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Piamjariyakul U, McKenrick SR, Smothers A, Giolzetti A, Melnick H, Beaver M, Shafique S, Wang K, Carte KJ, Grimes B, Haut MW, Navia RO, Patrick JH, Wilhelmsen K. Developing, implementing, and evaluating the visiting Neighbors' program in rural Appalachia: A quality improvement protocol. PLoS One 2024; 19:e0296438. [PMID: 38166130 PMCID: PMC10760886 DOI: 10.1371/journal.pone.0296438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/11/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months. PURPOSE The purpose of this paper was to describe the 3M's Visiting Neighbors protocol steps guiding the quality improvement procedures relating to program development, implementation, and evaluation. METHODS AND MATERIALS This Visiting Neighbors study used a single-group exploratory quality improvement design. This program was tested using quality improvement standards, including collecting participant questionnaires and visit observations. RESULTS Older adults (> 65 years) living alone (N = 30) participants were female (79%) with a mean age of 82.96 (SD = 7.87) years. Volunteer visitor participants (N = 10) were older adult females. Two volunteer visitors implemented each visit, guided by the 3M's activities manual. All visits were verified as being consistently delivered (fidelity). Enrollment and retention data found the program was feasible to conduct. The older adult participants' total program helpfulness ratings (1 to 5) were high (M = 51.27, SD = 3.77). All volunteer visitor's program helpfulness ratings were also high (M = 51.78, SD = 3.73). DISCUSSION The Visiting Neighbors program consistently engaged older Appalachian adults living alone in the 3M's activities. The feasibility and fidelity of the 3M's home visits were verified. The quality improvement processes included engaging the expert advisory committee and rural county stakeholders to ensure the quality of the program development, implementation, and evaluation.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Susan R. McKenrick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angel Smothers
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angelo Giolzetti
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Helen Melnick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Molly Beaver
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Saima Shafique
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kesheng Wang
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kerri J. Carte
- Family & Community Development, West Virginia University-Extension, Kanawha County, Charleston, WV, United States of America
| | - Brad Grimes
- Meredith Center for Career Services and Professional Development, West Virginia University College of Law, Morgantown, WV, United States of America
| | - Marc W. Haut
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Department of Behavioral Medicine/Psychiatry, Director, Memory Health Clinic, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
| | - R. Osvaldo Navia
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Division Chief of Geriatrics, Palliative Medicine & Hospice and Grace Kinney Mead Chair of Geriatrics, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Julie Hicks Patrick
- Life-Span Developmental Psychology, West Virginia University, Morgantown, WV, United States of America
| | - Kirk Wilhelmsen
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Chief Cognitive Neurology, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
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Gallo VJ, Cotton S, Theeke L, Barnhart C, Marino L, Messer J, Minor A, Smothers A. Evidence of Diversity, Equity, and Inclusion in Nursing Syllabi: A Descriptive Analysis. J Nurs Educ 2022; 61:665-671. [PMID: 36475989 DOI: 10.3928/01484834-20221003-02] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schools of nursing must produce nurses able to address the care needs of diverse populations. Within schools of nursing, faculty should intentionally construct syllabi to establish an environment of inclusivity where diversity is embraced. METHOD Content analysis of 81 undergraduate and graduate course syllabi from four university campuses was performed to determine explicit evidence of content on diverse populations, inclusive andragogy, and policies related to diversity, equity, and inclusion (DEI). RESULTS Three quarters of terms indicative of diverse populations were found in course syllabi; all terms that provided evidence of inclusive andragogy and all DEI-related policies were identified at least once in course syllabi. CONCLUSION Strengths and weaknesses were identified in communicating DEI content, policies, and inclusive andragogy to students. Faculty development on best practices related to inclusion of DEI in the classroom beginning with the syllabus is the first step to ensure a more inclusive nursing workforce. [J Nurs Educ. 2022;61(12):665-671.].
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Piamjariyakul U, Smothers A, Young S, Morrissey E, Petitte T, Wen S, Zulfikar R, Sangani R, Shafique S, Smith CE, Bosak K. Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results. Res Nurs Health 2021; 44:854-863. [PMID: 34196013 PMCID: PMC8440457 DOI: 10.1002/nur.22166] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence-based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end-of-life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1-5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.
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Affiliation(s)
| | | | | | - Elizabeth Morrissey
- West Virginia University, School of Nursing
- West Virginia University Hospital
| | | | - Sijin Wen
- West Virginia University, Department of Biostatistics School of Public Health
| | - Rafia Zulfikar
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Rahul Sangani
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Saima Shafique
- West Virginia University, Department of Epidemiology School of Public Health
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing
- University of Kansas Medical Center, School of Preventive Medicine
| | - Kelly Bosak
- University of Kansas Medical Center, School of Nursing
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Piamjariyakul U, Keener TA, Smothers A, Young S, Shafique S, McDill S, Keech K, Petitte T, Pacheco C. Mentoring Undergraduate Nursing Students in Palliative Home Care Research. Teach Learn Nurs 2021; 16:423-428. [PMID: 34720774 PMCID: PMC8553230 DOI: 10.1016/j.teln.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | | | - Saima Shafique
- West Virginia University, Department of Epidemiology, School of Public Health
| | | | | | | | - Cinthia Pacheco
- West Virginia University, Office of Undergraduate Research, Honors College
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Piamjariyakul U, Smothers A, Young S, Petitte T, Wen S, Morrissey E, Shafique S, Zulfikar R, Sangani R, Smith CE. Palliative care for rare advanced lung diseases in underserved Appalachia: Study protocol for a randomized controlled trial. J Adv Nurs 2020. [PMID: 32297352 DOI: 10.1111/jan.14395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/13/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 01/07/2023]
Abstract
AIM To pilot test a home end-of-life and palliative care intervention for family caregivers and patients with rare advanced lung diseases and to estimate effect-size for the power analysis in a future clinical trial. DESIGN This study uses a parallel randomized control trial. Families are randomly assigned to the intervention group or the control group in a 1:1 fashion. METHODS The study population includes patients with rare advanced lung diseases and their family caregivers who are involved in patients' home care. The control group receives standard care through their hospital or outpatient clinics. The intervention group receives standard care plus 2-weekly home end-of-life and palliative care coaching by experienced community nurses. Primary outcome is breathlessness measured by shortness of breath scale. Secondary outcomes are: (a) caregivers' anxiety and depression measures; (b) the presence of patient's signed advance directives in the medical record or not; and (c) Helpfulness of intervention measured by self-report Helpfulness scale. The study was funded in October 2018 and received ethical Institutional Review Board approval in February 2019. DISCUSSION West Virginia has one of the highest incidence rates of lung disease deaths in the nation. However, there is inadequate home end-of-life and palliative care for this underserved population. This is an initial interventional study of nurse-led coaching home-based palliative care for rare advanced lung diseases in rural Appalachia. Developing research collaboration with clinicians is essential for enrolment. Enrolment was successful due to regular meetings with pulmonologists who screened patients per the study inclusion criteria in their specialty clinic and made direct referrals to the research assistants. Results of this study will be used in the future trial. IMPACT The findings will contribute to the evidence-based home nursing care, planning for family/patient preferences and supportive end-of-life palliative care for managing advanced lung diseases at home. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03813667; registered January 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03813667.
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Affiliation(s)
| | - Angel Smothers
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Stephanie Young
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Trisha Petitte
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics School of Public Health, West Virginia University, Morgantown, WV, USA
| | | | - Saima Shafique
- Department of Epidemiology School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Rafia Zulfikar
- Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rahul Sangani
- Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Carol E Smith
- School of Nursing and School of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Piamjariyakul U, Petitte T, Smothers A, Wen S, Morrissey E, Young S, Sokos G, Moss AH, Smith CE. Study protocol of coaching end-of-life palliative care for advanced heart failure patients and their family caregivers in rural appalachia: a randomized controlled trial. BMC Palliat Care 2019; 18:119. [PMID: 31884945 PMCID: PMC6936135 DOI: 10.1186/s12904-019-0500-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Heart failure (HF) afflicts 6.5 million Americans with devastating consequences to patients and their family caregivers. Families are rarely prepared for worsening HF and are not informed about end-of-life and palliative care (EOLPC) conservative comfort options especially during the end stage. West Virginia (WV) has the highest rate of HF deaths in the U.S. where 14% of the population over 65 years have HF. Thus, there is a need to investigate a new family EOLPC intervention (FamPALcare), where nurses coach family-managed advanced HF care at home. METHODS This study uses a randomized controlled trial (RCT) design stratified by gender to determine any differences in the FamPALcare HF patients and their family caregiver outcomes versus standard care group outcomes (N = 72). Aim 1 is to test the FamPALcare nursing care intervention with patients and family members managing home supportive EOLPC for advanced HF. Aim 2 is to assess implementation of the FamPALcare intervention and research procedures for subsequent clinical trials. Intervention group will receive routine standard care, plus 5-weekly FamPALcare intervention delivered by community-based nurses. The intervention sessions involve coaching patients and family caregivers in advanced HF home care and supporting EOLPC discussions based on patients' preferences. Data are collected at baseline, 3, and 6 months. Recruitment is from sites affiliated with a large regional hospital in WV and community centers across the state. DISCUSSION The outcomes of this clinical trial will result in new knowledge on coaching techniques for EOLPC and approaches to palliative and end-of-life rural home care. The HF population in WV will benefit from a reduction in suffering from the most common advanced HF symptoms, selecting their preferred EOLPC care options, determining their advance directives, and increasing skills and resources for advanced HF home care. The study will provide a long-term collaboration with rural community leaders, and collection of data on the implementation and research procedures for a subsequent large multi-site clinical trial of the FamPALcare intervention. Multidisciplinary students have opportunity to engage in the research process. TRIAL REGISTRATION ClinicalTrials.gov NCT04153890, Registered on 4 November 2019.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA.
| | - Trisha Petitte
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - Angel Smothers
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - Sijin Wen
- Department of Biostatistics School of Public Health, West Virginia University, Morgantown, USA
| | - Elizabeth Morrissey
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - Stephanie Young
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - George Sokos
- Advanced Heart Failure, West Virginia University Heart and Vascular Institute, J.W. Ruby Memorial Hospital, Morgantown, USA
| | - Alvin H Moss
- Sections of Nephrology and Supportive Care, West Virginia University Center for Health Ethics and Law, Morgantown, USA
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing and School of Preventive Medicine, Morgantown, USA
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