Jacobs Institute of Women's Health
George Washington University: Health Sciences Research Commons (HSRC)Not a member yet
51297 research outputs found
Sort by
Preventing tipping points in high comorbidity patients: A lifeline from health coaches - rationale, design and methods
No full textBACKGROUND: This paper describes an innovative cluster randomized controlled trial design to evaluate the comparative effectiveness of two approaches to preventing significant destabilization, leading to unplanned hospitalization and increased disability for patients with high comorbidity, that is, multiple chronic diseases defined by an enhanced Charlson Comorbidity Index ≥4. METHODS: A total of 1974 patients were randomized in four waves at each of the sixteen Federally Qualified Health Centers (FQHCs) in four health systems -two in New York and two in Chicago. The two interventions compared 1) Patient-Centered Medical Home (PCMH) as implemented by the FQHCs (usual care control); or 2) PCMH plus a coaching intervention delivered by Health Coaches (experimental) helping patients identify life goals to encourage self-management enhanced by a positive affect/self-affirmation strategy. The two primary patient-centered clinical outcomes are 1) Unplanned hospitalizations; and 2) Within-patient changes in quality of life and disability, as measured by the World Health Organization Disability Assessment Scale 2 (WHODAS 2.0). The hypotheses are: 1) intervention patients will have a 5 % relative reduction in unplanned hospitalizations as compared to control patients; and 2) reduced disability measured by WHODAS2.0; 3) destabilization or \u27tipping points\u27 leading to hospitalization will be more often triggered by psychosocial issues than by medical Issues. CONCLUSION: This cluster RCT has the potential to transform the care for patients with high comorbidity by helping motivate patients to engage in self-management and to successfully navigate the barriers, challenges, and stresses leading to destabilization, hospitalization, and increased disability. CLINICALTRIALS: gov registration number: NCT04176510
Improving Emergency Department Orientation with Implementation of the Tiered Skills Acquisition Method
Get PDFBackground: Challenges to transition to practice highlighted the need to improve orientation for new nurses. Research supports a tiered skills acquisition method to increase confidence, improve clinical judgement, and better prepare new graduate nurses for Emergency Department (ED) challenges.
Objectives: The purpose of this quality improvement project was to implement and evaluate a new orientation program in the ED at two hospitals by introducing tiered skills acquisition orientation for new nurse graduates to optimize their confidence and clinical judgment in caring for a full assignment of patients, and to increase the efficiency of the orientation process.
Methods: A quasi-experimental design with parallel comparison groups was used to compare program outcomes (i.e., orientee’s self-assessed confidence, preceptor assessments of clinical judgement, orientation duration, and orientee and preceptor perceptions of the programs) from the tiered and traditional methods of orientation.
Results: Descriptive statistics were used to analyze all variables. Tiered skills acquisition method participants had improved clinical judgement and confidence as compared to the traditional participants. A two-tailed t-test used to compare the duration of the orientation of the control and intervention groups found there was a statistically significant decrease (t=2.18, p\u3c0.01) in orientation duration with the tiered skills acquisition method. Most preceptors preferred the tiered skills acquisition method over the traditional method.
Conclusions: The use of the tiered skills acquisition method for orienting new graduate nurses can help increase confidence and improve clinical judgement in caring for a full assignment of patients while increasing the efficiency of the orientation process.
Implications: Changing the orientation method may reduce attrition among new nurses by better equipping them to care for a full assignment of ED patients, while decreasing funding needed for orientation
A Nurse Educational Intervention to Improve Postpartum Depression Screening of Women in a Postpartum Hospital Unit
Get PDFBackground: Postpartum depression (PPD) is common in mothers, and early detection is essential for better outcomes. Barriers in screening success can reduce PPD detection, for which nurse education interventions have been shown to be effective at overcoming.
Gap in Care: In a Magnet-designated hospital’s Postpartum Unit, a lower-than-expected PPD positive screening rate was observed, signaling potential barriers in screening success.
Aims: This quality improvement project aimed to: (1) increase PPD screening rates by 5% without decreasing overall screening; (2) improve nursing knowledge by 10%; (3) enhance nursing confidence in PPD care to \u3e90%; and (4) increase patient education to \u3e90% without increasing perceived burden.
Methods: The quality improvement project implemented a nurse education program at the project site, with 74 nurses (93.7%) attending a one-hour education session on PPD. Data collection included monthly EPDS screening rates, knowledge tests, and confidence surveys.
Results: Positive screening rates increased slightly from 4.6% to 5.0% (p = 0.78). Nursing knowledge significantly improved from 72.3% to 84.9% (p \u3c 0.001). Post-intervention, 90.3% of nurses reported confidence in PPD care, and \u3e 90% reported educating patients about PPD. Overall screening rates remained stable (93.8% to 93.5%).
Conclusions: Targeted nursing education enhanced knowledge and confidence in PPD care but had limited impact on positive screening rates. Given the gap between observed rates (5.0%) and expected PPD prevalence (13.2%), further investigation of factors affecting screening accuracy is needed
Strengthening Community Reach and Equity Through Engaging Neighborhoods (SCREEN): Development of a Neighborhood Health Ambassador Network to Address Cancer Health Disparities in the National Capital Region
Get PDF
Micro-Interactions Between Students and Faculty Influence on Academic Motivation and Mentorship
Get PDFPitch, Patterns, and Parkinson\u27s: Investigating Accelerated Vocal Aging and Gender Differences
Get PDF
