Positive Influences: Keeping Black Women Living with HIV in Care

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Description
This manuscript option dissertation elucidates the role of patient-provider interactions in keeping HIV positive Black women in medical care. Since 2012, the Arizona State Department of Health has acknowledged that women of African descent are disproportionately affected by HIV and…

This manuscript option dissertation elucidates the role of patient-provider interactions in keeping HIV positive Black women in medical care. Since 2012, the Arizona State Department of Health has acknowledged that women of African descent are disproportionately affected by HIV and die at higher rates from AIDS-related complications than other women. The dissertation includes three manuscripts covering a feature of this topic. The first paper is a scoping review of literature on what is known about the influence of patient-provider relationships on adherence and viral suppression among Black women living with HIV in Arizona. The second is an empirical study built upon interviews with Black women living with HIV analyzed through constructivist grounded theory to understand women’s perspectives of provider actions that keep them in care. The third offers practice recommendations based on the interviews with Black women living with HIV, dialog with HIV advocates, and proceedings of the Phoenix Fast Track Cities ad hoc committee to end HIV as an epidemic. Together, the three manuscripts integrate the voices of women, advocates, and past research to support best practices and future steps for HIV retention strategies.
Date Created
2021
Agent

Stress in Healthcare Professionals: Caring for the Carers

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Description
Background: Healthcare Professionals commonly experience elevated stress levels, and this issue has only further intensified by the ongoing COVID-19 pandemic. Mindfulness-based intervention have been shown to improve stress levels in diverse populations. Objective: The purpose of this project was to…

Background: Healthcare Professionals commonly experience elevated stress levels, and this issue has only further intensified by the ongoing COVID-19 pandemic. Mindfulness-based intervention have been shown to improve stress levels in diverse populations. Objective: The purpose of this project was to evaluate if an online, multicomponent MBI can reduce stress levels in healthcare professionals enrolled in a graduate health program. Methods: Recruitment was conducted at two different Southwestern institutions via email announcement from university’s program directors. The brief, 12-day intervention involved (1) self-guided online educational modules, (2) one group course via the platform zoom, and (3) at home practice of guided meditation session. The Perceived Stress Scale-10 (PSS-10) was used to measure stress levels pre- and post-intervention. General feedback of experience was also inquired on Postsurvey. Results: Sample comprised of 17 health professionals enrolled in a graduate health program from two different Southwestern Institutions. Scores from PSS-10 in postsurvey (M=20.94, SD=6.04) were statistically significantly lower than scores in pre survey (M=24.24, SD=5.78), t(16) = 3.35, p = .004. A large effect size was detected with findings (d = .81). Conclusions: Mindfulness Based Interventions may be able to reduce stress levels in healthcare professionals. More literature should focus on mindfulness intervention tailored to the needs of healthcare professionals.
Date Created
2021-05-03
Agent

The Impact of Interprofessional Education and Curricular Design on Healthcare Participant Professional Integration

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Description
The landscape of healthcare is changing. All health providers in varying disciplines and roles must collaborate and function in teams for effective patient and care outcomes to take place. Collaborative practice starts in the academic environment through adoption of Interprofessional…

The landscape of healthcare is changing. All health providers in varying disciplines and roles must collaborate and function in teams for effective patient and care outcomes to take place. Collaborative practice starts in the academic environment through adoption of Interprofessional Education (IPE). Fostering IPE increases learner confidence and communication but requires a team-based approach to eliminate known learner barriers. These barriers include attitude toward collaboration, role delineation, team development and patient delivery and outcome. While IPE opportunities and activities can be looked at as unique, developing structured curricular standards can be applied to all IPE experiences. Healthcare Participants (HCP’s) (N=15) from two organizational settings participated in an online IPE experience using best practice IPE interventions and structured design formatting focusing on older adults. The course consisted of an online pre learning activity followed by one online session to work as teams on case studies alongside mentorship guidance. The previously validated and reliable ICCAS and RIPLS survey tools were used to measure outcomes of readiness for IPE and professional development. Though no statistically significant changes were noted on the dependent variables, there was clinical significance found in professional development.
Date Created
2021-05-03
Agent

Fall Prevention Assessment Education in Community Dwelling Older Adults

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Description
Background and Significance Falls are considered a problem of increasing proportion for older adults all over the world. Falls account for a large portion of injuries, hospitalizations, and death for persons over 65 years old. Research shows that risk factors for…

Background and Significance Falls are considered a problem of increasing proportion for older adults all over the world. Falls account for a large portion of injuries, hospitalizations, and death for persons over 65 years old. Research shows that risk factors for falls are multifactorial and modifiable. As such, falls should not be recognized as a natural part of aging, but as an increasing characteristic of frailty. Patient and caregiver education about how to identify and modify fall risk factors so that injurious falls and recurrent falls can be avoided. Methods Telephone interviews were conducted and recorded with employees and residents of an independent living facility about their history and knowledge of falls within the community. Content analysis was conducted to assess for common themes and concerns related to falls. Results Five participants, consisting of three residents living in a large HUD housing complex for older adults and two employees who work at the complex were interviewed. Results of the interview show that there is a generalized fear or awareness of the dangers of falling either in the home or within the community, but a lack of awareness of some of the risk factors. Discussion By analyzing gaps in knowledge of this housing complex, fall risk education can be tailored to their fall risk concerns and knowledge gaps and possibly help to reduce future falls for older adults. Keywords: community dwelling, older adults, fall risk
Date Created
2021-05-02
Agent

Changing Caregiver Attitudes Toward Dementia with a Brief Virtual Experience

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Description
Changing Caregivers Attitudes toward dementia study was conducted to assess changes in attitudes of formal caregivers caring for persons with dementia in a palliative care setting. An eight-minute virtual experience activity was delivered to 40 para-professional caregivers of those diagnosed…

Changing Caregivers Attitudes toward dementia study was conducted to assess changes in attitudes of formal caregivers caring for persons with dementia in a palliative care setting. An eight-minute virtual experience activity was delivered to 40 para-professional caregivers of those diagnosed with mild, moderate or severe dementia. The virtual experience consisting of a set of instructions, headphones and different materials, is a quick, effective and efficient way to mimic having some of the stressors those living with Alzheimer's, or other types of dementia, may experience in their day-to-day lives. The purpose of this study was to analyze the effect on caregivers’ emotions and attitudes toward dementia, before and after the virtual experience using a qualitative approach. It is hypothesized that the intervention will educate and instill empathy in the caregivers, overall, improving the delivery of their care in the future. Participants were asked open ended questions before and after the intervention using the virtual experience and four themes emerged: (1) Being more patient, (2) Slowing down, (3) Empathy and (4) Being positive. The findings suggest further education about the disease process is needed to help caregivers understand the actions of dementia related behaviors. Also, education about different strategies to handle some negative behaviors associated with Alzheimer’s or other types of dementia can be done to improve the situation. Overall, the findings showed an increase in empathy and positive words or phrases from the participants, suggesting the simulation experience was an applicable and ethical intervention.
Date Created
2020-05
Agent

Changing Caregiver Attitudes Toward Dementia with a Brief Virtual Experience

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Description
Changing Caregivers Attitudes toward dementia study was conducted to assess changes in attitudes of formal caregivers caring for persons with dementia in a palliative care setting. An eight-minute virtual experience activity was delivered to 40 para-professional caregivers of those diagnosed…

Changing Caregivers Attitudes toward dementia study was conducted to assess changes in attitudes of formal caregivers caring for persons with dementia in a palliative care setting. An eight-minute virtual experience activity was delivered to 40 para-professional caregivers of those diagnosed with mild, moderate or severe dementia. The virtual experience consisting of a set of instructions, headphones and different materials, is a quick, effective and efficient way to mimic having some of the stressors those living with Alzheimer's, or other types of dementia, may experience in their day-to-day lives. The purpose of this study was to analyze the effect on caregivers’ emotions and attitudes toward dementia, before and after the virtual experience using a qualitative approach. It is hypothesized that the intervention will educate and instill empathy in the caregivers, overall, improving the delivery of their care in the future. Participants were asked open ended questions before and after the intervention using the virtual experience and four themes emerged: (1) Being more patient, (2) Slowing down, (3) Empathy and (4) Being positive. The findings suggest further education about the disease process is needed to help caregivers understand the actions of dementia related behaviors. Also, education about different strategies to handle some negative behaviors associated with Alzheimer’s or other types of dementia can be done to improve the situation. Overall, the findings showed an increase in empathy and positive words or phrases from the participants, suggesting the simulation experience was an applicable and ethical intervention.
Date Created
2020-05
Agent

The Impact of Perceived Discrimination on Stress Levels of African American Women Struggling with Excess Weight: A Thematic Literature Review

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Description
The minority population of African American women (AAW) have been found to be most at risk when it comes to certain negative health outcomes (Hales, Carroll, Fryar, & Ogden, 2017). The purpose of this literature review is to discuss the…

The minority population of African American women (AAW) have been found to be most at risk when it comes to certain negative health outcomes (Hales, Carroll, Fryar, & Ogden, 2017). The purpose of this literature review is to discuss the negative effects of perceived discrimination on stress levels for obese AAW. Analysis of several studies have found that perceived discrimination increases the stress levels of AAW and can lead to an increase in physical health problems such as poor eating behaviors, which can lead to weight gain and chronic health issues such as hypertension, Type 2 Diabetes Mellitus, cardiovascular disease, osteoarthritis, sleep apnea, fatty liver disease, and pregnancy complications (Cooper, Thayer, & Waldstein, 2013; Hales, Carroll, Fryar, & Ogden, 2017; Hayman, McIntyre, & Abbey, 2015; U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2015). Through research, increased stress due to perceived discrimination was also found to have negative impacts on mental health such as depression, post-traumatic stress disorder (PTSD), anxiety, rumination, negative racial regard, and psychological distress (Carter, Walker, Cutrona, Simons, & Beach, 2016; Hill, & Hoggard, 2018; Knox-Kazimierczuk, Geller, Sellers, Baszile, & Smith-Shockley, 2018; Pascoe, & Richman, 2009). Article analysis found that many AAW use negative coping mechanisms such as rumination, negative racial regard, poor eating behaviors, and repressing feels of race-related events to combat stress when dealing with race-based events (Carter, Walker, Cutrona, Simons, & Beach, 2016; Hayman, McIntyre, & Abbey, 2015; Hill, & Hoggard, 2018). Positive coping mechanisms discussed to reduce stress and chronic disease included prayer and active coping to counteract the effects of rumination (Cooper, Thayer, & Waldstein, 2013; Hill, & Hoggard, 2018).
Date Created
2019-12
Agent

Screening, Brief Intervention and Referral to Treatment (SBIRT): Implementation in the Adolescent Inpatient Psychiatric Setting

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Description

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and…

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders

Date Created
2019-05-02
Agent

Natural Family Planning in Evidence Based Practice: Implementing a True Method of Family Planning in Client Education Programs.

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Description
Family planning educational programs offer a list of artificial contraceptive methods to couples wishing to avoid a pregnancy; however, many of these methods have disadvantages: many lead to negative individual and environmental health outcomes, do not promote a sense of…

Family planning educational programs offer a list of artificial contraceptive methods to couples wishing to avoid a pregnancy; however, many of these methods have disadvantages: many lead to negative individual and environmental health outcomes, do not promote a sense of fertility awareness in women and men, may be culturally incompatible with certain religious beliefs and worldviews, and do not take into account the full extent of family planning, which includes the ability to achieve as well as to avoid a pregnancy. Natural Family Planning (NFP) is a true method of family planning in that it offers to the couple the option to achieve as well as avoid a pregnancy. NFP methods holistically approach fertility by taking into account the woman's unique fertility cycle and patterns, the need for the couple to understand complex fertility issues, and the needs and family planning intentions of the couple as a whole. This thesis utilizes Evidence Based Practice in an effort to search the best literature regarding the effectiveness of Natural Family Planning methods to avoid a pregnancy, in comparison to the effectiveness of artificial contraceptive methods to avoid a pregnancy. If effectiveness rates are similar, it is reasonable for the health care profession to consider Natural Family Planning as a valid and reliable family planning method, to move towards further research on its effectiveness and benefits, and to implement a practice change by including it in family planning client education programs.
Date Created
2013-12
Agent

Identifying needs of older adults with Alzheimer's disease and related dementias in a rehabilitation setting: perceptions of formal and informal caregivers

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Description
The purpose of this study is to identify the needs of older adults with Alzheimer's disease (AD) and related dementias (ADRD) admitted to a rehabilitation setting where they are expected to physically and mentally function to their optimal level of…

The purpose of this study is to identify the needs of older adults with Alzheimer's disease (AD) and related dementias (ADRD) admitted to a rehabilitation setting where they are expected to physically and mentally function to their optimal level of health. To date, no studies have identified the needs and concerns of ADRD patients in rehabilitation settings. The Needs-Driven Dementia-Compromised Behavior (NDB) Model, the researcher's clinical experience, and the state of the current scientific literature will help guide the study. An exploratory qualitative research approach was employed to gather data and discover new information about the ADRD patient's needs and related behavioral outcomes. The qualitative findings on the discrepancies and similarities in perceptions of ADRD patient needs were obtained by examining formal and informal caregivers' perceptions. The researcher recruited registered nurses and certified nurse assistants (RNs and CNAs, formal) and family/friends (informal) who have provided care to patients in inpatient rehabilitation facilities to participate in focus groups and individualized focused interviews. The data were collated and analyzed using a thematic analysis approach. The overarching theme that developed as a result of this approach revealed discordant perceptions and expectations of ADRD patients' needs between the formal and informal caregivers with six subthemes: communication and information, family involvement, rehabilitation nurse philosophy, nursing care, belonging, and patient outcomes. The researcher provided recommendations to help support these needs. These findings will help guide the development of nurse-lead interventions for ADRD patients in a rehabilitation setting.
Date Created
2014
Agent
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