David Newman

Root Cause Analyses of Transfers of Skilled Nursing Facility Patients to Acute Hospitals: Lessons Learned for Reducing Unnecessary Hospitalizations.

BACKGROUND Performing root cause analyses (RCA) on transfers of skilled nursing facility (SNF) patients to acute hospitals can help identify opportunities for care process improvements and education that may help prevent unnecessary emergency department (ED) visits, hospitalizations, and hospital readmissions. OBJECTIVES To describe the results of structured, retrospective RCAs performed by SNF staff on hospital transfers to identify lessons learned for reducing these transfers. DESIGN SNFs enrolled in a randomized, controlled implementation trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program submitted RCAs on hospital transfers during a 12-month implementation period. SETTING SNFs from across the United States that volunteered and met the enrollment criteria for the implementation trial. PARTICIPANTS Sixty-four of 88 SNFs randomized to the intervention group performed and submitted retrospective RCAs on hospital transfers. INTERVENTIONS SNFs received education and technical assistance in INTERACT implementation. MEASURES Data were summarized from the INTERACT Quality Improvement (QI) tool, a structured, retrospective RCA on hospital transfers. RESULTS A total of 4856 QI tools were submitted during the 12-month implementation period. Most transfers were precipitated by multiple symptoms and signs, many of them nonspecific. Patient and/or family preference or insistence was noted to have played a role in 16% of the transfers. Hospital transfers were relatively equally distributed among days of the week, and 29% occurred on the night or evening shift. Approximately 1 in 5 transfers occurred within 6 days of SNF admission from a hospital, and 1 in 10 occurred within 2 days of SNF admission. After completing the RCA, SNF staff identified 1044 (23%) of the transfers as potentially preventable. Common reasons for these ratings included recognition that the condition could have been detected earlier and/or could have been managed safely in the SNF, and that earlier advance care planning and discussions with patients and families about preferences for care may have prevented some transfers. CONCLUSION Summarizing findings from RCAs of transfers of SNF patients to acute hospitals can provide important insights into areas of focus for care process improvements and related education that may help prevent unnecessary ED visits, hospital admissions, and readmissions.

Attitudes towards caring for older people in Scotland, Sweden and the United States

AIM To explore the attitudes of nurses and nursing students in Scotland, Sweden and the US towards working with older people. METHOD This quantitative study used the 20-item Multifactorial Attitudes Questionnaire (MAQ) to elicit attitudes on ageism, resources, working environment, education and professional esteem. Researchers from each country distributed the questionnaires to nursing students and nurses, giving a convenience sample of 1,587 respondents. Data were entered on the Statistical Package for Social Sciences version 18 and merged into one large dataset. RESULTS Scottish participants had the highest (positive) and Swedish participants the lowest mean MAQ score. The Kruskal-Wallis test showed significant differences in mean scores across the countries in 18 of the 20 statements, even when controlling for age and experience. Most participants gave positive responses, but agreed that negative attitudes towards working with older people pervade among peers due to working conditions, poor career prospects and a perceived lack of professional esteem. CONCLUSION Inspirational educators, excellent clinical placements and increasing the professional esteem of those working with older people are required to promote the specialty as an attractive career option.

Effects of an intervention to reduce hospitalizations from nursing homes: A randomized implementation trial of the INTERACT program

Importance Medicare payment initiatives are spurring efforts to reduce potentially avoidable hospitalizations. Objective To determine whether training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduced hospital admissions and emergency department (ED) visits. Design, Setting, and Participants This analysis compared changes in hospitalization and ED visit rates between the preintervention and postintervention periods for NHs randomly assigned to receive training and implementation support on INTERACT to changes in control NHs. The analysis focused on 85 NHs (36 717 NH residents) that reported no use of INTERACT during the preintervention period. Interventions The study team provided training and support for implementing INTERACT, which included tools that help NH staff identify and evaluate acute changes in NH resident condition and document communication between physicians; care paths to avoid hospitalization when safe and feasible; and advance care planning and quality improvement tools. Main Outcomes and Measures All-cause hospitalizations, hospitalizations considered potentially avoidable, 30-day hospital readmissions, and ED visits without admission. All-cause hospitalization rates were calculated for all resident-days, high-risk days (0-30 days after NH admission), and lower-risk days (≥31 days after NH admission). Results We found that of 85 NHs, those that received implementation training and support exhibited statistically nonsignificant reductions in hospitalization rates compared with control NHs (net difference, −0.13 per 1000 resident-days; P = .25), hospitalizations during the first 30 days after NH admission (net difference, −0.37 per 1000 resident-days; P = .48), hospitalizations during periods more than 30 days after NH admission (net difference, −0.09 per 1000 resident-days; P = .39), 30-day readmission rates (net change in rate among hospital discharges, −0.01; P = .36), and ED visits without admission (net difference, 0.02 per 1000 resident-days; P = .83). Intervention NHs exhibited a reduction in potentially avoidable hospitalizations overall (net difference, −0.18 per 1000 resident-days, P = .01); however, this effect was not robust to a Bonferroni correction for multiple comparisons. Conclusions and Relevance Training and support for INTERACT implementation as carried out in this study had no effect on hospitalization or ED visit rates in the overall population of residents in participating NHs. The results have several important implications for implementing quality improvement initiatives in NHs. Trial Registration clinicaltrials.gov Identifier: NCT02177058

The effect of Sit 'n' Fit Chair Yoga among community-dwelling older adults with osteoarthritis.

The study measured effects of Sit ‘N’ Fit Chair Yoga on pain and physical and psychological functioning. A quasi-experimental research design included a yoga intervention group and an attention control group. There was greater improvement in depression and life satisfaction in the yoga group than in the control group.

Guidance for using mixed methods design in nursing practice research

The mixed methods approach purposefully combines both quantitative and qualitative techniques, enabling a multi-faceted understanding of nursing phenomena. The purpose of this article is to introduce three mixed methods designs (parallel; sequential; conversion) and highlight interpretive processes that occur with the synthesis of qualitative and quantitative findings. Real world examples of research studies conducted by the authors will demonstrate the processes leading to the merger of data. The examples include: research questions; data collection procedures and analysis with a focus on synthesizing findings. Based on experience with mixed methods studied, the authors introduce two synthesis patterns (complementary; contrasting), considering application for practice and implications for research.

Attitudes of Nurses, and Student Nurses Towards Working with Older People and to Gerontological Nursing as a Career in Germany, Scotland, Slovenia, Sweden, Japan and the United States

Attitudes of Nurses, and student nurses towards working with older people and to gerontological nursing as a carrer in Germany, Scotland, Slovenia, Sweden, Japan and the United States

A Pilot Randomized Controlled Trial of the Effects of Chair Yoga on Pain and Physical Function Among Community-Dwelling Older Adults With Lower Extremity Osteoarthritis

To determine effects of Sit ‘N’ Fit Chair Yoga, compared to a Health Education program (HEP), on pain and physical function in older adults with lower extremity osteoarthritis (OA) who could not participate in standing exercise.

The Use of Research Syntheses and Nomological Networks to Develop HRD Theory

The Problem Research syntheses are rarely used in the field of human resource development (HRD). There are notable exceptions, but our search of the related literature found relatively few instances where procedures like meta-analyses are used to advance theory and empirically informed practice. The Solution To address this gap, this article provides a broad overview of different techniques for synthesizing literature. The article describes how research syntheses can be used to inform theory development; this is done via the description of a construct called nomological network. Such a network can be thought of as kind of minitheory, which is derived from the theoretical relationships among key constructs. The Stakeholders Readers interested in developing empirically informed HRD theory and practice should benefit from a description of how research syntheses can inform their work.

Self-Care for Nurse Leaders in Acute Care Environment Reduces Perceived Stress: A Mixed-Methods Pilot Study Merits Further Investigation:

Acute care practice settings are stressful. Nurse leaders face stressful demands of numerous competing priorities. Some nurse leaders experience unmanageable stress, but success requires self-care. This article presents a repeated measures intervention design study using mixed methods to investigate a self-care simple meditation practice for nurse leaders. Themes and subthemes emerged in association with the three data collection points: at baseline (pretest), after 6 weeks, and after 12 weeks (posttest) from introduction of the self-care simple meditation practice. An analysis of variance yielded a statistically significant drop in perceived stress at 6 weeks and again at 12 weeks. Conducting future research is merited.

Preliminary Psychometric Properties of the Verbal and Nonverbal Interaction Scale: An Observational Measure for Communication in Persons with Dementia

ABSTRACT Little attention has been given to sociable/unsociable communication in persons with dementia despite the importance of these behaviors in maintaining engagement in marital relationships. An observational measure of verbal and nonverbal communication in persons with dementia (Verbal and Nonverbal Interaction Scale-CR) who were engaged in conversations with spouses was tested for reliability and validity. Married persons with dementia were video-recorded at home conversing with spouses over 10 weeks (N = 118 recordings). Reliability [inter-coder (.92), test-retest (r =.61-.77), internal consistency (α =.65 -.79)] were adequate. Following an intervention, the Verbal and Nonverbal Interaction Scale-CR predicted improved communication over 10 weeks. The ratio of sociable to unsociable communication improved by 4.46 points per session [β = 4.46, t(10) = 1.96, p =.039]. VNVIS-CR is recommended to describe sociable and unsociable communication in persons with dementia as they engage in conversations with spouses.