Using Virtual Site Visits in the Clinical Evaluation of Nurse Practitioner Students: Student and Faculty Perspectives.

BACKGROUND: The use of telehealth technology to conduct virtual site visits is an innovative strategy for evaluating the performance of nurse practitioner (NP) students in remote settings. Although there is an abundance of studies on telehealth for the remote monitoring and assessment of patients, there are limited data on its use for evaluating NP students during clinical learning experiences. PURPOSE: The purpose of this project was to understand the perspectives of NP students and faculty on the feasibility of using virtual site visits to evaluate the students' performance during clinical experiences. METHODS: Online surveys were used to collect student and faculty perspectives on the use of virtual technology during clinical site observations. RESULTS: Overall, students and faculty reported positive experiences with the virtual site visits. CONCLUSION: Virtual site visits are feasible in most clinical settings.

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study.

BACKGROUND: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

Building a state coalition for nursing home excellence.

PURPOSE OF THE STUDY: This article describes the successful evolution of a state coalition for nursing home excellence that brought together organizations that had once worked in silos to improve the quality of care through the implementation of culture change for Arkansas' 240 nursing homes with 27,700 residents. DESIGN AND METHODS: The Coalition was established in 2004 when stakeholders were invited to participate in a retreat to explore how they could come together with a common goal to improve the care of older Arkansans. These stakeholders were encouraged to bring their organization's perspectives to the Coalition and determine ways to work with others. The continuous refinement of the Coalition's activities involved revisiting goals of the Coalition, assessing the need for other stakeholders, identifying gaps and overlaps in quality and culture change programming, and providing feedback to Coalition members. RESULTS: The Coalition stakeholders had the leadership to articulate and mobilize others around a common vision of improving quality of care in nursing homes through culture change. Over time, the Coalition members developed a willingness to share resources and to speak as one voice. IMPLICATIONS: Stakeholders from diverse organizations and governing bodies can come together to complement each other's work and collaborate on programs to build a better system of care for the frail and elderly persons across a state. The success of this statewide effort lends support for policies that encourage regional coalitions of providers to improve care.