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ABSTRACT: To examine the psychometric properties of an instrument used to evaluate the work environment of direct care nurses employed in hospital settings.
Healthy work environments are associated with increased retention and high-quality patient care.
Items for the instrument were based on the American Association of Critical Care Nurses' standards for a healthy work environment. Six items measured the individual's contribution to the work environment and six measured co-workers' contributions. Each item was graded on a scale from 'A=well above average' to 'F=failing'. The instrument was administered by nurse leaders to 210 direct care nurses in six hospitals.
The Cronbach α was 0.75 for the self-rating subscale and 0.89 for the co-workers rating subscale. Administrators rated their co-workers significantly higher [n=32, mean (M)=2.69, standard deviation (SD)=0.63] than direct care nurses rated theirs (n=209, M=2.31, SD=0.83, P=0.03). Direct care nurses intending to stay in nursing rated co-workers significantly higher (n=170, M=2.35, SD=0.81) than those not intending to stay (n=22, M=1.87, SD=0.81, P=0.01).
The instrument is a feasible, reliable and valid method for assessing the work environment.
The instrument can be used to assess the relationship of the work environment to nurse retention in hospitals.
Journal of Nursing Management 01/2011; 19(1):18-26. · 1.18 Impact Factor
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ABSTRACT: To compare health-related quality of life (HR-QOL) across subgroups defined by sleep disturbances and ethnicity.
Men (47%) and women (53%) Sleep Heart Health Study participants age 40 and older (N = 5237) underwent overnight polysomnography and completed self-report questionnaires on symptoms of sleep disturbances. The physical and mental composite scales (PCS and MCS) of the Medical Outcomes Study 36-item short form survey assessed HR-QOL and were compared to sleep data.
Participants self-identified as Caucasian/White (n = 4482, 86%), African American/Black (n = 490, 9%), or Hispanic/Mexican American (n = 265, 5%). The prevalence of obstructive sleep apnea (OSA) was 17%, frequent snoring was 34%, difficulty initiating or maintaining sleep (DIMS; insomnia symptoms) was 30%, and excessive daytime sleepiness (EDS) was 25%. African American participants with frequent snoring, insomnia symptoms, or EDS had significantly poorer physical health compared to Caucasians (p < 0.001). Hispanics with frequent snoring, insomnia symptoms, or EDS had significantly poorer mental health than Caucasian participants (p <0.001). Neither PCS nor MCS scores differed significantly across ethnic subgroups for participants with moderate to severe OSA (respiratory disturbance index > 15, 4% desaturation).
Across ethnic/racial subgroups, sleep disturbances are associated with worse physical and better mental HR-QOL than the U.S. norm, but this relationship may be moderated by comorbid health conditions. This study replicates and extends prior research indicating differences among minority and non-minority participants and highlights the need for future studies of sleep disturbances with larger samples of minorities that control for comorbid health conditions.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 04/2010; 6(2):176-83. · 3.23 Impact Factor
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ABSTRACT: The prevalence of overweight in adolescents with its associated outcomes continues to be a major public health concern. The purpose of this study was to assess whether adolescents perceived their weight accurately and to determine the relationships among perceived and actual weight, depression, anxiety, anger, disruptive behavior, and self-concept in minority adolescents. A descriptive, correlational design was conducted with 33 adolescents. Questions regarding weight perception, depression, anxiety, anger, disruptive behavior, and self-concept were correlated with body fat percentile, body mass index (BMI), and BMI percentile. Findings indicated that adolescent perception of overweight was positively related to actual weight and negatively related to self-esteem and disruptive behavior. Adolescents who were overweight identified their weight accurately and tried to lose weight.
Journal of pediatric nursing 12/2009; 24(6):474-80.
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ABSTRACT: Obesity and mental health disorders are 2 major public health problems in American adolescents, with prevalence even higher in Hispanic teens. Despite the rapidly increasing incidence and adverse health outcomes associated with overweight and mental health problems, very few intervention studies have been conducted with adolescents to improve both their healthy lifestyles and mental health outcomes. Even fewer studies have been conducted with Hispanic youth. The purpose of this study was to evaluate the preliminary efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, and Nutrition) program, a manualized educational and cognitive behavioral skills-building program, on Hispanic adolescents' healthy lifestyle choices as well as mental and physical health outcomes.
A cluster randomized controlled pilot study was conducted with 19 Hispanic adolescents enrolled in 2 health classes in a southwestern high school. One class received COPE and the other received an attention control program.
Adolescents in the COPE program increased their healthy lifestyle choices and reported a decrease in depressive and anxiety symptoms from baseline to postintervention follow-up. A subset of 7 overweight adolescents in the COPE program had a decrease in triglycerides and an increase in high-density lipoproteins. In addition, these overweight adolescents reported increases in healthy lifestyle beliefs and nutrition knowledge along with a decrease in depressive symptoms.
The COPE TEEN program is a promising school-based strategy for improving both physical and mental health outcomes in adolescents.
Journal of School Health 12/2009; 79(12):575-84. · 1.34 Impact Factor
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Worldviews on Evidence-Based Nursing 02/2009; 6(3):125-9. · 1.24 Impact Factor
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ABSTRACT: This article provides an overview of the current state of the art for incorporating personal digital assistants (PDAs) into nursing education. The development of PDA technology and the lessons learned by educators integrating PDA technology into nursing curricula are described. The current cycle of PDA evolution is discussed and contrasted with a proposed model for maximizing the impact of PDAs on technological innovation in nursing education and practice.
Nursing Clinics of North America 01/2009; 43(4):583-92, vii. · 0.52 Impact Factor
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ABSTRACT: It is important to be aware of the health and injury status of students in military training settings in order to adequately plan for their progression through required physical training and provision of health care to meet their needs. This paper describes the self-reported health status of students arriving in two medical training Battalions at Ft. Sam Houston. The results revealed that 43% of arriving soldiers had musculoskeletal symptoms and 35% had symptoms that interfered with their ability to accomplish the normal daily activities required as students. The most common sites of symptoms were knee (17 and 18%), foot/toe (16 and 13%), ankle (9 and 10%), and lower leg (9 and 12%) for the 232nd and 187th Medical Battalions respectively. Risk factors for those with musculoskeletal injury (MSI) symptoms that interfere with their abilities to do their jobs include gender, past history of injury, and self-reported stress and fitness levels. Other risk factors for medical specialties other than combat medic include being older (over 24 yrs of age), active duty status, being overweight, and use of smokeless tobacco. This information can help identify soldiers considered at risk of incurring a MSI during AIT. With this knowledge, physical training can be designed to help soldiers achieve fitness without additional injury and health care facilities can be designed to provide appropriate staffing of the health care professionals needed for evaluation and treatment.
Work 01/2009; 34(4):387-400. · 0.52 Impact Factor
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ABSTRACT: BACKGROUND Adolescents with substance-abusing parents need interventions to reduce their risk for a variety of problems. School-based support groups (SBSGs) have been proposed to increase resilience in this population. OBJECTIVE The purpose of this study was to evaluate a SBSG for adolescents with substance-abusing parents. STUDY DESIGN The randomized, controlled study was conducted with high-school students (n = 109) to evaluate the impact of SBSGs on resiliency. Resiliency was operationalized as positive physical health, mental health, and risk behaviors in the presence of adverse life events. Data were collected pre- and postintervention. RESULTS Significant improvements in knowledge of substance abuse were noted. Findings suggested gender differences in coping and health outcomes and positive trends in substance use. CONCLUSIONS SBSGs may increase resilience in this at-risk population. However, there were gender differences in response to the intervention, and group facilitators should be aware that participants' gender may influence response to the groups. J Am Psychiatr Nurses Assoc, 2008; 14(4), 297-309. DOI: 10.1177/1078390308321223.
Journal of the American Psychiatric Nurses Association 08/2008; 14(4):297-309.
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ABSTRACT: This study aims to examine the association between adolescent health, including physical complaints, mood, and social adjustment, and perceived severity of parental substance abuse.
Baseline data from a study of school-based support groups for adolescents with substance-abusing family members (n = 121) were used to examine the relationship between the severity of substance abuse and adolescent health.
Participants were divided into three groups on the basis of severity of parental substance abuse. The high-severity group had significantly more medical conditions, physical symptoms, and negative moods than those in the low- or moderate-severity groups (p < .02).
Nurses can use the Children of Alcoholics Screening Tool to assess severity of parental substance abuse and its impact on adolescents' physical and emotional health.
Journal for Specialists in Pediatric Nursing 01/2008; 13(1):15-25. · 0.83 Impact Factor
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ABSTRACT: Implementation of evidence-based practice (EBP) by health professionals is a key strategy for improving health care quality and patient outcomes as well as increasing professional role satisfaction. However, it is estimated that only a small percentage of nurses and other health care providers are consistently using this approach to clinical practice.
The aim of this study was to report on the development and psychometric properties of two new scales: (1) the 16-item EBP Beliefs Scale that allows measurement of a person's beliefs about the value of EBP and the ability to implement it, and (2) the 18-item EBP Implementation Scale that allows measurement of the extent to which EBP is implemented.
Nurses (N= 394) attending continuing education workshops volunteered to complete the scales. Data were analysed to evaluate reliability and validity of both instruments.
Cronbach's alpha was > .90 for each scale. Principal components analysis indicated that each scale allowed measurement of a unidimensional construct. Strength of EBP beliefs and the extent of EBP implementation increased as educational level increased (p < .001) and as responsibility in the workplace increased (p < .001).
In this study, initial evidence was provided to support the reliability and validity of the EBP Beliefs and Implementation Scales in a heterogeneous sample of practicing nurses. EVIDENCE TO ACTION: Use of the scales in future research could generate evidence to guide EBP implementation strategies in practice and education. Results could establish the extent to which EBP is being implemented and its effect on clinician satisfaction and patient outcomes.
Worldviews on Evidence-Based Nursing 01/2008; 5(4):208-16. · 1.24 Impact Factor
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ABSTRACT: The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.
Work 02/2007; 29(3):177-88. · 0.52 Impact Factor
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ABSTRACT: To compare homocysteine (Hcy) levels and possible modulatory factors, such as nutrient or supplement intake, between Mexican American and Non-Hispanic White (NHW) male military veterans scoring at high- versus low-risk for stroke.
A cross-sectional survey with a high and low stroke risk biomarkers substudy.
Voluntary participants were Mexican American (n=109) and NHW (n=120) veteran outpatients 54 to 85 years of age at a Southwestern Veterans Administration (VA) medical center. Measures included food frequency, health history, and stroke risk scale derived from the Framingham Study. Biomarker subgroups, 30 Mexican American and 30 NHW, half of each group scoring high or low on stroke risk, who were tested for morning fasting blood levels of Hcy, B12, and folate.
In the cross-sectional study (n=229), nutrient intake was comparable between ethnic groups. In the substudy, Mexican Americans (n=30) with high or low stroke risk scores and NHW (n=30) with high stroke risk scores had elevated Hcy levels (12.5; 11.9; 11.4 micromol/L respectively) compared to NHW veterans with low stroke risk scores (7.8 micromol/L) even after controlling for age, education, folate, diabetes, and smoking pack-years (p=.001). Mexican Americans compared to NHW were significantly more likely to be in the preclinical (17% versus 3% >10 micromol/L) and clinical ranges (69% versus 35% >15 micromol/L) for Hcy.
Mexican Americans showed higher levels of Hcy whether they scored high or low for stroke, and greater representation in clinical and preclinical Hcy ranges compared to NHW veterans. The Framingham-derived, predominantly NHW population-based stroke risk measure might require ethnically relevant stroke risk factors for Mexican Americans.
Journal of Nursing Scholarship 02/2007; 39(3):235-42. · 1.49 Impact Factor
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ABSTRACT: To compare 3 pressure-reduction devices for effectiveness in prevention of heel ulcers in moderate-risk to high-risk patients.
A prospective quasi-experimental 3-group design was used.
A sample of 338 "moderate-risk to high-risk" adult inpatients, ages 18 to 97, at 2 medical centers in South Texas were studied.
The Braden Scale for Pressure Ulcer Risk and investigator-developed history and skin assessment tools were used.
Subjects were randomly assigned to the High-Cushion Kodel Heel Protector (bunny boot), Egg Crate Heel Lift Positioner (egg crate), or EHOB Foot Waffle Air Cushion (foot waffle). Data are demographics, Braden scores, comorbidities, skin assessments, lengths of stay, and costs of devices. Analyses were Chi-square, analysis of variance, and regression.
Of 240 subjects with complete data, 77 (32%) were assigned to the bunny boot group, 87 (36.3%) to the egg crate, and 76 (31.7%) to the foot waffle. Twelve ulcers developed in 240 subjects (5% incidence). Six subjects had only 1 foot. Eleven ulcers were Stage I (nonblanchable erythema), and 1 was Stage II (partial thickness). Overall incidence was 3.9% for the bunny boot, 4.6% for the egg crate, and 6.6% for the foot waffle (not significantly different among groups). The bunny boot with pillows was most cost effective (F[3], N = 240) = 1.342, p <or= .001).
In this study, the bunny boot was as effective as higher-tech devices. The results, however, were confounded by nurses adding pillows to the bunny boot group.
Journal of WOCN 32(2):112-20. · 1.14 Impact Factor
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ABSTRACT: To investigate the feasibility of an exercise program patterned after a phase II cardiac rehabilitation program to improve selected physiologic and psychological parameters of health in patients with cancer.
Prospective, repeated measures study.
Two major military medical centers in the southwestern United States.
62 patients diagnosed with cancer within the previous two years. Ages ranged from 24-83 (meanX = 59). Half of the participants were male and half were female. Minorities made up 29% of the sample. Participants had a wide range of cancer diagnoses and all stages of cancer. Fifteen subjects were undergoing treatment when they enrolled in the study. More than half of the subjects exercised prior to their cancer diagnoses, but fewer than half were able to resume an exercise routine following their cancer diagnoses.
Subjects met two days each week for 12 weeks for exercise and education.
Exercise tolerance as measured with a graded exercise test, activity and sleep patterns as measured with a wrist actigraph, and quality of life (QOL) as measured with the Cancer Rehabilitation Evaluation System-Short Form.
Significant improvements were observed over time in exercise tolerance, selected activity and sleep patterns, and QOL among the 46 (74%) subjects who completed the program.
Patients with various types and stages of cancer can safely exercise using a cardiac rehabilitation model and can realize significant improvements in exercise tolerance, selected activity and sleep patterns, and QOL.
Most people are aware that regular exercise is part of a healthy lifestyle. After cancer diagnosis and treatment, patients experience uncertainty regarding how to resume exercise or how to begin an exercise program as part of their rehabilitation. Participation in a structured exercise program can provide patients with a safe environment within which to exercise at an intensity appropriate to their individual needs.
Oncology Nursing Forum 30(3):441-54; discussion 441-54. · 1.91 Impact Factor
