Recent Research Publications and Funding
Point of care hand hygiene—where’s the rub? A survey of US and Canadian health care workers’ knowledge, attitudes, and practices| May 10, 2016 4:00AM
BACKGROUND: Hand hygiene at the point of care is recognized as a best practice for promoting compliance at the moments when hand hygiene is most critical. The objective of this study was to compare knowledge, attitudes, and practices of US and Canadian frontline health care personnel regarding hand hygiene at the point of care.
METHODS: Physicians and nurses in US and Canadian hospitals were invited to complete a 32-question online survey based on evidence supporting point of care hand hygiene. Eligible health care personnel were in direct clinical practice at least 50% of the time.
RESULTS: Three hundred fifty frontline caregivers completed the survey. Among respondents, 57.1% were from the United States and 42.9% were from Canada. Respondents were evenly distributed between physician and nurses. The US and Canadian respondents gave identical ranking to their perceived barriers to hand hygiene compliance. More than half of the respondents from both the United States and Canada agreed or strongly agreed that they would be more likely to clean their hands when recommended if alcohol-based handrub was closer to the patient.
CONCLUSION: This survey demonstrates that similarities between Canada and the United States were more common than not, and the survey raises, or suggests, potential knowledge gaps that require further illumination.
May 2, 2016 4:00AM
Objectives: Radon is the second leading cause of lung cancer in the United States and the leading cause of lung cancer among nonsmokers. Residential radon is the cause of approximately 21,000 U.S. lung cancer deaths each year. Dangerous levels of radon are just as likely to be found in low-rise apartments and townhomes as single-family homes in the same area. The preferred radon mitigation strategy can be expensive and requires structural modifications to the home. The public health nurse (PHN) needs a collection of low-cost alternatives when working with low-income families or families who rent their homes.
Method: A review of the literature was performed to identify evidence-based methods to reduce radon risk with vulnerable populations.
Results: Fourteen recommendations for radon risk reduction were categorized into four strategies. Nine additional activities for raising awareness and increasing testing were also included.
Discussion: The results pair the PHN with practical interventions and the underlying rationale to develop radon careplans with vulnerable families across housing types. The PHN has both the competence and the access to help families reduce their exposure to this potent carcinogen.
Using Gagne's 9 Events of Instruction to Enhance Student Performance and Course Evaluations in Undergraduate Nursing Course.| May 1, 2016 4:00AM
Teaching large numbers of students can be a challenge for both teachers and students. Implementing new teaching strategies may be 1 way to address the problem. This paper presents the impact of using Gagne's 9 events of instruction on student learning and course evaluations over a 3-semester period. Student evaluation ratings indicated enhanced teacher mastery, effectiveness, and enthusiasm. Overall student final grades increased.
Part B: The Feasibility and Acceptability of mI SMART: A Nurse-Led Technology Intervention for Multiple Chronic Conditions in Primary Care| April 1, 2016 4:00AM
Background: An opportunity to improve care of multiple chronic conditions for those living in rural areas of the country may exist through the use of technology. Integrating technology interventions into existing rural health systems allows for increased access to healthcare services and augments self-management ability for patients. However, questions remain about acceptability and feasibility of technology use in rural populations. The purpose of this paper is to present the feasibility of mI-SMART, a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices designed to overcome the known health determinant of access to care for rural, chronically ill patients by using technology. Methods: The study was conducted at a primary-care clinic that provided healthcare at no or low cost to low income adults. Inclusion criteria encompassed adults, with at least one chronic condition, having at least 3rd grade reading level, without having dementia/psychosis. Each participant was given a Nexus7 tablet and Bluetooth self-monitoring devices. Feasibility was evaluated in four ways and acceptability was evaluated with post-intervention questionnaires. Results: Thirty participants [mean age: 52 years (SD: 10.0, range: 29 - 74)] were majority female (70%), white (70%), married (60%), high-school educated or less (56.7%), impoverished (less than $20,000 per annum (56.7%), with multiple chronic conditions (96.7%)). During the trial, all participants were able to transmit data. No error messages were due to the mI-SMART system. Errors were user related and solved with technical support. Mean number of self-monitor transmissions was 219.7 [(SD: 197.4), range: 1 - 733]. Participants logged into the system an average of 163. 1 [(SD: 169.7), range: 2 - 568] times and viewed an average of 1092.1 [(SD: 1205.6), range: 8 - 3851] intervention components. Over eighty-six percent of participants sent data for 12 weeks and 43.1% used the intervention for longer. Conclusions: The mI-SMART system is a feasible option for impoverished persons living in rural areas.
Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model| March 31, 2016 4:00AM
Background:Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care.
Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact.
Method: We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes.
Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes.
Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.
February 22, 2016 6:00AM
Collaborative goal setting (CGS) is a cornerstone of diabetes self-management support, but little is known about its feasibility and effectiveness during routine care. The aim of this study was to evaluate the implementation of an existing CGS intervention when integrated by primary care staff. Using a mixed-methods approach guided by the RE-AIM framework, intervention adoption, implementation, reach, and effectiveness were evaluated over 12 months. Three of four sites adopted the CGS intervention, in which 521 patients with type 2 diabetes (9–29 % of those targeted) received CGS. For those with suboptimal glycemic control (A1C ≥ 7.5 %), %A1C decreased by 1.1 for those receiving CGS (n = 204, p < 0.001) compared to 0.4 for a group who did not (n = 41, p = 0.23). Practice characteristics influenced adoption and implementation, while isolation of CGS from the remainder of clinical care likely influenced reach and effectiveness. CGS may benefit patients with diabetes, but a lack of integration by practice staff is a key barrier to overcome during implementation.
Supporting Working for Normalcy Post-Treatment: Guidance from a Qualitative Study of Older Cancer Survivors| February 11, 2016 6:00AM
Purpose/Objectives: To develop a better understanding of how older adult survivors of early-stage breast and prostate cancer managed the work of recovery.
Research Approach: Multiple case study design embedded in a larger randomized, controlled trial of a nurse-led patient navigation intervention.
Setting: Community-based research conducted via in-home visits and by phone with participants residing in non-metropolitan areas of a mid-Atlantic state.
Participants: Rural-dwelling adults aged 60 years or older with early-stage breast or prostate cancer and the people who support them (11 dyads).
Methodologic Approach: An approach to grounded theory analysis was used to evaluate the fit between existing theoretical knowledge and case findings and to generate new knowledge about the cancer recovery process.
Findings: Working toward normalcy was a core process of cancer recovery prompted by participants’ internal experiences and external interactions with their environments. This ongoing, iterative, and active process involved multiple concurrent strategies that were not necessarily medically oriented or cancer specific. Working toward normalcy resulted in movement along a continuum of self-appraisal anchored between participants experiencing life as completely disrupted by cancer to a life back to normal. A greater sense of normalcy was associated with higher engagement in valued activities and increased physical and psychological well-being.
Conclusions: In addition to the core process of working toward normalcy, multiple theories from nursing, sociology, psychology, and gerontology helped to explain case findings. This knowledge could serve as a foundation on which to design survivorship care that supports the goals of cancer survivors working toward normalcy post-treatment.
Interpretation: Post-treatment wellness goals can include a desire to reestablish or maintain a sense of normalcy. Nursing actions that promote survivors’ efforts to be perceived as capable, stay engaged in valued activities and roles, maintain a sense of control over their lives and bodies, and make plans for the future may help meet this goal. Existing theories about identity, dignity, inner strength, and the work of illness can inform nursing interventions.
January 25, 2016 6:00AM
Central-line-associated bloodstream infections (CLABSI) are among the deadliest heathcare-associated infections, with an estimated 12-25% mortality rate. In 2014, the Centers for Medicare and Medicaid Services (CMS) began to penalize hospitals for poor performance with respect to selected hospital-acquired conditions, including CLABSI. A structural factor associated with high-quality nursing care and better patient outcomes is The Magnet Recognition Program®. The purpose of this study was to explore the relationship between Magnet status and hospital CLABSI rates. We used propensity score matching to match Magnet and non-Magnet hospitals with similar hospital characteristics. In a matched sample of 291 Magnet hospitals and 291 non-Magnet hospitals, logistic regression models were used to examine whether there was a link between Magnet status and CLABSI rates. Both before and after matching, Magnet hospital status was associated with better (lower than the national average) CLABSI rates (OR = 1.60, 95%CI: 1.10, 2.33 after matching). While established programs such as Magnet recognition are consistently correlated with high-quality nursing work environments and positive patient outcomes, additional research is needed to determine whether Magnet designation produces positive patient outcomes or rewards existing excellence.
January 11, 2016 6:00AM
Cigarette smoking has been shown to be a health hazard. In addition to being considered a negative lifestyle behavior, studies have shown that cigarette smoking has been linked to genetic underpinnings of hypertension. Because African Americans have the highest incidence and prevalence of hypertension, we examined the joint effect of genetics and cigarette smoking on health among this understudied population. The sample included African Americans from the genome wide association studies of HyperGEN (N = 1083, discovery sample) and GENOA (N = 1427, replication sample), both part of the FBPP. Results suggested that 2 SNPs located on chromosomes 14 (NEDD8; rs11158609; raw p = 9.80 × 10−9, genomic control-adjusted p = 2.09 × 10−7) and 17 (TTYH2; rs8078051; raw p = 6.28 × 10−8, genomic control-adjusted p = 9.65 × 10−7) were associated with SBP including the genetic interaction with cigarette smoking. These two SNPs were not associated with SBP in a main genetic effect only model. This study advances knowledge in the area of main and joint effects of genetics and cigarette smoking on hypertension among African Americans and offers a model to the reader for assessing these risks. More research is required to determine how these genes play a role in expression of hypertension.
January 6, 2016 6:00AM
PURPOSE: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables.
METHODS: We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6-month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software.
RESULTS: Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearson's correlations r >.60; p values < .05).
CONCLUSIONS: We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs.