Two Different Primary Care Approaches for Caring for People With Dementia and Their Families

This study explored an established primary careebased dementia pathway in New Zealand (NZ) and nurse practitioner dementia diagnosis and care in 1 small United States state that has adopted a value-based de- livery model. Central to the NZ model was the education of primary care providers, clear delineation of specialists’ support and referral pathways, and routine and predictable family carer respite. The US re- spondents reported that the essential resources necessary to support the diagnosis and management of dementia were lacking. The primary care of older adults may increasingly be provided by nurse practitioners in the US, and the structured NZ pathway offers a promising approach to adopt in the US. Potential strategies for implementation are detailed

Interprofessional Care of Elders: Utilizing the Virtual Learning Environment

Background: Video conferencing and a virtual environment was used for teaching interprofessional practice (IPP) when caring for the elderly with students from eight healthcare professions. Is this pedagogy perceived as effective by the students in Interprofessional Competency Domains1? Methods: Twenty interprofessional conferences (90 minutes in length) were conducted. Students from nursing, physical therapy, speech and language therapy, social work, nutrition, medicine, exercise science, and pharmacy collaboratively developed a plan of care for a frail elder. Using the Interprofessional Competency Domains1, an evaluation survey was developed which included 14 Likert-scaled, five open-ended, and demographic questions. Quantitative data was analyzed using descriptive statistics in the aggregate for all students and by discipline. Differences between disciplines were compared using Fisher’s exact test. A qualitative analysis was performed on students’ comments. Findings: Eighty-three students completed the survey in the first year. Participants were predominantly female (77%) and white/Caucasian (83%). More than 60% of students strongly agreed on the value of the experience in the four competency domains. There were no significant differences by discipline (p values for difference between disciplines ranged from 0.14 to 0.89 depending on question). Thematic analysis of open-ended questions indicated the educational value of the experience; however, preference remained for in-person meetings. Second year results will be added after December, 2014. Discussion: This virtual interprofessional practice experience showed positive ratings by students for the elements of collaborative practice in the first year and offered a means to offset the logistical difficulties of scheduling students from 8 professions. The creation of a “virtual environment” for students to interview the patient and meet for conferencing was added to the project in the second year and evaluation of this addition will also be presented. Recommendation for Future Research: Further research involving IPP educational pedagogy and the use of distance technologies is needed

Implementing SBIRT in a Critical Access Emergency Department

Purpose: Universal screening and brief intervention with referral to treatment (SBIRT) has become best practice for emergency departments (EDs) over the last two decades. Given the prevalence of alcohol use and the subsequent health impacts of drinking, EDs are well positioned to be on the front line of screening for risky drinking. The available literature is clear in its consensus that universal screening for alcohol use in the ED is critical to identifying people at high risk for drinking and improving health outcomes. Aims: This project aimed to implement an SBIRT process in a critical access ED. To achieve this global aim, the project team developed an SBIRT process and educated nurses and providers on its use in the department. Methods: The project team performed a two-month retrospective chart review determining the baseline rate of alcohol screening in the department. An SBIRT process was implemented in the unit. After implementation of the SBIRT process, a two-month chart review measured staff usage of the new procedure. Results: Over the two-month implementation period, the percentage of patients in the ED screened for alcohol use increased from an average of sixty-five percent before the intervention to seventy-nine percent after. Conclusions: Increased alcohol screening for patients in a critical access ED is possible with education and buy in from clinical staff. The existing electronic screener tool was widely preferred to the newer, paper AUDIT_C tool. Embedding the new screener tool in the electronic chart may be a way to increase convenience and therefore its adoption. Keywords: SBIRT, alcohol use disorder, emergency department alcohol screening

A National Dementia Care Pathway Explored

Background: A national, systematic diagnosis and care pathway has the potential to alleviate pressing challenges experienced by individuals with dementia, their carers, and healthcare providers. International exemplars were sought to compare/contrast dementia care with current practice in the United States (US). The 2013 New Zealand (NZ) Framework for Dementia Care was explored. The aim was to understand this systematic, primary care-led, home- and community-focused dementia management approach from the perspective of those delivering care. Providers in one US state were similarly studied. Method: Maximum variation purposive sampling was used in this qualitative descriptive study of 28 participants (18 New Zealand, 10 United States). Semi-structured interviews were used, with recruitment of participants continuing until data saturation was reached. Data were then explored for themes using qualitative content analysis. Results: National standards in NZ provide a progressive pathway grounded in early primary care diagnosis and adaptable teams that foster caregiver support to decrease their burden. The approach also ensures streamlined access to specialists. This is in contrast to the US, where a reactive rather than proactive approach requires providers to navigate unpredictability as they strive to weave together insufficient, inadequate, inconsistent, and inequitable resources to provide families with foundations for an uncertain future. Conclusion: Compared to the US where only 2.12% of the Medicare spend is on primary care, NZ has a strong primary care foundation. Exploring total cost care models, some states have the capacity to redesign primary care for dementia management within practice and community settings and should take action

Firearm Safety Education in Vermont

INTRODUCTION Each year in Vermont, approximately 75 people die from gunshot wounds and 65 are injured. The majority of these deaths are suicides, while the majority of injuries are caused by unintentional discharges (VDOH 2021). METHODS A provider survey was pilot tested and sent to 25 providers for assessing their firearm safety discussions with patients and the need for a patient information pamphlet. Informed by that survey and literature/web search, a pamphlet directed at patients was drafted and reviewed. It details safe storage practices, recent Vermont legislation, tips to discuss firearm safety with loved ones, relevance of mental health to firearm safety, and prevalence of firearm injuries/deaths in Vermont. A provider-directed insert regarding initiating firearm safety conversations and an EPIC SmartText to prompt conversations and expedite note-taking were also created. FINDINGS Ten providers responded to the survey (response rate 40%): 60% indicated a patient-directed educational pamphlet would help conduct conversations about firearm safety; 90% reported discussing firearm presence in the home; 70% inquire how firearms are stored; 100% indicated firearm safety/storage tips and resources would be useful; 70% agreed a list of online educational resources would be useful. CONCLUSIONS Creation of the patient/provider pamphlets and EPIC SmartText may increase firearm safety education by Vermont providers. Materials need to be vetted/branded for broad dissemination within healthcare organizations. Determination of providers’ interest in this resource was limited by a small sample. Further research is needed to evaluate effectiveness of these materials in promoting firearm safety conversations by healthcare providers

Electronic Health Record's Effects on the Outpatient Office Visit and Clinical Education

Background: During an office visit, the provider has the important cognitive task of attending to the patient while actively using the electronic health record (EHR).  Prior literature suggests that EHR may have a positive effect on simple tasks, but a negative effect on tasks that require complex cognitive processes.  No study has examined the provider’s perception of EHR on multiple distinct aspects of the office visit.Methods: We surveyed providers/preceptors regarding their perception of EHR on multiple aspects of the office visit.  We summarized their EHR utilization history and their perceptions of the EHR during the visit using descriptive statistics.  We tested for associations between time spent using the EHR and distinct aspects of the visit using Chi-square tests of association.Results: In total, 83 providers/preceptors reported use of EHR (response rate 52%). Provider/preceptors reported an overall negative effect of EHR on the patient-provider connection, but an overall positive effect on the review of medications/medical records, communication between providers, review of results with patients and review of follow-up to testing results with patients. The effect of EHR on history taking and teaching students was neutral.  We observed no correlation between the provider’s time spent using the EHR and their perception of its effectiveness.Conclusions:  Providers reported a positive perception of EHR on aspects of the office visit that involved a single cognitive task.  However, providers reported a negative perception of EHR on patient-provider connection, which involves a high degree of cognitive processing

An Interprofessional End of Life Simulation Using a Movie/Discussion Format

An Interprofessional End of Life Simulation Using a Movie/Discussion Format Sigma Theta Tau International Nursing Research Congress Cape Town, South Africa July 25, 2016 Mary Val Palumbo, DNP, MSN, BS, APRN, GNP-BC1 Christina S. Melvin, MS, BS, PHCNS, BC, CHPN1 Nancy P. LeMieux, MSN, BSEd, RN1 Deborah A. O\u27Rouke, PhD, MA, MClSc, BSc, PT2 Jean Beatson, EdD, MS, RN3 Patricia A. Prelock, PhD, MA, BS, CCC-SLP, BCS-CL4 Kelly A. Melekis, PhD, MSW, LMSW5 Mary Alice Favro, MA, BS, CCC-SLP6 Vicki Hart, PhD7 (1)Department of Nursing, University of Vermont, Burlington, VT (2)Dept. of Rehabilitation and Movement Science, University of Vermont, Burlington, VT (3)Vermont Interdisciplinary Leadership Education for Health Professionals Program, University Of Vermont, Burlington, VT (4)Department of Communication Sciences & Disorders, University of Vermont, Burlington, VT (5)Department of Social Work, University of Vermont, Burlington, VT (6)Department of Communication Sciences and Disorders, University of Vermont, Burlington, VT, VT (7)Office of Health Promotion Research, University of Vermont, Burlington, VT Purpose: The interprofessional team’s role in end of life care provides a unique opportunity for an educational simulation. Novel ways to teach this content to a large number of students were needed. This research evaluated a palliative care interprofessional educational activity for healthcare students from six disciplines using an in-person movie/discussion format. Methods: Healthcare provider assessment visits and a death scene were pilot tested in actual simulations using twenty four students with standardized patients portraying a patient with ALS and his husband. Scripts were written from recordings of these simulations and were used in the dialogue of the movie which had standardized patient actors playing the patient, husband, sister and the student healthcare providers. The movie portrayed a patient with ALS and his husband in five scenes: assessment of patient and family needs by nursing, physical therapy, social work and speech language pathology; and a death scene. The movie was then edited to be used for discussion by large student groups. An evaluation survey was developed with 14 questions scored on a Likert scale and related to Interprofessional Competency Domains of 1. Values/Ethics, 2. Roles/Responsibilities, 3. Interprofessional communication, and 4. Teams/teamwork. These competencies provided a structure for the evaluation questions, and a review by faculty in each discipline also provided content validity. Reliability of the survey instrument was not tested or established. Graduate nurse practitioner, medical, communication sciences and disorders, social work and physical therapy students as well as undergraduate nursing students participated together in end of life movie discussions in four sessions held in a classroom equipped with tables of six. Survey responses were compared across disciplines and across the four interprofessional competency domains using a Chi-square test and adjusting for multiple comparisons. Significant differences were established at p Results: Student evaluations of the end of life simulations were consistently positive. Eighty percent of the participants (n=162) strongly agreed that they recognize the necessity of utilizing a healthcare team when providing care for patients at the end of life. All participants agreed that they would continue to forge relationships with other healthcare professionals to improve care for elders. Physical therapy students were consistently had the most positive responses; however, significant differences were only observed in three of the 14 questions. There were no significant differences between disciplines across the four interprofessional competency domains. A summary of qualitative data from the open ended questions will be also be presented. Conclusion: Interprofessional end of life care can be simulated in a carefully planned activity. The value of the experience was expressed by all students. Nurse practitioner students valued being able to practice supervising a palliative care team and facilitating the team discussion. Other students appreciated a safe place to discuss how to care for a dying patient and their family. Regarding the evaluation, small sample sizes in some disciplines may have limited the ability to detect significant differences between groups. Production of a movie and the discussion of the different scenes helped lower the cost of the simulation and scale up the activity for use with large groups of students. Interprofessional education requires innovative pedagogy that must be evaluated and disseminated. Consistent evaluation of interprofessional practice competency domains must be included in all educational activities

Improving Recognition of Delirium in Elderly Patients Hospitalized for Hip Fracture

Background: Delirium is a frequent, yet often under recognized, condition affecting elderly patients hospitalized with hip fracture. In the literature, delirium rates vary for this population. Objective: This project aimed to determine the delirium rate in elderly patients hospitalized for femur fracture and improve recognition through use of a screening tool at an academic medical center. Methods: The pre-intervention delirium rate in elderly hip fracture patients was determined via retrospective chart review with a validated instrument for patients hospitalized during a 3-month window. To improve delirium recognition, nurses completed training covering delirium and using the Confusion Assessment Method (CAM), a validated delirium screening tool. Presentation effectiveness was measured with pre/post surveys. Elderly hip fracture patients were screened using the CAM. Following implementation, nurses were surveyed regarding using the CAM. Retrospective chart review determined frequency and accuracy of CAM use. Results: Pre-implementation retrospective chart review demonstrated 45% (n=14) of elderly hip fracture patients developed delirium. Education increased reported comfort with delirium, its risk factors, and use of the CAM. During implementation, the CAM was used in 75% (n=9) of qualifying cases and rate of delirium was 25% (n=3). All cases were in patients with baseline cognitive impairment. Screening barriers included EHR and workflow difficulties. Conclusions: This institution’s delirium rate for this population aligns with the literature and serves as a benchmark for efforts to target and reduce delirium incidence in a measurable way. Dissemination of delirium education improved delirium competence, reduced its frequency, and improved recognition of the disorder

Adolescent Suicide Prevention via Parental Education

Purpose. Up to 24% of children from the ages of 12 to 17 have reported suicidal ideation, with 7-11% reporting at least one suicide attempt in the past 12 months (Hetrick, 2017). In a study by Jones et al (2019) over 50% of parents were unaware their child was exhibiting suicidal ideation. This project aims to increase community awareness of suicidal ideation and teach community members how to talk with adolescents about this sensitive topic. Methods. Five online training sessions were offered in Fall 2021, with each session lasting 90 minutes. Using Smith et al.’s Suicide Knowledge and Skills Questionnaire, participants’ knowledge and skills were measured pre-training, immediately post-training, and one month after training using two online surveys. Results. Fifteen participants took the Umatter Suicide Awareness training. Knowledge about suicide increased both immediately after training and one month after training compared to pre-training. Skills measured included the participant’s confidence in having received the training, skills, and support needed to assist those with suicidal intent. Skills decreased one month after training compared to immediate post-training, but still remained higher than pre-training levels. Conclusions. Participants showed an increase in their knowledge regarding suicide, and in their skills with interacting with those who show warning signs of suicidal ideation. Umatter shows promise as an online suicide awareness program for teaching community members about suicidality in adolescents. Given the ease of use of this program, advanced practice nurses could easily incorporate parts of this program into their practice with their patients