Informal caregiver decision-making factors associated with technology adoption and use in home health care: A systematic scoping review

Technology systems to alleviate the burden of managing patient’s health at home are increasing. The home is a unique place where chronic disease self-management is often performed by informal caregivers. Informal caregivers provide up to 80% of in‐home care to dementia patients. Yet, how caregivers make decisions about adopting a specific technology has not been thoroughly explored. This review mapped evidence on decision-making factors associated with technology adoption and use by caregivers for patients at home. This study followed the recommendations for performing systematic scoping reviews that were developed by members of the Joanna Briggs Institute. Four electronic databases (PubMed, Medline, CINAHL, and Embase) were searched using both medical subject headings (MeSH terms) and key words. A total of 6 papers were included for data synthesis. The scope of the technology types and patient diagnoses explored in the included studies has been mapped. Factors such as information, comprehension, motivation, time, perceived burden, and perceived caregiving competency were found to affect whether to adopt caregiver decision-making regarding on the use of technology when caring for patients at home. There are other factors uniquely springing from the patient and technology as well as shared issues between caregivers and patient or caregivers and technology. Informal caregiver decision-making on technology adoption can have a considerable impact on patient care at home. This systematic scoping review found that although some factors depend on technology type and patient diagnosis, there were some common factors across the research. Those factors can be carefully considered in referring technology use for caregivers. Further, more focused study in this under-investigated area is much needed

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

AimsEstimating survival is challenging in the terminal phase of advanced heart failure. Patients, families, and health‐care organizations would benefit from more reliable prognostic tools. The Palliative Performance Scale Version 2 (PPSv2) is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. It has been widely used to estimate survival in patients with cancer but rarely used in patients with heart failure. The aim of this study was to identify prognostic cut‐points of the PPSv2 for predicting survival among patients with heart failure receiving home hospice care.Methods and resultsThis retrospective cohort study included 1114 adult patients with a primary diagnosis of heart failure from a not‐for‐profit hospice agency between January 2013 and May 2017. The primary outcome was survival time. A Cox proportional‐hazards model and sensitivity analyses were used to examine the association between PPSv2 scores and survival time, controlling for demographic and clinical variables. Receiver operating characteristic curves were plotted to quantify the diagnostic performance of PPSv2 scores by survival time. Lower PPSv2 scores on admission to hospice were associated with decreased median (interquartile range, IQR) survival time [PPSv2 10 = 2 IQR: 1–5 days; PPSv2 20 = 3 IQR: 2–8 days] IQR: 55–207. The discrimination of the PPSv2 at baseline for predicting death was highest at 7 days [area under the curve (AUC) = 0.802], followed by an AUC of 0.774 at 14 days, an AUC of 0.736 at 30 days, and an AUC of 0.705 at 90 days.ConclusionsThe PPSv2 tool can be used by health‐care providers for prognostication of hospice‐enrolled patients with heart failure who are at high risk of near‐term death. It has the greatest utility in patients who have the most functional impairment.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148390/1/ehf212398_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148390/2/ehf212398.pd

Nursing Outcomes related to Purposeful Interprofessional Team Interventions

Thesis (Ph.D.)--University of Washington, 2017-06Objectives. Effective interprofessional (IP) teamwork and communication are critical to improve quality of patient care and nursing outcomes. IP team interventions are recommended as a strategy to achieve effective teamwork and better work environments. Given the importance of effective IP team functioning, this dissertation consists of three papers aimed to review and investigate the effectiveness of purposeful IP team interventions on nursing outcomes. The first paper is a systematic review of current IP team intervention studies that examined the effects of IP team interventions on outcomes related to nursing and IP team including nurses. The other two papers are part of a larger study that involved the implementation and evaluation of a purposeful IP team intervention at an academic medical center in the Pacific Northwest. Specifically, the aim of the second paper is to explore nurses’ experiences and perceptions following the purposeful IP team intervention. The third paper aims to examine the effectiveness of the purposeful IP team intervention focused specifically on nurse job satisfaction and retention pre-and post-intervention. Methods. In the first paper, a systematic search of PubMed, CINAHL, PsycINFO, and Embase was conducted using Boolean searching techniques and key search terms; 41 articles published between 2011 and 2016 were included for the final review. The second paper conducted a qualitative methods analysis of three focus group interviews among registered nurses. The third paper conducted a comparative cross-sectional study design using quantitative job satisfaction data and turnover data pre-and post-intervention. Results. The first paper provided a broad overview of various types of IP team interventions, and assessment methods commonly used, and included outcomes related to nursing, IP team, and patients. The findings revealed that the majority of the included studies were rated as low methodological quality. In the second paper, six interrelated themes were emerged from focus group interviews: (1) interprofessional team building, (2) psychological safety and cultural change, (3) efficiency in delivery of care, (4) quality of patient care, (5) job outcomes, and (6) team challenges. The third paper revealed that nurse job satisfaction was significantly improved, and nurse turnover was slightly decreased following the IP team intervention. Conclusions. Results from the first paper indicate that there needs to be improvement in methodological approaches to effectively evaluate effects of IP team interventions on team performance and nursing outcomes. Results from the other two papers suggest that ongoing coaching and team strategies need to be considered to maintain improved changes and to overcome the barriers to the implementation of the IP team intervention. In addition, efforts of organizational leadership to promote nurse job satisfaction and retention through improved interprofessional team functioning need to be considered to directly and indirectly promote patient delivery of care and patient outcomes in healthcare

Examining interprofessional team interventions designed to improve nursing and team outcomes in practice: a descriptive and methodological review

<p>Effective interprofessional (IP) team-based care is critical to enhance the delivery of efficient care and improve nursing and IP team outcomes. This study aims to review the most recent IP team intervention studies that focused on outcomes related to nursing and IP teams. PubMed, CINAHL, PsycINFO, and Embase were searched for existing literature published between January 2011 and December 2016. The search strategy was developed through both literature review and consultation with a health sciences librarian. This review included IP team intervention studies published in peer-reviewed journals and written in English. Studies were included if they conducted an IP team intervention for healthcare teams that include nurses and examined outcomes related to nursing and the IP teams. Based on inclusion and exclusion criteria, 41 articles were included for the final review. Two authors extracted data on the characteristics of IP team interventions, assessment methods, and their outcomes related to nursing and IP teams using a data abstraction tool developed by the research team. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We found that most of the included studies were conducted in the US and on inpatient units. A quasi-experimental study design was most commonly employed. Most studies conducted IP team training such as TeamSTEPPS® as a one-time activity. The most common outcomes measured were attitudes or perceptions about IP teamwork or communication, followed by patient-related outcomes, and knowledge or skills about IP competencies. The quality of the included studies was generally low. The findings from this review will contribute to understanding the characteristics of current IP intervention studies and call for IP scholars to design more rigorous yet realistic IP intervention studies.</p

Older adults can successfully monitor symptoms using an inclusively designed mobile application

OBJECTIVES Patient-Reported Outcomes Measurement Information System (PROMIS) measures can monitor patients with chronic illnesses outside of healthcare settings. Unfortunately, few applications that collect electronic PROMIS measures are designed using inclusive design principles that ensure wide accessibility and usability, thus limiting use by older adults with chronic illnesses. Our aim was to establish the feasibility of using an inclusively designed mobile application tailored to older adults to report PROMIS measures by examining (1) PROMIS scores collected with the application, (2) patient-reported usability of the application, and (3) differences in usability by age. DESIGN Cross-sectional feasibility study. SETTING Inpatient and outpatient cardiac units at an urban academic medical center. PARTICIPANTS A total of 168 English- and Spanish-speaking older adults with heart failure. INTERVENTION Participants used an inclusively designed mobile application to self-report PROMIS measures. MEASUREMENTS Eleven PROMIS Short-Form questionnaires (Anxiety, Ability to Participate in Social Roles and Activities, Applied Cognition-Abilities, Depression, Emotional Distress-Anger, Fatigue, Global Mental Health, Global Physical Health; Pain Interference, Physical Function, Sleep Disturbance), and a validated health technology usability survey measuring Perceived Ease-of-Use and Usefulness of the application. RESULTS Overall, 27% of participants were between 65 and 74 years of age, 10% were 75 years or older, 63% were male, 32% were white, and 96% had two or more medical conditions. There was no missing PROMIS data, and mean PROMIS scores showed the greatest burden of pain, fatigue, and physical function in the sample. Usability scores were high and not associated with age (Perceived Ease-of-Use P = .77; Perceived Usefulness P = .91). CONCLUSION It is feasible for older adults to use an inclusively designed application to report complete PROMIS data with high perceived usability. To ensure data completeness and the opportunity to study multiple domains of physical, mental, and social health, future work should use inclusive design principles for applications collecting PROMIS measures among older adults