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RNews CAPSULESSoap-opera videos promote healthy choices
Rachel Jones, RN, PhD, assistant professor at Rutgers, the State University of New Jersey, College of Nursing in Newark, and a team consisting of a filmmaker, actors, webmasters, programmers and women from the community, have launched a Web site that features the 43-minute soap-opera video Toni, Mike, and Valerie. In a recent pilot study, young adult urban women were found to identify with the protagonists in the video who suffer tragedy and heartbreak, and then exercise various choices to promote health. Messages about reducing HIV sexual risk behavior are communicated through the drama and context of relationships, a potential strength of the soap-opera modality. The heroines are young adult African-American and Latina women who engage in a process of “power as knowing participation in change” (Caroselli & Barrett, 1998)—acting with awareness of new choices and to promote health. The video is based on research supported by the National Institute of Nursing Research. The development of a decision-support system (DSS) that delivers a version of the video tailored to the woman’s partner type and level of HIV risk was funded by the National Library of Medicine. As reported in the Second Qtr. 2006 issue of Reflections on Nursing Leadership, the video was pilot tested in a randomized control experimental design using hand-held computers. The test sites were public housing developments, a community center and a downtown storefront, in neighborhoods reporting a high incidence of HIV/AIDS. According to the Centers for Disease Control, 80 percent of HIV-infected women in the United States were infected through unprotected sex with HIV-infected men (CDC, 2007). Jones’ research indicates there are many reasons women engage in unprotected sex with male partners, even when they are aware those partners engage in risk behaviors. Risk of sexual transmission of HIV may be perceived to be real; however, the risk of losing a male partner if one doesn’t engage in unprotected sex may be perceived to be greater. Sex script theory and Barrett’s theory of power as knowing participation in change are integrated into a framework to explain young adult urban women’s sex-scripted responses of unprotected sex as a normative relationship-promoting behavior (Jones, 2006). The videos portray women as they realistically emerge with powerful, health-promoting ways to handle challenges in relationships that may promote HIV risk. The project will continue to produce videos and further explore lower-power sex scripts that promote HIV risk and higher-power sex scripts that promote change. A six-minute clip extracted from the video titled Sex, Love, and Condoms may be viewed in this issue of Reflections on Nursing Leadership. To view the full set of videos and learn more about research to reduce HIV/AIDS through soap-opera dramatization, visit the newly created Web site, www.stophiv.newark.rutgers.edu References CDC. HIV/AIDS Surveillance Report, 2005. (2007). Retrieved June 28, 2007, from: http://www.cdc.gov/hiv/topics/surveillance/resources/ Jones, R. (2006). Sex scripts and power: A framework to explain urban women's HIV sexual risk with male partners. Nursing Clinics of North America, 41(3), 425-436. Patient safety and health improvements vary by state Hospitals across the United States have significantly improved the quality of care provided for patients suffering from heart attacks, heart failure and pneumonia over the past four years, but results vary from state to stare, according to a report from The Joint Commission. The report details the performance of accredited hospitals against standardized national performance measures and the Joint Commission’s National Patient Safety Goals. The report, Improving America’s Hospitals: A Report on Quality and Safety, also shows that almost all heart attack patients are receiving the life-saving benefits of aspirin when they arrive at the hospital, yet many heart failure patients do not receive specific discharge instructions about their condition and necessary follow-up care when they leave the hospital. Hospital performance in complying with National Patient Safety Goal requirements has also varied. Most hospitals do well in using objective methods to identify patients before undertaking treatments, but find it challenging to put processes in place to avoid medication mix-ups. The report, the first of what is to become an annual report, covers the time period from 2002 through 2005. The magnitude of improvement in the safety and quality of care provided ranged from 1.1 percent to 42.8 percent over the four-year period between 2002 and 2005, with performance improving fastest on measures where initial performance level was lowest. For example, the greatest improvement occurred in providing smoking cessation advice to patients admitted to the hospital with pneumonia. The national rate for telling these patients about the benefits of quitting smoking shot up from 37 percent in 2002 to 80 percent by 2005. Overall use of specific care interventions for patients admitted with heart attacks, as well as the actual in-patient mortality rates, also improved. These specific care interventions have been shown to reduce the risk of future heart attacks and lower mortality. Room for improvement exists for most of the quality measures. For example, hospitals are currently achieving 90 percent performance or higher for about half of the measures tracked since 2002. Hospitals are performing at less than 65 percent for two of these measures—providing pneumococcol vaccination to patients admitted with pneumonia, and providing discharge instructions to patients admitted with heart failure. Considerable variability exists in the performance of hospitals by state on most measures. For example, statewide averages for providing discharge instructions to patients admitted with heart failure range from 33.5 percent to 89 percent. On providing pneumococcol vaccination to patients admitted with pneumonia, performance ranges from 48 to 84 percent across the states. There are significant differences in performance between highest- and lowest-performing hospitals. Joint Commission data show that some hospitals perform better than others in treating particular conditions, and that more than 90 percent of the nation’s hospitals are achieving 90 percent performance on only one measure. To view hospital-specific performance on the measures, go to the individual hospital’s Quality Report on Quality Check at www.qualitycheck.org. Hospital compliance is lowest for National Patient Safety Goal requirements that a “time out” is taken by the surgical team before surgery to confirm patient identity and correct procedure, and to avoid certain potentially confusing abbreviations when ordering medications. Although National Patient Safety Goal compliance is trended over time for the various requirements, the report urges caution in interpreting these trends because Joint Commission surveyors have become increasingly sophisticated in assessing compliance with some of the requirements. For a complete copy of Improving America’s Hospitals: A Report on Quality and Safety, please visit the Joint Commission’s website, www.jointcommission.org. $2.6 million grant awarded to teach nurses use of geriatric health-assessment tools The Hartford Institute for Geriatric Nursing at New York University College of Nursing, in collaboration with the American Journal of Nursing, has been awarded a $2,622,560 grant from The John A. Hartford Foundation to produce and distribute demonstration videos and a companion series of journal articles for teaching nurses the use of geriatric health assessment tools. Terra Nova Films will partner with AJN to produce the videos. “Health assessment of older adults is important because illness in older people often looks different than in younger ones,” said Mathy Mezey, EdD, RN, FAAN, principal investigator, and director of The Hartford Institute for Geriatric Nursing. “Yet few faculty or care providers outside of the geriatric specialty are prepared to conduct or teach assessments specific to older adults, despite the prevalence of this population.” The need for teaching assessments of older adults is even more urgent in associate degree programs since, to date, other geriatric assessment initiatives have focused primarily on higher degree programs. Given that 63 percent of those entering the nursing workforce are graduates of associate degree nursing programs, the need for this preparation is paramount. The project will translate and disseminate the highly accessible Try This tool box of geriatric assessment tools, created by The Hartford Institute for Geriatric Nursing, into 30 Web-based, no-cost demonstration videos and articles for faculty, students and graduates. The toolbox provides knowledge of best practices in the care of older adults in a way that is easy to understand and implement by all direct-care nurses. Using actual nurses, patients and their families, the new video materials will demonstrate how geriatric assessments should be conducted, interpreted and communicated to plan the care for an older adult. Accompanying these videos will be a complementary series of continuing-education articles published in AJN that provide case studies and supporting information about the use of each assessment tool, which will be available online to read or download. The series will also target faculty and students in other nursing programs as well as hospital care providers, home health agencies, nursing homes, assisted living facilities and office settings with a variety of resources for bridging the gap that exists between research and current practices. “The Try This series addresses a wide range of symptoms and syndromes that require particular attention in older adults,” said Dr. Mezey. “For example, while a younger adult with a urinary tract infection may have symptoms such as frequent urination and pain, the changes that occur with aging often mask these symptoms. In an older adult, the first sign of a urinary tract infection might be confusion or a fall. If the nurse does not have the knowledge and skills to evaluate older adults, the infection can go untreated and may even result in death.” Diana J. Mason, RN, PhD, FAAN, co-principal investigator for the project and editor-in-chief of AJN, added, “While nurses are taught to generally assess older adults and adjust care accordingly, significant improvements in the quality of life and appropriateness of care can be made when nurses are taught how to assess older adults using standardized evidence-based geriatric assessment procedures. These improvements in care can result in lowering healthcare costs associated with complications, admissions, or re-admissions to hospitals, prolonged length of stay or admission to nursing homes due to missed diagnoses or improper treatment. AJN is pleased to partner with NYU on this important project.” According to the Alliance for Aging Research, older adults constitute almost half of all days of care in hospitals; additionally, 80 percent of people receiving home care and 90 percent of skilled nursing facility residents are 65 years of age or older. Older adults are the largest consumers of health services and nurses care for older adults more than any other patient group. Articles and videos from the Try This tool box series will be available for viewing and downloading at no cost, at www.AJNonline.com, www.HartfordIGN.org, www.GeroNurseOnline.org, and www.NursingCenter.com. Nursing shortage impacts communications Physicians, nurses and hospital administrators voice their concerns about the nursing shortage in a new study by Peter Buerhaus, RN, PhD, FAAN, professor of Nursing at Vanderbilt University and director of the Center for Interdisciplinary Workforce Studies at the Medical Center. The study, reported in an article titled, “Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspective,” is featured in the May/June issue of the journal, Health Affairs. |
