Cathy Catrambone

Point-of-care technology supports bedside documentation.

As the conversion to an electronic health record intensifies, the question of which data-entry device works best in what environment and situation is paramount. Specifically, what is the best mix of equipment to purchase and install on clinical units based on staff preferences and budget constraints? The authors discuss their evaluation of stationary personal computers, workshops on wheels, and handheld tablets related to timeliness of data entry and their use of focus groups to ascertain the pros/cons of data-entry devices and staff preferences. An assessment of the implications for costs related to the timeliness of data entry is also presented.

How Unit Level Nursing Responsibilities Are Structured in US Hospitals

Objectives: To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources. Background: The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes. Methods: Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel. Results: No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intrainstitutionally. There were large differences in the availability and deployment of non-unit-based supportive resources. Conclusions: Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.

'Global health' and 'global nursing': proposed definitions from The Global Advisory Panel on the Future of Nursing.

AIMSnTo propose definitions of global health and global nursing that reflect the new paradigm that integrates domestic and international health.nnnBACKGROUNDnIncreased globalization has led to expanded awareness of the importance of global health and global nursing among students and faculty in the health professions and among policymakers and practitioners.nnnDESIGNnDiscussion paper that includes a discussion and review of the literature related to global health and global nursing.nnnDATA SOURCESnA task force searched for and reviewed articles published in English, Spanish or Portuguese between 2005-2015, developed summaries, listed key elements, identified prevalent themes and developed consensus definitions.nnnIMPLICATIONS FOR NURSINGnThe definitions will be used by the Global Advisory Panelxa0on the Future of Nursing to guide promoting a voice and vision for nursing that will contribute to the advancement of the professions contribution to global health.nnnCONCLUSIONSnDefinitions of global health and global nursing were developed based on main themes and concepts identified in the literature review to guide contributions of nursing to global health.

The influence of caregiver’s psychosocial status on childhood asthma and obesity

BACKGROUNDnThe prevalence of childhood asthma and childhood overweight has increased in the last 2 decades, disproportionately burdening ethnic minority children and those living in poverty with no clear understanding of underlying mechanisms.nnnOBJECTIVEnTo explore the influence of demographic variables, childhood obesity (adjusted body mass index > or = 95th percentile), caregivers smoking status, and caregiver psychosocial status on asthma severity and asthma control in an urban sample of children with persistent asthma.nnnMETHODSnChild (with asthma)-caregiver dyads were recruited from public and archdiocese schools in Chicago, Illinois, as part of the Chicago Initiative to Raise Asthma Health Equity. Data were collected as part of the baseline face-to-face surveys conducted within the community.nnnRESULTSnThe 531 dyads were divided into 2 groups: 294 taking controller medications were in the asthma control analyses and 237 taking rescue medications only were in the asthma severity analyses. In multivariate models, asthma control was significantly worse in obese children (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.17-3.05), African American children (OR, 2.16; 95% CI, 1.05-4.46), and those with caregivers who had higher stress (OR, 1.09; 95% CI, 1.01-1.18). Older children had better control (OR, 0.79; 95% CI, 0.69-0.90). Children with caregivers who wanted more asthma-specific social support were more likely to have moderate to severe asthma (OR, 2.07; 95% CI, 1.06-4.05).nnnCONCLUSIONnIn this community-based sample of children with active asthma, asthma control and asthma severity were associated with different factors. Caregiver variables were significant in both outcomes, and childhood obesity was associated only with poor asthma control.

The who and whyʼs of side rail use

Full side rail usage and context vary by unit type. Managers can influence use through unit-based interventions and bed specification requirements.

Randomized Trial of a Discharge Planning and Telehealth Intervention for Patients Aged 65 and older after Coronary Artery Bypass Surgery

Background: It is well established that older patients are at increased risk for developing complications after cardiac surgery due to advanced disease, impaired cardiac status, and comorbidities. Objective: This study reports on the results of a telehealth and telephone Discharge Intervention for Cardiac Elderly (DICE) for patients ≥ age 65.

The Importance of Specific Education for Asthma Patients Discharged from the Emergency Department and Hospital

Discharge education from the hospital or emergency department (ED) is a challenging affair for everyone, including the asthma patient. An article in this issue of the Journal 1 identifies a lack of documentation of asthma education for patients discharged from the hospital. This properly suggests the likelihood of problems with education for those patients lacking such documentation. This problem also exists in the ED. While there may be more time or opportunity to conduct education for the patient admitted to the hospital, challenges in discharge from either the hospital or ED remain. We will address issues of discharge education from both settings. Concerning the finding of lack of documentation, as the authors note, education may occur in the course of the encounter that is not formally documented. 2 More importantly, even where the authors find documentation, there is not a description of the content of the materials distributed or documented. There are two crucial questions. First, where in the course of the encounter is education best done? And second, what is the content of that education? A recent article accompanying “pro and con” editorials describes a successful ED education program for patients. 3–5 A limitation in this program was the format. Education was done in a dedicated 20-minute session by one of the investigators, an experienced asthma clinician and educator. This format is unlikely to be practical in many hospitals and most EDs in the United States at this time. Most hospitals and EDs do not have independent, dedicated personnel for this task. Education thus is best done by the staff caring for the patient during the course of the hospital admission or ED encounter, which can include the nursing, medical, and respiratory staff. For example, during the course of the history, it may be discovered that a patient who should have been prescribed inhaled corticosteroids has not; this problem can be identified to the patient at that time and again when discharge medication plans are made. The recent US asthma guidelines 6 suggest the content for