1
|
Furdock R, Alejo A, Hoffa M, Vergon A, Romeo NM, Vallier HA. Improving Patient Recall Following Operative Orthopaedic Trauma. J Bone Joint Surg Am 2024:00004623-990000000-01186. [PMID: 39190689 DOI: 10.2106/jbjs.23.01366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
BACKGROUND Orthopaedic trauma patients may experience poor recall regarding their injury and treatment, impairing postoperative outcomes. We sought to evaluate the impact of a standardized postoperative educational protocol on patient recall, adherence to the treatment plan, and satisfaction. METHODS Two hundred and twenty adult, English-speaking patients with surgically treated lower-extremity fractures were prospectively included. One hundred and ten patients in the educational intervention cohort met with a non-physician study member after surgery but before hospital discharge. They were given a written questionnaire evaluating knowledge of key aspects of their injury and treatment plan. For incorrectly answered questions, the study team member told the patient the correct answer (e.g., "No, you broke your tibia."). Immediately after, the patient was verbally asked the question again (e.g., "Which bone did you break?"), repeating the process until the answer was correct. The 110 patients in the control cohort did not receive this "teach-back" protocol. During their first postoperative appointment, all 220 patients completed a follow-up questionnaire assessing recall, adherence to the treatment plan, and satisfaction. RESULTS The control cohort correctly answered 64% of recall-oriented questions versus 89% in the intervention cohort (p < 0.001). Eighty-two percent of control patients versus 89% patients in the intervention cohort adhered to postoperative weight-bearing restrictions (p = 0.09). Eighty-four percent of controls adhered to their deep venous thrombosis prophylaxis regimen versus 99% of the intervention cohort (p < 0.001). On a 5-point Likert scale, controls were less satisfied with their overall orthopaedic care compared with patients in the intervention cohort (mean of 4.38 ± 0.84 versus 4.54 ± 0.63 points; p = 0.02), although this difference was less than the minimal clinically relevant difference of 10% that was defined at study onset. On propensity score-weighted multivariable analysis, receipt of the postoperative educational intervention was the only modifiable factor associated with improvement in patient recall (26% improvement [95% confidence interval, 20% to 31%]; p < 0.001). CONCLUSIONS Some orthopaedic trauma patients' nonadherence to surgeon recommendations and dissatisfaction with care may be mitigated by postoperative education. This standardized postoperative educational protocol improves orthopaedic trauma patients' recall, adherence to their treatment plan, and satisfaction in a manner requiring minimal time. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ryan Furdock
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andrew Alejo
- Northeast Ohio Medical University, Rootstown, Ohio
| | - Matthew Hoffa
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anna Vergon
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicholas M Romeo
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | |
Collapse
|
2
|
Kaenkumchorn TK, Lampone O, Huebner K, Cramer J, Karls C. When parenteral nutrition is the answer: The case of pediatric intestinal rehabilitation. Nutr Clin Pract 2024. [PMID: 38961658 DOI: 10.1002/ncp.11179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
In pediatric patients with intestinal failure, parenteral nutrition is lifesaving but also has several associated risks. The goals of intestinal rehabilitation include promoting growth, minimizing complications associated with intestinal failure, and reaching enteral autonomy, if possible. Pediatric intestinal rehabilitation programs are interdisciplinary teams that strive to provide optimal care for children dependent on parenteral nutrition. The provision of parenteral nutrition requires close monitoring of patients' growth, nutrition concerns, clinical status, and laboratory parameters. Recent advances in the field of intestinal rehabilitation include new lipid emulsions, considerations regarding enteral feeding, advances in micronutrient provision, and central venous catheter preservation techniques. Challenges in the field remain, including improving overall quality of life with home parenteral nutrition administration and preventing recently recognized complications such as chronic intestinal inflammation.
Collapse
Affiliation(s)
- Tanyaporn K Kaenkumchorn
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Olivia Lampone
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Kayla Huebner
- Department of Pharmacy, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Jesse Cramer
- Department of Pharmacy, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Catherine Karls
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
3
|
Wang F, Feng WM, Zhu M, Sun Q, Zhang YM, Wang B, Luo XY, Shen JT, Fang XW, Zhang T, Cui G. A study on the effect of using the video teach-back method in continuous nursing care of stroke patients. Front Public Health 2024; 12:1275447. [PMID: 38532972 PMCID: PMC10964721 DOI: 10.3389/fpubh.2024.1275447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 03/28/2024] Open
Abstract
Objective To explore the effect of a video teach-back method on continuous family nursing care of stroke patients. Methods Stroke patients hospitalized in our hospital between March 2020 and March 2023 who met the inclusion criteria were randomly divided into an intervention group (n = 45), who received routine health education plus video teach-back training of caregivers, and a control group (n = 45), who received routine health education only. The effects on nursing-related variables were compared between the two groups. Results Total scores representing the caring ability of caregivers in the intervention group increased significantly over time relative to baseline and were higher than those of the control group. Scores representing the care burden of caregivers in the intervention group decreased significantly over time and were lower than those of the control group. Conclusion The teach-back method combined with video education improves the nursing ability of family caregivers and can improve the self-care ability of stroke patients.
Collapse
Affiliation(s)
- Fei Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Huzhou City, Huzhou City, Zhejiang, China
| | - Wen-Ming Feng
- Department of General Surgery, The First People’s Hospital of Huzhou City, Huzhou City, Zhejiang, China
| | - Ming Zhu
- Department of Nephrology, The First People’s Hospital of Huzhou City, Huzhou City, Zhejiang, China
| | - Qi Sun
- Department of Rehabilitation Medicine, The First People’s Hospital of Huzhou City, Huzhou City, Zhejiang, China
| | | | - Bing Wang
- Huzhou University, Huzhou City, Zhejiang, China
| | - Xiao-Yong Luo
- Hospital Office, Qingchuan People's Hospital, Guangyuan City, China
| | | | | | - Ting Zhang
- Huzhou University, Huzhou City, Zhejiang, China
| | - Ge Cui
- Department of Pathology, The First People’s Hospital of Huzhou City, Huzhou City, Zhejiang, China
| |
Collapse
|
4
|
Li B, Jiang L, Liao L, Chen Y, Xu Z, Wu N, Chen H, Wu P, Liu T. Time series analysis of using the PDCA method combined with the Teach-back method to improve spontaneous reports of adverse drug reactions in a grade IIIA hospital in China. Eur J Clin Pharmacol 2024; 80:383-393. [PMID: 38151504 DOI: 10.1007/s00228-023-03601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Spontaneous reporting of adverse drug reactions (ADRs) is essential for the post-marketing safety evaluation of drugs. Therefore, good monitoring of ADRs is vital for strengthening drug supervision, management, and guiding rational drug use. Chinese medical institutions are the primary source of ADR case reports, but the proportion of the reports in grade IIIA hospitals is still low due to serious under-reporting. The 3rd Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People's Hospital, also has such a problem. OBJECTIVE To improve the quantity and quality of ADR reports and enhance the level of pharmacovigilance in hospitals, the Third Affiliated Hospital of Chengdu Medical College, People's Hospital of Chengdu Pidu District experienced 10 years to gradually establish a management model to improve the medical staff's reporting rate of spontaneous reporting of ADRs. The management model is led by clinical pharmacists and combines the PDCA with Teach-back methods. The purpose of this paper is to introduce the management model and discuss its advantages and shortcomings of this model. METHODS This study was conducted at the Third Affiliated Hospital of Chengdu Medical College-Chengdu Pidu District People's Hospital. From 2016, the daily management of reporting, auditing, and data improvement of adverse drug reactions in the hospital was carried out by clinical pharmacists, who used the PDCA method combined with the Teach-back method to continuously improve the reporting program of ADRs in the hospital during 2016-2021. Then, the proportion of spontaneous reports of total, new, and serious ADRs was compared before and after the intervention. Also, we performed a time series analysis using an autoregressive moving average model to assess changes in the total number of spontaneous ADR reports before the intervention (2013-2015), the first intervention (2016-2018), and the second intervention (2019-2021). RESULTS After the combined PDCA and Teach-back method intervention, the median number of reported ADRs per year increased from 50 (range 37-55) in the pre-intervention period to 88 (range 83-162) in the first intervention period and to 374 in the second (range 312-566). Breakpoint regression analysis of the spontaneous reporting rate of ADRs showed that the instantaneous increase after the first intervention was not statistically significant (P = 0.526). However, the reporting rate of ADRs increased at a month-by-month growth rate during the second intervention compared to the first intervention. Its spontaneous reporting rate improved 1.034 times (P = 0.002). After the second intervention, the spontaneous reporting rate of ADRs transiently increased 6.111-fold (P < 0.001), and the month-to-month growth rate increased 1.024-fold (P < 0.001) again. CONCLUSION The management model that combines the PDCA and the Teach-back method significantly improves the reporting rate of adverse drug reactions.
Collapse
Affiliation(s)
- Bo Li
- Pharmacy Department, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Li Jiang
- Pharmacy Department, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Li Liao
- The Second People's Hospital of Yinbin - Yibin Hospital of West China Hospital of Sichuan University, Yibin, 644000, China
| | - Yao Chen
- Pharmacy Department, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Zhi Xu
- Department of Respiratory and Critical Care Medicine, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Ni Wu
- Pharmacy Department, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Heping Chen
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Pan Wu
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China
| | - Tianhu Liu
- Drug Clinical Trial Management Center, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China.
- Department of Cardiovascular Medicine, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, 611730, Sichuan, China.
| |
Collapse
|
5
|
Barksdale S, Stark Taylor S, Criss S, Kemper K, Friedman DB, Thompson W, Donelle L, MacGilvray P, Natafgi N. Improving Patient Health Literacy During Telehealth Visits Through Remote Teach-Back Methods Training for Family Medicine Residents: Pilot 2-Arm Cluster, Nonrandomized Controlled Trial. JMIR Form Res 2023; 7:e51541. [PMID: 37971799 PMCID: PMC10690523 DOI: 10.2196/51541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/29/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. OBJECTIVE We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. METHODS We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop's videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. RESULTS Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. CONCLUSIONS This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.
Collapse
Affiliation(s)
- Shanikque Barksdale
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shannon Stark Taylor
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Family Medicine Residency Greenville, Prisma Health, Greenville, SC, United States
| | - Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Karen Kemper
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Wanda Thompson
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
| | - Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Phyllis MacGilvray
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Family Medicine, Prisma Health, Greenville, SC, United States
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
| |
Collapse
|
6
|
Amonoo HL, Deary EC, Wang A, Newcomb RA, Daskalakis E, Weber D, Holmbeck KE, Choe JJ, Nabily A, Cutler C, Traeger LN, El-Jawahri A. Medication Adherence in Patients with Hematologic Malignancies Who Are Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study. Transplant Cell Ther 2023; 29:620.e1-620.e11. [PMID: 37516379 PMCID: PMC10592303 DOI: 10.1016/j.jtct.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Medication adherence is critical for optimal health outcomes in patients with hematologic malignancies who have undergone allogeneic hematopoietic stem cell transplants (HSCT). However, this population struggles with medication nonadherence. Research that comprehensively describes the complex patient- and medication-related factors which impact medication adherence in this population is lacking. Hence, we used semistructured qualitative interviews to explore the diverse and complex factors contributing to medication adherence in HSCT recipients. We conducted 30 in-depth interviews with patients who were more than 180 days post-allogeneic HSCT at the Dana-Farber Cancer Institute. The interviews explored the physical, social, psychological, and sociodemographic factors that facilitate or discourage adherence to the post-transplantation medication regimen. Interviews were audio-recorded, transcribed, and coded using NVivo software. Two themes emerged that characterized the barriers patients face with their medication regimen. Patients reported factors outside of their control, such as managing multiple pharmacies, health insurance difficulties, and dosage timing, as significant barriers to medication adherence. Patients also reported barriers within their control, such as familial responsibilities. Important facilitators for medication adherence included caregiver and clinician support, previous experience managing a medication regimen, and tools that aid pill organization and timing. Furthermore, patients reported that although medication side effects and quantity of pills did not directly impact medication adherence, it increased their psychological distress. Facilitators and barriers to medication adherence can be physical, psychological, organizational, and social. There are many aspects of medication regimens that significantly increase patient distress. Hence, supportive interventions to improve medication adherence in patients undergoing HSCT may need to incorporate strategies to manage medication side effects and skills to improve psychological well-being and social support.
Collapse
Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Annie Wang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine E Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychology, University of Miami, Coral Gables, Florida
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
7
|
Evaluating patient recall following operative orthopaedic trauma. Injury 2023:S0020-1383(23)00269-3. [PMID: 36931966 DOI: 10.1016/j.injury.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Orthopedic trauma patients may have poor recall of their injuries and treatment. This may lead to poor adherence to instructions. The purposes of this project were to quantify recall about injury and treatment information, and to assess adherence to postoperative instructions and satisfaction with care. METHODS A prospective cohort of 110 consecutive adult orthopaedic trauma patients treated for acute injury at a Level 1 trauma center were included. All had undergone surgical treatment of fractures of the pelvis or lower extremity. A brief survey to assess patient recall about injury and treatment knowledge, adherence to weightbearing and DVT recommendations and to evaluate patient satisfaction was administered during the first post-hospital clinic visit. RESULTS Patients correctly answered 64% of recall-oriented questions. 82% and 83% of patients, respectively, reported adherence to their weightbearing restrictions and their DVT prophylaxis regimen, while 66% of patients reported adherence to both. Forty-two percent of non-adherent patients could not remember their weightbearing restrictions, while 78% of non-adherent patients could not remember their DVT prophylaxis regimen. Average patient satisfaction was 4.3 (range 1-5), with 15% of patients indicating neutral sentiment or dissatisfaction with their care. CONCLUSION Orthopaedic trauma patients have poor recall, which likely reduces postoperative adherence and may impair patient satisfaction. A postoperative educational protocol focused on improving patient recall may be useful. LEVEL OF EVIDENCE Level 4, prognostic.
Collapse
|
8
|
Geyer D, Vessey JA, Chen A, DiFazio RL. Parental Caregiver Expectations and Satisfaction Following Hip Reconstruction and Spinal Fusion in Children With Cerebral Palsy. Orthop Nurs 2023; 42:94-102. [PMID: 36944203 DOI: 10.1097/nor.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Children with severe (Gross Motor Function Classification System [GMFCS] IV-V) cerebral palsy (CP) exhibit profound physical and developmental impairments and require assistance for all activities of daily living. No curative treatments exist although surgical procedures to correct underlying hip and spine deformities can improve their quality of life. Despite the efficacy of these surgeries, little is known regarding parental caregivers' expectations specific to surgical outcomes and their satisfaction with surgical outcomes. The purpose was to explore parental caregiver expectations and satisfaction with hip and spine surgeries that their children with GMFCS IV-V CP underwent. Variations among preoperative expectations, changes in expectations over time, and the relationship of expectations on caregiver satisfaction were examined. A qualitative descriptive approach with conventional content analysis was utilized. Three preoperative caregiver expectation themes were identified: increasing functionality, increasing comfort, and maintaining health and averting crisis. These themes were still present at 5-year follow-up; however, more caregivers refocused their expectations from improving function to providing palliation. A clear relationship between expectations and caregiver satisfaction, however, was not identified. A deeper understanding surrounding caregiver expectation and satisfaction following surgical procedures is needed.
Collapse
Affiliation(s)
- David Geyer
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Judith A Vessey
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Anna Chen
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Rachel L DiFazio
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| |
Collapse
|
9
|
Johnson TM, Whitman Webster LC, Mehta M, Johnson JE, Cortés-Penfield N, Rivera CG. Pushing the agenda for intravenous push administration in outpatient parenteral antimicrobial therapy. Ther Adv Infect Dis 2023; 10:20499361231193920. [PMID: 37600976 PMCID: PMC10434178 DOI: 10.1177/20499361231193920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
Intravenous push (IVP) antimicrobial administration refers to rapid bolus infusion of medication. This drug delivery method offers improved patient convenience, superior patient and nursing satisfaction, and cost savings when used in outpatient parenteral antimicrobial therapy (OPAT). Antimicrobial agents must demonstrate optimal physiochemical and pharmacologic characteristics, as well as sufficient syringe stability, to be administered in this manner. Additionally, impacts on medication tolerability, patient safety, and effectiveness must be considered. This narrative review summarizes the available data and practical implications of IVP administration of antimicrobials in the OPAT setting.
Collapse
Affiliation(s)
- Tanner M. Johnson
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Meera Mehta
- West Virginia University Hospitals, Morgantown, WV, USA
| | - Jessica E. Johnson
- Department of Medicine, Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | | | - Christina G. Rivera
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
10
|
Thominet L, Hamel LM, Baidoun F, Moore TF, Barton E, Heath EI, Carducci M, Lansey D, Eggly S. Physicians' use of plain language during discussions of prostate cancer clinical trials with patients. PATIENT EDUCATION AND COUNSELING 2022; 105:3453-3458. [PMID: 36085183 PMCID: PMC9675686 DOI: 10.1016/j.pec.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study described physicians' use of plain language during patient-physician cancer clinical trial discussions. METHODS Video-recorded clinical interactions and accompanying transcripts were taken from a larger study of communication and clinical trials (PACCT). Interactions (n = 25) were selected if they included invitations to participate in a clinical trial. We used descriptive, qualitative discourse analysis, a method that identifies language patterns at or above the sentence level. We first excerpted discussions of clinical trials, then identified instances of plain language within those discussions. Finally, we inductively coded those instances to describe physicians' plain language practices. RESULTS The analysis identified four plain language practices. Lexical simplification replaced medical terminology with simpler words. Patient-centered definition named, categorized, and explained complex medical terminology. Metaphor explained medical terminology by comparing it with known concepts. Finally, experience-focused description replaced medical terminology with descriptions of patients' potential physical experiences. CONCLUSION These plain language practices hold promise as part of effective information exchange in discussions of cancer clinical trials. Testing is needed to identify patient preferences and the extent to which these practices address patient health literacy needs. PRACTICE IMPLICATIONS Pending further testing, these plain language practices may be integrated into physician clinical trial and other communication training.
Collapse
Affiliation(s)
- Luke Thominet
- Department of English, Floria International University, Miami, FL, USA.
| | - Lauren M Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Fatmeh Baidoun
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Tanina F Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Ellen Barton
- Linguistics Program, Department of English, Wayne State University, Detroit, USA.
| | - Elisabeth I Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Michael Carducci
- Johns Hopkins Medicine/Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA.
| | - Dina Lansey
- Johns Hopkins Medicine/Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA.
| | - Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| |
Collapse
|
11
|
Holcomb J, Ferguson GM, Thornton L, Highfield L. Development, implementation, and evaluation of Teach Back curriculum for community health workers. Front Med (Lausanne) 2022; 9:918686. [PMID: 36405583 PMCID: PMC9669070 DOI: 10.3389/fmed.2022.918686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2023] Open
Abstract
Teach Back is a commonly used communication method to improve patient understanding and retention of health information. The method has been shown to be effective in improving patient and healthcare system outcomes, including patient health literacy and hospital readmissions. Community health workers (CHWs) are frontline healthcare workers who can help address patient health and social needs associated with hospital readmissions. However, a gap exists in Teach Back curricula and training methods reflecting the scope of work for CHWs. The objective of this training was to provide CHWs with didactic information and skill building practice curriculum focused on the integration of Teach Back into clinical patient interactions, care coordination, and follow-up support. A multidisciplinary team of academic and clinical partners at a large academic health university developed, implemented, and evaluated a 3-week pilot Teach Back training with CHWs through a quality improvement approach. The CHWs reported overall satisfaction with the training and instructors. The academic clinical partnership allowed the training to be tailored to the daily clinical workflow as reflected in the CHWs agreement that the training was relevant and practical. With the repeated exposure to Teach Back each week, the CHWs also reported an increase in confidence and conviction in using Teach Back. Additional implementation and evaluation of the training curriculum for CHWs is needed to gain further insights into Teach Back and training best practices and translation into practice.
Collapse
Affiliation(s)
- Jennifer Holcomb
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Gayla M. Ferguson
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Logan Thornton
- Division of Population Health and Evidence-Based Practice, Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, TX, United States
| | - Linda Highfield
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
- Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, TX, United States
| |
Collapse
|
12
|
Tiozzo E, Rosati P, Brancaccio M, Biagioli V, Ricci R, d'Inzeo V, Scarselletta G, Piga S, MSc S, Vanzi V, Dall'Oglio I, Gawronski O, Offidani C, Pulimeno MA, Raponi M. A Cell-Phone Medication Error eHealth App for Managing Safety in Chronically Ill Young Patients at Home: A Prospective Study. Telemed J E Health 2022; 29:584-592. [PMID: 36070555 DOI: 10.1089/tmj.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.
Collapse
Affiliation(s)
- Emanuela Tiozzo
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Rosati
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matilde Brancaccio
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Critical Care Department, Sant'Andrea Hospital, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Victoria d'Inzeo
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gianna Scarselletta
- Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Stat MSc
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Vanzi
- University Department of Pediatrics, and Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Unit of Legal Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Ausilia Pulimeno
- Center of Excellence for Nursing Scholarship, Nursing Professions Order of Rome (OPI), Rome, Italy
| | | |
Collapse
|
13
|
Cork T, White S. Exploring community pharmacists' use of health literacy interventions in their everyday practice. Res Social Adm Pharm 2022; 18:3948-3952. [PMID: 35810054 DOI: 10.1016/j.sapharm.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limited health literacy often results in people inadequately understanding medicines-related information and subsequently not taking medicines as prescribed. Using health literacy interventions is important for community pharmacists, as they are increasingly managing long-term conditions. However, there appear to be no previous studies of community pharmacists' everyday use of health literacy interventions in the UK. OBJECTIVES To explore UK community pharmacists' perspectives on the usability of health literacy interventions in their everyday practice. METHODS Semi-structured interviews were conducted with participants, following attendance at health literacy training that included practicing the use of four health literacy interventions (Teach-Back, Chunk and Check, Simple Language and visual aids) and two months experience of attempting to use them in their everyday practice. Participants were pharmacists from community pharmacies in Staffordshire, England who were invited to participate by an email sent to the pharmacy. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Analysis technique. RESULTS Four themes emerged from 11 interviews undertaken: intervention appeal, limitations, adaptations and continued use. Participants reported using all four health literacy interventions in their everyday practice but Teach-Back appeared to be favoured most. Most participants talked about practicing Teach-Back before using it with patients but described it as useable with patients of all ages, without being prohibitively time consuming. Chunk and Check seemed to be viewed as a type of Teach-Back, whilst visual aids were reported as being used in conjunction with Teach Back rather than as a standalone intervention. Participants reported that Simple Language was an easy concept but easily 'slipped back' into medical jargon and were challenged to use simple enough words. All participants said they would continue to use all four health literacy interventions. CONCLUSIONS The findings suggest that with training, community pharmacists can successfully incorporate these four health literacy interventions into their everyday practice.
Collapse
Affiliation(s)
- Tania Cork
- Keele University, Pharmacy Dept. Keele University, Staffordshire, ST5 5BG, UK.
| | - Simon White
- Keele University, Pharmacy Dept. Keele University, Staffordshire, ST5 5BG, UK
| |
Collapse
|
14
|
Holcomb J, Ferguson GM, Thornton L, Highfield L. Development of Training Curriculum to Improve Patient Communication Skills and Social Support Among Community Health Workers. Health Lit Res Pract 2022; 6:e142-e150. [PMID: 35680123 PMCID: PMC9179034 DOI: 10.3928/24748307-20220518-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Effective provider communication skills are important for patient decision-making and understanding, particularly for those with low health literacy. A gap exists in training methods and curriculum for community health workers (CHWs). Brief description of activity: Through a clinical and academic partnership, pilot training curriculum focused on patient communication skills was developed to align with CHW scope of work. Implementation: The curriculum was implemented in three 2-hour training sessions over WebEx with seven state-certified CHWs. The goal was for CHWs to understand the key elements and application of active listening, Teach Back, and action planning in a clinical setting. The sessions included didactic and skills practice modules for each skill. Results: A survey was distributed to CHWs to evaluate knowledge, skills, and attitudes and reactions to training methods, instructors, and relevance using the Kirkpatrick's evaluation model (Reaction and Learning). Although CHWs agreed that they had actively participated in the training and that the instructors were well-prepared, there was less agreement that the course was relevant. CHWs reported an increase in understanding of active listening and action planning, capability of using Teach Back and providing social support, and ability to teach, whereas a decrease was reported in the capability to use action planning. When probed about training relevance, CHWs felt action listening and Teach Back were relevant, but that action planning was not relevant to their responsibilities. This gap in responsibilities was also acknowledged by the clinical leadership. Lessons learned: The training allowed the CHWs to build on subsequent skills from previous sessions and to discuss struggles. A need for tools for integrating the skills in the clinical workflow were requested by CHWs and clinical leadership. These tools offer the opportunity to tailor future trainings on communication skills or patient scenarios. Future trainings should include CHWs to provide insight into scope of work. [HLRP: Health Literacy Research and Practice. 2022;6(2):e142–e150.] Plain Language Summary: It is important for community health workers to communicate with patients so that patients can understand information and make their own decisions. There is not enough known about the best way to train CHWs in patient communication. This training was created to help CHWs use three patient communication skills in their clinic.
Collapse
Affiliation(s)
- Jennifer Holcomb
- Address correspondence to Jennifer Holcomb, DrPH, MPH, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030;
| | | | | | | |
Collapse
|
15
|
Gibson C, Smith D, Morrison AK. Improving Health Literacy Knowledge, Behaviors, and Confidence with Interactive Training. Health Lit Res Pract 2022; 6:e113-e120. [PMID: 35522855 PMCID: PMC9126053 DOI: 10.3928/24748307-20220420-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ensuring that health care professionals are knowledgeable about the influence limited health literacy has on health outcomes and how to apply health literate strategies is crucial to transform quality and safety in care settings. Although many organizational efforts to address health literacy have focused on hospital settings, few have focused on primary care. The designation of a patient-centered medical home requires the need to address integrating health literacy and the training needs of primary care settings. Brief description of activity: An interactive health literacy training intervention was developed, implemented, and evaluated for 25 primary care clinics. This included an online educational module, in-person application activities, and a sustainability plan to continue skill building, reinforce behaviors, and support practice. IMPLEMENTATION Using a descriptive pre- and post-training design, three survey measures were used to rate health literacy knowledge, behaviors, and confidence levels of more than 475 primary care staff. A pre-training survey was completed prior to completion of an interactive online health literacy module and attendance at an in-person training session which followed. A post-training survey was then completed. Sustainment activities, including lunch and learns, and reinforcement activities by clinic leaders, were initiated to promote use of the strategies in practice. A 1-year follow-up survey was then administered to measure sustainability. RESULTS The interactive training intervention improved primary care staff's knowledge, behaviors, and confidence in using health literacy strategies with patients and families. Common barriers and facilitators around the use of these strategies were also identified. LESSONS LEARNED Careful consideration should be taken when developing health literacy training to ensure it will be effective, efficient, and sustainable. Using elements that facilitate the transfer of training to practice will help improve success. Addressing barriers and promoting facilitators, as well as integrating and connecting health literacy strategies with existing organizational goals and initiatives offer additional ways to reinforce and sustain the practice change. [HLRP: Health Literacy Research and Practice. 2022;6(2):e113-e120.] Plain Language Summary: Clinic staff can improve how they provide information and education to children and families. Interactive training about health literacy led clinic staff to (1) know more about health literacy, (2) use health literacy strategies more, and (3) feel more confident using health literacy strategies. Training over time, supporting staff, and connecting to organizational goals are important for sustainment.
Collapse
Affiliation(s)
- Cori Gibson
- Address correspondence to Cori Gibson, MSN, RN, CNL, Children's Wisconsin Corporate Center, Suite 650, 999 N. 92nd Street, Milwaukee, WI 53226;
| | | | | |
Collapse
|
16
|
Barks MC, Schindler EA, Ubel PA, Jiao MG, Pollak KI, Huffstetler HE, Lemmon ME. Assessment of parent understanding in conferences for critically ill neonates. PATIENT EDUCATION AND COUNSELING 2022; 105:599-605. [PMID: 34130892 PMCID: PMC8664893 DOI: 10.1016/j.pec.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVES This study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants. METHODS We enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as "absent," "yes/no," or "elaborated." RESULTS Fifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their answers most of the time (n = 55/60, 92%). Approximately three-quarter of partial assessments yielded no verbal response from parents. No conferences included a teach-back. CONCLUSIONS Although common, most clinician assessments of understanding were partial or close-ended and rarely resulted in elaborated responses from parents. Open-ended assessments are an effective, underutilized strategy to increase parent engagement and clinician awareness of information needs. PRACTICE IMPLICATIONS Clinicians hoping to facilitate parent engagement and question-asking should rely on open-ended statements to assess understanding.
Collapse
Affiliation(s)
- Mary C Barks
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA.
| | - Emma A Schindler
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Peter A Ubel
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Megan G Jiao
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hanna E Huffstetler
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA
| | - Monica E Lemmon
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
17
|
Jethwa TE, Moran KM, Maniaci MJ. Medication non-adherence as a cause of apixaban failure in venous thromboembolism: The importance of pharmacist medication reconciliation. Clin Case Rep 2022; 10:e05338. [PMID: 35140953 PMCID: PMC8811178 DOI: 10.1002/ccr3.5338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Venous thromboembolism is often treated with direct oral anticoagulants. In order for direct oral anticoagulants to be effective, patients must adhere to a specific dosing strategy. We report a case of apixaban failure, the clinical workup that ensued, and the eventual discovery of unsuccessful medication adherence as the cause.
Collapse
Affiliation(s)
- Trisha E Jethwa
- Department of Family MedicineMayo Clinic in FloridaJacksonvilleFloridaUSA
| | - Kaitlin M Moran
- Department of Internal MedicineMayo Clinic in FloridaJacksonvilleFloridaUSA
| | - Michael J Maniaci
- Department of Internal MedicineMayo Clinic in FloridaJacksonvilleFloridaUSA
| |
Collapse
|
18
|
Hoffman SC, Buczkowski AS, Mallory L, McGovern LB, Cappen SM, Douglass AS, Correia R, Longnecker L, Taylor CS, Holmes R, Poulin B, McElwain LL. Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments. Pediatrics 2022; 149:183844. [PMID: 34972225 DOI: 10.1542/peds.2020-032862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. METHODS The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. RESULTS Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%-81%) and for those with transportation insecurity (0%-57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. CONCLUSIONS Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.
Collapse
Affiliation(s)
- Sarah C Hoffman
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| | - Amy S Buczkowski
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| | - Leah Mallory
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| | - Lauren B McGovern
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Shannon M Cappen
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Amy S Douglass
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Russell Correia
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Lee Longnecker
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Campbell S Taylor
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Rebekah Holmes
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Brogan Poulin
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Lorraine L McElwain
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| |
Collapse
|
19
|
Eggly S, Manning M, Senft N, Moore TF, Albrecht TL, Penner LA, Heath E, Carducci MA, Lansey DG, Hamel LM. Development and pilot test of a physician-focused cancer clinical trials communication training intervention. PEC INNOVATION 2021; 1:100012. [PMCID: PMC10194245 DOI: 10.1016/j.pecinn.2021.100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 05/30/2023]
Abstract
Objective We describe the development and pilot test of a physician-focused, web-based training module designed to improve physician communication related to clinical trials in a diverse cancer patient population. Methods Researchers and stakeholders developed the training module, which included a video explaining patient-centered communication strategies for discussing trials, and re-enactments of actual clinical interactions. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two major urban cancer centers. Questionnaires assessed change in beliefs, behavioral attitudes, knowledge and comfort; and perceptions of the module. Results Nineteen physicians participated in the pilot test. Most were experienced in discussing trials. Assessments of change were mixed regarding beliefs; they showed marginal improvement in attitudes, and significant improvement in knowledge, but no change in comfort. Feedback on the module was favorable. Conclusions This stakeholder-developed physician communication training module was acceptable and effective, albeit in this small and highly-experienced physician sample. Future research should determine its effectiveness on communication in clinical settings. Innovation This is the first physician training module to focus on communicating about clinical trials in a diverse patient population. It offers a web-based format and re-enactments of naturally-occurring clinical interactions. Trial Registration Number: NCT02906241
Collapse
Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Mark Manning
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Tanina Foster Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Terrance L. Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Louis A. Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Michael A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Dina G. Lansey
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| |
Collapse
|
20
|
Osorio SN, Gage S, Mallory L, Soung P, Satty A, Abramson EL, Provost L, Cooperberg D. Factorial Analysis Quantifies the Effects of Pediatric Discharge Bundle on Hospital Readmission. Pediatrics 2021; 148:peds.2021-049926. [PMID: 34593650 DOI: 10.1542/peds.2021-049926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs). METHODS A 24 factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates. RESULTS RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%. CONCLUSIONS The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
Collapse
Affiliation(s)
- Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Sandra Gage
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Department of Child Health, College of Medicine-Phoenix, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Leah Mallory
- Department of Pediatrics, School of Medicine, Tufts University and The Barbara Bush Children's Hospital, Portland, Maine
| | - Paula Soung
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Alexandra Satty
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | | | | | | |
Collapse
|
21
|
Zhou H, Roberts PA, Della PR. Nurse-Caregiver Communication of Hospital-To-Home Transition Information at a Tertiary Pediatric Hospital in Western Australia: A Multi-Stage Qualitative Descriptive Study. J Pediatr Nurs 2021; 60:83-91. [PMID: 33676143 DOI: 10.1016/j.pedn.2021.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To observe and describe nurse-caregiver communication of hospital-to-home transition information at the time of discharge at a tertiary children's hospital of Western Australia. DESIGN AND METHODS A multi-stage qualitative descriptive design involved 31 direct clinical observations of hospital-to-home transition experiences, and semi-structured interviews with 20 caregivers and 12 nurses post-discharge. Eleven caregivers were re-interviewed 2-4 weeks post-discharge. Transcripts of audio recordings and field notes were analyzed using content analysis. Medical records were examined to determine patients' usage of hospital services within 30 days of discharge. RESULTS Four themes emerged from the content analysis: structure of hospital-to-home transition information; transition information delivery; readiness for discharge; and recovery experience post-hospital discharge. Examination of medical records found seven patients presented to the Emergency Department within 2-19 days post-discharge, of which three were readmitted. Primary caregivers of three readmitted patients all had limited English proficiency. CONCLUSION The study affirmed the complexity of transitioning pediatric patients from hospital to home. Inconsistent content and delivery of information impacted caregivers' perception of readiness for discharge and the recovery experience. PRACTICE IMPLICATIONS Nurses need to assess readiness for discharge to identify individual needs using a validated tool. Inclusion of education on hospital-to-home transition information and discharge planning/process is required in the orientation program for junior and casual staff to ensure consistency of information delivery. Interpreter services should be arranged for caregivers with limited language proficiency throughout the hospital stay especially when transition information is being provided. Nurses should apply teach-back techniques to improve caregivers' comprehension of information.
Collapse
Affiliation(s)
- Huaqiong Zhou
- Perth Children's Hospital, Western Australia, Australia; Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
| | - Pamela A Roberts
- Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
| | - Phillip R Della
- Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
| |
Collapse
|
22
|
Zhu J, Shao LW, Yuan JY, Zhu L, Chen CH, Hu XM. Impact of Video Technology on the Comprehension of Patients With First Insulin Injection and the Efficiency of Nurse Education. Clin Nurs Res 2021; 31:435-444. [PMID: 34409889 DOI: 10.1177/10547738211036600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to compare the effectiveness of video and paper materials used for teach-back education on the first insulin injection for patients with diabetes. The study enrolled 110 patients hospitalized for diabetes who had received education on their first insulin injection in the endocrinology department. The patients were divided into an intervention group (n = 55) and a control group (n = 55) using convenience sampling. Video materials were employed for the teach-back education of the intervention group, while paper materials were employed for the teach-back education of the control group. We compared cases who answered correctly to the common parts (selection and management of injection devices, selection and rotation of injection sites, proper use of injection angles and pinching, insulin storage, injection-related complications and their prevention, selection of the correct needle length, and safe disposal of needles after use) for the first time, the number of educational sessions and total education duration between the two groups and employed the "My View on Insulin" questionnaire to survey the two groups before and 28 days after the intervention. The intervention group had a shorter total education duration than the control group, a difference that was statistically significant (p < .001). The intervention group had more advantages over the control group in terms of rotation education at the injection site (p < .05). There was no statistically significant difference in the questionnaire scores between the two groups after the intervention (p > .05); however, both groups scored significantly higher than before the intervention, a difference that was statistically significant (p < .001). The teach-back method combined with video materials applied for educating patients on their first insulin injection could reduce the education duration by healthcare providers and improve the patients' psychological insulin resistance. The key to successfully teaching patients to self-administer insulin, and allowing them to master the steps involved, is to focus on "why" rather than "what" to do.
Collapse
Affiliation(s)
- Jing Zhu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University School of Medicine, Hangzhou, China
| | - Le-Wen Shao
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University School of Medicine, Hangzhou, China
| | - Jing-Yun Yuan
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liang Zhu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Can-Hua Chen
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xin-Mei Hu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
23
|
Nurse and Provider Pain Management Education Priorities and Barriers. Pain Manag Nurs 2021; 22:579-585. [PMID: 34393038 DOI: 10.1016/j.pmn.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this research was to describe health care nurse and providers' pain management education priorities and barriers for pediatric cardio-thoracic surgical (CTS) patients and their caregivers. DESIGN This was a qualitative-descriptive study design using survey methodology. METHODS A convenience sample of 206 (CTS) health care professionals including 172 nurses, 11 advanced practice providers, and 23 physicians were invited to participate in this study. The survey was distributed through a work e-mail within a 145-bed tertiary pediatric hospital and focused on collaborative pain management educational priorities and barriers. RESULTS Of the 206 cardio-thoracic service health care nurses/providers surveyed, 45.6 % (N = 94) responded to the survey. The top pain management education priority for these nurses/providers included immediate postoperative pain management knowledge for the caregiver and pediatric CTS patient. The lowest priority 13.8% (N = 13) included education related to pain management needs after discharge. Of the 94 nurses/providers who responded, 31.9% (n = 30) identified the presence of timing and communication barriers in providing pain management education with caregivers and pediatric CTS patients. AIMS The aim of this research was to describe health care providers pain management education priorities and barriers for cardio-thoracic surgical (CTS) pediatric patients and their caregivers. SETTING 145-bed tertiary pediatric hospital. PARTICIPANTS/SUBJECTS Nurses, advanced practice providers [APP's], and physicians. CONCLUSIONS Nurses and providers prioritize immediate postoperative pain management education; however, there remains a need to focus more on the outcomes of pain management education for caregivers and pediatric CTS patients after discharge.
Collapse
|
24
|
Abstract
BACKGROUND The St. Vincent Charity Medical Center's Patient and Family Education Policy directs staff to provide patients with easy-to-understand written and verbal communication. This includes using plain language and Teach-Back. Teach-Back-or asking patients to explain in their own words what they have learned-is a best practice that health care professionals use to ensure patient understanding. The effective use of plain language is key to using Teach-Back successfully. From random audits, we could assess whether staff were documenting their use of Teach-Back. We had not, however, ascertained whether that documentation was a true account of the use of Teach-Back. Brief description of activity: We created a three-part project to (1) assess staff knowledge and use of Teach-Back, (2) assess and address barriers to use of Teach-Back, and 3) assess patients' recall of their providers using Teach-Back. IMPLEMENTATION Internal medicine resident physicians (hereafter termed "residents") and nurses completed an anonymous, online survey regarding their experience with Teach-Back. After vetting, these responses were integrated into mandatory provider training. Focusing on health literacy and Teach-Back, the training addressed barriers, reinforced positive experiences, and tailored practice encounters to patients. We then randomly surveyed inpatients to assess their recall of their providers using Teach-Back. RESULTS The majority (96.3%) of providers indicated that Teach-Back should be used frequently. Only 79.9%, however, reported using Teach-Back. Providers regarded Teach-Back as important and rated their confidence level as high. Providers also reported barriers to Teach-Back. Of the 135 patients surveyed, 46% recalled their providers using this method. LESSONS LEARNED We note a gap between providers' self-reported use of Teach-Back and patients' recall of their providers using it. Providers may be overstating their utilization rate. The survey, further, assessed patients at random points in their hospital stays, to include those who had not yet received Teach-Back education. These factors could contribute to the observed discrepancy. Most notably, results confirmed our position that regular provider training helps address barriers and misconceptions about Teach-Back. [HLRP: Health Literacy Research and Practice. 2021;5(3):e226-e232.] Plain Language Summary: Our Health Literacy Institute was created in 2007 after receiving a grant to institutionalize health literacy across the continuum of patient care. Health literacy refers to a person's ability to obtain, understand, and process basic information, which empowers them to make appropriate health decisions.
Collapse
Affiliation(s)
- Karen Komondor
- Address correspondence to Karen Komondor, RN, BSN, CCRN, St. Vincent Charity Medical Center, 2351 E. 22nd Street, Cleveland, OH 44115; Karen.
| | | |
Collapse
|
25
|
Anderson KM, Leister S, De Rego R. The 5Ts for Teach Back: An Operational Definition for Teach-Back Training. Health Lit Res Pract 2021; 4:e94-e103. [PMID: 32293689 PMCID: PMC7156258 DOI: 10.3928/24748307-20200318-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/22/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Teach Back is a health communication strategy used to confirm patient understanding in a non-shaming way. Although Teach Back is widely recommended as a best practice strategy for improving patient outcomes and organizational health literacy, there is lack of consensus in the literature on the definition of Teach Back and the best methods for training health care workers (HCWs). Our experience suggests that if you teach specific, observable skills, these can be identified in practice and potentially measured in research. Brief description of activity: We created a training program, the 5Ts for Teach Back, based on a standardized operational definition of Teach Back and five specific, observable components. Participants use a Teach-Back Observation Tool to identify the 5Ts in practice and during peer evaluation. The program incorporates lecture, observation, practice, and videos with good and bad examples of Teach Back. Implementation: The training was offered to HCWs in a large academic health care system. Flexible training options ranged from a single 4-hour training to a more comprehensive program that included clinic-specific scenarios, peer coaching, and refresher activities over a 6-month period. Results: The 5Ts for Teach Back operationalizes the definition of Teach Back and provides a model for training HCWs in the use of Teach Back. The 5Ts for Teach Back can be used to train any HCW. A single training session does not guarantee proficiency in practice. Through coaching and refresher activities, competence in Teach Back increases. Lessons learned: Teaching entire clinical units may increase effectiveness, because Teach Back becomes embedded in the unit culture. The Observation Tool can be used for training, coaching, and evaluation. The standardized method and Observation Tool are potentially useful when evaluating Teach Back during outcomes and patient satisfaction research. [HLRP: Health Literacy Research and Practice. 2020;4(2):94–103.] Plain Language Summary: Health care workers may be clearer when giving information to patients if they use Teach Back. Studies do not show what methods are best for training health care workers how to do Teach Back. The 5Ts method breaks Teach Back into five skills that help health care workers do it well. The 5Ts can also confirm use and may be helpful for research.
Collapse
Affiliation(s)
- Kathryn M. Anderson
- Address correspondence to Kathryn M. Anderson, MA, University of New Mexico Hospitals, 2211 Lomas NE, Albuquerque, NM 87131;
| | | | | |
Collapse
|
26
|
Zhou H, Albrecht MA, Roberts PA, Porter P, Della PR. Using machine learning to predict paediatric 30-day unplanned hospital readmissions: a case-control retrospective analysis of medical records, including written discharge documentation. AUST HEALTH REV 2021; 45:328-337. [PMID: 33840419 DOI: 10.1071/ah20062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/18/2020] [Indexed: 11/23/2022]
Abstract
Objectives To assess whether adding clinical information and written discharge documentation variables improves prediction of paediatric 30-day same-hospital unplanned readmission compared with predictions based on administrative information alone. Methods A retrospective matched case-control study audited the medical records of patients discharged from a tertiary paediatric hospital in Western Australia (WA) between January 2010 and December 2014. A random selection of 470 patients with unplanned readmissions (out of 3330) were matched to 470 patients without readmissions based on age, sex, and principal diagnosis at the index admission. Prediction utility of three groups of variables (administrative, administrative and clinical, and administrative, clinical and written discharge documentation) were assessed using standard logistic regression and machine learning. Results Inclusion of written discharge documentation variables significantly improved prediction of readmission compared with models that used only administrative and/or clinical variables in standard logistic regression analysis (χ2 17=29.4, P=0.03). Highest prediction accuracy was obtained using a gradient boosted tree model (C-statistic=0.654), followed closely by random forest and elastic net modelling approaches. Variables highlighted as important for prediction included patients' social history (legal custody or patient was under the care of the Department for Child Protection), languages spoken other than English, completeness of nursing admission and discharge planning documentation, and timing of issuing discharge summary. Conclusions The variables of significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary add value to prediction models. What is known about the topic? Despite written discharge documentation playing a critical role in the continuity of care for paediatric patients, limited research has examined its association with, and ability to predict, unplanned hospital readmissions. Machine learning approaches have been applied to various health conditions and demonstrated improved predictive accuracy. However, few published studies have used machine learning to predict paediatric readmissions. What does this paper add? This paper presents the findings of the first known study in Australia to assess and report that written discharge documentation and clinical information improves unplanned rehospitalisation prediction accuracy in a paediatric cohort compared with administrative data alone. It is also the first known published study to use machine learning for the prediction of paediatric same-hospital unplanned readmission in Australia. The results show improved predictive performance of the machine learning approach compared with standard logistic regression. What are the implications for practitioners? The identified social and written discharge documentation predictors could be translated into clinical practice through improved discharge planning and processes, to prevent paediatric 30-day all-cause same-hospital unplanned readmission. The predictors identified in this study include significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary.
Collapse
Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Princess Margaret Hospital for Children, Perth, WA 6008, Australia; and School of Nursing, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia. Email address: ; ; ;
| | - Matthew A Albrecht
- School of Nursing, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia. Email address: ; ; ;
| | - Pamela A Roberts
- School of Nursing, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia. Email address: ; ; ;
| | - Paul Porter
- School of Nursing, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia. Email address: ; ; ; ; and Joondalup Health Campus, Joondalup, WA 6027, Australia
| | - Philip R Della
- School of Nursing, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia. Email address: ; ; ; ; and Visiting Professor, College of Nursing, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; and Corresponding author.
| |
Collapse
|
27
|
Eloi H. Implementing teach-back during patient discharge education. Nurs Forum 2021; 56:766-771. [PMID: 33931873 DOI: 10.1111/nuf.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
AIM To determine how registered nurses understood the teach-back method and whether such understanding translated to better evaluation of patients' understanding of discharge instructions. BACKGROUND The teach-back method helps nurses confirm whether the information provided to patients is understood. The current literature indicates the benefits of teach-back; however, nurses do not apply the method adequately during discharge teaching. DESIGN This study used a qualitative pretest-posttest design with an educational session. METHODS A consecutive sampling method was used. Twelve nurses were interviewed using a discussion guide to gauge their understanding of the teach-back method during the period July to August 2016. This was followed by an educational session on the teach-back method. Nurses then implemented the method on the medical/surgical unit. A second interview was conducted using a questionnaire to evaluate participants' understanding of the method. Data were analyzed using Atlas.ti 7 software. RESULTS Participants' knowledge of the teach-back method increased. Participants identified benefits associated with the method, but time constraint was a concern. CONCLUSION The findings contribute to an understanding of the teach-back method by nurses. Patient care will benefit if the method is reinforced among nurses through continuing in-service education.
Collapse
Affiliation(s)
- Hildreth Eloi
- Department of Undergraduate Studies, Cizik School of Nursing at UTHealth, Houston, Texas, USA
| |
Collapse
|
28
|
Uong A, Philips K, Hametz P, Dunbar J, Jain P, O’Connor K, Offenbacher R, Eliezer K, Pilnick C, Kiely V, Rinke ML. SAFER Care: Improving Caregiver Comprehension of Discharge Instructions. Pediatrics 2021; 147:peds.2020-0031. [PMID: 33707198 PMCID: PMC8015156 DOI: 10.1542/peds.2020-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND One in five pediatric patients suffers from adverse events related to hospital discharge. Current literature lacks evidence on effective interventions to improve caregiver comprehension (CC) of discharge instructions. We examined if a standardized framework for written and verbal discharge counseling was associated with increased CC of key discharge instructions after discharge from a general pediatric inpatient unit. METHODS An interprofessional team created the SAFER Care framework to encourage standard, comprehensive discharge counseling. Plan-do-study-act cycles included electronic health record smartphrases, educational initiatives, data feedback, visual aids, and family outreach. Caregivers were surveyed by phone within 4 days of discharge. Our primary outcome was the proportion of caregivers correctly responding to all questions related to discharge care, comparing pre- and postintervention periods. Data were plotted on a statistical process control chart to assess the effectiveness of interventions. RESULTS A total of 171 surveys were analyzed in the preintervention period, and 262 surveys were analyzed in the postintervention period. A total of 37% of caregivers correctly responded to all questions in the preintervention period, compared with 62% of caregivers in the postintervention period, meeting rules for special cause variation. CONCLUSIONS Development of the SAFER Care framework and its use in written and verbal discharge counseling was associated with significantly improved CC of discharge instructions in a general pediatric inpatient unit. Further studies should be focused on expanding this to other populations, particularly limited-English-proficiency families.
Collapse
Affiliation(s)
- Audrey Uong
- Children's Hospital at Montefiore, Bronx, New York; and .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Kaitlyn Philips
- Children’s Hospital at Montefiore, Bronx, New York; and,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Patricia Hametz
- Children’s Hospital at Montefiore, Bronx, New York; and,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Julie Dunbar
- Children’s Hospital at Montefiore, Bronx, New York; and,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Priya Jain
- Children’s Hospital at Montefiore, Bronx, New York; and,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine O’Connor
- Children’s Hospital at Montefiore, Bronx, New York; and,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | | | - Michael L. Rinke
- Children’s Hospital at Montefiore, Bronx, New York; and,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
29
|
Choe AY, Thomson JE, Unaka NI, Wagner V, Durling M, Moeller D, Ampomah E, Mangeot C, Schondelmeyer AC. Disparity in Nurse Discharge Communication for Hospitalized Families Based on English Proficiency. Hosp Pediatr 2021; 11:245-253. [PMID: 33531376 DOI: 10.1542/hpeds.2020-000745] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Effective communication is critical for safely discharging hospitalized children, including those with limited English proficiency (LEP), who are at high risk of reuse. Our objective was to describe and compare the safety and family centeredness of nurse communication at hospital discharge for English-proficient (EP) and LEP families. METHODS In this single-center, cross-sectional study, we used direct observation of hospital discharges for EP and LEP children. Observers recorded quantitative and qualitative details of nurse-family communication, focusing on 3 domains: safe discharge, family centeredness, and family engagement. Patient characteristics and percentages of encounters in which all components were discussed within each domain were compared between EP and LEP encounters by using Fisher's exact tests. We used field notes to supplement quantitative findings. RESULTS We observed 140 discharge encounters; 49% were with LEP families. Nurses discussed all safe discharge components in 31% of all encounters, most frequently omitting emergency department return precautions. Nurses used all family-centered communication components in 11% and family-engagement components in 89% of all encounters. Nurses were more likely to discuss all components of safe discharge in EP encounters when compared with LEP encounters (53% vs 9%; P < .001; odds ratio: 11.5 [95% confidence interval 4.4-30.1]). There were no differences in family centeredness or family engagement between LEP and EP encounters. CONCLUSIONS Discharge encounters of LEP patients were less likely to include all safe discharge communication components, compared with EP encounters. Opportunities to improve nurse-family discharge communication include providing written discharge instructions in families' primary language, ensuring discussion of return precautions, and using teach-back to optimize family engagement and understanding.
Collapse
Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | - Vanessa Wagner
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Colleen Mangeot
- Division of Epidemiology, Departments of Environmental and Public Health Sciences and
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine and.,Pediatrics and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| |
Collapse
|
30
|
Chen Q, Jiang M, Zeng M, Jiesisibieke ZL, Chen PE, Chien CW, Tung TH. Constructing a new health education model for patients with chronic hepatitis B. Medicine (Baltimore) 2020; 99:e23687. [PMID: 33327358 PMCID: PMC7738050 DOI: 10.1097/md.0000000000023687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To explore the effects of the project-achievement quality control circle in constructing a new health education model for patients with chronic hepatitis B.The quality control circle group was established and the theme of "constructing a new health education model for patients with chronic hepatitis B" was selected. The circle staff determined that this quality control circle was of project-achievement according to the quality control story judgment table, and then carry out activities in strict accordance with the 10 steps of project-achievement quality control circle, evaluate the tangible results and non-tangible results before and after the activity.After the implementation of the activity, the health education integrity of patients with chronic hepatitis B increased from 74.75 ± 11.00 to 95.00 ± 5.55 points (P < .001). The awareness of health education increased from 71.90 ± 13.48 to 95.60 ± 2.84 points (P < .001), the satisfaction rate of health education increased from 76.60 ± 8.71 points to 98.00 ± 2.03 points (P < .001), and the evaluation rate after health education increased from 10% to 100% (P < .001).The circle members have much more confidence in quality control circle activities, the use of techniques, and the knowledge related to scientific research.
Collapse
Affiliation(s)
- Qinhua Chen
- Department of Nursing, Maoming People's Hospital, Maoming, Guangdong
| | - Minyu Jiang
- Department of Nursing, Maoming People's Hospital, Maoming, Guangdong
| | - Meixing Zeng
- Department of Nursing, Maoming People's Hospital, Maoming, Guangdong
| | - Zhu Liduzi Jiesisibieke
- Institute for Hospital Management, Tsinghua University, Shenzhen Canpus, Shenzhen, Guangdong, China
| | - Pei-En Chen
- Institute of Health Policy and Management, Collgue of Public Health, National Taiwan University, Taipei, Taiwan, China
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsinghua University, Shenzhen Canpus, Shenzhen, Guangdong, China
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan, China
| |
Collapse
|
31
|
Abstract
OBJECTIVES The need for high-quality discharge summaries is critical to ensure safe transitions of care. Deficits may lead to lapses in communication and poor outcomes. In this study, we sought to characterize the completeness, accuracy, and quality of pediatric discharge summaries. METHODS A retrospective chart review of 200 discharge summaries of patients discharged from the general pediatrics service from July 2016 to October 2017 was conducted. These summaries were audited for 7 elements: admission date, discharge date, discharge diagnosis, medications, immunizations, pending laboratory tests, and follow-up appointments. Accuracy was verified through chart review. Quality of hospital course and patient instructions was evaluated by using a modified validated discharge summary evaluation tool. Additional data collected included medical complexity of the patient and the number of authors. Analysis of variance, χ2 tests, and Pearson correlations were used to analyze data. RESULTS Discharge diagnosis, medications, and follow-up appointments had the lowest rates of completion and accuracy. The quality of the hospital course and patient instructions was variable, with no statistical significance seen in quality scores on the basis of the number of authors or medical complexity. There were more inaccuracies in discharge medications for patients with baseline chronic conditions than those without chronic conditions (63% vs 35%; P < .001). CONCLUSIONS Content and quality of discharge summary documentation are inconsistent and have implications for patient outcomes after discharge. This study highlights areas of opportunity to improve pediatric discharge summaries. Future work should be focused on educational and systems-based interventions to improve documentation.
Collapse
Affiliation(s)
- Divya Lakhaney
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sumeet L Banker
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
32
|
Emerson ND, Bursch B. Communicating with Youth about Pain: Developmental Considerations. CHILDREN-BASEL 2020; 7:children7100184. [PMID: 33076255 PMCID: PMC7602494 DOI: 10.3390/children7100184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. METHODS This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. RESULTS Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. CONCLUSION Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.
Collapse
|
33
|
Skoutari A, Chounta E, Skenteris N, Tsoukalas N, Alexopoulou A, Tolia M. Oncologic Children Undergoing Radiotherapy: Ways to Alleviate the Psychological Burden: A Review. Rev Recent Clin Trials 2020; 16:166-172. [PMID: 33001016 DOI: 10.2174/1574887115666201001141936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/27/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radiation therapy is stressful for both the patient and family. After a child's cancer diagnosis, parents face the burden of dealing with fear, their children's needs and the unfamiliarity of radiotherapy procedure. INTRODUCTION This paper aims to present methods to alleviate the total psychological stress those children and parents feel during the radiation course. METHODS A literature search was performed until January 2020. RESULT Previous publications suggest a multidisciplinary proactive approach involving health professionals, patient, family, and extended family to lessen the stress associated with radiation therapy. A well-trained, specialist, healthcare radiotherapy-pediatric staff can help, educate and communicate effectively with the family. Maintaining the same health staff during radiotherapy creates intimacy and reduces anxiety. All necessary age-appropriate information as well as a list available with the most important things about the care-giving should be clearly written and easily accessible. An information exchange system among all the health specialists involved must be developed. Friendly and playful specialists are crucial in familiarizing the child with the computed tomography (CT) machines and radiotherapy process. A tablet with an educating application or machine models installed in the waiting area can be useful. Creative arts therapy may be a positive intervention. Maintaining a normal routine is vital for the psychological well-being of parents and children. A social worker may assist in regaining a good mental state. CONCLUSION With ongoing age-appropriate information and psychological support throughout the whole radiation period, both parents and children will be more optimistic, strong and encouraged to fight for the child's and family's well-being.
Collapse
Affiliation(s)
- Angeliki Skoutari
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larisa, 41500, Greece
| | - Eftychia Chounta
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larisa, 41500, Greece
| | - Nikolaos Skenteris
- Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larisa, Biopolis, 41500 Larisa, Greece
| | | | - Aikaterini Alexopoulou
- Department of Radiotherapy/Radiation Oncology, General Children's Hospital "P. & A. Kyriakou", Levadeiasstr, 115 27, Athens, Greece
| | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larisa, Biopolis, 41500 Larisa, Greece
| |
Collapse
|
34
|
Mahajan M, Hogewoning JA, Zewald JJA, Kerkmeer M, Feitsma M, van Rijssel DA. The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study. Int J Emerg Med 2020; 13:49. [PMID: 32972361 PMCID: PMC7513274 DOI: 10.1186/s12245-020-00306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. Methods A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2–4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. Results Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2–4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. Conclusion Teach-back is an efficient and non-time-consuming method to improve patients’ immediate and short-term recall and comprehension of discharge information in the ED.
Collapse
Affiliation(s)
- Mandhkani Mahajan
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Janine Alida Hogewoning
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | | | - Margreet Kerkmeer
- Science Department, Reinier de Graaf Hospital, Reinier Academy, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Mathilde Feitsma
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Daphne Annika van Rijssel
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| |
Collapse
|
35
|
Johnson NL, Lerret S, Klingbeil CG, Polfuss M, Gibson C, Gralton K, Garnier-Villarreal M, Ahamed SI, Riddhiman A, Unteutsch R, Pawela L, White-Traut R, Sawin K, Weiss M. Engaging Parents in Education for Discharge (ePED): Evaluating the Reach, Adoption & Implementation of an Innovative Discharge Teaching Method. J Pediatr Nurs 2020; 54:42-49. [PMID: 32531681 PMCID: PMC10465147 DOI: 10.1016/j.pedn.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This paper describes the evaluation of the implementation of an innovative teaching method, the "Engaging Parents in Education for Discharge" (ePED) iPad application (app), at a pediatric hospital. DESIGN AND METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation. Three of the five RE-AIM elements are addressed in this study: Reach, Adoption, and Implementation. RESULTS The Reach of the ePED was 245 of 1015 (24.2%) patient discharges. The Adoption rate was 211 of 245 (86%) patients discharged in the five months' study period. High levels of fidelity (89.3%) to Implementation of the ePED were attained: the Signs and Symptoms domain had the highest (93%) and Thinking Forward about Family Adjustment screen had the lowest fidelity (83.3%). Nurse themes explained implementation fidelity: "It takes longer", and "Forgot to do it." CONCLUSIONS The ePED app operationalized how to have an engaging structured discharge conversation with parents. While the Reach of the ePED app was low under the study conditions, the adoption rate was positive. Nurses were able to integrate a theory-driven practice change into their daily routine when using the ePED app. IMPLICATIONS FOR PRACTICE The rates of adoption and implementation fidelity support the feasibility of future hospital wide implementation to improve patient and family healthcare experience. Attention to training of new content and the interactive conversation approach will be needed to fully leverage the value of the ePED app. Future studies are needed to evaluate the maintenance of the ePED app.
Collapse
Affiliation(s)
- Norah L Johnson
- College of Nursing, Marquette University, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Stacee Lerret
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Carol G Klingbeil
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Michele Polfuss
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Cori Gibson
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Karen Gralton
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | | | - S Iqbal Ahamed
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Adib Riddhiman
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Rachel Unteutsch
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Louis Pawela
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | | | - Kathy Sawin
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Marianne Weiss
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| |
Collapse
|
36
|
Koterba CH, Baum KT, Hamner T, Busch TA, Davis KC, Tlustos-Carter S, Howarth R, Fournier-Goodnight A, Kramer M, Landry A, O’Neill J, Cass J, Wilson C, Slomine BS. COVID-19 issues related to pediatric neuropsychology and inpatient rehabilitation – challenges to usual care and solutions during the pandemic. Clin Neuropsychol 2020; 34:1380-1394. [DOI: 10.1080/13854046.2020.1811892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christine H. Koterba
- Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Katherine T. Baum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Taralee Hamner
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
- Neuropsychology Department, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tyler A. Busch
- Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Kimberly C. Davis
- Department of Psychology, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Tlustos-Carter
- Department of Rehabilitation, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado, USA
| | - Robyn Howarth
- Department of Neuropsychology, Children's Healthcare Atlanta, Atlanta, Georgia, USA
| | | | - Megan Kramer
- Neuropsychology Department, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allisen Landry
- Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Jilian O’Neill
- Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Cass
- Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Camille Wilson
- Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Beth S. Slomine
- Neuropsychology Department, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
37
|
Comparison of Group Discussion and Teach Back Selfcare Education Effects on Knowledge, Attitude, and Performance of Hemodialysis Patients. Nephrourol Mon 2020. [DOI: 10.5812/numonthly.105938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hemodialysis patients require self-care training to manage their problems. To understand the effectiveness of different educational methods, it is necessary to evaluate these methods using knowledge, attitude, and practice assessment tool. Objectives: The current study aimed to compare the effects of group discussion and teach-back self-care education on the knowledge, attitude, and performance of hemodialysis patients. Methods: This quasi-experimental study is conducted on 67 patients who were undergoing hemodialysis via fistula for at least 6 months. Using the convenient sampling method, the patients were randomly allocated into two groups: teach-back training (n = 34), and group discussion (n = 33). Both groups were provided with three sessions of self-care training on nutrition, activity, and fistula care by the researcher. Considering the teaching materials, patients in the teach-back group were taught individually to ensure complete comprehension of the information. On the other hand, subjects in the group discussion were exposed to the teaching materials in the form of group training. Data were collected before and one month after providing the training sessions. Results: In this study, the majority of patients in both groups were married men with an average age of 52 years. Following education, knowledge, attitude, and performance increased in both groups. However, the teach-back method (113.88 ± 4.13) had a higher impact on the attitude of patients than group discussion (110.48 ± 5.68) (P = 0.009). Conclusions: Teach-back education increased the knowledge, performance, and attitude of patients. It is, therefore, recommended to use this method for patients with negative attitudes toward treatment and disease.
Collapse
|
38
|
Yang MM, Liang W, Zhao HH, Zhang Y. Quality analysis of discharge instruction among 602 hospitalized patients in China: a multicenter, cross-sectional study. BMC Health Serv Res 2020; 20:647. [PMID: 32652990 PMCID: PMC7353724 DOI: 10.1186/s12913-020-05518-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to understand the quality of discharge guidance for patients with chronic diseases, to clarify the gap between patient needs and the content of discharge guidance, and to provide a reference for health education and clinical path management of patients with chronic diseases in the future. METHODS A total of 602 inpatients with stroke, coronary heart disease, cancer, chronic obstructive pulmonary disease and diabetes from the chronic disease-related departments of 7 tertiary general hospitals in China were selected by convenience sampling. Measures included a demographic questionnaire and the Quality of Discharged Teaching Scale(QDTS). Descriptive analysis ANOVA and paired t-test were completed by SPSS 22.0 software. RESULTS The overall average score of QDTS in this survey was 155.79 ± 23.29. The total score of QDTS in chronic obstructive pulmonary disease was lower than coronary heart disease (P < 0.001) and cancer (P = 0.02). While coronary heart disease was higher than stroke (P = 0.01) and diabetes (P = 0.01). And the scores of patients on discharge guidance skills and effects were higher than 8.50. CONCLUSIONS The level of the patients' perception of quality of discharge insrtuction is middle to high. Managers should understand the characteristics of various departments, give corresponding guidance and help, and clinical nurses should understand the characteristics of ward patients and pay more attention to individual guidance.
Collapse
Affiliation(s)
- Miao-Miao Yang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Wei Liang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Hui Hua Zhao
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Ying Zhang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| |
Collapse
|
39
|
Gupta A, Wood M, Kumar S, Misra S, Turner T. No Faculty Required: Use of a Health Literacy Low Inference Self-Assessment Measure to Promote Behavior Change. Acad Pediatr 2020; 20:712-720. [PMID: 32087380 DOI: 10.1016/j.acap.2020.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine if use of a health literacy low-inference, self-assessment measure (LISAM), promoted behavior change as measured by increased use of health literacy communication skills (HLCS). METHODS The LISAM is a tool used by educators to self-assess their performances after giving a lecture. The tool is low inference because it self-assesses behaviors that are specific, with little room for subjectivity. Forty-four third-year medical students self-assessed HLCS using a LISAM modified to include health literacy communication skills (LISAM-HLCS). Self-assessment followed participation in an audio recorded, standardized patient encounter and again after listening to the recording. Students also created 3 written goals for improvement. This session was repeated 1 week later. RESULTS At Session 2, 71.4% of students met at least 2 of their 3 self-created objectives. The 3 most commonly created objectives were using teach-back, asking more open ended questions, and obtaining patient input into the management plan. Use of the LISAM increased HLCS use at Session 2 versus Session 1 as assessed by both students and study investigators (P < .05). CONCLUSIONS Without faculty present, students met and adjusted objectives, catalyzing changes in HLCS. The LISAM-HLCS has the potential to empower students to improve communication skills and to reduce dependence on faculty observations.
Collapse
Affiliation(s)
- Aditi Gupta
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex.
| | - Margaret Wood
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex
| | - Shelley Kumar
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex; Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital (S Kumar and T Turner), Houston, Tex
| | - Sanghamitra Misra
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex
| | - Teri Turner
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex; Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital (S Kumar and T Turner), Houston, Tex
| |
Collapse
|
40
|
Lerret SM, Johnson NL, Polfuss M, Weiss M, Gralton K, Klingbeil CG, Gibson C, Garnier-Villarreal M, Ahamed SI, Adib R, Unteutsch R, Pawela L, White-Traut R, Sawin K. Using the Engaging Parents in Education for Discharge (ePED) iPad Application to Improve Parent Discharge Experience. J Pediatr Nurs 2020; 52:41-48. [PMID: 32163845 PMCID: PMC10465148 DOI: 10.1016/j.pedn.2020.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition. DESIGN/METHODS Using a quasi-experimental design, ePED was implemented on one inpatient unit (n = 211) and comparison group (n = 184) from a separate unit at a pediatric academic medical center. Patient experience outcome measures collected on day of discharge included Quality of Discharge Teaching Scale-Delivery (QDTS-D) and care coordination measured by Care Transition Measure (CTM). Thirty-day readmission was abstracted from records. RESULTS Parents taught using ePED reported higher QDTS-D scores than parents without ePED (p = .002). No differences in CTM were found between groups. Correlations between QDTS-D and CTM were small for ePED (r = 0.14, p 0.03) and non-ePED (r = 0.29, p < .001) parent groups. CTM was weakly associated with 30-day readmissions in the ePED group. CONCLUSION The use of ePED by the discharging nurse enhances parent-reported quality of discharge teaching. PRACTICE IMPLICATIONS The ePED app is a theory-based structured conversation guide to engage parents in discharge preparation. Nursing implementation of ePED contributes to optimizing the patient/family healthcare experience.
Collapse
Affiliation(s)
- Stacee M Lerret
- Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Norah L Johnson
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Michele Polfuss
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Marianne Weiss
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Karen Gralton
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Carol G Klingbeil
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Cori Gibson
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | | | - S Iqbal Ahamed
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Riddhiman Adib
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Rachel Unteutsch
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Louis Pawela
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | | | - Kathy Sawin
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| |
Collapse
|
41
|
Thorneloe RJ, Hall LH, Walter FM, Side L, Lloyd KE, Smith SG. Knowledge of Potential Harms and Benefits of Tamoxifen among Women Considering Breast Cancer Preventive Therapy. Cancer Prev Res (Phila) 2020; 13:411-422. [PMID: 31988145 PMCID: PMC7611305 DOI: 10.1158/1940-6207.capr-19-0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/19/2019] [Accepted: 01/21/2020] [Indexed: 12/28/2022]
Abstract
Tamoxifen reduces breast cancer incidence in women at increased risk, but may cause side effects. We examined women's knowledge of tamoxifen's potential harms and benefits, and the extent to which knowledge reflects subjective judgments of awareness and decision quality. After a hospital appointment, 408 (55.7%) women at increased risk of breast cancer completed a survey assessing objective knowledge about the potential benefit (risk reduction) and harms (endometrial cancer, thromboembolic events, and menopausal side effects) of tamoxifen, and subjective tamoxifen knowledge and decisional quality. Two hundred fifty-eight (63.2%) completed a 3-month follow-up survey. Sixteen percent (15.7%) of participants recognized the potential benefit and three major harms of using tamoxifen. These women were more likely to have degree-level education [vs. below degree level; OR, 2.24; 95% confidence interval (CI), 1.11-4.55] and good numeracy (vs. poor numeracy; OR, 5.91; 95% CI, 1.33-26.19). Tamoxifen uptake was higher in women who recognized all harms and benefits (vs. not recognizing; OR, 2.47; 95% CI, 0.94-6.54). Sixty-six percent (65.8%) of tamoxifen users were unaware of its potential benefit and harms. Most (87.1%) women reported feeling informed about tamoxifen, and subjective decisional quality was high [Mean (SD), 17.03 (1.87), out of 18]. Knowledge regarding the potential harms and benefit of tamoxifen is low in women considering prevention therapy, and they may need additional support to make informed decisions about tamoxifen preventive therapy.
Collapse
Affiliation(s)
| | - Louise Hazel Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Fiona Mary Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Lucy Side
- Wessex Clinical Genetics Service, University Hospitals Southampton, Southampton, United Kingdom
| | | | | |
Collapse
|
42
|
Nursing students use of teach-back to improve patients' knowledge and satisfaction: A quality improvement project. J Prof Nurs 2020; 36:70-76. [DOI: 10.1016/j.profnurs.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/19/2022]
|
43
|
Coleman D, McLaughlin D. Using simulated patients as a learning strategy to support undergraduate nurses to develop patient-teaching skills. ACTA ACUST UNITED AC 2020; 28:1300-1306. [PMID: 31714829 DOI: 10.12968/bjon.2019.28.20.1300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An increase in the number of patients with long-term conditions has required a greater focus on nurse-led educational interventions to enable patients to develop self-management strategies. However, patient education is frequently taken for granted, and nurses sometimes consider that their undergraduate training does not prepare them to participate in effective patient teaching. AIM The study aimed to formatively evaluate a simulated role-play scenario facilitated with third-year nursing students to support the development of patient-teaching skills. METHOD The study combined two approaches to simulation, using high-fidelity and mid-fidelity simulation scenarios sequentially. This enabled students (n=20) to apply the communication strategies learnt to both a skills-based procedural situation and a patient-teaching simulation. A five-item pro forma with four open questions and one closed question was used for formative evaluation. FINDINGS The results indicated that using a simulated patient to practise patient-teaching skills was perceived by the students to be a valuable method of learning that they could transfer to clinical practice. CONCLUSION The findings suggested that facilitating learning with a simulated patient is useful in replicating authentic verbal and practical interactions with a patient in practice.
Collapse
Affiliation(s)
| | - Dorry McLaughlin
- Lecturer in Palliative Care and Chronic Illness, Queen's University, Belfast
| |
Collapse
|
44
|
Zanobini P, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031036. [PMID: 32041282 PMCID: PMC7037285 DOI: 10.3390/ijerph17031036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.
Collapse
Affiliation(s)
- Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
- Correspondence: ; Tel.: +39-3663435179
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| | - Alberto Baldasseroni
- Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Central Tuscany LHU, Via di San Salvi, 12, 50135 Florence, Italy;
| | - Claudia Dellisanti
- Department of Epidemiology, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141 Florence, Italy;
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| |
Collapse
|
45
|
Lemos HJMD, Mendes-Castillo AMC. Social support of families with tracheostomized children. Rev Bras Enferm 2019; 72:282-289. [DOI: 10.1590/0034-7167-2018-0708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/02/2019] [Indexed: 02/17/2023] Open
Abstract
ABSTRACT Objective: To understand the social support of families with tracheostomized children. Method: Qualitative study using the Model of Dimensions of Social Support together with the Family System-Illness model as theoretical frameworks, based on the hybrid model of thematic analysis. Nine families with tracheostomized children were interviewed in an outpatient pediatric otorhinolaryngology department of a public hospital in the inner state of São Paulo. Results: The experience of social support to each phase of the family experience was presented in three themes: “Knowing the need for a tracheostomy”, “Performing a tracheostomy” and “Living with a tracheostomy”. Final considerations: Understanding how the experience of social support occurs can support assessment and intervention strategies, aiming to meet the demands of the family at each phase of its trajectory, collaborating for a continuous and integral nursing care.
Collapse
|
46
|
Vepraskas SH, O'Day P, Zhang L, Simpson P, Gage S. Parents Support Teach-back, Demonstration, and a Postdischarge Phone Call to Augment Discharge Education. Hosp Pediatr 2019; 8:778-784. [PMID: 30464003 DOI: 10.1542/hpeds.2018-0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify caregiver preferences for discharge education components, content, and techniques. METHODS Before discharge education, a 9-question structured interview was performed with caregivers of children from 2 populations admitted to the hospital medicine service: patients with asthma (age 2-17 years) or children who were not dependent on technology (age <2 years). McNemar's tests were used to evaluate for significant differences between response options. Open coding was used for theme development to interpret qualitative responses about information caregivers wished to receive before leaving the hospital. RESULTS The interview was administered to 100 caregivers. More than 90% of caregivers believed that instruction regarding follow-up appointments, medications, and reasons to call the pediatrician or return to the emergency department were important aspects of discharge education. Caregivers also identified a desire for education on their child's condition, care at home, and illness prevention. Most caregivers reported that teach-back, early discharge education, and a postdischarge phone call would be beneficial. Caregivers varied in their preferences for written, verbal, and video instruction, whereas live demonstration was rated almost universally as an effective method by 97% of caregivers (P < .0001). CONCLUSIONS In our study, we provide insight into caregivers' perspectives on the content, timing, and style of education needed to promote a safe transition of care from the hospital to the home. These findings add caregiver support to the expert consensus in Project Improving Pediatric Patient-Centered Care Transitions and elucidate additional themes to aid in further study and optimization of discharge education.
Collapse
Affiliation(s)
- Sarah H Vepraskas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Peter O'Day
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Sandra Gage
- Phoenix Children's Hospital, Phoenix, Arizona
| |
Collapse
|
47
|
Raphael BP, Takvorian-Bené M, Gallotto M, Tascione C, McClelland J, Rosa C, Dinan J, O'Connell B, Weinstock P. Learning Gaps and Family Experience, Nurse-Facilitated Home Parenteral Nutrition Simulation-Based Discharge Training: Proof-of-Concept Study. Nutr Clin Pract 2019; 36:489-496. [PMID: 31589007 DOI: 10.1002/ncp.10421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a life-sustaining therapy for children and adults suffering with severe digestive diseases, yet complications are commonplace, and predischarge trainings are variable. High-fidelity simulation training provides participants with an immersive experience using realistic equipment, supplies, and scenarios. Simulation training is rapidly becoming a potential gold standard for healthcare but is currently underutilized for families and caregivers. METHODS We prospectively collected data on pediatric patients managed at a single HPN program from September 1, 2016, to September 30, 2018. Participants in a pilot simulation-based training program (orientation, high-fidelity mannequin, realistic homelike space, standardized clinical scenarios, and structured debriefing) were compared with historical controls. We excluded patients with short-term HPN use and strictly palliative goals of care. RESULTS Nineteen (90%) families participated in the pilot initiative with a median (interquartile range) age of 0.9 (3.7) years and diagnosis of short-bowel syndrome in 14 (74%). During teaching scenarios, learning gaps were identified for aseptic needleless changes (53%), HPN equipment setup (84%) with specific difficulty adding multivitamin (32%), and dressing changes (63%). Thirty-day readmission rates in simulation-based training group vs historical cases were 42% vs 63% (P = not significant). There was no difference in length of stay between groups. All (100%) simulation-based training group participants would recommend this learning experience to others. CONCLUSION HPN discharge training is a novel use for high-fidelity simulation to address family/caregiver satisfaction and to identify learning gaps. Further studies are needed to refine predischarge training materials and examine the impact on postdischarge outcomes.
Collapse
Affiliation(s)
- Bram P Raphael
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Takvorian-Bené
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mary Gallotto
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christina Tascione
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer McClelland
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carolyn Rosa
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica Dinan
- Boston Children's Hospital Simulator Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Brianna O'Connell
- Boston Children's Hospital Simulator Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peter Weinstock
- Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital Simulator Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| |
Collapse
|
48
|
Abstract
The quality of discharge teaching is statistically linked to decreased readmission rates. Nursing most often bears the major responsibility of patient and caregiver teaching. Currently, discharge teaching is complicated by problems including time constraints, patient and caregiver overload, and coexisting comorbidities that add complexity to the patient's care needs at home. Not only are readmissions a preventable cost, more importantly, but they also are a negative patient experience signifying to our patients that they are unable to optimally care for themselves or that their disease or healing is not something they can care for alone. The following is a review of Agency for Healthcare Research and Quality's IDEAL discharge process, common problems in discharge teaching, and nursing's responsibilities with assessing a patient and his or her caregiver for discharge readiness. IDEAL is a structured discharge process with tools to help healthcare organizations improve their discharge process to decrease readmissions rates.
Collapse
|
49
|
Benscoter D, Borschuk A, Hart C, Voos K. Preparing families to care for ventilated infants at home. Semin Fetal Neonatal Med 2019; 24:101042. [PMID: 31648918 DOI: 10.1016/j.siny.2019.101042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.
Collapse
Affiliation(s)
- Dan Benscoter
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Adrienne Borschuk
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Catherine Hart
- Department of Otolaryngology, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, 45267, OH, USA.
| | - Kristin Voos
- Department of Pediatrics, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, 44106, OH, USA; Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, 44106, OH, USA.
| |
Collapse
|
50
|
Choe AY, Unaka NI, Schondelmeyer AC, Bignall WJR, Vilvens HL, Thomson JE. Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children. J Hosp Med 2019; 14:607-613. [PMID: 31339836 PMCID: PMC6817305 DOI: 10.12788/jhm.3240] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Achieving effective communication between medical providers and families with limited English proficiency (LEP) in the hospital is difficult. OBJECTIVE Our objective was to identify barriers to and drivers of effective interpreter service use when caring for hospitalized LEP children from the perspectives of pediatric medical providers and interpreters. DESIGN/PARTICIPANTS/SETTING We used Group Level Assessment (GLA), a structured qualitative participatory method that allows participants to directly produce and analyze data in an interactive group session. Participants from a single academic children's hospital generated individual responses to prompts and identified themes and relevant action items. Themes were further consolidated by our research team and verified by stakeholder groups. RESULTS Four GLA sessions were conducted including 64 participants: hospital medicine physicians and pediatric residents (56%), inpatient nursing staff (16%), and interpreter services staff (28%). Barriers identified included: (1) difficulties accessing interpreter services; (2) uncertainty in communication with LEP families; (3) unclear and inconsistent expectations and roles of team members; and (4) unmet family engagement expectations. Drivers of effective communication were: (1) utilizing a team-based approach between medical providers and interpreters; (2) understanding the role of cultural context in providing culturally effective care; (3) practicing empathy for patients and families; and (4) using effective family-centered communication strategies. CONCLUSIONS Participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. Future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
Collapse
Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Angela Y. Choe, MD; E-mail: ; Telephone: 513-636-3893; Twitter: @AChoeMD
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Whitney J Raglin Bignall
- Division of Psychology in the Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Heather L Vilvens
- Allied Health Department, University of Cincinnati Blue Ash College, Cincinnati, Ohio
| | - Joanna E Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|