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da Costa Ferreira Oberfrank N, Watkinson E, Buck H, Lopez KD. Assessing Heart Failure Self-management Knowledge Through Vignettes. J Cardiovasc Nurs 2024:00005082-990000000-00197. [PMID: 38888418 DOI: 10.1097/jcn.0000000000001107] [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: 06/20/2024]
Abstract
BACKGROUND Heart failure (HF) self-care is key to managing symptoms, but current HF knowledge instruments are at risk for social desirability bias (ie, tendency to respond in a way that is viewed favorably). Vignettes may be a useful method to mitigate this bias by measuring knowledge via scenarios in which individuals with HF are invited to respond to fictional characters' self-management problems rather than disclosing their own practices. OBJECTIVE The aims of the study were to develop and test the content validity of vignettes measuring individuals' knowledge of HF symptom self-management. METHODS The study had 3 phases. In phase 1, two vignettes were developed. One focused on psychological symptom self-management (ie, anxiety, depression), and the other focused on physical symptom self-management (ie, edema, fatigue). In phase 2, the research team and lay experts made improvements to the vignettes' readability. In phase 3, five HF self-care nurse experts evaluated the vignettes' clarity and importance with a 3-point Likert-type scale using Delphi methods. We calculated the vignettes' content validity using the scale-level content validity index. RESULTS The final content validation encompassed 2 Delphi rounds (phase 3), yielding a scale-level content validity index of 0.92 and 0.94 for the psychological and physical symptom vignettes, respectively. These results indicate excellent initial content validity. CONCLUSIONS The content of vignettes measuring individuals' knowledge of HF symptom self-management is valid based on the opinions of nurse experts. The vignettes offer a promising method to assess knowledge about HF self-care management without the pressure of disclosing individual patient practices.
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Williams TB, Crump A, Garza MY, Parker N, Simmons S, Lipschitz R, Sexton KW. Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure. PLoS One 2023; 18:e0286363. [PMID: 37319230 PMCID: PMC10270633 DOI: 10.1371/journal.pone.0286363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
The care delivery team (CDT) is critical to providing care access and equity to patients who are disproportionately impacted by congestive heart failure (CHF). However, the specific clinical roles that are associated with care outcomes are unknown. The objective of this study was to examine the extent to which specific clinical roles within CDTs were associated with care outcomes in African Americans (AA) with CHF. Deidentified electronic medical record data were collected on 5,962 patients, representing 80,921 care encounters with 3,284 clinicians between January 1, 2014 and December 31, 2021. Binomial logistic regression assessed associations of specific clinical roles and the Mann Whitney-U assessed racial differences in outcomes. AAs accounted for only 26% of the study population but generated 48% of total care encounters, the same percentage of care encounters generated by the largest racial group (i.e., Caucasian Americans; 69% of the study population). AAs had a significantly higher number of hospitalizations and readmissions than Caucasian Americans. However, AAs had a significantly higher number of days at home and significantly lower care charges than Caucasian Americans. Among all CHF patients, patients with a Registered Nurse on their CDT were less likely to have a hospitalization (i.e. 30%) and a high number of readmissions (i.e., 31%) during the 7-year study period. When stratified by heart failure phenotype, the most severe patients who had a Registered Nurse on their CDT were 88% less likely to have a hospitalization and 50% less likely to have a high number of readmissions. Similar decreases in the likelihood of hospitalization and readmission were also found in less severe cases of heart failure. Specific clinical roles are associated with CHF care outcomes. Consideration must be given to developing and testing the efficacy of more specialized, empirical models of CDT composition to reduce the disproportionate impact of CHF.
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Affiliation(s)
- Tremaine B. Williams
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Alisha Crump
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Maryam Y. Garza
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Nadia Parker
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Simeon Simmons
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Riley Lipschitz
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Kevin Wayne Sexton
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
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Westland H, Page SD, van Rijn M, Aryal S, Freedland KE, Lee C, Strömberg A, Vellone E, Wiebe DJ, Jaarsma T, Riegel B. Self-care management of bothersome symptoms as recommended by clinicians for patients with a chronic condition: A Delphi study. Heart Lung 2022; 56:40-49. [PMID: 35709644 DOI: 10.1016/j.hrtlng.2022.06.001] [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: 03/14/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronically medically ill patients often need clinical assistance with symptom management, as well as self-care interventions that can help to reduce the impact of bothersome symptoms. Experienced clinicians can help to guide the development of more effective self-care interventions. OBJECTIVE To create a consensus-based list of common bothersome symptoms of chronic conditions and of self-care management behaviors recommended to patients by clinicians to reduce the impact of these symptoms. METHODS A two-round Delphi study was performed among an international panel of 47 clinicians using online surveys to identify common and bothersome symptoms and related self-care management behaviors recommended to patients with heart failure, chronic obstructive pulmonary disease, asthma, type 2 diabetes, or arthritis. RESULTS A total of 30 common bothersome symptoms and 158 self-care management behaviors across the five conditions were listed. Each chronic condition has its own bothersome symptoms and self-care management behaviors. Consensus was reached on the vast majority of recommended behaviors. CONCLUSIONS The list of common bothersome symptoms and self-care management behaviors reflect consensus across four countries on many points but also disagreement on others, and a few recommendations are inconsistent with current guidelines. Efforts to encourage clinicians to recommend effective self-care management behaviors may reduce symptom impact in chronically ill patient populations.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands.
| | | | - Michelle van Rijn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands
| | - Subhash Aryal
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | | | - Christopher Lee
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Barbara Riegel
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Lau KHV, Hamlyn E, Williams TJ, Qureshi MM, Mak K, Mian A, Cervantes-Arslanian A, Zhu S, Takahashi C. The Effects of Video Instruction on Neuroscience Intensive Care Unit Nursing Skills in Case Presentations and Neurological Examinations. J Neurosci Nurs 2021; 53:129-133. [PMID: 33840806 DOI: 10.1097/jnn.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: The emergence of neuroscience intensive care units (NSICUs) for the past decades has led to growing interest in targeted training for NSICU nurses. We sought to evaluate the use of video instruction on NSICU nurses' skills in case presentations and neurological examinations, which has timely advantages as an asynchronous and distanced learning modality. METHODS: We enrolled NSICU and surgical intensive care unit nurses who took shifts in the NSICU at our institution. Participants were observed by a neurocritical care attending physician presenting the clinical details of an admitted patient and conducting a neurological examination, with both parties completing a 10-item evaluation on NSICU nursing presentation and examination skills. Participants randomized to an intervention group were given access to an instructional video on NSICU nursing skills. A median of 21 days later, participants were observed by a physician blinded to study randomization, with both parties recompleting the evaluation. Differences between day 1 and day 21 scores were analyzed using paired sample t tests. RESULTS: Fifteen NSICU and 55 surgical intensive care unit nurses were enrolled. Surgical intensive care unit nurses in both the intervention and control groups had statistically significant improvement between day 1 and day 21 physician-rated scores, with a greater increase in the intervention group; self-rated scores did not change. For NSICU nurses, there were no differences in physician-rated or self-rated scores for either group. CONCLUSIONS: Surgical intensive care unit nurses who underwent direct observation and self-evaluation had improvement in physician-rated NSICU nursing skills, likely as these activities allowed for reflective observation in Kolb's experiential learning cycle. Greater improvement in participants who viewed an instructional video highlights its value as a teaching modality for nurses.
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