Kamisha Hamilton Escoto

Work hours and perceived time barriers to healthful eating among young adults.

OBJECTIVE To describe time-related beliefs and behaviors regarding healthful eating, indicators of dietary intake, and their associations with the number of weekly hours of paid work among young adults. METHODS Population-based study in a diverse cohort (N=2287). RESULTS Working > 40 hours per week was associated with time-related barriers to healthful eating most persistently among young adult men. Associations were found among females working both part-time and > 40 hours per week with both time-related barriers and dietary intake. CONCLUSIONS Findings indicate that intervention strategies, ideally those addressing time burden, are needed to promote healthful eating among young, working adults.

Using a multi-method, user centred, prospective hazard analysis to assess care quality and patient safety in a care pathway

BackgroundCare pathways can be complex, often involving multiple care providers and as such are recognised as containing multiple opportunities for error. Prospective hazard analysis methods may be useful for evaluating care provided across primary and secondary care pathway boundaries. These methods take into account the views of users (staff and patients) when determining where potential hazards may lie. The aim of this study is to evaluate the feasibility of prospective hazard analysis methods when assessing quality and safety in care pathways that lie across primary and secondary care boundaries.MethodsDevelopment of a process map of the care pathway for patients entering into a Chronic Obstructive Pulmonary Disease (COPD) supported discharge programme. Triangulation of information from: care process mapping, semi-structured interviews with COPD patients, semi-structured interviews with COPD staff, two round modified Delphi study and review of prioritised quality and safety challenges by health care staff.ResultsInterview themes emerged under the headings of quality of care and patient safety. Quality and safety concerns were mostly raised in relation to communication, for example, communication with other hospital teams. The three highest ranked safety concerns from the modified Delphi review were: difficulties in accessing hospital records, information transfer to primary care and failure to communicate medication changes to primary care.ConclusionThis study has demonstrated the feasibility of using mixed methods to review the quality and safety of care in a care pathway. By using multiple research methods it was possible to get a clear picture of service quality variations and also to demonstrate which points in the care pathway had real potential for patient safety incidents or system failures to occur. By using these methods to analyse one condition specific care pathway it was possible to uncover a number of hospital level problems. A number of safety challenges were systems related; these were therefore difficult to improve at care team level. Study results were used by National Health Service (NHS) stakeholders to implement solutions to problems identified in the review.

Multiple User Considerations and Their Implications in Medical Error Reporting System Design

Objective: The study examined the differences between physicians and clinical assistants in their preferences for a statewide medical error reporting system. Background: Medical error reporting systems have been proposed as a means for studying the causes of medical error. Knowledge of user similarities and differences is needed for the development of design guidelines for medical error reporting systems. Method: Separate focus groups composed of 8 physicians and 6 clinical assistants (physician clinical support staff) were conducted. One-hour focus group meetings were conducted via toll-free teleconference lines one to two times per month for 9 months. All conversations were audiotaped and transcribed for analysis. An inductive content analysis was conducted. Results: Eighty-six major and minor themes emerged. Differences between physicians and clinical assistants included rules and regulations governing the use of the system, the medium of reporting, and aspects of the organization that may affect reporting levels. Conclusions: Although physicians and clinical assistants shared similar preferences and beliefs surrounding error reporting, there were differences that need to be considered if medical error reporting systems are to be effective. Application: To successfully deploy a medical error reporting system, the system itself must be designed for the potential users. This study uncovered previously underappreciated issues that should be incorporated into the design and implementation process. Actual or potential applications of this research include the improvement of the design and implementation of medical error reporting systems to account for the needs of different types of users.

Using Variance Analysis to Detect Hazards in a Bar-Code–Assisted Medication Preparation Process

BACKGROUND Medication errors have received significant attention, with studies pinpointing problems in the physician ordering, pharmacy dispensing, and nurse administering processes. Yet, the nursing process for preparing medications, which typically occurs in a medication room on the unit, has not received much attention. This process is deceptively complex, and without proper design, it could break down at numerous points. HUMAN FACTORS ENGINEERING ANALYSIS Prospective hazard analysis methods allow the detection of potential hazards during the planning, assessment, and design phases of a process or technology. A specific technique-variance analysis-is used within one type of prospective hazard analysis, the sociotechnical systems analysis (STSA). STSA provides guidance to (1) analyze existing or planned systems to understand the social, technical, and environmental system components; (2) collect and analyze the system data; and (3) use the analysis to design or redesign the system. DISCUSSION The STSA variance analysis is an additional tool that health care clinicians, administrators, and risk managers can use to proactively identify hazards for control. Although this larger analysis is more time consuming, it forces the analysts to conduct a true systems analysis before implementing technical, social, environmental, or organizational changes.

Nursing Workload and its Effect on Patient and Employee Safety

A well accepted human factors concept is that poorly designed work systems can produce workload levels that pose a threat to safety and performance. The purpose of this study was to assess a systems model of workload and safety developed for nursing/healthcare. Using survey data from six nursing units in two pediatric hospitals, the study measured the relationship between self-reported workload at the unit, job, and task levels on the one hand and job dissatisfaction, burnout, and medication error likelihood on the other. Multiple linear and logistic regression revealed that staffing adequacy and medication administration workload strongly predicted the above patient and employee safety outcomes. Design priorities and strategies for future research are discussed, including the need for multiple-level approaches.

Unhealthy and healthy weight control behaviours among bus operators

BACKGROUND Urban bus operators are an occupational group with high rates of overweight and obesity. Understanding methods bus operators use for weight control may be important; there may be increased risk for these workers to engage in less healthy weight management behaviours due to stressful working conditions. AIMS To examine the prevalence of unhealthy and healthy weight control behaviours used by bus operators and examine associations between use of unhealthy weight control behaviours and work-related and sociodemographic variables. METHODS Bus operators from four different transit garages were invited to complete a self-administered survey; height and weight were measured by research staff. Unhealthy and healthy weight control behaviours, work hours, work schedule and social support were measured with self-report items on the employee survey. Logistic regression analysis was conducted to estimate associations. RESULTS Nearly 60% of bus operators endorsed at least one unhealthy method; over 50% reported skipping meals, 30% fasted and 10% reported taking diet pills in the past year. Bus operator gender, race, body mass index status and hours worked per week showed significant associations with using at least one unhealthy weight control behaviour. CONCLUSIONS Worksite interventions should emphasize the benefit of healthy eating and physical activity but should also address the use of less healthy methods for weight control for individuals employed in transportation occupations.

Health Education Priorities: Perspectives From Women's Voices

The authors conducted a study to determine womens perceived health information needs in various geographic locations to plan health-related outreach in a Midwestern U.S. state. Eighty-seven women representing diverse communities in both urban and rural locations participated. Themes identified from transcripts of focus groups included confusion and information overload, concerns regarding lifestyle and specific health conditions, a lack of time for self care, factors influencing health-related behavior change, navigating the health system, and a need to “make this system work for me.” The voices of these women contribute to the search for solutions to provide comprehensive, holistic womens health care in the U.S. and internationally.

Engaging Black Churches to Address Cancer Health Disparities: Project CHURCH

African Americans in the United States suffer disproportionately from cancer, having the highest mortality rate of any racial/ethnic group across all cancers for the past several decades. In addition, significant disparities exist in several cancer risk behaviors, including obesity, intake of fruits and vegetables, leisure time physical activity and cancer screening. Addressing these disparities require successful development of relationships with minority communities to partner in the research process, in order to understand areas of critical need and develop interventions that are compatible with this community. In this manuscript we describe Project CHURCH (Creating a Higher Understanding of Cancer Research and Community Health), a collaborative partnership between The University of Texas MD Anderson Cancer Center and Houston-area African American churches. Project CHURCH was developed to understand disparities in cancer prevention risk factors and engage African Americans as partners in the research process. Using community-based participatory research principles, we describe the development and infrastructure of the research partnership, as well as how the church community has been engaged in the development and implementation of a large African American cohort study (N = 2,338). Finally, the characteristics of the cohort are presented along with cohort success in addressing community need while having significant contribution to the scientific literature. Project CHURCH serves as a valuable resource for cancer prevention in the African American community.

Do beliefs about hospital technologies predict nurses' perceptions of their ability to provide quality care?: a study in two pediatric hospitals

The purpose of this study was to test the hypothesis that nurse perceptions of technology they use in practice would affect their perception that they were able to provide high quality patient care. A survey assessing the variables was administered to 337 pediatric nurses from two academic freestanding pediatric hospitals in the US. Two separate equations were constructed, one to test whether technology perceptions affected individual quality of care and the other to test whether technology perceptions affected quality of care provided by the nursing unit. Nurse confidence in their ability to use hospital technology and their beliefs that the technologies were easy to use, useful, and fit their tasks are important predictors of nurse beliefs that they are able to provide quality care to their patients.