Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients\u27 perceptions of their readiness for hospital discharge. Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting: Midwestern tertiary medical center. Sample: 147 adult medical-surgical patients. Methods: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings: Living alone, discharge teaching (amount of content received and nurses\u27 skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis\u27 transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes

Who Benefits From Teams? Comparing Workers, Supervisors, and Managers

This paper offers a political explanation for the diffusion and sustainability of team-based work systems by examining the differential outcomes of team structures for 1200 workers, supervisors, and middle managers in a large unionized telecommunications company. Regression analyses show that participation in self-managed teams is associated with significantly higher levels of perceived discretion, employment security, and satisfaction for workers and the opposite for supervisors. Middle managers who initiate team innovations report higher employment security, but otherwise are not significantly different from their counterparts who are not involved in innovations. By contrast, there are no significant outcomes for employees associated with their participation in offline problem-solving teams

Professional Nursing Values Identified in the Philosophy of Nursing at Select Health Care Institutions

A nursing philosophy represents the value system of the profession, providing direction for the practice of nursing and the development of the profession. Nursing\u27s professional values are articulated in the American Nurses\u27 Association\u27s Code for Nurses (I985). The Code gives direction for nursing activity in relation to individuals, society, and the profession. It is the nursing administrator who sets and maintains the climate of nursing practice by formalizing and operationalizing professional nursing values. The values are enumerated in a philosophy of nursing document from which priorities will be set, standards developed, and resources allocated. The purpose of this study was ,to describe which values articulated in the ANA Code for Nurses (1985) were reflected in the philosophy of nursing documents of 10 health care institutions. The 10 health care institutions were drawn from a convenience sample of all acute care and long term skilled care facilities in a midwest metropolitan area. The institutions ranged in size from 87 to 700 licensed beds, and had been in existence from 15 to 115 years. Content analysis was employed to identify value themes in the ANA Code for Nurses (I985). Each institutional philosophy was examined for the presence of these Code themes. A binary index was created to systematically record the presence or absence of the themes. The number of themes in each philosophy was enumerated according to the individual Code value statements. The 10 institutional philosophies varied in length from a few sentences to thirteen pages. Using content analysis, the philosophy documents studied were found to reflect values of the ANA Code (1985), ranging from one statement in one philosophy to seven Code statements reflected in three nursing philosophies. None of the philosophies contained themes reflecting all eleven of the Code statements. Every philosophy reflected the dignity and worth of individual humanness (Code statement # 1). Eighty percent of the philosophies contained exemplars of Code statement #6 (nursing judgement in clinical decision making and delegation). Code statement #10 (protecting the public) was not reflected in any philosophy, and Code statement #11 (collaboration to meet the health needs of the public) was reflected in only one philosophy. Three philosophies each reflected 64% (7out of 11) of the Code values. Two philosophies each reflected 9% (1 out of 11) of the values. As an organization of professionals, nurses have a well articulated philosophy of values in the ANA Code for Nurses (1985). The Code is an appropriate vehicle for the nurse administrator to use in grounding nurses to professional values. A well defined philosophy of nursing requires a commitment of time and involvement by all nursing service members. The result can be a document that captures the passion and imagination of nurses to make the vision of professional nursing a reality

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes