemic introduced tremendous stressors to nurse leaders, for example, managing the complex staffing situation while balancing patients' and family's needs. METHODS During May to September 2021, an electronic survey was sent out to nurse leaders in Birmingham, Alabama, USA, and surrounding areas. RESULTS Fifty-six respondents were included in the study. The composite score of the work environment measure was moderately to highly related to resilience [ρ (rho) = .59] and burnout [ρ = -.63 to -.68] but had small association to intent to leave [ρ = -.30]. The resilience was highly correlated to burnout [ρ = -.53 to -.59] and moderately associated to intent to leave [ρ = -.32]. CONCLUSIONS A better work environment for nurse leaders is related to higher resilience, lower burnout, and lower turnover intention. Resilience impacts burnout and turnover intention among nurse leaders. IMPLICATIONS FOR NURSING MANAGEMENT Health care organizations and stakeholders should implement effective strategies to improve the work environment, which could lead to enhanced resilience, reduced burnout, and lower turnover intention of their nurse leaders especially during and following this pandemic.
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Affiliation(s)
- Aoyjai P. Montgomery
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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17
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Pogue CA, Li P, Swiger P, Gillespie G, Ivankova N, Patrician PA. Associations among the nursing work environment, nurse-reported workplace bullying, and patient outcomes. Nurs Forum 2022; 57:1059-1068. [PMID: 35908259 PMCID: PMC9771862 DOI: 10.1111/nuf.12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/15/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bullying may undermine patient safety in healthcare organizations threatening quality improvement and patient outcomes. PURPOSE To explore the associations between the nursing work environment, nurse-reported workplace bullying, and patient outcomes. METHOD Cross-sectional analysis of nurse survey data (N = 943). The Practice Environment Scale of the nursing work index was used to measure the work environment, nurse-reported bullying was measured with the short negative acts questionnaire, and single items measured care quality and patient safety grade. Random effects logistic regressions were used to determine associations controlling for individual, employment, and organizational factors. FINDINGS Fourty percent of nurses reported experiencing bullying. A higher work environment composite score was significantly associated with a lower risk of bullying (OR = 0.16 [0.12, 0.22], p < .0001). Nurses experiencing bullying were less likely to report good/excellent quality of care (OR = 0.28 [0.18, 0.44], p < .0001) or a favorable patient safety grade (OR = 0.36 [0.25, 0.51], p < .0001). DISCUSSION The nursing work environment influences the presence of bullying, which can negatively impact patient outcomes. Improving nurse work environments is one mechanism to better address nurse bullying.
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Affiliation(s)
- Colleen A. Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Peng Li
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Pauline Swiger
- Center for Nursing Science & Clinical Inquiry, Manson, Washington, USA
| | - Gordon Gillespie
- University of Cincinnati College of Nursing, Cincinnati, Ohio, USA
| | - Nataliya Ivankova
- University of Alabama at Birmingham School of Health Professions, Birmingham, Alabama, USA
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Siaki L, Patrician PA, Loan LA, Matlock AM, Start RE, McCarthy MS. Improving 9.5 Million Lives: Pilot Testing Ambulatory Care Nurse-Sensitive Quality Indicators. J Nurs Adm 2022; 52:613-619. [PMID: 36301870 DOI: 10.1097/nna.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate scientific acceptability, feasibility, utility, and value of ambulatory care nurse-sensitive quality indicators (ACNSIs) in military outpatient clinics. BACKGROUND Optimizing healthcare quality and cost requires scientifically sound metrics. However, ACNSI development and measurement have lagged behind inpatient nurse-sensitive indicators. Validated and reliable ACNSIs are urgently needed to maximize nurses' efforts to improve healthcare quality. METHODS Two staffing and 4 patient-centered ACNSIs were pilot tested in 5 military clinics over a 6-month period using a mixed-methods design. RESULTS Reliability and validity were generally acceptable. Most ACNSIs demonstrated feasibility, utility, and value for performance measurement. Challenges to using ACNSIs include absence of standardized administrative and clinical processes, infrastructure, and leadership and technological support. CONCLUSIONS These ACNSIs show promise as valid performance metrics. Provider- and nurse-level metrics may synergistically improve practice, enhancing the team approach so critical to ambulatory care.
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Affiliation(s)
- Leilani Siaki
- Author Affiliations: Nurse Scientist (Drs Siaki and McCarthy), Madigan Army Medical Center, Tacoma, Washington; Professor and Rachel Z Booth Endowed Chair in Nursing (Dr Patrician) and Associate Professor (Dr Loan), University of Alabama at Birmingham, School of Nursing; Service Chief- Medical Surgical Specialties Captain (Dr Matlock), United States Public Health Service, National Institutes of Health Clinical Center, Bethesda, Maryland; and Associate Vice President (Ms Start), Patient Care Services, Rush University Medical Center. Chicago, Illinois
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Caruso CC, Arbour MW, Berger AM, Hittle BM, Tucker S, Patrician PA, Trinkoff AM, Rogers AE, Barger LK, Edmonson JC, Landrigan CP, Redeker NS, Chasens ER. Research priorities to reduce risks from work hours and fatigue in the healthcare and social assistance sector. Am J Ind Med 2022; 65:867-877. [PMID: 35596665 PMCID: PMC10165664 DOI: 10.1002/ajim.23363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/03/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The services of Healthcare and Social Assistance (HCSA) workers are needed by society around the clock. As a result, these workers are exposed to shift work and long work hours. The combination of demanding work schedules and other hazards in the HCSA work environment increases the health and safety risks to these workers, as well as to their patients/clients and the public. METHODS This paper has three aims: (1) provide an overview of the burden of shift work, long hours, and related sleep and fatigue problems in this sector; (2) suggest research priorities that would improve these; and (3) discuss potential positive impacts of addressing these research priorities for the health and safety of workers and the public. The authors used a modified Delphi approach to anonymously rank-order priorities for improving HCSA worker health and safety and public safety. Input was also obtained from attendees at the 2019 National Institute for Occupational Safety and Health (NIOSH) Work Hours, Sleep, and Fatigue Forum. RESULTS The highest rated research priorities were developing better designs for work schedules, and improving the HCSA culture and leadership approaches to shift work and long work hours. Additional priorities are identified. CONCLUSION Research in these priority areas has the potential to benefit HCSA workers as well as their patients/clients, employers, and society.
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Affiliation(s)
- Claire C. Caruso
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Megan W. Arbour
- Department of Midwifery, Frontier Nursing University, Versailles, Kentucky, USA
| | - Ann M. Berger
- College of Nursing- Omaha, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Sharon Tucker
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Ann E. Rogers
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Laura K. Barger
- Department of Medicine, Brigham and Women’s Hospital, Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - J. Cole Edmonson
- Department of Administration, AMN Healthcare, Dallas, Texas, USA
| | - Christopher P. Landrigan
- Department of Pediatrics, Boston Children’s Hospital, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Eileen R. Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Meese KA, Colón-López A, Montgomery AP, Boitet LM, Rogers DA, Patrician PA. Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience. Patient Experience Journal 2022. [DOI: 10.35680/2372-0247.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Patrician PA, Bakerjian D, Billings R, Chenot T, Hooper V, Johnson CS, Sables-Baus S. Nurse well-being: A concept analysis. Nurs Outlook 2022; 70:639-650. [DOI: 10.1016/j.outlook.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/06/2022] [Accepted: 03/26/2022] [Indexed: 10/17/2022]
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22
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Patrician PA, Olds DM, Breckenridge-Sproat S, Taylor-Clark T, Swiger PA, Loan LA. Comparing the Nurse Work Environment, Job Satisfaction, and Intent to Leave Among Military, Magnet®, Magnet-Aspiring, and Non-Magnet Civilian Hospitals. J Nurs Adm 2022; 52:365-370. [PMID: 35608979 PMCID: PMC9154298 DOI: 10.1097/nna.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the nurse work environment, job satisfaction, and intent to leave (ITL) among military, Magnet®, Magnet-aspiring, and non-Magnet civilian hospitals. BACKGROUND The professional nurse work environment is an important, modifiable, organizational trait associated with positive nurse and patient outcomes; creating and maintaining a favorable work environment should be imperative for nursing leaders. METHODS Secondary data from the Army Nurse Corps and the National Database of Nursing Quality Indicators included the Practice Environment Scale of the Nursing Work Index (PES-NWI) and single-item measures of job satisfaction and ITL. RESULTS Magnet and military hospitals had identical PES-NWI composite scores; however, statistically significant differences existed among the subscales. Military nurses were the most satisfied among all groups, although this difference was not statistically significant, yet their ITL was highest. CONCLUSIONS Favorable work environments may exist in other organizational forms besides Magnet; however, the specific components must be considered.
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Montgomery AP, Patrician PA, Hall A, Miltner RS, Enogela EM, Polancich S. Modeling Patient Risk for Hospital-Acquired Pressure Injuries During COVID-19: A Retrospective Study. J Nurs Care Qual 2022; 37:162-167. [PMID: 34611108 PMCID: PMC8860131 DOI: 10.1097/ncq.0000000000000602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.
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Affiliation(s)
- Aoyjai P. Montgomery
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Patricia A. Patrician
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Allyson Hall
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Rebecca S. Miltner
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Ene M. Enogela
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Shea Polancich
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
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Baernholdt M, Jones TL, Anusiewicz CV, Campbell CM, Montgomery A, Patrician PA. Development and Testing of the Quality Improvement Self-efficacy Inventory. West J Nurs Res 2022; 44:159-168. [PMID: 33745388 PMCID: PMC8450303 DOI: 10.1177/0193945921994158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.
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Affiliation(s)
| | - Terry L. Jones
- Virginia Commonwealth University, Richmond, VA, United States
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Aoyjai Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Patricia A. Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
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Taylor-Clark TM, Swiger PA, Anusiewicz CV, Loan LA, Olds DM, Breckenridge-Sproat ST, Raju D, Patrician PA. Identifying Potentially Preventable Reasons Nurses Intend to Leave a Job. J Nurs Adm 2022; 52:73-80. [PMID: 35025828 PMCID: PMC9008872 DOI: 10.1097/nna.0000000000001106] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals. BACKGROUND Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable. METHODS This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used. RESULTS Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons. CONCLUSIONS Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention.
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Affiliation(s)
- Tanekkia M Taylor-Clark
- Author Affiliations: US Army Nurse Corps Officer (Dr Taylor-Clark), Associate Professor and Executive DNP Pathway Director (Dr Loan), and Professor and Rachel Z. Booth Endowed Chair (Dr Patrician), School of Nursing, University of Alabama at Birmingham; Deputy Chief (Dr Swiger), Center for Nursing Science and Clinical Inquiry, US Army, Landstuhl, Germany; Postdoctoral Fellow (Dr Anusiewicz), School of Nursing, University of Pennsylvania, Philadelphia; Research Assistant Professor (Dr Olds), School of Nursing, The University of Kansas; Consultant (Dr Breckenridge-Sproat), US Army Retired, Santa Fe, New Mexico; and Statistician (Dr Raju), Vidence, LLC, Boca Raton, Florida
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Taylor-Clark TM, Loan LA, Swiger PA, Hearld LR, Li P, Patrician PA. Predictors of Temporary Profile Days Among U.S. Army Active Duty Soldiers. Mil Med 2022; 188:e1214-e1223. [PMID: 35059717 DOI: 10.1093/milmed/usab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/26/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Introduction
More than 40,000 soldiers cannot deploy every year, which undermines readiness. The medical readiness of soldiers is a critical component of the overall operational readiness of the U.S. Army. Acute musculoskeletal injuries (MSIs) are the greatest threat to medical readiness. Medical providers place soldiers on temporary profiles to facilitate treatment and recovery of acute MSIs. Poorly managed temporary profiles negatively impact a soldier’s work attendance, resulting in the loss or limitation of over 25 million workdays annually. Upgrading the electronic profile system and implementing the Army Medical Home has led to improvements in managing temporary profiles over the last decade. The Army Medical Home encompasses care delivery platforms, including the Patient-Centered Medical Home (PCMH) and Soldier-Centered Medical Home (SCMH). The structure of U.S. Army PCMHs and SCMHs differ in ways that may affect care processes and patient outcomes. Temporary profile management is an important soldier health outcome that has not been studied in relation to the U.S. Army’s PCMH and SCMH structures or care processes. Access to care, continuity, and communication are three care processes that have been described as essential factors in reducing lost workdays and functional limitations in workers after an acute injury. Understanding the impact of the medical home on temporary profile days is vital to medical readiness. This study aimed to (1) compare temporary profile days between the U.S. Army PCMHs and SCMHs and (2) determine the influence of medical home structures and care processes on temporary profile days among active duty U.S. Army soldiers receiving care for MSIs.
Materials and Methods
This was a retrospective, cross-sectional, and correlational study guided by Donabedian’s conceptual framework. We used secondary data from the Military Data Repository collected in 2018. The sample included 27,214 temporary profile records of active duty U.S. Army soldiers and 266 U.S. Army PCMH and SCMH teams. We evaluated bivariate and multivariate associations between outcomes and predictors using general and generalized linear mixed regression models. The U.S. Army Medical Department Center and School Institutional Review Board approved this study.
Results
Total temporary profile days ranged from 1 to 357, with a mean of 37 days (95% CI [36.2, 37.0]). There was a significant difference in mean temporary profile days between PCMHs (43) and SCMHs (35) (P < 0.001). Soldiers in PCMHs were more likely to have temporary profiles over 90 days (OR = 1.54, 95% CI [1.17, 2.03]). Soldiers in the heavy physical demand category had fewer temporary profile days (P < 0.001) than those in the moderate physical demand category. Age, sex, rank level, physical demand category, profile severity, medical home type, the “explain things” communication subscale, and primary care manager continuity were significant predictors of temporary profile days.
Conclusions
Excessive temporary profile days threaten medical readiness and overall soldier health. Aspects of the medical home structure and care processes were predictors of temporary profile days for musculoskeletal conditions. This work supports continued efforts to improve MSI-related outcomes among soldiers. Knowledge gained from this study can guide future research questions and help the U.S. Army better meet soldier needs.
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Abstract
BACKGROUND Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified. PURPOSE This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. METHODS A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals. RESULTS In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P < .05) and work environment (OR for +1 SD ranging 4.35-4.89; P < .001) were related to the outcome of patient safety grade after controlling for nurse characteristics. CONCLUSIONS Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level.
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Taylor-Clark TM, Swiger PA, Hearld LR, Loan LA, Li P, Patrician PA. The Value of the Patient-Centered Medical Home in Getting Adults Suffering From Acute Conditions Back to Work: An Integrative Literature Review. J Ambul Care Manage 2022; 45:42-54. [PMID: 34669619 DOI: 10.1097/jac.0000000000000399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute conditions are the leading cause of work restrictions and missed workdays, contributing to over $27 billion in lost productivity each year and negatively impacting workers' health and quality of life. Primary care services, specifically patient-centered medical homes (PCMHs), play an essential role in supporting timely acute illness or injury recovery for working adults. The purpose of this review is to synthesize the evidence on the relationship between PCMH implementation, care processes, and outcomes. In addition, we discuss the empirical connection between this evidence and return-to-work outcomes, as well as the need for further research.
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Affiliation(s)
- Tanekkia M Taylor-Clark
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama (Drs Taylor-Clark, Loan, Li, and Patrician); Center for Nursing Science and Clinical Inquiry, Landstuhl, Germany (Dr Swiger); and Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham Alabama (Dr Hearld)
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Taylor-Clark TM, Hearld LR, Loan LA, Swiger PA, Li P, Patrician PA. Patient Vs. Soldier-Centered Medical Home: Comparing Access, Continuity, and Communication in the U.S. Army. Mil Med 2021; 188:e1232-e1239. [PMID: 34893857 DOI: 10.1093/milmed/usab515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/13/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Over the last 40 years, patient-centered medical home (PCMH) has evolved as the leading primary care practice model, replacing traditional primary care models in the United States and internationally. The goal of PCMH is to improve chronic condition management. In the U.S. Army, the scope of the medical home, which encompasses various care delivery platforms, including PCMH and soldier-centered medical home (SCMH), extends beyond the management of chronic illnesses. These medical home platforms are designed to support the unique health care needs of the U.S. Army's most vital asset-the soldier. The PCMHs and SCMHs within the U.S. Army employ patient-centered care principles while incorporating nationally recognized structural attributes and care processes that work together in a complex adaptive system to improve organizational and patient outcomes. However, U.S. Army policies dictate differences in the structures of PCMHs and SCMHs. Researchers suggest that differences in medical home structures can impact how organizations operationalize care processes, leading to unwanted variance in organizational and patient outcomes. This study aimed to compare 3 care processes (access to care, primary care manager continuity, and patient-centered communication) between PCMHs and SCMHs. MATERIALS AND METHODS This was a retrospective, cross-sectional, and correlational study. We used a subset of data from the Military Data Repository collected between January 1, 2018, and December 31, 2018. The sample included 266 medical home teams providing care for active duty soldiers. Only active duty soldiers were included in the sample. We reviewed current U.S. Army Medical Department policies to describe the structures and operational functioning of PCMHs and SCMHs. General linear mixed regressions were used to evaluate the associations between medical home type and outcome measures. The U.S. Army Medical Department Center and School Institutional Review Board approved this study. RESULTS There was no significant difference in access to 24-hour and future appointments or soldiers' perception of access between PCMHs and SCMHs. There was no significant difference in primary care manager continuity. There was a significant difference in medical home team continuity (P < .001), with SCMHs performing better. There was no significant difference in patient-centered communication scores. Our analysis showed that while the PCMH and SCMH models were designed to improve primary care manager continuity, access to care, and communication, medical home teams within the U.S. Army are not consistently meeting the Military Health System standard of care benchmarks for these care processes. CONCLUSIONS Our findings comparing 3 critical medical home care processes suggest that structural differences may impact continuity but not access to care or communication. There is an opportunity to further explore and improve access to appointments within 24 hours, primary care manager and medical home team continuity, perception of access to care, and the quality of patient-centered communication among soldiers. Knowledge gained from this study is essential to soldier medical readiness.
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Affiliation(s)
| | - Larry R Hearld
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Lori A Loan
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Pauline A Swiger
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
| | - Peng Li
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Patricia A Patrician
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Woods BM, Patrician PA, Fazeli PL, Ladores S. Infertility-related stress: A concept analysis. Nurs Forum 2021; 57:437-445. [PMID: 34873709 DOI: 10.1111/nuf.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop a clear definition of infertility-related stress using Rodgers' method of concept analysis. BACKGROUND Infertility affects approximately 13% of women in the United States. Though poorly defined in the literature, previous studies suggest infertility-related stressors contribute to psychological distress. DESIGN Rodgers' method of concept analysis guided the review, including sample and setting, literature search, and data analysis. DATA SOURCE PubMed, CINAHL, and PsycINFO were searched for relevant literature. REVIEW METHODS Following abstract, title, and text screenings, 21 articles were included and reported using the PRISMA-S checklist. Texts were analyzed and results informed the proposed definition of infertility-related stress. RESULTS Antecedents included infertility, desire for children, and fear of the unknown. Attributes were identity crisis, social isolation and stigma, sexual stress, and financial strain. Consequences included treatment dropout and marital strain. Anxiety, depression, and decreased quality of life were identified as both attributes and consequences. CONCLUSIONS Synthesized results informed a proposed definition of infertility-related stress. Improved understanding of infertility-related stress allows for measurement development and facilitates recognition of patients in need of additional support, while potentially reducing the impact on the health and well-being of infertile women.
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Affiliation(s)
- Brittany M Woods
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sigrid Ladores
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Trinkoff AM, Baldwin CM, Chasens ER, Dunbar-Jacob J, Geiger-Brown J, Imes CC, Landis CA, Patrician PA, Redeker NS, Rogers AE, Scott LD, Todero CM, Tucker SJ, Weinstein SM. CE: Nurses Are More Exhausted Than Ever: What Should We Do About It? Am J Nurs 2021; 121:18-28. [PMID: 34743129 DOI: 10.1097/01.naj.0000802688.16426.8d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.
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Affiliation(s)
- Alison M Trinkoff
- Alison M. Trinkoff is a professor at the University of Maryland School of Nursing, Baltimore. Carol M. Baldwin is professor emeritus and a Southwest Borderlands Scholar at Arizona State University's Edson College of Nursing and Health Innovation, Phoenix. Eileen R. Chasens is a professor and chair of the Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, where Jacqueline Dunbar-Jacob is dean and a distinguished service professor and Christopher C. Imes is an assistant professor. Now retired, at the time of this writing Jeanne Geiger-Brown was a professor and associate dean for research at the George Washington University School of Nursing, Washington, DC. Carol A. Landis is a professor emeritus at the University of Washington School of Nursing, Seattle. Patricia A. Patrician is a professor and the Rachel Z. Booth Endowed Chair at the University of Alabama at Birmingham School of Nursing, and a retired U.S. Army colonel. Nancy S. Redeker is the Beatrice Renfield Term Professor of Nursing at the Yale University School of Nursing, New Haven, CT. Ann E. Rogers is a professor at the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta. Linda D. Scott is a professor and dean of the University of Wisconsin-Madison School of Nursing. Catherine M. Todero is dean of the College of Nursing and vice provost of Health Sciences at Creighton University, Omaha, NE, and Phoenix, AZ. Sharon J. Tucker is the Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing and director of the Translational/Implementation Research Core at the Ohio State University College of Nursing, Columbus. Sharon M. Weinstein is chief executive officer of the Global Education Development Institute, and SMW Group LLC, North Bethesda, MD, and a clinical assistant professor at the College of Nursing, University of Illinois, Chicago. This article was a collaborative effort by the Fatigue Subgroup of the Health Behavior Expert Panel, American Academy of Nursing. The authors acknowledge Claire C. Caruso, PhD, RN, a research health scientist at the National Institute for Occupational Safety and Health, for her help in reviewing the manuscript. Contact author: Alison M. Trinkoff, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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Edwards RL, Patrician PA, Bakitas M, Markaki A. Palliative care integration: a critical review of nurse migration effect in Jamaica. BMC Palliat Care 2021; 20:155. [PMID: 34641826 PMCID: PMC8510844 DOI: 10.1186/s12904-021-00863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. METHODS A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. RESULTS Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. CONCLUSION Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.
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Affiliation(s)
- Rebecca L Edwards
- Department of Acute, Chronic, and Continuing Care, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA.
| | - Patricia A Patrician
- Family, Community and Health Systems Department, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Marie Bakitas
- Center for Palliative and Supportive Care, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue, South, Birmingham, AL, 35294-1210, USA
| | - Adelais Markaki
- PAHO/WHOCC for International Nursing, Family, Community and Health Systems Department, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
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Mileski MR, Shirey MR, Patrician PA, Childs G. Perceived Racial Discrimination in the Pregnant African American Population: A Concept Analysis. ANS Adv Nurs Sci 2021; 44:306-316. [PMID: 34387213 DOI: 10.1097/ans.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
African American women experience higher lifetime exposure to chronic stressors, such as perceived racial discrimination. Clearly defining perceived racial discrimination in the pregnant African American population has the potential to better explain the phenomenon and how it relates to adverse birth outcomes such as preterm birth. The purpose of this concept analysis is to more clearly define perceived racial discrimination in the pregnant African American population using Rodgers' evolutionary method. Defining the concept of interest has the potential to uncover modifiers that may help close the gap in the Black-White infant mortality rates in the United States.
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McMullan SP, Raju D, Patrician PA. The Psychometric Analysis of the Certified Registered Nurse Anesthetist Workload Perception Scale (CWPS): Final Phase. J Nurs Meas 2021; 30:JNM-D-20-00093. [PMID: 34518401 DOI: 10.1891/jnm-d-20-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE In two previous studies, the Certified Registered Nurse Anesthetist (CRNA) Workload Perception Scale (CWPS) was developed. The purpose of this paper is to report the final psychometric validation of the CWPS. METHODS An 11-item CWPS was tested in a population of CRNAs. Classical psychometrics were performed on the 11-item instrument piloted in a sample of 393 CRNAs. RESULTS Parametric and nonparametric analysis indicated 7 of 11 items were a good fit to measure perception of workload. CONCLUSIONS A revised 7-item final CWPS was developed.
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Affiliation(s)
- Susan P McMullan
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Dheeraj Raju
- University of Alabama at Birmingham School of Nursing, Boca Raton, Florida
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Ledlow JH, Patrician PA, Miltner RS. Medication administration errors: A concept analysis. Nurs Forum 2021; 56:980-985. [PMID: 34056718 DOI: 10.1111/nuf.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/19/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
AIM To provide an analysis of the concept of medication errors that occur during the nursing task of medication administration. BACKGROUND Medication errors occurring during medication administration have an increased risk for an adverse patient outcome. Many terms are associated with medication errors, with limited clarification for a medication administration error at the point of care delivery. DATA SOURCES Twenty-seven sources were chosen from database searches of PubMed, CINAHL, EMBASE, and Scopus. Key search terms used to narrow the search consist of the following terminology: ("bedside" OR "point-of-care" OR "nursing care*") AND "medication administration errors" AND ("acute care"). REVIEW METHODS Rodger's evolutionary method of concept analysis was used to clarify the concept of medication administration error. RESULTS The concept analysis identified three attributes of a medication administration error: nurse-provided care, administration, and point of care. Antecedents identified in the analysis are organizational factors and nurse factors. Consequences identified in the analysis are patient, nurse and organizational themes. CONCLUSION The continued occurrence of medication administration errors warrants the need for an investigation into existing safety measures. Using this concept analysis may help guide the study of the healthcare environment and determine empirical measures to assess the impact that a medication administration error has.
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Affiliation(s)
- Jennifer H Ledlow
- Acute, Chronic, and Continuing Care Department, The University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Patricia A Patrician
- Family, Community, and Health System Department, The University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Rebecca S Miltner
- Family, Community, and Health System Department, The University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
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Oner B, Zengul FD, Oner N, Ivankova NV, Karadag A, Patrician PA. Nursing-sensitive indicators for nursing care: A systematic review (1997-2017). Nurs Open 2021; 8:1005-1022. [PMID: 34482649 PMCID: PMC8046086 DOI: 10.1002/nop2.654] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023] Open
Abstract
AIM To provide a systematic review of the literature from 1997 to 2017 on nursing-sensitive indicators. DESIGN A qualitative design with a deductive approach was used. DATA SOURCES Original and Grey Literature references from Cochrane Library, Medline/PubMed, Embase, and CINAHL, Google Scholar Original and Grey Literature. REVIEW METHODS Quality assessment was performed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS A total of 3,633 articles were identified, and thirty-nine studies met the inclusion criteria. The quantitative assessment of investigated relationships in these studies suggests that nursing staffing, mortality, and nosocomial infections were the most frequently reported nursing-sensitive indicators. CONCLUSION This review provides a comprehensive list of nursing-sensitive indicators, their frequency of use, and the associations between these indicators and various outcome variables. Stakeholders of nursing research may use the findings to streamline the indicator development efforts and standardization of nursing-sensitive indicators. IMPACT This review provides evidence-based results that health organizations can benefit from nursing care quality.
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Affiliation(s)
- Beratiye Oner
- Department of Health Services AdministrationUniversity of Alabama at BirminghamBirminghamALUSA
| | - Ferhat D. Zengul
- Department of Health Services AdministrationUniversity of Alabama at BirminghamBirminghamALUSA
| | - Nurettin Oner
- Department of Health Services AdministrationUniversity of Alabama at BirminghamBirminghamALUSA
| | - Nataliya V. Ivankova
- Department of Health Services AdministrationUniversity of Alabama at BirminghamBirminghamALUSA
- School of NursingUniversity of Alabama at BirminghamBirminghamALUSA
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Polancich S, Hall AG, Miltner R, Poe T, Enogela EM, Montgomery AP, Patrician PA. Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence. J Healthc Qual 2021; 43:137-144. [PMID: 33955955 PMCID: PMC8210579 DOI: 10.1097/jhq.0000000000000301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.
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Abstract
INTRODUCTION It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition. METHODS Rodgers' evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care. RESULTS The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier's unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity. CONCLUSIONS The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept.
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Affiliation(s)
- Tanekkia M Taylor-Clark
- University of Alabama at Birmingham, School of Nursing, 1701 University Boulevard, Birmingham, AL, 35205
| | - Patricia A Patrician
- University of Alabama at Birmingham, School of Nursing, 1701 University Boulevard, Birmingham, AL, 35205
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Anusiewicz CV, Li P, Patrician PA. Measuring workplace bullying in a U.S. nursing population with the Short Negative Acts Questionnaire. Res Nurs Health 2021; 44:319-328. [PMID: 33634480 DOI: 10.1002/nur.22117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 11/12/2022]
Abstract
Efforts to decrease nurse-reported workplace bullying (WPB) is an interest among researchers, nursing leaders, and healthcare organizations. Varying conceptual definitions and measurement approaches of WPB, however, have created barriers for researchers to provide reliable and consistent information regarding WPB. In this paper, the authors aim to (1) evaluate the reliability and construct validity of the Short Negative Acts Questionnaire (SNAQ) in a sample of U.S. nurses working in hospitals located throughout Alabama, (2) determine targets and non-targets of WPB, and (3) evaluate the criterion validity of the SNAQ based on WPB classification. The internal consistency reliability and construct validity of the SNAQ in 943 Alabama registered nurses was evaluated using Cronbach's α and confirmatory factor analysis. An exploratory factor analysis was conducted to explore the underlying structure of the SNAQ. Targets and non-targets of WPB were identified using latent class analysis of the SNAQ and by the self-labeling item. Agreement between the two methods was evaluated with Cohen's κ. Using both methods, the association between WPB classification and outcomes empirically associated with nurse-reported WPB was evaluated with random effects multiple logistic regression to determine criterion validity. The results indicate that the SNAQ is a reliable and valid instrument to explore WPB in a sample of U.S. registered nurses working in hospitals throughout Alabama.
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Affiliation(s)
- Colleen V Anusiewicz
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Montgomery AP, Azuero A, Patrician PA. Psychometric properties of Copenhagen Burnout Inventory among nurses. Res Nurs Health 2021; 44:308-318. [PMID: 33598963 DOI: 10.1002/nur.22114] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/17/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Worldwide, nurses have been reporting high levels of burnout. Given the high prevalence of nurse burnout, measurements of burnout need to be carefully considered for their validity and reliability. Our research team used a relatively new instrument to measure burnout among nurses: the Copenhagen Burnout Inventory (CBI). This 19-item instrument measures burnout in three dimensions: Personal, Work-related, and Client-related Burnout. However, the psychometric properties of the CBI have not been examined in nurses. Thus, the purpose of this study was to determine the psychometric properties of the CBI in a state-wide survey of inpatient staff nurses. A total of 928 registered nurses working in Alabama-area hospitals (N = 42 hospitals) participated in this study. Confirmatory factor analysis resulted in an adequate fit to the data and supported construct validity. As evidence of convergent validity, the CBI was moderately to highly correlated with measures of the overall work environment, job satisfaction, and intent to leave, in the anticipated directions. The Cronbach's alphas for Personal Burnout, Work-related Burnout, and Client-related Burnout were 0.91, 0.89, and 0.92, respectively, demonstrating excellent internal consistency reliability for the subscales. Based on our data, the CBI demonstrates adequate validity and reliability for measuring burnout among frontline nurses. As nurses provide care to the most vulnerable patients in healthcare systems, their psychological well-being is important due to the impact on quality of care on patient outcomes. The availability of the CBI on its website allows nurses, nurse managers, and researchers to evaluate burnout in a variety of nursing populations with no licensing costs.
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Affiliation(s)
- Aoyjai P Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Montgomery AP, Azuero A, Baernholdt M, Loan LA, Miltner RS, Qu H, Raju D, Patrician PA. Nurse Burnout Predicts Self-Reported Medication Administration Errors in Acute Care Hospitals. J Healthc Qual 2021; 43:13-23. [PMID: 33394839 DOI: 10.1097/jhq.0000000000000274] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs). METHODS A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined. RESULTS All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = -0.17 to -0.21), years in nursing (r = -0.10 to -0.17), years of hospital work (r = -0.07 to -0.10), and work environment (r = -0.24 to -0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p < .05). CONCLUSIONS Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.
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Horstman MJ, Miltner RS, Wallhagen MI, Patrician PA, Oliver BJ, Roumie CL, Dolansky MA, Perez F, Naik AD, Godwin KM. Developing Leaders and Scholars in Health Care Improvement: The VA Quality Scholars Program Competencies. Acad Med 2021; 96:68-74. [PMID: 32769476 DOI: 10.1097/acm.0000000000003658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the need for leaders in health care improvement across health professions, there are no standards for the knowledge and skills that should be achieved through advanced interprofessional health care improvement training. Existing health care improvement training competencies focus on foundational knowledge expected of all trainees or for specific career pathways. Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The diverse skill set required of modern health care improvement leaders necessitates the development of training competencies specifically for fellowships in applied health care improvement. The authors describe the development of the revised national Veterans Affairs Quality Scholars (VAQS) Program competencies. The VAQS Program is an interprofessional, postdoctoral training program whose mission is to develop leaders and scholars to improve health care. An interprofessional committee of VAQS faculty reviewed and revised the competencies over 4 months beginning in fall 2018. The first draft was developed using 111 competencies submitted by 11 VAQS training sites and a review of published competencies. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement scholarship and implementation. These broad competencies are relevant to advanced training programs that develop health care improvement leaders and scholars and may be used by employers to understand the knowledge and skills expected of individuals who complete advanced fellowships in applied health care improvement.
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Affiliation(s)
- Molly J Horstman
- M.J. Horstman is assistant professor, Department of Medicine, Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, and core faculty, VA Quality Scholars Coordinating Center, Houston, Texas
| | - Rebecca S Miltner
- R.S. Miltner is associate professor, University of Alabama at Birmingham School of Nursing, and associate faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Margaret I Wallhagen
- M.I. Wallhagen is professor, Department of Physiological Nursing, director, UCSF Hartford Center of Gerontological Nursing Excellence, and senior nurse faculty scholar, VA Quality Scholars Fellowship Program, San Francisco VA Medical Center site, San Francisco, California
| | - Patricia A Patrician
- P.A. Patrician is professor and Rachel Z. Booth Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing, and senior faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Brant J Oliver
- B.J. Oliver is associate professor, Departments of Community and Family Medicine, Psychiatry, and Dartmouth Institute at Dartmouth-Hitchcock Medical Center, and Geisel School of Medicine at Dartmouth, adjunct associate professor, MGH Institute of Health Professions School of Nursing, Hanover, New Hampshire, and faculty senior scholar, VA Quality Scholars Fellowship Program, White River Junction VAMC site, White River Junction, Vermont
| | - Christianne L Roumie
- C.L. Roumie is associate professor of internal medicine and pediatrics, Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, Geriatrics Research and Education Clinical Center, Nashville, Tennessee
| | - Mary A Dolansky
- M.A. Dolansky is associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, associate director, VA Quality Scholars Fellowship Program, senior nurse faculty, Cleveland VA Quality Scholars Fellowship Program site, and director, Quality and Safety Education for Nurses Institute, Cleveland, Ohio
| | - Federico Perez
- F. Perez is associate professor, Department of Medicine, Case Western Reserve University School of Medicine, faculty scholar, VA Quality Scholars Fellowship Program, Cleveland VA Medical Center site, and investigator, VISN-10 Geriatrics Research, Education, and Clinical Center, Cleveland, Ohio
| | - Aanand D Naik
- A.D. Naik is investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, senior advisor for the VA Quality Scholars Coordinating Center, and associate professor, Department of Medicine, Sections of Health Services Research and Geriatrics, Baylor College of Medicine, Houston, Texas
| | - Kyler M Godwin
- K.M. Godwin is assistant professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, and director, VA Quality Scholars Coordinating Center, Houston, Texas
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Levi P, Patrician PA, Vance DE, Montgomery AP, Moss J. Post-Traumatic Stress Disorder in Intensive Care Unit Nurses: A Concept Analysis. Workplace Health Saf 2020; 69:224-234. [PMID: 33357068 DOI: 10.1177/2165079920971999] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intensive care unit (ICU) nurses are at an increased risk of post-traumatic stress disorder (PTSD) due to their stressful work environment. Using the Walker and Avant conceptual analysis method, we sought to review the literature to better understand PTSD as it pertained to ICU nurses and its impact on their lives, patient care, and health care organizations. METHODS For the review, we searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO. The keyword searches included the terms "post-traumatic stress disorder" AND "psychological stress" AND "intensive care unit nurses." Abstract and full text reviews were conducted. Ten articles met our inclusion criteria of being published in the past 10 years (2010-2020), peer reviewed, written in English, and referred specifically to PTSD and psychological stress in ICU nurses. FINDINGS Antecedents for PTSD in ICU nurses are their stressful work environment, where exposure to traumatic events is experienced, and a lack of support from their manager, coworkers, and organization. Defining attributes for ICU nurses with PTSD included reexperiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Consequences identified included burnout, job dissatisfaction, and the intention to leave their job. The conceptual definition of PTSD in ICU nurses was illustrated by the attributes, antecedents, consequences, model case, empirical referents, and by the negative impact on the nurse, patients, and the health care organization. CONCLUSION/APPLICATION TO PRACTICE Hospital administrators, nurse managers, and occupational health nurses should ensure that policies and interventions are in place to recognize and reduce the risk of PTSD among ICU nurses.
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Anusiewicz CV, Ivankova NV, Swiger PA, Gillespie GL, Li P, Patrician PA. How does workplace bullying influence nurses' abilities to provide patient care? A nurse perspective. J Clin Nurs 2020; 29:4148-4160. [PMID: 32757394 PMCID: PMC8040339 DOI: 10.1111/jocn.15443] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/14/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore how workplace bullying influences nurses' abilities to provide patient care. BACKGROUND Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. DESIGN Qualitative descriptive study. METHODS Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. RESULTS Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. CONCLUSIONS Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. RELEVANCE TO CLINICAL PRACTICE Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.
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Affiliation(s)
| | - Nataliya V. Ivankova
- The University of Alabama at Birmingham School of Health Professions, Birmingham, AL, USA
| | - Pauline A. Swiger
- The University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | | | - Peng Li
- The University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
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Mortensen B, Borkowski N, O'Connor SJ, Patrician PA, Weech-Maldonado R. The Relationship Between Hospital Interdepartmental Transfers and Patient Experience. J Patient Exp 2020; 7:263-269. [PMID: 32851150 PMCID: PMC7427363 DOI: 10.1177/2374373519836467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the association between interdepartmental transfers and the perceptions of care received by adult patients who were admitted and discharged from a 300-bed, not-for-profit community tertiary hospital in the Midwest. Transfers of patient care are daily and frequent hospital processes. However, limited attention has focused on the effect that intrahospital transfers of care have on the patient experience. Understanding this relationship is important, since value-based purchasing models directly tie patient experience measures into hospital reimbursements. The key finding of this study indicates that as patients' transfers increase, their perceptions of care decrease. Therefore, by reducing the frequency of interdepartmental transfers, patient satisfaction may increase. This research provides clinicians and administrators a better understanding of the relationship between a frequent and a daily hospital process (ie, interdepartmental transfers) and its influence on patients' perceptions of their experience.
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Affiliation(s)
- Betty Mortensen
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nancy Borkowski
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen J O'Connor
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia A Patrician
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Weech-Maldonado
- President of Innovative Healthcare Solutions, LLC, University of Alabama at Birmingham, Birmingham, AL, USA
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Campbell CM, Patrician PA. Generational preferences in the nursing work environment: A dimensional concept analysis. J Nurs Manag 2020; 28:927-937. [DOI: 10.1111/jonm.13024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
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Campbell CM, Prapanjaroensin A, Anusiewicz CV, Baernholdt M, Jones T, Patrician PA. Variables associated with missed nursing care in Alabama: A cross‐sectional analysis. J Nurs Manag 2020; 28:2174-2184. [DOI: 10.1111/jonm.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Marianne Baernholdt
- School of Nursing University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Terry Jones
- School of Nursing Virginia Commonwealth University Richmond Virginia
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Abstract
The Veterans Health Administration (VHA) led implementation of the Clinical Nurse Leader (CNL) role nationally with the goal to meet system needs for strong clinical leadership across all settings. After a decade of CNL role implementation, the VHA supported this evaluation to determine the current state, the successes, the challenges, and the fidelity to the original intent of the role. The team used mixed methods to evaluate the state of the CNL initiative. Ten evaluation activities were undertaken including a facility survey directed toward chief nurse executives at all VHA facilities, and a second survey directed at registered nurses who completed a CNL graduate program, were certified as a CNL, or were currently enrolled in a CNL graduate program. The evaluation results suggest the CNL initiative had not yet accomplished the stated goals to improve cost and financial outcomes, increase patient satisfaction, increase staff satisfaction and retention, improve quality and internal processes, and facilitate practice model transformation including evidence-based practice and collaborative, interdisciplinary practice across the system. Observed CNL practices within the VHA could serve as exemplars for developing a care delivery model that could achieve these goals and offer potential paths to move this role forward.
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Affiliation(s)
- Rebecca S Miltner
- University of Alabama at Birmingham School of Nursing, Birmingham (Drs Miltner and Patrician); WJB Dorn VA Medical Center, Columbia, South Carolina (Dr Haddock); and Central Texas Veterans Health Care System, Temple (Dr Williams)
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Sneed NM, Patrician PA, Morrison SA. Influences of added sugar consumption in adults with type 2 diabetes risk: A principle-based concept analysis. Nurs Forum 2019; 54:698-706. [PMID: 31612529 DOI: 10.1111/nuf.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to describe the concept added sugar in the context of type 2 diabetes (T2D) risk in adults. BACKGROUND Dietary added sugars are associated with a greater risk for T2D; however, it is unclear if added sugars influence T2D risk directly or if their effects are mediated by excess caloric intake and weight gain. DESIGN A principle-based concept analysis following the PRISMA guidelines was conducted to clarify the concept of added sugar. A systematic search was conducted using PubMed and Embase. Multidisciplinary, empirical evidence was appraised using four guiding principles outlined by the principle-based concept analysis method. RESULTS Thirty-five publications were included in this concept analysis. The concept, added sugar in the context of T2D risk, was found to be epistemologically immature and lacked conceptual clarity. CONCLUSIONS Added sugar is an immature concept warranting further refinement for conceptual advancement. To enhance conceptual clarity, the term "added sugar" should be used consistently in the scientific literature when discussing foods or beverages containing added sugars or caloric sweeteners. A clearer delineation of added sugar and its association with T2D risk in adults is critical to advance this concept within the scientific literature.
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Affiliation(s)
| | - Patricia A Patrician
- Department of Family, Community Health, and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shannon A Morrison
- Department of Family, Community Health, and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
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Sanchez RV, Speck PM, Patrician PA. A Concept Analysis of Trauma Coercive Bonding in the Commercial Sexual Exploitation of Children. J Pediatr Nurs 2019; 46:48-54. [PMID: 30852255 DOI: 10.1016/j.pedn.2019.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The sex trafficking of adolescents is known as commercial sexual exploitation of children (CSEC). CSEC is a complex phenomenon where identification requires understanding of developmental disruptions from toxic bonding experiences that increase in complexity over time. These toxic bonding experiences forced through coercive methods disrupt the holistic development of a self in the CSEC victim that interferes with daily functions, decision-making and social and emotional development. Lacking in the literature is a conceptual foundation for trauma coerced bonding. PURPOSE The purpose of the analysis is to define and clarify the future concept of trauma coerced bonding from trauma bonding as it relates to CSEC victimization. METHODS The concept analysis used Rodgers' evolutionary method to search four databases (PubMed, CINHAL, Scopus, and Google Scholar [for grey literature]), using terms associated with various descriptions of trauma bonding (for instance, Stockholm syndrome), resulting in twenty papers for review. RESULTS Attributes, antecedents, and consequences of trauma bonding were delineated and explained. It became apparent through this analysis that the concept of trauma bonding of adolescents exposed to CSEC is very different from other forms of trauma bonding, leading this author to a more precise term, trauma-coercive bonding. Trauma coercive bonding is a long process that is a developmentally disruptive form of bonding that has ramifications throughout the life span. DISCUSSION Trauma coercive bonding is influenced by more than just an emotional bond. The proposed definition of trauma coercive bonding brings an in-depth description of vulnerabilities and disruptions to childhood when CSEC, which persists long into adulthood. CONCLUSION Future qualitative research should pursue a grounded theory of trauma coercive bonding to further explain and study this phenomenon.
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Affiliation(s)
- Rosario V Sanchez
- Rutgers University-Newark, School of Nursing, United States of America.
| | - Patricia M Speck
- University of Alabama at Birmingham, School of Nursing, United States of America
| | - Patricia A Patrician
- University of Alabama at Birmingham, School of Nursing, United States of America
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