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Recent Research Publications and Funding
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November 1, 2011 4:00AM
BACKGROUND: Very little research has been focused on the interdisciplinary staffing characteristics of the operating room team, an essential component of providing safe patient care in a high-risk setting.
OBJECTIVES: The aim of this study was to determine how the operating room staffing of two surgical specialties compares in terms of social network variables.
METHODS: Staffing data from all general and neurosurgical procedures performed at a large Midwestern hospital were analyzed using Social Network Analysis methods. Network variables include centrality, team coreness, and the core/periphery network structure. Multidimensional scaling, correlation, and descriptive statistics were used for the analysis.
RESULTS: The core/periphery network structure was characteristic of both surgical services. Team coreness, a measure of how often the team worked together, was associated with the length of the case (p < .001). Procedure start time predicts the team coreness measure, with cases starting later in the day less likely to be staffed with a high core team (p < .001). Registered nurses constitute the majority of core interdisciplinary team members in both groups.
DISCUSSION: Analysis of the core/periphery structure of specialty team staffing networks indicates that many procedures are staffed with individuals who are associated peripherally with the specialty. Registered nurses as core group members are in a position to take a leadership role in the communication of norms and process variations to noncore members. The effect of having late starting cases staffed with a lower core team should be studied further because it pertains to patient outcomes. Future work should strive to account for the complex and dynamic nature of team development.
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October 21, 2011 4:00AM
OBJECTIVES: To determine effect size and acceptability of a multicomponent behavior and home repair intervention for low-income disabled older adults.
DESIGN: Prospective randomized controlled pilot trial.
SETTING: Participants' homes.
PARTICIPANTS: Forty low-income older adults with difficulties in one or more activities of daily living (ADLs) or two or more instrumental activities of daily living (IADLs).
INTERVENTION: The Community Aging in Place, Advancing Better Living for Elders (CAPABLE), coordinated occupational therapy, nursing, and handyman visits, was compared with attention-control visits. The intervention consisted of up to six visits with an occupational therapist, up to four visits with a nurse, and an average of $1,300 in handyman repairs and modifications. Each intervention participant received all components of the intervention clinically individualized to risk profile and goals. Each attention-control participant received the same number of visits as the intervention participants, involving sedentary activities of their choice.
PRIMARY OUTCOME: difficulty in performing ADLs and IADLs.
SECONDARY OUTCOMES: health-related quality of life and falls efficacy.
RESULTS: Thirty-five of 40 adults (87%) completed the 6-month trial, and 93% and 100% of the control and intervention group, respectively, stated that the study benefited them. The intervention group improved on all outcomes. When comparing mean change in the intervention group with mean change in the control group from baseline to follow-up, the CAPABLE intervention had effect sizes of 0.63 for reducing difficulty in ADLs, 0.62 for reducing difficulty in IADLs, 0.89 for quality of life, and 0.55 for falls efficacy.
CONCLUSION: The CAPABLE intervention was acceptable to participants and feasible to provide and showed promising results, suggesting that this multicomponent intervention to reduce disability should be evaluated in a larger trial.
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September 21, 2011 4:00AM
OBJECTIVE: Examine the safety and feasibility of a 12-week Tai Chi intervention among stroke survivors.
DESIGN: Two-group, prospective pilot study with random allocation.
SETTING: Outpatient rehabilitation facility.
SUBJECTS: Stroke survivors ≥50 years and at ≥three months post-stroke.
INTERVENTIONS: Tai Chi subjects attended group-based Yang Style classes three times/week for 12-weeks, while Usual Care subjects received weekly phone calls along with written materials/resources for participating in community-based physical activity.
MAIN OUTCOME MEASURES: Indicators of study safety and feasibility included recruitment rates, intervention adherence, falls or adverse events, study satisfaction, drop-outs, and adequacy of the outcomes measures.
RESULTS: Interested persons pre-screened by phone (n = 69) were on average 68 years old, (SD = 13) years old, 48% (n = 33) women, 94% (n = 65) were at least three months post-stroke. A total of 28 subjects aged 69 (SD = 11) years enrolled in this pilot study. Intervention adherence rates were very high (≥92%). There were no falls or other adverse events. The dose of Tai Chi exercise (≥150 minutes/week) was well tolerated. Overall study satisfaction was high (8.3 (SD = 1.9); 1 = not satisfied, 10 = most satisfied), while drop-outs (n = 3, 11%) were unrelated to study intervention. Score distributions for the outcome measures were approximately normal, sensitive to change, and seemed to favor the Tai Chi intervention.
CONCLUSIONS: Tai Chi is a safe, community-based exercise program for stroke survivors. Our data suggest that recruitment and retention of an adequate sample is feasible, and that in a full-scale study 52 subjects/group are needed to detect statistically significant between group differences (alpha = 0.05, power = 0.80).
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September 21, 2011 4:00AM
Objective: Examine the safety and feasibility of a 12-week Tai Chi intervention among stroke survivors.
Design: Two-group, prospective pilot study with random allocation.
Setting: Outpatient rehabilitation facility.
Subjects: Stroke survivors ≥50 years and at ≥three months post-stroke.
Interventions: Tai Chi subjects attended group-based Yang Style classes three times/week for 12-weeks, while Usual Care subjects received weekly phone calls along with written materials/resources for participating in community-based physical activity.
Main outcome measures: Indicators of study safety and feasibility included recruitment rates, intervention adherence, falls or adverse events, study satisfaction, drop-outs, and adequacy of the outcomes measures.
Results: Interested persons pre-screened by phone (n = 69) were on average 68 years old, (SD = 13) years old, 48% (n = 33) women, 94% (n = 65) were at least three months post-stroke. A total of 28 subjects aged 69 (SD = 11) years enrolled in this pilot study. Intervention adherence rates were very high (≥92%). There were no falls or other adverse events. The dose of Tai Chi exercise (≥150 minutes/week) was well tolerated. Overall study satisfaction was high (8.3 (SD = 1.9); 1 = not satisfied, 10 = most satisfied), while drop-outs (n = 3, 11%) were unrelated to study intervention. Score distributions for the outcome measures were approximately normal, sensitive to change, and seemed to favor the Tai Chi intervention.
Conclusions: Tai Chi is a safe, community-based exercise program for stroke survivors. Our data suggest that recruitment and retention of an adequate sample is feasible, and that in a full-scale study 52 subjects/group are needed to detect statistically significant between group differences (alpha = 0.05, power = 0.80).
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August 22, 2011 4:00AM
A repeat-length polymorphism of the serotonin promoter gene (5-HTTLPR) has been associated with depression and posttraumatic stress disorder (PTSD) in trauma-exposed individuals reporting unsupportive social environments. We examine the contributions of the triallelic 5-HTTLPR genotype and social constraints to posttraumatic stress (PTS) symptoms in a national sample following the September 11, 2001 (9/11) terrorist attacks. Saliva was collected by mail from 711 respondents (European American subsample n = 463) of a large national probability sample of 2,729 adults. Respondents completed web-based assessments of pre-9/11 mental and physical health, acute stress 9 to 23 days post-9/11, PTS symptoms, and social constraints on disclosure regarding fears of future terrorist attacks 2-3 years post-9/11. Social constraints were positively associated with PTS symptoms 2-3 years post-9/11. The triallelic 5-HTTLPR genotype was not directly associated with PTS symptoms, but it interacted with social constraints to predict PTS symptoms 2-3 years post-9/11: Social constraints were more strongly associated with PTS symptoms for individuals with any s/lg allele than for homozygous la/la individuals. Constraints on disclosing fears about future terrorism moderate the 5-HTTLPR genotype-PTS symptom association even when indirectly exposed to collective stress.
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August 5, 2011 4:00AM
Background: This article describes the context and student perceptions of integrating simulation into the baccalaureate acute and critical care nursing course.
Method: A total of 209 teaching evaluation tools completed by senior students from 2007 to 2010 were analyzed retrospectively.
Results: The response agreement on specific items was high; in addition, the effectiveness of simulation as a teaching strategy was elaborated by three themes that emerged from students’ comments: (a) More simulation experience is needed, (b) simulation should be introduced early in the program, and (c) simulation is a great way to learn.
Conclusion: Simulation is an effective teaching strategy that can be successfully integrated throughout the baccalaureate nursing curriculum.
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July 1, 2011 4:00AM
Purpose: To construct a theory of fatigue and sleep in nondepressed lower-income urban women in the 6 months after childbirth.
Design and Methods: We conducted this grounded theory study by recruiting participants from an inpatient postpartum unit in a Midwestern urban tertiary care facility. Sixteen participants, all of whom were negative for depressive symptoms, were interviewed at 1, 3, and 6 months postpartum.
Results: Participants engaged in "Persevering Toward Normalcy," in which they worked to minimize fatigue and maximize sleep by accessing flexible, dynamic social support networks, which enabled them to nap or sleep on weekends. The participants' fortitude, perseverance to "keep going" and push beyond exhaustion until their bodies "got used to" the lack of sleep and ongoing fatigue enabled them to continue working, pay rent, put food on the table, and keep children in school. At the onset of the study, participants firmly believed their fatigue would ease, and sleep would gradually improve as infant and family routines were established. Until such time, they simply needed to "deal with it."
Clinical Implications: In the early weeks postpartum, women can be taught how and when to access social support to promote sleep and prevent severe fatigue. Instruction on sleep hygiene and infant day/night entrainment may help women maximize sleep opportunities and infants establish a routine. To provide effective assistance, it is also necessary to understand the woman's individual sleep environment, as well as her socioeconomic and cultural contexts.
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July 1, 2011 4:00AM
This purpose of this study was to examine the role of nurses working in mechanical circulatory support (MCS) programs in the United States through a description of role characteristics, including demographic information, qualifications, compensation, job preparation, work setting and responsibilities, scope of practice, contributions to patient care, and organizational outcomes.
Surveys were mailed to 189 nurses at 95 MCS programs, with a response rate of 63% (n = 119). However, 11% of respondents did not meet the inclusion criteria, and thus the final sample totaled 106 participants. Results showed descriptive statistics and an analysis of contents showed many similarities among the nurses, along with some differences in work characteristics, compensation, scope of practice, and other items. The findings in this first national survey illustrate the multifaceted roles and related skill sets required of registered professional/advanced practice nurses in America’s rapidly growing MCS programs. The common use of “ventricular assist device coordinator” as job title for these specialized and highly skilled nurses is incongruent with their role in these programs. -
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July 1, 2011 4:00AM
The purpose of this study was to test the feasibility and impact of function-focused care for PD (FFC-PD) developed to optimize function and physical activity among people with PD who live in the community. Parkinson's disease (PD) results in a progressive loss of function such that family caregivers provide a large percentage of the personal care to PD patients living in the home setting. This pilot study was a single-group, 2 pretest, 3 posttest repeated-measures design to investigate the impact of the FFC-PD intervention over a 12-month period. Measurements included the Self-Efficacy and Outcome Expectations for Exercise and Functional Activities, Yale Physical Activity Scale, Unified Parkinson's Disease Rating Scale, Barthel Index, Schwab & England, Timed Chair Rise, Parkinson's Disease Questionnaire-39, and Geriatric Depression Scale. The study found that Function-focused care for PD has a significant effect on increasing and on strengthening outcome expectations related to exercise, time spent in exercise and physical activity and in improving functional performance in people with PD. Further research is needed to explore the use of objective measurements of functional performance and activity and to test FFC-PD in a randomized controlled trial.
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July 1, 2011 4:00AM
The benefits of computerized physician order entry systems have been described widely; however, the impact of computerized physician order entry on nursing workflow and its potential for error are unclear. The purpose of this study was to determine the impact of a computerized physician order entry system on nursing workflow. Using an exploratory design, nurses employed on an adult ICU (n = 36) and a general pediatric unit (n = 50) involved in computerized physician order entry-based medication delivery were observed. Nurses were also asked questions regarding the impact of computerized physician order entry on nursing workflow. Observations revealed total time required for administering medications averaged 8.45 minutes in the ICU and 9.93 minutes in the pediatric unit. Several additional steps were required in the process for pediatric patients, including preparing the medications and communicating with patients and family, which resulted in greater time associated with the delivery of medications. Frequent barriers to workflow were noted by nurses across settings, including system issues (ie, inefficient medication reconciliation processes, long order sets requiring more time to determine medication dosage), less frequent interaction between the healthcare team, and greater use of informal communication modes. Areas for nursing workflow improvement include (1) medication reconciliation/order duplication, (2) strategies to improve communication, and (3) evaluation of the impact of computerized physician order entry on practice standards.