National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 114 Research Studies DisplayedThate JA, Couture B, Schnock KO
Information needs and the use of documentation to support collaborative decision-making: implications for the reduction of central line-associated blood stream infections.
It is clear that interdisciplinary communication and collaboration have the potential to mitigate healthcare-associated harm, yet there is limited research on how communication through documentation in the patient record can support collaborative decision making. Understanding what information is needed to support collaborative decision making is necessary to design electronic health information systems that facilitate effective communication and, ultimately, safe care. To explore this issue, the investigators focused on information needs related to central venous catheter management and the prevention of central line-associated blood stream infections.
AHRQ-funded; HS0235335.
Citation: Thate JA, Couture B, Schnock KO .
Information needs and the use of documentation to support collaborative decision-making: implications for the reduction of central line-associated blood stream infections.
Comput Inform Nurs 2020 Nov 2;39(4):208-14. doi: 10.1097/cin.0000000000000683..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Shared Decision Making, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing
Smith JG, Rogowski JA, Lake ET
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
Being unable to provide required nursing care to infants could contribute to poorer neonatal nurse job outcomes, which may exacerbate staffing challenges. Little evidence exists about how missed nursing care relates to neonatal nurse job outcomes. The purpose of this study was to determine relationships among missed nursing care, job enjoyment and intention to leave for neonatal nurses.
AHRQ-funded; HS024918.
Citation: Smith JG, Rogowski JA, Lake ET .
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
J Nurs Manag 2020 Nov;28(8):1940-47. doi: 10.1111/jonm.12943..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Provider: Nurse, Provider, Burnout, Nursing
Gance-Cleveland B, McDonald CC, Walker RK
Use of theory to guide development and application of sensor technologies in nursing.
In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice.
AHRQ-funded; HS024738; HS018646.
Citation: Gance-Cleveland B, McDonald CC, Walker RK .
Use of theory to guide development and application of sensor technologies in nursing.
Nurs Outlook 2020 Nov-Dec;68(6):698-710. doi: 10.1016/j.outlook.2020.04.007..
Keywords: Health Information Technology (HIT), Nursing, Health Services Research (HSR), Research Methodologies
Lake ET, Staiger DO, Cramer E
Association of patient acuity and missed nursing care in U.S. neonatal intensive care units.
The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. The authors conducted a correlational study of using 2016 NICU registered nurse survey responses from the National Database of Nursing Quality Indicators. They found that 36% of nurses missed one or more care activities on their past shift. The most common activities missed involved patient comfort and counseling and parent education. They recommended that nurses' assignments account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger DO, Cramer E .
Association of patient acuity and missed nursing care in U.S. neonatal intensive care units.
Med Care Res Rev 2020 Oct;77(5):451-60. doi: 10.1177/1077558718806743..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Nursing, Quality Indicators (QIs), Quality of Care
Burns Z, Khasnabish S, Hurley AC
Classification of injurious fall severity in hospitalized adults.
The purpose of this project was to refine the National Database of Nursing Quality Indicators Major injury classification to derive a valid and reliable categorization of the types and severities of Major inpatient fall-related injuries. Three subcategories were created: A - injuries that caused temporary functional impairment, major facial injury without internal injury, or disruption of a surgical wound; B - injuries that caused long-term functional impairment or had the potential risk of increased mortality; and C - injuries that had a well-established risk of mortality. These subcategories enhanced the National Database of Nursing Quality Indicators categorization. Using this project’s administration manual, trained personnel can classify injurious fall severity with excellent reliability.
AHRQ-funded; HS025128.
Citation: Burns Z, Khasnabish S, Hurley AC .
Classification of injurious fall severity in hospitalized adults.
J Gerontol A Biol Sci Med Sci 2020 Sep 25;75(10):e138-e44. doi: 10.1093/gerona/glaa004..
Keywords: Elderly, Falls, Injuries and Wounds, Nursing, Quality Measures, Quality Indicators (QIs), Quality of Care, Inpatient Care
Bettencourt AP, Vance AJ, Jun J
Maximizing the academic nursing model in the era of COVID-19 and beyond.
This opinion paper revisits the 2016 American Association of Colleges of Nursing (AACN) position statement on academic nursing. In the age of COVID-19, the statement is reimagined as a means to maximize nursing’s contributions to this global health crises. The 2016 position statement discussed the potentials for nursing schools to work within healthcare systems beyond clinic training. Most academic nurses do not also provide clinical care which is limited by structural barriers that inhibit academic nursing transformation. Many academic nurses who also have a clinical practice have had to do so on their own time. This new vision would capitalize on nursing’s strength in population health. The authors urge nursing schools to transform their model of academic nursing.
AHRQ-funded; HS024552.
Citation: Bettencourt AP, Vance AJ, Jun J .
Maximizing the academic nursing model in the era of COVID-19 and beyond.
Nurs Outlook 2020 Sep-Oct;68(5):542-44. doi: 10.1016/j.outlook.2020.04.013..
Keywords: COVID-19, Nursing, Provider: Nurse, Public Health, Education: Academic
Simpson KR, Lyndon A, Spetz J
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
MCN Am J Matern Child Nurs 2020 Sep/Oct;45(5):280-88. doi: 10.1097/nmc.0000000000000644..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Breast Feeding, Inpatient Care, Nursing, Women
Shuman CJ, Costa DK
Stepping in, stepping up, and stepping out: competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks.
In this paper, the authors discuss competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks. They draw on the recent example of COVID-19s substantially burdened intensive care units and nursing staff. Informed by extant literature, American Organization of Nurse Leaders--identified competencies, and expert opinion, the authors suggest 3 areas of focused skill development to ensure leaders, especially leaders in ICU settings, are prepared for future crises.
AHRQ-funded; HS024552.
Citation: Shuman CJ, Costa DK .
Stepping in, stepping up, and stepping out: competencies for intensive care unit nursing leaders during disasters, emergencies, and outbreaks.
Am J Crit Care 2020 Sep 1;29(5):403-06. doi: 10.4037/ajcc2020421..
Keywords: Critical Care, Provider: Nurse, Nursing, COVID-19, Emergency Preparedness
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Dowding D, Russell D, Trifilio M
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Investigators sought to understand if and how home care nurses identify patients at high risk of infection and which strategies they use to mitigate that risk. Interviews with fifty nurses were audio recorded and transcribed. Factors identified by the nurses as putting a patient at higher risk of infection included being older, having diabetes, and inadequate nutrition as well as inadequate clinical information available at start of care. The main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviors and the ability to adjust a patient's plan of care according to their infection risk.
AHRQ-funded; HS024723.
Citation: Dowding D, Russell D, Trifilio M .
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Int J Nurs Stud 2020 Jul;107:103617. doi: 10.1016/j.ijnurstu.2020.103617..
Keywords: Home Healthcare, Community-Acquired Infections, Infectious Diseases, Patient Safety, Prevention, Nursing, Shared Decision Making
Baernholdt M, Yan G, Hinton ID
Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years.
This study looked at the effects of nursing care interventions aimed at preventing pressure ulcers in rural and urban hospitals over a 4-year period. This longitudinal study used unit-level data from the National Database of Nursing Quality Indicators 2010-2013. The authors analyzed 5761 units (332 rural and 5429 urban) in 772 hospitals (89 rural and 683 urban) that reported ulcer rates in two or more quarters. Outcomes from use of a three-care intervention combination was measured with decreases in pressure ulcers shown from any of those interventions (patients receiving skin assessment on admission, receiving risk assessment on admission, and receiving any risk assessment before the pressure ulcer). An increase in RN skill mix and two nurse outcomes (increase in job satisfaction and intent-to-stay) also led to decreases in ulcer rates.
AHRQ-funded; HS023147.
Citation: Baernholdt M, Yan G, Hinton ID .
Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years.
Int J Nurs Stud 2020 May;105:103455. doi: 10.1016/j.ijnurstu.2019.103455..
Keywords: Pressure Ulcers, Prevention, Skin Conditions, Nursing, Practice Patterns, Provider: Nurse, Provider, Quality Indicators (QIs), Quality Measures, Quality of Care
Nembhard IM, Buta E, Lee YSH
A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers.
The authors assessed effects of adding care coordination formally to nurses’ roles on care experiences of high-risk patients and clinician teamwork during the first 6 months of use. They conducted a quasi-experimental study in which changes in staff and patient experiences at six community health center practice locations that introduced the added-role approach for high-risk patients were compared to changes in six locations without the program in the same health system. They found that there were some positive effects of adding care coordination to nurses' role within 6 months of implementation, suggesting value in this improvement strategy. They concluded that addressing compatibility between coordination and other job demands is important when implementing this approach to coordination.
AHRQ-funded; HS016978.
Citation: Nembhard IM, Buta E, Lee YSH .
A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers.
BMC Health Serv Res 2020 Feb 24;20(1):137. doi: 10.1186/s12913-020-4986-0..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Care Coordination, Nursing, Patient Experience, Community-Based Practice, Patient-Centered Healthcare, Ambulatory Care and Surgery, Teams
Kelly Costa D, Liu H, Boltey EM
The structure of critical care nursing teams and patient outcomes: a network analysis.
This examined the connectiveness of critical nursing teams and patient outcomes. The study measured “coreness” (the degree to which a network is represented by a densely integrated core) and “betweenness” (whether a nurse lies on the path of others not directly connected). The researchers used ICU data from a medical center during 2011 and looked at nurses who worked in surgical ICU (SICU) or neurosurgical ICU (NICU) during that same time period. The sample included 598 adult patients and 281 nurses. The researchers found that the greater the coreness of the team, and the more betweenness there was with ICU nurses the less likely patients were to die.
AHRQ-funded; HS024552.
Citation: Kelly Costa D, Liu H, Boltey EM .
The structure of critical care nursing teams and patient outcomes: a network analysis.
Am J Respir Crit Care Med 2020 Feb 15;201(4):483-85. doi: 10.1164/rccm.201903-0543LE..
Keywords: Intensive Care Unit (ICU), Critical Care, Nursing, Teams, Outcomes, Healthcare Delivery, Patient-Centered Outcomes Research, Patient-Centered Healthcare
Krein SL, Kuhn L, Ratz D
Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: a survey-based study.
The authors identified the prevalence of and factors associated with having a designated nurse peripherally inserted central catheter (PICC) team among U.S. acute care hospitals. They found that nurse PICC teams inserted PICCs in more than 60% of U.S. hospitals during the study period. Moreover, certain practices to prevent central line-associated bloodstream infection, including maximum sterile barrier precautions, chlorhexidine gluconate for insertion site antisepsis, and facility-wide insertion checklists were regularly used by a higher percentage of hospitals with nurse PICC teams compared with those without. They concluded that nurse PICC teams play an integral role in PICC use at many hospitals and that use of such teams may promote key practices to prevent complications.
AHRQ-funded; HS022835.
Citation: Krein SL, Kuhn L, Ratz D .
Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: a survey-based study.
J Patient Saf 2019 Dec;15(4):293-95. doi: 10.1097/pts.0000000000000246..
Keywords: Nursing, Teams, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Inpatient Care, Hospitals, Patient Safety, Prevention, Provider: Nurse, Provider
Kreutzer L, Yang AD, Sansone C
Barriers to providing VTE chemoprophylaxis to hospitalized patients: a nursing-focused qualitative evaluation.
This study analyzed barriers for administration of VTE chemoprophylaxis to hospitalized patients from nurses. Researchers conducted 14 focus group interviews with nurses from five inpatient units to assess their perceptions of barriers to administration of VTE chemoprophylaxis. Barriers included nurses’ misconceptions that patients did not require chemoprophylaxis, their uncertainty when counseling patients on the importance of chemoprophylaxis, and a lack of comparative data regarding specific refusal rates.
AHRQ-funded; HS024516.
Citation: Kreutzer L, Yang AD, Sansone C .
Barriers to providing VTE chemoprophylaxis to hospitalized patients: a nursing-focused qualitative evaluation.
J Hosp Med 2019 Nov 1;14(10):668-72. doi: 10.12788/jhm.3290..
Keywords: Blood Clots, Patient Safety, Prevention, Inpatient Care, Care Management, Nursing
Hande K, Christenbery T, Phillippi J
Appreciative advising pilot study: an innovative approach to advising doctor of nursing practice students.
The purpose of this pilot study was to determine the feasibility of a doctor of nursing practice (DNP) appreciative advising model to advise students through the rigors of DNP education and improve student and faculty satisfaction. Faculty were provided with comprehensive guidebooks and received orientation on the model; qualitative responses were analyzed using content analysis. Results showed that the student and faculty participants reported satisfaction with the model and commented that the model allowed for early identification of needs and was helpful and worthwhile. These results suggest that the model may hold promise as a solution to assist students in adjusting to DNP education.
AHRQ-funded; HS024733.
Citation: Hande K, Christenbery T, Phillippi J .
Appreciative advising pilot study: an innovative approach to advising doctor of nursing practice students.
Nurse Educ 2019 Jul/Aug;44(4):187-91. doi: 10.1097/nne.0000000000000593..
Keywords: Provider: Nurse, Nursing, Education: Academic, Education: Continuing Medical Education
Wang J, Gephart SM, Mallow J
Models of collaboration and dissemination for nursing informatics innovations in the 21st century.
This study analyzed four nursing informatics projects to inform future informatics innovations. Four case studies were given a comparative cross-case analysis and were analyzed through the lens of the Informatics Research Organizing Model.
AHRQ-funded; HS022908.
Citation: Wang J, Gephart SM, Mallow J .
Models of collaboration and dissemination for nursing informatics innovations in the 21st century.
Nurs Outlook 2019 Jul - Aug;67(4):419-32. doi: 10.1016/j.outlook.2019.02.003..
Keywords: Health Information Technology (HIT), Nursing
Simpson KR, Lyndon A, Spetz J
Adaptation of the MISSCARE Survey to the maternity care setting.
This paper examines the feasibility of using the Missed Nursing Care (MISSCARE) Survey to study missed nursing care during labor and delivery. This survey has not been used to examine childbirth care although it is the most common reason for hospitalization in the United States. A modified version called the Perinatal Missed Care Survey appears to be the most feasible and promising instrument to evaluate missed nursing care during labor and delivery.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Adaptation of the MISSCARE Survey to the maternity care setting.
J Obstet Gynecol Neonatal Nurs 2019 Jul;48(4):456-67. doi: 10.1016/j.jogn.2019.05.005..
Keywords: Labor and Delivery, Maternal Care, Nursing, Pregnancy, Women
Liu J, Larson E, Hessels A
Comparison of measures to predict mortality and length of stay in hospitalized patients.
This study compared performance of five measures in order to predict mortality and length of stay (LOS) in hospitalized adults using claims data; the measures included three comorbidity composite scores, 3 M risk of mortality, and 3 M severity of illness subclasses. Binary logistic and zero-truncated negative binomial regression models were applied to a 2-year retrospective dataset of adult inpatient admissions from a large hospital system in New York City. All five measures demonstrated a good to strong model fit for predicting in-hospital mortality. The authors conclude that these measures can guide nurse managers in assigning nursing care and coordinating patient services, as well as administrators in supporting optimal nursing care more effectively and efficiently.
AHRQ-funded; HS024915.
Citation: Liu J, Larson E, Hessels A .
Comparison of measures to predict mortality and length of stay in hospitalized patients.
Nurs Res 2019 May/Jun;68(3):200-09. doi: 10.1097/nnr.0000000000000350..
Keywords: Hospitalization, Mortality, Nursing, Patient Safety, Risk
Monsees EA, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Integrating bedside nurses into antibiotic stewardship: a practical approach.
This study looked into a framework for nurses to integrate antibiotic stewardship (AS) into their clinical work with patients. The practices that nurses can take include improving antibiotic prescribing practices through appropriate obtainment of Cloistridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation of antibiotic allergy histories, and through the prompting of antibiotic time outs. Barriers were also identified to engagement of nurses in AS and offered potential solutions.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Monsees EA, Tamma PD, Cosgrove SE .
Integrating bedside nurses into antibiotic stewardship: a practical approach.
Infect Control Hosp Epidemiol 2019 May;40(5):579-84. doi: 10.1017/ice.2018.362..
Keywords: Antibiotics, Antimicrobial Stewardship, Guidelines, Healthcare-Associated Infections (HAIs), Medication, Nursing, Patient Safety
Holmes E, Thompson D, Michell D
An inpatient HIV support nurse to promote engagement in outpatient HIV care.
In this paper, the investigators describe an inpatient HIV support nurse to promote engagement in outpatient HIV care. It provides two case reports and a discussion. The investigators indicate that their hospital has employed an RN specializing in HIV care coordination for more than a decade on their dedicated HIV unit and has recently created a position to extend this work to PLWH who have been admitted to the 42 other adult units in their hospital.
AHRQ-funded; R01 HS024079.
Citation: Holmes E, Thompson D, Michell D .
An inpatient HIV support nurse to promote engagement in outpatient HIV care.
J Assoc Nurses AIDS Care 2019 Mar-Apr;30(2):245-48. doi: 10.1097/jnc.0000000000000017..
Keywords: Human Immunodeficiency Virus (HIV), Patient and Family Engagement, Care Coordination, Nursing, Healthcare Delivery
Manojlovich M, Frankel RM, Harrod M
Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad.
Poor communication between physicians and nurses continues to contributor to adverse events in the hospital setting. This article evaluates the use of video reflexive ethnography (VRE) as a means of improving communication and improving patient safety, and concludes that video-record communication between physicians and nurses during patient care rounds is feasible and acceptable.
AHRQ-funded; HS024760.
Citation: Manojlovich M, Frankel RM, Harrod M .
Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad.
BMJ Qual Saf 2019 Feb;28(2):160-66. doi: 10.1136/bmjqs-2017-007728..
Keywords: Adverse Events, Communication, Hospitals, Nursing, Patient Safety
Jarrin OF, Pouladi FA, Madigan EA
International priorities for home care education, research, practice, and management: qualitative content analysis.
The purpose of this study was to articulate an international vision for the future of home care education, research, practice, and management shared by experienced home care nurses working in leadership roles. Four major themes emerged, in this qualitative study, reflecting international priorities for the future of home care education, research, practice, and management: 1) Build the evidence base for home care; 2) Design better systems of care; 3) Develop leaders at all levels; and 4) Address payment and policy issues.
AHRQ-funded; HS022406.
Citation: Jarrin OF, Pouladi FA, Madigan EA .
International priorities for home care education, research, practice, and management: qualitative content analysis.
Nurse Educ Today 2019 Feb;73:83-87. doi: 10.1016/j.nedt.2018.11.020..
Keywords: Education: Continuing Medical Education, Healthcare Delivery, Home Healthcare, Nursing, Provider
Kutney-Lee A, Sloane DM, Bowles KH
Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment.
This study assessed the role of electronic health record (EHR) adoption and work environment for nurses. If the EHR system has positive usability ratings it impacts quality of care. Over 12,000 nurses in 353 hospitals were surveyed.
AHRQ-funded; HS023805.
Citation: Kutney-Lee A, Sloane DM, Bowles KH .
Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment.
Appl Clin Inform 2019 Jan;10(1):129-39. doi: 10.1055/s-0039-1678551..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing, Provider: Nurse, Quality of Care
de Cordova PB, Steck MBW, Vermeesch A
Health policy engagement among graduate nursing students in the United States.
This study researched the availability and requirements for graduate nursing students to take a dedicated health policy course. American Association of College of Nursing (AACN) member institution students were polled and over 75% reported taking a health policy course. There was an equal distribution between master’s and doctoral students.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Steck MBW, Vermeesch A .
Health policy engagement among graduate nursing students in the United States.
Nurs Forum 2019 Jan;54(1):38-44. doi: 10.1111/nuf.12295..
Keywords: Education: Continuing Medical Education, Nursing, Policy, Provider: Nurse