College of Public Health

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Technology Acceptance Model: Predicting Nurses’ Acceptance of Telemedicine Technology (eICU®)
(2008-06-03T19:15:57Z) Kowitlawakul, Yanika; Kowitlawakul, Yanika
The Technology Acceptance Model (TAM) is one of the promising models that represent an important theoretical framework to explain and predict an individual's technology acceptance. TAM has been used extensively in the business, education, and information technology settings, but rarely in a health care setting. Rapid growth of investment worldwide in information technology by health care organizations has dramatically raised the importance of technology acceptance as an issue. Technology systems can not enhance the performance of health care providers or improve patient outcomes if the technology systems are not accepted by the end users. In the health care industry, nurses are often identified as end users. Therefore, more investigation for better understanding of why nurses accept or reject new technology is needed. This research study attempted to examine the applicability of the TAM in explaining nurses' acceptance of telemedicine technology (eICU®) in a health care setting, and also determined factors and predictors that influenced the probability of the nurses' acceptance of this technology. The psychometric evidence (validity and reliability) of the measurement scales used in the study was discussed.
Study on Cultural Competency of Japanese Nurses
(2008-06-11T20:50:26Z) Kawashima, Asako; Kawashima, Asako
There is an increase in the number of immigrants and foreign residents in Japan. This social demographic change requires Japanese nurses to deliver culturally appropriate and sensitive care. It is thus necessary to expand the research addressing Japanese nurses' cultural competency. However, there are few studies addressing the issues regarding Japanese nurses' cultural competency and associated variables. Furthermore, the literature suggests that the nurses' habits of mind and attitudes regarding critical thinking dispositions (CTDs) may possibly be connected with some of the key components of cultural competence, but there are no studies examining the relationships among these variables. In addressing this gap, the purposes of this study were: 1) to examine the level of cultural competency reported by Japanese nurses; 2) to examine the level of CTDs reported by Japanese nurses; 3) to examine the relationship between nurses' cultural competency and their CTDs; and 4) to examine the relationship between nurses' cultural competency and selected demographic and personal factors. Cultural competency levels were measured by using the Japanese version of Campinha-Bacote's Inventory for Assessing the Process of Cultural Competency among Healthcare Professionals-Revised (IAPCC-R). The Japanese version of the California Critical Thinking Disposition Inventory (CCTDI) was employed to measure nurses' levels of CTDs. The study included a sample of 1,035 Japanese nurses. The findings indicated that nurses mostly perceived that they were only at a "culturally aware" level according to the IAPCC-R. Nurses' cultural competency levels were lower than those reported by western studies. Clinical experience in caring for culturally diverse clients, experience in taking courses and workshops related to cultural nursing care, other learning experiences about the concept of cultural diversity, and ability to speak a foreign language were significant factors influencing cultural competency levels. The findings further indicated that subscales of CCTDI including inquisitiveness, open-mindedness, self-confidence, systematicity, and maturity were predictors of nurses' cultural competency. Responses by nurses to a series of more qualitative questions provided additional insights into their experiences with, and perceptions of, caring for culturally diverse clients. Those responses also provided information regarding impressions of the study, feelings towards the issue of cultural competency, and suggestions relating to the modification of the IAPCC-R. Overall, the study suggests the need for the development of better cultural competency education and practice.
Diffusion of Innovation: A Descriptive Analysis of Pediatric Preparedness in Emergency Departments
(2008-06-16T19:10:20Z) Huddleston, Kathi C.; Huddleston, Kathi C.
The purpose of this study was twofold: First, to identify essential pediatric resuscitative equipment gaps in the nation's emergency departments; second, to identify associations among and between the domains of community and health care organizational structure as they related to hospital emergency departments' (EDs) adoption of the 2001 "Care of the Child in the Emergency Department: Guidelines for Preparedness" (Guidelines for Preparedness) published by the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP). Diffusion of Innovation (DOI) is the theoretical concept by which multiple characteristics within the domains of health care structure and community were examined. The study was conducted using extant data from the Center for Disease Control and Prevention (CDC) branch of the National Center for Health Statistics (CDC/NCHS). This descriptive study examined the relationships regarding the organizational and community characteristics of emergency departments with the adoption of the Guidelines for Preparedness. Characteristics of pediatric patient volume, pediatric subspecialty services, per capita income, urbanicity, and region were associated with the availability of pediatric emergency care essential equipment and services. Logistic regression was used to further explore variable relationships. The study identified hospital and community characteristics associated with pediatric emergency readiness and emergency medical care services essential for the care of critically ill or injured children. The study's community variables of per capita income and metropolitan status were significant, as were the structure variables of pediatric ED volume (size), pediatric trauma service, the presence of pediatric emergency medicine, and being a pediatric hospital. The DOI concepts of complexity and interconnectedness were drivers in both the adoption of the Guidelines for Preparedness and the compliance with pediatric essential emergency equipment. This study affirms that pediatric emergency equipment availability is a problem. Pediatrics continues to be an afterthought in emergency and disaster management, and as a nation we are not prepared for pediatric emergencies or pediatric disaster care.
Retaining the Wisdom: Deans’ Reflections on Extending the Academic Working Life of Aging Nurse Faculty
(2008-07-03T15:03:40Z) Falk, Nancy L.; Falk, Nancy L.
Aging nurse faculty members are vital human resources who serve as educators, researchers, and leaders within baccalaureate nursing programs nationwide. On average, aging nurse faculty members are over 50 years of age and face key retirement decisions over the next decade. Yet, there is little evidence that helps to inform education, practice, policy, and research about issues surrounding continued employment of aging nurse faculty. The purpose of this study was to begin to build substantive theory about deans' perceptions of extending the academic working life of aging nurse faculty members. In person and phone interviews were conducted with nine deans from baccalaureate nursing programs nationwide in this grounded theory study. The participants were employed at large, small, public, private, rural, and urban institutions in eight different states. They varied in age, race, and length of employment in the dean's role and at their current universities. Interviews were audiotaped and transcribed. Data were analyzed using constant comparative analysis. Four categories emerged from the interview data: valuing aging nurse faculty, enduring environmental challenges, recognizing stakeholder incongruence, and readjusting. Findings show that baccalaureate nursing programs and faculty members face environmental challenges including pressures, tensions, and ongoing change. Deans' reflections revealed that aging nurse faculty members are highly valued, bringing wisdom, experience, and institutional, historical, and cultural awareness to their many roles. In the ever-changing environment of baccalaureate nursing education however, some aging nurse faculty fail to keep knowledge, skills, and teaching modes current. In such situations, stakeholder incongruence arises as a mismatch develops between the needs of the baccalaureate nursing program and the skills and contributions of aging nurse faculty members. Baccalaureate nursing programs, program leaders, and aging nurse faculty members can lessen the incongruence by re-adjusting to address the pressures, tensions, and ongoing change.
The Relationships of Empowerment, Job Satisfaction, and Organizational Commitment among Filipino and American Registered Nurses Working in the U.S.A
(2008-12-22T16:36:55Z) Vacharakiat, Marayart; Vacharakiat, Marayart
The purpose of this study was to examine and compare the relationships between empowerment, job satisfaction, and organizational commitment among Filipino and American registered nurses (RNs) working in the United States. A descriptive-correlational design was used. The convenience sample of 176 participants of both Filipino and American RNs returned either online or paper and pencil surveys. Descriptive, correlational analyses, t-tests, and multiple regression tests were performed to answer the research questions. The study found correlations between structural empowerment, psychological empowerment, job satisfaction, affective and normative commitments among Filipino and American RNs (r ranged from .26 to .68, p<.05). No relationship was found between structural empowerment and continuance commitment in both RN groups. The two groups reported different scores in structural and psychological empowerment (M=3.85 (Filipino) vs. M=3.59 (American), p<.05; and M=4.37 (Filipino) vs. M=4.08 (American), p<.05, respectively). Filipino RNs showed higher values for both variables. Significant predictors for job satisfaction were structural empowerment among Filipino RNs, and structural and psychological empowerment among American RNs. Regarding affective and normative commitments, predictors for Filipino RNs were (1) structural empowerment , and (2) whether the RN worked in a critical care unit, R^2=.34 (for affective commitment), R^2=.24 (for normative commitment), and for American RNs only structural empowerment, R^2=.28 (for affective commitment) and R^2=.21 (for normative commitment). Overall, the study confirms the relationships between empowerment, job satisfaction, and organizational commitment among two RN groups. The study concludes that structural and psychological empowerment in the work environments appear to be significantly related to improved job satisfaction and commitment among RNs.
An Analysis of Variance in Nursing-Sensitive Patient Safety Indicators Related to Magnet Status, Nurse Staffing, and Other Hospital Characteristics
(2009-06-01T19:37:46Z) Solomita, Joy B.; Solomita, Joy B.
The purpose of this research was to identify if there was a significant difference in the risk-adjusted rates for a subset of five of the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Indicators (PSIs) in relation to ANCC's Magnet® designation in U.S. hospitals. This exploratory, cross-sectional study involved the analysis of organizational characteristics, including magnet status, nurse staffing, bed size (categorical and number of operated beds), and other organizational characteristics in relation to 5 of 20 of AHRQ's PSIs. The five PSIs were selected based on previous research findings that showed associations between nurse staffing and complications of care. Data from AHRQ's Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) for Calendar Year (CY) 2006 were combined with CY 2006 American Hospital Association (AHA) data, and hospitals with ANCC Magnet® designation were identified. The study used descriptive statistics, comparison of means, and a multivariate analysis of covariance (MANCOVA) to answer five research questions in relation to the differences is ANCC Magnet® hospitals versus non-magnet hospitals. The research questions addressed the following: (a) describing the differences in organizational characteristics, (b) identifying the risk-adjusted PSI rates, (c) determining nurse staffing differences, (d) identifying the relationships between organizational characteristics and the five selected PSIs, and (e) determining if there was a difference in the risk-adjusted PSI rates while controlling for nurse staffing and bed size. Findings included the following: (a) preventable adverse event rates were not lower in magnet hospitals; (b) nurse staffing was better in magnet hospitals; and (c) magnet status was not associated with preventable PSIs, while controlling for RN staffing and bed size. Significant findings included the following: (a) nurse staff hours per adjusted patient day (APD), (t = 2.513, df = 1001, p = .012) and RN hours per APD (t = 4.132, df = 1001, p < .000) were significantly higher in magnet than non-magnet hospitals; (b) magnet hospitals had a significantly higher rate of postoperative deep vein thrombosis (DVT) / pulmonary embolus (PE), (t = 2.44, df = 914, p = .015); and (c) magnet hospitals had a significantly lower rate of death among surgical inpatients (t = -2.05, df = 64.15, p = .044). The MANCOVA analysis indicated that magnet and non- magnet hospital groups did not significantly differ on the combined variable created from the five PSIs considered to be sensitive to nurse staffing (p = .383, tested at p < .05), while controlling for RN staffing and number of operated beds. The multivariate analysis revealed a significant relationship between the combined variable created from the selected PSIs in relation to the covariates of RN hours per APD (p = .001, tested at p < .05) and number of operated beds (p < .000, tested at p < .05). The univariate analysis indicated that the covariates had a significant relationship with four of the selected PSIs and included: (a) number of operated beds with the PSIs of decubitus ulcer, postoperative respiratory failure, and postoperative DVT/PE; and (b) RN hours per APD with the PSI of death among surgical inpatients. The study findings were limited by the size of the magnet group (n = 43) and by using administrative and AHA data, which are not validated by medical record review. Generalizability of the findings may be limited, and studies with a larger magnet sample need to be conducted. Further research is needed to reveal organizational characteristics and care delivery processes that contribute to safety and quality outcomes. Preventable adverse events can cause unnecessary harm to patients, waste resources, and increase operational cost and charges to payers, and are an increasing concern to nurse and hospital administrators related to reimbursement changes for the Centers for Medicare and Medicaid Services (CMS) "never events". Chief nurse executives (CNEs) need evidence-based strategies that optimize quality outcomes in relation to resources expended for staffing plans, skill mix, capital expenditures, and other resource allocation decisions. In the future, designation as an ANCC Magnet® facility needs to ensure that evidence related to better patient outcomes exists, similar to the many years of evidence relating magnet designation to better work environments and nurses' satisfaction.
The Injury Profile of the Sexually Assaulted Female
(2009-07-01T20:20:39Z) Rotolo, Suzanne L.; Rotolo, Suzanne L.
Rape is a serious, violent crime that is under-reported across the United States. Multiple factors affect the choice to report, as well as the legal processes that ensue when a rape is reported. Prior to the development of the formal Sexual Assault Nurse Examiners (SANEs) role in 1992, there were reports of poor documentation of the physical and genital injuries. The significance of this study is first to seek to improve care for women who have been sexually assaulted. The secondary significance is to seek to reduce the likelihood of court errors through improving the testimony by experts about the injuries that women may or may not have after being sexually assaulted. The purpose of this study was to describe the profile of injuries sustained by females who have been raped and subsequently examined by a SANE. In addition, the injury patterns of women reporting consensual and nonconsensual intercourse were compared. Genital injuries were documented using a three-part examination process (Direct visualization, use of toluidine \blue dye, and with magnification). This study was a logical extension of the research performed to date, and seeks to fill some of the methodological gaps in extant findings. The genital profile of the woman who was sexually assaulted is also variable, with no definitive pattern. With direct visualization, over 70% of the women did not have genital injuries. While genital injuries are present in approximately 30% of the women after a sexual assault, on direct visualization, injuries are not a determining factor that a sexual assault occurred.
Structural and Psychological Empowerment of Community/Public Health Nurses
(2010-01-27T18:31:53Z) Royer, Linda; Royer, Linda
This descriptive, non-experimental study examines the perceptions Community/Public Health Nurses (C/PHNs) have about the work they do and about their workplace when questioned about organizational factors that potentially lead to a sense of empowerment and commitment. Six hundred eighty-eight nurses from local and district health entities in 10 states which are seeking accreditation for organizational quality and health care delivery were invited to participate in a written survey. The survey was an instrument composed of questions concerning demographic and workplace characteristics, Spreitzer’s Structural and Psychological Empowerment questionnaire, and Meyer and Allen’s Employee Commitment and Career Change questionnaire. Participants (n=469) provided data important to recruitment and retention of nurses in this specialty. Results predictive of their leaving the job suggest that even though C/PHNs may feel attached to their work and workplace and even though they may feel loyal and duty-bound to it, if they are 35-45 years old and have worked in Public Health 1-36 months, they may be looking into or even planning to leave within one year. This paper describes the nursing workforce capacity crisis and empowerment and commitment theories as they relate to C/PHN perceptions, and offers suggestions to nurse leaders, public administrators, and policymakers for changes in nursing education, community nursing practice, research, and policy.
A Comparison of BMI Percentiles and Predictor Variables for Two Head Start Childhood Obesity Prevention Programs
(2010-06-04T13:53:25Z) Goldberg, Patricia; Goldberg, Patricia; Moore, Jean B.
A Head Start program enhancement, "I am Moving, I am Learning" (IMIL), is intended to 1) increase the amount of time per day that children participate in moderate to vigorous physical activity (MVPA); 2) improve the quality of structured movement activities that are led by teachers and other adults; and 3) promote and model healthy food choices for children. A quantitative study was conducted to determine if IMIL was effective in maintaining a healthy BMI in 354 four-year-old preschool children. Head Start secondary data were used to analyze and compare two groups of children: one group received the IMIL intervention; the control group received a standard Head Start nutrition program. T-tests, regression, and Chi-square analysis were conducted to compare improvement of BMI scores from baseline for the two groups. Results indicated that there was no significant improvement in BMI scores between (t= -25, df= 109.88, p= .81) and within the two groups of preschool children (IMIL group: t= -1.61, df= 257, p= .11; Control: t= -.70, df= 95, p= .49). Although there were several significant correlations between some of the variables, regression analysis for program variables indicated that the overall model did not significantly predict for BMI percentile change scores (R2 = .001, R2 adj. = -.007, F(3, 350) = .17, p = .91). Chi-square analysis for demographic variables indicated that only race/ethnicity had a significant relationship with BMI percentile scores (X2 = .011). Future studies of the IMIL obesity intervention should be conducted using a larger sample size composed of several Head Start regions in the U.S.
Inactive Registered Nurses Returning to Practice: Barriers and Successes
(2011-05-17) Hobbs, Deborah Leigh; Hobbs, Deborah Leigh; Milligan, Renee A.
This qualitative study describes the experiences of inactive registered nurses in their journey returning to nursing practice and the perceived and unexpected barriers and successes they met and overcame on their way. This study focused on the meaning of the situation and experiences of inactive registered nurses returning to practice. The qualitative research design of Dr. Joseph Maxwell was used as the model. Seventeen face-to-face interviews were conducted in March 2010. The purposive sample was of inactive registered nurses who had been inactive for at least five years and had completed a refresher course between 2007 and 2008 at either a community college or university in the metropolitan area of Washington, DC. In analyzing the context and process of how and why nurses return to practice, seven categories were revealed: the reasons to return, factors that inhibit returning, barriers of a refresher course, rewards of completing a refresher course, roadblocks of employment, rewards of returning to practice, and advice for all registered nurses. This qualitative study has the potential to pay tribute all nurses who practice the art of nursing by taking time to understand the meaning of the experience. This study provides a voice for the experiences of previously inactive registered nurses and reveals their barriers and successes in returning to practice.
Factors Influencing Health-Related Quality of Life Following Coronary Artery Bypass
(2011-05-26) Boyd, Janet Schoene; Boyd, Janet Schoene; Moore, Jean B.
This non-experimental descriptive study examined the influence of preoperative health-related quality of life (HRQOL) and clinical risk factors on adults’ postoperative HRQOL at 6 and 12 months after coronary artery bypass (CAB). Using the SF-12v2™ Health Survey (Standard Version 2.0) and the Society of Thoracic Surgeons (STS) Mortality and Morbidity risk assessment score, results indicate the overall model accounted for 21% (6 months) and 27% (12 months) of the variance in postoperative HRQOL. The greatest improvement in HRQOL was seen in the domains of physical function. No significant change in patients’ wellbeing indicated by the mental health domains was seen after surgery.
Shifting Life's Focus: African American Dialysis Patients' Experiences with Kidney Transplant Evaluation
(2011-08-22) Humphreys, Susan L.; Humphreys, Susan L.; Moore, Jean B.
Chronic Kidney disease is a growing health problem, in the United States, disproportionately affects African Americans. Although African Americans have a significantly higher incidence of kidney disease and end stage kidney failure than Caucasian Americans, they are less likely to receive a kidney transplant. This study begins to build a substantive theory about patients' experiences with the kidney transplant evaluation process to better understand this health disparity. Participants in this study were interviewed in the dialysis unit about these experiences. Shifting Life's Focus, the substantive theory emerging from this study, explains participants' experience with the process of kidney transplant evaluation as they physically and emotionally prepared to receive a kidney transplant. Three major concepts compose this theory: complex chronic health issues, financial concerns, and following through. This theory not only explains the experiences of these participants, but may help explain those of other African American patients on dialysis. Understanding this theory may provide insight to reasons why many African Americans may complete their transplant evaluations and be listed to receive a kidney transplant and therefore has direct application to both health policy and clinical practice.
The Influence of Values and Psychosocial Job Characteristics on Intent to Leave Among Hospital Nurses
(2012) Rosenkranz, Amanda Gail; Rosenkranz, Amanda Gail; Richards, Kathy C.
The supply of registered nurses is predicted to be insufficient to meet the healthcare needs of an aging society. It is imperative that nurses are retained to alleviate effects of this shortage on quality nursing care. Intent to leave is a behavior driven by many factors in registered nurses working in a hospital setting. The purpose of this study was to determine the relationships among personal values, individual and psychosocial job characteristics and intent to leave in hospital nurses. Individual characteristics included demographic variables such as age, gender, years of experience and education. Psychosocial job characteristics were decision latitude, psychological demands and social support. A nonexperimental, exploratory, cross-sectional survey research design was used. Data were collected using an online survey tool in a sample of registered nurses in the Mid-Atlantic Region. Participants ranged in age from 22 to 74 years old (M = 46.9). The majority of participants were female (n = 108, 93.1%), non-Hispanic Caucasian (n =94, 81%) and had obtained a bachelor of science degree (n=59, 50.9%). Participants had on average spent 11.9 years in their current job, had 20.9 years of experience, and worked 31.5 hours per week. The sample was dichotomized for bivariate comparisons: nurses with intent to leave (n=41) and nurses without intent to leave (n=75). Those with intent to leave had significantly lower income and a significantly lower score on the personal value of benevolence, indicating this was a lower value priority. Pearson correlations were computed and stepwise multiple regression was performed to determine the relationships among predictors of intent to leave. Fewer years of experience as a nurse, fewer years in the current job, and a higher score on the personal value of hedonism significantly predicted intent to leave, explaining 9.2% of the variance.
Midwives, Nurse Practitioners and Medicare: A Case Study Comparative Analysis of Medicare Reimbursement Efforts
(2012) Jessup, Debbie J.; Jessup, Debbie J.; Chong, Elizabeth; Hundley, Vanora
The historic health reform law included a provision that granted 100% Medicare reimbursement to nurse-midwives, marking the culmination of a nineteen year effort by the American College of Nurse-Midwives to achieve Medicare equity for its members. The purpose of this study was to formulate an in depth understanding of the politics, personalities and processes that defined the midwife Medicare reimbursement effort, and to explore how and why the process differed from the six year nurse practitioner Medicare reimbursement effort that culminated in 85% payment. The study used a comparative case study design to explore how the legislative efforts of midwives and nurse practitioners were impacted by special interest politics, feminist political epistemologies, and the realities of the political process and climate. Relevant data were collected from professional archival documents, congressional bill summaries, and interviews with professional organization leaders and advocates; and were organized using the strategies of case description and theoretical comparison. Analysis followed in the qualitative tradition of Yin (2009) and used pattern matching and cross case synthesis analytic techniques. The study established that Feldstein's economic version of the special interest group theory was sufficient to explain the differences in process and outcome between the NP and CNM efforts, and identified strengths and weaknesses in the two groups' political competency. Bryson's feminist political theory further clarified why these processes played out differently for two seemingly similar women's professional groups, one of whose care recipients were entirely women. The findings of this study will serve as a reference and resource for increasing the political competency of nurse practitioners and midwives.
The Experience of African Students Studying Nursing in the United States in Relation to Their Use of Critical Thinking
(2012-06-18) Tyson, Donald Lee; Tyson, Donald Lee; Mahon, Margaret M.
This qualitative study explores the critical thinking experiences of African nursing students enrolled in several universities in the U.S. Using a semi-structured interview approach, twelve African students discussed their experiences using and learning a western critical thinking approach, as well as described their educational experiences in Africa. Three major frameworks guided the study including van Manen’s interpretive hermeneutical approach to qualitative research, the conceptual models of critical thinking described by Sheffer and Rubenfeld’s (2000) nursing consensus statement and Barnett’s (1997) description of criticality, and the African concept of Ubuntu. Seven themes and a variety of subthemes emerged including learning experiences in Africa, using new learning tools to adapt to critical thinking, fear, desire for faculty interaction, cultural factors impeding critical thinking, evolving self-awareness, and the voice of those afraid to speak. The themes suggest that the majority of students interviewed experienced significant differences in educational styles and environments between Africa and the United States; and that these differences, in concert with their own cultural assumptions, created challenges for being successful in their nursing program. While faced with these challenges, the students strongly desired to become academically successful and to utilize a variety of adaptive tools for learning critical thinking from a western perspective. Implications for both educational institutions and further research were discussed that may help nursing educators better understand the African student experience and assist the students successfully complete their nursing education.
Continuous Access to Medication and Health Outcomes in Uninsured Adults With Type 2 Diabetes
(2012-06-18) Toulouse, Cheryl Dillard; Toulouse, Cheryl Dillard; Milligan, Renee A.
Background and Purpose: Achieving targets for HgbA1c, low density lipids (LDL), and blood pressure (BP) can improve outcomes in adults with diabetes. To meet targets, access to affordable and consistent medication is necessary. The Social Determinants of Health framework guided variable selection in this study that explored the relationship between continuous access to medication (CAM) and HgbA1c, LDL, BP, hospitalizations (HSPs), and emergency department visits (EDVs) in adults with type 2 diabetes who are uninsured and of low socioeconomic status. Hypothesis: CAM is related to improved HgbA1c, LDL, and BP, and reduced HSPs and EDVs. Methods: This within-subjects study was conducted in two steps using a sample that received healthcare on a mobile van and medications from a pharmaceutical program. Step1: Pre-Post (N = 65) exploratory analysis using Dependent t-Tests and McNemar’s tests. Step 2: Time-Series (N = 17) quasi-experimental analysis using RM-ANOVA. Pre-Post Results: CAM was related to improved HgbA1c (p = .003), LDL (p = .004), and systolic BP (p = .025). Time-Series Results: CAM was related to improved HgbA1c (p = .011) with a significant reduction in mean HgbA1c (-1.14%) from preintervention to postintervention (p = .014). Conclusions: Access to a consistent and reliable source of medication is essential to improving outcomes in adults with diabetes. In addition to providing excellent care, healthcare providers must foster opportunities to improve access to medication.
Identification of Individual Factors that Predict Structurational Divergence Among Nurses: A Secondary Analysis
(2012-07-17) Conway-Morana, Patricia; Conway-Morana, Patricia; Mahon, Margaret M.
Structurational Divergence (SD) occurs when an individual reaches a “nexus”, this point of being in the position of needing to satisfy two sets of equally interpenetrating, but contradictory social rules, practices, cultures, or structures, as well as the resulting cycle of communication breakdowns (unresolved conflict, erosion of personal and professional development, and immobilization) that occur when the individual is unable to satisfy both structures (Nicotera & Clinkscales, 2010; Nicotera, Mahon, & Zhao, 2010). The purpose of this cross sectional, non-experimental, secondary analysis was to examine data from 713 registered nurses from a large community hospital to determine if there were subsets of individual factors or communication attributes that predict SD. Correlations and simple linear regressions were used. SD was regressed with six individual factors and five communications attributes. Gender was a weak predictor of SD (r = -0.100; R2 = 0.010; adj. R2 =.009; p = .008); but age, clinical specialty, ethnicity, experience, and education were not predictors. The Conflict Styles of Non-confrontational (r = 0.160; R2 = 0.026; adj. R2 = 0.024; p = 0.000) and Controlling (r = 0.162; R2 = 0.026; adj. R2 = 0.025; p = 0.000) were predictors of SD, but Solution-Orientation was not a predictor. Verbal aggression (r = 0.161; R2 = 0.026; adj. R2 = 0.025; p = 0.000), and ambiguity intolerance (r = 0.233; R2 = 0.054; adj. R2 = 0.053; p = 0.000) were predictors of SD, but argumentativeness was not a predictor. Taking conflict personally (R2 = 0.054; adj. R2 = 0.053; p = 0.000) was a predictor of SD, as well as all of the subscales of Taking Conflict Personally (Personalization (R2 = 0.010; adj. R2 = 0.008; p = 0.009), Persecution (R2 = 0.078; adj. R2 = 0.077; p = 0.000), Stress Reaction (R2 = 0.034; adj. R2 = 0.033; p = 0.000), Positive Relational Effects (R2 = 0.009; adj. R2 = 0.007; p = 0.013), and Negative Relational Effects (R2 = 0.010; adj. R2 = 0.009; p = 0.007)) were weak predictors of SD. This analysis supports findings by Nicotera, Mahon, and Zhao (2010), that SD is a systemic phenomenon. While much research has been conducted on the work environment, this is one of the earliest studies that specifically examine SD within the nursing population. Further exploration related to the presence and severity of SD in relation to organizational structures is required.
Healthcare Worker Compliance with Documentation of Infection Prevention Protocols in Relation to Patient Factors of War-Wounded U.S. Service Members
(2012-10-09) English, Judith Fay Boylan; English, Judith Fay Boylan; Zhou, Qiuping (Pearl)
The purposes of this pilot study were to 1) examine the documented compliance to infection prevention procedures in the electronic medical record (EMR) by healthcare providers caring for war-wounded U.S. service members, and 2) assess patient factors that related to compliance. It was an observational retrospective cohort study of EMRs between June 1, 2009 and May 31, 2011. The study identified documentation of provider compliance / noncompliance with 1) active surveillance cultures (ASC), 2) isolation (ISO) precautions, and 3) administration of chlorhexidine gluconate (CHG) baths in relation to available patient factors from the Trauma Infectious Diseases Outcomes Study (TIDOS) data. A survey form was devised to gather compliance data related to ISO precautions and CHG baths documented in each subject’s EMR. A total of 236 traumatic U.S. war-wounded EMRs were surveyed covering 489 inpatient Sequences of Admission, Transfer, or Readmission. 226 (95.8%) of ASCs obtained upon Admission were fully compliant with the protocol that required submission of groin cultures to detect Gm (-) multidrug resistant organisms (MDROs) and other potentially transmissible pathogens within the first 48 hours following admission. Documentation of adherence to protocols related to ISO was 61.4% and administration of CHG cloth baths was 56.9%. The overall logistic regression model for patient factors related to ISO compliance (n = 286) was not statistically significant (χ2 = 3.7, df = 5, p = 0.59). CHG bath administration compliance was also not statistically significant (χ2 = 10.87, df = 5, p = 0.054). Infection Preventionists were more likely to document the initiation of ISO via Contact Precautions, responsible for most of the Progress Notes/Nursing Orders (90.3%, n = 334) communicating the need for Isolation Precautions to be initiated plus Progress Notes/Nursing Orders (90.5%, n = 306) communicating no further need for Isolation Precautions. Replication of this pilot utilizing the entire number of 599 war-wounded would help validate findings of this study. Additionally, hospitals need to rapidly progress in standardization of basic clinical content in the EMR in relation to evidence-based practices. Standardization will result in capabilities for Nursing, Infection Prevention, Medical Staff, Risk Management and Quality Improvement to query the EMR for compliance reports on best practices that are necessary for ever-increasing demands to provide transparency and target zero healthcare-associated infection rates.
Cervical Cancer Screening Behavior among Nepalese Women
(2013) Satyal, Kalpana Subedi; Satyal, Kalpana Subedi; Gaffney, Kathleen F.
Even-though Nepal has the highest age-standardized incidence and mortality rates of cervical cancer (CC) in the world, no universal coverage is available for cervical cancer screening (CCS) despite its known effectiveness in preventing and detecting CC. Although availability, accessibility, affordability and awareness are identified in literature as common barriers for women to undergo CCS in low-resource countries, there are new programs emerging in Nepal that provide services eliminating these barriers. Even then, the utilization of these services are reported to be sub-optimal. Sub-optimal utilization of CCS when the services are available, accessible and free indicate the need for further examination of the belief factors associated with CCS behavior, especially considering the major crisis of CC and low resources to provide CCS in Nepal.
EXCLUSIVE BREASTFEEDING DURATION IN RELATIONSHIP TO INFANT RISK FOR OVERWEIGHT AND OBESITY AT THREE YEARS OF AGE.
(2013) Franklin, Patricia Deam; Franklin, Patricia Deam; Gaffney, Kathleen F.; Kitsantas, Panagiota
This non-experimental, quantitative study examined exclusive breastfeeding during the first six months of life as a risk reduction factor of childhood overweight and obesity up to three years of age in a population of children who participated in a state Special Supplementary Nutrition Program for Women, Infants, and Children (WIC). A literature review described the salient issues involved in childhood obesity, examined the conflicting results in determining the association between breastfeeding and a risk of developing childhood obesity, and supported the need for further study in at-risk populations. The pediatric nutrition surveillance system (PedNSS) offered access to linked, longitudinal data with which to explore this relationship within a sample of children at risk for early childhood obesity. The results of this research project indicated that the longer an infant exclusively breastfeeds, the lower their risk for overweight/obesity at three years of age regardless of other contributing factors. Results also indicated pre-gestational, gestational, and early childhood mechanisms are areas for interdisciplinary research to develop effective, preventative strategies and policies

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