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Biomedical subjects

Souraya Sidani

Publications and source records attributed to Souraya Sidani.

At least 19 recordsLinked to original sources
PubMed2006

Relationship between nursing interventions and outcome achievement in acute care settings.

The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS). Research assistants audited charts for documentation of nursing interventions. The results indicated that nursing interventions aimed at exercise promotion, positioning, and self-care assistance predicted functional status outcome. Higher functional status outcome predicted therapeutic self-care ability at hospital discharge. The results demonstrate that nurses can use MDS and TSCS data on patient outcomes to gain insight into the effectiveness of their interventions.

Activities of Daily Living↗
PubMed2006

Eliciting patient treatment preferences: A strategy to integrate evidence-based and patient-centered care.

BACKGROUND: The integrated patient-centered evidence-based approach to care is integral to guide practice and enhance the quality of care. In this paper, a strategy to operationalize the integrated approach is described. DESCRIPTION OF STRATEGY: The strategy flows from the processes used to synthesize the best available evidence for interventions that address a clinical problem, and to elicit patient preferences for treatment options, which is an important step in patient-centered care. The strategy consists of three phases: (1) synthesis of evidence about the effectiveness and relevance of interventions derived from research and practice; (2) generation of written material describing the nature, dose, effectiveness, and risks associated with the evidence-based interventions; and (3) using the written descriptions to elicit patient preferences. Examples from an ongoing study are presented to illustrate the implementation of the strategy within the context of research. IMPLICATIONS: Nurses are invited to apply the strategy in practice and to evaluate its feasibility and utility in enhancing the quality of care.

Benchmarking↗
PubMed2006

Teaching and community hospital work environments.

The Institute of Medicine report suggests that nursing work environments experience threats to patient safety related to organizational management and workforce deployment practices, work design, and organizational culture. Organizational factors contribute to nursing and potentially patient outcomes, yet few studies have examined the differences in practices perceived by nurses employed in different settings. Nurses from 16 medical and surgical units in eight randomly selected acute care hospitals representing teaching and community organizations participated in this project. Nurses working in teaching hospitals reported lower levels of role tension, yet their perceptions of the quality of work, the work environment, nursing unit leadership, quality of care, and levels of job stress and job satisfaction were higher than their colleagues in the community sites. This study highlights some important differences between teaching and community hospitals that can inform nurse executives and policy makers of the unique work-life issues for different groups of nurses.

Adult↗
PubMed2006

Processes of care: comparison between nurse practitioners and physician residents in acute care.

The purpose of this study was to compare the processes of care (performance of role functions, provision of comprehensive care, coordination of services) of acute care nurse practitioners (ACNPs) and physician residents (PRs) assigned to various medical and surgical programs in acute care settings. A cross-sectional comparative design was used. ACNPs (n = 31) and PRs (n = 10) completed the study questionnaire within two weeks of consenting. Patients who received ACNP care (n = 320) and those who received PR care (n = 46) completed the questionnaire within one week of discharge. The results indicate that ACNPs engaged in management and informal coordination activities more than PRs did, while PRs engaged in more formal coordination activities compared to ACNPs. ACNPs encouraged more patient participation in care and provided more patient education than PRs. These findings, which reflect differences in the processes used by ACNPs and PRs to provide care to patients, could influence the quality and cost outcomes expected of these two groups of healthcare providers.

Acute Disease↗
PubMed2004

A theory-driven approach to evaluating quality of nursing care.

PURPOSE: To review the propositions of a theory-driven approach and to discuss its application to evaluating the quality of nursing care. ORGANIZING FRAMEWORK: The focus in the theory-driven approach to evaluation is on identifying patient, professional, and setting characteristics that affect the processes of care at micro and meso levels, which in turn contribute to outcome achievement. Implications for examining the interrelationships among characteristics, processes, and outcomes are discussed and illustrated with examples from published research. CONCLUSIONS: Determining how these variables influence each other provides a valid and comprehensive understanding of the contribution of nursing within the health care system.

Humans↗
PubMed2004

Evaluating the effectiveness of interventions: exploration of two statistical methods.

Repeated measures designs are often used to evaluate the effectiveness of interventions. In these designs, the outcomes are measured on several occasions before and after implementation of the intervention. Two statistical methods, the repeated measures analysis of variance (RM-ANOVA) and hierarchical linear models (HLM), can be used to analyze the data. The authors provide an overview of the statistical models underlying RM-ANOVA and HLM and discuss the strengths and limitations of each. They propose that the 2 methods are complementary in determining the effectiveness of interventions.

Analysis of Variance↗
PubMed2003

An alternative paradigm for clinical nursing research: an exemplar.

Effectiveness research is undertaken to evaluate the effects of interventions in achieving desired outcomes when tested in the real-world conditions of everyday practice. Although the randomized clinical trial (RCT) is considered the gold standard for effectiveness research, its feasibility, generalizability, and the clinical utility of its results are being questioned. This state of the science prompted the call for a paradigm shift, characterized by alternative methods for clinical research. The alternative methods attempt to account for clinical realities when conducting research, with the goal of minimizing discrepancies in the perspective and assumptions underlying practice and research. In this article a theory-driven approach to intervention evaluation is presented as a viable alternative paradigm for clinical research. The application of this approach demands changes in four aspects of research: participant selection criteria, assignment to treatment options, delivery of the intervention, and selection of outcome measures. The changes are discussed at the conceptual level and illustrated with examples from an ongoing multisite study aimed at determining the usefulness of this theory-driven approach to intervention evaluation.

Clinical Nursing Research↗
PubMed2003

Nurse staffing models as predictors of patient outcomes.

BACKGROUND: Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. RESEARCH DESIGN: A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. SUBJECTS: The sample comprised hospitals and adult medical-surgical and obstetric inpatients within those hospitals. MEASURES: The patient's functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. RESULTS: The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. CONCLUSIONS: The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.

Adult↗
PubMed2003

Enhancing the evaluation of nursing care effectiveness.

Evaluating the effectiveness of nursing care is necessary for developing a sound knowledge base to guide practice. Several studies have been conducted to evaluate the effectiveness of nursing care or interventions in producing the desired outcomes. While the results of these studies are encouraging, they do not provide a comprehensive and realistic evaluation of the contribution of nursing. Factors related to patient characteristics and implementation of care are not accounted for. The outcomes selected do not reflect the direct benefits of nursing care or interventions. In this paper, research methods for conducting effectiveness research in a way that would identify the unique contribution of nursing care delivered under the conditions of the real world of everyday practice are discussed. Examples are provided to illustrate the points of discussion.

Humans↗
PubMed2002

An empirical test of the Nursing Role Effectiveness Model.

AIMS OF THE STUDY: This study investigated the propositions depicted in the Nursing Role Effectiveness Model, in which nurse and patient structural variables were expected to influence nurses' role performance, which, in turn was expected to affect patient outcome achievement. RATIONALE/BACKGROUND: Increasingly, nurses are expected to demonstrate their contribution to patient outcome achievement as a basis for evaluating practice and for monitoring improvements in practice. A model was developed that describes nursing practice in relationship to the roles nurses assume in health care, and links patient and system outcomes to nurses' role functions (Nursing Economics 1998: 16, 58-64, 87). RESEARCH METHODS: A cross-sectional design was used to collect data on the structure, process, and outcome variables. Data were collected through structured questionnaires and chart audit, involving a total of 372 patients and 254 nurses from 26 general medical-surgical units in a tertiary care hospital. Patient structural variables included medical diagnosis, age, gender and education. Nurse structural variables included educational preparation and length of hospital experience. The unit structural variables included the adequacy of time to provide care, autonomy, and role tension. The quality of nurses' independent role performance was assessed by collecting data from patients on their perception of the quality of nursing care. Nurses' interdependent role performance was assessed by collecting data from nurses on the quality of nurse communication and co-ordination of care. Patient outcomes were assessed through self-report and consisted of the patients' therapeutic self-care ability, functional status, and mood disturbance at the time of hospital discharge. Structural equation modelling was used to test the hypothesized relationships among the structural, process, and outcome variables. RESULTS: Patients viewed nurses' independent role performance more effective on units where nurses reported less autonomy but more time to provide care. The quality of nurse communication was higher on units where nurses had higher education, more autonomy, less hospital experience, and lower role tension. However, the co-ordination of care was more effective on units where nurses had higher education, greater hospital experience, less autonomy and role tension. The three role performance variables were associated with patients' therapeutic self-care ability at hospital discharge. Nurses' independent role performance was associated with better patient functional status and less mood disturbance at hospital discharge. The role performance variables fully mediated the effect of the structural variables on patient outcomes, lending support for the proposition that nurses' role performance explains the relationship between structural variables, such as nurse education and autonomy, and patient outcome achievement. DISCUSSION: The Nursing Role Effectiveness Model provides a well-defined conceptual framework to guide the evaluation of outcomes of nursing care. For the most part the hypothesized relationships among the variables were supported. However, further work is needed to develop an understanding of how nurses engage in their co-ordinating role functions and how we can measures these role activities.

Adult↗
PubMed2002

Achieving clinical improvement: an interdisciplinary intervention.

This study evaluates whether training health care teams in continuous quality improvement methods results in improvements in the care of and outcomes for patients. Nine of the 25 teams who participated in the study were successful in improving the care/outcomes for patients. Successful teams were more effective at problem solving, engaged in more functional group interactions, and were more likely to have physician participation.

Clinical Competence↗
PubMed2002

Nurse staffing and work status in medical, surgical and obstetrical units in Ontario teaching hospitals.

This article reports on the staff mix and work status of nurses in the adult medical, surgical and obstetrical units in Ontario's teaching hospitals. While staff nurses have extensive career experience, most have been on their unit a much shorter period of time. More than one-third of the nursing staff in the study were employed on a part-time or casual basis, with few indicating an interest in moving into full-time positions. The need for enhanced retention strategies on these units is identified, as well as the development of a better understanding of motivating factors for nurses' regarding full-time, part-time or casual work options.

Adult↗
PubMed2002

Adequacy of time per visit in community nursing.

This article is a study of the experiences of community based nurses; specifically, their ratings of the adequacy of time they had to complete treatment and prevention activities. Perception of adequacy of time to complete job functions is important because of its links to job satisfaction and job stress. The largest predictor of a sense of inadequate time was visit characteristics. Specifically, it was the mental health speciality team which was most likely to experience inadequate time to deliver treatment and prevention activities. Possible explanations include the time required to deliver care to this patient population, and/or the greater travelling distances and coordination activities linked to provision of services to this patient population. Nurse characteristics were also important in the analysis. Nurses with an RN designation were less likely to report stress with the time they had to complete their activities. Years of community nursing experience was also an important predictor; individuals with greater community experience were less likely to report inadequate time for their duties.

Burnout, Professional↗
PubMed2002

Effects of demographic characteristics on preoperative teaching outcomes: a meta-analysis.

Patient education is an integral part of nursing practice. Since the 1960s many primary studies and several meta-analyses have been conducted to assess the effectiveness of education for patients undergoing surgery. Although these studies demonstrate that preoperative teaching is beneficial to the "average" patient, they have paid little attention to the representativeness of the sample and the generalizability of the results. Therefore, a meta-analysis of 20 studies was conducted to identify the demographic characteristics of patients who participated in preoperative teaching effectiveness studies, and to assess variation in length of hospital stay and pain outcomes in relation to age, ethnicity, gender, and education. The findings confirm the positive and moderate effects of preoperative teaching on these outcomes. However, the participants were primarily 41-60-year-old white females educated beyond the secondary level. Therefore, the findings are not generalizable to all patients undergoing surgery. This points to the need for preoperative teaching that is individually tailored and evaluated in everyday practice and for studies that examine the influence of demographic characteristics, particularly education and ethnicity, on the outcomes of preoperative teaching.

Humans↗
PubMedDate not supplied

Evaluating the effects of music on dyspnea during exercise in individuals with chronic obstructive pulmonary disease: a pilot study.

In this study, we examined the effects of music on the dyspnea and anxiety experienced by people with chronic obstructive pulmonary disease (COPD) when they are walking. A crossover design was used. Patients walked for 10 minutes without music and for 10 minutes while listening to music. The order of the interventions was determined by chance. The levels of perceived dyspnea (modified Borg scale) and anxiety (State-Trait Anxiety Inventory-State) were measured at baseline (before a 6-minute walk), at pretest (after that walk and before the 10-minute walks), and after the walks. Thirty subjects with a mean age of 70 +/- 7 years participated in the study. There were no differences in dyspnea or anxiety levels between the walks with music and with no music (p > 0.05). Despite some positive trends, this study did not provide conclusive evidence to support the efficacy of listening to music during exercise; further research is needed to support this intervention.

Aged↗
PubMedDate not supplied

The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease.

The purpose of this study was to investigate the effects of a walking/talking program on residents' communication, ambulation, and level of function when there were two residents to one care provider (2:1). A randomized control trial design was used. Subjects were residents with Alzheimer disease in three geriatric long-term care facilities in Metropolitan Toronto. Residents who met the inclusion criteria were randomly assigned to one of three groups: walk-and-talk group (30 min, 5 times per week for 16 weeks, walking/talking in pairs), talk-only group (30 min, 5 times per week for 16 weeks, talk only in pairs), or no intervention. The outcome measures were the Functional Assessment of Communication Skills for Adults, the 2-min walk test, and London Psychogeriatric Rating Scale. Residents who received the walk-and-talk intervention did not demonstrate statistically significant differences in the outcome variables measured posttest when compared with residents who received the talk-only intervention or no intervention, even after controlling for individual differences. Variability in the outcomes measured posttest is explained by differences in the residents' level of cognitive impairment before the study rather than by study group membership. These findings are contradictory to those of previous studies.

Activities of Daily Living↗