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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedWilliams M, Coppin JD, Bender M
Predictors of Clinical Nurse Leader implementation success across a national sample of settings: a Bayesian multilevel modeling analysis.
The aim of this study was to examine and compare patterns of empirical correspondence to the Clinical Nurse Leader (CNL) Practice Model and predict their influence on implementation success. The researchers conducted a secondary analysis of a 2015 national-level study with clinicians and administrators involved with CNL initiatives in their health system. A total of 920 participants responded, with 59% providing success scores. The variability around success score across CNL Practice Model element ratings was largest at the component level compared to either the domain level or the item level. The components most predictive of implementation success were (a) consensus CNL model can close gaps, (b) organization level implementation strategy, and (c) alignment of empirical CNL microsystem level structuring to the model's conceptualization.
AHRQ-funded; HS027181.
Citation: Williams M, Coppin JD, Bender M .
Predictors of Clinical Nurse Leader implementation success across a national sample of settings: a Bayesian multilevel modeling analysis.
J Nurs Scholarsh 2023 Nov; 55(6):1238-47. doi: 10.1111/jnu.12926..
Keywords: Nursing, Healthcare Delivery, Provider: Nurse
Huff NR, Chimowitz H, DelPico MA
The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: an experimental study using simulated patient cases.
The purpose of this experimental vignette research study was to explore the impact of emotionally evocative patient behavior and mental illness on 130 emergency nurses' emotions, patient assessments, testing advocacy, and written handoffs. The researchers asked the nurses to complete four multimedia computer-simulated patient encounters in which patient behavior (irritable vs. calm) and mental illness (present vs. absent) were purposely varied. The nurses recorded their emotions and clinical evaluations, recommended diagnostic tests, and provided written handoffs. The study found that the nurses experienced greater negative emotions (anger, unease) and reported decreased engagement when evaluating patients demonstrating irritable (vs. calm) behavior. Nurses also considered patients with irritable (vs. calm) behavior as more likely to exaggerate their pain and as poorer historians, and as less likely to cooperate, return to work, and recover. Nurses' handoffs were more likely to include negative descriptions of patients with irritable (vs. calm) behavior and exclude specific clinical information. The existence of mental illness increased unease and sadness and lead to nurses being less likely to recommend a needed test for a correct diagnosis.
AHRQ-funded; HS025752.
Citation: Huff NR, Chimowitz H, DelPico MA .
The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: an experimental study using simulated patient cases.
Int J Nurs Stud 2023 Jul; 143:104507. doi: 10.1016/j.ijnurstu.2023.104507..
Keywords: Emergency Department, Behavioral Health, Nursing, Workflow
Saucke MC, Alagoz E, Arroyo N
The invisible work of transfer centre nurses: a qualitative study of strategies to overcome communication challenges.
The objective of this study was to explore the role of transfer center nurses and their strategies to facilitate communication between providers during calls related to interhospital transfers. Researchers conducted semi-structured interviews with 17 transfer center nurses at one tertiary medical center and asked them to describe their work. The results indicated that transfer center nurses employed multiple strategies to overcome communication challenges; providers' lack of knowledge of the nurses' role can impede respectful and efficient transfer conversations. The researchers concluded that interventions to support and optimize the transfer center nurses' critical work are needed.
AHRQ-funded; HS025224.
Citation: Saucke MC, Alagoz E, Arroyo N .
The invisible work of transfer centre nurses: a qualitative study of strategies to overcome communication challenges.
J Adv Nurs 2023 Jul; 79(7):2539-52. doi: 10.1111/jan.15603..
Keywords: Communication, Provider: Nurse, Nursing
Hansen CJ, Rayo MF, Patterson ES
Perceptually discriminating the highest priority alarms reduces response time: a retrospective pre-post study at four hospitals.
Emergency alarms are the most urgent of hospital alarms, necessitating immediate attention and action to address a dangerous situation. These alarms are triggered by clinicians and have greater positive predictive value (PPV). High-priority alarms are different from emergency alarms, are automatically triggered, and have lower PPV. The purpose of this retrospective pre-post study was to decrease nurse response time for emergency alarms and high-priority alarms by improving the discernability between emergency alarms and all other alarms, as well as by suppressing redundant and false alarms in a secondary alarm notification system (SANS). The researchers analyzed data 15 months prior to and 25 months after a SANS redesign was implemented in four hospitals. For emergency alarms, the researchers integrated digitized human speech features to distinguish the emergency alarms from the automatically triggered alarms, leaving their onset and escalation pathways unaltered. The researchers suppressed some of the automatically triggered alarms by delaying their initial onset and escalation by 20 seconds. The study found that response time for emergency alarms decreased at all hospitals ad the improvements were sustained. The use of automatically triggered alarms decreased 25.0%. Response time for the three automatically triggered cardiac alarms increased at the four hospitals.
AHRQ-funded; HS024379.
Citation: Hansen CJ, Rayo MF, Patterson ES .
Perceptually discriminating the highest priority alarms reduces response time: a retrospective pre-post study at four hospitals.
Hum Factors 2023 Jun; 65(4):636-50. doi: 10.1177/00187208211032870..
Keywords: Hospitals, Nursing
Lake ET, Staiger D, Smith JG
The association of missed nursing care with very low birthweight infant outcomes.
This study examined the association of missed nursing care and health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs). The authors used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. Mortality, morbidity, and length of stay (LOS) was examined in 190 sample hospitals from 19 states in all regions. There was a significant association between higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage and missed nursing care.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger D, Smith JG .
The association of missed nursing care with very low birthweight infant outcomes.
Med Care Res Rev 2023 Jun; 80(3):293-302. doi: 10.1177/10775587221150950..
Keywords: Healthcare Cost and Utilization Project (HCUP), Quality Indicators (QIs), Nursing, Newborns/Infants, Outcomes, Healthcare Utilization, Quality of Care
Meddings J, Gibbons JB, Reale BK
The impact of nurse practitioner care and accountable care organization assignment on skilled nursing services and hospital readmissions.
The purpose of this study was to determine the relationship between Accountable Care Organizations (ACO) designation and nurse practitioners (NP) care delivery during skilled nursing facilities (SNF) visits and the relationship between NP care delivery during SNF visits and unplanned hospital readmissions. The researchers obtained a sample of 527,329 fee-for-service Medicare beneficiaries with 1 or more SNF stays between 2012 and 2017 and then measured the association between patient ACO designation and evaluation and management care delivered by NPs in addition to the association between evaluation and management services delivered by NPs and hospital readmissions. The study found that ACO beneficiaries were 1.26% points more likely to receive 1 or more E&M services delivered by an NP during their SNF visits. ACO-designated beneficiaries receiving most of their E&M services from NPs during their SNF visits were at a lower risk of readmission than ACO-attributed beneficiaries receiving no NP E&M care.
AHRQ-funded; HS024698.
Citation: Meddings J, Gibbons JB, Reale BK .
The impact of nurse practitioner care and accountable care organization assignment on skilled nursing services and hospital readmissions.
Med Care 2023 Jun; 61(6):341-48. doi: 10.1097/mlr.0000000000001826..
Keywords: Nursing, Provider: Nurse, Hospital Readmissions, Provider: Clinician
Wieben AM, Walden RL, Alreshidi BG
Data science implementation trends in nursing practice: a review of the 2021 literature.
The authors reviewed literature on the implementation of data science-driven applications focused on nurse-sensitive indicators to inform readers of trends in the nursing indicators, patient populations and settings of focus, and issues identified during the implementation of these tools. Their review showed that few studies reported on the implementation of applications focused on structural- or outcome-related nurse-sensitive indicators in 2021. They concluded that this gap in sharing implementation strategies needs to be addressed in order for these systems to be successfully adopted in health care settings.
AHRQ-funded; HS026395.
Citation: Wieben AM, Walden RL, Alreshidi BG .
Data science implementation trends in nursing practice: a review of the 2021 literature.
Appl Clin Inform 2023 May; 14(3):585-93. doi: 10.1055/a-2088-2893..
Keywords: Nursing, Evidence-Based Practice
Hewner S, Smith E, Sullivan SS
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
This study examined how patient cohorts generated by machine learning can be enhanced with clinical knowledge to increase translational value and provide a practical approach to patient segmentation based on a mix of medical, behavioral, and social factors. The authors used a primary care practice dataset (N=3438) of high need patients defined by practice criteria and parsed it to a subset population of patients with diabetes (n=1233). Three expert nurses selected variables for k-means cluster analysis using knowledge of critical factors for care coordination, and their knowledge was again applied to describe the psychosocial phenotypes in four prominent clusters, aligned with social and medical care plans. Four distinct clusters were used to create four cohorts including: (1) A large cluster of racially diverse female, non-English speakers with low medical complexity, and history of childhood illness; (2) A large cluster of English speakers with significant comorbidities (obesity and respiratory disease); (3) A small cluster of males with substance use disorder and significant comorbidities (mental health, liver and cardiovascular disease) who frequently visit the hospital; and (4) A moderate cluster of older, racially diverse patients with renal failure.
AHRQ-funded; HS028000.
Citation: Hewner S, Smith E, Sullivan SS .
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
Appl Clin Inform 2023 May; 14(3):408-17. doi: 10.1055/a-2048-7343..
Keywords: Primary Care, Health Information Technology (HIT), Nursing
Zhong J, Simpson KR, Spetz J
Linking patient safety climate with missed nursing care in labor and delivery units: findings from the LaborRNs Survey.
The objective of this study was to explore the association of nurses' perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units. Nurse respondents were recruited via email distribution of an electronic survey; hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. The results suggested that improving safety climate through means such as better teamwork and communication may improve nursing care quality during labor and birth through decreasing missed nursing care. Strategies to reduce missed care may also conversely improve the safety climate.
AHRQ-funded; HS025715.
Citation: Zhong J, Simpson KR, Spetz J .
Linking patient safety climate with missed nursing care in labor and delivery units: findings from the LaborRNs Survey.
J Patient Saf 2023 Apr 1;19(3):166-72. doi: 10.1097/pts.0000000000001106.
Keywords: Maternal Care, Pregnancy, Labor and Delivery, Nursing, Patient Safety, Provider: Nurse
Sullivan CE, Day SW, Ivankova N
Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study.
The purpose of this study was to create an initial core set of Nursing-sensitive indicators (NSIs) for international pediatric oncology nursing that would be important, actionable, and feasible to measure across different resource settings and countries. The researchers utilized purposive snowball sampling to identify 122 expert pediatric oncology nurses from 43 countries for participation. In round 1, the panelists identified five potential NSIs and constructs. These results were applied to round 2 in which panelists chose their top 10 NSIs and constructs and ranked them according to importance to patient care quality. Those results were then applied to round 3, in which panelists ranked the top 10 NSIs and constructs by order of importance for the particular population, then rated each NSI/Construct for actionability and feasibility of measurement. The study identified the preliminary core set of NSIs and constructs identified by the expert panel, and ranked them in the following order of importance: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. The study reported that all NSIs and constructs were rated as actionable; all constructs except palliative/end of life care were rated as feasible to measure. The researchers concluded that initial core NSIs and constructs offer improved insight into typical features of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.
AHRQ-funded; HS013852.
Citation: Sullivan CE, Day SW, Ivankova N .
Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study.
J Nurs Scholarsh 2023 Jan; 55(1):388-400. doi: 10.1111/jnu.12798..
Keywords: Children/Adolescents, Quality Indicators (QIs), Quality of Care, Nursing, Cancer
Niznik J, Zhao X, Jiang T
Anticholinergic prescribing in Medicare Part D beneficiaries residing in nursing homes: results from a retrospective cross-sectional analysis of Medicare data.
The primary objective of this study was to identify factors associated with low- and high-level anticholinergic burden in nursing home residents. Overall, 29.6 percent of subjects had a high anticholinergic burden and 35.2 percent had a low burden. High burden was most often (72 percent) due to one highly anticholinergic medication rather than a cumulative effect.
AHRQ-funded; HS023779.
Citation: Niznik J, Zhao X, Jiang T .
Anticholinergic prescribing in Medicare Part D beneficiaries residing in nursing homes: results from a retrospective cross-sectional analysis of Medicare data.
Drugs Aging 2017 Dec;34(12):925-39. doi: 10.1007/s40266-017-0502-6.
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Keywords: Elderly, Medicare, Medication, Nursing
Larson EL, Cohen B, Liu J
Assessing intensity of nursing care needs using electronically available data.
The aim of this project was to develop and test a Nursing Intensity of Care Index using electronically available data from 152,072 patient discharges from three hospitals. In preliminary testing, data for the Nursing Intensity of Care Index, which accurately reflect nursing care intensity, can be obtained electronically in real time. The next steps will be a discrete-event simulation model and large-scale field trials.
AHRQ-funded; HS024915.
Citation: Larson EL, Cohen B, Liu J .
Assessing intensity of nursing care needs using electronically available data.
Comput Inform Nurs 2017 Dec;35(12):617-23. doi: 10.1097/cin.0000000000000375.
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Keywords: Electronic Health Records (EHRs), Nursing, Workforce
Benda N, Hettinger A, Bisantz A
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
This study described the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. It found that physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas.
AHRQ-funded; HS022542.
Citation: Benda N, Hettinger A, Bisantz A .
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
Journal of Healthcare Informatics Research 2017 Dec;1(2):218-30.
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Keywords: Communication, Electronic Health Records (EHRs), Provider: Health Personnel, Emergency Department, Nursing
Hessels AJ, Darby SW, Simpser E
National testing of the nursing-kids intensity of care survey for pediatric long-term care.
The purpose of this study is to test the Nursing-Kids Intensity of Care, a measure of the intensity of nursing care needs, defined as the quantity and type of direct and indirect care activities performed by caregivers in a national sample. The authors concluded that additional testing to further establish psychometric sufficiency and expanded use to quantify the intensity of nursing care needs of children with complex medical conditions in pediatric long-term care settings is recommended.
AHRQ-funded; HS021470.
AHRQ-funded; HS021470.
AHRQ-funded; HS021470.
Citation: Hessels AJ, Darby SW, Simpser E .
National testing of the nursing-kids intensity of care survey for pediatric long-term care.
J Pediatr Nurs 2017 Nov/Dec;37:86-90. doi: 10.1016/j.pedn.2017.08.026..
Keywords: Children/Adolescents, Health Services Research (HSR), Long-Term Care, Nursing, Children/Adolescents
Squires A
Evidence-based approaches to breaking down language barriers.
This article provides background information about language barriers between nurses and patients and some strategies for addressing these gaps. After detailing how these barriers affect patient outcomes, practice-based strategies are offered to improve outcomes and reduce readmissions. Although the article doesn’t address barriers to communicating with patients with hearing loss, many of the same principles apply to these patients.
AHRQ-funded; HS023593.
Citation: Squires A .
Evidence-based approaches to breaking down language barriers.
Nursing 2017 Sep;47(9):34-40. doi: 10.1097/01.NURSE.0000522002.60278.ca.
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Keywords: Communication, Cultural Competence, Evidence-Based Practice, Nursing, Clinician-Patient Communication
Lau BD, Shaffer DL, Hobson DB
Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: a randomized clinical trial.
Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: a randomized clinical trial.
AHRQ-funded; HS024547.
Citation: Lau BD, Shaffer DL, Hobson DB .
Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: a randomized clinical trial.
PLoS One 2017 Aug 16;12(8):e0181664. doi: 10.1371/journal.pone.0181664.
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Keywords: Blood Clots, Education: Continuing Medical Education, Medication, Nursing, Prevention, Provider: Nurse, Web-Based, Practice Patterns
Farra SL, Miller ET, Gneuhs M
Disaster management: communication up, across, and down.
This case study uses the National Preparedness Leadership Initiative’s (NPLI) meta-leadership model as the guiding framework for developing and implementing an evacuation exercise focused on the safe evacuation of neonates. Key components of this framework include strategies for communicating up, across, and down among various stakeholders.
AHRQ-funded; HS023149.
Citation: Farra SL, Miller ET, Gneuhs M .
Disaster management: communication up, across, and down.
Nurs Manage 2017 Jul;48(7):51-54. doi: 10.1097/01.NUMA.0000520720.78549.e4..
Keywords: Emergency Preparedness, Communication, Nursing, Case Study
Boltey E, Yakusheva O, Costa DK
5 nursing strategies to prevent ventilator-associated pneumonia.
This article reviews the top five evidence-based nursing practices for reducing ventilator-associated pneumonia (VAP) risk in critically ill adults.
AHRQ-funded; HS024552.
Citation: Boltey E, Yakusheva O, Costa DK .
5 nursing strategies to prevent ventilator-associated pneumonia.
Am Nurse Today 2017 Jun;12(6):42-43..
Keywords: Critical Care, Healthcare-Associated Infections (HAIs), Nursing, Prevention, Pneumonia
Baernholdt M, Hinton ID, Guofen Y
A national comparison of rural/urban pressure ulcer and fall rates.
Despite recent decline in hospital acquired conditions (HACs), rates for pressure ulcers (PURs) and falls (FRs) remain at levels that require improvement. Contextual factors and care processes may impact HACs. Using the National Database of Nursing Quality Indicators (NDNQI®) this study examined differences in care processes and community, hospital, and nursing unit characteristics that influence PURs and FRs in 4238 rural and urban nursing units.
AHRQ-funded; HS023147.
Citation: Baernholdt M, Hinton ID, Guofen Y .
A national comparison of rural/urban pressure ulcer and fall rates.
Online J Issues Nurs 2017 May;22(2):1-12. doi: 10.3912/OJIN.Vol22No02PPT60..
Keywords: Injuries and Wounds, Nursing, Patient Safety, Pressure Ulcers, Quality of Care, Quality Improvement, Quality Indicators (QIs), Quality Measures, Rural Health, Urban Health
Bhattacharjee P, Churpek MM, Snyder A
Detecting sepsis: are two opinions better than one?
Researchers conducted a study to characterize the agreement between different providers' suspicion of infection and the correlation with patient outcomes using prospective data from a general medicine ward. They concluded that provider disagreement regarding suspected infection is common, with RNs suspecting infection more often, suggesting that a collaborative model for sepsis detection may improve timing and accuracy.
AHRQ-funded; HS000078.
Citation: Bhattacharjee P, Churpek MM, Snyder A .
Detecting sepsis: are two opinions better than one?
J Hosp Med 2017 Apr;12(4):256-58. doi: 10.12788/jhm.2721.
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Keywords: Diagnostic Safety and Quality, Nursing, Risk, Sepsis
Dunn Lopez K, Gephart SM, Raszewski R
Integrative review of clinical decision support for registered nurses in acute care settings.
To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses, the researchers performed an integrative review of qualitative and quantitative peer-reviewed original research studies. They concluded that clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality.
AHRQ-funded; HS022908.
Citation: Dunn Lopez K, Gephart SM, Raszewski R .
Integrative review of clinical decision support for registered nurses in acute care settings.
J Am Med Inform Assoc 2017 Mar 1;24(2):441-50. doi: 10.1093/jamia/ocw084.
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Keywords: Critical Care, Clinical Decision Support (CDS), Health Information Technology (HIT), Nursing, Patient Safety
Asan O, Flynn KE, Azam L
Nurses’ perceptions of a novel health information technology: a qualitative study in the pediatric intensive care unit.
The purpose of this study was to evaluate the use of a novel health information technology (HIT), a large customizable interactive monitor (LCIM), implemented in a pediatric intensive care unit (PICU). The study collected and analyzed data from 55 PICU nurses in seven focus groups. Six major themes emerged including familiarity and use routines, positive perceptions with the LCIM, negative perceptions with the LCIM, privacy, training, and suggestions for improvement.
AHRQ-funded; HS023626.
Citation: Asan O, Flynn KE, Azam L .
Nurses’ perceptions of a novel health information technology: a qualitative study in the pediatric intensive care unit.
Int J Hum Comput Interact 2017;33(4):258-64. doi: 10.1080/10447318.2017.1279828.
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Keywords: Health Information Technology (HIT), Intensive Care Unit (ICU), Patient and Family Engagement, Children/Adolescents, Nursing
Kolko RP, Kass AE, Hayes JF
Provider training to screen and initiate evidence-based pediatric obesity treatment in routine practice settings: a randomized pilot trial.
This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. Both live interactive training and Web-facilitated self-study training were acceptable, with higher ratings for live training and participants with previous experience. Knowledge and skill improved from pretraining to post-training and follow-up in both conditions.
AHRQ-funded; HS000078.
Citation: Kolko RP, Kass AE, Hayes JF .
Provider training to screen and initiate evidence-based pediatric obesity treatment in routine practice settings: a randomized pilot trial.
J Pediatr Health Care 2017 Jan - Feb;31(1):16-28. doi: 10.1016/j.pedhc.2016.01.001.
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Keywords: Children/Adolescents, Evidence-Based Practice, Nursing, Obesity, Training
de Cordova PB
Staffing and nurse-perceived quality of care.
This article comments on a study by Cho and colleagues, the purpose of which was to explore the associations between nurse staffing and overtime with nurse-perceived patient safety and care left undone. Cho and colleagues found that as patients per nurse and nurse work hours increase, so does the perception of reduced patient safety. The author argues that the study reinforces the view that educating nurses, administrators and policymakers about the importance of nurse staffing on quality care should continue.
AHRQ-funded; HS024339.
Citation: de Cordova PB .
Staffing and nurse-perceived quality of care.
Evid Based Nurs 2017 Jan;20(1):19. doi: 10.1136/eb-2016-102478.
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Keywords: Quality of Care, Provider, Nursing, Workforce