Barbara L. Brush

International Nurse Migration: Lessons From the Philippines

Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the worlds leading donor of nurse labor—the Philippines—is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.

Global Nurse Migration Today

PURPOSE To examine emerging trends in global nurse migration and those effects on nurse workforce planning and development efforts in select donor and recipient countries. DESIGN AND METHODS This integrative literature review is an analysis of current literature (journal articles, media, and press releases) and data from various sources (PUMS, NSSRN, CGFNS, Nurse & Midwifery Council) to explicate new trends in nurse migration. FINDINGS Rapid changes in nurse migration are significantly challenging nurse workforce management efforts in both donor and recipient nations. CONCLUSIONS As the market demand for nurses around the globe escalates, the changes and consequences associated with nurse migration are increasingly in need of policy solutions that indicate the needs and motivations of all stakeholders.

Trends in Characteristics and Country of Origin Among Foreign-Trained Nurses in the United States, 1990 and 2000

OBJECTIVES We describe long-term trends in the characteristics of foreign-trained new entrants to the registered nurse (RN) workforce in the United States. METHODS Using the 1990 and 2000 US Census 5% Public Use Microdata Sample files, we compared trends in characteristics of US- and foreign-trained new entrants to the RN labor force (n=40827) and identified trends in the country of origin of the foreign-trained new entrants. RESULTS Foreign-trained RNs grew as a percentage of new entrants to the RN workforce, from 8.8% in 1990 to 15.2% in 2000. Compared with US-trained RNs, foreign-trained RNs were 3 times as likely to work in nursing homes and were more likely to have earned a bachelors degree. In 2000, 21% of foreign-trained RNs originated from low-income countries, a doubling of the rate since 1990. CONCLUSIONS Foreign-trained RNs now account for a substantial and growing proportion of the US RN workforce. Our findings suggest foreign-trained RNs entering the United States are not of lower quality than US-trained RNs. However, growth in the proportion of RNs from low-income countries may have negative consequences in those countries.

Bed-exit alarm effectiveness

This study describes the accuracy of two types of bed-exit alarms to detect bed-exiting body movements: pressure-sensitive and a pressure-sensitive combined with infrared (IR) beam detectors (dual sensor system). We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1636.5h; an average of 18.3+/-22.3 (+/-S.D.) nights/participant for an average of 6.4+/-1.2 h/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means (LSM) show a marginally significant difference between the type of alarm groups on the number of true positives (NTP) (mean/S.E.M.=0.086/1.617) for pressure-sensitive versus dual sensor alarm (0.593/1.238; p=0.0599) indicating that the dual sensor alarm may have a higher NTP. While the dual sensor bed-exit alarm was more accurate than the pressure-sensitive alarm in identifying bed-exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed.

Reporting elder mistreatment

Elder mistreatment, defined as the abuse and neglect of older persons, includes physical, psychological, and sexual abuse, caregiver and self-neglect, and financial exploitation. Fifty states and the District of Columbia have passed legislation to establish adult protective service (APS) programs. State APS statutes authorize APS agencies to investigate cases of elder mistreatment. Some status fund services to alleviate the abusive or neglectful situation. This article analyzes the critical aspects of state-specific APS legislation affecting nursing practice with older adults and the nurses role in reporting cases of elder mistreatment.

Contractures in Frail Nursing Home Residents

Contractures are a common but preventable consequence of prolonged physical immobility among nursing home residents. Significant for their associated costs in institutions rendering care to frail elder residents, contractures further reduce mobility and increase the risk of other outcomes of decreased mobility, such as pressure ulcers. This secondary analysis examines the prevalence of contractures in 273 residents who participated in an interventional study focusing on reducing restrictive siderails. Almost two thirds of the participants had at least 1 contracture, with the most common locations being the shoulder and knee. Presence of pain and being non-White were significant predictors of contracture presence. This study highlights the high prevalence of contractures, the underlying factors associated with them, and the need to prevent or minimize contracture formation, including the role restorative nursing care plays in this avoidable condition.

Bed and toilet height as potential environmental risk factors

Seat height that is too high (> 120% of lower leg length [LLL]) or too low (< 80% of LLL) can impede safe transfer and result in falls. This study examines the difference between LLL of frail nursing home residents and the height of their toilets and beds in the lowest position, compares the patient or environmental characteristics of those able to transfer from the bed or toilet to those who cannot, and determines the relationship of patient or environmental characteristics to bed-related falls. A retrospective observational design using secondary data from 263 nursing home residents finds that bed height of three fourths of participants was greater than 140% of LLL, whereas toilet height of more than half was 100% to 120% of LLL. Increased fall risk is associated with increased age, shorter length of stay, normal lower extremity range of motion, less cognitive impairment, more behavioral symptoms, and no complaints of pain during exam.

Moving Toward Synergy: Lessons Learned in Developing and Sustaining Community-Academic Partnerships

Background: Community-academic partnerships are an increasingly popular approach to addressing community health problems and engaging vulnerable populations in research. Despite these altruistic foci, however, partnerships often struggle with fundamental issues that thwart sustainability, effectiveness, and efficiency.Objectives: We adapted a synergy-promoting model to guide the development and evaluation of a community-academic partnership and share lessons learned along the way.Methods: We analyzed the partnership process over time to determine the interaction of trust, collaboration, and engagement in creating partnership synergy and promoting sustainability.Lessons Learned: Few community-academic partnerships use a conscious and systematic approach to guide and evaluate their progress. We argue that this is an important first step in creating a partnership, sustaining a milieu of open dialogue, and developing strategies that promote trust and equalize power dynamics. Still, as we learned, the best laid plans can go awry, challenging partnership synergy throughout its lifespan.

Common issues, different approaches: strategies for community–academic partnership development

Communities around the United States face many challenging health problems whose complexity makes them increasingly unresponsive to traditional single-solution approaches. Multiple approaches have considered ways to understand these health issues and devise interventions that work. One such approach is community-based participatory research. This article describes the development of a new collaborative partnership between a school of nursing and an urban social service agency using community-based participatory research as a framework. We describe the partnerships evolution and process of data collection and analysis and evaluate the outcomes of both. We argue that community-based participatory research involves partnerships at its core whose members, both as individuals and part of the collaboration, must be committed and nimble in the face of shifting and challenging health and social problems, recognize common issues and concerns across the boundaries of community and academia, and respect each others different approaches and expertise.

Least Restrictive or Least Understood? Waist Restraints, Provider Practices, and Risk of Harm

ABSTRACT Since implementation of The Omnibus Budget Reconciliation Act of 1987, restraint use in American nursing homes has reduced dramatically. The reduction in vest restraints has resulted in an increase in “least restrictive” devices such as waist restraints. Although this analysis of U.S. Food and Drug Administration Adverse Event Reporting Data Files found that waist devices pose the same potential risk for asphyxial death as vest restraints, few health professionals and consumers are aware of this outcome. Post-marketing device reporting needs better data quality and surveillance, which can certainly benefit the Centers for Medicare and Medicaid Services in their efforts to regulate and enforce standards of care that reduce deaths and injuries to vulnerable nursing home residents.