Center for Nursing Research

Orlando, FL, United States

Center for Nursing Research

Orlando, FL, United States
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Kaufman J.,Childrens Hospital of Denver | Cook P.,Center for Nursing Research | Da Cruz E.M.,University of Colorado at Denver
Cardiology in the Young | Year: 2012

Background: Achievement of adequate oral nutrition is a challenging task after early neonatal cardiac surgery. This study aims to describe predictors of oral feeding outcomes for neonates after early surgical interventions. Materials and methods: A retrospective review of neonates admitted with congenital cardiac disease over a period of 1 year. We analysed predictors of the need for a feeding tube at discharge and the amount taken at each feeding. Multilevel modelling was used to look at individual change over time predicting oral amount at each feeding. Results: We identified 56 neonates. Diagnoses were heterogeneous; 23% of the infants had associated genetic syndromes and 45% required pre-operative mechanical ventilation. The median time from birth to surgery was 8.4 days, with 29 infants fed orally before surgery. The mean time from surgery to first oral feeding attempt was 12 hours. Time from surgery to oral feeding, the amount taken with first feeding, and cross-clamp times were significant predictors of oral feeding success, whereas the presence of a comorbidity - genetic abnormality - and longer ventilator dependency predicted failure. Almost half of the neonates required a feeding tube upon discharge, and no infant discharged was solely breastfed. Discharge with a feeding tube was associated with greater weight gain at that time. Conclusions: Neonates with congenital cardiac disease face significant barriers to successfully achieving oral feeding on hospital discharge. Enteral feeding guidelines focus on physiological stabilisation and do not always address the developmental milestones necessary to support oral feeding. Future prospective studies are necessary to identify multimodal strategies to optimise early feeding. © Copyright Cambridge University Press 2011.

Lampe J.,Orlando RegionalMedical Center | Penoyer D.A.,Center for Nursing Research | Hadesty S.,Progressive Care | Bean A.,Seminole State College | Chamberlain L.,Seminole State College
Clinical Nurse Specialist | Year: 2014

PURPOSE:: The purpose of this study was to evaluate the timing and practices of blood glucose testing and rapid-acting insulin administration around mealtimes. DESIGN:: This study used an observational, descriptive design to assess the time between blood glucose testing and insulin administration and the time between first bite of the meal and insulin administration. SETTING:: The setting was 4 cardiology units in 2 hospitals within a large community healthcare system. SAMPLE:: Sixty-four mealtime practice events at breakfast, lunch, and supper were observed. METHODS:: Investigators directly observed the timing of rapid-acting insulin administration at 3 mealtime periods an assessed timing of blood glucose testing, food intake, and method of glucose reporting. RESULTS:: Overall, 14% (n = 64) of the patients received blood glucose testing within 1 hour prior to insulin administration and insulin administration within 15 minutes of the meal. As separate elements, blood glucose testing was done within the defined ideal range 35% (n = 63) of the time, and insulin was administered within range 40% (n = 58) of the time. CONCLUSIONS:: Timing for meals, blood glucose testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various patient caregivers with low achievement of ideal practices. IMPLICATIONS:: Results to this study revealed opportunities for better coordination of mealtime insulin practices. Lack of coordination can lead to medication errors and adverse drug events. Further study should include effect of mealtime coordination on glycemic control outcomes and testing the effect of interventions on timing of mealtime insulin practices. Copyright © 2014 Wolters Kluwer Health.

Cameron J.,Australian Catholic University | Worrall-Carter L.,Center for Nursing Research | Page K.,Center for Nursing Research | Riegel B.,University of Pennsylvania | And 2 more authors.
European Journal of Heart Failure | Year: 2010

Aims: Cognitive impairment occurs often in patients with chronic heart failure (CHF) and may contribute to sub-optimal self-care. This study aimed to test the impact of cognitive impairment on self-care. Methods and results: In 93 consecutive patients hospitalized with CHF, self-care (Self-Care of Heart Failure Index) was assessed. Multiple regression analysis was used to test a model of variables hypothesized to predict self-care maintenance, management, and confidence. Variables in the model were mild cognitive impairment (MCI; Mini-Mental State Exam and Montreal Cognitive Assessment), depressive symptoms (Cardiac Depression Scale), age, gender, social isolation, education level, new diagnosis, and co-morbid illnesses. Sixty-eight patients (75%) were coded as having MCI and had significantly lower self-care management (η2= 0.07, P, 0.01) and self-confidence scores (η2= 0.05, P < 0.05). In multivariate analysis, MCI, co-morbidity index, and NYHA class III or IV explained 20% of the variance in self-care management (P < 0.01); MCI made the largest contribution explaining 9% of the variance. Increasing age and symptoms of depression explained 13% of the variance in self-care confidence scores (P < 0.01). Conclusion: Cognitive impairment, a hidden co-morbidity, may impede patients' ability to make appropriate self-care decisions. Screening for MCI may alert health professionals to those at greater risk of failed self-care. © The Author 2010.

Warrington Jr. W.G.,Center for Nursing Research | Penoyer D.A.,Center for Nursing Research | Kamps T.A.,Access Scientific | Van Hoeck E.H.,Orlando Regional Medical Center
JAVA - Journal of the Association for Vascular Access | Year: 2012

Background and Significance: Many hospitalized patients require an intravenous (IV) catheter to maintain vascular access or for administration of fluids and medications. The best approach to attaining peripheral intravenous (PIV) access for long term therapy is unknown, particularly inpatients with a history of difficult IV placement. Purpose: To measure clinical outcomes using a Modified Seldinger Technique (MST) with ultrasound (US) guidance to achieve and maintain PIVfor long term IV therapy. Methods: Subjects were patients with a history of difficult peripheral intravenous catheter placement and need for IV therapy longer than 72 hours. Modified Seldinger Technique was used with US guidance to place all PIVs in the deep veins of the upper extremities. Results: A convenience sample of 157 subjects was enrolled in the study. Mean dwell time for catheter duration was seven days. First attempt placement success was 95%, 88.5% of patients had completion of IV therapy, and a low overall complication rate (9.57/1000 catheter days). Conclusion: Using MST for access for long term PIV therapy was associated with low complications and effective in our study population. Using MST requires specialized knowledge and skills, including the use of US and specialized insertion techniques. In patients who require extended PIV therapy with a history of difficult IV placement, this type of insertion technique may have benefit.

Mahramus T.L.,Orlando Regional Medical Center | Penoyer D.A.,Orlando Regional Medical Center | Sole M.L.,Center for Nursing Research | Wilson D.,University of Central Florida | And 2 more authors.
Clinical Nurse Specialist | Year: 2013

PURPOSE/OBJECTIVE: Patients' self-management of heart failure (HF) is associated with improved adherence and reduced readmissions. Nurses' knowledge about self-management of HF may influence their ability to adequately perform discharge education. Inadequate nurse knowledge may lead to insufficient patient education, and insufficient education may decrease patients' ability to perform self-management. Prior to developing interventions to improve patient education, clinical nurse specialists should assess nurses' knowledge of HF. The purpose of this study was to determine nurses' knowledge of HF self-management principles. DESIGN: This was a prospective, exploratory, and descriptive online test. SETTINGS: There were 3 patient care settings: tertiary care teaching hospital, community hospital, and home healthcare division. SAMPLE: The sample was composed of 90 registered nurses who worked directly with patients with HF. METHODS: Nurses completed an online test of knowledge using the Nurses' Knowledge of Heart Failure Education Principles instrument. FINDINGS: Registered nurses (n = 90) completed the knowledge test instrument; their average score was 71% (SD, 10.8%) (range, 20%-90%). The percentage of correct items on each subscale ranged from 63.9% (SD, 30.0) for medications to 83.3% (SD, 25.0) for exercise. Only 8.9% of respondents achieved a passing score of greater than 85%, and a passing score was not associated with any demographic characteristics. CONCLUSIONS: Overall, nursing knowledge of HF self-management principles was low. Scores from our nurses were similar to those found in other studies. IMPLICATIONS: There is a need to develop interventions to improve nursing knowledge of HF self-management principles. Clinical nurse specialists can be instrumental in developing knowledge interventions for nurses. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Thibeau S.,Center for Nursing Research | Boudreaux C.,Ochsner Medical Center
Advances in Neonatal Care | Year: 2013

Purpose: The purpose of this study was to explore the use of mothers' own milk (colostrums, transitional milk, and mature milk) as oral care in the ventilator-associated pneumonia (VAP)- prevention bundle of mechanically ventilated preterm infants weighing 1500 g or less. Subjects: Mechanically ventilated preterm infants weighing 1500 g or less admitted to a regional level III NICU in the Gulf South between January 1, 2006, and December 31, 2009. Design: Retrospective descriptive. Methods: Oral care with mothers' own milk was implemented as part of the VAP-prevention bundle in the neonatal intensive care unit in the fourth quarter of 2007. Using retrospective deidentified data retrieved from the electronic medical record, the primary and secondary outcome variables were collected among eligible infants (-1500 g) admitted January 1, 2006, to December 31, 2007 (before implementation) and January 1, 2008, to December 31, 2009 (after implementation). Sample characteristics, including infant gestational age, birth weight, and gender, as well as maternal age, type of delivery, and incidence of maternal chorioamnionitis, were also collected. Data analysis included frequencies and distributions to summarize sample characteristics and variables of interest. Appropriate tests for differences were conducted on outcome variables between the before and after groups of the human milk oral care intervention. Main Outcome Measures: The feasibility outcome variable included nursing compliance with the oral care procedure. The safety outcome variable included record of any adverse events associated with the oral care procedure. The efficacy health outcomes included the rate of positive tracheal aspirates, positive blood cultures, the number of ventilator days, and length of stay. Results: Infant age (26.1-26.6 weeks) and weight (840-863 g) were similar in the before (n = 70) and after (n = 68) sample subjects. There were no statistically significant differences in ventilator days, -2 (46, n = 115) = 46.22, P = .46, and length of stay, -2 (75, n = 115) = 78.78, P = .36, between groups. Although the rate of positive tracheal aspirates and positive blood cultures reduced after implementation of oral care with mothers' own milk, these differences were not statistically significant (U(47) = 250, z = -7.1, P = .48; U(47) = 217.5, z = -1.44, P = .15). Conclusions: There were no statistically significant differences in the rates of positive tracheal aspirates and blood cultures after implementation of oral care with mothers' own milk. The findings of this study suggest that using mothers' own milk as part of the VAP-prevention bundle is a feasible and safe practice; however, further research is needed to determine the immunological benefits of this practice. Copyright © 2013 by The National Association of Neonatal Nurses.

Rice K.L.,Center for Nursing Research | Bennett M.,Louisiana State University Health Sciences Center | Gomez M.,Ochsner Medical Center | Theall K.P.,Tulane University | And 2 more authors.
Clinical Nurse Specialist | Year: 2011

Background: Delirium is the most frequent complication associated with hospitalization of older adults, responsible for 17.5 million additional hospital days in the United States each year; yet, nurses fail to recognize it more than 30% of the time. Objectives: The specific aim of the study was to measure staff nurses' recognition of delirium in hospitalized older adults by comparing nurse and expert diagnostician ratings for delirium using the Confusion Assessment Method (CAM). Method: This study investigated the rate of agreement/disagreement between researchers and a convenience sample of 167 nurses caring for 170 medical surgical patients (>65 years) in detecting delirium. Paired (nurse vs researcher) CAM ratings were completed at least every other day until either discharge or delirium was detected by the researcher. Results: The researcher detected delirium in 7% (12/170) of patients. Nurses failed to recognize delirium 75% (9/12) of the time, with poor agreement between nurse/researcher for all observations (κ = 0.34). A generalized estimating equation logistic regression model identified independent predictors of nurses' underrecognition of delirium that included increasing age and length of stay, dementia, and hypoactive delirium. Discussion: Findings provide further support for the significance of nurses' underrecognition of delirium in the hospitalized older adult when using the CAM. Additional research is warranted regarding the clinical decision-making processes that nurses use in assessing acute cognitive changes and in identifying strategies to improve delirium recognition. Copyright © 2011 Lippincott Williams & Wilkins.

PubMed | Cabrini Education and Research Precinct and Center for Nursing Research
Type: | Journal: International journal for quality in health care : journal of the International Society for Quality in Health Care | Year: 2016

In 2013, National Safety and Quality Health Service Standards accreditation became mandatory for most health care services in Australia. Developing and maintaining accreditation education is challenging for health care services, particularly those in regional and rural settings. With accreditation imminent, there was a need to support health care services through the process.A needs analysis identified limited availability of open access online resources for national accreditation education.A standardized set of online accreditation education resources was the agreed solution to assist regional and rural health care services meet compulsory requirements.Education resources were developed over 3 months with project planning, implementation and assessment based on a program logic model.Resource evaluation was undertaken after the first 3 months of resource availability to establish initial usage and stakeholder perceptions. From 1 January 2015 to 31 March 2015, resource usage was 20 272, comprising 12 989 downloads, 3594 course completions and 3689 page views. Focus groups were conducted at two rural and one metropolitan hospital (n = 16), with rural hospitals reporting more benefits. Main user-based recommendations for future resource development were automatic access to customizable versions, ensuring suitability to intended audience, consistency between resource content and assessment tasks and availability of short and long length versions to meet differing users needs.Further accreditation education resource development should continue to be collaborative, consider longer development timeframes and user-based recommendations.

PubMed | Center for Nursing Research, University of New Orleans and Tulane University
Type: Review | Journal: The Ochsner journal | Year: 2016

Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation). We present a review of selected studies of galactagogues and data indicating popular demand for such products.A systematic search was conducted for published studies on the use of galactagogues for breast-feeding. The following databases were searched: MEDLINE (PubMed), EBSCO (Academic Search Complete), and EMBASE. The search was conducted between July 15, 2015, and August 18, 2015; only English language articles were included, and we imposed no restrictions on publication date. Two authors independently reviewed the studies and extracted data.Blinded, placebo-controlled clinical trials of 2 pharmaceutical galactagogues (domperidone and metoclopramide) and 5 popular herbal galactagogues (shatavari, fenugreek, silymarin, garlic, and malunggay) were identified. All of the studies identified for domperidone showed a significant difference in milk production between the treatment and placebo groups. Of the 6 trials of metoclopramide, only 1 study showed a significant difference in milk production compared to placebo. Results of the clinical trials on herbal galactagogues were mixed. Our review of the evidence for the efficacy of popular pharmaceutical and herbal galactagogues revealed a dearth of high-quality clinical trials and mixed results.Health providers face the challenge of prescribing or recommending galactagogues without the benefit of robust evidence. Given the suboptimal rates of exclusive breast-feeding worldwide and the availability and demand for medical and herbal lactation therapies, controlled trials and analyses investigating these medicines are urgently warranted.

Aragon Penoyer D.,Center for Nursing Research
Critical Care Medicine | Year: 2010

Background: Studies over the past several decades have shown an association between nurse staffing and patient outcomes. Most of those studies were generated from general acute care units. Critically ill patients demand increased nurse staffing resources and nurses who have specialized knowledge and skills. Appropriate nurse staffing in critical care units may improve the quality of care of critically ill patients. Objectives: To review the literature evaluating the association of nurse staffing with patient outcomes in critical care units and populations. Methods: An annotated review of major nursing and medical literature from 1998 to 2008 was performed to find research studies conducted in intensive care units or critical care populations where nurse staffing and patient outcomes were addressed. RESULTS: Twenty-six studies met inclusion for this review. Most were observational studies in which outcomes were retrieved from existing large databases. There was variation in the measurement of nurse staffing and outcomes. Outcomes most frequently studied were infections, mortality, postoperative complications, and unplanned extubation. Most studies suggested that decreased nurse staffing is associated with adverse outcomes in intensive care unit patients. Conclusions: Findings from this review demonstrate an association of nurse staffing in the intensive care unit with patient outcomes and are consistent with findings in studies of the general acute care population. A better understanding of nurse staffing needs for intensive care unit patients is important to key stakeholders when making decisions about provision of nurse resources. Additional research is necessary to demonstrate the optimal nurse staffing ratios of intensive care units. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

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