A Cost Comparison for Telehealth Utilization in the Kidney Transplant Waitlist Evaluation Process.

BACKGROUND: There have been limited publications on telehealth utilization in transplantation with no prior reports of telehealth-related costs for pretransplant evaluations. The aim of this study is to compare costs throughout the evaluation process for those patients assessed initially by telehealth with those seen in-person. METHODS: All patients approved for kidney transplant waitlist evaluation at our center from March 2013 thru May 2016 with decisions were included in this study. Patients approved for evaluation were scheduled for either an initial telehealth or in-person visit, partly based on patient factors. Clinically related and travel-related costs were calculated. Time estimates for patient time needed to complete visit, time from application approval to initial visit, and time from application approval to decision were obtained. Comparisons were made using t tests. RESULTS: Thirty-nine months were included for 302 patients. All categories of clinically or travel-related costs were significantly less for the telehealth cohort (P < 0.0001). Total mean cost per patient was US $656.11 versus US $1108.91 for the cohort initially evaluated by telehealth versus in-person (P < 0.001). The time needed to complete an evaluation (1.7 vs 2.4 days, P < 0.001) and the time to initial evaluation (51.4 vs 87.9.0 days, P < 0.001) were significantly less in the telehealth cohort. The cohort seen by telehealth was older with increased comorbidities (<0.001). CONCLUSIONS: As telemedicine applications continue to proliferate, we present our experience with telehealth for initial kidney transplant waitlist evaluations with associated reductions in cost and time which may also improve access to transplantation.

Implementation of telehealth is associated with improved timeliness to kidney transplant waitlist evaluation.

Introduction The United States Department of Veterans Affairs (VA) National Transplant Program has made efforts to improve access by introducing Web-based referrals and telehealth. The aims of this study were to describe the programmatic implementation and evaluate the effectiveness of new technology on the timeliness to kidney transplant evaluation at a VA medical centre. Methods Between 1 January 2009 and 31 May 2016, 835 patients were approved for evaluation. Monthly data were summarized as: number of applications, median days to evaluation, and median percentage of evaluations that occurred within 30 days. Temporal trends were analysed using non-parametric comparisons of medians between three eras: Pre Web-based submission, Web-based submission, and Web-based submission with videoconference (VC) telehealth. Results The number of applications did not vary between eras ( p = 0.353). The median time to evaluation and the median percentage of patients with appointments within 30 days improved significantly in the Web-based submission with VC era when compared with the Web-based and Pre Web-based eras (37 vs. 260 and 116 days, respectively, p < 0.001; 100% vs. 8% and 0%, respectively, p < 0.001). Discussion We have been able to markedly improve the timeliness to kidney transplant waitlist evaluation with the addition of telehealth.

Critical service learning in community health nursing: enhancing access to cardiac health screening.

Critical service learning (CSL) offers promise for preparing community health nursing students to be advocates for social justice and social change. The purpose of this article is to describe a community based CSL project designed to provide cardiac health screening to an underserviced population, wherein nursing's role in social justice is integrated into nursing practice. First, the relationship between social justice and CSL is explored. Then, the CSL approach is examined and differentiated from the traditional service learning models frequently observed in the nursing curriculum. The CSL project is described and the learning requisites, objectives, requirements, and project outcomes are outlined. While not a panacea for system reform, CSL offers nursing students avenues for learning about social justice and understanding the social conditions that underlie health inequalities. Nurse educators may benefit from the new strategies for incorporating social justice into nursing curriculum; this paper suggests that CSL offers one possibility.

Service learning with vulnerable populations: review of the literature.

The service learning model has been touted as a powerful pedagogical approach, a reasonable option for providing care to vulnerable and diverse populations, and a vehicle for educating nursing students to become agents of social change. The literature on service learning with vulnerable populations in nursing education is reviewed and synthesized in this article. A description of service learning experiences, identification of knowledge and skills learned, opportunities for critical thinking and reflection, and a discussion of factors that act as enablers and barriers to service learning are explored. Recommendations for successful integration of service learning into educational settings are provided for nurse educators, academic institutions and community partners. As the service learning model spreads across nursing education it is suggested that it offers promise to foster social change and produce graduates who are fully engaged citizens and professionals.

Nurses' knowledge, attitudes, and confidence regarding preventing and treating deconditioning in older adults.

BACKGROUND: This article examines nurses' knowledge, beliefs, attitudes, and confidence regarding providing care to prevent and treat deconditioning in hospitalized older adults. METHODS: Data were collected from 157 registered nurses enrolled in a post-registered nurse, bachelor of science in nursing program using a descriptive cross-sectional survey. RESULTS: Nurses' responses reflected substantial gaps in their knowledge and theoretical understanding of deconditioning, and a strong belief in the need for more education on the prevention of it. Levels of confidence in preventing deconditioning in older adults were modest, but participants expressed positive attitudes toward nurses' role in deconditioning care. Barriers to deconditioning care included lack of education, low staffing levels, and a lack of valuing prevention efforts. CONCLUSION: This study suggests that it is important to establish gerontology continuing education programs with a core component on deconditioning treatment and prevention to enhance nurses' knowledge and confidence levels in providing care to older adults.

A chronicle of BScN honours/ non-honours outcomes and experiences post-graduation.

This paper reports on a graduate follow-up of the outcomes of participation in an honours BScN program, two to seven years post-graduation. It compares two groups of graduates with high GPA scores, both initially eligible to complete the honours program. One group completed the honours program; the other group completed the regular BScN program. In phase 1 of the study, a self-administered mailed questionnaire was sent to participants to assess their involvement in research activities, occupancy of leadership positions, enrollment in graduate studies and demonstration of liberal education competencies in their professional lives after graduation. In phase two, personal interviews were held with a purposive subsample of participants to explore early career workplace experiences with research-based activities and participants' perceptions of factors influencing their decision to complete or not to complete the honours program. Graduates with high GPA scores from both programs demonstrated expected professional outcomes post-graduation. Follow up at 10-12 years post-graduation and replication with larger samples are recommended.

Unmasking delirium.

The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. Delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. It has three categories: hyperactive, hypoactive and mixed. Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. Delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education.

Deconditioning in the hospitalized elderly.

Deconditioning is a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle. It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living. It is frequently associated with hospitalization in the elderly. The most predictable effects of deconditioning are seen in the musculoskeletal system and include diminished muscle mass, decreases of muscle strength by two to five percent per day, muscle shortening, changes in periarticular and cartilaginous joint structure and marked loss of leg strength that seriously limit mobility. The decline in muscle mass and strength has been linked to falls, functional decline, increased frailty and immobility. The authors describe a three-pronged strategy to combat deconditioning that includes a model of care appropriate to the growing population of elderly clients, the creation of an "elder-friendly" hospital environment and an exercise program.

University nurse graduates: perspectives on factors of retention and mobility.

This descriptive study explored the perspectives of 51 university nurse graduates from the St. Francis Xavier University School of Nursing. Qualitative and quantitative data were collected using telephone interviews to study a range of variables including geographic mobility patterns, career satisfaction and attitudes towards recruitment and retention factors. Given the negative perceptions in the media about nursing, the results of the study were unexpected and offer a sense of hope to those considering nursing as a career. Results indicate that graduates remained enthusiastic about their career choice and would choose nursing again as a career given the opportunity to do so. Furthermore, they would recommend nursing to others as a desirable career. The majority of graduates entered nursing because of a desire to make a meaningful difference in people's lives, and they were strongly influenced by positive nurse role models. Participants remained committed to a career in nursing, enjoyed considerable geographic mobility with migration to other Canadian provinces and the USA, but the majority returned to Canada for employment in nursing. The study confirms that the supportive nature of the work environment in which care is practised, the presence of visible and empowering nurse leaders, adequate compensation and benefits, and appropriate investment in continuing education and professional development of staff are significant factors in retaining nurses. Additional recommendations for enhanced recruitment and retention strategies are provided.

Honours education: releasing leadership potential.

There is debate within the nursing profession in regard to determining the best approach to Leadership development for the new millennium. Should nursing adopt career pathways Like other disciplines that enable individuals to develop leadership potential in a timely fashion? St. Francis Xavier University (StFXU), the number one ranked undergraduate school in the country (DeMont 2002), has established an innovative strategy that promotes Leadership development at the undergraduate level. It has launched a special stream of its BScN program that culminates in an honours degree. The program, the first of its type in Canada, is designed to produce nursing leaders and scholars who will possess the core competencies required for leadership in diverse environments. This paper discusses the role of honours education in nursing, describes the curriculum and related Learning activities in the StFXU honours program and explores the benefits and challenges that an honours program has to offer. The findings will benefit nurse leaders in educational and practice settings, professional organizations and policy arenas who are interested in influencing the development of leadership in nursing.