Laura J. Burke

Technology-Enhanced Practice for Patients With Chronic Cardiac Disease: Home Implementation and Evaluation

OBJECTIVE This 3-year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home-care nursing model, referred to as technology-enhanced practice (TEP). METHODS Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services. RESULTS Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status. CONCLUSION This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care.

Human factors and ergonomics in home care: Current concerns and future considerations for health information technology.

Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.

Research-based planning for change: assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition.

OBJECTIVE This article describes one medical centers experience in using research to plan for nursing staff integration after hospital acquisition. BACKGROUND Resistance to new policies, procedures, and standards; passive acceptance of new leadership; limited support for management plans; and failure to integrate with new nursing units are common staff reactions after acquisitions. Little has been written regarding which key staff variables to assess after acquisitions and how to use this data to plan for change. Structural contingency and attribution theory were used to guide leadership staffs assessment of acquired staff attributes to determine their congruence with concepts valued by the acquiring organization. METHODS Qualitative and quantitative data were collected using a survey method. All 141 registered nurses and licensed practical nurses of the acquired medical center received a mailed survey. Sixty-six completed surveys were returned through the U.S. mail. No identifying information was placed on the survey to assure anonymity. RESULTS The survey results described nurses perceptions of the advantages, concerns, and suggestions for a smooth transition after acquisition. In addition, the results clarified that nurses in the newly acquired hospital preferred a shared governance structure (congruent with the acquiring medical centers values) and the nurses perceived professional nursing autonomy was similar to that of nurses who worked at the acquiring medical center. CONCLUSIONS By sharing the findings, both staffs were sensitized to the similarities among the staff as well as to their differences. Transition strategies were planned to capitalize on this knowledge. This process may be useful for other nurse executives to replicate as they guide their organizations through similar transitions.

Work System Analysis of Home Nursing Care and Implications for Medication Errors

The purpose of this study was to examine the context of the provision of home nursing care for patients with congestive heart failure. A modified macroergonomic analysis and design work system analysis was undertaken in two phases with fourteen nurse participants: I) field observations of eight nurses for the collection of data on work elements and II) follow-up telephone interviews with six home care nurses. Open-ended questions were asked after the observations to identify clinical knowledge, policies, and procedures that influenced care decisions and practices. The telephone interviews focused on four different aspects of home health care delivery and were conducted using semi-structured questions. Results of the observations were translated into flowcharts and a summary report. The baseline findings described aspects of home medication management and its relevance to safety, quality of care, communication, and self-management.

Trust Through Feedback to the Chief Nurse Executive: Preliminary Results of a Pilot Study To Evaluate Performance Competence

In trusting health care organizations or organized delivery systems (ODSs), nursing personnel are involved in evaluating the performance competence of their Chief Nurse Executive (CNE). As ODSs increase in numbers and expand geographically, new approaches must be developed to assess the ways in which CNEs perform to ensure accountability. This article presents the results of a preliminary pilot study that describes a data collection instrument to assess the performance competence of a CNE in an ODS. The qualities of the data collection instrument are reported with illustrative items from the developed standardized protocol and with recommendations for future use.

Human Factors and Ergonomic Concerns and Future Considerations for Consumer Health Information Technology in Home Nursing Care

Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home care patient, which can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-management. Currently, a variety of consumer health information technologies (CHITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This article reviews the HFE considerations for information access, communication, and patient self-management, discusses how CHIT can potentially mitigate current problems, and explains how the design and implementation of CHIT itself requires careful HFE attention.

A theory-based problem-solving approach to recruitment challenges in a large randomized field trial

Despite best-laid plans, recruitment problems arise in large field trials. Research teams must work hard on problem solving and push comfort zones to sustain recruitment and accrual levels. A systematic theory-based problem-solving approach helped us look deeply for challenges and implement strategies continuously to sustain accrual to our target enrollment.