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- 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
- Prehabilitation (Prehab): Prevention in Motion.
- Creator
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Russell, Billie, Sole, Mary Lou, Chase, Susan, Damato-Kubiet, Leslee, Gammonley, Denise, University of Central Florida
- Abstract / Description
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ABSTRACTCardiovascular disease is the leading cause of death for U.S. adults. It adds greater than $100 billion to U.S. health care costs annually. Rates of morbidity, mortality, and economic burden of the disease could be dramatically reduced with improvements in sedentary behaviors among adults with coronary artery disease (CAD). A regular commitment to moderate physical activity can reduce ischemic heart events up to 50%. Although the benefits of physical activity are well-known for...
Show moreABSTRACTCardiovascular disease is the leading cause of death for U.S. adults. It adds greater than $100 billion to U.S. health care costs annually. Rates of morbidity, mortality, and economic burden of the disease could be dramatically reduced with improvements in sedentary behaviors among adults with coronary artery disease (CAD). A regular commitment to moderate physical activity can reduce ischemic heart events up to 50%. Although the benefits of physical activity are well-known for individuals with coronary artery disease, an estimated 70% of this population remains relatively sedentary. Hospital-based cardiac rehabilitation programs are the single secondary prevention option offered to improve physical activity habits in persons with CAD. Although effective, cardiac rehabilitation is inaccessible for the majority of CAD sufferers and is offered only after an acute cardiac event. Different from rehabilitation, prehabilitation (prehab) programs use physical activity as a means to deter a worsening condition or prevent injury before an acute event occurs. These programs have proved successful in other areas of medicine but there are currently no such secondary prevention programs available for stable persons with CAD in the U.S. A home-based prehab program could help adults with CAD establish improved physical activity habits and circumvent many of the barriers associated with admission and attendance of a hospital-based cardiac rehabilitation program. Researchers have indicated that self-efficacy is key to initiation and sustentation of a regular physical activity habit, regardless of the physical activity program that one attends. These habits are more likely to last when participants receive self-efficacy based support for an average of 66 days. The purpose of this study was to determine if a nurse-practitioner-led, home-based, prehab program could assist adults with CAD to improve and maintain increased physical activity habits and levels of self-efficacy for physical activity. The five primary facilitators of self-efficacy were used to devise a 10-week prehab program. A convenience sample of 54 adults with diagnosed CAD was recruited from cardiology practices in St. Johns County, Florida. The research population was 68.5% (n=37) male, 88.9% (n=48) Caucasian, and 74% (n=40) married with a mean age of 68.57 years. Participants attended a 90-minute prehab class which offered health education and group discussion of barriers and goals for regular physical activity. Following the class, participants were contacted weekly for 10-weeks to discuss goal progress, assist in circumventing barriers, and revise physical activity goals as needed. After the 10-week call period, participants were contacted 30-days later to assess for physical activity habit maintenance and any sustained benefit in self-efficacy for physical activity. Self-efficacy for exercise was measured before the prehab class, after the prehab class, and after the 10-week intervention period using the Short Self-Efficacy Expectations scale (SSEE), Multidimensional Outcomes Expectations for Exercise Scale (MOEES), and the Barriers Self-Efficacy Scale (BARSE). All baseline measures of self-efficacy (MOEES, BARSE, SSEE) improved significantly immediately following the prehab class. Baseline physical outcome expectations of the MOEES (m=21.87, sd=4.67), self-evaluative outcome expectations of the MOEES (m=16.70, sd=4.15) and SSEE (m=12.75, sd=4.02) remained significantly improved after the 10-week intervention period (p(<).05). At the 10-week assessment, mean significant self-efficacy scores were 24.39 (sd=1.26, p(<).01) for physical outcome expectations, 18.39 (sd=2.27, p(<).02) for self-evaluative outcome expectations, and 15.06, (sd=3.25, p(<).001) for SSEE. The SSEE was reassessed 30-days after the study and remained significantly improved compared to baseline (m=15.65, sd=3.42, p(<).01). Qualitative data collection coincided with the quantitative self-efficacy findings. Participants reported satisfaction with physical activity goal attainment and increased confidence to continue with a regular physical activity plan. The Godin Leisure-Time Exercise Questionnaire (GLTEQ) was used to assess activity levels at baseline, during each weekly phone call, at the end of 10-weeks, and 30-days after the study. Repeated-measures ANOVA (F (2,90) = 21.86, p(<).001) revealed that participant's baseline physical activity volume measured by GLTEQ (m=18.39, sd= 16.93) improved significantly after 10 weeks in the prehab study (m=41.10, sd=24.11, p(<).001) and remained significantly improved when re-measured 30-days after the study (m=39.02, sd=21.87, p(<).001). Qualitative data concurred with quantitative data with participants reporting physical activity habit formation and maintenance of self-regulatory skills. Qualitative data also demonstrated that participants in prehab experienced very similar facilitators and barriers compared to other adults with CAD attempting an exercise program. In summary, the prehab study findings coincided with other research findings in this area. Self-efficacy based support can assist individuals with CAD to improve and maintain physical activity habits. The ease of the intervention likely contributed to lower cost and attrition rates (7%) compared to hospital-based cardiac rehabilitation programs. Although more research is needed, study findings suggest that a nurse-practitioner-led, home-based program could be a viable secondary prevention strategy for stable adults with CAD. This should be considered for the future given that even modest improvements in physical activity can substantially reduce all-cause mortality in this population.
Show less - Date Issued
- 2016
- Identifier
- CFE0006384, ucf:51530
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006384
- Title
- Family Care Giver Knowledge, Patient Illness Characteristics, and Unplanned Hospital Admissions in Older Adults with Cancer.
- Creator
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Geddie, Patricia, Loerzel, Victoria, Sole, Mary Lou, Gammonley, Denise, Norris, Anne, University of Central Florida
- Abstract / Description
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Unplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated...
Show moreUnplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated with unplanned hospital admissions in older adults under treatment for cancer. A conceptual framework based on the literature and this researcher's clinical experienced guided this study. The purpose of this study was to explore the factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions of older adults with cancer. A convenience sample of 129 dyads of older adults with cancer and their family caregivers were approached and enrolled in the adult oncology outpatient infusion centers and inpatient units within a community cancer center in central Florida. Patient demographic and clinical data were obtained through a retrospective medical record review. Family caregiver demographic and side effect knowledge data was collected prospectively during interviews with family caregivers using a newly developed tool, Nurse Assessment of Family Caregiver Knowledge and Action Tool (NAFCKAT). The NAFCKAT contains 11 items to determine baseline knowledge about side effects and plan for managing side effects. A fever subsection consists of 4 knowledge and 2 action questions and a dehydration subsection consists of 2 knowledge and 2 action questions. Preliminary research was conducted to determine reliability and validity of the NAFCKAT. Excellent inter-reliability was found for the tool and preliminary support for validity was determined for the fever subscale. Descriptive statistics and logistic regression analyses were used to evaluate data collected from patient medical records and NAFCKAT scores. Study findings revealed that unplanned hospital admissions were more likely to occur when older adults had the presence of impaired function prior to treatment initiation and/or experienced side effects of infection /fever and vomiting/diarrhea during treatment. The presence of impaired function and family caregiver support (knowledge and availability) did not moderate the relationship between side effects and unplanned hospital admissions. Findings suggest that the presence of impaired function and side effects of infection and fever, and vomiting and diarrhea, predict unplanned hospital admissions in older adults during the active cancer treatment phase. Nurses should advocate for and conduct targeted assessments to identify the presence of functional impairments prior to cancer treatment initiation. In addition, nurses should actively monitor for the presence of cancer treatment-related side effects during the treatment phase of the cancer trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to support older adults and their family caregivers during cancer treatment and reduce the risk for unplanned hospital admissions.
Show less - Date Issued
- 2015
- Identifier
- CFE0005618, ucf:50214
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005618
- Title
- Mobile Phone Short Message Service (SMS) to Improve Malaria Pharmacoadherence in Zambia.
- Creator
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Steury, Elinda, Sole, Mary Lou, Bushy, Angeline, Conner, Norma, Haiduven, Donna, University of Central Florida
- Abstract / Description
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ABSTRACTMalaria significantly contributes to morbidity and mortality rates in Zambia. The currently accepted malaria treatment is artemisinin-based combination therapy (ACT); it is more than 97% effective when the regimen is strictly adhered to. However, the mean ACT adherence rate in sub-Saharan Africa is only approximately 38-48%. Poor pharmacoadherence remains a significant barrier to malaria control and elimination.The purpose of this study was to determine if adherence rates to a six...
Show moreABSTRACTMalaria significantly contributes to morbidity and mortality rates in Zambia. The currently accepted malaria treatment is artemisinin-based combination therapy (ACT); it is more than 97% effective when the regimen is strictly adhered to. However, the mean ACT adherence rate in sub-Saharan Africa is only approximately 38-48%. Poor pharmacoadherence remains a significant barrier to malaria control and elimination.The purpose of this study was to determine if adherence rates to a six-dose ACT antimalarial treatment differ between patients in Zambia who received short message service (SMS) reminders and those who did not. An experimental, randomized, controlled trial was conducted to collect data from a sample of 96 adult patients with malaria who presented to Fisenge Clinic in the Copperbelt Province of Zambia. Participants were randomly assigned to a control or intervention group. The intervention group received SMS messages to remind them to take their medication according to the regimen. An electronic pillbox was used to measure pharmacoadherence for both groups, and patients were classified as probably adherent or probably non-adherent.Data were analyzed using Chi-square for association between the SMS intervention and pharmacoadherence, and logistic regression used for predictors of adherence. No significant association was found between SMS reminders and pharmacoadherence among malaria patients being treated with ACT when evaluated with respect to those who received the SMS reminders and those who did not (?2=0.19, df=1, p=0.67). Binary logistic regression indicated that there were no variables associated with adherence (p(>)0.05).Findings from this study contribute to the research regarding the use of mobile phones to promote adherence. This is the first study of its kind using SMS directly to the patient for ACT adherence in sub-Saharan Africa known to the author. It is possible that the use of the electronic pillbox and/or the novelty of participating in a research study contributed to higher levels of adherence than previously found in this geographical area. While data suggested that there was no association between SMS and adherence, further research is needed to explore the value of this intervention.
Show less - Date Issued
- 2014
- Identifier
- CFE0005421, ucf:50430
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005421
- Title
- Impact of Interruption Frequency on Nurses' Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting.
- Creator
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Campoe, Kristi, Talbert, Steven, Sole, Mary Lou, Andrews, Diane, Jentsch, Florian, University of Central Florida
- Abstract / Description
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Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of...
Show moreProblem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of interruption frequency on nurses' PCA interaction has not been fully measured or described.Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses' (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses' perceptions of the impact of interruption frequency.Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar's test, and Friedman's test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs' perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar's test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses' perception of interruption frequency: the nature of interruptions and nurses' reaction to the interrupted work environment.Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs' described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs' perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs' performance accuracy and cognitive workload.
Show less - Date Issued
- 2015
- Identifier
- CFE0005770, ucf:50099
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005770
