Parkview Health Research Repository
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Longitudinal Associations Between Early Childhood Externalizing Behavior, Parenting Stress, and Child Media Use.
No full textLimited research has examined bidirectional associations between modern media (e.g., smartphone, tablet) use and behavior in early childhood. This study aimed to test the hypotheses that, over 6 months, (H1) child externalizing behavior would predict later media use, mediated by parenting stress, and (H2) media use would predict later externalizing behavior. Participants included mothers and fathers from 183 heterosexual couples with a child 1-5 years old, followed for 6 months-assessed at baseline, 1, and 6 months. Frequency of child media use was assessed at baseline and 6 months through parent report across eight items (e.g., television [TV], smartphone, tablet use). Child externalizing behavior was assessed through the Child Behavioral Checklist, and parent stress through the Parenting Stress Index. Hypotheses were tested using structural equation modeling. Mothers were 31.8 (standard deviation
Appropriateness of intravenous acetaminophen use in the emergency departments across a multi-hospital community health system
No full text2020 ASHP Midyear Clinical Meeting
The objective of this study was to evaluate adherence to institutional restriction criteria for intravenous acetaminophen use in the emergency departments within a community hospital system
Evaluation of Nursing Experience of Caring for Patients at the End-of-Life in Units without an Established Bereavement Program
Get PDFThis research study is an effort to identify and describe nursing attitudes and experiences with caring for patients at the end-of-life in a unit without an established bereavement program. The study will assess attitudes and experience pre and post implementation of a facility-wide bereavement program. The anticipated benefit will be acknowledging the impact of death on nurses who provide end-of-life nursing care. When nurses have support for bereavement, patients and their families will benefit.
PI: Lisa Morgan BSN, RN, CNRN
Contact: lisa.morgan@ Parkview.co
Fatigue in the Nursing Workforce
Get PDFMany injuries or adverse events related to patient care may be caused by fatigue in nurses. This phenomenon is under-reported and has not been a focus in healthcare. The purpose of this survey is to identify fatigue in Parkview Nursing Workforce and determine causes that potentially could be mitigated in the future with a change in practice. By determining the amount of fatigue and identifying potential causes, interventions can be implemented to mitigate these risks
Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA).
No full textPersonas can be used to understand patterns of variation in patients\u27 performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons, using critical incident and fictitious scenario interviews. Qualitative analyses produced three personas but revealed that individuals exemplify different personas across situations. The Rule-Following persona seeks clear rules, exercises caution under uncertainty, and grounds actions in confidence in clinician experts. The Researching persona seeks information to gain better understanding, invents strategies, and conducts experiments independently or with clinicians. The Disengaging persona does not actively seek rules or information and does not attempt to reduce uncertainty or conduct experiments. We discuss the situational nature of personas, their use in design, and the benefits of P-CTA for studying patient decision making
Engaging Patients in Atrial Fibrillation Management via Digital Health Technology: The Impact of Tailored Messaging.
Get PDFPatients with atrial fibrillation (AF) demonstrate persistent knowledge gaps regarding their condition and a substandard adherence to oral anticoagulant (OAC) medication, which contribute to thromboembolic stroke and other clot-related complications. Tailored patient education and medication reminders may help reduce these negative health outcomes. We sought to improve disease knowledge and medication adherence among a sample of AF patients using tailored education and nudges. The intervention leveraged three digital health technologies: a patient portal, an electronic-prescribing data feed, and a smart pill bottle. The content of the educational messaging, nudges, and cadence were tailored according to findings from our user-centered design studies and delivered via a patient portal (MyChart®; Epic Systems, Verona, WI, USA), with which participants were familiar. In a six-month randomized controlled trial with parallel groups, we used MyChart® to send educational messages and medication reminders according to a decision tree that emerged from our prior user-centered design studies. The intervention group demonstrated higher AF knowledge at study completion than the control group and more MyChart® logins throughout the trial, suggesting intervention uptake. Women were more adherent than men and patients diagnosed more than one year ago were more adherent than those with more recent diagnoses. The intervention and control group adherence rates were 93.1% and 89.5%, respectively; intervention effect was moderated by age, medication type, and prior MyChart® use. Within the intervention group, younger patients, those taking once-daily rivaroxaban, and those who were less active MyChart® users prior to the study benefited relative to their control group counterparts. Tailored educational and reminder messages contributed to increased adherence and disease knowledge among AF patients, though certain patient characteristics moderated the intervention\u27s effectiveness. Technology-based health interventions can be useful for older adults with effective tailoring and training
Technoference: Parent mobile device use and implications for children and parent-child relationships.
No full textThe increase in the prevalence of smartphones and mobile devices has spurred changes in the caregiving environment of infants and young children, as phones and mobile devices are used at times during caregiving and in caregiving spaces. This use could create disruptions and cause distractions during parenting (termed technoference). This article summarizes the potential impacts on parent responsiveness and the experiences of infants and young children. Yet, it also warns that it is important to consider the reason for and type of parent use. Finally, the article ends with practical tips for working with parents concerning mobile device use
The heart didn’t know enough to stop”: Insights from patient metaphors about living with cardiac implantable electronic devices
No full text“The heart didn’t know enough to stop”: Insights from patient metaphors about living with cardiac implantable electronic devices
Metaphors conceptualize one idea in terms of another (Lakoff & Johnson, 1980), and can provide insight into how people view their health conditions in the context of lived experience. Importantly, understanding patients’ perspectives through the use of metaphor can improve patient-centered communication (Periyakoil, 2008). This study included interviews with thirteen older adults with cardiac implantable electronic devices (CIEDs), who were part of a larger study with older adults with heart failure (N=24). The purpose of the larger study was to understand how adults with heart failure make decisions about their health and to design a patient-facing technology for heart failure self-management. The interviews took place at a large, non-profit hospital system in the Midwest. During preliminary analyses of the interviews (Daley et al., 2018; Holden et al., 2018), we observed metaphors in the transcripts naturally used by participants when talking about their health. I (CD) conducted a metaphor analysis (Goering, 2015; Schmitt, 2005) on 13 transcripts of participants with CIEDs that revealed themes related to patients’ perceptions of their device and heart functioning. Participants were ages 66-84 (mean 74.2, SD 5.5), 9 males and white. The analysis revealed four metaphoric frames: The device is overpowering. This frame portrayed a violent or controlling impact from the device: knocked off your feet, hit, whipped, zapped, bolt of lightening, and you’re not gonna outbeat that shock. One participant described the shock as a “loud bang… like someone’s held a gun up to your ear and pulled the trigger.” Another participant explained that his pacemaker “started running me”. 2. The device’s job is to revive. This frame construed the therapeutic, life-saving aspects of the device positively, such as: “so far that good ole pacemaker has done its job. I got paced back in”; and “it (the device) does a good job… it starts the heart back beating.” The heart is autonomous. This frame portrayed the heart as a separate being, capable of having its own knowledge and communication: “I don’t know where it (the heart) gets its information from,”; the “right side (of the heart) didn’t know enough to stop”, and “the heart finally told me, we’re gonna create limits to ya..” The heart is a machine. This frame included mechanical terms that were used to describe the heart, such as “pump” and “power” and “operating on 30%”.
Participants’ metaphors suggest that there’s a lack of perceived control concerning device therapy and their heart functioning. Prior interview studies also show that patients feel of loss of control (Morken, Severinsson, & Karlsen, 2010) and stress related to consequences of living with a device (Humphreys, Lowe, Rance, & Bennett, 2016). However, metaphors in this study also revealed participants’ perceptions of the life-saving ability of their devices. In clinical encounters, listening for metaphors that patients use could help clinicians communicate with heightened sensitivity to patients’ perspectives, and enhance their understanding of their device and heart functioning
An Evaluation of Vancomycin Use in Patients with Urosepsis
No full textPoster Presentation
Background and Objective:
Urosepsis is an infection that originates from the urinary tract and accounts for 9% of all sepsis cases. 1 Pathogens commonly associated with urosepsis include E. coli, Proteus spp., Enterobacter spp., Klebsiella spp., and P. aeruginosa, and gram-positive bacteria (5% of cases). Sepsis treatment guidelines do not provide specific recommendations for the management of urosepsis; however, they state to utilize anti-MRSA agents, such as vancomycin, when risk factors for MRSA exist. 2 The prevalence of urosepsis caused by gram-positive organisms has been reported at low rates. The objective of this study is to evaluate how often vancomycin is used empirically in patients with urosepsis and the outcomes that are associated with its use
Evaluation of pharmacy to dose heparin protocol in neurological conditions
No full text2020 ASHP Midyear Clinical Meeting / Virtual / Poster
The objective of this study was to assess the safety and efficacy of the current pharmacy to dose heparin protocol for neurological conditions