Multidisciplinary Organization and Outcomes for Chronic Heart Failure Patients in the VA

This presentation was made at the fifth annual meeting of the Interdisciplinary Nursing Quality Research Initiative and was given by Joanne Disch and Doug Wholey. This research team tested a theory of the effect of nurse-physician co-leadership, the effective modeling by nurses and physicians of individual role behaviors and a strong shared inter-professional relationship, in chronic heart failure care groups in Veterans Health Administration medical centers.

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The Effects of Nurse Presenteeism on Quality of Care and Patient Safety

This presentation was made at the fifth annual meeting of the Interdisciplinary Nursing Quality Research Initiative and was given by Susan Letvak and Sat Gupta. The primary aim of this project was to evaluate the influence of presenteeism (decreased productivity due to health problems) on hospital Registered Nurses' quality of patient care. A secondary aim is to assess economic costs to the healthcare system associated with presenteeism. The study used a mixed methods (quantitative survey and qualitative focus groups) design of RNs in North Carolina.

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The Res-Care-AL Intervention Study

This presentation was made at the fifth annual meeting of the Interdisciplinary Nursing Quality Research Initiative and depicts a randomized controlled trial to test a restorative care intervention for assisted living. The project incorporated patient centered outcomes (falls); nursing centered outcomes (restorative care services); and system-centered outcomes (staff turnover) as designated by the National Quality Forum. The primary aim of this study was to maintain or improve the residents' physical activity, physical status, function, and length of stay in the facility. The secondary aim related to residents' focuses on mood, life satisfaction, resilience, self-efficacy and outcome expectations, social-support for exercise, and person-environment fit. This team was co-led by Barbara Resnick, PhD, CRNP, a nurse researcher, and Sheryl Zimmerman, PhD, MSW, a social worker.

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The Effect of Off-Peak Hospital Environments on Nurses' Work: an Institutional Ethnography

This presentation was made by Patti Hamilton and Gretchen Gemeinhardt during the fifth annual meeting of the Interdisciplinary Nursing Quality Research Initiative regarding the completion of their project on off-peak hospital environments on nurses' work.

This project used Institutional Ethnography (IE) to situate nursing in the center of an interdisciplinary approach to learn how and why off-peak work environments are different, and how they affected nurses' work and patient care. Two types of data have been collected. Level I data is transcripts from individual and focus-group interviews. Level II included managerial policies, documents, and other texts, used to improve quality and efficiency by standardizing and controlling the work of nurses. This project has provided researchers with insight into how to account for temporal variations in nurses' work environment when specifying causal models linking nursing care to patient outcomes. The project also has provided stakeholders with materials that help them identify, evaluate, and anticipate effects of initiatives to improve efficiency, effectiveness, quality and cost on nursing care provided during off-peak periods.







This team is co-led by Patti Hamilton, PhD, RN, a nurse researcher, and Gretchen Gemeinhardt, PhD, MBA, a psychologist with a background in management and organizational behavior.

Small Troubles, Adaptive Responses [STAR]: Fostering a Quality Culture in Nursing

This presentation was made by Robert Ferrer and Kathleen Stevens during the fifth annual meeting of the Interdisciplinary Nursing Quality Research Initiative regarding the completion of their project on nursing workarounds.

This project aimed to improve nursing units' quality and efficiency. The research question was whether a program designed to identify and address small problems encountered by nurses in patient care occurring about once per hour per nurse and managed with workarounds in 95% of cases can lead organizational learning that will drive large improvements in safety, quality, and efficiency. The intervention, adapted from theoretically-based programs proved effective in other settings, combined a methodology for enhancing the underlying performance improvement capability of nursing units with a toolbox of quality improvement strategies relevant for tackling the small problems encountered in practice.

This team is co-led by Kathleen Stevens, EdD, RN, FAAN, a nurse researcher, and Robert Ferrer, MD, MPH, a medical doctor with a background in family medicine and biology.

How Do You Translate Research into Policy?

Special thanks to Gretchen Wright for PR Solutions for helping INQRI researchers understand how to use their research to impact policy.  Gretchen reviewed the Foundation's policies in regards to connecting with policymakers and offered some solid tips:

• Share your 3-4 most important pieces of data.
• Avoid jargon and acronyms.
• Tell a story or use an analogy to convey impact.
• Remember that methodology is not most important thing to convey to policymakers - they need to know what you found and what it means.

Gretchen also recommended two resources:
"Am I Making Myself Clear? by Cornelia Dean
"Making Data Talk" by David Nelson, Bradford Hesse, Robert Croyle

Thank you, Gretchen, for sharing your thoughts with us... as this was the last presentation of the meeting, we will all leave the 2010 INQRI annual meeting thinking about how research can make a difference!!

Here's to this year's meeting and we can't wait for 2011!

The First I in INQRI - Recap

INQRI Co-Director, Mark Pauly led a wonderfully engaging discussion on the importance of interdisciplinary collaboration in research.  Joined by Carolyn Aydin, a social scientist, and Stephen Setter, a pharmacist, our panel encouraged the meeting participants to share what has worked for them and why collaboration between disciplines should be continued.

The group agreed that the multiple perspectives offered by interdisciplinary collaboration are well-worth learning each other's jargon!  Seasoned researchers encouraged others to establish norms for communicating and Polly Pittman directed everyone to the "glossary" on hsrmethods.org to learn about breaking down the language-barriers between disciplines.  Another resource was offered by grantee Bonnie Spring: check out http://www.teamscience.net/ for tips on working together as a team.

Check out the thread on twitter via #INQRI2010 for more...

Is it Lunch Time Already?

We just concluded an exciting morning at our 5th Annual Meeting...

Special thanks to Kevin Volpp, MD, PhD for his fabulous presentation, "Applying Behavioral Economics to Health Care Delivery."  Dr. Volpp gave us much to consider about the way that people make the choices that affect their health.

We were also thrilled to welcome the members of INQRI's newest cohort, who will begin their work on November 1.  These researchers provided us with their project plans and received wonderful encouragement and suggestions who have been where they are now.  More info to come on these six terrific teams.

The morning concluded with updates from the five teams in our 4th cohort.  These researchers presented work that spans across a number of diverse settings: ICUs, long term care, community centers.  These teams are in the midst of their work and will present their findings at next year's annual meeting.  Click here to learn more about Cohort 4.

We have more to come this afternoon - remember to follow us via Twitter using hashtag #INQRI2010.

Day 1 is Over (That was Fast!)

Time flies with so many amazing presentations!

Thanks to the remaining members of Cohort 3 who presented findings this afternoon:

Nancy Donaldson and Carolyn Aydin examined the impact of: unit level nurse workload, staff nurse characteristics, selected risk assessment practices and preventive intervention processes of care on patient outcomes.  They found that unit and patient characteristics and workload can prevent medication errors.  They also noted that microsystem evidence suggested an association between hospital acquired pressure ulcers and rate of falls, suggesting that perhaps they witnessed a "culture of safety" factor.

Barbara Resnick and Sheryl Zimmerman tested the implementation of a function focused nursing approach to improve the quality of care provided to residents in assisted living communities.  They found that direct care workers and residents both embraced the function focused care and that despite fears of injury, there were no adverse events (deaths, falls) experienced in their intervention.  In fact, they found a significant decrease in hospital transfers of enrolled residents paired with improved balance and improvements in walking 50 feet.

Joanne Disch and Doug Wholey presented on their project which was designed to characterize nurse-physician co-leadership of heart failure care in the VA.  They noted that heart failure care is about more than routines and processes - it involves effective teamwork.  They found that teamwork effects readmissions through its effect on being prepared to provide individual care and that nurse-physician co-leadership improves teamwork.

Cindy Corbett and Stephen Setter presented on their work to empower home care nurses to efficiently resolve medication discrepancies.  In their work, they found that nurses resolved about 93% of the discrepancies they identified.  The pharmacists found twice as many discrepancies, but only resolved half of them. 

Ciaran Phibbs and Pat Stone discussed the impacts of nurse staffing, skill mix and experience on quality and costs in long term care.  They found that having more RNs, more LPNs and more stable staffing are all correlated with lower readmissions. Also, the number of nursing hours, skills mix, tenure and contract affect quality of care.

Sue Letvak and Sat Gupta presented on their team's project to determine the prevalence of nurse presenteeism (working when sick) due to muscoskeletal pain and depression and its impact on quality of care and costs.  The results were staggering - 18% of interviewed nurses reported some depression (compared to a national average of 9%), 70% reported pain and 61% reported presenteeism.  They found that the number of patient falls and medication errors both increased by about 18% with each unit of presenteeism score.  Additionally, there were significant cost losses due to productivity reduction, reduction in quality of care, increased fall and medication errors.

As you can tell, we had quite the day... and there is much more to come tomorrow!

Check back for updates and be sure to follow us via Twitter using hashtag #INQRI2010.

What a Morning!

It's already 1pm and we have already heard so much!

Special thanks to Nancy Shute, Beth McGlynn, Linda Aiken, Andy Hyman and Maryjoan Ladden for such an engaging discussion on opportunities for nursing in health reform. Check out the Twitter feed #INQRI2010 to read recaps.

We also want to congratulate our first two teams from Cohort 3 on the presentation of their findings.

Kathleen Stevens and Bob Ferrer studied the impact of addressing "small troubles" in nursing care on patient safety.  The ultimate outcomes of their work were inspiring ones: fewer errors, better quality benchmarks, less turnover and greater efficiency. 

Gretchen Gemeinhardt and Patti Hamilton examined the impact of receiving care during "off-peak" times - on nights and weekends.  Sixty-four percent of nursing occurs "off-peak" and consumers are (rightfully) concerned about being admitted during those times.  They found that nurses have much to contribute about what they do and the environments in which they do it... and believe that we must engage direct care nurses in planning off-peak work flow to reduce problems.

Remember, follow our discussion on Twitter using hashtag #INQRI2010... and there is more to come!

What Happens When You Go "One Tweet Too Far?"

Gretchen Wright from PR Solutions kicked off our fifth annual meeting tonight with an engaging presentation on using social media... and what can happen when you type before you think it through.  Gretchen provided our grantees some valuable tips about using social media to advance their research agendas... and some suggestions on pitfalls to avoid.

Check out these two articles about social media issues gone awry:

"When Facebook goes to the hospital, patients may suffer," Los Angeles Times article, August 8, 2010

"Who had the worst week in Washington? Twitter." Washington Post editorial, September 12, 2010


Follow the 5th annual INQRI meeting on Twitter with hashtag #INQRI2010.

We're on Our Way to Princeton

INQRI program leaders, grantees and invited guests are all on the way to Princeton for the 5th Annual INQRI meeting.  Although the meeting will officially start tomorrow, we'll have an informal dinner tonight which will feature a fascinating topic: “One Tweet Too Far? Challenges Presented by Social Media.”  This presentation will be given by Gretchen Wright at PR Solutions, who will be returning later in the meeting to give a presentation on "Translating Research into Policy."

Gretchen Wright is the vice president and a principal of PR Solutions, a public relations consulting firm that serves national advocacy groups, associations, foundations and think tanks working on progressive issues and public education. PR Solutions supports the Foundation’s Human Capital team and in this role, provides all communication support to the INQRI program and grantees.

Remember, you can follow along with the meeting via Twitter by using hashtag #INQRI2010.

"The First I in INQRI"

The INQRI program supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality.  At our annual meetings, these teams are each represented by two project leaders to ensure that that interdisciplinary viewpoint is a part of our discussion.  This year, we will be hosting a panel discussion featuring some of these researchers to talk about the importance of interdisciplinary collaboration.

The panel will be moderated by Mark V. Pauly, Ph.D., INQRI's Co-Director and the Bendheim Professor at the University of Pennsylvania's Wharton School.

 

The panel will feature:

• Carolyn Aydin, Ph.D., Research Scientist and CALNOC Data Manager, Cedars-Sinai Medical Center
• Stephen M. Setter, PharmD, CDE, CGP, FASCP, Associate Professor of Pharmacotherapy, Washington State University
• Debra Fishman, Psy.D., Psychologist, University of California Davis Medical Center

Follow the discussion on Thursday from 1p-2pET via Twitter using hashtag #INQRI2010.

Applying Behavioral Economics to Health Care Delivery

Keynote Speaker, Kevin Volpp, Ph.D. will address this topic on Day 2 (Thursday) of next week's fifth annual INQRI meeting. 

Dr. Volpp is an Associate Professor of Medicine and Health Care Management and Director of the Leonard Davis Institute of Health Economics Center for Health Incentives at the University of Pennsylvania.  For his complete biography, please click the link below.

You can follow the discussion of Dr. Volpp's presentation on Thursday from 9am-10amET via Twitter by using hashtag #INQRI2010.

What Opportunities Exist for Nursing in the Affordable Care Act?

That is the question that a panel of experts will be discussing at next week's INQRI meeting.  Moderated by health journalist Nancy Shute (contributing editor for U.S. News and World Report), the panel will feature:

• Elizabeth McGlynn, INQRI National Advisory Committee Member and Associate Director for RAND Health at the RAND Corporation
• Linda Aiken, INQRI National Advisory Committee Member and Claire M. Fagin Leadership Professor of Nursing at the University of Pennsylvania
• Maryjoan Ladden, Senior Program Officer at the Robert Wood Johnson Foundation
• Andy Hyman, Team Director for the Coverage team at the Robert Wood Johnson Foundation

We will provide updates after their panel discussion next Wednesday and you can also follow along with the discussion on Twitter by using hashtag #INQRI2010.

 

Click below to learn more about our panel.

 

More Prep for Next Week's Meeting

During next week's annual meeting, INQRI leaders, national advisory committee members and invited stakeholders will hear updates from grantees in the middle of their two year projects.  Cohort 4 teams are working on a variety of topics, in a variety of settings.  We look forward to hearing from them about how their first year went and how they envision the completion of their work.  We will be posting updates from Cohort 4 on Day 2 of the meeting (next Thursday).  You can read about them on the blog or by following the meeting on Twitter using hashtag #INQRI2010.

In the meantime, click here to learn more about Cohort 4.

Get Prepped - INQRI Annual Meeting Next Week

Next week, INQRI will host its fifth annual meeting at the Robert Wood Johnson Foundation in Princeton, NJ.  During the meeting, you will have the opportunity to follow us via Twitter using hashtag #INQRI2010.  We will have exciting guest speakers, engaging panels and the presentation of findings from our third cohort of INQRI grantees.  Keep checking this blog, too - we'll provide updates each day and post video in the weeks following the event.

Click here to learn more about Cohort 3.
Click here to follow us on Twitter.

INQRI's Fifth Annual Meeting

In just about a month, we'll be heading to Princeton, NJ for INQRI's Fifth Annual Meeting, held at the Robert Wood Johnson Foundation.  Since the program began, we have awarded 34 grants across four cohorts of teams.  Two of these cohorts have completed their projects, becoming "alumni" of the program.  At this year's annual meeting, we will introduce our newest cohort, hear updates from the fourth cohort and be presented with findings from our third cohort who will soon join the ranks of our alumni.

Click here to learn about Cohort 3... and stay tuned for other updates about our annual meeting.  You will have the opportunity to follow the meeting on Twitter.  Stay tuned.