Mary Jo Clark

Effect of Morbidity and Mortality Peer Review on Nurse Accountability and Ventilator-Associated Pneumonia Rates

Objective: This program was designed to evaluate the effect of morbidity and mortality peer review conferences (MMPRCs) for ventilator-associated pneumonia (VAP) on nurse accountability and compliance with evidence-based VAP prevention practices. Background: Ventilator-associated pneumonia is associated with longer average length of stay (ALOS), greater cost, and increased morbidity and mortality. Traditionally, passive or punitive methods have been used to reduce undesirable outcomes. The MMPRC is not a conventional nursing intervention. Methods: Each MMPRC included case history, relevant hospital course, diagnostic comorbidities, and compliance with VAP prevention strategies. The preventability of each VAP was determined by RN peers. Ventilator days, VAP bundle compliance, VAP incidence, ICU ALOS, cost, and satisfaction data were collected. Results: Nurse accountability improved significantly (χ2 = 24.041, P < .001), and VAP incidence was reduced. Data demonstrated satisfaction with the MMPRC. Number of ventilator days and ALOS did not change significantly, although VAP bundle compliance improved from 90.1% to 95.2%. Conclusions: The nonpunitive MMPRC process was cost-effective and should be considered for other nurse-sensitive indicators to increase nurse accountability and improve outcomes.

DETERMINANTS OF PHYSICAL ACTIVITY IN PRIMARY SCHOOL STUDENTS USING THE HEALTH BELIEF MODEL

Background Thailand is a middle-income country in which two-thirds of children demonstrate an insufficient level of physical activity. Physical inactivity is a major risk factor for obesity and many other health-related consequences in children. Thus, it is important to understand how primary school children perceive things in their daily life as determinants of physical activity. The purpose of this study was to investigate the impact of cues, perceived benefits, and perceived barriers on the level of physical activity among primary school students. Methods A cross-sectional study was conducted in Phitsanulok Province, Thailand, in 2011. Multistage sampling selected a total of 123 primary school students. The Physical Activity Questionnaire for Older Children and the Cues, Perceived Benefits, and Barriers to Physical Activity Questionnaire were used to assess the student levels of physical activity, as well as the perceived benefits, barriers, and cues to action. The association between these factors and the level of physical activity was determined by correlation statistics and confirmed by robust regression. Multivariate analysis of variance compared health belief model determinants: perceived benefits, perceived barriers, and cues to action on physical activity between male and female students. Self-administered questionnaires were validated and tested in a pilot study. Results The level of activity among primary school children was significantly influenced by perceived barriers, such as fear of strangers when playing outdoors, bad weather, and too much homework. However, activity was not influenced by cues to action or perceived benefits. Perceived benefits, barriers, and cues to physical activity did not differ by gender. Conclusion A safe environment and fewer barriers, such as amount of homework, could enhance physical activity in primary school children.

Cross-cultural research: challenge and competence.

Increasing globalization, population diversity and health disparities among non-dominant cultures necessitate cross-cultural research. Research with other cultures is fraught with challenges that must be addressed by the competent cross-cultural researcher. Areas for consideration include choice of research foci, ethical concerns, cultural adaptation of research measurements and interventions, participant recruitment and retention, strategies for data collection and analysis, dissemination of findings and perspectives of time. Approaches to dealing with these challenges are addressed, with an emphasis on community-based participatory research.Increasing globalization, population diversity and health disparities among non-dominant cultures necessitate cross-cultural research. Research with other cultures is fraught with challenges that must be addressed by the competent cross-cultural researcher. Areas for consideration include choice of research foci, ethical concerns, cultural adaptation of research measurements and interventions, participant recruitment and retention, strategies for data collection and analysis, dissemination of findings and perspectives of time. Approaches to dealing with these challenges are addressed, with an emphasis on community-based participatory research.

Supporting cardiovascular risk reduction in overweight and obese hypertensive patients through DASH diet and lifestyle education by primary care nurse practitioners.

Purpose: To describe an intervention among overweight and obese hypertensive patients, encouraging Dietary Approaches to Stop Hypertension (DASH) diet and lifestyle changes, designed and led by a primary care nurse practitioner (NP). Data sources: A pre‐ and postintervention quasi‐experimental time‐series design was implemented over 2 months. Intervention included three group classes and two individual counseling telephone calls. Forty‐five hypertensive patients enrolled, with a mean age of 55 years and mean initial BMI of 32. Twenty‐six (58%) completed the program. Standard instruments (Rapid Eating Assessment for Patients [REAP] and Partners in Health [PIH] questionnaires) were used to evaluate diet and lifestyle factors before and after the program. Conclusions: Participants had statistically significant improvements in diet and lifestyle scores on both REAP and PIH questionnaires, as well as statistically significant weight loss (average 3.6 pounds lost) over the 2‐month intervention period. Implications for practice: This NP‐led primary care intervention on diet and lifestyle showed early success in improving the health of overweight and obese hypertensive patients. Investment in NP‐led diet and lifestyle counseling should be considered among high‐risk patients in the primary care setting.

The Patient Protection and Affordable Care Act of 2010 (PL 111-148): an analysis of maternal-child health home visitation.

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act, setting in motion a historic and, for many, a long-awaited radical change to the current American health care system. Section 2951 of the PPACA addresses provision and funding of maternal, infant, and early childhood home visiting programs. The purpose of this article is to acquaint the reader with the legislative odyssey of home visitation services to at-risk prenatal and postpartum women and children as delineated in the PPACA and to discuss the nursing practice and research implications of this landmark legislation. Few question the need for more rigorous methodology in all phases of home visitation research. Public health nursing may provide the comprehensive approach to evaluating effective home visitation programs.

Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep?

Community Engagement Approach Developing a Culturally Appropriate Intervention for Hispanic Mother–Child Dyads

Childhood obesity affects approximately 20% of U.S. preschool children. Early prevention is needed to reduce young children’s risks for obesity, especially among Hispanic preschool children who have one of the highest rates of obesity. Vida Saludable was an early childhood obesity intervention designed to be culturally appropriate for low-income Hispanic mothers with preschool children to improve maternal physical activity and reduce children’s sugar-sweetened beverage consumption. It was conducted at a large southwestern United States urban health center. Presented here are the methods and rationale employed to develop and culturally adapt Vida Saludable, followed by scoring and ranking of the intervention’s cultural adaptations. An empowered community helped design the customized, culturally relevant program via a collaborative partnership between two academic research institutions, a community health center, and stakeholders. Improved health behaviors in the participants may be attributed in part to this community-engagement approach. The intervention’s cultural adaptations were scored and received a high comprehensive rank. Postprogram evaluation of the intervention indicated participant satisfaction. The information presented provides investigators with guidelines, a template, and a scoring tool for developing, implementing, and evaluating culturally adapted interventions for ethnically diverse populations.

Thai American women's perceptions regarding mammography participation.

OBJECTIVES To identify the factors influencing mammography screening among Thai immigrant women in Southern California. BACKGROUND Asian women have lower mammography screening rates than other U.S. women (Centers for Disease Control [CDC], 2007), and only 53% of Thai women in Los Angeles had a mammogram in the prior 2 years (Thai Community Development Center, 2004). DESIGN A phenomenological approach was used to elicit Thai immigrant womens perceptions of the reasons for screening participation. Phenomenology is an appropriate means of describing screening as experienced by members of a population for which there is little information. Focus groups were used to collect data to provide a group perspective. SAMPLE Thai women over 40 years of age in 2 Southern California counties were recruited at a local temple and a social services agency. MEASUREMENT Participants were asked about mammography participation and to describe the factors that influenced screening for themselves, family members, and friends. Thematic analysis identified major themes. RESULTS Factors influencing mammography screening included knowledge, encouragement, health consciousness, physical factors, fear, cultural factors, social responsibilities, and logistical barriers. CONCLUSIONS Participants identified factors amenable to nursing intervention that may influence mammography screening in this population. Further study is needed to determine the prevalence of these factors.

Enhancing Acquisition of Health Care Management Skills in Youth Living With HIV Prior to Transition: A Pilot Study

Andrew J. White, DNP, APRN, NP-C, is the Transition Nurse Specialist for persons living with HIVat the University of California San Diego, San Diego, California, USA. Lois Howland, DPH,MSN, is an Associate Professor, Hahn School of Nursing and Health Science, San Diego, California, USA. Mary Jo Clark, PhD, RN, PHN, is a Professor, Hahn School of Nursing and Health Science, San Diego, California, USA.

Literature review: patients' and health care providers' perceptions of stressors in critical care units.

The purpose of this article was to provide a historical review and analysis of the research literature focusing on patients’, nurses’, and health care providers’ perceptions of stressors in the critical care setting. A narrative historical literature review method was used. The inclusion criteria include English-language studies of stressors as perceived by patients and health care providers from 1984 to 2011. Several studies investigated perceptions of stressors using the Environmental Stressors Questionnaire and the findings did not show any significant changes of stress perception over time since 1989 until the present. There is a need to further investigate stress perceptions in the health care setting using a mixed qualitative and quantitative approach to provide a more precise description of stressors and stress perceptions in the critical care setting.