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Work Index (work + index)
Kinds of Work Index Selected AbstractsAn Independent Evaluation of Four Quantitative Emergency Department Crowding ScalesACADEMIC EMERGENCY MEDICINE, Issue 11 2006Spencer S. Jones MStat Background Emergency department (ED) overcrowding has become a frequent topic of investigation. Despite a significant body of research, there is no standard definition or measurement of ED crowding. Four quantitative scales for ED crowding have been proposed in the literature: the Real-time Emergency Analysis of Demand Indicators (READI), the Emergency Department Work Index (EDWIN), the National Emergency Department Overcrowding Study (NEDOCS) scale, and the Emergency Department Crowding Scale (EDCS). These four scales have yet to be independently evaluated and compared. Objectives The goals of this study were to formally compare four existing quantitative ED crowding scales by measuring their ability to detect instances of perceived ED crowding and to determine whether any of these scales provide a generalizable solution for measuring ED crowding. Methods Data were collected at two-hour intervals over 135 consecutive sampling instances. Physician and nurse agreement was assessed using weighted , statistics. The crowding scales were compared via correlation statistics and their ability to predict perceived instances of ED crowding. Sensitivity, specificity, and positive predictive values were calculated at site-specific cut points and at the recommended thresholds. Results All four of the crowding scales were significantly correlated, but their predictive abilities varied widely. NEDOCS had the highest area under the receiver operating characteristic curve (AROC) (0.92), while EDCS had the lowest (0.64). The recommended thresholds for the crowding scales were rarely exceeded; therefore, the scales were adjusted to site-specific cut points. At a site-specific cut point of 37.19, NEDOCS had the highest sensitivity (0.81), specificity (0.87), and positive predictive value (0.62). Conclusions At the study site, the suggested thresholds of the published crowding scales did not agree with providers' perceptions of ED crowding. Even after adjusting the scales to site-specific thresholds, a relatively low prevalence of ED crowding resulted in unacceptably low positive predictive values for each scale. These results indicate that these crowding scales lack scalability and do not perform as designed in EDs where crowding is not the norm. However, two of the crowding scales, EDWIN and NEDOCS, and one of the READI subscales, bed ratio, yielded good predictive power (AROC >0.80) of perceived ED crowding, suggesting that they could be used effectively after a period of site-specific calibration at EDs where crowding is a frequent occurrence. [source] The Nursing Worklife Model: Extending and Refining a New TheoryJOURNAL OF NURSING MANAGEMENT, Issue 3 2007CCRN, MILISA MANOJLOVICH PhD Aims, We tested a modification of Leiter and Laschinger's Nursing Worklife Model by examining the impact of structural empowerment on professional work environment factors that lead to nursing job satisfaction. Background, The original model explains how five magnet hospital practice domains described by Lake (2002) interact to influence nurses' work lives by either contributing to or mitigating burnout. Methods, A non-experimental design was used. Five hundred randomly selected nurses in Michigan were surveyed (response rate 66%, n = 332). Instruments included the Conditions for Work Effectiveness Questionnaire-II, the Practice Environment Scale of the Nursing Work Index, and the Index of Work Satisfaction. Path analysis was used to test the model. Results, The final model fit the data well (,2 = 96.4, d.f. = 10, NFI: 0.90, CFI: 0.43, RMSEA: 0.18), supporting both hypotheses. Conclusions, The expanded Nursing Worklife Model demonstrates the role of empowerment in creating positive practice conditions that contribute to job satisfaction. [source] Organizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses,RESEARCH IN NURSING & HEALTH, Issue 2 2010Patricia A. Patrician Abstract The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals. Data were analyzed with logistic regression for nested data. Unfavorable nursing practice environments had a substantial association with job dissatisfaction (OR 13.75, p,<,.01), emotional exhaustion (OR 12.70, p,<,.01), intent to leave (OR 3.03, p,<,.01), and fair to poor quality of care (OR 10.66, p,<,.01). This study provides the first system-wide analyses of nursing practice environments in AMEDD hospitals in the U.S. Similar to findings in civilian samples, poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:99,110, 2010 [source] Measuring the hospital practice environment: A Canadian contextRESEARCH IN NURSING & HEALTH, Issue 4 2002Carole A. Estabrooks Abstract The primary purpose of this study is to document the psychometric properties of the revised Nursing Work Index (NWI-R) in the context of a large Canadian sample of registered nurses. A self-administered survey containing the NWI-R was completed by 17,965 registered nurses working in 415 hospitals in three Canadian provinces. Using exploratory principal components analysis, with a forced one-factor solution, the practice environment index was obtained. In addition, key assumptions were tested from previous work about the rationale for the aggregation of NWI-R responses. In the Canadian context the one-factor solution provides a parsimonious index of the practice environment of registered nurses working in acute care hospitals. Further work is needed to determine the predictive capability of this index and its relevance to cross-national organizational contexts. © 2002 Wiley Periodicals, Inc. Res Nurs Health 25:256,268, 2002 [source] Development of the practice environment scale of the nursing work index,,RESEARCH IN NURSING & HEALTH, Issue 3 2002Eileen T. Lake Abstract Five subscales were derived from the Nursing Work Index (NWI) to measure the hospital nursing practice environment, using 1985,1986 nurse data from 16 magnet hospitals. The NWI comprises organizational characteristics of the original magnet hospitals. The psychometric properties of the subscales and a composite measure were established. All measures were highly reliable at the nurse and hospital levels. Construct validity was supported by higher scores of nurses in magnet versus nonmagnet hospitals. Confirmatory analyses of contemporary data from 11,636 Pennsylvania nurses supported the subscales. The soundness of the new measures is supported by their theoretical and empirical foundations, conceptual integrity, psychometric strength, and generalizability. The measures could be used to study how the practice environment influences nurse and patient outcomes. © 2002 Wiley Periodicals, Inc. Res Nurs Health 25:176,188, 2002 [source] Does Simultaneous Antegrade and Retrograde Cardioplegia Improve Functional Recovery and Myocardial Homeostasis?JOURNAL OF CARDIAC SURGERY, Issue 5 2000F.E.T.C.S., M. J. Jasinski M.D. Methods: Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted. Results: In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group. Conclusions: Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone. [source] Development of the practice environment scale of the nursing work index,,RESEARCH IN NURSING & HEALTH, Issue 3 2002Eileen T. Lake Abstract Five subscales were derived from the Nursing Work Index (NWI) to measure the hospital nursing practice environment, using 1985,1986 nurse data from 16 magnet hospitals. The NWI comprises organizational characteristics of the original magnet hospitals. The psychometric properties of the subscales and a composite measure were established. All measures were highly reliable at the nurse and hospital levels. Construct validity was supported by higher scores of nurses in magnet versus nonmagnet hospitals. Confirmatory analyses of contemporary data from 11,636 Pennsylvania nurses supported the subscales. The soundness of the new measures is supported by their theoretical and empirical foundations, conceptual integrity, psychometric strength, and generalizability. The measures could be used to study how the practice environment influences nurse and patient outcomes. © 2002 Wiley Periodicals, Inc. Res Nurs Health 25:176,188, 2002 [source] Resuscitation with Na+/H+ exchanger inhibitor in traumatic haemorrhagic shock: Cardiopulmonary performance, oxygen transport and tissue inflammationCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 3 2010Dongmei Wu Summary 1. The aim of the present study was to examine the effects of inhibition of the Na+/H+ exchanger (NHE-1) on cardiopulmonary performance, oxygen carrying capacity and tissue inflammation in a pig model of traumatic haemorrhage,resuscitation. 2. In 12 instrumented anaesthetized pigs, traumatic haemorrhage was modelled by producing tibia fractures, followed by haemorrhage of 25 mL/kg for 20 min, and then a 4 mm hepatic arterial tear with surgical repair after 20 min. Animals then underwent low-volume fluid resuscitation with either Hextend (vehicle; n = 6; Hospira, Lake Forest, IL, USA) or 3 mg/kg BIIB513 (an NHE-1 inhibitor) + Hextend (n = 6). The experiment was terminated 6 h after the beginning of resuscitation. 3. Compared with vehicle-treated controls, the addition of NHE-1 inhibition with BIIB513 significantly improved the left ventricle stroke work index and attenuated increases in pulmonary arterial pressure and pulmonary vascular resistance. Furthermore, BIIB513 treatment significantly increased the oxygenated haemoglobin ratio, blood oxygen content and mixed venous blood oxygen saturation and improved blood oxygen delivery. In addition, BIIB513 treatment reduced lung tissue levels of interleukin-6 by 80%, tumour necrosis factor-, by 37% and myeloperoxidase activity by 38%. Nuclear factor-,B DNA binding activity in the lung was also slightly and significantly attenuated following BIIB513 treatment. 4. In conclusion, the present study shows that NHE-1 inhibition facilitates the response to fluid resuscitation after traumatic haemorrhage by improving cardiac function, pulmonary vascular function and oxygen carrying capacity, which results in reduced tissue inflammatory injury. [source] Influence of right ventricular pre- and afterload on right ventricular ejection fraction and preload recruitable stroke work relationCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 1 2001Wolfram Burger When right ventricular (RV) afterload is abnormally increased, it correlates inversely with right ventricular ejection fraction (RVEF). We tested, whether this would be different with normal afterload. Additionally, we investigated whether previous studies on the slope of RV preload recruitable stroke work (SW) relation, which used rather non-physiological measures to change RV preload, could be transferred to more physiological loading conditions. RV volumes were determined by thermodilution in 16 patients with stable coronary artery disease and normal pulmonary artery pressure (PAP) at rest. Pre- and afterload were varied by body posture, nitroglycerin (NTG) application and by exercise at different body positions. At rest, the change from recumbent to sitting position decreased PAP, cardiac index (Ci), RV diastolic and systolic volumes, and RVEF. Additionally, mean pulmonary artery pressure (MPAP) correlated positively with both RVEF and cardiac index. After correction for mathematical coupling, the RV preload recruitable SW relation was: right ventricular stroke work index (RVSWi) (103 erg m,2)= 8·1 × (RV end-diastolic volume index ,4·9), with n=96, r=0·57, P,0·001. Exercise abolished this correlation and led to an inverse correlation between RV end-systolic volume (ESV) and RVSW. In conclusion, (i) RVEF correlates positively with RV afterload when afterload varies within normal range; (ii) the slope of the RV preload recruitable SW relation, which is obtained at steady state under normal loading conditions, is substantially flatter than previously described for dynamic changes of RV preload. With increasing afterload, preload loses its determining effect on RV performance, while afterload becomes more important. This puts earlier assumptions of an afterload independent RV preload recruitable SW relation into question. [source] | ||||||||||