Barbara B Brewer

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Scholarly Contributions

Chapters

• Brewer, B. B. (2019). Forward. In Assessing and measuring caring in nursing and health sciences. Springer.
• Alexandrov, A. W., Brewer, T. L., & Brewer, B. B. (2019). The Role of Outcomes and Quality Improvement in Enhancing and Evaluating Practice Changes. In Evidence Based Practice in Nursing & Healthcare. Wolters Kluwer.
• Brewer, B. B., & Watson, J. (2018). The Development of Caring Research in Practice Settings: The International Watson Caritas Comparative Database. In Handbook for Caring Science: Expanding the Paradigm. Springer.
• Reed, P. G., & Brewer, B. B. (2018). Generating Knowledge in Practice: Philosophical and Methodological Considerations. In Nursing Knowledge and Theory Innovation. Springer.

Journals/Publications

• Brewer, B. B., Carley, K. M., Benham-Hutchins, M., & Effken, J. A. (2020). Exploring the Stability of Communication Network Metrics in a Dynamic Nursing Context. Social Networks.
• Brewer, B. B., & Snyder, K. A. (2018). Workforce Agility: An answer to turbulence in acute care nursing environments?. Nursing Management.
• Halfer, D., Brewer, B., Ulrich, B., & Kramer, M. (2019). A Professional Nursing Acute Care Practice Curriculum. The Journal of nursing administration, 49(12), 604-609.
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  Caring for multiple complex patients simultaneously is 1 of the biggest challenges for clinical nurses (CNs) in acute care. We utilized the results of research to develop a 6-hour Professional Nursing Practice Curriculum (PNPC) specifically for CNs who are professionally and legally responsible for providing holistic care to an assigned group of patients on inpatient clinical units in acute care hospitals. The curriculum can be used by faculty to prepare senior nursing students for their 1st professional practice role in an acute care setting. Components of the PNPC will be beneficial for nurse leaders in an assessment of their educational practices for transitioning newly licensed RNs to practice and addressing professional development needs of CNs.
• Rosenfeld, A., Davis, M. P., Carrington, J. M., Brewer, B. B., & Shea, K. D. (2019). A model to evaluate data science in nursing doctoral curricula. Nursing Outlook.
• Benham-Hutchins, M., Carley, K. M., Brewer, B. B., Effken, J. A., & Reminga, J. (2018). Nursing Unit Communication During a US Public Health Emergency: Natural Experiment. JMIR Nursing, 1(1).
• Brewer, B. B., Carley, K., Benham-Hutchins, M., & Effken, J. A. (2018). Nursing Unit Design Relationships with Nursing Staff Communication and Patient Safety. Health Environments Research & Design.
• Brewer, B. B., Carley, K., Benham-Hutchins, M., & Effken, J. A. (2018). Relationship of Staff Information-Sharing and Advice Networks to Patient Safety Outcomes. Journal of Nursing Administration.
• Hayter, K. L., & Brewer, B. B. (2017). Halldorsdottir's Modes of Being with Another to Evaluate Patient Comments International Journal for Human Caring. International Journal for Human Caring.
• Hayter, K. L., & Brewer, B. B. (2018). Patient Perceptions of Caring in a Midwestern Hospital International Journal for Human Caring. International Journal for Human Caring, 23(2), 147-152.
• Nibbelink, C. W., Young, J. R., Carrington, J. M., & Brewer, B. B. (2018). Informatics Solutions for Application of Decision-Making Skills. Critical care nursing clinics of North America, 30(2), 237-246.
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  Critical care nurses practice in a challenging environment that requires responses to patients with complex, often unstable health conditions. The electronic health record, access to clinical data, and Clinical Decision Support Systems informed by data from clinical databases are informatics tools designed to work together to facilitate decision-making in nursing practice. The complex decision-making environment of critical care requires informatics tools that support nursing practice through integration of current evidence with clinical data. Recommendations include continuing efforts toward the development of clinical decision support tools based on patient data that include predictive models to support increased patient safety.
• Rosenfeld, A., Davis, M. P., Carrington, J. M., Brewer, B. B., & Shea, K. D. (2019). A model to evaluate data science in nursing doctoral curricula. Nursing Outlook. doi:doi:10.1016/j.outlook.2018.10.007
• Shea, K. D., Brewer, B. B., Carrington, J. M., Davis, M., Gephart, S., & Rosenfeld, A. (2018). A model to evaluate data science in nursing doctoral curricula. Nursing outlook.
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  Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare.
• Brewer, B. B., & Verran, J. A. (2013). Measuring nursing unit environments with four composite measure. Nursing economic$, 31(5), 241-9.
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  Understanding the context in which nurses work is an important step to designing work environments in which nurses can achieve targeted quality. Developing a usable instrument for describing the work environment and the relationship to staffing is essential for the development of evidence-based staffing decisions. The major implications of the research reported here are that the work environment of nurses, while complex, can be modeled with composite variables that reflect various dimensions of that environment. This ability to model the environment with fewer variables enhances the interpretation of environmental factors that have the greatest impact on patient outcomes. This reduction is valuable to the clinician, manager, and administrator in determining the key factors that need to be altered in the work environment to improve the quality of the patient experience.
• Brewer, B. B., Carrington, J. M., Young, J., & Nibbelink, C. (2018). Informatics solutions for application of decision-making skills. Critical Care Clinical of North America, 30, 237-246.
• Kramer, M., Brewer, B. B., Halfer, D., Hnatiuk, C. N., MacPhee, M., Duchscher, J. B., Maguire, P., Coe, T., & Schmalenberg, C. (2017). Impact of Professional Nursing Practices on Patient/Nurse Outcomes: Testing the Essential Professional Nursing Practices Instrument. The Journal of nursing administration, 47(5), 278-288.
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  Increasing patient and healthcare system complexity and the need to accurately measure the engagement of clinical nurses (CNs) in holistic, professional nursing practice indicates that an update to the Essentials of Magnetism instrument is needed. The purposes of this research were to critique and weight items, assess the value and psychometric properties of the newly constructed Essential Professional Nursing Practices (EPNP) instrument, and establish relationships between EPNPs and CN job, practice, and nurse-assessed patient satisfaction.
• Nibbelink, C. W., & Brewer, B. B. (2017). Decision-making in nursing practice: An integrative literature review. Journal of clinical nursing.
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  To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM).
• Parmar, R., Brewer, B. B., & Szalacha, L. A. (2017). Foot Massage, Touch, and Presence in Decreasing Anxiety during a Magnetic Resonance Imaging: A Feasibility Study. Journal of alternative and complementary medicine (New York, N.Y.).
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  The purpose of the study was to determine (1) recruitment feasibility; (2) intervention adherence; (3) intervention acceptability; and (4) the preliminary effects of touch or foot massage interventions on anxiety during a magnetic resonance imaging (MRI).
• Crist, J. D., Brewer, B. B., Poedel, R. J., & Mathew, L. (2016). Designing a virtual simulation case for cultural competence using a community-based participatory research approach: A Puerto Rican case. Nurse Educator. doi:10.1097/NNE.0000000000000338
• Mathew, L., Brewer, B. B., Crist, J. D., & Poedel, R. J. (2016). Designing a Virtual Simulation Case for Cultural Competence Using a Community-Based Participatory Research Approach: A Puerto Rican Case. Nurse educator.
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  In this study, a community-based participatory research approach was used for developing content for a virtual simulation case. The virtual simulation case was designed to develop the cultural competence of prelicensure nursing students in caring for a Puerto Rican patient with diabetes. This article presents the method used to establish a Puerto Rican community advisory board to develop content for a virtual simulation case for cultural competency.
• Brewer, B. B., & Watson, J. (2015). Evaluation of Authentic Human Caring Professional Practices. The Journal of nursing administration, 45(12), 622-7.
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  The aim of this study was to present an instrument and comparative database designed to evaluate patients' perceptions of caring behaviors of caregivers.
• Watson, J., & Brewer, B. B. (2015). Caring science research: criteria, evidence, and measurement. The Journal of nursing administration, 45(5), 235-6.
• Duffy, J. R., Brewer, B. B., & Weaver, M. T. (2014). Revision and Psychometric Properties of the Caring Assessment Tool. Clinical Nursing Research, 23(1), 80-93.
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  Abstract: Evaluation of the Caring Assessment Tool (CAT) is essential for its use in the monitoring and ongoing improvement of patient-nurse relationships. This descriptive, prospective study evaluated the dimensionality and internal reliability of the instrument in a sample of hospitalized adults. In addition, reduction of items was achieved, lessening clinical and administrative burden. Data were collected from 1,111 patients in 12 U.S. hospitals in 4 geographically distinct regions. A single factor explained 73% of the variance in the construct and the number of items was reduced to 27. Internal consistency remained high (a =.97). Patient-nurse relationship data were collected safely and efficiently from hospitalized patients using a paper-and-pencil approach. The CAT holds promise for providing acute care registered nurses with the information they need to deliver reliable patient-centered care. © The Author(s) 2010.
• Duffy, J. R., Brewer, B. B., & Weaver, M. T. (2014). Revision and psychometric properties of the caring assessment tool. Clinical nursing research, 23(1), 80-93.
  More info

  Evaluation of the Caring Assessment Tool (CAT) is essential for its use in the monitoring and ongoing improvement of patient-nurse relationships. This descriptive, prospective study evaluated the dimensionality and internal reliability of the instrument in a sample of hospitalized adults. In addition, reduction of items was achieved, lessening clinical and administrative burden. Data were collected from 1,111 patients in 12 U.S. hospitals in 4 geographically distinct regions. A single factor explained 73% of the variance in the construct and the number of items was reduced to 27. Internal consistency remained high (a = .97). Patient-nurse relationship data were collected safely and efficiently from hospitalized patients using a paper-and-pencil approach. The CAT holds promise for providing acute care registered nurses with the information they need to deliver reliable patient-centered care.
• Kramer, M., Brewer, B. B., Halfer, D., Hnatiuk, C. N., MacPhee, M., & Schmalenberg, C. (2014). The evolution and development of an instrument to measure essential professional nursing practices. The Journal of nursing administration, 44(11), 569-76.
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  Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.
• Brewer, B. B., & Verran, J. A. (2013). Measuring nursing unit environments with four composite measures. Nursing Economics, 31(5), 241-249.
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  PMID: 24294650;Abstract: Understanding the context in which nurses work is an important step to designing work environments in which nurses can achieve targeted quality. • Developing a usable instrument for describing the work environment and the relationship to staffing is essential for the development of evidence-based staffing decisions. • The major implications of the research reported here are that the work environment of nurses, while complex, can be modeled with composite variables that reflect various dimensions of that environment. • This ability to model the environment with fewer variables enhances the interpretation of environmental factors that have the greatest impact on patient outcomes. • This reduction is valuable to the clinician, manager, and administrator in determining the key factors that need to be altered in the work environment to improve the quality of the patient experience.
• Effken, J. A., Gephart, S. M., Brewer, B. B., & Carley, K. M. (2013). Using *ORA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes. Computers, informatics, nursing : CIN, 31(1), 36-44.
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  Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest. Using *ORA's visualization and analysis capabilities, we examined the relationships between the handoff communication network metrics and a variety of patient safety quality and satisfaction outcomes. Unique network patterns were observed for different types of outcome variable (eg, safety, symptom management, self-care, and patient satisfaction). This exploratory project demonstrates the power of *ORA to identify communication patterns for large groups, such as patient care units. *ORA's network metrics can then be related to specific patient outcomes.
• Effken, J. A., Gephart, S. M., Brewer, B. B., & Carley, K. M. (2013). Using *oRA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes. CIN - Computers Informatics Nursing, 31(1), 36-44.
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  PMID: 23114394;Abstract: Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest. Using *ORA's visualization and analysis capabilities, we examined the relationships between the handoff communication network metrics and a variety of patient safety quality and satisfaction outcomes. Unique network patterns were observed for different types of outcome variable (eg, safety, symptom management, self-care, and patient satisfaction). This exploratory project demonstrates the power of *ORA to identify communication patterns for large groups, such as patient care units. *ORA's network metrics can then be related to specific patient outcomes. Copyright © 2013 Lippincott Williams & Wilkins.
• Kramer, M., Brewer, B. B., & Maguire, P. (2013). Impact of Healthy Work Environments on New Graduate Nurses' Environmental Reality Shock. Western Journal of Nursing Research, 35(3), 348-383.
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  PMID: 21498813;Abstract: Do healthy work environments (HWEs) facilitate new graduate transition into professional practice in hospitals? Are such environments related to a decrease in Environmental Reality Shock? Experienced nurses in 17 Magnet hospitals completed the Essentials of Magnetism II© (EOMII©) instrument that measures health of unit work environments. New graduates (N = 468) were then tracked with modified versions of the EOMII© from immediate post hire to 4, 8, and 12 months post hire to ascertain degree of Environmental Reality Shock. New graduate nurses have extremely high anticipations of unit work environments that would enable delivery of quality patient care. HWE is the most-significant variable in Environmental Reality Shock, number of related Issues and Concerns, and perceptions of quality of patient care. Suggestions of how to improve quality of unit work environments are offered. © The Author(s) 2011.
• Kramer, M., Brewer, B. B., & Maguire, P. (2013). Impact of healthy work environments on new graduate nurses' environmental reality shock. Western journal of nursing research, 35(3), 348-83.
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  Do healthy work environments (HWEs) facilitate new graduate transition into professional practice in hospitals? Are such environments related to a decrease in Environmental Reality Shock? Experienced nurses in 17 Magnet hospitals completed the Essentials of Magnetism II(©) (EOMII(©)) instrument that measures health of unit work environments. New graduates (N = 468) were then tracked with modified versions of the EOMII(©) from immediate post hire to 4, 8, and 12 months post hire to ascertain degree of Environmental Reality Shock. New graduate nurses have extremely high anticipations of unit work environments that would enable delivery of quality patient care. HWE is the most-significant variable in Environmental Reality Shock, number of related Issues and Concerns, and perceptions of quality of patient care. Suggestions of how to improve quality of unit work environments are offered.
• Kramer, M., Brewer, B. B., Halfer, D., Maguire, P., Beausoleil, S., Claman, K., Macphee, M., & Duchscher, J. B. (2013). Changing our lens: Seeing the chaos of professional practice as complexity. Journal of Nursing Management, 21(4), 690-704.
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  PMID: 23700981;Abstract: Aim: The purpose of this evidence-based management practice project was to analyse dimensions of the Getting my Work Done issue, the only one of seven issues of highest concern for which 907 nurse interviewees were unable to identify effective strategies, formulate a 'best management practice', integrate the practice into clinical settings and evaluate results. Method/process: The evidence-based management practice process was used to identify the major impediment to Getting Work Done-assignment to multiple patients with simultaneous complex needs. Best management practice consisted of class presentation of a clinical-management problem scenario to 144 residents in nine Magnet hospitals, a private action commitment, class discussion and terminal action commitments. Results: Responses indicated that this 'best management practice' was effective in helping newly licensed registered nurses manage and handle multiple patients with simultaneous complex needs. A major avenue of resolution was perception of professional practice responsibilities as a series of complex, interrelated, adaptive systems. Conclusions/implications for nursing management: Perception and use of the principles of complexity science assists newly licensed registered nurses in mastering management dilemmas that inhibit professional practice. In many participating hospitals, plans are underway to expand this best practice to include input and perception exchange among experienced nurses, managers and physicians. © 2013 Blackwell Publishing Ltd.
• Kramer, M., Brewer, B. B., Halfer, D., Maguire, P., Beausoleil, S., Claman, K., Macphee, M., & Duchscher, J. B. (2013). Changing our lens: seeing the chaos of professional practice as complexity. Journal of nursing management, 21(4), 690-704.
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  The purpose of this evidence-based management practice project was to analyse dimensions of the Getting my Work Done issue, the only one of seven issues of highest concern for which 907 nurse interviewees were unable to identify effective strategies, formulate a 'best management practice', integrate the practice into clinical settings and evaluate results. METHOD/PROCESS: The evidence-based management practice process was used to identify the major impediment to Getting Work Done-assignment to multiple patients with simultaneous complex needs. Best management practice consisted of class presentation of a clinical-management problem scenario to 144 residents in nine Magnet hospitals, a private action commitment, class discussion and terminal action commitments.
• Kramer, M., Maguire, P., Halfer, D., Brewer, B., & Schmalenberg, C. (2013). Impact of Residency Programs on Professional Socialization of Newly Licensed Registered Nurses. Western Journal of Nursing Research, 35(4), 459-496.
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  PMID: 21816962;Abstract: Do Nurse Residency Programs (NRPs) reflect the professional socialization process? Residency facilitators in 34 Magnet hospitals completed Residency Program Questionnaires constructed to reflect the goals, themes, components, and strategies of the professional socialization process described in the literature. NRPs in 4 hospitals exemplified the complete two-stage (role transition and role/community integration) process. In 14 hospitals, NRPs were of sufficient length and contained components that reflected the professional socialization process. In 16 hospitals, NRPs exemplified the "becoming" role transition stage. What components are most effective in the professional socialization of new graduate nurses? A total of 907 new and experienced nurses, nurse managers, and educators working on clinical units with confirmed healthy work environments in 20 Magnet hospitals with additional "excellence designations" were interviewed. Components identified as most instrumental were precepted experience, reflective seminars, skill acquisition, reflective practice sessions, evidence-based management projects, and clinical coaching-mentoring sessions. Suggestions for improvement of NRPs are offered. © The Author(s) 2011.
• Effken, J. A., Carley, K. M., Lee, J. S., Brewer, B. B., & Verran, J. A. (2012). Simulating nursing unit performance with OrgAhead: strengths and challenges. Computers, informatics, nursing : CIN, 30(11), 620-6.
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  In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursingworkload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead). Validation studies demonstrated acceptable correspondence between actual and virtual units. For all but the highest performing unit, we generated strategies that improved virtual performance and could reasonably be implemented on actual units to improve outcomes. Nurse managers, to whom we reported the results, responded positively to the unit-specific recommendations, which other methods cannot provide. In the end, resolving the modeling challenges we encountered has improved OrgAhead's functionality and usability.
• Effken, J. A., Carley, K. M., Lee, J., Brewer, B. B., & Verran, J. A. (2012). Simulating nursing unit performance with OrgAhead: strengths and challenges.. Computers, informatics, nursing : CIN, 30(11), 620-626.
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  PMID: 22918133;PMCID: PMC3509226;Abstract: In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursingworkload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead). Validation studies demonstrated acceptable correspondence between actual and virtual units. For all but the highest performing unit, we generated strategies that improved virtual performance and could reasonably be implemented on actual units to improve outcomes. Nurse managers, to whom we reported the results, responded positively to the unit-specific recommendations, which other methods cannot provide. In the end, resolving the modeling challenges we encountered has improved OrgAhead's functionality and usability.
• Effken, J. A., Carley, K. M., Lee, J., Brewer, B. B., & Verran, J. A. (2012). Simulating nursing unit performance with orgahead: Strengths and challenges. CIN - Computers Informatics Nursing.
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  Abstract: In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursing workload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead). Validation studies demonstrated acceptable correspondence between actual and virtual units. For all but the highest performing unit, we generated strategies that improved virtual performance and could reasonably be implemented on actual units to improve outcomes. Nurse managers, to whom we reported the results, responded positively to the unit-specific recommendations, which other methods cannot provide. In the end, resolving the modeling challenges we encountered has improved OrgAhead's functionality and usability.
• Brewer, B., Effken, J. A., Carley, K. M., Gephart, S., Verran, J. A., Bianchi, D., Reminga, J., & Brewer, B. B. (2011). Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. International journal of medical informatics, 80(7).
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  We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units.
• Duffy, J. R., & Brewer, B. B. (2011). Feasibility of a multi-institution collaborative to improve patient-nurse relationship quality. Journal of Nursing Administration, 41(2), 78-83.
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  PMID: 21266886;Abstract: Objective: The objective of the study was to assess the feasibility of a multi-institution quality improvement collaborative to improve patient-nurse relationship quality. Background: Patient-nurse relationships provide the foundation for nursing services and are linked to patient outcomes. Measuring the quality of these relationships is important for ongoing practice changes. Methods: A prospective evaluation approach was used. Patients from 12 hospitals in 4 distinct areas of the United States comprised the sample. Results: All 12 hospitals submitted patient data on a quarterly basis, yielding a reliable database for performance improvement. The Caring Assessment Tool (CAT) performed well, and individual hospitals used the results to improve their performance. Inconsistencies in labeling, differing sample sizes, and administrative burden limited the results. Conclusions: Adult patients were willing to provide feedback about their care during hospitalization and multiple institutions successfully participated in the project. An electronic version of the CAT with real-time analysis would decrease burden and provide more timely and accurate results for actionable practice changes. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
• Duffy, J. R., & Brewer, B. B. (2011). Feasibility of a multi-institution collaborative to improve patient-nurse relationship quality. The Journal of nursing administration, 41(2), 78-83.
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  The objective of the study was to assess the feasibility of a multi-institution quality improvement collaborative to improve patient-nurse relationship quality.
• Effken, J. A., Brewer, B. B., Logue, M. D., Gephart, S. M., & Verran, J. A. (2011). Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow. International Journal of Medical Informatics, 80(10), 698-707.
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  PMID: 21862397;PMCID: PMC3206610;Abstract: Purpose: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain. Methods: Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n=20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager's environment in terms of the constraints it imposes on the nurse manager's ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. Results: The results highlight the competing priorities, and external and internal constraints that today's nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering " what if" questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality. © 2011 Elsevier Ireland Ltd.
• Effken, J. A., Brewer, B. B., Logue, M. D., Gephart, S. M., & Verran, J. A. (2011). Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow. International journal of medical informatics, 80(10), 698-707.
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  To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.
• Effken, J. A., Carley, K. M., Gephart, S., Verran, J. A., Bianchi, D., Reminga, J., & Brewer, B. B. (2011). Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. International Journal of Medical Informatics, 80(7), 507-517.
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  PMID: 21536492;PMCID: PMC3104105;Abstract: We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units. Methods: Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days. Patient outcome data were collected via a separate survey. Results of the staff survey were used to represent the communication networks for each unit in ORA. We then used ORA's analysis capability to generate communication metrics for each unit. ORA's visualization capability was used to better understand the metrics. Results: We identified communication patterns that correlated with two safety (falls and medication errors) and three quality (e.g., symptom management, complex self care, and patient satisfaction) outcome measures. Communication patterns differed substantially by shift. Conclusion: The results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes. © 2011 Elsevier Ireland Ltd.
• Kramer, M., Maguire, P., & Brewer, B. B. (2011). Clinical nurses in Magnet hospitals confirm productive, healthy unit work environments. Journal of Nursing Management, 19(1), 5-17.
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  PMID: 21223400;Abstract: Aim To describe extent to which experienced nurses in Magnet hospitals confirm healthy work environments (HWE).Background Differentiating differences in HWE allows managers to focus attention where changes may be needed to improve nurse and patient outcomes. Method The sample was 12 233 experienced nurses from 717 clinical units in 34 Magnet hospitals. Based on Essentials of Magnetism II unit level scores, units were grouped as very healthy work environments (VHWE), HWE or work environments needing improvement. Results VHWE or HWE was confirmed by nurses on 82% of 540 clinical units. The most significant correlates of HWE units occur within individual hospitals. More nurses prepared at the Bachelor of Science in Nursing level or above work on VHWE or HWE units and score higher on seven essential work processes. Nurses' ratings of quality of patient care directly correlate to quality of work environment. Conclusions Clinical units in 34 Magnet hospitals were markedly skewed toward excellence. Visionary leadership, empowerment and collaboration have an impact on development and maintenance of HWE. Implications for nursing management Implementation of structures that promote interdisciplinary and intradisciplinary collaboration and decision-making positively affect development of HWE. Gap analysis of the steps/components of the eight work processes/relationships essential to HWE may enable achievement of HWEs on all hospital clinical units. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
• Kramer, M., Maguire, P., & Brewer, B. B. (2011). Clinical nurses in Magnet hospitals confirm productive, healthy unit work environments. Journal of nursing management, 19(1), 5-17.
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  To describe extent to which experienced nurses in Magnet hospitals confirm healthy work environments (HWE).
• Brewer, B. B., Brewer, M. A., & Schultz, A. A. (2009). A Collaborative Approach to Building the Capacity for Research and Evidence-Based Practice in Community Hospitals. Nursing Clinics of North America, 44(1), 11-25.
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  PMID: 19167545;Abstract: The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care. © 2009 Elsevier Inc. All rights reserved.
• Brewer, B. B., Brewer, M. A., & Schultz, A. A. (2009). A collaborative approach to building the capacity for research and evidence-based practice in community hospitals. The Nursing clinics of North America, 44(1), 11-25, ix.
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  The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care.
• Clarke, P. N., Watson, J., & Brewer, B. B. (2009). From theory to practice: Caring science according to watson and brewer. Nursing Science Quarterly, 22(4), 339-345.
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  PMID: 19858513;Abstract: Caring science is presented by Jean Watson and Barbara Brewer through an interview and dialogue format. Jean Watson presents caring science and its philosophy and evolution and the impact of her model on nursing and other disciplines. Barbara Brewer addresses the implementation of the model in a Magnet hospital setting and describes how her leadership facilitated implementation. © 2009 The Auther(s).
• Clarke, P. N., Watson, J., & Brewer, B. B. (2009). From theory to practice: caring science according to Watson and Brewer. Nursing science quarterly, 22(4), 339-45.
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  Caring science is presented by Jean Watson and Barbara Brewer through an interview and dialogue format. Jean Watson presents caring science and its philosophy and evolution and the impact of her model on nursing and other disciplines. Barbara Brewer addresses the implementation of the model in a Magnet hospital setting and describes how her leadership facilitated implementation.
• Kramer, M., Schmalenberg, C., Brewer, B. B., Verran, J. A., & Keller-Unger, J. (2009). Accurate assessment of clinical nurses' work environments: Response rate needed. Research in Nursing and Health, 32(2), 229-240.
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  PMID: 19152405;Abstract: Improvement of hospital unit work environments is key to quality patient care, productivity, nurse retention, and job satisfaction. Accurate measurement of such environments is necessary prior to introduction and evaluation of improvement structures and strategies. Characteristics and attributes of work environments are group level phenomena. Accurate assessment of these phenomena requires survey response rates of sufficient size to ensure sample representativeness and data that can reliably be aggregated to group level. What is the sufficient response rate? This question was answered through psychometric testing of five random samples from the population of 23 M.D. Anderson Cancer Center clinical units that had 100% response rates on an environmental survey. Response rates of 40% or more had acceptable psychometric properties for unit-specific scales. © 2009 Wiley Periodicals, Inc.
• Kramer, M., Schmalenberg, C., Brewer, B. B., Verran, J. A., & Keller-Unger, J. (2009). Accurate assessment of clinical nurses' work environments: response rate needed. Research in nursing & health, 32(2), 229-40.
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  Improvement of hospital unit work environments is key to quality patient care, productivity, nurse retention, and job satisfaction. Accurate measurement of such environments is necessary prior to introduction and evaluation of improvement structures and strategies. Characteristics and attributes of work environments are group level phenomena. Accurate assessment of these phenomena requires survey response rates of sufficient size to ensure sample representativeness and data that can reliably be aggregated to group level. What is the sufficient response rate? This question was answered through psychometric testing of five random samples from the population of 23 M.D. Anderson Cancer Center clinical units that had 100% response rates on an environmental survey. Response rates of 40% or more had acceptable psychometric properties for unit-specific scales.
• Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B. B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2009). Walk the talk: Promoting control of nursing practice and a patient-centered culture. Critical Care Nurse, 29(3), 77-93.
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  PMID: 19487783;
• Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B. B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2009). Walk the talk: promoting control of nursing practice and a patient-centered culture. Critical care nurse, 29(3), 77-93.
• Brewer, B. B., Verran, J. A., & Stichler, J. F. (2008). The Systems Research Organizing Model: a conceptual perspective for facilities design. HERD, 1(4), 7-19.
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  The purpose of this article is to (1) demonstrate the utility of the Systems Research Organizing Model (SROM) for evidence-based design; (2) explicate the SROM; and (3) demonstrate how the SROM can advance the science of healthcare design.
• Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B. B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2008). Structures and practices enabling staff nurses to control their practice. Western Journal of Nursing Research, 30(5), 539-559.
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  PMID: 18195080;Abstract: This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures. © 2008 Sage Publications.
• Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B. B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2008). Structures and practices enabling staff nurses to control their practice. Western journal of nursing research, 30(5), 539-59.
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  This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.
• Milton, D., Pipe, T. B., Hatler, C., Brewer, B. B., LaMar, K., Clark, C., & Estrada, N. (2008). Clarifying the Role of Director of Nursing Research in Clinical Settings: Expectations and Challenges. Nurse Leader, 6(4), 29-33.
• Schmalenberg, C., Kramer, M., Brewer, B. B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2008). Clinically competent peers and support for education: Structures and practices that work. Critical Care Nurse, 28(4), 54-65.
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  PMID: 18669707;
• Schmalenberg, C., Kramer, M., Brewer, B. B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2008). Clinically competent peers and support for education: structures and practices that work. Critical care nurse, 28(4), 54-60, 62-5.
• Brewer, B. B., Wojner-Alexandrov, A. W., Triola, N., Pacini, C., Cline, M., Rust, J. E., & Kerfoot, K. (2007). AACN Synergy Model's characteristics of patients: psychometric analyses in a tertiary care health system. American journal of critical care : an official publication, American Association of Critical-Care Nurses, 16(2), 158-67.
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  Models for delivery of patient care that recognize the relationship between the characteristics of the patient and the competencies of the nurse are essential for high-quality outcomes.
• Brewer, B. B., Wojner-Alexandrov, A. W., Triola, N., Pacini, C., Cline, M., Rust, J. E., & Kerfoot, K. (2007). AACN Synergy model's characteristics of patients: Psychometric analyses in a tertiary care health system. American Journal of Critical Care, 16(2), 158-167.
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  PMID: 17322017;Abstract: BACKGROUND Models for delivery of patient care that recognize the relationship between the characteristics of the patient and the competencies of the nurse are essential for high-quality outcomes. OBJECTIVES (1) To test application of a case report form used to assess patients' characteristics as defined by the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care in a general population of pediatric and adult patients and (2) to evaluate the internal consistency reliability and construct validity of the patient characteristics measure found on the American Association of Critical-Care Nurses Web site. METHODS A cross-sectional correlational study was conducted in 2 phases. The first phase consisted of secondary data analysis of 481 ratings of patients provided by 11 expert nurses. The second phase consisted of primary data collection of 279 ratings of patients provided by 116 general and critical care nurses. The case report form was used to rate characteristics of patients in both phases; a self-rated nursing proficiency scale was used in the second phase. Descriptive statistics were used to describe the sample. Correlational techniques were used to evaluate internal consistency reliability and evidence of construct validity. RESULTS The case report form based on the AACN Synergy Model's characteristics of patients showed satisfactory internal consistency reliability and evidence of discriminant construct validity. Exploratory factor analysis resulted in a 2-factor solution representing an intrapersonal interaction factor and an interpersonal interaction factor. CONCLUSION The case report form for assessing characteristics of patients showed utility in a general population of adult and pediatric patients, some critically ill and some not. Nurses without previous knowledge of the AACN Synergy Model were able to apply the model during routine patient care. © 2007 American Association of Critical-Care Nurses.
• Kramer, M., Maguire, P., Schmalenberg, C., Brewer, B., Burke, R., Chmielewski, L., Cox, K., Kishner, J., Krugman, M., Meeks-Sjostrom, D., & Waldo, M. (2007). Nurse manager support: What is it? Structures and practices that promote it. Nursing Administration Quarterly, 31(4), 325-340.
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  PMID: 17909432;Abstract: Professional nursing organizations identify nurse manager (NM) support of staff nurses as an essential component of a productive, healthy work environment. Role behaviors that constitute this support must be identified by staff nurses. In this mixed-method study, supportive role behaviors were identified by 2382 staff nurses who completed the investigator-developed Nurse Manager Support Scale. In addition, semistructured interviews were conducted with 446 staff nurses, managers, and physicians from 101 clinical units in 8 Magnet hospitals in which staff nurses had previously confirmed excellent nurse manager support. Through individual and focus group interviews with NM and chief nurse executives in the 8 participating hospitals, the organizational structures and practices that enabled NM to be supportive to staff were determined. The 9 most supportive role behaviors cited by interviewees were as follows: is approachable and safe, cares, "walks the talk," motivates development of self-confidence, gives genuine feedback, provides adequate and competent staffing, "watches our back," promotes group cohesion and teamwork, and resolves conflicts constructively. Supporting structures and programs identified by managers and leaders include the following: "support from the top," peer group support, educational programs and training sessions, a "lived" culture, secretarial or administrative assistant support, private office space, and computer classes and seminars. © 2007 Lippincott Williams & Wilkins, Inc.
• Brewer, B. B. (2006). Is patient acuity a proxy for patient characteristics of the AACN Synergy Model for patient care?. Nursing Administration Quarterly, 30(4), 351-357.
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  PMID: 17077716;Abstract: PURPOSE: To test the feasibility of using patient acuity indicators as proxy measures for the AACN Synergy Model for Patient Care patient characteristics. DESIGN AND METHODS: Secondary data analysis of a convenience sample of 481 patient ratings from adult and pediatric critical and noncritical medical surgical patients. FINDINGS: Combining dichotomous patient acuity indicators into multilevel categorical variables allowed evaluation of linear relationships between acuity and patient characteristics indicators. Of the 8 patient characteristics, only participation in care exhibited meaningful correlations with the acuity indicators. According to these findings, acuity indicators should not be substituted for the Synergy Model patient characteristics. © 2006 Lippincott Williams & Wilkins, Inc.
• Brewer, B. B. (2006). Relationships among teams, culture, safety, and cost outcomes. Western Journal of Nursing Research, 28(6), 641-653.
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  PMID: 16946107;Abstract: The objective of this study is to test the transtheoretical integration model, which proposes relationships among team-based phenomena and patient safety and resource-use outcome variables. The sample consisted of 411 nursing staff (n = 372) and multidisciplinary team members (n = 39) from 16 medical surgical units. Staff were surveyed to evaluate their perceptions of hospital culture, work group design, and positive and negative team processes. Managers provided data concerning outcome variables of patient falls with injury, average length of stay (LOS), and labor and supply expenses for their patient care units. A group-type hospital culture predicted fewer patient falls with injury; a developmental-type hospital culture predicted higher patient care unit costs. Team design and processes were predictive of longer LOS for patients on medical-surgical units. Conclusions of the study were that hospital contexts external to the patient care unit may be important contributors to patient safety and resource use on nursing units. © 2006 Sage Publications.
• Brewer, B. B. (2006). Relationships among teams, culture, safety, and cost outcomes. Western journal of nursing research, 28(6), 641-53.
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  The objective of this study is to test the transtheoretical integration model, which proposes relationships among team-based phenomena and patient safety and resource-use outcome variables. The sample consisted of 411 nursing staff (n = 372) and multidisciplinary team members (n = 39) from 16 medical surgical units. Staff were surveyed to evaluate their perceptions of hospital culture, work group design, and positive and negative team processes. Managers provided data concerning outcome variables of patient falls with injury, average length of stay (LOS), and labor and supply expenses for their patient care units. A group-type hospital culture predicted fewer patient falls with injury; a developmental-type hospital culture predicted higher patient care unit costs. Team design and processes were predictive of longer LOS for patients on medical-surgical units. Conclusions of the study were that hospital contexts external to the patient care unit may be important contributors to patient safety and resource use on nursing units.
• Nadolski, G. J., Bell, M. A., Brewer, B. B., Frankel, R. M., Cushing, H. E., & Brokaw, J. J. (2006). Evaluating the quality of interaction between medical students and nurses in a large teaching hospital. BMC Medical Education, 6.
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  PMID: 16638142;PMCID: PMC1459856;Abstract: Background: Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations. Methods: We surveyed 268 Indiana University medical students and 175 nurses who worked at Indiana University Hospital, the School's chief clinical training site. The students had just completed their third year of training. The survey instrument consisted of 7 items that measured "relational coordination" among members of the health care team, and 9 items that measured psychological distress. Results: Sixty-eight medical students (25.4%) and 99 nurses (56.6%) completed the survey. The relational coordination score (ranked 1 to 5, low to high), which provides an overall measure of interaction quality, showed that medical students interacted with residents the best (4.16) and with nurses the worst (2.98; p < 0.01). Conversely, nurses interacted with other nurses the best (4.36) and with medical students the worst (2.68; p < 0.01). Regarding measures of psychological distress (ranked 0 to 4, low to high), the interpersonal sensitivity score of medical students (1.56) was significantly greater than that of nurses (1.03; p < 0.01), whereas the hostility score of nurses (0.59) was significantly greater than that of medical students (0.39; p < 0.01). Conclusion: The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration. Medical students and nurses experience different levels of psychological distress, which may adversely impact the quality of their interaction. © 2006Nadolski et al; licensee BioMed Central Ltd.
• Nadolski, G. J., Bell, M. A., Brewer, B. B., Frankel, R. M., Cushing, H. E., & Brokaw, J. J. (2006). Evaluating the quality of interaction between medical students and nurses in a large teaching hospital. BMC medical education, 6, 23.
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  Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations.
• Brewer, B. B. (2005). Is patient acuity a proxy for patient characteristics of the AACN Synergy Model for Patient Care?. Nursing administration quarterly, 30(4), 351-7.
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  To test the feasibility of using patient acuity indicators as proxy measures for the AACN Synergy Model for Patient Care patient characteristics.
• Effken, J. A., Brewer, B. B., Patil, A., Lamb, G. S., Verran, J. A., & Carley, K. (2005). Using OrgAhead, a computational modeling program, to improve patient care unit safety and quality outcomes. International Journal of Medical Informatics, 74(7-8), 605-613.
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  PMID: 16043085;Abstract: As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement. © 2005 Elsevier Ireland Ltd. All rights reserved.
• Effken, J. A., Brewer, B. B., Patil, A., Lamb, G. S., Verran, J. A., & Carle, K. (2004). Using computational modeling to improve patient care unit safety and quality outcomes. Studies in Health Technology and Informatics, 107, 726-730.
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  Abstract: As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we are using a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 16 units in 5 hospitals. Subsequent validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report on our initial efforts to use OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus is on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units by 6-8 percentage points. Nurse Managers have responded enthusiastically to the additional decision support for quality improvement. © 2004 IMIA. All rights reserved.
• Effken, J. A., Brewer, B. B., Patil, A., Lamb, G. S., Verran, J. A., & Carley, K. (2004). Using computational modeling to improve patient care unit safety and quality outcomes.. Medinfo, 11(Pt 1), 726-730.
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  PMID: 15360908;Abstract: As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we are using a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 16 units in 5 hospitals. Subsequent validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report on our initial efforts to use OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus is on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units by 6-8 percentage points. Nurse Managers have responded enthusiastically to the additional decision support for quality improvement
• Effken, J. A., Brewer, B. B., Patil, A., Lamb, G. S., Verran, J. A., & Carley, K. (2003). Using computational modeling to study the impact of workplace characteristics on patient safety outcomes.. AMIA . Annual Symposium proceedings [electronic resource] / AMIA Symposium. AMIA Symposium, 837-.
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  PMID: 14728342;PMCID: PMC1480268;Abstract: How do patient characteristics, organization characteristics and patient care unit characteristics interact to affect quality, safety, and cost outcomes? What changes can nurse managers make on their units that will optimize outcomes for their patients? To answer these questions, we are collecting data from 35 nursing units in 12 hospitals in Arizona, and using the results as a basis for computational modeling. Although it has been used in clinical research, until now computational modeling has had little application to healthcare or nursing organizations. In this poster session, we describe our application of Orgahead, a computational modeling program.
• Effken, J. A., Brewer, B. B., Patil, A., Lamb, G. S., Verran, J. A., & Carley, K. M. (2003). Using computational modeling to transform nursing data into actionable information. Journal of Biomedical Informatics, 36(4-5), 351-361.
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  PMID: 14643731;Abstract: Transforming organizational research data into actionable information nurses can use to improve patient outcomes remains a challenge. Available data are numerous, at multiple levels of analysis, and snapshots in time, which makes application difficult in a dynamically changing healthcare system. One potential solution is computational modeling. We describe our use of OrgAhead, a theoretically based computational modeling program developed at Carnegie Mellon University, to transform data into actionable nursing information. We calibrated the model by using data from 16 actual patient care units to adjust model parameters until performance of simulated units ordered in the same way as observed performance of the actual units 80% of the time. In future research, we will use OrgAhead to generate hypotheses about changes nurses might make to improve patient outcomes, help nurses use these hypotheses to identify and implement changes on their units, and then measure the impact of those changes on patient outcomes. © 2003 Elsevier Inc. All rights reserved.
• Phillips, L. R., Brewer, B. B., & Torres, E. (2001). The Elder Image Scale: A Method for Indexing History and Emotion in Family Caregiving. Journal of Nursing Measurement, 9(1), 23-47.
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  PMID: 11469139;Abstract: Although caregiving has been studied extensively, most studies have focused on the activities performed by caregivers, problems encountered and caregivers' reactions. Less attention has been paid to measuring historical and interpersonal factors that may shape the situation and affect outcomes, but are not necessarily embedded in the role itself. The objective of this article is to report on the development and testing of the Elder Image Scale (EIS) which indexes the personal identity of the elder, the mental image the caregiver has of the elder derived from past associations, present observations, and the reconciliation of the past with present impressions. This scale was based on the Family Caregiving Dynamics Model and the personal image of the elder is predicted to be shaped by certain structural factors and to impact both the perceptions of caregivers and the outcomes of caregiving. This article reports on four separate investigations; six-hundred-and-fifty-six caregivers participated. The EIS is in the semantic differential format. Internal consistency ranged from .92 to .98 over four studies. Stability after two weeks was .93 for both subscales. All correlations with criteria were in the direction predicted and most were significant. Known group comparisons showed all group differences were statistically significant as predicted. The EIS is internally consistent, stable and evidences construct validity. In addition, measuring this concept appears to have great relevance for explaining both perceptions of caregivers and outcomes of caregiving.
• Brewer, B. B., & Jackson, L. (1997). A case management model for the emergency department. Journal of Emergency Nursing, 23(6), 618-621.
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  PMID: 9460403;

Presentations

• Carrington, J. M., Gephart, S. M., Rosenfeld, A. G., Davis, M. P., Brewer, B. B., & Shea, K. D. (2017, spring). Leading Change: Threading Data Science through the Nursing PhD Curriculum. Nursing Annual Regional Conference. Denver, CO: Western Institute of Nursing.
• Carrington, J. M., Brewer, B. B., Davis, M. P., Rosenfeld, A. G., Shea, K. D., & Gephart, S. M. (2017, April). Use of NLP to Analyze Core Course Content and Weave in Data Science. InSpire 2017: Developing the Health Informatics Workforce of the Future Conference. La Jolla, California: American Medical Informatics Association.
• Gephart, S. M., Brewer, B. B., Carrington, J. M., Doyle, M., Shea, K. D., & Rosenfeld, A. G. (2017, January). Weaving data science into the fabric of core curriculum for the nursing research doctorate. Doctoral Education Conference. San Diego, CA: AACN.
• Shea, K. D., Brewer, B. B., Davis, M. P., Rosenfeld, A. G., Gephart, S. M., & Carrington, J. M. (2017, January). Weaving data science into the fabric of core curriculum for the nursing research doctorate. AACN Doctoral Education Conference. Coronado, CA: American Academy for Colleges of Nursing.
• Shea, K. D., Shea, K. D., Brewer, B. B., Brewer, B. B., Davis, M. P., Davis, M. P., Rosenfeld, A. G., Rosenfeld, A. G., Gephart, S. M., Gephart, S. M., Carrington, J. M., & Carrington, J. M. (2017, spring). Leading Change: Threading Data Science through the Nursing PhD Curriculum. Nursing Annual Regional Conference. Denver, CO: Western Institute of Nursing.