Sarah P. Farrell

Predicting whether patients receive continuity of care after discharge from state hospitals: Policy implications

This article reports the results of a comprehensive study of predictors of factors influencing continuity of care for individuals discharged from state hospitals to communities. Continuity of care is defined and the predisposing, enabling and need factors are examined using a statewide database. The conceptual model is based on community support system principles, and it drives the research. The findings will influence policy, which will then affect community support system principles. Logistic regression analysis is employed as statistical analysis that lends itself to graphical form. Implications for policy and future research are presented.

Shared Decision Making in Mental Health Treatment: Qualitative Findings from Stakeholder Focus Groups

PURPOSE This article reports on findings from seven stakeholder focus groups conducted in exploring shared decision making (SDM) between provider and consumer in mental health (MH) treatment in public MH. BASIC PROCEDURES Seven focus groups were conducted with stakeholders-consumers, family members, prescribers, MH clinicians, and rural providers. Each of the focus groups was recorded digitally, transcribed into text, and analyzed qualitatively for recurring themes. MAIN FINDINGS Provider barriers to SDM include history of the medical model, MH crises, lack of system support, and time. Consumer-related barriers included consumer competency, fears, insight, literacy, and trauma from past experiences. Information-exchange issues include consumer passivity, whether consumers could be viewed as experts, and importance of adequate history information. New skills needed to practice SDM included providers knowledge about alternative treatments, mastery of person-first language, and listening skills; consumers ability to articulate their expert information; and computer skills for both providers and consumers. Outcomes expected from practice of SDM include greater sharing of power between provider and consumer, greater follow-through with treatment plans, greater self-management on the part of consumers, and improved therapeutic alliances. PRINCIPAL CONCLUSIONS Implementing SDM in public MH will impact consumers and their families, providers, prescribers, and administrators. More SDM trials in public MH are needed to answer some of the many questions that remain.

Electronic Screening for Mental Health in Rural Primary Care: Implementation

The goals of this study were to develop a computer-based electronic screening tool (eScreening) and determine the feasibility of implementing eScreening for rural users of primary care. This descriptive pilot adapted existing screening measures for depression and alcohol abuse to a portable computer-based format and examined the feasibility of its adoption and use. This was a three-step design using convenience samples for (1) a focus group with providers, (2) usability testing with selected rural patients using the computerized touch screen, and (3) implementing the touch screen platform with a small sample in primary care to determine feasibility. This paper reports on Phase III, which assessed consumer response to eScreening.

eScreening: Developing an Electronic Screening Tool for Rural Primary Care

The Rural Health Care Research Center at the University of Virginia, School of Nursing, conducted a pilot study to develop a computer-based electronic screening tool that screens for alcohol abuse and depression among rural patients in a primary care setting. The eScreening tool provides a graphical user interface with audio outputs for users who may be functionally or computer illiterate. The interface is a macromedia flash movie shown on a Web site. A database automatically and anonymously records the screening data. Two phases of user-testing for a prototype of the eScreening tool were conducted in June and July 2005. Future work on the eScreening tool entails expanding administrative controls, including screenings for other disorders, and providing a Spanish version

Accuracy and efficiency of novice nurse practitioners using personal digital assistants.

PURPOSE To determine if using personal digital assistants (PDAs) increased accuracy and efficiency of clinical decisions made by novice nurse practitioners (NPs). DESIGN Experimental with a repeated measures design. METHODS The study sample included 40 novice NPs. Data were collected from December 2003 to March 2004 following a stratified random assignment of the subjects to a textbook or PDA group. Participants identified appropriate laboratory value assessments, diagnosis, and medication decisions using the assigned resources when given two randomly administered clinical scenarios. Accuracy was determined by the correct response score to each clinical question. The completion of the scenario was timed by the investigator. Length of time necessary to answer each part of the scenario determined efficiency. Data analysis included mixed design repeated measures analysis of variance. FINDINGS There was a significant interaction and difference in accuracy in the laboratory analysis section of the case scenarios (F(1,38) = 21.256, p ≤ .001) in the PDA group when compared with the textbook group. There were no differences in accuracy by section. In three of six efficiency variables measured, the PDA users were significantly more efficient. CONCLUSIONS In both laboratory values and one of the treatment sections, the PDA users were more efficient in determining an answer to the clinical questions. Accuracy of PDA users was equal to textbook users. CLINICAL RELEVANCE The findings lend support to benefits for novice practitioners using PDAs when evaluating clinical situations, both in accessing certain correct information and doing this in a timely manner.

Electronic Screening for Mental Health in Rural Primary Care: Feasibility and User Testing

Despite attention to prevention and screening for depression and alcohol use, Healthy People 2010 objectives continue to include goals to increase the detection of depression and decrease the rates of alcohol abuse. These problems remain significant. The overall goal of this study was to develop a computer-based electronic screening (eScreening) tool and determine the feasibility of implementing computer-based eScreening technology for rural visitors to a primary care clinic. The study called specifically for an electronic touch screen with voice prompts. This tool, called the eScreening tool, screens for alcohol abuse and depression among rural patients in a primary care setting. The screening was offered to rural adults who are not in acute distress and not at end of life, regardless of their stated reason for seeking medical care. Phase 1 of the pilot was used to determine the perceptions of nurses, other providers, and consumers regarding the acceptability and perceived usefulness of an eScreening tool. Phase 2 involved user testing of the eScreening tool. The longer term goals of the research program are to work with rural nurses to improve patient outcomes and develop interventions and for educational, consultation, and/or direct clinical care.

Schizophrenia, Tardive Dyskinesia, and the Abnormal Involuntary Movement Scale (AIMS)

The incidence of tardive dyskinesia as a side effect of antipsychotic medications is well documented in the literature on the treatment for schizophrenia. Although the new generation of atypical neuroleptics helps diminish the incidence of such side effects, a complete elimination has yet to be fully realized. Nurses continually observe and assess patients. As such, nurses in all settings can effectively contribute to both preventative and palliative care of the patient who is about to receive or is currently receiving antipsychotic medications. Familiarity with the Abnormal Involuntary Movement Scale (AIMS) and expertise in the application of AIMS in patient assessment assist in these important prevention efforts.