Parkview Health Research Repository
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From Biliary Dilatation to Meningitis: Finding Listeria in a patient with Advanced Cholangiocarcinoma
No full textThis presentation won 1st prize for the 2024 ACP Indiana conference in the oral clinical vignette. Case Presentation
Prepping as an Inclusive Team for a Successful TJC Site Visit
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Background: Department rounds and leadership virtual meetings were being used to prep for an anticipated Joint Commission Re-accreditation survey. Preparation did not provide a robust frontline multifaceted approach for both non-clinical and clinical co-workers which posed communication and preparedness gaps. Purpose: To develop a multifaceted approach in coworker preparation for an upcoming Joint Commission Onsite Survey by increasing staff awareness, knowledge, and understanding of the survey process. Ultimately striving for decreased survey anxiety and citations received. Methods: Preparation was developed and implemented from a multifaceted approach to include both non-clinical and clinical teams and an array of healthcare team members. Modalities included frequent consistent weekly rounds, in the moment education with utilization of closed loop communication, table top exercises by practicing the application to scenarios of information taught, development of quality, safety, infection prevention and risk (QSIR) champions on clinical and non-clinical teams in key regulatory requirements, clinical department meetings with interactive discussion, manager focused in-person meetings with virtual option, executive leadership in-person meetings with virtual option, and provider interactive education in person and via newsletter format. Key Results: Implementing a multifaceted, interactive, trust building approach provided a strong foundation for the clinical and non-clinical healthcare employees to be confident, prepared, proactive, and focus on prevention of gaps prior to the Joint Commission survey. Feedback received via Microsoft Forms survey from nursing leadership after survey recap. The Joint Commission survey citations for the hospital location received 18 total citations, 5 of which were clinically focused. This was less than the prior survey results that had a total of 20 citations, 8 of those being conditional level and 9 of those pertaining to direct clinical care. Positive verbal feedback received from surveyors, frontline staff, and leadership regarding staff knowledge, culture, and collaboration. Conclusion: Being inclusive of all disciplines from clinical to non-clinical and pairing with a level setting in a mutual respectful end user friendly manner positively impacted the number, type and severity of citations received at the designated hospital. Additionally, focusing on closed loop communication and the interpretation of standards, and using tabletop exercises helped provide in the moment education to help connect how to meet the intent of Joint Commission standard
Birth by Land or by Water: Implementing Waterbirth at Parkview Randallia
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Background: Childbirth is a natural physiologic event, with most women requiring some form of pain relief during their birth experience. The transition of Parkview’s Certified Nurse Midwife Program to Parkview Randallia’s Family Birthing Center in the fall of 2023 increased the demand for non-pharmacologic labor and birth options for low-risk pregnant patients. One option for non-pharmacologic pain relief is water immersion and waterbirth. Water immersion during labor and waterbirth can promote comfort and reduce the need for medical interventions during labor. There is currently no option for women to achieve a waterbirth experience within a hospital setting that has access to emergency services within the region. Objective: Implement a quality improvement project to expand birthing options for women wanting water immersion and waterbirth within the hospital setting. Methods: An interdisciplinary team met in the early spring of 2023 to begin planning waterbirth at the facility. The team set a goal to offer waterbirth with the midwives\u27 transition to the unit. The process included the creation of a waterbirth policy and procedure, provider and staff training, documentation workflows in the EHR, changes in nursing practice, and the implementation of new workflows surrounding the use of portable hospital-grade tubs. Results: Since implementation, 26 women have experienced a successful waterbirth, with more utilizing water immersion during labor. Of those who experienced a successful waterbirth, over 50% experienced no perineal trauma, and over 75% had second-stage pushing times of 30 minutes or less. Infants delivered in the water included average APGARs of 8.04 and 8.96 at 1 minute and 5 minutes, respectively. The most common neonatal intervention at delivery was skin-to-skin, and no infants delivered in the water required an increased length of stay or transfer to a higher level of care. Conclusion: The quality improvement project demonstrates that women and their families want additional comfort and birth options available within a hospital setting to achieve their desired birth experience. Parkview Randallia’s Family Birthing Center meets this need while maintaining quality outcomes for mothers and newborns
Cyberbullying and Bullying Reports Among Youth in a Behavioral Health Inpatient Unit: Insights From Youth and Parent Intake Surveys.
No full textBACKGROUND: Limited studies have examined the extent to which cyberbullying and offline bullying are factors related to youth admissions to behavioral health inpatient units. However, considering the rising use of technology and prevalence of youth bullying, intake procedures require adaptation to account for modern-day psychological pressures facing youth. AIMS: Our aims were to pilot and analyze results from a novel intake form, assessing offline bullying and cyberbullying, in a youth inpatient behavioral health facility. METHODS: Upon admission at an inpatient behavioral health facility in the Midwestern United States, 622 youth (ages 10 and older) and their parent/guardian completed intake forms including questions about their experience of bullying, cyberbullying, and feelings of safety in different environments, and feelings about whether bullying contributed to their inpatient admission. RESULTS: Overall, 21.50% (134/622) of youth self-reported being a cybervictim, 6.10% (38/622) reported being an offline bully victim, and 8.04% (50/622) reported mixed bullying. Bullied youth felt significantly less safe in all environments than non-bullied youth, and bullied youth who felt unsafe were more likely to attribute their hospitalization to bullying. Troublingly, only about one-third of parents were aware of cyberbullying. CONCLUSION: Using traditional standards of care that do not address offline bullying/cyberbullying, mental health care workers may be missing critical factors that contribute to youth inpatient hospitalization for mental health issues. Behavioral health units should consider adapting intake forms to include offline bullying/cyberbullying questions and developing programming for parents and adults to address issues of online and offline safety
Coparenting of child media use and associations with child media limits and frequency of media use in the United States
No full textResearch on the parental mediation of child media use has not often addressed how children may have multiple caregivers, and therefore the successful management of child media use may be tied to the coordination between caregivers (i.e. coparenting). The current study examined how various coparenting behaviors surrounding child media use (i.e. support, undermining, and conflict) were linked with the consistency of child media use limit setting and the frequency of child media use. Participants included 523 U.S. parents who were married or had a relationship partner and had at least one child (M age = 6.68 years, SD = 6.01); participants completed an online survey. Results revealed that both greater supportive and undermining coparenting predicted greater consistency of media limit setting, while coparenting conflict predicted greater child media use. Moreover, these associations were maintained regardless of child age. Thus, the coordination between parents in their parenting of child media use may have important connections with how child media use may develop. Researchers, educators, clinicians, and health professionals may wish to consider how to study and assist parents in finding ways to support each other’s parenting of child media use while avoiding conflict over child media use in front of the child. Impact Summary Prior State of Knowledge
Research on parental mediation of child media use has not often addressed how children may have multiple caregivers, and therefore the management of child media use may be tied to the coordination between caregivers (i.e. coparenting). Novel Contributions
The coparenting of child media use is connected to media limit setting and child media use frequency. Both greater supportive and undermining coparenting predict greater media limit settings, while coparenting conflict predicts greater child media use. Practical Implications
Researchers, educators, clinicians, and health professionals could consider how to assist parents in finding ways to support each other\u27s parenting of child media use while avoiding conflict over media use in front of the child
Technoference in Parenting and Impacts on Parent–Child Relationships and Child Development
Get PDF“Technoference” is a term that describes how parent media use (e.g., phone use) can interfere with parent–child relationships and interactions. Research has shown technoference effects on parents and children ranging in age from infancy to adolescence, such as decreased parent responsiveness and adverse child behavioral outcomes. However, potential benefits of parent media use have also been identified, such as media use to cope with stress, stay connected, increase breastfeeding perseverance, and seek parenting information. Technoference has only been researched for about a decade, and there are large research gaps. We propose a research agenda to parse out long-term or cumulative effects of technoference on parenting and child outcomes, while also accounting for the role of context and content of device use on the potential effects of technoference. We propose that guidance for parents should not guilt or stigmatize them but rather consider reasons for media use and offer tailored suggestions for managing use. However, the proliferation of persuasive design features in apps and media makes self-control and change of device behavior difficult. We also propose that the burden for managing media usage should not solely lie with parents; policymakers and the tech industry should play a pivotal role
Parent social media use and gaming on mobile phones, technoference in family time, and parenting stress.
No full textPossible effects of parent phone use on parent–child interactions and child behavior are of concern, warranting research to understand parent phone use. In this survey study of 183 families with a young child (M = 2.89 years), we examined parents’ phone use for texting/calling, social media (SM) use, mobile gaming (MG), and perceptions of cutting into family time; we also examined differences between mothers and fathers and associations with parenting stress. Mothers engaged in greater SM use but less MG compared to fathers; 61% of mothers and 38% of fathers used SM 31+ min per day, while 23% of fathers and 16% of mothers played mobile games 31+ min. Mothers were also more likely to feel their SM use, but not MG, cut into family time. Greater parenting stress was associated with greater MG and perceptions of SM or MG as cutting into family time. As differences were found between mothers and fathers on phone activities, it may be beneficial to adapt interventions based on type of activity and parent gender. Moreover, as perceived interference from phone use in family interactions is more likely when parents are stressed, we call for future research to consider the context/purpose of phone use and coping strategies
Dofetilide initiation in a tertiary medical center: A medication use evaluation.
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This evaluation found that adherence to a pharmacist-managed protocol significantly increased dofetilide continuation rates at discharge and six months. Future implementation includes refining the current dofetilide order set, expanding the pharmacist’s role in dose selection, and standardizing documentation and intervention notes to improve protocol adherence
Determining Ideal Practices for Student Course Evaluations Using a Modified Delphi Approach.
No full textOBJECTIVE: While approaches for utilizing student course evaluations (SCEs) have been discussed in the literature, there remain opportunities to identify ideal practices for SCEs. Thus, the objective of this project was to generate consensus on best practices in creating, administering, and using SCEs.
METHODS: A modified Delphi approach was utilized to generate a set of items based on the literature and prior work. Experts were identified from different roles, institution types, and geographic regions to participate in the panel. Consensus-building rounds were performed until no new ideas were introduced using an electronic survey platform. Data were analyzed descriptively in each round.
RESULTS: After the second round, 47 items met consensus. Key recommendations included enhanced training of students to provide feedback, transparency with students on how feedback is utilized, using SCEs as one element of data sources, and the importance of ensuring intentional approaches based on theoretical constructs used in the field of course evaluation.
CONCLUSION: This Delphi study established consensus on approaches programs can use to optimize SCEs, according to experts from across the academy. Though some items are very specific, there are opportunities for individualization based on program priorities
Transformative Peer Connections: Early Experiences From the ASCO Palliative Care Community of Practice.
No full textThe integration of palliative care into routine oncology practice is the standard of care by most leading cancer organizations. Palliative medicine helps to deliver higher quality of care at a lower cost. However, there are barriers to implementing palliative oncology at many institutions for myriad reasons. In this article, we discuss an innovative strategy that ASCO implemented called the Communities of Practice (CoP). We share our experiences as the Palliative Care CoP and how our group seeks to develop processes and structures to collectively promote systemic change and enhance palliative care delivery for people with cancer. Our Palliative Care CoP engages with senior leaders, administrators, and those in power to achieve a shared vision of delivering holistic health care for people with serious illness. We continue to evolve to meet our members\u27 growing needs by addressing eight main domains: (1) increasing palliative care education and resources; (2) creating opportunities for global palliative care research; (3) providing peer mentorship and community building; (4) engaging with patient advocates; (5) supporting and developing interdisciplinary teams; (6) assisting with professional development and identity formation, especially for trainees and early career faculty; (7) extending our outreach through social media; and (8) enhancing the clinical practice of palliative oncology. The ASCO CoP has been a vital forum to realize ASCO\u27s mission of conquering cancer and advancing the Art and Science of Cancer Care: From Comfort to Cure