Allison P Squires

Abstract

~

Abstract

~

Abstract

~

Abstract

~

Abstract

Background: National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies. Aim: This study's aim was to describe the pre-data collection instrument adaptation challenges when designing the first national nursing workforce study in Poland while participating in the Nurse Forecasting: Human Resources Planning in Nursing project. Methods: A descriptive analysis of the pre-data collection phase of the study. Instrument adaptation was conducted through a two-phase content validity indexing process and pilot testing from 2009 to September 2010 in preparation for primary study implementation in December 2010. Means of both content validation phases were compared with pilot study results to assess for significant patterns in the data. Results: The initial review demonstrated that the instrument had poor level of cross-cultural relevance and multiple translation issues. After revising the translation and re-evaluating using the same process, instrument scores improved significantly. Pilot study results showed floor and ceiling effects on relevance score correlations in each phase of the study. Limitations: The cross-cultural adaptation process was developed specifically for this study and is, therefore, new. It may require additional replication to further enhance the method. Conclusions: The approach used by the Polish team helped identify potential problems early in the study. The critical step improved the rigour of the results and improved comparability for between countries analyses, conserving both money and resources. This approach is advised for cross-cultural adaptation of instruments to be used in national nursing workforce studies. Implications for nursing and health policy: Countries seeking to conduct national nursing workforce surveys to improve nursing human resources policies may find the insights provided by this paper useful to guide national level nursing workforce study implementation. International Nursing Review

Abstract

BACKGROUND: Low health literacy (HL) is common, particularly in underserved communities. HL deficits have been associated with patient safety issues and poor health outcomes. Provider use of HL-informed communication strategies, including plain language verbal and written communication, and use of “teach back” to confirm patient understanding, has been linked to improved patient outcomes, therefore; a “universal precautions” approach is recommended. A recent survey of medical schools found that 72 % of the 133 U.S. allopathic medical schools included HL in their curriculum, with a only a median time spent of 3 h in total (Coleman & Appy, 2012). As part of a needs assessment of residents at our institution, we surveyed residents across 7 programs to determine their previous training in HL, current practices, comfort level with HL skills and desire for further training. This allowed us to assess overall need and to identify differences by specialty. METHODS: Data was collected from residents via an online survey (Qualtrics) during the 2013-2014 academic year. Residency programs surveyed included Emergency Medicine (EM), Internal Medicine (IM), Obstetrics/Gynecology (OB), Orthopedics (OR), Pediatrics (PED), Primary Care (PC), and Surgery (SUR). Completed responses were received from 269 residents (of 394 total), for a response rate of 68% overall. This ranged from a 100% response rate from OR down to 57% from EM. HL questions for the survey were adapted from Schwartzberg et al. (2007) and Turner et.al. (2009). The following domains were assessed: 1) prior HL training (1Q), 2) use of HL techniques (8Q), 3) perceived skill in key HL techniques (3Q), 4) desire for HL training (1Q). Prior HL training was assessed with a question about whether they had HL training, and if so, where they received it. Use of HL techniques was rated on a 5-point Likert scale from1 (never) to 5 (always); techniques included teach-back, providing easy to read written materials, underlining key points on written materials. A Overall HL Use score was calculated by averaging responses (Cronbach's alpha=.88). Perceived skill in key HL techniques was, rated on a 4-point scale from 1 (not at all skilled) to 4 (very skilled); skills assessed included teach-back, choosing appropriate written materials, and converting medical terms into plain language. A HL Skills score was calculated by averaging responses (Cronbach's alpha=.70). Finally, participants were asked to respond to open-ended questions re: what HL training they would like. RESULTS: Sixty-five percent of residents reported prior training related to HL, with the majority of this being in medical school; educational formats used included didactics and OSCEs. Across specialties, 84 % of OR residents reported having had previous training, while IM was the lowest at 47 %. Statistically significant differences in reported Overall HL Use across programs was determined by one way ANOVA (F (6, 268)=8.77, p=.0.0001). Post hoc Tukey test revealed that SUR Overall HL Use score was significantly higher than the other specialties, (p=0.05). No other significant differences were found. For the HL Skill score, one way ANOVA was significant (F(6265)=3.48, p= 0.002). Tukey post-hoc analysis revealed that SUR was again the highest scorer, with scores significantly higher than both IM and OB (p=0.05). When asked what future training residents wanted, there were consistent themes across the specialties. Many residents wanted to know where to find easily accessible printed material suitable for low-literacy patients, ways to match health education literature to patients' HL levels, and pragmatic strategies for integrating HL approaches in a busy clinical setting with diverse patient populations. CONCLUSIONS: Most residents across multiple specialties report at least some training in HL during medical school, although the extent of such training is not known. There are differences between specialties with respect to self-reported use of and comfort with HL approaches, with surgeons feeling the most prepared and internal medicine and obstetrics trainees less so. In spite of their reported skill level, all groups identified need for further HL training. Additionally, this study assessed self-report of HL skill and use. To better understand differences by specialty assessing actual HL skill and use from an observational study is planned.

Abstract

BACKGROUND: The US Preventive Services Task Force recommends screening for and treating obesity. However, there are many barriers to successfully treating obesity in primary care (PC). Technology-assisted weight loss interventions offer novel ways of improving treatment, but trials are overwhelmingly conducted outside of PC and may not translate well into this setting. We conducted a systematic review of technology-assisted weight loss interventions specifically tested in PC settings. METHODS: We searched the literature from January 2000 to March 2014. Inclusion criteria: (1) Randomized controlled trial; (2) trials that utilized the Internet, personal computer, and/or mobile device; and (3) occurred in an ambulatory PC setting. We applied the Cochrane Effective Practice and Organization of Care (EPOC) and Delphi criteria to assess bias and the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) criteria to assess pragmatism (whether trials occurred in the real world versus under ideal circumstances). Given heterogeneity, results were not pooled quantitatively. RESULTS: Sixteen trials met inclusion criteria. Twelve (75 %) interventions achieved weight loss (range: 0.08 kg – 5.4 kg) compared to controls, while 5–45 % of patients lost at least 5 % of baseline weight. Trial duration and attrition ranged from 3–36 months and 6–80 %, respectively. Ten (63 %) studies reported results after at least 1 year of follow-up. Interventions used various forms of personnel, technology modalities, and behavior change elements; trials most frequently utilized medical doctors (MDs) (44 %), web-based applications (63 %), and self-monitoring (81 %), respectively. Interventions that included clinician-guiding software or feedback from personnel appeared to promote more weight loss than fully automated interventions. Only two (13 %) studies used publically available technologies. Many studies had fair pragmatism scores (mean: 2.8/4), despite occurring in primary care. DISCUSSION: Compared to usual care, technology-assisted interventions in the PC setting help patients achieve weight loss, offering evidence-based options to PC providers. However, best practices remain undetermined. Despite occurring in PC, studies often fall short in utilizing pragmatic methodology and rarely provide publically available technology. Longitudinal, pragmatic, interdisciplinary, and open-source interventions are needed.

Abstract

~

Abstract

NEEDS AND OBJECTIVES: Treating obesity is a complex task and barriers to effective counseling include lack of adequate time during clinical encounters and insufficient provider training. Further, providers become frustrated when they perceive that obese patients are not motivated to change their lifestyles. Implementation of obesity curricula within graduate health professions education programs to address these barriers is important. Use of a curriculum that incorporates an interprofessional approach may foster and facilitate collaborative efforts among health professionals; a multi-disciplinary approach to the treatment of obesity is considered to be especially effective.We sought to design an interprofessional curriculum in obesity counseling that could be individualized based on learner needs and would be appropriate for use across the lifespan and which focused on acquisition of skills related to two domains: 1) motivational interviewing (MI) and 2) health literacy. SETTING AND PARTICIPANTS: The curriculum was piloted in the Department of Pediatrics in an urban academic hospital with three residents and two nurse practitioner students. It is scheduled to be piloted with Ob/GYN and internal medicine residents. DESCRIPTION: The curriculum included 3 one-hour interactive sessions followed by an evaluative OSCE. Materials for the sessions were compiled by adapting existing curricula that had been developed separately for pediatrics and internal medicine residents. To this curriculum we included additional items based on a needs assessment obtained from the program director and trainees. The first session included discussion about perceived barriers to obesity treatment and a review of health literacy principles and obesity counseling as well as a brief introduction to MI. The second session focused on challenges in the assessment of the literacy levels of patients and an introduction to specific MI skills, such as change talk and goal setting. The third session was reserved for role playing using the skills learned in the first two sessions. Each session concluded with plans for skills practice within the clinical setting. EVALUATION: We evaluated the curriculum with a 10-minute OSCE station counseling a resistant adolescent on weight reduction. Participants were assessed on use of counseling techniques, including MI skills. Following the OSCE, qualitative feedback was obtained from the trainees via a written survey and audio-taped debriefing session. DISCUSSION/REFLECTION/LESSONS LEARNED: Learners had strong feelings of frustration and resignation about their experiences with obesity counseling and were initially resistant to using MI. To address this, we strove to create an environment where learners could be honest about their perceptions and attitudes. Feedback from participants indicated that there was increasing acceptance of MI over the sessions. Learners highly valued the opportunity to learn in an interprofessional setting, identifying areas of similarity and difference in approach to obesity counseling.

Abstract

Background: Nursing faculty shortages threaten a country's ability to produce the amount of nurses necessary to sustain the delivery of healthcare services. Programs that "fast track" graduate education options for registered nurses are one solution to the problem. Objectives: To 1) evaluate admission criteria into PhD programs for direct entry from a bachelor's degree; 2) ascertain bachelors and masters degree nursing students' perspectives on pursuing a BSN to PhD course of study; 3) clarify factors that influence students' decision-making processes behind pursuing a PhD and identify characteristics of those who would be likely recruits for PhD study; 4) to test the survey questions to develop an instrument for future use. Design: A cross-sectional pilot study. Setting: A nursing program at a large urban university in the United States of America with an enrollment of over 1400 students. Participants: Currently enrolled bachelor's, master's, and doctor of nursing practice students. Methods: Students were sampled via a 10-question (including one open-ended question) electronic mail survey that included 1385 eligible subjects. Results: Among the 606 respondents (57% response rate), 63% were between ages 18 and 30 and 87% indicated that full tuition funding with a living stipend would make them more interested in pursuing a PhD. Current program track was a significant predictor of course of study and area of interest (p = .029). Analysis of the 427 respondents to the open-ended question revealed themes around "time" and "money" as the main barriers to study. The desire to gain clinical experience prior to PhD study was the third theme and an unanticipated finding. Conclusions: The questionnaire offered some predictive ability for gauging intent to study for a PhD among bachelor's and graduate degree prepared nurses. The results do offer some suggestions for nursing workforce development to help address faculty shortages.