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1.
J Appl Gerontol ; : 733464820906685, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32081058

RESUMO

Electronic health records (EHRs) can improve quality of care and patient safety, as demonstrated in a variety of health care settings. However, greater use of EHRs in nursing homes (NHs) is needed. To understand which NHs have and have not adopted EHR systems, all federally certified NHs in Arkansas (n = 223) were surveyed, with 27.9% responding. Non-responders were similar to responders on all characteristics except for staffing skill mix, with responders having a higher skill mix than non-responders. Two thirds of responding Arkansas NHs reported having an EHR system in use (69.8%), while only a few reported no plans for an EHR system (4.8%). NHs with greater resources and in competitive markets were more likely to implement EHR systems. Full implementation across all NHs may require intervention, which should be explored in future research. In addition, future investigation should consider the level of interoperability of EHR systems that are in place among NHs.

2.
Nurs Res ; 68(6): E8-E12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693558

RESUMO

BACKGROUND: Scarce and differing reasons for including closing questions in qualitative research exist, but how data generated from these questions are used remains uncertain. OBJECTIVES: The purpose of the study was to understand if and how researchers use closing questions in qualitative research, specifically the research questions were: (a) "Why do qualitative researchers include or exclude closing questions during interviews?" and (b) "How do qualitative researchers use data from closing questions?" METHODS: A qualitative descriptive design using a single, asynchronous, web-based, investigator-designed survey containing 14 items was used to collect data. Convenience and snowball sampling were used to recruit participants. Data were analyzed using descriptive statistics and qualitative content analysis. Codes were developed from the qualitative data. Subcategories were derived from similar codes, and these subcategories were further scrutinized and were used to create broad categories. RESULTS: The number of respondents per question ranged from 76 to 99; most identified nursing and sociology as their academic disciplines, lived in the United States, and were involved in qualitative research for 1-10 years. Data, the interview, the interviewee, and the interviewer were broad categories to emerge as reasons for including closing questions. Only one respondent reported a reason for excluding closing questions. The uses of closing question data were described in four broad categories: analysis, data, the interview guide, and inquiry. DISCUSSION: Researchers frequently included closing questions in qualitative studies. The reasons for including these questions and how data are used vary, and support limited previously published literature. One unique reason, adding "new breath" to the interview, emerged. Study findings can aid qualitative researchers in deciding whether to include closing questions.


Assuntos
Internet , Entrevistas como Assunto , Pesquisa Qualitativa , Inquéritos e Questionários , Tomada de Decisões , Humanos
3.
Res Gerontol Nurs ; 12(4): 184-192, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158297

RESUMO

There is a dearth of evidence on safely transporting frail older adults in the community. Therefore, the purpose of the current study was to gain a better understanding of behavioral expression exhibited by older adults during van transportation and to learn what actions van assistants and van drivers take to prevent or address behavioral expressions, which can create potential challenges to safe transportation. A qualitative descriptive approach was used and included four focus groups of van assistants and van drivers (N = 32) at one urban Program of All-Inclusive Care for the Elderly (PACE), which routinely transports approximately 90% of enrollees to and from the PACE center. Conventional content analysis was used to analyze the data. Four themes emerged. The first two themes were common behaviors: Removing Seat Belts and Verbal Behaviors. The remaining two themes addressed unusual behaviors that left lasting impressions: Physical Aggression and Conflict Between Passengers. Van assistants and van drivers used redirection and reassurance as preventive interventions to keep everyone safe. Transportation of PACE enrollees requires well-trained and astute van assistants and van drivers skilled with preventing and diffusing potentially unsafe behaviors. [Res Gerontol Nurs. 2019; 12(4):184-192.].

4.
Aging Ment Health ; 23(6): 781-791, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29608338

RESUMO

OBJECTIVES: This qualitative descriptive study explored provider-surrogate communication during Physician Orders for Life-Sustaining Treatment (POLST) discussions for patients with advanced dementia. METHODS: Data from participant observations and audio-recordings of ten POLST discussions were analyzed using directed content analysis within the context of an existing conceptual model of Communication and Surrogate Decision Making. RESULTS: Surrogates primarily focused on making sense of the clinical information about life-sustaining treatments during POLST conversations. Providers delivered clinical information about the trajectory of dementia, life-sustaining treatments, and/or features of POLST. They also demonstrated emotional support, by valuing what the surrogate said, acknowledging the surrogate's emotions, listening carefully, understanding the patient as a person, and eliciting questions. However, providers rarely conveyed comprehensive information about the patient's current condition and end-of-life treatment options. Also, open communication of expectations and preferred decision-making roles was rarely observed during the discussions. CONCLUSION: Findings highlight areas that require providers' attention to conduct effective communication, such as delivering comprehensive information about life-sustaining treatments including discussion of risks and benefits in the context of dementia. Findings also support the use of the conceptual model as a framework to examine provider-surrogate communication in the context of POLST discussions, advanced dementia, and non-hospital settings. Additional research is necessary to confirm these findings in larger, more diverse groups of patients, surrogates, and providers.

6.
Aging Ment Health ; 23(9): 1164-1173, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30472881

RESUMO

Objectives: Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating depression in older adults, they have been slowly adopted by Home Health Care (HHC) agencies. Therefore, this study was conducted to determine how HHC agencies perceive and use telehealth technology for depression care among homebound older adult patients. Methods: Five-hundred-and-sixteen staff from the National Association for Homecare & Hospice (NAHC) member home health care agencies completed the online survey. Questions were asked of HHC staff regarding performance expectancy, effort expectancy, social influences, facilitating conditions, telehealth use and intention to use/continue to use telehealth. Results: The majority had a neutral or positive perception towards telehealth. However, participants from agencies that have yet to use telehealth (mean: 3.25, SD: 1.56) reported a less intention to use the technology for depression care versus those from agencies that did (mean: 4.64, SD: 1.37). This may be partially explained by the finding that only 32% perceived themselves as having the knowledge and 25% as having resources to use telehealth. Additionally, facilitating conditions and social influences were significant predictors of intention to use/continue to use telehealth for depression care (p-values < .01). Conclusion: Overall, staff had a neutral or positive perception towards telehealth. Factors such as fewer years of experience in using telehealth and a small annual budget may explain a negative perception towards telehealth. Therefore, further education and resources are needed to support telehealth use. Future studies may consider comparing telehealth programs and identifying supporting policies.

7.
J Gerontol Soc Work ; 62(4): 451-474, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30040598

RESUMO

Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating chronic diseases, and comorbid depression among older adults, they have been slowly adopted by home health care (HHC) agencies. Therefore, this study aimed to identify factors that determine telehealth technology adoption. Twenty directors from the National Association for Homecare & Hospice member agencies completed a 45-min telephone interview. Questions were asked regarding their perceptions of telehealth, the key determinants of telehealth adoption and use, and recommendations they would give on telehealth adoption. The majority of the participants perceived telehealth as effective for managing symptoms and reducing cost. Meanwhile, some participants had a mixed feeling toward telehealth for depression care as they did not recognize their agency as equipped with the necessary resources and trained staff. Moreover, significant determinants of telehealth adoption included the agency-related characteristics, the patient-home environment, reimbursement and cost-related factors, and staff telehealth perception. Findings imply that there is a need for financial support both at the state and the federal levels to encourage telehealth adoption among HHC agencies. Future studies should consider exploring strategies used by successful programs to overcome barriers.

8.
Gerontol Geriatr Educ ; 40(1): 30-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30160623

RESUMO

An interprofessional education (IPE) simulation-based geriatric palliative care training was developed to educate health professions students in team communication. In health care, interprofessional communication is critical to team collaboration and patient and family caregiver outcomes. Studies suggest that acquiring skills to work on health care teams and communicate with team members should occur during the early stage of professional education. The Interprofessional Education Collaborative (IPEC®) competency-based framework was used to inform the training. An evaluation examined attitudes toward health care teams, self-efficacy in communication skills, interprofessional collaboration, and participant satisfaction with the training experience. One-hundred and eleven participants completed pre- and post-training surveys. Overall, a majority of participants (97.3%) were satisfied with the training and reported more positive attitudes toward health care teams and greater self-efficacy in team communication skills. IPE participants had higher collaboration scores compared to observer learners. Further research is needed to explore long-term effects of IPE in clinical practice.


Assuntos
Comunicação , Geriatria/educação , Ocupações em Saúde/economia , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Adulto , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Feminino , Humanos , Relações Interprofissionais , Masculino , Autoeficácia , Treinamento por Simulação/organização & administração , Adulto Jovem
10.
J Comp Eff Res ; 7(9): 913-922, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30203668

RESUMO

AIM: The goal of this study was to compare postacute care costs of three care management interventions. MATERIALS & METHODS: A total of 202 hospitalized older adults with cognitive impairment received either Augmented Standard Care, Resource Nurse Care or the Transitional Care Model. The Lin method was used to estimate costs at 30 and 180 days postindex hospital discharge. RESULTS: The Transitional Care Model had significantly lower costs than the Augmented Standard Care group at both 30 (p < 0.001) and 180 days (p = 0.03) and significantly lower costs than Resource Nurse Care at 30 days (p = 0.02). CONCLUSION: These findings suggest that the Transitional Care Model can reduce both the amount of other postacute care and the total cost of care compared with alternative services for cognitively impaired older adults. Clinicaltrials.gov : NCT00294307.


Assuntos
Disfunção Cognitiva/economia , Cuidado Transicional/economia , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Disfunção Cognitiva/terapia , Custos e Análise de Custo , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Enfermeiras e Enfermeiros/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente/economia , Pennsylvania
11.
J Nurs Educ ; 57(8): 493-497, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30070675

RESUMO

BACKGROUND: Patients with life-limiting illnesses need health professionals who can communicate with each other, as well as with patients and family members. Nursing faculty teach these skills in a variety of formats and, increasingly, via simulation experiences. METHOD: This pilot study aimed to compare a group of interprofessional health professions students' (N = 73) self-reported level of confidence in communication, explore behavior change and professional identity, and identify areas for future interprofessional education. Students participated in a simulated team meeting with a standardized family member of an older adult patient hospitalized with an acute aspiration pneumonia and a chronic, progressive illness. RESULTS: Postworkshop, students rated themselves as significantly more confident in interprofessional and palliative care communication (p ⩽ .001) than preworkshop, identified important areas of behavior change and professional identity, and provided faculty with ideas for future simulation workshops. CONCLUSION: Additional research is needed regarding longitudinal curricular efforts and direct patient care outcomes. [J Nurs Educ. 2018;57(8):493-497.].


Assuntos
Comunicação , Práticas Interdisciplinares , Relações Interprofissionais , Cuidados Paliativos , Equipe de Assistência ao Paciente/organização & administração , Treinamento por Simulação/métodos , Estudantes de Ciências da Saúde/psicologia , Adulto , Educação de Pós-Graduação , Educação de Pós-Graduação em Enfermagem , Feminino , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Humanos , Aprendizagem , Masculino , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Projetos Piloto , Autoeficácia , Estudantes de Ciências da Saúde/estatística & dados numéricos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Adulto Jovem
12.
J Interprof Care ; : 1-4, 2018 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-30136912

RESUMO

Standardized patients can be trained to portray standardized family members (SFMs) for interprofessional education (IPE) initiatives to maximize student learning. To date, studies of IPE often focus on student learning outcomes rather than on the feedback and perspectives of SFMs and faculty facilitators (FFs), The purpose of our study was to examine SFMs' and FFs' perspectives immediately after participating in an IPE workshop. SFMs and FFs completed a semi-structured questionnaire consisting of open-ended questions to identify positive and challenging aspects of interactions with health professions students during an IPE workshop. A directed content analysis approach was used to assess written feedback (N = 29) from SFMs and FFs. Study findings highlight many similar themes between SFMs and FFs as well as minor differences regarding recognition of emotion and communication transitions. SFMs and FFs both agreed, however, that these are areas for further development by students to improve communication. Our study adds insight into SFMs' and FFs' feedback immediately after an IPE workshop.

13.
J Am Assoc Nurse Pract ; 30(2): 69-77, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29757818

RESUMO

BACKGROUND AND PURPOSE: Little is known about surrogates' experiences of engaging in Physician Orders for Life-Sustaining Treatment (POLST) discussions. This study describes family surrogates' experiences when engaging in POLST discussions with primary care providers. METHODS: Semistructured interviews were conducted with 10 family surrogates of individuals with advanced dementia who were enrolled in a Program of All-Inclusive Care for the Elderly or resided in a nursing home. Interviews were analyzed using directed content analysis based on the conceptual model of communication and surrogate decision making by Torke et al. RESULTS AND CONCLUSION:: Surrogates reported that clear explanations of clinical information and the opportunity to ask questions and reiterate what they heard were helpful in making treatment decisions. Moreover, surrogates reported feeling respected and understood when providers expressed concern for them or their family member with advanced dementia and asked them about their emotional responses to decision making. Although nine surrogates reported very positive communication with providers, one surrogate expressed discomfort with the interaction and described feeling pressured to make health care decisions. IMPLICATIONS FOR PRACTICE: With effective communication, family surrogates feel emotionally supported during communication and decision-making processes. Providers are encouraged to focus on developing expert communication skills for end-of-life care discussions.


Assuntos
Demência/complicações , Família/psicologia , Padrões de Prática Médica/normas , Idoso , Tomada de Decisões , Demência/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Pennsylvania , Pesquisa Qualitativa , Ordens quanto à Conduta (Ética Médica)/psicologia
15.
Qual Health Res ; 28(9): 1395-1405, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29577844

RESUMO

Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients' characteristics, communication between patients and HCPs, the prioritization of patients' basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.


Assuntos
Centros Comunitários de Saúde/organização & administração , Pessoas em Situação de Rua , Anamnese/normas , Comportamento Sexual , Antropologia Cultural , Atitude do Pessoal de Saúde , Comunicação , Centros Comunitários de Saúde/normas , Competência Cultural , Feminino , Comportamentos de Risco à Saúde , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Relações Profissional-Paciente
16.
J Nurs Care Qual ; 33(2): 116-122, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29466260

RESUMO

The purpose of this quality improvement initiative was to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on 3 inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased.


Assuntos
Programas de Rastreamento/métodos , Equipe de Assistência ao Paciente , Pneumonia Aspirativa/prevenção & controle , Melhoria de Qualidade , Transtornos de Deglutição/diagnóstico , Humanos
18.
Int J Nurs Stud ; 74: 162-171, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28783561

RESUMO

OBJECTIVE: The purpose of this review was to critically analyze, interpret, and synthesize the literature on men's experiences after prostatectomy. DESIGN: A meta-synthesis was conducted. DATA SOURCES: Six databases (PubMed, EMBASE, CINAHL, PsycINFO, AgeLine, and Sociological Abstract) were searched from the earliest year to 2016. From initial searches with main keywords (prostatectomy and qualitative study), 642 abstracts were retrieved. Based on inclusion criteria (English-language published qualitative study focusing on the experience of men after prostatectomy), this meta-synthesis included 15 studies. REVIEW METHODS: Components of meta-study (meta-data-analysis, meta-method, and meta-theory) were employed to analyze, interpret, and synthesize the results of included studies. Three authors independently appraised the methodological quality of the included studies using a combined appraisal tool (The Critical Appraisal Skills Programme Qualitative Research Checklist and Paterson et al.'s Primary Research Appraisal Tool). The Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement was used to strengthen the completeness of reporting. RESULTS: Fifteen studies met inclusion criteria and quality appraisal guidelines, however, most did not identify or relate their findings to theory. Through meta-synthesis, five themes emerged: facing a life-changing situation, experiencing changes and their impact, striving to manage and adjust to changes, coping with masculinity, and anticipating the future. CONCLUSIONS: After prostatectomy, men experienced physical, psychological, and social changes. Many men are physically and psychologically ill-prepared and suffer from lack of information and support. Health care providers need to be sensitive to men's needs including perceptions of masculinity, realize the importance of support as an essential component of men's adaptation post-prostatectomy, and provide comprehensive and individualized patient-centered interventions. Future studies need to use rigorous research methods, clearly identify methodological approaches, and consider employing or developing theory.


Assuntos
Prostatectomia/psicologia , Humanos , Masculino , Pesquisa Qualitativa
19.
West J Nurs Res ; 39(8): 1151-1168, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28322638

RESUMO

This cross-sectional, descriptive study explored perspectives of discharge planners regarding transitions of hospitalized patients who are severely obese seeking discharge to a nursing home. Attention has been focused on care transitions regarding high hospital readmission rates, yet specific needs of patients who are severely obese have been largely overlooked. Ninety-seven (response rate 39.8%) discharge planners returned surveys addressing frequency of, and issues encountered when, arranging placements. Community and hospital characteristics were also collected. One third of the respondents from Pennsylvania and Arkansas reported inability to transfer patients; barriers included reimbursement, staffing, and equipment. Respondents perceiving nursing homes to have equipment concerns were nearly 7 times more likely to report patient size as a barrier ( p = .001). Given increasing obesity rates, health care delivery systems must be prepared to provide necessary resources and all levels of care, including transitions for hospitalized patients who are severely obese needing nursing home care post-discharge.


Assuntos
Hospitais/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Obesidade Mórbida/enfermagem , Alta do Paciente/estatística & dados numéricos , Arkansas , Estudos Transversais , Humanos , Pennsylvania , Inquéritos e Questionários , Recursos Humanos
20.
Violence Against Women ; 23(5): 623-642, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27130923

RESUMO

Migration across international borders places tremendous stress on immigrant families and may put women at greater risk for intimate partner violence. In this study, we used narrative analysis methods to explore how nine Mexican immigrant women in the Northeastern United States described their experiences of intimate partner sexual violence, and how these stories were embedded within narratives of transition and movement across borders. We identified three major themes: The Virgin and the Whore, The Family, and Getting Ahead. We share important implications for researchers and health and social service providers working with this population.


Assuntos
Emigrantes e Imigrantes/psicologia , Relações Interpessoais , Violência por Parceiro Íntimo/psicologia , Adulto , Feminino , Humanos , Violência por Parceiro Íntimo/etnologia , México/etnologia , Pessoa de Meia-Idade , New England , Pesquisa Qualitativa
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