MSJ Imposition Single pgs January-February 2013 • Vol. 22/No. 126 Marie Boltz, PhD, RN, is Assistant Professor, New York University, College of Nursing, New York, NY. Elizabeth Capezuti, PhD, RN,...

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MSJ Imposition Single pgs January-February 2013 • Vol. 22/No. 126 Marie Boltz, PhD, RN, is Assistant Professor, New York University, College of Nursing, New York, NY. Elizabeth Capezuti, PhD, RN, FAAN, is Dr. John W. Rowe Professor in Successful Aging, New York University, College of Nursing, New York, NY. Laura Wagner, PhD, RN, is Assistant Professor, University of California, San Francisco School of Nursing, San Francisco, CA. Marie-Claire Rosenberg, PhD, RN, is Assistant Professor, New York University, College of Nursing, New York, NY. Michelle Secic, MS, is President, Biostatistician, Secic Statistical Consulting, Inc., Chardon, OH. Acknowledgments: This work was supported by the Margretta Madden Styles Credentialing Scholars Grants Program and the John A. Hartford Foundation’s Building Academic Geriatric Nursing Capacity Award Program. Patient Safety in Medical-Surgical Units: Can Nurse Certification Make a Difference? Adults age 65 and older repre-sent approximately 38% ofall admissions to hospitals and approximately 60% of patients on medical-surgical units (DeFrances & Hall, 2007; Wier, Pfuntner, & Steiner, 2010). Com pared to younger patients, older adults are more at risk for complications from safety- related events, including increased falls and injurious falls (Agency for Healthcare Research and Quality [AHRQ] 2007; Centers for Disease Control and Prevention, 2012) pres- sure ulcers (Baumgarten et al., 2006), catheter-associated urinary tract infections (Fakih et al., 2010), and adverse outcomes associated with restraint use (AHRQ, 2007). Complications in older adults are associated with higher morbidity, mortality, and costs (DeFrances, Lucas, Buie, & Golosinskiy, 2008; Jencks, Williams, & Coleman, 2009). Such outcomes are considered nurs- ing-sensitive clinical indicators; they are regarded widely as having strong links to quality (Dunton & Motalvo, 2009; Hart, Bergquist, Gajewski, & Dunton, 2006) and determine reim- bursement in the pay-for-perform- ance Medicare system (McNair, Luft, & Bindman, 2009). Nursing-sensitive quality indica- tors are those in which the quality or quantity of nursing interventions in - fluence a patient’s outcome. The National Database of Nursing Quality Indicators (NDNQI®) is a database of the American Nurses Association that collects and evaluates nurse-sensitive data from U.S. hospitals (Dunton, Montalvo, & Dunton, 2011). These indicators are used in quality im - provement activities, research, staff development, and registered nurse Research for PracticeResearch for Practice Marie Boltz, Elizabeth Capezuti, Laura Wagner, Marie-Claire Rosenberg, and Michelle Secic (RN) retention efforts, and to satisfy reporting requirements for regulato- ry agencies or Magnet® designation (Draper, Felland, Liebhaber, & Melichar, 2008; Montalvo & Dunton, 2007). Nursing-sensitive quality indicators are related to staffing (e.g., RN hours/patient day), turnover, staff mix, job satisfaction, education/certification levels, and patient safety outcomes, such as patient falls, injurious falls, pressure ulcers, and restraints (Dunton et al., 2011). Because older adults are the highest users of hospital services on medical-surgical units (DeFrances et al., 2008), the NDNQI patient safety indicators can have a tremendous impact on older adult care. Literature Review Nursing-Sensitive Quality Indicators Falls and injurious falls. Medical and medical-surgical units have the largest number of falls and fall injuries, with one study reporting 3.15 to 4.18 falls per 1,000 patient- days (Dykes et al., 2010). Approxi - mately 26% of falls result in injury (Dunton, Gajewski, Klaus, & Pierson, 2007). The incidence of both falls and injurious falls increases with patient age,attributed to both intrin- sic and extrinsic factors (Oliver, Healey, & Haines, 2010). Recom - mended fall prevention programs include multi-modal interventions, with nursing knowledge and clinical competence considered to be critical elements in implementing such pro- grams (Coussement et al., 2008; Dykes et al., 2010; Krauss et al., 2008). More hours per patient day and a higher percentage of RNs, especially those with more experi- ence, are associated with lower fall and injurious fall rates (Dunton et al., 2007). Restraint use. The rate of restraint use has declined in the past 20 years on general medical and surgical units. However, evidence of contin- ued utilization, despite health care policies limiting their use, exists. Additionally, wide variation in restraint prevalence rates persists (3 to 123 restraint-days/1,000 patient- January-February 2013 • Vol. 22/No. 1 27 days), demonstrating major practice differences even when controlling for patient population (Minnick, Mion, Johnson, Catrambone, & Leipzig, 2007). The decision to use physical restraint continues to be based on individual judgment and beliefs rather than evidence-based guidelines, and is associated with lack of knowledge and skills specific to the care of older adults.The use of approaches to enhance cognitive and physical function, staff educa- tion, organizational strategies, and environmental interventions can reduce physical restraints and also reduce fall rates (Amato, Salter, & Mion, 2006; Capezuti et al., 2008). Unit-acquired pressure ulcers. Ac - cording to VanGilder, Harrison, and Meyer (2009), a study of 86,932 U.S. acute care facilities found an overall pressure ulcer prevalence rate of 11.9%; the facility-acquired rate was 5.0%, and 3.1% when stage I ulcers were excluded. Effective interven- tions (assessment of skin, skin care, pressure redistribution, reposition- ing, and nutrition) are provided directly by nurses or through their supervision or coordination. Higher staffing levels, skill mix, and nurses’ professional tenure are associated with decreased iatrogenic pressure ulcer rate (Dunton et al., 2007). Also, the use of protocols, staff education programs, and nurse-coordinated quality improvement activities are recommended to prevent the occur- rence of facility-acquired pressure ulcers (Black et al., 2011). Certification and Quality Increased public concern for adverse events and patient safety, together with mandates for quality, and cost-effective care, has empha- sized nursing responsibility for the outcomes of patient care (Institute of Medicine [IOM], 2010). State licen- sure provides the legal authority to practice professional nursing; certifi- cation, which is provided by individ- ual specialty nursing organizations, demonstrates a voluntary commit- ment to a standard of excellence beyond licensure (Shirey, 2005; Wade, 2009). Although definitions of certifica- tion vary, certification generally is defined as the validation of cognitive knowledge (Landon, 2008). The International Study of the Certified Nurse Workforce reported more than 410,000 nurses in North America were certified in 2000 by 67 certify- ing bodies representing 34 specialty organizations (Cary, 2001). The NDNQI guidelines (Montalvo, 2007) on certification acknowledge certifi- cation for specialty practice by a national nursing specialty organiza- tion. Certified nurses have demonstrated higher knowledge of care related to pressure ulcers (Zulkowski, Ayello, & Wexler, 2007) and familiarity with cancer care guidelines (Coleman et al., 2009). Nurse supervisors have rated certified nurses, with higher perform- ance scores for education/collabora- tion, care planning, and evaluation when compared to non-certified nurs- es (Redd & Alexander, 1997). Certified nurses have reported their perception that certification demonstrates profes- sional growth and credibility (Ameri - can Board of Nursing Specialities, 2006; Gaberson, Schroeter, Killen, & Valentine, 2003; Kendall-Gallagher & Blegen, 2009). Certification also has been associated with professional opportunities (e.g., access to continu- ing education and job promotion) (Sechrist, Valentine, & Berlin, 2006) and higher salaries/benefits (Stierle et al., 2006). While many positive professional and process outcomes associated with certification are known, the relationship between specialty certi- fication and patient safety outcomes is a relatively new area of inquiry in nursing. Kendall-Gallagher and Blegen (2009) investigated the rela- tionship between nurse certification and the risk of harm to patients in 48 intensive care units in 29 hospitals. In addition to finding total hours of nursing care were related to medica- Introduction Hospitalized older adults experience more safety-related complications than younger patients, including increased falls and injurious falls, pressure ulcers, and adverse outcomes associated with restraint use. These clinical areas are dominant- ly under the control of nursing practice and thus are regarded as nursing-sensitive quality indicators. Certified nurses have demonstrated competency in evidence- based gerontological nursing care practice. However, the influence of nursing cer- tification upon quality indicators is not established. Purpose The purpose of this study was to examine the relationship between nurse certifi- cation (in any specialty practice as well as gerontological) and unit-level, nursing- sensitive quality indicators in units that primarily serve older adults. Method In a sample of 44 medical and medical-surgical units in 25 NICHE (Nurses Improving Care for Healthsystem Elders) hospitals, a retrospective descriptive design used multivariate regression techniques. Findings Binary logistic regression modeling yielded a significant relationship between cer- tification in any specialty and falls (chi-square wald=3.80, p=0.05, df=1). Conclusion Nursing-sensitive outcomes in hospitalized older adults may be influenced by nurse certification. The data from this pilot study support a larger prospective study that will investigate the relationship between nurse certification, workforce factors, and nursing-sensitive quality indicators in all types of units in both NICHE hospitals and non-NICHE hospitals. The inability of some program coordinators to obtain unit-level patient data points to the need for management tools and edu- cation related to quality improvement for mid-level managers. Patient Safety in Medical-Surgical Units: Can Nurse Certification Make a Difference? January-February 2013 • Vol. 22/No. 128 Research for Practice tion administration errors, and years of experience were related to the fre- quency of urinary tract infections, authors concluded the unit propor- tion of certified RNs was related inversely to the rate of falls. Results did not establish a relationship between certification and three other quality indicators (injurious falls, restraint prevalence, unit pres- sure ulcer prevalence). Researchers acknowledged this study was limited by a small sample size and the use of secondary data; however, findings of this study suggest a relationship between specialty certification and patient safety in intensive care units. A substantial gap in research exists in addressing the contribution of certification to patient safety out- comes in medical-surgical units. These areas primarily serve older adults as the age cohort most vulner- able to adverse events. Age-related changes and numerous co-morbidi- ties may predispose elders to adverse events (Covinsky, Pierluissi, & Johnston, 2011). Clinician knowl- edge and skill play a critical role in preventing negative safety outcomes and in developing organizational strategies for reducing adverse events (Boltz et al., 2008a; Boltz et al., 2008b; Capezuti et al., 2012). Recognizing the substantive and positive impact of nursing interven- tions in reducing adverse events (IOM, 2010), the Nurses Improving Care for Healthsystem Elders (NICHE) program provides staff edu- cation programs, clinical protocols, and organizational strategies to pre- vent avoidable complications in hos- pitalized older adults (Boltz et al., 2008a; Boltz et al., 2008b; Capezuti et al
Answered Same DayJul 16, 2021

Answer To: MSJ Imposition Single pgs January-February 2013 • Vol. 22/No. 126 Marie Boltz, PhD, RN, is Assistant...

Tanaya answered on Jul 17 2021
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Running Head: CLINICAL CERTIFICATION        1
CLINICAL CERTIFICATION        2
CLINICAL CERTIFICATION: CERTIFIE
D MEDICAL SURGICAL REGISTERED NURSE
Nursing certification authorizes knowledge for speciality practice of registered nurses. Certified nurses have exhibited expertise in handling cases related to pressure ulcers and cancer care guidelines. Certified nurses have shown higher performance levels in care planning, effective medical response and skills as compared to non-certified nurses. As stated in a study by Boltz, Capezuti, Wagner, Rosenberg and Secic (2013), an overall rate of 11.9% of pressure ulcers...
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