The impact of dementia family caregiving on adolescent well-being: A scoping review.

With rates of dementia on the rise and upward trends in multigenerational households, the number of families providing care to persons with dementia is likely to increase. Although caregiver stress in adults has been well-documented, less is known about the impact of dementia family caregiving on adolescents. We conducted a scoping review to assess research on the impact of dementia family caregiving on adolescents. Eight articles representing five studies were identified. Findings suggest that while adolescents developed strategies to cope with the challenges of dementia caregiving, the long-term impact of caregiving on overall well-being has not been well described. Further, research has shown inconsistent findings with studies reporting both improved and strained adolescent relationships. The paucity of research on the impact of dementia family caregiving on the well-being of adolescents is a serious omission given that adolescents are at high-risk for emerging health problems.

Psychiatric Nursing Workforce Survey: Results and Implications.

OBJECTIVE: The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics. METHODS: An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce. RESULTS: Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance. CONCLUSIONS: Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

Living Through the Pandemic: The Voices of Persons With Dementia and Their Caregivers.

Social-distancing guidelines from the COVID-19 pandemic have potential to compound morbidity in persons with dementia (PwD) and increase caregiver burden. This qualitative study utilized semi-structured interviews between August-November 2020 to explore the impact of COVID-19 on PwD and caregivers. Conventional qualitative content analysis was used. Inter-coder reliability was confirmed using the kappa coefficient. Twenty-five interviews were completed with four themes emerging: disruption of socialization, fear and risk mitigation, coping strategies, and caregiver burden. Participants described how lack of socialization and confinement led to feelings of loneliness, depression, and worsening memory problems. Caregivers reported increased burden and heightened feelings of responsibility for their loved one. Increased isolation imposed by the pandemic has a detrimental impact on PwD. Further work is needed to develop interventions to support PwD and other cognitive impairments and caregivers during the pandemic and when in-person socialization is not possible.

Evaluation of an Interprofessional Team Training Program to Improve the Use of Patient Safety Strategies Among Healthcare Professions Students.

PURPOSE: To assess whether our introductory TeamSAFE (Team Simulation and Fearlessness in Education) program improved student knowledge of effective teamwork skills; impacted their perception of their own teamwork skills and preparedness for teamwork in clinical practice; and augmented their understanding of the roles and responsibilities of different healthcare team members. METHODS: Students completed an online learning module, then attended a simulation-based workshop to practice patient safety and teamwork skills. A pre-post-test design was used to assess knowledge of TeamSTEPPS® concepts and perception of teamwork skills among 959 students from 7 health professions. We conducted a qualitative analysis of student responses to open-ended questions about their perceptions of teamwork skills. RESULTS: Qualitative analysis revealed three themes: 1) put patients first; 2) recognize that the whole is greater than the sum of its parts; and 3) embrace the unknown. Quantitative analysis suggested that students gained knowledge from the workshop. Item analysis using item response theory showed that items have difficulty and discrimination in the lower range. CONCLUSION: Findings suggest that the workshop was effective in improving knowledge of teamwork skills, improving student self-perception of teamwork skills and practice readiness, increasing understanding of the roles and responsibilities of students from different health professions, and understanding the importance of patient safety.

Beyond the classroom walls: qualitative findings from an interprofessional student hotspotting learning collaborative.

'Hotspotting,' the use of interprofessional teams to address the needs of complex patients in the community, is an approach to reduce overuse of acute care services. While the influence of interprofessional education on student attitudes, knowledge and skills relative to collaborative practice has been a focus of evaluation, research is limited on the outcomes of interprofessional student teams in the community. This qualitative study examines the experiences of students and faculty participating in the interprofessional student Hotspotting program at Thomas Jefferson University. We used purposive sampling to conduct semi-structured interviews and focus groups with 14 students and faculty advisors participating in the program during the 2017-2018 academic year. Data were analyzed using directed content analysis. Three themes emerged: 1) addressing unmet needs in a complex system, 2) beyond the classroom walls, and 3) sitting in discomfort. Findings suggest that Hotspotting is beneficial to students and promotes their understanding of the interaction between social factors and health. This study contributes to the growing body of literature documenting the positive influence of Hotspotting on student development as a member of an interprofessional team. Future research should focus on the patient's experience working with students and the sustainability of student Hotspotting.

COVID-19 vaccination readiness among nurse faculty and student nurses.

BACKGROUND: Unprecedented efforts are underway to develop COVID-19 vaccines, widely seen as critical to controlling the pandemic. Academic nursing leaders must be proactive in assuring widespread faculty and student vaccination uptake. PURPOSE: The purpose of this study was to describe nursing faculty and student nurse factors associated with COVID-19 vaccine readiness. METHODS: Cross-sectional online survey of nursing faculty and student nurses at a university affiliated with an academic medical center was conducted. FINDINGS: Most full-time faculty (60%) intended to receive the vaccine; but only 45% of adjunct faculty and students reported intending to get vaccinated. The major reasons for not getting vaccinated were vaccine safety and side effects. Collectively, participants reported a low level of knowledge related to vaccine development. DISCUSSION: As the most trusted profession, nurses will play a decisive role in counseling patients about COVID-19 risks and benefits. Findings suggest that academic nursing leaders need to consider faculty and student vaccine concerns and provide vaccine development education.

Development and preliminary validation of a scale to measure patient uncertainty: The "Uncertainty Scale".

Research suggests that patient uncertainty related to experiencing symptoms may drive decisions to seek care. The only validated measure of patient uncertainty assesses uncertainty related to defined illness. In prior work, we engaged patients to describe uncertainty related to symptoms and used findings to develop the 'U-Scale' scale. In this work, we present results from preliminary scale reliability and validity testing. Psychometric testing demonstrated content validity, high internal consistency, and evidence for concurrent validity. Next steps include administration in diverse populations for continued refinement and validation, and exploration of the potential contribution of uncertainty to healthcare utilization.

Patient Uncertainty as a Predictor of 30-day Return Emergency Department Visits: An Observational Study.

OBJECTIVE: The objective was to examine the relationship between patient uncertainty at the time of emergency department (ED) discharge as measured by the "Uncertainty Scale" (U-Scale) and 30-day return ED visits. We hypothesized that a higher score on the U-Scale predicts a higher likelihood of a 30-day return ED visit. METHODS: This was a cross-sectional single-site pilot study performed with adult patients discharged from an urban academic ED to assess the relationship of U-Scale total and subscale scores with 30-day return ED visits. We collected demographic and U-Scale scores at the time of ED discharge and subsequent 30-day ED utilization data by follow-up telephone call. RESULTS: No association was found between the total U-Scale score and subsequent ED utilization. Patients with higher uncertainty on the Treatment Quality subscale of the U-Scale had higher odds of a 30-day return ED visit (adjusted odds ratio [AOR] = 1.16), while patients with lower uncertainty on the Decision to Seek Care subscale had higher odds of a 30-day return ED visit (AOR = 0.68). CONCLUSION: Patient uncertainty as measured by the U-Scale total score was not predictive of subsequent ED utilization. However, uncertainty related to treatment quality and the decision to seek care as measured by the U-Scale subscales may be important in predicting repeat ED utilization. Unlike individual patient factors such as age and race that have been associated with frequent ED visits in prior studies, these domains of uncertainty are potentially modifiable. Providers and health systems may successfully prevent recurrent acute care encounters through implementation of interventions designed to address patient uncertainty. Further work is needed to refine the U-Scale and test its predictive utility among a larger patient cohort.

Use of Group Concept Mapping to Identify Patient Domains of Uncertainty That Contribute to Emergency Department Use.

INTRODUCTION: Prior research suggests that uncertainty related to symptoms is a driver of emergency department (ED) use, and that patients often leave the ED with uncertainty not being addressed. Our objective was to engage patients to identify domains that contribute to feelings of uncertainty and decisions to use the ED. METHODS: We used Group Concept Mapping, a quasi-qualitative/quasi-quantitative method, to elicit patients' views on how uncertainty related to experiencing symptoms contributes to decisions to access the ED. Purposive sampling was used to recruit participants who either sought treatment at the ED twice within a 30-day period, or visited both the ED and a primary care provider at least once within the past year. RESULTS: Thirty-four participants engaged in two rounds of Group Concept Mapping during which participants participated in structured brainstorming of ideas, followed by ranking and clustering of ideas into domains. The first round generated 47 idea statements reflecting uncertainty about consequences, severity, emergency room services, primary care options, finances, and psychologic concerns. The second round generated 52 idea statements reflecting uncertainty about self-management, causation, diagnosis and treatment plan, trust in the provider and institution, accessibility, and alternative care options. DISCUSSION: Factors that contribute to uncertainty and decision-making about ED use are both intrinsic (ie, cause, symptom severity) and extrinsic (ie, finances, accessibility). These domains can inform approaches to measure the uncertainty that patients experience, and to design and test interventions for nurses and other providers to help manage patient uncertainty during acute illness.

Interprofessional Collaborative Practice in the Medical Intensive Care Unit: a Survey of Caregivers' Perspectives.

BACKGROUND: Research on caregivers, defined as designated family members or support persons, in the medical intensive care unit (MICU) has primarily focused on their emotional needs and experiences, thus leaving a gap in knowledge related to their perceptions of team dynamics. OBJECTIVE: To examine caregivers' perceptions of team interactions and competencies for interprofessional collaborative practice (IPCP) and overall satisfaction with the MICU team. METHODS: The Support Person Jefferson Teamwork Observation Guide (JTOG)™ was administered to a convenience sample of caregivers in the MICU at a large urban academic medical center between May 2016 and December 2016. RESULTS: One hundred sixty-one JTOG surveys were completed. Caregivers agreed on the importance of healthcare professionals working together as a team to provide patient care (3.97 out of 4.0 on Likert response scale where 1 is "Not at all important" and 4 is 'Extremely important") and were satisfied with the MICU team (3.74 out of 4.0), positively evaluating the four core competencies for IPCP (3.55 for values/ethics, 3.58 for interprofessional communication, 3.61 for roles/responsibilities, and 3.64 for teams/teamwork) and the patient/family-centeredness sub-competency (3.58 out of 4.0). There was a strong positive correlation between caregivers' Global JTOG scores and overall satisfaction with the MICU team (r = 0.596, p < 0.01). Caregivers' comments about factors that affected their experience focused on aspects of interprofessional communication and patient/family-centeredness. CONCLUSION: Findings underscore the importance of interprofessional communication and providing patient/family-centered care. Assessing caregivers' perceptions of IPCP can provide a critical lens into team functioning and, thus, be used to identify teams' strengths as well as opportunities for improvement.

Patient-Identified Needs Related to Seeking a Diagnosis in the Emergency Department.

STUDY OBJECTIVE: Although diagnosis is a valuable tool for health care providers, and often the reason patients say they are seeking care, it may not serve the same needs for patients as for providers. The objective of this study is to explore what patients specifically want addressed when seeking a diagnosis at their emergency department (ED) visit. We propose that understanding these needs will facilitate a more patient-centered approach to acute care delivery. METHODS: This qualitative study uses semistructured telephone interviews with participants recently discharged from the ED of a large urban academic teaching hospital to explore their expectations of their ED visit and postdischarge experiences. RESULTS: Thirty interviews were analyzed. Many participants reported wanting a diagnosis as a primary reason for seeking emergency care. When further asked to identify the functions of a diagnosis, they described wanting an explanation for their symptoms, treatment and guidance for symptoms, and clear communication about testing, treatment, and diagnosis. For many, a diagnosis was viewed as a necessary step toward achieving these goals. CONCLUSION: Although diagnosis may not be a feasible outcome of every acute care visit, addressing the needs associated with seeking a diagnosis may be achievable. Reframing acute care encounters to focus on addressing specific patient needs, and not just identifying a diagnosis, may lead to more effective transitions home and improved patient outcomes.

Long-term outcomes of the New Jersey nurse faculty preparation program scholars.

BACKGROUND: Rising concerns over the capacity of nursing education to prepare enough nurses to meet population demand have received national attention. The Robert Wood Johnson Foundation implemented the New Jersey Nursing Initiative Faculty Preparation Program to address nursing workforce issues in New Jersey. PURPOSE: This paper describes program and scholar outcomes and provides recommendations for nurse faculty development. METHODS: This descriptive study uses data from scholar surveys and interviews with grantees. DISCUSSION: Findings suggest that a faculty preparation program that targets doctoral students and includes financial support, socialization to the faculty role, and formal education courses produces graduates who maintain a career in nursing education for up to three years after program completion. However, most master's-level students who also received formal preparation in nursing education were employed in clinical practice. CONCLUSIONS: Program developers must carefully consider the design of programs that integrate faculty preparation and advanced clinical training for master's-level students.

Implementation of a Reverse Colocation Model: Lessons from Two Community Behavioral Health Agencies in Rural Pennsylvania.

This qualitative study examined the implementation of a reverse colocation pilot program that sought to integrate medical care in two community behavioral health agencies. To accomplish this, each agency hired a registered nurse, provided training for its staff to function as wellness coaches, and implemented a web-based tool for tracking consumer outcomes. The findings from two rounds of stakeholder discussions and consumer focus groups suggested that agencies successfully trained their staffs in wellness coaching, integrated nurses into agency functions, developed integrated care planning processes, and increased awareness of wellness among staff and consumers. Similar to other complex interventions, the agencies experienced challenges including difficulty establishing new procedures and communication protocols, discomfort among staff in addressing physical health concerns, difficulty building collaborative relationships with primary care providers, and modest uptake of the web-based tool. The study offers insights into the practical aspects of integrating care and makes recommendations for future efforts.

Who will educate our nurses? A strategy to address the nurse faculty shortage in New Jersey.

BACKGROUND: The nurse faculty shortage hampers the capacity of the nursing workforce to respond to the demands of the evolving health care system. As a strategy to address the shortage in New Jersey, the Robert Wood Johnson Foundation implemented the New Jersey Nursing Initiative Faculty Preparation Program to prepare nurses for the faculty role. This article highlights program implementation successes and challenges, scholar and faculty perceptions of the program, and provides recommendations for others interested in preparing nurse faculty. METHODS: This evaluation uses data from scholar surveys and focus groups, interviews with grantees, and grantee reports. RESULTS: Findings suggest that a program that includes generous monetary support, socialization to the nurse faculty role, and formal education courses produces graduates who readily assume a faculty position and are committed to at least a part-time career in nursing education. CONCLUSIONS: This evaluation emphasizes the need to carefully design programs that integrate faculty preparation and advanced clinical training.

Workload and the nurse faculty shortage: implications for policy and research.

Although it is hypothesized that workload is a causative factor of the nurse faculty shortage and that nurse faculty workload is not equitable with that of faculty from other academic disciplines, it is not known whether evidence supports this assertion. This paper has three objectives: (1) to identify what is known about nurse faculty workload and its relationship to the nurse faculty shortage, (2) to determine whether evidence supports the assertion that nurse faculty workload is not equitable with faculty workload in other disciplines, and (3) to discuss policy and research implications for addressing workload and the nurse faculty shortage. Science Direct, medline, CINAHL, HealthSTAR databases, and the web were searched using combinations of nurse faculty, workload, academia, and equity. Findings suggest that the majority of research on nurse faculty workload has been limited to a single institution or region. Further, the literature lacks a comparison of nurse faculty workload with that of faculty from other disciplines. A study comparing workload across disciplines would shed light on the workload inequity hypothesis. More importantly, a systematic analysis of nurse faculty workload would facilitate the prioritization of strategies to address the shortage.

An exploratory analysis of the relationship between psychiatric nurses' perceptions of workload and unit activity.

Although research exists relative to psychiatric nurses' perceptions of their work conditions, the relationship between nurses' perceptions of their workloads and the activities in which they engage has been unexplored. The purpose of this study is to examine the relationship between unit activity and nurses' perceptions of their workloads. The design is a secondary analysis using two data sources: (a) reports from 36 psychiatric nurses consisting of perceptions of their work conditions (n = 383) and (b) the hospital census and activity and acuity 24-hour shift reports (n = 384). Nurses' perceptions of workloads were related to unit activity; the greater the number of heavy and medium-to-heavy workloads, the higher the unit activity. This evidence contributes to the growing body of research demonstrating that nurses accurately provide information related to the hospital environment.

Measuring adverse outcomes in inpatient psychiatry: the reliability of nurse recall.

Nurses have been used in studies to report on quality-of-care issues and may be the most feasible sources of information about adverse outcomes. To date, however, the use of nurses to recall adverse outcomes of inpatient psychiatric care has not been examined systematically. The purpose of this study was to determine the reliability of psychiatric nurses' recall of physical restraint episode(s) (PRE) and assaultive/aggressive episode(s) (A/AE) and to describe the factors that influence recall. The study design was prospective and retrospective, and used a convenience sample of 36 nurses from a psychiatric hospital located in a large eastern city. Despite differences in nurse characteristics, perceptions of shift conditions, and organizational characteristics, nurse recall of PRE and A/AE was reliable overall. The majority of nurses actually recalled the exact number of events they had prospectively reported. Furthermore, the period for recall (2 vs. 4 weeks) did not significantly affect the reliability of nurse recall. These results suggest that psychiatric nurses are reliable informants of adverse outcomes. Lacking readily accessible and systematically reported data on PRE and A/AE, nurses may be the most feasible sources of information for these outcomes of inpatient psychiatric treatment. Future research should replicate these findings in other psychiatric treatment settings.

The conceptualization of physical restraint as a nursing-sensitive adverse outcome in acute care psychiatric treatment settings.

The occurrence of physical restraint episodes in psychiatric settings is a major public health issue because the therapeutic utility of this form of behavior control has not been substantiated empirically. The purpose of this article was to examine the extant literature to determine if evidence supports the conceptualization of a physical restraint episode as an adverse client outcome that is sensitive to the organization of nursing care in psychiatric settings. An adapted version of the Quality Health Outcomes Model (Mitchell, P. H., Ferketich, S., & Jennings, B. M. (1998). Quality Health Outcomes Model. Image Journal of Nursing Scholarship, 30, 43-46) was used as the conceptual model to guide this inquiry. The databases Cumulative Index to Nursing and Allied Health Literature, Health and Psychosocial Instruments, HealthSTAR/Ovid and Healthstar, Medline, and psychINFO were searched from 1990 to 2005. There are 101 sources in this review. Evidence strongly suggests that a physical restraint episode is an adverse outcome that is sensitive to the organization of nursing care. A systematic exploration of the specific structures and processes of the organization that affect adverse outcomes, such as physical restraint episodes, is lacking in the United States.

Core data elements tracking elder sexual abuse.

Sexual abuse in the older adult population is an understudied vector of violent crimes with significant physical and psychological consequences for victims and families. Research requires a theoretical framework that delineates core elements using a standardized instrument. To develop a conceptual framework and identify core data elements specific to the older adult population, clinical, administrative, and criminal experts were consulted using a nominal group method to revise an existing sexual assault instrument. The revised instrument could be used to establish a national database of elder sexual abuse. The database could become a standard reference to guide the detection, assessment, and prosecution of elder sexual abuse crimes as well as build a base from which policy makers could plan and evaluate interventions that targeted risk factors.

State of the science: outcomes of acute inpatient psychiatric care.

Identifying client outcomes related to nursing care is critical to establish empirical evidence that supports the effectiveness of psychiatric nursing. The purpose of this article is to conduct a methodological review of the literature that examines client outcomes after treatment in acute care inpatient psychiatric hospitals and psychiatric units of general hospitals. The databases Medline, CINAHL, HealthSTAR/Ovid HealthSTAR and psycINFO were searched for articles published between 1991and 2004. A review of literature was conducted of studies related to client outcomes after inpatient psychiatric treatment. Forty-seven studies were reviewed. There is a dearth of literature related to client outcomes after inpatient psychiatric treatment. The existing literature has conceptual and methodological limitations. The organization of psychiatric nursing care, in relation to outcomes is nonexistent in the literature. Outcomes that are sensitive to nursing care must be conceptualized theoretically and then examined empirically. The Quality Health Outcomes model is proposed to conceptualize outcomes of acute inpatient psychiatric treatment that are sensitive to nursing interventions and the organization of nursing care.