Polly Ryan

Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy.

Background:Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives:The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design:This study used a randomized controlled trial with three arms and longitudinal outcome measurement. Setting:Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. Methods:All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. Results:After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. Discussion:Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

Integrated Literature Review of Postdischarge Telephone Calls

This systematic review of the literature assessed the impact of a postdischarge telephone call on patient outcomes. Nineteen articles met inclusion criteria. Data were extracted and an evidence table was developed. The content, timing, and professional placing the call varied across studies. Study strength was low and findings were inconsistent. Measures varied across studies, many sample sizes were small, and studies differed by patient population. Evidence is inconclusive for use of phone calls to decrease readmission, emergency department use, patient satisfaction, scheduled and unscheduled follow-up, and physical and emotional well-being. Among these studies, there was limited support for medication-focused calls by pharmacists but no support for decreasing readmission. Health care providers benefited from feedback but did not need to place the call to realize this benefit. Inpatient nurses were unable to manage the volume of calls. There was no standardized approach to the call, training, or documentation requirements.

Computer-Based Intervention to Enhance Self-Management of Calcium and Vitamin D Intake in Women

Despite the growing prevalence of osteoporosis, many middle-age women do not engage in recommended bone health promotion behaviors. Based on the Integrated Theory of Health Behavior Change, an intervention was designed to increase the self-management behaviors of calcium and vitamin D intake by strengthening health beliefs and using self-regulation skills. In this repeated measures experimental study, a convenience sample of 148 healthy women between 40 and 60 were assigned to either the computer-based intervention group (CBIG) or usual care group (UCG). Measures of health beliefs and calcium and vitamin D intake were obtained at baseline, 8 and 14 weeks, and 6 months. An interaction effect was observed for self-efficacy and approached significance for goal congruence. The CBIG had higher level of calcium intake at 14 weeks than women in the UCG when analyzed using intention to treat. Self-efficacy predicted calcium intake.

Testing the Integrated Theory of Health Behaviour Change for postpartum weight management

AIM This is a report of a correlational study to test the Integrated Theory of Health Behaviour Change within the context of postpartum weight self-management including the impact of race/ethnicity and weight classification. BACKGROUND Women experiencing childbirth face increasing challenges to manage their weight postpartum. Little is known about womens weight self-management during the complex physiological and psychosocial transition of the postpartum period. METHODS Data were collected during the birth hospitalization and 4 months postbirth during 2005 and 2006. A quota sample of 250 postpartum women using two strata, race/ethnicity and prepregnant weight classification, were enrolled; 179 women completed the follow-up survey. A survey questionnaire measured concepts from the Integrated Theory of Health Behaviour Change concepts, including knowledge and beliefs (self-efficacy, outcome expectancy and goal congruence), self-regulation skills and abilities, and social facilitation (social support and social influence) and the proximal outcome of weight retention. Factor analysis identified 5 factors consistent with the theoretical concepts that accounted for 47·1% of total survey variance. RESULTS Model testing using path analysis explored the relationship among factors. The final model explained 25·7% of the variance in self regulation at 4 months, but did not explain weight retention. The contribution of select concepts to total variance was different for Caucasian and African American women, but not by weight classification. CONCLUSIONS Findings support use of theoretical concepts and relationships to understand postpartum weight self-management. The different relationships among concepts in Caucasian and African American women should be considered in planning targeted postpartum weight self-management interventions.

Clinical nurse specialist-led evaluation of temporal artery thermometers in acute care.

Purpose: A systematic review of literature and intensive evaluation were conducted using a quality process to assess temporal artery thermometer (TAT) accuracy in an acute-care setting. Background: Inaccurate temperature measurements were reported following adoption of the TAT. Concern for patient safety and outcomes generated a need to reevaluate use of the TAT. Description of the Project: Using components of evidence-based practice and intensive evaluation processes, a clinical nurse specialist (CNS)-led team evaluated existing research, assessed current practice, and obtained additional clinical data. Outcomes: Existing research provides inadequate evidence to support use of the TAT for acutely ill hospitalized patients. Findings from an intensive evaluation indicated low interrater reliability in controlled testing, inaccurate technique by staff despite retraining, lack of nurse confidence in the accuracy of the device, and a need for continuous costly retraining. These findings are consistent with findings in a University HealthSystem Consortium report. Summary and Conclusions: A multifaceted evaluation process was needed for the team to compile data, identify issues, and make decisions. A recommendation was made to discontinue use of the TAT. Implications: Clinical nurse specialists have the knowledge and ability to provide clinical leadership at a system level. When usual processes result in safety concerns, the CNS provides leadership to identify patterns, provide direction, creatively integrate evaluation processes, synthesize findings, and uses his/her influence within the system to change practice.

Evaluation of satisfaction and use of electronic intervention for behavior change.

This report describes use and satisfaction of a tailored intervention delivered via Web site and handheld computer. All participants used both delivery methods. Healthy women (N = 74) aged 40 to 60 years participated in this mixed-method descriptive study. Satisfaction was measured via Computer Satisfaction Questionnaire and open-ended comments. Data on use of the handheld computer were embedded into program and captured real time. Unique Internet provider addresses tracked Web site use from March 2007 through August 2008. Results indicate 80% of participants were very to extremely satisfied. There was no significant relationship between use and satisfaction. Knowledge but not self-efficacy scores differed over time. Usage was not related to knowledge scores. Handheld computer was used most frequently during the first week, with use decreasing over 7 weeks. Personal assessment of calcium intake and feedback sections were used most frequently. Handheld computer was used by 71% of participants for 4 weeks, 55% for 6 weeks, and 29% for the full 8 weeks. Participants commented on intervention content and positive and negative aspects of the devices and keyboard. This study presented an opportunity to examine data related to actual use. This dimension of intervention fidelity is more readily available in eHealth applications than with printed information.

Background and method of the Striving to be Strong study a RCT testing the efficacy of a m-health self-management intervention

BACKGROUND Osteoporosis is a prevalent and debilitating condition affecting >50% of post-menopausal women. Yet, a low percentage of women regularly engage in health promoting behaviors associated with osteoporosis prevention. Complex, multidimensional, m-Health interventions hold promise to effect engagement in health behavior change related to calcium and vitamin D intake, balance, core and leg strength, and physical activity. METHODS Striving to be Strong study (R01NR013913-01) tests the efficacy of a research and theory based, patient centered, dynamically tailored intervention delivered via smart phone apps. Ecological Momentary Assessments (EMAs) enhance immediate feedback and complement traditional measures. The desired outcomes are the maintenance of osteoporosis self-management behaviors and a decrease in the loss of bone density over time. The Individual and Family Self-management Theory provided the conceptual foundation for the study. The sample consists of 290 healthy women between the ages of 40 and 60 with an anticipated attrition of 33%. This three group repeated measures Randomized Clinical Trial spans a 12-month time period. Data collected occurs via web site, smart-phone app, self-report, observation, and measures. Proximal (engagement in osteoporosis health behaviors) and distal (serum vitamin D, DXA, and body composition) outcomes are collected for testing of the efficacy of the intervention and theory evaluation. DISCUSSION Active and rigorous quality management processes continually evaluate enrollment and retention goals, functionality of the automated intervention delivery and data collection systems, EMAs, and dispersion of incentives.