The feasibility of academic detailing for acute oral pain management in outpatient dentistry: A pilot study.

BACKGROUND: Opioids are overprescribed in the outpatient dental setting. Therefore, opportunities exist for opioid stewardship. OBJECTIVES: The purpose of this pilot study was to test the feasibility of an academic detailing (AD) intervention to promote appropriate prescribing of opioids in outpatient dentistry. METHODS: We implemented an AD intervention targeting management of acute oral pain in a Midwestern Veterans Affairs outpatient dental facility. The intervention targeted dentists who actively prescribed opioids at the time of the study. The pilot study tested feasibility, adoption, and acceptance of the AD campaign. Visit-based prescribing rates were obtained from the Veterans Health Administration's Corporate Data Warehouse for baseline and postintervention using difference-in-differences analyses to detect potential changes in health service outcomes. RESULTS: Results indicate moderate levels of feasibility through participation rates (n = 5, 55.5%) and high levels of organizational readiness for change (average of 88.6% agree to strongly agree). Furthermore, fidelity of the AD intervention was high. Adoption measures show moderate indication of motivation to change, and trends suggest that participating dentists decreased their visit-based opioid prescribing rates (P > 0.05). CONCLUSION: The intervention demonstrated feasibility with some indications of adoption of intervention techniques and decrease in opioid prescribing. We further recommend working closely with frontline providers to gather feedback and buy-in before scaling and implementing the AD campaign.

Analysis of shared cognitive tasks in the application of non-invasive ventilation to patients with COPD exacerbation.

Interprofessional teamwork plays a key role in the uptake of evidence-based interventions, such as noninvasive ventilation (NIV) for patients with exacerbated Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify the shared cognitive tasks in interprofessional teams using NIV for patients with COPD exacerbation. We used a cognitive task analysis approach (CTA) to engage nurses, rapid response team members, respiratory therapists, and physicians involved in the use of NIV to treat patients with COPD exacerbation. Clinicians participated in a semi-structured interview (n = 21) that elicited cognitions needed to treat COPD exacerbation. Three shared cognitive tasks were identified: Complete a thorough assessment, Formulate a care plan, and Continuously monitor patient status. Findings attest to the importance of having access to up-to-date information and expertise necessary to make accurate clinical inferences for patient assessment. Shared understanding of the formulated care plan among all members of the care team was important to its execution. Continuous monitoring was crucial; however, this cognitive task relied on patient assessment skills and ongoing collaboration within the clinical care team. Application of NIV for patients with COPD exacerbation may require enhancing collaboration through nontechnical skills and interprofessional training.

Identifying themes to inform nursing decisions when caring for patients with acute exacerbation of chronic obstructive pulmonary disease on noninvasive ventilation: A qualitative descriptive study.

Prior studies analyzing patient experience with noninvasive ventilation (NIV) found the most impactful interaction that patients remembered was with nurses, however a survey of nurses regarding the management of patients treated with NIV has shown that most nurses felt unprepared to care for these sick patients. Our qualitative descriptive study explored the current nursing experience using NIV as a treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Nine (n = 9) subject matter expert nurses practicing in a variety of clinical settings participated in semi-structured interviews. The COnsolidated criteria for REporting Qualitative research checklist was followed for interview development. Interview transcripts were subsequently analyzed using deductive thematic analysis. Themes identified from the interviews pertained to patient assessment, novice nurses' need for clinical support, team communication, and nursing education. Improving interprofessional team communication and collaboration skills, and implementing guidelines for NIV utilization were specified as essential components of NIV education for nurses. Even though the nursing role in the care of AECOPD NIV patient could be institution dependent, the themes presented in our study are useful in identifying opportunities for NIV nursing education and areas for further research. Patient or Public Contribution: Nurses served as interviewees for this study.

Prevalence of Effective Audit-and-Feedback Practices in Primary Care Settings: A Qualitative Examination Within Veterans Health Administration.

OBJECTIVE: The purpose of this study is to uncover and catalog the various practices for delivering and disseminating clinical performance in various Veterans Affairs (VA) locations and to evaluate their quality against evidence-based models of effective feedback as reported in the literature. BACKGROUND: Feedback can enhance clinical performance in subsequent performance episodes. However, evidence is clear that the way in which feedback is delivered determines whether performance is harmed or improved. METHOD: We purposively sampled 16 geographically dispersed VA hospitals based on high, low, consistently moderate, and moderately average highly variable performance on a set of 17 outpatient clinical performance measures. We excluded four sites due to insufficient interview data. We interviewed four key personnel from each location (n = 48) to uncover effective and ineffective audit and feedback strategies. Interviews were transcribed and analyzed qualitatively using a framework-based content analysis approach to identify emergent themes. RESULTS: We identified 102 unique strategies used to deliver feedback. Of these strategies, 64 (62.74%) have been found to be ineffective according to the audit-and-feedback research literature. Comparing features common to effective (e.g., individually tailored, computerized feedback reports) versus ineffective (e.g., large staff meetings) strategies, most ineffective strategies delivered feedback in meetings, whereas strategies receiving the highest effectiveness scores delivered feedback via visually understood reports that did not occur in a group setting. CONCLUSIONS: Findings show that current practices are leveraging largely ineffective feedback strategies. Future research should seek to identify the longitudinal impact of current feedback and audit practices on clinical performance. APPLICATION: Feedback in primary care has little standardization and does not follow available evidence for effective feedback design. Future research in this area is warranted.

Associations between safety outcomes and communication practices among pediatric nurses in the United States.

PURPOSE: To gain a deeper understanding of RNs communication related to patient safety. RESEARCH AIMS: To determine: (1) the associations between the communication of registered nurses (RNs) within their health care teams and the frequency that they reported safety events; (2) the associations between RNs' communication within their health care teams and their perceptions of safety within the hospital unit; and (3) whether RNs' communication had improved from 2016 to 2018. THEORETICAL FRAMEWORK AND METHODS: We used the United Kingdom's Safety Culture model as the theoretical framework for this study. Our secondary data analysis from the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture included 2016 (n = 5298) and 2018 (n = 3476) using multiple regression models to determine associations between responses for Communication Openness and Feedback & Communication About Error, and outcome responses for Frequency of Events Reported and Overall Perceptions of Safety. RESULTS: Our findings were: 1). In both 2016 and 2018 datasets, Feedback About Error had a greater impact on Reporting Frequency than Open Communication; 2). Feedback About Error had a greater impact on Safety Perceptions than Open Communication; 3). Open Communication and Feedback About Error and their associations with Reporting Frequency and Safety Perceptions showed little change; and, 4). The proportion of variance was low, indicating factors other than Open Communication and Feedback About Error were involved with Reporting Frequency and Safety Perceptions. CONCLUSION: Pediatric RNs' communication, reporting, and perceptions of patient safety have not improved. (245 words).

Intention to Vaccinate Against the Novel 2019 Coronavirus Disease: The Role of Health Locus of Control and Religiosity.

The urgency to develop a vaccine against the 2019 coronavirus (COVID-19) has waxed stronger in speed, scale, and scope. However, wisdom dictates that we take a vantage position and start to examine the demographic predictors of COVID-19 vaccine hesitancy. The objective of this study was to examine the role of health locus of control (HLOC) in the relationship between religiosity and COVID-19 vaccination intention. In a cross-sectional survey (N = 501), we found a significantly negative association between religiosity and COVID-19 vaccination intention. This relationship was partially mediated by external HLOC. Collaborative efforts with religious institutions may influence COVID-19 vaccine uptake.

The Role of Work Environment in Training Sustainment: A Meta-Analysis.

OBJECTIVE: The purpose of this meta-analytic review is to examine the role of three work environment support variables (i.e., peer, supervisor, and organizational support) in training transfer and sustainment or long-term use of learned knowledge, skills, and attitudes (KSAs). BACKGROUND: Estimates demonstrate that little training is transferred to the job, wasting billions in organizational spending each year and resulting in significant loss to safety and individual and team performance. Prior research shows the importance of a supportive work environment to facilitating transfer; however, we know little of the relative importance of specific support variables. This study seeks to examine the unique roles of distinct support variables in training transfer. METHOD: A meta-analysis was conducted with multiple regressions to answer three primary research questions. RESULTS: All work environment support variables demonstrate moderate and positive correlations with transfer of training. Furthermore, multiple regressions demonstrate that each factor of the work environment explains unique variance as a predictor, with the model accounting for 32% of transfer and peer support accounting for most of R2. Motivation to transfer mediates the relationship between all three work environment support variables and transfer. Furthermore, three support variables are positively related to sustainment, with peer and supervisor support showing the strongest relationships. CONCLUSION: Findings illuminate the relative contribution of peer, supervisor, and organizational support to transfer and sustainment of training. As transfer continues to be an important yet understudied measure of the effectiveness of workplace training, these findings hold implications for both research and practice.

Cardiac Measures of Cognitive Workload: A Meta-Analysis.

OBJECTIVE: We aimed to provide an assessment of the impact of workload manipulations on various cardiac measurements. We further sought to determine the most effective measurement approaches of cognitive workload as well as quantify the conditions under which these measures are most effective for interpretation. BACKGROUND: Cognitive workload affects human performance, particularly when load is relatively high (overload) or low (underload). Despite ongoing interest in assessing cognitive workload through cardiac measures, it is currently unclear which cardiac-based assessments best indicate cognitive workload. Although several quantitative studies and qualitative reviews have sought to provide guidance, no meta-analytic integration of cardiac assessment(s) of cognitive workload exists to date. METHOD: We used Morris and DeShon's meta-analytic procedures to quantify the changes in cardiac measures due to task load conditions. RESULTS: Sample-weighted Cohen's d values suggest that several metrics of cardiac activity demonstrate sensitivity in response to cognitive workload manipulations. Heart rate variability measures show sensitivity to task load, conditions of event rate, and task duration. Authors of future work should seek to quantify the utility of leveraging multiple metrics to understand workload. CONCLUSION: Results suggest that assessment of cognitive workload can be done using various cardiac activity indicators. Further, given the number of valid and reliable measures available, researchers and practitioners should base their selection of a psychophysiological measure on the experimental and practical concerns inherent to their task/protocol. APPLICATIONS: Findings bear implications for future assessment of cognitive workload within basic and applied settings. Future research should seek to validate conditions under which measurements are best interpreted, including but not limited to individual differences.

A Systematic Review of Team Training in Health Care: Ten Questions.

BACKGROUND: As a result of the recent proliferation of health care team training (HTT), there was a need to update previous systematic reviews examining the underlying structure driving team training initiatives. METHODS: This investigation was guided by 10 research questions. A literature search identified 197 empirical samples detailing the evaluation of team training programs within the health care context; 1,764 measures of HTT effectiveness were identified within these samples. Trained coders extracted information related to study design and training development, implementation, and evaluation to calculate percentages detailing the prevalence of certain training features. RESULTS: HTT was rarely informed by a training needs analysis (k = 47, 23.9%) and most commonly addressed communication strategies (k = 167, 84.8%). HTT programs that incorporated practice (k = 163, 82.7%) often employed high-fidelity patient simulators (k = 38, 25.2%) and provided participants with feedback opportunities (k = 107, 65.6%). Participants were typically practicing clinicians (k = 154, 78.2%) with a lower prevalence of health care students (k = 35, 17.8). Evaluations primarily relied on repeated measures designs (k = 123, 62.4%) and self-reported data (k = 1,257, 71.3%). Additional trends were identified and are discussed. CONCLUSIONS: Many trends in HTT practice and evaluation were identified. The results of this review suggested that, in the literature, HTT programs are more frequently following recommendations for training design and implementation (for example, providing feedback) in comparison to findings from previous reviews. However, there were still many areas in which improvement could be achieved to improve patient care.

Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors.

Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.