An Exploratory Study of Patient Falls

Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body

Culture Care Meanings, Beliefs and Practices of Rural Dominicans in a Rural Village of the Dominican Republic: An Ethnonursing Study Conceptualized within the Culture Care Theory

The purpose of this ethnonursing study was to discover, describe and analyze the meanings, beliefs and practices of care for Dominican people living in a rural village of the Dominican Republic. Leininger\u27s Culture Care Diversity and Universality Theory and ethnonursing method was utilized as an organizing framework for studying the domain of inquiry. Interviews were conducted with nineteen general informants and ten key informants, all of whom were rural Dominicans living in the village of Villegas 60 miles northwest of Santo Domingo. Exhaustive analysis of audio-taped interviews revealed eighteen categories and nine patterns from which three main themes emerged. The themes were (a) family presence is essential for meaningful care experiences and care practices for rural Dominicans, (b) respect and attention are central to the meaning of care and care practices for rural Dominicans, and (c) rural Dominicans value and utilize both generic (folk) and professional care practices. These findings also detailed what rural Dominicans and Dominican immigrants may value and expect from caregivers in the professional caring relationship. Implications and recommendations for nursing theory, practice, education, policy and research are described

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Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Knowledge-based clinical pathway for medical quality improvement

Clinical pathways have been adopted for various diseases in clinical departments for quality improvement as a result of standardization of medical activities in treatment process. Using knowledge-based decision support on the basis of clinical pathways is a promising strategy to improve medical quality effectively. However, the clinical pathway knowledge has not been fully integrated into treatment process and thus cannot provide comprehensive support to the actual work practice. Therefore this paper proposes a knowledgebased clinical pathway management method which contributes to make use of clinical knowledge to support and optimize medical practice. We have developed a knowledgebased clinical pathway management system to demonstrate how the clinical pathway knowledge comprehensively supports the treatment process. The experiences from the use of this system show that the treatment quality can be effectively improved by the extracted and classified clinical pathway knowledge, seamless integration of patient-specific clinical pathway recommendations with medical tasks and the evaluating pathway deviations for optimization

An Exploration of the Culture Care Experiences of Puerto Rican Families with a Child with Special Health Care Needs as Perceived by the Family Caregiver

Advances in medical care have resulted in rising numbers of children living with chronic illness. Nurses care for families with special needs during all aspects of their care from the office visit, the inpatient stay, and in the home. Therefore, nurses need to be highly skilled and sensitive to the families\u27 cultural needs in order to assist with coping and the daily challenges they face. This study explored the culture care experiences of Puerto Rican families with a child with special health care needs as perceived by the family caregiver. This family member is the individual who has the greatest amount of interaction with the health care system and is most intimately involved in the care of the special health care needs child. Interviews with the family caregiver, using a self-developed semi-structured interview guide explored the culture care experiences of the family caregiver. The Culture Care Diversity and Universality Theory guided the study and Leininger\u27s four phases of data collection and analysis was implemented. A sample of 16 general and 8 key informants were interviewed and data was organized and managed using NVIVO 10.0 software. The findings included the identification of 14 categories, and 5 patterns from which emerged the themes of: 1) The family caregiver describes the of burden of care, 2) the family caregiver perceives caring behaviors as attentiveness and respect, and 3) the family caregiver\u27s feelings of responsibility for the child creates fear and uncertainty in their ability to meet the child\u27s needs. The themes indicate that nurses must ensure the development of a trusting, respectful therapeutic relationship with the caregiver and the child in order to promote confidence in the caregiver as well as decrease stress and anxiety levels

Culture Care of Puerto Rican Elderly in a Community Setting

The purpose of this ethnonursing study was to discover the culture care meanings, beliefs, expressions, and practices of urban elderly Puerto Ricans residing in a mid-sized community. The Culture Care Theory was used as the guiding framework in studying the domain of inquiry: the discovery of the meanings and practices of generic care and professional health care of elderly community dwelling Puerto Ricans. The qualitative research method used for this study was the ethnonursing research method. Twelve key informants and twenty-one general informants were interviewed. Four themes were extracted from analysis of the data, and patterns to support the themes were derived from emic care constructs. Discussion for culturally congruent nursing care within the nursing care actions of cultural care preservation or maintenance, culture care accommodation or negotiation, and culture care repatterning or restructuring are presented. Implications for nursing theory, education, and practice are suggested to facilitate the provision of culturally congruent nursing care. Recommendations for further research are presented

Understanding the Culture Care Practices of Rural Immigrant Mexican Women

The purpose of this ethnonursing study was to understand the culture care meanings, expressions, patterns and practices of immigrant Mexican women who live in a rural community in Ohio. Leininger\u27s Culture Care Diversity and Universality Theory was utilized as an organizing framework in studying the domain of inquiry. Interviews were conducted with twenty-four general informants and twelve key informants all of whom were immigrant Mexican women. Exhaustive analysis of audio-taped interviews revealed nine data categories and five patterns from which three main themes emerged. Respecting and supporting cultural identity, self-determination, self-reliance and the role of mothers were discovered as significant culture care values of informants. These findings also detailed what immigrant Mexican women value and expect from nurses in the professional caring relationship. A pictorial model was developed to illustrate the interrelationships of these findings and culturally congruent care. Implications and recommendations for nursing theory, practice, education, administration, and research are offered with directions for future nursing research

Generic and Professional Health Care Beliefs, Expressions and Practices of Syrian Muslims Living in the Midwestern United States

The purpose of this ethnonursing study was to discover the generic and professional health care beliefs, expressions, and practices of Syrian Muslims living in the Midwestern United States and to describe the influence of worldview, cultural context, and social structure, such as technological, religious, political, educational, and economical factors on their folk care beliefs and practices. Leininger\u27s Culture Care Theory was used as an orientational framework for this study. Ten key and twenty general informants participated in this study. Several qualitative enablers were used to assist with the collection and analysis of data. QSR NUD*IST 4, a qualitative research software program, was used to assist with data analysis. Extensive analysis of audio taped interviews and the researcher\u27s observations and participation experiences revealed numerous data categories and fourteen patterns from which four main themes were discovered. The findings from this study assisted in the identification of nursing care actions and decisions to provide Syrian Muslims with culturally congruent care. Implications for nursing theory, education, practice, and research were offered as well as considerations for future research