Einav Srulovici

Low Mobility During Hospitalization and Functional Decline in Older Adults

OBJECTIVES: To examine the association between mobility levels of older hospitalized adults and functional outcomes.

Hospitalization as a Turning Point for Sleep Medication Use in Older Adults

BackgroundUse of sleep medications as a result of hospitalization among older adults is common and has been shown to result in chronic use and increased risks for adverse effects such as falls and cognitive decline. However, few studies have explored in-hospital sleep medication use or disuse as a possible factor related to subsequent home use.ObjectiveThe aim of this study was to examine changes in sleep medication use pre- to post-hospitalization as a function of in-hospital use. Methods: The study was designed as a prospective cohort study, and included 485 acute medical patients aged 70 years and older, hospitalized in a large, Israeli, teaching medical centre. Sleep medication use was assessed by patient interviews regarding patterns of use prior to, during and at 1 and 3 months after discharge. Post-discharge using patterns were assessed as a function of in-hospital discontinuation or initiation of sleep medications; background demographic and clinical characteristics were assessed as well. Logistic regressions were modelled separately for discontinuation and initiation of sleep medication use at each follow-up.ResultsOf those patients who used sleep medications prior to admission, 37 (18% of 206 prior users) discontinued use during the hospital stay. Non-use of sleep medications during hospitalization was the main significant characteristic associated with post-hospitalization discontinuation among prior users, when comparing patients who continued with those who discontinued using sleep medications in bivariate analyses. Discontinuation was associated with an adjusted odds ratio (AOR, adjusted for cognitive status) of 3.91 (95% confidence interval [CI] 1.64, 9.30) for non-use at the 1-month follow-up. Of those who did not use sleep medications prior to admission, 39 (14% of 279 non-prior users) initiated use during hospitalization. Again, sleep medication initiation at time of hospitalization was the main correlate of change in post-hospitalization medication use status, when comparing post-discharge users and non-users, among the non-prior users. Hospital initiation of sleep medications was associated with an AOR (adjusted for levels of education and morbidity, readmission, and functional status) of 4.65 (95% CI 1.95, 11.09) for post-discharge use. Similar results were obtained for the 3-month follow-up, reaching significance levels only for the discontinuation group.ConclusionsThough overall prevalence rates of sleep medication use pre-and post-hospitalization are fairly similar, rigorous scrutiny of the findings demonstrates that in-hospital sleep medication use and disuse may be a significant turning point both for initiation and discontinuation of sleep medications, especially in the short post-discharge time frame. Thus, in-hospital sleep medication prescribing policies should acknowledge the potential for changes in the post-discharge sleep medication regimen.

Hospitalization as a turning point for sleep medication use in older adults: prospective cohort study.

BACKGROUNDnUse of sleep medications as a result of hospitalization among older adults is common and has been shown to result in chronic use and increased risks for adverse effects such as falls and cognitive decline. However, few studies have explored in-hospital sleep medication use or disuse as a possible factor related to subsequent home use.nnnOBJECTIVEnThe aim of this study was to examine changes in sleep medication use pre- to post-hospitalization as a function of in-hospital use.nnnMETHODSnThe study was designed as a prospective cohort study, and included 485 acute medical patients aged 70 years and older, hospitalized in a large, Israeli, teaching medical centre. Sleep medication use was assessed by patient interviews regarding patterns of use prior to, during and at 1 and 3 months after discharge. Post-discharge using patterns were assessed as a function of in-hospital discontinuation or initiation of sleep medications; background demographic and clinical characteristics were assessed as well. Logistic regressions were modelled separately for discontinuation and initiation of sleep medication use at each follow-up.nnnRESULTSnOf those patients who used sleep medications prior to admission, 37 (18% of 206 prior users) discontinued use during the hospital stay. Non-use of sleep medications during hospitalization was the main significant characteristic associated with post-hospitalization discontinuation among prior users, when comparing patients who continued with those who discontinued using sleep medications in bivariate analyses. Discontinuation was associated with an adjusted odds ratio (AOR, adjusted for cognitive status) of 3.91 (95% confidence interval [CI] 1.64, 9.30) for non-use at the 1-month follow-up. Of those who did not use sleep medications prior to admission, 39 (14% of 279 non-prior users) initiated use during hospitalization. Again, sleep medication initiation at time of hospitalization was the main correlate of change in post-hospitalization medication use status, when comparing post-discharge users and non-users, among the non-prior users. Hospital initiation of sleep medications was associated with an AOR (adjusted for levels of education and morbidity, readmission, and functional status) of 4.65 (95% CI 1.95, 11.09) for post-discharge use. Similar results were obtained for the 3-month follow-up, reaching significance levels only for the discontinuation group.nnnCONCLUSIONSnThough overall prevalence rates of sleep medication use pre- and post-hospitalization are fairly similar, rigorous scrutiny of the findings demonstrates that in-hospital sleep medication use and disuse may be a significant turning point both for initiation and discontinuation of sleep medications, especially in the short post-discharge time frame. Thus, in-hospital sleep medication prescribing policies should acknowledge the potential for changes in the post-discharge sleep medication regimen.

Interventions for Reducing Parenting Stress in Families With Pediatric Conditions: An Integrative Review.

Parenting stress increases in the presence of serious-acute or chronic pediatric health conditions, potentially triggering negative outcomes for families. Parenting stress reduction interventions have been widely disseminated. The current review describes the types, components, and outcomes of these interventions in diverse pediatric populations. A systematic literature search yielded 26 experimental and quasi-experimental studies describing such interventions. Quality assessment was conducted by two doctorally prepared nursing researchers using the Downs and Black’s checklist for randomized and nonrandomized studies of health care interventions. Interventions were categorized as follows: interventions with supporting and cognitive components (n = 3), interventions with empowerment and skill development components (n = 18), interventions targeted to children’s condition (n = 9), and interventions focusing on the parent–child relationship (n = 5). Most interventions reduced immediate parenting stress levels (n = 23), but failed to demonstrate long-term gains. Future family interventions should target long-term parenting stress, while focusing on specific family needs across pediatric conditions.

Diabetes Conversation Map™ and health outcomes: A systematic literature review

OBJECTIVESnTo identify, describe, and assess the evidence regarding the effects that the Diabetes Conversation Map™ program, an educational tool that engages patients with diabetes in group discussions about diabetes-related topics, has over a range of patient outcomes.nnnSTUDY DESIGNnA systematic review.nnnDATA SOURCESnFive databases, including PubMed, CINAHL, Scopus, EMBASE, and Cochrane Collaboration, were utilized to identify studies that evaluated the Conversation Map™ program. Additionally, the reference lists of the identified studies were manually reviewed.nnnREVIEW METHODSnStudies that evaluated the Conversation Map™ program since 2005 were included. Non-English languages, non-journal papers, and studies that only included a description of the program were excluded. A quality assessment of relevant studies was performed. Outcomes were grouped into: objective (e.g., HbA1c levels), subjective (e.g., self-efficacy), and health behaviors (e.g., medication adherence).nnnRESULTSnOf the 85 studies originally identified, 24 studies were included in the final sample. The overall methodological quality of the studies was intermediate (score: 17 of 28). Almost all studies examined objective health measures, with most indicating non-significant differences between the Conversation Map™ intervention and the control groups. Conflicting results were found regarding the influence the program had on HbA1c. The majority of studies reported no significant change in blood pressure and mixed results were found regarding other health indicators. Twelve studies examined subjective measures and 11 assessed the effects on health behaviors, mostly reporting non-significant or positive findings.nnnCONCLUSIONSnOur review shows that although the Diabetes Conversation Map™ program holds the potential to improve patient behaviors and outcomes, current research on the program provides limited support as to their relationship with positive patient outcomes. Larger, more sophisticated studies are needed in order to determine the potential influence Conversation Map™ can have on long-term health outcomes.

Nurses’ personal and ward accountability and missed nursing care: A cross-sectional study

BACKGROUNDnMissed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods.nnnOBJECTIVESnThis study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses assessments of missed nursing care.nnnDESIGNnA cross-sectional design, where nurses were nested in wards.nnnPARTICIPANTSnA total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals.nnnMETHODSnMissed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy.nnnRESULTSnFocal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean=1.87, SD=0.71 and Mean=2.09, SD=0.84, respectively; r=0.55, p<0.01). Regarding the focal nurses assessment of his/her own missed nursing care, findings showed that, above and beyond nurses overload and personal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β=-0.29, p<0.01), whereas ward accountability was not (β=-0.23, p>0.05). The interaction effect was significant (β=-0.31, p<0.05); the higher the ward accountability, the stronger the negative relationship between nurses personal accountability and missed nursing care. Similar patterns were obtained for the incoming nurses assessment of focal nurses missed care.nnnCONCLUSIONSnUse of focal and incoming nurses missed nursing care assessments limited the common source bias and strengthened our findings. Personal and ward accountability are significant values, which are associated with lower missed nursing care, beyond scarce resources. Implementation of local and national education programs for nurses and managers, accompanied with empirical research, might increase personal and ward accountability, thereby decreasing missed nursing care. This might help to create a safety culture and reduce negative outcomes for patients, nurses, and organizations.

Factors associated with iatrogenesis in neonatal intensive care units: an observational multicenter study

The objective of our study was to assess factors associated with iatrogenic events in Neonatal Intensive Care Units (NICUs). This was a retrospective analysis based on a cohort of patients who participated in our previous prospective study (Pediatrics 122:550–555, 2008), conducted in four tertiary university-affiliated NICUs in Israel, that included all consecutive infants (nu2009=u2009615) hospitalized during the study period. Ongoing monitoring of iatrogenic events was performed by designated “iatrogenesis advocates.” The main outcome measures were the association of individual infant characteristics and NICUs’ environmental characteristics with iatrogenic events assessed by univariate and multiple logistic regression analysis. We found that four infant characteristics were significantly (pu2009<u20090.001) associated with iatrogenic events in a univariate analysis: gestational age, birth weight, severity of initial illness as assessed by the Score for Neonatal Acute Physiology and Perinatal Extension (SNAPPE II), and length of stay (LOS). All four factors demonstrated a significant (pu2009<u20090.001) dose–response relationship with iatrogenic events. Univariate analysis for environmental characteristics showed that type of shift, but not nursing workload, was significantly associated with iatrogenic events (pu2009<u20090.001). In a multiple logistic regression analysis, only LOS (adjusted OR 1.02 [95xa0% CI, 1.01–1.03]) and type of shift, morning vs. evening (adjusted OR 3.44 [95xa0% CI, 2.33–5.08]) and morning vs. night (adjusted OR 6.07 [95xa0% CI, 3.86–9.56]), remained independently associated with iatrogenic events (pu2009<u20090.001). Prolonged LOS and morning shifts were found to be significantly associated with iatrogenic events. Further prospective research is warranted to identify the specific causes for iatrogenic events in order to target active interventions to prevent them.

The personality profile of the accountable nurse and missed nursing care

AIMnThe aim of this study was to examine the mediating role of nurses personal accountability in the relationships between nurses personality and missed nursing care.nnnBACKGROUNDnPersonal accountability is considered as a core value in nursing, shaped by the nurses personality, education, socialization into the profession and experience. Personality antecedents may be uniquely suited to predicting accountability, since it reflects variation in individuals deep-seated values and beliefs. Personal accountability can be related to the prevalent phenomenon of missed nursing care (tasks that are omitted or delayed).nnnDESIGNnA multicentre cross-sectional study with 290 nurses from direct-care nursing wards during 2017. Personality traits were assessed with the 44-item Big Five Inventory. Personal accountability was assessed with a 19-item scale. Missed nursing care was assessed with the 22-item MISSCARE survey. An indirect mediated path analysis was performed and compared with an alternative model with direct effects.nnnRESULTSnPath-analyses findings supported a full-mediation model of accountability in the relationships between personality traits and missed nursing care. Conscientiousness, Agreeableness, Openness and Neuroticism, but not Extraversion, were significantly related to personal accountability. In addition, greater personal accountability was significantly related to lower frequency of missed nursing care.nnnCONCLUSIONSnPersonal traits are important antecedents of personal accountability, which relates to missed nursing care. Findings delineate the profile of the accountable nurse and might help in developing strategies for the selection of nurses with high personal accountability and determining the best means to strengthen accountable behaviours in the workplace.

Towards a measure of accountability in nursing: A three-stage validation study

AIMSnThe aim of this study was to develop and psychometrically evaluate a three-dimensional questionnaire suitable for evaluating personal and organizational accountability in nurses.nnnBACKGROUNDnAccountability is defined as a three-dimensional value, directing professionals to take responsibility for their decisions and actions, to be willing to explain them (transparency), and to be judged according to societys accepted values (answerability). Despite the relatively clear definition, measurement of accountability lags well behind. Existing self-report questionnaires do not fully capture the complexity of the concept nor do they capture the different sources of accountability (e.g., personal accountability, organizational accountability).nnnDESIGNnA three-stage measure development.nnnMETHODSnData were collected during 2015-2016. In Phase 1, an initial database of items (Nxa0=xa074) was developed, based on literature review and qualitative study, establishing face and content validity. In Phase 2, the face, content, construct, and criterion-related validity of the initial questionnaires (19 items for personal and organizational accountability questionnaire) were established with a sample of 229 nurses. In Phase 3, the final questionnaires (19 items each) were validated with a new sample of 329 nurses and established construct validity.nnnRESULTSnThe final version of the instruments comprised 19 items, suitable for assessing personal and organizational accountability. The questionnaire referred to the dimensions of responsibility, transparency, and answerability. The findings established the instruments content, construct, and criterion-related validity as well as good internal reliability.nnnCONCLUSIONnThe questionnaire portrays accountability in nursing, by capturing nurses subjective perceptions of accountability dimensions (responsibility, transparency, answerability), as demonstrated by personal and organizational values.

Patterns of patients' interactions with the healthcare organization and their impacts on health quality measurements: A study protocol (Preprint)

Background Data collected by health care organizations consist of medical information and documentation of interactions with patients through different communication channels. This enables the health care organization to measure various features of its performance such as activity, efficiency, adherence to a treatment, and different quality indicators. This information can be linked to sociodemographic, clinical, and communication data with the health care providers and administrative teams. Analyzing all these measurements together may provide insights into the different types of patient behaviors or more accurately to the different types of interactions patients have with the health care organizations. Objective The primary aim of this study is to characterize usage profiles of the available communication channels with the health care organization. The main objective is to suggest new ways to encourage the usage of the most appropriate communication channel based on the patient’s profile. The first hypothesis is that the patient’s follow-up and clinical outcomes are influenced by the patient’s preferred communication channels with the health care organization. The second hypothesis is that the adoption of newly introduced communication channels between the patient and the health care organization is influenced by the patient’s sociodemographic or clinical profile. The third hypothesis is that the introduction of a new communication channel influences the usage of existing communication channels. Methods All relevant data will be extracted from the Clalit Health Services data warehouse, the largest health care management organization in Israel. Data analysis process will use data mining approach as a process of discovering new knowledge and dealing with processing data extracted with statistical methods, machine learning algorithms, and information visualization tools. More specifically, we will mainly use the k-means clustering algorithm for discretization purposes and patients’ profile building, a hierarchical clustering algorithm, and heat maps for generating a visualization of the different communication profiles. In addition, patients’ interviews will be conducted to complement the information drawn from the data analysis phase with the aim of suggesting ways to optimize existing communication flows. Results The project was funded in 2016. Data analysis is currently under way and the results are expected to be submitted for publication in 2019. Identification of patient profiles will allow the health care organization to improve its accessibility to patients and their engagement, which in turn will achieve a better treatment adherence, quality of care, and patient experience. Conclusions Defining solutions to increase patient accessibility to health care organization by matching the communication channels to the patient’s profile and to change the health care organization’s communication with the patient to a highly proactive one will increase the patient’s engagement according to his or her profile. International Registered Report Identifier (IRRID) RR1-10.2196/10734