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PubMedDate not supplied

Nurses's knowledge of heart failure education principles.

OBJECTIVE: The goal of this study was to determine nurses' knowledge of heart failure (HF) self-management education principles. DESIGN: The study was exploratory and descriptive and included a convenience sample. SETTING: Research took place in a large midwestern health care system that included a university-based hospital, community hospitals, and home or palliative care. SUBJECTS: Subjects included 300 nurses who provide care to patients with HF. OUTCOME MEASURE: The outcome measures included overall and topic specific perceptions of basic information important to HF self-management. Topics included diet, fluids or weight, signs or symptoms of worsening condition, medications, and exercise. INTERVENTION: A 20-item, true or false written survey was administered between February 2000 and April 2000. RESULTS: Of the 300 nurses surveyed, 92% were registered nurses and 8% were licensed practical nurses; 38% worked in a large university-based hospital; 44% were employed at 5 community hospitals; and 18% worked in home or hospice-palliative care. Mean HF self-management knowledge score was 15.2 +/- 2.0. Registered nurses scored significantly higher than licensed practical nurses (15.3 vs 14.1; P =.004). Individual questions with overall scores <30% were related to dry or ideal weight in daily weight monitoring (24%), nonsymptomatic, low blood pressure (26%), and short-term dizziness when rising (19%). Individual question scores >30% and < or =75% were related to nonsteroidal anti-inflammatory inhibitor use (49%), potassium-based salt substitute use (52%), rest vs activity (72%), and lean delicatessen meat use in a low sodium diet (75%). In questions with scores <30%, nurses requested more information only 5% to 8% of the time. Overall analysis of variance indicated differences by work experience. HF nurses (primary population) scored higher than critical-care, medical-surgical, or telemetry floor nurses (16.2 +/- 1.7; 15.1 +/- 1.8; and 14.7 +/- 2.0, respectively; P <.001); home care nurses scored higher than hospital or palliative care nurses (15.9 +/- 1.5; 15.1 +/- 2.0; and 14.0 +/- 1.5, respectively; P =.006). CONCLUSION: Nurses may not be properly educated in HF self-management principles and must be provided with the right information so they can improve the quality and amount of information they offer to patients. Nurses who are better prepared to educate patients with HF may be more likely to carry out this nursing function as a part of their daily job role.

Adult↗
PubMed1995

A nursing survey to determine the characteristics of medication administration through enteral feeding catheters.

A statewide survey was designed to develop a better understanding of the current practices and problems encountered with medication administration through enteral feeding catheters (EFCs). The sample of 223 registered nurses and licensed practical nurses estimated that a median of 10% of patients received medications through an EFC. EFC obstruction was estimated to have occurred a median of 1.5 times per week, with 50% of obstructions estimated to be due to medication administration. Nine of 14 specific medications reported as "most frequently contributing to" feeding catheter obstruction available in liquid form, yet tablets were crushed and given. When nurses perceived the pharmacy department as helping them insure that liquid dosage form was used, there was greater use of liquid forms, less use of crushed forms, and less medication-associated catheter obstruction. In this sample, the majority of nurses did not follow consistently the few recommendations available.

Drug Therapy↗
PubMed1984

Workshop helps nurses develop pain management techniques.

Recognizing that nurses' attitudes, their knowledge of medications, and their communication practices can influence pain management effectiveness, health care professionals at St. John's Hospital, Springfield, IL, developed a workshop to educate registered nurses and licensed practical nurses on the pharmacology and uses of analgesics. The eight-hour workshop incorporated lectures, role playing, audiovisuals, and case study applications. To evaluate the program, a questionnaire was distributed to participants three months after the workshop. Responses indicated that nurses believed they had improved their pain management skills, and project coordinators' observations on the subacute and acute care nursing units confirmed this. For example, nurses communicated pain assessments and medication follow-ups more frequently. A pain intensity scale and a pain relief worksheet were designed to assist nurses in charting patients' medication needs. The nurses also developed confidence in discussing patients' needs with physicians. If an analgesic failed to control a patient's pain, the nurses became more assertive in asking for a more effective medication. The workshops, which helped promote cooperation among physicians, nurses, pharmacists, and other health care professionals, now are presented regularly to new nursing staff as an ongoing part of St. Joseph's pain management education program.

Hospital Bed Capacity, 500 and over↗
PubMed1994

Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long-term care settings.

BACKGROUND: Because educational needs of staff in long-term care facilities regarding infection control have, not been well studied, we conducted this study to measure long-term care staff members' knowledge, self-reported practices, and opinions about infection control and handwashing. METHODS: A pilot study was conducted with 24 staff members of one long-term care facility to examine psychometric properties of study instruments. All nursing staff members (n = 105) from two additional long-term care facilities then completed a 14-item knowledge questionnaire, 22-item opinion survey, and 26-item survey of self-reported handwashing practices. RESULTS: Respondents were predominantly female with mean age of 46 years; most had completed high school. Mean length of employment in the study facility was 12.4 years. Registered nurses and licensed practical nurses scored significantly higher on knowledge (p = 0.0002) but significantly lower on self-reported practices (p = 0.01) than did trained nursing assistants. There was no significant correlation between self-reported practices and opinions regarding handwashing (p = 0.55). Neither level of knowledge nor positive opinion about the value of handwashing was associated with self-reported increases in handwashing practices. CONCLUSION: We conclude that education alone is not likely to be associated with changes in handwashing behavior. Instruments developed and tested in this study can be used in further research to correlate self-reported with observed behavior and to evaluate the effects of interventions on knowledge, opinions, and self-reported handwashing behavior.

Aged↗
PubMed1994

Change champions at the grassroots level: practice innovation using team process.

A nursing administrative group recognized the critical value of staff participation in the formulation of a restructuring project and guidance throughout the project. Using a team approach, a task force of three staff nurses, two assistant nurse managers, a nurse clinician, a nursing practice specialist, and a representative from nursing administration came together. They were given responsibility for researching and setting the course for restructuring change. A unit-based team including a unit secretary, a nursing attendant, licensed practical nurse (LPN), and six staff nurses was formed from volunteers from the 40-bed medicine unit to develop that unit's plan for restructuring. The unit-based team analyzed patient care needs and staff member roles. They created a new patient care technician role as well as a nurse care coordinator role. The role of the LPN was envisioned as providing technical support. Staffing mix was also determined by the unit-based team. Both the task force and the unit-based team continue to evaluate, troubleshoot, and take every opportunity to sell their vision to solidify it further as the foundation for the future of patient care services at the hospital. The process will soon move forward to a large surgical unit.

Communication↗
PubMed1998

Nurses' attitudes towards cost-effectiveness and quality of care.

OBJECTIVE: To describe nurses' attitudes toward cost-effectiveness in nursing practice and its perceived effects on quality of care, and to examine the influence of role, education, and experience on these attitudes. DESIGN: A comparative, descriptive design was used. SETTING: Two community hospitals in the midwest. SUBJECTS: Registered nurses and licensed practical nurses. MEASUREMENTS AND MAIN RESULTS: Blaney Hobson Nursing Attitude Scale was used to measure nurses' attitudes toward cost-effectiveness. Demographic information was obtained by asking open-ended questions. Scores ranged from 30 to 96, with a mean score of 65.57 (SD = 13.58). CONCLUSIONS: Nurses with greater than 10 years experience had more positive attitudes than nurses with 10 years or less experience. Nurses in administration/management positions had more positive attitudes than did staff nurses. No significant correlation was found between education level and attitudes toward cost-effectiveness. The major concern of participants was that quality of care would suffer due to cost containment efforts. The majority of participants agreed that education in cost containment and budgetary issues should begin in basic nursing school and should be included in employer orientation programs.

Attitude of Health Personnel↗
PubMed2002

Nurse-staffing levels and the quality of care in hospitals.

BACKGROUND: It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. METHODS: We used administrative data from 1997 for 799 hospitals in 11 states (covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes, differences in the nursing care needed for each hospital's patients, and other variables. RESULTS: The mean number of hours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by licensed practical nurses, and 2.4 hours by nurses' aides. Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of care per day provided by registered nurses were associated with a shorter length of stay (P=0.01 and P<0.001, respectively) and lower rates of both urinary tract infections (P<0.001 and P=0.003, respectively) and upper gastrointestinal bleeding (P=0.03 and P=0.007, respectively). A higher proportion of hours of care provided by registered nurses was also associated with lower rates of pneumonia (P=0.001), shock or cardiac arrest (P=0.007), and "failure to rescue," which was defined as death from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis (P=0.05). Among surgical patients, a higher proportion of care provided by registered nurses was associated with lower rates of urinary tract infections (P=0.04), and a greater number of hours of care per day provided by registered nurses was associated with lower rates of "failure to rescue" (P=0.008). We found no associations between increased levels of staffing by registered nurses and the rate of in-hospital death or between increased staffing by licensed practical nurses or nurses' aides and the rate of adverse outcomes. CONCLUSIONS: A higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients.

Cross Infection↗
PubMed1994

Reducing restraints. Impact on staff attitudes.

1. Changing the practice of using physical restraints must include nursing staff members as one of the main targets for change. 2. Following education and the implementation of a restraint-reduction program, 58% of the nursing staff participants found restraint use to be less important in caring for the elderly. Changes were more significant, however, immediately after the mandatory inservice program. 3. Nursing staff members whose perceptions changed tended to be registered nurses or licensed practical nurses who had more years of experience and more seniority at work. 4. The provision of ongoing education to nursing staff members is a necessary step to decrease feelings of frustration and stress and to assist the staff in being aware of alternatives to restraints.

Aged↗
PubMed1997

Research-based planning for change: assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition.

OBJECTIVE: This article describes one medical center's experience in using research to plan for nursing staff integration after hospital acquisition. BACKGROUND: Resistance to new policies, procedures, and standards; passive acceptance of new leadership; limited support for management plans; and failure to integrate with new nursing units are common staff reactions after acquisitions. Little has been written regarding which key staff variables to assess after acquisitions and how to use this data to plan for change. Structural contingency and attribution theory were used to guide leadership staff's assessment of acquired staff attributes to determine their congruence with concepts valued by the acquiring organization. METHODS: Qualitative and quantitative data were collected using a survey method. All 141 registered nurses and licensed practical nurses of the acquired medical center received a mailed survey. Sixty-six completed surveys were returned through the U.S. mail. No identifying information was placed on the survey to assure anonymity. RESULTS: The survey results described nurses perceptions of the advantages, concerns, and suggestions for a smooth transition after acquisition. In addition, the results clarified that nurses in the newly acquired hospital preferred a shared governance structure (congruent with the acquiring medical center's values) and the nurses perceived professional nursing autonomy was similar to that of nurses who worked at the acquiring medical center. CONCLUSIONS: By sharing the findings, both staffs were sensitized to the similarities among the staff as well as to their differences. Transition strategies were planned to capitalize on this knowledge. This process may be useful for other nurse executives to replicate as they guide their organizations through similar transitions.

Adult↗
PubMed2002

State policies and nurses with substance use disorders.

PURPOSE: To investigate the effects of two state regulatory policies on nurses with substance use disorders (SUD) on relapse rates and retention in the nursing workforce. DESIGN & METHODS: This longitudinal comparative study consisted of six data-collection points in 6 months. One sample of 100 registered nurses (RNs) and licensed practical nurses or vocational nurses (LPN/VNs) had disciplinary actions taken against their licenses by four U.S. state regulatory boards using a traditional, disciplinary approach. The alternative sample consisted of 119 RNs and LPN/VNs from three U.S. states where the regulatory board diverted nurses to programs for treatment and for determining suitability to return to practice. Data were collected via mailed surveys. FINDINGS: When compared to the sample, the alternative sample had more nurses with active licenses, fewer with criminal convictions, and more nurses employed in nursing. No difference in relapse rate was found. Fewer than 15% of nurses in either sample experienced one or more episodes of relapse during the 6-month study. Of those who did relapse, the majority used alcohol or street drugs. CONCLUSIONS: Alternative policies worked as well as disciplinary policies and were a more humane and rehabilitative approach. Alternative policy is consistent with the recommendation in Healthy People 2010 to eliminate financial barriers limiting access to treatment. Further investigation is needed to identify situations that trigger relapse.

Nurses↗
PubMed1998

A causal model of voluntary turnover among nursing personnel in long-term psychiatric settings.

Causal modeling was used to explore the processes by which individual characteristics, job satisfaction, and intention to quit explain turnover among nursing personnel in 29 Department of Veterans Affairs (VA) long-term psychiatric settings. The sample consisted of 1,106 registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides. We conceptualized turnover as a multistage process linking social and experiential orientations, attitudes toward the job, the decision to quit, and the behavior of actually quitting. Intention to quit was the strongest direct predictor of turnover. Professional growth opportunities and workload were important indirect predictors of turnover. Dissatisfaction with work hazards and relationships with coworkers were both indirect and direct predictors of turnover. Attitudes towards the job varied by nursing group. LPNs and aides were less satisfied than RNs with autonomy and work hazards. RNs were more dissatisfied with workload. We conclude that strategies to promote retention need to address aspects of jobs tailored to specific nursing groups.

Adult↗
PubMed1987

Disabling back injuries among nursing personnel: research needs and justification.

The need for more research on the problem of work-related back injuries among nursing personnel is documented by two comparisons based on the ratio of back injury workers' compensation claims to eligible employees. The first analysis of occupations across industries indicated that nursing aides, licensed practical nurses, and registered nurses all had high back injury ratios compared to other occupations. The second analysis of occupations within four parts of the health care industry indicated that aides in nursing and personal care facilities had the greatest problem with disabling back disorders. The article concludes with a list of research needs and suggested research methodologies.

Back Injuries↗
PubMed2006

Mental health care deficiency citations in nursing homes and caregiver staffing.

In this paper, we examine the association between caregiver staffing levels and mental health outcomes in approximately 17,000 U.S. nursing homes. As outcomes, we focus on deficiency citations available in the Center for Medicare and Medicaid Services' Online Survey, Certification, And Recording data. We examine nurse aide, licensed practical nurse, registered nurse, and mental health provider staffing. Our results show that the level of nursing staff matter with respect to mental health outcomes. Whereas greater RN staffing was associated with a lower likelihood of being cited for deficiencies in mental health care, greater LPN and NA staffing were associated with a higher likelihood. We found no association between mental health provider staffing levels and mental health outcomes.

Health Care Surveys↗
PubMed1982

Nosocomial hepatitis A transmission by an adult patient with diarrhea.

Hepatitis A occurred in five registered nurses, a licensed practical nurse, and a recently discharged patient at a community hospital; one of these seven was asymptomatic. All had been exposed to a woman with confirmed hepatitis A who had undergone elective cholecystectomy and who had had vomiting, diarrhea, and fecal incontinence during the eight days before onset of jaundice. Of the 107 hospital workers identified as having at least some exposure to the source patient, 58 (54.2 percent) had no pre-existing antibody to hepatitis A virus (anti-HAV) and were considered susceptible. Six persons, including the five clinically ill registered nurses, had IgM-specific anti-HAV. The infection attack rate was 5.6 percent for all exposed hospital workers but 10.3 percent for the 58 who were serosusceptible. Risk of infection was highest for persons with documented or probable contact with the source patient and for registered nurses. Among hospital personnel, the prevalence of anti-HAV increased with age but varied inversely with socioeconomic status. Hospital personnel and patients may be at risk for hepatitis A infection when exposed to patients who are in the prodromal stage of hepatitis A. Vomiting, diarrhea, and fecal incontinence may increase the risk of transmission.

Adult↗
PubMed1994

Nursing-home staff perception of behavior disturbance and management of confused residents.

An exploratory study was conducted to identify nursing-home staff's perceptions of confused residents' behavior problems and what they did to intervene. Six focus groups were conducted at two nursing homes. A convenience sample of 58 health care providers participated: registered nurses and licensed practical nurses; certified nursing assistants; social workers; clinical nurse specialists; therapeutic recreation therapists; and physical, speech, and occupational therapists. Four categories of behavior disturbances emerged: verbal, fear-related, wandering, and level of awareness-related. Four categories emerged from intervention data analysis: interpreting reality, maintaining normalcy, meeting basic needs, and managing behavior disturbances.

Aged↗
PubMed2003

Nurses' attitudes toward family presence during resuscitative efforts and invasive procedures.

INTRODUCTION: This study explored variables influencing hospital nurses' and ENA members' attitudes and beliefs about family presence during resuscitative or invasive procedures, using Ajzen and Fishbein's theory of reasoned action. METHODS: Two hundred eight hospital nurses and New Jersey ENA members completed the 13-item Family Presence Support Staff Assessment Survey, which is designed to identify the health care practitioner's attitude toward family presence during resuscitation and/or invasive procedures. In addition, 6 open-ended questions elicited respondents' perceptions of system barriers and personal beliefs about family presence. RESULTS: Pearson correlations showed significant relationships between attitude toward family presence and (1) educational preparation (r =.216, P <.01), (2) type of certification (r =.216, P <.01), and (3) area of specialization (r = -.234, P <.01). Education, specialty certification, professional designation (registered nurse or licensed practical nurse), and specialty area were significant predictors of positive attitudes toward family presence (R(2) =.096, df = 5, P <.001). DISCUSSION: Qualitative findings revealed that personal, organizational, and social factors influenced attitudes of nurses toward family presence.

Adult↗
PubMed2004

A comparison of wait times and patients leaving without being seen when licensed nurses versus unlicensed assistive personnel perform triage.

INTRODUCTION: In today's health care environment, nurses are sometimes substituted with unlicensed assistive personnel (UAP), despite the lack of research into the possible negative effects. This study compared the wait time and the number of patients who left without being seen (LWBS) between triage systems that use nurses (including licensed practical nurses, nurses with an associate's degree, and nurses with a baccalaureate degree) versus UAP. METHODS: This study was a comparative descriptive retrospective chart review. The sample consisted of 2 parts: Part 1 involved charts for every fifth patient presenting to the emergency department during the second shift in April 1997 (N = 323) and April 1998 (N = 281). Part 2 included the monthly number of patients who LWBS between January 1997 and April 1998. Data were collected from department-generated reports with use of investigator-designed forms. Specific time increments were calculated and compared between triage systems via 2-tailed t tests. The number of patients who LWBS was analyzed for trends. RESULTS: Wait time decreased by 73 minutes and the number of patients who LWBS decreased by 85% when nurses performed triage. DISCUSSION: Results of this study show that a triage system using nurses provided more services during triage and were associated with less wait time after triage and a decreased likelihood of patients LWBS compared with the triage system using UAP.

Emergency Nursing↗
PubMedDate not supplied

Sigmoidoscopy training for nurses and resident physicians.

Five gastrointestinal nurses (three licensed practical nurses and two registered nurses) and five resident physicians were enrolled in a sigmoidoscopy training protocol. Patients referred for a screening sigmoidoscopy were randomized to have the procedure performed by a nurse or a resident. Objective criteria for proficiency were depth of endoscope insertion, procedure time, and identification of anatomic landmarks and pathologic lesions; subjective criteria included thoroughness and the need for assistance. Four nurses and all of the residents were deemed proficient at a mean of 20 procedures in both groups. One registered nurse did not achieve proficiency after 35 procedures; this determination was based on subjective criteria. Insertion depth and identification of normal anatomy improved with experience. Trainees missed 1.4% of pathologic lesions, and no complications were observed. Nurses can be trained to perform a screening sigmoidoscopy in a safe and effective manner, with results similar to those for doctors.

Education, Nursing, Continuing↗