Biofeedback in Grandmothers Raising Grandchildren: Evaluating Intervention Parameters.

This study examined the six critical parameters for evaluating interventions, including necessity, acceptability, feasibility, safety, fidelity, and effectiveness, of a heart rate variability (HRV) biofeedback training intervention in a sample of 20 grandmothers who were the primary caregivers of their grandchildren. After the grandmothers completed the HRV biofeedback training, they answered open-ended questions to provide data on the six parameters during face-to-face interviews. The findings of the study provided evidence for the necessity, acceptability, feasibility, safety, fidelity, and effectiveness of the HRV biofeedback intervention for reducing the stress experienced by grandmothers in raising their grandchildren.

Psychiatric Inpatient Bedside Handoff: Implementation of a Quality Improvement Project and Nurses' Responses.

Psychiatric inpatient unit nurses implemented a quality improvement project to explore strategies to enhance the effectiveness of the change of shift communication between nurses and patients and obtain goals of care information. Three nurses championed a 6-month project to implement more efficient, patient-centered communication; influence patient outcomes; and assess nurses' perceptions about patient satisfaction. A survey established the level of nurse satisfaction regarding the length of time spent at change of shift obtaining patient information. Following a literature review, nurses used a standardized approach for their change of shift report, which they called patient bedside handoff. Nurses reported increased satisfaction with the length of time spent with the patient bedside handoff from a pre-implementation average score of 5.7 (somewhat satisfied) to a post-implementation score of 8.3 (very satisfied). This nurse-led quality improvement project helped illuminate perceived barriers to the implementation of patient bedside handoff and the changes in nurses' perceptions over time. [Journal of Psychosocial Nursing and Mental Health Services, 54(7), 33-37.].

Assessing Access to Five Types of Insurance by People with Multiple Sclerosis Using a Cross-sectional Online Survey.

BACKGROUND: Many individuals with multiple sclerosis (MS) depart the workforce prematurely. In the United States, access to insurance, including health, disability income, long-term care, and life insurance, is largely employment-based or purchased from earnings. Many individuals we see in the clinic experience financial hardship because of a lack of insurance, even if working. We sought to determine the proportion of workers who are financially protected through insurance coverage and the sources of this coverage in a large sample. METHODS: We developed an online survey and opened it to individuals aged 18 to 65 years registered with the North American Research Committee on Multiple Sclerosis, iConquerMS, or the National Multiple Sclerosis Society Minority Advisory Council. Data collected included demographic and disease characteristics, current information about each insurance type (coverage vs no coverage), and when the current insurance policies were obtained relative to MS diagnosis. RESULTS: Of 2507 survey respondents, 82.9% were female, 3.8% Hispanic/Latino, and 91.2% White. The mean ± SD age was 53.5 ± 8.5 years and disease duration was 16.4 ± 8.5 years after diagnosis. The most frequently held insurance types were health (96.3%) and life (58.8%). Only 9.7% of respondents had long-term care insurance. Except for life insurance, most current policies were obtained after MS diagnosis. CONCLUSIONS: Individuals with MS might not prioritize the possible short- and long-term benefits of these types of insurance. Health care providers can direct patients to nonprofit agencies that educate about of these insurance types and emphasize that others with MS have obtained these insurance types after their diagnosis.

Grandchildren's Depressive Symptoms and Perceptions of Family Functioning: Protective and Influencing Factors.

A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children's living situation, parental monitoring, child's resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insight into factors influencing children's depressive symptoms and perceived family functioning, and provides direction for the development of future interventions.

Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.

PURPOSE: This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. METHODS: Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators' summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model. RESULTS: Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers. CONCLUSIONS: Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors' needs. IMPLICATIONS FOR CANCER SURVIVORS: Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.