Implementation of the Maternal Fetal Triage Index to Improve Obstetric Triage.

OBJECTIVE: To compare implementation and effectiveness of the Maternal Fetal Triage Index (MFTI) in an urban academic hospital and a suburban private hospital. DESIGN: A pre-/postintervention, hybrid Type 3 effectiveness-implementation study design was used. Data collected 2 months preceding the intervention served as preintervention data. The MFTI was implemented for 2 months at each hospital, generating postintervention data for comparison. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used to guide the implementation and evaluation. SETTING/LOCAL PROBLEM: The volume of and various reasons women present for emergency evaluation on maternity units requires systematic triage. Women are typically seen based on when they arrive with limited exceptions, rather than triaged according to acuity, hindering the responsiveness needed to address potentially life-threatening conditions. The term women refers strictly to the biological and anatomic female sex characteristics that are required for intrauterine pregnancy. PARTICIPANTS: Medical records of pregnant women presenting for emergency evaluation and physician and nurse documentation were used for data collection. INTERVENTIONS/MEASUREMENTS: The intervention was triage with the MFTI, acuity level assignment, and screenings within predetermined time frames. Fidelity to protocols and the timeliness of nurse contact and screenings were measured. RESULTS: Implementation across all shifts was associated with greater adherence. The MFTI was associated with a significant reduction in the time from arrival to registered nurse contact for all acuity levels and time to screening foracuity levels overall, as well as for "prompt" and "urgent" acuities independently. CONCLUSION: This project provides a benchmark for quality obstetric triage and a roadmap for further exploration of the MFTI's clinical impact. Through systematic triage, the MFTI establishes effective prioritization and safety, supports favorable health outcomes, and is becoming the standard of practice for obstetric triage.

Relationships between activation level, knowledge, self-efficacy, and self-management behavior in heart failure patients discharged from rural hospitals.

Non-adherence to self-management guidelines accounted for 50% of hospital readmissions in heart failure patients. Evidence showed that patient activation affects self-management behaviors in populations living with chronic conditions. The purpose of this study was to describe patient activation level and its relationship with knowledge, self-efficacy and self-management behaviors in heart failure patients discharged from rural hospitals. Our study populations were recruited from two hospitals in rural areas of Nebraska. We found that two-thirds of the participants reported low activation levels (e.g., taking no action to manage their heart failure condition). In addition, low patient activation levels were associated with inadequate heart failure knowledge (p=.005), low self-efficacy (p<.001) and low engagement in heart failure self-management behaviors (p<.001) after discharge from hospital.

A Conceptual Framework for Barriers to the Recruitment and Retention of Rural CVD Participants in Behavior Intervention Trials.

BACKGROUND: Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials. OBJECTIVE: The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials. METHODS: We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks. RESULTS: We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients' intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research. CONCLUSION AND IMPLICATION OF RESULT: The findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.

Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol.

UNLABELLED: Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients' health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden.  CLINICAL TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053.

Symptom management strategies used by elderly patients after coronary artery bypass surgery.

The purpose of this secondary analysis was to describe symptom management strategies used by elderly patients (n = 236) 3 and 6 weeks after coronary artery bypass surgery (CABS). Three weeks after surgery, the most frequently used strategies were rest to manage shortness of breath (53%) and fatigue (53%), medications for incision pain (24%), and repositioning for swelling (35%) and sleep disturbance (18%). Overall, fewer patients experiencing sleep disturbances (39%), incision pain (39%), swelling (46%), and appetite problems (17%) reported using a strategy to manage their symptom. Nurses must assist patients in symptom identification and problem solving to accomplish effective symptom management.

Medications and associated symptoms/problems after coronary artery bypass surgery.

OBJECTIVE: The purpose of this secondary analysis was to describe medication use and examine the relationship between medications and postoperative symptoms/problems in the first 3 months after coronary artery bypass surgery (CABS). METHODS: The sample consisted of older (≥65 years) men and women (n = 232) who had undergone CABS. Medication data were collected through self-report 3 and 6 weeks and 3 months after surgery. RESULTS: Most patients reported taking aspirin (88.2%-85.7%), statins or cholesterol-lowering drugs (88.6%-87%), and beta-blockers (68%-55.6%). No significant differences were found between the proportion of patients taking and not taking beta-blockers, antiarrhythmics, cholesterol-lowering drugs, or angiotensin-converting enzyme inhibitor medications for common medication-specific symptoms/problems. CONCLUSION: Patients experience symptoms after surgery, but these symptoms did not seem to be side effects from medications. Nursing assessments and interventions targeting postoperative symptoms, symptom management, and medication side effects can enhance recovery and reinforce medication adherence.