Jan R. Atwood

Innovative Retention Strategies for Nursing Staff

The creation of innovative retention strategies will be a major focus for nursing administration as a shortage of nurses recurs and turnover of staff becomes a problem. A recent study provides information on which to formulate retention strategies. The findings suggest that retention strategies, to be effective, need to be targeted specifically to particular conditions of the nursing staff, e.g., educational preparation and the clinical service on which staff are functioning. The authors outline their research findings and the innovative strategies that have been constructed.

NURSING STAFF TURNOVER, STRESS AND SATISFACTION: MODELS, MEASURES, AND MANAGEMENT

Staff turnover, stress, and satisfaction are continual problems plaguing the delivery of health care and, specifically, nursing care. Numerous investigations have been conducted to identify the major phenomena pertaining to these concerns. Models have been constructed and tested specifying the relationships among staff stress, satisfaction, other predictive factors, and voluntary/involuntary turnover. Traditionally, turnover has been the focus of research endeavors, while the other factors have been investigated in terms of their impact on it (Mobley, Griffeth, Hand, & Meglino, 1979).

Replication and Validation of Anticipated Turnover Model for Urban Registered Nurses

Replication of the Anticipated Turnover Model Among Nurses for urban registered nurses provided substantial support for the stability and generalizability of the theoretical model. In both the original and replication studies, causal modeling was used to test the theoretical model predicting job satisfaction, anticipated turnover, and actual turnover. The replication study included 385 full-time nurses in two public and two private urban hospitals. The replication validated, with younger, more educated staff, the major findings from the original study. Group cohesion and job satisfaction effectively predicted anticipated turnover in the replication and the original study. Anticipated turnover was a good predictor of actual turnover, with discriminant analysis yielding 73.2% successful predictions in the replication study and 76.2% in the original study. Job satisfaction effectively buffered job stress. The replication also substantiated the position that job satisfaction strategies need to be targeted specifically to the types of clinical services.

Validity and Reliability of the Family Inventory of Needs (FIN): Measuring the Care Needs of Families of Advanced Cancer Patients

Two studies balanced qualitative and quantitative data to provide evidence of satisfactory validity and reliability of the Family Inventory of Needs (FIN). The FIN is designed to measure the importance of care needs of families of advanced cancer patients (FIN-Importance of Care Needs subscale) and the extent to which families perceive that their care needs have been met (FINFulfillment of Care Needs subscale). The first study involved development of the instrument and testing for clarity, apparent internal consistency (nonquantitative assessment of homogeneity of content), and content validity using a panel of six experts (family members of advanced cancer patients). The FIN met or exceeded the preset criteria specified used in this phase of testing. The second study of the project used 109 family members of advanced cancer patients from three hospice programs to test the FIN for internal consistency and construct validity. Internal consistency of the FIN-Importance of Care Needs subscale as measured by Cronbach’s alpha coefficient was .83 without redundancy. Construct analysis was assessed using factor analysis techniques. An inability to extract a substantively meaningful minimum number of factors, together with the fact that a theta reliability coefficient of .85 was obtained (only .02 higher than the alpha coefficient), suggested that the items were parallel supporting the conclusion that the subscale is unidimensional. Support for the construct validity of the FINImportance of Care Needs subscale was also obtained using predictive modeling. The internal structure of the FIN-Fulfillment of Care Needs subscale was assessed using cluster analysis. Results suggested that the subscale is a unidimensional one. Overall, the FIN met the preset reliability and validity criteria providing promising evidence for the instrument’s sound psychometric properties for use in research and clinical settings.

Care needs of home-based cancer patients and their caregivers. Quantitative findings.

The purpose of this study was to identify care needs of home-based patients receiving treatment for cancer and their caregivers. The sample consisted of 30 patients receiving radiation therapy and/or immunologically based treatments for a variety of cancers and 29 caregivers. Patient and caregiver needs scales were used to elicit the needs of patients and caregivers. Patients and caregivers were able to cite their unique needs. Patients had more needs for themselves in the areas of personal care, activity management, and interpersonal interaction than did the caregivers. The necessity for individualization of care was noted by both patients and caregivers, an area that nursing is in a unique position to address.

A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol.

BACKGROUND Many rural residents do not have access to high-quality nutrition counseling for high blood cholesterol. The objective of this study was to assess the effectiveness of an intervention program designed to facilitate dietary counseling for hypercholesterolemia by rural public health nurses. METHODS Eight health departments (216 participants) were randomized to give the special intervention (SI) and nine (252 participants) to give the minimal intervention (MI). The SI consisted of three individual diet counseling sessions given by a public health nurse, using a structured dietary intervention (Food for Heart Program), referral to a nutritionist if lipid goals were not achieved at 3-month follow-up, and a reinforcement phone call and newsletters. Diet was assessed by the Dietary Risk Assessment (DRA), a validated food frequency questionnaire, at baseline, 3-, and 12-month follow-up; blood lipids and weight were assessed at baseline, 3-, 6-, and 12-month follow-up. RESULTS Participants were largely female (71%), older (mean age 55), and white (80%). At 3-month follow-up, the average reduction (indicating dietary improvement) in total Dietary Risk Assessment score was 3.7 units greater in the SI group (95% confidence interval [CI] 1.9 to 5.5, P = 0.0006), while both groups experienced a similar reduction in blood cholesterol, 14.1 mg/dL (0.37 mmol/L) for SI and 14.5 mg/dL (0.38 mmol/L) for minimal intervention group (difference -0.4 mg/dL [-0.010 mmol/L], 95% CI -12.5 to 11.7 [-0.32 to 0.30], P = 0.9). At 12-month follow-up, the reduction in total Dietary Risk Assessment score was 2.1 units greater in the SI group (95% CI 0.8 to 3.5, P = 0.005), while the reduction in blood cholesterol was similar in both groups, 18.4 mg/dL (0.48 mmol/L) for SI and 15.6 mg/dL (0.40 mmol/L) for minimal intervention group (difference 2.8 mg/dL [0.07 mmol/L], 95% CI -7.5 to 13.1 [-0.19 to 0.34], P = 0.6). During follow-up, weight loss was greater in the SI group; the difference between groups was statistically significant at 3 (1.9 lb [0.86 kg], 95% CI 0.3 to 3.4 [0.14 to 1.55], P = 0.022) and 6 months (2.1 lb [0.95 kg], 95% CI 0.1 to 4.1 [0.04 to 1.86], P = 0.04). At 12 months, the difference was not significant (1.6 lb [0.73 kg], 95% CI -0.05 to 3.7 [-0.02 to 1.68], P = 0.13). CONCLUSIONS Improvement in self-reported dietary intake was significantly greater in the SI group, while reduction in blood cholesterol was similar in both groups.

Effects of a Physical Activity Intervention for Women

Physical activity is associated with health and reduced mortality risk, yet only15% ofU.S. adults achieve adequate activity. This study is an experimental repeated measures nested design randomizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program (HSPAP) (Peterson, 2002) in promoting physical activity in midlife women (n =42) aged 35 to 65 years. The HSPAP, an innovative church-based health promotion intervention, is conceptualized in social support and designed to increase physical activity, energy expenditure (EE), and cardiorespiratory fitness (VO2 max), measured over time. A significant interaction (p < .001) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week. HSPAP participants increased their VO2 max level by 75% (p < .001) and 10%; comparison groups stayed the same or declined 16%. Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary, rural, midlife women.

Self-efficacy scale for pap smear screening participation in sheltered women

Background: Sheltered, homeless women disproportionately experience cervical dysplasia and cervical cancer. Low rates of Pap smear screening contribute to late diagnosis with accompanying increased morbidity and mortality. Self-efficacy (SE) has been demonstrated to be predictive of several health behaviors, but limited evidence about SE for Pap smear screening exists. Objectives: To develop, test, and refine the conceptually based Self-Efficacy Scale for Pap Smear Screening Participation (SES-PSSP). Methods: This correlational, descriptive study included a purposive sampling of sheltered women (N = 161). Results: The 20-item SES-PSSP demonstrated acceptable initial validity and reliability. Reliability estimates of stability (≥84%) and internal consistency (α = .95) exceeded criteria. Content validity and construct validity were supported (e.g., common factor analysis and predictive model testing that included SE, decisional balance, knowledge regarding Pap smear screening, demographics, health-related behaviors, health status, and personal beliefs about risks for cervical cancer and dysplasia). Self-efficacy, decisional balance, illicit drug usage, and age predicted 28% of the variance in stages of change (precontemplation, contemplation, preparation, action, and maintenance) for Pap smear screening participation. Discussion: The SES-PSSP provides a new scale for measuring SE pertinent to Pap smear screening participation in a vulnerable, ethnically diverse sample of sheltered, inner-city women. Validity testing demonstrated that the SE concept was predictive of Pap smear screening behavior, suggesting that SE-based interventions tailored to the SES-PSSP subscale or total scores could increase screening. A 10-minute completion time supports feasibility for use in the clinic setting.

Mediator analysis of Moms on the move.

This study examined whether improvements in physical activity discovered in a test of Moms on the Move were mediated by the behavioral constructs from which the intervention was derived. Identifying mediator variables is vital for intervention planning. The intervention was derived from the Transtheoretical Model (TTM) of behavior change and promoted moderately intense activities like walking. Sedentary mothers with children enrolled in the Women, Infants, and Children program (N = 44) were randomly assigned to the experimental intervention or attention control. Large effect sizes were reported for improvements in physical activity and changes in TTM constructs. This study examined whether the physical activity improvements were mediated by the behavioral constructs. Statistical analyses used bivariate correlation coefficients and two-stage multiple linear regression. These exploratory findings did not support the hypothesis that increased physical activity, which was associated with the experimental intervention, was mediated by the TTM constructs.

Reliability, validity, and scoring of the Health Status Questionnaire-12 version 2.0.

Measuring health status as an indicator of individual, population, and community health is critical in reducing health disparities in populations. The purpose of this study was to test the psychometric properties of the Health Status Questionnaire-12 (HSQ-12) Version 2.0, a brief self-reported health status instrument available within the public domain, in a lowincome sample (N = 7,793). The internal consistency reliability was .88. Initial and confirmatory factor analysis revealed two factors explaining 67% of the variance, interpreted as super scales of physical and mental health. Second order factor analysis isolated one factor explaining 82% of the variance, interpreted as a total health status. Comparison of subjects with and without disabilities using t tests and the Mann–Whitney U Test showed that the scale, super scale, and total scale scores differentiated significantly. The HSQ-12 is a reliable, valid, and low-cost measure of health status.