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CDA 06-301 – HSR&D Study

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CDA 06-301
Nursing Processes of Care and VA Inpatient Quality
Lynn M. Soban RN PhD MPH
VA Greater Los Angeles Healthcare System, Sepulveda, CA
Sepulveda, CA
Funding Period: October 2007 - September 2012

BACKGROUND/RATIONALE:
Assuring patient safety in hospitals, and preventing the estimated million or more injuries that result from poor safety practices, is a top priority in our nation's health care system. Nurses and nursing processes for patient care are central to promoting patient safety in the hospital environment, yet have received comparatively little attention from patient safety researchers. Pressure ulcer (PrU) prevention is a critical patient safety concern for which delivery of recommended care processes are substantially, independently shaped by nursing leadership, nursing units, and the individual nurses within the units. Nationally accepted guidelines specify nursing care processes for PrU prevention (e.g., risk assessments), yet evidence indicates low rates of nurse adherence. While Quality Improvement (QI) efforts have reduced the overall incidence of PrU, an understanding of how these programs work and how they are influenced by organizational context (the local conditions within the setting in which care is delivered) has been absent. Such an understanding is needed to assure consistent delivery of PrU preventive care, and in turn, to assure consistently low rates of hospital-acquired pressure ulcers.

OBJECTIVE(S):
This Career Development Award sought to begin the development of an evidence-base for implementation of PrU preventive care by examining the role of organizational contextual features in delivery of this care.

METHODS:
A variety of methods were used including: a systematic review of the literature and meta-analytic techniques; qualitative data collection and analysis; and survey development.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The work accomplished, underway, and recently funded during this Career Development Award represents an integrated body of research in an emerging area. Findings from this body of work will enable VA to move towards more consistent delivery of high quality PrU preventive care by: (1) informing the design and testing of intervention strategies to improve PrU preventive care in VA inpatient acute care settings; and (2) informing operational and policy decisions specific to PrU prevention activities nationally.


PUBLICATIONS:

Journal Articles

  1. Soban LM, Hempel S, Munjas BA, Miles J, Rubenstein LV. Preventing pressure ulcers in hospitals: A systematic review of nurse-focused quality improvement interventions. Joint Commission Journal on Quality and Patient Safety. 2011 Jun 1; 37(6):245-52.
  2. Needleman J, Parkerton PH, Pearson ML, Soban LM, Upenieks VV, Yee T. Overall effect of TCAB on initial participating hospitals. The American Journal of Nursing. 2009 Nov 1; 109(11 Suppl):59-65.
  3. Parkerton PH, Needleman J, Pearson ML, Upenieks VV, Soban LM, Yee T. Lessons from nursing leaders on implementing TCAB. The American Journal of Nursing. 2009 Nov 1; 109(11 Suppl):71-6.
  4. Pearson ML, Needleman J, Parkerton PH, Upenieks VV, Soban LM, Yee T. Participation of unit nurses: front-line implementation on TCAB pilot units. The American Journal of Nursing. 2009 Nov 1; 109(11 Suppl):66-70.
  5. Upenieks VV, Needleman J, Soban L, Pearson ML, Parkerton P, Yee T. The relationship between the volume and type of transforming care at the bedside innovations and changes in nurse vitality. The Journal of nursing administration. 2008 Sep 1; 38(9):386-94.
Conference Presentations

  1. Soban L, Finley E, Miltner R. Implementation of Pressure Ulcer Prevention Programs: An Opportunity to Improve Value in Healthcare. Paper presented at: International Nursing Administration Research Conference; 2014 Nov 13; Dallas, TX.
  2. Soban LM, Butler JN, Rose DE, Hamilton A, Rubenstein LV. Influence of organizational context on nurses' delivery of pressure ulcer preventive care: Findings from a pilot study in a large VA Medical Center. Paper presented at: Greater Los Angeles Nursing Research and Evidence-Based Practice Annual Conference; 2012 Mar 2; Los Angeles, CA.
  3. Soban LM. Implementing Evidence-Based Practices Using Quality Improvement. Paper presented at: RWJ Foundation Enhancing Nursing Undergraduate Teaching and Learning in the Clinical Setting Conference; 2010 Oct 20; Arlington, VA.
  4. Soban LM, Hempel S, Rubenstein LV. Hospital-Based Nurse-Focused Interventions for Pressure Ulcer Prevention: A Systematic Review. Paper presented at: University of Iowa Hospital and Clinics Evidence-Based Practice National Conference; 2010 Apr 23; Iowa City, IA.
  5. Dobalian A, Bowman CC, Wyte T, Soban LM, Simon B, Needleman J. An Innovative Approach to Address the Nursing Faculty Shortage: Initial Findings from the First Cohort of the VA Nursing Academy. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.
  6. Soban LM, Rubenstein LV, Yano EM, Needleman J, Sales A. Laying the groundwork to improve the quality of hospital nursing care for pressure ulcer prevention. Poster session presented at: VA Career Development Award Program Annual Conference; 2009 Feb 11; Baltimore, MD.


DRA: Health Systems, Acute and Combat-Related Injury
DRE: Prevention
Keywords: none
MeSH Terms: none

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