MEDICA@MUSC (Medical University of South Carolina)
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Resilience Culture in the Healthcare Team During COVID-19
Get PDFAbstract
Background: Resilience commonly refers to the ability of an individual or organization to continue to maintain routine, normal, function despite sudden disruptions. Purpose: The purpose of this dissertation research was to provide a deeper understanding of healthcare team resilience. The goal of this research dissertation was to investigate how resilience manifested itself in the healthcare team during the COVID-19 pandemic.
AIM 1: What is the concept of resilience in healthcare teams?
AIM 2: Identify the barriers and facilitators of healthcare team resilience during the COVID-19 pandemic.
AIM 3: Describe how the pandemic influenced healthcare team decision making.
Methods: In the first manuscript we performed a comprehensive systematic analysis that delves into the concept of healthcare team resilience in the literature. Based on these results, in the second manuscript the authors utilized an adapted model developed by the research team that frames the healthcare team as a cohesive and aware entity, rather than merely a group of individuals or a subset of personnel within a healthcare system. Finally, the third manuscript uses this adapted model to present research findings from interviews on resilience culture, based on a thematic analysis.
Findings: In chapter 2, we found 41 distinct definitions of the concept, with three defining attributes: 1) resilience is triggered by an a priori disruptive event that serves as a catalyst activating the healthcare team\u27s latent potential; 2) this potential leads to the actualization of skills and abilities that enable the team to respond to the disruption in an adaptive manner; 3) the team’s adaptive response enables them to continue executing responsibilities in the face of the disruption. This contributed to AIM 1 by describing the concept of resilience in healthcare teams during COVID-19. The concept analysis brought to light a significant disparity arising from the prevailing literature primarily emphasizing individual resilience as a lens to understand healthcare team resilience, thus potentially obscuring any hidden aspects of resilience within the healthcare team. This discrepancy underscored the necessity to develop a comprehensive model to explore healthcare team resilience during COVID-19 that acknowledges the healthcare team as a singular cognizant entity and not an individual or group of individuals. In chapter 3, we found by integrating knowledge and principles from the domains of resilience engineering, systems engineering, patient safety, and naturalistic decision- making we could create a framework by which AIM 2 and AIM 3 could be addressed. An adapted model was created. The exploration of the barriers and facilitators of resilience and the impact of COVID-19 on the decision-making processes in healthcare teams could be thoroughly explored using the adapted model. A qualitative descriptive study was conducted in 2021 and data were analyzed using reflexive thematic analysis. Chapter 4 presents the findings of this study related to AIM 2 and AIM 3. The study utilized the adapted model as a guide for the interview questions. The author developed the interview questions, which were reviewed and approved by faculty mentors. The author interviewed (N=22) interprofessional healthcare participants who worked during the COVID-19 pandemic. A thematic analysis of the interview data resulted in the identification of five themes related to resilience in the healthcare team during COVID-19: working in a pressure cooker; healthcare team cohesion; applying past lessons to current challenges; knowledge gaps, and altruistic behaviors. The evidence indicates that the pressures form working during COVID-19 and gaps in explicit knowledge, negatively influenced adaptive behaviors to maintain healthcare team resilience. Team cohesion, tacit knowledge and altruistic behaviors positively influenced adaptive behaviors and decision making.
Conclusion: This compendium presents the exploration of resilience within healthcare teams amidst the challenges posed by the COVID-19 pandemic. The literature review revealed that the conventional approach to understanding the concept and measuring healthcare team resilience primarily focused on individual resilience. However, this research recognized the need for an adapted model that recognizes the healthcare team as a cohesive and cognizant entity to identify barriers and facilitators of resilience that may be otherwise obscured when solely emphasizing the resilience of individuals, or specific groups. Through a reflexive thematic analysis, several significant findings were identified regarding the impact of the COVID-19 pandemic on the healthcare team: 1) Emotionality played a crucial role in influencing adaptive behaviors, encompassing emotions such as fear, stress, anxiety, and frustration; 2) Drawing upon their tacit knowledge gained from prior experiences, the healthcare team demonstrated the capacity to anticipate and effectively respond to the crisis despite their lack of explicit knowledge, and 3) The solidarity and camaraderie within the healthcare team not only bolstered their overall functionality but also facilitated unified decision-making processes
The Association Between Race and Rurality on Maternal and Infant Outcomes in North Carolina
Get PDFThe closure of rural hospitals and obstetric units have disproportionally impacted expectant mothers on Medicaid, increased travel distances, and accessibility to adequate prenatal care. These closures are affecting communities of color and low-income communities at greater rates than other communities, contributing to access to care barriers. Literature shows lack of rural obstetric access contributes to rural women having higher rates of cesarean sections. This is specifically impactful to North Carolina, one of the top 10 most rural states in the nation.
Using North Carolina HCUP hospital admissions data for 2017, a retrospective cohort analysis was conducted to determine outcomes of Black mothers and infants compared to white mothers and infants in rural and nonrural zip codes. Using this data, cesarian sections and complications during childbirth were assessed for mothers while and mortality complications within the first year of life were examine for infants. Models were assessed using multivariable logistic regression.
Results found confirmed disparities related to infant mortality (OR=2.4), higher odds of delivering via cesarian section for Black mothers vs white mothers in rural zip codes (OR=1.08), and increased odds of experiencing complications for black mothers compared to white mothers (OR=1.11)
Animal-Assisted Therapy: A Program Evaluation of One Substance Abuse Treatment Center
Get PDFAnimal-assisted therapy (AAT) has the possibility of enhancing health outcomes for those living with substance abuse disorders. Previous research primarily focused on individuals with a diagnosis of dementia and other cognitive related disorders. Prior research that did look at individuals with substance abuse focused on the use of horses rather than canines and were limited to small sample sizes. We used an electronic medical record system to identify eligible patients to volunteer to participate in two weeks of animal-assisted therapy at one substance abuse treatment center in southeastern United States. Volunteers completed pre and post survey questions measuring overall satisfaction in the treatment program. It was found that anxiety was significantly decreased after animal-assisted therapy sessions. Feelings of self-worth, confidence, and overall satisfaction were trending in the right direction, but did not yield a positive result
Advances in Spatiotemporal Modeling of Count Data With Application to COVID-19 Health Outcomes
No full textCOVID-19 has created a global health crisis since its emergence in late 2019. According to the Centers for Disease Control and Prevention (CDC), there have been over 104 million cases and 1.13 million deaths reported in the United States (US) as of June 2023. COVID-19 data are complex and present a number of statistical challenges that must be addressed to ensure valid inferences. These challenges include overdispersion of case and death counts, modeling of complex health effects, and zero-inflation. This dissertation proposes three aims to address these challenges: In Aim 1, we develop a Bayesian negative binomial regression model with spatially varying dispersion. This aim extends existing methods to address the issue of spatial heterogeneity and varying degrees of overdispersion in COVID-19 incidence data across counties. Using a simulation study, we demonstrate that ignoring heterogeneity in dispersion can lead to biased and inefficient estimation. For illustration, we apply the model to study the effect of social vulnerability index (SVI) on COVID-19 incidence from March 15 to December 31, 2020 in the state of Georgia. In Aim 2, we extend the current methods for continuous outcomes in environmental health mixture studies to count settings and develop a negative binomial Bayesian kernel machine regression (BKMR) method to model complex exposure-response associations involving count outcomes. Using a simulation study, we evaluate the performance of the proposed method in estimating the exposure-response function and identifying the most relevant mixture components. We apply the proposed method in modeling the joint effect of the social vulnerability index (SVI) variables on COVID-19 deaths from January 1 to December 31, 2021 in South Carolina. In Aim 3, we extend marginalized zero-inflated models to spatial setting and develop a marginalized zero-inflated negative binomial model for spatial data. In addition to capturing zero-inflation, the proposed method allows for direct modeling of the marginal mean, which is often the target of interest in public health and disease mapping studies involving zero-inflated data. We conduct simulation studies to investigate the features of the model and use the model to examine predictors of COVID-19 deaths in the US state of Georgia for the 2021 calendar year
The Effect of Non-Invasive Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) on Hypoxic-Ischemic Injury in Newborn Rats
No full textNeonatal hypoxic-ischemic brain injury (HI) is an acute neurologic syndrome where decreased blood flow and oxygen to the brain cause acute and chronic brain dysfunction. The only proven neuroprotective intervention for HI is therapeutic hypothermia (TH); however, 50% of survivors still have long-term deficits. Pre-clinical studies on adult ischemic brain injury models demonstrate that vagus nerve stimulation (VNS) has anti-inflammatory effects and attenuates brain damage. In HI infants, a non-invasive VNS called transcutaneous auricular VNS (taVNS) is safe and may improve motor skills for bottle feeding. Our objective was to determine if a combination of TH and taVNS treatment in neonatal rats shortly after HI can reduce brain injury and behavioral deficits in neonatal rats compared to TH treatment alone.
The HI model involved ligating the right common carotid artery (CCA) in postnatal day 7 (P7) rats, followed by 2.5 hours of hypoxia and 2 hours of TH. For sham surgery, we explored the CCA without ligation, hypoxia, and TH. taVNS was administered for 30 minutes in awake rats using a bipolar electrode on the auricular concha region. The active-taVNS intensity was kept below the perceptual threshold (PT) as per clinical protocol, while inactive-taVNS was administered at 0 mA. The experimental groups included HI/active, HI/inactive, sham/active, and sham/inactive.
We found taVNS was feasible when delivered below PT in awake rat pups up to P13. taVNS acutely decreased HR, suggesting parasympathetic activation by the vagus fibers. We assessed the acute effects of a single taVNS treatment and the chronic effects of repeated taVNS on HI brain injury and behavior. TH-only treated HI pups had acute and chronic brain injuries and behavior deficits. A single taVNS-TH treatment reduced the number of HI male pups with acute brain injury. However, repeated taVNS after HI and TH did not attenuate chronic brain injury or behavior deficits compared to TH-only.
Overall, this study demonstrates that taVNS is feasible in brain-injured rat pups and may have acute neuroprotection in males. These first pre-clinical studies of a non-invasive brain stimulation technique provided valuable information for further development of taVNS in neonatal HI and other developmental disorders