Karen H. Frith

Assessing and Selecting Data for a Nursing Services Dashboard

Nurse leaders are held accountable for staffing decisions and quality outcomes, sometimes without proper decision support tools. A nursing services dashboard can provide information to guide staffing decisions for positive outcomes. The authors examine the sources, attributes, and uses of administrative data to assist nurse leaders to make informed decisions in selecting data for inclusion in their nursing services dashboard.

Medication errors in the intensive care unit: literature review using the SEIPS model.

Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.

Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia.

PURPOSE/OBJECTIVES To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. DESIGN Practice change. SETTING The oncology unit of an urban hospital in the south-eastern United States. SAMPLE Adult patients with cancer and febrile neutropenia admitted six months prior to (n = 30) or during the three months following (n = 23) implementation of the order set. METHODS Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Time intervals were analyzed using SPSS® software, version 18. MAIN RESEARCH VARIABLES Initial antibiotic times, order-set use, and length of stay. FINDINGS An overall reduction in time intervals for initiation of antibiotic therapy was observed for presentation (t = 2.25; degrees of freedom [df] = 37; p = 0.031) and order (t = 2.67; df = 40.17; p = 0.012) to antibiotic administration, with an order-set usage of 31% in the inpatient unit and 71% in the emergency department. CONCLUSIONS Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit-based medication dispensing machines helped reduce time intervals for initial antibiotic therapy. IMPLICATIONS FOR NURSING The use of an evidence-based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence-based practice changes.

The development and initial testing of the Internet Consequences Scales (ICONS).

The Internet has become a tool for everyday use in the lives of many people; however, little is known about the consequences of using the Internet on the well-being of individuals. This article describes the development of the Internet Consequences Scale (ICONS), a tool to measure the physical, behavioral, economic, and psychosocial consequences of Internet use. Content validity was established using a panel of experts in Internet communications, and construct validity was established using a confirmatory factor analysis. Reliability of the ICONS was established statistically using Cronbachs alpha. The result was a 44-item tool containing four subscales to measure the consequences of Internet use.

Preliminary analysis of physiological changes of nursing students during training

Long-term exposure to stress has been associated with chronic diseases, depression, and immune disorders. The precise detection and assessment of stress depends on personalized physiological monitoring and assessment of influence of personal and workplace factors We monitored nursing students during training on a high fidelity simulator in the Real-time Physiological Monitoring Lab at the University of Alabama in Huntsville. In this paper we present the preliminary results of this pilot study. A total of 14 participants were recorded: 12 female and 2 male subjects, 23-46 years old with an average age of 32.8 years. We analyzed heart rate, Heart Rate Variability (HRV), respiration, and physical activity. The results indicate significant strain on subjects during simulation: heart rate increased 16.7%, from 82.8 to 96.6 bpm (p<;0.001), falling to a slightly increased level after the training session (84.9 bpm); Root Mean Square of Successive RR Differences (RMSSD) decreased from 38.9 ms to 37.7 ms; the breathing rate increased during the simulation from 16.9 to 17.7 breaths/min. Distractions also significantly influenced physiological parameters: the first telephone call increased heart rate on average 9 bpm (p<;0.001), while the second call increased heart rate 8.6 bpm (p<;0.001). The simulated patient-related events created even more prominent response; the average heart rate increased 17.4 bpm (p<;0.001) at the onset of “patient in crisis” event. Real-time wearable monitoring may provide assessment of occupational stress.

Electronic Medical Records in Clinical Teaching

The purpose of the project was to provide students with experiences to develop their technology competency and examine student perceptions about an academic electronic medical record (EMR) as a learning tool. Nurse educators need to integrate EMRs into their curricula to give students practice in the use of electronic documentation and retrieval of clinical information. The findings of this study indicated that students’ use of EMRs at least 5 times resulted in the development of positive perceptions about their EMR experience.

Real-time monitoring of occupational stress of nurses

Prolonged exposure to stress has been associated with chronic diseases, depression, and immune disorders. Stress perception is highly subjective. Assessment of occupational stress requires personalized physiological monitoring and timely collection of individual characterization of sources of stress. We implemented a wearable system for monitoring of occupational stress of nurses — UAHealth. Personal monitors are implemented on iPhone smartphones with Ant+ wireless interface. Interbeat intervals are collected from a chest belt, and step count and cadence from foot pod sensor. All data are processed in real-time on the phone to assess stress index. A 30-minute personalized maximum over predefined threshold initiates a questionnaire to collect assessment of sources of stress. In this paper we present system organization and preliminary results.

Obesity, prediabetes, and perceived stress in municipal workers

The primary cause of death for men and women in the United States is heart disease. Obesity and diabetes are major contributors to heart disease, and the risk is worsened in the presence of stress. It is clinically useful to identify predictors of obesity and prediabetes in a working population. The purpose of this current cross-sectional, correlational study was to examine relationships among obesity, prediabetes, and perceived stress in municipal workers using a subset of worksite wellness program data from employees screened in 2010 and 2011. Multiple regression models indicated that age, gender, race, HA1c, shift schedule, physical activity, and occupation were significant predictors of obesity in municipal workers (p < .01). Prediabetes in municipal workers was predicted by age, Black race, and body mass index (BMI; p < .01). Perceived stress was not a significant predictor of obesity or prediabetes in municipal workers. Overall, the findings of this study provide guidance to occupational health nurses when evaluating individuals in an occupational health setting. Further research is needed to examine relationships among the variables and validate the models.

Promoting Best Practices for Managing Acute Low Back Pain in an Occupational Environment

Providers treating low back pain must be confident and knowledgeable in evidence-based practice (EBP) to provide the best outcomes. An online education course was created in an effort to increase knowledge and confidence in EBP and clinical practice guidelines specific to low back pain in an occupational setting. There were 80 participants who completed the pre-test and post-test. The results showed a statistically significant improvement in knowledge and confidence scores after completion of the course. An online education course was shown to be a cost-effective, accessible tool to increase knowledge and confidence of EBP for different health care providers.

The Effect of Transplant Education on Nurses Attitudes Toward Organ Donation and Advocacy for Transplantation: Instrument Development

Nurses are the largest group of health-care professionals, yet they are not uniformly educated regarding transplantation and organ donation. The future of transplantation hinges on education of this group. Before meaningful studies can be conducted, an instrument to measure attitudes and commitment to organ transplantation is needed. The purpose of this study was to examine content and construct validity as well as establish internal reliability of an investigator-developed online instrument to measure nurses’ attitudes and commitment to organ transplantation by registered nurses. The online instrument was administered to registered nurses enrolled in transplantation electives at the University of Alabama in Huntsville and Vanderbilt University. Exploratory factor analysis revealed 4 components with eigenvalues over 1.0. The components were as follows: (1) desire to work in transplantation, (2) confidence in transplantation advocacy, (3) organ donation advocacy, and (4) procurement. Internal consistency of the revised instrument was established (α = .94). The Transplant-Registered Nurse (TXP-RN) instrument is a new instrument with excellent reliability and validity that can be used to measure attitudes and knowledge of American nurses about organ donation and transplantation. This important step is necessary before educational interventions can be accurately assessed.