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Kent-Marvick J, Gibson B, Bristol AA, St Clair S, Simonsen SE. Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study. JMIR Form Res 2024; 8:e52583. [PMID: 38441920 PMCID: PMC10951822 DOI: 10.2196/52583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman's experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. OBJECTIVE This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. METHODS Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. RESULTS The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video's motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women's difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. CONCLUSIONS Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions.
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Affiliation(s)
| | - Bryan Gibson
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alycia A Bristol
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Stephanie St Clair
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Sara E Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
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Wallace AS, Raaum SE, Johnson EP, Presson AP, Allen CM, Elliott M, Bristol AA, Elmore CE. Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients. Discov Health Syst 2023; 2:45. [PMID: 38045443 PMCID: PMC10689550 DOI: 10.1007/s44250-023-00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Background COVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients. Objective To understand the impact of pandemic-related system effects on patient-reported discharge preparation. Design This mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021. Participants 616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences. Main measures Readiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing). Key results Adult patients aged 30-45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation. Conclusions While there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00060-8.
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Affiliation(s)
- Andrea S. Wallace
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Sonja E. Raaum
- University of Utah School of Medicine, Salt Lake City, USA
| | | | | | | | - Mackenzie Elliott
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Alycia A. Bristol
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Catherine E. Elmore
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
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Kent-Marvick J, St Clair SL, Bristol AA, Gibson B, Simonsen SE. Perceptions about future health trajectories among women at risk for developing cardiometabolic disease: A qualitative study. Res Sq 2023:rs.3.rs-3386180. [PMID: 37961339 PMCID: PMC10635306 DOI: 10.21203/rs.3.rs-3386180/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background The reproductive years provide a window into future risk for Type 2 Diabetes (T2DM); women's risk is seven to 10 times higher after gestational diabetes (GDM) and two to four times higher after a hypertensive disorder of pregnancy (HDP). Targeting reproductive-aged women at high risk for T2DM could reduce future T2DM incidence. However, little is known about such women's diabetes risk perceptions, or their knowledge or barriers/motivators of lifestyle change-information essential to understanding how to engage these at-risk women in tailored prevention programs promoting long-term health. This study's aims include: among reproductive-aged women at high risk for T2DM, what is/are 1) personal health-risk awareness, 2) lifestyle-change interest, and 3) barriers/motivators of participation in lifestyle-change programs? Methods Women aged 18 to 48 were eligible if they had one of the following health risks: 1) GDM or HDP during pregnancy, 2) prediabetes diagnosis, or 3) BMI classified as obese. Three Zoom focus groups, organized by risk group, were conducted with a total of 20 participants. Qualitative content and thematic analysis were used for the focus group transcriptions. Results Women's personal health-risk awareness was limited and generalized (e.g., being overweight might lead to other risks) and rarely reflected awareness connected to their personal health history (e.g., GDM increases their lifetime risk of T2DM). Participants reported that healthcare providers did not adequately follow or address their health risks. All women expressed interest in making healthy lifestyle changes, including engagement in formal programs, but they shared multiple barriers to healthy behavior change related to being "busy moms." Women emphasized the need for social support and realistic solutions that accounted for the dynamics of motherhood and family life. Common motivators included the desire to maintain health for their families and to set a good example for their children. Conclusions Participants lacked knowledge and were eager for information. Healthcare improvement opportunities include better coordination of care between primary and specialty-care providers, and more frequent communication and education on diabetes-related health risks and long-term health. Formal lifestyle programs should tailor content by providing multiple formats and flexibility of scheduling while leveraging peer support for sustained engagement.
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Bristol AA, Elmore CE, Weiss ME, Barry LA, Iacob E, Johnson EP, Wallace AS. Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge. BMJ Qual Saf 2023; 32:447-456. [PMID: 36100445 PMCID: PMC10512519 DOI: 10.1136/bmjqs-2022-015120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/13/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Intrahospital transitions (IHTs) represent movements of patients during hospitalisation. While transitions are often clinically necessary, such as a transfer from the emergency department to an intensive care unit, transitions may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals. However, carers frequently experience exclusion from care planning during IHTs, potentially decreasing their awareness of patients' clinical status, postdischarge needs and carer preparation. The purpose of this study was to explore family carers' perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care. METHODS Sequential, explanatory mixed-methods study involving retrospective analysis of hospital inpatients from a parent study (1R01HS026248; PI Wallace) for whom patient and family carer Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. Maximum variation sampling was used to recruit a subsample of carers with diverse backgrounds and experiences for the participation in semistructured interviews to understand their views of how IHTs influenced preparation for discharge. RESULTS Of discharged patients from July 2020 to April 2021, a total of 268 had completed the RHDS and 23 completed the semistructured interviews. Most patients experienced 0-2 IHTs and reported high levels of discharge readiness. During quantitative analysis, no association was found between IHTs and patients' RHDS scores. However, carers' perceptions of patient discharge readiness were negatively associated with increased IHTs. Moreover, non-spouse carers reported lower RHDS scores than spousal carers. During interviews, carers shared barriers experienced during IHTs and discussed the importance of inclusion during discharge care planning. CONCLUSIONS IHTs often represent disruptive events that may influence carers' understanding of patient readiness for discharge to home and, thus, their own preparation for discharge. Further consideration is needed regarding how to support carers during IHT to facilitate high-quality discharge planning.
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Affiliation(s)
- Alycia A Bristol
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Catherine E Elmore
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Marianne E Weiss
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Lisa A Barry
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Eli Iacob
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Erin P Johnson
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Andrea S Wallace
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
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Bristol AA, Litchman M, Berg C, Grigorian E, Small D, Glazener A, Jones C, Allen NA. Using Continuous Glucose Monitoring and Data Sharing to Encourage Collaboration Among Older Adults With Type 1 Diabetes and Their Care Partners: Qualitative Descriptive Study. JMIR Nurs 2023; 6:e46627. [PMID: 37494110 PMCID: PMC10413231 DOI: 10.2196/46627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Persons with diabetes use continuous glucose monitoring (CGM) to self-manage their diabetes. Care partners (CPs) frequently become involved in supporting persons with diabetes in the management of their diabetes. However, persons with diabetes and CP dyads may require more communication and problem-solving skills regarding how to share and respond to CGM data. OBJECTIVE The purpose of this study was to describe the experiences of persons with diabetes and CPs who participated in the Share "plus" intervention, which addresses dyadic communication strategies, problem-solving, and action planning to promote sharing of CGM data among the dyad. METHODS Ten dyads participated in the Share "plus" telehealth intervention. Participants were interviewed during and after the Share "plus" intervention. Thematic analysis was used to analyze interview data. RESULTS During postsession interviews, dyads described feeling a sense of shared responsibility yet viewed the persons with diabetes as ultimately responsible for the disease. Additionally, dyads shared that communication patterns improved and were able to recognize the negative aspects of previously established communication patterns. Dyads reported communication focused on hypoglycemia episodes while also differing in the frequency they reviewed CGM data and set alerts. Overall, dyads expressed positive reactions to the Share "plus" intervention. CONCLUSIONS Share "plus" was helpful in promoting positive CGM-related communication among dyads and encouraged more CP support. CPs play an important role in supporting older adults with type 1 diabetes. Communication strategies help support dyad involvement in CGM data sharing and self-management among persons with diabetes.
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Affiliation(s)
- Alycia A Bristol
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Michelle Litchman
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Cynthia Berg
- College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
| | - Ernest Grigorian
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Denise Small
- College of Pharmacy, Roseman University, South Jordan, UT, United States
| | - Ashley Glazener
- College of Pharmacy, Roseman University, South Jordan, UT, United States
| | - Christopher Jones
- Cottonwood Medical Clinic Endocrine and Diabetes, Intermountain Healthcare, Murray, UT, United States
| | - Nancy A Allen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
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Wallace AS, Wang CY, Flake N, Bristol AA, Altizer R. Feasibility and usefulness of the going home toolkit, an mhealth app, during hospital discharge: patient and clinician perspectives. Inform Health Soc Care 2023; 48:1-12. [PMID: 35234556 DOI: 10.1080/17538157.2022.2043330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Feasibility and Usefulness of the Going Home Toolkit, an mHealth App, during Hospital Discharge: Patient and Clinician Perspectives. Objective Communication gaps during discharge planning contribute to post-discharge outcomes. mHealth Apps may allow health systems to provide resources to fill patients' needs. The study's purpose was to elicit feedback regarding The Going Home Toolkit (GHT), an App that aims to facilitate patient communication about discharge needs. Participants Twenty patients hospitalized within the past year, and seven case managers involved in discharge processes from an academic health sciences center. Methods Using tablets installed with the GHT prototype, remote engagement studio interviews were used to observe GHT use and perceptions about usefulness and feasibility. Results Patients successfully used the GHT to identify resources that they may not have known otherwise. Clinicians reported the GHT would support patient engagement during discharge. However, patients liked being able to search for resources, while clinicians focused on offering a list of information. This can be described as a pull vs. push approach to accessing resources. Participants recognized the GHT's unique focus on cognitive processes related to self-management vs. knowledge transfer. Conclusions The GHT represents a valuable tool for facilitating anticipatory planning and procurement of resources post-discharge. Future work should focus on refining the user interface and user experience of the app and creating seamless links to community resources.
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Affiliation(s)
- Andrea S Wallace
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Ching-Yu Wang
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Naomi Flake
- Community Collaboration and Engagement Team, University of Utah, Salt Lake City, Utah, USA
| | - Alycia A Bristol
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Roger Altizer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Abstract
CLINICAL TRIAL REGISTRATION This study is a part of a parent study: Social Needs and Resources in the Evaluation and Enhancement of Discharge Support. The trial registry is clinicaltrials.gov, number NCT04248738. Initial release was 1/27/2020 and the first participant was enrolled on 2/4/2020. Link to the information on the registry: https://clinicaltrials.gov/ct2/show/NCT04248738.
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Affiliation(s)
| | | | | | | | - Sonja E Raaum
- University of Utah Department of Internal Medicine School of Medicine, Salt Lake City, USA
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Gettel CJ, Voils CI, Bristol AA, Richardson LD, Hogan TM, Brody AA, Gladney MN, Suyama J, Ragsdale LC, Binkley CL, Morano CL, Seidenfeld J, Hammouda N, Ko KJ, Hwang U, Hastings SN, Bellolio MF, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden MS, Forrester S, Gerson L, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings SN, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Matlock D, McFarland F, Melady D, Morano C, Morrow‐Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts‐Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Camille Vaughan E, Voils C, Wei D, Wexler N. Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1430-1439. [PMID: 34328674 DOI: 10.1111/acem.14360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- National Clinician Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Lynne D. Richardson
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Teresita M. Hogan
- Department of Medicine Section of Emergency Medicine The University of Chicago School of Medicine Chicago Illinois USA
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing New York New York USA
| | - Micaela N. Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Joe Suyama
- Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luna C. Ragsdale
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
- Department of Emergency Medicine Durham VA Health Care System Durham North Carolina USA
| | - Christine L. Binkley
- Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Carmen L. Morano
- School of Social Welfare University at AlbanyState University of New York Albany New York USA
| | - Justine Seidenfeld
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | - Nada Hammouda
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kelly J. Ko
- West Health Institute La Jolla California USA
| | - Ula Hwang
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Geriatrics Research, Education, and Clinical Center James J. Peters VAMC Bronx New York USA
| | - Susan N. Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Medicine Duke University School of Medicine Durham NC USA
- Geriatric Research, Education, and Clinical Center Durham VA Health Care System Durham North Carolina USA
- Center for the Study of Human Aging and Development Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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Bristol AA, Martin-Plank L, Crist JD. Health Care Professionals' Experiences as Family Caregivers During Intra-Hospital Transitions. J Gerontol Nurs 2021; 47:31-36. [PMID: 33497448 DOI: 10.3928/00989134-20210113-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
Family caregivers are often perceived as inexperienced family members assuming caregiving duties. However, health care professionals may also find themselves in an informal caregiving role as older adult relatives or friends are hospitalized and experience intra-hospital transitions. The purpose of the current study was to describe the experiences of health care professionals assuming the role of informal caregiver during intra-hospital transitions. As part of a larger study, a separate analysis of six semi-structured interviews from family caregivers with health care backgrounds was considered. Health care professionals as family caregivers (HCP-FCs) reported they sought inclusion in the care provided, they had unique insider perspectives, and experienced role struggle between health care professional and new informal caregiver. Moreover, HCP-FCs reported increased role struggle during interactions with colleagues and fellow health care professionals. Understanding of the role of HCP-FCs during transitions in care is necessary to develop interventions supportive of patient- and family-centered care. [Journal of Gerontological Nursing, 47(2), 31-36.].
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Dassel KB, Towsley GL, Utz RL, Ellington L, Terrill A, Scammon D, Bristol AA, Thompson A, Mickens M. A Limited Opportunity: COVID-19 and Promotion of Advance Care Planning. Palliat Med Rep 2021; 2:194-198. [PMID: 34223520 PMCID: PMC8244510 DOI: 10.1089/pmr.2021.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Little is known about how COVID-19 has influenced the role of family caregivers in advance care planning (ACP). Objectives: To explore the experiences of family caregivers and ACP in the United States during the COVID-19 pandemic. Design: Exploratory sequential mixed-methods design of caregiver characteristics and pandemic response to ACP. Settings/Subjects: Family caregivers of care recipients with varied caregiving needs (dementia, mental illness, etc.). Measurements: Quantitative survey was done of fixed-choice questions of 82 caregivers. Semistructured qualitative telephone interviews were performed of a subsample of participants (n = 28). Results: Some (19%) of family caregivers revisited or updated advance directives of care recipients and/or had some type of contingency plan (33%) if they were to become ill. We identified three barriers caregivers faced during the pandemic that may have limited their engagement with ACP. Conclusions: Family caregivers need education regarding ACP and specific resources that can guide and support them through the process of ACP, for both themselves and care recipients.
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Affiliation(s)
- Kara B. Dassel
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Gail L. Towsley
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca L. Utz
- Department of Sociology, College of Social and Behavioral Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alexandra Terrill
- Department of Occupational and Recreational Therapies, College of Health, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Debra Scammon
- Department of Marketing, David Eccles School of Business, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alycia A. Bristol
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amber Thompson
- Department of Sociology, College of Social and Behavioral Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Melody Mickens
- Division of Physical Medicine and Rehabilitation, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Bristol AA, Chaudhry S, Assis D, Wright R, Moriyama D, Harwood K, Brody AA, Charytan DM, Chodosh J, Scherer JS. An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care. Am J Hosp Palliat Care 2021; 38:1242-1249. [PMID: 33438435 DOI: 10.1177/1049909120986121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. METHODS Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. RESULTS We identified 2 themes: "Communication addressing the emotional and physical aspects of disease" and "Filling gaps in care"; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. SIGNIFICANCE OF RESULTS Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.
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Affiliation(s)
- Alycia A Bristol
- 16177University of Utah College of Nursing, Salt Lake City, UT, USA
| | | | - Dana Assis
- 1940Yale New Haven Health, New Haven, CT, USA
| | | | - Derek Moriyama
- 12223Keck School of Medicine of University of Southern California, CA, USA
| | - Katherine Harwood
- Columbia University-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, NY, USA.,Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
| | - David M Charytan
- Division of Nephrology, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
| | - Joshua Chodosh
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
| | - Jennifer S Scherer
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA.,Division of Nephrology, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
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12
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Bristol AA, Mata AC, Mickens M, Dassel KB, Ellington L, Scammon D, Thompson A, Towsley GL, Utz RL, Terrill AL. "You Feel Very Isolated": Effects of COVID-19 Pandemic on Caregiver Social Connections. Gerontol Geriatr Med 2021; 7:23337214211060166. [PMID: 34993276 PMCID: PMC8724994 DOI: 10.1177/23337214211060166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
One in five individuals in the United States provides care and support to ill, disabled, and aging family members in the home, leading to feelings of burden, stress, and poor health and well-being. Social support represents an important buffer for family caregivers that allows them to feel less isolated and more positive about their caregiving role. This sequential mixed-methods study aimed to examine the effect of the COVID-19 pandemic on family caregivers' social connections. Eighty-two caregivers completed a web-based survey which comprised of fixed-choice and open-ended questions. Survey data showed that the majority of caregivers (83%) reported an increase in stress and feeling lonely (77%) during the pandemic. Qualitative interviews with a subsample of caregivers (n=27) further explored social connections during the pandemic. Three themes echoed the quantitative findings and centered around defining boundaries, intentionality in social interactions, and loss of social resources. Although caregivers were often strained by new or increased caregiving demands, many experienced positive changes such as feeling a deeper connection with the care-recipient. Findings from this study highlight the need for further consideration of the impact of social isolation on the well-being of caregivers.
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Affiliation(s)
- Alycia A. Bristol
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Aaron C. Mata
- College of Social & Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Melody Mickens
- Division of Rehabilitative Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kara B. Dassel
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Debra Scammon
- Department of Marketing, School of Business, University of Utah, Salt Lake City, UT, USA
| | - Amber Thompson
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Gail L. Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L. Terrill
- Department of Occupational & Recreational Therapy, College of Health, University of Utah, Salt Lake City, UT, USA
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13
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Lin SY, Schneider CE, Bristol AA, Clancy M, Sprague SA, Aldridge M, Cortes T, Goldfeld KS, Kutner JS, Mitchell SL, Shega JW, Wu B, Zhu CW, Brody AA. Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial. The Gerontologist 2020; 62:304-314. [DOI: 10.1093/geront/gnaa220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background and Objectives
Many investigators of Alzheimer’s disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT.
Research Design and Methods
Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care—Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate (“feasibility”), ≥80% posttraining survey respondents indicating intention for practice changes (“applicability”), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining (“fidelity”).
Results
Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices’ limited research experience and infrastructure.
Discussion and Implications
This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives.
Clinical Trials Registration Number
NCT03681119
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Affiliation(s)
- Shih-Yin Lin
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Catherine E Schneider
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Alycia A Bristol
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Maureen Clancy
- MJHS Hospice and Palliative Care, New York, New York, USA
| | - Sara A Sprague
- Providence TrinityCare Hospice, Torrance, California, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Tara Cortes
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Keith S Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joseph W Shega
- Vitas Healthcare, Miami, Florida, USA
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Bei Wu
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
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Brody AA, Sadarangani T, Jones TM, Convery K, Groom L, Bristol AA, David D. Family- and Person-Centered Interdisciplinary Telehealth: Policy and Practice Implications Following Onset of the COVID-19 Pandemic. J Gerontol Nurs 2020; 46:9-13. [PMID: 32845343 DOI: 10.3928/00989134-20200811-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
With the onset of the COVID-19 pandemic, telehealth was thrust to the forefront, becoming one of the most predominant forms of care almost overnight. Despite years of research, practice, and policymaking, tenets for providing telehealth in an interdisciplinary, family- and person-centered fashion, and across a wide breadth of settings remain underdeveloped. In addition, although telehealth has the potential to increase equity in care, it can also further exacerbate disparities. The current article discusses the opening created by the pandemic and provides recommendations for how to make permanent changes in telehealth policy and practice to allow for interdisciplinary, person- and family-centered care while also taking care to address issues of equity and ethics and privacy issues related to telehealth and remote monitoring. [Journal of Gerontological Nursing, 46(9), 9-13.].
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Bristol AA, Convery KA, Sotelo V, Schneider CE, Lin SY, Fletcher J, Rupper R, Galvin JE, Brody AA. Protocol for an embedded pragmatic clinical trial to test the effectiveness of Aliviado Dementia Care in improving quality of life for persons living with dementia and their informal caregivers. Contemp Clin Trials 2020; 93:106005. [PMID: 32320844 PMCID: PMC7269690 DOI: 10.1016/j.cct.2020.106005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Persons living with Alzheimer's disease and related dementias (ADRD) frequently experience pain and behavioral and psychological symptoms of dementia (BPSD) which decrease quality of life (QOL) and influence caregiver burden. Home healthcare professionals however may underrecognize or lack the ability to manage BPSD. INTERVENTION This protocol describes an ADRD palliative quality assurance performance improvement program for home healthcare, Aliviado Dementia Care-Home Health Edition. It includes training, mentoring, and a toolbox containing intervention strategies. METHODS This embedded pragmatic clinical trial will utilize a multi-site, cluster randomized control design. Recruitment will occur from three home healthcare agencies located in New Jersey, Utah, and Florida. At each agency, care teams will be randomized as clusters and assigned to either the Aliviado Dementia Care program or usual care. We plan to enroll 345 persons living with ADRD and their informal caregiver dyads. The primary outcome will be to measure QOL in both the person living with ADRD and their informal caregiver, and emergency department visits and hospital admissions. Secondary outcomes in the person living with ADRD will include the examination of pain, BPSD, antipsychotic and analgesic use. Secondary outcomes in caregivers include burden, depressive symptoms, functional health and wellbeing, and healthcare utilization. CONCLUSION This study will be the first large-scale embedded pragmatic clinical trial in home healthcare focused on care quality and outcomes in addressing QOL in ADRD. If proven successful, the intervention can then be disseminated to agencies throughout the country to improve the quality of care for this vulnerable, underserved population. TRIAL REGISTRATION Clinical Trials.gov: NCT03255967.
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Affiliation(s)
| | - Kimberly A Convery
- The Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, United States
| | - Victor Sotelo
- The Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, United States
| | | | - Shih-Yin Lin
- NYU Rory Meyers College of Nursing, United States
| | | | - Randall Rupper
- University of Utah School of Medicine, United States; George E. Wahlen Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, Geriatric Research, Education and Clinical Center, Salt Lake City, UT, United States
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, United States
| | - Abraham A Brody
- The Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, United States.
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Abstract
Background A large proportion of our older adults live with Alzheimer's Disease and Related Dementias and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbate the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home. Purpose of Review The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons' symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last three years was conducted. Recent Findings One thousand twenty four articles were found, of which nine met inclusion criteria. Five articles used occupational based therapy, two used exercise therapy and one article was found utilizing aromatherapy and music therapy.
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Affiliation(s)
- Catherine E Schneider
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010
| | - Alycia A Bristol
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7170
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7341
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Brody AA, Lin SY, Schneider CE, Bristol AA, Convery KE, Sotelo V. DEVELOPING AND IMPLEMENTING ALIVIADO DEMENTIA CARE IN HOSPICES: CHALLENGES ENCOUNTERED AND LESSONS LEARNED. Innov Aging 2019. [PMCID: PMC6840677 DOI: 10.1093/geroni/igz038.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hospice was originally developed to care for individuals with metastatic, solid-tumor cancers. While advanced ADRD is now the primary illness in approximately 19% of the hospice population and presents as a co-morbid condition in many more, little evidence-based work has been performed to retool hospice to care for persons with ADRD and their caregivers. Aliviado Dementia Care-Hospice Edition is a systems level change program consisting of hospice workforce training, an implementation toolbox, and agency-wide workflow changes. Aliviado seeks to improve the quality of life for persons with ADRD and their caregivers receiving hospice, focused specifically on BPSD and pain assessment and management. In developing a coalition of hospice agencies and implementing this pragmatic intervention, we discuss our solutions to overcoming a number of barriers, including varying electronic health records, performing culture change with a disseminated workforce, scaling to 25 hospices, and working with some hospices who lack experience performing research.
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Affiliation(s)
| | - Shih-Yin Lin
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | | | - Alycia A Bristol
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | | | - Victor Sotelo
- NYU Rory Meyers College of Nursing, New York, New York, United States
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Lin SY, Bristol AA, Schneider CE, Convery K, Sotelo V, Brody AA. ALIVIADO DEMENTIA CARE-HOSPICE EDITION: FEASIBILITY AND ACCEPTABILITY RESULTS OF A TWO-PHASED PILOT STUDY. Innov Aging 2019. [PMCID: PMC6846757 DOI: 10.1093/geroni/igz038.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Limited work has been performed in helping hospice agencies to care for persons with dementia (PWD) and their caregivers in an evidence-based manner despite the increasing number of PWD cared for in this setting. To change the culture of care for PWD and their caregivers receiving hospice, we adapted Aliviado Dementia Care, an evidenced-based interdisciplinary quality improvement program, for use in hospice. The purpose of this pilot study is to examine feasibility and applicability of implementing the Aliviado Dementia Care-Hospice Edition sequentially in 2 hospice agencies in preparation for a nation-wide pragmatic trial. In the first pilot, concluded in March 2019, seven hospice interdisciplinary clinicians were trained as program champions and completed a two-day in-person intensive training on dementia symptom assessment and management, and quality improvement processes. Additionally, 47 interdisciplinary team (IDT) members were provided training via a 5-hour, online program covering dementia symptom assessment and management. All champions trained (100%) reported being satisfied/very satisfied with the program and agreed that the training is applicable to hospice practices. All IDT members who completed the online training (100%) reported being satisfied/very satisfied with the program quality, or agreed/strongly agreed that the content was relevant. The high rates of satisfaction and applicability, reported by the hospice champions and IDT members, provided preliminary evidence supporting the feasibility and applicability of the Aliviado Dementia Care-Hospice Edition.
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Affiliation(s)
- Shih-Yin Lin
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | - Alycia A Bristol
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | | | - Kimberly Convery
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | - Victor Sotelo
- NYU Rory Meyers College of Nursing, New York, New York, United States
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Schneider CE, Bristol AA, Ford A, Lin SY, Brody AA. THE IMPACT OF ALIVIADO DEMENTIA CARE HOSPICE EDITION TRAINING PROGRAM ON HOSPICE STAFF’S DEMENTIA SYMPTOM KNOWLEDGE. Innov Aging 2019. [PMCID: PMC6845631 DOI: 10.1093/geroni/igz038.3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A lack of high quality dementia training for healthcare workers is a key barrier to effective care for persons with dementia (PWD), a vulnerable and increasing population across the care continuum. Hospice agencies in particular are underprepared to care for this population, although annually about 17% of hospice patients have a primary diagnosis of dementia and an additional 28% as a comorbidity. Aliviado Dementia Care-Hospice Edition is an interdisciplinary, evidence-based quality improvement program developed to assist hospice interdisciplinary teams in caring for PWD and their caregivers. Interdisciplinary hospice team members in two agencies were enrolled in online training modules, which addressed multiple areas including pain, behavioral and psychological symptoms of dementia (BPSD), and working with caregivers. They were also provided a toolkit to integrate training in daily practice. Changes in knowledge, confidence and attitudes were tested before and after training and paired t-tests were utilized to evaluate the program’s effect. Thirty-five individuals completed the program and pre/post tests. Paired t-tests showed clinically and statistically significant increases in knowledge, attitudes and confidence in five of 10 domains including depression knowledge and confidence and BPSD knowledge, confidence and interventions. The greatest increase was in using BPSD interventions (18.5% increase, p-value: 0.0002), depression confidence (15.9% increase, p-value: 0.006) and BPSD confidence (12.6% increase, p-value: 0.02). Aliviado is an evidence-based, systems-level intervention shown to improve clinical knowledge, attitudes and confidence in treating pain and BPSD in PWD. This training could be used to produce systems-level practice change for hospice interdisciplinary team members serving PWD.
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Affiliation(s)
| | - Alycia A Bristol
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | - Ariel Ford
- New York University, New York, New York, United States
| | - Shih-Yin Lin
- NYU Rory Meyers College of Nursing, New York, New York, United States
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Pettis J, Bristol AA, Brody AA, Gilmartin MJ, D’Amico CO, Greenberg S, Sullivan-Marx EM. DEVELOPMENT AND EVALUATION OF THE NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS (NICHE) LONG-TERM CARE PROGRAM. Innov Aging 2019. [PMCID: PMC6846200 DOI: 10.1093/geroni/igz038.3180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Nurses Improving Care for Healthsystem Elders (NICHE) is a geriatric care model that positions nurses as leaders to address the unique care needs of older adults. From 2016 to 2019, we developed and piloted the NICHE-LTC program. NICHE-LTC program includes the three interrelated components of 1). the Geriatric Resource Nurse (GRN) and Geriatric Certified Nursing Assistant (GCNA) clinical leadership roles; 2) research-based clinical protocols and assessment tools; and 3). staff development, quality improvement (QI), and care coordination models to build clinician and organizational capacity in geriatrics. We report the results of a summative program evaluation of the NICHE-LTC program. We collected data on organizational and participant demographics, facility enrollment and retention, program completion rates, clinical quality improvement project plans, and participant satisfaction data from 369 individuals working in 79 facilities participating in NICHE-LTC program from January 2016 to February 2019. The majority of participants (80%) reported a positive learning outcome after completing NICHE-LTC program. Additionally, 80% reported they agreed or strongly agreed that their knowledge and ability to implement quality improvement initiatives in their facilities improved. The NICHE-LTC supported facilities ability to move from process-oriented QI priorities to patient-based outcome QI priorities such as falls, pain management, and managing behaviors of dementia. Over the three-year pilot period, NICHE-LTC program maintained an 89.4% annual retention rate. The high annual retention rate suggests that members value the program as an approach to address the clinical quality and nursing workforce development needs in LTC settings.
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Affiliation(s)
- Jennifer Pettis
- New York University Rory Meyers College of Nursing, Nurses Improving Care for Healthsystem Elders (NICHE), New York, New York, United States
| | - Alycia A Bristol
- NYU Rory Meyers College of Nursing, New York, New York, United States
| | | | - Mattia J Gilmartin
- New York University Rory Meyers College of Nursing, Nurses Improving Care for Healthsystem Elders (NICHE), New York, New York, United States
| | | | - Sherry Greenberg
- Seton Hall University College of Nursing, South Orange, New Jersey, United States
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21
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Abstract
Geriatric nurses are skilled in the special needs of hospitalized older adults. While significant focus has been placed on improving care transitions upon discharge, less attention has been placed on intra-hospital transitions. Intra-hospital transitions represent transfers occurring between hospital units or rooms. Intra-hospital transitions challenge normal nursing workflow and require careful consideration of care coordination to prevent adverse events for older adults. Frequent changes in environment and a lack of consistency in care may support the development or prolongation of delirium as older adults are transferred between units and rooms. Additional adverse event risks include infections and falls, which also increases with each transfer. Geriatric nurse involvement can enhance communication between units as well as ensuring appropriate geriatric assessments occur. Geriatric nurses are thus well positioned to act as leaders during intra-hospital transitions, potentially reducing these and adverse events.
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Affiliation(s)
- Alycia A Bristol
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, United States.
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Bristol AA, Nibbelink CW, Gephart SM, Carrington JM. Nurses' Use of Positive Deviance When Encountering Electronic Health Records-Related Unintended Consequences. Nurs Adm Q 2018; 42:E1-E11. [PMID: 29194338 DOI: 10.1097/naq.0000000000000264] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As organizations adopt electronic health records (EHRs), nurses frequently encounter system barriers and difficulty performing role expectations. This article describes nurses' experiences with unintended consequences emerging from the use of an EHR. In some situations, nurses were positively deviant when encountering unintended consequences relating to EHRs to accomplish patient care or protect patient safety. Nurses engaged in work-arounds to provide patient care when the EHR did not meet their needs, sometimes in positively deviant ways. Qualitative data were collected from 5 open-ended questions at the end of a quantitative survey. Analysis included coding of responses and organization of processes in line with the triangle model, a human factors framework, to identify overarching themes. Five themes emerged: (1) User support after implementation of EHR; (2) User satisfaction with EHR; (3) Communication for patient care, quality, and safety; (4) Effort to complete tasks; and (5) Areas for improvement. Nurses' ability to adopt positive deviance as they experience unintended consequences offers opportunities for organizations to engage nursing perspectives in improving the EHR and engineer it to be more resilient to nursing work.
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Affiliation(s)
- Alycia A Bristol
- School of Nursing, Loma Linda University, Loma Linda, California (Dr Bristol); and College of Nursing, The University of Arizona, Tucson (Drs Nibbelink, Gephart, and Carrington)
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23
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Bristol ST, Lloyd SL, Bristol AA. Integrating Spiritual Bereavement Skills Into an Advanced Practice Curriculum. J Nurs Educ 2017; 56:439-442. [PMID: 28662262 DOI: 10.3928/01484834-20170619-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 02/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND When advanced practice nurses (APNs) encounter the need to address a bereaved individual's spirituality, gaps in educational preparation may prevent effective intervention. In addition, past and current research studies have not provided clear guidance for spiritually based bereavement care curricula within the graduate APN program. METHOD Graduate advanced practice faculty successfully introduced classroom-based spiritual bereavement care education modules for APN students. RESULTS Course evaluations indicated student appreciation for the new content and practicum experiences provided. Students felt the new content to be essential in their development as expert practitioners. CONCLUSION Through this innovation, the authors found that a variety of learning activities that addressed spiritual needs during the bereavement process was perceived as highly satisfactory by APNs. Within an ever increasingly diverse society, APNs have a significant role in performing responsibilities for bereaved individuals. [J Nurs Educ. 2017;56(7):439-442.].
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