Browsing by Subject "Nurse"

Now showing 1 - 9 of 9
  • Thumbnail Image
    Item
    Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii
    (Taylor & Francis, 2021) Fontenot, Holly B.; Mattheus, Deborah; Lim, Eunjung; Michel, Alexandra; Ryan, Nicole; Davis, Katherine Finn; Zimet, Gregory; Pediatrics, School of Medicine
    Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18-50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination.
  • Thumbnail Image
    Item
    Coincidence Analysis: A Novel Approach to Modeling Nurses' Workplace Experience
    (Thieme, 2022) Womack, Dana M.; Miech, Edward J.; Fox, Nicholas J.; Silvey, Linus C.; Somerville, Anna M.; Eldredge, Deborah H.; Steege, Linsey M.; Emergency Medicine, School of Medicine
    Objectives: The purpose of this study is to identify combinations of workplace conditions that uniquely differentiate high, medium, and low registered nurse (RN) ratings of appropriateness of patient assignment during daytime intensive care unit (ICU) work shifts. Methods: A collective case study design and coincidence analysis were employed to identify combinations of workplace conditions that link directly to high, medium, and low RN perception of appropriateness of patient assignment at a mid-shift time point. RN members of the study team hypothesized a set of 55 workplace conditions as potential difference makers through the application of theoretical and empirical knowledge. Conditions were derived from data exported from electronic systems commonly used in nursing care. Results: Analysis of 64 cases (25 high, 24 medium, and 15 low) produced three models, one for each level of the outcome. Each model contained multiple pathways to the same outcome. The model for "high" appropriateness was the simplest model with two paths to the outcome and a shared condition across pathways. The first path comprised of the absence of overtime and a before-noon patient discharge or transfer, and the second path comprised of the absence of overtime and RN assignment to a single ICU patient. Conclusion: Specific combinations of workplace conditions uniquely distinguish RN perception of appropriateness of patient assignment at a mid-shift time point, and these difference-making conditions provide a foundation for enhanced observability of nurses' work experience during hospital work shifts. This study illuminates the complexity of assessing nursing work system status by revealing that multiple paths, comprised of multiple conditions, can lead to the same outcome. Operational decision support tools may best reflect the complex adaptive nature of the work systems they intend to support by utilizing methods that accommodate both causal complexity and equifinality.
  • Thumbnail Image
    Item
    Development and use of a toolkit to facilitate implementation of an evidence-based intervention: a descriptive case study
    (BMC, 2020-10-06) Thoele, Kelli; Ferren, Melora; Moffat, Laura; Keen, Alyson; Newhouse, Robin; School of Nursing
    Background Implementation of evidence-based clinical interventions in real-world settings becomes a futile effort when effective strategies to foster adoption are not used. A toolkit, or a collection of adaptable documents to inform and facilitate implementation, can increase the use of evidence-based interventions. Most available toolkits provide resources about the intervention but lack guidance for adaptation to different contexts or strategies to support implementation. This paper describes the development and use of a toolkit to guide the implementation of an evidence-based intervention to identify and intervene for people with risky substance use. Methods A descriptive case study describes the development and use of a toolkit throughout a two-year study. Investigators and site coordinators from 14 acute care hospitals developed tools and engaged external stakeholders as they prepared for implementation, integrated the clinical intervention into practice, and reflected on implementation. Results The final toolkit included 54 different tools selected or created to define the intervention, engage and communicate with stakeholders, assess for readiness and plan for implementation, train clinical nurses and other stakeholders, evaluate training and implementation effectiveness, create policies and procedures for different contexts, and identify opportunities for reimbursement. Each tool corresponds to one or more implementation strategies. Conclusion The approach used to develop this implementation toolkit may be used to create resources for the implementation of other evidence-based interventions.
  • Thumbnail Image
    Item
    Effects of a structured SBIRT training program for hospital nursing leaders on utilization of SBIRT within their medical-surgical units: cohort study
    (Springer Nature, 2025-04-23) Newhouse, Robin; Agley, Jon; Bakoyannis, Giorgos; Ferren, Melora; Mullins, C. Daniel; Keen, Alyson; Parker, Erik; School of Nursing
    Background: Psychoactive substances contribute to numerous deaths annually, and more than 60% of the US population aged 12 + years reports past-month substance use. Screening, brief intervention, and referral to treatment (SBIRT) may support identification of substance-related risks and facilitate targeted interventions, but best practices and implementation designs remain elusive. Our study examined whether a standardized SBIRT toolkit and training-of-trainers for nurse site coordinators was prospectively associated with documented performance of core SBIRT-related functions in medical-surgical hospital units. Methods: This was a prospective cohort study conducted from January 2018 to May 2019 in 14 adult medical-surgical units (one/hospital). Hospitals were randomly allocated to two groups (n = 7 hospitals/each), which received identical interventions: an SBIRT training-of-trainers (8 h), supportive follow-up, and a toolkit containing information, resources, and guidance. However, group 1 sites were trained four months earlier than group 2 sites. At three points (baseline, 10-months, and 16-months), 61 patient records per hospital unit (n = 854) were randomly selected for extraction. Inclusion criteria for random selection were age (18+) and being admitted and discharged from the selected unit. Main outcome measures were analyzed using generalized linear mixed models, including screening within 24 h of admission, using a validated screening tool, screening positive, and receiving a brief intervention or referral to treatment. Results: For groups 1 and 2, patients had 1.81 and 2.66 greater odds, respectively, of being screened for alcohol at 10-months, 1.92 and 4.68 greater odds of being screened for drugs, and 1.96 and 2.06 greater odds of being screened for tobacco. For hospital group 2, patients also had greater odds of being screened for alcohol (3.92), drugs (6.31), and tobacco (2.41) at 16-months. For both hospital groups and benchmarks, patients were hundreds of times more likely to be screened with a validated tool, reflecting a shift from near absence of such behaviors (around 1% prevalence) to prevalence rates from 24 to 56%. Conclusions: The SBIRT intervention was associated with the initiation and sustained use of validated screening tools for alcohol and drugs, and with short-term increases in overall alcohol, tobacco, and drug screening prevalence.
  • Thumbnail Image
    Item
    “I Don’t Want to Go to Work”: A Mixed-Methods Analysis of HealthcareWorker Experiences from the Front- and Side-Lines of COVID-19
    (MDPI, 2023-05-25) Heavner, Smith F.; Stuenkel, Mackenzie; Russ Sellers, Rebecca; McCallus, Rhiannon; Dean, Kendall D.; Wilson, Chloe; Shuffler, Marissa; Britt, Thomas W.; Stark Taylor, Shannon; Benedum, Molly; Munk, Niki; Mayo, Rachel; Buford Cartmell, Kathleen; Griffin, Sarah; Kennedy, Ann Blair; Health Sciences, School of Health and Human Sciences
    During the COVID-19 pandemic, healthcare workers (HCW) were categorized as “essential” and “non-essential”, creating a division where some were “locked-in” a system with little ability to prepare for or control the oncoming crisis. Others were “locked-out” regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.
  • Thumbnail Image
    Item
    Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit
    (Thieme, 2022) Lindroth, Heidi L.; Pinevich, Yuliya; Barwise, Amelia K.; Fathma, Sawsan; Diedrich, Daniel; Pickering, Brian W.; Herasevich, Vitaly; School of Nursing
    Objectives: Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign. Methods: A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9-12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4. Results: In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information. Sixty-four percent (n = 68/107) indicated that current EHR visualization was insufficient. At the start of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%, n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0-100 scale, standard deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107). Conclusion: We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.
  • Thumbnail Image
    Item
    The lived experiences of Indian nurses working in the United States : perceptions and attitudes towards nurse-physician collaboration
    (2013) Hale, Robyn Kathleen; Fisher, Dr. Mary L.; Sloan, Rebecca S.; Riner, Mary Beth; Ward, Richard E.
    Nurse-physician collaboration has received much attention over the past decade in the USA. The release of three reports from the Institute of Medicine implicated poor communication and collaboration among nurses and physicians as a major contributing factor to the incidence of sentinel events and medical errors. Despite the growing awareness of the imperative related to collaboration between nurses and physicians to ensure patient safety, the problem of poor nurse-physician collaboration remains endemic throughout the country. Indian nurses, along with many other internationally educated nurses, comprise 12-15.2% of the nursing workforce in the USA. Little is known about how Indian nurses culture potentially influences their ability to effectively collaborate with physicians to ensure patient safety. The purpose of this study is to understand Indian nurses’ attitudes and perceptions about nurse-physician collaboration. Hermeneutic interpretive phenomenology as influenced by the work of Martin Heidegger guided this study through the use of interviews via Skype. The overall experience of the Indian nurses was of one experiencing a dramatic positive change in nurse-physician collaboration in the USA as compared to India. Four themes emerged describing this phenomenon: Respect/feeling heard, Being Trusted, Assurance of Accountability, and Finding Freedom. Indian nurses practicing in the USA find a freedom that empowers them to collaborate with physicians for patient safety. They, as all nurses may, benefit from continuing educational opportunities that demonstrate ways to collaborate more fully.
  • Thumbnail Image
    Item
    A Multisite Study of Nurse-Reported Perceptions and Practice of ABCDEF Bundle Components
    (Elsevier, 2020-10) Boehm, Leanne M.; Pun, Brenda T.; Stollings, Joanna L.; Girard, Timothy D.; Rock, Peter; Hough, Catherine L.; Hsieh, S. Jean; Khan, Babar A.; Owens, Robert L.; Schmidt, Gregory A.; Smith, Susan; Ely, E. Wesley; Medicine, School of Medicine
    Objectives: ABCDEF bundle implementation in the Intensive Care Unit (ICU) is associated with dose dependent improvements in patient outcomes. The objective was to compare nurse attitudes about the ABCDEF bundle to self-reported adherence to bundle components. Research methodology/design: Cross-sectional study. Setting: Nurses providing direct patient care in 28 ICUs within 18 hospitals across the United States. Main outcome measures: 53-item survey of attitudes and practice of the ABCDEF bundle components was administered between November 2011 and August 2015 (n = 1661). Results: We did not find clinically significant correlations between nurse attitudes and adherence to Awakening trials, Breathing trials, and sedation protocol adherence (rs = 0.05-0.28) or sedation plan discussion during rounds and Awakening and Breathing trial Coordination (rs = 0.19). Delirium is more likely to be discussed during rounds when ICU physicians and nurse managers facilitate delirium reduction (rs = 0.27-0.36). Early mobilization is more likely to occur when ICU physicians, nurse managers, staffing, equipment, and the ICU environment facilitate early mobility (rs = 0.36-0.47). Physician leadership had the strongest correlation with reporting an ICU environment that facilitates ABCDEF bundle implementation (rs = 0.63-0.74). Conclusions: Nurse attitudes about bundle implementation did not predict bundle adherence. Nurse manager and physician leadership played a large role in creating a supportive ICU environment.
  • Thumbnail Image
    Item
    Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach
    (Biomed Central, 2018-12-27) Newhouse, Robin; Janney, Michelle; Gilbert, Anne; Agley, Jon; Bakoyannis, Giorgos; Ferren, Melora; Mullins, C. Daniel; Johantgen, Meg; Schwindt, Rhonda; Thoele, Kelli; School of Nursing
    BACKGROUND: Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use. METHODS: This study uses a phased cluster randomized mixed method design to test nurse-led implementation of an SBIRT toolkit on one medical-surgical unit at 14 acute care hospitals (critical access, community and academic health centers). Medical surgical units will be randomly assigned to implement the SBIRT toolkit (engagement and communication, assessment, planning, training, and evaluation tools) or a wait-list usual care control group that begins implementation 6 months later. Primary endpoints are documentation of SBIRT delivery in randomly selected electronic medical records at baseline, 6 months and 12 months after group 1 implementation (61 records per unit per time period, N = 2562). Two surveys will be administered to unit nurses: smoking cessation activities will be assessed at baseline and SBIRT use will be assessed on randomly-selected days after implementation. In addition, site coordinators will complete a baseline capacity assessment, an implementation fidelity survey post-implementation, and a structured interview at the end of the study. Multilevel mixed-effects effects logistic and linear models will be used to analyze use of SBIRT and cost outcomes. DISCUSSION: This study will guide subsequent SBIRT implementation, dissemination, and spread across rural, community and urban healthcare systems throughout the state and beyond. The long-term objective is to activate clinicians to recognize, intervene and refer people with risky substance use to improve health and decrease substance use disorders. Trial registration ClinicalTrials.gov