Biomedical subjects

Barbara B Brewer

Publications and source records attributed to Barbara B Brewer.

6 recordsLinked to original sources

PubMed2006

Evaluating the quality of interaction between medical students and nurses in a large teaching hospital.

BACKGROUND: Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations. METHODS: We surveyed 268 Indiana University medical students and 175 nurses who worked at Indiana University Hospital, the School's chief clinical training site. The students had just completed their third year of training. The survey instrument consisted of 7 items that measured "relational coordination" among members of the health care team, and 9 items that measured psychological distress. RESULTS: Sixty-eight medical students (25.4%) and 99 nurses (56.6%) completed the survey. The relational coordination score (ranked 1 to 5, low to high), which provides an overall measure of interaction quality, showed that medical students interacted with residents the best (4.16) and with nurses the worst (2.98; p < 0.01). Conversely, nurses interacted with other nurses the best (4.36) and with medical students the worst (2.68; p < 0.01). Regarding measures of psychological distress (ranked 0 to 4, low to high), the interpersonal sensitivity score of medical students (1.56) was significantly greater than that of nurses (1.03; p < 0.01), whereas the hostility score of nurses (0.59) was significantly greater than that of medical students (0.39; p < 0.01). CONCLUSION: The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration. Medical students and nurses experience different levels of psychological distress, which may adversely impact the quality of their interaction.

Adult↗

PubMed2006

Relationships among teams, culture, safety, and cost outcomes.

The objective of this study is to test the transtheoretical integration model, which proposes relationships among team-based phenomena and patient safety and resource-use outcome variables. The sample consisted of 411 nursing staff (n = 372) and multidisciplinary team members (n = 39) from 16 medical surgical units. Staff were surveyed to evaluate their perceptions of hospital culture, work group design, and positive and negative team processes. Managers provided data concerning outcome variables of patient falls with injury, average length of stay (LOS), and labor and supply expenses for their patient care units. A group-type hospital culture predicted fewer patient falls with injury; a developmental-type hospital culture predicted higher patient care unit costs. Team design and processes were predictive of longer LOS for patients on medical-surgical units. Conclusions of the study were that hospital contexts external to the patient care unit may be important contributors to patient safety and resource use on nursing units.

Costs and Cost Analysis↗

PubMed2005

Using OrgAhead, a computational modeling program, to improve patient care unit safety and quality outcomes.

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement.

Arizona↗

PubMed2004

Using computational modeling to improve patient care unit safety and quality outcomes.

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we are using a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 16 units in 5 hospitals. Subsequent validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report on our initial efforts to use OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus is on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units by 6-8 percentage points. Nurse Managers have responded enthusiastically to the additional decision support for quality improvement

Accidental Falls↗

PubMed2003

Using computational modeling to study the impact of workplace characteristics on patient safety outcomes.

How do patient characteristics, organization characteristics and patient care unit characteristics interact to affect quality, safety, and cost outcomes? What changes can nurse managers make on their units that will optimize outcomes for their patients? To answer these questions, we are collecting data from 35 nursing units in 12 hospitals in Arizona, and using the results as a basis for computational modeling. Although it has been used in clinical research, until now computational modeling has had little application to healthcare or nursing organizations. In this poster session, we describe our application of Orgahead, a computational modeling program.

Models, Nursing↗

PubMedDate not supplied

Using computational modeling to transform nursing data into actionable information.

Transforming organizational research data into actionable information nurses can use to improve patient outcomes remains a challenge. Available data are numerous, at multiple levels of analysis, and snapshots in time, which makes application difficult in a dynamically changing healthcare system. One potential solution is computational modeling. We describe our use of OrgAhead, a theoretically based computational modeling program developed at Carnegie Mellon University, to transform data into actionable nursing information. We calibrated the model by using data from 16 actual patient care units to adjust model parameters until performance of simulated units ordered in the same way as observed performance of the actual units 80% of the time. In future research, we will use OrgAhead to generate hypotheses about changes nurses might make to improve patient outcomes, help nurses use these hypotheses to identify and implement changes on their units, and then measure the impact of those changes on patient outcomes.

Computational Biology↗