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Tzeng HM, Franks HE, Passy E. Facilitators and Barriers to Implementing the 4Ms Framework of Age-Friendly Health Systems: A Scoping Review. Nurs Rep 2024; 14:913-930. [PMID: 38651482 PMCID: PMC11036203 DOI: 10.3390/nursrep14020070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND This scoping review explored the evidence in the peer-reviewed published journal literature to identify the facilitators and barriers to implementing the 4Ms Framework of Age-Friendly Health Systems in inpatient and outpatient clinical settings. METHODS Our search strategy focused on primary and secondary data sources that described the barriers and facilitators of incorporating the 4Ms Framework in clinical settings. We focused on older adults 65 years and older and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCR). RESULTS The evidence analyses of the 19 identified articles revealed six facilitator themes and five barrier themes to implementing the 4Ms Framework of Age-Friendly Health Systems in inpatient and outpatient clinical settings. The most recurring facilitator theme was embedding the 4Ms Framework into routine clinical practice with clinical pathways and designated personnel. The most frequently reported barrier theme was the lack of clinicians' buy-in. CONCLUSIONS Future research may translate the findings of this scoping review into a facilitator and barrier checklist or a "reality-check" measure to monitor the progress of the journey of embracing the 4Ms Framework in outpatient or inpatient clinical settings. This study was not registered.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch at Galveston, Galveston, TX 77555-1132, USA
| | - Hannah E. Franks
- School of Health Professions, The University of Texas Medical Branch at Galveston, Galveston, TX 77555-1132, USA;
| | - Elise Passy
- Alzheimer’s Health Systems Director-Texas, National Division of Health Systems, Alzheimer’s Association, Houston, TX 77087, USA;
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Karo M, Simorangkir L, Daryanti Saragih I, Suarilah I, Tzeng HM. Effects of mindfulness-based interventions on reducing psychological distress among nurses: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2024; 56:319-330. [PMID: 37955233 DOI: 10.1111/jnu.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/11/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Nurses increasingly use mindfulness as an effective mental health intervention to reduce psychological distress. The effectiveness of mindfulness-based interventions remains inconclusive, which may lead to implementation of interventions in an inefficient or ineffective manner. This study aimed to examine the effects of mindfulness-based interventions on reducing stress, anxiety, and depression among nurses. DESIGN Systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) were searched using six databases published through May 20, 2023, which evaluated the effects of mindfulness-based interventions on reducing psychological distress among nurses. To assess the quality of methodology included in the RCTs, version 2 of the Cochrane risk-of-bias instrument for RCTs with five domains was used. Standardized mean difference (SMD) with 95% confidence interval (CI) were calculated using the random-effects model in the meta-analyses. Publication bias was assessed using Egger's regression test. Further, the robustness effect size of the pooled analysis was assessed using leave-one-out sensitivity analysis. FINDINGS A total of 16 RCTs were included in the final analysis. Overall, the modalities appeared to alleviate stress (pooled SMD: -0.50 [95% CI: -0.82 to -0.18]; p < 0.001) and depression (pooled SMD: -0.42 [95% CI: -0.78 to -0.06]; p = 0.02) among nurses. CONCLUSION Mindfulness-based interventions appear to alleviate stress and depression in nurses. Future research evaluating mindfulness-based interventions among working nurses with more rigorous methodological and larger sample size. CLINICAL RELEVANCE Support for nurses' mental health must be included while implementing personal and professional development plans.
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Affiliation(s)
- Mestiana Karo
- School of Nursing, STIKES Santa Elisabeth Medan, Medan, Indonesia
| | | | | | - Ira Suarilah
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch, Galveston, Texas, USA
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Saragih ID, Everard G, Tzeng HM, Saragih IS, Lee BO. Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update. J Cardiovasc Nurs 2023; 38:E192-E217. [PMID: 37816087 DOI: 10.1097/jcn.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.
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Tran JT, Theng B, Tzeng HM, Raji M, Serag H, Shih M, Lee WCM. Cultural Diversity Impacts Caregiving Experiences: A Comprehensive Exploration of Differences in Caregiver Burdens, Needs, and Outcomes. Cureus 2023; 15:e46537. [PMID: 37927752 PMCID: PMC10625452 DOI: 10.7759/cureus.46537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Many Americans are informal caregivers providing unpaid care for their loved ones living with chronic conditions, such as dementia and heart failure. As the US population continues to age and live longer with more complex chronic conditions, informal caregivers play an increasingly important role in the care of older adults with functional impairment and multiple comorbidities. Caregivers face many challenges in managing the health of themselves and their loved ones, including physical, emotional, and financial burdens, which may potentially vary by race and ethnicity. Therefore, it is critical to develop culturally tailored solutions, such as smart technology, aimed at improving the quality of life of informal caregivers and care recipients from diverse backgrounds. Methods Data were collected from a convenient sample of 69 informal caregivers in Texas who were members or volunteers for either the International Buddhist Progress Society-Dallas (IBPS Dallas) or University of Texas Medical Branch (UTMB). Caregivers answered questions about their caregiving experiences, including the type of care they provided, challenges they faced, and lessons learned. Responses were stratified by race/ethnicity (White, Hispanic, or Asian American) to assess for potential cultural differences in caregiving experiences. A chi-squared test and one-way analysis of variance (ANOVA) were conducted. Results White, Hispanic, and Asian American caregivers all reported high non-medical related needs. White, Hispanic, and Asian American care recipients all had a high degree of neurological disease and functional impairment. White and Hispanic caregivers were also more likely to offer emotional support (p=0.007) and financial support (p=0.025) than Asian American caregivers. Asian American caregivers reported greater worry about the health-related knowledge of their family members (p=0.040) than White and Hispanic caregivers. Hispanic (18.8%) and Asian American caregivers (12.5%) reported the least knowledge of caregiving-related government policies than White caregivers (43.2%) (p=0.025). Hispanic (18.8%) and Asian American caregivers (18.8%) also reported the least knowledge of available support programs and services for care recipients (p=0.001). Conclusions White, Hispanic, and Asian American informal caregivers vary in their types of worries, care provided, and challenges faced. Our study found that Asian American caregivers reported greater worry about the health-related knowledge of their family members than White and Hispanic caregivers. White caregivers were better at navigating government resources and caregiver support programs than Hispanic and Asian American caregivers. While race and ethnicity are potential factors for these observed differences, several other factors may have played a role, including age, gender, income, education, patient diagnosis, and disease severity. Future research should consider these factors and evaluate a larger and more diverse sample for more definitive racial and ethnic comparisons. Understanding disparities in caregiving experiences is a critical initial step to developing culturally appropriate interventions to reduce caregiving burden and promote the health and well-being of both patients and their informal caregivers from diverse backgrounds.
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Affiliation(s)
- Jessica T Tran
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Bunnarin Theng
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, USA
| | - Mukaila Raji
- Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, USA
| | - Hani Serag
- Department of Internal Medicine, Division of Endocrinology, University of Texas Medical Branch, Galveston, USA
| | - Miaolung Shih
- Humanistic Buddhism Practice (HBP), Osher Lifelong Learning Institute at University of Texas Medical Branch, Galveston, USA
| | - Wei-Chen Miso Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, USA
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Tarihoran DETAU, Daryanti Saragih I, Saragih IS, Tzeng HM. Effects of videoconferencing intervention on stroke survivors: A systematic review and meta-analysis of randomised controlled studies. J Clin Nurs 2023; 32:5938-5947. [PMID: 37035861 DOI: 10.1111/jocn.16716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 06/03/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Videoconferencing has been proposed as an innovative telerehabilitation approach for stroke survivors, demand for which is growing. AIM To evaluate the efficacy of a videoconferencing intervention for stroke survivors. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic review of the literature in the databases Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Ovid (and its companion UpToDate), and Web of Science published from January 1, 2002, to May 27, 2021. The methodologic quality of the included studies was evaluated using version 2 of the Cochrane risk-of-bias tool. A meta-analysis using a random-effects model calculated the pooled standardised mean difference (SMD) for using a videoconferencing intervention with stroke survivors and for the ability of survivors to perform activities of daily living (ADLs) and to maintain balance. The Stata software application (version 16.0: StataCorp LP) was used for the statistical analysis. RESULTS Nine studies with 603 participants were included in the analysis. Videoconferencing interventions were observed to be effective in improving the ability of stroke survivors to carry out their ADLs (SMD: 0.57; 95% confidence interval [CI]: 0.13 to 1.01) and to recover their balance (SMD: 1.96; 95% CI: 1.27 to 2.66). CONCLUSIONS Stroke survivors were able effectively to improve their ADL and balancing abilities. Further studies could consider the frequency, duration, and standard protocol for videoconferencing interventions. RELEVANCE TO CLINICAL PRACTICE This study could change the approach to patient support in future clinical practice and might constitute an alternative for improving care for stroke survivors in their homes or in long-term care facilities.
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Affiliation(s)
- Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana, Jakarta, Indonesia
- School of Nursing Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | - Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Tzeng HM, Downer B, Li CY, Raji M, Haas A, Kuo YF. Association Between Cognitive Impairment and Repeat Fractures in Medicare Beneficiaries Recently Hospitalized for Hip Fracture. J Gerontol A Biol Sci Med Sci 2023; 78:1677-1682. [PMID: 36810779 PMCID: PMC10460551 DOI: 10.1093/gerona/glad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Repeat fractures contribute substantially to fracture incidents in older adults. We examined the association between cognitive impairment and re-fractures during the first 90 days after older adults with hip fractures were discharged home from a skilled nursing facility rehabilitation short stay. METHODS Multilevel binary logistic regression was used to analyze 100% of U.S. national postacute-care fee-for-service Medicare beneficiaries who had a hospital admission for hip fracture from January 1, 2018, to July 31, 2018; were admitted for a skilled nursing facility stay within 30 days of hospital discharge; and were discharged to the community after a short stay. Our primary outcome was rehospitalization for any re-fractures within 90 days of skilled nursing facility discharge. Cognitive status assessed at skilled nursing facility admission or before discharge was classified as either intact or having mild or moderate/severe impairment. RESULTS In 29 558 beneficiaries with hip fracture, odds of any re-fracture were higher in those with minor (odds ratio: 1.48; 95% confidence interval: 1.19-1.85; p < .01) and moderate/major cognitive impairment (odds ratio: 1.42; 95% confidence interval: 1.07-1.89; p = .0149) than in those classified as intact. CONCLUSIONS Beneficiaries with cognitive impairment were more likely than their counterparts with no cognitive impairment to experience re-fractures. Community-dwelling older adults with minor cognitive impairment may experience a higher likelihood of experiencing a repeat fracture leading to rehospitalization.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
| | - Brian Downer
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- School of Health Professions, University of Texas Medical Branch, Galveston, USA
| | - Chih-Ying Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- School of Health Professions, University of Texas Medical Branch, Galveston, USA
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Department of Internal Medicine, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Allen Haas
- Office of Biostatics, University of Texas Medical Branch, Galveston, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Office of Biostatics, University of Texas Medical Branch, Galveston, USA
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, USA
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Theng B, Tran JT, Serag H, Raji M, Tzeng HM, Shih M, Lee WCM. Understanding Caregiver Challenges: A Comprehensive Exploration of Available Resources to Alleviate Caregiving Burdens. Cureus 2023; 15:e43052. [PMID: 37680399 PMCID: PMC10480575 DOI: 10.7759/cureus.43052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Aging is associated with significant alterations in physical, cognitive, and emotional functions, predisposing older adults to multimorbidity and functional dependence that necessitate assistance with the activity of daily living (ADL) and medical care from caregivers. With a substantial increase in the aging population comes a growing demand for caregivers, particularly informal caregivers who provide unpaid care to older adults with complex needs. However, they face substantial physical, emotional, and financial burdens as they balance caregiving with their family and job demands. AIM This study aimed to explore key challenges faced by caregivers and the resources they need to address their caregiving burden. Additionally, we wanted to identify whether the number of years of caregiving is associated with their burden. These study findings will inform the design and development of our smartphone app which aims to alleviate the burden of diseases for older adults and the burden of caregiving for caregivers. METHODS From October to December 2022, we invited 80 self-reported caregivers for an anonymous online survey. The caregivers were located in three cities (Galveston, Houston, and Dallas in Texas) and were affiliated with the International Buddhist Progress Society-Dallas (IBPS Dallas) and the University of Texas Medical Branch (UTMB) Osher Lifelong Learning Institute (OLLI). The collected data were subjected to content analysis through systematic examination for meaningful patterns, themes, and insights. Individual characteristics and caregiving experiences were divided by years of care: 0-4 vs. 5+ years to investigate whether the caregiving burden was affected by the duration of caregiving. RESULTS The results showed several important insights, including gender dynamics and traditional norms, the advanced age of caregivers, and the prevalent health conditions they are managing. Caregivers' roles ranged from medical (insurance and medication assistance, etc.) at 63.8% to the provision of non-medical related resources (basic needs, utility, transportation, financial assistance, etc.) at 96.3%. Caregiving is also associated with some positive outcomes, such as changes in knowledge and skills (77.5%) with more confidence in ADL support tasks and a deepening of caregiver/care recipient dyad relationships (56.3%). Some faced challenges in navigating complex healthcare and social service systems and others experienced neglect and received inadequate support from the government-supported social services (33.8%). However, there is no significant variation between those with 0-4 and 5+ years of experience across all identified themes, suggesting that the burdens and resource needs of caregivers can manifest early on and are likely to persist beyond the five-year mark. CONCLUSION Our findings reveal that the number of caregiving years does not significantly influence the types of caregiving burden experienced by caregivers or the resources they require. This indicates the need for providing long-term support to older adults with chronic conditions from the early stage, while also emphasizing the critical role of immediate assistance for caregivers to alleviate caregiving burden. A free-of-charge technology like our smartphone app has the potential to effectively reduce stress for caregivers, offering them support at any time and place. Future studies will focus on evaluating the outcomes of caregivers after utilizing our app.
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Affiliation(s)
- Bunnarin Theng
- Radiology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Jessica T Tran
- Medicine, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Hani Serag
- Department of Internal Medicine - Endocrinology, University of Texas Medical Branch, Galveston, USA
| | - Mukaila Raji
- Department of Internal Medicine - Geriatrics & Palliative Medicine, University of Texas Medical Branch, Galveston, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, USA
| | - Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, USA
| | - Miaolung Shih
- Artificial Intelligence, Humanistic Buddhism Practice (HBP), Osher Lifelong Learning Center, University of Texas Medical Branch, Galveston, USA
| | - Wei-Chen Miso Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, USA
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Shih M, Lee WCM, Tzeng HM, Serag H, Raji M. Comparing Use Patterns and Acceptability of Mobile Digital Devices Between Care Recipients and Caregivers. Cureus 2023; 15:e41832. [PMID: 37575767 PMCID: PMC10423037 DOI: 10.7759/cureus.41832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The use of smartphones and other digital devices (such as tablets and smartwatches) is important for the aging population to enhance and optimize communications with caregivers, families, friends, and providers. It also provides a platform for app-based activities to promote mental, physical, spiritual, and social well-being and virtual social connectedness. We, therefore, examined types of digital devices and categories of smartphone functions used by caregivers and care recipients in comparison to those without any caregiving roles. METHOD The project team has developed a smartphone app based on Buddhist meditative practice principles for the enhancement of the physical, mental, cognitive, and emotional well-being of older adults and their caregivers and tested it in Galveston, Houston, and Dallas, TX. The study comprised a convenient sample of older adults, including members or volunteers of the International Buddhist Progress Society-Dallas (IBPS Dallas) and the University of Texas Medical Branch Osher Lifelong Learning Institute (UTMB OLLI). The survey focused on people who were 55 years and older (n = 219), with 177 valid responses (~80.8%) meeting the study's inclusion criteria. The survey collected data on (1) caregiving role, (2) demographic characteristics and caregiving concerns, and (3) types of devices, functions, and utilization. Descriptive analysis and logistic regression were used to describe and compare patterns of smartphone function/use by the different groups, i.e., caregivers, care recipients, and neither. RESULTS All of our survey respondents were 55 years and older, and among them, 17.5% were caregivers, 9.1% were care recipients, and 73.4% did not have any role. The majority of the caregivers were females (80.6%), and the average age of their care recipients was 66 years. The care recipients in our sample reported that the average age of their caregiver is only 55 years. Around three-fourths of caregivers reported that they have an app related to health or they are willing to use a health-related app, 32% of them use smart home appliances, whereas only 16% of people who are neither caregivers nor care recipients use such apps. Approximately 42% of caregivers reported taking care of their parents or parents-in-law, and their major concerns are about maintaining their income, scheduling tasks, and updating their knowledge as needed to better care for their loved ones. People use texting or messaging the most. However, the second and third highest utilization are different. The "neither" group significantly spends more time checking email and watching TV; the care recipients spend more time reading and watching TV (sedentary activities); the caregiver group spends more time on phone calls and listening to music. CONCLUSIONS Findings of different patterns of digital device use exist between caregivers, care recipients, and the "neither" group, with 75% of caregivers using a digital device app related to health or reporting willingness to use a health-related app developed from our study. Our findings of their caregiving experiences might also inform the design of different intervention programs aimed at promoting mental, physical, and social well-being, improving quality of life while reducing disease/disability burden for older adults, and preventing burnout among caregivers.
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Affiliation(s)
- Miaolung Shih
- Osher Lifelong Learning Institute, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Wei-Chen Miso Lee
- Department of Family Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Hani Serag
- Department of Internal Medicine - Endocrinology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Mukaila Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, USA
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Tzeng HM, Raji MA, Tahashilder MI, Kuo YF. Association between medicare annual wellness visits and prevention of falls and fractures in older adults in Texas, USA. Prev Med 2022; 164:107331. [PMID: 36334680 PMCID: PMC9691561 DOI: 10.1016/j.ypmed.2022.107331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/17/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
Fall-related injuries contribute to increased frailty, disability, and premature death in older adults (≥65 years). The US Centers for Medicare and Medicaid Services began reimbursing annual wellness visits (AWVs) in 2011. In the present study, we assessed the effect of AWV receipt in 2017 on fall and fracture prevention through December 31, 2018. Using Texas Medicare data for 2014-2018, we identified cohorts of Medicare beneficiaries ≥68 years, matched for the presence/absence of an AWV in 2017 by propensity score, and observed two outcomes: fracture as a primary diagnosis, and fall occurrences. Rates of each outcome were estimated using the Kaplan-Meier method. Of the 2017 beneficiaries, 32.2% received an AWV. For the 742,494 beneficiaries in the matched cohort, conditional Cox proportional hazards models revealed that receiving an AWV in 2017 was associated with reduced risks for future falls (3.9%) and fractures (4%). The effect of the AWV was stronger on fall reduction in rural residents (HR: 0.799; 95% CI: 0.679 to 0.941) and on fracture reduction in beneficiaries with ≥4 morbidities (HR: 0.918; 95% CI: 0.867 to 0.972). Receipt of an AWV in three consecutive years (2015-2017) further lowered the risk of future falls. We conclude that the risks for future falls/fractures are lower in older adults receiving AWVs. Our study underscores the need for expanded public education programs that raise awareness about AWVs and the potential for AWV data to inform fall prevention interventions and other health promotion practices.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine-Geriatrics and Palliative Medicine Division, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine-Geriatrics and Palliative Medicine Division, University of Texas Medical Branch, Galveston, TX, USA; Office of Biostatics, University of Texas Medical Branch, Galveston, TX, USA; Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
The Brief Interview for Mental Status (BIMS) is used to identify delirium and needed supports in patients living in skilled nursing facilities (SNFs) and long-term care facilities (LTCFs). We analyzed 3,537,404 patients discharged from acute hospitals to SNFs or LTCFs with factor and Rasch analyses to examine the clinical utility of the BIMS. More than 40% of the sample had maximum scores, indicating a ceiling effect. "Repetition of three words" was the easiest and the only misfit item (Outfit = 3.14). The ability of the BIMS to distinguish individuals into two cognitive levels (with person strata of 1.48) was limited. Although the BIMS is a widely used screening tool for cognitive impairment, we found it lacked sensitivity for approximately one half of patients admitted to SNFs/LTCFs. Our results suggest the BIMS should be interpreted with caution, particularly for patients with mild cognitive impairment. [Research in Gerontological Nursing, 15(3), 124-130.].
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Okpalauwaekwe U, Li CY, Tzeng HM. Social Determinants and Self-Care for Making Good Treatment Decisions and Treatment Participation in Older Adults: A Cross-Sectional Survey Study. Nurs Rep 2022; 12:198-209. [PMID: 35324566 PMCID: PMC8948722 DOI: 10.3390/nursrep12010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Community-dwelling adults who can perform self-care behaviors related to making treatment decisions and participating in treatment have been found to use less emergency care. In this exploratory study, we examined the relationships in older adults between five social determinants (urban/rural residence, sex, age, marital status, and education) and the perceived importance, desirability, and ability to perform 11 self-care behaviors related to making good treatment decisions and participating in treatment. Methods: This cross-sectional study surveyed 123 community-dwelling older adults living in the southern United States in 2015-2016. All participants were 65 years or older. Data were collected using the Patient Action Inventory for Self-Care and analyzed using descriptive, univariate, and multivariate logistic regression analyses. Results: The social determinants (identified as barriers) of self-care behaviors related to making good treatment decisions and participating in treatment were: having less than a high school education, being 75 years or older, and being separated from a spouse. Sex and residence were found to be neither barriers nor facilitators. Conclusions: Our findings suggest that, in older adults, attending to the needs related to health literacy education and improving social support might increase self-care behaviors related to making good treatment decisions and participating in treatment. Future research will compare the differences across diverse populations to validate our study findings.
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Affiliation(s)
- Udoka Okpalauwaekwe
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada;
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
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Tzeng HM, Raji MA, Chou LN, Kuo YF. Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners: A National Study in the United States. J Nurs Care Qual 2022; 37:6-13. [PMID: 34483310 PMCID: PMC8608008 DOI: 10.1097/ncq.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety. PURPOSE This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018. METHODS We used data from a random selection of 20% of Medicare beneficiaries (66 years or older) from 2015 to 2018 to perform multilevel logistic regression. A PIM prescription was classified as initial or refill on the basis of medication history 1 year before a visit. PIM use after an outpatient visit was the primary study outcome. RESULTS We included 9 000 224 visits in 2016 and 9 310 261 in 2018. The PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018. CONCLUSIONS Changes could be due to individual state practices.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Lin-Na Chou
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
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Tzeng HM, Downer B, Haas A, Ottenbacher KJ. Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay. J Am Med Dir Assoc 2022; 23:128-132.e2. [PMID: 34237256 PMCID: PMC8712356 DOI: 10.1016/j.jamda.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. DESIGN Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. SETTINGS AND PARTICIPANTS 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. METHODS Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. RESULTS Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. CONCLUSIONS AND IMPLICATIONS Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Allen Haas
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
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Saragih ID, Tarihoran DETAU, Batubara SO, Tzeng HM, Lin CJ. Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta-analysis of randomised controlled studies. J Clin Nurs 2021; 31:2678-2690. [PMID: 34873756 DOI: 10.1111/jocn.16142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stroke is one of the most common causes of disability worldwide. In recent years, diverse telehealth programmes for stroke survivors have suggested that this mode of rehabilitation could improve stroke survivors' abilities to perform activities of daily living (ADLs) and maintain balance. Although increasingly utilised in clinical and community settings, the effectiveness of telehealth interventions in stroke survivors remains inconclusive. This warrants investigation so that telehealth interventions are evidence-based and are not merely modalities of convenience. AIM To identify the effects of telehealth interventions on the ability to perform ADLs and maintain balance in stroke survivors. DESIGN A systematic literature review and meta-analysis were conducted in accordance with PRISMA guidelines. METHODS A systematic literature search was performed using seven databases for literature dated up to April 25, 2021. The revised Cochrane risk of bias tool for randomised trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth interventions. Stata 16.0 was used for the statistical analyses. RESULTS A total of 14 studies with 1,367 participants were included in the analysis. Overall, telehealth interventions were effective in improving stroke survivors' abilities to carry out their ADLs (standardised mean difference: .45; 95% confidence interval: .12 to .78); however, no significant effects were found on balance. CONCLUSION Telehealth interventions are beneficial for improving stroke survivors' performance of their ADLs. Future telehealth intervention trials should focus on identifying essential intervention delivery components that facilitate intervention adoption by clinicians and stroke survivors and sustain the positive effects on stroke survivors' performance of their ADLs in different settings. RELEVANCE TO CLINICAL PRACTICE It is essential to build flexibility in the telehealth-based intervention delivery protocol to meet individual stroke survivors' needs to motivate and enhance their ADL performance.
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Affiliation(s)
| | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing Faculty of Medical and Health Sciences and Assistant Professor, School of Nursing, Krida Wacana Christian University, UKRIDA, Jakarta, Indonesia, University of Auckland, New Zealand
| | | | - Huey-Ming Tzeng
- University of Texas, Medical Branch, School of Nursing, Galveston, Texas, USA
| | - Chia-Ju Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Okpalauwaekwe U, Tzeng HM. Adverse Events and Their Contributors Among Older Adults During Skilled Nursing Stays for Rehabilitation: A Scoping Review. Patient Relat Outcome Meas 2021; 12:323-337. [PMID: 34803416 PMCID: PMC8599876 DOI: 10.2147/prom.s336784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify factors that contribute to adverse events among older adults during short stays at skilled nursing facilities (SNFs) for rehabilitation (ie, up to 100 resident days). Adults aged 65 years and older are at serious risk for adverse events throughout their continuum of care. Over 33% of older adults admitted to SNFs experienced an adverse event (eg, falls) within the first 35 days of their stay. Design A scoping review. Setting and Participants Older adults admitted for short stays in SNFs. Methods Eligibility criteria were peer-reviewed original articles published between 1 January 2015 and 30 May 2021, written in English, and containing any of the following key terms and synonyms: “skilled nursing facilities”, “adverse events”, and “older adults”. These terms were searched in PubMed, MEDLINE, CINAHL, EBSCOHost, and the ProQuest Nursing and Allied Health Database. We summarized the findings using the Joanna Briggs Institute and PRISMA-ScR reporting guidelines. We also used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavioral change as a framework to guide the content, thematic, and descriptive analyses of the results. Results Eleven articles were included in this scoping review. Intrinsic and extrinsic contributors to adverse events (ie, falls, medication errors, pressure ulcers, and acute infections) varied for each COM-B domain. The most frequently mentioned capacity-related intrinsic contributors to adverse events were frailty and reduced muscle strength due to advancing age. Inappropriate medication usage and polypharmacy were the most common capacity-related extrinsic factors. Opportunity-related extrinsic factors contributing to adverse events included environmental hazards, poor communication among SNF staff, lack of individualized resident safety plans, and overall poor care quality owing to racial bias and organizational and administrative issues. Conclusion These findings shed light on areas that warrant further research and may aid in developing interventional strategies for adverse events during short SNF stays.
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Affiliation(s)
- Udoka Okpalauwaekwe
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Huey-Ming Tzeng
- The University of Texas Medical Branch at Galveston, School of Nursing, Galveston, TX, USA
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Tzeng HM, Knight G. Could negative behaviors by patients with dementia be positive communication? Seeking ways to understand and interpret their nonverbal communication. Nurs Forum 2021; 57:318-322. [PMID: 34812493 PMCID: PMC9299486 DOI: 10.1111/nuf.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
In interactions with caregivers, patients with dementia have communication challenges that are common and worrisome to families. Family and professional caregivers find it challenging to “guess” or “interpret” what their patients with dementia are trying to tell them. In this creative controversy article, we discuss how family and professional caregivers can seek to understand and correctly interpret the nonverbal communications of patients with dementia (behaviors, actions, facial expressions, and vocal sounds). Equipping family and professional caregivers with the resources to interpret the nonverbal communications of patients with dementia requires a commitment to in‐service and family education in healthcare facilities. Nurses could play a critical role in raising the awareness among the public about the potential changes and declines in verbal communications of the patients with dementia.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Abstract
This discussion article highlights the challenges of providing hospice care in nursing homes since the start of the COVID-19 (coronavirus disease 2019) pandemic and illuminates practice changes needed in nursing homes. The article provides an overview of the expectations of hospice care, explains the differences in delivering hospice care during the COVID-19 pandemic, examines social isolation and emotional loneliness and the role of familial caregivers, and describes policy changes related to the COVID-19 affecting hospice care delivery in nursing homes. This article answers the following questions: (1) How did residents receiving hospice care have their needs met during the COVID-19 pandemic? (2) What areas of nursing home care need to be improved through governmental policy and restructuring? This article also summarized the lessons learned as a result of the COVID-19 pandemic and provided practical implications for nursing, specific to changes in hospice care deliveries for nursing home residents.
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Tzeng HM, Jansen LS, Okpalauwaekwe U, Khasnabish S, Andreas B, Dykes PC. Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. J Nurs Care Qual 2021; 36:327-332. [PMID: 33534349 DOI: 10.1097/ncq.0000000000000547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Falls are the leading cause of injury-related hospitalizations and deaths among older adults globally. LOCAL PROBLEM About 24% of Canadian nursing home residents fall annually. This quality improvement project evaluated the impact of the Fall Tailoring Interventions for Patient Safety (TIPS) program on preventing falls and fall-related injuries among older adult nursing home residents in a subacute care unit in Canada. METHODS We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines for reporting. The intervention site is a 15-bed subacute care unit within a government-funded nursing home. INTERVENTION The Fall TIPS program was adapted to a nursing home setting to prevent falls. It provides fall prevention clinical decision support at the bedside. RESULTS The rates of falls and injuries decreased after implementing the Fall TIPS intervention. CONCLUSION Engaging nursing home older adult residents in fall prevention is crucial in translating evidence-based fall prevention care into clinical practice.
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Affiliation(s)
- Huey-Ming Tzeng
- The University of Texas Medical Branch, Galveston (Dr Tzeng); University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Jansen and Mr Okpalauwaekwe), Saskatchewan Health Authority, Saskatchewan, Canada (Ms Andreas); and Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Dykes and Ms Khasnabish)
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Abstract
INTRODUCTION Hospital patient satisfaction has been a salient policy concern. We examined rurality's impact on patient satisfaction measures. METHODOLOGY We examined patients (age 50 and up) from 65 rural and urban hospitals in Massachusetts, using the merged data from 2007 American Hospital Association Annual Survey, State Inpatient Database and Survey of Patients' Hospital Experiences, utilizing Hierarchical binary logistic regression analyses to examine the rural disparities in patient satisfaction measures. RESULTS Relative to the urban location, rurality reduced the likelihood of cleanliness of environment (odds ratio = 0.66, 95% confidence interval: [0.63-0.70]); but increased the likelihood of staff responsiveness and quietness. Compared to Caucasian counterparts, Hispanic patients were less likely to reside in a quiet hospital. Compared to other payments, Medicare or Medicaid coverage each reduced the likelihood of staff responsiveness and cleanliness. Compared to other diagnoses, depressive or psychosis disorders predicted smaller odds in responsiveness and cleanliness. Anxiety diagnosis reduced the likelihood of cleanness and quietness. At the facility level, higher registered nurse full-time equivalent (FTE)s or being a teaching hospital increased the likelihood of all measures. CONCLUSION Relative to the urban counterparts, rural patients experienced lower likelihood of staff responsiveness after adjusting for other factors. Compared to Caucasian patients, Hispanic patients were less likely to reside in quiet hospital environment. Research is needed to further explore the basis of these disparities. Mental health diagnoses in depressive and psychosis disorders also called upon further studies in special care needs.
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Affiliation(s)
- Yu (Sunny) Kang
- School of Health and Human Services, College of Public Affairs, University of Baltimore, Liberal Arts and Policy Building, Baltimore, MD, USA
| | - Huey-Ming Tzeng
- The University of Texas Medical Branch, School of Nursing, Galveston, TX, USA
| | - Ting Zhang
- Department of Finance and Economics, Merrick School of Business, Jacob France Institute, University of Baltimore, Baltimore, MD, USA
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Tzeng HM, Okpalauwaekwe U, Lyons EJ. Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review. Clin Interv Aging 2020; 15:971-989. [PMID: 32612356 PMCID: PMC7323788 DOI: 10.2147/cia.s256599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
Purpose Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COM-B dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.
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Affiliation(s)
- Huey-Ming Tzeng
- The University of Texas Medical Branch, School of Nursing, Galveston, TX, USA
| | - Udoka Okpalauwaekwe
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Elizabeth J Lyons
- University of Texas Medical Branch, Department of Nutrition and Metabolism, School of Health Professions, Galveston, TX, USA
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Tzeng HM. OLDER ADULTS’ IMMIGRANT STATUS AND SELF-REPORTED ABILITY TO NAVIGATE THROUGH THE HEALTHCARE SYSTEM. Innov Aging 2019. [PMCID: PMC6845773 DOI: 10.1093/geroni/igz038.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
This exploratory study examined the association between older adults’ immigrant status and their self-reported ability to perform each of the 51 self-care behaviors that are needed for them to navigate through the healthcare system. Secondary data analysis was conducted based on a 2018 telephone survey of community-dwelling adults 65 y/o or older, living in a western Canada province (N = 1,000). A previously validated survey tool, Patient Involvement Behaviors in Health Care (e.g., indicating Yes=1 or No=0 regarding their ability to perform each self-care behavior), and a demographic data form (e.g., are you an immigrant? Yes=1 or No=0) were used. Descriptive analyses and chi-square tests for independence (alpha= 0.05) were conducted. Among the 993 adults who indicated their immigrant status, 51 (5.1%) self-declared as immigrants. 32 (62.7%) of the immigrant participants and 457 (48.5%) of the non-immigrant participants resided in the urban areas. 88.2% of these immigrant participants was white, 7.8% was Asian, and 2% was black; 72.5% indicated that English is their first language. Immigrant participants were less likely to report being able to perform 5 self-care behaviors than non-immigrant participants. These 5 behaviors were: bringing someone to help you move around when needed; asking your providers to share your medical record with each other; finding insurance that best matches your needs; changing health insurance coverage as needed; and knowing of any interactions with old and new treatments. Clinicians should co-create approaches with older adult immigrants to improve their self-care capacity (e.g., connecting with relevant peer support networks).
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Tzeng HM, Barker A, Kang YS, Okpalauwaekwe U, Yin CY. Are older adults' demographic characteristics social determinants of their perceived importance, desire, and ability to perform end-of-life self-care actions? Nurs Forum 2019; 54:565-574. [PMID: 31321787 DOI: 10.1111/nuf.12371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Demographic characteristics play a role in influencing the decision to make end-of-life (EOL) directives among older adults living in the United States. AIMS To examine the associations between older adults' demographic characteristics (age, sex, marital status, residential site, and educational level) and their perceived importance of four self-care actions for EOL planning, as well as their desire and ability to perform these actions. SETTINGS A cross-sectional survey study of community-dwelling adults living in the southern United States from 2015 to 2016. PARTICIPANTS Community-dwelling adults aged 65 years and older (N = 123). METHODS A self-administered tool, the Patient Action Inventory for Self-Care and a demographic questionnaire were used. Multiple logistic regression was performed. RESULTS Forty-seven of (38.2%) participants lived in an urban community and 76 (61.8%) in a rural community. Demographic variables that were significant across the predictive models were older adults' residence, education levels, age, and marital status. Four demographic characteristics of living in rural areas, without a high school education, being 75 years or older, and married could be social determinants of EOL planning. CONCLUSIONS Older adults may need community-based support to address their end-of-life needs, especially those elders who want to remain independent in their home environment.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch, Galveston, Texas
| | - Anne Barker
- Center for Community Health Ministry, Inc, and Nursing Instructor, Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, TN
| | - Yu Sunny Kang
- School of Health and Human Services, College of Public Affairs, University of Baltimore, Baltimore, MD
| | - Udoka Okpalauwaekwe
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chang-Yi Yin
- Taiwan History Research Foundation, Taipei, Taiwan
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Tzeng HM, Okpalauwaekwe U, Yin CY. Older adults' suggestions to engage other older adults in health and healthcare: a qualitative study conducted in western Canada. Patient Prefer Adherence 2019; 13:331-337. [PMID: 30863021 PMCID: PMC6388726 DOI: 10.2147/ppa.s182941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIM This qualitative study reports identified themes from suggestions made by 533 Canadian older adults, aged ≥65 years in response to the open-ended question contained in a Saskatchewan Telephone Survey: "What suggestions can you make to engage someone in their health and healthcare?". BACKGROUND In 2016, seniors accounted for 16.9% of the Canadian population. As Canadians age over the next 30 years, emergency room visits are predicted to increase by 40%, outpacing the expected 30% population growth. Avoiding this increase could save the nation about $210 million annually. A recent US study reported that the ability of seniors to carry out self-care actions predicted lower likelihood of emergency department use within 3 months. MATERIALS AND METHODS We conducted a secondary data analysis based on a province-wide, cross-sectional Saskatchewan (Canada) Telephone Survey of seniors' self-care needs conducted in March-June 2018 (N=1,000). Results were analyzed using qualitative thematic content analysis. Data were charted and coded separately by two researchers; coding conflicts were resolved by consensus. RESULTS A total of 533 seniors answered the open-ended question. Content analysis resulted in 11 contextual content areas with 956 total suggestions. Five key themes emerged, which included the following: feasible healthcare access, being proactive toward healthy living, having social support systems, being more open to alternative medicine, and other self-care options, and having more trained healthcare professionals to care for seniors. CONCLUSION This study reveals facilitators and challenges that currently face seniors. Seniors want equitable access to professional healthcare services and an environment that fosters self-care actions in everyday living. There is a gap in supports that would assist seniors to engage in their health and healthcare. Additional research on this issue could further inform health and human service providers to develop patient-centered strategies for promoting self-care among seniors.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada,
| | - Udoka Okpalauwaekwe
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Chang-Yi Yin
- Taiwan History Research Foundation, Taipei, Taiwan
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Zou L, Yeung A, Li C, Chiou SY, Zeng N, Tzeng HM, Wang L, Ren Z, Dean T, Thomas GA. Effects of Mind⁻Body Movements on Balance Function in Stroke Survivors: A Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health 2018; 15:E1292. [PMID: 29925770 PMCID: PMC6025433 DOI: 10.3390/ijerph15061292] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/15/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022]
Abstract
Objective: We performed a systematic review with meta-analysis and meta-regression to determine if mind⁻body movements (MBM) could be effective in rehabilitating balance function among stroke survivors. Methods: A literature search was conducted using major Chinese and English electronic databases from an inception until January 2018. Randomized controlled studies were included in our meta-analysis. Data was independently extracted by two review authors using a pre-developed table and confirmed by a third party to reach a consensus. Pooled effect size (Hedge’s g) was computed while the random-effect model was set. Results: The meta-analytic results showed a significant benefit of the MBM intervention on increased balance function compared to the control groups (Hedge’s g = 1.59, CI 0.98 to 2.19, p < 0.001, I² = 94.95%). Additionally, the meta-regression indicated that the total number of sessions (β = 0.00142, 95% CI 0.0039 to 0.0244, p = 0.0067) and dose of weekly training (β = 0.00776, 95% CI 0.00579 to 0.00972, p = 0.00) had significantly positive effects on balance function. Conclusions: The study encouraging findings indicate the rehabilitative effect of a MBM intervention for balance function in stroke survivors. However, there were significant limitations in the design among several of the included trials. Additional studies with more robust methodologies are needed to provide a more definitive conclusion.
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Affiliation(s)
- Liye Zou
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
- Department of Sports Science and Physical Education, the Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Albert Yeung
- Depression Clinical and Research Program, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
| | - Chunxiao Li
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong, China.
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Nan Zeng
- School of Kinesiology, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA.
| | - Huey-Ming Tzeng
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
| | - Zhanbing Ren
- Department of Physical Education, Shenzhen University, Shenzhen 518060, China.
| | - Taquesha Dean
- Depression Clinical and Research Program, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
| | - Garrett Anthony Thomas
- Depression Clinical and Research Program, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
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Morrison-Beedy D, Tzeng HM, Abriam-Yago K. Building the pipeline of diverse nursing leaders: Reflections from the AACN Deans' mentoring program. J Prof Nurs 2018; 34:9-11. [PMID: 29406145 DOI: 10.1016/j.profnurs.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Dianne Morrison-Beedy
- US - UK Fulbright Commission at Edinburgh Napier University and University of South Florida College of Nursing.
| | - Huey-Ming Tzeng
- Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, TN 38505-0001, USA.
| | - Katherine Abriam-Yago
- The Valley Foundation School of Nursing, College of Applied Sciences & Arts, San Jose State University, One Washington Square, San Jose, CA 95192-0057, USA.
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Tzeng HM, Marcus Pierson J. Measuring patient engagement: which healthcare engagement behaviours are important to patients? J Adv Nurs 2017; 73:1604-1609. [PMID: 28103394 DOI: 10.1111/jan.13257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
AIM(S) This study identified patient healthcare engagement behaviours that are important to community-dwelling adult patients living in the southern region of the USA. BACKGROUND Patient engagement has been identified as a key driver for containing healthcare costs, but the public and healthcare professionals lack a scientific understanding of patient engagement. A valid tool is needed for prompting patients to discuss health activities with their healthcare providers and to obtain support. DESIGN This exploratory cross-sectional survey study used a quantitative research design. It was conducted in seven senior centres in the southern region of the USA in 2015. METHODS This project used convenience sampling to recruit subjects. Subjects were community-dwelling adult patients older than 18 years and living in the Upper Cumberland region of Tennessee. Individuals who had taken the survey previously were excluded. The survey tool, Patient Involvement Behaviors in Health Care, was developed by the authors and used for data collection. RESULTS Ninety-two participants completed or partially completed the survey. The response rate was 74·8%. Among the 51 identified behaviours, 17 were identified as being important by less than 95% of participants; eight of these 17 behaviours were important to less than 90% of participants. CONCLUSIONS We identified 34 behaviours that at least 95% of the participants indicated were important. Nurses may use this tool to help individual patients identify engagement behaviours that are important to them, to respect their personal preferences and thus improve their engagement in health care.
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Affiliation(s)
- Huey-Ming Tzeng
- Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, Tennessee, USA
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Tzeng HM, Pierson JM. What are the highly important and desirable patient engagement actions for self-care as perceived by individuals living in the southern United States? Patient Prefer Adherence 2017; 11:181-191. [PMID: 28203062 PMCID: PMC5293496 DOI: 10.2147/ppa.s127519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This exploratory survey study aimed to identify patient engagement actions that are the most frequently named as being highly important (top 30 by importance) or ones that they want to do (top 30 by desire) for community-dwelling adult patients living in the southern United States. Items not making the list of the top 30 by ability were also identified. BACKGROUND Patient engagement is still an ambiguous term among population health and health care professionals in the United States as we lack a clear understanding of what it entails. METHODS This 2015-2016 study used convenience sampling to recruit subjects in a university's student health service department and in eight senior centers. Two hundred and fifty adult patients older than 18 years in the Upper Cumberland region of Tennessee participated in the study (82% response rate). A 57-item inventory, "The Patient Action Inventory for Self-Care," was developed and used to ascertain patients' self-designated preferences and capabilities in order to understand their needs for education and support. RESULTS Respondents included 159 (63.6%) women, 62 (24.8%) men, and 29 (11.6%) who did not indicate their gender. Combining the list of the top 30 importance items and the list of the top 30 desired items yielded a list of 35 items; noteworthy is the fact that the list of the top 30 ability actions contained nine items that were not found in a previously mentioned list of 35 high-ranking importance and desired items. This study validated the necessity of analyzing patient engagement actions by importance, desirability, and ability to accomplish it. These three levels are distinct from each other. CONCLUSION Nurses may use future versions of the inventory to assist patients in identifying self-care actions to engage in. Use of the inventory will demonstrate respect for patients' preferences and may thus improve engagement.
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Affiliation(s)
- Huey-Ming Tzeng
- Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, TN
- Correspondence: Huey-Ming Tzeng, Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, 10 W. 7th Street, Cookeville, TN 38505-0001, USA, Tel +1 734 358 0358, Email
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Abstract
This article aims to help readers to learn about health care related cultural and religious beliefs and spiritual needs in Chinese communities. The recall diary of a severe acute respiratory syndrome (SARS)-infected intern working in Hoping Hospital in Taiwan during the 2003 SARS epidemic is presented and used to assist in understanding one patient’s spiritual activities when personally confronted with this newly emerging infectious disease. The article also gives an overview of the 2003 SARS epidemic in Taiwan, and discusses people’s general perceptions towards infectious diseases, their coping strategies concerning disease, and their spiritual beliefs, the psychological impact of the 2003 SARS outbreak in Chinese communities, Chinese myths about infectious disease, and the religious activities of a SARS-infected intern in Taiwan. Recommendations are given on how to achieve quality holistic nursing care.
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Affiliation(s)
- Huey-Ming Tzeng
- I-Shou University, Nursing Department, Ta-Shu Hsiang, Kaohsiung, Taiwan.
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30
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Affiliation(s)
- Huey-Ming Tzeng
- I-Shou University, Nursing Department, No. 1, Section 1, Kaohsiung County, 815, Taiwan.
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Abstract
This survey aimed to illustrate factors that contribute to nurses' fear when faced with a possible human-to-human avian flu pandemic and their willingness to care for patients with avian flu in Taiwan. The participants were nursing students with a lesser nursing credential who were currently enrolled in a bachelor degree program in a private university in southern Taiwan. Nearly 42% of the nurses did not think that, if there were an outbreak of avian flu, their working hospitals would have sufficient infection control measures and equipment to prevent nosocomial infection in their working environment. About 57% of the nurse participants indicated that they were willing to care for patients infected with avian influenza. Nurses' fear about an unknown infectious disease, such as the H5N1 influenza virus, could easily be heightened to levels above those occurring during the 2003 severe acute respiratory syndrome outbreak in Taiwan.
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MESH Headings
- Adult
- Attitude of Health Personnel
- Codes of Ethics
- Cross-Sectional Studies
- Disease Outbreaks/prevention & control
- Disease Outbreaks/statistics & numerical data
- Education, Nursing, Baccalaureate
- Education, Professional, Retraining
- Fear
- Female
- Global Health
- Health Knowledge, Attitudes, Practice
- Humans
- Infection Control
- Influenza A Virus, H5N1 Subtype
- Influenza, Human/epidemiology
- Influenza, Human/nursing
- Influenza, Human/prevention & control
- Nurse's Role/psychology
- Nursing Methodology Research
- Occupational Health
- Patient Advocacy
- Refusal to Treat/ethics
- Social Responsibility
- Students, Nursing/psychology
- Surveys and Questionnaires
- Taiwan/epidemiology
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Affiliation(s)
- Huey-Ming Tzeng
- University of Michigan, School of Nursing, Division of Nursing, Business and Health Systems, Ann Arbor 48109-0482, USA.
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Tzeng HM, Yin CY. Patient Engagement in Hospital Fall Prevention. Nurs Econ 2015; 33:326-334. [PMID: 26845821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input).
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Tzeng HM, Yin CY. Perceived top 10 highly effective interventions to prevent adult inpatient fall injuries by specialty area: A multihospital nurse survey. Appl Nurs Res 2015; 28:10-7. [DOI: 10.1016/j.apnr.2014.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 04/11/2014] [Accepted: 04/17/2014] [Indexed: 11/25/2022]
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Tzeng HM, Hu HM, Yin CY. Relationship between inpatient pressure ulcer prevalence and patient satisfaction levels based on US Medicare's Hospital Compare data. J Clin Nurs 2014; 24:1730-2. [DOI: 10.1111/jocn.12715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing; Washington State University; Spokane WA USA
| | - Hsou Mei Hu
- Office of Clinical Affairs; University of Michigan; Ann Arbor MI USA
| | - Chang-Yi Yin
- Department of History; Chinese Culture University; Taipei Taiwan
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Tzeng HM. Patient Engagement and Self-Management Across the Care Continuum. Medsurg Nurs 2014; 23:425-426. [PMID: 26281648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
PROBLEM Could engaging patients in their care be a means to oppose obscurantism? Obscurantism is defined by Merriam-Webster as "the practice of keeping knowledge or understanding about something from people". METHODS This paper discusses the importance of promoting patient engagement and emphasizes that patients and healthcare providers are equally important stakeholders in health care. FINDINGS The discussion occurs in the context of hospital inpatient care as nurses play a critical role in patients' hospitalization experience, including engaging patients in their own care during hospital stays. Paternalism of healthcare providers is recognized as one of the main barriers to integrating the concepts of patient engagement and patient centeredness into every aspect of the care system. Promoting patient engagement is a two-way responsibility, and it requires the cooperation of both patients and healthcare providers. CONCLUSIONS As scientists and healthcare providers, we have the duty to counter obscurantism by promoting understanding of the health of individual citizens and society at large. A culture change in healthcare systems toward being patient-centric and placing value on patient engagement is warranted, and this change must come from healthcare providers. Patient-centered tools that support patient engagement, patient portals, or personal health records are still needed.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA
| | - Chang-Yi Yin
- Department of History, Chinese Culture University, Taipei, Taiwan
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Abstract
Decreasing patient fall injuries during hospitalization continues to be a challenge at the bedside. Empowering patients to become active participants in their own fall prevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fall prevention; when the nurse left a brochure on the topic, but did not provide any (or limited) verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients' needs, we developed "i Engaging", a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fall prevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Chang-Yi Yin
- Department of History, Chinese Culture University, Taipei, Taiwan
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Abstract
This retrospective, descriptive, chart review study was done to demonstrate one strategy for communicating aggregated and actionable fall data to bedside nurses. It was conducted at a nonprofit acute care hospital in the northwestern United States to analyze the quantitative data captured in post-fall audit reports of patient falls (March 1-December 31, 2012, N = 107 falls). Descriptive and binary statistical analyses were used. The quarterly National Database of Nursing Quality Indicators 2011 and 2012 reports showed that implementation of post-fall audit reports can lead to a lower overall fall rate and a lower fall-injury rate. Increased nursing hours could be a confounding factor of the positive impact of conducting post-fall audits in this study. It is concluded that timely and systematic reporting, analysis, and interpretation of fall data in an electronic format can facilitate prevention of falls and fall injuries.
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Affiliation(s)
| | - Chang-Yi Yin
- Chinese Culture University, Taipei, Taiwan, Republic of China
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Abstract
This perspective paper was intended to raise awareness and the urgency of needing additional evacuation-related, hospital building design policies. We addressed the challenges to maintain the integrity of exits and inadequate hospital design considerations for individuals with restricted mobility. Hospitals are occupied by people who may have restricted mobility and visitors who are likely unfamiliar with their surroundings. A hospital fire threatens all people in the building, but especially patients in the intensive care unit who are frail and have limited mobility. Evacuating immobile patients is complex, involving horizontal and vertical evacuation approaches. Hospital design must consider the needs of individuals with restricted mobility, who are the most vulnerable in case of a hospital fire. Consequently, we urge that acutely ill patients and others with restricted mobility should occupy units located on the ground floor or Level 2. In addition, when configuring the physical environment of hospitals, providing step-free ground floor access (indoor or outdoor ramps) and evacuation aids for vertical evacuation is crucial. Step-free ground floor access between Level 2 and the ground floor should be wide enough to allow transporting patients on their beds. A standard revision to include these recommendations is desperately needed.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA
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Tzeng HM, Grandy GA, Yin CY. Staff response time to call lights and unit-acquired pressure ulcer rates in adult in-patient acute care units. Contemp Nurse 2013; 45:182-7. [PMID: 24299246 DOI: 10.5172/conu.2013.45.2.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The US National Pressure Ulcer Advisory Panel claimed that most pressure ulcers are avoidable (2007). Identifying nursing-process indicators that are objective and associated with pressure ulcer rates is desperately needed. As a result, the purpose of this exploratory study was to examine the relationship between staff response time to call lights and the rate for unit-acquired pressure ulcers stage II and greater, in adult in-patient acute care units. We used archived data of one Michigan hospital located in the United States from July 2005 to December 2008 for analyses. The unit of analysis was the patient care unit-month. Pearson product-moment correlation analyses were used. The results showed that a faster staff response time to call lights was found to be associated with a lower percentage of unit-acquired pressure ulcers stage II and greater among surveyed patients. Staff response time is a significant process indicator to predict unit-acquired pressure ulcer rates.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA, USA
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Tzeng HM. Nurse staffing is indeed a patient safety matter! Nurs Econ 2013; 31:311-266. [PMID: 24592537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Dabney BW, Tzeng HM. Service quality and patient-centered care. Medsurg Nurs 2013; 22:359-364. [PMID: 24600931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | - Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA, USA
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Tzeng HM, Yin CY. Most and least helpful aspects of fall prevention education to prevent injurious falls: a qualitative study on nurses' perspectives. J Clin Nurs 2013; 23:2676-9. [DOI: 10.1111/jocn.12295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing; Washington State University; Spokane WA USA
| | - Chang-Yi Yin
- Department of History; Chinese Culture University; Taipei Taiwan
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Tzeng HM, Grandy GA, Yin CY. Staff response time to call lights and unit-acquired pressure ulcer rates in adult inpatient acute care units. Contemp Nurse 2013. [DOI: 10.5172/conu.2013.2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tzeng HM, Yin CY, Schneider TE. Medication error-related issues in nursing practice. Medsurg Nurs 2013; 22:13-50. [PMID: 23469494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Professional nurses are more exposed to civil claims for negligence than in the past. Issues related to medication errors, and strategies to decrease them, are addressed.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA, USA
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Tzeng HM, Yin CY. Toileting-related inpatient falls in adult acute care settings. Medsurg Nurs 2012; 21:372-377. [PMID: 23477031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A toileting-related fall was associated with history of a previous fall, use of physical restraints, and risk for falling in hospital settings. This study provided insights to be used to prioritize patient fall prevention strategies.
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Affiliation(s)
- Huey-Ming Tzeng
- Washington State University College of Nursing, Spokane, WA, USA
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Abstract
This qualitative and descriptive study examined the feasibility of a bed-height alert system as a fall-prevention strategy. The alpha prototype was developed to measure and record bed height, and to remind staff to keep patient beds in the lowest position. This pilot project was conducted in a 52-bed adult acute surgical inpatient care unit of a Michigan community hospital. Qualitative and quantitative information was gathered during semistructured interviews of nursing staff (18 RNs and 13 PCAs; January-April 2011). Descriptive content analysis and descriptive analyses were performed. The overall response rate was 44.9%. The mean values of the feasibility questions are all favorable. Staff's comments also support the view that the alert system would promote patient safety and prevent falls. In short, this system was found to be somewhat useful, feasible, appropriate, and accurate. It has the potential to promote patient safety and prevent bed-associated injurious falls in inpatient care settings.
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Tzeng HM, Yin CY, Anderson A, Prakash A. Nursing staff's awareness of keeping beds in the lowest position to prevent falls and fall injuries in an adult acute surgical inpatient care setting. Medsurg Nurs 2012; 21:271-274. [PMID: 23243783 PMCID: PMC3639136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
High beds are a safety concern. This qualitative study used pre-existing nurse interview data and confirmed nurses' awareness of the importance of keeping patient beds in the lowest position. Lowering the bed helps promote patient safety and prevent falls.
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Affiliation(s)
- Huey-Ming Tzeng
- Professor and Associate Dean for Academic Programs, Washington State University, College of Nursing, Spokane, WA, USA ()
| | - Chang-Yi Yin
- Professor, Chinese Culture University, Department of History, Taipei, Taiwan ()
| | - Allison Anderson
- Staff Nurse, The University of Michigan Health Systems, Ann Arbor, Michigan, USA ()
| | - Atul Prakash
- Professor, Department of Electrical Engineering and Computer Science, College of Engineering, The University of Michigan, Ann Arbor, Michigan, USA ()
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Tzeng HM, Prakash A, Brehob M, Devecsery DA, Anderson A, Yin CY. Keeping patient beds in a low position: an exploratory descriptive study to continuously monitor the height of patient beds in an adult acute surgical inpatient care setting. Contemp Nurse 2012; 41:184-9. [PMID: 22800384 DOI: 10.5172/conu.2012.41.2.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This descriptive study was intended to measure the percentage of the time that patient beds were kept in high position in an adult acute inpatient surgical unit with medical overflow in a community hospital in Michigan, United States. The percentage of the time was calculated for morning, evening, and night shifts. The results showed that overall, occupied beds were in a high position 5.6% of the time: 5.40% in the day shift, 6.88% in the evening shift, and 4.38% in the night shift. It is recognized that this study was unable to differentiate whether those times patient beds being kept in a high position were appropriate for an elevated bed height (e.g., staff were working with the patient). Further research is warranted. Falls committees may conduct high-bed prevalence surveys in a regular basis as a proxy to monitor staff members' behaviors in keeping beds in a high position.
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Affiliation(s)
- Huey-Ming Tzeng
- Department of Nursing, School of Health Professions and Studies, The University of Michigan-Flint, Flint, MI, USA
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Hu HM, Tzeng HM. A Hospital’s Adoption of Information Technology Is Associated With Altered Risks of Hospital-Acquired Venous Thromboembolism. Am J Med Qual 2012; 27:305-12. [DOI: 10.1177/1062860611426349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hsou Mei Hu
- University of Michigan Health System, Ann Arbor, MI
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