Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 5 Articles
Background: Team-based models of care are efficacious in improving outcomes for patients with mental and\nphysical illnesses. However, primary care clinics have been slow to adopt these models. We used iterative\nstakeholder engagement to develop an intervention to improve the implementation of team-based care for this\ncomplex population.\nMethods: We developed the initial framework for Relational Team Development (RELATED) from a qualitative study\nof Primary Care Providersâ?? (PCPsâ??) experiences treating mental illness and a literature review of practice facilitation\nand psychology clinical supervision. Subsequently, we surveyed 900 Colorado PCPs to identify factors associated\nwith PCP self-efficacy in management of mental illness and team-based care. We then conducted two focus groups\nfor feedback on RELATED. Lastly, we convened an expert panel to refine the intervention.\nResults: We developed RELATED, a two-part intervention delivered by a practice facilitator with a background in\nclinical psychology. The facilitator observes PCPs during patient visits and provides individualized coaching. Next, the\nfacilitator guides the primary care team through a practice change activity with a focus on relational team dynamics.\nConclusion: The iterative development of RELATED using stakeholder engagement offers a model for the\ndevelopment of interventions tailored to the needs of these stakeholders....
One in four clients discharged from an acute care facility to a skilled nursing\nfacility (SNF) required readmission to the hospital within 30 days. Neuman,\nWirtalla & Werner believe that two-third of those readmissions are avoidable.\nReducing the frequency of rehospitalization from short-stay care is essential\nfor two primary reasons: 1) Clients are exposed to hospital-acquired infections\nthat lead to increased comorbidities, and 2) potentially avoidable hospitalization\nwill decrease the amount of funding distributed by Medicare. The\nsetting for the proposed change initiative was a for-profit, nondenominational\nSNF in Missouri. Of the 120 beds, 16 were devoted to short-stay care. The\nconvenience sample included four registered nurses and eight licensed practical\nnurses who had agreed to participate in the pilot. The purposive sample\nincluded short-stay clients. Interventions implemented at the pilot skilled\nnursing facility are components of the validated INTERACT quality improvement\nprogram. INTERACT (Appendix A) is comprised of several tools\ndesigned to assist and guide front-line staff in early identification, assessment,\ncommunication, and documentation about acute changes in client condition.\nMeasured results examined the effectiveness of the proposed intervention.\nThe outcome being assessed in the project was the number of avoidable hospital\nadmissions after implementation of the INTERACT quality initiative\ntools. The long-term objective for the pilot was a 2% decrease in client rehospitalizations\nfrom the short-care unit during the eight weeks of practice implementation.\nThe clinical question for the proposed practicum project was,\nâ??For the nursing staff on a short-term rehab unit, does the implementation of\nan evidence-based patient evaluation tool, INTERACT lead to a reduction in\navoidable hospital admissions?â?....
Background: Many patients suffer from unrelieved pain in hospital settings. Nurses have a pivotal role in pain\nmanagement. Hence, a nurse-based pain management programme may influence how hospitalized patients\nexperience pain. In this study we investigated hospitalized patientsâ?? experience of pain before and after the\nintroduction of a two-component nurse-based pain management programme.\nMethods: A quasi-experimental design with a separate sample pretest-posttest approach was conducted on a\nconvenience sample of 845 patients (Survey 1: N = 282; Survey 2: N = 283; Survey 3: N = 280) admitted to the four\ninpatient units (medical, surgical, maternity, and gynecology) of a university medical center. Data were collected at\nbaseline, before the intervention six weeks after pain management education, and finally immediately after four\nmonths of rounding using an interviewer-administered questionnaire adopted from a Brief Pain Inventory and the\nAmerican Pain Society Patient Outcome Questionnaire.\nResults: All the samples had similar sociocultural backgrounds. The proportion of patients who reported average\nmoderate and severe pain intensity in the last 24 h were 68.8% in Survey 1, 72.8% in Survey 2 and then dropped to\n48.53% in Survey 3 whereas those who reported moderate and severe pain intensity at the time of interview were\n53.9% in Survey 1, 57.1% in Survey 2 and then dropped to 37.1% in Survey 3. The mean pain interference with the\nphysical and emotional function was generally reduced across the surveys after the introduction of the nurse-based\npain management programme. These reductions were statistically significant with p < 0.05.\nConclusions: Though the survey findings must be taken with caution, they demonstrate that the nurse-based pain\nmanagement programme positively influenced patient-reported pain intensity and functional interference at the\nuniversity medical center. This shows the potential clinical importance of the programme for hospitalized patients....
Background: Medication transcription errors (MTEs) are frequent in hospitalized patient settings. Definitions and\nscenarios that represent potential MTEs in the Palestinian nursing practice were not previously approached using\nformal consensus techniques. This investigation was conducted to develop a consensual definition of MTEs and\nscenarios that represent different MTE situations by a panel of nurses and other healthcare professionals.\nMethods: In this observational study, consensus was sought using the Delphi technique. Panelists (n = 64) were\ninvited and recruited from different hospitals in Palestine and a two-iterative rounds Delphi technique was used to\nachieve consensus on a proposed definition of MTEs and 76 different scenarios representing potential MTEs.\nResults: Consensus was achieve to accept the definition and to consider 69 of the 76 proposed scenarios (77.6%)\nas MTEs, exclude 3 scenarios (3.9%), and 4 scenarios (5.3%) remained equivocal. Equivocal scenarios might be\nconsidered as MTEs or not depending on the clinical situation.\nConclusions: Consensus was achieved on a definition of MTEs and scenarios representing MTEs by a panel of\nnurses and other healthcare professionals. This study showed that it was possible to develop and achieve\nconsensus on a definition and scenarios representing MTE situations using formal consensus techniques. Such\nconsensual definitions could be useful in future epidemiological studies investigating MTEs. Using consensual\ndefinitions might reduce methodological variations, promote congruence in error counting and reporting, and\npermit comparing error rates in different hospital settings....
Background: Diabetes has become one of public health problem up until now. As the disease progressed, it\nmight lead to increasing complication as well as death related to them. Diabetes as chronic disease in older\npeople can lead to more vulnerable conditions if they fail to carry out a proper diabetes self-management.\nDiabetes literacy is an internal factor affecting how the older people go about their diabetes management\nroutines. This study aimed to describe diabetes literacy of the older people and identify the relation of\ndiabetes literacy to diabetes self-management of the older people with T2DM in selected areas of Depok City,\nWest Java, Indonesia.\nMethod: A cross-sectional observational study was utilized and used 106 samples of older people\nindividuals with T2DM, all of whom were chosen via cluster sampling. This research took place in five\nselected areas under the supervision of three public health center in Depok City. The data were analyzed\nusing a bivariate t-independent test, the Pearson product-moment correlation, and logistic regression for\nmultivariate analysis to determine the relationship of independent and dependent variable.\nResult: This research shows a significant correlation between diabetes literacy and diabetes self-management\n(p = 0,011).\nConclusion: Diabetes self management is associated with diabetes literacy in older people with type 2\ndiabetes mellitus. Diabetes literacy should be considered when assessing and addressing diabetes-specific\nhealth education needs....
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