How Incarceration Affects Maternal Identify of Female Inmates

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Ashlee Manwaring and Dr. Janelle Macintosh, College of Nursing

I proposed an ORCA with Janelle Macintosh, RN, PhD, last fall, and was awarded the grant in February. Our original idea was to investigate how incarceration affects maternal identify of female inmates. This was closely related to Dr. Macintosh’s original dissertation proposal and completed dissertation. However, we were not able to successfully complete the required IRB for the Department of Corrections. We determined a change in population would probably be the best course of action. Our goal was to do the same research on a different population.

As we considered different populations, we determined we would try to get utilize a teen parenting class and investigate the effectiveness of the class by measuring parental self-efficacy. Unfortunately, even with the help of many trying to find us a class to use, we were unable to access a class that was willing to participate in a research study of parenting self-efficacy.

Once again, we were back to the drawing board, trying to find a population we could easily slip into and measure either parental identity or parental self-efficacy. Our next idea, due to Dr. Macintosh’s previous work experience in Newborn Intensive Care Units (NICU), was to investigate how first-time parents measured their parental identity when their child was a NICU baby. We did much preliminary research to investigate the previous literature of this topic. However, this change occurred about two weeks before the beginning of fall semester. As my classes started up again, I found my time too limited to finish the literature review required or any other research related needs.

About this same time, I began to be interested in the new federal policy that bases Medicare and Medicaid reimbursement on the scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). After doing some preliminary research of my own, I met with Dr. Macintosh to discuss changing our project once more. We have agreed to do a literature review looking at how this new policy of Medicare and Medicaid reimbursement being based on HCAHPS scores affects nursing care and the future of nursing.
After this final change in our research topic, I officially change our ORCA research project. Due to the unforeseen problems we encountered throughout this process, I have learned more than I ever anticipated. I have learned much about the process that goes into organizing, planning, and executing research. I have learned that sometimes, research projects must change and be altered; although, hopefully, not as much as we have had to alter our project. I have seen what goes into writing an IRB proposal. I have performed multiple literature reviews, which is the first step to doing any form of research, to gain an understanding of what has already been done and the need for further research. I am grateful for the knowledge I have gained, and know that it will bless me greatly in my future as I am involved in future research projects and as I work on my own doctoral degree. Additionally, we were able to present poster presentations at the Utah Conference for Undergraduate Research and Western Institute of Nursing Conference.

Following is the abstract for our research:

Purpose: To examine how the new policy of Medicare/Medicaid reimbursement being based on HCAHPS scores affects nursing care.

Rationale: The Patient Protection and Affordable Care Act (PPACA) mandates that Medicare and Medicaid reimbursement be based on hospital performance and patient satisfaction. Patient satisfaction is measured nationally through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey was development in the early 2000’s to create a uniform measure for patient perspectives regarding their inpatient stay; however, with the HCAHPS scores being related to Medicare and Medicaid reimbursement, hospitals are required to reevaluate their quality of care from the patient, not medical, perspective. Van Empel et al. (2011) found that physicians and nurses primarily value medical outcomes of treatment. While, at the same time, patient’s value patient-centeredness, even if it means decreasing the desired outcome of treatment.

Undertaking: A literature review was completed by searching in CINAHL and Medline. Preliminary research used HCAHPS and Medicare reimbursement as key words. Second, a search was completed using HCAHPS and nursing as key words. All results were published between 2008 and 2012.

Outcomes: Kutney-Lee et al. (2009) reported that patient satisfaction was primarily linked with nurse-to-patient ratio, interdisciplinary collaboration and work environment. Research by Robinson and Watters (2010) found the main factor in patient dissatisfaction was feeling like the nurses were short staffed, task-oriented and rushed, leaving the patient lacking adequately communication to understand their situation. Van Empel et al. (2011) reported patients’ willingness to change providers and facilities to received patient-centered care.

Conclusion: Nurses have the greatest potential to effect patient satisfaction. Therefore, with the new regulation of Medicare and Medicaid reimbursement based on patient satisfaction surveys, nurses have a greater responsibility to ensure patient satisfaction. From the research presented, the main nursing implication is to help each patient feel like their care is centered on what is important to that individual. This can most easily be accomplished by the nurse opening a line of communication with the patient, and then advocating for the patient’s wishes.

References:

  • Kutney-Lee, A., McHugh, M. D., Sloane, D. M., Cimiotti, J. P., Flynn, L., Neff, D. F. & Aiken, L. H. (2009). Nursing: A key to patient satisfaction. Health Affairs 28 (4) 669-677.
  • Robinson, K. L. & Watters, S. (2010). Bridging the gap through implementation of a patient navigator program. Pensylvania Nurse 65 (2) 19-21.
  • Van Empel, I. W. H., Dancet, E. A. F., Koolman, X. H. E., Nelen, W. L. D. M., Stolk, E. A., Semeus, W., …Kremer, J. A. M. (2011). Physicians underestimate the importance of patient-centeredness to patients: A discrete choice experiment in fertility care. Human Reproduction, 26 (3), 584-593.