Recent Research Publications and Funding

The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence.

OBJECTIVE: The purpose of this study was to describe clinicians' evaluation and management of co-existing mental health, substance abuse (MHSA), and chronic pain (CP) conditions in patients with prolonged critical illness. Little is known about the evaluation and management of these conditions in the intensive care unit, and practice guidelines do not address management in the context of critical illness, optimal sedation/analgesia, or ventilator weaning.

DESIGN: Longitudinal qualitative description.

SETTING: Intensive care unit of an urban academic medical center.

PATIENTS: Total of 12 patients with co-existing MHSA or CP conditions who were weaning from mechanical ventilation.

INTERVENTIONS: Intensive care unit clinicians, patients, and family members were formally interviewed and directly observed in the critical care setting for 56 consecutive weeks.

MEASUREMENTS AND MAIN RESULTS: Transcribed interviews, field notes, and clinical records, representing >400 documents, were reviewed and coded using constant comparative analysis to identify the facilitators, barriers, contextual factors, and consequences associated with the evaluation and management of MHSA and CP conditions. Numeric clinical data supplemented and clarified thematic findings. Facilitators of MHSA and CP evaluation and management included family as history keepers, the use of subspecialty consultations, and anticipated alcohol withdrawal. Barriers included limited history taking and assessment of MHSA and CP conditions and the use of cognitive shortcuts. Consequences included nonintegration of MHSA and CP medications and diagnoses, episodic pharmacologic responses to psychobehavioral symptoms, and clinician-patient interpersonal tension. Contextual factors involved ambiguous psychobehavioral symptomatology, patients' critical illness and inability to speak, and competing clinical goals.

CONCLUSIONS: The explicit evaluation and management of MHSA and CP conditions was highly variable and inconsistent across cases. Findings suggest that MHSA and CP conditions require monitoring and management similar to that required for other chronic conditions. Multidisciplinary, individual-level, and system-level responses are warranted to address the complex interplay of barriers, consequences, and context.

OBJECTIVE: People living in rural areas have the same incidence of mental illness but far less access to mental health services compared with people living in urban areas. This brief report describes the workforce of advanced-practice psychiatric nurses (APPNs) and explores their potential to ease the rural mental health workforce shortage. 

METHODS: National certification data were used to describe workforce characteristics and the rural distribution of APPNs. All nationally certified APPNs in 2003 were included (N=8,751). 

RESULTS:APPNs were more likely than psychiatrists to live in rural areas. The ratio of APPNs to state rural populations ranged from .06 to 14.9. The mean SD ratio of APPNs per 100,000 in the rural population was 3.0±3.0. 

CONCLUSIONS: APPNs have great potential to be a solution to the rural mental health workforce shortage. Even so, the number of APPNs must increase and barriers to their full scope of practice must be removed.

BACKGROUND: Most prior research on the outcomes of restorative care programs has been focused on resident outcomes including such things as functional performance, behavior, and quality of life. Treatment fidelity issues and compliance with the programs were not addressed in these studies. Without such an evaluation, it is impossible to evaluate the effectiveness of restorative care activities. PURPOSE: To test the reliability and validity of the Restorative Care Behavior Checklist (RCBC), which is an observed measure of restorative care activities performed by nursing assistants (NAs). METHODS: The study involved a single observation of care activities and completion of survey data among NAs working in nursing homes. A total of 386 participants from eight nursing homes were included in the study. In addition to completion of the RCBC during a 15-minute observation of care activities, demographic data were obtained, and participants completed a paper-and-pencil survey that included assessments of self-efficacy, outcome expectations, knowledge of restorative care, and job attitude. Reliability testing was based on person separation reliability and interrater reliability. Validity testing was based on evidence of the unidimensionality of the measure, the fit of the items using Rasch analysis, and evidence of convergent validity. RESULTS: There was support for the reliability of the RCBC with a person separation reliability of .77 and interrater reliability, with 83% to 100% agreement on each of the care activities. Support for validity was provided based on evidence of unidimensionality and a good fit of the items. There was minimal support for convergent validity. DISCUSSION: The development and psychometric testing of the RCBC are an important first step in the observational assessment of restorative care activities performed by NAs, or other caregivers of older adults, living in long-term care settings.