Cynthia Padula

Providence Hospital, Mobile, Alabama, United States

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Publications (34)34.1 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.
    No preview · Article · Sep 2014 · Journal of Clinical Nursing
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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.
    No preview · Article · Sep 2012 · Dimensions of critical care nursing: DCCN
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    ABSTRACT: In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.
    No preview · Article · Jul 2012 · Gerontology & geriatrics education
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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.
    No preview · Article · May 2012 · The Journal of nursing administration
  • 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.
    No preview · Article · Apr 2012 · Journal of nursing care quality
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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.
    No preview · Article · Jul 2011 · Journal of nursing care quality
  • 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.
    No preview · Article · Jun 2011 · The Journal of nursing administration
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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.
    Preview · Article · Jan 2011 · Oncology Nursing Forum
  • 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.
    No preview · Article · Oct 2009 · Nursing administration quarterly
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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.
    Preview · Article · May 2009 · Journal of nursing care quality
  • Cynthia A Padula · Evelyn Yeaw · Saurabh Mistry
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    ABSTRACT: People with heart failure (HF) are living longer but with disabling dyspnea that erodes quality of life (QOL). Decreased strength of inspiratory muscles (IMs) may contribute to dyspnea in HF, and inspiratory muscle training (IMT) has been shown to improve the strength of IMs. The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program. Bandura's Self-Efficacy Theory directed nursing interventions. This randomized controlled trial employed an experimental group (IMT) and a control group (education). Data were collected during six home visits. Outcome measures included maximal inspiratory pressure, perceived dyspnea, self-efficacy, and health-related QOL. Significant differences in PI(max), dyspnea, and respiratory rate were found. Implications for further research and practice are discussed.
    No preview · Article · Mar 2009 · Applied nursing research: ANR
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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.
    No preview · Conference Paper · Jan 2009
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    ABSTRACT: We test the efficacy of an intervention based on the transtheoretical model to increase the intake of fruits and vegetables and to describe differences in psychosocial variables based on the achievement of the 5 A Day Program target. This study is a randomized controlled trial comparing a 12-month fruit and vegetable intervention to a control condition with a 12-month follow-up. Participants included 1,277 community-residing persons who were 60 years of age or older; 834 provided dietary data at all three time points and are included in our outcome analyses. The intervention group increased intake by 0.5 to 1.0 serving more than the control group over 24 months as measured by the NCI Fruit and Vegetable Screener and the 5 A Day Program screener. The majority of the participants (58%) perceived that they maintained 5 or more servings per day for 24 months. These maintainers had a higher intake at each time point for all dietary measures and differed from those who failed to progress (11%) for most transtheoretical model variables. The intervention was effective in increasing the intake of fruits and vegetables in older adults. Those who maintained their level of perceived intake as 5 or more servings per day consumed 2-4 servings per day more than those who failed to progress.
    No preview · Article · Jul 2008 · The Gerontologist
  • Source
    Cynthia A Padula · Evelyn Osborne · Joyce Williams

    Preview · Article · Feb 2008 · Journal of WOCN
  • Cynthia A Padula · Evelyn Yeaw
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    ABSTRACT: Inspiratory muscle training (IM training) is a technique that is designed to improve the performance of the respiratory muscles (RMs) that may be impaired in a variety of conditions. Interest in IM training has expanded over the past two decades, and IM training has been used in an increasingly wide range of clinical conditions. However, the benefits of IM training continue to be debated, primarily because of methodological limitations of studies conducted to date. The focus of this article is to provide a critical review of IM training research in conditions other than chronic obstructive pulmonary disease for which it has been used, including asthma, bronchiectasis, cystic fibrosis, pre- and postsurgery, ventilator weaning, neuromuscular diseases, and chronic heart failure. Emphasis is placed on what has been learned, remaining questions, future applications, and significance to practice.
    No preview · Article · Feb 2007 · Research and theory for nursing practice
  • Cynthia A Padula · Mary Sullivan
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    ABSTRACT: Knowledge about health promotion behaviors and their determinants in older individuals is scant. Even less is known about persons in long-term marriages, although a growing interdependence in health decision-making has been suggested. The purpose of this study was to identify determinants of health promotion activities in older adults who were in long-term marriages. Pender's Health Promotion Model and a proposed re-conceptualization of Pender's interpersonal influences were used to guide selection of study variables. Perceived barriers and perceived self-efficacy, two behavior-specific cognitions, and relationship quality and social support, proposed interpersonal influences, were hypothesized to predict participation in health promotion behaviors. A convenience sample of 80 individuals in long-term marriages was recruited. Regression analysis identified four predictor variables as explaining 31% of the participation in health promotion behaviors: relationship quality, perceived barriers, perceived self-efficacy, and social support. Implications for nursing practice and for further research are discussed.
    No preview · Article · Nov 2006 · Journal of Gerontological Nursing
  • 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.
    No preview · Article · Aug 2006 · AORN journal
  • Cynthia A Padula · Evelyn Yeaw
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    ABSTRACT: This article provides a critical review of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD). Although extensive research on IMT has accumulated, its benefits have been debated, primarily because of methodological limitations of studies. Using relevant key words, multiple databases were searched from 1966. Selected studies used PImax (maximal inspiratory pressure) as an outcome variable. Overall, research demonstrated that a standard protocol of 30% or higher for a duration of 20 to 30 minutes per day for 10 to 12 weeks improves dyspnea and inspiratory strength and endurance with either inspiratory resistive or inspiratory threshold training. Regardless of method, IMT protocols for people with COPD and inspiratory muscle weakness and dyspnea are generally safe, feasible, and effective. Patient selectivity and study of subgroups are recommended.
    No preview · Article · Feb 2006 · Research and theory for nursing practice
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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.
    No preview · Article · Apr 2005 · JONA The Journal of Nursing Administration
  • Cynthia A Padula · Merrilyn McNatt
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    ABSTRACT: The purpose of this study was to explore communication patterns between long-term married couples to better understand the process by which later-life couples participate in health promotion. Forty community-residing couples married for 30 years or longer were asked to respond to open-ended questions and to participate in a decision-making activity. The majority of couples made health decisions jointly, with wives acting as the final deciders 54% of the time. Most couples used positive communication strategies during a structured scenario. Findings highlight the importance of expanding beyond traditional individual-focused models to include joint decision-making processes. Implications for future research and for nursing practice are discussed.
    No preview · Article · Sep 2004 · Journal of Gerontological Nursing

Publication Stats

595 Citations
34.10 Total Impact Points


  • 2008-2014
    • Providence Hospital
      Mobile, Alabama, United States
  • 2009-2012
    • Rhode Island College
      • Department of Nursing
      Providence, Rhode Island, United States
  • 1999-2009
    • University of Rhode Island
      • • College of Nursing
      • • Department of Nutrition and Food Sciences
      • • Cancer Prevention Research Center
      Kingston, Rhode Island, United States