Factors Associated with Inpatient Falls and Injurious Falls in Acute Care Hospitals

Inpatient falls and injurious falls in acute care settings have significant impact on patients. Despite the implementation of several federal initiatives in preventing falls and injurious falls, inpatient falls and injurious falls still are prevalent in the United States. Inpatient falls and injurious falls are a complicated phenomenon and can be contributed to multilevel factors including organization at the hospital and unit levels, nursing care process, and patient-specific factors. However, gaps exist in the literature on the associations of injurious falls with multilevel factors. The purpose of this study was to examine the associations of injurious falls in acute care hospitals with multilevel factors including hospital and unit structure, nursing care process, and patient-specific factors. The modified Donabedian Structure–Process–Outcome (SPO) model was used as a conceptual framework to guide the study. This cross-sectional, correlational study used July 2013 to June 2014 data from the National Database of Nursing Quality Indicators® (NDNQI®). The STATA (Version 14) was used to conduct hierarchical regression analyses to examine the significance of association of injurious falls with multilevel factors including organizational structure (i.e., hospital size, teaching status, and Magnet® status), unit structure (i.e., nurse staffing and unit type), nursing care process (i.e., falls without employee assistance, fall risk assessment, implementation of fall prevention protocol, and physical restrain use) and unit patient population factors for patients who fell (i.e., gender, and fall risk status). The results of the study suggested hospital structure (i.e. teaching status), unit structure (i.e. surgical unit and RN hours per patient day), unit nursing care process (i.e. falls without employee assistance), unit patient population characteristics (i.e. at fall risk) and 1000 patient days were significantly associated with incidence of injurious falls. The findings from this study provide further knowledge on multilevel factors contributing to inpatient injurious falls. Nurse leaders, researchers and policy makers may develop, implement and improve fall prevention programs based on the identified risk factors. The study also provides important implications for future research on injurious fall prevention in acute care hospitals

Relationships Among Substance Use, Multiple Sexual Partners, and Condomless Sex: Differences Between Male and Female U.S. High School Adolescents

Male and female students manifest different behaviors in condomless sex. This cross-sectional, exploratory, correlational study examined the differences in risk factors for condomless sex between male and female high school students, using secondary data from 4,968 sexually active males and females participating in the 2011 National Youth Risk Behavior Survey. Results in descriptive statistics and multivariate binary logistic regressions revealed that condomless sex was reported as 39.70% in general. A greater proportion of females engaged in condomless sex (23.26%) than did males (16.44%). Physical abuse by sex partners was a common reason for failure to use condoms regardless of gender. Lower condom use was found in (1) those experiencing forced sex by a partner in males, (2) female smokers, and (3) female with multiple sex partners. Thus, sexual health education should address the different risk factors and consider gender characteristics to reduce condomless sex

Nursing Interventions to Manage Postoperative Delirium: An Integrative Literature Review

Postoperative delirium is prevalent and has adverse effects on patients and healthcare organizations. This literature view evaluates the effect of nursing interventions in postoperative delirium management. Findings suggest nursing interventions have a positive impact on preventing and managing postoperative delirium

Hierarchical Modulation with Vector Rotation for E-MBMS Transmission in LTE Systems

Enhanced Multimedia Broadcast and Multicast Service (E-MBMS) is considered of key importance for the proliferation of Long-Term Evolution (LTE) network in mobile market. Hierarchical modulation (HM), which involves a “base-layer” (BL) and an “enhancement-layer” (EL) bit streams, is a simple technique for achieving tradeoff between service quality and radio coverage. Therefore, it is appealing for MBMS. Generally, HM suffers from the severe performance degradation of the less protected EL stream. In this paper, HM with vector rotation operation introduced to EL stream is proposed, in order to improve EL's performance. With the proper interleaving in frequency domain, this operation can exploit the inherent diversity gain from the multipath channel. In this way, HM with vector rotation can effectively enhance multimedia broadcasting on quality video and coverage. The simulation results with scalable video coding (SVC) as source show the significant benefits in comparison with the conventional HM and alternative schemes

A Vibration Model of Ball Bearings with a Localized Defect Based on the Hertzian Contact Stress Distribution

To study the vibration mechanism of ball bearings with localized defects, a vibration model of a ball bearing based on the Hertzian contact stress distribution is proposed to predict the contact force and vibration response caused by a localized defect. The calculation of the ball-raceway contact force when the ball passes over the defect is key to establishing a defect vibration model. Hertzian contact theory indicates that the contact area between the ball and the raceway is an elliptical contact surface; therefore, a new approach is used to calculate the ball-raceway contact force in the defect area based on the stress distribution and the contact area. The relative motion between the inner ring, the outer ring, and the balls is considered in the proposed model, and the Runge-Kutta algorithm is used to solve the vibration equations. In addition, vibration experiments of a bearing with an outer ring defect under different loads are performed. The numerical signals and experimental signals are compared in the time and frequency domains, and good correspondence between the numerical and experimental results is observed. Comparisons between the traditional model and the proposed model reveal that the proposed model provides more reasonable results

Amino-functionalized NUS-8 nanosheets as fillers in PIM-1 mixed matrix membranes for CO2 separations

Journal of Membrane Science64

Investigation on Roles of Packing Density and Water Film Thickness in Synergistic Effects of Slag and Silica Fume

The ternary blended cement with finer slag and silica fume (SF) could improve the packing density (PD) through the filling effect. The excess water (water more than needed for filling into voids between the cement particles) can be released to improve the fresh properties and densify the microstructure which is beneficial for improving the hardened properties. To verify the hypothesis and reveal how and why (cement + slag + SF) the ternary blends could bring such advantages, the binder pastes incorporating slag and SF with various water-to-binder ratios were produced to determine the PD experimentally. To evaluate the optimum water demand (OWD) for maximum wet density, the influence of the dispersion state of the binder on PD was investigated using the wet packing density approach. The effect of PD of various binary and ternary binder systems on water film thickness (WFT), fluidity, setting time, and compressive strength development of cement paste was also investigated. The results show that the ternary blends could improve the PD and decrease the water film thickness (WFT). The enhanced PD and altered WFT are able to increase fluidity and compressive strength. The ternary blends could improve the compressive strengths by increasing PD and exerting nucleation and pozzolanic effects

Outcomes Associated with Stage 2 Pressure Injuries Among Surgical Critical Care Patients: A Retrospective Cohort Study

Background Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined outcomes of stage 2 pressure injuries among critical care patients. Objectives To examine outcomes of stage 2 hospital-acquired pressure injuries among critical care patients and identify factors associated with nonhealing stage 2 hospital-acquired pressure injuries. Methods Electronic health record data were used to identify surgical critical care patients with stage 2 hospital-acquired pressure injuries at a level I trauma center. Univariate Cox regressions were used to identify factors associated with healed stage 2 hospital-acquired pressure injuries. Results Of 6376 surgical critical care patients, 298 (4.7%) developed stage 2 hospital-acquired pressure injuries; complete data were available for 253 patients. Of these 253 patients, 160 (63%) had unhealed pressure injuries at hospital discharge. Factors inversely related to the presence of a healed hospital-acquired pressure injury were older age (hazard ratio, 0.98; 95% CI, 0.97-0.99; P = .003), elevated serum lactate (hazard ratio, 0.85; 95% CI, 0.75-0.96; P = .01), elevated serum creatinine (hazard ratio, 0.87; 95% CI, 0.77-0.98; P = .02), and lower oxygenation (hazard ratio, 0.64; 95% CI, 0.41-1.00; P = .05). Conclusions Stage 2 hospital-acquired pressure injuries were not healed at discharge in 63% of the patients in our sample. Nurses should be especially vigilant in treating pressure injury patients who are older, have altered oxygenation or perfusion (elevated serum lactate level or decreased oxygenation), or have evidence of renal compromise