Patient-centered interventions

The development and preliminary evaluation of the Genetic Counseling Skills Checklist

Genetic counseling (GC) relies on communication to help people understand and adapt to genetic contributions of disease, and there is need for a practical and reliable method of comprehensively documenting GC communication skills without intensive coding. To this end, we created a novel process measure called the Genetic Counseling Skills Checklist (GCSC), utilizing previously validated measures, communication/counseling frameworks, and prior research findings. A multistage iterative process was used to develop, evaluate, and modify the GCSC to improve its clarity, usability, and content validity. To assess interrater reliability, randomly assigned, untrained individuals (i.e., coders) used the GCSC version 3 to code multiple simulated GC sessions. Average measures intraclass correlation coefficients (ICCs) were calculated for each of the 8 GCSC process categories using one-way, random effects models. After relatively minor modifications to the GCSC, two pairs of experienced coders used GCSC version 4 to independently code additional GC sessions and Cohen's Kappa coefficients (κ) were calculated to assess interrater reliability for each process category. The GCSC contains five to eight items within each category and demonstrates good content validity given its ability to capture nearly all GC skills that genetic counselors reported using in a prior qualitative study. Interrater reliability of GCSC version 3 among coders with limited experience was moderate or good for 6 out of the 8 process categories as evidenced by ICCs ranging from 0.55 to 0.86. Average interrater reliability of GCSC version 4 among one pair of experienced coders was strong for all eight process categories (κ ranging from 0.82 to 0.94); among the second pair of experienced coders scores were strong for six categories (κ ranging from 0.80 to 0.87) and moderate for two categories (κ of 0.77 and 0.78). The results suggest the need for training and experience to assure adequate interrater reliability across GCSC coders. Future work is needed to create a formalized training program for coders, complete a larger study to further validate the measure, and use the GCSC to document variability in skills used across providers and sessions.

Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis

BACKGROUND

Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients' and families' psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families.

OBJECTIVE

A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members.

METHODS

Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute's critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach.

RESULTS

A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients' quality of life with a small effect size (Hedges g=0.05, 95% CI -0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=-0.72, 95% CI -1.89 to 0.46; I2=97.6%; P<.001).

CONCLUSIONS

This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice.

TRIAL REGISTRATION

PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698.

Development, feasibility, and acceptability of SPoRT: a dating violence and sexual risk prevention intervention for college student-athletes

BACKGROUND

Student-athletes are one subgroup of college students in the USA at risk for dating violence and sexual risk behaviors. Despite this, research on student-athletes' dating behaviors is limited; existing research pertains primarily to the National Collegiate Athletic Association (NCAA) Division I athletes and focuses on male student-athletes as perpetrators of dating and sexual violence. While some existing programs aim to reduce dating violence and promote healthy relationships, these programs are education based, and not tailored to the specific strengths and challenges of student-athletes. We therefore designed Supporting Prevention in Relationships for Teams (SPoRT), a novel, four-session prevention intervention for Division III student-athletes of all genders to reduce dating violence and sexual risk behavior by targeting knowledge and skills identified in pilot research, incorporating psychoeducation with techniques from cognitive-behavioral therapy, mindfulness, bystander intervention, and normative feedback.

METHODS

This study represents stage 1 of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, evaluating the feasibility and acceptability of SPoRT. We describe the development, content, and proposed delivery methods for SPoRT and evaluated the feasibility and acceptability of the program using a mixed-methods approach. Thirty college student-athletes (12 men, 18 women) completed questionnaires and participated in focus groups to provide feedback on the program's length, timing, group size and dynamics, content, and suggestions for making the SPoRT prevention intervention more feasible and acceptable.

RESULTS

Our recruitment procedures were successful, and participants rated the program as feasible in terms of delivery methods and logistics. Participants liked that SPoRT was developed based on pilot data collected from student-athletes, brief, and skills based and tailored to athletic team needs. SPoRT was perceived as appropriate and relevant to student-athlete needs in terms of dating violence and sexual risk prevention knowledge and skills. Most participants (63%) rated the program as "excellent" and said they would recommend it to others.

CONCLUSIONS

We found SPoRT to be both feasible and acceptable in terms of content and delivery. Suggested modifications will be incorporated into the SPoRT healthy relationships prevention intervention to be tested in an NIH Stage 1 efficacy trial.

An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes

Introduction

The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information".

Methods

A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time.

Results

A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3).

Conclusion

Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

A novel scale for the evaluation of physician drawn medical illustrations

Effective communication is a crucial component of patient-centered care and individuals with low health literacy face significant challenges in managing their health, leading to longer hospital stays and worse outcomes. Visual aids, such as medical illustrations and pictograms, can enhance patient understanding and memory retention; however, there is a lack in the medical field of tools for evaluating and improving a physician's ability to draw clinical illustrations for their patient. This article explores an aesthetic scale created in collaboration between Boston University Medical School and the Boston University Fine-Arts department. The scale scores basic design elements that could reasonably be improved in a clinical setting. A pilot study demonstrated interrater reliability between trained artists scoring images of varying concepts and visual quality with a Cronbach's alpha of 0.95. This scale has potential use in medical visual education and clinical evaluation.

Transcranial Direct Current Stimulation in Nicotine Use: Nursing Implications for Patient Outcomes

ABSTRACT

Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.

School-based interventions for children and adolescents following traumatic brain injury: A systematic review

BACKGROUND

Childhood traumatic brain injury (TBI) can result in impairments in learning, cognition, and behaviour; all of which can adversely influence educational outcomes. Schools can play a crucial role in rehabilitation, therefore it is important that evidence-based supports are available in these settings.

OBJECTIVE

The aim of this systematic review was to evaluate the effectiveness of school-based supports and interventions available following childhood TBI.

METHODS

A comprehensive search strategy involved eight research databases, grey literature, and backward reference searching.

RESULTS

The search identified 19 studies, reporting on sixteen distinct interventions, which used a variety of person-centred and systemic approaches, and typically contained multiple components, including: psychoeducation, behavioural scripts, and attention training. While offering some indication for future directions in intervention, the evidence base for individual interventions was typically limited, and does not take account of cost or issues in sustainability.

CONCLUSION

While there appears to be great potential to support students who may otherwise not gain access to services, there is insufficient evidence to guide widespread policy or practice change without further research. Greater collaboration between researchers, clinical practitioners, and educators is necessary to ensure that all interventions developed are robustly evaluated and disseminated.

Robots in Assisted Living Facilities: Scoping Review

BACKGROUND

Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain.

OBJECTIVE

This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research.

METHODS

On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework.

RESULTS

The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26%) considered the context of care: most studies (48/69, 70%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors' disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics.

CONCLUSIONS

The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards.

Nurse competence provides more individuality in the care of older hospitalized people

AIM

The aim of the study was to assess Registered Nurses' perceptions of general nurse competence, patient-centred care competence, and individuality in the care of older patients and to explore their associations.

DESIGN

A descriptive correlative survey.

METHODS

Data were collected using questionnaires at one Finnish university hospital during winter 2016-2017 amongst Registered Nurses (n = 223) and analyzedd statistically using descriptive and inferential statistics (ANOVA, Pearson's correlations coefficients) and path analysis.

RESULTS

Registered Nurses assessed their general competence, patient-centred care competenc,e and individuality in the care of older patients at a good level. The Path model confirmed general nurse competence was a predictor of patient-centred care competence, which in turn was a predictor of individuality in the nursing care of older patients. The novelty lies in empirical confirmation of the association between nurse competence and individuality in the care. Increasing competence may enhance individuality in the care of older people and enable interventions to support care outcomes.

Risk Factors for Tube Feeding at Discharge in Infants Undergoing Neonatal Surgery for Congenital Heart Disease: A Systematic Review

Approximately 30-50% of infants undergoing neonatal surgery for congenital heart disease (CHD) cannot meet oral feeding goals by discharge and require feeding tube support at home. Feeding tubes are associated with increased readmission rates and consequent hospital, payer, and family costs, and are a burden for family caregivers. Identification of modifiable risk factors for oral feeding problems could support targeted care for at-risk infants. Therefore, the aim of this systematic review is to determine risk factors for tube feeding at discharge in infants undergoing neonatal surgery for CHD. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. Studies published before 2010 were excluded. The search resulted in 607 records, of which 18 were included. Studies were primarily retrospective cohort designs and results were often inconsistent. Study quality was assessed using the Joanna Briggs Critical Appraisal Tools. As a group, the studies exhibited substantial risk for bias. Based on the findings, infants who struggle with feeding preoperatively, experience increased nil per os duration and/or low oral feeding volume postoperatively, experience increased duration of mechanical ventilation, or have vocal cord dysfunction may be at risk for tube feeding at hospital discharge. Factors warranting further examination include cardiac physiology (e.g., aortic arch obstruction) and the relationship between neurodevelopment and oral feeding. Clinicians should use caution in assuming risk for an individual and prioritize early implementation of interventions that facilitate oral feeding development.

A Meta-Synthesis Study of Person-Centered Care Experience from the Perspective of Nursing Home Residents

Purpose: To systematically review and synthesize the evidence for the experience of person-centered care from the perspective of nursing home residents to understand their views in depth. Methods: The seven steps of Nobit and Hare’s meta-ethnography, a well-known meta-synthesis method, were applied. We used four databases for the literature search (PubMed, Web of Science, EMBASE, and CINAHL). Results: A total of seven studies were included for review. As a result of synthesizing the results, three themes (“promotion of mutual understanding through communication”, “care that acknowledges the independence of residents” and “finding the optimized state”) and six sub-themes were derived. Conclusions: This study has provided an in-depth understanding of person-centered care and will contribute to increasing its practical application.

The Effect of Individual Nursing on Anxiety and Depression in Patients with Temporomandibular Disorders

Objective

This study aimed to explore the effects of individualized nursing in patients with temporomandibular disorders (TMD).

Methods

From June 2019 to April 2021, 80 patients with TMD were admitted to the First Affiliated Hospital of Wenzhou Medical University. Among them, 40 patients (control group, CG) received routine nursing and 40 patients (experimental group, EG) received individualized nursing. Functional exercise compliance, pain score, maximum mouth opening, nursing satisfaction questionnaire, self-rating anxiety scale, and self-rating depression scale were investigated.

Results

From June 2019 to April 2021, 81 patients with TMD were admitted to the First Affiliated Hospital of Wenzhou Medical University. Among them, 40 patients (control group) received routine care and 41 patients (experimental group) received individual care. There were no significant differences in mouth opening and pain score between the two groups before surgery (P > 0.05), but there were significant differences in mouth opening and pain score between the two groups 3 weeks after surgery. Patients' anxiety and depression were assessed by the SAS and SDS scores. Before nursing, the control group and experimental group (P < 0.05) had no significant difference. After nursing, the score of both groups decreased (P < 0.05). However, the score was lower in the experimental group, compared to the control group (P < 0.01).

Conclusion

In summary, individualized nursing can improve patients' physical condition and reduce negative emotions and complications. In light of this, the study needs further verification by a large sample randomized controlled trial.

Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions

Art making has been adopted across multiple disciplines as a health intervention. However, our understanding of art making as a health intervention and how it differs from art therapy is still limited. Therefore, we conducted a concept analysis to better understand art making as a health intervention guided by Walker and Avant's approach. We examined 85 studies in which we found 4 defining attributes, 4 antecedents, and physical, cognitive, emotional, and psychological consequences. We suggest several nursing research and practical implications for nurse researchers and clinicians to aid in designing and implementing art making health interventions.

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses

PURPOSE

This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care.

DESIGN

The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States.

METHODS

Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models.

FINDINGS

Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent.

CONCLUSION

These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care.

CLINICAL RELEVANCE

Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions

Background:

Person-centered care (PCC) is an important concept in many countries’ national guidelines and dementia plans. Key intervention categories, i.e., a taxonomy of person-centered (PC)-interventions, to provide person-centered dementia care, are difficult to identify from literature.

Objective:

This systematic review aimed to identify and categorize published PC-interventions into key intervention categories to guide the provision of person-centered dementia care.

Methods:

Conduct of this systematic review followed Cochrane guidelines. A search of the dimensions ‘Dementia’, ‘Person-Centered Care’, and ‘Intervention’ combined was performed in PubMed, EMBASE, and Web of Science. Study selection was based on 2-stage screening against eligibility criteria, limited to controlled study designs. Information about interventions and outcomes was extracted into an “Effects Table”. The identified PC-interventions were categorized in intervention categories to provide person-centered dementia care.

Results:

Searches identified 1,806 records. 19 studies were included. These covered a range of psychosocial interventions, oftentimes multi-component interventions, which followed heterogeneous approaches. Studies were conducted in long-term care/hospital settings. Nine key intervention categories were identified: social contact, physical activities, cognitive training, sensory enhancement, daily living assistance, life history oriented emotional support, training and support for professional caregivers, environmental adjustments, and care organization.

Conclusion:

Our findings provide a current overview of published PC-interventions in dementia, which followed heterogeneous approaches under the PCC-concept. The heterogeneity made it challenging to identify a well-defined concept of PCC and common key intervention categories. An effectiveness-evaluation of “PC” - including “relationship-centered”-interventions may be valuable, to assess whether an explicit focus on relationships around PCC-interventions yields an added benefit.

PROSPERO-ID: CRD42021225084.

The Development of a Situation-Specific Nurse-Led Culturally Tailored Self-Management Theory for Chinese Patients With Heart Failure

INTRODUCTION

Self-management is essential for treating heart failure (HF). Culture influences the ability to cope, negotiate, and adopt self-management behaviors. However, current HF self-management interventions for Chinese patients do not take culture into consideration. The aim of this article is to describe the development of a situation-specific nurse-led culturally tailored self-management theory for Chinese patients with HF.

METHODOLOGY

An integrative approach was used as theory development strategy for the situation-specific theory.

RESULTS

Based on theoretical and empirical evidence, and theorists' experiences from research and practice, a nurse-led culturally tailored self-management theory for Chinese patients with HF was developed.

DISCUSSION

Researchers addressing health phenomena often have difficulty defining, conceptualizing, and operationalizing culture. The situation-specific theory developed in this study has the potential to increase specificity (i.e., logical adequacy and usefulness) of existing theories while informing the application to nursing practice. Further critique and testing of the situation-specific theory is warranted.

Biopsychosocial characteristics associated with engagement in art making among older adults

In order to design patient-centered art making interventions for health and well-being, investigators need to understand the population of interest regarding their relationship to engagement in art making activities. This study, therefore, aimed to examine older adults' characteristics that were associated with engagement in art making activities, and to provide practical examples of how to use the identified characteristics. We conducted correlation analyses to evaluate such associations, using cross-sectional survey data from the 2014 Health and Retirement Study (n=731). Female sex, higher education, personality traits, positive attitude toward the arts, and a larger social network size were positively associated with engagement in art making activities (p<.05). Males and those with lower education could be targeted, while the type of art making activity could be tailored based on personality traits for patient-centered art making interventions. Future studies can use this information to empirically study art making interventions for older adults.

Patient-centred, self-administered acupressure for Chinese advanced cancer patients experiencing fatigue and co-occurring symptoms: A pilot randomised controlled trial

OBJECTIVES

To evaluate the feasibility and potential effects of patient-centred self-administered acupressure for alleviating fatigue and co-occurring symptoms among Chinese advanced cancer patients receiving treatment.

METHODS

Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4-week patient-centred self-administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue-sleep disturbance-pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy.

RESULTS

Twenty-four participants (80%) completed the study. Adherence to self-administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post-intervention in the intervention group. Among these outcomes, only the between-group difference in anxiety post-intervention was significant. The group × time interaction effect was nonsignificant for all outcomes.

CONCLUSIONS

Patient-centred self-administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect.

INtervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer's Symptomatic Expression (INCREASE), a randomized controlled trial: rationale, study design, and protocol

BACKGROUND

The course of Alzheimer's disease (AD) includes a 10-20-year preclinical period with progressive accumulation of amyloid β (Aβ) plaques and neurofibrillary tangles in the absence of symptomatic cognitive or functional decline. The duration of this preclinical stage in part depends on the rate of pathologic progression, which is offset by compensatory mechanisms, referred to as cognitive reserve (CR). Comorbid medical conditions, psychosocial stressors, and inappropriate medication use may lower CR, hastening the onset of symptomatic AD. Here, we describe a randomized controlled trial (RCT) designed to test the efficacy of a medication therapy management (MTM) intervention to reduce inappropriate medication use, bolster cognitive reserve, and ultimately delay symptomatic AD.

METHODS/DESIGN

Our study aims to enroll 90 non-demented community-dwelling adults ≥ 65 years of age. Participants will undergo positron emission tomography (PET) scans, measuring Aβ levels using standardized uptake value ratios (SUVr). Participants will be randomly assigned to MTM intervention or control, stratified by Aβ levels, and followed for 12 months via in-person and telephone visits. Outcomes of interest include: (1) medication appropriateness (measured with the Medication Appropriateness Index (MAI)); (2) scores from Trail Making Test B (TMTB), Montreal Cognitive Assessment (MoCA), and California Verbal Learning Test (CVLT); (3) perceived health status (measured with the SF-36). We will also evaluate pre- to post-intervention change in: (1) use of inappropriate medications as measured by MAI; 2) CR Change Score (CRCS), defined as the difference in scopolamine-challenged vs unchallenged cognitive scores at baseline and follow-up. Baseline Aβ SUVr will be used to examine the relative impact of preclinical AD (pAD) pathology on CRCS, as well as the interplay of amyloid burden with inappropriate medication use.

DISCUSSION

This manuscript describes the protocol of INCREASE ("INtervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer's Symptomatic Expression"): a randomized controlled trial that investigates the impact of deprescribing inappropriate medications and optimizing medication regimens on potentially delaying the onset of symptomatic AD and AD-related dementias.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02849639. Registered on 29 July 2016.

Is Digital Treatment the Holy Grail? Literature Review on Computerized and Blended Treatment for Depressive Disorders in Youth

Computerized and blended treatments seem to be an attractive treatment for adolescents as an alternative to face-to-face treatment, but mental health professionals seem hesitant to use these treatment modalities. This review provides an overview of factors contributing to and withholding from using computerized or blended treatment in routine care. Three databases were searched with terms related to (1) adolescents, (2) depression, (3) computerized or blended, and (4) treatment. Of the 33 articles identified, 10 focused on unguided computerized treatments, six on guided, two on blended, two compared unguided, blended- and face-to-face treatment to no treatment, and eight studies on games. Further, two articles that were focused on an online monitoring tool and three on intervention characteristics or preferred modes of help-seeking. Evidence for effectiveness, adherence, drop-out, and forming therapeutic relations were suspected to be barriers, but are no reason to reject computerized or blended treatment. Improvement in mental health literacy and the possibility to tailor the intervention are facilitators. However, adolescents' intention to seek help, acceptability of computerized treatment, symptom severity, time spent by therapist, and other facilities are identified as barriers and they need to be taken into account when using computerized or blended interventions. Nevertheless, computerized and blended are promising treatments for depressed youth.

Development of the concept of patient-centredness - A systematic review

OBJECTIVE

Patient-centredness is often linked to high-quality patient care, but the concept is not well-defined. This study aims to provide an overview of how patient-centredness has been defined in the literature since Mead and Bower's review in 2000, and to provide an updated definition of the concept.

METHOD & DESIGN

We performed a systematic literature search in PubMed to identify original articles with a sufficient definition of patient-centredness. We analysed extracted data defining patient-centredness.

RESULTS

Eighty articles were included. The dimensions "biopsychosocial", "patient-as-person", "sharing power and responsibility" and "therapeutic alliance" corresponded to four of five dimensions described by Mead and Bower. "Coordinated care" was a new dimension.

CONCLUSION

The identified dimensions are encompassed by three elements: the patient, the doctor-patient relationship and the framework of care i.e. the health care system. The additional focus on coordinated care could reflect increasing complexity of the health care system.

PRACTICE IMPLICATIONS

Narrowing down the understanding of patient-centredness to these three focus areas, viz. 1) understanding of the patients' experience of the illness in their life situation, 2) the professional's relationship with the patient, and 3) coordination of care in the system, could make the operationalisation and implementation of a patient-centred approach more manageable.

The association of job satisfaction and burnout with individualized care perceptions in nurses

Background:

Individualized care is closely related to the fulfillment of nurses’ ethical responsibilities regarding the provision of healthcare as well as having a strong foundation in the philosophy of nursing.

Objective:

This study aimed to determine the association of job satisfaction and burnout with individualized care perceptions in nurses working at a university hospital located in the Central Black Sea region of northern Turkey.

Research design:

A cross-sectional correlational survey design.

Participants and research context:

The study was conducted between 15 February 2017 and 15 August 2017 with 419 nurses working at a public university hospital located in Samsun. Data were collected using an information form, the Individualized Care Scale-Nurse Version, the Minnesota Job Satisfaction Scale, and the Maslach Burnout Inventory. The Mann–Whitney U test, Kruskal–Wallis test and Spearman Correlation were used.

Ethical considerations:

Ethical approval for the study was obtained from the Ondokuz Mayıs University Clinical Studies Board of Ethics. Oral informed consent was taken from the participants.

Findings:

There was a significant positive relationship between the total Individualized Care Scale-A Nurse Version score and the General Satisfaction subscale score of the Minnesota Job Satisfaction Scale (r = 0.121, p < 0.05). The total Individualized Care Scale-A Nurse Version score increased as the General Satisfaction subscale score of the Minnesota Job Satisfaction Scale increased. There was a significant negative relationship between the total Individualized Care Scale-B Nurse Version score and the Desensitization (r = –0.143, p < 0.01) and Personal Achievement subscale scores of the Maslach Burnout Inventory (r = –0.182, p < 0.01). The Desensitization and Personal Achievement subscale scores of the Maslach Burnout Inventory increased as the total Individualized Care Scale-B Nurse Version score decreased.

Discussion:

Factors associated with the individualized care perceptions of nurses, such as job satisfaction and burnout levels and factors related to personal life and worklife should be taken into consideration. Also in order to increase job satisfaction and motivation in nurses, personal preferences regarding the service they want to work at should be taken into account.

Conclusion:

Nurses with lower burnout and higher job satisfaction were found to have higher individualized care perceptions and to support the individuality of patients in care applications. It is important to consider work-related factors associated with individualized care perceptions, job satisfaction, and burnout in nurses.

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury

BACKGROUND

Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts.

OBJECTIVE

This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited.

PARTICIPANTS

Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups.

SETTING

An urban Midwestern city's hospital-based Children's Advocacy Center.

METHODS

Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change.

RESULTS

From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts.

CONCLUSIONS

The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.

A positive psychology-motivational interviewing intervention for patients with type 2 diabetes: Proof-of-concept trial

OBJECTIVE

Eighteen million Americans with type 2 diabetes (T2D) do not follow recommended guidelines for physical activity. Motivational interviewing (MI) has had modest effects on activity and related behaviors in T2D. Positive psychological attributes (e.g., optimism) are associated with superior medical outcomes in T2D, and positive psychology (PP) interventions promote such attributes. There had been no study in T2D of a combined PP-MI intervention to promote well-being and health behavior adherence. We developed a novel, telephone-delivered, 16-week PP-MI intervention and explored its feasibility and impact in T2D patients in a single-arm, proof-of-concept trial.

METHOD

Participants completed PP-based exercises and MI-based physical activity goal-setting activities and reviewed these activities weekly with a study trainer for 16 weeks. Feasibility and acceptability were assessed via exercise completion rates and post-exercise ratings of ease/utility (0-10 scales). Impact was explored by examining changes in physical activity (via accelerometers and self-report), other health behaviors, psychological measures, and medical outcomes (e.g., hemoglobin A1c (A1C)) from baseline to 16 weeks, using paired t tests.

RESULTS

Twelve participants enrolled, and 10 provided follow-up data. Seventy-eight percent of PP-MI activities were completed, and participants rated the PP-MI content and sessions as easy (mean = 8.2/10, standard deviation (SD) = 1.9) and useful (mean = 9.1/10, SD = 1.5). PP-MI was associated with improved adherence to health behaviors and overall self-care, variable effects on accelerometer-measured activity and psychological outcomes, and modest beneficial effects on body mass index and A1C.

CONCLUSION

Further testing of this intervention is warranted in a larger, controlled trial to assess its effects on important health outcomes.

Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study

CONTEXT/OBJECTIVE

Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI.

DESIGN

A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group.

SETTING

Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County.

PARTICIPANTS

Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group.

INTERVENTIONS

The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts.

OUTCOME MEASURES

Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures.

RESULTS

Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants.

CONCLUSIONS

Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01999816.

Person-centered care model in dentistry

BACKGROUND

To achieve optimal health and oral health, the system of care must place a person and their social well-being at the center of decision making and understand factors spent outside the clinical settings, including individual behavior, context and lifestyle.

MAIN TEXT

Person-centered care offers a unique and compelling opportunity for dentistry, and its practitioners, to improve quality of care and overall health outcomes. For decades, the dominant treatment modalities within dentistry primarily focused on a surgical, treatment-oriented approach as opposed to health promotion and improvement. However, new business and care models are disrupting the dental care system, and transforming it into one that is focused on disease management and prevention-oriented primary care that considers overall health and well-being. We proposed a person-centered care model to improve oral health as an integral part of overall health. The model identified three key players who act as change agents with their respective roles and responsibilities: Person, provider, and health care system designer.

CONCLUSIONS

While previous person-centered models in dentistry focused on the role of providers within the clinical setting, this work emphasizes the role of the care designer in creating an environment where both person and provider are able to communicate effectively and achieve improved health outcomes.

Implementation Quality: Implications for Intervention and Translational Science

PURPOSE

Implementation quality (IQ), a critical concept for translational science, measures the discrepancy between an intervention's intended design and its implementation. Quantifying the impact of IQ on intervention outcomes informs efforts to improve intervention translatability. The purpose of this article is to define and describe IQ and its dimensions (content adherence, quality of delivery, and engagement) with a focus on individualized interventions being delivered in research and practice settings.

APPROACH

We apply IQ concepts from intervention science in two contexts: (a) an intervention currently being investigated in an efficacy trial, and (b) a practice situation involving the application of evidence-based practice guidelines during clinic visits. IQ measurement approaches are presented using a study protocol, progress notes, interdisciplinary meeting notes, or clinical guidelines, depending upon whether the intervention is delivered during a research study or a clinical encounter.

CONCLUSIONS

The investigators describe the necessary infrastructure and support for capturing IQ data and the subsequent complexities and challenges of collecting, measuring, and analyzing these data. Understanding IQ is critical to advancing translational science. Such understanding informs application of appropriate IQ measures, and promotes effective translation of evidence-based interventions into practice. Policy changes are needed to promote IQ assessment to ensure high-quality clinical encounters during which interventions are effectively delivered.

CLINICAL RELEVANCE

In both research and practice settings, the conceptualization and measurement of IQ will improve patient outcomes by advancing translational science and integrating evidence-based interventions into nursing practice.

The Gender Congruence and Life Satisfaction Scale (GCLS): Development and validation of a scale to measure outcomes from transgender health services

Background: It is vital that the treatment offered at transgender health services can be evaluated to ensure a high quality of care. However, the tools currently used to evaluate treatment at transgender health services are limited by mainly focusing on mental health or because they have been developed for binary transgender people only. This study therefore aimed to develop and validate a tool that addresses these limitations. The Gender Congruence and Life Satisfaction Scale (GCLS) was developed through reviewing the literature, conducting interviews with transgender people, and holding discussions with experts working in transgender healthcare. An initial pool of items was developed and feedback on these was obtained. The tool was then validated. Method: For the validation of the tool, a total of 789 participants (451 transgender [171 transgender females, 147 transgender males, 133 people identifying as non-binary], and 338 cisgender [254 females, 84 males]) were recruited from the United Kingdom to test the factor structure and validity of the GCLS. Results: Exploratory factor analysis retained 38 items which formed seven subscales (psychological functioning; genitalia; social gender role recognition; physical and emotional intimacy; chest; other secondary sex characteristics; and life satisfaction). These seven subscales were found to have good internal consistency and convergent validity. The GCLS was also found to be capable of discriminating between groups (e.g., people who have and have not undergone gender affirming medical interventions). Transgender and cisgender subscale norms are provided for the GCLS. Conclusion: The GCLS is a suitable tool to use with the transgender population to measure health-related outcomes for both clinical and research purposes.

Possible Solutions as a Concept in Behavior Change Interventions

PROBLEM

Nurses are uniquely positioned to implement behavior change interventions. Yet, nursing interventions have traditionally resulted from nurses problem-solving rather than allowing the patient to self-generate possible solutions for attaining specific health outcomes.

PURPOSE

The purpose of this review is to clarify the meaning of possible solutions in behavior change interventions.

METHODS

Walker and Avant's method on concept analysis serves as the framework for examination of the possible solutions.

CONCLUSION

Possible solutions can be defined as continuous strategies initiated by patients and families to overcome existing health problems.

IMPLICATIONS FOR NURSING PRACTICE

As nurses engage in behavior change interventions, supporting patients and families in problem-solving will optimize health outcomes and transform clinical practice.

My Hypertension Education and Reaching Target (MyHEART): Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension

Background

Young adults (18 to 39 years old) with hypertension have the lowest rates of blood pressure control (defined as blood pressure less than 140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults have high blood pressure, increasing their risk of future heart attack, stroke, congestive heart failure, and/or chronic kidney disease. Many young adults reported having few resources to address their needs for health education on managing cardiovascular risk.

Objective

The goal of our study was to develop and disseminate a website with evidence-based, clinical information and health behavior resources tailored to young adults with hypertension.

Methods

In collaboration with young adults, health systems, and community stakeholders, the My Hypertension Education and Reaching Target (MyHEART) website was created. A toolkit was also developed for clinicians and healthcare systems to disseminate the website within their organizations. The dissemination plan was guided by the Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ).

Results

Google Analytics data were acquired for January 1, 2017 to June 29, 2017. The MyHEART website received 1090 visits with 2130 page views; 18.99% (207/1090) were returning visitors. The majority (55.96%, 610/1090) approached the website through organic searches, 34.95% (381/1090) accessed the MyHEART website directly, and 5.96% (65/1090) approached through referrals from other sites. There was a spike in site visits around times of increased efforts to disseminate the website.

Conclusions

The successfully implemented MyHEART website and toolkit reflect collaborative input from community and healthcare stakeholders to provide evidence-based, portable hypertension education to a hard-to-reach population. The MyHEART website and toolkit can support healthcare providers' education and counseling with young adults and organizations' hypertension population health goals.

Development of a Symptom Management Intervention: Qualitative Feedback From Advanced Lung Cancer Patients and Their Family Caregivers

BACKGROUND

Little is known about cancer patient and family caregiver preferences for the content and format of nonpharmacologic interventions. Revising interventions based on patient and caregiver feedback before implementation may improve intervention feasibility and acceptability, especially in the context of advanced-stage cancer.

OBJECTIVES

The aim of the study was to obtain feedback from patients with advanced-stage, symptomatic lung cancer and their family caregivers on the content and format of a nonpharmacologic symptom management intervention under development. The intervention blended evidence-based cognitive-behavioral and emotion-focused strategies to reduce physical and psychological symptoms.

METHODS

Semistructured qualitative interviews were conducted with 21 patients with advanced-stage, symptomatic lung cancer and caregivers. Participants reviewed handouts regarding intervention components and provided feedback.

RESULTS

Patients and caregivers desired intervention components that addressed the patient's high symptom burden such as education regarding treatment adverse effects and the provision of various coping tools. Offering interventions with a brief or flexible length and delivering them via telephone were other suggestions for enhancing intervention acceptability. Participants also preferred an equal focus on patient and caregiver concerns and a more positive intervention framework.

CONCLUSIONS

Intervention preferences of patients with advanced-stage lung cancer and caregivers underscore the severity of the disease and treatment process and the need to adapt interventions to patients with high symptom burden. These preferences may be incorporated into future intervention trials to improve participant recruitment and retention.

IMPLICATIONS FOR PRACTICE

Nurses can modify interventions to meet the needs of patients with advanced-stage, symptomatic lung cancer and caregivers. For example, flexibility regarding intervention content and length may accommodate those with significant symptoms.

Lessons from Practice: Designing Tools to Facilitate Individualized Support for Quitting Smoking

Many health care providers, with a variety of trainings, counsel clients on quitting smoking on a day-to-day basis. In their clinical practice, they draw from and adapt guidelines and research-based strategies to fit individual client situations and challenges. Designers of technologies to support quitting smoking can learn from these real world practices to create tools that better adapt to individual differences. We present findings from interviews with 28 providers with diverse experiences in smoking cessation counselling. Through analysis of their individualization strategies, challenges, and perceptions of technology, we find that providers: (1) individualize context appropriate coping strategies by involving clients in brainstorming, (2) emphasize the need to support nicotine withdrawal in clients, (3) mitigate social triggers and mediate social support for clients, and (4) need to navigate dependencies with other providers for managing medications and comorbid health conditions of clients. With this empirical understanding, we extend the discussion on the design of technology to support quitting smoking, highlight current barriers to individualization, and suggest future opportunities to address these barriers.

Development and Assessment of the Feasibility of a Nurse-Led Care Program for Cancer Patients in a Chemotherapy Day Center: Results of the Pilot Study

BACKGROUND

The increasing number of cancer patients and inadequate communication in clinics are posing challenges to cancer patients receiving outpatient-based chemotherapy and healthcare providers. A nurse-led care program was proposed as one way of dealing with at least some of these challenges.

OBJECTIVE

The objectives of the pilot study were to assess the feasibility of the subject recruitment, care, and data collection procedures and to explore the acceptability of this program.

METHODS

A pilot study with a 1-group pretest-posttest design was conducted. Five cancer patients receiving chemotherapy in a chemotherapy day center participated. Each patient had a nurse consultation before chemotherapy and received 2 telephone calls after the first and second cycles of chemotherapy. Four questionnaires were adopted to evaluate the subjects' quality of life, self-efficacy, symptom experiences, and satisfaction with care. Questionnaires were completed before the chemotherapy and after the second cycle. The subjects were also interviewed to understand their comments on the service.

RESULTS

The recruitment, care, and data collection procedures were completed smoothly. Slight changes were observed in quality of life and self-efficacy. All 5 subjects were highly satisfied with the care.

CONCLUSIONS

The nurse-led care program is feasible and acceptable.

IMPLICATIONS FOR PRACTICE

The effect of the nurse-led care program will be evaluated in a single-center, open, randomized controlled trial. If the encouraging results can be confirmed, it may be an effective approach to improving the quality of ambulatory chemotherapy care. It would also shed light on the development of nurse-led care in other areas.

A meta-intervention to increase completion of an HIV-prevention intervention: Results from a randomized controlled trial in the state of Florida

OBJECTIVE

A randomized control trial with 722 eligible clients from a health department in the State of Florida was conducted to identify a simple, effective meta-intervention to increase completion of an HIV-prevention counseling program.

METHOD

The overall design involved 2 factors representing an empowering and instrumental message, as well as an additional factor indicating presence or absence of expectations about the counseling. Completion of the 3-session counseling was determined by recording attendance.

RESULTS

A logistic regression analysis with the 3 factors of empowering message, instrumental message, and presence of mediator measures, as well as all interactions, revealed significant interactions between instrumental and empowering messages and between instrumental messages and presence of mediator measures. Results indicated that (a) the instrumental message alone produced most completion than any other message, and (b) when mediators were not measured, including the instrumental message led to greater completion.

CONCLUSIONS

The overall gains in completion as a result of the instrumental message were 16%, implying success in the intended facilitation of counseling completion. The measures of mediators did not detect any experimental effects, probably because the effects were happening without much conscious awareness. (PsycINFO Database Record

Beliefs About Dysmenorrhea and Their Relationship to Self-Management

Dysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self-management of dysmenorrhea is not well understood in the US, and little evidence is available on factors that influence dysmenorrhea self-management. Guided by the Common Sense Model, we examined women's representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self-management behaviors, and investigated the relationship between representations and self-management behaviors. We conducted a cross-sectional, web-based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants had varied beliefs about the causes of their dysmenorrhea symptoms, which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well and perceived them as moderately controllable but them to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care-seeking and use of self-management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self-management interventions that address dysmenorrhea representations and facilitate evidence-based management. © 2016 Wiley Periodicals, Inc.

Feasibility and Acceptability of a Positive Psychological Intervention for Patients With Type 2 Diabetes

OBJECTIVE

Positive psychological attributes (eg, optimism) have been associated with a healthier lifestyle and superior medical outcomes in patients with type 2 diabetes; however, there has been minimal study of behavioral interventions that target positive psychological constructs in this population. Accordingly, we developed a novel, telephone-based, 12-week positive psychology intervention and assessed its feasibility and short-term impact in adults with type 2 diabetes and suboptimal health behavior adherence.

METHOD

This was a pilot and feasibility study in adult inpatients and outpatients at an urban academic medical center recruited between December 2013 and December 2014. Adult patients with (1) type 2 diabetes (meeting American Diabetes Association criteria, eg, glycated hemoglobin A1c [HbA1c] > 6.5% or fasting glucose > 126 mg/dL) and (2) suboptimal adherence (score < 15/18 on the Medical Outcomes Study Specific Adherence Scale items for medication, diet, and exercise) were eligible. Participants received a positive psychology manual, completed exercises (eg, writing a gratitude letter, performing acts of kindness), and reviewed these activities by phone with a study trainer over the 12-week study period. Feasibility and acceptability were assessed via exercise completion rates and postexercise ratings of ease/utility on 0-10 Likert scales. Longer-term efficacy was explored by examining changes in psychological states and health behaviors from baseline to 12 weeks using random-effects regression models and estimates of effect size.

RESULTS

A total of 15 participants enrolled; 12 participants provided complete baseline and follow-up data and were included in the analyses. Over 90% of these participants completed at least 2 exercises, and 75% completed a majority of the exercises. Participants rated the exercises as helpful (mean = 7.8/10) and easy to complete (mean = 7.1/10), and they reported improvements in optimism, gratitude, depression, anxiety, physical function, self-care, and health behaviors (Cohen d = 0.28-1.00).

CONCLUSION

A positive psychology intervention for suboptimally adherent patients with type 2 diabetes was feasible, acceptable, and associated with broad pre-post psychological and health behavior improvement in a small initial study. Further testing of this promising intervention is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02736084.

Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management

Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators.

Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables.

Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping).

Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity.

Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.

Reproductive Health Knowledge among African American Women Enrolled in a Clinic-Based Randomized Controlled Trial to Reduce Psychosocial and Behavioral Risk: Project DC-HOPE

BACKGROUND

Washington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care.

METHODS

Project DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored counseling sessions to address their psychosocial and behavioral risk(s) (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence). Women in the control group received usual PNC. Participants completed a 10-item reproductive knowledge assessment at baseline (n = 1,044) and postpartum (n = 830). Differences in total reproductive health knowledge scores at baseline and postpartum between groups were examined via χ(2) tests. Differences in postpartum mean total score by group were assessed via multiple linear regression.

RESULTS

Women in both groups and at both time points scored approximately 50% on the knowledge assessments. At postpartum, women in the intervention group had higher total scores compared with women receiving usual care (mean 5.40 [SD 1.60] vs. 5.03 [SD 1.53] out of 10, respectively; p < .001).

CONCLUSIONS

Although intervention participants increased reproductive health knowledge, overall scores remained low. Development of interventions designed to impart accurate, individually tailored information to women may promote reproductive health knowledge among high-risk pregnant African American women residing in Washington, DC.

A proposed model of person-, family-, and culture-centered nursing care

BACKGROUND

For decades person-, patient-, family-centered, and culturally competent care models have been evolving and conceptualized in the literature as separate. To our knowledge, there has not been a systematic approach to comparing all four of these conceptual models of care.

PURPOSE

To explicate and compare four conceptual care models: person-, patient-, family-centered, and culturally competent care.

METHODS

A comparative concept analysis informed by Rogers' evolutionary concept analysis was used to compare 32 nursing research on person-, patient-, family-centered care, and culturally-competent care published between 2009 and 2013.

RESULTS

Collective results of analyses of 32 nursing research articles found 12 attributes: collaborative relationship, effective communication, respectful care, holistic perspective, individualized care, inter-professional coordination, self-awareness, empowerment, family as unit of care, interpersonal relationships, cultural knowledge, and cultural skills. Antecedents included: lack of empirical evidence, poor patient outcomes, implementation problems, knowledge deficits, patient/parent emotional distress, poor patient-provider relationships, and health disparities. Consequences included: improved health-related outcomes, increased satisfaction, enhanced patient/family-provider relationships, reduced hospitalization, improved quality of life, improved quality of parent-child relationships, increased trust, enrollment in research, insights about biases, and appreciation for cultural differences. Social justice, advocated by scholars and national organizations, was absent from all studies.

CONCLUSIONS

Findings informed the proposed blended conceptual care framework that embraces the attributes of each care model and includes social justice.

Factors influencing hospitalized patients' perception of individualized nursing care: a cross-sectional study

Background

Individualized care is a cornerstone of patient-centered nursing care. To foster individualized care, influencing factors should be known. The aim of this study was to identify the individual and organizational factors influencing hospitalized patients’ perception of individualized care.

Methods

A cross-sectional study was conducted of 606 patients from 20 wards from five hospitals across Germany. Individualized care and potential influencing factors were assessed via structured questionnaires. To identify influencing factors, we applied a hierarchical linear model with two levels.

Results

Self-rated health, length of ward stay, educational level and shared decision-making process about nursing care were perceived to influence individualized care. A higher rating of health and longer ward stay correlated with improved perceptions of individualized nursing care. In addition, an educational level of nine or fewer years and a perceived shared decision-making process about nursing care positively influenced the perception of nursing care as being tailored to individual needs.

Conclusions

Several factors influence patients’ perception of individualized care. However, only the decision-making process can be actively influenced by nurses. Therefore, nurses should be encouraged to promote shared decision-making regarding patients’ nursing care.

Trial number

DRKS00005174 (Date of registration: 2013/08/01).

Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): development

BACKGROUND

As a result of cost-containment efforts, preparation programs for outpatient surgery are currently not available to the majority of children and parents. The recent dramatic growth in the Internet presents a unique opportunity to transform how children and their parents are prepared for surgery. In this article, we describe the development of a Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS).

DEVELOPMENT OF PROGRAM

A multidisciplinary taskforce agreed that a Web-based tailored intervention consisting of intake, matrix, and output modules was the preferred approach. Next, the content of the various intake variables, the matrix logic, and the output content was developed. The output product has a parent component and a child component and is described in http://surgerywebtips.com/about.php. The child component makes use of preparation strategies such as information provision, modeling, play, and coping skills training. The parent component of WebTIPS includes strategies such as information provision, coping skills training, and relaxation and distraction techniques. A reputable animation and Web design company developed a secured Web-based product based on the above description.

CONCLUSIONS

In this article, we describe the development of a Web-based tailored preoperative preparation program that can be accessed by children and parents multiple times before and after surgery. A follow-up article in this issue of Anesthesia & Analgesia describes formative evaluation and preliminary efficacy testing of this Web-based tailored preoperative preparation program.

Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): formative evaluation and randomized controlled trial

BACKGROUND

The purpose of this 2-phase project was to conduct a formative evaluation and to test the preliminary efficacy of a newly developed Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS).

METHODS

Phase 1 enrolled 13 children 2 to 7 years of age undergoing outpatient elective surgery and their parents for formative evaluation of WebTIPS. Parent participation focus groups are common in qualitative research and are a method of asking research participants about their perceptions and attitudes regarding a product or concept. In phase 2, children 2 to 7 years of age in 2 medical centers were assigned randomly to receive the WebTIPS program (n = 38) compared with children receiving the standard of care (n = 44). The primary outcome of phase II was child and parent preoperative anxiety.

RESULTS

In phase 2, parents reported WebTIPS to be both helpful (P < 0.001) and easy to use (P < 0.001). In phase 2, children in the WebTIPS group (36.2 ± 14.1) were less anxious than children in the standard of care group (46.0 ± 19.0) at entrance to the operating room (P = 0.02; Cohen d = 0.59) and introduction of the anesthesia mask (43.5 ± 21.7 vs 57.0 ± 21.2, respectively, P = 0.01; Cohen d = 0.63). Parents in the WebTIPS group (32.1 ± 7.4) also experienced less anxiety compared with parents in the control group (36.8 ± 7.1) in the preoperative holding area (P = 0.004; Cohen d = 0.65).

CONCLUSIONS

WebTIPS was well received by parents and children and led to reductions in preoperative anxiety.

A concept analysis of patient-centred nursing in the intensive care unit

AIM

To report an analysis of the concept of patient-centred nursing in the context of intensive care.

BACKGROUND

Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care.

DESIGN

Concept analysis.

DATA SOURCES

CINAHL, PsycINFO, Medline and PubMed databases (2000-2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched.

METHODS

Walker and Avant's eight-stage approach was used.

RESULTS

Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention.

CONCLUSION

Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.