Tip Sheet Research Articles

Abstract TP378: Can I Eat? Improving the Stroke Swallow Screen Process for Previously Lethargic Patients

For stroke patients at our facility, the stroke swallow screen is one of the initial assessments completed by the RN. This screen is typically completed in the Emergency Department prior to any oral intake. RNs on the stroke unit noticed some patients who failed the screening due to lethargy were kept NPO awaiting formal swallow evaluation by Speech Language Pathology (SLP). Some of these patients arrived on the stroke unit no longer lethargic and requesting something to eat or drink; however, due to policy, the patient would be kept NPO until evaluated by SLP. At times, patients admitted in the late evening/overnight remained NPO until morning causing frustration and, at times, agitation. An interdisciplinary team convened to review stroke swallow screen literature. A comprehensive review was completed, and no evidence was found against allowing the RN to repeat a screening if a patient failed due to lethargy. Due to this, policy was changed to allow the RN to repeat the swallow screen for patients that had an improvement in their mental status, only if the patient initially failed due to lethargy. If this patient were to fail the repeated screen, they would remain NPO until evaluated by SLP. Education was created for the RNs, including computer-based learning, tip sheet and face-to-face education. Data was gathered from a random sample of patients seen at our facility since this policy change was implemented in September 2018. Of 20 patients, 75% passed the repeated swallow screen completed by the RN and were able to begin oral intake; the remainder of the patients were referred for evaluation by SLP. A survey of RNs on the stroke unit revealed: 100% RNs feel comfortable repeating the swallow screen under the new policy, 100% RNs feel the new policy has improved patient/family and MD satisfaction, 72% RNs feel a reduced level of stress regarding patients’ ability to eat, drink, and take medications by mouth, prior to this policy change, 72% RNs had dealt with difficult situations in which a patient was kept NPO after failing a swallow screen due to lethargy.

Improving Support for Children Facing Serious Illness or Death of a Loved Adult (FR408A)

•Explore barriers that hinder adult-focused palliative care team support for children affected by the serious illness or death of a loved adult.•Identify how developmental changes in child perspectives of illness and death influence family discussions and coping.•Describe the impact of the “Coping for Kids” program on palliative care team member comfort exploring the child experience when a loved adult is serious ill or dying. The illness and death of loved ones are stressful for children, yet mechanisms to support children during a loved adult's illness are often lacking. We conducted a quality improvement initiative focused on inpatient palliative care team members (PCTM) to: (1) improve recognition of children affected by serious illness or death of a loved adult, and (2) increase provider comfort exploring and supporting the child experience and coping. Small group interviews and a focus group with PCTM illuminated knowledge gaps and barriers. A child and family support program, “Coping for Kids,” was implemented. The program included: age-specific handouts, provider “tip sheet”, one-time educational sessions for PCTM and inpatient social workers (SW), and a resource library of age-appropriate books for families and children. Pre- and post-implementation surveys assessed program efficacy. Perceived PCTM barriers included limited knowledge and training regarding child coping, uncertainty providing guidance, lack of resources, and time constraints. Fifty-one pre- and 33 post-implementation surveys were completed. Confidence identifying affected children was “somewhat”-“very” comfortable for > 90% pre/post-implementation. Confidence coaching families was “somewhat”-“very” comfortable for 75% pre- and 72% post-implementation. 30% identified “all team members equally appropriate” to provide coaching. Family comfort talking with children was assessed “frequently”-“always” in 46% pre- and 55% post-implementation. Implementation increased resource access 2-to-4-fold. Over 85% of respondents found the tip sheet helpful. PCTM reported only modest improvements in the top 5 barriers, particularly for "unsure what guidance is helpful". Comparatively more robust improvements were reported in all 5 barriers by SW. “Coping for Kids” shows promise to improve recognition and support of children affected by serious adult illness or death. Despite improved access to resources, ongoing care team discomfort persists. Opportunities exist for continued education, identification of needs, and program refinement.

DEVELOPING A QUALITY-OF-RELATIONSHIP INTERVENTION FOR STROKE-SURVIVOR FAMILY CAREGIVER DYADS

A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. At present, few interventions are specifically designed to strengthen the relationship between members of the care dyad. The aim of this study is to develop, validate, and pilot test a quality of relationship intervention for stroke dyads. This poster presents findings from the content validity phase of the study and includes “tips” that dyads offered for maintaining a strong relationship. Semi-structured interviews were conducted with N=19 dyads to solicit information about relationship problems and tips. These data were used to develop a 17-item relationship assessment questionnaire with 17 “tip sheets” corresponding to each item. A Delphi process was used to obtain feedback from a 10-member expert panel about the degree to which the questionnaire and each tip sheet was (1) relevant; (2) clear; (3) accurate, and; (4) useful. Expert agreement ranged for 80% to 100%. The final materials included tips for dealing with issues that arise when one or both partners experience communication, mobility, cognitive, or emotional issues; reaching agreement about different aspects of recovery; working together to meet each partners’ needs; adjusting to new roles after stroke; dealing with relationship problems that predated stroke, and; getting support from other family members, friends, peers, and professionals. Findings highlight areas to consider in promoting strong relationships in care dyads. Future research is needed to examine whether these materials can help to reduce stressful interactions for care dyads, promote dyadic coping, and improve overall relationship quality.

How to Talk about Mental Health: Addressing Misunderstandings about Mental Health in the Media

This tip sheet was developed as a collaboration between the Massachusetts Statewide Youth Advisory Council (SYAC) and the Learning and Working Center at the Transitions to Adulthood Center for Research (TACR) to clear up some common misunderstandings about mental health conditions and to share strategies to talk about mental health in a more accurate and more helpful way! Read on to learn more about mental health.

For Families or Caregivers: Self-Care is Putting on YOUR Oxygen Mask First

This tip sheet was written by the Transitions to Adulthood Center for Research's Family Advisory Board (FAB). The tip sheet is written for the parents and care-givers of young adults with serious mental health conditions. It provides explains why self-care is important and offers self-care tips and resources.

A randomized controlled pilot study of the University of Minnesota mentoring excellence training academy: A hybrid learning approach to research mentor training.

Research mentor training is a valuable professional development activity. Options for training customization (by delivery mode, dosage, content) are needed to address the many critical attributes of effective mentoring relationships and to support mentors in different institutional settings. We conducted a pilot randomized controlled trial to evaluate a hybrid mentor training approach consisting of an innovative, 90-minute, self-paced, online module (Optimizing the Practice of Mentoring, OPM) followed by workshops based on the Entering Mentoring (EM) curriculum. Mentors (n = 59) were randomized to intervention or control arms; the control condition was receipt of a two-page mentoring tip sheet. Surveys (pre, post, 3-month follow up) and focus groups assessed training impact (self-appraised knowledge, skills, behavior change) and participants' perceptions of the blended training model. The intervention (∼6.5 hours) produced significant improvements in all outcomes, including skills gains on par with those reported previously for the 8-hour EM model. Knowledge gains and intention-to-change mentoring practices were realized after completion of OPM and augmented by the in-person sessions. Mentors valued the synergy of the blended learning format, noting the unique strengths of each modality and specific benefits to completing a foundational online module before in-person engagement. Findings from this pilot trial support the value of e-learning approaches, both as standalone curricula or as a component of hybrid implementation models, for the professional development of research mentors.

CAUTIon With Our Patients: The Development and Implementation of a CAUTI Tracer Program

BACKGROUND The most common hospital acquired infection is catheter associated urinary tract infection (CAUTI). Approximately 75% of urinary tract infections acquired in the hospital are associated with urinary catheters. CAUTI increases the length of stay by two days and incurs unnecessary costs to the patient. Our nosocomial CAUTI SIR (Standardized infection ratio) in 2017 was 1.161 which is above the Center for Medicare and Medicaid services Hospital Value- Based Purchasing (CMS VBP) benchmark of 0.822. The purpose of this project is to reduce nosocomial CAUTI SIR and to increase catheter bundle compliance. METHODS We utilized a multidisciplinary approach partnering with our corporate Infection Preventionist. We performed a gap analysis using the Targeted Assessment for Prevention (TAP) report to identify our units with opportunities for improvement. We built a CAUTI tracer tool that can be utilized to measure compliance of catheter care and a report can be generated for analysis. A tip sheet was developed and education was provided on all of the bundle components including alternatives for external urinary devices. For sustainment we engaged senior leadership and the units identified with opportunities were required to perform daily catheter care audits until CAUTI free for four months. RESULTS After the process changes were initiated in quarter 1 2018, the hospital acquired CAUTI SIR started to show a steady decline. The 2018 quality year January through September CAUTI SIR is at 0.883 which is a 28% reduction from 2017. With the implementation of the tracer tool, bundle compliance was observed to increase from 80% to 95%. CONCLUSIONS Initiation of the education tip sheet and the CAUTI tracer tool were successful interventions in reducing hospital acquired CAUTI's. Support from both corporate and entity leadership has proven to be effective towards deployment, reduction and sustainment.

Safe Medication Disposal.

Safe disposal of expired or unused medications is essential for individual and environmental safety, yet many patients report not having received education on proper medication disposal. Unused medications in homes and improper medication disposal create various risks including intentional or accidental misuse, overdose, addiction in humans, as well as toxic effects in pets. As part of their community health clinical experience, senior nursing students from the University of Pennsylvania School of Nursing visited patients of a large home care and hospice agency in a Philadelphia suburb throughout the semester. A survey conducted with a small number (N = 15) of home care patients suggested the majority of patients had inadequate knowledge about safe medication disposal. The nursing students created and presented a tip sheet on safe medication disposal and a list of local prescription medication disposal sites to home care patients. They also obtained and provided medication disposal bags for patients and caregivers who were unable to get to medication disposal sites.

Tip sheet for board members: Prevent board role mistakes

Use these tips to prevent board‐role mistakes such as micromanagement of nonprofit staff.

Sickle Cell Education for Medical Professionals: A Pre and Post Test Analysis

Background and Objectives: Sickle cell disease is a severe inherited form of anemia caused by a genetic mutation. Polymerization of hemoglobin leads to a cascade of effects decreasing blood flow. This causes tissue hypoxia leading to acute and chronic damage to the organs and endothelial lining. This disease requires complex management that relies on comprehensive training and knowledge regarding the disease process. Often accurate knowledge of sickle cell disease and how to provide appropriate care in the general medical population is limited. The purpose of this project was to develop a sickle cell educational training module for medical professionals. Such a module could be used to guide the provision of accurate education regarding sickle cell disease and best practice when caring for this patient population.Methods: Goals and learning objectives were created and current medical literature about caring for sickle cell disease was reviewed. A comprehensive PowerPoint presentation was produced along with a provider tip sheet and a pre and posttest. The presentation, tip sheet, and tests were reviewed by a board certified pediatric hematologist/oncologist along with the hospital's educational review committee in the Department of Professional Regulation. Once approved, the PowerPoint, tip sheet, and tests were combined into a learning module and uploaded onto an online learning system utilized by the hospital system. The module was sent to over 2,400 outpatient providers and staff and to all inpatient staff on units where sickle cell patients stay when admitted. The module consisted of the participant completing a 10 question pretest, then reviewing the PowerPoint presentation and tip sheet. Following the review of the PowerPoint and tip sheet, the participant completed a 10 question posttest and completed an evaluation of the module.Analysis: There were 223 people who completed the Sickle Cell Disease Learning Module. A paired t-test was conducted to compare pre-test scores to post-test scores. There was a significant difference in the pre-test scores (M = 5.98, SD = 1.66) and post-test scores (M = 9.17, SD = 1.36); p = <0.0001.Conclusion: The goal of this module was to increase baseline medical knowledge of sickle cell disease. The results indicate there was statistically significant improvement in baseline knowledge, based on pre and post data (p = <0.0001). While the results indicate statistically significant increases in performance, it would be important to see if improvements are sustained over time. Reassessment of participants one year after completion of module can be beneficial to see if learned knowledge has been retained. DisclosuresNo relevant conflicts of interest to declare.

Supporting Employment for Young Adults Living with Mental Health Conditions

Having a job as a youth or young adult is a predictor of long-term work success. Having a job has also been related to improved self-esteem, self-efficacy, and life satisfaction. However, there is a significant gap in work experience for many young adults living with mental health conditions. This tip sheet has information on 1) why work is especially important for young adults; 2) the impact of receiving disability benefits rather than employment early in life; 3) how to cultivate motivation toward employment goals; 4) ways to promote work experiences; 5) tips on helping young adults with mental health conditions get a job; 6) and resources to learn more. A Portuguese translation of this publication is available for download.

What Were You Thinking? Brain Development in Young Adults

During the transitions to adulthood, young adults with mental health conditions struggle more than their typically-developing counterparts. Studies have shown that adolescents and young adults with mental health conditions are delayed in all areas of psychosocial development except sexuality. This tip sheet offers ways to work with young adults with mental health conditions and make this transition process easier. A Portuguese translation of this publication is available for download.

Partnering with Families &amp; Other Natural Supports on Individualized Service Plans (ISPs)

Positive familial support can be a good resource for young people during their transition years. However, family involvement and support during the transition years for young adults with mental health conditions can be complicated by changing family dynamics. This tip sheet describes what we know about partnering with families, offers best practices when working with young adults and their families and providers some resources to learn more.

Tips and Tricks to Starting a Young Adult Council Part 1: 10 Steps to Starting a Young Adult Advisory Council [English and Spanish versions

This tip sheet will walk you through ten steps of developing a young adult mental health advisory council. Young adult advisory councils are groups of likeminded young adults who come together on a consistent basis to share resources and advise organizations on how to better serve and support young people. By incorporating young adult expertise into the design and delivery of mental health services, these councils provide direct feedback on how to improve services and make them more relevant to young adult culture. These steps are based on the Transitions to Adulthood Center for Research’s (ACR's) own experience with creating a Youth Advisory Board (YAB). A Spanish translation of this publication is available for download. Part 2 of this tip sheet is available at: https://doi.org/10.7191/pib.1126.

Tips and Tricks to Starting a Young Adult Council Part 2: The Do’s and Don’ts of Young Adult Councils [English and Spanish versions

Young adult advisory councils are groups of likeminded young adults who come together on a consistent basis to share resources and advise organizations on how to better serve and support young people. This tip sheet, which is based on direct experiences from young adult council members across the United States, provides a list of Do’s and Don’ts for your organization to consider when developing and running a young adult council. A Spanish translation of this publication is available for download. Part 1 of this tip sheet is available at: https://doi.org/10.7191/pib.1125.

Tip sheet: Boost board giving

There is much debate about how successful you can be in making effective fundraisers out of board members who don't like to fundraise. But there is no debate when it comes to the importance of board members making a personal gift to the organization.

Tip sheet for board evaluation of the CEO

Tip sheet for board evaluation of the CEO

Video Review Process: Enhancing Impact and Resident/Faculty Satisfaction.

Although video review (VR) is a common component of family medicine (FM) resident education, levels of faculty and resident satisfaction and the perceived impact of the VR process are unknown. Our FM residency program made several changes to our VR process, including a new feedback form highlighting strengths and areas for growth, a post-VR email to the resident including a tip sheet on an identified skill, and follow-up shadowing by a behavioral health clinician to increase VR impact and reinforce skill development. FM residency faculty (n=11) and residents (n=34) completed an anonymous 20-item online survey. The survey was administered twice, first at baseline and then 9 months after the changes were instituted. Survey questions targeted the preceding 9 months and assessed satisfaction with VRs and perceived value and impact of the VR process. At baseline, both faculty and residents reported low levels of satisfaction and perceived impact and value of the VR process. Among both residents and faculty, significant improvements emerged in ratings of satisfaction and perceived value of the VR process. At postsurvey, significantly more residents reported feeling equipped with specific tips on how to improve their communication skills after VR than at baseline. Our evaluation documented significant improvements in satisfaction and perceived value in our VR process following the changes in our procedures. Future research could develop measures to assess communication skills that are more sensitive to change, thereby strengthening this line of research by supplementing self-report data with more objective observational data.

Feasibility and acceptability of a brief online self-compassion intervention for mothers of infants

To evaluate the acceptability and potential utility of a small package of online resources designed to improve self-compassion for mothers of infants. A within-groups repeated-measures study design was used. A community sample of 262 mothers who were ≤ 24months post-partum were given access to a set of online resources (two videos plus a tip sheet) that outlined simple techniques for increasing self-compassion drawn from compassion-focused therapy (CFT). Participants completed pre-intervention assessment, followed by post-intervention assessment 1month later. Assessment included self-report measures of self-compassion, psychological flexibility and shame in the mothering role; symptoms of post-traumatic stress (PTS) following childbirth; subjective breastfeeding experience; and satisfaction with infant feeding. Overall, 49.8% of participants accessed some or all of the resources, with lack of time the most common barrier to use. The vast majority (96%) agreed that self-compassion is helpful for women experiencing birth or breastfeeding difficulties. t tests examined change in scores from pre- to post-intervention, indicating increases in self-compassion, decreases in PTS symptoms (intrusion, hyperarousal and total PTS score) and improved subjective breastfeeding experience as well as overall satisfaction with breastfeeding. There were no changes in scores for psychological flexibility, shame, or satisfaction with general infant feeding. This pilot study supports the acceptability and potential utility of self-compassion resources, drawn from CFT, to support mothers' well-being in the first years of their baby's life. This novel approach to maternal health intervention warrants further exploration, development and testing in future research.

This Old Man: All in Pieces by Roger Angell

Reviewed by: This Old Man: All in Pieces by Roger Angell Mike Broida (bio) Roger Angell, This Old Man: All in Pieces (Anchor Books, 2015), 320 pp. To live a "long and happy life" is one of those stock phrases with interchangeable parts: one might wish for a "long and productive" life or a "long and healthy" life or even the Trekkie motto to "live long and prosper." But what does it mean to live a long life, well after most of one's friends, colleagues, and loved ones are gone, and why do we desire it so? Born in 1920, nonagenarian and longtime New Yorker editor Roger Angell confronts the beauty and pain of this "long life" in This Old Man: All in Pieces, which Angell refers to as "a portrait of my brain at 94: a different serving, with good days and bad days in there, some losses and recurring afterthoughts right next to a midnight haiku, a fugitive great movie, a party conversation reborn." Angell is perhaps the last of The New Yorker's old guard of editors and writers; his mother, Katherine White, was an editor, and his stepfather, E. B. White, a frequent contributor. As an autobiographical retrospective, This Old Man presents a sort of writerly memento of life in and around the famed and quasi-secretive magazine. Filling the nooks and crannies between Angell's longer features and articles are inter-office memos, cartoons from the magazine, notes for the annual Christmas poem "Greetings, Friends!", and letters to numerous writers—including a charming correspondence with the poet Philip Levine and a kindhearted rejection letter to Ann Beattie, in reference to a story where "no one here [at The New Yorker] could recognize these people; they don't seem to have any connection with real life." In his tribute to former colleague William Maxwell and the bevy of famous writers he worked with, Angell sneaks in his own philosophical convictions about writing and its tug on the human spirit: I believe, rather, that their stories [those of Maxwell's authors] are the same stories that we tell ourselves, each of us, over and over, every day and every night, returning to our distant or recent past, possibly in search of happiness but much more often in the hope of finding an unexpected window or bend in the path there. We want our stories to come out differently, but they never do. [End Page 335] The assembled mass of essays makes Angell's collection feel part tip sheet—as in pieces like "Storyville," about his time as fiction editor for The New Yorker—and part history of the magazine, replete with tributes to men and women of yore: Harold Ross, Donald Barthelme, Edith Oliver, William Maxwell, and John Updike, among others. This rosy nostalgia—many of the pieces have the candor and warmth and soft edges of a story told by one's grandparent—suits Angell's preferred subject, baseball, nicely. As a sport, the "national pastime" is ripe and romantic in American consciousness. There is great power in Angell's ability to recast many of the long-ago greats who were never immortalized by the advent of the video camera. One is "The Heater from Van Meter," Cleveland Indians pitcher Bob Feller, nemesis and archrival to Angell's boyhood Yankees: "He'd glare in at the batter over his upraised left shoulder, kick his front leg straight across, and clamp down in late delivery and at the same instant, it seemed, the catcher was straightening up with the ball in his mitt again." Many of Angell's more recent pieces on baseball take a short form, often whimsical and nostalgic, such as a tribute to Derek Jeter after his retirement, as noted in "S'Long, Jeet" (a "Talk of the Town" piece), or recaps of World Series sagas in "The Best" or "Post Patsy," where "A World Series opening game always feels like a kid's first trip to Luna Park—a sunlit space, with good things happening all day." Angell's remembrances, from Jackie Robinson to Vladimir Nabokov, fill the implicit obligation of one of advanced age—to be a repository of memory and...