Implementing a Zen Room to Influence Well-Being in Rural Hospital Employees

Purpose: The COVID-19 pandemic significantly increased work-related stress and anxiety in healthcare workers worldwide, increasing their potential for burnout. Rural hospitals experienced additional challenges as they often provided care with limited resources and staff. Efforts are made by rural hospitals to mitigate employees' work-related stress and anxiety, but few studies or projects have been published that highlight these efforts. Our evidence-based practice project aimed to answer the question, does the use of a "Zen" or recovery room influence rural healthcare staff stress and anxiety levels during their shift? Sample: The project's convenience sample included 36 healthcare workers and hospital staff in an acute care facility, solely servicing a rural county in north-central Texas. Method: Following the IOWA Model, a literature search was conducted, and IRB review of the project was obtained. A private, restful space was created in a room with soft lighting, a massage chair, aromatherapy, and other various tools for relaxation. From June 2021 – January 2022, all staff were invited to use the room and complete a brief voluntary anonymous survey when they entered and exited the room. An additional short-answer survey was conducted in March 2022 to explore employees' perceptions of the project. Findings: On average, participants reported significantly lower levels of stress and anxiety after using the Zen room. Pre-room anxiety scores significantly predicted participants' post-room stress levels. Barriers to room use included employee's perception of available time and enough staff during the shift to step away from their duties. Conclusion: The availability of private, uninterrupted space decreased staff stress and anxiety and allowed them to return to work with a renewed sense of energy. Rural hospitals would benefit in implementing such a space and conducting further research on the effects of stress and anxiety levels, even as COVID-19 shifts to an endemic disease.

Benefits and Challenges of Telehealth Use during COVID-19: Perspectives of Patients and Providers in the Rural South

Social workers and other health care researchers have examined benefits and challenges of telehealth in rural communities before the COVID-19 pandemic. Yet, experience with virtual platforms and other technologies have rapidly evolved during the pandemic. The research team interviewed 14 health care providers and 17 patients after the onset of the pandemic in a predominantly rural state to examine perceptions of telehealth. MaxQDA analytic software was used to identify benefits and challenges in the use of telehealth. Findings identified commonly discussed benefits of telehealth including convenience for patients, increasing patient access to care, improved patient experience of care, and ability of telehealth to attract/retain patients. Challenges identified in this study included concerns about quality of care being compromised, patients' comfort and access to technology, policy challenges for providers, and the impersonal nature of telehealth visits. Persistent issues warrant research, education, and policy advocacy to improve access for rural populations. Social workers should play a key role in educating the emerging and existing workforce around barriers such as quality of care and patient comfort with technology, convening professionals and patients to establish sustained and effective reimbursement models, and advocating for structural access via enhanced broadband and other resource allocations. © 2022 Authors.

Perceived Barriers and Use of Evidence-Based Practices for Adolescent HPV Vaccination among East Texas Providers.

Adolescents living in rural areas are less likely to be up to date on the human papillomavirus (HPV) vaccine, which can prevent cervical cancer. We administered a telephone survey to 27 clinics in rural East Texas to assess perceived barriers to HPV vaccination and current use of evidence-based interventions to promote HPV vaccination. Perceived barriers were assessed using a 5-point Likert scale and clinical implementation of evidence-based practices was determined. Findings are reported using descriptive statistics. The most commonly reported barriers were missed vaccination opportunities due to the pandemic (66.7%), followed by vaccine hesitancy due to the pandemic (44.4%) and due to the HPV vaccine specifically (33.3%). Fewer than a third of clinics reported using the evidence-based strategies of use of a "refusal to vaccinate" form (29.6%), having an identified HPV vaccine champion (29.6%), and recommending the HPV vaccine at age 9 (22.2%). While many clinics surveyed currently implement evidence-based practices to promote HPV vaccination, there is a need and desire for additional HPV vaccination interventions in East Texas clinics.

Trends and Predictors of Short Wait Time for Transcatheter Aortic Valve Replacement in a Rural Health Care Network

Background Prolonged wait times for Transcatheter Aortic Valve Replacement (TAVR) are associated with increased mortality. Rural health care systems may have challenges in efficiency due to travel related delays. We determined temporal trends and predictors of Short TAVR Wait Time (STWT: TAVR <=30 days from first referral). Methods We identified 918 consecutive patients with Aortic Stenosis (AS) undergoing TAVR from 1/1/19-6/30/22 at a rural tertiary care center. Patients with wait times?>90 days (N=87) were excluded due to patient preferences or treatment of comorbidities. We assessed TAVR wait times (means and STWT%) over time and determined the impact of COVID 19 onset (3/1/20) and driving distance on TAVR efficiency. Results Half of the cohort achieved STWT (51%). TAVR volumes, patient age, sex, and comorbidities were generally stable over time. Mean wait times decreased despite the onset of COVID 19: pre-COVID 36+/- 19 vs post-COVID 31+/- 19 days (p=0.003) (Figure). There was no interaction of travel distance and mean wait time: 33+/- 19 days <= 60 miles vs 32+/- 19 days?> 60 miles (P=NS). Conclusion TAVR efficiency improved over the past 4 years with one half of patients experiencing a STWT. Neither COVID 19 nor long travel distance negatively impacted TAVR efficiency in a rural health care network. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Mobilizing the Community to Implement Mass Coronavirus Disease-2019 Vaccination Clinics: The Power of Free and Charitable Clinics.

A free and charitable clinic successfully designed and implemented mass COVID-19 vaccination clinics in a semirural area in Central Pennsylvania. A total of 172 clinics were offered, approximately 500 volunteers were mobilized, and approximately 45,000 vaccine doses were administered. Partnering with local schools, universities, and recreation centers to offer mass vaccination clinics made it possible to expand the clinic's reach beyond its own patients. Findings provide evidence for the capacity of small community clinics to respond to major public health emergencies, such as a pandemic.

Hand hygiene adherence at entrances and exits of healthcare facilities in two rural districts of Uganda

Background: During the COVID-19 pandemic, the World Health Organization (WHO) has recommended hand hygiene (HH) stations (ie, with soap and water for handwashing or alcohol-based hand rub or ABHR) at entrances and exits of every public or private commercial building, including healthcare facilities (HCFs). Methods: Enumerators observed the HH materials present at the entrances and exits of 37 public HCFs in the Moroto and Kotido districts and patient and visitor use of those HH materials. When handwashing stations were nonfunctional or out of water, no HH observations were made. Results: Of the 37 HCF entrances and exits assessed, 4 (11%) met the recommended guidance for HH materials: 3 (8%) had water and soap, and 1 (3%) had ABHR and water and soap. In other HCFs, 12 (32%) had no HH station present, 13 (35%) handwashing stations had no water, and 8 (22%) had water but not soap. Of 180 persons observed, 52 (29%) attempted HH and only 10 (6%) used appropriate HH technologies (4 with ABHR and 6 with water and soap). Of 52 people who attempted HH, 42 (81%) used only water without soap. All HH observed occurred when entering facilities;no HH occurred when exiting (0 of 68). Of those 52 who performed HH, 48 (92%) performed HH for the recommended time of >20 seconds. However, only 9 (5%) of 180 adhered to suggested HH technologies and length of time (used water and soap scrubbing for ≥20 seconds or used ABHR). Conclusions: We detected poor HH practice by patrons at entrances and exits of HCFs, which may be due to lack of appropriate HH materials, particularly lack of soap. Optimal strategies for adherence to WHO-recommended HH practices at entrances and exits of public and private commercial buildings, including HCFs, should be explored.Funding: NoneDisclosures: None

Conducting a Global Quadruple Aim Thematic Analysis of Telemedicine Performance in Rural Indigenous Populations and Evidence-Based Recommendations for Improvement

As telehealth is a growing form of healthcare delivery across the world, particularly after the COVID-19 pandemic, it’s impact on patient populations particularly in aboriginal and rural communities boasts many questions. As the health disparities between aboriginal groups living in rural areas on reserves and the rest of the Canadian demographics remain to be mountainous, telemedicine is often seen as the new way forward in reducing these healthcare gaps. Presently, much research has been conducted on these cohorts, particularly in the health equity atmosphere. However, much of this research lacks a comprehensive framework or tool in which it analyzes the efficacy of outcomes. In this review paper, the quadruple aim – the ideal standard of care which North American health systems seek to conform to – will be used to analyze telemedicine performance, and assert evidence-based recommendations for improvement. Therefore, this paper seeks to conduct a thematic analysis on the various issues and barriers to telemedicine delivery and usage in aboriginal populations with respect to the quadruple aim as well as identifying evidence-based solutions to alleviate some of these concerns and bolster care.

Another Mortality Penalty for Rural Populations: Covid 19?

There is a gap in mortality between rural and urban people. This has been referred to as the rural mortality penalty. There are more deaths in five major areas among rural than urban populations. Data are now emerging that indicate rural Americans are in the unenviable position of being more likely to have died from COVID-19 than those in urban areas. Although COVID was initially seen more frequently and was the cause of more deaths in urban than rural areas;by Aug 1, 2020 the mortality rates were equal. Rural mortalities became higher than urban in all but three reporting weeks thereafter. In this data, rural was defined using Office of Management and Budget, 2013 criteria for counties outside of a metropolitan statistical area. The largest difference in rural/urban COVID mortality, occurred Dec 2020;rural 8.29 vs. urban 4.79, per 100,000 per week. Since Feb 2022, mortality rates have declined in rural and metropolitan areas. Nurse scientists focused on rural health should delve into the problem of higher crude COVID mortality rates among rural dwellers. They need to redouble efforts toward vaccination and education on mitigating methods and treatments.

A New Model of Care: Pediatric Asthma Management

Utilization of telehealth services and the provision of chronic care management in school-based clinics have proven to be successful care models in the management of pediatric asthma. Such models of care have also been positively correlated with an improvement in pediatric asthma outcomes. These models of care were historically implemented to improve access to healthcare for patients living in rural populations. During the pandemic, such services were employed to improve access to care to everyone as they practiced social distancing to slow the spread of covid-19. The pandemic levelled the playing field and made access to care a problem for not only rural populations, but a problem for everyone. In order to continue insurer reimbursements for telehealth and school-based healthcare services, research is needed in support of these healthcare models.

Disparities in cancer treatment delays or discontinuation among cancer patients diagnosed with SARS-CoV-2 infection: An analysis of the U.S. ASCO COVID-19 and cancer registry

Background: Due to societal factors in the US, racial/ethnic minority adults are disproportionately impacted by the COVID-19 pandemic, particularly those with existing comorbid conditions such as cancer. It is currently unknown whether disparities exist in cancer treatment delivery among racial/ethnic minority patients with cancer and SARS-CoV-2. Methods: Data were obtained from the ASCO COVID-19 and Cancer Registry (March 2020-July 2021), including data from cancer patients diagnosed with SARS-CoV-2 during their care (n=3193) at 60 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, cancer clinical characteristics, and modifications to cancer treatment plans. Cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the original scheduled date. We descriptively evaluated demographic and clinical characteristics, compared disparities in TDD by race/ethnicity and urban/rural residency, and evaluated reasons for TDD as reported by the clinics. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, body mass index, number of comorbidities, cancer type, cancer extent, cancer status at SARS-CoV-2 diagnosis (progressing/stable) and SARS-CoV-2 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Cancer patients with SARS-CoV-2were mostly female (57%), urban residents (84%), and NH-White (66%);49% were 65+ years old. Most patients had solid tumors (75%). At SARS-CoV-2 diagnosis, 2403 patients (76%) were scheduled to receive drug-based therapy (69%), radiation therapy (7%), surgery (4%), or transplant (0.7%), of whom 49% experienced TDD. The most reported TDD reason from the clinic perspective was the patient's COVID-19 disease (90%). Overall, NH-Black (64%) and Hispanic (57%) with SARS-CoV-2 were more likely to experience TDD versus NH-White adults (46%) (p<0.001). This disparity was also observed across urban residing adults (p<0.001). Among rural adults, NH-AI/AN (75%) and NH-Black (61%) were more likely to experience TDD versus NH-White patients (39%). In multivariable analyses, disparities persisted, by NH-Black cancer patients with 92% (aOR:1.92, 95% CI:1.24-2.96) and Hispanic patients with 41% (aOR:1.41, 95% CI:1.03-1.91) higher odds of experiencing TDD. We observed consistent results among urban and rural subgroups. Conclusion: Racial/ethnic disparities exist in TDD among cancer patients with SARS-CoV-2 in urban and rural care settings. Future studies should evaluate the impacts of delays to cancer treatment delivery on cancer outcomes among minoritized communities in the US.

The Health Wagon Partners with the Virginia Department of Health to Provide COVID-19 Testing in Rural Southwest Virginia.

The Health Wagon has been providing care for the rural population of southwest Virginia for the past 40 years. The mission of the Health Wagon is to provide quality health care to the medically underserved people in the mountains of Appalachia. It has expanded to two stationary clinics, three mobile units, and a mobile dental unit, logging over 19,000 patients encounters in the past year.

Self-Efficacy and Concerns of Graduate Nursing Students Regarding the COVID-19 Pandemic

Purpose: Many nurse practitioner students work as nurses while balancing family obligations and graduate school work. The purpose of this project is to learn more about the self-efficacy and concerns of rural graduate nursing students during the COVID-19 pandemic. Sample: Family nurse practitioner students at a rural, public, liberal arts university in the Southeastern United States participated in the study. Method: Demographic information and survey information was obtained from graduate nursing students to assess their self-efficacy and concerns about the COVID-19 pandemic, using the 10-item General Self-Efficacy (GSE) Scale. Findings: Respondents reported varied effects of the COVID-19 pandemic on work schedules. The mean GSE self-efficacy score was 3.32 across two-time points (n=67). Nine qualitative themes were revealed: concerns about contracting and transmitting COVID-19, importance of personal protective equipment and hygiene, impacts at home, stress, decreased clinical placements, coping strategies, public health preparedness, future effects of COVID-10, and a renewed commitment to nursing. Conclusion: This study provides insight into the experiences of rural graduate nursing students caring for patients during the COVID-19 pandemic.

Rewards and employee creativity among rural healthcare employees: the mediating role of organizational support for innovation and the moderating impact of supervisory support

PurposeThis paper aims to explore the mediating effect of organizational support for innovation and moderating impact of supervisory support on how rewards shape employee creativity among rural healthcare employees, a group with few resources and considerable expectations.Design/methodology/approachUsing a regression-based moderated path analysis, the authors tested the hypotheses with healthcare employee survey data from a large Southern rural hospital in the USA.FindingsThe empirical results suggest organizational support for innovation mediates the influence of rewards on employee creativity. In addition, the indirect effect of rewards on employee creativity via organizational support for innovation is moderated by supervisory support, such that the indirect effect is more pronounced at high levels of supervisory support than at low levels of supervisory support.Originality/valueThis study contributes to the organizational support and creativity literature by exploring the indirect relations of rewards on employee creativity through organizational support for innovation, and the moderating role of supervisory support in such relations.

The success of Australia's 'No Jab, No Pay' policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch-up vaccinations.

Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p < .001) and 7.8% in 2017 (p = .027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11 years (3.2%-5.6%, p = .038), 12-15 years (7.5%-14.7%, p < .001) and 16-19 years (3.3%-10.2%, p < .001) along with a statistically significant reduction in children aged 1-3 years (11.4%-6.2%, p = .015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.

[COVID-19 as a catalyst of development of telemedicine services to rural population].

The paper presents a review of publications concerning issues of development of telemedicine in rural health care of the USA during in conditions of COVID-19 pandemic and expediency of extensive application of telemedicine technologies during "post-COVID" period. The issues, aspects, prospects and required conditions for extensive diffusion of telemedicine services to the rural population are considered.

Rural Telehealth Use during the COVID-19 Pandemic: How Long-term Infrastructure Commitment May Support Rural Health Care Systems Resilience.

Amid concerns of inadequate medical supplies and staffing anticipated from a surge in COVID-19 cases, many health care systems across the United States (U.S.) began shutting down non-essential patient services in March 2020. These sudden shifts bring up questions about the long-term effects of COVID-19 on already fragile rural health care systems and the ability of rural populations, including farmers and farm workers, to meet their health care needs. To provide alternative and safe access to health care, the Federal government relaxed telehealth regulations, which effectively removed some of the largest regulatory barriers that had limited the adoption of telehealth in the U.S. In this commentary, we draw on the example of the Marshfield Clinic Health System (MCHS), a large rural health care system in Wisconsin and provide an early assessment of how it adjusted its telehealth services during the early months of COVID-19. While the long-term effects of the pandemic on rural health care systems will not be known for some time, the example of MCHS points to the importance of on-going and sustained investments to support the resilience of health care systems and their ability to weather crises. With early evidence that MCHS patients and practitioners are interested in continuing to use telehealth post-COVID-19, we conclude our commentary by offering three recommendations to remove hurdles and improve quality of telehealth care.

COVID-19: Challenges and its consequences for rural health care in India.

This commentary highlights the potential consequences of the COVID-19 pandemic for India's rural population. The rural health care system in India is not adequate or prepared to contain COVID-19 transmission, especially in many densely populated northern Indian States because of the shortage of doctors, hospital beds, and equipment. The COVID-19 pandemic creates a special challenge due to the paucity of testing services, weak surveillance system and above all poor medical care. The impacts of this pandemic, and especially the lockdown strategy, are multi-dimensional. The authors argue for the need to take immediate steps to control the spread and its aftereffects and to use this opportunity to strengthen and improve its primary health care system in rural India.