Purpose: To describe differences in perioperative RN job satisfaction by specialty certification status.Design: A retrospective, exploratory, cross-sectional design.Methods: We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified.Findings: Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses.Conclusions: As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.(c) 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Developing a nursing research project with American Indian tribes and navigating the institutional review board approval process can appear daunting to investigators because of tribal research requirements in addition to academic requirements. Nurse investigators conducted a research project exploring experiences of American Indian women with polycystic ovary syndrome. After successful implementation of the project, a model emerged to guide researchers working with tribal communities through project development and the institutional review board process. The model is based on the American Indian medicine wheel with each quadrant aligned with a season of the year: spring, summer, fall, and winter. The seasonal approach divides project development into sections that can be developed independently or simultaneously. The model emphasizes collaborative relationships between the research team and tribe. Researchers can adapt and customize the model for their projects based on their objectives and targeted populations. The purpose of this article is to describe the medicine wheel model and, as an exemplar, demonstrate application of the model in a project involving American Indian women with polycystic ovary syndrome. Additionally, potential implications of the model for nursing research, education, and practice are presented.

Health literacy has risen to become one of the dominant issues in Taiwan's healthcare system today. Level of health literacy impacts upon public health outcomes. Nevertheless, healthcare professionals in Taiwan remain largely unfamiliar with the concept and importance of health literacy. This paper employs concept analysis as described by Walker & Avant to introduce and analyze the attributes, antecedents and consequences of health literacy. Defining attributes of health literacy include: 1. enabling an individual to function successfully in a healthcare context; 2. facilitating the obtaining, comprehending, communicating and evaluating of health information to make appropriate health decisions and conduct positive health practices; and 3. achieving a good health status. The antecedent of health literacy is literacy. Consequences of health literacy include differences in health outcomes such as health knowledge, use of healthcare services and health status. Hopefully, through concept analysis, findings can help promote nursing clinical practice and related research quality.

The three components of the Triple - Aim enhancing the patient experience, improving population health, and reducing costs - have become the guide for optimizing healthcare system performance in the U.S. (Berwick, Nolan, & Whittington, 2008; Sikka, Morath, & Leape, 2015). The three aims are intrinsically intertwined and therefore need to be addressed simultaneously. However, constant efforts to maintain a harmonious balance of the Triple Aim is a challenge and often causes unintended consequences especially as it relates to a consistent change in clinician work processes, decreased joy in work, and burnout (Dyrbye et al., 2017; Shanafelt et al., 2016). Clinician burnout is emphasized in a call to action by the National Academy of Medicine (NAM) "to explore and address this unrecognized threat to safe, high-quality care" (Dyrbye et al., 2017). Burnout is associated with lower patient satisfaction, poor health outcomes, increased costs, and also threatens patient safety (Brigham et al., 2018). To address these issues, Bodenheimer and Sinsky (2014) proposed a fourth aim (hence, the Quadruple Aim) of improving the well-being of clinicians and staff. The added fourth aim addresses the complex and underdefined concept of professional practice work environments (PPWE). Optimized PPWEs are universally considered to be a key strategy to address the Triple Aim (Feeley, 2017). This brief will focus on two critical issues that would support clinician well-being and joy in work: 1) implementing true interprofessional teams to improve communication and quality of care while reducing costs of care; and 2) addressing the documentation burden, usability, and interoperability issues of electronic health records (EHR) through redesign so that they are care-centered.

BACKGROUND:Polycystic ovary syndrome (PCOS), a common androgen-excess disorder in reproductive-aged women, is often a missed diagnosis. Rural nurse practitioners (NPs) need to be able to diagnose and provide basic management for PCOS. This study's objective was to determine whether a continuing education program about PCOS would improve NPs' knowledge about PCOS.METHOD:A pretest-posttest design was used. Forty-eight participants attending a regional NP conference completed a pretest before a continuing education presentation about PCOS. Afterward, 43 participants completed an identical posttest. A two-step multivariate analysis of variance compared the results.RESULTS:Pretest results indicated NPs had low levels of knowledge for assessing, diagnosing, and managing PCOS. The posttest results demonstrated significant (p = .000) improvements in these areas.CONCLUSION:Continuing education presentations have the potential to increase rural NPs' knowledge about PCOS so they can provide evidence-based care to rural women with PCOS. J Contin Educ Nurs. 2018;49(4):164-170.

OBJECTIVE The aim of this study is to explore the relationship between nursing specialty certification and surgical site infections (SSIs) for colon (COLO) and abdominal hysterectomy (HYST) surgical procedures. BACKGROUND SSI following COLO and HYST procedures is a preventable complication now included in the Centers for Medicare & Medicaid Services’ Hospital Inpatient Quality Reporting Program. METHODS Data from 69 hospitals, 346 units, and 6585 RNs participating in the National Database of Nursing Quality Indicators and SSI data on 22 188 patient COLO and HYST procedures from the National Healthcare Safety Network were examined in multivariate logistic regression analysis. RESULTS Magnet® status was associated with lower SSI occurrence after adjusting for other variables. Higher American Society of Anesthesiologists scores, longer surgical procedure time, and wound class were associated with higher SSI occurrence. CONCLUSIONS Future theory-based research should examine the association of nursing specialty certification with patient outcomes and investigate the effect of Magnet status on SSI.

To explore American Indian (AI) women's experience in a cohort with clinically diagnosed polycystic ovary syndrome (PCOS) by examining symptoms and the effects of PCOS on their health-related quality of life (HRQL). The experience of the participants with health care providers (HCPs) in diagnosing and managing PCOS also was explored. A descriptive, mixed methods study with an ethnographic lens using semi-structured interviews and three validated surveys: Polycystic Ovary Syndrome Questionnaire (PCOSQ)1, Short Form-12 (SF-12)2, Diabetes Risk Test (DRT)3. A sample of 12 AI women with PCOS clinically confirmed by the Rotterdam criteria4 was recruited from a reservation in the western United States. Inclusion criteria were aged 18-40, able to read and write in English, and eligible to receive services at Indian Health Services. Surveys were analyzed with descriptive statistics using SPSS. Interviews were analyzed using a constant comparison approach. Mean age of participants was 30.25 years (range: 24-36 years), and mean BMI was 37.85 kg/m2 ± 8.68 kg/m2. Scores on the PCOSQ indicated that weight (2.47) had the poorest function, followed by menstrual problems (3.08), emotions (3.86), body hair (3.87), and infertility problems (4.00). Mean DRT score was 3.83 ± 1.19 with some women scoring 5 indicating increased risk for diabetes. For the physical component summary (PCS) on the SF-12, 42% of the sample were at the general population norm (GPN), while 8% were above, and 50% below the GPN. For the mental component summary (MCS), 67% were at the GPN, while 8% were above and 25% were below the GPN. Interview data with the women supported these quantitative findings. Women were interested in maintaining their health and weight with holistic measures including diet and exercise. Many women discussed problems regulating their menstrual cycles. Many were worried about the long-term consequences of PCOS including diabetes. Some women experienced stigmatization in the form of teasing due to their PCOS symptoms. In some women desiring to conceive, infertility problems was the PCOSQ domain of most concern to some of them. Some women expressed a desire for large families. Women felt more community information was needed about PCOS. Some women were frustrated that it had taken so long to diagnose their PCOS or expressed relief at receiving a PCOS diagnosis. Women felt they had not been provided with enough information about PCOS, and they wanted culturally specific information. The study data contribute to an evidence-based management program for AI women with PCOS. AI women need to be screened for PCOS at annual wellness visits. Providers need to be knowledgeable about PCOS. Some AI women may be interested in fertility treatments. Culturally appropriate self-management materials need to be developed for AI women. AI communities need to increase public awareness about PCOS.

Background: A culture of health requires a commitment from all—individuals, families, communities, organizations, and municipalities—to value health and make decisions reflective of a healthy society. At the individual level, health literacy is a necessary precursor to assist individuals in achieving a higher level of health. Method: One method for ensuring that staff members are routinely assessing and promoting health literacy is using competencies and practices previously identified for all health professions. Results: Cross-walking these competencies with the Health Literacy Tapestry model can be extremely helpful in framing assessment, action steps, and outcomes for nurses. Conclusion: Professional development nurse leaders have the challenge of ensuring that nurses are addressing patient health literacy as a fundamental nursing activity in every nursing–patient–family interaction. Assuming health literacy deficits as a “universal approach” to care is one method of ensuring health literacy needs are routinely addressed by staff. J Contin Educ Nurs. 2018;49(2):73–78.

Health literacy is a precursor to health and achievement of a culture of health (Barton et al, 2017Barton A.J. Allen P.E. Boyle D.K. Loan L.A. Stichler J.F. Parnell T.A. Health literacy: Essential for a culture of health.Journal of Continuing Education in Nursing. 2017; (In press)Google Scholar). Patient empowerment, engagement, activation, and maximized health outcomes will not be achieved unless assurance of health literacy is applied universally for every patient, every time, in every health care encounter, and across all environments of care. Organizations such as the Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) endorse the use of available resources such as the Health Literacy Universal Precaution Toolkit (Brega et al, 2015Brega A.G. Barnard J. Mabachi N.M. Weiss B.D. DeWalt D.A. Brach C. West D.R. Health literacy universal precautions toolkit.in: 2nd ed. AHRQ Publication No. 15-0023-EF. Agency for Healthcare Research and Quality., Rockville, MD2015http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmlGoogle Scholar). Health literacy universal precautions are suggested steps that can be implemented by health care systems and practices when they assume that everyone may have difficulty understanding health information and accessing health services. The toolkit is a resource that provides evidence-based guidance to primary care practices with the overarching goals of reducing the complexity of health care, increasing patient understanding of health information, and providing support for all patients regardless of their health literacy level (Brega et al, 2015Brega A.G. Barnard J. Mabachi N.M. Weiss B.D. DeWalt D.A. Brach C. West D.R. Health literacy universal precautions toolkit.in: 2nd ed. AHRQ Publication No. 15-0023-EF. Agency for Healthcare Research and Quality., Rockville, MD2015http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmlGoogle Scholar). Despite these endorsements, health literacy is not well understood by clinicians, rarely approached as a health care system issue, and is not universally executed across health care domains. Strategies and initiatives must be implemented to prepare nurses and other health care providers to embrace the importance of health literacy and to use available resources to enhance health literacy skills. In health-care systems and community health care settings, leaders must provide resources that enable all health-care providers to minimize the gap between patient skills and abilities and the demands and complexities of health care systems. In the United States, 88% of adults have health literacy limitations, and 77 million Americans—more than one third of U.S. adults—struggle with routine self- and family-care management tasks, such as following discharge instructions, complying with directions for taking prescribed medications, and adhering to pediatric immunization schedules (Kutner et al, 2006Kutner M. Greenberg E. Jin Y. Paulsen C. The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. U.S. Department of Education, National Center for Education Statistics, Washington, DC2006Google Scholar). Individuals with low health literacy are more likely to experience poor health status (DeWalt et al, 2004DeWalt D.A. Berkman N.D. Sheridan S. Lohr K.N. Pignone M. Literacy and health outcomes: A systematic review of the literature.Journal of General Internal Medicine. 2004; 19: 1228-1239http://dx.doi.org/10.1111/j.1525-1497.2004.40153.xCrossref PubMed Scopus (1262) Google Scholar). Health literacy is recognized as a social determinate of health based on its impact on health outcomes. The link between health inequality and low health literacy is also well established, and both are prevalent among the elderly, the poor, ethnic minorities, and in populations with chronic health conditions (Logan et al, 2015Logan R.A. Wong W.F. Villaire M. Daus G. Parnell T.A. Willis E. Paasche-Orlow M.K. Health literacy: A necessary element for achieving health equity. Institute of Medicine, Washington, DC2015https://nam.edu/perspectives-2015-health-literacy-a-necessary-element-for-achieving-health-equity/Google Scholar). Beginning definitions of health literacy focused on an individual's risk, as in the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Institute of Medicine, 2004Institute of Medicine Health literacy: A prescription to end confusion. The National Academies Press, Washington, DC2004https://doi.org/10.17226/10883Google Scholar). The health literacy definition evolved toward a public health focus of promotion and empowerment that allow people to have greater control over their health and to determine an individual's motivation and ability to access, understand, and use information to promote and maintain good health (Nutbeam, 2008Nutbeam D. The evolving concept of health literacy.Social Science and Medicine. 2008; 67: 2072-2078http://dx.doi.org/10.1016/j.socscimed.2008.09.050Crossref PubMed Scopus (1516) Google Scholar). Financial ramifications of low health literacy have added a cost emphasis to the health literacy imperative. According to the American Medical Association (AMA) Foundation, the average annual health care cost for individuals with low health literacy is more than four times higher than for similar individuals with high health literacy ($13,000 as compared with $3,000) (Weiss, 2007Weiss B.D. Health literacy and patient safety: Help patients understand. Manual for clinicians.2nd ed. American Medical Association Foundation and American Medical Association, Chicago, IL2007https://psnet.ahrq.gov/resources/resource/5839Google Scholar). Although definitions and foci have evolved over time, the nursing potential to enhance low health literacy is unchanged. Nurses have formidable direct and indirect influences on health literacy as we are often at the first point of care and are leaders in organizational and public health transformation. Nurses have a vital role in the promotion of health literacy, are employed across many areas of health care and public health, and are uniquely positioned to create the cultural change required to shift the focus from sickness to optimizing health and wellness (Parnell, 2014Parnell T.A. Nursing leadership strategies, health literacy, and patient outcomes.Nurse Leader. 2014; 12: 49-52http://dx.doi.org/10.1016/j.mnl.2014.09.005Abstract Full Text Full Text PDF Scopus (10) Google Scholar). The dialogue about antecedents to and consequences of low health literacy is ubiquitous; calls for its status as a universal precaution exist (DeWalt et al, 2010DeWalt D.A. Callahan L.F. Hawk V.H. Broucksou K.A. Hink A. Rudd R. Brach C. Health literacy universal precautions toolkit. Agency for Healthcare Research and Quality, Rockville, MD2010http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmlGoogle Scholar). Agencies and organizations such as the Agency for Healthcare Research and Quality (AHRQ) (Anonymous, 2017Anonymous AHRQ health literacy universal precautions toolkit. Agency for Healthcare Research and Quality, Rockville, MD2017https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2.htmlGoogle Scholar), the Centers for Disease Control and Prevention, 2017Centers for Disease Control and Prevention Health literacy.https://www.cdc.gov/healthliteracy/Date: 2017Google Scholar, the Health Resources and Services Administration, 2017Health Resources and Services Administration Health literacy.https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/index.htmlDate: 2017Google Scholar, the Health Research and Educational Trust, 2015Health Research and Educational Trust Health literacy resources and recommendations.http://www.hret-hiin.org/resources/display/health-literacy-resources-and-recommendationsDate: 2015Google Scholar, the American Hospital Association's Hospital in Pursuit of Excellence platform (American Hospital Association (AMA), 2017American Hospital Association (AMA) Hospitals in Pursuit of Excellence Platform (HOPE).http://www.hpoe.org/resources?q=health%20literacyDate: 2017Google Scholar), and the AMA Foundation (Weiss, 2007Weiss B.D. Health literacy and patient safety: Help patients understand. Manual for clinicians.2nd ed. American Medical Association Foundation and American Medical Association, Chicago, IL2007https://psnet.ahrq.gov/resources/resource/5839Google Scholar) provide health literacy-specific policy recommendations, resources, tools, and training. A PubMed search of published works using the terms “health literacy” and “nursing” retrieves more than 1,700 articles. With so much emphasis on health literacy, it is disheartening to note that there is no policy promoting health literacy as a nursing imperative. Additionally, the teach-back method commonly used by nurses is effective, not just for improving patients' understanding but also for improving outcomes (Schillinger et al, 2003Schillinger D. Piette J. Grumbach K. Wang F. Wilson C. Daher C. Bindman A.B. Closing the loop: Physician communication with diabetic patients who have low health literacy.Archives of Internal Medicine. 2003; 163: 83-90Crossref PubMed Scopus (888) Google Scholar). However, evidence associating the use of other nursing tools with diminished impact of low health literacy is lacking. Health literacy is a precursor to health and achievement of the Robert Wood Johnson Foundation's vision for a culture of health (Barton et al, 2017Barton A.J. Allen P.E. Boyle D.K. Loan L.A. Stichler J.F. Parnell T.A. Health literacy: Essential for a culture of health.Journal of Continuing Education in Nursing. 2017; (In press)Google Scholar). Patient engagement is well recognized as a cornerstone of successful health care reform (Pelletier, Stichler, 2013Pelletier L.R. Stichler J.F. Action brief: Patient engagement and activation: A health reform imperative and improvement opportunity for nursing.Nursing Outlook. 2013; 61: 51-54http://dx.doi.org/10.1016/j.outlook.2012.11.003Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, Pelletier, Stitchler, 2014Pelletier L.R. Stitchler J.F. Patient-centered care and engagement: Nurse leaders imperative for health reform.Journal of Nursing Administration. 2014; 44: 473-480http://dx.doi.org/10.1097/NNA.0000000000000102Crossref PubMed Scopus (20) Google Scholar), and health literacy is fundamental to engaging patients in their own health (Koh et al, 2013Koh H.K. Brach C. Harris L.M. Parchman M.L. A proposed health literate care model would constitute a systems approach to improving a systems approach to improving patient's engagement in care.Health Affairs. 2013; 32: 357-367http://dx.doi.org/10.1377/hlthaff.2012.1205Crossref PubMed Scopus (222) Google Scholar). Patient engagement is also a critical aspect of success for accountable care organizations and a vital component of patient-centered medical homes. The endorsement of health literacy policies, strategies, and initiatives aligns with the Academy's vision—to transform health policy and practice through nursing knowledge and leadership. Health literacy is also congruent with the Academy's strategic goal 1—to influence the development and implementation of policy that improves the health of populations and achieves health equity, and part two of this strategic goal, to advance evidence-based policies that support patient and family engagement in health care and care decisions (American Academy of Nursing, 2017American Academy of Nursing 2017-2020 strategic plan.http://www.aannet.org/about/strategic-plan-2017-20Date: 2017Google Scholar). The complex concept of health literacy acknowledges the need for assessing and addressing health literacy for every patient, every time, and in every health-care encounter; and ensuring patients know what they must do after all health care encounters to self-manage their health. Additionally, there is a need for research and evidence-based findings concerning the relationships among nursing interventions to mitigate untoward consequences of low health literacy and patient safety, as well as patient and system outcomes. The timing is right for a call to action to increase nurses' knowledge, attitudes, behaviors, practice resources, and system capabilities to lessen the health literacy-related burden on patients and costs for health care. Implementation of a nursing-specific health literacy policy will result in patient empowerment, engagement, and activation; increased health care equity; and improved patient, population, organization, and system outcomes (Parnell, 2015Parnell T.A. Health literacy in nursing: Providing person-centered care. Springer Publishing Company, New York City, NY2015Google Scholar, Pelletier, Stichler, 2013Pelletier L.R. Stichler J.F. Action brief: Patient engagement and activation: A health reform imperative and improvement opportunity for nursing.Nursing Outlook. 2013; 61: 51-54http://dx.doi.org/10.1016/j.outlook.2012.11.003Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, Pelletier, Stitchler, 2014Pelletier L.R. Stitchler J.F. Patient-centered care and engagement: Nurse leaders imperative for health reform.Journal of Nursing Administration. 2014; 44: 473-480http://dx.doi.org/10.1097/NNA.0000000000000102Crossref PubMed Scopus (20) Google Scholar). The overarching goal of this policy statement is to influence policy in three domains—practice, systems of care, and partnerships—to minimize the gap between patient skills and abilities and the demands and complexities of health care systems. Health literacy is fundamental to the success of every patient and health care professional interaction (U.S. Department of Health and Human Services, 2010U.S. Department of Health and Human Services National action plan to improve health literacy. Office of Disease Prevention and Health Promotion, Washington, DC2010Google Scholar). In fact, patient safety cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care (The Joint Commission, 2007The Joint Commission “What did the doctor say?:” Improving health literacy to protect patient safety.https://www.jointcommission.org/assets/1/18/improving_health_literacy.pdfDate: 2007Google Scholar). A nursing focus on health literacy as an essential component of all patient care will enhance the provision of person-centered care, patient safety (Parnell, 2015Parnell T.A. Health literacy in nursing: Providing person-centered care. Springer Publishing Company, New York City, NY2015Google Scholar), and patient, population, and system outcomes. Recommendation: Partner with nursing and other health care organizations to accomplish any and all of the following health literacy practice goals:•Urge the global use of a health literacy universal precautions approach and advocate for assuming all patients are at risk for not understanding health information (DeWalt et al, 2010DeWalt D.A. Callahan L.F. Hawk V.H. Broucksou K.A. Hink A. Rudd R. Brach C. Health literacy universal precautions toolkit. Agency for Healthcare Research and Quality, Rockville, MD2010http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmlGoogle Scholar, Koh et al, 2013Koh H.K. Brach C. Harris L.M. Parchman M.L. A proposed health literate care model would constitute a systems approach to improving a systems approach to improving patient's engagement in care.Health Affairs. 2013; 32: 357-367http://dx.doi.org/10.1377/hlthaff.2012.1205Crossref PubMed Scopus (222) Google Scholar).•Integrate patient-centered nursing practice elements that maximize patient engagement and health literacy into interprofessional practice models.•Assimilate patient-specific health literacy nursing diagnoses, nursing interventions, and patient predischarge self-management capabilities as components of the electronic medical record.•Promote shame-free environments where health literacy can flourish (Brach et al, 2012Brach C. Keller D. Hernandez L.M. Baur C. Parker R. Dreyer B. Schillinger D. Ten attributes of health literate health care organizations. The National Academies Press, Washington, DC2012https://nam.edu/perspectives-2012-ten-attributes-of-health-literate-health-care-organizations/Crossref Google Scholar, Rudd, Anderson, 2006Rudd R.E. Anderson J.E. The health literacy environment of hospitals and health centers. Harvard School of Public Health, Boston, MA2006Google Scholar).•Use plain language and the teach-back method in all patient communications (Baker et al, 2011Baker D.W. DeWalt D.A. Schillinger D. Hawk V. Ruo B. Bibbins-Domingo K. Pignone M. “Teach to goal”: Theory and design principles of an intervention to improve heart failure self-management skills of patients with low health literacy.Journal of Health Communication. 2011; 16: 73-88http://dx.doi.org/10.1080/10810730.2011.604379Crossref PubMed Scopus (66) Google Scholar). Health literacy is a priority area for patient safety and quality improvement in the U.S. health care system (Nielsen-Bohlman et al, 2004Nielsen-Bohlman L. Panzer A.M. Kindig D.A. Health literacy: A prescription to end confusion. The National Academies Press, Washington, DC2004https://www.nap.edu/catalog/10883/health-literacy-a-prescription-to-end-confusionCrossref Google Scholar, U.S. Department of Health and Human Services, 2010U.S. Department of Health and Human Services National action plan to improve health literacy. Office of Disease Prevention and Health Promotion, Washington, DC2010Google Scholar, U.S. Department of Health and Human Services, 2017U.S. Department of Health and Human Services Healthy People 2020 topics & objectives: Health communication and health information technology.https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technologyDate: 2017Google Scholar). Health literate care organizations are those that implement strategies universally and make it easier for all patients to navigate, understand, and use health information and services so they can take care of their health (Brach et al, 2012Brach C. Keller D. Hernandez L.M. Baur C. Parker R. Dreyer B. Schillinger D. Ten attributes of health literate health care organizations. The National Academies Press, Washington, DC2012https://nam.edu/perspectives-2012-ten-attributes-of-health-literate-health-care-organizations/Crossref Google Scholar). Recommendation: Collaborate with the IHI, AHRQ, the AMA Foundation, American Hospital Association, the American Organization of Nurse Executives (AONE), and other organizations to•promote organizational use of existing resources such as the Health Literacy Universal Precautions Toolkit (Brega et al, 2015Brega A.G. Barnard J. Mabachi N.M. Weiss B.D. DeWalt D.A. Brach C. West D.R. Health literacy universal precautions toolkit.in: 2nd ed. AHRQ Publication No. 15-0023-EF. Agency for Healthcare Research and Quality., Rockville, MD2015http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmlGoogle Scholar), Building Health Literate Organizations: A Guidebook to Achieving Organizational Change (Abrams et al, 2014Abrams M.A. Kurtz-Rossi S. Riffenburgh A. Savage B.A. Building health literate organizations: A guidebook to achieving organizational change.https://www.unitypoint.org/filesimages/Literacy/Health%20Literacy%20Guidebook.pdfDate: 2014Google Scholar), Ten Attributes of Health Literate Health Care Organizations (Brach et al, 2012Brach C. Keller D. Hernandez L.M. Baur C. Parker R. Dreyer B. Schillinger D. Ten attributes of health literate health care organizations. The National Academies Press, Washington, DC2012https://nam.edu/perspectives-2012-ten-attributes-of-health-literate-health-care-organizations/Crossref Google Scholar), and The Health Literacy Environment of Hospitals and Health Centers (Rudd, Anderson, 2006Rudd R.E. Anderson J.E. The health literacy environment of hospitals and health centers. Harvard School of Public Health, Boston, MA2006Google Scholar);•increase the use of health communication strategies, health information technology, and measures of patient postencounter self-management competency to monitor and improve health care quality and population health outcomes, and to achieve health equity (U.S. Department of Health and Human Services, 2017U.S. Department of Health and Human Services Healthy People 2020 topics & objectives: Health communication and health information technology.https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technologyDate: 2017Google Scholar);•develop goals, accountability, and financial incentives for professionals in all health care settings to use evidence-based models and guidelines that improve health literacy and enhance patient engagement and empowerment;•build a business case for recruiting and retaining a diverse workforce with health literacy expertise (Brach et al, 2012Brach C. Keller D. Hernandez L.M. Baur C. Parker R. Dreyer B. Schillinger D. Ten attributes of health literate health care organizations. The National Academies Press, Washington, DC2012https://nam.edu/perspectives-2012-ten-attributes-of-health-literate-health-care-organizations/Crossref Google Scholar); and•encourage and engage community partners to participate in the development and evaluation of health literacy initiatives (Brach et al, 2012Brach C. Keller D. Hernandez L.M. Baur C. Parker R. Dreyer B. Schillinger D. Ten attributes of health literate health care organizations. The National Academies Press, Washington, DC2012https://nam.edu/perspectives-2012-ten-attributes-of-health-literate-health-care-organizations/Crossref Google Scholar). Partnerships to promote health across specialties, professions, and sectors, are effective, because of alliances formed around values and common goals. Recommendation: Develop and implement policies that promote health literacy to ensure consistency and sustainability.•Collaborate with nursing and other health care organizations to integrate nursing models of care for health literacy into Quality and Safety Education for Nurses (QSEN), Nursing Alliance for Quality Care, and other national health care initiatives to improve quality and patient safety.•Encourage nurse educators and leaders to use the Health Literacy Tapestry conceptual model (Parnell, 2015Parnell T.A. Health literacy in nursing: Providing person-centered care. Springer Publishing Company, New York City, NY2015Google Scholar) in education and practice to describe and define health literacy across the continuum of care.•Urge The Joint Commission to evaluate successful incorporation of a health literacy universal precautions approach as a required component for attaining Joint Commission accreditation (Brach et al, 2012Brach C. Keller D. Hernandez L.M. Baur C. Parker R. Dreyer B. Schillinger D. Ten attributes of health literate health care organizations. The National Academies Press, Washington, DC2012https://nam.edu/perspectives-2012-ten-attributes-of-health-literate-health-care-organizations/Crossref Google Scholar, Koh et al, 2013Koh H.K. Brach C. Harris L.M. Parchman M.L. A proposed health literate care model would constitute a systems approach to improving a systems approach to improving patient's engagement in care.Health Affairs. 2013; 32: 357-367http://dx.doi.org/10.1377/hlthaff.2012.1205Crossref PubMed Scopus (222) Google Scholar, Parnell, 2014Parnell T.A. Nursing leadership strategies, health literacy, and patient outcomes.Nurse Leader. 2014; 12: 49-52http://dx.doi.org/10.1016/j.mnl.2014.09.005Abstract Full Text Full Text PDF Scopus (10) Google Scholar).•Advocate for funding to evaluate nursing and other health literacy programs in education, practice, and systems of care.•Urge the American Nurses Credentialing Center to requiring evidence of health literacy initiatives and sustained achievements as a component of Magnet recognition. This policy brief represents the work of the Health Literacy Task Force of the Quality Health Care Expert Panel of the American Academy of Nursing. The authors acknowledge the assistance provided by the members of the Quality Health Care Expert Panel, American Academy of Nursing Board Liaison Patricia Hinton Walker, PhD, RN, FAAN, PCC, and American Academy of Nursing Policy Manager and Staff Liaison, Matthew Williams, JD, MA.

Polycystic ovary syndrome (PCOS) occurs in 6%-15% of women. Some international studies have demonstrated that women with PCOS use maladaptive coping to manage stress. In this study we examined coping strategies used to manage stressful situations in 72 women with PCOS in the United States. Most women used adaptive coping, including social support, problem-solving, and positive reappraisal. A subset of women with increased psychological severity scores used maladaptive coping, including increased escape-avoidance coping and less problem-solving and positive reappraisal coping. Nurse practitioners have a valuable role in assessing coping skills in women with PCOS and intervening with adaptive coping interventions.

PURPOSE: The purpose of this study was to describe the (a) number and types of employed WOC certified nurses in acute care hospitals, (b) rates of hospital-acquired pressure injury (HAPI) and catheter-associated urinary tract infection (CAUTI), and (c) effectiveness of WOC certified nurses with respect to lowering HAPI and CAUTI occurrences. DESIGN: Retrospective analysis of data from National Database of Nursing Quality Indicators. SUBJECTS AND SETTINGS: The sample comprised 928 National Database of Nursing Quality Indicators (NDNQI) hospitals that participated in the 2012 NDNQI RN Survey (source of specialty certification data) and collected HAPI, CAUTI, and nurse staffing data during the years 2012 to 2013. METHODS: We analyzed years 2012 to 2013 data from the NDNQI. Descriptive statistics summarized the number and types of employed WOC certified nurses, the rate of HAPI and CAUTI, and HAPI risk assessment and prevention intervention rates. Chi-square analyses were used to compare the characteristics of hospitals that do and do not employ WOC certified nurses. Analysis-of-covariance models were used to test the association between WOC certified nurses and HAPI and CAUTI occurrences. RESULTS: Just more than one-third of the study hospitals (36.6%) employed WOC certified nurses. Certified continence care nurses (CCCNs) were employed in fewest number. Hospitals employing wound care specialty certified nurses (CWOCN, CWCN, and CWON) had lower HAPI rates and better pressure injury risk assessment and prevention practices. Stage 3 and 4 HAPI occurrences among hospitals employing CWOCNs, CWCNs, and CWONs (0.27%) were nearly half the rate of hospitals not employing these nurses (0.51%). There were no significant relationships between nurses with specialty certification in continence care (CWOCN, CCCN) or ostomy care (CWOCN, COCN) and CAUTI rates. CONCLUSIONS: CWOCNs, CWCNs, and CWONs are an important factor in achieving better HAPI outcomes in acute care settings. The role of CWOCNs, CCCNs, and COCNs in CAUTI prevention warrants further investigation.

Objective: Assessing diabetes self care management is essential for nursing care for diabetes. There is a need to have valid and reliable scales that assess the actual performance of diabetes self management. The purpose of this study was to revise and conduct psychometric testing and analysis of the Diabetes Self Management Scale (DSMS). Methods: A cross-sectional methodological design was used. A convenience sample was used and 78 adults with diabetes and taking insulin from five sites in the Midwest area of the U.S participated in the study. Reliability analysis was done using Ferketich techniques to make decisions about whether any given item should be retained or deleted. Results: A descriptive analysis for the 60 items of the scale was conducted; several items had low variability compared to the other items on the scale. The correlation matrices showed that a total of 20 items had poor item characteristics. These 20 items were deleted resulting in developing 40- item version of the scale. The 40 - item scale had high level of internal consistency (Cronbach's α = 0.947). The validity testing of the 40 - item scale was guided by the Research Model for Diabetes Self Care Management; results were congruent with the model and showed strong correlation with self efficacy, moderate correlation with self care agency, and weak correlation with diabetes knowledge. Conclusion: The items and the scale (DSMS) have undergone careful psychometric testing. The 40-item DSMS is a reliable and valid instrument to measure diabetes self care management among people with diabetes.

•Relationships exist between nursing specialty certification and 5 patient outcomes.•Inconsistent or contradictory evidence also exists.•Many completed studies were not guided by a conceptual framework or model.•The Expanded Conceptual Model can drive theory based research on specialty certification.•Intervening variables are Invisible Architecture, Work Organization, Performance.

BACKGROUND:An objective measure of nutrition literacy is unavailable for use in the primary care population. The Nutrition Literacy Assessment instrument (NLit) is a tool designed to measure nutrition literacy across six domains and has been previously piloted in breast cancer and parent populations. The purpose of this research was to engage nutrition experts and patients to guide revisions of the NLit for use in adult primary care.METHODS:Experts (n=5) reviewed each item in the NLit using a survey to assign rankings of their agreement according to relevance, clarity, and reading difficulty. Relevance rankings were used to calculate Scale Content Validity Index. After suggested revisions were made, patients (n=12) were recruited from urban primary care clinics of a University Medical Center located in the Midwestern United States and were interviewed by trained researchers using the cognitive interview approach to generate thoughts, feelings, and ideas regarding NLit items. Data analysis involved qualitative and quantitative methods.RESULTS:Content validity from expert review was confirmed with a total Scale Content Validity Index of 0.90. Themes emerging from the cognitive interviews resulted in changes in the NLit to improve instrument clarity.CONCLUSION:These data suggest the NLit achieves its target constructs, is understood by the target audience, and is ready to undergo validity and reliability testing within the primary care population.

• Specialty Certification Rates o Perioperative o SICU o Surgical Unit o MedicalSurgical Units o Wound & Ostomy • RN Autonomy • RN Decision Making • RN-Physician Relations • Surgical Site Infection Rates Study Variables 1. Urban JA. Cost analysis of surgical site infections. Surg Infect. 2006;7 Suppl 1:S19-22. 2. Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;26:1743-1748. 3. Donabedian A. The role of outcomes in quality assessment and assurance. Qual Rev Bull. 1992;18:356-360. • Retrospective, secondary analysis of merged data from NDNQI and NHSN.

Although remarkable efforts have been made to improve patient fall reporting through the utilization of standardized definitions, injury falls reporting has rarely been examined. This study used an overall intra-class correlation coefficient (ICC) estimate and factor analysis to assess the reliability and validity of the National Database of Nursing Quality Indicators® (NDNQI®) falls with injury measure. Data were collected from an online Fall Injury Level Survey that was administered to 1,159 NDNQI site coordinators (39.7% response rate; 91% registered nurses [RNs]). Estimated overall ICC was .85. Exploratory factor analysis (EFA) with a Promax rotation (root mean square error of approximation [RMSEA] = 0.053) identified three latent factors: No Injury, Minor Injury, and Moderate/Major Injuries. Final confirmatory factor analysis (CFA) assessment (comparative fit index [CFI] = 0.914, Tucker Lewis Index [TLI] = 0.910, RMSEA = 0.048) confirmed an acceptable model fit. Results provided strong evidence that the NDNQI falls with injury measure is reliable and valid in supporting hospitals' fall prevention efforts and future injurious falls research.

Background: Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement.Objective: The study objective was to develop a unit-level inpatient composite nursing care quality performance index the Pressure Ulcer and Fall Rate Quality Composite Index.Design: Two-phase measure development study.Settings: 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors (R) during the year 2013.Methods: The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling.Results: The Pressure Ulcer and Fall Rate Quality Composite Index = 100 - PUR - FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores.Conclusions: The Pressure Ulcer and Fall Rate Quality Composite Index is a step toward providing a more holistic perspective of unit level nursing quality than individual measures and may help nurses nursing administrators obtain a broader view of which patient care units are the higher and lower performers. Further study is needed to examine the usability of the Pressure Ulcer and Fall Rate Quality Composite Index. (C) 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license

OBJECTIVE:The aim of this study is to compare rates and reasons for registered nurse (RN) turnover by Magnet® status.BACKGROUND:Although lower RN turnover rates in Magnet hospitals have been documented well in the literature, little is known about specific separation reasons for RN turnover and whether the reasons differ between Magnet and non-Magnet hospitals.METHODS:This descriptive, correlational study analyzed unit-level 2013 National Database of Nursing Quality Indicators® turnover data (2,958 units; 497 hospitals). Poisson regression and Wilcoxon-Mann-Whitney test were used.RESULTS:Registered nurse turnover due to environment-related reasons was higher on units in non-Magnet hospitals than units in Magnet hospitals. Units in non-Magnet hospitals had 4.684 times higher turnover rates due to staffing/workload and 1.439 times higher rates due to work schedules than did units in Magnet hospitals.CONCLUSIONS:Nursing administrators in both Magnet and non-Magnet hospitals need to continually strive to improve unit work environments, particularly staffing and workload conditions and work scheduling.