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JoAnne M Youngblut

Publications and source records attributed to JoAnne M Youngblut.

14 recordsLinked to original sources
PubMed2006

Nurse dose as a concept.

PURPOSE: To describe the concept of Nurse Dose. METHODS: The concept of nurse dose has been identified from decades of clinical research as a concept essential in the delivery of safe and high quality health care. The components of nurse dose were conceptualized through review of the literature from nursing, medicine, and health services research. FINDINGS: Nurse dose is conceptualized as having three equally essential components: dose, nurse, and host and host response. Dose in the macro view includes the number of nurses per patient or per population in cities, states, regions, or countries. Dose in a micro view includes the amount of nurse time and the number of contacts. The nurse component consists of the education, expertise, and experience of the nurse. Host is represented by an organization and its characteristics (culture, autonomy, practice control) in a macro view and by the patient and characteristics (beliefs, values, culture) in a micro view. Host response includes response to the autonomy and acceptability of the nurse. CONCLUSIONS: Greater nurse dose has been associated with decreases in patient mortality, morbidity, and healthcare costs.

Clinical Competence↗
PubMed2005

Pediatric head trauma: parent, parent-child, and family functioning 2 weeks after hospital discharge.

OBJECTIVE: To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge. METHODS: Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission. RESULTS: Mental health after discharge was related to social support and baseline mental health. Mothers' parental distress was related to perceived injury severity and social support. Greater family cohesion was related to baseline mental health, social support, and being in a two-parent family for mothers, and to social support for fathers. CONCLUSIONS: Parents' mental health and social support were important for parent mental health and family cohesion after discharge. Perceived injury severity and parent reactions to hospitalization also played a role.

Adult↗
PubMed2005

Child care use by low-income single mothers of preschoolers born preterm versus those of preschoolers born full term.

This study describes prewelfare reform child care use by 64 primarily low-income single mothers (65.6% African American) with preschoolers (half born preterm). Forty percent used child care for more than 75% of their children's lives, 20% did when not employed. Preschool children born preterm were more likely to receive child care from nonrelatives throughout their lives than children born full term. Children with health problems used a greater number of child care arrangements. Findings suggest addressing child care issues with both employed and nonemployed mothers and adequacy of child care for children with special needs.

Adult↗
PubMed2005

The cost of prematurity: hospital charges at birth and frequency of rehospitalizations and acute care visits over the first year of life: a comparison by gestational age and birth weight.

The proportion of preterm and low-birth-weight infants has been growing steadily for two decades. Most of the more than US 10 billion dollars spent on neonatal care in the United States in 2003 was spent on the 12.3% of infants who were born preterm. Research has shown higher initial hospital costs and a higher rate of acute care visits and rehospitalization for preterm and low-birth-weight infants, but only a limited number of studies of the cost of prematurity that follow infants through the first year of life have been conducted. This study is a secondary analysis of data on a subset of infants drawn from a randomized clinical trial that examined health outcomes and health care costs in women with high-risk pregnancies and their infants. For the current study, a sample of 84 singleton infants was chosen. Forty-three infants (51%) were full term (37 weeks' gestation or more) and 41 (49%) were born preterm (less than 37 weeks' gestation). Fifty-five infants (65.5%) were born at normal birth weights (2,500 g or greater), 24 (28.5%) were born at low birth weights (1,501 to 2,499 g), and five (6%) were born at very low birth weights (less than 1,500 g). Data on the initial hospital charges and the rates of rehospitalization and acute care visits in the first year of life in relation to gestational age and birth weight were collected. The results clearly demonstrated that the charges for initial hospitalizations increased as birth weights and gestational ages decreased. Low-birth-weight infants were less likely to have unscheduled acute care visits than normal-birth-weight infants. Interventions to improve prenatal care targeted to women at high risk for delivering preterm or low-birth-weight infants would reduce health care costs and improve health outcomes of infants as well.

Birth Weight↗
PubMed2005

Parents' reactions at 24-48 hrs after a preschool child's head injury.

OBJECTIVES: Our objectives were, first, to compare mothers' and fathers' early reactions (stressors, concerns) to the preschool child's head injury, their perceptions of the child's injury severity, and their social support and mental health; second, to compare families with a child in the pediatric intensive care unit (PICU) vs. general care unit (GCU) on these variables; and third, to describe the relationships between parents' early reactions and perceived and objective injury severity, their social support, and mental health. DESIGN: Analysis of data collected in the hospital 24-48 hrs after the child's admission as part of a longitudinal study of parent and family functioning after a preschool child's head injury. SETTING: Seven tertiary care centers: three free-standing children's hospitals and four comprehensive hospitals. PARTICIPANTS: Participants were 182 mothers and 64 fathers of 183 preschool children (ages 3-6) hospitalized for head injury, half in a PICU. INTERVENTIONS: Data collection. MEASUREMENTS AND MAIN RESULTS: We measured parents' early reactions (stressors, concerns), influenced by parent mental health, social support, and objective and perceived injury severity. Mothers reported more stress than fathers regarding the child's behavior and emotions, communication with staff, and their parental role. Mothers in the PICU group reported more concern about the child's future and more stress regarding the child's appearance, sights and sounds of the unit, and procedures done to the child than mothers in the GCU group. Fathers in the PICU and GCU groups reported similar levels of stress and concern. Mothers' reactions were influenced by objective and perceived injury severity, social support, and psychological distress. Fathers' reactions were influenced by objective injury severity and psychological distress. CONCLUSIONS: Although mother-father couples rated their child's injury severity similarly, mothers experienced more stress than fathers. Social support decreased the stress for mothers but not for fathers. The experience of pediatric head trauma was more stressful for mothers of children in the PICU than mothers of children in the GCU.

Adult↗
PubMed2005

South Florida: a national microcosm of diversity and health disparities.

South Florida is a microcosm of diversity that reflects a changing national population. The purpose of this paper is to examine some common health status indicators in the four counties that comprise South Florida. The researchers look at birthweight, neonatal and infant death rates, receipt of prenatal care, major causes of death, availability of health care facilities and services, and expenditures for health. Data indicate that, of the four counties, the most affluent has the worst health indicators, and the least affluent--with the highest proportion of minority residents--has some of the best health status indicators. The researchers provide implications for practitioners and future research.

Adolescent↗
PubMed2003

Patient problems, advanced practice nurse (APN) interventions, time and contacts among five patient groups.

PURPOSE: To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs. DESIGN AND METHODS: Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n = 39); (b) women with unplanned cesarean birth (n = 61), (c) high-risk pregnancy (n = 44), and (d) hysterectomy (n = 53); and (e) elders with cardiac medical and surgical diagnoses (n = 139). Logs containing recordings of all APN interactions with participants, APN time and type of patient contact were content analyzed with the smallest phrase or sentence representing a "unit." These units were then classified using the Omaha Classification System to determine patient problems and APN interventions. Groups were compared concerning total amount of APN time, number of contacts per patient, and mean length of time per APN contact. All studies were conducted in the United States. FINDINGS: Groups with greater mean APN time and contacts per patient had greater improvements in patients' outcomes and greater health care cost savings. Of the 150,131 APN interventions, surveillance was the predominant APN function in all five patient groups. Health teaching, guidance, and counseling was the second most frequent category of APN intervention in four of the five groups. In all five groups, treatments and procedures accounted for < 1% of total APN interventions. Distribution of patient problems (N = 150,131) differed across groups reflecting the health care problems common to the group. CONCLUSIONS: Dose of APN time and contacts makes a difference in improving patient outcomes and reducing health care costs. Skills needed by APNs in providing transitional care include well-developed skills in assessing, teaching, counseling, communicating, collaborating, knowing health behaviors, negotiating systems, and having condition-specific knowledge about different patient problems.

Aged↗
PubMed2002

Identification of sleep-disordered breathing in children: variation with event definition.

STUDY OBJECTIVES: To determine the effect of varying approaches to the measurement of the respiratory disturbance index (RDI) on identification of sleep disordered breathing (SDB) in children. DESIGN: Cross-sectional study of SDB in a well-characterized birth cohort (stratified for term and preterm birth) participating in longitudinal studies of cognition and behavior. SETTING: Community-based; overnight studies conducted in participant's homes. PARTICIPANTS: 433 children, ages 8-11 years, un-referred for clinical assessment of SDB. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Participants underwent unattended overnight in-home recording of respiratory inductance plethysmography, pulse oximetry, body position, and heart rate. The relationships among RDIs derived from various definitions of apnea and hypopneas and thresholds for frequency of events were assessed. Median RDI varied by more than 20-fold for definitions using the more liberal criteria for event definition (all respiratory events; i.e., central or obstructive events and hypopneas with no requirement for associated desaturation) to the most conservative definition (using obstructive apneas only or obstructive apnea and hypopneas requiring a 5% associated desaturation). Prevalence estimates for SDB based on RDIs that included central apneas were 40% to 140% higher than those that excluded central apneas. CONCLUSIONS: Different approaches for quantifying RDI contribute to substantial variability in identification and classification of SDB in children and will lead to discrepant estimates of its presence and severity.

Child↗
PubMed2002

Institutional research responsibilities and needed infrastructure.

PURPOSE: To describe research grantee institutions' responsibilities to the funding agencies, research participants, and investigators, and the infrastructure and resources necessary for successful completion of funded research projects. ORGANIZING FRAMEWORK: Grants management includes investigator access to institutional and school infrastructure and resources, oversight and monitoring of the implementation of the research, and strategies to maximize research yield while stretching research dollars. CONCLUSIONS: Grantee institutions are responsible for overseeing the conduct of research, protecting rights of research participants, safety of study personnel, monitoring conflict of interest, fiscal management, access to data, and disseminating study findings. Central and school departments that provide needed services are important infrastructure supports. In addition to research space and investigator time, senior research mentors and research administrators are the most valuable resources for research success.

Ethics, Institutional↗
PubMed2002

Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care.

PURPOSE: To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. ORGANIZING CONSTRUCT: The Quality Cost Model of APN Transitional Care. METHODS: Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. FINDINGS: APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. CONCLUSIONS: To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost.

Clinical Competence↗
PubMedDate not supplied

High-risk pregnancy: postpartum rehospitalization.

OBJECTIVE: Examine frequency, timing, and reasons for maternal postpartum rehospitalizations and acute care visits 1 year postpartum after a high-risk pregnancy. STUDY DESIGN: Secondary analysis of data collected during a randomized clinical trial of advanced practice nurses gives transitional care for women with high-risk pregnancies. The 171 women were primarily African American, never married, Medicaid eligible, diagnosed with pregestational diabetes (20), gestational diabetes (23), either diagnosed (48) or at risk (44) for preterm labor, and chronic hypertension (36). RESULTS: Of the total rehospitalizations (17%) and acute care visits (32%), over one third occurred in the first 8 weeks postpartum. Chronic hypertensives and gestational diabetics had the highest rate of rehospitalization and proportion of acute care visits. Six women were rehospitalized for subsequent pregnancies. CONCLUSION: Women with high-risk pregnancies have continued high health care resource use over the first postpartum year demonstrating the need for more intensive patient education and follow-up to improve outcomes and reduce resource use.

Adult↗
PubMedDate not supplied

Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one.

The purpose of this qualitative study was to describe practices surrounding death of a loved one by European, Asian, Caribbean, Central American, and South American families living in the United States. A focus group with 14 masters nursing students from a wide variety of cultural and religious backgrounds was conducted to gain a better understanding of the beliefs, ceremonies, and rituals surrounding death. Many commonalties were found across cultures and religions. A pervasive theme was that beliefs about the soul of the deceased lead families to perform rituals and ceremonies that foster passage to God, the "light," or another life. The stronger their beliefs, the more dedicated the family is in completing the rituals and ceremonies in the way dictated by their religion or culture. Participants had difficulty separating the influence of culture and religion on these practices.

Adult↗