Nurse practice environments and outcomes: Implications for oncology nursing

PURPOSE/OBJECTIVES: To examine practice environments and outcomes of nurses working in oncology units or Magnet hospitals and to understand the association between the two. DESIGN: Secondary analysis of survey data collected in 1998. SETTING: Medical and surgical units of 22 hospitals, of which 7 were recognized by the American Nurses Credentialing Center Magnet program. SAMPLE: 1,956 RNs, of whom 305 worked in oncology units. METHODS: Chi-square tests compared nurse-reported outcomes by work setting, analysis of variance tested practice environment differences by setting, and logistic regression estimated the effects of practice environment, specialty, and Magnet status on outcomes. MAIN RESEARCH VARIABLES: Practice environments, emotional exhaustion, job satisfaction, and quality of care. FINDINGS: Oncology nurses had superior outcomes compared with nononcology nurses. Emotional exhaustion was significantly lower among oncology nurses working in Magnet hospitals. Scores on the Collegial Nurse-Physician Relations subscale were highest among oncology nurses. Outcomes were associated with Practice Environment Scale of the Nursing Work Index scores and Magnet status. Oncology nurses with favorable collegial nurse-physician relations were twice as likely to report high-quality care. CONCLUSIONS: Oncology nurses benefit from working in American Nurses Credentialing Center Magnet hospitals. Adequate staffing and resources are necessary to achieve optimal outcomes. Collegial nurse-physician relations appear to be vital to optimal oncology practice settings. IMPLICATIONS FOR NURSING: In addition to pursuing American Nurses Credentialing Center Magnet recognition, nurse managers should assess practice environments and target related interventions to improve job satisfaction and retention. High-priority areas for interventions include ensuring adequate staff and resources, promoting nurse-physician collaboration, and strengthening unit-based leadership.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94160/1/Nurse practice environments and outcomes Implications for oncology nursing.pd

Disparities in breast cancer care delivery: Solving a complex puzzle

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94110/1/Disparities in breast cancer care delivery Solving a complex puzzle.pd

The effects of meson mixing on dilepton spectra

The effect of scalar and vector meson mixing on the dilepton radiation from hot and dense hadronic matter is estimated in different isospin channels. In particular, we study the effect of $\sigma$-$\omega$ and $\rho-a_0$ mixing and calculate the corresponding rates. Effects are found to be significant compared to standard $\pi$-$\pi$ and $K$-${\bar K}$ annihilations. While the mixing in the isoscalar channel mostly gives a contribution in the invariant mass range between the two-pion threshold and the $\omega$ peak, the isovector channel mixing induces an additional peak just below that of the $\phi$. Experimentally, the dilepton signals from $\rho$-$a_0$ mixing seem to be more tractable than those from $\sigma$-$\omega$ mixing.Comment: 10 pages, 9 figure

Theory of Optical Tweezers

We derive a partial-wave (Mie) expansion of the axial force exerted on a transparent sphere by a laser beam focused through a high numerical aperture objective. The results hold throughout the range of interest for practical applications. The ray optics limit is shown to follow from the Mie expansion by size averaging. Numerical plots show large deviations from ray optics near the focal region and oscillatory behavior (explained in terms of a simple interferometer picture) of the force as a function of the size parameter. Available experimental data favor the present model over previous ones.Comment: 4 pages, 3 figure

Failure to rescue in the surgical oncology population: Implications for nursing and quality improvement

PURPOSE/OBJECTIVES: To analyze the frequency, type, and correlates of postoperative complications for surgical patients with cancer to illustrate practical application of the failure to rescue concept in oncology nursing practice. DESIGN: Secondary analysis of inpatient claims. SETTING: Data obtained from the Pennsylvania Health Care Cost Containment Council were linked with data from the Pennsylvania Cancer Registry. SAMPLE: 24,618 patients with solid tumors hospitalized for tumor-directed surgery in 164 acute care hospitals from 1998-1999. METHODS: Frequency distributions examined the incidence of each complication, the proportion of patients who died with the complication, and complication frequency by tumor type. Chi-square tests compared the frequency of complications for patients who were admitted routinely or via the emergency department. MAIN RESEARCH VARIABLES: 30-day mortality, postoperative complications, and tumor type. FINDINGS: The most frequent complication in the sample was gastrointestinal bleeding (13.2%); however, 37.1% of patients who died had respiratory compromise as a complication. Admission through the emergency department was significantly associated with experiencing a complication (71.9% versus 43.9%). CONCLUSIONS: Treatable but serious postoperative complications are frequent and can be fatal in the surgical oncology population. Complication frequency and fatality vary significantly by cancer type. IMPLICATIONS FOR NURSING: The complications studied are detectable by nurses and can be managed successfully with timely intervention. Recognition of complications at an early stage and evidence-based management may assist nurses in patient rescue and, ultimately, improve quality of care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94126/1/Failure to rescue in the surgical oncology population Implications for nursing and quality improvement.pd

Variations in nursing practice environments: Relation to staffing and hospital characteristics

BACKGROUND: While improvements in nursing practice environments are considered essential to address the nursing shortage, relatively little is known about the nursing practice environments in most hospitals. OBJECTIVES: The objectives of this study are to describe variations in nursing practice environments across hospitals and to examine their associations to hospital bed size, community size, teaching intensity, and nurse staffing levels. METHODS: The research design was cross-sectional analyses of nurse survey and administrative data for 156 Pennsylvania hospitals from 1999. For comparative reference, nurse survey data from earlier years from two small samples of nursing magnet hospitals were analyzed. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI). RESULTS: Nursing practice environments varied greatly among the hospitals studied. The nursing practice environments of the small samples of magnet hospitals were superior to those of the Pennsylvania sample. About 17% of the hospitals in the Pennsylvania sample had favorable practice environments. Pennsylvania hospitals with better practice environments had higher RN-to-bed ratios. Practice environment differences were not associated with hospital bed size or community size. Hospitals with a modest teaching level had less favorable environments. DISCUSSION: Considerable variation exists in the quality of hospital nursing practice environments. Five out of six hospitals are targets for improvement. Favorable nursing practice environments can be achieved in a wide variety of hospital settings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94159/1/Variations in nursing practice environments Relation to staffing and hospital characteristics.pd

Interferometry signatures for QCD first-order phase transition in heavy ion collisions at GSI-FAIR energies

Using the technique of quantum transport of the interfering pair we examine the Hanbury-Brown-Twiss (HBT) interferometry signatures for the particle-emitting sources of pions and kaons produced in the heavy ion collisions at GSI-FAIR energies. The evolution of the sources is described by relativistic hydrodynamics with the system equation of state of the first-order phase transition from quark-gluon plasma (QGP) to hadronic matter. We use quantum probability amplitudes in a path-integral formalism to calculate the two-particle correlation functions, where the effects of particle decay and multiple scattering are taken into consideration. We find that the HBT radii of kaons are smaller than those of pions for the same initial conditions. Both the HBT radii of pions and kaons increase with the system initial energy density. The HBT lifetimes of the pion and kaon sources are sensitive to the initial energy density. They are significantly prolonged when the initial energy density is tuned to the phase boundary between the QGP and mixed phase. This prolongations of the HBT lifetimes of pions and kaons may likely be observed in the heavy ion collisions with an incident energy in the GSI-FAIR energy range.Comment: 16 pages, 4 figure

Hospital characteristics, clinical severity, and outcomes for surgical oncology patients

BACKGROUND: Patients and payers wish to identify hospitals with good surgical oncology outcomes. Our objective was to determine whether differences in outcomes explained by hospital structural characteristics are mitigated by differences in patient severity. METHODS: Using hospital administrative and cancer registry records in Pennsylvania, we identified 24,618 adults hospitalized for cancer-related operations. Colorectal, prostate, endometrial, ovarian, head and neck, lung, esophageal, and pancreatic cancers were studied. Outcome measures were 30-day mortality and failure to rescue (FTR) (30-day mortality preceded by a complication). After severity of illness adjustment, we estimated logistic regression models to predict the likelihood of both outcomes. In addition to American Hospital Association survey data, we externally verified hospitals with National Cancer Institute (NCI) cancer center or Commission on Cancer (COC) cancer program status. RESULTS: Patients in hospitals with NCI cancer centers were significantly younger and less acutely ill on admission (P < .001). Patients in high volume hospitals were younger, had lower admission acuity, yet had more advanced cancer (P < .001). Unadjusted 30-day mortality rates were lower in NCI-designated hospitals (3.76% vs 2.17%;P = .01). Risk-adjusted FTR rates were significantly lower in NCI-designated hospitals (4.86% vs 3.51%;P = .03). NCI center designation was a significant predictor of 30-day mortality when considering patient and hospital characteristics (OR, 0.68; 95% CI, 0.47-0.97;P = .04). We did not find significant outcomes effects based on COC cancer program approval. CONCLUSION: Patient severity of illness varies significantly across hospitals, which may explain the outcome differences observed. Severity adjustment is crucial to understanding outcome differences. Outcomes were better than predicted for NCI-designated hospitals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94122/1/Hospital characteristics, clinical severity, and outcomes for surgical oncology patients.pd

National Cancer Institute cancer center designation and 30-day mortality for hospitalized, immunocompromised cancer patients

PURPOSE: To examine 30-day mortality and National Cancer Institute (NCI) designation for cancer patients who are immunocompromised and hospitalized. METHOD: Secondary analysis of 1998 and 1999 hospital claims, cancer registry, and vital statistics (n = 10,370) linked to survey and administrative data from 160 Pennsylvania hospitals. Logistic regression models estimated the effects of NCI designation on the likelihood of 30-day mortality. RESULTS: NCI-designated centers were associated with a 33% reduction in the likelihood of death, after adjusting for patient, hospital, and nursing characteristics. CONCLUSIONS: Immunocompromised cancer patients have lower mortality in NCI-designated hospitals. Identification and adoption of care processes from these institutions may improve mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94121/1/National Cancer Institute cancer center designation and 30-day mortality for hospitalized, immunocomprommised cancer patients.pd

Hospital variation in missed nursing care

Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care that is omitted. This article reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in 10 acute care hospitals. Missed nursing care patterns as well as reasons for missing care (labor resources, material resources, and communication) were common across all hospitals. Job title (ie, registered nurse vs nursing assistant), shift worked, absenteeism, perceived staffing adequacy, and patient work loads were significantly associated with missed care. The data from this study can inform quality improvement efforts to reduce missed nursing care and promote favorable patient outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94115/1/Hospital variation in missed nursing care.pd