Ann C. Hurley

Self-efficacy: strategy for enhancing diabetes self-care.

This study found that the concept of self-efficacy was associated with diabetes self-care behaviors for individuals with complex insulin requirements. Individuals with higher levels of self-efficacy were better able to manage their diabetes self-care. Diabetes educators are encouraged to incorporate the self-efficacy concept into teaching programs to help individuals develop their own strategies for long-term management of their diabetes. The diabetes scales that made both concepts, self-efficacy and self-care, operational have content validity and measurement reliability and may be used in practice settings to obtain pretreatment information and to evaluate outcomes.

Scales for evaluation of End-of-Life Care in Dementia.

Systematic evaluation of end-of-life care in dementia has been hampered by a lack of instruments to specifically address those issues that are unique for persons who are dying with dementia. This study evaluated psychometric properties of three scales designed to measure outcomes of care of persons suffering from terminal dementia. A survey of family caregivers whose loved one died during the past year was conducted using a questionnaire that included questions regarding satisfaction with care, physical and emotional symptoms that occurred during the last 90 days of the care recipients life, and comfort during the dying process. Three scales were developed based on responses from 156 questionnaires: Satisfaction with Care at the End-of-Life in Dementia (SWC-EOLD), Symptom Management at the End-of-Life in Dementia (SM-EOLD) with Physical and Psychological Symptoms subscales, and Comfort Assessment in Dying with Dementia (CAD-EOLD) with four subscales: Physical Distress, Dying Symptoms, Emotional Distress, and Well Being. The three scales developed and evaluated in this study can be used as outcome measures in studies investigating effectiveness of interventions aimed to improve end-of-life care for individuals with dementia.

Quantifying Nursing Workflow in Medication Administration

New medication administration systems are showing promise in improving patient safety at the point of care, but adoption of these systems requires significant changes in nursing workflow. To prepare for these changes, the authors report on a time-motion study that measured the proportion of time that nurses spend on various patient care activities, focusing on medication administration-related activities. Implications of their findings are discussed.

Development and testing of the resistiveness to care scale

A conceptual model and objective scale for measuring resistiveness to care in individuals with advanced dementia of the Alzheimer type (DAT) were empirically generated from the perspective of nursing staff caregivers and through observation of residents with DAT. The resistiveness to care scale (RTC-DAT) was judged to have content validity and reduced to 13 items. Quantifiable scoring procedures and methods for rating videotapes and conducting clinical observations were developed. The RTC-DAT was tested with 68 subjects at three sites. The RTC has a range of 0-156. Initial testing provided reliability estimates of .82-.87 for internal consistency and good to excellent kappas. Criterion-related validity with observed discomfort and construct validity by factor analysis support the RTC-DAT. Measurement issues and recommendations for use in research are discussed.

Development of a Model of Moral Distress in Military Nursing

The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments.

Recovery from Medical Errors: The Critical Care Nursing Safety Net

BACKGROUND Safety initiatives have primarily focused on physicians despite the fact that nurses provide the majority of direct inpatient care. Patient surveillance and preventing errors from harming patients represent essential nursing responsibilities but have received relatively little study. METHODS The study was conducted between July 2003 and July 2004 in a 10-bed academic coronary care unit. Direct observation of nursing care and solicited and institutional incident reports were used to find potential incidents. Two physician reviewers rated incidents as to the presence, preventability, and potential severity of harm of errors and associated factors. RESULTS Overall data were collected for 147 days, including 150 hours of direct observation. One hundred forty-two recovered medical errors were found, including 61% (86/142) during direct observations. Most errors (69%; 98/142) were intercepted before reaching the patients. Errors that reached patients included 13% that were mitigated before resulting in harm and 18% that were ameliorated before more severe harm could occur. DISCUSSION Protecting patients from the potentially dangerous consequences of medical errors is one of the many ways critical care nurses improve patient safety. Interventions designed to increase the ability of nurses to recover and promptly report errors have the potential to improve patient outcomes.

Characteristics of dementia end-of-life care across care settings

End-of-life care for persons with dementia in different care settings was retrospectively surveyed. In this sample, care recipients receiving hospice care and pain control stayed at home longer and were more likely to die at home. Psychiatric symptoms increased caregiver burden and were the most common reason for admission to an institution, and psychiatric care was associated with longer stay at home. Presence of advance directives decreased hospital stay and increased the likelihood of dying in a nursing home. Care recipients dying at home had fewer symptoms and less discomfort than care recipients dying in other settings. These results indicate that quality end-of-life care can be provided at home and is facilitated by hospice programs, effective pain control, and psychiatric care.

Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?

Objective: Obtain the views of nurses and assistants as to why patients in acute care hospitals fall. Background: Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals. Methods: Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for analysis. Results: Positive and negative components of 6 concepts-patient report, information access, signage, environment, teamwork, and involving patient/family-formed 2 core categories: knowledge/ communication and capability/actions that are facilitators or barriers, respectively, to preventing falls. Conclusion: Two conditions are required to reduce patient falls. A patient care plan including current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Second, stakeholders must use that information plus their own knowledge and skills and patient and hospital resources to carry out the plan.

Predicting short-term survival for patients with advanced Alzheimer's disease

The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT).

Patients' perspectives of falling while in an acute care hospital and suggestions for prevention

Patient falls and falls with injury are the largest category of reportable incidents and a significant problem in hospitals. Patients are an important part of fall prevention; therefore, we asked patients who have fallen about reason for fall and how falls could be prevented. There were two categories for falls: the need to toilet coupled with loss of balance and unexpected weakness. Patients asked to be included in fall risk communication and asked to be part of the team to prevent them from falling. Nurses need to share a consistent and clear message that they are there for patient safety.