Biomedical subjects
Publications and source records attributed to Martha Buffum.
This descriptive study examined reports of behavioral problems among older patients hospitalized in acute care medical settings. Greater numbers of behavioral problems were reported by nursing staff on the Neuropsychiatric Inventory-Questionnaire than were documented in medical charts over the same time period. Such underreporting may have clinical and administrative implications.
This article is an annotated bibliography on the topic of nurse staffing and patient care outcomes in the acute care setting. The authors have been involved in the developmental and pilot phase of the Veterans Affairs Nursing Outcomes Database project to build a database of acute care nursing-sensitive quality indicators. In the section preceding the annotated bibliography, a context for the development of this literature review is explained and a summary synthesizing key issues is presented.
PURPOSE: To explicate a replicable methodology for designing and analyzing a large ongoing reliable and valid quality database to examine nurse staffing and patient care outcomes in acute care hospitals. DESIGN: Prospective nurse staffing, process of care, and patient outcomes data based on the American Nurses Association's (ANA) nursing quality indicators collected from a voluntary convenience sample at acute care hospitals in California with rolling-site accrual. METHODS: The ongoing CalNOC database development and repository project, the largest statewide effort of its kind in the United States (US), currently includes data on hospital nurse staffing, patient days, patient falls, pressure ulcer and restraint prevalence, registered nurse (RN) education, and patients' perceptions of satisfaction with care. FINDINGS: As of May 2003, the CalNOC database contained staffing data from 842 units in 134 acute care hospitals over 20 quarters from April 1998 to March 2003. The repository also included clinical outcome information on 34,262 reported patient falls, pressure ulcer prevalence data on 41,982 patient observations, and service outcome data on patient satisfaction from 26,461 patients. Participating hospitals receive quarterly reports allowing them to benchmark their own performance against other participating hospitals. CalNOC methods have been adapted and replicated by both the Military Nursing Outcomes Database and VA Nursing Outcomes Database projects, and CalNOC nursing-sensitive measures have been endorsed by the National Quality Forum. CONCLUSIONS: This working model for collecting reliable and valid data was derived from multiple hospitals across California. The data are the basis for studies to contribute to the development of evidence-based public policy, and for ongoing study of the effects of nurse staffing on clinical and service outcomes.
OBJECTIVES: (a) To determine the quantity and quality of behavioral problems in older hospitalized patients on acute care units; (b) to determine the burden of these behaviors on staff; and (c) to identify predictors of behavioral problems. METHODS: Upon admission, patients performed the Mini-Mental State Exam (MMSE), the Geriatric Depression Scale (GDS), and information was obtained on age, ethnicity, level of education, living arrangement, and psychiatric history. Two days post-admission, a clinical staff member caring for each patient, performed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) to assess patients' behavioral problems and staff distress. PARTICIPANTS AND SETTING : Forty-two patients, over 60 years of age, admitted to medical and surgical units of the Veterans Affairs Hospitals in Palo Alto and San Francisco, participated. RESULTS: Twenty-three of 42 (55%) patients exhibited behavioral problems. Anxiety, depression, irritability, and agitation/aggression were the most frequently observed behaviors. The severity of the behavioral problems was significantly correlated with staff distress. Lower performance on the MMSE at admission was significantly associated with higher NPI-Q ratings. Specifically, of those cases with scores less than or equal to 27 on the MMSE, 66% had behavioral problems during hospitalization, compared to only 31% of those with scores greater than 27. CONCLUSION: Behavioral problems in older hospitalized patients appear to occur frequently, are a significant source of distress to staff, and can result in the need for psychiatric consultation. Assessment of the mental status of older adults at admission to hospital may be valuable in identifying individuals at increased risk for behavioral problems during hospitalization.
Patients undergoing colonoscopy who have poor bowel cleansing must undergo repeated colon lavage and procedure, resulting in the possibility of additional discomfort and risk. Patient compliance with the necessary 4 liters of colon lavage fluid is essential. At our facility, the current colon lavage solution is unflavored and most patients complain about the taste. These are the patients who are likely to have poorly cleansed bowels. Patient preference for flavor of lavage is not known. A randomized controlled trial of 130 patients was undertaken to learn whether Colyte flavor made a difference in bowel cleansing. Results showed flavor made no difference in bowel cleansing (chi2 = 0.064, p =.96, NS); successful cleansing occurred in 75% (n = 45) of patients who received flavored and 76% (n = 53) who received unflavored Colyte. Results suggest flavor is not a factor in patients' completion of the prep nor cleansing effectiveness. As unflavored Colyte costs less than flavored, cost savings can result from continuing use of unflavored Colyte. While this clinical trial did not answer the dilemma about how to improve colon preparation, the staff's process of conducting nursing research inspired critical thinking and innovative problem-solving. Patients who are undergoing a colonoscopy are required to do a bowel cleansing the day before the procedure. Without proper bowel cleansing, colonic lesions such as polyps, neoplasms, and arteriovenous malformations (AVMs) may go undetected by being covered with small particles of stool ( Cohen et al., 1994). Poor bowel cleansing results in the need for repeat colon preparation and repeat procedure, which pose risk and discomfort for the patient and cost for the staff and institution. Done under moderate sedation, colonoscopy poses potential cardiac risks and respiratory problems for the patient. In addition, the endoscopy procedure itself could cause perforation and bleeding. Avoiding repeat procedures because of failed colonic preparation is, therefore, essential for patient safety and organization cost. Optimally, completing the colon prep solution results in adequate bowel cleansing. Prep flavor was theorized to be a possible cause of noncompliance. The purposes of this study were to determine whether patients' preferred prep solution would yield better compliance with the colon lavage solution and whether the improved compliance results in an adequately prepared bowel.
Patients scheduled for gastrointestinal procedures such as colonoscopy or esophagogastroduodenoscopy are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported education, coping skills, relaxation techniques, and combinations of these including music, have decreased anxiety in patients across many settings. Self-selected music therapy for preprocedural anxiety has not been studied. A randomized controlled trial of 198 patients was undertaken to determine whether 15 minutes of self-selected music reduced preprocedure anxiety. The State Trait Anxiety Inventory was used to measure patients' anxiety. One-hundred ninety-three men and 5 women comprised the sample with an average age of 61 (SD 10.5). Patients who listened to music (n = 100) reduced their anxiety score from 36.7 (SD 9.1) to 32.3 (SD 10.4), while those who did not listen to music (n = 98) reduced their anxiety score from 36.1 (SD 8.3) to 34.6 (SD 11.5). These differences were statistically significant (F = 7.5, p =.007) after controlling for trait anxiety. There were no significant vital sign changes premusic and postmusic. Music is a noninvasive nursing intervention that can significantly reduce patients' anxiety prior to gastrointestinal procedures. Further research should address using music to reduce anxiety in other procedure areas and testing effectiveness of self-selected versus investigator-selected music in reducing anxiety.