Innovative Projects: A Unique Approach to Telehealth Education.

ABSTRACT: During the COVID-19 pandemic, telehealth utilization grew astronomically, encouraging more institutions of higher education to become innovative and proactive in preparing health care providers to deliver high-quality telehealth care. Telehealth can be creatively implemented throughout health care curricula given the appropriate guidance and tools. This article speaks to the development of student telehealth projects as part of the work of a national taskforce funded by the Health Resources and Services Administration and charged with the development of a telehealth toolkit. Proposed telehealth projects allow students to take the lead in their innovative learning and allow faculty to facilitate project-based evidence-based pedagogy.

Telehealth Policy and the Advanced Practice Nurse.

Telehealth is an efficient and effective method of care delivery used by advance practice registered nurses (APRNs) nationally, especially in the wake of the coronavirus disease 2019 pandemic. With the ever-changing rules and regulations governing telehealth practice, the APRN may struggle to keep abreast. Telehealth is governed by legislation and regulation in addition to telehealth-specific laws. APRNs delivering care through telehealth must be informed about the crucial aspects of telehealth policy and how their practice is affected. Telehealth-related policy is complex and evolving and varies by state. This article provides APRNs with essential knowledge about telehealth-related policy to support legal and regulatory compliance.

The Association of Skin Cancer Prevention Knowledge, Sun-Protective Attitudes, and Sun-Protective Behaviors in a Navy Population.

INTRODUCTION: U.S. Navy service members are primarily between the ages of 18 and 30 years and often required to be outside for extended periods of time in geographical locations with increased and often unfamiliar ultraviolet indexes that collectively increase their risk for skin cancer. Skin cancer is the country's most common form of cancer, yet there is a paucity of skin cancer prevention literature, especially within the U.S. Navy. The purpose of this study was to describe skin cancer risk and skin cancer prevention "cues-to-action" and to determine if skin cancer prevention knowledge was associated with sun-protective attitudes (e.g., prevention perceptions, benefits, threats, barriers, and sun-protective behavior self-efficacy) and sun-protective behaviors (e.g., wearing long sleeve shirts and using sunscreen and not deliberately exposing skin for a tan) in a Navy population. MATERIALS AND METHODS: A cross-sectional, descriptive, correlational design was utilized, and the study approval was obtained by the Naval Medical Center Portsmouth Institutional Review Board. Two-hundred twenty-nine active duty Navy service members aged 18-30 years who presented to primary care for their periodic health assessment completed the Brief Skin Cancer Risk Assessment and the Skin Cancer Survey. Descriptive statistics were utilized to assess service members' perceptions and knowledge regarding skin cancer prevention along with sociodemographic characteristics. The Spearman rank-order correlation and the Mann-Whitney U test were used to assess associations. P-values <.05 were used to determine statistical significance. RESULTS: Skin cancer prevention knowledge was significantly related to sun-protective behavior self-efficacy (r = 0.218, P = .001), benefits (r = 0.271, P ≤ .001), sun protection behaviors (r = 0.152, P = .024), skin cancer risk (r = 0.256, P = .001), current frequency of high-risk sun behavior (r = 0.183, P = .006), past frequency of high-risk sun behavior (r = 0.219, P = .001), sun exposure (U = 4,813.50, P = .005), tanning bed use (U = 3,154.50, P = .031), and training (U = 4,099.50, P = .005). CONCLUSIONS: Integrating skin cancer education into primary care visits (i.e., periodic health assessments) may improve Navy service members' modifiable sun-protective attitudes and behaviors and may contribute to lowering future skin cancer rates.

Examining Health-Seeking Behaviors of Korean Immigrant Women.

OBJECTIVE: To identify specific factors that potentially influence the willingness of Korean immigrant women to seek preventive health care. DESIGN: A descriptive cross-sectional correlational pilot study examining health-seeking behaviors of Korean immigrant women. SETTING: Participants were recruited from multiple sites, including Korean churches, small businesses, e-mail, and social media. PARTICIPANTS: A convenience sample of 87 Korean immigrant women (i.e., both parents Korean), 18 years or older, able to read and understand English and/or Korean, and currently living in the United States. INTERVENTION/MEASUREMENTS: Data were collected using a 62-item bilingual questionnaire, composed of researcher-developed questions and the Risk Behavior Diagnosis Scale. Pearson's correlations were performed to analyze bivariate relationships between willingness to seek care and outcome variables. RESULTS: Korean immigrant women were significantly more willing to seek preventive health care when they were prompted by outside sources of information and exhibited greater self-efficacy. Significant positive correlations were found between participant's age, years lived in the United States, cues to action, and self-efficacy. CONCLUSION: Promoting preventive health information at every opportunity and fostering self-efficacy in culturally sensitive ways are important to increase health care use among Korean immigrant women. Developing cultural-based interventions to improve the health-seeking behaviors of Korean immigrant women was shown to be imperative.

Telehealth Competencies: Leveled for Continuous Advanced Practice Nurse Development.

BACKGROUND: The COVID-19 pandemic spurred a rapid uptake of telehealth utilization, with advanced practice registered nurses (APRNs) at the forefront of telehealth care delivery. To advance training of nurse practitioners and support curricular development, essential APRN student competencies in telehealth were developed. PROBLEM: Although telehealth competencies have been developed, little is understood about their evaluation across the curricula. Moving to competency-based nursing education involves leveling broad competencies into subcompetencies, including those for telehealth. Subcompetencies support frequent, multimodal evaluation of student progress across APRN curricula. APPROACH: Adapting Benner's Novice to Expert Theory, faculty experts in telehealth and graduate nursing education used an iterative process to develop and level subcompetencies aligned with the Four Ps of Telehealth framework. OUTCOMES: Telehealth subcompetencies were leveled for preclinical and clinical rotations and for readiness for practice. CONCLUSIONS: The leveled subcompetencies, aligned with the Four Ps of Telehealth framework, will support APRN faculty in diverse programs as they implement competency-based education in telehealth.

The Impact of Robotic Companion Pets on Depression and Loneliness for Older Adults with Dementia During the COVID-19 Pandemic.

Purpose: Differences in depression and loneliness, during the COVID-19 pandemic, for older adults with mild to moderate dementia living in residential care after interacting with a robotic companion dog or cat were explored. Experiences of family members and professional caregivers were also examined. Design: This study used a mixed research design with pre- and post-questionnaires on depression and loneliness. Method: Quantitative data exploring the impact of companion pets on depression and loneliness were collected from participants pre-intervention and at 3- and 6-week intervals. Qualitative data were collected during the 6-week study period, permitting researchers to explore the impact of robotic companion pets on participants, family members, and professional caregivers. Findings: Results indicated depression (χ2F(2) = 21.29, p < 0.001) and loneliness (χ2F(2) = 21.11, p < 0.001) improved. Moreover, participants were engaged with their companion pet, providing meaningful, activity and positive experiences. Conclusions: Robotic companion pet therapy, a holistic, nonpharmacologic animal-assisted therapy (AAT), changed the AAT landscape at the study site and provided an alternative option to live pet therapy during COVID-19. Participant interactions with their robotic companion pets enhanced their well-being and quality of life, especially during stringent COVID-19 restrictions and social isolation.

Telehealth Competencies for Nursing Education and Practice: The Four P's of Telehealth.

BACKGROUND: Telehealth is a rapidly growing health care delivery modality with advanced practice nurses as key providers. This growth has occurred without critical consideration of provider training. Training requires the development of competencies situated within a framework. PROBLEM: Standardized telehealth competencies for advanced practice nursing are missing. The purpose of this article is to describe the development of telehealth competencies for education and practice. APPROACH: Using the Four P's of Telehealth framework (planning, preparing, providing, and performance evaluation), a modified Delphi technique was used to identify, develop, and evaluate telehealth competencies. OUTCOMES: Competencies were arranged around telehealth domains, expected activities, and outcomes. Effective use of the competencies to guide curriculum development, practice, and future research related to telehealth was identified. CONCLUSIONS: Providing education with competencies aligned to the Four P's Telehealth framework will provide learners with tools to assume leadership roles in all phases of telehealth implementation, delivery, and refinement.

Telehealth Education: An Interprofessional Online Immersion Experience in Response to COVID-19.

BACKGROUND: In March 2020, due to the COVID-19 pandemic, universities halted in-person education and health care pivoted to telehealth delivery models. This article describes a nurse-led educational program that transitioned to fully online delivery to prepare interprofessional teams of health care students to use telehealth during the pandemic and beyond. METHOD: Participants included 67 students from seven professions. Researchers developed "the four Ps of telehealth" model to guide the curriculum. The program used pre- and postassessments including the Confidence in Planning for Telehealth Scale, the Telehealth Etiquette Knowledge Scale, and the Confidence in Providing Telehealth Scale. RESULTS: There were significant improvements in scores on all scales following the program (p = .000). CONCLUSION: The results suggest that comprehensive telehealth education should focus on more than just delivering telehealth but also planning and preparing for its delivery. Programs such as this online program can serve as a model for future telehealth programs to prepare providers. [J Nurs Educ. 2020;59(10):570-576.].

Telehealth Etiquette Training: A Guideline for Preparing Interprofessional Teams for Successful Encounters.

BACKGROUND: Telehealth technologies have increased in many health care settings. However, much of the training that occurs regarding telehealth is vendor driven. Training that is typically offered focuses on technical aspects of using telehealth equipment, legal issues, and reimbursement. Rarely does industry training involve soft skills or "screen side etiquette" unique to telehealth encounters. PURPOSE: The purpose of this article is to present a training program that prepares students with the unique skill set necessary to conduct telehealth visits. METHODS: A training program was developed to teach health care students (n = 103) proper telehealth etiquette. Preprogram and postprogram data were collected on students' understanding of telehealth etiquette. RESULTS: Results demonstrate significant improvement in knowledge in all areas of telehealth etiquette following the program. CONCLUSION: Students recognized some improper telehealth etiquette prior to the program but improved significantly following the program.

Preparing students to be ready for practice: An innovative approach to teaching advanced physical assessment skills online.

Distance graduate nursing education has been expanding. Although many didactic courses are taught through an online platform, there are often challenges to providing skill-based courses, such as advanced physical assessment, through an online format. To prepare and assess advanced practice nursing students on their clinical knowledge and physical assessment skills, an online course was developed using multisource feedback and videography. Students used videography to record themselves as they conducted physical assessments on a volunteer patient. Students then critiqued their own video, critiqued two of their colleagues' videos, and the final critiques of the videos were conducted by faculty. All students were expected to perform and pass a complete physical examination on a standardize patient as their final examination. The final scores of the students learning through the online course were equivalent to the scores achieved by the students in the traditional face-to-face physical assessment course.

Interdisciplinary Rounds on a Hospitalist Service: Impact on Palliative Care Measures, Quality, and Utilization Outcomes.

BACKGROUND: Despite growth in service availability, palliative care (PC) referrals are often underutilized or delayed, which may compromise patient outcomes. LOCAL PROBLEM: Underutilized or delayed PC referrals among hospitalized adults prompted this project aimed at improving PC measures, quality, and utilization outcomes. METHODS: Data extracted from the electronic medical record were used to identify needed improvements in PC. INTERVENTION: Interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting. RESULTS: Following implementation, median time to PC referral decreased by 2 days. Length of stay (LOS), direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility. CONCLUSIONS: Results support IDRs as a mechanism to improve time to PC referral, decrease LOS, direct cost, and 30-day mortality among hospitalized adults. A more objective method of identifying patients with unmet PC needs may be warranted.

A Workshop for Addressing the Impact of the Imposter Syndrome on Clinical Nurse Specialists.

PURPOSE: The imposter syndrome creates feelings of self-doubt in individuals, which can result in emotional paralysis preventing them from achieving their fullest potential. Clinical nurse specialists are not immune to this phenomenon. The purpose of this article is to describe an educational program designed to assist healthcare professionals, including clinical nurse specialist students, in identifying, understanding, and addressing imposter syndrome. DESCRIPTION OF PROGRAM: Interprofessional students from 8 professions came together for a 2-week interprofessional education experience that included a 1-day workshop. After experiential team building and small group encounters with complicated standardized patients, students were introduced to the imposter syndrome. Students completed the Clance Impostor Phenomenon Scale and engaged in rich dialogue about the phenomenon, its effects, and personal strategies to overcome its impact. OUTCOME: When surveyed using the Clance Impostor Phenomenon Scale, clinical nurse specialist students consistently had high imposter tendencies. As a result of the program, students expressed feelings of liberation and empowerment. CONCLUSION: Clinical nurse specialist students can be impacted by the imposter syndrome, which has a potential to decrease their confidence, thus limiting their ability to practice at their highest potential. Programs that empower the clinical nurse specialists to recognize and address this phenomenon may increase their ability to optimize their role in healthcare.

A Technology Intervention for Nurses Engaged in Preventing Catheter-Associated Urinary Tract Infections.

Catheter-associated urinary tract infections account for 40% of healthcare-acquired infections. This study explored the addition of cloud-based software technology to an established nursing quality improvement program to reduce catheter-associated urinary tract infections. Unit-based nurse champions evaluated peers' evidence-based catheter-associated urinary tract infection prevention practices using manual, paper-based feedback. That process achieved reduced rates of catheter-associated urinary tract infection over 18 months. However, it was resource intensive. Cloud-based software technology was introduced to replace the paper. Nurse champions' satisfaction, catheter-associated urinary tract infection and indwelling urinary catheter utilization, and prevention practices were compared before and after the technology intervention. Compliance with the provision of a chlorhexidine bath demonstrated improvement (P = .003), while other practice measures did not significantly change. The indwelling urinary catheter utilization ratio was lower (P = .01), yet the intervention yielded no change in catheter-associated urinary tract infection rates. The short time interval of the intervention was potentially a contributing factor in no significant rate change. Nurse champions (N = 14) were more satisfied with the cloud-based technology (P = .004), the clarity of improvement targets (P = .004), and the speed of sharing data (P = .001). Their time to share data decreased from 4 days or more to 1 hour or less. Nurse champions readily adopted the cloud-based technology. These findings suggest additional research on technology innovations for nursing quality improvement is needed.

How to Prepare Interprofessional Teams in Two Weeks: An Innovative Education Program Nested in Telehealth.

PROBLEM: Preparing health professional students for interprofessional collaborative practice, especially at a distance where provider shortages prevail remains difficult. APPROACH: A two-week interprofessional education (IPE) immersion experience preparing students from 11 disciplines and four universities was implemented. Week-one, using online technology, students develop/present an interprofessional careplan for a complex patient. Students then meet face-to-face to conduct group interviews with two standardized patient dyads. Week-two, students develop a website for use of the patient dyads. Websites are presented to faculty and fellow students via an online virtual meeting space. OUTCOMES: To date, 594 students have participated demonstrating capacity to: 1.effectively engage in interprofessional care, 2. utilize Telehealth to impact care and break down barriers of isolation, and 3. implement skills to advance healthcare. CONCLUSION: IPE combined with Telehealth technology provides future providers with knowledge and skills for interprofessional care regardless of geographic barriers. Next Step: Integrate more technology using mobile devices and enhance the evaluation process.

Telehealth and eHealth in nurse practitioner training: current perspectives.

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.

Interprofessional team performance, optimized.

Enhance development with behavioral profiles.

An Interprofessional Virtual Healthcare Neighborhood: Effect on Self-Efficacy and Sleep Among Caregivers of Older Adults With Dementia.

An Interprofessional Virtual Healthcare Neighborhood (VHN) was designed to deliver information, peer support, and professional guidance to caregivers of individuals with dementia. The VHN was also enhanced with an actigraphy band to monitor caregivers' sleep. The study sample comprised two groups (N = 28): caregivers participating in the VHN and those receiving usual care. Measures of sleep quality and quantity, using an actigraphy band; general self-efficacy, using the General Self-Efficacy Scale; and insomnia, using the Insomnia Severity Index, were measured pre- and postintervention for the intervention and comparison groups. Neither group reported significant changes in sleep quality or quantity over time. Insomnia severity decreased for both groups. Self-efficacy became worse for the comparison group, yet remained virtually unchanged for the intervention group. Overall, the current study also showed an effective use of technology to reach homebound caregivers of older adults with dementia. [Journal of Gerontological Nursing, 42(11), 39-47.].

Factors That Influence Women to Disclose Sexual Assault History to Health Care Providers.

OBJECTIVE: To examine women's experiences with sexual assault screening by health care professionals and identify factors that influence women to disclose their sexual assault history to providers. DESIGN: Cross-sectional descriptive survey with correlational analysis. SETTING: On-line survey distributed nationally. PARTICIPANTS: One hundred forty-three women. METHODS: Participants were recruited through social media; the authors e-mailed organizations across the nation and asked them to share links to a Facebook page connected to the survey. Descriptive statistics, Spearman's rho, and contingency tables were calculated, and qualitative content analysis was performed by thematic analysis. RESULTS: Most (n = 103, 72.5%) participants reported that they felt comfortable with being asked about sexual assault, but only 41 (28.7%) participants were screened for sexual assault by health care professionals. Positive attitude and increased comfort level with screening were associated with increased intention to disclose past assault (p < .05). A total of 113 (82.5%) women reported intentions to disclose sexual assault to a provider if asked, whereas only 35 (24.6%) women would voluntarily disclose. Women identified prevention of medical and physical consequences as main facilitators to disclosure, and provider attitude and demeanor as the main barriers. Sixty-nine (48.9%) participants were victims of sexual assault. Women with a history of sexual assault were no more likely than women not victimized to have been screened for sexual assault. CONCLUSION: Study findings suggest that women are often not screened for sexual assault despite being receptive to inquiry. Health care professionals often do not identify those who have been sexually assaulted because they do not ask. Thus, many victims do not receive needed sexual assault resources and support.

The Noncompete Clause and the Nurse Anesthetist: An Assessment of Knowledge, Perception, and Experience.

Economic pressures and the challenge to maintain competitive advantage have resulted in many healthcare entities requiring their practitioners to contractually enter into noncompete clauses (NCCs). Many student registered nurse anesthetists (SRNAs) and Certified Registered Nurse Anesthetists (CRNAs) are unaware of NCCs in employee contracts. An anonymous, web-based questionnaire regarding NCCs was distributed to SRNAs and CRNAs nationwide. Of 242 practicing CRNAs who responded, 147 (60.7%) were employed without a noncompete clause and 22 (9.1%) were unaware whether they had such a provision in their employment contracts. The knowledge level of the nurse anesthetist respondents was low (average score of 55.3%). There was a significant difference in knowledge level between independently practicing CRNAs and group-practice CRNAs (P = .007) as well as practicing CRNAs vs SRNAs (n = 8, P = .006). Independent CRNAs had more experience with declining positions, changing positions, and loss of employment due to NCCs. More CRNAs believed the NCC is not applicable to practice, and no evidence existed to show a relationship between geographic location and having an NCC. Business-minded CRNAs with a practical knowledge of keyterms, concepts, and legal implications of NCCs are in a better position to bargain and negotiate against objectionable provisions.

Barriers in asthma care for pediatric patients in primary care.

INTRODUCTION: There are many barriers to treating children with asthma. Barriers limit access with subsequent disturbances in quality outcomes. This study explored the difference in quality outcomes, utilization outcomes, parental knowledge, and barriers to care between children who had controlled versus uncontrolled asthma. METHOD: Data were analyzed between two intact groups of caregivers of children with asthma. Caregivers in both groups completed the Asthma Knowledge Test and the Asthma Barrier Questionnaire. RESULTS: Caregivers (n = 62) were primarily mothers (85.5%). Children with uncontrolled asthma missed 33.3% more days of school. The caregivers of the children with controlled asthma answered more questions on the Asthma Knowledge Test correctly and had a lower score on the Asthma Barrier Questionnaire. DISCUSSION: Asthma control is essential. By identifying barriers to care, health care providers can build an action care plan to individualize each patient's needs.