Joseph Vasey

Employment pathways in a large cohort of adult cancer survivors

Employment and work‐related disability were investigated in a cohort of adult cancer survivors who were working when they were diagnosed from 1997 to 1999 with a variety of cancers. Employment from the time of diagnosis through the early years of survivorship was studied, self‐reported effects of cancer survival on disability and employment were quantified, and risk factors associated with cancer‐related disability and withdrawal from employment were identified.

Relational coordination among nurses and other providers: impact on the quality of patient care

AIM The present study examined nurse reports of relational coordination between nurses and other providers and the impact of relational coordination on patient care quality. BACKGROUND While communication between providers has been traditionally considered important to improve quality, relational coordination extends this view, emphasising the value of high-quality relationships exemplified by shared goals, shared knowledge and mutual respect; and high-quality communication that is timely, frequent, accurate and problem-solving. METHODS Direct care registered nurses (RNs) (n=747) completed surveys to assess relational coordination across five provider functions and six types of patient care units. Nurses also reported perceptions about patient care quality. RESULTS In all analyses, relational coordination between nurses and other providers was significantly related to overall quality, in the expected directions. As relational coordination increased, nurses reported decreases in adverse events such as hospital-acquired infections and medication errors. CONCLUSIONS Enhancing relational coordination between nurses and other providers is central to improving the quality of patient care. IMPLICATIONS FOR NURSE MANAGERS AND NEW KNOWLEDGE: The emerging theory of relational coordination provides a useful new research-based framework for managers to use to improve provider relationships, communication and the quality of care.

Electronic medical records: are physicians ready?

The use of electronic medical records (EMR) in healthcare organizations will require substantial changes in the way physicians and their staff provide patient care. This study is the first part of a larger study assessing factors that influence successful implementation of EMR in ambulatory care settings. The purposes of this study were to identify specific attitudes or factors that should be targeted before implementating an EMR project, and demonstrate empirical support for a model of perceived usefulness of EMR. We found that computer experience, computer anxiety, and perceptions of organizational support predict the degree to which physicians and mid-level practitioners view the EMR effort positively. Strategies for the successful management of EMR implementation include engaging the physicians and practitioners in computer activities prior to implementation and providing strong organizational support before and during the redesign effort. Acceptance of EMR by physicians and their support staff is essential if computerization is to be successful, yet anecdotal reports of resistance and negative attitudes are frequently reported. Empirical studies indicate that physicians have not yet embraced this technology. As part of strategic planning and deployment of a computerized patient record, attitudes of end-users must be assessed. Using an integrative framework from the job design literature and management information sciences, we propose that multiple factors influence attitudes toward EMR, offer a conceptual model of end-user acceptance, and present findings from an empirical test of our model.

Impact of telehealth on clinical outcomes in patients with heart failure.

The purpose of this randomized field study was to determine the effects of telehomecare on hospitalization, emergency department (ED) use, mortality, and symptoms related to sodium and fluid intake, medication use, and physical activity. The sample consists of 284 patients with heart failure. The authors used logistic regression to study the effects of telehomecare on health services utilization and mortality and a general linear model to analyze changes in self-reported symptoms. On average, patients in the telehomecare groups had a lower probability of hospitalizations and ED visits than did patients in the control group. Differences were statistically significant at 60 days but not 120 days. Results show a greater reduction in symptoms for patients using telehomecare compared to control patients. The technology enables frequent monitoring of clinical indices and permits the home health care nurse to detect changes in cardiac status and intervene when necessary.

Long-Term Effects of Cancer Survivorship on the Employment of Older Workers

OBJECTIVE To estimate the long-term effects of cancer survivorship on the employment of older workers. DATA SOURCES Primary data for 504 subjects who were 55-65 in 2002 and were working when diagnosed with cancer in 1997-1999, and secondary data for a comparison group of 3,903 similarly aged workers in the Health and Retirement Study (HRS) in 2002. STUDY DESIGN Three employment outcomes (working, working full time, usual hours per week) were compared between the two groups. Both Probit/Tobit regressions and propensity score matching were used to adjust for potentially confounding differences between groups. Sociodemographic characteristics, baseline employment characteristics, and the presence of other health conditions were included as covariates. DATA COLLECTION METHODS Four telephone interviews were conducted annually with cancer survivors identified from tumor registries at four large hospitals in Pennsylvania and Maryland. Many of the questions were taken from the HRS to facilitate comparisons. PRINCIPAL FINDINGS Cancer survivors of both genders worked an average of 3-5 hours less per week than HRS controls. For females, we found significant effects of survivorship on the probability of working, the probability of working full-time, and hours. For males, survivorship affected the probability of full-time employment and hours without significantly reducing the probability of working. For both genders, these effects were primarily attributable to new cancers. There were no significant effects on the employment of cancer-free survivors. CONCLUSIONS Survivors with recurrences or second primary tumors may particularly benefit from employment support services and workplace accommodation. Reassuringly, any long-term effects on the employment of cancer-free survivors are fairly small.

Measuring staff nurse decisional involvement: The Decisional Involvement Scale

Key organizations and new legislation are promoting staff nurse involvement in decisions about nursing practice and patient care as a long-term strategy to improve the culture of the work environment. The authors discuss the Decisional Involvement Scale (DIS), a multipurpose measure that can be used as a diagnostic tool, an organizational development strategy, and an evaluative instrument. In addition, support to substantiate the DIS as a valid and reliable measure is summarized.&NA; Key organizations and new legislation are promoting staff nurse involvement in decisions about nursing practice and patient care as a long‐term strategy to improve the culture of the work environment. The authors discuss the Decisional Involvement Scale (DIS), a multipurpose measure that can be used as a diagnostic tool, an organizational development strategy, and an evaluative instrument. In addition, support to substantiate the DIS as a valid and reliable measure is summarized.

Dietary supplement use in adult cancer survivors.

PURPOSE/OBJECTIVES To assess dietary supplement use and its association with demographic and health-related characteristics among cancer survivors and to investigate differences in supplement use patterns by cancer site. DESIGN A cross-sectional survey. SETTING Computer-assisted telephone survey. SAMPLE 1,233 adult (ages 30-69) survivors participating in the Penn State Cancer Survivor Study who underwent an interviewer-administered questionnaire. METHODS Descriptive statistics with multivariate logistic regression to determine demographic, disease, and health-related predictors of supplement use. MAIN RESEARCH VARIABLES Use of dietary supplements and types of supplements taken. FINDINGS Supplement use ranged from 50% among blood cancer survivors to 85% among melanoma skin cancer survivors, with an overall prevalence rate of 73%. Multivariate logistic regression revealed statistically significant associations (p values < 0.05) between supplement use and older age (>or= age 50), higher levels of education and physical activity, female gender, lower body mass index, and white ethnicity. CONCLUSIONS Overall, a wide variety of supplements were reported, although multivitamins, calcium and vitamin D combinations, and antioxidant vitamin combinations were the most prevalent. Seventy-eight percent of supplement users took more than one supplement. IMPLICATIONS FOR NURSING The findings support continued efforts by oncology nurses to identify the types of supplements cancer survivors are using. Nurses should caution against the use of individual supplements as well as combinations of different supplements containing nutrient quantities above recommended daily intake levels. Furthermore, oncology nurses and other healthcare professionals should be receptive to questions and prepared to initiate conversations with patients about their use of dietary supplements.

Examination of Treatment Pattern Differences by Race

Examine differences in treatment patterns among Blacks and non-Blacks in the U.S. Schizophrenia Care and Assessment Program. Baseline data from medical record abstraction, participant self-report and clinical assessment used to examine differences by race (race–gender pairings) (n = 2,239). Descriptive and multivariate (logistic) analysis employed. More Blacks were diagnosed with paranoid subtype. Blacks exhibited a more negative PANSS composite score, lower quality of life scores, and higher AIMS scores than non-Blacks. There was no statistically significant difference in the number of outpatient visits or inpatient admissions between Blacks and non-Blacks. Blacks had lower medication adherence and received less second-generation agents and more antiparkinson/anticholinergic agents. Proportion of Black males receiving depot was greater than other race–gender pairings. Regression results indicate Blacks more likely to be prescribed only first-generations after controlling for depot (OR = 1.64; CI = 1.27–2.12; p = 0.0002). Schizophrenia is, on average, accompanied by different diagnoses and symptoms in Blacks. Symptom profiles indicate that second-generation antipsychotics may be underprescribed to Black patients.

Managing heart failure patients after formal homecare.

The aim of this study was to determine whether using a teleheath system after discharge from formal home health services would improve clinical outcomes and self-management behaviors. Patients were recruited from 10 home health agencies (HHAs) across the United States. All patients used the Health Buddy telehealth system during formal home health services. Patients were randomly assigned to either the telehealth group or the control group upon discharge from the HHA. Patients in the telehealth group used the Health Buddy for an additional 180 days; patients in the control group received no further telehealth or home health services. Results show that patients who continued using telehealth beyond the formal episode of care showed greater improvements in respiratory status and activities of daily living. None of the patients who used telehealth during this stage had any hospitalizations or Emergency Department (ED) events, while 28.3% of the control group patients required hospitalization and 26.1% had at least one ED visit. Telehealth patients were more likely to report that they measured their weights daily, and were more likely to report an increase in diuretic dose following sudden weight gain, ankle swelling, or shortness of breath. We conclude that patients with heart failure may benefit from continued use of telehealth following formal home health services. Results of this study will inform managers and clinicians who are responsible for integrating telehealth into chronic disease protocols.

The Staff Nurse Decisional Involvement Scale: Report of Psychometric Assessments

Background: For decades, enhancing staff nurse decisional involvement in matters of nursing practice and patient care has been identified as a long-term strategy to improve the quality of the nursing work environment and the safety and quality of patient care. Objective: To describe psychometric assessments of the Decisional Involvement Scale (DIS), a diagnostic and evaluative measure of nurse decisional involvement. Methods: A series of assessments were conducted to evaluate the psychometric performance of the scale. Content validity was assessed by experts in the field. Descriptive statistics were used to examine the use and performance of the scale. The contrasted groups approach was used to assess construct validity. Item analysis was used to explore evidence of the internal consistency of items and subscales across multiple samples. Structural modeling was used to conduct a confirmatory factor analysis using data from two independent samples of staff registered nurses (RNs; n = 849 and 650). Results: Acceptable content validity indexes (CVIs) were independently generated by three content experts. Construct validity was supported, as hypothesized; nurses working on professional practice units scored significantly higher for all items when compared to nurses working on units without professional practice models in place. Internal consistency (coefficient alpha) was high and nearly identical for the total measure and all subscales across the two independent nurse samples. Six subscales were identified using factor analysis, and these were confirmed by structural modeling. Conclusion: Psychometric findings support that the DIS is a valid and reliable measure of staff nurse decisional involvement.