Cynthia Padula

Providence Hospital, Mobile, Alabama, United States

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Publications (13)13.21 Total impact

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    ABSTRACT: Aims and objectivesTo develop a clinical algorithm to guide nurses' critical thinking through systematic surveillance, assessment, actions required and communication strategies. To achieve this, an international, multiphase project was initiated.Background Patients receive hospital care postoperatively because they require the skilled surveillance of nurses. Effective assessment of postoperative patients is essential for early detection of clinical deterioration and optimal care management. Despite the significant amount of time devoted to surveillance activities, there is lack of evidence that nurses use a consistent, systematic approach in surveillance, management and communication, potentially leading to less optimal outcomes. Several explanations for the lack of consistency have been suggested in the literature.DesignMixed methods approach.Methods Retrospective chart review; semi-structured interviews conducted with expert nurses (n = 10); algorithm development.ResultsThemes developed from the semi-structured interviews, including (1) complete, systematic assessment, (2) something is not right (3) validating with others, (4) influencing factors and (5) frustration with lack of response when communicating findings were used as the basis for development of the Surveillance Algorithm for Post-Surgical Patients.Conclusion The algorithm proved beneficial based on limited use in clinical settings. Further work is needed to fully test it in education and practice.Relevance to clinical practiceThe Surveillance Algorithm for Post-Surgical Patients represents the approach of expert nurses, and serves to guide less expert nurses' observations, critical thinking, actions and communication. Based on this approach, the algorithm assists nurses to develop skills promoting early detection, intervention and communication in cases of patient deterioration.
    Journal of Clinical Nursing 09/2014; 24(5-6). DOI:10.1111/jocn.12670 · 1.26 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the impact of 0.12% chlorhexidine rinses and an oral care protocol on ventilator-associated pneumonia rates. A quasi-experimental preintervention-postintervention design was used. The sample included all patients admitted to critical care and on mechanical ventilation at any time during the study period. Data were collected 6 months before and 12 months after intervention. Ventilator-associated pneumonia rates were reduced from 4.3 to 1.86 per 1000 ventilator-days during the study period, with an estimated cost avoidance of $700,000 to $798,000.
    Dimensions of critical care nursing: DCCN 09/2012; 31(5):301-8. DOI:10.1097/DCC.0b013e3182619b6f
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    ABSTRACT: This study explored the impact of unit design and healthcare information technology (HIT) on nursing workflow and patient-centered care (PCC). Healthcare information technology and unit layout-related predictors of nursing workflow and PCC were measured during a 3-phase study involving questionnaires and work sampling methods. Stepwise multiple linear regressions demonstrated several HIT and unit layout-related factors that impact nursing workflow and PCC.
    The Journal of nursing administration 05/2012; 42(5):256-65. DOI:10.1097/NNA.0b013e3182480918 · 1.27 Impact Factor
  • Jayne Ritz · Barbara Pashnik · Cynthia Padula · Katie Simmons ·
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    ABSTRACT: The purposes of this study were to examine the impact of chlorhexidine on the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on an inpatient oncology unit, compare the cost of 2 chlorhexidine bath delivery methods, and evaluate nursing time and satisfaction to administer the baths. MRSA and VRE transmission rates decreased from those during the previous years. Costs associated with bathing increased, but time to administer the bath decreased with the chlorhexidine cloths, and nursing staff reported satisfaction with their use.
    Journal of nursing care quality 04/2012; 27(2):171-5. DOI:10.1097/NCQ.0b013e3182398568 · 1.39 Impact Factor
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    ABSTRACT: Preventing falls in acute care hospitals is a major challenge, and achieving positive outcomes has remained elusive. The purpose of this study was to examine the impact of lower extremity strengthening exercises and mobility on fall rates and fall rates with injury. A nonequivalent control group design was used. Subjects on the intervention unit received targeted lower extremity strengthening exercises and ambulation using a nurse-driven mobility protocol; subjects on the control unit received ambulation alone. One assisted fall occurred on the intervention unit.
    Journal of nursing care quality 07/2011; 26(3):279-85. DOI:10.1097/NCQ.0b013e318207decb · 1.39 Impact Factor
  • Nicholas Watkins · Mary Kennedy · Maria Ducharme · Cynthia Padula ·
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    ABSTRACT: Despite growing awareness that hospital design can impact meaningful outcomes, the same-handed medical-surgical inpatient unit configuration has not been empirically investigated. This study measured differences in patient and nurse outcomes between the same-handed and mirrored unit configurations. It has been hypothesized that the same-handed unit configuration may contribute to operational efficiencies, fewer adverse events, and reduced noise levels. A natural experiment of 8 medical-surgical inpatient units used 2 questionnaires developed for the study. The first questionnaire was available to registered nurses. The second was available to the nurses' patients. Compared with participants on the mirrored unit configuration, participants on the same-handed unit configuration reported lower noise levels, better sleep quality, more frequent approaches to patients' right side, and improved satisfaction with organization of the workspace at patients' bedsides. The increased right-side approach was related to fewer instances of patients catching themselves from falling. The same-handed unit configuration benefits patient experience, patient safety, and operational outcomes. Before renovation or new construction of units, nurse executives should consider the advantages of a same-handed unit configuration.
    The Journal of nursing administration 06/2011; 41(6):273-9. DOI:10.1097/NNA.0b013e31821c47b4 · 1.27 Impact Factor
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    Susan F Korber · Cynthia Padula · Julie Gray · Margot Powell ·
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    ABSTRACT: to identify barriers to and enhancers of completion of breast cancer treatment from the perspective of participants in a breast health navigator program. qualitative, using focus group methodology and telephone interview. two teaching hospital ambulatory cancer centers. women enrolled in the breast navigator program, including patients who completed (n = 13) and did not complete (n = 1) breast cancer treatment. researchers used semistructured, open-ended questioning to guide the interviews and elicit identification of barriers to and enhancers of treatment. A flexible approach was used and the interviews were recorded. Content analysis was used to identify themes. perceived barriers and enhancers of breast cancer treatment. the most common theme was the value of the education and information received from the navigator. Several participants saw this as the essence of the role. Assistance with managing symptoms, access to financial and community resources, and the team approach were completion enhancers. completion of breast cancer therapy and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role. the intentional presence of the oncology nurse and the nursing emphasis on culturally appropriate education and care can be seen as key competencies of the navigator. As the concept of the navigation process is expanded to other cancers, oncology nurses are particularly well positioned to advocate for the navigator role as a nursing domain.
    Oncology Nursing Forum 01/2011; 38(1):44-50. DOI:10.1188/11.ONF.44-50 · 2.79 Impact Factor
  • Ann Barrett · Carolyn Piatek · Susan Korber · Cynthia Padula ·
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    ABSTRACT: Lateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. The purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. The sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre-post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. RN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. Key to a cohesive environment is an effective nurse manager able to drive and sustain change.
    Nursing administration quarterly 10/2009; 33(4):342-51. DOI:10.1097/NAQ.0b013e3181b9de0b
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    Cynthia A Padula · Cynthia Hughes · Lisa Baumhover ·
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    ABSTRACT: The purpose of the study was to determine the impact of a nurse-driven mobility protocol on functional decline. A nonequivalent control group design was used; the independent variable was mobility protocol and dependent variables were functional status and length of stay. Older adults who participated in a mobility protocol maintained or improved functional status and had a reduced length of stay. Practice implications include an emphasis on ambulation in hospitalized older adults.
    Journal of nursing care quality 05/2009; 24(4):325-31. DOI:10.1097/NCQ.0b013e3181a4f79b · 1.39 Impact Factor
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    ABSTRACT: Purpose: Purpose is to prevent occurrence/transmission of MRSA and VRE in hospitalized patients. Secondary purpose is to compare: cost of 4% chlorhexidine basin baths versus pre-packaged chlorhexidine cloth baths; nursing time to administer baths; nursing satisfaction with baths; cost of bath methods. Significance: Hospitals provide an ideal environment for the spread of bacteria. Bacterial carriage and unrecognized cases are contributors. Strategies include prompt identification, contact precautions, private rooms, and handwashing. Chlorhexidine gluconate has low toxicity and proven efficacy. Strategy and Implementation: This study will use a quasi-experimental, two group design. The study unit is a 30 bed oncology unit with all private rooms. The study duration is six months: three months control, followed by three months intervention. The control group will receive daily bathing using 4% chlorhexidine solution, 2 ounces added to a half basin of water. The intervention group will receive daily bathing with 2% chlorhexidine impregnated cloths. Prior to the beginning of data collection for both groups, an Infection Control RN will inservice staff related: procedure for obtaining specimens; bathing procedures; handwashing procedures, and will periodically verify accuracy. Outcomes data will be collected related to MRSA and VRE rates. All patients will be pre-screened on admission with a nasal and peri-rectal swab and re-screened at discharge; patients who are positive.Other outcome data includes: nursing time for administration of bath; cost of bathing; nurse satisfaction with bathing. Evaluation: LOS, age, DRGs, and nosocomial infection (rates per 1000 patient days)will be collected. Bath time will be evaluated using a protocol. Nurses will complete a satisfaction with bathing survey. Comparative cost of bath products will be examined. Differences between the groups will be calculated. Implications for Practice: Preventing and reducing transmission of bacteria in hospitals is imperative. Bath basins become heavily contaminated with skin flora. Chlorhexidine gluconate 2% impregnated cloths offer an alternative to the traditional bed bath and may improve nursing satisfaction and reduce overall cost.
    3rd Annual Data Use Conference; 01/2009
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    Cynthia A Padula · Evelyn Osborne · Joyce Williams ·

    Journal of WOCN 02/2008; 35(1):65-75; discussion 76-8. DOI:10.1097/01.WON.0000308620.78884.88 · 1.18 Impact Factor
  • Dennis Sewchuk · Cynthia Padula · Evelyn Osborne ·
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    ABSTRACT: Absence of pressure ulcers is increasingly being used as an indicator of quality nursing care, based on the premise that pressure ulcers are preventable. This retrospective study examined the occurrence, presentation, and timing of pressure ulcer development in 150 patients undergoing cardiac surgery. Pressure ulcer incidents were recorded in groups of patients who underwent surgery with use of a standard foam OR bed mattress; use of a fluid, pressure-reducing OR bed mattress; or use of a fluid, pressuring-reducing mattress after a comprehensive educational program on pressure ulcer prevention was presented to RNs. Tcers decreased when the fluid, pressure-reducing OR bed mattresses were used in conjunction with the comprehensive RN education program.
    AORN journal 08/2006; 84(1):75-96. DOI:10.1016/S0001-2092(06)60100-2
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    ABSTRACT: The purpose of this study was to determine the impact of a team-building intervention on group cohesion, nurse satisfaction, and turnover rates. Creating an environment that supports and retains nurses represents a formidable challenge for nursing leaders. Research related to strategies that positively impact the culture in which nurses practice, thus potentially improving nurse satisfaction and reducing turnover, is critically needed. Registered nurses (RNs) employed on inpatient units in a 247-bed, private acute care Magnet teaching hospital participated in this quasi experimental preintervention and postintervention design. The RN-RN interaction subscale from the National Database of Nursing Quality Indicators Adapted Index of Work Satisfaction, the National Database of Nursing Quality Indicators Adapted Index of Job Enjoyment, the Group Cohesion Scale, and a facilitator-developed measure were completed preimplementation and postimplementation of unit-tailored intervention strategies, which took place over a 12-month period. Turnover rates were collected 6 month preintervention and postintervention. Improvement in group cohesion, RN-RN interaction, job enjoyment, and turnover was demonstrated. Targeted, unit-based strategies can be an effective means of reducing turnover rates and improving group cohesion and nurse satisfaction.
    JONA The Journal of Nursing Administration 04/2005; 35(3):110-20. DOI:10.1097/00005110-200503000-00003 · 1.27 Impact Factor