Using Large-Group Simulation Incorporating a Variety of Media Formats in Innovating Interprofessional Education.

ABSTRACT: Innovative teaching strategies incorporated into curricula can prepare students for interprofessional practice and have a positive impact on patient outcomes and team dynamics in health care. Our team of faculty from nursing, social work, and pharmacy developed and implemented an activity using simulation in the large classroom to improve students' perceptions of working in interprofessional teams. Effectiveness was assessed using the Interprofessional Collaborative Competencies Attainment Survey with a pretest-posttest design. Our experience indicated that this teaching approach can be an effective strategy for maximizing resources and providing meaningful interprofessional student experiences.

Ten Lessons Learned in the Implementation of Mobile, Community-Based Interprofessional Clinics.

ABSTRACT: Incorporation of interprofessional activities within health profession programs is critical to prepare students for practice. Faculty at our institution saw a need to incorporate interprofessional education in the nursing, pharmacy, social work, and dietetics program curricula. We collaborated with a medical school in the area to develop a mobile, community-based interprofessional clinic to deliver care and education and address the needs of older adults while also providing unique, meaningful learning opportunities for students. We describe several lessons learned from our experience of developing and implementing this interprofessional clinic.

Support for diabetes using technology: a pilot study to improve self-management.

Technology may assist people living with type 2 diabetes with self-management. A pilot study that used Apple iPad technology to support diabetes self-management is described.

Insomnia in the Veteran Population: A Sleep Health and Wellness Intervention.

The purpose of this evidence-based project (EBP) was to determine if an evidence-based sleep health and wellness intervention improved sleep in veterans self-reporting a history of insomnia. Insomnia can negatively affect an individual's physical and psychological well-being, as well as increase health-care costs and decrease the overall quality of life. The intervention utilized a combination of insomnia treatments, delivered to two American Legion veteran participant groups: an Alabama American Legion Retreat and individuals at an American Legion Post site. The holistic-focused modalities used in this intervention included Cognitive Behavioral Therapy for Insomnia (CBT-I) techniques, sleep hygiene principles, and Complementary and Alternative Medicine (CAM) methods. The measurement tool, the Insomnia Severity Index (ISI), indicated statistically significant changes in the severity of participants' self-reported insomnia. Based upon the research evidence and results of the pre- and post-test ISI, a more permanent, ongoing sleep health and wellness intervention is feasible and would have numerous beneficial effects for the veteran's management of insomnia symptoms. Future efforts include implementing sleep hygiene, CAM interventions, and holistic nursing-supported education interventions at other sites and venues within the Alabama American Legion, as well as maintaining long-term community partnerships with veteran groups such as the Alabama American Legion.

Achievement of interprofessional competencies in live and virtual community clinics: A comparative study.

BACKGROUND: Interprofessional education is imperative for training future healthcare professionals. While barriers exist within and across institutions to implement and sustain effective interprofessional education experiences for students, virtual clinics utilizing electronic health records may provide comparable benefits to in-person clinics. OBJECTIVE: To determine whether differences in pre- and post-test self-assessments of interprofessional collaborative competencies are different between in-person and virtual clinics. DESIGN: Pretest-posttest design utilizing the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) before and immediately after participating in clinics, virtual or in-person. SETTING: A large, public university in the southeastern United States. PARTICIPANTS: Senior nursing students, third-year pharmacy students, senior nutrition/dietetics students, and undergraduate and graduate social work students. METHODS: This study was conducted evaluating five cohorts of students engaged in interprofessional education clinics. Two cohorts completed in-person community clinics in 2019. In March 2020, the interprofessional education program adopted virtual clinics (three cohorts) utilizing pre-selected electronic health record cases. Student responses from the 20-item ICCAS, which was completed before and immediately after clinics, were aggregated into interprofessional competency subscale scores (communication, collaboration, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution, and team functioning) and a total ICCAS score. Two-way ANOVA assessed Pre-Post and Mode (in-person vs. virtual) on total ICCAS score. t-tests compared Pre-Post ICCAS scores for each Mode. RESULTS: Effects of Pre-Post (p < 0.001), but not Mode (p = 0.523), were observed on Total ICCAS scores. All ICCAS subscale scores were significantly higher in Post compared to Pre regardless of Mode. CONCLUSIONS: Virtual interprofessional education clinics confer similar benefits to interprofessional collaborative competencies in healthcare professions students compared to in-person community clinics. Thus, modality offers flexibility for interprofessional education and provided several benefits over the in-person clinic approach.

The effects of an advanced practice nurse led telephone intervention on outcomes of patients with heart failure.

This study sought to determine the effect of an advanced-practice-nurse (APN)-led telephone intervention on hospital readmissions, quality of life, and self-care behaviors (SCBs) of patients with heart failure (HF). Twenty participants were randomly assigned to either an experimental group that received the APN-led telephone intervention (ALTI) or a control group that received usual care in this pretest-posttest experimental study. The results of this study support the idea that an ALTI positively impacts outcomes of patient with HF, particularly by improving SCBs and decreasing hospital readmissions. An ALTI warrants consideration to improve outcomes of patients with HF.

Increasing cultural competence in nursing through international service-learning experiences.

As society becomes increasingly culturally diverse, preparing nursing students to become culturally competent practitioners has become more critical. The authors share one school's experience with the development and implementation of a cross-cultural, international, service-learning experience. Discussion will include the development of an elective nursing course with cross-cultural content and the implementation of an international service-learning trip to Quito, Ecuador.

Predictors of hospital readmission after discharge in patients with congestive heart failure.

PURPOSE: The purposes of this study were to (1) describe the characteristics of the population with congestive heart failure (CHF) who were admitted to a large, southeastern, acute-care hospital and (2) determine which patients are at risk for readmissions within 6 months. METHODS: A descriptive correlational design, using variables maintained in a computerized data bank on patients with CHF (N = 557, 39% were black) who were admitted between October 2000 and March 2002, was used to describe the adult population with CHF and identify variables associated with a likelihood of readmission. RESULTS: In the 6 months after the index admission, 224 (40%) of the patients were readmitted to the hospital for CHF. Variables significantly associated with readmission included lack of cardiology consult during admission, living status, point of entry of index admission, receiving Medicare, and having pulmonary hypertension. Four models, composed of subsets of variable from the data bank were developed and tested with logistic regression. The model composed of discharge variables was the only model that predicted readmission at a significant level. CONCLUSIONS: There is a need to develop comprehensive data banks to describe patterns of care and their outcomes. Such data should inform plans to manage this vulnerable population.

Impact of a service-learning project on nursing students.

This article describes the incorporation of a service-learning project in a maternal-infant health course in a baccalaureate nursing program. Partnership goals between university faculty and project Early Head Start were to develop and implement a clinical education experience that not only enhanced services to teenage mothers, but also taught students key elements in the delivery of community services to this vulnerable population. This article examines the impact of the service-learning experience on students' understanding of diversity, perceptions of social responsibility in community service, and health care issues. Implications for faculty investment of time and resources are also explored.

Higher Healthy Eating Index-2005 scores are associated with better physical performance.

BACKGROUND: Little is known regarding the relationship between overall diet quality and physical performance among older adults. We examined the association between overall diet quality, as measured by the US Department of Agriculture's Healthy Eating Index-2005 (HEI-2005), and physical performance, as measured by gait speed (n = 2,132) and knee extensor power (n = 1,392), among adults aged 60 years or older. METHODS: Using data from the 1999-2002 National Health and Nutrition Examination Survey, multiple linear regression models controlling for age, gender, race/ethnicity, education, smoking status, comorbidities, medication use, cognitive function, body mass index, and physical activity were used in the analyses. RESULTS: After adjusting for age, gender, race/ethnicity, education, and smoking status, total HEI-2005 scores were positively associated with both gait speed (p for trend = .02) and knee extensor power (p for trend = .05). Older adults with higher HEI-2005 scores had a faster gait speed (p = .03 for both Quartile 3 and Quartile 4 vs quartile 1) compared with those with HEI-2005 scores in the lowest quartile. Those with HEI-2005 scores in Quartile 4 had a greater knee extensor power compared with those with HEI-2005 scores in the lowest quartile (p = .04). The associations between HEI-2005 scores and physical performance remained after further adjustment for comorbidities, medication use, cognitive function, and body mass index. However, the associations were no longer statistically significant after further adjustment for physical activity. CONCLUSION: Adherence to overall dietary recommendations is associated with better physical performance among older adults.

Enhancing faculty resources through peer mentoring.

Peer mentoring is a relationship in which a more experienced person assists a less experienced person to achieve desired outcomes. Mentoring relationships provide benefits for both the mentor and the mentee. The authors describe a peer-mentoring strategy implemented in a skills laboratory to improve skills knowledge, decrease anxiety associated with skills demonstrations, and provide positive socialization and its outcomes.

Contribution of snacking to older adults' vitamin, carotenoid, and mineral intakes.

Decreased food and beverage consumption among older adults can lead to inadequate intakes of energy and numerous micronutrients. Although older adults are prone to having inadequate diets, little research attention has been directed at their dietary behaviors, such as snacking. The purpose of this study was to examine the association between snacking frequency and older adults' daily intakes of vitamins, carotenoids, and minerals. Cross-sectional data for 2,056 older adults (65 years and older) from the 2003-2006 National Health and Nutrition Examination Survey were used for this study. Dietary data were collected through two 24-hour dietary recall interviews. Participants' snacking occasions and daily nutrient intakes were averaged during the two 24-hour recalls. Using linear regression models to adjust for multiple covariates, mean vitamin, carotenoid, and mineral intakes by snacking category were estimated. As snacking frequency increased, daily intakes of vitamins A, C, and E and beta carotene increased. Older adults' daily intakes of magnesium, copper, and potassium also increased as snacking frequency increased. As older adults' snacking frequency increased, their daily intake of selenium decreased, and their snacking frequency was not associated with their daily intakes of the B-complex vitamins, vitamin K, lycopene, phosphorus, iron, and zinc. Providing healthy snacks on a regular basis has practical implications for institutions, centers, or organizations that serve older adults; however, nutritional benefits obtained from snack food and beverages warrant their inclusion in older adults' diet.

Total water intakes of community-living middle-old and oldest-old adults.

BACKGROUND: Literature reporting total daily water intake of community-dwelling older adults is limited. We evaluated differences in total water intake, water sources, water from meal and snack beverages, timing of beverage consumption, and beverage selection for three older age groups (young-old, 65-74 years; middle-old, 75-84 years; and oldest-old, >or=85 years). METHODS: Data for 2,054 older adults from the 1999-2002 National Health and Nutrition Examination Survey were used for this study. Multivariate analyses controlling for age, sex, race-ethnicity, education, and marital status were conducted to determine differences in water intake variables across the age groups. RESULTS: Total water intakes found for the middle-old and oldest-old age groups were significantly lower than those found for the young-old age group. The relative contributions of beverages to total water intake were 40.8%, 38.3%, and 36.4% for the young-old, middle-old, and oldest-old, respectively. The water intakes from beverages consumed at snack occasions were significantly lower for the middle-old and oldest-old groups than those for the young-old group. All groups consumed the greatest amount of water in the morning. Coffee was the predominant source of water from beverages for all groups. CONCLUSIONS: This study fills a gap in the literature by providing an analysis of the daily water intake of middle-old and oldest-old adults. We found that the total water intake for the middle-old and oldest-old was significantly lower than that for the young-old. Future research needs to investigate the clinical outcomes associated with declining water intakes of community-dwelling older adults.