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A Reflection on the Use of Telehealth to Improve Treatment Adherence and Healthcare Utilization
No full textBackground: As the largest payor of mental health services in the U.S., Medicaid is a responsive mechanism for the approximately 48% of people with mental illnesses (PMI) insured by this payor source (Adelmann, 2003). The 2010 expansion of Medicaid services in the U.S. improved coverage for specialized mental healthcare treatment (Blunt et al., 2020; Breslau et al., 2020), but several barriers persist in mental healthcare among Medicaid beneficiaries. Yet, telehealth services are crucial in responding to the access, adherence, and appointment keeping needs of Medicaid beneficiaries (Adepoju et al., 2022; Creedon et al., 2020; McBain et al., 2023).
Purpose: To assess the responsiveness of telehealth use on adherence and healthcare utilization among adult PMI.
Methods: A cross-sectional analysis of 2018 to 2022 Kentucky State Medicaid claims dataset of adult PMI. Demographic, psychiatric diagnosis, residence, payor type, medication adherence, healthcare visits and costs, and telehealth use codes were extracted. Linear or logistic regression analyses were used to examine the effect of telehealth use on adherence, visits, and costs.
Results: Participants were mostly female, White non-Hispanic, and urban residents. Only 0.5% of the beneficiaries had any telehealth visit codes. When controlling for other study variables, telehealth use was associated with greater medication adherence (OR=2.1, 95%CI=1.8-2.5), mean number of outpatient visits (β=2.0, t=16.4, p\u3c.001), any outpatient visit (OR=6.1, 95%CI=4.9-7.7) and higher pharmacy costs (β=2.2, t=10.8, p\u3c.001). Further, telehealth use was associated with lower mean number of emergency visits (β=-0.5, t=4.1, p\u3c.001) any emergency visits (OR=0.9, 95%CI=0.8-0.9) and outpatient costs (β=-0.6, t=13.1, p\u3c.001).
Discussion: Telehealth was underutilized among our sample of PMI. This underutilization presents an opportunity for nurses to advocate for policies to improve telehealth services access. Based on our findings of greater medication adherence and lower healthcare utilization (related to emergency visits and outpatient costs), nursing leaders may consider the financial benefits of adopting telehealth services into care delivery settings. Future studies may examine strategies to enhance telehealth adoption to improve treatment outcomes while balancing healthcare utilization. Such studies will be important to leverage the adoption of such novel technologies for PMI globally
Podcasting in Pediatrics: Engaging Students through Faculty-Led Conversations
No full textGeneration Z learners often prefer fast-paced, engaging, pragmatic learning environments and material. As digital natives, they are accustomed to the role of technology in education.1 One study found that podcasts “enhance knowledge and skills, in particular for international students and those with special learning needs.”2 To keep up with today’s learners, including those with diverse learning styles, faculty from a traditional baccalaureate nursing program sought to utilize a different instructional modality through podcasting. In order to ensure that all students placed in various clinical settings were exposed to crucial conversations in pediatric nursing, three podcast episodes were developed on hot topics in pediatrics today: vaccine hesitancy, social media and mental health, and child maltreatment. Each thirty-minute podcast episode included a robust discussion between pediatric nursing faculty and a content expert. Desired learning outcomes included ensuring students possess the theoretical knowledge base needed to address difficult conversations in clinical practice as well as exposing students to their unrealized perceptions to foster greater cultural sensitivity. Following each episode, students were required to participate in self-reflection utilizing a learning management system (LMS) discussion board to promote peer-to-peer learning through further group discussion. Discussion board questions asked students to reflect on their thoughts and feelings on the topic before and following the podcast episode
Understanding Beliefs and Barriers to Seeking Mental Health Care Amongst Immigrant Population
No full textIntroduction: Migration to a new country and/or environment with different values, morals, culture, and language are all factors which contribute to the continual rise of mental health disorders in the immigrant population. Understanding the barriers and beliefs of this population from their perspective is imperative to having a positive mental health outcome.
Methodology: A Quality Improvement project was conducted, utilizing the Plan-Do-Study-Act model, an inductive thematic analysis and iterative process guided this qualitative project. Data was collected from 12 participants, through a 10 question semi-structured questionnaire, for four months through convenience sampling.
Results: Themes identified were Stigma, Mental Health Literacy and Knowledge, and Barriers and Beliefs.
Discussion: Insight into the different cultural differences in mental health knowledge, identification, and symptom management, allowed for individualized culturally competent care when meeting the needs of this population
Goodbye Textbook: Content Creation for a Non-Clinical Nursing Course Using AI Tools
No full textPurpose: To provide guidance for faculty interested in creating materials using AI tools for nursing courses which allows ‘unadoption’ of textbooks.
Background: When discussing AI text generation tools like ChatGPT and Gemini (AI tools), many nursing faculty are only aware of the risks to academic writing (Abujaber et al., 2023). But there are many pedagogical benefits of AI tools that enhance student learning (Elting & Desio, 2024; Glauberman et al., 2023; Srinivasan et al., 2024) and manage faculty teaching, communication, and administrative tasks (Srinivasan et al., 2024). What is less known is how AI tools can be used to create course content and replace textbooks. Students report that costs prevent them from buying books even if it might harm their grade (US PIRG Education Fund, 2021) and if purchased many are not reading them (McMurtrie, 2024). For faculty, requiring a textbook when only sections are used reinforces student perceptions that textbooks are not important. Before AI tools, creating original content was time-consuming. Now faculty who are content experts can easily create effective materials, particularly in courses with stable foundational knowledge, such as research or policy.
Approach: In an undergraduate nursing research/EBP course, prompts to create modules aligned with weekly topics in the course schedule were entered into ChatGPT. Together 12 topic modules were created and pasted into Google docs. As a content expert, the author reviewed the modules carefully to ensure information was correct and appropriate for the course. Content was deleted, rewritten, or added, as were graphics and website links. The results were content specific 2-4 page modules credited to ChatGPT and edited by the faculty. References included a research text, journal articles, government websites, and professional nursing organizations. Saved as ‘view only’ docs to allow updates, the links were pasted into the learning management system.
Results and Implications: Students were initially unhappy that slides were not provided but were assured everything they needed was in the short modules. They appreciated not paying for a book - some admitted they would not have bought it anyway. Now faculty track module use and students prepare for class more consistently, which promotes active participation and critical thinking. While perhaps not appropriate for clinical nursing courses, using AI tools in courses with stable content foundations has been very successful
Parents’ Awareness of Antimicrobial Resistance: A Qualitative Study Utilizing the Health Belief Model
No full textObjective: This study aimed to determine local factors that promote or prevent parents’ responsible use of antibiotics for their children in Perth, Western Australia.
Methods: The Health Belief Model was used to guide this study. Four focus group discussions were conducted, with 26 participants. Participants were recruited purposively through a parent group organisation. The Framework Method was utilised to analyse the data.
Results: Participants agreed that antimicrobial resistance (AMR) is a serious health problem. However, participants admitted that they lacked awareness of AMR, inhibiting their ability to assess the risks of developing AMR infections among their children. Participants knew the indications and risks of antibiotic use but still viewed antibiotics as a time-saving solution that minimised disruption to their routine. Participants’ previous experiences in managing their children\u27s illness increased their confidence and linked their positive and negative experiences with their general practitioners in their judicious use of antibiotics.
Conclusions: While parents demonstrated awareness of the indications of antibiotics, they continue to lack AMR awareness and overvalue antibiotics.
Implications for public health: The findings highlight that incorporating parent empowerment and participation in decision-making regarding antibiotics use, and maintaining a positive relationship with healthcare providers, were important strategies to encourage the appropriate use of antibiotics
Challenges and Difficulties Faced by Children with Special Healthcare Needs and their Caregivers
No full textChildren and youth with special health care needs (CYSHCN) and children with medical complexity (CMC) encompass a broad spectrum of children with varying medical conditions and health care needs. They use a greater number of resources due to their higher level of specialty care visits, greater emergency department use, and higher rate of hospitalizations compared to children without special health care needs. The purpose of this literature review is to identify the caregivers of CYSHCN and CMC experiences and difficulties related to caring for their high-needs children. A literature search was conducted using the keywords children and youth with special health care needs, children with disabilities, disabled children, children with medical complexity, caregivers of children with special health care needs, caregiver challenges, quality of life of children and youth with special health care needs and lived experiences of children and youth with special health care needs. A total of 23 relevant studies were included from years 2002 to 2021. Findings included challenges and difficulties such as reduced work hours, high out of pocket costs for their child’s medical condition, disrupted sleep, and impaired social engagements. Parents believed the quality of life for CYSHCN and CMC is lower compared to that of non-special health care needs children. However, studies examining quality of life from the perspective of CYSHCN and CMC were limited. Of the studies included in the review, most focused on parent’s perspectiv
Adult From Heart to Sole: Screening and Early Identification of Congenital Heart Disease
No full textIntroduction: This pilot study explores a non-invasive, low cost screening method for identification of congenital heart disease (CHD).
Methods: A survey was distributed via social media platforms(Facebook, LinkedIn, webpages). Study participants were asked if they have a CHD diagnosis, other health problems, and whether they have a specific crease on either or both feet. This study has been approved by the Institutional Review Board at The College of New Jersey and the Medical Advisory Board Research Committee of the Adult Congenital Heart Association.
Results: All study participants(n= 53) were over the age of 18 years, 69.6% were female (n=37), nine did not disclose their gender, and the remaining were male. Most participants reported their race as Caucasian (n=36). A diagnosis of CHD was reported by 32 participants. The most frequently reported CHD (67.9%) was Tetralogy of Fallot(TOF) (n=20). SPSS IBM (version 29) was used to conduct a Fisher exact test that identified a statistically significant association between having any CHD diagnosis and the presence of a crease on either foot (p value = 0.15). Participants who reported presence of a foot crease also reported a prior CHD diagnosis with the exception of one individual with a chromosomal syndrome. No association was identified between Caucasian race and the presence of a crease on either foot (p value = 1), or between gender and presence of a crease on either foot (p value = 0.214). Small sample size limited analyzing associations between other CHD diagnoes, other racial groups, and presence of a crease on either foot.
Conclusions: This pilot study identified a statistically significant association between having a CHD and the presence of a crease on either foot. Further research is needed to identify if there is an association between a specific CHD and presence of the crease on either foot. Research is also needed to evaluate if a low cost, readily available screening exam for a foot crease could be used globally for early identification of CHD in newborns
Addressing Malnutrition in Togo: A Community Nursing Initiative for Sustainable Health Outcomes
No full textThis community nursing project was developed as part of an international clinical initiative in partnership with global organizations in Togo. Findings from assessment tools and research identified malnutrition as a critical issue among children, significantly contributing to high childhood mortality rates. The World Food Programme (2022) reported that 24% of Togolese children suffer from chronic malnutrition, and the Global Hunger Index ranked Togo 92nd out of 120 countries (Global Nutrition Report, n.d.).
The Togo nursing initiative addressed malnutrition through three levels of intervention: education, screening, and treatment. At the primary intervention level, nursing education aimed to raise awareness about nutrition and promote the use of Moringa, a locally available tree, as a key dietary supplement to combat malnutrition (Islam et al., 2021). At the secondary level, health screenings utilized mid-upper arm circumference (MUAC) tapes developed by UNICEF (n.d.) to identify individuals suffering from malnutrition. At the tertiary level, individuals identified with severe malnutrition were evaluated by a medical team, provided with nutritional food, and linked to local health organizations for long-term care.
Over four days, the project assessed 1,016 children in the communities of Dududzeme, Kati, Kebonou, and Wohoe in Agou, Togo. Despite meeting most objectives, seed distribution was hindered by the loss of seeds during transport from the United States to Togo. Data analysis revealed that 4% (36 children) were severely malnourished, 7% (105) moderately malnourished, and 24% (338) mildly malnourished. Additionally, 35% (479) faced significant food insecurity. These findings highlight the urgent need for international and local collaboration to combat malnutrition, with nurses playing a pivotal role as the first line of care in improving population health.
Building on its success, the project is being refined for a second year of implementation. Plans include addressing language barriers, securing reliable medical supplies, and developing a tracking system to keep monitoring individuals at severe risk of malnutrition. The initiative also emphasizes the importance of sustained local workforce engagement to ensure continuous care and treatment. From research to implementation, this project demonstrated the transformative impact of nurses in supporting local communities as primary caregivers, driving progress toward better health outcomes in Togo
Experiences of Non-Hispanic Black and African American Women with Postpartum Healthcare
No full textRacial and ethnic disparities in maternal mortality and morbidity are stark in the United States, especially for non-Hispanic Black and African American women who experience elevated rates of pregnancy-related deaths and severe maternal morbidity.1,2 Effective postpartum healthcare is essential for optimizing birthing people’s health,3 yet little is known about non-Hispanic Black and African American women’s experiences with postpartum healthcare in the year following delivery. The purpose of this study was to describe non-Hispanic Black and African American women’s experiences with postpartum healthcare throughout the one-year postpartum period from their perspectives. For this qualitative descriptive study semi-structured interviews with 20 non-Hispanic Black and African American women in Indiana were conducted within 12 months of childbirth. Data were analyzed using qualitative content analysis. Participants identified eight types of positive and eight types of negative experiences interacting with healthcare providers and nine types of facilitators and 12 types of barriers to healthcare during the one-year postpartum period. Finally, participants shared eight recommendations for improving postpartum healthcare for non-Hispanic Black and African American women in Indiana. The findings revealed (1) participants’ feelings about their postpartum healthcare were primarily influenced by relational experiences with providers (e.g. feeling attended to or dismissed, treated well or badly, rushed or not rushed) and whether their care needs were or were not met by providers, and (2) participants’ experiences accessing healthcare were primarily influenced by health system factors (e.g. having or not having enough appointments, receiving or not receiving referrals to other care), resource and practical factors (e.g. childcare, transportation), and financial and insurance factors (e.g. insurance covering healthcare costs). Participants recommended more postpartum healthcare, mental health support, guidance, and resources. They also recommended providers listen more, be aware of cultural differences, and treat women of color fairly. The study results provide preliminary insights into non-Hispanic Black and African American women’s experiences with healthcare in Indiana throughout the one-year postpartum period and support the need for additional understanding and multi-level strategies to enable more respectful, equitable, and supportive services
AI Literacy for Nurse Leaders: Advancing Innovation and Transforming Care
No full textWith the rapid integration of artificial intelligence (AI) in healthcare, it is imperative for nurse leaders to develop AI literacy to effectively lead and manage their teams. This presentation explores the significance of AI literacy for nurse leaders, focusing on the benefits of understanding AI technologies and their applications in nursing practice. By equipping nurse leaders with the knowledge and aptitudes to navigate AI systems, healthcare organizations can advance clinical decision-making, streamline administrative workflows, and achieve transformative improvements in care delivery.The purpose of this presentation is to highlight the critical role of AI literacy in nursing leadership and to provide a roadmap for nurse leaders to acquire and implement AI knowledge. The presentation will start with foundational AI concepts, then build on what technologies are AI, which technologies are not AI, and how AI transforms the clinical environment. Specific strategies will be presented to include embedding AI concepts into nursing education and leadership training, fostering interdisciplinary collaboration, and addressing ethical considerations such as data privacy, algorithmic bias, and informed decision-making. By leveraging frameworks like the Data-Information-Knowledge-Wisdom (DIKW) model and Bloom’s Taxonomy, nurse leaders can systematically develop competencies in understanding, applying, and evaluating AI technologies.This presentation highlights the implications of AI literacy for the nursing profession, offering substantial details on how nurse leaders can integrate AI into practice to improve outcomes and innovation. It emphasizes the critical need for responsible use and continuous monitoring and ongoing professional development and collaboration with AI experts to ensure successful adoption and responsible implementation of AI system