Sandra L. Siedlecki

Predictors of Over-the-Counter Drug and Herbal Therapies Use in Elderly Patients With Heart Failure

BACKGROUND Over-the-counter (OTC) drug and herbal therapies (HT) may worsen heart failure or interact with prescription medications. Frequency of and predictors for routine OTC drug and HT use are not well studied. METHODS AND RESULTS We examined routine use of OTC drug and HT in patients at 8 medical centers. Medical conditions independently associated with use of OTC drugs, HT, or both were assessed using multivariable logistic regression models. Of 374 subjects, OTC drug and HT were routinely used by 349 and 43 patients, respectively. Mean age was 69.6 +/- 13.1 years, 63% were male, and 81% were Caucasian. Common OTC drugs were antiplatelets (baby-dose aspirin), vitamins, acetaminophen, antacids, laxatives, and calcium. The most common HT used was echinacea. History of hypercholesterolemia was associated with higher OTC drug use (OR 4.36; 95% CI 1.60-11.87; P = .004); renal failure predicted less use (OR 0.09; 95% CI 0.01-0.59; P = .013). History of hypertension was associated with less HT use (OR 0.47, 95% CI 0.24-0.92; P = .028). CONCLUSIONS In HF patients, routine use of OTC drugs was common, but HT use was not. OTC drugs were used more often in patients with hypercholesterolemia and were used for a variety of reasons; thus, routine assessment and individualized education are advocated.

Development and psychometric exploration of the professional practice environment assessment scale.

PURPOSE Development of the Professional Practice Environment Assessment Scale (PPEAS) was based on the assumptions that a positive professional practice environment is more than and different from the absence of negative, abusive, or disrespectful behaviors by physicians; a positive professional practice environment improves patient outcomes as well as nurse and physician satisfaction; and a positive professional practice environment is characterized by mutual respect, understanding of roles, collaborative decision making, effective communication, and beliefs in the importance of nurse-physician relationships on patient outcomes. The PPEAS is intended as both a research tool and a method of assessing and monitoring changes in an organizations professional practice environment as it relates specifically to the impact the nurse and physician relationship has on the professional practice environment. The purpose of this study was to examine the psychometric properties of the PPEAS and determine if it was a valid and reliable instrument for assessing the positive attributes of the professional practice environment. DESIGN A large acute care facility in the Midwestern section of the United States provided the setting for this psychometric study. The sample (N= 1,332) consisted of 801 nurses and 531 physicians. METHODS Psychometric examination, which included principal component analysis with varimax rotation and assessment of internal consistency, was conducted to validate the reliability and validity of the PPEAS. FINDINGS Analysis identified a four-factor solution. The four factors were classified as positive physician characteristics (five items), positive nurse characteristics (three items), collaborative decision making (two items), and positive beliefs in the value of the nurse-physician relationship (three items). Cronbachs α for the entire scale was .86, with subscales ranging from .73 to .89. CONCLUSIONS Findings from this analysis support our model and provide evidence of the usefulness of this scale for assessing the presence of a positive professional practice environment. Using the total score, organizations can examine the status of their professional practice environment and examine changes in the environment over time. Subscale analysis can identify specific areas where the organization performs well and those areas in need of improvement. CLINICAL RELEVANCE The professional practice environment has been implicated as a variable that impacts patient outcomes. The absence of negative physician behaviors is an inadequate measure for assessing the positive attributes of the professional practice environment. Instruments for assessing the professional practice environment typically looked at the presence of negative physician behaviors or examined a single aspect of the nurse-physician relationship. This article provides a theoretical framework that can be used to guide both practice and research. The PPEAS was developed within a theoretical framework that can be adapted to a variety of settings, cultures, and countries. The PPEAS is a valid and reliable instrument that can be used to assess the professional practice environment in a variety of settings.

Frontline nurse managers' confidence and self-efficacy

AIM This study was focused on determining relationships between confidence levels and self-efficacy among nurse managers. BACKGROUND Frontline nurse managers have a pivotal role in delivering high-quality patient care while managing the associated costs and resources. The competency and skill of nurse managers affect every aspect of patient care and staff well-being as nurse managers are largely responsible for creating work environments in which clinical nurses are able to provide high-quality, patient-centred, holistic care. METHOD A descriptive, correlational survey design was used; 85 nurse managers participated. RESULTS Years in a formal leadership role and confidence scores were found to be significant predictors of self-efficacy scores. CONCLUSIONS Experience as a nurse manager is an important component of confidence and self-efficacy. IMPLICATIONS FOR NURSING MANAGEMENT There is a need to develop educational programmes for nurse managers to enhance their self-confidence and self-efficacy, and to maintain experienced nurse managers in the role.

Perceived knowledge and self-confidence of pediatric nurses as patient educators.

Patient education is an integral component of nursing care. Patient education has been associated with favorable patient outcomes but may be difficult if resources are unavailable, “teachable moments” are unrecognized, or if self-confidence of the nurses providing the education is low. Using the theoretical model developed by the authors and focusing on the delivery of patient/family education, we examined pediatric nurses’ perceptions about patient/family education in the hospital setting. A 20-item questionnaire that explored factors affecting teaching behaviors of 54 pediatric nurses in an acute care hospital setting was completed. Results from this study suggest that pediatric nurses’ confidence was disorder-specific. Nurses were confident providing education about common disorders (asthma, pneumonia, and bronchiolitis) and less confident providing education about less common disorders (oncology, cardiac). The barrier to providing education identified most often was lack of written materials. Findings from this study can be used to develop teaching resources for nurses and to plan educational programs specific to less common pediatric problems.

Do We Know What Our Patients With Diabetes Are Eating in the Hospital

Diabetes is one of the most prevalent diagnoses seen in hospitalized patients in the United States, accounting for ∼ 38% of all patients admitted to hospitals.1 Research on the benefits of glucose control in the hospital setting has focused primarily on critically ill cardiovascular patients.1–5 Hyperglycemia has been linked to immunosuppression, increased coagulapathies, increased infection rates, endothelial dysfunction, and prolonged lengths of hospitalizations.2,6 A diabetic population is at greater risk for developing complications if glucose levels are not controlled. Improved glycemic control is dependent on establishment of glycemic targets, adjustment of diabetes medication regimens (including insulin), monitoring of glucose trends, and assessment of eating behaviors. Accordingly, to understand glycemic control in the hospitalized population, it is important to examine meal consumption, as well as pharmacological therapies.7 Unfortunately, eating patterns and actual nutritional intake are not well understood for this population.2 Thus, the aim of this study was to explore meal consumption patterns of hospitalized patients with diabetes. The research questions included: 1. What is the average daily meal consumption of hospitalized patients with diabetes receiving subcutaneous insulin therapy? 2. Is there a difference between actual meal consumption and estimated nutritional requirements in hospitalized patients with diabetes? 3. What factors affect meal consumption in hospitalized patients with diabetes? ### Setting and sample Investigators recruited a convenience sample of patients from two medical and two surgical units in a large, urban, tertiary care facility in the Midwest. Adult patients diagnosed with type 1 or type 2 diabetes, > 20 years of age, who were receiving subcutaneous insulin were included. Patients receiving steroid therapy, oral glucose-lowering agents, tube feedings, parenteral nutrition, or pre-packaged kosher meals and those who could not understand English were excluded. The study took place from July to November 2007 with approval of the institutional review board. ### Study design Dietitians …

Research Intervention Fidelity: Tips to Improve Internal Validity of Your Intervention Studies

The clinical nurse specialist is often involved in intervention studies to determine whether a specific treatment or program improves some important outcome. However, a common problemwith all intervention studies is the possibility of a type I or II error that is attributable to how the intervention is administered rather than how well the intervention worked. A type I error occurs when the researcher incorrectly concludes that there is a difference between groups (those who receive the intervention and those who do not receive the intervention), when the difference may be caused by the introduction of unintentional bias into the protocol. In contrast, a type II error occurs when the researcher concludes that there is no difference between groups, although there actually is a difference. Any variation in how the intervention is administered will decrease power and make it difficult to find a difference, although a difference may actually exist. Understanding how to prevent or minimize intervention variation is a key factor when designing a sound and rigorous research study. Ultimately, researchers want to accurately assess the impact of an intervention on an outcome of interest. The purpose of this article was to identify issues associated with intervention fidelity and to provide tips that researchers can use to enhance the validity of intervention study findings.

Understanding Interrater Reliability and Validity of Risk Assessment Tools Used to Predict Adverse Clinical Events.

Purpose: This article will describe how to assess interrater reliability and validity of risk assessment tools, using easy-to-follow formulas, and to provide calculations that demonstrate principles discussed. Description: Clinical nurse specialists should be able to identify risk assessment tools that provide high-quality interrater reliability and the highest validity for predicting true events of importance to clinical settings. Making best practice recommendations for assessment tool use is critical to high-quality patient care and safe practices that impact patient outcomes and nursing resources. Optimal risk assessment tool selection requires knowledge about interrater reliability and tool validity. Outcome: The clinical nurse specialist will understand the reliability and validity issues associated with risk assessment tools, and be able to evaluate tools using basic calculations. Conclusion: Risk assessment tools are developed to objectively predict quality and safety events and ultimately reduce the risk of event occurrence through preventive interventions. To ensure high-quality tool use, clinical nurse specialists must critically assess tool properties. The better the tools ability to predict adverse events, the more likely that event risk is mediated. Interrater reliability and validity assessment is relatively an easy skill to master and will result in better decisions when selecting or making recommendations for risk assessment tool use.

Employee Engagement and a Culture of Safety in the Intensive Care Unit.

A descriptive, retrospective design was used to explore the relationship between employee engagement and culture of safety in ICUs within a large Midwestern healthcare system. Results demonstrated a strong positive relationship between total engagement score and total patient safety score (r = 0.645, P < .01) and positive relationships between total engagement score and the 12 safety culture dimensions. These findings have implications for improving managerial strategies relative to employee engagement that may ultimately impact perceptions of a safety culture.

Caring Behaviors: Perceptions of Acute Care Nurses and Hospitalized Patients with Diabetes

Caring behaviors Perceptions of acute care nurses and hospitalized patients with diabetes Purpose The purpose of this study was to examine the perceptions of caring behaviors that influence the patient experience in acute care nurses and hospitalized patients with diabetes. Background Nurses are the caregivers who render most of the direct care patients receive while they are hospitalized. Understanding what patients perceive as caring behaviors is essential in tailoring nursing interventions to meet patient needs. Data sources Data collection occurred at a 1,200 bed, nonprofit academic medical center located in the Midwest. Description Sixty-four nurses and 54 patients with diabetes were queried about their experience with diabetes caring behaviors. Conclusion Nurses consistently reported providing caring behaviors more frequently than patients reported receiving them. Implications This study has implications for understanding the patient experience in the hospital setting specifically related to patient education. Providing patient education is an important caring intervention that directly affects the patient experience. However, none of the patients in this study identified this as a caring behavior used by nurses.

Survey design research: a tool for answering nursing research questions.

The clinical nurse specialist is in a unique position to identify and study clinical problems in need of answers, but lack of time and resources may discourage nurses from conducting research. However, some research methods can be used by the clinical nurse specialist that are not time-intensive or cost prohibitive. The purpose of this article is to explain the utility of survey methodology for answering a number of nursing research questions. The article covers survey content, reliability and validity issues, sample size considerations, and methods of survey delivery.