Predictors and Outcomes of Postpartum Mothers\u27 Perceptions of Readiness for Discharge after Birth

Objective: To identify predictors and outcomes of postpartum mothers\u27 perceptions of their readiness for hospital discharge. Design: A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables. Setting: Midwestern tertiary perinatal center. Participants: One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants. Methods: Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data. Main Outcome Measures: Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services. Results: Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers\u27 perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses\u27 skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services. Conclusion: A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth

Rankings Matter: Nurse Graduates from Higher-ranked Institutions Have Higher Productivity

Background Increasing demand for baccalaureate-prepared nurses has led to rapid growth in the number of baccalaureate-granting programs, and to concerns about educational quality and potential effects on productivity of the graduating nursing workforce. We examined the association of individual productivity of a baccalaureate-prepared nurse with the ranking of the degree-granting institution. Methods For a sample of 691 nurses from general medical-surgical units at a large magnet urban hospital between 6/1/2011–12/31/2011, we conducted multivariate regression analysis of nurse productivity on the ranking of the degree-granting institution, adjusted for age, hospital tenure, gender, and unit-specific effects. Nurse productivity was coded as “top”/“average”/“bottom” based on a computation of individual nurse value-added to patient outcomes. Ranking of the baccalaureate-granting institution was derived from the US News and World Report Best Colleges Rankings’ categorization of the nurse’s institution as the “first tier” or the “second tier”, with diploma or associate degree as the reference category. Results Relative to diploma or associate degree nurses, nurses who had attended first-tier universities had three-times the odds of being in the top productivity category (OR = 3.18, p \u3c 0.001), while second-tier education had a non-significant association with productivity (OR = 1.73, p = 0.11). Being in the bottom productivity category was not associated with having a baccalaureate degree or the quality tier. Conclusions The productivity boost from a nursing baccalaureate degree depends on the quality of the educational institution. Recognizing differences in educational outcomes, initiatives to build a baccalaureate-educated nursing workforce should be accompanied by improved access to high-quality educational institutions

Resonant-state expansion for open optical systems: Generalization to magnetic, chiral, and bi-anisotropic materials

The resonant-state expansion, a recently developed powerful method in electrodynamics, is generalized here for open optical systems containing magnetic, chiral, or bi-anisotropic materials. It is shown that the key matrix eigenvalue equation of the method remains the same, but the matrix elements of the perturbation now contain variations of the permittivity, permeability, and bi-anisotropy tensors. A general normalization of resonant states in terms of the electric and magnetic fields is presented.Comment: 4 page

Through the Eye of the Beholder: Multiple Perspectives on Quality in Women\u27s Health Care

Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of care, how well they were treated, and the responsiveness of the provider to their needs. This qualitative study using a semi-structured interview defined quality from the perspectives of patients, physicians, nurses, and payers associated with a hospital-based women\u27s service line, and how the attributes of quality varied among the multiple groups. The study also described how stakeholders become aware of quality and how they determined a hospital\u27s quality. From the findings of the study, a conceptual framework of quality in women\u27s health was developed

Decay of correlations in the dissipative two-state system

We study the equilibrium correlation function of the polaron-dressed tunnelling operator in the dissipative two-state system and compare the asymptoptic dynamics with that of the position correlations. For an Ohmic spectral density with the damping strength $K=1/2$, the correlation functions are obtained in analytic form for all times at any $T$ and any bias. For $K<1$, the asymptotic dynamics is found by using a diagrammatic approach within a Coulomb gas representation. At T=0, the tunnelling or coherence correlations drop as $t^{-2K}$, whereas the position correlations show universal decay $\propto t^{-2}$. The former decay law is a signature of unscreened attractive charge-charge interactions, while the latter is due to unscreened dipole-dipole interactions.Comment: 5 pages, 5 figures, to be published in Europhys. Let

A Substruction Approach to Assessing the Theoretical Validity of Measures

Background Validity is about the logic, meaningfulness, and evidence used to defend inferences made when interpreting results. Substruction is a heuristic or process that visually represent the hierarchical structure between theory and measures. Purpose To describe substruction as a method for assessing the toretical validity of research measures. Methods Using Fawcett\u27s Conceptual-Theoretical-Empirical Structure. an exemplar is presented of substruction from the Individual and Family Self-Management Theory to the Striving to be strong study concepts and empirical measures. Results Substruction tables display evidence supporting theoretical validity of the instruments used in the study. Conclusion A high degree of congruence between theory and measure is critical to support the validity of the theory and to support attributions made about moderating, mediating, causal relationships, and intervention effects

Development and Psychometric Analysis of The Patient Perceptions of Patient-Empowering Nurse Behaviours Scale (PPPNBS)

Aim To (1) develop and psychometrically test the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale, which measures patient perceptions of empowering nurse behaviours during hospitalization; and (2) refine to a shorter, more useful form, for measurement in clinical settings. Background Although patient empowerment has been promoted as a way to engage patients in chronic illness care, there is not a measure reported by patients as recipients of empowering nurse behaviours during hospitalization. Design Psychometric evaluation of construct and predictive validity, reliability and item reduction. Method Data gathered during hospitalization and six weeks postdischarge between April 2012 - August 2014 were used to determine the validity and reliability of the long and short-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale in a sample of 395 chronically ill medical and surgical adult patients. Results The long and short-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale demonstrated strong reliability and convergent validity with pre-discharge 13-item Patient Activation Measure scores. Both forms of the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale predicted postdischarge 13-item Patient Activation Measure scores and the long-form predicted physical health status. Confirmatory factor analysis demonstrated improved model fit for the short-form instrument when compared with the long-form fit. The short-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale explained 98% of the variance of the long-form Patient Perceptions of Patient-Empowering Nurse Behaviours Scale. Conclusion The results provide evidence supporting reliability and validity of both forms. While the scales measure patient reports and not direct observation of empowering nurse behaviours, incorporating patients\u27 experiences as recipients of care is necessary to validate the contribution of nursing care to patients\u27 engagement in chronic illness management