The Relationship Between Barcode Medication Administration Satisfaction and the Use of Workarounds Among Registered Nurses

Adverse drug events, resulting in preventable patient harm or death, are of great concern. To keep patients safe, hospitals have implemented barcode medication administration (BCMA) technology for RNs who have accepted this technology with varying levels of satisfaction. When nurses are dissatisfied with a BCMA system, they may find alternative methods to complete their work. Framed by the Technology Acceptance Model (Davis, 1989), this analytic, cross-sectional study aimed to understand the relationship between BCMA satisfaction and workarounds, perceived ease of use (PEOU) and perceived usefulness (PU) of a BCMA system by 80 hospital-based RNs in northeastern US. Data were collected using the Workaround Usage and Satisfaction with Barcoding Instrument for Nurses (WUSBIN), which was adapted from Hurley\u27s (2006) Medication Administration System-Nurses Assessment of Satisfaction Scale (MAS-NAS) Halbesleben and Rathert\u27s (2010) Workaround Assessment. Results suggested that RNs who were more satisfied with the BCMA system were less likely to use workarounds than nurses who were less satisfied (r2(78)= -.681, p \u3c .05). Significant relationships were noted among BCMA Satisfaction and PEOU (r2(78) = -.725, p \u3c .05), Workaround Usage and PEOU (r2(78) =.943, p \u3c .05) and Workaround Usage and PU (r2(78)=.501, p \u3c .05). RNs perceived the BCMA system to be easy to use (PEOU), but not very useful (PU). BCMA Satisfaction was significantly related to the use of six workarounds, while Workaround Usage was significantly related to five. Significant relationships were also noted among both BCMA Satisfaction (r2(78) = -.393, p \u3c .01), and Workaround Usage (r2(78) = .423, p \u3c .01) with the total number of workarounds used. Significant relationships were found among demographic variables, BCMA Satisfaction, and Workaround Usage. Since admitting to the use of workarounds may be a sensitive matter for RNs, measuring BCMA satisfaction may help understand the state of patient safety related to medication administration. Based on high satisfaction scores and low workaround usage, a profile may be developed to identify nurse champions to improve quality of care. Further research is indicated to fully understand these possibilities

Practice Makes Prize-Winning Pies

Not only February but every month is cherry pie month for Marjorie Campbell, home economics freshman from New York. She made 160 pies in the winter of 1954-1955 (that\u27s more than one a day), to practice for the 23rd National Cherry Pie Baking Contest

Empowering Teachers, Empowering Leadership: A Multisite Case Study of School Restructuring and Accountability for Student Achievement

Accountability is the watchword of the 1990s, particularly in education. In exchange for greater flexibility and autonomy, schools have been asked to assume greater accountability for student outcomes. Implicit in this shift of authority and responsibility is the belief that changing the locus of control will result in changes in student achievement. Decentralizing accountability thus has multiple implications for the teaching and learning process, governance and decision making, and school site leadership. In 1993, San Diego City Schools adopted a student achievement accountability policy and initiated a demonstration program to develop an accountability system model for the district. This ethnographically-oriented case study investigated three of these pilot schools through interviews with teachers and site administrators, site observations, and document review. The purpose was to explore issues, challenges, and successes involved in school reform around student achievement accountability; identify what kinds of governance and leadership were most embraced by the teachers and administrators; look into school accountability cultures; and discuss implications for educational policymakers and practitioners. The study found that implementation of the accountability policy occurred uniquely in each context in interaction with school culture and collective experience. At all three schools, however, focusing on standards and developing related assessments engaged teachers in substantive conversations about student performance, and teaching and learning, which began to influence instructional practices. These schools embraced participatory governance structures that empowered teachers to engage in and influence decision making, and school site leadership began to evolve into a communal endeavor shared among teachers and administrators. The intersection of student achievement accountability, school restructuring, and school site leadership has significant implications for educators. The study presents the following recommendations to educational policymakers and practitioners: (a) encourage and sustain site autonomy and accountability by building capacity for meaningful, participatory school site decision making; (b) invest heavily in ongoing, systematic professional and organizational development; (c) promote entrepreneurial mindsets grounded in sound educational practice, and consider reform efforts as research and development opportunities; and (d) reconceptualize and develop leadership as an empowering, relational process

Educational interventions for the management of cancer-related fatigue in adults

Background: Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. Objectives: To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. Selection criteria: We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. Main results: We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision. There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention. Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some. No adverse events were reported in any of the studies. Authors' conclusions: Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions. The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research

The Connection, Volume 5, Issue 01, Summer 2006

The Connection is published by the Prevention Research Center (PRC), Prevention & Population Sciences, University of New Mexico, Albuquerque. The purpose of The Connection is to provide reports and updates on programs of the PRC and those of its Community Advisory Council and other partners.https://digitalrepository.unm.edu/hsc_prc_newsletters/1032/thumbnail.jp

The Connection, Volume 6, Issue 01, Summer 2007

The Connection is published by the Prevention Research Center (PRC), Prevention & Population Sciences, University of New Mexico, Albuquerque. The purpose of The Connection is to provide reports and updates on programs of the PRC and those of its Community Advisory Council and other partners.https://digitalrepository.unm.edu/hsc_prc_newsletters/1030/thumbnail.jp

Understanding choice in assistive technology service provision: considerations for research methodology

The adoption of choice as a policy principle in disability services reforms warrants research into the practical implications for assistive technology provision. This paper outlines methodological considerations for the investigation of how choice is constructed and experienced in assistive technology provision. It argues for an interpretive approach that considers the interactions between stakeholders and the influence of contextual factors on choices over time. Understanding stakeholders’ interpretations and contextual factors that affect their choice behaviors in AT acquisition will assist the interpretation of AT outcomes. It may also assist in efforts to increase the usability of AT services, develop improved service delivery models, and target policy initiatives to support AT provision practices

The Connection, Volume 4, Issue 02, Fall 2005

The Connection is published by the Prevention Research Center (PRC), Prevention & Population Sciences, University of New Mexico, Albuquerque. The purpose of The Connection is to provide reports and updates on programs of the PRC and those of its Community Advisory Council and other partners.https://digitalrepository.unm.edu/hsc_prc_newsletters/1033/thumbnail.jp

The Connection, Volume 6, Issue 02, Spring 2008

The Connection is published by the Prevention Research Center (PRC), Prevention & Population Sciences, University of New Mexico, Albuquerque. The purpose of The Connection is to provide reports and updates on programs of the PRC and those of its Community Advisory Council and other partners.https://digitalrepository.unm.edu/hsc_prc_newsletters/1029/thumbnail.jp