INQRI Grantee's New Site to Disseminate Function Focused Care

INQRI grantee Barbara Resnick was awarded two Helen and Leonard Stulman Foundation grants to expand her INQRI work on disseminating function focused care to additional assisted living facilities. With part of this funding, Dr. Resnick has established a website which provides information and tips for caregivers to encourage residents to participate in routine daily functional tasks and engage in other types of physical activity. The site features video coaching and other resources.

This is just one of the videos available on the site:


Check out the rest of the resources here.

INQRI Team Publishes New Article on Intragroup Social Dynamics, Methods

INQRI grantee Tracey Yap and her team recently a new article in the Journal of Mixed Methods Research which discusses intragroup social dynamics and the work of their nursing and education research team as a community of research practice interested in organizational cultures and occupational subcultures. The dynamics were characterized by processes of socialization through reeducation and group social identity formation that allowed members to cross disciplines and produce interdisciplinary mixed methods combinations.

Yap's INQRI team developed a sustainable, system-wide program for pressure ulcer prevention that enhances mobility of long-term care (LTC) residents. The primary goal was to reduce LTC facility-acquired pressure ulcer incidence by 50% using a cost-effective innovative program to increase resident active or passive movement. The team was led by Yap, a nurse researcher, and Jay Kim, PhD, an engineer.

To learn more about their new article, please visit the journal's website.

AcademyHealth: Tuesday

If you are at AcademyHealth today, be sure to check out this INQRI presentation today:
 
Poorer Outcomes in Hospitals with High Concentrations of Black Babies are related to Inferior Nursing Resources 
E.T. Lake, D. Staiger, J. Horbar, M. Kenny, T. Patrick, J. Rogowski
Tuesday, June 25: 11:30 AM

New Brief Makes the Case for Baccalaureate-Prepped Nurses

A new policy brief authored by Ann Kutney-Lee and Linda Aiken and distributed by the Leonard Davis Institute of Health Economics at the University of Pennsylvania makes the case for baccalaureate-prepared nurses.

Researchers found that increases in the percentage of nurses with baccalaureate degrees were associated with significant reductions in surgical mortality rates and failure-to-rescue rates.  They also found that a ten-point increase in a hospital’s percentage of baccalaureate-prepared nurses was associated with an average reduction of 2.12 deaths for every 1,000 patients. (The average reduction was 7.47 deaths per 1,000 patients in the subset of patients with complications.)

These results suggest that if all the hospitals in the study had increased their percentage of baccalaureate nurses by ten points, about 500 deaths might have been prevented.  This is an incredibly important finding, given the recommendation made in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health to increase the number of nurses holding a baccalaureate degree to 80% by the year 2020.

The brief also explains that in addition to improving patient outcomes, higher numbers of baccalaureate-prepared nurses could also lead to an increased number of graduate-level nurses prepared to either become nurse faculty or accept advanced-practice positions in primary care.  Aiken found that nurses with initial associate's degrees were less likely than those with an initial baccalaureate degree to earn a master's degree.

This brief is based on the following articles: 

1. A. Kutney-Lee, D.M. Sloane, L.H. Aiken. An increase in the number of nurses with baccalaureate degrees is linked to lower rates of post-surgery mortality, Health Affairs, March 2013, vol. 32, pp. 579-586;
2. L.H. Aiken. Nurses for the future. New England Journal of Medicine, January 20, 2011, vol. 364, pp. 196-198.

AcademyHealth: Monday Events

If you are at AcademyHealth today, be sure to check out these INQRI presentations today:
 
Patient and Nurse Discharge Readiness Assessments and Return to Hospital 
M. Weiss
Poster Session: B
Monday, June 24: 9:45 AM - 11:15 AM

Scaling Up Qualitative Methods for Translational Research 
S. Tavernier
Poster Session: B
Monday, June 24: 9:45 AM - 11:15 AM

Testing Strategies to Improve Pain Care Quality in U.S. Hospitals 
S. Beck
Poster Session: C
Monday, June 24: 6:45 PM - 8:15 PM

AcademyHealth: Sunday Events

If you are at AcademyHealth today, be sure to check out these INQRI presentations today:
 
Implementation Science and Health System Interventions 
M. Titler, R. Newhouse, B. Mittman, A. Harris
Sunday, June 23: 4:30 PM

Nurse Workforce Characteristics and Quality of Care in Department of Veterans Affairs Community Living Centers 
M. Uchida
Poster Session: A
Sunday, June 23: 2:30 PM - 4:00 PM

AcademyHealth: Saturday Events

If you are at AcademyHealth today, be sure to check out these INQRI presentations today:

Poorer Outcomes in Hospitals with High Concentrations of Black Babies are related to Inferior Nursing Resources 
E.T. Lake, D. Staiger, J. Horbar, M. Kenny, T. Patrick, J. Rogowski
Health Disparities Interest Group Meeting, Saturday, June 22: 2 PM

The Role of Nurse Education for Patient Outcomes and Costs of Hospitalization 
O. Yakusheva
Interdisciplinary Research Group on Nursing Issues Interest Group Meeting, Saturday, June 22: 3:35 PM - 4:50 PM

New INQRI Article on the Failure to Rescue Metric

INQRI researchers Marcelline Harris, Jack Needleman, and their team recently published a new piece in Medical Care, focused on their project, "Improving the National Quality Forum (NQF) Failure to Rescue Metric."  The team's goal was to refine one of the most controversial measures of nursing-sensitive quality of care: failure to rescue.

The new article examines whether the accuracy of failure to rescue exclusion rules can be improved with data with good "present on admission" indicators. The authors concluded that failure to rescue is a robust quality measure, sensitive to nursing across alternative exclusion rule specifications.

Click here to learn more.

Health Wonk Review: Rhetorical Question Edition

This week's Health Wonk Review blog carnival was compiled by Sarah Sonies and Jennifer Salopek and is over at the Wing of Zock blog.  Sonies and Salopek note that this week's edition features a  "wide-ranging roundup of blog posts on such topics as costs, insurance, policy, money, and more."

We were pleased to have one of our posts included in the carnival and we encourage all of our readers to head on over to the Wing of Zock!

PCORI and NIA Announce New Partnership on Fall Prevention

The Patient-Centered Outcomes Research Institute (PCORI) recently announced an agreement with the National Institute on Aging (NIA) to form a new partnership that will fund a major intervention study aimed at preventing injuries from falls in older adults. This agreement is the first step in the formation of the "Falls Injuries Prevention Partnership," which is the basis for developing an NIA-PCORI funding announcement for a large-scale, multi-year clinical trial on preventing injurious falls in non-institutionalized older individuals. PCORI plans to commit up to $30 million to this effort, though the final amount is yet to be determined. The NIA is in the process of developing a Funding Opportunity Announcement that is expected to be finalized in late July; further details will be available at that time. NIA has issued a Request for Information to gather insights from individual stakeholders and organizations involved in the care and well-being of older individuals.

The INQRI program has long been interested in this topic and has funded two recent studies designed to take a personal approach to fall prevention.  Led by Patti Dykes, one INQRI team has developed and tested a fall prevention tool kit using health information technology that successfully reduced the number of in-hospital falls among older patients. The tool kit includes a fall risk assessment, a patient-specific prevention plan, a handout for patients and their families and a poster to hang over a patient’s bed. INQRI also funded a team headed by Marita Titler to test fall prevention interventions tailored to patients’ risks for falls. This study involves three Michigan community hospitals which will implement processes to address multiple patient-specific factors that can contribute to and put patients at risk for falls, creating a “targeted risk factor fall prevention bundle” for each patient.

Click here to check out INQRI resources related to falls.
Click here to learn more about the PCORI-NIA partnership.

Improvement Science Research Network Offers Tips on Publishing Quality Improvement Projects

As the Improvement Science Research Network's (ISRN) 2013 Summer Institutes on Quality Improvement* are rapidly approaching, the ISRN is offering tips about publishing quality improvement projects and getting involved with their events. 

• If your quality improvement project produced ‘something to share’ with a larger readership, it may be ‘tricky’ to find a journal for publishing your message. You can locate ‘journals that publish QI projects’ in the BLOG, “Where to Publish your QI Results.”  Click here>>>
  
  
• This is a resource from the Improvement Science Research Network (ISRN), developed by the national CTSA Nursing Special Interest Group. Once this need was recognized you are invited to ADD TO THIS COLLECTION through your comments.
  
  
• Learn more about the Improvement Science Research Network (ISRN) resources and collaborate in one of the Network Research Studies by attending the Improvement Science Summit (a research methods conference), held July 9-10 in San Antonio, TX. See Page 3 of the brochure: Click here to download brochure (PDF)
  
  
• Check out the ISRN Specialty Workshops (July 10): 
• Educators’ EBP Workshop®- This year’s them is Interprofessional Education for Interprofessional Care. Expand your interprofessional education initiative by attending this specialty workshop. 
• TeamSTEPPS® Fundamentals Training Workshop-Build your agency’s capacity in this crucial skill set in team building and communication. Bring a team to this specialty workshop. 
• Essential Elements Workshop- An essential introduction to the basics of Evidence-Based Practice. Click here for details

*The 2013 Summer Institutes on Quality Improvement: A Cluster of Interprofessional Conferences will be held July 9-13 in San Antonio, TX.

INQRI at AcademyHealth

This weekend, scholars from across the country will be gathering in Baltimore for the 2013 Annual Research Meeting (ARM). We are pleased to announce that once again, INQRI will be well-represented at the meeting as several of our teams will be presenting on their INQRI-funded projects. We are also thrilled to congratulate Susan Tavernier, a member of Susan Beck's INQRI team, who has been chosen as a recipient of the 2013 Presidential Scholarship for New Health Services Researchers at this year's meeting.

If you are attending ARM this year, be sure to check out these presentations:

Invited Session 

Implementation Science and Health System Interventions 
M. Titler, R. Newhouse, B. Mittman, A. Harris
Sunday, June 23: 4:30 PM

Podium Presentation 

Poorer Outcomes in Hospitals with High Concentrations of Black Babies are related to Inferior Nursing Resources 
E.T. Lake, D. Staiger, J. Horbar, M. Kenny, T. Patrick, J. Rogowski
Tuesday, June 25: 11:30 AM and Health Disparities Interest Group Meeting, Saturday, June 22: 2 PM

The Role of Nurse Education for Patient Outcomes and Costs of Hospitalization 
O. Yakusheva
Interdisciplinary Research Group on Nursing Issues Interest Group Meeting, Saturday, June 22: 3:35 PM - 4:50 PM

Poster Presentations 

Nurse Workforce Characteristics and Quality of Care in Department of Veterans Affairs Community Living Centers 
M. Uchida
Poster Session: A
Sunday, June 23: 2:30 PM - 4:00 PM

Patient and Nurse Discharge Readiness Assessments and Return to Hospital 
M. Weiss
Poster Session: B
Monday, June 24: 9:45 AM - 11:15 AM

Scaling Up Qualitative Methods for Translational Research 
S. Tavernier
Poster Session: B
Monday, June 24: 9:45 AM - 11:15 AM

Testing Strategies to Improve Pain Care Quality in U.S. Hospitals 
S. Beck
Poster Session: C
Monday, June 24: 6:45 PM - 8:15 PM

Sharing Nursing's Knowledge... with Lots of INQRI News

Check out the June edition of the Robert Wood Johnson Foundation's Sharing Nursing's Knowledge newsletter.  We were pleased to see that INQRI was heavily featured in this month's collection of stories... Read on!

Highlights:

• The Future of Nursing national research agenda announces four new grantees supported by the INQRI program.
• The section on recent nursing research features an INQRI study on heart failure.
• Last week, RWJF announced a $20M grant to support nurse PhD scientists.

Of course, this is just a sampling of the exciting news shared in the newsletter.  Check it out!

Staffing, Quality, and Costs

The New York State Nurses Association is supporting a bill currently under discussion in the New York state legislature that would establish required nurse staffing ratios in the state's 185 acute care hospitals.  The hospitals oppose the bill, noting that the suggested ratios would cost their institutions and nursing homes about $3 billion a year and would affect their ability to shift staff use as needed.

This is an important conversation, given that research is demonstrating that nurse staffing levels have a definite impact on the quality of patient care.

INQRI researchers Mary Blegen and Tom Vaughn examined the extent to which nurse staffing levels affected the incidence of complications and the failure to rescue from those complications, (i.e. death following complications). Their examination showed that nursing hours per patient day were strongly associated with lower rates of pressure ulcers and hospital acquired infections, and fewer deaths from complications. Further, more RN hours in the mix had additional benefit with still lower rates of failure to rescue and hospital acquired infections. Their work shows that higher levels of nursing hours per patient day and RN skill mix in intensive care units and in general units will lead to better patient outcomes, information that can guide states considering regulation of nurse-patient staffing ratios to address patient safety gaps.

Findings from the first study to look at the link between nursing and very low birthweight infants in the neonatal intensive care unit (NICU) indicate that nurse staffing and practice environment do matter. INQRI researchers Eileen Lake and Jeannette Rogowski examined care in more than 100 NICUs around the U.S. and found that when babies are treated in units where nurses have less support and less frontline experience they are at higher risk of developing infections. Babies in hospitals where nurses are supported and have more experience are less likely to have medical complications such as bleeding in the brain, which leads to costly complications. The study results could guide decisions related to setting standards for all hospitals to follow when creating and staffing a neonatal intensive care unit where infants thrive.

Click here to read an article about the New York legislation in the Wall Street Journal.
Click here to learn more about the Blegen-Vaughn study.
Click here to learn more about the Lake-Rogowski study.

Star Struck: How the Work of the INQRI Program Leaves Me in Awe

Terri Schmitt PhD, APRN, FNP-BC, Assistant Professor, Florida Atlantic University.  Follow Dr. Schmitt on Twitter. 

Last April, while sitting in a hotel bar in Washington, D.C., typing away on my laptop, I was suddenly interrupted by bright lights and a camera crew interviewing what appeared to be several television and movie celebrities.  For a Midwestern girl like myself, this was a once in a lifetime spotting. I later learned that these were attendees of the National Press Corps dinner and friends joked with me that I should have interrupted, asked for autographs, etc.  However, this brief brush with what the world defines as fame was not the most moving, memorable, important, or exciting, event of that day. 

Mary Naylor, Terri Schmitt, Heather Kelley

That day and the previous 48 hours, for me, had been a true once-in-a-lifetime opportunity.  I was invited to attend the national conference of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative (INQRI) program and learn from some of the country’s most prominent nurse researchers and interdisciplinary research teams.  Launched in 2005 by RWJF, the INQRI program funded 40 different interdisciplinary research teams.  The work of this organization, that was not even a decade in the making, has changed the face of nursing research and patient outcomes forever.

During those spring days in Washington, I was exposed to teams of nurses, physicians, statisticians, and other health researchers who bring their expertise together to create improved patient outcomes.  The summaries of research, impact, evaluations, revisions, and new projects stemming from the brief 7 years of INQRI funding was more than impressive, it was the visionary foundation for interdisciplinary nursing research.  Meeting the true ‘rock stars’ of nursing science and healthcare in action was exhilarating. 

From the meeting, I took away four meaningful ideals which now impact the way I practice, teach, and view nursing research.

• Interdisciplinary nurse-led research must be done. Within the interdisciplinary nature of healthcare, professions must work together to find solutions.
• Rapid dissemination of sound, peer-reviewed, research is key.  INQRI has employed publications, conferences, the internet, social media, webinars, and the like to more quickly push out results.  To my knowledge, they are the first nursing research entity of its kind to so rapidly and diversely make research findings available.
• The expertise of nursing is critically needed to improve patient outcomes.  Nursing research has often been overlooked in competitive funding proposals because it is not aimed toward some of the groundbreaking science and pharmaceutical advances.  However, the experience of human illness, barriers to care, complications in acute care settings and beyond, inflated costs of readmissions, falls, home care, are just a few of the areas in which nurses are experts.  Our work can be measured, is life and cost saving, and has impact.
• Nurses of all education levels should not only read nursing research, but readily take part in it.  From bedside and classroom, to administration. 

The foundational work of the INQRI program has changed healthcare and nursing forever.

Today, when I teach other nurses about their critical part in nursing research, I reflect on my brief encounter with some of the greatest heroes of nursing research. In April 2012, I got to meet one of the most incredibly impressive people I have ever read.  Her work is far reaching and her leadership has changed how I, and so many others, practice, and her name is Dr. Mary Naylor, the director of the INQRI program.  When I first was introduced I fumbled for words, but finally I knew what to say: “Thank you.”

To the Robert Wood Johnson Foundation and the leaders of the INQRI program, thank you for your belief in nurses and their commitment to patients, to changing how we as nurses research and practice, and for your commitment of time and resources.  At this one-year anniversary, the dream continues, for patients, for nurses, for healthcare.

Nurses' Contributions to Delivering Care Efficiently

A new piece in Advance for Nurses discusses ways nurses are improving workflow efficiency in a magnet hospital setting.  INQRI researchers have also turned their attention to the question of how nurses can provide care efficiently.

In fact, our fourth call for proposals built on the question of efficiency and delivering care cost-effectively by examining the value of nursing in achieving efficient, high quality patient care. INQRI sought proposals that would investigate the value of nurses in generating and leading innovations, preventing medical errors and other complications, and community-based quality improvement efforts.

Among the five grantees selected for funding in 2009 were teams that:

• examined nursing’s contributions to quality palliative care;
• evaluated a counseling intervention to promote successful pain self-management in patients after spine surgery;
• examined the value of a computer-based nurse communication training and materials program  on intensive care unit patient care outcomes;
• initiated an interdisciplinary team approach to reducing pressure ulcers; and 
• conducted an intervention with visiting nurses to reduce the risk of Type 2 diabetes in at-risk adults.

AACN Webinar on Managing Alarm Fatigue

On Thursday, June 20 at 10am, the American Association of Critical Care Nurses (AACN) will present a free webinar: "Managing Alarm Fatigue: New Approaches and Best Practices."

The patient safety organization, ECRI Institute, has identified alarm hazards as its Top Health Technology Hazard for 2013 and The Joint Commission issued an April 2013 Sentinel Event Alert on alarm fatigue. AACN’s free, live webinar will discuss the scope of this growing problem, management of environmental alarms for improved patient safety and strategies for creating a more effective (and quieter) workplace.

Panel presenters:
• Marjorie Funk, RN, MSN, PhD, FAAN, FAHA
• Maria Cvach, RN, MSN, CCRN
• Sue Sendelbach, RN, PhD, CCNS, FAHA

Register here.

Sebelius Kicks off "Datapalooza" by Highlighting Use of Health Care Data

At this week's annual "Datapalooza" event, Health and Human Services Secretary Kathleen Sebelius noted that better use of health care data has led to new developments in software and other technologies and has improved patient experiences.

Health Datapalooza is an annual national conference derived from government efforts to liberate health data. This forum features the newest and most innovative and effective uses of health data by companies, startups, academics, government agencies and individuals.

Click here to learn more about Sebelius's remarks.
Click here to learn more about Health Datapalooza.

Reflecting Back: INQRI Special Issue of Medical Care

Anne Sales PhD, RN, Deputy Editor, Medical Care

A few months ago, Medical Care published a special issue, reporting on several of the 40 projects funded through the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) program. This edition represents a milestone in the ongoing journey of studying and reporting on the relationship between nursing care and outcomes for patients, providers, and systems of care. As the papers in this special issue highlight, there have been consistent improvements in methods and findings, leading to a better understanding of how nursing care contributes and is valued.

As this year’s AcademyHealth meeting draws near, I am reminded of my initial experience with this work. One of the gathering places for the research community where RWJF senior program officer Lori Melichar described the INQRI program in its early days was the Interdisciplinary Research Group on Nursing Issues (IRGNI), a special interest group organized through AcademyHealth. Several of the researchers on the interdisciplinary teams funded through INQRI were members of IRGNI, and used the annual IRGNI meetings at each AcademyHealth Annual Research Meeting to develop relationships and build teams. Since its inception, INQRI funded a number of highly leveraged and valuable collaborations, extending and building the community of researchers who engage in nursing health services and intervention research.

The degree to which the INQRI program has fostered a true community of researchers who are likely to continue their collaborations and research foci long after the end of the program was evident during the program’s 2012 national conference. The authors of the papers took the opportunity provided during the event to talk with each other, present their ideas to stakeholders, and use these interactions to develop their ideas.

After several months of working with the authors of each paper, and the individuals who provided valuable feedback through the review process, I think the collection of papers in this special issue achieve the purpose of celebrating the life of an important and valuable funding program, but also provide benchmarks for assessing progress in several areas of interdisciplinary research focusing on nursing care. I think it’s important to contextualize these papers in a wider context than a single funding program, no matter how valuable and important that program has been. The review of nursing research at the beginning and end of the INQRI program provides some evidence of changes over this period. However, it is important to note that similar progress can be seen in other countries and other interdisciplinary areas. The focal area of implementation research, commented on in some papers in this issue, has grown considerably over this period, and nurse researchers have continued in leading roles in this work, as they have in the period before the term “implementation research” came into wide use. INQRI’s special issue of Medical Care highlights much of this work, and introduces some new themes and findings. As implementation research grows and expands into new areas, staying current can be a challenge. I invite readers to take a look at the April special issue of the International Journal of Nursing Studies as well, to get a sense of how nurse researchers in other countries are involved in similar work, and extending our knowledge about how nursing contributes to improved services and systems around the world.

Recently, I noted that the IRGNI group has posted their agenda for the upcoming meeting. I was pleased to find that things have gone full circle, as I realized that INQRI grantee (and contributor to this special edition), Olga Yakusheva is one of the presenters. Clearly, the impact of this work continues.

Newly Released IHI Video Focuses on QI Forums

The Institute for Healthcare Improvement (IHI) recently released this new video focuses on the quality improvement lessons shared during their National Forums on Quality Improvement in Health Care.



Click here to learn about this year's event.