Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk ...for persistent psychological distress and what patterns of distress emerge over time. A secondary data analysis was used to examine self-reported psychological distress (defined as ≥14 unhealthy days due to poor mental health in the past month) at 30 and 180 days following enrollment in a randomized control trial of 513 medically complex Veterans after a nonpsychiatric ED visit. We used a multivariable ordered logistic regression model to examine the association of a priori factors baseline psychological distress, age, race, income, health literacy, deficits in activities of daily living (ADL), and deficits in instrumental activities of daily living with three psychological distress classifications (no/low, intermittent, and persistent). Among 513 Veterans, 40% reported at baseline that they had experienced high psychological distress in the previous month. Older age was associated with lower odds of high psychological distress (OR = 0.95; 95% CI: 0.94-0.97). Baseline factors associated with significantly higher odds of persistent psychological distress at 30 and 180 days assessments, included having the inadequate income (OR = 1.61; 95% CI: 1.02-2.55), having low health literacy (OR = 1.63; 95% CI: 1.01-2.62), and reporting at least one ADL deficit (OR = 1.94; 95% CI: 1.13-3.33). Psychological distress at follow-up was common among medically complex Veterans with a recent ED visit. Future research should explore interventions that integrate distress information into treatment plans and/or link to mental health referral services.
Patients with Parkinson disease have prolonged motor and nonmotor symptoms affecting their ability to perform activities of daily living. Providers are tasked not only to provide quality care to ...afflicted patients but also to offer assistance to their informal caregivers who play a critical supportive role along the illness trajectory.
Compliance with safety features on smart pumps with drug libraries is a challenge for health care systems. Noncompliance and workarounds heighten the risk for adverse drug events and subsequent costs ...of patient care. This quality improvement project describes a pump champion innovation implemented over a 6-month period. There was a significant increase in nurses' compliance to drug library software in smart pumps and a decrease in severe harms averted.
Objectives
Although the importance of home caregivers of chronic kidney disease patients has been increasingly recognized, their perceived caregiving difficulties and requisites remain underexplored. ...This study investigated the challenges and needs of home caregivers of hemodialysis patients in the Philippines.
Methods
We utilized a mixed‐method (QUAN + qual), explanatory sequential design. Data were collected from July 2017 to May 2018 from 46 home caregivers of hemodialysis patients. A three‐part researcher‐made survey were developed from literature search, personal values and cultural context, while some items were generated from a standardized tool that measures caregiver infrastructure and needs of those caring from frail US veterans. The tool developed gathered the participants' profile, caregiving characteristics, and related needs. The tool was validated and pretested for reliability. Fifteen participants were also interviewed to explore caregiving challenges and needs. Descriptive and χ2 statistics were used for quantitative outcomes, while thematic analysis was employed for qualitative data.
Results
Participants provided moderate assistance to patients, spending an average of 10.65 h/day and 5.08 days/week in caregiving. The most difficult caregiving circumstances were having costly expenses (78.26%); missing work (50.00%); and experiencing negative feelings (47.83%), stress (43.48%), and physical difficulties (34.78%). They also had the lowest confidence in deciding when to contact health providers (x̅ = 3.31, SD = 0.94) and finding patient care services (x̅ = 2.93, SD = 1.08). Qualitative findings further revealed caregiving needs and challenges in cost management, physical and psychological health, assumption of multiple roles, lifestyle adjustment, and reinforcement of carer knowledge, skills, and attitudes.
Conclusion
Supportive strategies are needed to address the challenges encountered by home caregivers of hemodialysis patients. Findings can be utilized in developing appropriate interventions for home caregivers in low‐resource settings where home caregiving and healthcare system issues, such as lack of access to resources and social support, are prevalent.
To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health ...Administration (VHA) data, and "Super User" status, defined as more than 3 ED visits within 6 months of the index ED visit.
Retrospective cohort study.
Using McNemar's test, we compared rates of high-risk classification between CAN score and Super User status. We examined differences in patient characteristics and healthcare utilization across 4 levels of risk classification: high CAN and Super User status (n = 198), CAN <90 and non-Super User (n = 622), high CAN and non-Super User (n = 616), or Super User and CAN score <90 (n = 106). We used logistic regression to identify associations between risk classification and any ED visit within 90 days.
Of 1542 veterans, 52.8% (n = 814) had a CAN score ≥90 and 19.7% (n = 304) were Super Users (P <.0001), indicating discrepant rates of high-risk classification. However, we found no differences in patient characteristics. Rates of subsequent ED use were high: 63.1% of patients had 1 or more ED visits. No levels of risk classification were associated with subsequent ED use within 90 days (P = .25).
Among the VHA users with multimorbidity and 3 or more prior ED visits or hospitalizations, subsequent ED use was high. Although CAN scores have demonstrated utility for predicting hospitalizations and deaths, prior utilization and multimorbidity without further risk classification identified a high-risk group for repeat ED use.
Background:
In the United States, inadequate attention has been given to the mental health needs of chronically ill adults, and the attempts to integrate mental health in primary care have fallen ...short.
Method:
This article describes the beginning efforts of the faculty at Duke University School of Nursing to integrate mental health concepts into its adult–gerontological nurse practitioner and family nurse practitioner curricula.
Results:
Competency and course content mapping activities revealed opportunities for mental health enhancement. Five mental health concepts were identified for module development: spectrum of emotions, validation skills, self-management, resilience, and diversity. Mental health modules will be integrated in the nurse practitioner Physical Assessment and Diagnostic Reasoning course, as well as in various clinical courses.
Conclusion:
Challenges and lessons learned, including efforts to foster active interprofessional learning among medical, physician assistant, and nurse practitioner students, are described. Challenges and lessons learned, including efforts to foster active interprofessional learning among medical, physician assistant, and nurse practitioner students, are described.
J Nurs Educ.
2015;54(11):645–649.
BACKGROUND
Many nursing studies are conducted in the United States, Europe, and Australia, where only a fourth of the world's population resides. There is a need to promote nursing research in Asia ...to enhance the contextual relevance of their evidence‐based nursing interventions. A first step toward this goal is to determine the perceived research capacity among nursing faculty in academic settings in the Philippines.
METHODS
This study described the perceived research capacity among nursing faculty of the University of Santo Tomas ‐ College of Nursing, Manila, Philippines. The study used a survey that contained four sections: subject demographics; knowledge and skill on research designs and research process; research involvement, services, and incentives; and factors affecting research involvement. Chi‐square test of homogeneity and MANOVA analyzed the gathered data.
RESULTS
Findings showed that the faculty perceived themselves as knowledgeable and skillful in conducting research. However, current teaching assignments hindered their capacity to conduct research. University‐sponsored incentives and college‐based research services had also remained underutilized despite their availability. Overall, heavy teaching load was the greatest hindrance to research endeavors.
CONCLUSION
Actions must be taken to reconfigure effort allocations with careful consideration of existing university and institutional bylaws.
Traditional timeouts done ineffectively before surgical procedures can result in late blood product requests, inadequate preparation of needed intraoperative apparatus, improper administration of ...required antibiotics, and operating room (OR) time delays. This clinical concern is important to address because based on current evidence, implementing a Standardized Surgical Checklist (SSC) during timeout can impact patient safety by reducing complications following surgery and can promote good communication and teamwork among the care team. This quality improvement project is aimed to develop, implement, and evaluate the impact of SSC on communication and teamwork among an interdisciplinary surgical care team at Los Angeles County and University of Southern California Medical Center (LAC + USC). The design of this project was a pre- and postinnovation survey. The participants were the members of the interdisciplinary care team who participated in the surgical timeout before and after the innovation was implemented. The surveys consisted of 219 participants. Results from an independent t test demonstrated that the mean improvement score for both communication (t = −3.704, df = 190, p < .001) and teamwork (t = −3.028, df = 184, p = .003) were significantly higher in the postinnovation group than in the preinnovation group. These results indicate that SSC can improve communication and teamwork among providers inside the OR which can potentially lead to a safer delivery of care.
Acute bronchitis is a predominantly viral illness and, according to clinical practice guidelines, should not be treated with antibiotics. Despite clear guidelines, acute bronchitis continues to be ...the most common acute respiratory illness for which antibiotics are incorrectly prescribed. Although the national benchmark for antibiotic prescribing for adults with acute bronchitis is 0%, a preliminary record review before implementing the intervention at the project setting showed that 96% (N = 30) of adults with acute bronchitis in this setting were prescribed an antibiotic. This quality improvement project utilized a single-group, pre-post design. The setting for this project was a large urgent care network with numerous locations in central North Carolina. The purpose was to determine whether nurse practitioners and physician assistants, after participating in a multifaceted provider education session, would reduce inappropriate antibiotic prescribing for healthy adults with acute uncomplicated bronchitis. Twenty providers attended 1 of 4 training sessions offered in October and November 2015. The face-to-face interactive training sessions focused on factors associated with inappropriate antibiotic prescribing, current clinical practice guidelines, and patient communication skills. Retrospective medical record review of 217 pretraining and 335 posttraining encounters for acute bronchitis by 19 eligible participating providers demonstrated a 61.9% reduction in immediate antibiotic prescribing from 91.7% to 29.8%. Delayed prescribing, which accounted for a small percentage of the total prescriptions given, had a small but significant increase of 9.3% after training. Overall, this multifaceted, interactive provider training resulted in significant reductions in inappropriate prescriptions.
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