Shaké Ketefian

The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs

BackgroundNurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. ObjectivesTo examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. MethodsUsing two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes. ResultsThree statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. ConclusionPatients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.

Moral Competence in Nursing Practice

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand.

Application of selected nursing research findings into nursing practice: A pilot study

This study investigated the extent to which one research finding, obtained through a series of investigations and reported widely in the nursing literature, was being utilized by nurse practitioners for the improvement of nursing practice. Based on the research findings of Nichols and colleagues on the oral mode of temperature determination, a questionnaire was constructed and administered to 87 registered nurses in the states of Massachusetts and New York. Only one response corresponded to the findings of Nichols and colleagues on how oral temperature is correctly determined. Contradictions between theory and practice, moreover, were cited.

Professional and bureaucratic role conceptions and moral behavior among nurses

This descriptive study tested the relationship between professional and bureaucratic role conceptions and moral behavior. It was theorized that professional-bureaucratic role conceptions of nurses, and their perceptions of the discrepancy between ideal and actual values influence the manner in which they practice and operationalize their professional values, including moral behavior. Data were obtained from 217 practicing nurses representing different positions, areas of practice, education, age, ethnic groups, and work settings. Two of the subscales of Nursing Role Conceptions (Pieta, 1976) were used to measure professional and bureaucratic role conceptions; moral behavior was measured by Judgments About Nursing Decisions (Ketefian, 1981). Professional categorical role conception was positively related to moral behavior. Professional normative role conception and professional role discrepancy were negatively related. Bureaucratic role discrepancy was found to be positively related to moral behavior. Hierarchical multiple regression analyses showed that the combination of professional normative and bureaucratic normative role conceptions, professional categorical and bureaucratic categorical role conceptions, and professional and bureaucratic role discrepancies explained greater variance in moral behavior than either one of the pairs of variables alone. The interactions between these variables were not significant.

Doctoral preparation for faculty roles: expectations and realities.

The purpose of this report is to clarify the issues and discongruities between educational preparation of doctoral program graduates and employer expectations (educational institutions), and to stimulate thinking concerning strategies that might be used by doctoral programs to more effectively prepare graduates to deal with an integrated professional role, including that of faculty.

Promoting scientific integrity in nursing research, part II: Strategies

In part II of this two-part series reporting on a survey of doctorate-granting schools of nursing on scientific integrity, the authors deal with publication and authorship practices, promotion/tenure policies, and suggested strategies to promote scientific integrity at institutional and broader levels, and the role of various agents in this regard. The findings suggest the importance of the role of senior faculty in socializing and serving as role models for junior colleagues and doctoral students. Professional journals and professional organizations were similarly seen to have a role in standard setting. At the institutional level, educational/facilitative functions, as well as leadership and monitoring activities, were highlighted. The essay presents recommendations for promoting scientific integrity in a proactive manner rather than focusing on procedures for dealing with misconduct.

Essentials of doctoral education: Organization of program around knowledge areas

This article presents a case study describing how one nursing doctoral program faculty has identified, organized, and taught the disciplinary knowledge component of the curriculum. Three foci were chosen: health promotion and risk reduction; acute, critical, and long-term care; and systems. Faculty groups designed each focus to capitalize on current faculty research strengths and did not use a formalized knowledge structure a priori. Scholarship content and sample courses are described. Factors affecting implementation included providing students with choice; a mixture of full-time and part-time students; little interchangeability of faculty in courses; balancing doctoral teaching with teaching at other levels; advisement issues; a lengthy formal curriculum approval process; and highly specific needs of individual students. Initial reflection shows the possibility of integrating the research methods content into the disciplinary courses in light of their interdependence; help gained through the process in achieving clarity about what the school wishes to be known for; the necessity of a critical mass of faculty with active research programs along with commitment to program enrichment; the role of the foci in providing intellectual sustenance and mutual faculty mentorship; and concern about the inability to fit of some faculty.

A case study of theory development: Moral behavior in nursing

The theoretical considerations, operationalization of the constructs, and measurement issues of an ongoing program of research designed to explain ethical practice in nursing are presented. They illustrate the constant give and take among research, the empirical world, and theory building. This case study depicts the iterative and complex process of developing constructs and relationships, based on research findings, that explain moral behavior in nursing practice.

Promoting scientific integrity in nursing research part I: Current approaches in doctoral programs

Schools of nursing with doctoral programs were surveyed to determine current approaches and elicit suggestions for institutional- and professional-level strategies to promote scientific integrity. Results from 38 schools are reported in a two-part series. Part 1 reports findings concerning formal and informal instruction about responsible science and the standards, norms, and guidelines being used to direct scientific inquiry. Information on misconduct and scientific integrity was typically included in required research methods, courses, and optional workshops, but the extent and scope of the instruction was variable, and a majority of respondents judged it to be marginal or inadequate. A high value was placed on informal student-mentor interaction. Where they existed, institutional guidelines were more specific than federal guidelines, but dealt primarily with procedures for handling alleged misconduct rather than for promoting responsible science. Findings suggest the need for a more proactive and consistent approach to promoting scientific integrity in doctoral programs.

Inpatient and ambulatory patient satisfaction with nursing care.

This study reports on the development and psychometric testing of inpatient and ambulatory patient satisfaction scales designed to measure patient satisfaction using the standards of nursing practice within a medical center. The surveys were administered to patients 4–6 weeks after discharge from the hospital or following a clinic visit. A total of 619 inpatient and 955 ambulatory patient questionnaires were analyzed. Factor analyses suggest there exist four scales for inpatient satisfaction and five scales for outpatient satisfaction with high reliability and reasonable validity.