Improving Student Perceptions of Simulation Effectiveness With Co-Facilitation From Prebriefing Through Debriefing.

ABSTRACT: Co-facilitation (combining presence and expertise of clinical faculty and simulationists during all stages of simulation) presents an opportunity to improve student perceptions of effectiveness. Using a retrospective before and after comparison, data on students' perceptions were collected from baccalaureate nursing students in clinical courses after each simulation experience. Mean differences in Simulation Effectiveness Tool-Modified scores for pre- and post-implementation were compared, as well as scores between levels of students. Statistically significant improvements in student-rated simulation effectiveness were found with co-facilitation. The authors recommend future studies expanding this methodology and considering co-facilitation where feasible.

Dementia caregiver burdens predict overnight hospitalization and hospice utilization.

OBJECTIVES: To determine sociodemographics and caregiver burdens associated with overnight hospitalization, hospice utilization, and hospitalization frequency among persons with dementia (PWD). METHODS: Cross-sectional analysis of PWD (n = 899) of the National Health and Aging Trends Study linked to the National Study of Caregiving. Logistic and proportional odds regression determined the effects of caregiver burdens on overnight hospitalization, hospice use, and hospitalization frequency. Differences between PWD alive not-alive groups were compared on overnight hospitalization and frequency. RESULTS: Alive PWD (n = 804) were 2.36 times more likely to have an overnight hospital stay (p = 0.004) and 1.96 times more likely to have multiple hospitalizations when caregivers found it physically difficult to provide care (p = 0.011). Decedents aged 65-74 (n = 95) were 4.55 times more likely to experience overnight hospitalizations than 85+, hospitalizations were more frequent (odds ratio [OR] = 4.84), and there was a significant difference between PWD alive/not alive groups (p = 0.035). Decedents were 5.60 times more likely to experience an overnight hospitalization when their caregivers had financial difficulty, hospitalizations were more frequent when caregivers had too much to handle (OR = 8.44) and/or no time for themselves (OR = 10.67). When caregivers had no time for themselves, a significant difference between alive/not alive groups (p = 0.018) was detected in hospitalization frequency. PWD whose caregivers had emotional difficulty helping were 5.89 times more likely to utilize hospice than caregivers who did not report emotional difficulty. SIGNIFICANCE OF RESULTS: Care transitions among PWD at the end of life are impacted by the circumstances and experiences of their caregivers. Subjective caregiver burdens represent potentially modifiable risks for undesired care transitions and opportunities for promoting hospice use. Future work is warranted to identify and address these issues as they occur.

COVID-19 Experiences of Relatives of Nursing Home Residents.

Nursing home residents comprise a disproportionate share of coronavirus-related deaths in the United States. Additionally, lockdown restrictions disrupted residents' relationships with their family members to an unknown extent. This study explored family members' perceived family role and interactions with nursing home residents and staff during the COVID-19 pandemic. Using a qualitative descriptive approach, 10 family members were interviewed using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, and data were analyzed using Braun and Clarke's Reflexive Thematic analysis. Themes and subthemes indicated that family members accounted for residents' care in new ways, found existing relationships becoming amplified under stress, maintained connections through creative alternatives, and also felt powerless to provide care, despite their knowledge and experience. Family members increasingly relied on staff to meet residents' care needs and provide updates, and often desired to provide assistance and companionship beyond what policy permitted, representing a major opportunity for improving experiences.

Family Planning Research in African Immigrant and Refugee Women: A Scoping Review.

INTRODUCTION: African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States. METHODS: Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020. RESULTS: The small number of retrieved studies for the literature review clearly highlights a dearth of research. Available evidence indicates stark disparities in health care access, unmet individual needs, and unacknowledged preferences. DISCUSSION: Ignoring cultural considerations for the growing African immigrant population perpetuates the divide in family planning practices.

Development of a Longitudinal Dataset of Persons With Dementia and Their Caregivers Through End-of-Life: A Statistical Analysis System Algorithm for Joining National Health and Aging Trends Study/National Study of Caregiving.

Background: Alzheimer's disease and related dementias (AD/ADRD) are terminal conditions impacting families and caregivers, particularly at end-of-life. Longitudinal, secondary data analyses present opportunities for insight into dementia caregiving and decision-making over time; however, joining complex datasets and preparing them for analysis poses many challenges. Objectives: To describe an approach to linking national survey data of older adults with their primary caregivers to build a prospective, longitudinal dataset, and to share the Statistical Analysis System (SAS) coding statement algorithms with other researchers. Methods: The National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) are joined using a series of algorithms based on conceptual and operational definitions of dementia, primary caregivers, and the occurrence of death. A series of SAS algorithms resulting in the final longitudinal dataset was created. Results: NHATS/NSOC participants were linked using three preliminary data files (n = 12 427) and one final data join (n = 3305) over nine rounds of data collection. Presence of dementia was defined based on the indicator in the year preceding the last month-of-life (LML) interview. Primary caregivers were defined as the person providing the most frequent care over time. Additional flag variables (LML interview, dementia classification, and cohort (2011 vs 2015)) were created. The SAS algorithms are presented herein. Discussion: The SAS coding statement algorithms provide an opportunity to conduct longitudinal analysis of care for both members of the dyad in the context of dementia and end-of-life. Future research using the proposed dataset can further explore care and caregiving in these populations.