Mary J. Findorff

Risk factors for work related violence in a health care organization

Objective: Identify the exposure effects of job family, patient contact, and supervisor support on physical and non-physical work related violence. Design: Cross sectional study of employees in a Midwest health care organization, utilizing a specially designed mailed questionnaire and employer secondary data. Subjects: Respondents included 1751 current and former employees (42% response rate). Results: Physical and non-physical violence was experienced by 127 (7.2%) and 536 (30.6%) of the respondents, respectively. Multivariate analyses of physical violence identified increased odds for patient care assistants (odds ratio (OR) 2.5, 95% confidence interval (CI) 1. 1 to 6.1) and decreased odds for clerical workers (OR 0.1, 95% CI 0.03 to 0.5). Adjusted for job family, increased odds of physical violence were identified for moderate (OR 5.9, 95% CI 2.1 to 16.0) and high (OR 7.8, 95% CI 2.9 to 20.8) patient contact. Similar trends were identified for non-physical violence (OR 1.4, 95% CI 1.1 to 2.0 and OR 1.7, 95% CI 1.3 to 2.3). Increased supervisor support decreased the odds of both physical (OR 0.7, 95% CI 0.6 to 0.95) and non-physical violence (OR 0.5, 95% CI 0.4 to 0.6), adjusting for job family and demographic characteristics. Conclusions: Increased odds of physical violence were identified for the job family of nurses, even when adjusted for patient contact. Increased patient contact resulted in increased physical and non-physical violence, independent of job family, while supervisor support resulted in decreased odds of physical and non-physical violence.

Measuring the direct healthcare costs of a fall injury event

Background: Falls are a leading cause of injury in older adults. Obtaining cost data for a randomized controlled trial aimed at preventing falls was problematic, and an approach was needed to obtain these data on a relatively small sample of women who used healthcare services. Approach: The study population was 272 community-dwelling women aged 70 and over who were participants in a fall prevention trial. Fall incident reports and billing records were used to obtain costs associated with outpatient visits, emergency department visits, acute care hospitalizations, nursing home stays, home healthcare visits, rehabilitation visits, and ambulance use. Average time and costs for obtaining fall-related healthcare cost data also were estimated. Results: The mean age of those with falls requiring healthcare utilization was 78.9 years (SD = 5.1 years). Billing records were obtained for 47 of 55 injurious falls (85%). Costs ranged from

Predictors of Long-term Exercise Adherence in a Community-Based Sample of Older Women

63 to

Health and illness over time: The trajectory perspective in nursing science

85,984, with a mean cost of

Does the Transtheoretical Model (TTM) Explain Exercise Behavior in a Community-Based Sample of Older Women?

6,606 and a median cost of

Use of Time Studies for Determining Intervention Costs

658 per fall-related injurious event. The average time it took to collect the data was just over 5 hr per fall, with an estimated data collection cost of

The impact of educational research centers on occupational health and safety alumni competence. A program evaluation.

170 per fall. Discussion: The mean cost of falls was higher than seen in other studies, although methods differ. Collecting cost data related to a specific fall injury event directly from study participants was feasible, practical, and relatively inexpensive. Direct costs of injurious falls are greater than have been estimated in previous studies.

Circumstances and consequences of falls in community-dwelling older women

BACKGROUND Few studies have examined long-term exercise adherence in older women. The purpose of this study was to assess predictors of adherence to an intervention involving walking and balance exercises. METHODS This was a randomized controlled trial with 2-year follow-up. Sedentary women (n = 137) aged > or =70 randomized to the exercise intervention were evaluated in their homes. The exercise prescription included walking 30 minutes per day 5 days per week and completing 11 balance exercises twice per week. The main outcome measure was exercise adherence of the intervention group only. RESULTS The average number of minutes walked per week was 95.2 (SD 68.8); 17% walked the recommended 150 minutes or greater. The average number of times the balance exercises were done was 1.5 (SD 1.6) per week. Results of regression analysis for walking adherence showed clinical variables accounted for the greatest variance (17%) of all the blocks, and cognitive variables were second highest (12%). The final model explained 19% of the variance in predicting adherence to walking. Results of regression analysis for adherence to balance exercises showed health-related quality of life (HRQOL) variables accounted for the greatest variance (14%), followed by cognitive variables (12%). The final model explained 24% of the variance in predicting adherence to balance exercises. CONCLUSIONS Adherence to exercise was below recommended goals, although this study demonstrated that sedentary women can adopt and continue regular exercise long term. Predictors of adherence varied with different forms of exercise. Individually tailored exercise interventions may be most amenable to older women.

Design of Control-Group Conditions in Clinical Trials of Behavioral Interventions

BACKGROUND Understanding change in health and illness over time is central to creating and evaluating interventions for individuals, families, and populations. The term health trajectory is a succinct and useful way to describe change in health status over time. OBJECTIVES The aims of this article were to define the notion of a health trajectory; comment on the usefulness and current status of health trajectory research for nursing science and practice; and identify and illustrate the key elements of theory, design, and statistical models for health trajectory research. APPROACH Constructs in theory about individual change are summarized, synthesized with characteristics of longitudinal design and statistical models for change, and discussed in light of current and emerging health care priorities and trends in nursing research. RECOMMENDATIONS Health trajectory research is person focused and congruent with the person-centered emphasis of nursing practice. The contribution of nursing science to the overall effort to improve health will be enhanced when change over time is explicit in nursing theory, longitudinal designs are used, and contemporary statistical approaches for modeling change in health status are incorporated into research plans.

Reporting violence to a health care employer: a cross-sectional study.

Objective: To determine whether patterns of exercise adoption by older women would conform to the Transtheoretical Model (TTM) of behavior change. Methods: Participants were randomized into an exercise group (walk 30 minutes per day, 5 days per week, plus balance exercises twice per week) or attention control (health education on topics other than exercise). The intervention was conducted over 28 weeks with 1-year follow-up. Results: Participants included 272 sedentary women aged 70 and above. Exercise adoption was higher in the intervention group (83% vs. 17% among controls). After 1 year, 60% of the intervention group was in action or maintenance, compared to 16% of the control group. Self-efficacy following the intervention predicted long-term exercise adherence. Discussion: Few studies have addressed longitudinal analysis of the TTM for exercise adoption. Most constructs from the TTM were useful in explaining exercise adoption in older sedentary women.