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PubMed2004

A test instrument for palliative care.

This article describes a methodological study concerning the development of a test instrument that can be used for measuring the effects of a course in palliative care on registered nurses and licensed practical nurses. This test instrument is comprised of two parts: an expertise and insight test and a self-efficacy instrument and is tested in three panels. The expertise and insight test appears to be usable for measuring the effects of a course in palliative care. The reliability and validity of the test were found to be adequate for evaluation of the effects of a post-basic palliative care course. The generality of the self-efficacy instrument was reduced because high-scoring items in the area of communication had to be removed. Moreover, the scores of the various categories of respondents discriminate less than expected on the basis of their previous education and the test results. Many respondents, regardless of their background, believed themselves to have a high level of competency. The self-efficacy instrument must therefore be used cautiously.

Analysis of Variance↗
PubMed2003

Coping with a crowded ED: an expanded unique role for midlevel providers.

Crowding in the emergency department (ED) has multiple causes, including space and staffing in both inpatient areas and the ED. Waiting for inpatient beds is the primary issue in our ED. Waiting inpatients require continuing care and attention from emergency-medicine (EM) physicians. As a managerial response, we developed a unique role for midlevel practitioners (MLPs) in which they could provide "back-end" work for patients awaiting inpatient beds. After initial EM physician evaluation, patients without ready inpatient beds were grouped in the ED and their care was transferred to the transition team (TT). The TT consisted of an MLP (nurse practitioner or physician assistant) and a registered nurse or licensed practical nurse, all reporting to ED supervisors. MLPs were readily available from the local medical professional market. The TT provided all patient care until a patient was seen by the admitting inpatient service or until the patient left for an inpatient unit. The major TT objectives were a reduction of EM physician work in caring for inpatients, and improved patient care. We demonstrated that the TT assumed a significant patient load, an indirect measure of reduced EM physician work, but this did not improve patient satisfaction. The TT clinical role is less desirable to MLPs than are other traditional clinical roles. The TT is a potentially available, incremental staffing resource for a crowded ED.

Continuity of Patient Care↗
PubMed2000

Nurses' knowledge of wound irrigation and pressures generated during simulated wound irrigation.

OBJECTIVE: Our objective was to describe nurses' knowledge of wound irrigation and their ability to produce appropriate irrigation pressures established by the US Agency for Healthcare Research and Quality (AHRQ) during simulated procedures. SUBJECTS AND SETTING: A convenience sample of 28 registered nurses and licensed practical nurses from a university medical center in the Northwest United States comprised the subjects. METHODS: Participants were asked to complete a demographic data sheet and a questionnaire related to wound irrigation and to perform 2 simulated wound irrigations. The questionnaire developed for the study contained 9 questions about general knowledge of wound irrigation and 9 questions about wound irrigation technique. A device to measure the pressures generated by the participants during simulated wound irrigation was developed and calibrated using a transducer calibrated by the National Institute of Science and Technology. RESULTS: Participants' scores were high on items querying general knowledge of wound irrigation but lower on questions relating to irrigation technique. Thirteen participants achieved irrigation pressures within the guidelines established by the AHRQ, 14 fell below the guidelines, and 1 produced pressures exceeding the guidelines. CONCLUSION: The majority of nurses participating in this small study had some difficulty answering questions relating to wound irrigation technique. In addition, performance on simulated irrigation showed that the majority were not able to generate pressures in the recommended range. Nursing professionals and educators should be aware of these knowledge and performance issues and incorporate educational content and experiences in nursing programs designed to aid nurses in improving wound irrigation practice.

Academic Medical Centers↗
PubMed1991

An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study.

OBJECTIVE: To prospectively examine the epidemiology of blood and body fluid exposures sustained by medicine housestaff, medical school students, registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides (NAs) on general medicine wards and to define problem areas that may be amenable to change. DESIGN: Daily data collection during 9 months using a self-reporting questionnaire. SETTING: General medical wards in 2 tertiary referral hospitals. PARTICIPANTS: Medicine housestaff/students and nursing personnel. RESULTS: Physicians reported 644 exposures, of which 98 (15.2%), 296 (46.0%), and 250 (38.8%) were sustained by medicine residents, interns, and students, respectively. Blood contact occurred with 591 (91.8%) exposures. For physicians, 575 (89.3%) exposures occurred during venipuncture, intravenous catheter manipulation, and arterial punctures. Interns and students most commonly incurred exposures during venipunctures and intravenous manipulations; residents commonly were exposed during emergent intravenous catheter placements. Five-hundred-twenty-two (81%) exposures occurred between 7 A.M. and 7 P.M. During 524 (81.4%) exposures, physicians were not using barrier devices. Nurses reported 235 exposures, of which 140 (59.6%), 23 (9.8%), and 72 (30.6%) were sustained by RNs, LPNs, and NAs, respectively. RN exposures commonly occurred during intravenous manipulations and glucometer fingersticks. LPNs and NAs incurred a higher percentage of exposures during nonprocedural patient care. Blood contact and wound drainage accounted for 167 (71.1%) and 31 (13.2%) exposures, respectively. CONCLUSIONS: Exposures to blood and body fluids frequently are incurred by healthcare workers on general medical wards. Efforts to reduce these exposures should be directed not only at improving procedural skills of healthcare workers for venipunctures, intravenous catheter insertions, and glucometer fingersticks, but also in increasing barrier use during procedural and nonprocedural tasks.

Blood↗
PubMed2002

Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities.

The validity and cost-effectiveness of three methods for detecting medication errors were examined. A stratified random sample of 36 hospitals and skilled-nursing facilities in Colorado and Georgia was selected. Medication administration errors were detected by registered nurses (R.N.s), licensed practical nurses (L.P.N.s), and pharmacy technicians from these facilities using three methods: incident report review, chart review, and direct observation. Each dose evaluated was compared with the prescriber's order. Deviations were considered errors. Efficiency was measured by the time spent evaluating each dose. A pharmacist performed an independent determination of errors to assess the accuracy of each data collector. Clinical significance was judged by a panel of physicians. Observers detected 300 of 457 pharmacist-confirmed errors made on 2556 doses (11.7% error rate) compared with 17 errors detected by chart reviewers (0.7% error rate), and 1 error detected by incident report review (0.04% error rate). All errors detected involved the same 2556 doses. All chart reviewers and 7 of 10 observers achieved at least good comparability with the pharmacist's results. The mean cost of error detection per dose was $4.82 for direct observation and $0.63 for chart review. The technician was the least expensive observer at $2.87 per dose evaluated. R.N.s were the least expensive chart reviewers at $0.50 per dose. Of 457 errors, 35 (8%) were deemed potentially clinically significant; 71% of these were detected by direct observation. Direct observation was more efficient and accurate than reviewing charts and incident reports in detecting medication errors. Pharmacy technicians were more efficient and accurate than R.N.s and L.P.N.s in collecting data about medication errors.

Chi-Square Distribution↗
PubMed2006

Measuring staff turnover in nursing homes.

PURPOSE: In this study the levels of staff turnover reported in the nursing home literature (1990-2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined in nursing homes. DESIGN AND METHODS: Data came from a survey mailed to administrators of 526 nursing homes during March 2003. Facilities were located in four states: Missouri, Texas, Connecticut, and New Jersey. Three hundred and fifty-four responses were received, giving a response rate of 67%. RESULTS: The 1-year turnover rates identified in these facilities were 119%, 89%, 87%, 57%, and 48%, for nurse aides, licensed practical nurses, registered nurses, administrators, and directors of nursing, respectively. However, findings show that the definition of turnover used could influence the relative difference between these reported rates by as much as 47%. IMPLICATIONS: As a result of measurement error, turnover rates may be misrepresented in prior studies. On the basis of the results of this investigation, several recommendations are made for future data-collection initiatives that will eliminate some of this measurement error.

Data Collection↗
PubMed1996

Nurses' compliance with universal precautions before and after implementation of OSHA regulations.

The principal objective of this study was to investigate whether or not nurses' compliance with universal precautions procedures improved after the mandatory Occupational Safety and Health Administration regulations were implemented in 1992. Two random samples of registered nurses and licensed practical nurses registered in Tennessee responded to survey questionnaires measuring universal precautions compliance and practice barriers to compliance in 1991 and 1993 (n = 306). The 1993 sample of nurses reported significantly greater compliance with universal precautions (p < 0.001) than the 1991 sample. The most noteworthy improvement between the 1991 and the 1993 groups was a significant increase in compliance for patients described as HIV/HBV-status unknown and HIV/HBV-negative (p < 0.001). Practice barriers hindering compliance with universal precautions decreased significantly (p < 0.001) in the 1991-1993 time frame. Problematic practice barriers identified in both groups were needle recapping, preference for isolation door signs, and concerns about offending patients and visitors.

Adult↗
PubMedDate not supplied

The effect of nursing professional pay structures and pay levels on hospitals' heart attack outcomes.

The effect of nursing professionals (i.e., nurse aid/orderly, licensed practical nurse, registered nurse) pay structures and pay levels on hospitals risk-adjusted heart attack outcomes was determined. Operationalizing hospitals' heart attack outcomes as their thirty-day risk-adjusted mortality rates, a positive curvilinear relation is hypothesized between pay dispersion and hospitals' heart attack outcomes, whereas a direct relation is hypothesized between pay level and hospitals' heart attack outcomes. Pay level is also hypothesized as a moderator of the relation between pay dispersion and hospitals' heart attack outcomes. Using a sample of 138 California hospitals, support is not found for either the curvilinear relation between hospitals' nursing professionals pay dispersion and hospitals' heart attack outcomes, or the direct relation between nursing professionals' pay level and hospitals' heart attack outcomes. Support is found for the moderation hypothesis in which nursing professionals' pay level moderates the relation between hospitals' nursing professionals pay dispersion and hospitals' heart attack outcomes. Implications for practice are discussed in light of the study's results.

California↗
PubMedDate not supplied

Nurses' attitudes toward do-not-resuscitate orders.

A study was carried out to evaluate burn nurses' attitudes toward do-not-resuscitate (DNR) orders. Questionnaires were submitted to 57 staff members, 52 of whom responded. Seventy-five percent of those responding ranged in age from 30 to 49 years. Seventy-one percent were registered nurses or licensed practical nurses. Sixty-five percent of the respondents had been in health care for more than 10 years; 25% had been in burn care for more than 10 years. Fifty percent were Protestants. Thirty-seven percent of the total described themselves as very religious. Ninety-four percent of respondents felt that DNR orders are sometimes appropriate. Eighty-eight percent felt that DNR decisions should not be made solely by the physician. Ninety-five percent felt that input from patients, family members, or both is essential. Having formal ethics committees make such decisions was opposed by 75% of the respondents. Fifty-six percent felt nurses should be involved in such decisions and 21% opposed such involvement. There was considerable uncertainty, disagreement, or both about whether a DNR order should include stopping all medical treatment, ventilators, intravenous fluids, gastric feedings, and medication. The study indicated statistically significant support for the view that DNR orders are appropriate in some cases. Which patients should be given DNR status and who should make the decision about writing DNR orders were more controversial questions.

Adult↗
PubMed1998

The relationship of job satisfaction with organizational variables in public health nursing.

OBJECTIVE: This study examined the relationship of the organizational variables of structure, technology, and environment with job satisfaction among public health nurses in a southeastern state. BACKGROUND: There is little research on the characteristics of the work environment that influence nurses to remain in the public health work setting. Prior research in this setting has focused on the negative aspects of the nursing positions. These aspects of least desirability for the public health nurse provide only a partial view of job satisfaction. To decide and plan specific strategies, the nurse administrator must have valid and useful information about the positive aspects of job satisfaction of public health nurses. METHODS: The researchers distributed a questionnaire to all licensed nursing personnel employed by a state public health department. Data collection consisted of four tools: 1) structure instrument; 2) technology instrument; 3) environmental uncertainty instrument; and 4) McCloskey-Mueller Job Satisfaction Scale (MMSS). The sample of 838 public health nurses (response rate of 50.6%) included representation from all 13 districts and the central office of the public health department. RESULTS: Significant relationships were found between job satisfaction and the demographic variables of nurse category (registered nurse and licensed practical nurse) and years of experience with the public health department. The critical variable for predicting job satisfaction in this group of public health nurses was organizational structure (vertical participation, horizontal participation, and formalization). Dimensions of structure accounted for 41% of the variance in job satisfaction. Structure remained the critical predictor of job satisfaction, although the findings do not suggest a conclusive model. The three dimensions of technology (instability, variability, and uncertainty) and environmental uncertainty assumed significance only in concert with each other or with the dimensions of structure. CONCLUSIONS: This study contributes to nursing management theory by examining the relationship of organizational structure, technology, and environmental uncertainty with job satisfaction in public health nurses. This research also has implications for nurse administrators in public health for creating more flexible work environments and facilitating staff involvement in decision making.

Education, Nursing↗
PubMed2006

End-of-life care: an educational intervention for rural nurses in southeastern USA.

AIM: To assess the impact of three educational presentations as an intervention for increasing knowledge of end-of-life care for rural nurses in assisted living and nursing home environments. DESIGN: A repeated measures design (quantitative component) evaluated the effects of the educational intervention. Two open-ended questions yielded qualitative data. SAMPLE AND SETTING: A convenience sample (n = 9) of Registered Nurses and Licensed Practical Nurses employed in an assisted living facility or nursing home in the rural, southeastern region of the USA. Level of nursing experience ranged from 6 to 28 years. ANALYSIS: Frequency distributions, difference of means test for paired samples. RESULTS: Post test scores were significantly higher (t = 6.999; p < 0.001) than pretest scores regarding overall knowledge on end-of-life care. Attitudes and perceptions of participants changed in defining what constitutes a 'good death'. CONCLUSIONS: Classroom educational presentations are an effective means of changing attitudes and improving end-of-life care knowledge. Additional education and support for rural nursing personnel involved with residents of long-term care may enhance end-of-life care.

Adult↗
PubMed2002

[Social representation of nursing workers who are not nurses (nursing technicians and aids) on the work at the intensive care unit in a teaching hospital].

The study identifies and analyses social representations of Intensive Care Unit (ICU) nursing staff about their work and how they express feelings of sorrow and pleasure associated to their job. The theoretical and methodological reference used by this study was the Theory of Social Representations. Interviews were carried out with auxiliary nursing personnel (licensed practical nurse and nurse technician). The data were analyzed by analysis-of-content technique, in particular the enunciation. The results indicate that ICU units causes much suffering, forcing nursing staff to utilize, individually, several defense mechanisms traditionally described by psychoanalysis and psychopathology.

Brazil↗
PubMed2005

Associations of sleep problems and recent life events with smoking behaviors among female staff nurses in Japanese hospitals.

For the purpose of examining the relation of sleep problems and other possible correlates with smoking among staff nurses in hospitals, the cross-sectional data of a self-administered questionnaire survey for 522 Japanese female staff nurses were reanalyzed. Registered nurses or licensed practical nurses were 82%, while nursing assistants were 18%. The prevalence of current smoking (PCS) was 29%, being higher than that in the general population of Japanese women. The current smokers exhibited a high tendency toward tobacco dependence. Multivariate analyses revealed that PCS was associated with recent frequent night shifts and a large amount of support from coworkers, while the association of a large amount of job control and a feeling of light overnight sleep with PCS was also suggested. The tobacco-dependent tendency was associated with recent life events and the presence of insomnia. It is possible that smoking is a countermeasure against sleepiness caused by the disadaptation to shift-work, or that tobacco-intake pharmacologically disturbs sleep. For decreasing PCS in staff nurses, further research should focus on the relation of smoking with their sleepiness and shift-working system, and also on the process in which major life events develop smoking behaviors.

Adult↗
PubMedDate not supplied

Home study refresher courses for RNs and LPNs.

The home study refresher courses for registered nurses and licensed practical nurses have met a real need in this time of nursing shortage. The provision for self-paced study and self-arranged supervision of clinical practice allows the maximum flexibility to adjust to family responsibilities.

Curriculum↗
PubMedDate not supplied

Factors associated with a perceived harmful outcome from medication errors: a pilot study.

The purpose of this pilot study was: 1) to describe factors associated with a perceived harmful outcome following medication errors made by nurses and 2) to refine the Medication Error Risk Profile (MERP) (Wolf, 1992). Ninety-four registered nurses and licensed practical nurses completed the MERP. Multiple stepwise regression analyses were used to explain the variance in the dependent variable of perceived patient harm with: 1) phases of preparation and administration; 2) categories of person responsible for the error; 3) interventions needed following the error and symptoms related to the error. The exploratory regression analysis suggests a model in which the dispensing phase of administration, the physician and pharmacist categories of persons responsible for the error, and the interventions of patient transfer to another unit and additional medications given following the error explain 53% of the variance in perceived harmful outcome for patients consequent to medication errors. A moderately strong correlation (r = .46, P < .001) existed between perceived patient harm as measured on the four-point scale and total intervention score following medication errors.

Adult↗
PubMed1997

Unity and power: lessons from baccalaureate entry.

Education for nurses has been a contentious issue within and outside of the nursing profession since the American Nurses Association's 1965 support of the baccalaureate degree in nursing as basic educational criteria for the professional nurse (American Nurses Association, 1965). For 10 years, North Dakota has remained the only state to have achieved this educational goal, and North Dakota nurses have been able to defend this position against repeated challenges within the state since 1985. This article places nursing education within the context of the evolving, sweeping changes that are impacting all providers in the health care arena. The authors explain how and why North Dakota nurses were able to accomplish the standardization of nursing education for two levels of nurses: registered nurses and licensed practical nurses. The article describes the positive outcomes for nurses and clients that have occurred over the past 10 years.

American Nurses' Association↗
PubMed1999

The effects of managed care and prospective payment on the demand for hospital nurses: evidence from California.

OBJECTIVE: To examine the effects of managed care and the prospective payment system on the hospital employment of registered nurses (RNs), licensed practical nurses (LPNs), and aides. DATA SOURCES: Hospital-level data from California's Office of Statewide Health Planning and Development (OSHPD) Hospital Disclosure Reports from 1976/1977 through 1994/1995. Additional information is extracted from OSHPD Patient Discharge Data. STUDY DESIGN: Multivariate regression equations are used to estimate demand for nurses as a function of wages, hospital output, technology level, and ownership. Separate equations are estimated for RNs, LPNs, and aides for all daily services and for medical-surgical units. Instrumental variables are used to correct for the endogeneity of wages, and fixed effects are included to control for unobserved differences across hospitals. PRINCIPAL FINDINGS: HMOs are associated with a lower use of LPNs and aides, and HMOs do not have a statistically significant effect on the demand for RNs. Managed care has a smaller effect on nurse staffing in medical-surgical units than in daily service units as a whole. The prospective payment system does not have a statistically significant effect on nurse staffing. CONCLUSIONS: HMOs have affected nursing employment both because HMOs have reduced the number of discharges and because of a direct relationship between HMO penetration and the demand for LPNs and aides. Contrary to press reports, LPNs and aides have been affected more by HMOs than have registered nurses.

California↗
PubMed2000

Nurses' perceptions of interdisciplinary collaboration.

The purpose of this study was to statistically characterize nurses' perceptions of the collaboration between nursing and other health disciplines and to examine the relationships among education level, education, experience, and work setting as they relate to the perception of collaboration. The significance of collaboration was conceptually supported by Luszki and Gray's framework of interdisciplinary collaboration. The convenience sample consisted of undergraduate nursing students, licensed practical nurses (LPNs), registered nurses (RNs) pursuing a baccalaureate degree in nursing (BSN), and graduate level BSN-prepared nurses pursuing a master's degree (MSN) in some subspecialty. The findings were significant for an increased level of education and increased perception of collaboration.

Cooperative Behavior↗