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(1 - 6 of 6)
- Title
- The Effect of Registered Nurse Supply on Population Health Outcomes: A Distributed Lag Model Approach.
- Creator
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Sampson, Carla Jackie, Unruh, Lynn, Malvey, Donna, Liu, Albert Xinliang, Neff, Donna, University of Central Florida
- Abstract / Description
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Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth...
Show moreRegistered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables in the hypothesized relationship. Therefore, these variables were examined using three different models: contemporaneous; a three-year lagged; and a distributed lag (both contemporaneous and lagged variables). Quadratic terms for RN and physician supply variables were included. Because the Area Health Resource File (AHRF) outcome variables were skewed toward zero and left censored, Tobit regression analyses were used. Data were obtained from 19 states using historical RN Supply data for 1,472 counties, representing 47% of the total target population of 3,108 U.S. counties and county equivalents. Regions with rural populations(-)the Midwest and Southeast(-)were overrepresented. Higher RN supply is positively related to higher mortality rates from ischemic heart disease, other cardiovascular disease, and chronic lower respiratory disease in the distributed lag models. Higher RN supply is not significantly related to rates of low infant birth weight, infant mortality, or mortality from cerebrovascular disease in any model. Higher RN supply is positively related to total deaths in the contemporaneous and lagged model. The results suggest a counter-intuitive, but non-linear relationship between RN supply and health outcomes. More research is needed to understand these relationships and policies must be devised to reduce the current and growing future RN shortage.
Show less - Date Issued
- 2018
- Identifier
- CFE0007091, ucf:51933
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007091
- Title
- Rapid Response Teams versus Critical Care Outreach Teams: Unplanned Escalations in Care and Associated Outcomes.
- Creator
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Danesh, Valerie, Neff, Donna, Aroian, Karen, Andrews, Diane, Unruh, Lynn, University of Central Florida
- Abstract / Description
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The incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO)...
Show moreThe incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO) model is related to the frequency of unplanned intra-hospital escalations in care compared to a RRT system based on staff nurse identification of vital sign derangements and physical assessments. The RRT model, in which staff nurses identified vital sign derangements to active the system, was compared with the addition of a CCO model, in which rapid response nurses activated the system based on Early Warning Score line graphs of patient condition over time. Logistic regressions were used to examine retrospective data from administrative datasets at a 237-bed community non-teaching hospital during two periods: 1) baseline period, RRT model (n=5,875) (Phase 1: October 1, 2010 (-) March 31, 2011), and; 2) intervention period, RRT/CCO model (n=6,273). (Phase 2: October 1, 2011 (-) March 31, 2012). The strongest predictor of unplanned escalations to the Intensive Care Unit was the type of rapid response system model. Unplanned ICU transfers were 1.4 times more likely to occur during the Phase 1 RRT period. In contrast, the type of rapid response model was not a significant predictor when all unplanned escalations (any type) were grouped together (medical-surgical-to-intermediate, medical-surgical-to-ICU and intermediate-to-ICU). This is the first study to report a relationship between unplanned escalations and different rapid response models. Based on the findings of fewer unplanned ICU transfers in the setting of a CCO model, health services researchers and clinicians should consider using automated Early Warning score graphs for hospital-wide surveillance of patient condition as a safety strategy.
Show less - Date Issued
- 2015
- Identifier
- CFE0006212, ucf:51093
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006212
- Title
- Nurse Managers, Work Environment Factors and Workplace Bullying.
- Creator
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Parchment, Joy, Andrews, Diane, Neff, Donna, Conner, Norma, Yan, Xin, Saunders, Carol, University of Central Florida
- Abstract / Description
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The purpose of this dissertation is to explore relationships between authentic leadership style, global social power, job demand, job control, and workplace bullying of nurse managers in acute care settings across the United States.Over 30 years of workplace bullying research exists. Consequences are linked to intent to leave, turnover, and harmful emotional and physical effects. Published studies identifying nurse managers as targets of workplace bullying and work environment factors that...
Show moreThe purpose of this dissertation is to explore relationships between authentic leadership style, global social power, job demand, job control, and workplace bullying of nurse managers in acute care settings across the United States.Over 30 years of workplace bullying research exists. Consequences are linked to intent to leave, turnover, and harmful emotional and physical effects. Published studies identifying nurse managers as targets of workplace bullying and work environment factors that contribute to nurse managers being recipients of workplace bullying either, downward from their leaders, horizontally from their nurse manager peers, and upwards from their clinical nurses were not identified.A descriptive, cross-sectional design using an online survey was utilized. Descriptive, inferential, and multivariate analyses were used to identify relationships and the likelihood of workplace bullying occurring. Thirty-five percent (n = 80) of nurse managers reported being a target of workplace bullying. Managers sustained occasional (56%, n = 45) and severe (44%, n = 35) levels of workplace bullying, 65% (n = 43) identified their executive nurse leader as the predominate perpetrator. Authentic leadership, job demand, job control correlated significantly (p = (<).01) with workplace bullying and job demand demonstrated the strongest likelihood (OR = 3.9) for predicting workplace bullying. Nurse Managers are four times more likely to be a recipient of workplace bullying when their job responsibilities are classified as demanding. This study expanded the science and demonstrated that nurse managers, the backbone of organizations, are recipients of workplace bullying emanating predominately from executive nurse leaders, but also from clinical nurses and their nurse manager peers. Given the harmful consequences of workplace bullying, as 'guardians' of and 'advocates' for their teams, executive nursing leaders, have an ethical and operational responsibility to ensure nurse managers are able to practice in a safe environment.
Show less - Date Issued
- 2015
- Identifier
- CFE0005986, ucf:50771
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005986
- Title
- Perceived social support and self-care in patients hospitalized with heart failure.
- Creator
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Chamberlain, Lyne, Sole, Mary Lou, Conner, Norma, Neff, Donna, Hofler, Richard, University of Central Florida
- Abstract / Description
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Problem: Heart failure is the most frequent cause for hospital readmissions in Medicare recipients, with an estimated annual cost of $12 billion. Heart failure hospitalizations are also an independent risk factor for increased mortality. Self-care, thought to be enhanced by perceived social support, is key to managing this syndrome, and up to 50% of readmissions are considered the result of inadequate self-care.Purpose: To evaluate perceived social support and self-care characteristics of...
Show moreProblem: Heart failure is the most frequent cause for hospital readmissions in Medicare recipients, with an estimated annual cost of $12 billion. Heart failure hospitalizations are also an independent risk factor for increased mortality. Self-care, thought to be enhanced by perceived social support, is key to managing this syndrome, and up to 50% of readmissions are considered the result of inadequate self-care.Purpose: To evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure, and to compare these characteristics with a study of ambulatory patients with heart failure. In addition, to assess the relationship between perceived social support and self-care.Methods: This was a multi-site descriptive comparative study. Following informed consent, participants were screened for sufficient cognition to consent. Patients were then administered the Medical Outcome Study-Social Support emotional/informational subscale, and the three Self-Care of Heart Failure Index subscales. Two-sample t tests and multiple regression were utilized to analyze the data. Results were compared with a sample of community-dwelling heart failure patients in another study.Results: Of 161 consented patients 121 passed the cognition screening and were included in the study. Average age was 71 years; gender and type of heart failure was evenly split. Mean Charlson Comorbidity Score was 7.43, and the mean six month number of hospitalizations was 2.43. Approximately 31% of participants were African American. Both perceived social support (t=-4.007, df=211, p(<).001) and self-care maintenance (t=-3.343, df=220, p(<).002) scores were lower in the hospitalized participants than the comparison group of community dwellers. Perceived social support was associated with self-care confidence (?=.210, t=-2.210, p(<).029), but not self-care maintenance or self-care management. Forty-six percent of participants scored higher than the 70% cut point for adequate self-care confidence, which was 1.4 times higher than in the community participants. Self-care confidence was also related to self-care maintenance (?=.388, t=4.676, p(<).001) and self-care management (?=.327, t=3.793, p(<).001).Conclusions: Results have implications for facilitating self-care knowledge and skills in heart failure patients. Patient education during hospitalization may not be the ideal timing to promote understanding and retention. Interventions to enhance self-care confidence may assist patients to develop self-care skills more than current teaching techniques. Because cognitive deficiencies were found in 25% of pre-screened participants for this study, further research is recommended to determine if hospitalized patients have transient cognitive issues or if cognitive impairments are more prevalent in all heart failure patients.
Show less - Date Issued
- 2015
- Identifier
- CFE0005933, ucf:50844
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005933
- Title
- The Impact of Relational Coordination and the Nurse on Patient Outcomes.
- Creator
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Dejesus, Fanya, Andrews, Diane, Sole, Mary Lou, Neff, Donna, Yan, Xin, Unruh, Lynn, University of Central Florida
- Abstract / Description
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Healthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with...
Show moreHealthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with injury, catheter- associated urinary tract infection, and central line-associated blood stream infection. A retrospective correlational survey design using cross sectional data was used to conduct this quantitative study. An electronic relational coordination survey was sent to 1124 eligible registered nurses from 43 nursing units within a 5-hospital magnet-designated healthcare system to gather their perception of the strength of relationship and communication ties of their work team. The nurse practice environment as well as nurse education were control variables. With 406 nurses who completed the survey (36% response rate), findings revealed that the stronger relational coordination ties are amongst the healthcare team, the lower the rate of adverse nurse sensitive patient outcomes as indicated by their inverse relationship. (rs=-.31, p=.050). In a Negative Binomial Regression model, relational coordination was a significant predictor (?-1.890, p=.034) of nurse sensitive patient outcomes whereas nurse education level (p=.859) and nurse practice environment (p=.230) were not. Data affirms that relational coordination, a relationship and communication intensive form of coordination does impact patient outcomes. This research provides significant information to health care leaders and institutions with goals of improving patient care outcomes through enhancement of coordination of care and optimization of healthcare teams.
Show less - Date Issued
- 2015
- Identifier
- CFE0005939, ucf:50823
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005939
- Title
- An Evaluation of Anxiety Following Substance Abuse Withdrawal and Assessment of Somatic Treatments presently Available with a Focus on Cranial Electrotherapy Stimulation.
- Creator
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Hutchison, Janet, Neff, Donna, Weiss, Josie, Covelli, Maureen, Seikel Thomas, Stacy, University of Central Florida
- Abstract / Description
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Addictive disorders/substance use disorders (SUDS) affect almost everyone in the United States, either directly or indirectly. The cost of substance abuse to the social and economic structure in the United States is huge. Anxiety is one of the most frequently mentioned symptoms which lead to relapse during the early weeks of recovery due to neurohormonal changes in the limbic system as well as cortisol production which occur during this time. Present research in the treatment of anxiety in...
Show moreAddictive disorders/substance use disorders (SUDS) affect almost everyone in the United States, either directly or indirectly. The cost of substance abuse to the social and economic structure in the United States is huge. Anxiety is one of the most frequently mentioned symptoms which lead to relapse during the early weeks of recovery due to neurohormonal changes in the limbic system as well as cortisol production which occur during this time. Present research in the treatment of anxiety in substance abuse and long term recovery is focused on genetics and pharmaceuticals, however most pharmaceuticals produce sedation. Additional therapies in early recovery, which decrease the symptoms of anxiety while enhancing cognitive ability to learn and apply coping skills, are needed.Purpose: The purpose of this dissertation was to identify the natural degradation of anxiety symptoms occurring during the first few weeks following detox from alcohol or opiates. To identify non pharmacological methods in use to decrease anxiety symptoms during this period, and then examine whether treatment with Cranial Electrotherapy Stimulation (CES) would enhance the degradation of anxiety symptoms. Methods and Results: The initial prospective study of 53 men in residential treatment, measured anxiety on entry, 30 and 60 days. The results found that increased anxiety measured prior to a participant leaving against medical advice was more significant than increased anxiety measured on admission. The follow-on pilot study in the same residential program was a double-blind experimental study using CES with active and placebo CES units loaned from the manufacturer. The intervention was conducted during the first 3 weeks of opiate/alcohol abstinence; a period identified when anxiety peaks, and dropout rate is high. There were 29 men in the experimental group and 31 in the placebo group. Salivary cortisol and state anxiety were measured on the first and final day of CES treatment. Anxiety was also measured at study enrollment and at 30 days when study enrollment was terminated. The results were statistically inconclusive as both the placebo and CES (experimental) groups trended downward; however the trend was greater in the CES group. Discussion/Implications: Anxiety was identified as a significant factor in leaving treatment early. Cranial Electrotherapy Stimulation appears to decrease anxiety in non-substance abusing populations. However, these finding were not supported in this substance abusing population during the first month of recovery. Although CES appeared to be the most promising alternative therapy, more research is needed in the use of this and other emerging therapies for the treatment of anxiety symptoms during this early recovery period.
Show less - Date Issued
- 2016
- Identifier
- CFE0006118, ucf:51169
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006118
