Publications by authors named "Katherine N Scafide"

10 Publications

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Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses.

Adv Neonatal Care 2021 Sep 30. Epub 2021 Sep 30.

School of Nursing, George Mason University, Fairfax, Virginia (Drs Kutahyalioglu, Scafide, and Mallinson); and College of Nursing, University of Rhode Island, Kingston (Dr D'Agata).

Background: Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice.

Purpose: The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses.

Methods: This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments.

Results: Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β = 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices (r = - 0.199, P < .001).

Implication For Research And Practice: Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.
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September 2021

Development and Pilot Analysis of the Bruise Visibility Scale.

SAGE Open Nurs 2021 Jan-Dec;7:23779608211020931. Epub 2021 Jun 7.

College of Health and Human Services, George Mason University, Fairfax, Virginia, United States.

The accuracy of assessing and documenting injuries is crucial to facilitate ongoing clinical care and forensic referrals for victims of violence. The purpose of this cross-sectional, pilot study was to evaluate the inter-rater reliability and criterion validity of a newly developed Bruise Visibility Scale (BVS). The instrument was administered to a diverse sample (n = 30) with existing bruises. Bruises were assessed under fluorescent lighting typical of an examination room by three raters who were randomly selected from a pool of eight experienced clinical nurses. Colorimetry values of the bruise and surrounding tissue were obtained using a spectrophotometer. The BVS demonstrated good single (ICC = 0.71, 95% CI = 0.54 - 0.84) and average agreement (ICC = 0.88, 95% CI = 0.78 - 0.94) between raters. A significant, positive moderate correlation was found between mean BVS scores and overall color difference between the bruise and surrounding skin (Pearson's r = 0.614,  < 0.001). With further research, the BVS has the potential to be a reliable and valid tool for documenting the degree of clarity in bruise appearance.
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June 2021

Multimedia in preoperative patient education for adults undergoing cancer surgery: A systematic review.

Eur J Oncol Nurs 2021 Jun 23;52:101981. Epub 2021 May 23.

George Mason University, College of Health and Human Services, 4400 University Drive, Mail Stop Number 3C4, Fairfax, VA, 22030, United States.

Purpose: The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients.

Methods: A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design.

Results: The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods.

Conclusions: In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.
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June 2021

Quantifying the Degree of Bruise Visibility Observed Under White Light and an Alternate Light Source.

J Forensic Nurs 2021 Jan-Mar 01;17(1):24-33

School of Public Health, Georgia State University.

Background: Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS).

Methods: Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales.

Results: Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values.

Implications For Practice: Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.
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May 2021

Bedside Technologies to Enhance the Early Detection of Pressure Injuries: A Systematic Review.

J Wound Ostomy Continence Nurs 2020 Mar/Apr;47(2):128-136

Katherine N. Scafide, PhD, RN, College of Health and Human Services, George Mason University, Fairfax, Virginia.

Background: Hospital-acquired pressure injuries strain organizational resources and negatively impact the quality of life of affected patients. However, early detection of pressure injuries is limited due to challenges with visual assessment, particularly in individuals with dark skin.

Purpose: The purpose of this systematic review was to determine whether sufficient research evidence exists to support the use of bedside technologies for early detection of pressure injures, which is inclusive of pressure-related blanchable erythema (PrBE), pressure-related nonblanchable erythema (PrNBE), and deep tissue pressure injury (DTPI).

Search Question: What available bedside technologies enhance the early detection of pressure injuries?

Methods: A systematic search of Medline, CINAHL, Web of Science, and Cochrane databases was executed. Quantitative studies were included that examined whether accessible technologies could indicate the presence of PrBE, PrNBE, and DTPI. The quality of the research was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale.

Findings: We identified 18 eligible studies that represented a variety of technologies, including ultrasound (n = 5), thermography (n = 7), subepidermal moisture (SEM) measurement (n = 5), reflectance spectrometry (n = 2), and laser Doppler (n = 1). The methodological rigor in study quality was variable. Subepidermal moisture measurement provided the most consistent findings in the early detection of pressure injury.

Conclusions: Objective methods that provide accurate and timely assessment of DTPIs augment early implementation of optimal prevention and treatment measures. Evidence identified in this systematic review supports the use of SEM measurement devices as effective tools for early pressure injury detection. However, more research in the field of technology-enhanced, pressure injury detection is needed to support the use of existing and emerging devices.
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October 2020

Bruise detection and visibility under alternate light during the first three days post-trauma.

J Forensic Leg Med 2020 Jan 19;69:101893. Epub 2019 Dec 19.

Georgia State University, School of Public Health, PO Box 3995, Atlanta, GA, 30302, United States.

Introduction: Cutaneous bruises are often hard to detect particularly on individuals with a darker complexion. Researchers and federal agencies have recommended the use of alternate light to aide in the assessment of subtle injury. However, studies are limited in their evaluation of wavelength performance during the first few days of bruise healing. The purpose of this pilot study was to examine whether an alternate light source (ALS) improves detection of bruises when compared to normal light typical of clinical practice during the first three days following induction.

Methods: A sample of eight healthy adults between 22 and 36 years of age with diverse skin color were recruited for this study. One bruise was induced on each participant by dropping a 4-oz (113g) steel ball through a 5-ft (1.5 m) vertical pipe onto the anterior surface of the forearm. Using the ALS, bruises were assessed under 14 different combinations of ultraviolet and short narrowband visible wavelengths and filters along with overhead fluorescent "examination" lighting. Participants were examined 3 to 4 times per day at approximately 4-h intervals for three consecutive days post induction.

Results: Repeated bruise assessments on 8 subjects resulted in 59 bruise assessments and 885 total observations under the different wavelengths and filters combinations. A bruise was detectable in 46 (78%) of the assessments, with bruise ages ranging from 30 min to 57 h. Twenty (34%) bruises not detectable under normal light were visible with ASL. Multilevel modeling revealed a strong association between time and detection for shorter wavelengths, such as 365 nm (ultraviolet) and 450 nm.

Conclusion: The results of our study suggest alternate light is more likely to detect faint bruises than normal lighting during the first three days post injury. However, more research is needed to determine which wavelengths and filter combinations are most effective during that time frame.
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January 2020

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial.

J Forensic Sci 2020 Jul 3;65(4):1191-1198. Epub 2020 Feb 3.

School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA, 30303.

Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350-535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35-6.56; 450 nm: OR = 4.08, 95% CI: 3.36-4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37-3.70; fat: OR = 1.21, 95% CI: 1.09-1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.
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July 2020

Systematic Review of Racial/Ethnic Outcome Disparities in Home Health Care.

J Transcult Nurs 2017 Nov 26;28(6):598-607. Epub 2017 Mar 26.

1 George Mason University School of Nursing, Fairfax, VA, USA.

Introduction: Though extensive evidence demonstrates that U.S. minority patients suffer health care disparities, the incidence of disparities among the 3.3 million adult patients receiving skilled intermittent home health care services annually is unclear. The purpose of this systematic review is to determine the relationship of race/ethnicity on home health care patient outcomes.

Methodology: PRISMA guidelines were used to perform a systematic search of the literature within the CINHAL, Medline, and Web of Science databases. Search terms included variations on the terms: home health, minority race/ethnicity, and patient outcomes. Included studies evaluated adult patient outcomes to intermittent skilled home health care services from Medicare-certified agencies using federally defined race/ethnicity categories. Research quality was evaluated using the Johns Hopkins Evidence Based Practice Grading Scale.

Results: Seven studies were identified in the search. All studies were of good-to-high quality with the majority having large samples. All seven found a significant difference in patient outcomes related to race/ethnicity. Specifically, minority patients had more adverse events, less improvement in functional outcomes, and worse patient experiences when compared with majority patients.

Conclusion: Home health care disparities exist and efforts should be made to provide culturally and linguistically appropriate care to all patients.
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November 2017

Alternate Light Source Findings of Common Topical Products.

J Forensic Nurs 2016 Jul-Sep;12(3):97-103

Author Affiliations: 1Mercy Medical Center; 2Johns Hopkins University School of Nursing; 3George Mason University College of Health and Human Sciences; and 4College of Nursing, Texas A&M Health Sciences Center.

Background: One of the important roles of a forensic clinician is to perform examinations of patients who are victims and suspects of crime. Alternate light source (ALS) is a tool that can improve evidence collection and enhance visualization of injuries. The purpose of this study was to examine if commonly used topical products fluoresce or absorb when examined with an ALS. Second, we aimed to identify patient and examination variables that may impact findings.

Methods: A convenience sample of 81 subjects was used. After the application of 14 over-the-counter products, researchers observed the participants' skin with an ALS under 18 combinations of wavelengths and colored filters.

Results: Of the 14 products viewed (n = 1458 observations per product), six were found to fluoresce under alternate light in more than 40% of observations, five fluoresced in 1%-10% of observations, and three fluoresced less than 1% of the time. One product (a makeup product) absorbed ALS light consistently (81%), and a second (a sunscreen product) absorbed in 7%, whereas the remaining 12 products produced absorption findings in less than 1% of observations. In generalized mixed linear models, absorption findings were more commonly identified in participants with light or medium skin tones when compared with those with dark skin tones.

Discussion: These results suggest that the presence of topical products may impact ALS findings. A thorough forensic clinical assessment should include a documented history, including assessment of potential sources of findings, to aid in interpretation.
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March 2017

Reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour.

Injury 2016 Jun 9;47(6):1258-63. Epub 2016 Mar 9.

Georgia State University, School of Public Health, United States.

Background: Bruising is one of the most common types of injury clinicians observe among victims of violence and other trauma patients. However, research has shown commonly used qualitative description of cutaneous bruise colour via the naked eye is subjective and unreliable. No published work has formally evaluated the reliability of tristimulus colourimetry as an alternative for assessing bruise colour, despite its clinical and research applications in accurately assessing skin colour. The purpose of this study was to systematically evaluate the test-retest and inter-observer reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour.

Methods: Two researchers obtained repeated tristimulus colourimetry measures of cutaneous bruises with participants of diverse skin colour. Measures were obtained using the Minolta CR-400 Chomameter. Commission Internationale d'Eclairage (CIE) L*a*b* colour space was used. Data was analysed using intraclass correlation coefficients (ICC), Cronbach's alpha, and minimal detectable change (MDC) on all three L*a*b* values.

Results: The colorimeter demonstrated excellent test-retest or intra-rater reliability (L* ICC=0.999; a* ICC=0.973; b* ICC=0.892) and inter-rater reliability (L* ICC=0.997; a* ICC=0.976; b* ICC=0.982).

Conclusions: With consistent placement, the tristimulus colourimetry is reliable for the objective assessment and documentation of cutaneous bruise colour for purposes of clinical practice and research. Recommendations for use in practice/research are provided.
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June 2016