Descriptive Program Evaluation Research Articles

Developing a specialist children\u2019s nursing workforce in sub-Saharan Africa: a descriptive programme evaluation

BackgroundAchieving Universal Health Coverage in low and lower-middle income countries requires an estimated additional five and a quarter million nurses. Despite an increasing focus on specialist nursing workforce development, the specialist children’s workforce in most African countries falls well below recommended densities. The Child Nursing Practice Development Initiative was established with the aim of building the children’s nursing workforce in Southern and Eastern Africa, and Ghana. The purpose of this evaluation was to enable scrutiny of programme activities conducted between 2008 and 2018 to inform programme review and where possible to identify wider lessons of potential interest in relation to specialist nursing workforce strengthening initiatives.MethodsThe study took the form of a descriptive programme evaluation. Data analysed included quantitative programme data and contextual information from documentary sources. Anonymised programme data covering student enrolments between January 2008 and December 2018 were analysed. Findings were member-checked for accuracy.ResultsThe programme recorded 348 enrolments in 11 years, with 75% of students coming from South Africa and 25% from other sub-Saharan African countries. With a course completion rate of 94, 99% of known alumni were still working in Africa at the end of 2018. Most graduates were located at top-tier (specialist) public hospital facilities. Nine percent of known alumni were found to be working in education, with 54% of graduates at centres that offer or plan to offer children’s nursing education.ConclusionThe programme has made a quantifiable, positive and sustained contribution to the capacity of the specialist clinical and educational children’s nursing workforce in nine African countries. Data suggest there may be promising approaches within programme design and delivery in relation to very high course completion rates and the retention of graduates in service which merit further consideration. Outputs from this single programme are however modest when compared to the scale of need. Greater clarity around the vision and role of specialist children’s nurses and costed plans for workforce development are needed for investment in specialist children’s nursing education to realise its potential in relation to achievement of Universal Health Coverage.

Integrated Multimodality Telemedicine to Enhance In-Home Care of Infants During the Interstage Period.

Performing interstage home monitoring using digital platforms (teleIHM) is becoming commonplace but, when used alone, may still require frequent travel for in-person care. We evaluated the acceptability, feasibility, and added value of integrating teleIHM with synchronous telemedicine video visits (VVs) and asynchronous video/photo sharing (V/P) during the interstage period. We conducted a descriptive program evaluation of patient-families receiving integrated multimodality telemedicine (teleIHM + VV + V/P) interstage care from 7/15/2018 to 05/15/2020. First, provider focus groups were conducted to develop a program logic model. Second, patient characteristics and clinical course were reviewed and analyzed with univariate statistics. Third, semi-structured qualitative interviews of family caregivers’ experiences were assessed using applied thematic analysis. Within the study period, 41 patients received teleIHM + VV + V/P care, of which 6 were still interstage and 4 died. About half (51%) of patients were female and 54% were a racial/ethnic minority. Median age was 42 days old (IQR 25, 58) at interstage start, with a median of 113 total days (IQR 72, 151). A total of 551 VVs were conducted with a median 12 VVs (IQR 7, 18) per patient. Parents sent a median 2 pictures (IQR 0–3, range 0–82). Qualitatively, families reported an adjustment period to teleIHM, but engaged favorably with telemedicine overall. Families felt reassured by the oversight routine telemedicine provided and identified logistical and clinical value to VVs above teleIHM alone, while acknowledging trade-offs with in-person care. Integration of multimodality telemedicine is a feasible and acceptable approach to enhance in-home care during the interstage period.

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment.

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the “cold call” following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.

Growing Responsible Fathers Descriptive Program Evaluation

Growing Responsible Fathers Descriptive Program Evaluation

Person-Centered Care: Evaluation of a Resident-Directed Medication Administration Program.

Objective The resident-directed medication administration program (RDMA) is a personalized medication approach designed to improve the medication administration process in long-term care facilities (LTCFs). This evaluation aimed to document staff experience with the RDMA program compared with staff working in facilities using a facility-directed medication administration program (FDMA). Design This descriptive program evaluation invited staff members to share their experiences with the medication administration process through an anonymous survey. Setting Three LTCFs using a RDMA program and three LTCFs using a FDMA program operated by a nonprofit health system in the mid-Atlantic region. Participants All medication administration staff working in six LTCFs were invited to participate (n = 28), and 22 evaluable surveys were returned. Pharmacists (n = 2), providers (n = 5), and nursing staff (n = 4) working in the RDMA facilities described their experiences with the RDMA program. Primary Outcome Measures Time spent administering medications, satisfaction with the medication administration process, medication administration error rate. Results Most staff members were satisfied with the program and would recommend it for other facilities. Medication administration staff at RDMA facilities reported that they were able to spend more time engaged with residents and less time administering medications. There were fewer medication administration errors in RDMA facilities. Conclusion Implementation of a personalized approach to medication administration is feasible and can promote a positive staff experience with the medication administration process with fewer medication errors.

The Role of Unpaid Volunteers in a Group Caregiving Approach: Validation of the Share the Care™ Program

ABSTRACTShare The Care™ (STC) is a caregiving program that has been guiding people on how to pool their skills and resources to assist someone facing a health, aging, or medical crisis. The purpose of this research was to conduct a descriptive program evaluation to establish STC as an advanced program within the caregiver continuum that helps to alleviate caregiver burnout and isolation through the formation of an organized “caregiving family” for support. A sample of 134 participants completed an online questionnaire and 7 participated in follow-up phone interviews. The data collection was conducted in 2 phases, beginning with an online survey and followed by in-depth phone interviews of a sample of survey participants. The results of the study demonstrate that STC is successful in providing alternative caregiving strategies, helping to prevent isolation among adults living alone, easing burden among caregivers, and improving the overall wellbeing of those involved. A majority of caregivers (83%) reported a decreased sense of burden and 80% became more accepting of their family member’s challenge or diagnosis. STC is a replicable caregiving program that has been supported by evidence. Adapting this model could provide benefits to participants and communities.

A Systematic Review of the Effectiveness of Remediation Interventions to Improve NCLEX-RN Pass Rates

First-time NCLEX-RN pass rates are important measures of educational quality in prelicensure nursing education programs. Licensure pass rate problems has been the subject of countless nursing education articles and studies over the past several decades. To improve NCLEX-RN pass rates, remediation is often prescribed for students who have academic performance deficits. This article presents a systematic review of studies on remediation interventions and their effects on NCLEX-RN pass rates. Most studies of remediation and its effects on licensure pass rates are descriptive program evaluation reports. The overall quality of studies included in this review is uneven but generally low. Nursing education researchers should focus on conducting higher quality intervention studies in which the fidelity of remediation interventions can be examined. Viewing licensure pass rates from a process improvement perspective and accounting for pass rate variations could also change the nature of scholarship on this topic.

An In-Home Synagis Program for RSV Prevention in High-Risk Infants

OBJECTIVES: To evaluate and describe outcomes associated with a novel in-home administration program of respiratory syncytial virus (RSV) prophylaxis with palivizumab; to analyze health resource utilization and cost outcomes; and to assess parental satisfaction with in-home administration of prophylaxis for high-risk children. DESIGN: Descriptive program evaluation. SETTING: A national in-home RSV prophylaxis program for high-risk infants and children. PARTICIPANTS: 396 infants and children at risk for serious RSV infection. MAIN OUTCOME MEASURES: Incidence of RSV-related hospitalizations and emergency department (ED) visits, adverse events, program and hospitalization costs, compliance, and satisfaction. RESULTS: Compared with published reports of office, outpatient, or clinic based RSV prophylaxis with palivizumab, in-home prophylaxis demonstrated low incidence of total hospitalizations (11.4% versus 14.4%) and RSV-related hospitalizations (2.3% versus 4.8%). Less than 10% of patients required an ED visit and only 1% of those were related to RSV illness. Only one of the hospitalized infants required ICU admission. One-fourth of the patients experienced fever or ear infection; 43.2% developed cold symptoms. In-home palivizumab prophylaxis has the potential for saving $214 per patient over drug administration and hospitalization costs. Parental satisfaction with the in-home program was 98.6%, leading to high compliance; less than 2% of patients discontinued the program due to noncompliance. CONCLUSIONS: In-home administration of palivizumab RSV prophylaxis can provide favorable outcomes, high parent satisfaction, and potential cost savings. Incidence of RSV-related hospitalizations among patients given prophylaxis at home was substantially lower than has been reported with outpatient or clinic-based prophylaxis. Compliance was excellent due to ease of administration of intramuscular palivizumab, convenience for families with multiple or premature infants or infants requiring cumbersome medical devices, and parents' desire to minimize the risk of exposure to RSV and other communicable diseases in clinics. Improved clinical outcomes observed with in-home prophylaxis may translate into substantial cost savings for health care purchasers.