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Perceptions of Teams in Providing Safe Handoffs
Get PDFBackground: Pediatric hematology/oncology patients are highly complex and providing care to these patients requires effective communication and coordination. Purpose: This project explored the perceptions of handoffs and transitions of team, at a quaternary pediatric health care system, with a descriptive, cross-sectional, non-experimental survey using convenient sampling. The goal was to identify the three top themes of team member perceptions to drive improvement efforts. Sample: 411 team members were invited to participate in survey; 124 completed the survey, a 29% participation rate. Methodology: The project employed quantitative methodology using quantitative data collection with a Likert-style survey to rank handoff experiences within the service line. Sixteen questions were divided into four domains, information, responsibility, accountability, and teamwork. The survey tool was validated by a 10 member panel of subject-matter experts. The tool exceeded Lawshe’s Content Validity Index (\u3e0.70- 0.80) with the score 0.9375. Two open-ended questions probed barriers to handoffs, and ideal characteristics of handoffs. Data Analysis: Descriptive findings considered role, focus of work, location of work, and years of work. Nonparametric testing in SPSS used Kendall’s tau (τ), Friedman’s (χ²) ANOVA, and Cronbach’s alpha for analysis. Findings: Two strengths were identified: 1. Team members frequently consider risk to patients of harm during transitions and 2. Team members demonstrate a personal accountability to get the information in handoffs. Shared goals and shared plan of care were identified as low performers. Conflict resolution and role understanding emerged as needs from open-ended comments. Recommendation: These findings support three themes for future work to improve handoffs. The data supports developing a shared mental model of how goals and plan of care moves with the patient across the service line, and care continuum, along with clear contact information for clarification needs. Handoffs are not just about the transfer of information, there are many correlating factors that influence this process. Attending to the relationships and the team dynamics will be an important focus of this project
Implementation of a Pregnancy Intention Screening Question at a Federally Qualified Health Center
Get PDFObjective: Process improvement project idea was examined due to the need to fulfill a requirement within a grant. One measure needed for the grant was a pregnancy intention screening question (PISQ) asked of women during their visits. There currently was no formal PISQ. The primary outcomes for this project are to measure effects of the addition of a PISQ on the provision of contraceptive counseling and/or contraceptive methods. Methods: The staff and providers were provided education of the workflow and documentation of the PISQ and the diagnosis codes for contraception counseling and methods. Data was collected three months prior to the education and three months following. Results: The Friedman test indicated that the means score between the pre-and post-interventions was different and that difference was statistically significant (x2 = 14.619, p = .012). The mean score of patients who had a documented PISQ in the pre-intervention timeframe was 23 and the post-intervention timeframe was 168.33. The increase of the mean supports the change in the number of patients with documented answers of the PISQ. The total percentage of patients in the pre-intervention timeframe who received contraception counseling was 6.11% and in the post-intervention timeframe was 5.26%. This was a -13.91% change in patients receiving contraception counseling pre vs post intervention. Conclusion: Implications to practice would include more studies looking at the use of a PISQ. Consider looking at how this question is received by patients and staff’s comfort in asking. Consider for practice is not the contraceptive outcomes of a patient but that the PISQ may start a conversation between patient and provider that may not have been discussed without the question
Lateral corticospinal tract and dorsal column damage: predictive relationships with motor and sensory scores at discharge from acute rehabilitation after spinal cord injury
No full textObjective: to determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS), and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post SCI at time of discharge from inpatient rehabilitation.
Design: retrospective analyses of imaging and clinical outcomes.
Setting: University and academic hospital.
Participants: 151 participants with SCI.
Interventions: Inpatient rehabilitation.
Main outcome measures: LEMS and LT scores at discharge from inpatient rehabilitation.
Results: In 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percent recovered (β = 0.56, 95% CI: 0.37, 0.73, R = 0.43, p \u3c 0.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percent recovered (β = 0.66, 95% CI: 0.50, 0.82, R = 0.51, p \u3c 0.001). DC spared tissue demonstrated a significant predictive relationship with LT percent recovered (β = 0.69, 95% CI: 0.52, 0.87, R = 0.55, p \u3c 0.001). When subgrouping the participants into motor complete versus incomplete SCI, motor relationships were no longer significant but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue compared to those who did not recover motor function.
Conclusions: LCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits following SCI and to provide corresponding targeted interventions
Scale of Internalized Trans Oppression: Measure Development and Exploratory Factor Analysis
No full textA growing amount of research uses the Minority Stress Model [Meyer, Psychological Bulletin, 129(5), 674–697 (2003). 10.1037/0033-2909.129.5.674] to explore the effects of discrimination on the well-being of transgender people. Most of this research focuses on the effects of overt discrimination and the anticipation of discrimination, but few studies have explored the internal aspect of minority stress for transgender people. This may be because current measurement options are limited. To address this oversight, our study developed the Scale of Internalized Trans Oppression (SITO). The SITO moves beyond current measures of internalized prejudice to, instead, assess for the ubiquitous effects of internalized oppression. Results from our exploratory factor analysis provide preliminary evidence of a four-factor structure. Reliability analyses have established high internal consistency for both the Self-Doubt from Oppression subscale and Openness about Gender Identity subscale. Additionally, the Horizontal Hostility from Oppression subscale and the Fortitude subscale showed good internal consistency. Finally, research and clinical implications are discussed for this preliminary version of the SITO
Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study
No full textStudy design: Retrospective. Objectives: Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting: University/hospital. Methods: Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results: In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions: Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship: This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577
Strategies Used by Whites to Address Their Racism: Implications for Autonomous White Racial Identities
No full textThis article presents findings from a study that explored the lived experiences of Whites committed to antiracism action—those who, according to Janet Helms\u27s (1990, 1995, 2014) White racial identity model, exhibit characteristics of the autonomy status. Thematic outcomes indicated participants’ (N = 10) efforts to manage their own racism in ways that are both proactive and responsive in nature. Findings are compared with theoretical and empirical literature regarding the racial identity development of Whites committed to antiracist action. Este artículo presenta los hallazgos obtenidos a partir de un estudio que exploró las experiencias vitales de personas blancas comprometidas con la acción antirracista. Según el modelo de identidad racial blanca de Janet Helms (1990, 1995, 2014), estas personas son aquellas que muestran características del estado de autonomía. Los resultados temáticos indicaron que los esfuerzos de los participantes (N = 10) por controlar su propio racismo son por naturaleza tanto proactivos como reactivos. Se comparan los hallazgos con la literatura teórica y empírica en torno al desarrollo de la identidad racial de personas blancas comprometidas con la acción antirracista
A Layered Model for Building Cyber Defense Training Capacity
No full textAs technology proliferates and becomes indispensable to all functions of society, so does the need to ensure its security and resilience through cyber defense training, education, and professional development. This paper presents a layered model that supports cyber defense training progressively through the development of technology services, digital context, performance assessment, and impact analysis. The methods used were applied to college laboratories associated with cybersecurity classes, defense training exercises, cyber based competitions, and graduate research program designs. The service layer presents methods for developing the technical infrastructure and agile deployment necessary to support cyber defense training. This, then, is layered with conceptual frameworks to guide teams as they immerse into scenarios within cyberspace. To enhance team performance in this space and to enhance the value of the training process itself, psychometric feedback, Agile methods, and quantitative assessments are used to track efficacy and facilitate future development. The final layer represents active incident response and ongoing collaborative efforts between institutions and across disciplines. The work is presented as a progression and illustrates a decade of research from 2010 to 2020. The context has been updated here with the intention that it can be used as a guide for designing a broad range of collaborative cyber defense and cyber range programs. The influence of socio-behavioral factors increasingly illuminates the path forward
II. The question of god in the struggle for racial justice
No full textIn March 1943, having narrowly escaped Europe three years earlier, Abraham Joshua Heschel published The Meaning of This War, his first essay in an American publication. The essay shows, quite remarkably, his full command of literary English. It also shows, as biographer Edward Kaplan remarks, that Heschel had found his militant voice. Emblazoned over the gates of the world in which we live, the essay begins, is the escutcheon of the demons. The mark of Cain in the face of man has come to overshadow the likeness of God. There have never been so much guilt and distress, agony and terror. At no time has the earth been so soaked with blood. Heschel\u27s extraordinary life\u27s witness, his whole body of work, traverses precisely this anthropological and theological knife\u27s edge: The mark of Cain in the face of man has come to overshadow the likeness of God. Where is God? Or better, Who is God? In relation to the rapacious misuse and idolatrous distortion of human freedom? Or simply, Is God
The Ancient Mesopotamian Mīs Pî Ritual: An Application of the Ecological Anthropology of Roy Rappaport
No full textThis article presents the ancient Mesopotamian Mīs Pî ceremony as a case study in the relationship between ritual and the natural world using Roy Rappaport’s framework of Ecological Anthropology as a guide. Rappaport’s premise is that human populations do not operate independently but are instead, “ecological populations in an ecosystem that also includes the other living organisms and the nonliving substances found within the boundaries of [their] territory.” In Rappaport’s framework, rituals involving the use of animal, plant, and other organic materials link human communities to the ecosystems in which they dwell and to that which they seek to ritualize. Applying this mode of analysis to the Mīs Pî ritual yields the thesis that, from the perspective of the Mīs Pî, nature is integral to the ritual maintenance and well-being of the divine and human realms, and, in effect, the well-being of the cosmos
Seeing with New Eyes: Costa Rican Pilgrimage as Transformation
No full textIn summer 2019, eleven faculty and staff members from Loyola Marymount University in Los Angeles, California embarked on an immersion study trip to Costa Rica. An integral part of the university’s commitment to mission and identity, it is one of a number of opportunities for its members to explore the mission and its Jesuit identity within a global context. Framed around the Ignatian principle of pilgrimage, this article describes the focus and goals for the study trip, pre-trip preparations, and the trip itself. We highlight some of the activities in which faculty and staff participated and summarize their reflections of the experience. We conclude with considerations for next steps