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Community-Based Smart Health Monitoring System for Older Adults Experiencing Poverty
No full textBackground: By 2050, adults age 60+ will comprise 22% of the world’s population.1 95% of Americans have a chronic condition2 and 63% live in poverty.3-4 Innovative low-cost solutions are needed to support aging-in-place.5-7 The purpose of this case study is to examine the experience of one older adult using a low-cost Smart Health System (SHS) designed to assist with managing chronic conditions. The prototype health monitoring system was retrofitted in existing homes. It included 1 multisensor per room (motion, light, humidity); 2 door use sensors (main entry, refrigerator); an algorithm continuously processing sensor data and sending alerts when the resident exhibited clinically relevant activity pattern changes (e.g., bathroom use frequency); a people-based system of family/friends, community health workers, and nurses.
The case was part of a larger mixed methods prospective study where the SHS was installed for 6 months in the homes of independent, community-dwelling older adults age 60+ residing in subsidized housing in the United States’ Pacific Northwest. Demographically and language diverse older adults (N=47) volunteered to trial the SHS and rate adoptability. Sensor-based analytics and alerts were generated. Extensive field notes were recorded for alert-initiated telehealth calls and end-of-study interviews.
Methods: The illustrative case was studied of an 80-90-year-old female experiencing poverty and living alone while using the SHS for 195 days during which time she experienced an episode of renal dysfunction. Sensor data were quantified. Field notes and semi-structured interviews were analyzed using qualitative description.
Findings: Sensor data showed a decrease in kitchen (59%), living room (53%), time out of the home (46%), and bathroom use (26%), with an increase in bedroom use (56%). Salient alerts were not responded to resulting in a community health worker contacting the participant who reported “not feeling well” and “more secure” because “someone is there watching my back.” Her Net Promotor Score was 10 indicating a strong propensity to recommend the SHS to others.
Implications: This case reveals lessons for future sensor-based health monitoring in clinical practice: (1) sensors offer meaningful information about health behaviors, (2) the alert system was not used by the participant as envisioned, (3) having a people component increases efficacy, affording upstream opportunities for community supported management of chronic conditions
Patient-Provider Communication in CKD Care: Patient Experiences and Nursing Implications
No full textBackground: Chronic kidney disease (CKD) is a complex condition that requires extensive knowledge for adequate patient self-management. Many individuals with CKD lack sufficient understanding of their diagnosis, leading to poorer health outcomes. Effective patient-provider communication is crucial in closing this knowledge gap, particularly given the intricacies of managing CKD, other comorbidities, and complex medication regimens. This communication is essential in primary care settings, where most patients with CKD are managed. Yet, little is known, from the patient’s perspective, about how these critical conversations unfold during the clinical encounter. Understanding patients\u27 experiences communicating with primary care providers about CKD can offer valuable insight into strategies for enhancing patient understanding and knowledge about CKD.Purpose: This qualitative study described patients’ experiences communicating about their CKD with their primary care providers.Methods: Participants were recruited through purposive and snowball sampling. Semi-structured individual interviews were conducted, audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Results: In-depth interviews with twelve participants revealed two overarching themes: negative and positive clinical encounters. The negative clinical encounter was characterized by dismissiveness, lack of accessibility, and providing unclear information. These negative experiences made participants feel dissatisfied with care, navigating the healthcare system alone, and developing distrust toward providers. The positive clinical encounter was characterized by participants feeling heard, collaborating with their providers, and having a provider that was accessible. These positive experiences resulted in a positive feeling about the care received and a patient-provider match.Conclusions and Implications: Findings underscore the essential role of effective and positive communication in managing kidney disease. Nurses, an underutilized resource in primary care settings, are well-equipped to enhance patients’ experiences and serve as a bridge between patients and providers. Nurses possess the expertise to educate and promote patient-centeredness, making patients feel valued and engaged in their care. By utilizing these skills, nurses can facilitate provider accessibility and ensure patients receive the critical information and strategies needed to learn about and manage their CKD effectively
Auditory Hallucinations as Patients\u27 Allies: Challenges for Psychiatric Nurses in Clinical Care
No full textBackground: Auditory hallucinations are a prevalent positive symptom in schizophrenia, with 20-60% of patients experiencing them even with regular medication. Nurses\u27 expertise in managing these hallucinations directly influences symptom stability. Nurses who feel overwhelmed by handling auditory hallucinations may also consider leaving the profession. Thus, understanding psychiatric nurses\u27 experiences and challenges in managing auditory hallucinations is valuable.
Aim: To explore psychiatric nurses\u27 experiences in caring for patients with auditory hallucinations.
Methods: This qualitative study included 39 nurses (10 male, 29 female) across four psychiatric hospitals. Three rounds of focus group interviews were conducted weekly from June to August 2024, and data were analyzed using thematic analysis.
Results: Four main themes emerged: (1) Coexisting with auditory hallucinations—some patients perceive hallucinations as helpful; (2) Concerns—hallucinations sometimes urge self-harm or harm to others; (3) Medication necessity—medication remains a priority in acute phases; and (4) Barriers—insufficient training in recognizing and managing auditory hallucinations.
Conclusions: This study provides insights into psychiatric nurses\u27 perspectives on caring for patients with auditory hallucinations, offering guidance for future training programs in auditory hallucination management
Addressing LGBTQ+ Health in Ireland: A Scoping Review to Identify the Current Landscape
No full textIntroduction: Sexual and gender minority (SGM) health research in Ireland remains limited, with substantial gaps in knowledge concerning health disparities among diverse LGBTQ+ populations. This scoping review provides a comprehensive synthesis of the current evidence, offering a foundational understanding of the existing research landscape and pinpointing areas for future exploration.
Aims & Objectives: The review aims to map the scope of SGM health research in Ireland, identifying primary areas of focus and critical gaps in representation to guide future research priorities and policy development.
Methods: A systematic search was performed across PubMed, PsycInfo, CINAHL, and Embase, utilising search terms created in collaboration with a specialist librarian. The initial search yielded 1,455 records, which, after duplicate removal, resulted in 1,197 unique studies for screening. After title, abstract, and full-text reviews, 59 studies were included. Studies were categorised by health domain and population group, allowing an analysis of prevailing themes and research gaps.
Outcomes: The review revealed that mental health (22 studies) and sexual health (20 studies) are the primary focus areas, followed by substance use (6), cancer (3), and ageing (1). Additionally, eight studies specifically examined transgender health, and two explored happiness and social connection, reflecting the core themes within Irish SGM health research.
Discussion: The findings show a marked focus on gay, bisexual, and other men who have sex with men (gbMSM), with limited representation of intersex individuals, bisexual populations, and sexual minority women. Minority stress theory underpins much of the research as an explanatory model for SGM health disparities, yet it may inadequately address the intersecting social and contextual influences affecting health across diverse identities. Furthermore, Ireland’s lack of sexual orientation and gender identity (SOGI) data in national health surveys and electronic health records hinders a comprehensive understanding of SGM health needs, restricting efforts to address health inequities across LGBTQ+ populations.
Conclusion: More research is essential to adequately address the health needs of Ireland’s sexual and gender minority populations. The integration of SOGI data into national health datasets is imperative for tracking health outcomes and achieving health equity across all LGBTQ+ communities
Musculoskeletal Health and Physical Performance in Gynecological Cancer Women During Chemotherapy
No full textBackground: Chemotherapy-related musculoskeletal adverse effects, such as muscle wasting, reduced muscle mass, muscle and joint pain, decreased bone density, joint stiffness, and inflammation, can impair physical activity and impact overall survival (Sutton et al., 2019; Sturgeon et al., 2019; Pin et al., 2018; Jang et al., 2020; Lee et al., 2019). However, limited research exists on the changes in musculoskeletal health and physical performance among women with gynecological cancer throughout chemotherapy.
Purpose: This study aimed to examine changes in musculoskeletal health and physical performance across chemotherapy cycles and identify factors influencing these changes.
Methods: A prospective longitudinal design was employed. Adult women with gynecologic cancer scheduled for their first chemotherapy cycle (every 3–4 weeks) were recruited from a medical center in Taiwan. Musculoskeletal health was assessed through hand grip, lower limb muscle strength, skeletal muscle mass, and 4-meter walking speed. Physical performance was evaluated using the Karnofsky Performance Status (KPS), the SARC-F for sarcopenia screening, and the International Physical Activity Questionnaire Short Form (IPAQ-T-SS). Data collection occurred at three points: before chemotherapy (T0), 3–4 weeks post-first cycle (T1) and post-third cycle (T2). Generalized Estimating Equations (GEE) analyzed changes across chemotherapy cycles.
Results: Thirty-four participants were included, with an average age of 56.3 years (Range: 38–74, SD=9.93). The primary cancer type was ovarian (n=17, 50%), with most participants (44.12%, n=15) at FIGO stage III. Significant declines were observed in KPS scores (B=-6.454, p\u3c.001; B=-6.092, p\u3c.001) and borderline declined changes in 4-meter walking speed (B =-1.12, p=.06) over the chemotherapy cycles. Age was a significant factor affecting KPS and walking speed. However, skeletal muscle mass, hand grip strength, lower limb strength, sarcopenia risk, and physical activity levels remained unchanged across the chemotherapy cycles.
Conclusion: Increased chemotherapy cycles were significantly associated with reduced physical performance, especially among older patients. These findings align with prior research (Fukushima et al., 2020), underscoring the importance of monitoring musculoskeletal health and physical performance in patients undergoing chemotherapy, with particular attention to older patients
Promoting Resilience of Nurses in the Pediatric Intensive Care Unit
No full textBackground: Second victims are nurses involved in a perceived traumatic patient-related event.1 Exposure to these events, especially throughout a career, can lead to psychological, emotional, or physical distress, known as second-victim syndrome.2, 3 Studies have shown that the most effective management of distress for second victims is through immediate emotional support from a peer.4 Therefore, reflective nurse leaders understand the need to develop organizational support systems to promote resilience and mitigate symptoms of second victim syndrome.5, 6Objective: The objective was to reduce second victims\u27 perceived distress levels by 10% within three months of deploying a second victim support program. The program was piloted in a 20-bed pediatric intensive care unit (PICU), as working in an intensive care unit is a known risk factor for developing second victim syndrome due to the vulnerable patient population it serves.6Methods: An IRB-approved mixed methods study was developed by an interprofessional team of nurses, social workers, physicians, and the employee assistance program coordinator. The Scott Three-Tiered Model was the framework used to develop a peer support program and train volunteers to provide emotional support to second victims after a patient-related traumatic event.Results: Thirteen participants completed pre- and post-intervention self-assessments. Findings showed a statistically significant reduction in distress levels after meeting with a second-victim peer supporter (t(12) = -16.401, p \u3c .05).Conclusions: The project highlights the value of peer support programs as an effective strategy for reducing distress among healthcare professionals. Regardless of their formal roles, nurse leaders are ideally positioned to advocate for and provide emotional support to foster resilience among nurses who suffer from second-victim syndrome.Limitations: Limitations of the study include the limited sample size, which may restrict the generalizability of the results.Nursing Implications: This project offers a framework for nursing leaders interested in promoting a support system for resilience among nurses who may suffer from second-victim syndrome
Seizure First Aid Simulation: Teaching Students While Exploring Future Faculty Collaboration
No full textBackground: Epilepsy is disproportionately distributed across the world, with 80% of individuals with epilepsy living in low and middle-income countries (World Health Organization, 2024). The prevalence of epilepsy in Pakistan is estimated to be approximately 1%, with those living in rural areas less likely to receive treatment (Khatri et al., 2003).
Nurses need to know the immediate actions to take when someone experiences a seizure; however, gaps in training are common (Lee & Sim, 2020; Liu et al., 2024). Seizure First Aid training programs have been developed to help healthcare professionals and caregivers of persons with epilepsy respond to seizures (Asadi-Pooya et al., 2022; Shafer et al., 2022). Simulation has been used to help prepare nursing students and other health professionals to respond to seizures (Kahraman et al., 2019; Mikhaeil-Demo et al., 2020).Methods: Nursing faculty from the United States and Pakistan developed a simulation for BSN students at a university in Pakistan to teach Seizure First Aid while exploring potential future faculty collaboration (Shafer et al., 2022). The simulation utilized rapid cycle deliberate practice with pre-brief and debrief (de Oliveira et al., 2024; Perretta et al., 2020). Students completed pre- and post-simulation surveys.Results: 19 BSN students participated in the 1.5-hour simulation. Most participants (n=18, 95%) were male, and almost half (n=9, 47%) reported previous experience caring for someone experiencing a seizure. Students reported increased confidence in caring for someone experiencing a seizure and described the simulation as a psychologically safe learning environment. Stigma and myths emerged as themes influencing nursing care. All students were able to describe and demonstrate the steps of Seizure First Aid. Overall, student feedback about the simulation was positive, though 22% (4/18) of respondents noted they would prefer to practice on a real person instead of a mannequin. Secondary informal project outcomes included the establishment of a collaborative relationship between nursing faculty from the United States and Pakistan. Priorities identified through the simulation for future faculty projects included best practices for simulation, outcome evaluation, and competency-based education.Conclusion: This simulation helped students gain knowledge, confidence, and skills related to acute seizure care and allowed faculty to explore a new collaboration and identify future priorities
Targeting Safety & Satisfaction in Hourly Rounds to Enhance Patient Experience on Ortho-Spinal Unit
No full textThe purpose of this Value Improvement Project was to address the problem of declining patient experience on our Orthopedic Spinal Unit at our inpatient acute care facility and we used the CAHPS Likelihood to Recommend domain as out measurement tool. At the start of the project, we were at the 55th percentile rank for the second quarter of 2024. We decided to infuse our patient rounding with proactive interventions so that our rounds were not simply to say someone last saw the patient breathing at 1500 but to round with more patient centered purpose! Purposeful hourly rounding has emerged as a vital strategy in healthcare settings to improve patient experience, satisfaction and safety (Jones & Brown 2020). Smith & Johnson (2019) conducted a systematic review and found that purposeful hourly rounding had a positive impact on patient experience and satisfaction. In addition to patient satisfaction, studies indicate that proactive interventions during rounding followed by ACE IT Anything, such as assisting with toileting, adjusting bed positions, and ensuring the availability of personal items, contribute to a safer environment for patients (Karaca & Durna, 2019; George, 2024). Our interventions included education of ACE IT, ANYTHING Standard Work, Patient Rounding Standard work, and Rounding Log sheets during in-services and announcements at huddle each shift. Our goal was to increase our unit’s CAHPS Likelihood to Recommend Scores to the 60th percentile by Q3 2024
Increasing Access to Substance Use Disorder Treatment Through Interdisciplinary Education
No full textThe opioid and SUD epidemic drives a need to dramatically increase treatment opportunities, yet there is a dearth of practitioners who feel comfortable and competent in this area. And there are not enough specialists. To address this, we have developed an elective, online, asynchronous course for Nursing, Medicine, Pharmacy, Social Work, and Public Health housed within a DNP program at UW School of Nursing. Course content includes concepts of trauma-informed practice (and education), stigma, etc., and are woven throughout the course. Use of telehealth simulation scenarios served to prepare students for therapeutic patient interactions and to practice skills of motivational interviewing and reducing stigma. Strong interest in this elective course quickly became apparent through immediately robust registration, requiring an expansion of roster capacity from 50 to 75 students. Future plans exist to offer course content as CE to practitioners post-licensure, and introduce content in undergraduate (prelicensure) nursing education
It is Not Easy : The Psychosocial Distress of Ghanaian Adults Living With Chronic Blood Cancers
No full textBackground: Living with chronic blood cancer can cause significant psychosocial challenges, especially in low- and middle-income countries with limited healthcare access. Compared to solid tumours, blood cancer patients experience higher rates of anxiety and depression, which are exacerbated for those with chronic blood cancers due to disease uncertainty. Without proper support, these psychological struggles can lead to a poor quality of life, underscoring the importance of identifying the psychosocial burdens and coping mechanisms among adults undergoing treatment.
Method: The study utilized descriptive phenomenology qualitative design to investigate the experiences of adults receiving treatment for chronic blood cancers at a public tertiary facility in Ghana. Individual face-to-face interviews were conducted using a semi-structured guide with participants purposively sampled from the haematology outpatient department between July and September 2024, reaching data saturation with the 10th participant. Data was audio-recorded and transcribed verbatim. The data were analysed using a thematic analysis approach.
Results: Participants were aged 25 to 65+ and had lived with the chronic types of common blood cancers, chronic myeloid leukaemia, chronic lymphoid leukaemia, non-Hodgkin’s lymphoma, and myeloma for one to five years and above. Three main themes emerged from the data, (1) initial response to diagnosis (2) impact of the disease, and (3) coping strategies. The key findings revealed that despite some informal support and adaptation efforts, the journey remains distressing, with some individuals considering suicide.
Conclusion: Findings revealed that the cancer journey is emotionally taxing, with some individuals contemplating suicide despite informal support and personal adaptation efforts. Distress persisted from diagnosis through treatment and often extend to their family members, disrupting their role as primary support providers.
Nursing Implications: The study highlights the need for routine screening for psychosocial distress and open discussions on self-care and coping mechanisms for adults receiving treatment for chronic blood cancers. Nurses and other healthcare professionals should provide formal social support and counselling to patients and their families and refer severe cases to mental health professionals. Additionally, nurses can advocate for socio-economic support for adults with chronic blood cancers