Technology-Enhanced Practice for Patients with Chronic Cardiac Disease: Home Implementation and Evaluation

Objective: This 3-year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home-care nursing model, referred to as technology-enhanced practice (TEP). Methods: Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services. Results: Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status. Conclusion: This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care

Equality in Health: An Annotated Bibliography With Resources on Health Disparities and Cultural and Linguistic Competency

Provides citations for articles, reports, books, and online resources on racial/ethnic disparities in health and health care, strategies to reduce them, assessment tools for cultural and linguistic competency, training and education, and other issues

Effectiveness and Feasibility of In-office versus Smartphone Text-delivered Nutrition Education in the College Setting: A Mixed-methods Pilot Study

Often, being away from home for the first time, coupled with limited knowledge regarding healthy eating behaviors, leads to poor food choices and an increased risk of obesity among college-aged young adults. These college students are prone to high-calorie diets and limited physical activity, putting them at risk for obesity, a physiologically, psychologically, and financially costly epidemic in the United States. College students use their cellular phones over eight and a half hours a day and cell phones are their primary means of information consumption outside of the classroom, suggesting that the phones would be a useful tool to provide nutrition education to this at-risk population. This mixed-methods randomized-controlled trial took place over eight weeks, between 9/15/15 and 12/2/15. The primary aims of this study were to assess the effectiveness and feasibility between an educational nutrition intervention delivered via smartphone texts and a traditional in-office setting for 18-22-year-old, overweight college students at the Sonoma State University Student Health Center. Using simple randomization, participants were assigned to one of two groups: text, or in-office. Participants in the in-office group received one-on-one nutrition counseling framed within the social cognitive theory by a registered nurse at the study onset, week two, and week four. Participants in the text group received the same information, broken up into weekly text messages with links to websites, YouTube, and explanations of content. Participant characteristics, including weight, height, and health behaviors (hours of sleep a night, number of fruits and vegetables per day), were assessed at the study onset (T1) and again at week two (T2), week four (T3), and week eight (T4). All participants were invited to take part in an in-depth, qualitative, face-to-face interview at the end of the study (T4). Nine participants completed both the trial and interviews. Two-thirds (66.7%, n=6) were in the text group, 66.7% (n=6) were female, 33.3% (n=3) were minorities, 66.7% lived on- campus, and 44.4% (n=4) took part in the university’s on-campus meal plan. No statistically significant differences were noted in participant characteristics, or health behaviors between the two groups throughout the study. Although no statistical significance was noted between the two groups with regard to weight change, the text group’s mean weight decreased from 188.25(sd=25.03) pounds to 184.58(sd=24.67) pounds while the in-office group’s mean weight increased from 254.00(sd=90.15) to 257.00(sd=94.14) pounds. Weight loss in the text group should be further evaluated as it may hold clinical significance for effectiveness of the intervention. Through qualitative interviews exploring participants’ experiences, four major themes emerged. All participants in the text group (n=6) stated that they felt there was a need for their method of education, they felt their method was effective, they would recommend their method, and their health behaviors changed positively. For the in-office group, all participants (n=3) said there was a need for their method of education, 67% (n=2) said it was effective, all would recommend it, and 67% stated that they changed their behaviors. Both the quantitative and qualitative findings of this study hold clinical significance as to the effectiveness and feasibility of text messages as a means of providing nutrition education in the college setting. Future research with larger sample sizes and a longer-term study are recommended for more statistical power and to determine the long-term benefits of these methods of nutrition education

Advances in Teaching & Learning Day Abstracts 2004

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2004

Impact of Health Information Technology Patient Education with Teach-Back on Patient Satisfaction and Hospital Readmissions

Background: With the advances in medical care, patients are being asked to manage more complicated self-care regimens, and there is often a gap between what the nurse teaches and what the patient understands. This can lead to re-hospitalizations that are burdensome for patients and are costly to the American healthcare system. The Department of Health and Human Services (DHHS) challenged healthcare organizations to leverage technology that engages patients in self-management support and encourages clinician use of patient-centered communication techniques, such as teach-back. Purpose: The purpose of this project is to evaluate the use of health information technology along with an evidence-based practice communication technique, teach-back, to improve patient satisfaction, and decrease hospital readmissions. Methods: A descriptive, quasi-experimental study design using pre and post-test comparisons was used to make comparisons between thirty-day readmission rates, Consumer Assessment of Healthcare Providers and Systems (CAHPS) with transition of care, and a nurse satisfaction survey. Results: There was no evidence of statistical significance in the comparison of outcomes before and after the intervention. The nurses provided teach-back following the video clips with 16% of the patients so the intervention was not implemented by the staff as planned. However, 90% of the patients that answered the Interactive Patient Care System (IPC) satisfaction survey before discharge responded that they were able to easily use the system, it helped them understand more about their health condition and how to care for themselves, and it positively impacted their hospital stay. While the results are not statistically significant, they are still sufficiently conclusive to support further study to analyze the effectiveness of using an IPC system with evidence based practice teaching techniques

Cultural Transformation in Health Care

Describes the role of organizational culture in healthcare organizations. Recommends strategies for innovative approaches to improve the overall performance of the U.S. healthcare system

Developing Outpatient, Clinic-Based Education for Patients With Diabetes and Prediabetes

Abstract Education and support provided to the newly diagnosed prediabetic or Type 2 Diabetic are inadequate in the outpatient arena. In rural areas, instruction for diabetes is minimal to nonexistent, and patients are paying for this with their health and lives many times. The financial burden of diabetes in the United States is astronomical. The loss of life and life quality is significantly high as well. A systems-based approach to education in the rural health clinic would be of great benefit and has proven to be enough to reverse or avoid the progression of the disease. A clinic or field-based diabetes education program is far superior to typical and usual inpatient education and minimizes complications and decreases morbidity and mortality rates in the individual with diabetes as well as decreases costly hospital stays and risks for nonpayment at an organizational level. Keywords: diabetes mellitus, inpatient, self-care, type 1 diabetes, type 2 diabete

Reducing Heart Failure in an Era of Reform

Heart failure (HF) affects an estimated 5 million Americans, with 550,000 new patients diagnosed yearly (American Heart Association, 2004). Despite advancements, readmissions for HF remain high. Management is especially important due to recent legislation that penalizes hospitals with excessive readmissions. The purpose of this evidence-based project (EBP) was to determine if a chronic disease HF management program with advance practice nurse, home care, and telehealth would affect hospital readmission 4 weeks post-discharge. Orem’s Self-Care Deficit Nursing Theory and the Iowa Model guided this system change. The project used a longitudinal experimental pre- and post-test design with convenience sample from two hospitals in the Midwest. An algorithm guided the EBP that began while hospitalized and continued 30 days. The Self-Care of Heart Failure Index (SCHFI) was administered pre- and post-intervention to measure changes in self-care. Descriptive statistics were compared to a chart audit of patients with HF utilizing homecare and telehealth in 2011. Paired-samples t test were used to compare the mean pre- and post-test scores in all SCHFI domains. Mean maintenance pre-test scores (M = 56.43; SD = 27.77) and post-test scores (M = 89.01;SD = 6.88) were significantly different; (t (13) = -4.415, p \u3c .001). Mean pre-testmanagement scores (M = 25.00; SD = 13.22) and post-test scores (M = 73.33; SD =25.16) were significantly different (t (2) = -6.653, p \u3c .02). Mean confidence pre-test scores (M = 88.14; SD= 19.76) and post-test scores (M = 100; SD = .00) were significantly different (t (13) = -2.245. p \u3c .04). There were no readmissions in the EBP participants compared to 2 (16%) readmissions in 2011. The implementation of the evidence-based HF chronic disease management program resulted in improved self-care and reduced readmissions. Replication of this EBP has been adopted by the Project Coordinator\u27s (PC) institution

Activating the Patient: A Nurse Led Coaching Intervention to Engage Health Information Seeking Behaviors Using the IDEAL Discharge Framework and Get Well Network

Background: Cardiovascular (CV) patients are often overwhelmed by the unexpected emergence of the health condition, volume of knowledge for self-care mastery and acceptance of the responsibility for self-care upon care transition to the home setting. Low health literacy levels have been linked to poor outcomes in CV patients, requiring investigation into appropriate methods for patient education. The Get Well Network (GWN), an interactive digital patient education care plan at UK HealthCare (UKHC), is underutilized in this patient population. Purpose: the purpose of this study is to assess the effect of a nurse-to-patient coaching intervention using the IDEAL discharge framework from the Agency for Healthcare Research and Quality (AHRQ) on patient utilization of available education resources via GWN. Conceptual Framework: The health belief model and Orem’s self-care framework informed this study, asserting that an individual’s belief in the readiness and motivation to change self-care behaviors leads to positive change and engagement. A coaching intervention on outcomes-related information for patient success encourages patient activation to positive change. Methodology: In this quasi-experimental study, a sample (n=25) of the inpatient population of cardiovascular patients on four cardiovascular units (CVU) at a UKHC, an academic medical center, undergo the coaching intervention to investigate any influence on patient utilization of GWN. This sample is compared to a sample pre-intervention. Results: Data indicate the coaching intervention did not influence patient activation, health belief or self-care motivation through increased utilization of GWN. On receiving reminders for engagement with video content, the majority of patients chose to defer participation. However, engagement with medication review approached significance (p=0.054). Discussion: GWN was designed to engage patients in their own health care through personalized education but relies on activation and motivation of the patient. Patients acknowledge greater need for education and responsibility for self-care but lack understanding of engagement necessary before hospital discharge to manage knowledge and acquisition. Conclusion: GWN continues to be a valuable resource at UKHC, however further studies are needed to determine the most effective strategies to inspire patients and their caregivers to access the education resources provided