Barriers and facilitators to caring for individuals with serious persistent mental illness in long-term care.

OBJECTIVE: Many older adults in the United States with serious persistent mental illness reside in long-term facilities, and evidence suggests increasing numbers of long-term care residents with serious persistent mental illness. Healthcare professionals in these settings may face challenges in providing care to these residents. The purpose of this study was to describe health care professionals' perceptions of the barriers and facilitators to caring for long-term care residents with serious persistent mental illness. METHODS: A qualitative descriptive design was employed. RESULTS: Ten healthcare professionals working in long-term care were interviewed. Themes that emerged from the interviews were: coming to know the individual and their unique needs takes time; offering choices and being flexible facilitates trust; respecting the inherent worth of each individual promotes caring. CONCLUSIONS: Caring for individuals with serious persistent mental illness in long-term care requires an individualized, person-centered approach.

Missed Screening Mammography Appointments: Patient Sociodemographic Characteristics and Mammography Completion After 1 Year.

OBJECTIVE: Patients who miss screening mammogram appointments without notifying the health care system (no-show) risk care delays. We investigate sociodemographic characteristics of patients who experience screening mammogram no-shows at a community health center and whether and when the missed examinations are completed. METHODS: We included patients with screening mammogram appointments at a community health center between January 1, 2021, and December 31, 2021. Language, race, ethnicity, insurance type, residential ZIP code tabulation area (ZCTA) poverty, appointment outcome (no-show, same-day cancelation, completed), and dates of completed screening mammograms after no-show appointments with ≥1-year follow-up were collected. Multivariable analyses were used to assess associations between patient characteristics and appointment outcomes. RESULTS: Of 6,159 patients, 12.1% (743 of 6,159) experienced no-shows. The no-show group differed from the completed group by language, race and ethnicity, insurance type, and poverty level (all P < .05). Patients with no-shows more often had: primary language other than English (32.0% [238 of 743] versus 26.7% [1,265 of 4,741]), race and ethnicity other than White non-Hispanic (42.3% [314 of 743] versus 33.6% [1,595 of 4,742]), Medicaid or means-tested insurance (62.0% [461 of 743] versus 34.4% [1,629 of 4,742]), and residential ZCTAs with ≥20% poverty (19.5% [145 of 743] versus 14.1% [670 of 4,742]). Independent predictors of no-shows were Black non-Hispanic race and ethnicity (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.12-2.07; P = .007), Medicaid or other means-tested insurance (aOR, 2.75; 95% CI, 2.29-3.30; P < .001), and ZCTAs with ≥20% poverty (aOR, 1.76; 95% CI, 1.14-2.72; P = .011). At 1-year follow-up, 40.6% (302 of 743) of patients with no-shows had not completed screening mammogram. DISCUSSION: Screening mammogram no-shows is a health equity issue in which socio-economically disadvantaged and racially and ethnically minoritized patients are more likely to experience missed appointments and continued delays in screening mammogram completion.

Findings From a Provider-Led, Mindfulness-Based, Internet-Streamed Yoga Video Addressing the Psychological Outcomes of Breast Cancer Survivors.

The aim of this study was to explore the psychological outcomes of a mindfulness-based Internet-streamed yoga video in breast cancer survivors. A one-group, repeated-measures, purposive sample using a directed qualitative descriptive and convergent mixed-methods approach was used. Participants were recruited from breast oncology practices across 2 settings in the northeastern United States in April 2019. Education about the video was provided, and the link to the video was sent to participants. Demographic information, Knowing Participation in Change Short Form (KPCSF), Short Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and the Generalized Anxiety Distress Scale (GAD-7) were obtained at baseline and at 2 and 4 weeks. A semistructured interview was conducted at 4 weeks. Thirty-five women (mean age = 56 years) participated. A one-group, repeated-measures analysis of variance indicated statistically significant changes occurred in all measures between week 0 and week 4: decreased GAD (t = -2.97, P = .004), improved WEMWBS (t = 2.52, P = .008), and increased KPC (t = 2.99, P = .004). Qualitative findings suggest the overall experience of the video was positive and the women would recommend its use to others. Improvements in all psychological measures were achieved with video use. Findings indicate an improvement in psychological measures and support the theory of Knowing Participation in Change. This work further contributes to accessible, flexible interventions available through the Internet and/or mobile applications aimed at improving breast cancer survivorship.

Results of a Team Objective Structured Clinical Examination (OSCE) in a Patient with Pain.

PURPOSE: As rates of chronic pain and opioid use disorder continue to rise, improved pain education is essential. Using an interprofessional team objective structured clinical examination (OSCE) simulation, this study evaluates whether prior exposure to a case-based learning module improves students' assessment and treatment planning of a standardized patient prescribed chronic opioids presenting with acute pain. METHODS: A quasi-experimental mixed method approach using convenience sampling was employed to evaluate student performance and the impact of the educational intervention. RESULTS: Fourteen (intervention) and 16 (control) nurse practitioner, physician assistant, medical, pharmacy, and dental students in the final pre-licensure program years completed the team OSCE. Demographics, OSCE learning scores, Interprofessional Attitudes Scale scores, and pain management plans did not differ between groups. All students evaluated the activity highly. Qualitative analysis did not demonstrate differences between groups, but did identify similar themes: students missed opportunities to establish patient-provider rapport and educate across disciplines; opioid use disorder was assumed with chronic opioid therapy; team discussions improved treatment plans; moderators variably influenced team discussion. CONCLUSIONS: This novel approach to interprofessional training in pain management using a team OSCE is promising, with modifications suggested. A case-based learning module without structured education prior to the OSCE did not improve students' assessment and pain management skills compared to a control group. Nonetheless, important themes emerged including biases towards the standardized patient. Additional research is needed to develop effective curricular initiatives to foster and improve interprofessional collaboration in assessing and managing a standardized patient with acute and chronic pain.

The Experience of Animal Assisted Therapy on Patients in an Acute Care Setting.

Animal assisted therapy (AAT) programs are popular and there has been a proliferation of programs across settings. However, the research to support this intervention has not kept pace. This is particularly so for people who are hospitalized. This investigation aimed to explore the effects of the AAT dog visitation program on patients. A single group pre-post quasi-experimental design evaluated the effect of pet therapy on patients. Measures included salivary cortisol, anxiety, wellbeing, comfort, respiratory and heart rate. Analysis indicates a significant reduction in heart and respiratory rates p < .01 and level of anxiety p < .000 with improved levels of comfort and well-being p < .000. The salivary cortisol result was non-significant p = .623. This ATT dog program resulted in reduced anxiety levels and decreased heart and respiratory rates while improving subjective measures of comfort and wellbeing.

Factors Associated With the Rate of Sepsis After Surgery.

BACKGROUND: Sepsis is a critical illness that requires early detection and intervention to prevent disability and/or death. OBJECTIVE: To analyze the association between various hospital-related factors and rates of sepsis after surgery in Massachusetts hospitals. METHODS: The sample consisted of 53 hospitals with intensive or critical care units and 25 hospitals with step-down units. Hospital characteristics, staffing levels, and health care-acquired conditions were examined using publicly available data. Analysis of variance and linear regression were performed to explore the relationship between nurse and physician staffing levels and sepsis rates. RESULTS: Sepsis rates were significantly lower when nurses cared for fewer patients (P < .001) and when intensivist hours were greater (P = .03). Linear regression for nurse staffing revealed that higher rates of catheter-associated urinary tract infection (P = .001) and higher numbers of step-down patients cared for by nurses (P = .001) were associated with a significantly higher rate of sepsis (P < .001). Linear regression for physician staffing revealed that higher rates of catheter-associated urinary tract infection (P < .001) and wound dehiscence after surgery (P < .001), greater hospitalist hours (P = .001), and greater physician hours (P = .05) were associated with a significantly higher sepsis rate, while greater intensivist hours were associated with a lower sepsis rate (P = .002). CONCLUSION: In this study, greater nurse staffing and intensivist hours were associated with significantly lower rates of sepsis, whereas greater physician staffing and hospitalist hours were associated with significantly higher rates. Further research is needed to understand the roles of the various types of providers and the reasons for their differing effects on sepsis rates.

The Last Day Narratives: An Exploration of the End of Life for Patients with Cancer from a Caregivers' Perspective.

Background: Surviving family caregivers describe the end-of-life experience as "very distressing" and half of those surveyed indicate inadequate emotional support; however, little is known about the causes of distress on the last day of life. Objective: The purpose of this study was to explore the experience of the last day of life from the perspective of the surviving caregiver. Design: The study used a narrative inquiry approach. Setting/Subject: Surviving caregivers of deceased adult cancer patients at a single institution were invited to participate. Measurements: After reviewing, coding, and categorizing the narratives individually, they were collectively considered and thematically analyzed across all cases to provide a summative analysis. Results: Six themes captured the overall experiences: (1) relationships and communication with health care providers impact overall experience, (2) being able to prepare for death was a source of comfort, (3) being a caregiver impacts quality of life and identity, (4) spiritual visitations as a welcome experience, (5) navigating the dying days and early grief period wrought with guilt and closure, and (6) loss of community contributes to distress and distracts from healing. Conclusions: In this study, distress was most often linked to communication failures. Caregivers also experienced distress and guilt related to the loss of their caregiver role. Findings also support a need for increased preparation for caregivers. Finally, the study showed the frequency of visitations/spiritual experiences during grieving.