Publications by authors named "Nancy M Daraiseh"

15 Publications

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The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis.

MDM Policy Pract 2020 Jul-Dec;5(2):2381468320940708. Epub 2020 Jul 7.

James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs' preferences. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic's peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs' roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as "final decision makers." Knowledge and experience were facilitators identified to participating in medical decision making. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.
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July 2020

Nurse Responses to Physiologic Monitor Alarms on a General Pediatric Unit.

J Hosp Med 2019 10 19;14(10):602-606. Epub 2019 Jun 19.

Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Background: Hospitalized children generate up to 152 alarms per patient per day outside of the intensive care unit. In that setting, as few as 1% of alarms are clinically important. How nurses make decisions about responding to alarms, given an alarm's low specificity for detecting clinical deterioration, remains unclear.

Objective: Our objective was to describe how bedside nurses think about and act upon monitor alarms for hospitalized children.

Design, Setting, Participants: This was a qualitative study that involved the direct observation of nurses working on a general pediatric unit at a large children's hospital.

Measurements: We used a structured tool that included predetermined categories to assess nurse responses to monitor alarms. Data on alarm frequency and type were pulled from bedside monitors.

Results: We conducted 61.3 patient-hours of observation with nine nurses, in which we documented 207 nurse responses to patient alarms. For 67% of alarms heard outside of the room, the nurse decided not to respond without further assessment. Nurses most commonly cited reassuring clinical context (eg, medical team in room), as the rationale for alarm nonresponse. The nurse deemed clinical intervention necessary in only 14 (7%) of the observed responses.

Conclusion: Nurses rely on clinical and contextual details to determine how to respond to alarms. Few of the alarm responses in our study resulted in a clinical intervention. These findings suggest that multiple system-level and educational interventions may be necessary to improve the efficacy and safety of continuous monitoring.
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October 2019

Enhancing the detection of injuries and near-misses among patient care staff in a large pediatric hospital.

Scand J Work Environ Health 2018 07 7;44(4):377-384. Epub 2018 May 7.

Research in Patient Services; Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH 45229, USA. MLC 7014.

Objectives Compared to other industries, healthcare has one of the highest rates of non-fatal occupational injury/illness. Evidence indicates these rates are underestimated, highlighting the need for improved injury surveillance. This study aims to demonstrate the feasibility of integrating active data collection in a passive injury surveillance system to improve detection of injuries in a healthcare establishment. Methods Using digital voice recorders (DVR), pediatric healthcare providers prospectively recorded events throughout their shift for two weeks. This sample-based active injury surveillance was then integrated into an institutional surveillance system (ISS) centered on passive data collection initiated by employee reports. Results Injuries reported using DVR during two-week intervals from February 2014 to July 2015 were 40.7 times more frequent than what would be expected on the basis of the usual ISS reports. Psychological injuries (eg, stress, conflict) and near-misses were captured at a rate of 16.1 per 1000 days [95% confidence interval (CI) 14.1-18.3] and 35.6 per 1000 days (95% CI 32.7-38.8), respectively. Finally, 68% (95% CI 65-72%) of participants preferred using DVR either as an alternative or complement to the existing ISS. Conclusions This study showed that it is feasible to improve injury surveillance in a healthcare establishment by integrating active data collection based on voice recording within a passive injury surveillance system. Enhanced surveillance provides richer information that can guide the development of effective injury prevention strategies.
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July 2018

Barriers and Facilitators of Adverse Event Reporting by Adolescent Patients and Their Families.

J Patient Saf 2020 09;16(3):232-237

James M. Anderson Center for Health Systems Excellence.

Objectives: The objectives were (1) to describe barriers and facilitators of adverse event reporting by adolescent patients and parents in a pediatric hospital and (2) to identify characteristics the participants wished to have in a formal reporting system of adverse events.

Methods: We used a qualitative design in which 6 focus groups, 3 with parents and 3 with adolescents, were conducted. The transcripts of audio recordings, notes of team debriefings, and written field notes of group behaviors were analyzed using NVivo software for qualitative data analysis.

Results: Participants reported that the quality of the experience with the health care system, type of communication with health care providers, and degree of personal self-confidence in communication within the health care system were 3 interacting factors influencing willingness to report adverse events. Preferred reporting mechanisms were different for different participants and included face-to-face meetings with hospital representatives, Web sites, smart phone capability, phone calls from a human, and paper mail. Reporting systems should be easy to use, ensure confidentiality, and provide user feedback.

Conclusions: Experience, communication, and confidence are 3 factors that can engage an adolescent patient and parents in their health care. Confident adolescent patients and parents in turn have a possibility of reporting an adverse safety event given an opportunity.
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September 2020

Developing a Patient Classification System for a Neonatal ICU.

J Nurs Adm 2016 Dec;46(12):636-641

Author Affiliations: Assistant Professor (Dr Daraiseh), Research in Patient Services and James M. Anderson Center for Health Systems Excellence; Project Manager (Mr Vidonish and Ms Keissling), Center for Professional Excellence; Statistician, Research in Patient Services (Ms Lin), Cincinnati Children's Hospital Medical Center, Ohio.

Objective: The purpose of this study was to develop a valid and reliable patient classification system (PCS) for a neonatal ICU (NICU).

Background: PCSs have been widely used to determine required care hours, budgeting, and staffing. There is a lack of and a vital need for a valid and reliable pediatric PCS because of differences in needs and treatment from adults.

Methods: Data were collected in a NICU using work sampling, chart reviews, and expert opinion. The resulting PCS was assessed for validity and reliability, ease of use, effectiveness, and satisfaction.

Results: The PCS showed significantly high reliability and validity. Survey scores revealed nurses perceived the tool to be easy to use and effective.

Conclusions: Using subjective and objective methods, a NICU PCS was shown to be a valid and reliable measure to determine the hours per patient day required to provide care.
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December 2016

Selection of employee personal protective equipment based on aggressive behavior in pediatric neuropsychiatry.

Dev Neurorehabil 2018 Jan 28;21(1):32-39. Epub 2016 Oct 28.

d Center for Behavior Analysis and Language Development , Shabani Institute , Santa Monica , California , USA.

Purpose: Hospitalized patients with a developmental or intellectual disability and a psychiatric disorder (dual-diagnosis) often pose a risk to themselves or others leading to high injury rates for their providers. Therefore, evidence-based strategies to reduce employee injuries resulting from interactions are necessary.

Methods: To reduce injuries resulting from interactions with dual-diagnosis patients, the Initial Behavioural Assessment (IBA) and Protective Equipment Decision Key (PEDK) were used in inpatient neuropsychiatry. The IBA-PEDK identify patients' aggressive behaviors to provide employees with personal protective equipment (PPE). Inter-rater reliability, validity, and adherence were examined.

Results: Injuries significantly decreased after implementing the IBA-PEDK. The average kappa coefficient was 0.64 with a 90.6% agreement. Ninety-three percent of respondents reported wearing PPE at the time of injury.

Conclusions: A quick, user-friendly tool that provides a standardized method for determining PPE based on patient-specific behavior can significantly reduce aggression-related injuries.
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January 2018

Noise Exposure on Pediatric Inpatient Units.

J Nurs Adm 2016 Sep;46(9):468-76

Author affiliations: Assistant Professor, Research in Patient Services and James M. Anderson Center for Health Systems Excellence (Dr Daraiseh); Sr Vice President, Patient Services (Dr Hoying); Project Manager, Center for Professional Excellence (Mr Vidonish); Statistician, Research in Patient Services (Ms Lin); Associate Professor, Division of Biomedical Informatics (Dr Wagner), Cincinnati Children's Hospital Medical Center, Ohio.

Background: Noise is a problem placing registered nurses (RNs) at risk for safety events, decreased job performance, fatigue, irritability, and hearing loss.

Objective: The purpose of this study is to measure noise levels and sources on pediatric inpatient units as well as to explore the health impact of noise on RNs.

Methods: This was a descriptive nonexperimental study with 65 pediatric RNs from 14 units. Noise (levels, source, location, and activity), heart rate (HR), and stress were measured. Correlations between sound pressure levels (SPLs), HR, and stress were examined.

Results: Mean (SD) SPLs were 75.8 (8.9) dBA and were significantly higher than SPLs for patients. Noise was significantly associated with HR but not with time in tachycardia or stress. Primary sources of noise were employee conversations in patient rooms.

Conclusions: On all units, SPLs exceeded protection agency guidelines. Cost-prohibitive structural changes underscore the importance of using behavioral and culture modification to reduce noise.
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September 2016

Impact of Noise on Nurses in Pediatric Intensive Care Units.

Am J Crit Care 2015 Sep;24(5):377-84

J'ai Watson is a graduate student, Low Back Biomechanics and Workplace Stress Laboratory, Department of Environmental Health, University of Cincinnati, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Angela Kinstler is clinical director, cardiac intensive care unit, William P. Vidonish is a project manager, and Li Lin is a statistician, Center for Professional Excellence, Cincinnati Children's Hospital Medical Center. Michael Wagner is an associate professor, Department of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio. Kermit G. Davis is an associate professor, Low Back Biomechanics and Workplace Stress Laboratory, Department of Environmental Health, University of Cincinnati. Susan E. Kotowski is an assistant professor, Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati. Nancy M. Daraiseh is an assistant professor, Research in Patient Services, James M. Anderson Center for Health Systems Excellence, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center.

Background: Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing.

Objective: To measure noise levels and noise duration on specialty pediatric intensive care units to explore sources of noise and its effects on the health of registered nurses.

Methods: In a cross-sectional pilot study, levels and sources of noise in 3 different specialty pediatric intensive care units were assessed. Fifteen nurses were observed for 4-hour sessions during a 24-hour period. Sound pressure levels (noise) and heart rate were measured continuously, and stress ratings were recorded. Descriptive statistics were calculated for noise (level, source, location, and activity), heart rate, and stress. The Pearson correlation coefficient was calculated to analyze the relationship between heart rate and noise.

Results: Mean noise level was 71.9 (SD, 9.2) dBA. Mean heart rate was 85.2/min (SD, 15.8/min) and was significantly associated with noise, unit, within-unit location, nurse sources, and noise activities. The most frequent sources of noise were patients' rooms, care activities, and staff communications.

Conclusions: Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes.
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September 2015

Inpatient falls in freestanding children's hospitals.

Pediatr Nurs 2014 May-Jun;40(3):127-35

Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.
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September 2014

Sources of work-related acute fatigue in United States hospital nurses.

Nurs Health Sci 2014 Mar 23;16(1):19-25. Epub 2014 Jan 23.

College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA.

This study identified the nursing work activities that could be the primary sources of work-related acute fatigue in US hospital nurses. Continuous recording of working heart rate and random observations of nursing activities were applied to collect data from eight nurses during two consecutive 12 h day shifts. Using descriptive statistics and random-effect analysis of variance, the contributions of individual nursing work activities to acute fatigue were compared based on the activity frequencies and nurses' corresponding heart rate elevations. Of 860 observed nursing-related work activities, manual patient-handling, bedside-care, care-coordinating, and walking/standing activities accounted for 5%, 16%, 38%, and 41%, respectively. After controlling for the differences of participant and shift, the percentage of working heart rate to maximal heart rate of manual patient-handling (64.3%), bedside-care (59.7%), and walking/standing (57.4%) activities were significantly higher than that of care-coordinating activities (52.3%, F[3, 38.0]  = 7.5, P < 0.001). These findings suggest that bedside care and walking/standing, other than manual patient handling, contributed most to the level of acute fatigue.
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March 2014

Codeine-related adverse drug reactions in children following tonsillectomy: a prospective study.

Laryngoscope 2014 May 13;124(5):1242-50. Epub 2013 Nov 13.

Division of Human Genetics, University of Cincinnati, Cincinnati, Ohio; Division of Pharmacy, University of Cincinnati, Cincinnati, Ohio.

Objectives/hypothesis: To prospectively determine factors associated with codeine's adverse drug reactions (ADRs) at home in a large homogenous population of children undergoing outpatient tonsillectomy.

Study Design: Prospective, genotype blinded, observational study with a single group and repeated ADR measures documented by parents at home.

Methods: A total of 249 children 6 to 15 years of age scheduled for tonsillectomy were enrolled. The primary outcome was number of daily codeine-related ADRs. We examined the number and type of ADR by race and by days and further modeled factors potentially associated with ADR risk in a subcohort of white children. Sedation following a dose of codeine was a secondary outcome measure. Parents recorded their children's daily ADRs and sedation scores during postoperative days (POD) 0 to 3 at home.

Results: Diaries were returned for 134 children, who were given codeine. A total of 106 (79%) reported at least one ADR. The most common ADRs were nausea, lightheadedness/dizziness for white children and nausea, and vomiting for African American children. In a subcohort of white children ≤ 45 kg, increased ADR risk was associated with the presence of one or more full function CYP2D6 alleles (P < 0.001), POD (P < 0.001), and sex (P = 0.027). Increased pain intensity (P = 0.009) and PODs 0 and 1 (P = 0.001) contributed to a higher sedation risk. Neither obstructive apnea nor predicted CYP2D6 phenotype were associated with sedation risk.

Conclusions: Our results provide evidence that multiple factors are associated with codeine-related ADRs and support the FDA recommendation to avoid codeine's routine use following tonsillectomy in children.
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May 2014

Fatigue and recovery in 12-hour dayshift hospital nurses.

J Nurs Manag 2014 Jul 23;22(5):593-603. Epub 2013 Apr 23.

School of Nursing and Health Studies, Northern Illinois University, DeKalb, IL, USA.

Aim: The study investigated the status of acute fatigue, chronic fatigue and inter-shift recovery among 12-hour shift nurses and how they differed by organisational and individual factors.

Background: While the 12-hour shift has been a widely accepted staffing solution in hospitals, the fatigue-recovery process in nurses working 12-hour shifts remains unclear.

Methods: A cross-sectional survey was completed by 130 full-time nurses working 12-hour dayshifts in three hospitals to assess the perceived levels of acute fatigue, chronic fatigue and inter-shift recovery, as well as their associations with selected organisational and individual factors.

Results: Nurses experienced a moderate to high level of acute fatigue and moderate levels of chronic fatigue and inter-shift recovery. Fatigue and recovery levels differed by the interaction between hospital and unit after controlling for individual factors. Lack of regular exercise and older age were associated with higher acute fatigue.

Conclusions: An unhealthy fatigue-recovery process was found for nurses working a 12-hour shift during the day.

Implications For Nursing Management: There appears to be a need to establish fatigue intervention programmes for 12-hour shift nurses in hospitals. Hospital administration, unit managers and staff nurses need to collaborate to achieve a healthy fatigue-recovery balance when implementing 12-hour shifts.
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July 2014

Pediatric inpatient falls and injuries: a descriptive analysis of risk factors.

J Spec Pediatr Nurs 2012 Jan 10;17(1):10-8. Epub 2011 Nov 10.

Research and Evidence-Based Practice, Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Purpose: This study identified patient characteristics and environmental factors related to falls and injuries at one pediatric hospital.

Design And Methods: This descriptive study was part of a multisite study based on inpatient pediatric falls reported over a 6-month period.

Results: Fall prevalence was .84/1,000 patient days. Thirty-one of the 53 falls (58.5%) resulted in injury; 17% required treatment. Of the injured children, 83% were developmentally appropriate, 58% were in the hospital room, and five fell from a bed.

Practice Implications: Comprehensive fall prevention programs are required to promote patient safety.
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January 2012

Physiological and behavioural response patterns at work among hospital nurses.

J Nurs Manag 2011 Jan 9;19(1):57-68. Epub 2010 Dec 9.

School of Nursing and Health Studies, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL, USA.

Aim: The aim was to determine whether hospital nurses are experiencing physiological strain at work by examining their physiological and behavioural response patterns over 12-hour shifts.

Background: Excessive workload for nurses may lead to poor quality of care and high nursing turnover rates. Energy expenditure (EE), heart rate (HR) and work pace (WP) can be used to examine the physiological impact from the workload.

Methods: A total of 145 nurses wore monitors for one 12-hour day shift to record HR and WP, which were used to calculate EE. Individual and work-related factors were assessed through questionnaires and work logs.

Results: Energy expenditure accumulated over the 12 hours reached the EE level of 8-hour shifts in which individuals work at a moderate physical intensity level. The HR data indicated a moderate cardiac stress level throughout the shifts, despite which WP decreased after 15.00 hours. Inadequate work break and sleep, family care-giving responsibility and aging may challenge work recovery.

Conclusions: Nursing workload of 12-hour shifts has a negative physiological impact on hospital nurses.

Implications For Nursing Management: Nurse managers need to be aware of the physiological strain experienced by staff nurses, and focus on ensuring sufficient breaks and proper work accommodations for older nurses.
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January 2011

Evaluation of the Magic Island: Relaxation for Kids, compact disc.

Pediatr Nurs 2009 Sep-Oct;35(5):290-5

Center for Professional Excellence-Research and Evidence-Based Practice, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Managing post-operative pain continues to elude health care professionals despite children's reports of severe pain. Although research has demonstrated that guided imagery is a beneficial complementary treatment for pain, clinicians rarely incorporate it into their practice. This study evaluated the effectiveness of a guided imagery audio compact disc (CD) in reducing post-operative pain, increasing relaxation, and stimulating imagery in children by child life specialists in the clinical setting. This cross sectional study compared pain and relaxation scores before and after the use of the CD. Sixteen children (7 to 12 years of age) reported pain on a 0 to 10 scale and relaxation on a 1 to 5 scale, and answered questions about what they imagined. Pain scores were significantly decreased, with no significant differences in relaxation scores. Findings support that school-age children are capable of using guided imagery, and relaxation may not be necessary to achieve pain reduction.
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December 2009