Author Interviews, Duke, JAMA, Nursing, Sexual Health, STD / 12.08.2021

MedicalResearch.com Interview with: Vincent Guilamo-Ramos, PhD MPH, LCSW, RN, ANP-BC, PMHNP-BC, AAHIVS, FAAN Vincent Guilamo-Ramos is dean and professor at the Duke University School of Nursing, vice chancellor for nursing affairs, Duke University, and director of the Center for Latino Adolescent and Family Health (CLAFH) at Duke. Dr. Guilamo-Ramos served as a member of the National Academies of Sciences, Engineering, and Medicine (National Academies) Committee on Prevention and Control of STIs in the U.S. that wrote the recent consensus study report. He also serves as a member of the Presidential Advisory Council on HIV/AIDS (PACHA) and the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents. MedicalResearch.com: What is the background for this study? Response: The National Academies of Sciences, Engineering, and Medicine (National Academies) recently released a consensus study report on prevention and control of sexually transmitted infections (STIs) in the United States. The report entitled “Sexually Transmitted Infections: Adopting a Sexual Health Paradigm” includes a strong emphasis on adolescents and young adults as an important priority population for the response to record-level STI rates that have reached an all-time high for the sixth year in a row in 2019. The report also highlights the well-supported and crucial role of parents in addressing STIs and promoting sexual health among adolescents and young adults. In this new Viewpoint article, my co-authors and I, who contributed to the National Academies report as committee members or consultants, discuss the practical implications for health care professionals of engaging parents in adolescent sexual health services. (more…)
Education, Nursing / 30.04.2021

It is not unusual to hit a slump in our careers and realize that we may have taken the wrong career path. This could be because our initial drive and ambitions were focused on the wrong thing (e.g., aiming for a job purely because of its high salary, for example), and has now caused you to dislike and regret heading to work each morning. While salary is important as you need to be able to look after yourself and pay for a house but also have money left over to treat yourself, you also need to work in a job and industry that you enjoy. Working in a job that brings you little to no joy can cause you to feel depressed. This can be dangerous, as it can lead to mental and physical health problems that could impact your quality of life. At the end of the day, everyone deserves to work a job that they love and brings them happiness. Changing your career, however, can be a daunting prospect for many. This can be especially true if you are wanting to make a massive leap from one industry to another, or into an industry like healthcare which requires a lot of education, degrees, and training. Remember, though, that if the role of becoming a nurse seems like the right job for you, the heartache of making the transition will be worth it in the end. Are you looking to change your career and become a nurse but are unsure of the best steps on how to do so? If so, read on for guidance on how you can make the switch as seamless as possible! (more…)
Education, Nursing / 30.04.2021

There are many reasons why people might decide to change their careers. If you have been working in the same position for some time and it’s not as exciting or as rewarding as you hoped it would be, you could be thinking about doing something different. If you want to work in a career where you can make a real difference to the lives of others and enjoy a rewarding work experience every day, nursing could be the ideal option for you. Nursing is a highly satisfying career option with a high demand due to the nursing shortage in the US. Here are some of the key things to consider before you switch your career to nursing.

Training as a Nurse

nursing-education-healthcareAs a specialized healthcare position where you will be responsible for the health and wellbeing of patients, nurses are required to hold a degree and a license before they can begin work. To qualify as a registered nurse, you will need to obtain a BSN degree, which typically takes around four years when studying full-time. However, if you already have a bachelor’s degree in another subject, there is an option that will allow you to become a nurse in half the time; accelerated nursing programs are designed for those who already have a bachelor’s degree and want a quick career change into nursing. The top accelerated nursing programs can be found via this link. (more…)
Education, Nursing / 16.04.2021

Recent events have pushed the nursing profession back to the forefront and more people than ever are considering the position. There is also a growing respect for nurses and their role in society, and nursing has become a mission for many. Some people may want to join the ranks and see how they could help. Thankfully, nursing is a field that is welcoming of people from all professional backgrounds, and no matter what your expertise is, chances are you'll be able to apply some of it in nursing. Here's how you can switch to nursing as a second career.

Consider If You’re Fit for the Job

nurses-nursingNursing is a job like no other and you need to have a specific set of skills to succeed. You might have all the best intentions in the world, but it takes a special kind of person to be a nurse, so you have to assess your personal and professional skills before making the jump. For one, this is a job where you will routinely have to deal with loss and grief, so if you don't have a strong enough disposition, you won't be able to make it in this field. However, you still need to be compassionate to help patients and their loved ones get through a tough diagnosis and death. Nurses have to be able to juggle between being human and emotionally available, and being able to separate their work from their personal lives. As well as this, you will need to be a good communicator. If you're not a people person or are introverted, you might have to look at either another field or positions where you won't have to interact as much. But, in most cases, jobs will require that you give direct assistance to patients. As a matter of fact, you will have a much closer relationship with patients than they may have with their doctor. You will need to be able to deal with people coming from different social, economic, religious, and cultural backgrounds. You will need to respect their wishes and beliefs. You also have to be able to offer equal care to all. Also, you need to know how to work as part of a team. You also have to accept hierarchy and be able to take orders. You might disagree with what someone higher than you is saying, but you have to follow through no matter what. Teamwork is especially important in this business, and you have to think of the unit first and not yourself. Lastly, you need to be very organized and be able to perform under pressure. You might have to deal with a whole floor full of patients on a double short-handed shift and have to keep track of everything. Your decisions could literally mean life or death, and unless you can deal with that kind of pressure, nursing is not a field you should be pursuing. (more…)
Education, Electronic Records, Nursing / 10.03.2021

medical-technology-nursingFor many years now, professional nursing has held a unique place in the American health care system. Nurses make up one of the largest health care professions in the U.S. with more than 3.1 million nurses working in diverse fields and settings. Although most nurses work in health care settings like hospitals, a nurse’s expertise expands well beyond the hospital walls. Working on their own and alongside other healthcare professionals, nurses promote the health of families, individuals, and communities. Nurses have always played an important role in healthcare settings. However, their role has changed a lot over the years. In the past, nurses had extraordinarily little formal medical training. In fact, nurses learned the medical skills they needed from their mothers or other women in the nursing profession. Today, the nursing profession has changed for the better. Not only are there extensive training programs available for nurses, but this role now comes with a level of prestige that was not there before. And this is not the only thing that has altered. Technology has also played a huge role in changing this profession for the better. Keep reading below to find out about the history of nursing and how technology has changed the role of nursing:

How Nursing Has Changed Over Time

Time has done a lot for many career paths. However, the nursing profession has seen more changes than most. Here are some of the ways the nursing profession has changed over time: Training – in the past, nurses were not required to have any formal education. However, nowadays nurses are no longer able to care for patients without passing the correct certification first. Setting – many years ago, nurses would take care of people in their homes or on the battlefield. Although some nurses still care for patients in their homes, nowadays, most nurses work in a hospital setting. Responsibilities – nursing responsibilities have come a long way from the early days when they used to look a lot like a household chore list. The change in responsibilities for nurses stems from several changes in the profession, including the changing views of women, more comprehensive training, and the growing demand for medical professionals. Culture – in the 20th century, nursing culture was known as being mainly made up of females who had a small amount of medical knowledge. While nursing culture has not changed completely, it has changed a lot over the years. In fact, research suggests that more men than ever are choosing to train in this profession. Patient care – patient care is more important than ever before. The advancements in technology have created an environment that makes patient care more helpful and efficient for patients. These advancements have altered almost every industry in the U.S. and the medical field is no different. (more…)
Nursing / 08.03.2021

If you are a registered nurse, or you are thinking about nursing as a career option, then becoming a nurse practitioner is a great way to prove your experience and expertise. It allows you more agency when working with patients, as the advanced level of qualification that nurse practitioners have means that they are allowed to make treatment decisions without the supervision of a physician. Becoming a nurse practitioner also gives you access to higher remuneration, and to specialize in an area of medicine which can be incredibly fulfilling.

What is a nurse practitioner?

nursing, nurse, health care, NP, nurse practitionerNurse Practitioners are registered nurses who have carried out extra training, which means that they have more authority than registered nurses and share a similar responsibility level to doctors. They are able to prescribe medications, order diagnostic tests and provide treatments much as a physician would. Also like a physician, they will have undertaken their training to specialize in a particular area of medicine. Nurse Practitioners begin their careers as registered nurses, which means that they are used to approaching medicine in a patient-centric way. They will often work with an idea of patient comfort at the forefront of their minds, whereas a doctor can operate with an idea of medical treatment at the forefront of theirs. This means that a combination of doctors and Nurse Practitioners within a healthcare facility can lead to a more rounded care experience. In some states, Nurse Practitioners are able to operate without the supervision of a doctor. However, in others, they do need to get a sign off for any treatments that they provide. There is a general movement towards allowing Nurse Practitioners more agency as this is helping to relieve strain on the healthcare system. (more…)
Education, Nursing / 18.02.2021

Though it is not always necessary to have clear-cut goals for your career, it does wonders for your efforts if you know the general vicinity of where you want to end up. When you know this, you can make the right decisions both in your career and in your personal life to help you achieve your goals. In most professions, this is still very subjective, but if you work in healthcare (particularly as a physician or a nurse), then your way forward is rather simple. You still have plenty of options and opportunities to customize your career, both in terms of what you do and where you do it, but because of the sheer amount of training necessary, it is a good idea to be confident in your career choices from the outset. This guide will help you to track where you want to go in your nursing career and see your goals successfully attained. Just remember to take your time, mind your health and wellbeing, and never give up:

Know Your Options

The most important part of starting a new career is to know your options. It is not always easy, especially if your career is new or subjective, but in careers like nursing, your choices are all available on the table. You cannot start a new nursing role because the state and the government need to ratify that role first. It does put some constrictions, but many would admit knowing all their options makes it much easier to find their place. You can always customize your career in small ways but knowing the roles available at the apex of your career can help keep your efforts focused. (more…)
Author Interviews, Education, Nursing / 15.02.2021

nursing-education-dnpIf you’re currently working as a nurse, you are probably well aware of just how rewarding and fulfilling a job role it can be. You get to help patients from all walks of life every single day and make a real difference to not only people’s health but their lives more generally. It’s also a career in which there is a lot of scope for progression. There are so many different spheres within the field of nursing that you can choose to specialize in, whether it’s a particular age group (like pediatrics or gerontology) or a particular health condition (like oncology or emergency care). Some of these paths involve training on the job, whereas others require you to return to college to study and obtain a postgraduate qualification. Among these, one of the highest possible qualifications you can aim for is the DNP, or Doctor of Nursing Practice. DNP online programs and campus courses prepare you for a wide range of advanced nursing roles, including both direct patient care and indirect patient care positions. As such, they are a fantastic choice for nurses who want to reach the top levels in their field. This article will cover everything you need to know about the DNP qualification to help you decide whether it is a degree program that you would like to pursue. This includes more detail about the course itself, the advantages it can bring you, as well as information about eligibility and how to apply. MedicalResearch.com: What are DNP online programs? DNP stands for Doctor of Nursing Practice, and it is a doctoral-level qualification in the field of nursing. It’s also a terminal degree, meaning that it is the highest level certification you can achieve in clinical nursing education. The idea of the program is to prepare registered nurses (RNs) for top career positions in areas such as advanced practice nursing, nursing education, healthcare administration, and healthcare policy. DNP online programs and on-campus courses are becoming more popular, partly because the American Association of Colleges of Nursing has called for the qualification to become a requirement in order to work in advanced practice nursing. Although, in many cases, a Master’s qualification in nursing is sufficient, for those who wish to boost their clinical skills and knowledge to the highest level, a DNP is preferable. (more…)
Author Interviews, Nature, Neurological Disorders, Nursing / 18.04.2019

MedicalResearch.com Interview with: Elsa F. Fouragnan PhD School of Psychology (Faculty of Health and Human Sciences) University of Plymouth MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Counterfactual thinking is a psychological process that involves the tendency to create possible alternatives to life events that are currently happening. It is very important because it gives us the ability to switch away from uninteresting activities if better ones become available. For example, if you are working or doing the housework, you may be thinking about gardening or watching a movie later. As soon as your duties are finished, you may engage in these more exciting activities. In our study, macaque monkeys were tasked to find treats under several colored cups (on a screen). Some of these cups were better than others but were not always available, thus the animals had to retain what they had learnt about the good cups in case they became available again. We found that a frontal part of the brain called the anterior cingulate cortex was responsible for tracking which cups were the best in order to efficiently switch to them if the opportunity arose. If this part of the brain was not functioning properly, then animals were stuck in non-optimal choices. To reveal the causal role of the anterior cingulate cortex, we used a new neurostimulation method called low-intensity repetitive ultrasound to modulates activity in this part of the brain with millimetre accuracy. (more…)
Author Interviews, Hospital Readmissions, JAMA, Nursing / 29.01.2019

MedicalResearch.com Interview with: Marianne Weiss DNSc RN READI study Principal Investigator Professor of Nursing and Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health Marquette University College of Nursing Milwaukee Wi, 53201-1881 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our team of researchers has been studying the association of patient readiness for discharge and readmission for several years. We have previously documented that patients who had ‘low readiness’ on our Readiness for Hospital Discharge Scale were more likely to be readmitted. In this study we added structured protocols for discharge readiness assessment and nurse actions to usual discharge care practices to determine the optimal protocol configuration to achieve improved post-discharge utilization outcomes. In our primary analysis that included patients from a broad range of patient diagnoses, we did not find a significant effect on readmission from adding any of the discharge readiness assessment protocols. The patient sample came from Magnet hospitals, known for high quality care, and the average all-cause readmission rates were low (11.3%). In patients discharged from high-readmission units (>11.3%), one of the protocols was effective in reducing the likelihood of readmission. In this protocol, the nurse obtained the patients self-report of discharge readiness to inform the nurse’s discharge readiness assessment and actions in finalizing preparations for discharge. This patient-informed discharge readiness assessment protocol produced a nearly 2 percentage point reduction in readmissions. Not unexpectedly, in lower readmission settings, we did not see a reduction in readmission; not all readmissions are preventable. In the last phase of study, we informed nurses of a cut-off score for ‘low readiness’ and added a prescription for nurse action only in cases of ‘low readiness’; this addition to the protocol added burden to the nurses’ daily work and eliminated the beneficial effects, perhaps because it limited the nurse’s attention to only a subset of patients.  (more…)
Author Interviews, Cost of Health Care, JAMA, Nursing, University of Pittsburgh / 06.06.2017

MedicalResearch.com Interview with: Kristin Ray, MD, MS Assistant Professor Health Policy Institute University of Pittsburgh School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were interested in understanding how nurse practitioners and physician assistants are working with specialist physicians to provide specialty care. Much has been described and studied about nurse practitioners and physician assistants providing primary care, but the literature about their role in specialty care is more sparse. There have been many concerns over time about the supply of specialist physicians, heightening our interest in the role of nurse practitioners and physician assistants in working with specialist physicians. We focused on examining whether care to physician specialist's patients by nurse practitioners and physician assistants has increased over time as well as examining characteristics of patients seen by nurse practitioners and physician assistants. We found that visits with NPs and PAs for specialty care have increased over time, but remains a small fraction of specialty care overall. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Education, Nursing, Pediatrics / 25.04.2017

MedicalResearch.com Interview with: Deborah A. Raines PhD, EdS, RN, ANEF School of Nursing University at Buffalo MedicalResearch.com: What is the background for this study? What are the main findings? Response: This research grew from my experience as a neonatal nurse. I have worked with many families preparing to take their baby home and have seen the anxiety they experience wondering if they will be able to take care of their baby’s medical needs at home. Parents are usually most anxious about emergency situations that may occur. Majority of these parents are able to state what they should do, but have never experienced the actual situation with their baby. This study was designed to see if a simulation experience would fill this gap in parents’ preparation for the discharge of their baby from the NICU. This study had parents participated in a customized simulation to have them experience the care needed by their baby at home following discharge from the NICU. The findings revealed that parents reported a nearly 30 percent increase in confidence in their abilities to care for their baby after participating in the simulation. (more…)
Asthma, Author Interviews, Nursing / 30.03.2017

MedicalResearch.com Interview with: Catherine M. Pound MD The Ottawa Children’s Treatment Centre MedicalResearch.com: What is the background for this study? Response: Asthma is the most common chronic disease of childhood and contributes to a large portion of Canadian hospital pediatric admissions.  Once patients are admitted to hospitals, they receive salbutamol, a medication used for acute asthma exacerbations, at a pre-determined frequency.  In most hospitals, physicians are the ones to decide of the frequency of administration of the salbutamol, and they decide when to wean patients off it. However, children whose salbutamol treatment administration can be decreased are usually considered stable, and often do not require immediate medical attention, which may results in delays in reassessments as well as administration of unneeded salbutamol treatments, particularly if physicians are busy looking after other sicker patients.  Additionally, physicians’ assessments of children with asthma and their decisions to wean salbutamol frequency are not standardized, and vary among physicians. Therefore, in order to improve efficiency and standardize patient assessments, we developed a clinical pathway allowing nurses to wean salbutamol for children hospitalized with asthma based on a validated asthma scoring system. (more…)
Author Interviews, BMJ, Cost of Health Care, Nursing, Outcomes & Safety, University of Pennsylvania / 16.11.2016

MedicalResearch.com Interview with: Dr Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing Professor of Sociology, School of Arts & Sciences Director, Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing Center for Health Outcomes and Policy Research Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? Response: The idea that adding lower skilled and lower wage caregivers to hospitals instead of increasing the number of professional nurses could save money without adversely affecting care outcomes is intuitively appealing to mangers and policymakers but evidence is lacking on whether this strategy is safe or saves money. (more…)
Author Interviews, Emergency Care, Nursing / 02.09.2016

MedicalResearch.com Interview with Mathew Douma, RN BSN ENC(C) CNCC(C) Emergency Department, Royal Alexandra Hospital Edmonton, Alberta, Canada; Masters of Nursing Student University of Toronto, Toronto MedicalResearch.com: What is the background for this study? Response: Many emergency departments experience crowding, which is typically defined as a situation where demands for service exceed the ability of the emergency department to provide quality care in a timely fashion. Typically when patients are waiting in a waiting room they do not undergo diagnostics or treatments. In an effort to speed the process up and reduce the amount of time the patient spends in the emergency department, some facilities have created protocols for diagnostics or treatments typically outside the traditional scope of practice of nursing staff. Our emergency department had protocols like this for almost 15 years, though we had never evaluated their effectiveness. So an interdisciplinary group in our emergency department updated them and then we set out to evaluate them. (more…)
Accidents & Violence, Author Interviews, Education, Geriatrics, Nursing / 10.07.2016

MedicalResearch.com Interview with: MedicalResearch.com: What is the background for this study? What are the main findings? Response: The impetus for this article was our experience from working at FAU’s Christine E. Lynn College of Nursing’s Louis and Anne Green Memory and Wellness Center with families as we conducted assessments of older adults referred to our program by family members or law enforcement. We realized that there is a need to educate nurses that a) they can help to identify persons who may be at risk for unsafe driving before accidents occur, and b) there are resources to help families and nurses navigate this challenging topic. This awareness is especially important for persons and friend/family members who find themselves trying to cope with a known or potential diagnosis of dementia. (more…)
Author Interviews, Frailty, Geriatrics, Nursing / 27.06.2016

MedicalResearch.com Interview with Oleg Zaslavsky PhD Assistant Professor at the department of Biobehavioral Nursing and Health System School of Nursing University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Frailty is a common, but serious medical condition among older adults. It is characterized by weight and muscle loss, fatigue, slow walking and low levels of physical activity. It’s important to accurately diagnose and treat frailty, especially because demographic trends show the percentage of U.S. adults age 65 years and older will increase 19% by 2030. Frailty is commonly assessed by the Cardiovascular Health Study (CHS) frailty phenotype, which includes a set of physical measurements for slowness, weakness, fatigue, low physical activity and body-weight loss. According to the CHS phenotype, individuals with three or more of these characteristics are at increased risk for falls, hip fractures, disability and mortality. Although the CHS phenotype is good for predicting adverse conditions, it requires direct measurement of physical performance. Refining the phenotype so it doesn’t involve physical measurements of patients in a doctor’s office has practical advantages for research and clinical purposes. For this study, University of Washington School of Nursing researchers worked with Fred Hutchinson Cancer Research Center faculty to refine the Women’s Health Initiative (WHI) frailty phenotype, originally developed in 2005. This new phenotype uses self-reporting from patients instead of measurements of physical performance to determine frailty and associated health outcomes. In this report, we show that our newly-proposed WHI measuring scheme performs as well as the more complex CHS phenotype in predicting death, hip fractures and falls in older women. (more…)
Author Interviews, Nursing, Zika / 10.02.2016

MedicalResearch.com Interview with: Nancy Dirubbo, DNP, FNP, FAANP, Certificate in Travel Health, American Association of Nurse Practitioners (AANP) Fellow Cindy Cooke, DNP, FNP-C, FAANP, American Association of Nurse Practitioners (AANP) President of the Board Medical Research: Can you provide some background on what is the Zika virus? Response: Zika virus was first found in monkeys in the Zika Forest of Uganda in 1947 during a research project on mosquito borne viral diseases. From Africa, it spread to India, Indonesia and South East Asia over the next 20-30 years. Not much attention was paid to this illness, as it is often asymptomatic (perhaps as much as 80% of all cases). It causes few symptoms in adults (mild rash, conjunctivitis and headache) and so is often underdiagnosed or misdiagnosed as other self-limiting, viral diseases. Then fast forward to 2015, when a sudden increase in infants born in Brazil with microcephaly occurred and a connection was made with a sharp increase in Zika viral infections, even though the direct mechanism for causing this birth defect is not known. In 2014, there were less than 150 cases of microcephaly in Brazil, and by October 2015, there were 4,700 cases reported. Medical Research: What is the concern regarding pregnant women and their babies? Response: The concern for pregnant women is that there appears to be a link between Zika virus and microcephaly, still birth and miscarriages. Children who do survive have severe intellectual disabilities. The virus is most often transmitted by mosquitos, but may also be sexually transmitted. According to the CDC, “Sexual transmission of Zika virus is possible, and is of particular concern during pregnancy. Current information about possible sexual transmission of Zika is based on reports of three cases.” The CDC also recommends, “Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse or fellatio) for the duration of the pregnancy.” It has yet to be determined if Zika virus can be transmitted in other ways, including blood transfusions. (more…)
Author Interviews, Hand Washing, Hospital Acquired, Nursing / 26.01.2016

MedicalResearch.com Interview with: Donna Powers, DNP, RN Kransoff Quality Management Institute North Shore Long Island Jewish Health System New York, NY  Medical Research: What is the background for this study? What are the main findings? Dr. Powers: Despite widely published, accessible guidelines on infection control and negative health consequences of noncompliance with the guidelines, significant issues remain around the use of Standard Precautions to protect nurses  from bloodborne infectious diseases. Only 17.4% of ambulatory nurses reported compliance with all nine standards. The nurses represented medicine, cardiology, dialysis, oncology, pre - surgical testing, radiation and urology practices. Compliance rates varied considerably and were highest for wearing gloves (92%) when exposure of hands to bodily fluids was anticipated, however only 63% reported washing hands after glove removal.  68% provided nursing care considering all patients as potentially contagious. Overall, the ambulatory care nurses chose to implement some behaviors and not others, and this behavior puts them at risk for acquiring a bloodborne infection.” The study also found knowledge of HCV was variable. Although HCV is not efficiently transmitted by sexual activity, more than one in four nurses (26 %) believed that sexual transmission is a common way that HCV is spread.  14 percent believed incorrectly that most people with HCV will die prematurely because of the infection, 12 percent did not know that HCV antibodies can be present without an infection, and 11 percent did not know there are multiple HCV genotypes. A statistically significant relationship was found between compliance and perception of susceptibility to HCV illness (P = .05) and between compliance and perception of barriers to use of Standard precautions (P=.005). (more…)
Author Interviews, JAMA, Nursing, Outcomes & Safety, Surgical Research, University of Pennsylvania / 20.01.2016

More on Nursing Research on MedicalResearch.com MedicalResearch.com Interview with: Jeffrey H. Silber, M.D., Ph.D. The Nancy Abramson Wolfson Professor of Health Services Research Professor of Pediatrics and Anesthesiology & Critical Care,  The University of Pennsylvania Perelman School of Medicine Professor of Health Care Management The Wharton School Director, Center for Outcomes Research The Children's Hospital of Philadelphia Philadelphia, PA 19104  Medical Research: What is the background for this study? Response: We wanted to test whether hospitals with better nursing work environments displayed better outcomes and value than those with worse nursing environments, and to determine whether these results depended on how sick patients were when first admitted to the hospital. Medical Research: What are the main findings? Response: Hospitals with better nursing work environments (defined by Magnet status), and staffing that was above average (a nurse-to-bed ratio greater than or equal to 1), had lower mortality than those hospitals with worse nursing environments and below average staffing levels. The mortality rate in Medicare patients undergoing general surgery was 4.8% in the hospitals with the better nursing environments versus 5.8% in those hospitals with worse nursing environments. Furthermore, cost per patient was similar. We found that better nursing environments were also associated with lower need to use the Intensive Care Unit. The greatest mortality benefit occurred in patients in the highest risk groups. (more…)
Author Interviews, Cancer Research, End of Life Care, Nursing / 30.10.2015

Dr-Hsien-SeowMedicalResearch.com Interview with: Dr. Hsien Seow, PhD Associate Professor Department of Oncology Cancer Care Ontario Research Chair in Health Services Research Associate Member, Department of Clinical Epidemiology & Biostatistics McMaster University Canadian Institutes of Health Research Young Investigator Hamilton, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Seow: Despite being commonplace in healthcare systems, little research has described the effectiveness of publicly-provided generalist homecare nursing to reduce unnecessary acute care use at end-of-life, such as emergency department (ED) visits. It is also unclear how homecare nursing intent, which varies by standard care or end-of-life, affects this relationship. Our study examined a population-based cohort of cancer decedents in Ontario, Canada who used homecare nursing in their last six months of life. Specifically, we examined the relationship between homecare nursing rate in a given week on the ED visit rate in the subsequent week. In our cohort of 54,576 decedents, there was a temporal association between receiving end-of-life nursing in a given week during the last six months of life, and of more standard nursing in the last month of life, with a reduced ED rate in the subsequent week. Homecare nursing for those who are receving end of life care will find that it can provide immediate assistance when needed. (more…)
Author Interviews, BMJ, Nursing / 16.09.2015

Chiara Dall'Ora MSc Nursing and Midwifery Sciences University of SouthamptonMedicalResearch.com Interview with: Chiara Dall'Ora MSc Nursing and Midwifery Sciences University of Southampton  Medical Research: What is the background for this study? What are the main findings? Response: There is a trend for healthcare employers to adopt longer shifts, typically 2 shifts per day each lasting 12 hours. This allows nurses to work fewer shifts each week. Changes are driven by perceived efficiencies for the employer, and anecdotal reports of improved work life balance for employees because they work fewer days per week. However, it is unclear whether these longer shits adversely affect nurses' wellbeing, in terms of burnout, job dissatisfaction, dissatisfaction with work schedule flexibility and intention to leave the job. We found that when nurses work 12 h shifts or longer they are more likely to experience high burnout, dissatisfaction with work schedule flexibility and intention to leave their job, compared to nurses working 8 h or less. All shifts longer than 8 hours are associated with nurses' job dissatisfaction. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Fertility, Nursing, Occupational Health / 08.08.2015

Dr. Audrey J Gaskins Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MAMedicalResearch.com Interview with: Dr. Audrey J Gaskins Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Gaskins: Previous studies have linked shift work, long working hours, and physical factors to an increased risk of menstrual cycle disturbances, spontaneous abortion, preterm birth, and low birth weight; however the association with fecundity is inconsistent. Several papers have also reviewed the occupational exposures of health care workers and concluded that reproductive health issues are a concern. Therefore we sought to determine the extent to which work schedules and physical factors were associated with fecundity in a large cohort of nurses. Women who work in an industry that requires them to work from a height or even lift heavy objects requires them to undertake training which guides them though the effective stages on how to work safely at heights. Without the right training, this sort of work can become very dangerous. Our main findings were that that working >40 hours per week and moving or lifting a heavy load >15 times per day (including repositioning or transferring patients) were associated with reduced fecundity in our cohort of female nurses planning pregnancy. However, all other factors such as frequency of night work, duration of rotating and non-rotating night shifts, and time spent walking or standing at work were not significantly associated with fecundity in this cohort. (more…)
Author Interviews, Emergency Care, Nursing / 29.05.2015

Jessica Castner, PhD, RN, CEN Assistant Professor University at Buffalo, New YorkMedicalResearch.com Interview with: Jessica Castner, PhD, RN, CEN Assistant Professor University at Buffalo, New York Medical Research: What is the background for this study? Dr. Castner: There are groups of people more likely to visit the emergency department (ED) frequently.  One of these groups are people insured by Medicaid, the insurance for those with low incomes.  By finding what factors increase the risk for frequent emergency department use, healthcare leaders can target interventions to design a more effective and accessible healthcare delivery system.  With approximately 12 million ED visits each year related to behavioral health issues, we wanted to investigate how smoking, substance abuse and psychiatric diagnoses increased the risk for repeat ED use for adults insured by Medicaid. There are many problems associated with frequent emergency department use, including less than ideal continuity of care, crowding, and cost. Every year, there are over 136 million visits to United States EDs, and 12 million are linked to some sort of behavioral health issue.  Unlike primary care, the patient is not likely to see a healthcare provider in the emergency department who knows them or one who may not have access to their complete and up-to-date records.  The patient might get conflicting guidance or have tests ordered that duplicate tests recently done in other settings. Frequent emergency department visitors also contribute to crowded EDs, where demand outstrips capacity. Studies have shown an association with increased morbidity and mortality for patients treated in the ED during these times of crowding. Medical Research: What are the main findings? Dr. Castner: The main findings of our study include helping to dispel the myth of “inappropriate emergency department use.”  Our research analyzed the 2009 Medicaid claims for Erie and Niagara County. Our findings indicate that there is a positive relationship between outpatient visits and frequent emergency department use.  In other words, people who are sicker and have more complex illnesses use all services more – both the emergency department and their outpatient care provider.  In addition, we found that smoking, substance abuse, and psychiatric diagnoses all substantially increased the odds of frequent emergency department use – or ED bouncebacks.  The most surprising finding was that healthy individuals were four times more likely to be frequent ED users if they smoked. (more…)
Accidents & Violence, Author Interviews, CDC, Nursing, Occupational Health / 28.04.2015

MedicalResearch.com Interview with: Ahmed Gomaa, MD, ScD, MSPH Medical Officer / Surveillance Branch Division of Surveillance Hazard Evaluation and Health Studies National Institute for Occupational Safety and Health (NIOSH) Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? Dr. Gomaa:  In 2013, one in five reported nonfatal occupational injuries occurred among workers in the health care and social assistance industry, the highest number of such injuries reported for all private industries. In 2011, U.S. health care personnel experienced seven times the national rate of musculoskeletal disorders compared with all other private sector workers. To reduce the number of preventable injuries among health care personnel, CDC's National Institute for Occupational Safety and Health (NIOSH), with collaborating partners, created the Occupational Health Safety Network (OHSN) to collect detailed injury data to help target prevention efforts. OHSN, a free, voluntary surveillance system for health care facilities, enables prompt and secure tracking of occupational injuries by type, occupation, location, and risk factors. (more…)
Aging, Author Interviews, Case Western, Nursing / 17.04.2015

kathy-wrightMedicalResearch.com Interview with: Kathy Wright, PhD, RN, GCNS-BC, PMHCNS-BC KL2 Postdoc, Clinical Instructor 2011-13 SAMHSA Scholar 2010-12 National Hartford Center of Gerontological Nursing Excellence Patricia G. Archbold Scholar Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, Ohio MedicalResearch: What is the background for this study? Dr. Wright: This study was a secondary analysis of baseline data from the After Discharge Care Management of Low Income Frail Elderly (Agency for Healthcare Research and Quality grant #1 R01 HS014539-01A1). The participants were aged 65 and older enrolled during an acute care hospitalization. Each participant had at least one deficit in activities of daily living (e.g., bathing, dressing) or two deficits in instrumental activities of daily living (e.g., transportation, paying bills). The purpose of the study was to test House’s Conceptual Framework for Understanding Social Inequalities in Health and Aging in Medicare-Medicaid enrollees in a group of low-income older adults to determine the relationships between socio-demographic factors (i.e., race, education, age, gender, income, and neighborhood poverty), health behaviors, and physical function and emotional well-being. As a part of the health behavior component, participants were interviewed and asked questions regarding the amount of physical activity they engaged in during the week. (more…)
Author Interviews, Mental Health Research, Nursing / 09.02.2015

Erin L. Kelly PhD Post Doctoral Scholar Health Services Research Center University of California, Los Angeles, CaliforniaMedicalResearch.com Interview with: Erin L. Kelly PhD Post Doctoral Scholar Health Services Research Center University of California, Los Angeles, California MedicalResearch: What is the background for this study? What are the main findings? Dr. Kelly: Mental health facilities can be hazardous workplaces. Nationally, compared to their counterparts in other healthcare settings, mental health workers are at the highest risk for patient assaults. Many studies have focused on predictors for assault such as gender, years of experience, or the position that staff hold in the hospital, which can account for a small amount of violence. However, psychiatric care is largely about relationships. Our study examined how conflicts with patients and coworkers, and how people react to conflict, influences their risk of assault. In our study, 70% of staff at a large public mental hospital were assaulted in a single year, which is closer to the lifetime assault rate for mental health workers. We also found that the likelihood of assault is predicted by conflicts when we also include stress reactions to conflict as a moderator. We found that workers who reported being less reactive to conflict but experienced a great deal of conflict, with staff or patients, were at the highest risk of assault. This could mean that people who aren't afraid of conflict with patients are more likely to jump in with agitated patients or that people who are insensitive to conflict are missing important social cues and being assaulted more often. However, despite the similarity in the relationships of staff conflict and patient conflict with assault risk, it’s possible that the direction of the relationship between staff conflict and assault may be different. For example, mental health staff who have a lot of conflict with their co-workers may be isolated and therefore a target for assault by patients. (more…)
Author Interviews, Brigham & Women's - Harvard, Nursing, Occupational Health / 07.01.2015

Eva Schernhammer, MD, DrPH Associate Professor of Medicine Brigham and Women's Hospital and Harvard Medical School Associate Professor of Epidemiology Harvard School of Public Health Channing Division of Network MedicineMedicalResearch.com Interview with: Eva Schernhammer, MD, DrPH Associate Professor of Medicine Brigham and Women's Hospital and Harvard Medical School Associate Professor of Epidemiology Harvard School of Public Health Channing Division of Network Medicine Medical Research: What is the background for this study? What are the main findings? Prof. Schernhammer: The study is an observational cohort study of over 70,000 registered nurses from within the US who reported the total number of years they had worked rotating night work and were followed for several decades. We examined overall mortality in these women, and observed significantly higher overall mortality, as well as higher mortality from cardiovascular disease in women with several years of rotating night shift work, compared to nurses who had never worked night shifts. There was also some suggestion for modest and non-significant increases in mortality from a few cancers. The study is unique due to its size, the fact that all participants were nurses (eliminating potential biases arising from differing occupational exposures), the long follow-up, and the possibility to take into account most known risk factors for chronic diseases that we currently know of (all of this information has been collected regularly and repeatedly).  (more…)
Author Interviews, Cost of Health Care, Geriatrics, Nursing / 11.12.2014

Karen Dorman Marek, PhD, MBA, RN, FAAN Bernita 'B' Steffl Professor of Geriatric Nursing Arizona State University College of Nursing & Health Innovation Phoenix, AZ 85004-0696MedicalResearch.com Interview with: Karen Dorman Marek, PhD, MBA, RN, FAAN Bernita 'B' Steffl Professor of Geriatric Nursing Arizona State University College of Nursing & Health Innovation Phoenix, AZ 85004-0696 Medical Research: What is the background for this study? What are the main findings? Response: For many older adults, self-management of chronic illness is an overwhelming task, especially for those with mild cognitive impairment or complex medication regimens. The purpose of this study was to evaluate cost outcomes of a home-based program that included both nurse care coordination and technology to support self-management of chronic illness, with as an emphasis on medications in frail older adults. A total of 414 older adults, identified as having difficulty self-managing their medications, were recruited at discharge from three Medicare-certified home health care agencies in a large Midwestern urban area. A prospective, randomized, controlled, three-arm, longitudinal design was used. A team consisting of both Advanced Practice Nurses (APNs) and Registered Nurses (RNs) coordinated care to two groups: home-based nurse care coordination (NCC) plus mediplanner group and NCC plus the MD.2 medication-dispensing machine group. Major findings were:
  • Total Medicare costs were $447 per month lower in the NCC + mediplanner group (p=0.11) when compared to the control group.
  • For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC + mediplanner group (p=0.06) compared to the control group.
  • The cost of the NCC intervention was $151 per month, yielding a net savings of $296 per month or $3552 per year for the NCC + mediplanner group.
  • Participants who received the nurse care coordination intervention scored significantly better than the control group in depression (p < 0.001), functional status (p < 0.001), cognition (p < 0.001), and quality of life (p < 0.001) than participants in the control group.
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