Recent Research Publications and Funding

  •  | February 1, 2008 6:00AM

    OBJECTIVES: This study considered the factors that facilitated or prevented nursing assistants (NAs) from engaging in restorative care activities. DESIGN: This was a qualitative study using a focus group methodology. SETTING: Study participants were recruited from 6 nursing homes. PARTICIPANTS: Participants were nursing assistants (NAs) from a study testing the implementation of a restorative care intervention (Res-Care) study. Of the 244 NAs recruited from the 6 treatment sites, 179 were available at 12 months and 93 (52%) participated in the study. MEASUREMENT: An interview guide was used during each of the focus groups. Data analysis was done using basic content analysis. RESULTS: Sixty-one codes were identified and reduced to 4 themes: facilitators of restorative care; barriers to restorative care; benefits of restorative care; and sustaining restorative care. CONCLUSION: The findings provide an important NA perspective with regard to implementation of a restorative philosophy of care and provide recommendations for future work in this area.  

  •  | February 1, 2008 6:00AM

    The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence.

  •  | February 1, 2008 6:00AM

    The authors conducted confirmatory factor analyses of reports of posttraumatic stress reactions using a national probability sample of individuals indirectly exposed to the terrorist attacks of September 11, 2001 (n = 675). Reactions at three time points in the year after the attacks were best accounted for by a lower-order, 4-factor solution (Reexperiencing, Strategic Avoidance, Emotional Numbing, and Hyperarousal Symptoms). Indirect exposure to a traumatic event appears to induce a response with a similar symptom structure as responses to direct exposure.

  •  | January 1, 2008 6:00AM

    OBJECTIVE: The purpose of this study was to describe clinicians' evaluation and management of co-existing mental health, substance abuse (MHSA), and chronic pain (CP) conditions in patients with prolonged critical illness. Little is known about the evaluation and management of these conditions in the intensive care unit, and practice guidelines do not address management in the context of critical illness, optimal sedation/analgesia, or ventilator weaning.

    DESIGN: Longitudinal qualitative description.

    SETTING: Intensive care unit of an urban academic medical center.

    PATIENTS: Total of 12 patients with co-existing MHSA or CP conditions who were weaning from mechanical ventilation.

    INTERVENTIONS: Intensive care unit clinicians, patients, and family members were formally interviewed and directly observed in the critical care setting for 56 consecutive weeks.

    MEASUREMENTS AND MAIN RESULTS: Transcribed interviews, field notes, and clinical records, representing >400 documents, were reviewed and coded using constant comparative analysis to identify the facilitators, barriers, contextual factors, and consequences associated with the evaluation and management of MHSA and CP conditions. Numeric clinical data supplemented and clarified thematic findings. Facilitators of MHSA and CP evaluation and management included family as history keepers, the use of subspecialty consultations, and anticipated alcohol withdrawal. Barriers included limited history taking and assessment of MHSA and CP conditions and the use of cognitive shortcuts. Consequences included nonintegration of MHSA and CP medications and diagnoses, episodic pharmacologic responses to psychobehavioral symptoms, and clinician-patient interpersonal tension. Contextual factors involved ambiguous psychobehavioral symptomatology, patients' critical illness and inability to speak, and competing clinical goals.

    CONCLUSIONS: The explicit evaluation and management of MHSA and CP conditions was highly variable and inconsistent across cases. Findings suggest that MHSA and CP conditions require monitoring and management similar to that required for other chronic conditions. Multidisciplinary, individual-level, and system-level responses are warranted to address the complex interplay of barriers, consequences, and context.


  •  | January 1, 2008 6:00AM

     The concept of continuing bonds (CB) is a human response to health and illness within paediatric palliative care. This literature review aims to: define and explain the significance of CB; describe the history of the concept; critically analyze the literature related to CB; and make recommendations for future research. Exploration of CB as a response to life-threatening illness and to losing a child is significant in terms of improving care for children and their families living with life-threatening illness. This paper focuses on children with a life-threatening illness, but CB also needs to be studied with other populations, such as those with life-limiting conditions.

  •  | January 1, 2008 6:00AM

    OBJECTIVE: People living in rural areas have the same incidence of mental illness but far less access to mental health services compared with people living in urban areas. This brief report describes the workforce of advanced-practice psychiatric nurses (APPNs) and explores their potential to ease the rural mental health workforce shortage. 

    METHODS: National certification data were used to describe workforce characteristics and the rural distribution of APPNs. All nationally certified APPNs in 2003 were included (N=8,751). 

    RESULTS:APPNs were more likely than psychiatrists to live in rural areas. The ratio of APPNs to state rural populations ranged from .06 to 14.9. The mean SD ratio of APPNs per 100,000 in the rural population was 3.0±3.0. 

    CONCLUSIONS: APPNs have great potential to be a solution to the rural mental health workforce shortage. Even so, the number of APPNs must increase and barriers to their full scope of practice must be removed.

  •  | December 14, 2007 6:00AM

    Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women's health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.  

  •  | December 1, 2007 6:00AM

    BACKGROUND: Most prior research on the outcomes of restorative care programs has been focused on resident outcomes including such things as functional performance, behavior, and quality of life. Treatment fidelity issues and compliance with the programs were not addressed in these studies. Without such an evaluation, it is impossible to evaluate the effectiveness of restorative care activities. PURPOSE: To test the reliability and validity of the Restorative Care Behavior Checklist (RCBC), which is an observed measure of restorative care activities performed by nursing assistants (NAs). METHODS: The study involved a single observation of care activities and completion of survey data among NAs working in nursing homes. A total of 386 participants from eight nursing homes were included in the study. In addition to completion of the RCBC during a 15-minute observation of care activities, demographic data were obtained, and participants completed a paper-and-pencil survey that included assessments of self-efficacy, outcome expectations, knowledge of restorative care, and job attitude. Reliability testing was based on person separation reliability and interrater reliability. Validity testing was based on evidence of the unidimensionality of the measure, the fit of the items using Rasch analysis, and evidence of convergent validity. RESULTS: There was support for the reliability of the RCBC with a person separation reliability of .77 and interrater reliability, with 83% to 100% agreement on each of the care activities. Support for validity was provided based on evidence of unidimensionality and a good fit of the items. There was minimal support for convergent validity. DISCUSSION: The development and psychometric testing of the RCBC are an important first step in the observational assessment of restorative care activities performed by NAs, or other caregivers of older adults, living in long-term care settings.

  •  | December 1, 2007 6:00AM

    Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

  •  | December 1, 2007 6:00AM

    This study examined adolescents’ adjustment following the attacks of September 11, 2001 (9/11). A Web-based survey was administered 2 weeks and 7 months postattacks to a national sample of adolescents (N =104). A randomly selected parent also completed a survey at the 7-month assessment. Although exposure to the attacks was indirect, over half the participants felt threatened. Adolescents’ posttraumatic stress symptoms were associated with their acute stress symptoms, parental distress, parental coping advice, parental availability to discuss the attacks, and reports that 9/11-related discussions were unhelpful. Adolescents’ distress symptoms were associated with a history of mental health problems, acute stress symptoms, and parental unavailability to discuss the attacks.