Margory A. Molloy

The Nature and Scope of Stressful Spousal Caregiving Relationships

The caregiving literature provides compelling evidence that caregiving burden and depressive symptoms are linked with stressful care relationships, however, relational difficulties around caregiving are seldom described in the literature. This article presents findings from content analysis of baseline interviews with 40 Alzheimer’s disease (AD) and Parkinson’s disease (PD) spousal caregivers enrolled in a home care skill-training trial who identified their care relationship as a source of care burden. Disappointment and sadness about the loss of the relationship; tension within the relationship; and care decision conflicts within the relationship were recurrent themes of relational stress in caregiving. These spousal caregivers had relationship quality scores below the mean and burden and depressive symptom scores above the means of other caregivers in the study. These findings provide support for developing dyadic interventions that help spouses manage relational losses, care-related tensions, and care decision-making conflicts.

Adapters, Strugglers, and Case Managers A Typology of Spouse Caregivers

Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer’s or Parkinson’s disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case managers’ interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver’s management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed.

Do nurse-led skill training interventions affect informal caregivers' out-of-pocket expenditures?

PURPOSE OF THE STUDY This paper is a report of a study of the Assistance, Support, and Self-health Initiated through Skill Training (ASSIST) randomized control trial. The aim of this paper is to understand whether participating in ASSIST significantly changed the out-of-pocket (OOP) costs for family caregivers of Alzheimers disease (AD) or Parkinsons disease (PD) patients. DESIGN AND METHODS Secondary analysis of randomized control trial data, calculating average treatment effects of the intervention on OOP costs. Enrollment in the ASSIST trial occurred between 2002 and 2007 at 2 sites: Durham, North Carolina, and Birmingham, Alabama. We profile OOP costs for caregivers who participated in the ASSIST study and use 2-part expenditure models to examine the average treatment effect of the intervention on caregiver OOP expenditures. RESULTS ASSIST-trained AD and PD caregivers reported monthly OOP expenditures that averaged

Cultivating a Culture of Medication Safety in Prelicensure Nursing Students.

500-

It Takes a Village”: An Interprofessional Patient Safety Experience for Nursing and Medical Students

600. The intervention increased the likelihood of caregivers spending any money OOP by 26 percentage points over usual care, but the intervention did not significantly increase overall OOP costs. IMPLICATIONS The ASSIST intervention was effective and inexpensive to the caregiver in direct monetary outlays; thus, there are minimal unintended consequences of the trial on caregiver financial well-being.

Using Trigger Films as a Bariatric Sensitivity Intervention: Improving Nursing Students' Attitudes and Beliefs About Caring for Obese Patients.

Safety education in nursing has traditionally focused at the level of individual nurse-patient interactions. Students and novice clinicians lack clinical experience to create context and understand the complexity of the health care system and safety science. Using the Quality and Safety Education for Nurses quality and safety competency as a framework, the objective of this education project was to design comprehensive, engaging, learner-centered, online modules that increase knowledge, skills, and attitudes about medication safety.

A Telehealth Case Study: The Use of Telepresence Robot for Delivering Integrated Clinical Care.

Background: Interprofessional education (IPE) is a “core” competency in professional school education. Challenges to successful collaboration include: aligning student abilities/experience, providing meaningful clinically-based interaction, and the need for extensive planning. Methods: Curriculum. A 3-1/2 hour IPE patient safety experience for final-semester medical and nursing students was developed. The content included an introduction, small-group low-fidelity simulation, and a large-group discussion of patient safety events observed by students during clinical rotations. Logistics. A planning committee met monthly to plan the curriculum and train faculty facilitators. Four sessions were held, accommodating 92 medical and 82 nursing students. Thirty faculty facilitators and 10 support personnel were needed for each session. Results: Over 70% students reported that the experience resulted in new learning and prompted self-reflection; 57% said it would change their practice. Students confirmed that the experience taught them about the importance of patient involvement in the team, the development of a shared mental model, and the importance of everyone’s role on the team. Conclusions: This collaboration successfully aligned students with similar levels of clinical experience, involved many faculty from both professional schools, and gave students opportunities to discuss differences in their roles and responsibilities, while highlighting patient-centered care.

How Prepared Are Medical and Nursing Students to Identify Common Hazards in the Intensive Care Unit

Nurse educators are uniquely positioned to improve obesity-related attitudes and beliefs among prelicensure nursing students. A bariatric sensitivity intervention using 6 trigger films with facilitated debriefing was designed and delivered to 70 first-semester baccalaureate nursing students. Attitudes and beliefs significantly improved immediately after the intervention on 3 of the 5 attitude measures and on the belief measure. Improvements in beliefs/attitudes were sustained 30 days after the intervention but may require content reinforcement throughout the curriculum for long-term effects.

Utilizing Trigger Films to Enhance Communication Skills of Home Care Clinicians.

Telehealth technology is transforming the health care landscape and patient care. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, and examples include videoconferencing, the Internet, streaming media, and wireless communications (Foster & Sethares, 2014; Glasper, 2011). The use of telehealth technologies eliminates distance as a barrier to help geographically isolated individuals access quality health care, mitigate unnecessary provider visits, and increase the value in the delivery of health care services (Lustig, 2012; Moehr et al., 2006). This allows for improved patient outcomes and reduced health care costs (Hilty et al., 2013). Telehealth improves access to care for people who live in remote areas or who, due to illness or immobility, cannot travel. Telehealth can also increase the provider’s presence and allow for an increased number of visits to maximize patients’ care. Assimilating telehealth technologies into clinical practice has been expanding and has demonstrated success for diagnosing and treating many medical and psychiatric disorders (Egede et al., 2015; Hilty et al., 2013). Telehealth allows psychiatric services to be offered to clients in-between visits and is reimbursable by Medicare, Medicaid, and other third-party payers under specific guidelines (Antoniotti, Drude, & Rowe, 2014). However, realizing the benefits of telehealth necessitates health care educators to integrate innovative ways to introduce and engage licensed and prelicensed students in telehealth. This means educational programs need to implement training programs using telehealth technology that reflect the changing health care landscape. Incorporating telehealth technologies into patient simulation is one innovative way to increase exposure and practice with telehealth technologies—such as the use of a telepresence robot—prior to entering a clinical environment. We describe a scenario in which a telepresence robot is used to introduce the use of telehealth in a home care visit. A telepresence robot allows for remote team members to have a presence from afar. A telepresence robot is a remote-controlled, wheeled device with a display to enable video chat and videoconferencing, among other purposes. These robots incorporate the positive qualities of video calls, such as allowing a provider at a distance to observe patients and students at a distance to participate in simulations. The robots are placed on a wheeled device that puts the remote clinician or student in control. This allows the user to communicate in real-time through audio and video modalities. Clinicians have the autonomy to drive and position the device around remotely and autonomously participate in postclinical debriefings from afar. This facilitates engagement with patients and enhances team dynamics and if used during clinical simulation allows student to learn how to operate telehealth technology. The scenario centers on a widowed older adult requiring home care visits for evaluation of an infected open wound on her hand needing daily dressing changes. The primary care provider is concerned about the possibility of the patient experiencing depression and wants further follow-up by a psychiatric-mental health home care nurse. The patient lives in an independent senior living community in a rural town, 90 miles from her primary care provider. She is unable to drive and has limited financial resources for transportation for these frequent visits. The independent senior living community invested in a telepresence robot and allowed residents to use it on a shared basis in order to connect with remote family members. An added benefit to this technology has been its use for telehealth purposes. Staff members are available to assist the seniors, in their home, with the use of the telepresence robot. The telepresence home care nurse can “visit” the patient virtually to provide these integrated health care services affordably and more often. In addition, the robot allows the nurse to autonomously move around the patient’s environment, creating a greater sense of realism 617037 JAPXXX10.1177/1078390315617037Journal of the American PsychiatricVaughn et al. research-article2015

Use of deliberate practice in teaching in nursing

Rationale: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. Although the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students’ formal education may not prepare them adequately for this role. Objectives: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified. Methods: Mixed‐methods observational study of graduating nursing (n = 51) and medical (n = 93) students who completed two “Room of Horrors” simulations to identify patient safety hazards. Qualitative analysis was used to extract themes from students’ written hazard descriptions. Fishers exact test was used to determine differences in frequency of hazards identified between groups. Results: Identification of hazards by students was low: 66% did not identify missing personal protective equipment for a patient on contact isolation, and 58% did not identify a medication administration error (medication hanging for a patient with similar name). Interprofessional differences existed in how hazards were identified: medical students noted that restraints were not indicated (73 vs. 2%, P < 0.001), whereas nursing students noted that there was no order for the restraints (58.5 vs. 0%, P < 0.0001). Nursing students discovered more issues with malfunctioning or incorrectly used equipment than medical students. Teams performed better than individuals, especially for hazards in the second simulation that were similar to those in the first: need to replace a central line with erythema (73% teams identified) versus need to replace a peripheral intravenous line (10% individuals, P < 0.0001). Nevertheless, teams of students missed many intensive care unit‐specific hazards: 54% failed to identify the presence of pressure ulcers; 85% did not notice high tidal volumes on the ventilator; and 90% did not identify the absence of missing spontaneous awakening/breathing trials and absent stress ulcer prophylaxis. Conclusions: Graduating nursing and medical students missed several hazards of hospitalization, especially those related to the intensive care unit. Orientation for residents and new nurses should include education on hospitalization hazards. Ideally, this orientation should be interprofessional to allow appreciation for each others roles and responsibilities.