Midwestern Community Hospital Research Articles

Outcomes Related to Dehydration in the Pediatric Population

The purpose of this pilot study was twofold: 1) to determine whether there was a statistically significant difference in nursing-sensitive patient outcome ratings from admission to discharge, and 2) to describe nursing interventions used to care for children admitted with a primary diagnosis of dehydration to a 272-bed Midwestern community hospital. Twenty-nine patient care records meeting study criteria were extracted from all pediatric admission records during the study period. The patient care records are part of a computerized clinical documentation system using the standardized nursing languages of the North American Nursing Diagnosis Association, the Nursing Interventions Classification, and the Nursing Outcomes Classification (NOC). A statistically significant improvement in outcome ratings from admission to discharge was demonstrated for seven of eight NOC outcomes.

The vulnerable leader

Katie is a competent 40-year-old nurse manager in a Midwestern community hospital. She is sharp, well prepared, and committed to her organization's vision of quality patient care. In the past, she frequently suggested viable ways to achieve her unit's goals and solve its problems. She made her recommendations even if they challenged the status quo.

Postpartum Depression

This study evaluated the reliability of screening women for symptoms of postpartum depression by a telephone assessment after hospital discharge. Correlational design with a convenience sample of women from a Midwestern community hospital. One hundred and twenty-six women agreed to participate prior to hospital discharge and 106 women were in the final sample (response rate 84%). Telephone contact was made 8 weeks after discharge, when the Postpartum Depression Screening Scale was administered. Twenty-seven percent of the women screened had scores indicating moderate-to-severe depression (score range 60-128). Reliability coefficients were calculated on the data for the short and long forms of the PDSS, as well as for all seven subscales (alpha coefficients were .72 and .94, respectively, for the short- and long-form totals). Subscale scores for the 35-item form were as follows: sleeping/eating disturbances .80, anxiety/insecurity .77, emotional lability .82, mental confusion .80, loss of self .87, guilt/shame .82, and contemplating harming oneself.90. The correlation between the short-form total and the long-form total was r = .91 (p = < 01.) Studies using the PDSS as an in-person instrument were compared with scores for telephone screening, and the overall mean scores were similar. Telephone screening is a reliable method to screen for postpartum symptomatology that may occur later than the 6-week office visit. Women who are at risk, especially those who have a history of treatment for depression, current treatment for depression or increased anxiety, should be screened for postpartum depression symptomatology.

Nursesʼ Knowledge of Heart Failure Education Topics as Reported in a Small Midwestern Community Hospital

Recurrent heart failure (HF) is the most common cause for readmission of elderly patients with HF. Patient education is an essential component of care for these patients. Healthcare providers must have a sufficient knowledge base to facilitate this education. This study aims to describe nurses' knowledge of HF self-management education principles. Fifty-one nurses working in a small Midwestern community hospital completed a 20-item true or false written survey developed by Albert et al (Heart Lung. 2002;31:102-112) to assess their knowledge of 5 areas of HF self-management. The sample included 14 nurses working in an intensive care unit and 41 nurses working on a general medical unit, all routinely providing care to patients with HF. The mean (+/-SD) HF self-care knowledge score was 14.6 +/- 2 (range = 9-19). There was no statistical difference in mean score between intensive care unit (14.7 +/- 1.6) and floor (14.5 +/- 2.1) nurses. Correct responses to individual survey items ranged from 20% to 100%; 6 questions resulted in mean scores >90% correct, 9 questions had mean scores between 70% and 90% correct, and 5 questions had mean scores <70% correct. Most respondents (90%) answered 6 questions correctly, but on 9 questions, 70% and 90% answered correctly. On 5 questions, less than 70% answered them correctly. Two questions (need for daily weight monitoring when asymptomatic and the importance of notifying the doctor of new onset or worsening of fatigue) were answered correctly by all participants. Subject areas of frequently missed questions were the use of nonsteroidal anti-inflammatory drugs, use of potassium-based salt substitutes, assessment of weight results, and physician notification of asymptomatic low blood pressure and momentary dizziness when rising. These results suggest that nurses working in a small community hospital may not be sufficiently knowledgeable in HF management principles. Additional emphasis on HF educational principles may improve the quality of patient education. One suggested intervention is to provide ongoing education for nurses regarding HF management.

The Effect of Health Care Coverage on Circumcision Rates Among Newborns

Social and personal biases are thought to have a role in the decision to circumcise newborns. However, economic factors such as the type of health care coverage may determine which parents are offered circumcision during the newborn period. Therefore, we examined the rates of newborn circumcision among patients with and without insurance at a midwestern community hospital and tertiary care center. A retrospective analysis of all patients undergoing circumcision at 2 different labor and delivery facilities between January 1997 and December 2001 was performed. Female gender, prematurity and all congenital anomalies comprised exclusion criteria. Circumcision rates were stratified by health care coverage and race. To assess characteristics of patients who did not undergo circumcision during the newborn period the indications for circumcision and insurance status were examined at a children's hospital. Health care coverage differed significantly between the 2 labor and delivery facilities. Medicaid or uninsured patients comprised approximately 72% of the population at the tertiary care facility and slightly less than 10% of the total deliveries at the community hospital. Despite the difference in health care coverage status, there was no statistically significant difference between the rates of circumcision among newborns. The circumcision rates were 81% (4,021 of 4,992 cases) and 82% (8,059 of 9,859) at the community and tertiary care facilities respectively. Similarly, there was no difference between circumcision rates when stratified by health care status or race. At the children's hospital there were 2 distinct populations seeking circumcision. Of Medicaid patients 87% younger than 3 years sought circumcision because they were denied circumcision during the newborn period. In contrast, adoption was cited 90% of the time as the reason for seeking circumcision in the privately insured patients. Although health care coverage may influence the indications for circumcision in older children, health care coverage does not appear to influence newborn circumcision rates in the Midwest.

Testing the Nursing Outcomes Classification in Three Clinical Units in a Community Hospital

The testing of the Nursing Outcomes Classification (NOC) was the focus of a 4-year study to evaluate the use of the outcomes and measurement scales developed by the Iowa Outcomes Project, a research team at the University of Iowa. Three units in a Midwest community hospital collected data as part of the larger (ten) clinical site study to test the reliability, validity, and sensitivity of the NOC. This article focuses on the results of sensitivity testing obtained in a birth center, behavioral health center, and an oncology unit in a midwestern community hospital. Methods used in this study focused on change scores from initial assessment to post-treatment status for the outcomes studied in each unit. Average baseline ratings, average follow-up ratings, average change scores, and range of change are reported. Thirty-five outcomes are reported for the behavioral health unit, 21 outcomes are reported for the Birth Center, and 8 outcomes for the Oncology Unit. The overall average baseline for the behavioral health unit was 1.89 with an average follow-up rating of 3.22. For the Birth Center, the average baseline rating was 3.23 with an average follow-up score of 3.88. For the Oncology Unit, the average baseline score was 3.01 with an average follow-up rating of 3.12. The results of this study suggest that the NOC outcomes are able to identify change in some outcome ratings through time and in a direction expected for the populations studied in these three specialty units.

Testing the nursing outcomes classification in three clinical units in a community hospital.

The testing of the Nursing Outcomes Classification (NOC) was the focus of a 4-year study to evaluate the use of the outcomes and measurement scales developed by the Iowa Outcomes Project, a research team at the University of Iowa. Three units in a Midwest community hospital collected data as part of the larger (ten) clinical site study to test the reliability, validity, and sensitivity of the NOC. This article focuses on the results of sensitivity testing obtained in a birth center, behavioral health center, and an oncology unit in a midwestern community hospital. Methods used in this study focused on change scores from initial assessment to post-treatment status for the outcomes studied in each unit. Average baseline ratings, average follow-up ratings, average change scores, and range of change are reported. Thirty-five outcomes are reported for the behavioral health unit, 21 outcomes are reported for the Birth Center, and 8 outcomes for the Oncology Unit. The overall average baseline for the behavioral health unit was 1.89 with an average follow-up rating of 3.22. For the Birth Center, the average baseline rating was 3.23 with an average follow-up score of 3.88. For the Oncology Unit, the average baseline score was 3.01 with an average follow-up rating of 3.12. The results of this study suggest that the NOC outcomes are able to identify change in some outcome ratings through time and in a direction expected for the populations studied in these three specialty units.

Assessing Clinical Pathways Use in a Community Hospital: It Depends on What “Use” Means

Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used". Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as stand-alone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.

Women’s perceptions of their social roles after heart surgery and coronary angioplasty

Objective: The goal of this study was to describe the influence of physical health on social role perceptions, role performance, and role balance in women after heart surgery and coronary angioplasty. Design: A cross-sectional descriptive survey was used. Setting: The study was undertaken at a Midwestern community hospital. Sample: The study considered 58 midlife and older women who had received heart surgery or coronary angioplasty. Outcome Measures: The following measures were used: Inventory of Adult Role Behavior, Role Discrepancy Measure, Role Balance Measure, and Salient Social Roles Measure. Results: Women in poorer health had lower role performance and more negative role perceptions. In general, the balance of rewards and concerns in roles rated most important were not affected by health status. Conclusion: Dimensions of women’s social roles are related to physical health after heart surgery and angioplasty. Knowledge about the effect of physical health on women’s social role experiences is important information for clinicians who care for women with heart disease. If a woman can be helped to achieve better functional health to perform role and daily living tasks, she may feel more positive about her current and future health states. (Heart Lung® 2001;30:117-27.)

Effect of a postdischarge education class on coronary artery disease knowledge and self-reported health-promoting behaviors

To determine the effect of a single 2-hour postdischarge education class on knowledge and health-promoting behaviors of patients undergoing cardiac catheterization. Descriptive, two-group, posttest survey. Midwestern community hospital. One hundred fourteen patients who had experienced a cardiac catheterization, 53 patients who had attended a postdischarge coronary artery disease education class, and 61 patients who had not attended the class. Knowledge of coronary artery disease and coronary artery disease risk factor, and health-promoting behaviors. Those who attended the postdischarge class scored significantly higher on both knowledge and health-promoting behaviors. Patients who attended a single 2-hour postdischarge education class had significantly higher knowledge of coronary artery disease and coronary artery disease risk factors. Knowledge may better prepare people to increase health-promoting behaviors.

Clinical Dietitians’ Activity Analysis in a Midwestern Community Hospital

LEARNING OUTCOME: To identify the three groups of activities requiring the greatest percent of clinical dietitians’ time.The objectives of this project were to identify activities performed by clinical dietitians in a mid-sized, community hospital in a midwestern state, recommend reassignment of activities to more appropriate staff or using other resources, and compare data collected by structured observation and self-reporting.The authors focused on work activity analysis using structured observation to provide in-depth data, although clinical dietitians’ activities have been identified in several research studies utilizing survey methods. Three clinical registered dietitians were asked to record their activities for 15 consecutive working days. Using structured observation, the researcher also observed and recorded clinical dietitians’ activities for either three or four of the 15 days. Activities, times for each activity, and diagnosis were recorded.The chi-square test for goodness-of-fit was used to determine if differences existed between data sets obtained by structured observation and by self-reporting. Analysis indicated that statistically significant differences existed. Structured observation results showed that clinical dietitians spent 52.3% of their time for client related activities, 22.4% for both forced and personal delays, 12.5% for administrative activities, 8.8% for transit, 4.0% for clerical activities and 0% for professional activities.Recommendations for reassignment of activities were suggested by clinical dietitians during interviews following data collection. Reassignment of non-clinical and low-risk clinical activities was recommended.

The effects of music interventions on anxiety in the patient after coronary artery bypass grafting

To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery. Prospective, repeated measures, quasiexperimental, random assignment. The cardiovascular intensive care and progressive care units of a midwestern community hospital were used as the setting for this study. Ninety-six patients who underwent elective, heart bypass surgery; the mean age of the subjects was 67 years, with an age range of 37 to 84 years. Most subjects were men (n = 65, 68%). Physiologic measures of anxiety and mood include blood pressure and heart rate. Additional measures included the use of Spielberger's state-trait anxiety inventory (STAI) and patient verbal ratings of both mood and anxiety with use of a numeric rating scale (NRS). Patients were randomly assigned to one of three groups: (1) music therapy, (2) music-video therapy, or (3) scheduled rest group. Subjects in the groups received their assigned 30-minute intervention at two episodes on postoperative days 2 and 3. Subjects had physiologic measures of blood pressure and heart rate measured immediately before the intervention and at 10-minute intervals throughout the intervention. Mood and anxiety were evaluated by having subjects use a NRS (i.e., 0 to 10) to give rating of mood and anxiety immediately before and after each session. Anxiety was further measured with the STAI. A baseline measure of STAI was taken before surgery; patients also completed the "state" anxiety tool before the intervention session on postoperative day 2 and on completion of the session on postoperative day 3. With use of an analysis of covariance (ANCOVA), subjects' mood ratings showed significant improvement in mood among subjects in the "music intervention" group after the second intervention when controlling for the preintervention rating of mood, F(2, 87) = 4.33, p = 0.016. However, no significant differences were reported for anxiety ratings as measured by the NRS and state anxiety instruments. With use of repeated measures analysis of variance (ANOVA), there were no significant interactions between the intervention groups and time for any of the physiologic variables. However, there were significant main effects over time for heart rate and systolic and diastolic blood pressure, which indicated a generalized physiologic relaxation response. Although none of the three interventions was overwhelmingly superior, the overall response by all intervention groups demonstrated a generalized relaxation response. It is also important to note that there was reduced anxiety and improved mood within all three groups.

A Quality Assurance Plan for an Epidural Analgesia Program

A midwestern community hospital established an Acute Pain Service to implement epidural analgesia on the general care units. It developed a multidisciplinary quality assurance plan using the Joint Commission on Accreditation of Healthcare Organizations' 10-step monitoring and evaluation process. Quality assurance monitors provided information regarding important aspects of care. Data collected from the monitors enabled nurses and other disciplines to make decisions and changes about the growing epidural analgesia program.

Sources of Stress in Nursing Terminal Patients in a Hospice

A study was undertaken in the hospice unit at a large, midwestern community hospital to investigate the sources of stress experienced by hospice nurses. The case material reported in this article is based on observations, interviews with nurses, written stressful incident reports completed by nurses, and support group discussions. A number of sources of stress experienced by hospice nurses are identified. Physical characteristics of the unit as well as staffing policies designed to improve the quality of care resulted in conflict and feelings of alienation from other hospital personnel. Procedures followed in admitting patients to the hospice created stress when they were not fully supported by hospital administrators and physicians. Other policies related to the preparation of meals and open visitation increased the nurse's work load. At the same time, greater involvement with the patient and family during the dying process resulted in increased emotional demands on the nurse. Nurses experienced a sense of loss when a patient they had grown attached to died or was discharged to another institution. Stress also resulted from the nurse's exclusive involvement with terminally ill patients. Continual involvement with dying patients precipitated anxiety and superstitions concerning the nurse's own vulnerability and was particularly stressful when the nurse had experienced the death of someone close to her outside of the hospital.