Chakra Budhathoki

Study protocol for a comparative effectiveness trial of two parent training programs in a fee-for-service mental health clinic: can we improve mental health services to low-income families?

BackgroundUntreated behavioral and mental health problems beginning in early childhood are costly problems affecting the long-term health and wellbeing of children, their families, and society. Although parent training (PT) programs have been demonstrated to be a cost-effective intervention modality for treating childhood behavior problems, they have been less effective for children from low-income and underserved racial and ethnic populations. The purpose of this randomized trial is to compare the effectiveness, cost, and social validity of two manualized evidence-based PT programs that were developed and tested on different populations and employ different delivery models: (1) The Chicago Parent Program (CPP), a group-based program developed in collaboration with a community advisory board of African-American and Latino parents; and (2) Parent-Child Interaction Therapy (PCIT), an individualized parent-child coaching model considered to be ‘the gold standard’ for parents of children with externalizing behavior problems.MethodsThis trial uses an experimental design with randomization of parents seeking behavioral treatment for their 2- to 5-year-old children at a mental health clinic in Baltimore, MD (80% African-American or multi-racial; 97% receiving Medicaid). Using block randomization procedures, 262 parents are randomized to CPP or PCIT. Clinicians (n = 13) employed in the mental health clinic and trained in CPP or PCIT are also recruited to participate. Primary outcomes of interest are reductions in child behavior problems, improvements in parenting, perceived value of the interventions from the perspective of parents and clinicians, and cost. Parent distress and family social risk are assessed as modifiers of treatment effectiveness. We hypothesize that CPP will be at least as effective as PCIT for reducing child behavior problems and improving parenting but the programs will differ on cost and their social validity as perceived by parents and clinicians.DiscussionThis is the first study to compare the effectiveness of a PT program originally designed with and for parents from underserved racial and ethnic populations (CPP) against a well-established program considered to be the ‘the gold standard’ (PCIT) with a high-risk population of parents. Challenges related to conducting a randomized trial in a fee-for-service mental health clinic serving urban, low-income families are discussed.Trial registrationNCT01517867

Use of multiuser, high-fidelity virtual simulation to teach leadership styles to nursing students.

According to the American Association of Colleges of Nursing’s Essentials of Master’s Education in Nursing, leadership (Essential II) and use of technology (Essential V) are key elements in a master’s nursing curriculum. Faculty members may argue it is difficult for students to act in a leadership position when in the role of a student learner in a new clinical environment. To provide students an engaging learning experience as a leader, an innovative approach involves using a virtual clinical environment. Using virtual environments is advantageous so students become comfortable with technology as well as experience challenging clinical experiences from the vantage of a leader. This pedagogy has not been well studied. Evidence regarding the effectiveness of using virtual simulation in the classroom is needed to guide faculty. The purpose of the study was to evaluate the intervention of virtual simulation to teach leadership styles to students in a master’s program in nursing education.

Evaluation of child and parent outcomes after a pediatric cardiac camp experience

PURPOSE This study evaluated the effects of a cardiac camp experience on children with heart disease and their parents. DESIGN AND METHODS A repeated measures design was used with 49 parent-child dyads. Repeated measures evaluated the effects of camp on anxiety, attitude toward illness, and psychosocial functioning of the children. Parental anxiety was also evaluated. RESULTS Results demonstrated decreases in parent anxiety, decreases in child trait anxiety, and positive psychosocial outcomes in the areas of self-esteem, social, physical, and emotional functioning. PRACTICE IMPLICATIONS Findings can be used to support decisions for those contemplating a camping experience for the child with heart disease.

Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: A feasibility study

A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain.

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

This mixed method study examined factors associated with parents not attending their child’s mental health treatment after initially seeking help for their 2–5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71 % African American or multi-racial; 97.6 % low-income), 36 (29.3 %) never attended their child’s first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child’s first treatment session were more likely to live with more than four adults and children (p = .007) and have more depressive symptoms (p = .003). Median length of treatment delay was 80 days (IQR = 55) for those who attended and 85 days (IQR = 67.5) for those who did not attend their child’s first treatment session (p = .142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.

The Presence of Symptoms With Comorbid Conditions in Individuals With Multiple Sclerosis (MS)

Individuals with multiple sclerosis (MS) may experience symptoms that impact comorbid conditions and quality of life (QOL). There is some evidence that symptom severity may vary in certain common health conditions in this population. We aimed to examine symptom severity in light of comorbid conditions commonly seen in individuals with MS (N = 339). Using a cross-sectional Internet survey, we found there was a significant increase in symptom severity of common symptoms of fatigue, imbalance, and weakness, specifically with presence or absence of certain comorbid conditions (depression, arthritis, migraine headaches, coronary artery disease [CAD]). These findings endorse the presence of more severe symptoms with certain comorbid conditions compared with individuals with MS who do not report having comorbid conditions. The findings support the importance of symptom management in individuals with MS who also have comorbid conditions.

A Mixed-Methods, International, Multisite Study to Develop and Validate a Measure of Nurse-to-Physician Communication in Simulation

AIM This study examined the reliability and validity of the ISBAR Interprofessional Communication Rubric (IICR). BACKGROUND Improving education regarding communication in health care is a global priority. Communication is difficult to measure and no evaluation rubrics were located that uniquely focused on nurse‐to‐physician communication in simulation. METHOD This study used a mixed‐methods design and included five sites. RESULTS The IICR was determined reliable among nurse educator raters (rs = 0.79). The scale was found valid as assessed by nurse and physician experts (content validity index = 0.92). When describing their experience of using the tool, nurse educator raters described three categories: overall acceptability of the tool, ease of use, and perceptions of the importance of communication skills for patient safety. CONCLUSION Teaching and evaluating communication in simulation with a standardized rubric is a research area in need of further exploration and refinement.

Secondary health conditions in individuals with multiple sclerosis: A cross-sectional Web-based survey analysis

ABSTRACT Purpose: The purpose of this study was to compare the rates of secondary health conditions in individuals with multiple sclerosis (MS) with age-matched U.S. general population norms. Method: This was a cross-sectional study in which data were collected using a Web-based survey from members of the greater Midwest MS society chapter. Questions were modeled from the National Health Interview Survey to assess the presence of six health conditions. Self-reported health conditions among the sample were compared to U.S. general population norms from the National Health Interview Survey. Results: Individuals with MS reported higher rates of depression, arthritis, diabetes, coronary artery disease, migraine headaches, and cancer than the normative population. Although the rates of health conditions increased with age in the normative sample, the MS sample showed a curvilinear (bimodal) pattern as a function of age for some secondary health conditions.

Effect of bronchodilator treatment on the incidence of postoperative atrial fibrillation after cardiac surgery

OBJECTIVE We sought to examine the effects of bronchodilator treatment on the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery. METHODS A cross-sectional design using a retrospective chart review was performed in patients who underwent cardiac surgery. Those who had previous atrial fibrillation or preoperative bronchodilator treatment were excluded from the final sample (n = 506). The Statistical Package for the Social Sciences (SPSS, Inc., Chicago, IL) was used for statistical analyses. RESULTS The incidence of POAF in this study was 27.9%, and was associated with age (P < .01) and type of cardiac surgery (P < .05), indicating that increasing age, and combined cardiac surgery were more likely to precipitate POAF. Bronchodilator treatment did not increase POAF. However, combined therapy significantly (P < .01) precipitated more POAF (48.7%) than did albuterol (21.4%) or levalbuterol (18.5%). CONCLUSIONS Postoperative atrial fibrillation continues to be a common complication after cardiac surgery. Bronchodilator treatment with either albuterol or levalbuterol did not precipitate POAF, unless both agents were given to the same patients postoperatively.

Use of Virtual Simulation to Impact Nursing Students’ Cognitive and Affective Knowledge of Evidence-Based Practice

BACKGROUND Today’s nurse educators are faced with the challenge of teaching evidence-based practice (EBP) in a meaningful way. Along with the struggle of bringing forward current evidence in this dynamic age of information, nurse educators are encouraged to use the latest technology to make the highest impact on student learning outcomes. Virtual simulation is an emerging pedagogy that may facilitate optimal learning through the use of experiential learning and technology. Virtual simulation has been suggested to be an effective pedagogy to teach select skills in nursing. Research has demonstrated that use of virtual simulation is effective in teaching communication, decision-making, team work, leadership, disaster training, and the art of instruction (Caylor, Aebersold, Lapham, & Carlson, 2015; Farra, Miller, Timm, & Schafer, 2013; Foronda, Budhathoki, & Salani, 2014; Foronda, Gattamorta, Snowden, & Bauman, 2014; Foronda, Lippincott, & Gattamorta, 2014; Hudson, Taylor, Kozachik, Shaefer, & Wilson, 2015). Virtual simulation builds upon principles of experiential learning and adult learning (Knowles, Holton, & Swanson, 1998; Kolb, 1984). There is, however, a paucity of evidence surrounding use of virtual simulation to teach EBP. The aims of this study were to examine the impact of an in-class, group virtual simulation exercise on nursing students’ (a) cognitive knowledge of EBP and (b) affective knowledge about how evidence affects clinical decision-making.