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Browsing by Author "Pittman, Joyce"
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Item Building Evidence-Based Nursing Practice Capacity in a Large Statewide Health System(Wolters Kluwer, 2019-04) Storey, Susan; Wagnes, Lisa; LaMothe, Julie; Pittman, Joyce; Cohee, Andrea A.; Newhouse, Robin; School of NursingIntegration of evidence-based practice (EBP) into the culture of a healthcare organization is essential to provide safe patient care and promote a thriving culture for the nurses within the healthcare organization. Collaboration and utilization of both clinical and academic experts facilitate the removal of barriers to EBP. This article describes the successful partnership between a healthcare system and school of nursing in executing a 3-phased multimodal approach to an EBP training program.Item Complications And Stoma Care Self-Efficacy Are Associated With Ostomy Adjustment In People With An Intestinal Or Urinary Ostomy(Office of the Vice Chancellor for Research, 2016-04-08) Lopez, Erika I.; Pittman, Joyce; Rawl, Susan M.More than 120,000 new ostomies, or surgically created openings through the abdomen for bowel or urinary elimination, are created annually in North America. Up to 80% of patients with a new ostomy experience ostomy-related complications that can interfere with adjustment to living with an ostomy and diminish quality of life. The purpose of this study was to examine relationships among ostomy complications, stoma care self-efficacy, and ostomy adjustment in people living with an intestinal or urinary ostomy. Examining relationships is important to identify people at risk for poor adjustment and to allow for early intervention to improve outcomes for these patients. Data were collected from 202 participants by trained telephone interviewers. Eligible participants: 18 years of age or older, had ostomy surgery within the past 24 months, currently have an ostomy, and were able to speak English. The Ostomy Adjustment Inventory-23 was used to assess adjustment to living with an ostomy and the Stoma Self- Efficacy Scale measured confidence in caring for an ostomy. Univariate analyses were conducted using t-tests, ANOVA, and correlations using the Statistical Package for the Social Sciences. Higher ostomy adjustment scores were observed in participants with permanent versus temporary ostomies (p=.002). Compared to those who did not experience ostomy complications, participants who developed peristomal dermatitis (p=.005), parastomal hypergranulation (p=.003), stomal bleeding (p=.004), and stomal retraction (p=.015) had lower ostomy adjustment scores. Stoma care self-efficacy scores were significantly correlated with ostomy adjustment scores (r=0.534, p=.000). Ostomy complications that may be modifiable influence ostomy adjustment. Additional support and education to reduce complications and enhance stoma care self-efficacy are needed for people at risk for poor adjustment. Future research is needed to develop and test the effectiveness of interventions to enhance self-efficacy and ostomy adjustment.Item Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections(Wolters Kluwer, 2023) Beeson, Terrie; Pittman, Joyce; Davis, Carmen R.; School of NursingPurpose: The purpose of this study was to examine the effectiveness of an external female urinary management system (external urinary device for female anatomy [EUDFA]) in critically ill women unable to self-toilet and to identify rates of indwelling catheter use, catheter-associated urinary tract infections (CAUTIs), urinary incontinence (UI), and incontinence-associated dermatitis (IAD) before and after the introduction of the EUDFA. Design: Prospective, observational, and quasi-experimental design. Subjects and setting: The sample comprised 50 adult female patients in 4 critical/progressive care units using an EUDFA at a large academic hospital in the Midwestern United States. All adult patients in these units were included in the aggregate data. Methods: Prospective data collected from the adult female patients over 7 days included urine diverted from the device to a canister and total leakage. Aggregate unit rates of indwelling catheter use, CAUTIs, UI, and IAD were retrospectively examined during 2016, 2018, and 2019. Means and percentages were compared using t tests or chi-square tests. Results: The EUDFA successfully diverted 85.5% of patients' urine. Indwelling urinary catheter use was significantly lower in 2018 (40.6%) and 2019 (36.6%) compared with 2016 (43.9%) (P < .01). The rate of CAUTIs was lower in 2019 than in 2016, but not significantly (1.34 per 1000 catheter-days vs 0.50, P = .08). The percentage of incontinent patients with IAD was 69.2% in 2016 and 39.5% in 2018-2019 (P = .06). Conclusions: The EUDFA was effective in diverting urine from critically ill female incontinent patients and indwelling catheter utilization.Item Factors Associated With Ostomy Adjustment In People Living With An Intestinal Or Urinary Ostomy(Office of the Vice Chancellor for Research, 2015-04-17) Lopez, Erika I.; Pittman, Joyce; Samra, Lavleen; Tabor, Chelsea; Rawl, Susan M.More than 120,000 new ostomies, or surgically created openings through the abdomen for bowel or urinary elimination, are created annually in North America. Up to 80% of patients with a new ostomy experience ostomy-related complications that can interfere with adjusting to living with an ostomy and diminish quality of life. Short hospital stays and fragmented follow-up care make it difficult for people with new ostomies to adjust and find the support and resources they need. Little is known about factors that influence positive adjustment to a new ostomy. The purpose of this study was to explore demographic factors that may be associated with adjustment to living with an ostomy. Potentially eligible participants who had ostomy surgery in the past 24 months were identified from lists generated by wound, ostomy, and continence nurses in 5 hospitals affiliated with a major health system in Indiana. Introductory study letters were mailed to potentially eligible participants. Trained research assistants telephoned participants who did not call the office to decline in order to assess eligibility, explain the study, and answer questions. Quantitative and qualitative data were collected via telephone interviews from 203 participants and entered directly into the RedCap database. The Ostomy Adjustment Inventory-23 was used to assess adjustment to living with an ostomy. Data were analyzed using correlations, t-tests, and analyses of variance using the Statistical Package for the Social Sciences. Results indicated that participants with higher incomes had significantly better adjustment scores than those with lower incomes (p<.000). No other demographic variables were associated with ostomy adjustment. People with lower incomes may be at risk for poor adjustment after ostomy surgery. Additional support and education may be needed to enhance ostomy adjustment for people at risk. Future research is needed to develop and test the effectiveness of interventions to support ostomy adjustment.Item Hospital-Acquired Pressure Injuries and Acute Skin Failure in Critical Care: A Case-Control Study(Wolters Kluwer, 2021) Pittman, Joyce; Beeson, Terrie; Dillon, Jill; Yang, Ziyi; Mravec, Michelle; Malloy, Caeli; Cuddigan, Janet; Biostatistics and Health Data Science, School of MedicinePurpose: The purpose of this study was to examine clinical characteristics and risk factors for critically ill patients who develop pressure injuries and identify the proportion of validated unavoidable pressure injuries associated with the proposed risk factors for acute skin failure (ASF). Design: Retrospective case-control comparative study. Subjects and setting: The sample comprised adult critically ill participants hospitalized in critical care units such as surgical, trauma, cardiovascular surgical, cardiac, neuro, and medical intensive care and corresponding progressive care units in 5 acute care hospitals within a large Midwestern academic/teaching healthcare system. Participants who developed hospital-acquired pressure injuries (HAPIs) and patients without HAPIs (controls) were included. Methods: A secondary analysis of data from a previous study with HAPIs and matching data for the control sample without HAPIs were obtained from the electronic health record. Descriptive and multivariate logistic regression analyses were conducted. Results: The sample comprised 475 participants; 165 experienced a HAPI and acted as cases, whereas the remaining 310 acted as controls. Acute Physiology and Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001), mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P < .001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002) were higher in the HAPI group. Multivariate logistic regression analysis identified participants with respiratory failure (odds ratio [OR] = 3.00; 95% confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI, 3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002), severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR = 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95% CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences between unavoidable HAPI, avoidable HAPI, or the control group were identified based on the proposed ASF risk factors. Conclusion: This study provides important information regarding avoidable and unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as patient acuity, organ failure, tissue perfusion, sepsis, and history of prior pressure injury, are associated with avoidable and unavoidable HAPI development. In addition, we were unable to support a relationship between unavoidable HAPIs and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the documentation of appropriate interventions and not necessarily with the identification of clinical risk factors.Item A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Practice(Wiley, 2019) Pittman, Joyce; Cohee, Andrea; Storey, Susan; LaMothe, Julie; Gilbert, Jason; Bakoyannis, Giorgos; Ofner, Susan; Newhouse, RobinBackground Implementation and sustainability of a culture of evidence-based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts. Aims To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals. Methods A nonexperimental descriptive correlational design was used to conduct a web-based survey of direct-care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT). Results Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor's or associate degree), role (direct-care nurses had lower Culture than managers and lower Social Capital), and work status (full-time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals). Linking Evidence to Action Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses’ contributions, balance nurses’ personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.Item Psychometric evaluation of the ostomy complication severity index(Journal of Wound, Ostomy and Continence Nursing, 2014-03) Pittman, Joyce; Bakas, Tamilyn; Ellett, Marsha; Sloan, Rebecca; Rawl, Susan M.PURPOSE: The purpose of this study was to evaluate the psychometric properties of a new instrument to measure incidence and severity of ostomy complications early in the postoperative period. SUBJECTS AND SETTINGS: 71 participants were enrolled, most were men (52%), white (96%), and married or partnered (55%). The mean age of participants was 57 ± 15.09 years (mean ± SD). Fifty-two participants (84%) experienced at least 1 ostomy complication in the 60-day postoperative period. The research setting was 3 acute care settings within a large healthcare system in the Midwestern United States. INSTRUMENT: We developed an evidence-based conceptual model to guide development and evaluation of a new instrument, the Pittman Ostomy Complication Severity Index (OCSI). The OCSI format includes Likert-like scale with 9 individual items scored 0 to 3 and a total score computed by summing the individual items. Higher scores indicate more severe ostomy complications. METHOD: This study consisted of 2 phases: (1) an expert review, conducted to establish content validity; and (2) a prospective, longitudinal study design, to examine psychometric properties of the instrument. A convenience sample of 71 adult patients who underwent surgery to create a new fecal ostomy was recruited from 3 hospitals. Descriptive analyses, content validity indices, interrater reliability testing, and construct validity testing were employed. RESULTS: Common complications included leakage (60%), peristomal moisture-associated dermatitis (50%), stomal pain (42%), retraction (39%), and bleeding (32%). The OCSI demonstrated acceptable evidence of content validity index (CVI = 0.9) and interrater reliability for individual items (k = 0.71-1.0), as well as almost perfect agreement for total scores among raters (ICC = 0.991, P = .001). Construct validity of the OCSI was supported by significant correlations among variables in the conceptual model (complications, risk factors, stoma care self-efficacy, and ostomy adjustment). CONCLUSION: OCSI demonstrated acceptable validity and reliability and can be used to assess incidence and severity of ostomy complications in the early postoperative period. We found the OCSI to be brief, easy-to-use, and clinically practical. It can be used to (a) identify priority areas for nursing intervention related to the ostomy, (b) determine appropriate interventions to prevent or treat complications, and (c) evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.