Volume 1, Issue 1, 2010

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  • Publication
    The Journal of BSN Honors Research
    (2010-06-18) Scott, Kelly; Pendley, Alison E.; Curtis Neely, Melanie; Kelly, Cara; Dunton, Nancy; Teel, Cynthia; Wambach, Karen; Bergquist-Beringer, Sandra
  • Publication
    Magnet Status: Implications for Quality of Patient Care
    (2010-06-18) Scott, Kelly; Dunton, Nancy
    Research has shown that hospital structure, e.g. nursing characteristics, affects patient outcomes. Nursing characteristics have been shown to be better in Magnet® hospitals. Previous studies have found that nursing workforce characteristics such as nurse‐to‐patient ratio, job satisfaction, and skill mix correlate with lower incidence of nosocomial infection and higher nurse‐reported and patient‐reported quality of care. Little research has been done, however, on the correlation between Magnet status and patient outcomes. The purpose of this study was to determine if patients have fewer nosocomial infections in Magnet hospitals than non‐Magnet hospitals. The Donabedian structure‐processes‐outcomes model for assessing quality of health care was the underlying conceptual framework for the study. The study design employed a descriptive correlational design. Over 500 critical care units from hospitals participating in the National Database of Nursing Quality Indicators® contributed data for the analysis. T‐tests indicated that there was a higher number of total nursing hours per patient day (TNHPPD), percentage of RNs with a bachelor’s degree, and higher job satisfaction scores, on critical care units in Magnet accredited facilities than those without Magnet status (p < 0.001). The mean rates of three types of nosocomial infections were similar for Magnet and non‐Magnet hospitals, and no significant correlations were found between these workforce characteristics and patient outcomes. The analysis conducted for this study did not support the hypothesis that Magnet hospitals would have lower nosocomial infection rates because they have superior nursing workforce attributes. Further research is indicated to determine why the workforce characteristics that contribute to Magnet accreditation do not lead to a higher quality of care, and to find what factors do determine higher quality of patient care.
  • Publication
    Developing a Center for Nursing Scholarship and Leadership in Kansas
    (2010-06-18) Pendley, Alison E.; Teel, Cynthia
    Most states in the United States have nursing centers that focus on workforce issues, although some centers focus on nursing research and scholarship. Kansas does not currently have a state‐wide center of any type. In recent summits of nurse educators and clinical nurses in Kansas, participants identified the need for a state‐wide center for nursing excellence that would support nursing research, scholarship, and the development of nurse leaders. Prior to developing the new center, data from state workforce and other centers of nursing excellence were collected to identify the purpose, mission, organizational structure, and funding mechanisms that have guided development of other centers. Data were collected from the web sites of the 33 established workforce centers and from several additional, institution‐based centers. Content analysis was used to identify common themes for the purpose, structure, and funding of centers and these findings In addition to the summary reports from the state‐wide summits of nurse educators and clinical nurses, were used to guide development of a proposed center for Kansas. The Kansas Center for Nursing Scholarship & Leadership will be virtual, independent, and not‐for‐profit. The Center will have an Advisory Council that will include participants state‐wide, from all levels of nursing education, nursing practice, and regulatory partners. Strategies for development, implementation, and evaluation of a state‐wide Center for Nursing Scholarship and Leadership are discussed. In addition, strategies for promoting innovative, collaborative projects across educational levels and between schools and clinical partners are suggested.
  • Publication
    Breastfeeding Experiences of Mothers Using Telehealth at One and Four Weeks Postpartum
    (2010-06-18) Curtis Neely, Melanie; Wambach, Karen
    Research demonstrates that breastfeeding provides many health benefits for both mothers and infants. However, many mothers stop breastfeeding in the early postpartum period due to problems such as sore nipples, engorgement, mastitis, and insufficient milk supply. Lactation support is associated with increased breastfeeding duration. However, in underserved rural and urban areas some mothers lack access to lactation support. Telehealth technology has not been used to address this problem in the U.S., but may be an alternative means to provide mothers with lactation support. The purpose of the parent study was to evaluate the feasibility and reliability of telehealth methods for assessing and providing lactation support in women’s homes over the first four weeks after birth. The purpose of this ancillary study was to identify the breastfeeding experiences of mothers at one and four weeks postpartum, and to determine if telehealth enhanced breastfeeding support. Seven mother‐baby dyads were recruited from the maternity unit of a 600 bed Midwestern university‐affiliated hospital and a free standing birthing center. Data were collected using videoconferencing and face to face home visits to compute LATCH breastfeeding assessment scores. The Breastfeeding Experience Scale (BES) was administered via the telephone at one and four weeks postpartum. Data analyses included descriptive statistics and narrative analysis. At one week, the most frequent experiences of mothers were feeling tired/fatigued, (85.8%), followed by baby’s reluctance to nurse due to sleepiness (85.7%), and sore nipples (85.7%). On a 5‐point scale, the most severe experiences were sore nipples (moderate, 3) and engorgement (mild, 2). At week four, the most frequent experiences were mothers feeling tired/fatigued (85.8%), mothers feeling tense and overwhelmed (85.8%), and baby’s reluctance to nurse due to fussiness (71.5%). The most severe experiences were feeling tired/fatigued (moderate, 3), sore nipples, baby’s reluctance to nurse due to sleepiness and fussiness, leaking breasts, and feeling tense and overwhelmed (mild, 2). The majority of mothers (n=6) reported they had an improved breastfeeding experience and that they had a decrease in breastfeeding problems because of their telehealth experience. At four weeks, 5 were exclusively breastfeeding. In conclusion, telehealth may be an important tool in breastfeeding assessment and support and more research in this area is needed.
  • Publication
    A New Look at the Braden Scale for Pressure Ulcer Risk Among Older Adults in Home Health Care
    (2010-06-18) Kelly, Cara; Bergquist-Beringer, Sandra
    Only two previous studies have examined Braden Scale use in home health care. Findings are mixed and suggest the Braden Scale is not a reliable tool for identifying elder home health care patients who are at risk for pressure ulcer development. However, each previous study was limited to one home health care agency and no subsequent study has been conducted to clarify these results. The purpose of this study was to reexamine the validity of the Braden Scale in a large sample of elder home health care patients from multiple (N=5) agencies across the United States. The Conceptual Schema for the Study of the Etiology of Pressure Sores guided the research study. Secondary analysis of data from a retrospective cohort study was performed. The sample included 2120 patients age 60 years and older who were admitted for intermittent skilled home health care and had a documented admission Braden Scale score. New pressure ulcer development (n=30) was determined from OASIS (Outcome and Assessment Information Set) data completed after patient admission. Statistical analyses included a description of the sample and new pressure ulcers by stage. Specificity, sensitivity, predictive value positive, and predictive value negative values across the range of Braden Scale scores were calculated for the total sample (n=2120) and a subset of patients who were pressure ulcer free on admission (n=2111) to determine the optimal cutoff score for pressure ulcer risk. A Braden Scale score of 18 or less yielded the best balance between sensitivity (73.30%) and specificity (65.50%) for the total sample and for the subset of patients who were pressure ulcer free on admission (sensitivity = 71.43; specificity = 65.60). Receiver‐Operator Characteristic curve analyses confirmed the cutoff score for both groups. The area under the curve was 0.76 for the total sample (95% CI=0.66‐0.85) and 0.73 for patients who were pressure ulcer free on admission (95% CI=0.620.84). Results will guide home health care provider use of the Braden Scale for identifying elder patients at risk for pressure ulcer development.