Barbara Penprase

Nursing leadership style and psychosocial work environment.

AIM This study examines the relationship between leadership style and the psychosocial work environment of registered nurses. BACKGROUND Research consistently supports the positive relationship between transformational leadership style and job satisfaction. There is less evidence, which identifies the relationship between leadership style and psychosocial work environment. METHOD The Multifactor Leadership Questionnaire 5× was used to identify the leadership style. The Copenhagen Psychosocial Questionnaire was used to measure psychosocial work environment dimensions. Statistical analysis included Pearsons r correlation between leadership style and psychosocial work environment and anova to analyse group means. RESULTS There is a significant correlation between leadership style and 22 out of the 37 dimensions of the psychosocial work environment. This correlation was significant ranging from r = 0.88, P < 0.01 to r = 0.18, P < 0.05. Nurses divided into groups based on transformational leadership scores of the immediate supervisor report significant differences in their psychosocial work environment. CONCLUSION This study supports the significant correlation between leadership style and psychosocial work environment for registered nurses. IMPLICATIONS FOR NURSING MANAGEMENT The results of this study suggest that there would be an improvement in the nursing psychosocial work environment by implementation of transformational and contingent reward leadership behaviours.

A closer look at academic probation and attrition: what courses are predictive of nursing student success?

The purpose of this retrospective study was to identify undergraduate courses that serve as predictors of success for nursing students completing a BSN program. The sample included records of 327 students placed on probation or dismissed from a Midwest school of nursing between 2002 and 2010. Though previous research has shown that science courses can be used as predictors of nursing student success, our results suggest that non-science courses can serve in this capacity as well. In particular, an across-the-life-span fundamental psychology course was found to be an important predictor in determining whether or not probationary students eventually completed the program. These results suggest that nursing programs need to evaluate their programs not only reviewing students success in nursing courses but also in prerequisites beyond just science courses such as chemistry and biology.

The efficacy of preemptive analgesia for postoperative pain control: a systematic review of the literature.

The purpose of preemptive analgesia is to reduce postoperative pain, contributing to a more comfortable recovery period and reducing the need for narcotic pain control. The efficacy of preemptive analgesia remains controversial. This systematic review of the literature evaluated the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, and gabapentin as preemptive oral analgesics for surgical patients. Included articles were limited to studies of adult patients that compared the difference in postoperative pain between control and treatment groups. Of 40 studies reviewed, 14 met the inclusion criteria, including two on NSAIDs, four on COX-2 inhibitors, and eight on gabapentin. Research was predominantly conducted outside the United States. Gabapentin and COX-2 inhibitors were found to be the most effective preemptive analgesics for postoperative pain control. As part of a collaborative team, perioperative nurses and certified RN anesthetists are responsible for ongoing pain assessment and management for preemptive analgesic interventions.

Reducing Hospital ICU Noise: A Behavior-Based Approach

Noise in Intensive Care Units (ICUs) is gaining increasing attention as a significant source of stress and fatigue for nursing staff. Extensive research indicates that hospital noise also has negative impact on patients. The objective of this study was to analyze noise variations as experienced by both nursing staff and patients, to gain a better understanding of noise levels and frequencies observed in ICU settings over extended (week-long) durations, and to implement a low cost behavior modification program to reduce noise. The results of our study indicate that behavioral modification alone is not adequate to control excessive noise. There is a need for further research involving the supportive involvement by clinicians, ICU staff, along with effective medical device alarm management, and continuous process improvement methods.

Perceptions, orientation, and transition into nursing practice of accelerated second-degree nursing program graduates.

This study discusses factors that influence newly graduated accelerated second-degree nursing students to remain at the bedside. It also identifies areas for improvement within the program curriculum to better prepare these unique nursing graduates for the transition into nursing practice. Twenty-nine graduate second-degree nursing students were surveyed 3 months after graduation from an accelerated second-degree nursing program. Key findings indicated that preceptorship within nursing courses and orientation programs was the most significant factor in preparing the graduates for the transition from student nurse to registered nurse. Also important to the successful transition into practice was the acceptance and support of the nursing staff on the clinical unit. The participants overwhelmingly cited preceptorships, at both the student nurse and recent graduate levels, as critical to preparing them for the transition from student nurse to registered nurse.

Nursing practice patterns: Timing of insulin administration and glucose monitoring in the hospital

Purpose The purpose of this study was to describe diabetes nursing practice patterns related to the timing of morning insulin administration, blood glucose monitoring, and meal intake for patients with type 2 diabetes and to report how frequently nurses were able to meet the expected standard of care. Methods Observations were made of 50 incidents of morning diabetes care on medical-surgical units in an acute care setting. Timeliness of rapid-acting insulin administration and glucose monitoring in relation to the morning meal were evaluated, as were the subsequent prelunch glucose levels. Results Patients did not receive rapid-acting insulin with in the standard recommended time of 10 minutes premeal/postmeal 84% of the time, nor did they receive glucose monitoring within the recommended 30 minutes premeal 57% of the time. There was no significant relationship found between timely insulin administration and glucose monitoring. There were no significant relationships found between care activities and prelunch glucose control or glucose variability. Conclusions Coordinating insulin administration, glucose monitoring, and meal delivery within the tight time frames required for rapid-acting insulin is a significant challenge not being met. Timeliness of diabetes nursing care is not the sole determining factor to good glucose control in hospitalized patients. Standards regarding timing of these activities need to be evaluated.

Collaboratively Developing an Orientation Program for OR Nurses

Many articles have addressed perioperative educations role in recruiting and retaining perioperative nurses, yet they continue to decline in number. The challenging, and sometimes stressful, perioperative environment often inhibits recruitment and retention of perioperative nurses. A unique, collaborative effort between a school of nursing and a hospital resulted in the development of a nursing orientation program that focuses its attention on reducing reality shock and preparing nurses for the perioperative environment. The orientation program incorporates AORNs standards and recommended practices.

Factors Influencing Registered Nurses' Decision to Activate an Adult Rapid Response Team in a Community Hospital.

Background:One factor impacting patient outcomes in the acutely deteriorating patient is a delay by nursing staff to activate a rapid response team (RRT); however, a gap in knowledge exists concerning factors influencing activation of an RRT by nursing staff working in adult areas outside the medical-surgical and telemetry setting. Objectives:The purpose of this study was to examine beliefs and behaviors that influence registered nurses’ decision to activate an adult rapid response team in a community hospital that includes 3 specialties: medical-surgical and telemetry, peripartum, and psychiatric areas. Methods:One hundred sixty-three nurses were surveyed using a 17-item Likert-style instrument to assess registered nurses’ beliefs and attitudes on and barriers to utilizing an RRT. Results:The survey was analyzed yielding 3 factors: RRT barriers, RRT positive/intent to activate, and patient management beliefs. Barriers cited by other research to activate RRT including criticism by the team and perception that the RRT increases workload or reduces skills were not found to be influential considerations. A significant difference was found among the 3 specialty groups related to RRT positive/intent to activate (F2,159 = 6.09, P = .003) and patient management beliefs (F2,159 = 5.87, P = .003). A strong negative correlation was found between years of experience as an RN and RRT barriers (&rgr;161 = −0.250). Discussion:Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.

Cardiovascular Disease Risk in Children and Adolescents

Atherosclerosis is a global health issue beginning in childhood. Childrens early development of cardiovascular disease (CVD) risk factors may include exposure to key biological components responsible for vascular inflammation in young adults. A retrospective medical record review based on the 2008 American Academy of Pediatrics childhood lipid screening recommendations examined current and initial CVD risk factors for 227 at-risk school-aged children during wellness exams to better determine the age when children are most likely to convert from being risk-free to at risk for CVD. An original risk trend algorithm analyzed risk clustering and risk trend progression. Risk onset was young (M=2.88 years), with family risk most prevalent and risk clustering and accumulation noted, perhaps precluding primordial prevention.

Relative Dose Intensity—Improving Treatment and Outcomes in Early-Stage Breast Cancer: A Retrospective Study

PURPOSE/OBJECTIVES To determine the amount of chemotherapy delivered compared to amount of chemotherapy scheduled by calculating relative dose intensity (RDI) and to identify factors associated with nonadherence of scheduled treatment regimens for patients with early-stage breast cancer (ESBC). DESIGN Retrospective, descriptive, correlational study. SETTING Two community hospital cancer centers in northern Michigan. SAMPLE 77 patients with ESBC receiving adjuvant chemotherapy. METHODS The RDI Calculator™ was used for data collection. A worksheet was developed for each patient and included characteristics, treatment information, and RDI calculations. SAS®, version 19.2, was used for multivariate analyses based on logistical regression analyzing relationships among dependent and independent variables. MAIN RESEARCH VARIABLES Dependent variables were RDI prescribed and RDI received. Independent variables included chemotherapy regimen, clinical characteristics, planned dose, and schedule. FINDINGS The average RDI was 86.6%. The average RDI was 86.7% for patients younger than age 65, and 85.5% for those 65 and older. The most common reasons for dose reduction or dose delay were treatment toxicity, chronic disease risk factors, age, unplanned versus planned treatment dose, institution (different standards of care), patient preference, and weight. CONCLUSIONS Meeting treatment goals of RDI for patients with ESBC has been shown to increase the disease-free survival rate and positively affects overall survival. IMPLICATIONS FOR NURSING Nurses have the unique opportunity to case manage patients with ESBC throughout the spectrum of care. One of the key areas of focus is education of the patient and her family members from the time of diagnosis throughout treatment and rehabilitation.