Promote Quality Care Research Articles

Technology for nursing consultation with transsexual women in the light of Leininger's transcultural theory.

to describe the construction and validation of a nursing consultation technology for transgender women. a methodological study developed in three stages with construction based on the Leininger's Cross-Cultural Theory, content validation performed by experts in transgender sexual health and evaluation by nurses of care for transgender women. Items with a minimum agreement of 80% were considered validated, according to the Content Validity Index and binomial test. the technology contains 59 items in three blocks: the first, for identification of the transsexual woman; the second, with the Clinical Data; and the third, regarding the Propaedeutics of Care. All items reached agreement higher than 0.8 and an overall Validity Index of 80%. the technology was content-validated and evaluated by nurses and can be applicable in clinical and outpatient practice as well as in academia to promote quality care for transgender women.

Educational Experiences Within the Learning Community: ECHO Effects on Participants and Clients

Although Project ECHO is a well-established, effective model to promote quality care in the general healthcare field, this project is the first attempt to implement the model with community care providers of individuals with IDD who are affected by dementia. In order to capture spokes’ (community providers and NTG-Affiliated Regional Trainers) experiences and explore potential benefits, we conducted a content analysis of qualitative data gathered from a spoke feedback session and follow-up surveys from the same group (n = 20). Our findings indicated that spokes appreciated (1) didactic sessions by gaining new knowledge; (2) in-depth, mutual discussion about their cases; (3) experts taking time and ensuring their good practices; and (4) the ability to apply this gained knowledge to their day-to-day practices to improve quality of life for individuals with IDD and their families. We will discuss specific examples that inform future practices.

Development and Evaluation of Best Practice Alerts: Methods to Optimize Care Quality and Clinician Communication.

Development and Evaluation of Best Practice Alerts: Methods to Optimize Care Quality and Clinician Communication.

Virtual Reality Skills Training Trends in Nurse Practitioner Education

Technology developments change education strategies. Incorporating virtual reality into lesson plans allows education to focus not only on learning knowledge but also on knowledge and skills integration. In simulation education, learning environments are designed to approximate actual clinical situations, allowing students to practice skills in virtual clinical situations continuously. In addition, clinical lecturers may observe the students' practice process and provide feedback. Furthermore, through experiencing and practicing clinical procedures, students gain critical clinical judgment, skills, and teamwork operation competences, which may be applied in the real world. In Taiwan, the majority of nurse practitioner training is implemented in hospitals, and clinical training is done using hands-on and face-to-face teaching strategies within a mentorship framework. Because of the ongoing COVID-19 pandemic, this hospital-based training model has been significantly challenged. However, this represents an opportunity to migrate the nurse practitioner training model toward technology-based simulation education. Developing more virtual-reality-based lesson plans centered on clinical situations may help students complete training that is normally conducted in hospital teaching environments. Through repetitive practice in virtual reality settings, students may obtain comprehensive knowledge and clinical skills that will help relieve the subsequent stress of clinical practicum work and promote care quality and patient safety.

A Preliminary Investigation of Social Justice Perceptions Among U.S. Speech-Language Pathologists: Clinical Implications.

Purpose The purpose of this survey research is to provide preliminary data regarding speech-language pathologists' (SLPs') perceptions of the role that social justice (SJ) plays in their work. As our professional organizations call us to advocate and communicate with regulatory agencies and legislative bodies to promote quality care for all individuals, this topic has become particularly important at this time. At present, there is a lack of data in peer-reviewed publications within the discipline of communication disorders on SJ and even less regarding the perceptions of SLPs on SJ. Method The survey was sent to American Speech-Language-Hearing Association (ASHA)-certified SLPs, identified by the ASHA ProFind database, across six U.S. geographic regions, including both urban and rural communities. Four themes were explored through the survey: (a) importance of SJ, (b) awareness of SJ, (c) current practices related to SJ, and (d) barriers to SJ implementation. Results The majority of respondents view SJ as important to the profession (91.2%) and value the work of creating equality among groups (96.0%). Many SLPs are actively involved in implementing SJ principles in their own practice by accepting Medicaid (40.7%), engaging in political outreach (55.0%), and providing transdisciplinary educational outreach (77.9%). Identified barriers to incorporating SJ include time (62.7%), resources (65.6%), and finances (70.0%). Conclusions Working for SJ is important to a majority of the respondents, and various efforts are implemented to create equal opportunities for service to clients. Barriers continue to exist that limit the degree to which SLPs can work toward SJ. A list of actions to be considered in order to promote SJ in the field is provided. Supplemental Material https://doi.org/10.23641/asha.16584044.

SPN 2021 Poster Abstract Awards

SPN 2021 Poster Abstract Awards

Adaptations and Evolution during COVID-19 in a Pediatric Satellite Setting

Background InformationThe global Covid-19 pandemic has required the rapid development and implementation of processes that support safety and quality of care. Prior to this unprecedented challenge, our satellite pediatric ambulatory surgical center consisted of four units: a preoperative unit (Preop), six operating rooms, a Post Anesthesia Care Unit (PACU), and an Inpatient Short Stay unit. Although the Preop and PACU nurses were cross-trained to cover both areas, Inpatient nurses maintained a distinct skill set and were a standalone unit. In effort to support virus containment, including social distancing, a flexible staffing model required the integration of Preop, PACU, and Inpatient nurses into one cohesive team.Objectives of ProjectDevelopment and implementation of changes to perioperative processes that support quality care and safety during Covid-19.Process of ImplementationInpatient areas were converted to support the preop care of patients/families and facilitate the adoption of COVID safety regulations. Inpatient nurses were oriented to the Preop nurse role, Preop Covid test screening, and Visitor/Employee lobby screening. This cross-training educational program included in-services on Preop documentation and procedures and one to one orientation with a Preop nurse. Presently, nurses may care for the same patient/families preoperatively and during their inpatient stay which promotes quality care and an improved surgical experience. Changes to staffing models were evaluated through staff survey, analysis of Press Ganey patient satisfaction feedback and surgical throughput data.Statement of Successful PracticeA majority (83.3%) of nurses agreed or strongly agreed that the new flexible staffing model promoted team cohesion and ensured safety and quality throughout the surgical experience. Between May and September 2020, our integrated perianesthesia team cared for 1206 perioperative patients. Press Ganey scores were overwhelmingly positive. One family stated “Before surgery the nurse kept us calm, engaged, & informed. After surgery that nurse did the same thing & was also a great teacher regarding home care”.Implications for Advancing the Practice of Perianesthesia NursingAs ambulatory surgical centers, continue to adapt during the pandemic, it is imperative that perianesthesia nurses design and implement flexible staffing models that promote team cohesion and ensure safety and quality during surgery.

Food-induced anaphylaxis morbidity: Emergency department and hospitalization data support preventive strategies.

Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. A total of 25 articles were selected, 80% published in the last 5years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.

AUDITORIA HOSPITALAR COMO INSTRUMENTO NA PREVENÇÃO DE ERROS MEDICAMENTOSOS

The process performance of drug administration in a hospital environment erroneously has direct implications in the quality and the safety of care. The identification of these errors has been analyzed in audit processes to improve clinical practice, involving from the analysis of medical records, the monitoring of prescriptions by electronic systems or administrative databases. Reclamations regarding errors and adverse events related to associated medications are used directly in monitoring safety. The audit process has great influence on clinical practice and hospital management, promoting changes in the provision of health care, appreciating guidelines and protocols described and developing a sense of clinical responsibility, interprofessional understanding, and sensitivity to patients' needs. In this sense, the aim of this study is to evaluate the role of hospital auditing in the prevention of errors related to to improve care and greater safety. Thus, a systematic search of the literature the SCIELO platform was carried out using the terms patient safety, medication and audit. Medication errors and drug-related adverse events have important implications, from increased hospital stay and costs to undue discomfort and disability or increased mortality. Auditing is a process that allows quality improvement that seeks to improve care and results through systematization review of care in relation to explicit criteria and the implementation of changes, assisting in promoting quality care by offering a systematic structure to investigate and evaluate the work of health professionals and to introduce and monitor improvements. All studies evaluated reported errors related both in the process of prescription of medications and in their administration, causing harm to patients, especially adverse events, highlighting the failure in the quality of care, thus compromising safety.

Policy Throughout The Pandemic

Policy Throughout The Pandemic

Factors Associated with Health Care Provider Attitudes, and Confidence for the Care of Women and Girls Affected by Female Genital Mutilation/Cutting.

Background: Female genital mutilation/cutting (FGM/C) is a cultural practice that includes procedures that intentionally alter or cause harm to female genital organs for nonmedical reasons, affecting ∼200 million women and girls globally. Health care providers in the United States often lack confidence to provide appropriate FGM/C-related care, and experience attitudes that may negatively impact quality of care for FGM/C.Methods: We conducted a cross-sectional survey of health care providers to explore the associations between health care provider characteristics, awareness of health complications of FGM/C, attitudes, and confidence for FGM/C care.Results: Factors associated with more Confidence for Clinical FGM/C Care include awareness of health complications, ever cared for a woman with FGM/C, being a woman or person of color, and more than 5 years of clinical practice. Increased Confidence in Communication Skills for FGM/C Care was associated with awareness of more health complications for FGM/C. Women endorsed significantly less Negative Attitudes toward FGM/C compared with men; no other factors were associated with health care provider attitudes.Conclusion: Future research should further investigate factors associated with health care provider attitudes toward FGM/C and those affected by the practice to promote quality care. Health providers require adequate training for clinical FGM/C care and in the communication skills that promote patient/provider communication cross-culturally.Trial Registration: Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649

Supportive care practice: do we need guidelines?

To review the role of evidence-based clinical practice guidelines in promoting the quality and consistency of supportive care in oncology to meet the needs of practitioners and patients. To maintain quality, guidelines must be regularly updated in terms of content as new treatment modalities like immunotherapy are introduced, adapted to new methodologies such as the application of artificial intelligence, adoption of multiple symptoms or orphan symptoms and capture new endpoints such a patient-reported outcomes. This helps prevent a major barrier to implementation; negative attitudes of practitioners towards guidelines. Digital guidelines provide greater opportunities for dissemination, ease of updating and can be linked to education modules. The quality must be assured by critically appraising the literature and then grading the level of evidence of the guidelines. The benefits of supportive care guidelines include guidance for clinical decision-making in a changing field, continuing professional development of practitioners, a source of information for patients and in highlighting the gaps where further research is necessary. The implications are that guidelines are required for supportive care in cancer but they must be constantly updated and evolve in their structure, the rigour of appraisal and content to promote quality care.

PATIENTS’ JOURNEY THROUGH INFLAMMATORY BOWEL DISEASE (IBD): A QUALITATIVE STUDY

Inflammatory bowel disease (IBD) is a debilitating intestinal condition, manifesting as Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC). The patient experience is impacted by a lack of awareness from other stakeholders despite growing global disease prevalence. To gain deeper insight of the patient experience, promote quality care, and enhance quality of life, we performed a qualitative study of the patient journey starting from pre-diagnosis through treatment.

PATIENTS’ JOURNEY THROUGH INFLAMMATORY BOWEL DISEASE (IBD): A QUALITATIVE STUDY

Abstract Background Inflammatory bowel disease (IBD) is a debilitating intestinal condition, manifesting as Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC). The patient experience is impacted by a lack of awareness from other stakeholders despite growing global disease prevalence. To gain deeper insight of the patient experience, promote quality care, and enhance quality of life, we performed a qualitative study of the patient journey starting from pre-diagnosis through treatment. Methods U.S. patients with IBD were recruited via UC/CD support groups and organizations, social media platforms, blog followers, and personal networks. Participants were screened via an emailed survey and asked to self-identify as medically diagnosed on the basis of reported diagnostic testing. Interviews were conducted by qualitative researchers by phone or web conferencing. Open-ended questions were developed to support and gather information about our learning objectives—primarily, our desire to understand the unique experiences of UC/CD patients in their journey from symptom onset through diagnosis, treatment and maintenance (e.g. “Upon diagnosis, what were your immediate thoughts about the condition?”). This qualitative data were analyzed using Human-Centered Design methodology, including patient typologies (personas), forced temporal zoom (journey maps), forced semantic zoom (stakeholder system mapping), and affinity mapping for pattern recognition of unmet needs. Results A total of 32 patients were interviewed: N=17 CD patients, N=13 UC patients and N=2 IC patients. The interviewed population reflected regional, demographic, and disease-related diversity (Table 1). Five unique, mutually exclusive journeys were identified to understand and classify patient experiences: (1) Journey of Independence, (2) Journey of Acceptance, (3) Journey of Recognition, (4) Journey of Passion and (5) Journey of Determination (Figure 1). Patients with IBD expressed a need for increased awareness, education, and training for providers to shorten the path to diagnosis. Mental health support was found to be a critical gap in care, particularly for major treatment decisions (e.g., surgery). The inclusion of emotional support into the treatment paradigm was perceived as essential to long-term wellness. Patient attitudes and self-advocacy varied on their individual journeys; understanding these journeys may accelerate time to diagnosis and treatment. Conclusion Better understanding of patient journeys can help healthcare providers improve their approach to patient care and coordination.

Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial

BackgroundInsomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment.MethodsThis is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™’s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM’s sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM’s sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group.DiscussionDigital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members.Trial registrationClinicalTrials.gov NCT04366284. Registered on 28 April 2020.

The Strategies to Improve Quality Care in Pediatric Angiography

Background and Aim: The development of technology and the increase of intensive care beds strongly demand a professional care team in these areas. In addition, intensive care staff experience severe occupational stressors such as time pressure, low social support, overwork, and spiritual and moral distress. This study aimed to explain the strategies for promoting quality care in pediatric angiography. Materials and Methods: This is a qualitative study conducted with the participation of 20 members of the care unit. Sampling was done until data saturation. Data analysis was performed using qualitative content analysis. Results: By analyzing the data, three reform classes of structural management, human resource management, and human interaction were found. Conclusion: The strategies to improve the management of the Angiography Department are affected by various factors such as structural management, human resource management, and human interaction. To improve the management of this department, managers should pay special attention to the standardization of the department and increase the level of communication skills of the care team.

Bridging hospital quality leadership to patient care quality

Understanding what drives quality in the delivery of healthcare services is critical to improve the patient care experience. In a hospital, the integration of technology platforms and effective teamwork promote quality care, but this outcome requires that hospital leadership prioritizes technology integration and commits resources to sustain effective healthcare delivery teams. Some of these concepts have been investigated with a limited focus or in very narrow research contexts. Because these concepts do not interact in isolation, an empirical study that examines the relationships between them simultaneously is important to explore the links between hospital quality leadership (QL), technology integration (TI), healthcare team effectiveness (HTE) and patient care quality (PCQ). An online survey of 300 middle and senior-level U.S. hospital executives and quality heads completed during a four-month period is used to test the research hypotheses drawn primarily from quality management, information processing, and team effectiveness theories. The results suggest that hospital leaders should emphasize the integration of all technology systems in their hospitals and continuously encourage their healthcare teams to work effectively thereby improving the quality of patient care delivered. Based on the post-hoc results, we suggest that hospital quality leaders should recognize the difference in magnitude of the effects of HTE and TI on the four PCQ facets.

Barriers and Challenges Faced by Social Workers Caring for Dementia Patients in Acute Care Settings

The nature of dementia care provided by social workers across various hospital settings is unexplored. This study utilized the “rigorous and accelerated data reduction” (RADaR) qualitative analysis technique to explore the process of care among social workers for persons with dementia (PWDs) across a Midwestern tertiary care system with two aims: 1) to identify environmental barriers and supports to quality dementia care in two hospital settings (medical and psychiatric emergency departments (ED), and the main inpatient hospital (IP)), and 2) to identify existing strengths and challenges to high quality social work dementia care within these settings. Twelve qualitative interviews were conducted with a purposive, snowball sample of social workers in dementia care in a large, academic health care system in 2016. Results identify environmental barriers in both settings (physical space design, patient-environment interactions, safety, and discharge disposition). Environmental aspects that promote quality care include supportive staff and family in the patient environment in the IP and ED hospital sections while the discharge disposition is more relevant in the IP. While there are some areas of social work involvement (discharge, psycho-social needs, treatment/management issues) that promote quality of care across locales, the pattern of performing roles varied, e.g. there is more focus on discharge planning and less management of competing demands in the IP than in the ED. Also, social workers were more involved in the diagnosis of dementia in the ED than other settings. We offer policy and practice recommendations to improve care for PWDs in academic hospital settings.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

Dementia-Focused Person-Directed Care Training With Direct Care Workers in Nursing Homes: Effect on Symptom Reduction.

The majority of older adult nursing home residents have dementia and are at risk of not having their care needs met, largely due to communication deficits. Promoting comfort and minimizing distress for these residents is important. Direct care workers (DCW) and clinical staff completed a 6-day training on a person-directed care (PDC) model-a model guided by the needs of the individual that focuses on empowering DCW to understand and support resident preferences and remaining abilities supported by relationship development and consistent staffing. A retrospective comparison was conducted of residents in two PDC communities with matched residents (n = 72) and three traditional communities (n = 72) on functional and clinical outcomes over a 6-month period. A two-way analysis of variance showed a significant interaction between group and time, where only those in the PDC group had a decreased number of clinical symptoms (e.g., pain, depression, agitation) over time. This study found support for the benefit of PDC on clinical outcomes of interest over time. PDC training for DCW and clinical staff promotes quality care and the reduction of clinical symptoms, leading to improved quality of life. [Journal of Gerontological Nursing, 46(8), 7-11.].