Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

Purpose This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). Design/methods In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3 weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). Results Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B = 0.54) and nurse assessment (B = 0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B = − 0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%. Conclusion There is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission. Practice Implications Efforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions

Transition of Experienced and New Graduate Nurses to a Pediatric Hospital

This study reports on the 3-, 6-, 12-, and 18-month outcomes of 118 newly hired registered nurses (RNs) who completed a 12-month transition-to-practice program at a pediatric hospital. Experienced RNs (n = 42) and new graduate RNs (n = 76) showed improved organization, prioritization, communication, and leadership skills over time. The experienced RNs reported better communication and leadership skills than the new graduate nurses. Results inform transition program development for both new and experienced nurses. The American Association of Colleges of Nursing (2012) predicts that, without a multifaceted approach, a national nursing shortage will occur by 2020. Many nurses leave their first position and sometimes the profession within the first year of employment (Baxter, 2010; Welding, 2011). Retaining nurses is a vital component of any approach to averting a nursing shortage. In an attempt to retain nurses, healthcare institutions often provide a transition-to-practice (TTP) or nurse residency program for new graduate nurses (NGN) entering the profession. The Institute of Medicine (2011) in its Future of Nursing report also recommends a transition program for nurses moving to a new specialty or to advanced practice roles. Completing a NGN transition program is associated with a decrease in nurse attrition by as much as 80% (Halfer, Graf, & Sullivan, 2008; Rush, Adamack, Gordon, Lilly, & Janke, 2013; Spector et al., 2015). This reported decrease has led to organizational interest in transition programs to improve retention. The goals of residency programs for the NGN have ranged from increasing new nurse confidence and competence, to increasing satisfaction and retention (Fink, Krugman, Casey, & Goode, 2008; Goode, Lynn, McElroy, Bednash, & Murray, 2013; Institute of Medicine, 2011; Spector et al., 2015). Although literature supports the effectiveness of transition programs for the NGN (Fink et al., 2008; Goode et al., 2013; Spector et al., 2015), there is little evidence on the experienced nurse’s transition to a new specialty practice. Furthermore, most transition programs do not report outcomes beyond the first 12 months of employment. Thus, the purpose of this study is to evaluate nurse stressors and supports during and after a 12-month transition-to-employment program for both new and experienced nurses transitioning to a pediatric practice

Une étude exploratoire. Interaction entre les dyades mère-nourrisson et père-nourrisson chez les couples à faible revenu

Vingt-neuf parents à faible revenu et leurs nourrissons ont participé à une recherche exploratoire portant sur les interactions parent-nourrisson et décrivant le niveau d'interactions, les similarités et les différences au sein des dyades mère-nourrisson et père-nourrisson. L'échelle de mesure Nursing Child Assessment Teaching Scale, un instrument d'observation standardisé de 73 items, a été utilisée pour mesurer les interactions. Les résultats ont montré que bien que la majorité (69%) des dyades parent-nourrisson n'ont pas démontré de comportements interactifs à risque, près de 31% de l'échantillon étaient désorganisés dans leurs interactions. De plus, les résultats ont démontré que bien que les deux parents étaient sensibles et répondaient aux signaux de leurs nourrissons, les mères étaient plus aptes que les pères à répondre à la détresse de leurs nourrissons alors que les nourrissons étaient plus clairs et répondaient mieux aux pères qu'aux mères. Avec cette information, les cliniciens et les chercheurs peuvent mieux comprendre les interactions au sein du contexte familial et renforcer les programmes d'intervention visant à maintenir et à améliorer les interactions parent-nourrisson.Interaction between low-income mother-infant and father-infant pairs: an exploratory study Twenty-nine low-income parents and their infants participated in an explanatory study about parent-infant interaction — describing the level of interaction and the similarities and differences in mother-infant and father infant pairs. The Nursing Child Assessment Teaching Scale, a 73-item standardized observation instrument, was used to measure interaction. Results showed that although the majority (69%) of parent-infant dyads did not demonstrate risky interactive behaviors, nearly 31% of the sample was disorganized in their interactions. Further, results showed that while both mothers and fathers were sensitive and responsive to their infants' cues, mothers were more apt to respond to their infants' distress than fathers, and infants were clearer and more responsive with their fathers than with their mothers. With this information clinicians and researchers can better understand interactions within a family context and strengthen intervention programs aimed at maintaining and improving parent-infant interactions.Una investigación exploratoria. Interacción entre los pares madre-niño lactante y padre-niño lactante en las parejas a ingreso modesto Veinte-nueve padres con ingreso modesto y sus niños lactantes participaron en una investigación exploratoria sobre las interacciones padre-niño lactante y el nivel de interacciones, las similitudes y las diferencias en el seno de las dyadas madre-niño lactante y padre-niño lactante. Para medir las interacciones se utilizó un instrumento de observación standardizado de 73 elementos, la escala de medida Nursing Child Assessment Teaching Scale. Los resultados indican que aunque la mayoridad (69%) de las dyadas padre-niño lactante no demuestran comportamientos interactivos con riesgo, cerca de 31% de la muestra estaban desorganisados en sus interacciones. Además, los resultados demuestraron que aunque los dos padres eran sensibles y respondian a los señales de sus niños lactantes, las madres estaban más aptas que los padres a responder al desemparo de sus niños cuando los niños estaban más tranquilos y respondian mejor a los padres que a las madres. Con esta información, los clínicos y los investigadores pueden comprender mejor las interacciones en el seno del contexto familial y reforzar programas de intervención aspirando mantener y mejorar las interacciones padre-niño lactante

Development of a Self‐Management Theory‐Guided Discharge Intervention for Parents of Hospitalized Children

Background Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self‐management of their child\u27s care at home after discharge. Problem No theory‐based discharge intervention exists to guide pediatric nurses\u27 preparation of parents for discharge. Purpose To develop a theory‐based conversation guide to optimize nurses\u27 preparation of parents for discharge and self‐management of their child at home following hospitalization. Methods Two frameworks and one method influenced the development of the intervention: the Individual and Family Self‐Management Theory, Tanner\u27s Model of Clinical Judgment, and the Teach‐Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine‐domain conversation guide for use in acute care pediatric hospitals. Conclusions The theory‐based intervention operationalized self‐management concepts, added components of nursing clinical judgment, and integrated the Teach‐Back method. Clinical Relevance Development of a theory‐based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention

Nurse Researchers in Children\u27s Hospitals

Little is known about the role of nurse researchers (NRs) and the structure of nursing research programs in children\u27s hospitals in the United States. This descriptive study obtained survey data from 33 NRs. Data suggest that the NR role is emerging and has both commonalities and unique components when compared with the previous studies of NRs in adult hospitals. Most participants have been in their position for less than 4 years. Conducting research, having staff development related to research, and facilitating evidence-based practice or research were common responsibilities. The structure of nursing research programs impacts both the NRs and the program outcomes

Lessons Learned: Newly Hired Nurses\u27 Perspectives on Transition into Practice

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes

Pilot Study Protocol of a Mhealth Self‐Management Intervention for Family Members of Pediatric Transplant Recipients

Solid‐organ transplantation is the treatment of choice for end‐stage organ failure. Parents of pediatric transplant recipients who reported a lack of readiness for discharge had more difficulty coping and managing their child\u27s medically complex care at home. In this paper, we describe the protocol for the pilot study of a mHealth intervention (myFAMI). The myFAMI intervention is based on the Individual and Family Self‐Management Theory and focuses on family self‐management of pediatric transplant recipients at home. The purpose of the pilot study is to test the feasibility of the myFAMI intervention with family members of pediatric transplant recipients and to test the preliminary efficacy on postdischarge coping through a randomized controlled trial. The sample will include 40 family units, 20 in each arm of the study, from three pediatric transplant centers in the United States. Results from this study may advance nursing science by providing insight for the use of mHealth to facilitate patient/family–nurse communication and family self‐management behaviors for family members of pediatric transplant recipients

Examining Long‐Term Effects Of An Infant Mental Health Home‐Based Early Head Start Program On Family Strengths And Resilience

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home‐based Early Head Start (IMH‐HB EHS) program on family functioning. The sample includes 152 low‐income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH‐HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH‐HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH‐HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH‐HB EHS services are maintained after services cease.RESUMENLa meta de las intervenciones con base en la salud mental infantil es promover el desarrollo sano de infantes y bebés por medio de promover un funcionamiento familiar sano para adoptar relaciones de apoyo entre el pequeño niño y sus importantes cuidadores. Este estudio examinó el impacto que sobre el funcionamiento familiar tiene un programa “Early Head Start” de salud mental infantil con base en casa (IMH‐HB EHS). El grupo muestra lo componen 152 familias de bajos recursos del Medio Oeste de Estados Unidos, en espera de o ya criando a un niño menor de un año de edad, que fueron asignadas al azar para recibir los servicios de IMH‐HB EHS (n=75) o a una condición comparativa (n=77). Las madres que recibieron los servicios de IMH‐HB EHS reportaron un funcionamiento sicológico y familiar más saludable, resultados que son consistentes con el enfoque de IMH, cuando sus niños tenían entre 3 y 7 años de edad. Específicamente, las madres en el grupo IMH‐HB EHS reportaron un funcionamiento y relaciones familiares más saludables, mejores habilidades para arreglárselas que eran necesarias para abogar por sus familias, así como menos estrés en el papel de crianza al ser comparadas con aquellas madres en la condición comparativa. El estudio también examinó la manera de arreglárselas buscando apoyo, algunas de las cuales cambiaron diferentemente a través del tiempo con base en las asignaciones de grupo del programa. En general, los resultados sugieren que los aspectos positivos que las familias alcanzan como resultado de participar en los servicios de IMH‐HB EHS se mantienen después que los servicios terminan.RÉSUMÉLes interventions fondées sur la santé mentale ont pour but de promouvoir le développement sain des nourrissons et des jeunes enfants en promouvant le fonctionnement saind'une famille afin de favoriser des relations de soutien entre le jeune enfant et ceux qui s'occupent d'elle ou de lui. Cette étude a examiné les impacts d'un programme américain de Early Head Start focalisé sur la santé mentale du nourrisson (abrégé IMH‐HB EHS) sur le fonctionnement de la famille. L’échantillon a compris 152 familles de milieu défavorisé de la région centre des Etats‐Unis, attendant un enfant ou s'occupant d'un enfant de moins d'un an, a qui on a assigné au hasard les services IMH‐HB EHS (n=75) ou une condition de comparaison (n=77). Les mères ayant reçu les services IMH‐HB EHS ont fait état d'un meilleur fonctionnement psychologique et familial, des résultats qui correspondent à l'objectif de santé mentale du nourrisson, lorsque leurs enfants avaient entre 3 et 7 ans. Plus spécifiquement, les mères du groupe IMH‐HB EHS ont fait état d'un meilleur fonctionnement familial et de meilleurs relations familiales, de meilleures capacités à s'adapter nécessaires afin de se porter les avocates de leurs familles, et de moins de stress de parentage comparé à celles du groupe de comparaison. L’étude a aussi examiné l'adaptation liée à la quête de soutien, qui a en partie changé différemment au fil du temps, en fonction du groupe de placement. Au bout du compte les résultats suggèrent que les gains obtenus par les familles comme résultat de la participation aux services du IMH‐HB EHS se maintiennent après que les services cessent.ZUSAMMENFASSUNGInterventionen, die auf der mentalen Gesundheit von Säuglingen basieren, zielen darauf ab, die gesunde Entwicklung von Säuglingen und Kleinkindern zu verbessern, indem ein gesundes familiäres Funktionieren gefördert wird, um unterstützende Beziehungen zwischen dem Kleinkind und ihren/seinen wichtigsten Bezugspersonen zu begünstigen. Diese Studie untersuchte die Effekte eines Early Head Start‐Hausbesuchs‐Programms (IMH‐HB EHS) auf das familiäre Funktionieren. Die Stichprobe umfasst 152 Familien mit niedrigem Einkommen aus dem Mittleren Westen der USA. Es handelt sich bei der Stichprobe um werdende Eltern oder Eltern mit einem Kind unter einem Jahr, die randomisiert einer Dienstleistung zugewiesen wurden: zum IMH‐HB EHS‐Programm (n = 75) oder zu einer Vergleichsbedingung (n = 77). Mütter, die das IMH‐HB EHS‐Programm erhielten, berichteten von gesünderem psychologischem und familiärem Funktionieren, wenn ihre Kinder im Alter zwischen 3 und 7 Jahren waren. Dies sind Ergebnisse, die mit dem IMH Fokus übereinstimmen. Im Speziellen berichteten Mütter, die in der IMH‐HB EHS‐Gruppe waren, von gesünderem familiären Funktionieren und familiären Beziehungen, besseren Bewältigungsstrategien, um für ihre Familien einzustehen und von weniger Stress in der Elternrolle verglichen mit den Müttern der Vergleichsbedingung. Die Studie untersuchte auch unterstützungssuchende Bewältigungsstrategien, von denen sich einige basierend auf der Gruppenzugehörigkeit im Laufe der Zeit in unterschiedlicher Weise veränderten. Insgesamt deuten die Ergebnisse darauf hin, dass die Gewinne, die die Familien infolge der Teilnahme am IMH‐HB EHS‐Programm erzielten, nach Ende des Programms aufrechterhalten werden.抄録乳幼児精神保健に基づく介入は、幼い子どもとその重要な養育者との間の支持的な関係性を育てるという健康な家族機能の促進を通して、乳幼児の健康な発達を促進することを目的としている。この研究は、乳幼児精神保健在宅早期ヘッドスタートInfant Mental Health home‐based Early Head Start (IMH‐HB EHS)プログラムが、家族機能に与える影響を調査した。対象はアメリカ合衆国中西部の妊娠中か1歳以下の子どもを育てている152の低所得家族で、IMH‐HB EHSサービスを受ける(n=75)か、比較の条件か(n=77)に、ランダムに割り当てられた。IMH‐HB EHSサービスを受けた母親は、子どもが3歳から7歳の間に、より健康的な心理機能および家族機能を報告した。これはIMHの焦点と一致している結果だった。特に、IMH‐HB EHS群の母親は、比較条件の母親と比べ、より健康な家族機能と関係性、家族を擁護するのに必要なよりよい対処機能、そして親役割にストレスが少ないことを報告した。研究はまた、支援を求める対処についても調査した。その一部はプログラム群への割り当てに基づいて時間経過により異なって変化していた。全体として、IMH‐HB EHSサービスに参加した結果として家族が達成し獲得したものは、サービスが終了した後も、維持されている。摘要以幼兒心理健康為基礎的介入旨在通過健康的家庭運作去培養小童與其重要看護者間的支持性關係, 以此促進幼兒和學步兒的健康發展。本文探討一個幼兒心理健康家訪早期搶步計畫 (IMH‐HB‐EHS) 對家庭運作的影響。樣本包括一百五十二個在美國中西部低入息的家庭。這些家庭正待產或在養育一個少於一歲的小孩。參與家庭被隨機分派到接受IMH‐HB‐EHS服務 (n=75) 或一個比較環境 (n=77)。有接受IMH‐HB‐EHS服務的母親報告在孩兒三至七歲間有較健康的心理和家庭運作, 這結果與IMH的焦點相附合。具體來說, 在IMH‐HB‐EHS組的母親較在比較環境組的母親報告有健康些的家庭運作和關係, 有好些的因應技巧為家庭作鼓吹, 及在親職角色中有少些壓力。本文亦探討尋求支持的因應, 發現這會根據組別分派而有不同的隨時間改變。總體而言, 探討結果顯示家庭從參與IMH‐HB‐EHS服務所得的收益在服務停止後仍會維持。Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112230/1/imhj21518.pd

Air Pollution and Odor in Communities Near Industrial Swine Operations

BackgroundOdors can affect health and quality of life. Industrialized animal agriculture creates odorant compounds that are components of a mixture of agents that could trigger symptoms reported by neighbors of livestock operations.ObjectiveWe quantified swine odor episodes reported by neighbors and the relationships of these episodes with environmental measurements.MethodsBetween September 2003 and September 2005, 101 nonsmoking volunteers living within 1.5 mi of industrial swine operations in 16 neighborhoods in eastern North Carolina completed twice-daily odor diaries for approximately 2 weeks. Meteorological conditions, hydrogen sulfide, and particulate matter ≤ 10 μm in aerodynamic diameter (PM10) were monitored in each neighborhood. We used mixed models to partition odor variance within and between people and between neighborhoods, and to quantify relationships between environmental factors and odor.ResultsParticipants reported 1,655 episodes of swine odor. In nine neighborhoods, odor was reported on more than half of study-days. Odor ratings were related to temperature, PM10, and semivolatile PM10 in standard but not mixed models. In mixed models, odor increased 0.15 ± 0.05 units (mean ± SE) for a 1-ppb increase in H2S, and 0.45 ± 0.14 units for a 10-μg/m3 increase in PM10 at wind speeds > 6.75 miles per hour. The odds of reporting a change in daily activities due to odor increased 62% for each unit increase in average odor during the prior 12 hr (t-value = 7.17).ConclusionsThis study indicates that malodor from swine operations is commonly present in these communities and that the odors reported by neighbors are related to objective environmental measurements and interruption of activities of daily life

Recommendations of Common Data Elements to Advance the Science of Selfâ Management of Chronic Conditions

PurposeCommon data elements (CDEs) are increasingly being used by researchers to promote data sharing across studies. The purposes of this article are to (a) describe the theoretical, conceptual, and definition issues in the development of a set of CDEs for research addressing selfâ management of chronic conditions; (b) propose an initial set of CDEs and their measures to advance the science of selfâ management; and (c) recommend implications for future research and dissemination.Design and MethodsBetween July 2014 and December 2015 the directors of the National Institute of Nursing Research (NINR)â funded P20 and P30 centers of excellence and NINR staff met in a series of telephone calls and a faceâ toâ face NINRâ sponsored meeting to select a set of recommended CDEs to be used in selfâ management research. A list of potential CDEs was developed from examination of common constructs in current selfâ management frameworks, as well as identification of variables frequently used in studies conducted in the centers of excellence.FindingsThe recommended CDEs include measures of three selfâ management processes: activation, selfâ regulation, and selfâ efficacy for managing chronic conditions, and one measure of a selfâ management outcome, global health.ConclusionsThe selfâ management of chronic conditions, which encompasses a considerable number of processes, behaviors, and outcomes across a broad range of chronic conditions, presents several challenges in the identification of a parsimonious set of CDEs. This initial list of recommended CDEs for use in selfâ management research is provisional in that it is expected that over time it will be refined. Comment and recommended revisions are sought from the research and practice communities.Clinical RelevanceThe use of CDEs can facilitate generalizability of research findings across diverse population and interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134268/1/jnu12233_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134268/2/jnu12233.pd