Clinical Nursing Research

Care transitions involve coordination of patient care across multiple care settings. Many problems occur during care transitions resulting in negative patient outcomes and unnecessary readmissions. The purpose of this study was to describe the experience of care transitions from patient, caregiver, and health-care provider perspectives in a single metropolitan Midwest city. A qualitative descriptive design was used to solicit patients’, caregivers’, and health-care providers’ perceptions of care transitions, their role within the process, barriers to effective care transitions, and strategies to overcome these barriers. Five themes emerged: preplanned admissions are ideal; lack of needed patient information upon admission; multiple services are needed in preparing patients for discharge; rushed or delayed discharges lead to patient misunderstanding; and difficulties in following aftercare instructions. Findings illustrated provider difficulty in meeting multiple care needs, and the need for patient-centered care to achieve positive outcomes associated with quality measures, reduced readmissions, and care transitions.

Emergency departments (ED) are a point of care for many young adults and may provide a teachable moment leading to behavioral change. We determined the descriptive epidemiology of health-compromising behaviors in the young adult ED population by computing demographic-adjusted estimates of prevalence and frequency of hazardous drinking, risky driving, cigarette smoking, fast-food consumption, lack of exercise, and sleep deficit. We screened 8,815 young adults during an ED visit. Younger males had higher levels of fast-food and cigarette consumption. Non-Whites and females reported more days of little to no exercise. Whites and older individuals reported more nights of less sleep. Younger Whites reported consuming the most alcohol, with males consuming more than females. Risky driving was more frequent among younger males. Prevalence of health-compromising behaviors varied by demographics, but was higher than in the general population. Prevention strategies such as implementing a teachable moment in the ED may hold promise to reduce health-compromising behaviors.

This qualitative and descriptive study examined the feasibility of a bed-height alert system as a fall-prevention strategy. The alpha prototype was developed to measure and record bed height, and to remind staff to keep patient beds in the lowest position. This pilot project was conducted in a 52-bed adult acute surgical inpatient care unit of a Michigan community hospital. Qualitative and quantitative information was gathered during semistructured interviews of nursing staff (18 RNs and 13 PCAs; January-April 2011). Descriptive content analysis and descriptive analyses were performed. The overall response rate was 44.9%. The mean values of the feasibility questions are all favorable. Staff’s comments also support the view that the alert system would promote patient safety and prevent falls. In short, this system was found to be somewhat useful, feasible, appropriate, and accurate. It has the potential to promote patient safety and prevent bed-associated injurious falls in inpatient care settings.

The objective of this research was to study influence of birth routines on mother–infant interaction at Day 4. The present research is part of a longitudinal study where mother–infant pairs were randomized by infant location and apparel. We intended to assess mother–infant interaction from videos filmed at Day 4. A protocol for the assessment/coding of the affective quality of maternal behaviors indicative of early mother–infant interaction was developed and interculturally validated. Results were compared with birth randomization, as to explain impact of birth practices. Findings indicate that separation and swaddling at birth interfered with mother–infant interaction during a breastfeeding session at Day 4; these mothers significantly demonstrated more roughness in their behaviors with their infants at Day 4. Results also show evidences of a sensitive period for separation after birth. Implications are to encourage immediate and uninterrupted skin-to-skin contact at birth, and rooming-in during postpartum, as recommended in World Health Organization/UNICEF Ten Steps for Successful Breastfeeding.

Neonatal intensive care unit (NICU) light and noise may be stressful to preterm infants. This research evaluated the physiological stability of 54 infants born at 28- to 32-weeks’ gestational age while wearing eye goggles and earmuffs for a 4-hour period in the NICU. Infants were recruited from four NICUs of university-affiliated hospitals and randomized to the intervention–control or control–intervention sequences. Heart rate (HR), heart rate variability (HRV), and oxygen saturation (O₂ sat) were collected using the SomtéTM device. Confounding variables such as position and handling were assessed by videotaping infants during the study periods. Results indicated that infants had more stress responses while wearing eye goggles and earmuffs since maximum HR was found to be significantly higher and high-frequency power of HRV significantly lower during the intervention as compared with the control period. Therefore, this intervention is not recommended for the clinical practice.

While showering is thought to be an effective coping strategy during labor, research on this comfort measure is lacking. The purpose of this study was to measure effectiveness of therapeutic showering on pain, coping, tension, anxiety, relaxation, and fatigue in labor. A quasi-experimental pretest-posttest single group design was conducted in a community hospital. Participants were women who had singleton, uncomplicated pregnancies and were in active labor at term (N = 24). After completing pretest measures, participants took a 30 min shower where they were encouraged to be seated but could choose positions of comfort. There were significant reductions in tension and anxiety and increased relaxation and coping. Showering may be a safe and effective comfort measure for healthy, laboring women who are experiencing tension or anxiety, or having difficulty relaxing or coping with labor. Further research is needed to test the maternal and neonatal outcomes of this nonpharmacologic comfort measure.

The aims of the study were to validate the English and Spanish Versions of the Health-Promoting Lifestyle Profile II (HPLP II) with Hispanic male truck drivers and to determine if there were any differences in drivers’ responses based on driving responsibility. The methods included a descriptive correlation design, the HPLP II (English and Spanish versions), and a demographic questionnaire. Fifty-two Hispanic drivers participated in the study. There were no significant differences in long haul and short haul drivers’ responses to the HPLP II. Cronbach’s alpha for the Spanish version was .97 and the subscales alphas ranged from .74 to .94. The English version alpha was .92 and the subscales ranged from .68 to .84. Findings suggest the subscales of Health Responsibility, Physical Activities, Nutrition, and Spirituality Growth on the HPLP II Spanish and English versions may not adequately assess health-promoting behaviors and cultural influences for the Hispanic male population in the southwestern border region.