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Recent Research Publications and Funding
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February 3, 2015 6:00AM
The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.
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February 1, 2015 6:00AM
BACKGROUND: Cognitive impairment is a distressing, disruptive, and potentially debilitating symptom that can occur as a direct result of cancer or its treatment. National organizations have identified cognitive impairment as a challenge many survivors face and call for research to address this problem. Despite the priority, research is still relatively limited and questions remain unanswered about prevalence and impact on survivors, as well as coping strategies and effective treatment options available to address this potentially debilitating problem.
OBJECTIVES: The purpose of this article is to (a) analyze the prevalence and types of cognitive impairment that commonly affect survivors; (b) delineate the impact that cognitive impairment after cancer and cancer treatment has on self-esteem, social relationships, work ability, and overall quality of life among survivors; and (c) synthesize and appraise commonly used coping strategies used by survivors to address cognitive impairment and evidence-based interventions that may be incorporated into clinical practice.
METHODS: A comprehensive review and synthesis of the literature was conducted.
FINDINGS: Evidence-based interventions to address cognitive changes after cancer and cancer treatment are limited. However, emerging research has demonstrated that nonpharmacologic treatments, such as cognitive training, are likely to be effective.
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February 1, 2015 6:00AM
The purpose of this literature review is to describe the state of the science on teen dating violence (TDV) research identifying support and barriers in accessing services. This review will help identify gaps in dating violence (DV) research and inform secondary and tertiary prevention services, as well as ways that these could be integrated into comprehensive primary prevention efforts. This review was conducted via electronic search through CINAHL, PubMed, and PsychINFO. Results show a serious lack of research in the content area and the importance of increasing research efforts in discovering supports for accessing DV services is emphasized.
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January 30, 2015 6:00AM
Current medical models frequently overlook functional limitations and the home environment even though they partially determine healthcare usage and quality of life. The Centers for Medicare and Medicaid Services (CMS) Innovation Center funds projects that have potential to affect the "triple aim," a framework for decreasing costs while improving health and quality of life. This article presents preliminary data from Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a model funded by the CMS Innovation Center and designed to overcome the functional and home environmental barriers of older adults. CAPABLE is a patient-directed, team-based intervention comprising an occupational therapist, a registered nurse, and a handyman to decrease hospitalization and nursing home usage of community-dwelling older adults with functional limitations who are dually eligible for Medicare and Medicaid. Activity of daily living limitations improved in 79% of the first 100 people who completed the intervention. Preliminary findings of this novel intervention may have implications for other older adults with functional limitations.
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January 14, 2015 6:00AM
Developing innovative delivery methods is needed to overcome time and logistic barriers to in-person participation in evidence-based parent training programs.
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January 10, 2015 6:00AM
Dating violence is a significant problem for older adolescents with implications for the survivor's health. Survivors disclose the violence to friends who are often ill equipped to help them manage the consequences. The purpose of this pilot study was to evaluate the effectiveness and feasibility of Friends Helping Friends, a community-level education program to teach older adolescents to recognize and intervene in dating violence. A convenience sample of 101 students aged 18 to 22 years were nonrandomly allocated to a treatment or control group and completed pre- and post-test measures. Compared with the control group, treatment group participants reported increased perceived responsibility to help, skills to act as a bystander, and intention to help and decreased rape myth acceptance. Friends Helping Friends shows promise as an effective strategy for older adolescent females in the prevention and response to dating violence.
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January 6, 2015 6:00AM
BACKGROUND: Increasing population diversity in the United States creates challenges for providing culturally responsive health care to immigrant adolescents. Nursing providers have few effective concepts to guide their understanding of how culturally diverse adolescents handle different cultural influences (between family and society) and how straddling two cultures may influence adolescents' decision making about health.
AIM: Bicultural straddling is defined as an ongoing process of adaptation resulting from living within two different cultural influences. A concept analysis of bicultural straddling is important to nursing professionals in caring for culturally diverse adolescents.
METHOD: Walker and Avant's methodology was used to guide our understanding about how immigrant adolescents straddle cultural influences between their homes and society.
RESULTS: Straddling two different cultures influences adolescents' health-related beliefs, attitudes, perceptions, and behaviors as they navigate everyday struggles to make informed health decisions. Adolescents' ability to achieve active straddling will allow them to experience positive social functioning, psychological development, and health outcomes.
CONCLUSIONS: By understanding the ongoing process of "bicultural straddling" as a balancing act, nurse professionals can develop effective interventions to alleviate stress derived from acculturation among immigrant families and ultimately help adolescents achieve biculturalism.
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January 6, 2015 6:00AM
Rationale, aims and objectives: Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults.
Methods: Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback.
Results: Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant.
Conclusions: Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits.
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December 26, 2014 6:00AM
The objective of this article is to examine the racial and ethnic diversity profile of the nurse workforce over time and by geographic region. We conducted survey analysis using the National Sample Survey of Registered Nurses from 1988 to 2008, and further supplemented our trend analysis using published findings from the 2013 National Workforce Survey of Registered Nurses. The gap in racial/ethnic minority representation between the RN workforce and the population has been persistent and has widened over time. This diversity gap is primarily due to underrepresentation of Hispanics and Blacks in the RN workforce, which varied across states and regions, with the largest gaps occurring for Hispanics in the South and West and for Blacks in the South. Greater levels of sustained and targeted support to increase nurse workforce diversity are needed and should be geared not only to specific underrepresented groups but also to the regions and states with the greatest needs.
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December 20, 2014 6:00AM
The purpose of this study was to pilot test Perinatal Dyadic Psychotherapy, a novel dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of mother-infant relationships related to child development outcomes in mother-infants dyads in which the mother was experiencing elevated postpartum depression symptoms (sub-threshold or meeting diagnostic criteria for MDD). The specific aims were to: (1) Assess participant acceptability of study intervention and overall feasibility of study procedures, including recruitment, adherence, and retention; (2) Assess the preliminary efficacy of the PDP intervention on the primary outcomes of reducing maternal depression and enhancing the quality of mother-infant interaction at post-intervention and at three-month follow-up in order to provide information to enable sample size calculation for future studies; and (3) Explore the effects of the intervention on secondary outcomes of maternal anxiety, parenting stress, and maternal self-esteem at post-intervention and follow-up.
We hypothesized that, compared to control dyads, mother-infant dyads who received the intervention would evidence significantly (a) fewer maternal depression diagnoses, (b) lower depression severity, (b) more optimal mother-infant interaction, (c) lower maternal anxiety, (d) lower parenting stress, and (e) higher maternal self-esteem, at post-intervention and follow-up.