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Posts from the ‘Evidence’ Category

Mixed Research Synthesis of Stress in Mothers of Preterm Infants

The current featured ANS article is titled “Posttraumatic Stress in Mothers While Their Preterm Infants Are in the Newborn Intensive Care Unit: A Mixed Research Synthesis” by Cheryl Tatano Beck, DNSc, CNM, FAAN and Jennifer Woynar, BSN, RN.  The article is available to download at no cost while it is featured on the ANS site!  Here are messages from each of the authors about their work:

Cheryl Beck:

In my qualitative program of research on traumatic childbirth, mothers have repeatedly shared how traumatic giving birth

Cheryl Tatano Beck

prematurely was. Their posttraumatic stress did not stop after giving birth but continued as their fragile infants were now in the NICU fighting for their lives.  I wanted to get a handle on just how pervasive mothers’ posttraumatic stress is while their infants are in the NICU. I decided to synthesize all the published literature I could locate- qualitative studies, quantitative studies, and mixed methods studies. In order to integrate these qualitative and quantitative findings in a single systematic review, I chose to do a mixed research synthesis. In the past I have published metasyntheses and meta-analyses but never a mixed research synthesis.  I wanted to try my hand at this type of literature review. Another reason I had for conducting this mixed research synthesis was that in teaching my PhD students I love to provide them with my own concrete examples of research that I have done to help them understand the various methods.  Over the semester I conducted this mixed research synthesis I was fortunate to have Jennifer Woynar, my wonderful co-author, as my graduate assistant. This opportunity provided Jen with hands on experience with doing this type of research synthesis which can enhance the breadth and depth of understanding complex problems or phenomena.

Jennifer Woynar

Jennifer Woynar:

As a first-year BSN-PhD student, I was excited to embark on this mixed research synthesis adventure with Dr. Beck. The connection between the qualitative and quantitative data provided me, as the reader, with both the emotional journey of mothers with preterm infants, as well as interventional studies to build on that data.  Rating the articles based on the CASP scores was engaging and I felt supported in discussing and resolving any incongruences with these ratings.  Overall this was a very meaningful experience and I hope that the reader enjoys this work.


Embedding a Palliative Approach in Nursing Care Delivery

We are delighted to feature the open access article titled “Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis” authored by Richard Sawatzky, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Joyce Lee, PhD; Leah Liang, MSN; Sheryl Reimer-Kirkham, PhD; Barb Pesut, PhD; Tilly Schalkwyk, MSN; Kelli Stajduhar, PhD; Carolyn Tayler, MSA; Jennifer Baumbusch, PhD; and Sally Thorne, PhD. This article not only addresses the significant challenges of palliative care, but also serves as an example of the translation of knowledge into practice. We welcome you to download and read the article at any time – it is permanently available at no cost to readers.  Then return here and share your comments and ideas!  This is a message from Dr. Sawatzky about the work of this team of authors:

“A palliative approach is not a service” (quote from Carolyn Tayler)

Richard Sawatzky

Although we realize that end of life care may require care from professionals who have been formally trained in palliative care, mostpeople who have life limiting illnesses receive care in settings where access to palliative care professionals is limited. To address this, our team has been studying how the notion of “a palliative approach” can help to embed general principles and practices of palliative care broadly into the healthcare system. The Initiative for a Palliative Approach in Nursing: Evidence and Leadership (, led by Kelli Stajduhar and Carolyn Tayler) engages nurse researchers, practitioners, and administrators in British Columbia, Canada, who share a common goal to integrate a palliative approach throughout the healthcare system. Building on our prior publication on “Conceptual Foundations of a Palliative Approach” (Sawatzky, Porterfield et al. 2016), the current article is one of the iPANEL studies that specifically seeks to synthesize across insights derived from different sources of knowledge relevant to a palliative approach as the basis for supporting nursing care teams to embed a palliative approach into their practice. In doing so, we have broadened the scope of what is

Pat Porterfield

typically considered “knowledge synthesis”, by translating general knowledge from previous studies into particular contexts of nursing practice. This knowledge synthesis process reflects the fundamental form of nursing knowledge application we articulated in a prior publication in ANS on “Particularizing the General” (Thorne and Sawatzky, 2014). We hope that, in addition to contributing to an understanding of a palliative approach, the article will spark further discourse about effective methodologies for particularizing general knowledge within local contexts of everyday nursing practice.

Evidence guiding culturally safe nursing practice

The current ANS featured article titled “Toward Cultural Safety Nurse and Patient Perceptions of Illicit Substance Use in a Hospitalized Setting”  is based on a collaborative project that focuses on cultural safety in health care.  The authors, Bernadette (Bernie) Pauly, PhD, RN; Jane McCall, MSN, RN; Annette J. Browne, PhD, RN; J. Parker, MA and Ashley Mollison, MA shared this background about their work:

Our article describes an ethnographic research project examining the experiences of people who use illicit drugs and nurses who provide care for them in acute care settings. The idea for this research emerged from a recognition that people who are identified as using illicit drugs and facing socio-economic disadvantages often experience stigma when accessing health care services. Nurses working at Insite, Vancouver’s supervised injection site, found that cultural safety helps to mitigate stigma when working with people who use illicit drugs, so this project set out to explore what cultural safety might look like with this population in other settings. Cultural safety was developed in New Zealand to address persistent health inequities experienced by Maori people and has been a strategy to enhance care for people experiencing the negative effects of stigma, racism and other forms of discrimination, and ongoing marginalization.

In exploring the meaning of cultural safety, from the perspectives of people who use illicit drugs and nurses, participants described 3 main conceptualizations of illicit drug use, as 1) individual failings; 2) criminal activity, and 3) a disease of ‘addiction’. They discussed how these intersect to negatively impact access to care, management of pain, and access to of harm reduction supplies.

In relation to illicit drug use, cultural safety can prompt nurses and other healthcare providers about the importance of situating drug use in the history of the criminalization of drug use, and how continued legacies of that criminalization impact the care that people receive, preventing people from accessing health services now and in the future. Creating culturally safe(r) environments involves health care professionals
examining their own values and conceptualizations of drug use, and about people who use drugs, and how that might affect practices and policies in acute care

This project would not have been possible without the leadership and input from a peer advisory committee comprised of members of the Society of Living Illicit Drug Users (SOLID), an organization run by and for people who use(d) illicit drugs. The peer advisory met regularly throughout the project to provide direction on the interview questions, strategies for data collection, and input on research findings. A nurse advisory committee provided parallel leadership and direction to the research process. The advisory groups ensured that the research questions were relevant, that the process of data collection was attentive to needs of participants, and that the research findings were interpreted within an appropriate context of lived experience and practice. Together with the research team, the nurses and peers developed a practical set of recommendations for practice.

The results of the research were presented at two hospital forums where advisory committee members, nurses and managers discussed how research recommendations could be implemented through changes to hospital policy and practice. As a result of the research there have been changes to hospital harm reduction policies and practices. Today, the cultural safety bulletin is being mobilized by SOLID to offer peer-run trainings to front line health and social service providers.

This article is available for download without cost while it is featured on the ANS web site!  Download and read it now!  Then come back here and share your comments – we would be delighted to hear from you!

Modifying barriers to screening for memory loss


L to R: Drs. Tappan, Weise & Williams

Our current featured article presents an analysis of research that provides evidence for removing barriers to cognitive screening in rural populations.  The article, titled “Analysis of Barriers to Cognitive Screening in Rural Populations in the United States,” is by Florida Atlantic University scholars  Lisa Kirk Wiese, PhD, RN; Christine L. Williams, RN, DNSc, PMHCHS-BC and Ruth M. Tappen, RN, EdD, FAAN.  You can access their article without charge on the ANS web site while it is featured!  They have each prepared a message for ANS readers, plus a video sharing some background about their work.  We welcome your comments and perspectives on this important work in the comments below!

Dr. Wiese: I became interested in research about cognitive screening in rural populations as I am from WV and my mother has Alzheimer’s disease.  WV has the second highest percentage of older adults in the country, and is the only state that lies completely in Appalachia.  Appalachia has the highest sustained rates of poverty in the US, higher rates of diabetes and hypertension, less health insurance, and is less educated than the rest of the country.

Dr. Williams: Rural populations overall have a high incidence of dementia yet unique barriers to screening hinder awareness of the risk. Appalachians have geographical challenges that impact access to care. Early recognition of cognitive impairment is vital because the medications we have available to slow cognitive decline are more effective when patients are treated early. Early detection may help prevent negative consequences by ruling out treatable conditions that can cause cognitive impairment such as medication effects, cardiovascular conditions, or depression; offering treatments of cognitive and behavioral symptoms; maintaining the patients’ safety; and facilitating support for caregivers.

Dr. Tappen: Although public awareness of Alzheimer’s disease (AD) has increased exponentially, there are still many myths and misunderstandings particularly among underserved populations. In prior research done with urban underserved populations, participants described the effect of AD on the brain as “the brain collapsing in on itself.” Others talked about shaking and tremors, probably confusing AD with Parkinson’s disease and several mentioned becoming “like a baby” again. Myths and misunderstandings about AD are often a barrier to cognitive screening.


Preventing Hospital Readmission

The current “Post-Hospital Nursing” featured article provides a report of a study to determine hospital admission variables that might predict a risk for re-admission.  The article, titled “Can Nurses Tell the Future? Creation of a Model Predictive of 30-Day Readmissions,” is authored by Adonica Dugger, DNP; Susan McBride, PhD; and Huaxin Song, PhD.  Dr. Dugger sent this message about this work for ANS readers:

Hello, and thank you for your interest in our article published in the current issue of Advances in Nursing Science, “Can nurses predict the future? Creation of a model to predict readmissions.”   I would also like to thank Advances in Nursing Science for the privilege of having the article published. The journey to the research for this project started, as I was a director for case management and was attempting to identify patients who may have a readmission to my hospital. I Dugger-Adonica_400thought of all the factors that I, and my fellow case managers, felt, when present, would likely predict a readmission to the hospital.   I reviewed many of the predictive models available in the literature, but I couldn’t find one I felt addressed the population of patients seen at my hospital in West Texas.   At that point I wasn’t sure what to do next, but I soon started my studies toward a DNP at Texas Tech University Health Science Center.   Soon after beginning, I met Susan McBride and learned how a predictive model was created and validated. With guidance from Dr McBride and Dr Song, I was able to examine the data and create a model to predict the patients most likely to readmit to my hospital within 30 days.

Through this project, I have learned much about how a nurse with a PhD and one with a DNP can work together to solve a problem and put the solutions into practice more quickly. These partnerships allow for a nurse’s practice to be truly evidence based and help to improve the quality of care we give to our patients in the acute care setting. I also learned the value of the data that is available as the use of electronic health records grow throughout Texas and the nation. Nurses can use this data to help prove both how and why changes to current practices should and could be made.

Since this article was submitted in April of 2014, I have moved from case management back into the surgical services area of the hospital. We are looking at ways to predict our daily, weekly, and monthly case loads, which patients may be more likely to have a post operative infection, and factors that will delay our case starts. Throughout the hospital, change is also being considered with predictive modeling, as nurses examine our patients with pressure ulcers and seek to determine if a risk scoring system specific to our patient population can be created.

You can download this article for free while it is featured on the ANS web site!  Read this article, then return here and share your comments!

Racism and Children’s Mental Health: Evidence for Practice

The authors of the current ANS feature article titled “Perceived Discrimination and Children’s Mental Health Symptoms,” Cheryl L. Cooke, PhD, MN, RN; Bonnie H. Bowie, PhD, MBA, RN; and Sybil Carr`ere, PhD, present the results of their study the association between perceived discrimination and children’s symptoms of anxiety and depression. The results of their study contributes to evidence that is needed for research, teaching and practice that can intervene to alleviate the harmful effects of racism and discrimination. I am delighted to include here a video they have prepared for the ANS audience, followed by a written message providing more background about their work! I encourage you to download the article while it is featured from the ANS web site, read it and then return here to engage wth us in discussion of the very important issues that their work has addressed.

More from the authors:

Our article on health inequities is based on data from our five-year longitudinal study of families with a child transitioning from middle childhood to adolescence – the Family Health Project. All 3 of us were members of the University of Washington School of Nursing. At the beginning of the Family Health Project in 2000, Cheryl Cooke was a post-doctoral fellow, Bonnie Bowie was a doctoral student, and Sybil Carrère was a research professor. Our goal was to look at family emotional dynamics, and more specifically, parenting practices that were associated with children exhibiting good physical and mental health.   We wanted to learn from “expert” parents what works best in raising happy, healthy children who do well in social and academic worlds. Our premise was that when parents help their children to learn about their emotions and what to do in emotionally overwhelming situations (e.g., bullies at school, grief, anger, stress), that the children are better able to meet the challenges that society presents them. The longitudinal study was funded by a grant from the National Institute of Mental Health (MH42484). Our work was also supported by subsequent funding from the National Institute for Nursing Research (P30 NR04001; T32 NR07039)), National Institute of Child Health and Human Development (P30 HD 02274) and the National Institute of Minority Health and Health Disparities (P20MD002722), and National Institute on Drug Abuse (T32 DAO7257-14).

Our initial plan was to recruit a sample of families in the Puget Sound area which over-represented ethnic and racial minorities, relative to the demographics of the area. As we began recruiting our sample for the study, we found a high number of Multiracial families volunteering to be a part of the study. This happy coincidence led us to alter our sampling strategy such that we created 3 matched groups of families: Multiracial, African American, and European American families. The families were matched on marital satisfaction and neighborhood crime statistics.

As we interacted with our families in their homes and in our laboratory, we began to see some compelling patterns in the kinds of information parents imparted to their children in order to help their children’s emotional development and ability to navigate the stressors of childhood. We observed that racial and ethnic minority family members discussed some of the discrimination they encountered – both the parents and the children. This lead us to the conclusion that we needed to assess both the parents and the children’s perceptions of discrimination, even if the timing of our anecdotal observations meant we would only be able to measure perceived discrimination in the final time point of the study. We wanted to find a questionnaire that would tap into discrimination that might be experienced by any ethnic or racial group. This proved a challenge because most of the perceived discrimination scales at the time of our study focused on the African American experience. We were fortunate to find the Perceived Ethnic Discrimination questionnaire by Brondolo and her colleagues (2005) that measures perceived discrimination experienced by any racial or ethnic group. We were able to use the questionnaire with the parents and children in our 3rd and final time point of the study. The results of this paper stem from the inclusion of this questionnaire in our research project.

One of the joys of the Family Health Project was the strong collegial bonds and friendship the three of us have developed and maintained over the course of our work on the research. This paper brings together our interests in the impact of discrimination on families – particularly families of color, parenting practices that lead to optimal trajectories of children’s emotional development, and health inequities. We are very excited about what we learned from the analyses presented in this paper – but, as usual, it raises many more questions that we hope to pursue, together, in the future.

Brondolo, E., Kelly, KP, Coakley, V., et. al. The perceived discrimination questionnaire; development and preliminary validation of a community version. Journal of Applied Social Psychology. 2005. 35(2): 335-365.

What’s the Point of the Evidence Debate?

We have just published ahead of print an article that will be published in the first issue of 2014!  The article is titled “Particularizing the General: Sustaining Theoretical Integrity in the Context of an Evidence-Based Practice Agenda” by Sally Thorne, PhD, RN, FAAN, FCAHS and Richard Sawatzky, PhD, RN.  Dr. Thorne and Dr. Sawatzky have extended their discussion of the “evidence” debate with this message for ANS blog readers:

Although we realize that “the evidence debate” may seem like a tired topic for some readers, we think it remains one of the most important avenues through which nurses can find their grounding in why the philosophy of science really matters to our discipline. Health and public policy get made on the basis of a complex and highly

Dr. Sally Thorne

Sally Thorne, PhD, RN, FAAN, FCAHS

politicized combination of ideology and science. We tend to think about ideology as if it exists in the world of “the other” and not in our own disciplinary knowledge. And yet, we must recognize that nursing has always been driven by so much more than just empirical science or philosophy, even if we sometimes struggle with how to name, conceptualize and justify those other forms of knowledge that influence our practice.

For us, the history of theoretical and philosophical knowledge-building in nursing is quite fascinating. Although it has taken a lot of twists and turns along the way (some of them sufficiently awkward as to be downright embarrassing), once you clear away the “noise” and reflect on what many of the founding nurse theorists and scholars were struggling with, you realize that they were grappling with incredible complexities. The language they used was sometimes a bit convoluted or misleading, and the competitiveness among the individual theorists and their disciples was at times unseemly. Nevertheless they were trying to work out ways of conceptualizing the rather marvelous constellation of intellectual and behavioral competencies that characterize the practice of nursing when it is done at its best, in order that we could improve our capacity to help nurses achieve that.

Of course if nursing were derived from a simple skillset, then that theorizing and philosophizing would have been

Dr. Sawatzky

Richard Sawatzky, PhD, RN

easy.  But it is not. And that’s what makes the story so fascinating. Patients are complex and adaptive, and so are we. The social and ideational worlds within which people experience health and illness are dynamic, multilayered, and fraught with uncertainties and complexities.  The thinking nurse – that nurse we refer to as “expert” within his or her population group or setting – is always skillfully navigating that great chasm between science (which represents the general past) and context (which represents the particular moment), not to mention looking forward to considerations of possible implications for the future.

In re-entering the “evidence debate” in this manner, we wanted to juxtapose ideas about how we make sense of knowledge that comes from certain kinds of formally derived scientific processes with those that have to do with nursing’s inherent interest in the individual case. We believe that the trend towards standardized practice in health care during recent decades (e.g., reliance on general clinical practice guidelines) is increasingly at odds with notions of heterogeneity and individual differences (or “anti-standardization”), such as those prompted by field of personalized medicine. Just as many forms of medical management are moving away from population-based science (i.e., reliance on population averages) toward novel targeted and individualized therapies arising from genomics, proteomics and pharmacogenomics, we believe that nurses will need systems and structures through which to focus and strengthen individualized care and patient-centered approaches. These are not simply vague abstractions, but complex and challenging dimensions of the intellectual approach that nurses must always bring to their practice.

So for us, it seems useful to really push nurses toward clarity in what does and does not constitute evidence in the conventional sense. Slippage with how we frame the basis of what we think we know will only serve to discredit our profession as a credible contributor to the larger world that is wrestling with these evolving ideas. We are concerned that the tendency to reconceptualize certain forms of knowledge as “evidence,” in an attempt to obtain credibility, will not serve the nursing well. Nursing practice and theories are unavoidably influenced by many valuable forms of nursing knowledge that do not necessarily conform to conventional notions of “evidence.” Rather than “branding” all nursing knowledge as “evidence,” nurses are challenged to articulate what these “non-evidential” forms of knowledge are and what the basis is of their justification. We want to remobilize an enthusiasm for why nurses ought to care about the nursing theory world by bringing into focus the relevance that disciplinary thought has in the larger world of contested practices and influence upon futures.

We keep returning to this idea that the dialectic between the general and the particular is really the essential element in the uniqueness of nursing knowledge, our defining characteristic, the idea best captures what we are.  As we continue to develop our collective expertise and wisdom with regard to evidence generation and interpretation – figuring out how we learn about the patients of the future through systematic and rigorous exploration of the past – it will be imperative that we not forget the “artform” of individualized holistic care, enacting relational practice, and taking an intersectional lens on the social determinants that may be shaping the health and illness experience of the patient who is before us in the moment.

Thanks for taking this journey with us, and we look forward to a lively debate!

You can download this article at no charge now on the ANS web site!  Get it, read it, and come back here to engage in this very important, and interesting debate!

Evidence for creating distance delivery systems

We are now featuring the article titled “Barriers to Mental Health Care: Perceived Delivery System Differences” by Patricia Lingley-Pottie,  PhD, BNRN, CCRC; Patrick J. McGrath, PhD, OC, FRSC; and Pantelis Andreou, PhD.  This article reports the results of a study designed to explore differences between distance and face-to-face delivery of care for families with children who have mental health problems.  They used tools to measure perceived treatment barriers, therapeutic processes, and outcomes.  Their results provide evidence that distance delivery is a viable mode of health care delivery and has potential to bridge gaps in delivery that exist for marginalized populations. In Dr. Lingley-Pottie’s description of her work, she explains how her program of research has evolved; we include here links to the two articles that precede this one so that you can explore more background leading to this article.

It is an honor to have our manuscript published in Advances in Nursing Science (ANS). This is the final paper of my PhD dissertation and the last in a series of three that have been published in ANS. My research focuses on exploring the distance treatment experience from the participants’ perspective. The participants received Strongest Families intervention, evidence-based, psychologically informed mental health services that are delivered from a distance using highly-trained, non-professional coaches. Strongest Families was designed to ensure that neither time nor distance are barriers to care; coaching calls are scheduled at times convenient to families.

With the emergence of new distance service delivery systems and a scarcity of research in the field of pediatric mental health via telehealth using non-professionals, we decided to plan a series of research studies involving Strongest Families intervention programs.

Our initial research showed that therapeutic alliance existed in the absence of face-to-face contact between a coach and adult or child participant. The qualitative data collected to examine the participants’ opinions about advantages and disadvantages of distance treatment versus a face-to-face treatment experience (Lingley-Pottie & McGrath, 2007) suggested enhanced therapeutic alliance, uninhibited self-disclosure and the virtual elimination of stigma, which were attributed to visual anonymity and privacy offered by the distance setting. Results suggested that the barriers that exist with traditional mental health services were absent with Strongest Families. Moreover, results indicated possible differences in therapeutic processes between systems, informing the next projects.

An extensive literature search revealed that existing theoretical frameworks are based on face to face intervention and may not sufficiently apply to distance treatment, especially if a new phenomenon such as visual anonymity has an impact on therapeutic processes. Moreover, existing scales were primarily derived from professional opinion and may not adequately capture important participant or end service user information. To further examine differences between delivery systems (Distance versus face-to-face), we developed and validated a scale (Treatment Barrier Index-TBI) that was grounded in the participants’ distance experience to ensure inclusion of concepts relevant to the distance treatment and the end users’ perspective (Lingley-Pottie & McGrath, 2011).

The TBI was then used in this current study, the featured publication, to explore differences in perceived barriers to care and therapeutic process between two delivery systems (distance versus face-to-face). The results showed significantly Dal.Psych.2013-300fewer barriers associated with distance treatment and suggests significant differences in therapeutic processes between systems. Therapeutic alliance and self-disclosure significantly influenced the TBI score, favoring distance treatment and supporting the assumption that distance systems offering visual anonymity may eliminate the negative effects of stigma that some individuals experience with face-to-face treatment.

Innovative, cost-effective delivery systems are an important key to health care reform. These interesting findings will hopefully inform and generate more research in distance system design as well as stimulate the rethinking of existing theories and their relevance or applicability to distance treatment. Continued research will be important to ensure that programs are designed to meet the users’ needs and yield strong health outcomes. Nurses are often at the forefront of innovation in service delivery. We have the potential to make a significant contribution in this exciting, developing field of research.

Visit the ANS web site today!  You can download this current article at no cost while it is featured, and also connect to the other articles published by these authors!

Designing Evidence-based Practice

If you are interested in a model for designing approaches in practice that are evidence-based, this is the article for you!  The article is titled Development and Testing of an Intervention to Improve Outcomes for Partners Following Receipt of an Implantable Cardioverter Defibrillator in the Patient” and is authored by Cynthia M. Dougherty, PhD, FAHA, FAAN, ARNP; Elaine A. Thompson, PhD, RN; and Peter J. Kudenchuk, MD, FACC, FAHA.  Go to the ANS web site while this article is featured, and you can download a copy of the article free of charge!

This “Editor’s Pick” article describes how the authors used the results of three research studies to design and test a “patient and partner” nursing intervention for patients in the time after they return home from receiving an implantable cardioverter defibrillator. Dr. Dougherty has shared this photograph of the team that worked on this project, and a brief description description of their work:


P+P Research Team, University of Washington, School of Nursing, 2012

Back Row:  Dr. Elaine Thompson (Author), Lisa Foley, Susanne Steffes, Chayna Davis, Lisa Hales, Mary Strasser.

Front Row:  Pagna Prom, Seieun Oh, Caylene Castagno, Dr. Cynthia Dougherty (Author).

Since 1990, Dr. Dougherty has been working with patients who suffer cardiac arrest and receive an ICD and their families.  This research program spans numerous iterations in the technological development of the implantable defibrillator (ICD) as well ever changing patient populations who are eligible to receive the ICD.  The paper outlines a series of investigations that have lead to the formal testing of the patient and partner (P+P) intervention after ICD study, currently funded by the National Heart, Lung, and Blood Institute of the NIH.


Prevention of Re-hospitalization

One of the most important preventable factors that contributes to high medical costs for the elderly is re-hospitalization.  In the current “Editor’s Pick” article, Dr. Hong Tao, PhD, RN, and her colleagues (Carol Hall Ellenbecker, PhD, RN; Jie Chen, PhD; Lin Zhan, PhD, RN, FAAN and Joanne Dalton, PhD, APRN,BC) provide specific evidence that can be used in reaching the goal of preventing re-hospitalization.  The article, titled “The Influence of Social Environmental Factors on Rehospitalization Among Patients Receiving Home Health Care Services,” summarizes a study based guided by Orem’s Self-Care theory.  The researchers conducted a retrospective study of the Outcome and Assessment Information Set (OASIS) records of 1268 elderly patients, 262 of whom were rehospitalized within the first 20 days of being enrolled in home care.  The two hypotheses of the study were supported, providing important evidence that can be considered in designing programs aimed toward prevention of rehospitalization.

Dr. Tao shared this description of how this study evolved, as well as her current and future research activities:

I embarked on this program of research during my doctoral studies supervised by Dr. Ellenbecker, whose expertise is health policy and home healthcare. Since the Prospective Payment System case mix methodology does not contain

Hong Tao and Carol Ellenbecker

Hong Tao and Carol Ellenbecker

OASIS items that are cited as triggers for social work referrals, we realized that it may be critical to find evidence that social environmental factors could be independent predictors for readmission and should be assessed to identify high-risk patients.

The findings of the study summarized in this article have led to a series of studies and expanding collaboration to sites in Wisconsin where I am now residing. In a recently conducted pilot study of Visiting Nurses and case managers we found that the early identification of changes in health condition by family members is a factor in preventing re-hospitalization. Families’ ability to identify changes in health condition in a timely manner was influenced by three primary factors: effective communication between healthcare providers and patients/families; supportive self-care/family-care guidance; and patient and family member’s perception of constricted option (e.g. the hospital is the only place/first option at all times). My future research will focus on developing an intervention to reduce re-hospitalization targeting family members of elderly patients with multiple comorbid conditions, who are discharged to home healthcare immediately following hospitalization.

This is an excellent example of research based on a nursing framework that has broad applicability for all disciplines concerned with prevention of rehospitalization.  You can download your own copy of this article now, at no charge!  Visit the ANS web site today!



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