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Nurse labor has been shown to be related to some patient outcomes, but varying definitions and measurement approaches have resulted in conflicting findings about the nature of the relationship. Nurse administrators and researchers need to know rates of missing data and error in labor data to better inform decision making. The authors compare the degree of completeness and the agreement between these approaches (nurse survey and nurse-to-patient ratio staffing plans) to obtain patient-to-nurse ratios at the unit level.
OBJECTIVES - The cooperation of healthcare personnel is essential for implementing clinical research, yet little is known about the willingness of staff to facilitate research. This study assessed attitudes of prenatal clinic and delivery room (DR) staff toward facilitation of research, with a particular focus on the National Children's Study (NCS).
METHODS - Staff from seven sampled prenatal clinics (N=82) and all three DRs in Kent County, MI (N=169) completed anonymous surveys assessing willingness to recruit patients (clinic) or collect biological specimens (DR), desired incentives, and barriers to research in general and the NCS specifically.
RESULTS - Clinic staff included 36 office workers, 29 nurses, 11 medical assistants and 6 physicians/physician assistants. DR staff included 127 nurses, 19 support staff, 11 physicians and 10 technicians. Clinic staff would hand out brochures (72%) and describe studies (65%), but only 44% wanted outside research staff to recruit patients. Non-White staff were 4.1 times more likely (95% CI. 1.2-14.1) to permit outside staff to recruit. DR staff would collect placentas (84%) and cord blood (77%), and preferred DR staff to perform the collections. In both settings, financial incentives were not required or were modest. Lack of time was the most reported research barrier, followed by patient flow and lack of space. A small fraction of healthcare workers reported refusal to facilitate research tasks.
CONCLUSIONS - Careful planning of research with all clinic and DR staff will be necessary for successful execution of the NCS or other large-scale clinical research studies.
OBJECTIVES - To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources.
BACKGROUND - The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes.
METHODS - Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel.
RESULTS - No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources.
CONCLUSIONS - Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.
This paper describes a framework for compliance the regulatory agency requirements and internal service standards in response to service decentralization and institution of a multi-task environmental worker role. Initiation and maintenance of the compliance system and the coordination of institutionally specific service standards are described. Five keys for success are detailed.
Supervisory nurses in seven nursing homes were taught how to implement a quality control management system that permitted the time-efficient assessment of how well a prompted voiding toileting program continued to be implemented by indigenous nursing aides. Random-hour wet checks taken during the 6-month management period revealed a reduction in wetness from 43% to 21% (p < .0001), which was sustained over the full 6-month period.