Browsing by Subject "nursing"
Now showing 1 - 11 of 11
- Results Per Page
- Sort Options
Item Bibliography: Nursing Research and Practice with Refugees.(Center for Urban and Regional Affairs, University of Minnesota, 1990) Muecke, Marjorie A.Item Caring for our Caregivers: an Evaluation of the Minnesota Safe Patient Handling Act(2020-05) Rosebush, ChristinaBackground Minnesota is one of 12 states to pass safe patient handling legislation aimed at reducing high rates of musculoskeletal disorders (MSDs) in health care workers.1 MSD rates are 2- and 3- times higher in U.S. hospitals and nursing homes, respectively, compared to the private sector average.2 Further, MSDs comprise almost half of all reportable injuries in these settings.2 State safe patient handling (SPH) laws generally require health care facilities to implement multicomponent safe patient handling programs. Studies of multicomponent programs in large health care systems show substantial reductions in reportable injuries and workers’ compensation claims, but few evaluations of statewide mandates have been conducted. The 2007 Minnesota Safe Patient Handling (MN SPH) Act requires each health care facility to obtain adequate assistive lifting equipment and create a written safe patient handling plan and committee. The effectiveness of the law in nursing homes is of particular interest due to the frequency of patient handling tasks, challenging physical environment, and unique workforce comprised largely of certified nursing assistants (CNAs). To evaluate the MN SPH Act and better protect Minnesota nursing home workers, studies are needed to characterize patient handling injuries by occupation, assess temporal trends in injuries following enactment of the MN SPH Act, and compare Minnesota’s experience to states without SPH legislation. Objective The overall objectives of this research are to provide a profile of patient handling injuries in Minnesota nursing home workers and to evaluate the effectiveness of the MN SPH Act in reducing workers’ compensation claims. Results will be used to inform future safe patient handling policymaking and to identify groups of Minnesota workers and types of facilities in need of additional state outreach and support. Manuscript 1: Aim: Compare workers’ compensation indemnity claim rates and severity among occupational groups in Minnesota nursing homes. Methods: Negative binomial and linear regression models with generalized estimating equations were used with 2005-2016 data from the statewide workers’ compensation database to model the effect of occupation on type of workers’ compensation indemnity claim. Minnesota Nursing Home Report Card data were used to calculate claim rates by occupation. Results: Claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers in CNAs, licensed practical nurses (LPNs), and registered nurses (RNs), respectively. CNAs were more likely to experience musculoskeletal and patient handling injuries than RNs. However, their claims were less likely to result in temporary total disability or permanent partial disability benefits and more likely to result in stipulation settlements. Manuscript 2: Aim: Compare pre- and post-MN SPH Act trends in patient handling injury claim rates among Minnesota nursing homes and assess whether temporal trends are modified by facility-level staffing and retention. Methods: Negative binomial regression models with generalized estimating equations were used with 2005-2016 statewide workers’ compensation data matched to Centers for Medicare and Medicaid Services data to evaluate the impacts of time, staffing, and retention on patient handling injuries. Results: Compared to 3 pre-law years, the patient handling indemnity claim rate declined by 38% in years 7-9 following enactment of the MN SPH Act. Claims for all other injuries and illnesses declined by 20%. The association between time and patient handling claims was not modified by staffing or retention. However, across time, nursing homes with annual staff retention ≥75% (vs. <65%) had a 17% lower patient handling injury claim rate. Manuscript 3: Aim: Compare injury trends in Minnesota nursing homes, hospitals, and outpatient facilities to Wisconsin, a state without safe patient handling legislation. Methods: Mixed effects negative binomial regression models were used with 2005-2017 workers’ compensation data from a single large insurer. The effects of the MN SPH Act were evaluated by assessing the interaction between state and time period on workers’ compensation claim outcomes. Results: In both Minnesota and Wisconsin, patient handling injuries comprised the largest proportion of claims in nursing homes (54% and 45%, respectively) and smallest proportion in outpatient facilities (6% for both states). The change in mean annual facility-level patient handling claims from pre-law (2005-2007) to second post-implementation (2014-2017) did not differ between states. Further, changes in patient handling claims over time did not differ by healthcare setting. Conclusion Temporal trends in workers’ compensation indemnity claims suggest that the MN SPH Act may have successfully reduced patient handling injuries in Minnesota nursing homes. However, among health care facilities enrolled with a single large insurer, the change in indemnity and medical only workers’ compensation claims from pre-law to post-implementation did not differ between Minnesota and Wisconsin, a state without SPH legislation. Due to data limitations, including a small Wisconsin sample size, more research comparing Minnesota to states without legislation is needed. In Minnesota, state support of the law should target nursing homes with elevated claim rates, including those that have low staff retention, are non-profit, not affiliated with a hospital, or outside the Twin Cities metropolitan area. Further, additional support is needed to prevent and accommodate patient handling injuries among nursing home CNAs, an occupation with high patient handling and MSD injury rates and adverse workers’ compensation claim outcomes.Item Collaborative Rural Nurse Practitioner Survey: Results and Technical Report.(Minnesota Center for Survey Research (MCSR), 2000) Minnesota Center for Survey ResearchItem Housing Options for Low-Income Elderly.(Study conducted as part of the High Rise Nursing Project of the School of Nursing. Part I of a series of III, 1987) Hunter, Kathleen K.Item Minimally Disruptive Medicine: State of the Science and Plan for the Future(2018-04) Boehmer, KaseyBackground Patients living with multiple chronic conditions, or multimorbidity, represent a growing portion of the adult population. One in four adult Americans, three in four over the age of 65, live with multimorbidity. This population experiences unique challenges, many of which are driven by the way healthcare is delivered. Specifically, patients must cope with the work of being a patient. For patients with a single condition to follow recommended guidelines, the work amounts to approximately two hours per day. However, with multiple chronic conditions, this can quickly become a part- or full-time job for patients and their families. The ability to cope with this work rests on patients’ capacity, which is a result of their interactions with their biography, resources, environment, patient and life work, and social network. When this capacity is overwhelmed by the work of being a patient, problems accessing and using healthcare and enacting self-care arise, which if unaddressed can have negative impacts on patients’ health outcomes and quality of life. Minimally Disruptive Medicine (MDM) is a philosophy of care, supported by a conceptual model and multiple theoretical frameworks, that seeks to address and remedy problems of patient workload-capacity imbalance. To date, chronic care remains unexamined in light of the principles of MDM, and MDM remains untested. Aims Therefore, the aims of this dissertation were to: 1) Conduct a systematic review and synthesis of recent interventions using the Chronic Care Model to examine the extent to which MDM had been adopted within those interventions; 2) Evaluate the implementation process of a six-month pilot of an MDM-driven intervention, Capacity Coaching, in primary care using focused ethnographic observations and in-depth interviews; and 3) Propose a detailed protocol to implement and test MDM using a proven culture-change curriculum. Methods We conducted a systematic review and qualitative thematic synthesis of reports of Chronic Care Model (CCM) implementations published from 2011 – 2016, a focused ethnographic study, which included the synthesis of written artifacts, nine hours of clinic observation, and nine interviews with ten key stakeholders, and propose a mixed-methods, cluster-randomized trial to test MDM using a culture-change approach. Results CCM implementations examined were mostly aligned with the healthcare system’s goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Capacity Coaching’s implementation, however, addressed most of these shortcomings of past chronic care interventions, including being available to patients living with any chronic condition(s), acknowledging and seeking to reduce patient work, and supporting patient capacity holistically across all constructs described in the Theory of Patient Capacity. Its implementation was successful in getting many individuals on the healthcare team to understand the purpose of the program and the ways in which it was distinguishable from other programs and in getting a small group of dedicated champions to drive implementation of the program forward. However, implementation struggled to get a broader group of individuals across the clinic involved in the program and to build in evaluation of the program’s success. These challenges are ones specifically addressed in the Leadership Saves Lives culture-change curriculum. Conclusion MDM offers a unique lens to meet the needs of the growing population living with multimorbidity. However, recent chronic care interventions have not implemented most MDM principles. Capacity Coaching is a novel intervention that uses MDM principles and when implemented showed promise in overcoming past chronic care shortcomings. Its pilot implementation highlighted challenges in enrolling the full healthcare team to drive MDM forward. The LSL program offers promise to overcome these challenges, but deserves large-scale testing.Item Nurses’ Perceived Comparative Usefulness between an Icon-based Electronic Clinical Dashboard and an Integrated Clinical System(2019-06) Fratzke, Jason JeffreyNurses place a high value on spending as much time as possible directly caring for patients. Optimizing the health system to allow nurses adequate patient-centered time is essential for improved patient experiences, improved health of populations, reducing the overall cost of healthcare, and improving the work life of health care clinicians and staff. As nurses are asked repeatedly to do more with less in a constantly changing and demanding work environment, it will be essential that technology is viewed by nurses as a partner. Pivotal to a successful integration of the technology is understanding nurses’ intentions to use the technology within their practice. The purpose of this research is to compare nurses’ perceived usefulness (PU), perceived ease of use (PEU), and workload burden for the Integrated Clinical System (ICS) and the icon-based electronic clinical dashboard system, INFUZE. The comparison of the nurses’ perceptions between the ICS and INFUZE, was conducted via a retrospective descriptive, comparative mixed-methods design using secondary data. Data from a private clinical database representing 189 registered nurses (RNs) practicing from September 2012 through December 2012 was used in the secondary data analysis. Data compared RNs’ perceptions of the current electronic health record (EHR) system and a home-grown (native) prototype called INFUZE. The dataset included quantitative measurement regarding usefulness, ease of use, and cognitive workload as measured by either a five-point (Technology Assessment Model [TAM]) or seven-point (NASA Task Load Index [TLX]) Likert scale. To complement and provide further insight, focus group data was also included and analyzed using a constant comparative and content analysis. The mixed-method design compared nurses’ perceptions of the availability of patient data between two systems and measured the need for timely access to pertinent patient data. New insights for clinical data use to support nurses were discovered. This descriptive, comparative mixed methods study compared nurses’ PU, PEU, and workload burden for the ICS and the icon-based electronic clinical dashboard system, INFUZE. The research approach used an extended conceptual framework, utilization the TAM and NASA TLX models and the inclusion of external variables of support resources, experience, demographics, and relevance to task. The secondary dataset included ICS (N=131) questionnaire data INFUZE (n=85) questionnaire data complete between September 19, 2012 and January 31, 2013. Transcripts of three voluntary focus groups were analyzed using content analysis methods to synthesize the feedback of 13 nurse participants. For PEU and PU, ICS was favored over INFUZE. For workload, INFUZE was favored over ICS. Focus group analysis revealed that there would be value in implementing an integrated dashboard interface if it is helpful in consuming actionable data rapidly; however, if it is not helpful, the interface would be irrelevant and/or burdensome. Furthermore, nurses considered the learning curve for new technology burdensome. In summary, the use of icons and/or dashboards tailored to the specific needs of nursing has potential to improve nurses’ experience, if the dashboard is a seamless part of the workflow and is integrated within existing technology. Further research is needed to understand human-computer interaction for specific interfaces in situ, toward the goal of developing an interface that is effective as an integrated and seamless companion to the core EHR.Item Nursing Cost Estimates: Educating One Nurse.(2002) Smith, JeddItem Overview of Alcohol-Related Problems and the Services for Older High-Rise Residents of the Minneapolis Area.(Study conducted as part of the High Rise Nursing Project of the School of Nursing. Part II of a series of III., 1987) Gustafson, WinnifredItem Project 32 - Preliminary Report(University of Minnesota, 1969-01) Manthey, Marie; Preston, DavidItem Supporting Care Partner Mental Health: Feasibility of a Behavioral Intervention Tailored for Stroke Survivor-Care Partner Dyads(2020-04) Hultman, MeghanThis dissertation begins with an introduction to the current state of the science in patient-caregiver dyad research. Current studies have largely focused on cancer and dementia, and additional research is needed in other chronic conditions. Evidence suggests that various factors may impact caregiver outcomes such as caregiver burden, depression, and quality of life (QOL), and these outcomes may improve with intervention. Three manuscripts are presented, the first presenting a review of the literature related to characteristics of stroke survivors that are associated with depressive symptoms in their caregivers. The findings offer support for dyad-focused interventions to manage depressive symptoms in stroke survivor-caregiver dyads. This led to development of a two-arm randomized feasibility study exploring the use of problem-solving therapy (PST) compared to stroke-related health education for depressive symptoms and QOL in stroke survivor-caregiver dyads. Dyad-focused PST is a novel approach. The second manuscript describes challenges and lessons learned tailoring PST to dyads. These include: personalizing the intervention, balancing participation, maintaining focus, managing conflict, and addressing ethical concerns. Considerations for future research involving dyad-focused interventions are presented. The third manuscript illustrates the design, methods and results of the study. Recruitment required substantial efforts, yielding a recruitment rate of 14.4%. Overall attrition was 25%. Dyads completing the study showed excellent protocol adherence and provided positive experiential feedback, especially for PST, supporting intervention acceptability. No significant changes in outcome measures were seen over time for care partners or stroke survivors. Finally, the work is synthesized, highlighting key takeaways and implications for research and practice.Item Transforming the University: Preliminary Report of the AHC Task Force on Health Professional Workforce(University of Minnesota, 2006-03-27) Brandt, Barbara F.; Ling, LouisCombined, the six schools of the Academic Health Center educate and train 70% of Minnesota’s dentists, advanced nurse practitioners, pharmacists, physicians, public health professionals, and veterinarians. In addition, many graduates become researchers and faculty in Minnesota, nationally and internationally. The growing demand for health professionals, the increasing cost of health professional education, the decreasing public investment in health professional education, and the shift to community-based education partnerships in Minnesota necessitates an analysis of how we will meet the state’s future health professional workforce needs.