Using Design Thinking to Spread iPACE™: An Interprofessional Medical Education Innovation in an Academic Medical Center

Problem Statement: The Interprofessional Partnership to Advance Care and Education (iPACE™) model and its core principles are spreading across the MaineHealth system. Thus, there is a need for a standardized approach that is adaptable and incorporates the requirements of diverse patient care settings. Background: In 2017, the original iPACE™ model was designed and piloted on a new teaching unit for adult internal medicine at Maine Medical Center. Analysis of the pilot data showed improved teaming, care team experiences, interprofessional collaborations, and patient satisfaction. Because the pilot model will require adaptation to be successfully implemented in other disciplines, the authors sought a framework to facilitate implementation of core iPACE™ principles in diverse clinical care settings. Application/Recommendation: The Design Thinking (DT) framework was selected as a structured, standardized approach to accelerate innovation and implementation of the iPACE™ model in a new patient care setting. The DT framework consists of 6 consecutive process steps and iteration loops: Understand, Observe, Point of View, Ideate, Prototype, and Test. This paper outlines specific metrics and activities in each step, as well as opportunities for tailoring each step based on the care setting

Opposite-polarity motors activate one another to trigger cargo transport in live cells

Mechanical interactions between any two opposite-polarity motors are necessary and sufficient for bidirectional organelle transport in live cells

Rehabilitation after surgery for hip fracture – the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study

Purpose: To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture. Methods: A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders. Results: Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5–13) and 20 (IQR 8–38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2–3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2–3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02). Conclusion: Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS

Generalized weakness in the geriatric emergency department patient: an approach to initial management.

Generalized weakness in the geriatric patient is a vexing chief compliant to address in any setting, especially in the hectic emergency department. Studies suggest that it is associated with poor outcomes, although the ideal workup is elusive. A minimum of laboratory and imaging testing is recommended with the addition of neuroimaging if focal weakness is discovered. Considering a wide differential with attention to geriatric-specific concerns is labor intensive but necessary for this presentation

Exploring Provider Attitudes toward Falls Prevention in the Inpatient Setting

The rate of falls and falls with injury within Maine Medical Center are rising. •MMC’s InterprofessionalFalls Committee performed a root cause analysis to identify the factors driving this change. •This analysis highlighted the role that nursing and PT/OT’s have on fall prevention and it uncovered the lack of engagement amongst physicians and APPs. •We performed a literature review and found that there were no references identifying specific barriers to inpatient provider engagement; however, in other clinical settings such as the ED and assisted living, barriers to provider falls assessment have been identified. •We utilized the theoretical domains framework (TDF) to identify the barriers to behavior change (i.e. lack of engagement).https://knowledgeconnection.mainehealth.org/lambrew-retreat-2022/1015/thumbnail.jp

The role of clinical nurse specialists in the implementation and sustainability of a practice change.

AIM: This project\u27s purpose was to promote and sustain a practice change focusing on delirium utilising the clinical nurse specialist (CNS) in a leadership role. BACKGROUND: Delirium is an altered state of consciousness accompanied by an acute change in cognition that tends to have a fluctuating course. Delirium is strongly associated with negative outcomes and is often unrecognised. METHOD: A policy was implemented stating that the RNs will screen patients for delirium with the confusion assessment method (CAM). Interdisciplinary delirium education was offered prior to the practice change and repeated at 3, 6 and 12 months after implementation. The documentation, completion and CAM accuracy screening were determined by the CNS. RESULTS: The CAM documentation and completion audit goal was met and sustained by week 21, and screenings were accurate 83% of the time. CONCLUSIONS: The CNS has an opportunity to take a leadership role when instituting an innovative practice change. Successful implementation of a new practice requires that patient care units are divided into cohorts with systematic roll-out of the initiative. IMPLICATIONS FOR NURSING MANAGEMENT: In addition to leadership, CNS availability on the patient care units is imperative to staff acceptance and sustainability of a practice change

The role of clinical nurse specialists in the implementation and sustainability of a practice change.

Aim This project\u27s purpose was to promote and sustain a practice change focusing on delirium utilising the clinical nurse specialist (CNS) in a leadership role. Background Delirium is an altered state of consciousness accompanied by an acute change in cognition that tends to have a fluctuating course. Delirium is strongly associated with negative outcomes and is often unrecognised. Method A policy was implemented stating that the RNs will screen patients for delirium with the confusion assessment method (CAM). Interdisciplinary delirium education was offered prior to the practice change and repeated at 3, 6 and 12 months after implementation. The documentation, completion and CAM accuracy screening were determined by the CNS. Results The CAM documentation and completion audit goal was met and sustained by week 21, and screenings were accurate 83% of the time. Conclusions The CNS has an opportunity to take a leadership role when instituting an innovative practice change. Successful implementation of a new practice requires that patient care units are divided into cohorts with systematic roll-out of the initiative. Implications for nursing management In addition to leadership, CNS availability on the patient care units is imperative to staff acceptance and sustainability of a practice change

Coping, (mal)adaptive personality and identity in young adults: A network analysis

Coping, personality, and identity are three well-known constructs within the field of psychology. Yet, findings regarding how these constructs relate to each other have been inconsistent. The present study employs network analysis to investigate coping, adaptive and maladaptive personality, and identity and how they are related, using data from the Flemish Study on Parenting, Personality, and Development (FSPPD; Prinzie et al., 2003; 1999-current). Young adults ( N = 457; 47% male), aged between 17-23 years old, completed a survey on coping, adaptive and maladaptive personality, and identity. Results indicate clear associations between coping and both adaptive and maladaptive personality within the network, suggesting coping and personality are distinct, yet highly related constructs whereas identity proved largely unrelated. Potential implications and suggestions for future research are discussed