Browsing by Author "Ebright, Patricia R."
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Item “Anybody on this list that you're more worried about?” Qualitative analysis exploring the functions of questions during end of shift handoffs(BMJ, 2016-02) O'Brien, Colleen M.; Flanagan, Mindy E.; Bergman, Alicia A.; Ebright, Patricia R.; Frankel, Richard M.; Department of Health Policy and Management, Richard M. Fairbanks School of Public HealthBackground Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective To investigate questions and the functions they serve in nursing and medicine handoffs. Research design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Subjects Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.Item Implementation strategies to improve critical care nurses' knowledge of and adherence to evidence-based guidelines(2016-04-01) Reynolds, Staci Sue; Bakas, Tamilyn; McLennon, Susan Margaret; Murray, Laura L.; Ebright, Patricia R.Healthcare workers are responsible for providing evidence-based care to patients; however, many patients receive unnecessary or harmful care. Successful implementation of evidence-based guidelines can improve patient outcomes, particularly among vulnerable neuroscience patients. Focused efforts to improve nursing knowledge of and adherence to these guidelines are warranted. The purpose of this dissertation was to determine the most effective strategies for implementing evidence-based guidelines into nursing practice. First, an integrative review of the literature was conducted to explore studies addressing implementation of evidence-based guidelines in nursing. Implications from the review suggested further research to better understand which strategies should be utilized to best implement evidence-based nursing practices. Two pre- and posttest studies were then designed to identify a bundle of implementation strategies to improve neurocritical care nurses' knowledge of and adherence to stroke and spinal cord injury guidelines. The tailored, multi-faceted strategies consisted of local opinion leaders, printed educational materials, and educational outreach. Improvements in nursing knowledge of and adherence to these guidelines were noted. Lastly, program evaluations were conducted using a mixed-methods study to understand neurocritical care nurses' perceptions of the usefulness of the strategies employed during the two studies. Findings from this research provided support for the most effective implementation strategies to enhance knowledge development and guideline adherence among neurocritical care nurses for implementation of stroke and spinal cord guidelines.Item Lessons Learned: Nurses’ Experiences with Errors in Nursing(Elsevier, 2016-11) Koehn, Amy R.; Ebright, Patricia R.; Burke Draucker, Claire; IU School of NursingBackground Health care organizations seek to maximize the reporting of medical errors to improve patient safety. Purpose This study explored licensed nurses' decision-making with regard to reporting medical errors. Methods Grounded theory methods guided the study. Thirty nurses from adult intensive care units were interviewed, and qualitative analysis was used to develop a theoretical framework based on their narratives. Discussion The theoretical model was titled “Learning Lessons from the Error.” The concept of learning lessons was central to the theoretical model. The model included five stages: Being Off-Kilter, Living the Error, Reporting or Telling About the Error, Living the Aftermath, and Lurking in Your Mind. Conclusion This study illuminates the unique experiences of licensed nurses who have made medical errors. The findings can inform initiatives to improve error reporting and to support nurses who have made errors.Item Malyglycemia and health outcomes in hospitalized patients with acute myleoid leukemia(2015-04-09) Storey, Susan; Von Ah, Diane Marie; McDaniel, Anna; Ebright, Patricia R.; Weaver, Michael TimothyAcute Myeloid Leukemia (AML) is the most common hematologic malignancy. Malglycemia is a disorder of glucose metabolism and includes hyperglycemia, hypoglycemia and the combination of hyperglycemia and hypoglycemia. Malglycemia has been shown to occur frequently during hospitalization among critical care patients and has been associated with increased risk of sepsis and mortality. Little is known, however, about the prevalence and role of malglycemia on the health outcomes of AML patients hospitalized for initial induction therapy. Malglycemia may be of particular importance to the patient with AML because, researchers have found that malglycemia may promote cellular changes which facilitate the progression of cancer, alter treatment response, and attenuate immune response. The purpose of this study was to determine the prevalence of malglycemia (hyperglycemia, hypoglycemia or the combination) and to examine its role on a comprehensive set of health outcomes (neutropenic days, infection, and septicemia, and sepsis, induction hospital length of stay, complete remission and mortality) in AML patients hospitalized for initial induction therapy. A retrospective cohort study design was used. Records of 103 AML patients, hospitalized for initial induction chemotherapy were reviewed. Results of the study showed that 98% of the AML patients had at least one episode of hyperglycemia, with a prevalence rate of 33% over the entire induction inpatient hospitalization for this population. All patients noted with hyperglycemia also had hypoglycemia and thus, the prevalence rate of hypoglycemia alone could not be determined. Prevalence of the combination of hyperglycemia and hypoglycemia was 1.4 %. Although not statistically significant, a trend was noted for AML patients with hyperglycemia to experience more days with neutropenia, greater numbers of infection, sepsis, septicemia and death (mortality) than patients without hyperglycemia during induction treatment. Patients with the combination of hyperglycemia and hypoglycemia also experienced an increased risk of developing septicemia (p = .025) and sepsis (p =.057). Future studies with larger sample sizes are needed to confirm these findings.Item Nursing Perceptions of Patient Safety at Hamad Medical Corporation in the State of Qatar(2009-03-18T18:27:21Z) Al-Ishaq, Moza A Latif; Ebright, Patricia R.; Keck, Juanita; Stokes, Lillian; Jeffries, Pamela R.The ability to improve the safety of patient care delivery is dependent on the safety culture, or the norms surrounding reactions following an error, the learning that takes place, and the proactive strategies in place to prevent future errors. While measurement of patient safety culture is now common in the United States (US) using instrument specifically developed for US healthcare organizations, no measurements of safety culture had been conducted at Hamad Medical Corporation in the State of Qatar, a Middle Eastern country; nor were valid or reliable instruments available. The purpose of this study was to assess registered nurses’ perceptions of the safety culture in the units where they provide nursing care at Hamad Medical Corporation using a modified version of the Agency for Healthcare Research and Quality (AHRQ) patient safety culture an instrument (Hospital Survey of Patient Safety Culture). Eight hundred surveys were distributed to all randomly-selected nurses from eight targeted clinical services with a response rate of 57%. Survey results were compared with those from US hospitals using the original AHRQ survey. Ranking of subscales for this study in terms of strengths and areas needing improvement were almost identical to the ordering of US hospital results, with teamwork within units ranked highest and indicating a strength; and the subscale non-punitive response to error the lowest and indicating an area for improvement. Positive response rates in terms of safety culture for this study were generally lower on most subscales compared to the US results and may reflect the intensity of patient safety improvement activity in the US over the last eight years in response to the Institute of Medicine’s report on medical errors in 1999. Results from this study provide a baseline measurement for safety culture at Hamad Medical Corporation and beginning adaptation of an instrument that can be used in other Middle Eastern healthcare organizations in the future.Item Stress and Coping in Nurse Managers: A Qualitative Description(2009-03-18T18:50:58Z) Shirey, Maria R.; McDaniel, Anna M.; Doebbeling, Bradley N.; Ebright, Patricia R.; Fisher, Mary L.Objective: This study provided a qualitative description of stress and coping as perceived by today's nurse manager incumbents. Background: The healthcare work environment as a source of overwork and stress has been implicated in today's nursing shortage. Nurse managers play a pivotal role in creating work environments for staff nurses, but little is known about the nature of nurse manager work. Methods: This qualitative descriptive study determined what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at three U.S. acute care hospitals participated in the study. Participants completed a demographic questionnaire and a 14-question interview incorporating components of the Critical Decision Method. Content analysis was completed and themes identified. Results: Difficult situations reported included feeling pressure to perform, interpersonal conflicts associated with organizational communication deficits, and issues of human resources and staffing. Nurse managers utilized a combination of emotion-focused and problem-focused coping strategies. When comparing novice nurse managers (3 years or less in role) with experienced nurse managers (greater than 3 years in role), the novices used predominantly emotion-focused coping strategies, a narrow repertoire of self-care strategies, and experienced negative psychological, physiological, and functional outcomes related to their coping efforts. Experienced nurse managers working as co-managers demonstrated mostly problem-focused coping strategies, a broad repertoire of self-care strategies, and reported no negative health outcomes. The study produced a cognitive model in the form of 10 questions that guide nurse manager decision-making related to stressful situations. The study generated four themes amenable to intervention. Conclusions: Performance expectations for nurse managers in acute care hospitals have increased since the 1990's making the role requirements unrealistic. Rising expectations increase nurse manager stress perceptions, making coping more difficult, and potentially harming nurse manager and work environment well-being. Findings from this study suggest that to address stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual factors as well as organizational culture, supportive structures, and systems that facilitate the role.Item Understanding interprofessional education : a multiple-case study of students, faculty, and administrators(2013-07) Henkin, Katherine; Helfenbein, Robert J.; Ebright, Patricia R.; Shew, Ronald L.; Torbeck, Laura J.; Wilbur, Lee G.Although interprofessional education (IPE) opportunities can help prepare students for future practice and patient-centered care, many health professions students in the country are not educated in an environment with opportunities to learn with, from, or about students from other health professions. With upcoming curricular changes at the Indiana University School of Medicine (IUSM) and the Indiana University School of Nursing (IUSN), IPE remains at the forefront of these changes in both schools. To date, few studies have explored student, faculty, and administrators’ conceptualizations of IPE prior to formal implementation. Additionally, previous studies have not compared IPE conceptualizations across these groups. This multiple-case study explores and compares how groups of stakeholders from the IUSM (Indianapolis) and the IUSN (Indianapolis) conceptualize IPE. Data collection included the examination of discipline-specific public documents and one-on-one interviews (N=25) with pre-licensure students, clinical faculty, and administrators from each school. Coding and extraction of themes transpired through within-case and cross-case analysis and data supported the following findings: the ‘business of medicine’ may prevent IPE from becoming a priority in education; stakeholders’ conceptualizations of IPE are shaped through powerful experiences in education and practice; students desire more IPE opportunities at the institution; stakeholders at the IUSN have a long-standing investment in IPE; and the institution requires a ‘culture shift’ in order to sustain IPE efforts. The findings suggest that IPE belongs in all education sectors and IPE efforts deserve reward and reimbursement. The findings also insinuate that leadership, roles, and team training education belong in IPE and IPE culture requires all individuals’ (e.g., student, faculty, administrators, patients) commitment. Importantly, the institution must continue IPE development, research, and dissemination. These findings can help shape curricula as time progresses, increase the likelihood of developing a successful new curriculum, and prompt ongoing reflection about IPE. This information can influence how institutions approach IPE and may lead to a more successful and informed IPE curriculum in the first years of implementation. And, hopefully what is learned through IPE will be translated into healthcare practice environments.Item The Use of Skin Conductance as a Marker of Intuitive decision making in nursing(2009-03-18T18:41:07Z) Payne, Leslie K.; Sims, Sharon L.; Carpenter, Janet S.; Ironside, Pamela M.; Ebright, Patricia R.A quasi-experimental design was undertaken to explore the possibility of utilizing electrodermal activity as a marker of intuitive decision making in nursing. This study compared 11 senior female nursing students to 10 female nurses with more than five years of nursing experience completing a clinical decision making task utilizing MicroSim© program software while measuring skin conductance response (SCR). The clinical decision making task chosen was based on the cognitive continuum theory. The somatic marker hypothesis is also a theoretical base for this study. This theory suggests that physiological markers are present during decision making. An independent t-test was conducted in SPSS comparing the total number of skin conductance responses generated and overall score in the card task and clinical scenario between the two groups. According to the Somatic Marker Hypothesis, the researcher’s definition of intuition, and the results of this experiment, SCR generation shows promise as a marker of intuitive decision making in nursing.Item Vigilance Experiences: Cancer Patients, Family Members, and Nurses(2009-03-18T18:29:44Z) Kooken, Wendy Carter; Haase, Joan E.; Carpenter, Janet S.; Ramanujam, Rangaraj; Ebright, Patricia R.VIGILANCE EXPERIENCES: CANCER PATIENTS, FAMILIES, AND NURSES Cancer disease, treatment, and errors in health care put patients at increased risk for poor outcomes. To improve outcomes and protect patients, researchers recommend increased vigilance; yet, research on vigilance in health care is minimal. There are even fewer studies on patients, family members, and nurses’ experiences of vigilance, although such studies could contribute to understanding mechanisms that foster vigilance within and across groups. The purpose of this study was twofold: Aim 1 was to describe the experiences of vigilance as perceived at the individual levels of patients receiving treatment for cancer, family members of a patient with cancer, and oncology nurses. Aim 2 was to evaluate commonalities in the lived experience of vigilance as described by patients receiving treatment for cancer, one of their family members, and a nurse caring for them. A qualitative, empirical phenomenological method guided this research. The sample consisted of 7 cancer patients, 6 family members of cancer patients, and 7 oncology nurses. Broad, data generating questions were constructed to elicit rich, narrative descriptions of participants’ experiences with vigilance, which were audio-taped and transcribed. Each participant group data were individually analyzed, using Colaizzi’s method. Significant statements from each participant were identified, restated in the language of science, and interpreted for formulated meanings. From formulated meanings, theme categories were constructed and merged across participants within the groups. A narrative of the commonalities of the experience within each group was developed. The across group commonalities were analyzed in a matrix. A total of 5,272 total significant statements were derived from three participant groups. Eleven themes were derived from patient data, ten from family member data, and ten from nurses’ data. Vigilance appeared as a complex, multidimensional phenomenon, which is implicitly shared within and across these three groups. Common vigilance themes found across all 3 groups included: identification of threats, the key importance of knowledge, trust, hope and connectedness, the beyond the call of duty nature of vigilance, ways vigilance takes energy and effort, what promotes and interferes with vigilance, and vigilance as a shared phenomenon. Implications were found for the healthcare system and nursing care.