YSN Library September 25 - September 29

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 9/25
8:30 - 3:30

Tuesday 9/26
See me in Medical Library for assistance - 737-2964
Class: 10-11am Business Resources for Health Care Professionals

Wednesday 9/27
11:00 - 5:00
Class: 7-8pm Powerpoint Basics

Thursday 9/28
See me in Medical Library for assistance - 737-2964
Class: 4-5pm EndNote Basics

Friday 9/29
8:30 - 5:00

Complete list of classes

Decision making by healthy volunteeers in clinical trials

The study reported inthis article set out to test the quality of the decision-making process of healthy volunteers in clinical trials.

Researchers fear that the decision to volunteer for clinical trials is taken inadequately and that the signature on the consent forms, meant to affirm that consent was 'informed', is actually insubstantial. Over a period of a year, candidates were approached during their screening process for a proposed clinical trial, after concluding the required 'Informed Consent' procedure. In all, 100 participants in phase I trials filled out questionnaires based ultimately on the Janis and Mann model of vigilant information processing, during their stay in the research centre.

The results were that only 35% of the participants reached a 'quality decision'. There is a definite correlation between information processing and quality decision-making. However, many of the healthy research volunteers (58%) do not seek out information nor check alternatives before making a decision.

The research conluded that full disclosure is essential to a valid informed consent procedure but not sufficient; emphasis must be put on having the information understood and assimilated. Research nurses play a central role in achieving this objective.

Rabin C, Tabak N. Healthy participants in phase I clinical trials: the quality of their decision to take part. J Clin Nurs. 2006 Aug;15(8):971-9. PMID: 16879541

Environmental Health Nursing Education

Environmental health has received minimal attention in nursing curricula over the past decade, despite efforts by the Institute of Medicine (1995) and others to advance the environmental health agenda in nursing education, practice, and research.

This paper describes an initiative that was first funded as a part of the Environmental Health Scholars Program in 2000 to incorporate environmental health into master's and undergraduate nursing programs at one university. Evaluation of this initiative highlights the challenges and successes experienced in this academic setting.

A number of recommendations based on this experience and the literature are offered. There is a perceived need to define the critical body of knowledge and skills in environmental health and to develop tools to enable educators and practitioners to apply this knowledge in public health nursing and other specialty practices. In tandem, opportunities and incentives are needed to encourage faculty development and the infusion of environmental health into existing curricula. Changes are also needed across practice settings to proactively address environmental health issues so that environmental health becomes and remains an integral part of nursing.

Hewitt JB, Candek PR, Engel JM. Challenges and Successes of Infusing Environmental Health Content in a Nursing Program. Public Health Nurs. 2006 Sep;23(5):453-464.
PMID: 16961564

Use of community-based participatory research in public health nursing

There is growing demand for research using a community-based participatory (CBPR) approach. CBPR requires that the academic research team actively partner with community members and stakeholders in the entire research process. The community members are full partners with the researchers in relation to the development and implementation of the study, analysis of the data, and dissemination of the findings.

The purpose of this article is to review four basic principles of CBPR and provide an example of how these CBPR principles were used in an ethnographic study related to the culture of African American infant health. In the pilot study, CBPR provided the framework for recruitment and retention of participants, ongoing data analysis, and dissemination of findings. Using CBPR provided the researchers an introduction into the selected community. Community members served as key informants about the culture of the community and provided access to potential participants. The community partners contributed to analysis of emerging themes and in the dissemination of findings to the community, stakeholders, and the scientific community.

CBPR provides opportunities for community health nurse researchers to conduct research with vulnerable populations and sets the stage for implementing evidenced-based nursing interventions in the community.


Savage CL, Xu Y, Lee R, Rose BL, Kappesser M, Anthony JS. A case study in the use of community-based participatory research in public health nursing. Public Health Nurs. 2006 Sep-Oct;23(5):472-8.

Impact of empirical studies of spirituality and culture on nurse education

Spirituality and cultural dimensions of care are considered to be integral to holistic care. The healing potentials of spiritual and cultural care are well documented.

This article discusses a research programme which used action research comprising largely of qualitative approaches. As the holistic and multiperspective nature of spirituality and culture requires a multidisciplinary approach and flexibility of methodology, various research techniques were used. The findings led to the development of theories, models and conceptual literature on spiritual and cultural care. In particular, two models evolved from the studies: the ASSET for spiritual cares education and training and the ACCESS for transcultural care practice. The critical incident studies provide insights into nurses' roles in spiritual care interventions. The phenomenological study highlights that chronically ill patients use spiritual strategies in coping with their illness.

Overall, the paper offers a body of evidence that has an impact upon curriculum development in nurse education and nursing practice.

The ASSET model offers a framework for spiritual care education. The ACCESS model offers a framework for transcultural care practice. The critical incident studies map out nurses' roles in spiritual and cultural care with scope for development of care intervention models for the future. The coping mechanisms study highlights how patients use spiritual coping strategies such as prayer and other resources to cope with their chronic illnesses.

To read the full article:
Narayanasamy A. The impact of empirical studies of spirituality and culture on nurse education. J Clin Nurs. 2006 Jul;15(7):840-51. Review. PMID: 16879377

YSN Library September 18 - September 22

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 9/18
8:30 - 12:00
Class: 4-5pm Ovid MEDLINE Basics

Tuesday 9/19
See me in Medical Library for assistance - 737-2964
Class: 2-3pm EndNote Basics

Wednesday 9/20
See me in Medical Library for assistance - 737-2964
Class: 7-8pm RefWorks Basics

Thursday 9/21
See me in Medical Library for assistance - 737-2964
Class: 5-6pm RefWorks Basics

Friday 9/22
8:30 - 5:00

Complete list of classes

Strategies for reducing nursing shortage

A recent report published in Health Affairs by the Center for Studying Health System Change finds that while competitive salaries, agency labor, and other short-term fixes have helped temporarily alleviate the nursing shortage, health care officials need to place more focus on long-term efforts to increase the size of the nurse workforce and improve nurses' work environments. Based on a survey of 32 hospitals in 12 nationally representative markets, researchers estimate that 75% of hospitals use temporary nursing staff, 31% use internal staffing agencies, and 19% employ foreign nurses to meet short-term staffing needs.

Ten of the 24 hospitals that use agency nurses said they had reduced their reliance on temporary nurses, with several facilities creating internal per-diem nurse pools to help reduce reliance on agency staffing. Other short-term strategies include raising salaries; offering sign-on, retention, or referral bonuses; implementing flexible and self-schedule systems; and offering a broader range of shift types. All but one of the hospitals surveyed reported using at least one strategy involving the expansion of nurse-education programs.

Nine of the 22 hospitals that had implemented nurse training initiatives reported plans to expand the programs, with many facilities using their training capabilities to operate nursing schools, offer loan repayment in return for a work commitment, or tailor nursing-degree programs to meet the needs of current ancillary staff. In addition, several of the hospitals have begun directly subsidizing nurse faculty salaries, loaned their own nurses to help teach courses at nursing schools, or helped local nursing schools recruit new faculty.

Meanwhile, 88% of hospitals have made changes to nurses’ working environments to help recruit and retain nurses, including altering nurse staffing levels; repositioning nursing roles and responsibilities; making nursing units more accessible and nurse-friendly; and implementing changes to improve care quality. The authors note that while hospitals have expressed a commitment to reducing the nursing shortage, there is an “important role for public financial support.” They also call for further expansion of state and federal grant initiatives for prospective nurses, as well as other strategies to increase nurse faculty positions and training opportunities.

May J.H., Bazzoli G.J., Gerland A.M. (2006) Hospitals' responses to nurse staffing shortages. Health Aff (Millwood). 25(4):W316-23. Epub 2006 Jun 26

100,000 Lives Campaign

Institute for Healthcare Improvement (IHI) has announced that the roughly 3,100 U.S. hospitals participating in the 100,000 Lives Campaign—an initiative aimed at preventing medical errors and unnecessary patient deaths—have exceeded their goals and prevented an estimated 122,300 deaths since the program began 18 months ago.

The campaign, which now involves approximately 75% of all U.S. hospital beds, requires participating hospitals to report mortality data, error rates, and patient infections, as well as to adopt some or all of six evidence-based care practices and life-saving interventions; the interventions include rapid response teams for the emergency care of patients whose vital signs suddenly begin to deteriorate, use of preoperative antibiotics to prevent surgical infections, and treatment of heart attack patients with aspirin and beta-blockers.

Approximately 33% of participating hospitals have implemented all six practices and more than 50% have implemented three or more practices. In addition, nearly 100 hospitals that have achieved excellence in specific areas targeted by the campaign have agreed to mentor other hospitals striving to provide better patient care. Speaking yesterday at a hospital conference in Atlanta, the president and CEO of IHI said that the campaign “signals no less than a new standard of health care in America,” noting that he had “never before witnessed such widespread collaboration and commitment” from the health care industry to make such significant improvements in patient care.

Research Results for the Public

The NIH has published a new website Research results for the Public. Its aim is to inform the public about research that is being conducted. The web site has links to fact sheets that enable people to "learn more about how NIH is pursuing its goal to make important medical discoveries that improve health and save lives."

Role discrepancy: is it a common problem among nurses?

This paper reports a study of nurses' perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences.

The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice,
this assumption has not been tested.

Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses
experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decision-making and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals.

Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses' conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the
current healthcare environment.

To read the full article:
Takase M, Maude P, Manias E. (2006) Role discrepancy: is it a common problem among nurses? J Adv Nurs. 54(6):751-9.

STD Treatment Guidelines Updated

The Centers for Disease Control has issued new guidelines for sexually treated diseases.

These guidelines for the treatment of persons who have sexually transmitted diseases (STDs) were developed by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta, Georgia, during April 19–21, 2005. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2002.

Read Summary
Full Guideline - web version
Full guideline - PDF version

Health Literacy of American Adults

Results from the Health Literacy component of the 2003 National Assessment of Adult Literacy (NAAL) were just released. The health literacy findings are based on the first large-scale national assessment designed specifically to measure the health literacy of adults living in America.

This report measures health literacy among American adults including their ability to read, understand, and apply health-related information in English.

Findings include:

• The majority of American adults (53 percent) had Intermediate health literacy. Fewer than 15 percent of adults had either Below Basic or Proficient health literacy.
• Women had higher average health literacy than men.
• Adults who were ages 65 and older had lower average health literacy than younger adults.
• Hispanic adults had lower average health literacy than adults in any other racial/ethnic group.

To download, view and print the publication as a PDF file, please visit:
http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483

Comments on Health Literacy of America' Adults - NEJM

From Dr. Marcus is an assistant professor of clinical medicine in the Division of General Internal Medicine at the University of Miami Miller School of Medicine, Miami.

Marcus, E.N. (2006). The Silent Epidemic — The Health Effects of Illiteracy New England Journal of Medicine, 355 (4), 339-41 http://content.nejm.org/cgi/content/full/355/4/339?query=TOC

YSN Library September 11 - September 15

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 9/11
8:30 - 2:30

Tuesday 9/12
See me in Medical Library for assistance - 737-2964

Wednesday 9/13
10:30 - 2:30

Thursday 9/14
11:30 - 4:30

Friday 9/15
8:30 - 5:00

Complete list of classes

YSN Library September 4 - September 9

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 9/5
University Holiday

Tuesday 9/6
See me in Medical Library for assistance - 737-2964

Wednesday 9/7
See me in Medical Library for assistance - 737-2964

Thursday 9/8
8:30 - 4:30

Friday 9/9
Call the Information Desk for assistance - 737-4065

Complete list of classes