Improving Care Transitions: An Academic Service Partnership to Achieve Coordination of Care Using Students as Health Coaches.

To avoid penalty through the Hospital Readmission Reduction Program, an academic practice partnership, Health Transitions Alliance, was formed with the local university, resulting in adoption of an innovative transitional care model. Key to the model was a health coach who operationalized transition care to the home setting. Health coaches, interns in their last semester of college, used motivational interviewing to help patients set disease management goals. As a result of this model, the readmission rate for program participants in the initial 7 months was reduced by 72%.

Use of Technology to Promote Effective Medication Adherence.

Ineffective medication adherence among older adults can lead to the exacerbation of chronic health conditions, hospital admissions, and other avoidable health care costs. As hospitals increasingly focus on population health, the use of technology in patient homes is one approach to increase overall adherence with medications. The successful use of technology can reduce the number of medication errors, including missed doses, taking extra doses, and taking the wrong drug.

Improving Crew Overboard Recovery for Commercial Fishing in the Gulf of Mexico.

Occupational fatality rates in the commercial fishing industry in the United States remain more than 20 times higher than the national average. The burden of commercial fishing fatalities due to unintentional falls overboard is highest in the Gulf of Mexico (GOM) shrimp fishery. The objective of this quasi-experimental, pre-/post-test project design was disseminating recovery slings to GOM captains/deckhands, training in their use, and assessing the attitudes, beliefs, and intentions of fishermen in their adoption. Due to the COVID-19 pandemic, a land-based simulation was used to train commercial fishermen at three port locations in use of crew overboard (COB) recovery slings. A survey was developed to assess the attitudes, beliefs, and intentions of commercial fishermen in COB recovery. Purposive sampling was employed to recruit 30-50 fishermen at each location. Following pre-/post-training surveys, fishermen received one recovery sling per vessel along with a task list of instructions for use of the sling. A third survey and task list questions were performed at 12-18 months. There were 119 recovery slings and training in their use provided to 123 commercial shrimp fishing vessel owners/captains and deckhands along the Texas and Louisiana Gulf Coast. Repeated measures analysis of variance of the three surveys showed that positive change in normative beliefs was significant for the importance of quickly and safely maneuvering the vessel to the crew member. This change was most significant over the period from the initial training and receipt of the recovery sling by the vessel captain/deckhand, to the time of follow-up 12-18 months later (p = .03). Regarding control beliefs, training was associated with immediate statistically significant improved confidence that, with assistance, the fisherman would be able to use the sling and other equipment to hoist the COB (p = .02). However, this confidence waned significantly over time (p = .03). Attitudes and beliefs of commercial fishermen in the GOM can be favorably influenced toward a COB recovery device, as well as their confidence, and intention to use such devices. However, results show that attitudes and beliefs may wane over time, emphasizing the importance of repeated training and survival drills in this industry.

Graduate nursing online orientation course: transitioning for success.

Graduate nursing students beginning their graduate education often lack technological preparedness when beginning the journey in a virtual e-learning environment. These gaps in preparedness include lack of understanding course delivery, accessing resources remotely, participating in asynchronous course activities, and use of emerging health care technologies. This article describes an educational innovative online orientation course that simulates course activities so that students get a true perspective of what e-learning entails. With enhanced education through the accelerated learning modules, students became proficient with distance education, which promotes success in an online master's of science in nursing program.

Self-reported back pain among farm women in southeast Louisiana.

This cross-sectional survey details the incidence and predictors of self-reported back pain among farm women from southeastern Louisiana. The sample was obtained from a preexisting data set of a cross-sectional randomized sample of farm women who participated in the Louisiana Farm Family Injury Prevention and Health Initiative research project. The Haddon Injury Model was used as the conceptual framework. Approximately one fourth of the women in the sample reported back pain in the past year. The major findings from logistic regression analysis were that women reported back pain if they were hauling animals to market and had physical health conditions. Implications for nursing practice include assessing the risk of back pain among farm women and providing client education that includes the importance of compliance with recommended health screenings for early detection and treatment of physical health conditions associated with back pain.

Experiences in the Gulf of Mexico: Overcoming Obstacles for Commercial Fishing Occupational Safety and Health Research.

Researchers involved in community-based participatory research often face challenges due to numerous dynamic factors, including the physical location of the study population, willingness to participate, language barriers, cultural norms, social stigmas, and unpredictable weather and other disasters. Investigators who work with commercial fishermen are all too familiar with these potential obstacles and barriers to performing occupational safety and health research. Such has been the case along the Texas and Louisiana gulf coasts, where the burden of occupational fatalities in the shrimp fishery remains high. Moreover, the need for strategic community, regulatory agency, and research partnerships in order to explore solutions that can help to reduce this burden is ongoing. The IFISH 5 conference and the panel session described in this brief report offered a venue to acknowledge and create awareness of these barriers and opportunities for developing sustainable solutions that can have an impact on this loss of life. The approach taken was to explore the perspectives of a panel of regional collaborators including two researchers, an outreach community liaison, and a marine safety and health official from the U. S. Coast Guard. Key barriers emerging from the panel fell into four themes, each emphasized by one of the four panel members, allowing for discussion of potential solutions. The themes included: (1) language gap; (2) cultural influences and use of personal flotation devices; (3) relationships with the community; and (4) enforcement agency role as a trusted opinion leader. This panel session can readily serve as a model to promote similar exploration of barriers and solutions in commercial fishing across other regions of the US and internationally as well.

My father's experience with macular degeneration: implications for the home healthcare nurse.

Macular degeneration has become a problem of substantial proportions for older adults. This article can help the home health nurse gain a greater understanding of macular degeneration and therefore be more effective in the home setting. The addition of vision rehabilitation also can prolong older adults' independent years and enhance their satisfaction with life. Using Parse's human-becoming theory as a theoretical framework, the home health nurse can coparticipate in the older adult's experience of living and thus enhance the probability that the last years will be a rewarding time of life.

The impact of hearing impairment, perceptions and attitudes about hearing loss, and noise exposure risk patterns on hearing handicap among farm family members.

Farm noise exposure is the major cause of noise-induced hearing loss among farmers. Hearing impairment associated with hearing loss, however, may not adequately represent communication handicap and the impact on quality of life. This descriptive correlational study examines the impact of hearing impairment, perceptions and attitudes about hearing loss, and noise exposure risk patterns on hearing handicap among farm family members. A convenience sample of 56 farmers and family members recruited from community-based agricultural events was studied. A hearing impairment was noted in the majority of the participants (80.4%). Fewer than 10 reported regularly wearing protection during work or recreational activities. High-frequency hearing loss in the left ear (F= 10.30, p < .002), the attitude that wearing hearing protection prevents others from getting one's attention (F= 11.90, p < .001), and the self-reported description of hearing (F= 6.66, p < .013) significantly predicted hearing handicap using multiple regression analysis. Farmers and family members do not use hearing protection because they are concerned they will not hear others who are trying to communicate with them. The findings of this study confirm that this attitude, along with hearing loss in the left ear, is associated with a communication handicap in work settings. Although being able to hear others on a day-to-day basis is important, this attitude may contribute to behaviors leading to hearing loss and decreased communication over time.

Workplace Safety Interventions for Commercial Fishermen of the Gulf.

Commercial fishing continues to have one of the highest rates of occupational fatalities compared with other work sectors in the United States. Attitudes/beliefs among Vietnamese shrimp fishermen of the Gulf of Mexico may influence behaviors that are risk factors for fatal and nonfatal injuries. The study employs a community trial with quasi-experimental pretest/posttest intervention design. An advisory group made up of key stakeholders including representatives from the US Coast Guard was assembled. A survey was designed using the Theory of Planned Behavior as the theoretical framework. Three community groups at port sites along the Texas/Louisiana Gulf Coasts were identified. Focus groups were convened at each site to select priority areas for risk intervention using training and awareness measures. Initial and follow-up surveys were administered pre-/post-interventions for each of the three community groups (2008, n = 217 completed surveys; 2012, n = 206 completed surveys). The follow-up survey was condensed and "intent to act" questions were added for the priority concerns identified (noise-induced hearing loss, machinery/winches, and fatigue). Statistically significant changes (P ranging from .000 to .042) were observed in selective attitude/belief responses for hearing/noise and fatigue. Intent to action or to adopt the intervention was high among all three groups of shrimp fishermen (hearing conservation, 82.4%; machinery/winch safety, 94.6%; fatigue awareness, 95.3%). Simple, yet culturally appropriate training and awareness measures in the form of visual and written safety messages favorably influence attitudes, beliefs, and behavioral intent related to priority risk factors identified by Vietnamese commercial shrimp fishermen along the Texas and Louisiana Gulf Coasts.

Occupational risky business: injury prevention behaviors of farm women and children.

On farms in the United States, there are approximately 100 fatal and 32,800 nonfatal injuries annually in children 19 years and younger (United States Department of Labor, 1999). Up to 40% of nonfatally injured children are left with permanent disabilities. The impact of injury and death on children associated with farming in the United States is substantial. Research suggests that modeling of health behaviors may be an effective technique for the socialization of children's health behaviors. The purpose of this study is twofold. First, the study describes the participation and use of protective farm equipment or practices by the caregiver and the child. The second purpose is to compare the practices of the caregivers and the children in relation to the use of protective farm equipment and practices. Descriptive and categorical data analysis methods were used to examine the associations of 177 pairs of caregivers and children and their use of protective equipment and preventative behaviors. Greater than 50% of the children under the age of 7 had handled or touched livestock, as well as rode as passengers on tractors. Many children in all age categories had ridden in the back of pick-up trucks. Modeling of the prevention behavior by the caregivers did parallel the use of the equipment by the children. However, the opposite also was true; if the caregiver did not use the equipment, neither did the child.

Adiponectin responses to continuous and progressively intense intermittent exercise.

PURPOSE: Adiponectin is a recently discovered adipocyte protein that is lower in patients with coronary artery disease and in Type II diabetics who have insulin resistance. Regular exercise is known to be a preventative factor in the development of atherosclerosis and Type II diabetes. Acute exercise increases insulin sensitivity; however, it also increases beta-adrenergic and glucocorticoid activities that may suppress adiponectin expression. Two experiments were conducted to determine whether acute exercise affects adiponectin concentrations. METHODS: In the first experiment, six healthy male subjects completed 30 min of heavy continuous running exercise at 79% of VO (2max). In the second experiment, well-trained runners completed strenuous intermittent exercise consisting of treadmill running at 60, 75, 90, and 100% VO (2max). A resting control trial for the second experiment was also conducted. RESULTS: Glucose and insulin were not altered significantly in the first experiment, but both increased significantly (P < 0.05) in the second experiment. A significant increase (P < 0.05) in adiponectin in the first experiment was no longer significant after correction for plasma volumes shifts. In the second experiment, there were significant (P < 0.05) changes in adiponectin concentrations over time but not a significant difference between adiponectin responses in exercise and control trials. CONCLUSIONS: The data suggest that 30 min of heavy continuous running or more strenuous intermittent running does not stimulate an increase in production and release of adiponectin, and small increases in adiponectin concentrations resulting from the exercise may be attributed to normal plasma volume shifts.

Nonfatal injury experiences among women on family farms.

Agricultural injury occurrence was determined among 1,096 working farm women in Texas and Louisiana. The 1-year cumulative incidence was 4.8%. Lower extremities were the body parts most frequently injured. The leading external causes were contact with foreign object, followed by falls and overdoing/ lifting. The seasonal pattern of injury was consistent with warm weather. The factors predictive of increased injury risk in multiple logistic regression included large animal farm type, greater time commitment, recurrent or persistent back conditions or weakness during the previous 12 months, hauling goods to market, and driving a tractor more than 52 days per year. Most women consulted a physician as a result of the injury. Resolving the problem of preventable farm-related injuries will require a major and coordinated effort aimed not only at farm women themselves but also at multiple variables that profoundly affect the underlying conditions and behaviors that lead to farm-related injuries.

Health hazards and preventive measures of farm women. Emerging issues.

Currently, an increasing number of farms are family owned and women are directly involved in the farming operations as an independent manager or partner. Women play an important role in farm management by marketing farm products, purchasing materials, and financial planning. Because of this involvement, women can be exposed to potential health hazards that can result in chronic illness, debilitation, or death. This study explored and described health hazards affecting farm women in southeast Louisiana, preventive measures used by farm women, and their consistency in using protective equipment with varying levels of time commitment toward farm operations. This cross sectional study included women older than 18 whose family participated in farming operations. A stratified, random sample design with parishes comprising the strata and simple random selection without replacement within each stratum was used to select family addresses. A total of 519 women who met the criteria completed a structured 30 minute telephone interview conducted using The Louisiana Farm Health and Injury Survey instrument. Information elicited included farm work characteristics, prevention practices, and demographics. Results showed that women working 1 to 20 hours per week were less likely to wear personal protective equipment (PPE) than women working more than 20 hours per week. This included wearing seat belts on tractors; using hearing, eye, or breathing protection; and wearing gloves or boots. No differences were found between groups for use of skin protection, hair holders, or helmets on all terrain vehicles (ATVs). The researchers concluded that if nursing interventions such as teaching and counseling related to prevention methods could be provided, the incidence of acute and chronic illnesses and traumatic injury would decline.

Helping Gulf shrimpers adopt safety measures: importance of partnerships and research to practice.

Commercial fishing continues to be a dangerous line of work. There are many hazards and the work is complex, even on a small scale. Along the United States Gulf Coast, the make-up of the commercial fishing population is diverse, with many Vietnamese shrimpers. Cultural barriers can interfere with critical communication and with receptivity to necessary safety training. In the course of studying these factors, it became apparent that language was a significant barrier among Vietnamese shrimp fishermen learning sound signals and making Mayday calls, potentially contributing to adverse events. This article is a qualitative description of a pilot project in response to this observation and aimed at the development of a model simulating the bridge of a commercial fishing vessel (including horn blast and radio). The model is used to improve knowledge and skills of the fishermen by providing instruction in Vietnamese. As a Mayday call must be made in English, instructional aids are provided to assist fishermen in the exercise. This example of research to practice (r2p) demonstrates how research findings may enhance acquisition of safety knowledge and skills through development of these types of models as well sustainable instructional tools like the multi-lingual interactive CD described here. It further illustrates the importance of partnerships in the design and delivery of workplace safety training interventions. The model, instructional aids, and CD are timely as they coincide with new regulation which mandates certification of these competencies or skills.

Evaluation of a school-based train-the-trainer intervention program to teach first aid and risk reduction among high school students.

BACKGROUND: Farming is a hazardous occupation posing health risks from agricultural exposures for the farm owner and family members. First Aid for Rural Medical Emergencies (F.A.R.M.E.) was developed to support a train-the-trainer (TTT) program to prepare high school students to teach first aid skills and risk reduction through peer interaction. This study was designed to evaluate the educational effectiveness for first aid skill development and awareness of safety issues and injury prevention impacting agricultural communities. METHODS: Forty-three agricultural science students from a rural high school participated in the study. A quasi-experimental design was used to evaluate knowledge acquisition and anticipatory action among groups: those participating in training and a comparison group with no training. The intervention group included 27 participants trained as first aid peer instructors using the F.A.R.M.E. manual, return demonstration, case scenario facilitation training, and teaching evaluation sessions. The effectiveness of the program was evaluated using triangulated data. Independent t test analyses were conducted on post-test scores to evaluate the knowledge acquisition and anticipatory action scores between groups. Focus group sessions assessed attitudes, experiences, and values held following the intervention of teaching peers. RESULTS: Results indicate that the intervention group scored significantly higher on anticipatory action (t = 2.23, p = .03) but not knowledge acquisition (t = 1.37, p = .18). Focus group data suggest that the TTT format bolstered confidence in teaching, confirmed that teens enjoy learning from teens, and fostered pride in team work. CONCLUSIONS: The F.A.R.M.E. TTT resulted in a theory and evidence-based intervention that can be implemented in a school setting to promote knowledge and skill acquisition of first aid and injury prevention among rural high school students.

Factors influencing safety among a group of commercial fishermen along the Texas Gulf Coast.

The commercial fishing trades are among the most dangerous jobs in the world. Little published information exists regarding some populations of commercial fishermen such as along the United States Gulf Coast. Studying these unique and often vulnerable groups is important to characterize potential influences on or barriers to safety in anticipation of designing interventions that can change safety behaviors. Working closely with the United States Coast Guard (USCG), a cross-sectional convenience sample of Gulf Coast shrimp fishermen in and near the Port of Galveston, Texas, was surveyed. The survey included demographic factors and broadly covered areas such as type of work and fishing activities, general or global perceptions and beliefs related to safety and accidents, self-report of ability to use safety equipment or apply procedures aboard vessel, and training considerations. Surveys were obtained following informed consent (n = 133). Of the participants, 96.7% were male with 60.9% ≥40 years old. A majority were of Asian descent (57.1% of all fishermen, 82.1% of shrimp fishermen). Over half claimed to speak little or no English and nearly 60% considered the job to be very safe to neutral. A third to half of respondents expressed doubt about their knowledge of using essential safety equipment in the event of emergency. A large portion of the participants preferred hands-on safety training (40.6%). Important findings about this group of commercial fishermen will help with future development of effective prevention practices through the delivery of culturally appropriate safety awareness training. One element that must be addressed in training programs is to increase the awareness among fishermen about the severe occupational risks inherent in this type of work. Community trust and collaborative partnerships are essential to the success of such initiatives.

Cultural influences on safety and health education among Vietnamese fishermen.

Every ethnic group has its own cultural background and history that influences how it views health behaviors. By virtue of their work history, many Vietnamese have pursued the fishing industry when migrating to the United States. Even though the fishing trades are among the most dangerous jobs in the world, there has been little attention in the literature to the significant role that culture plays in the expression and experience of occupational health practices among Vietnamese shrimp fishermen. Three focus group sessions were conducted to identify factors that hinder or facilitate receptivity to available training and to guide culturally appropriate content. Participants were recruited using purposive sampling among various Vietnamese shrimp fishermen communities in Texas. Utilizing a series of open-ended questions, sessions were conducted in their native language among owners/captains/deckhands; support infrastructure--adult family members and religious/community leaders; and industry management and insurance representatives. Translations of transcribed documents were compared with simultaneous translations to ensure thematic consistency. Conducting hands-on training among Vietnamese by experienced fishermen, specifically targeting captains, was considered key to safety culture on the vessels. Findings of the study support that training should occur in a variety of formats (hands-on), but should be periodic, current, practical, convenient, taught in the primary language of the audience by an experienced individual, culminate in a certificate of completion, and target captains first. These findings illustrate the importance of considering cultural factors in the design of workplace interventions that focus on changes in safety and occupational health behaviors.

Behavior change, environmental hazards and respiratory protection among a southern farm community.

The agricultural industry ranks as one of the most dangerous in terms of occupational deaths and injuries. A wide variety of respiratory illnesses can result from the exposure to grain and organic dusts and working in animal confinement facilities and barns. This article analyzes the Transtheoretical Model of Change for implications relevant to health promotion and education. This study explored differences of perception of occupational health, environmental exposures, and stages of change consistent with the readiness to take action and the confidence to act toward respiratory health among farmers who report respiratory symptoms with physical activity and those who do not. A convenience sample of 123 farm owners and agricultural employees recruited from community-based agricultural events in southeast and central Louisiana completed three surveys: (a) Health Risk and Environmental Assessment; (b) Identification of Respiratory Mask Use; (c) Stage of Awareness and Preventive Respiratory Health; and demographic information. Subjects performed pulmonary function tests including three Forced Vital Capacity (FVC) maneuvers while connected to a Renaissance spirometer. Even though the majority of subjects rated themselves in action stage of change, subjects reported using respiratory protective devices less than 10% of the time. No significant differences were found in environmental exposures. Using chi-square analysis, those farmers who reported breathlessness were significantly more likely to report fatigue, chest pain, and dizziness. Those farmers who report breathlessness are significantly less likely to perceive respiratory health as important compared to other occupational illnesses/conditions. There is a need for additional studies to further examine the relationship between respiratory symptoms, exposure risks, and behavior change theory.