PubMed Health⌕ Search

Biomedical subjects

J Salyer

Publications and source records attributed to J Salyer.

At least 19 recordsLinked to original sources
PubMed2000

Market, hospital, and nursing unit characteristics as predictors of nursing unit skill mix: a contextual analysis.

The objective was to examine the relative contributions of market, hospital, and nursing unit characteristics to the prediction of nursing unit skill mix. The strongest predictors of nursing skill mix were found to be the technological sophistication of the hospital, the volume of services offered, and the percentage of patients covered by managed care payors. The results suggest that skill mix on nursing units is buffered from market forces but is highly sensitive to hospital characteristics. These factors need to be taken into account when decisions are made about the allocation of personnel resources. In this article, the terms "nursing skill mix" and "nurse staffing" are used interchangeably.

Clinical Competence↗
PubMed1999

Nursing in the nineties: managing the uncertainty.

OBJECTIVE: This study examined qualitative data on nurses' work lives from 53 hospitals that participated in the National Institutes of Health (NIH)-funded Outcomes Research in Nursing Administration Project (ORNA). BACKGROUND: The ORNA project examines the impact of nursing unit organizational structure on outcomes. The information reported in this article amplifies the quantitative data with qualitative data that enhances understanding of nurses' work lives. METHODS: Site coordinators at all participating hospitals were requested to send monthly journal entries for 6 months. Data were documented according to an agreed-on content outline that consisted of critical incidents and implications. Data were collected from 53 of the 65 study site coordinators (response rate 81.5%). Content analysis of all collected data was conducted by the research team. RESULTS: Study site coordinators in 53 hospitals characterize the acute care environment as turbulent and uncertain. Contributing factors include: 1) work load (fluctuating census, staff preparation, turnover); 2) loss of workplace identity (unit consolidation, hospital buy-outs, and system mergers); and 3) re-engineering (skill mix, new equipment/system changes, new documentation systems, rumored changes). CONCLUSIONS: This study adds to the growing body of literature that portrays environmental uncertainty from the narrative perspective. Although there is an ongoing need for the employment of fiscally accountable, quality enhancing organizational/management strategies, all initiatives are at risk unless personnel needs are attended to and seen as unique in each care setting. Some strategies are offered to meet this dual imperative.

Attitude of Health Personnel↗
PubMed1998

Impaired exercise capacity late after cardiac transplantation: influence of chronotropic incompetence, hypertension, and calcium channel blockers.

BACKGROUND AND METHODS: Patients undergoing orthotopic cardiac transplantation manifest reduced exercise capacity during the first postoperative year, which is related primarily to chronotropic incompetence of the denervated heart. To determine whether exercise capacity improves during the long term after transplantation, we prospectively studied 45 patients from 1 month to 6 years after cardiac transplantation by use of maximal treadmill exercise testing for measurement of exercise duration, peak heart rate, and peak VO2. All had normal left ventricular ejection fractions. Patients were categorized according to length of time since transplant and compared to 14 untrained normal subjects. RESULTS: Peak exercise heart rate and exercise duration were progressively higher as time after transplantation increased. However, patients who had undergone transplantation more than 2 years earlier continued to manifest a significant reduction in peak exercise heart rate (157+/-3 beats/min vs 178+/-14 beats/min) and reduced exercise duration (8.6+/-0.5 minutes vs 13.2+/-2.0 minutes) compared with controls. In contrast, peak VO2 was similar at all times after transplant and remained markedly reduced in patients who underwent transplantation more than 2 years earlier as compared with controls (22.1+/-0.7 mL/kg/min vs 42.1+/-9.1 mL/kg/min). The potential effects of 14 clinical variables on exercise performance were evaluated by regression modeling. Patients with poorly controlled hypertension had a shorter median exercise duration (7.4 minutes vs 9.7 minutes) and a lower median peak VO2 (20.3 mL/kg/min vs 23.2 mL/kg/min) compared with patients with normal or well-controlled blood pressure. Patients treated with calcium channel blockers for hypertension had greater chronotropic incompetence during exercise (peak heart rate 139 beats/min vs 158 beats/min). There was no relation between exercise capacity and recipient age, donor age, recipient sex, donor ischemic time, pretransplant diagnosis, length of peritransplant hospitalization, percentage of ideal body weight, left ventricular ejection fraction, frequency or severity of allograft rejection, or long-term use of oral prednisone therapy. CONCLUSIONS: Exercise capacity, as measured by treadmill exercise time and peak heart rate, improves in the first 2 years after transplantation, but does not reach normal values in patients up to 6 years after transplant. Peak VO2 remains significantly reduced at all times after transplantation despite the presence of normal resting left ventricular systolic function.

Adult↗
PubMed1997

Environmental turbulence: staff nurse perspectives.

The purpose of this qualitative study was to explore staff nurses' perceptions of how turbulence in the internal environment affected their ability to provide patient care. The themes that emerged from the data point toward multiple factors impinging on a staff nurse's ability to provide quality care in today's healthcare environment. The authors discuss these factors, the consequences for staff nurses, patients, and the organization, and the implications for nursing administrators and their colleagues in hospital administration.

Adult↗
PubMed1997

Outcomes research. Clues to quality and organizational effectiveness?

Outcomes research has often been touted as the best response to concerns about quality in today's health care organizations. Yet, outcomes research is accompanied by its own set of problems. These problems must be addressed if outcomes research is, in fact, to guide assessments of quality and of organizational effectiveness. One question is how quality and organizational effectiveness should be defined. In addition, measurement issues are particularly problematic in outcomes research, as is the availability of appropriate data. This article discusses each of these areas, and concludes by presenting an integrated model to guide the assessment of outcomes, quality, and organizational effectiveness.

Data Collection↗
PubMed1996

Rapid detection of group B streptococcal colonization of the genital tract by a commercial optical immunoassay.

The performance of a commercial optical immunoassay (OIA) was compared at two institutions with that of routine agar and broth culture methods for the detection of group B streptococcal (GBS) colonization of the genital tract. The Strep B OIA (Bio Star, USA) was used to test 962 vaginal swabs from pregnant women for the presence of GBS antigen. The prevalence of GBS vaginal colonization in this population was 22.4%. The OIA results were compared with those of culture on trypticase soy agar with 5% sheep blood (TSA) and broth enhanced culture (Lim broth). Sensitivity and specificity values of the OIA method compared to TSA culture alone were 82.5% and 91.8%, respectively. The sensitivity of the OIA method was equivalent to that of TSA culture (62.4% vs. 64.4%; p > 0.5, chi 2 = 0.01) when the data were compared with broth culture. The extent of colonization affected the sensitivity of the OIA method: 100% of 4+, 94% of 3+, 96% of 2+, and 63% of 1+ TSA plates were detected by the OIA test. The commercial OIA method demonstrated sensitivity equivalent to that of TSA culture for the detection of GBS colonization. The OIA test offers two additional advantages over culture: reduced time required to obtain results (30 min vs. days) and the ability to detect GBS antigen in samples with compromised viability. The results of this study suggest that the Strep B OIA test can be a useful diagnostic tool in the management of early-onset GBS disease.

Antigens, Bacterial↗
PubMed1996

Development and Psychometric evaluation of an instrument to measure staff nurses' perception of uncertainty in the hospital environment.

Perceived environmental uncertainty is an individual response to stimuli in the internal and/or external environment. The measurement of uncertainty in the health care environment is important in order to characterize the impact of this phenomenon on nursing practice. This study describes the development, pilot testing, and initial psychometric evaluation of the Perceived Environmental. Uncertainty in Hospitals Scale (PEU-H) in a sample of 95 hospital staff registered nurses. Principal components analysis of the PEU-H was conducted and indicated that the factor structure represented one factor that explained 37.3% of the variance. Internal consistency reliability using Cronbach's alpha was .83, which is acceptable for a scale in the early stages of development.

Adult↗
PubMed1995

Environmental turbulence. Impact on nurse performance.

Changes in the external regulatory environment have created turbulence in the internal hospital environment. Nursing administrators must create and maintain clinical environments that support practice; however, little is known about the effects of the dramatic changes in the healthcare environment on nurse performance. The author discusses a study that analyzed the effects of environmental turbulence on nurses' job performance. One characteristic of a turbulent environment, the number of admissions to/discharges from a unit in a 24-hour period, had a negative impact on self-rated quality of performance. The findings give direction to nurse administrators regarding efforts and resources required to support nurse performance in the unstable and rapidly changing healthcare environment.

Adaptation, Psychological↗
PubMed1990

Malignant histiocytosis in a patient with acquired immunodeficiency syndrome-related complex.

A patient with acquired immunodeficiency syndrome-related complex was examined for fever and hepatosplenomegaly. During his hospitalization, liver failure developed in the patient, and he became infected with Pseudomonas and Staphylococcus. At autopsy, in addition to signs of bacterial infection, malignant histiocytic infiltrates were found that involved his liver, spleen, lymph nodes, and lungs. To our knowledge, malignant histiocytosis has not been reported in a patient with acquired immunodeficiency syndrome or acquired immunodeficiency syndrome-related complex.

AIDS-Related Complex↗
PubMed1985

Nurse-patient interaction in the intensive care unit.

Patients in the ICU, especially those who are unable to communicate verbally, need sensitive and individualized communication to prevent feelings of isolation and alienation and to promote continued socialization throughout their hospitalization and return to the community. The results of this study indicate that the quality and effect of the interactions between nurses and intubated patients in the ICU require further study to delineate the factors that contribute to the effective or ineffective communication. We believe that the Categories of Nurse-Patient Interaction that was developed for this study is useful and practical measure of nurse-patient interaction in the ICU.

Communication↗
PubMedDate not supplied

Lifestyle and health status in long-term cardiac transplant recipients.

OBJECTIVE: The purpose of this pilot study was to describe the lifestyle and health status of long-term cardiac transplant recipients. DESIGN AND SETTING: The study was a descriptive correlational design at a health sciences center. MEASURES: We measured lifestyle, using the Health-Promoting Lifestyle Profile-II, and indicators of health status (eg, number of medications, infections, and rejections; systolic and diastolic blood pressure; lipid profile; and percent ideal body weight) in 47 patients after an annual evaluation or follow-up visit after patients received cardiac transplantation. RESULTS: Patients were primarily male, white, 56.5 years old and 75.6 months after transplant. Spiritual growth was the most frequently reported lifestyle characteristic (mean, 27.4; SD, 4.9). The least frequently reported lifestyle characteristic was engagement in physical activity (mean, 18.4; SD, 5.7). Factorial between-subjects analysis of variance demonstrated that women had a higher high-density lipoprotein level (P =.0001) and reported healthier dietary habits (P =.02) and greater spiritual growth (P =.006) than men. African Americans reported poorer stress management behaviors (P =.04). Recipients whose heart failure was due to ischemic cardiomyopathy had a lower percent ideal body weight than those with a nonischemic cause (P =.01). Recipients with cardiac allograft vasculopathy had a higher low-density lipoprotein cholesterol level (P =.05) and lower high-density lipoprotein cholesterol level (P =.05) than those without cardiac allograft vasculopathy, and those persons who required maintenance corticosteroid therapy reported poorer interpersonal relationships than those persons not receiving corticosteroids (P =.04). CONCLUSION: Cardiac transplant recipients did not consistently include health-promoting behaviors in their lifestyles although some of the behaviors were associated with a better health status. Future research should be aimed at identifying factors that affect the ability to make and sustain changes in lifestyle and improve health status.

Adult↗
PubMedDate not supplied

AIDS: holistic home care.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗