Dissemination innovation: Using found poetry to return study results to patients and partners facing cancer.

Objective: Investigators should return study results to patients and families facing cancer to honor their research contributions. We created a found poem from transcripts of sexual and gender minority (SGM) couples facing cancer and returned it to study participants. Methods: Participants were randomized to receive the found poem in text, text and audio, audio, or video format, completed dissemination preferences and emotion questionnaires, and open-ended questions about their experience receiving the poem. Results: Participants preferred the format they received (n = 15, 75.0%), with text-only and combined text and audio formats evoking the greatest number of emotions (n = 13 each). The following categories and subcategories were identified: dyadic experiences (support, strength, depth, durability); dissemination preferences (timing, method); emotion (positive, negative); utility of the found poem (affirming; fostering reflection; not useful or inaccurate, and sense of community). SGM participants utilized positive emotion, affirming, and a sense of community with greater frequency than non-SGM participants. Conclusion: Innovative approaches to dissemination are acceptable; providing choices in how and when participants receive results may increase engagement; and SGM versus non-SGM groups may describe dyadic experiences differently. Innovation: Returning study results via found poetry is an innovative way to honor research participants facing cancer.

Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study.

BACKGROUND: Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence. OBJECTIVES: Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report. DESIGN: Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey. METHODS: Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models. RESULTS: Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence. CONCLUSIONS: Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety. REGISTRATION: Not registered. TWEETABLE ABSTRACT: Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Comparison of recruitment methodologies for clinical trials: Results from the time for living and caring (TLC) intervention study.

BACKGROUND: Recruiting participants for research studies is a critical yet challenging task. Community-engaged recruitment strategies have gained prominence as effective means to engage diverse populations and ensure the representativeness of study samples. This case study aims to investigate the cost and effectiveness of various recruitment methods in enhancing research participation. METHODS: A comparative approach was employed to assess the outcomes of five different recruitment strategies used in the Time for Living & Caring (TLC) research study. Data on recruitment success, participant demographics, and retention rates were collected and analyzed using descriptive statistics, including ANOVA and Chi-squares, to statistically compare the outcomes associated with 5 different recruitment methodologies. The recruitment methodologies included two community-engaged strategies (community partner referral and community-based recruiters), a clinical database, social media, and word-of-mouth referral. CONCLUSION: The meta-data used to build this methodological case study describe different recruitment methodologies that may be used for clinical trials. This data-driven evaluation provides examples and considerations for researchers when developing budgets and proposals for future clinical trials. The primary finding is that there are tradeoffs in terms of cost, time, labor, and ultimately the representativeness of the sample, based on the type of recruitment methodology chosen.

Iterative Review and Revision of the Enhancing Active Caregiver Training (EnACT) Intervention.

Interventions that actively engage dementia caregivers show promise in reducing the negative outcomes of caregiving but lack optimization and systematic testing. The purpose of this manuscript is to describe an iterative process developed to refine an intervention to enhance active engagement. A three-stage review process with content experts was developed to refine activities in preparation for focus group feedback and pilot testing. We identified caregiving vignettes, reorganized engagement techniques, and optimized focus group activities for online delivery to promote caregiver access and safety. The framework developed from this process is included, along with a template to guide intervention refinement.

The development of knowledgeable nursing assistants as creative caregivers (KNACC).

Certified nursing assistants (CNAs) provide 80% of direct care in long-term care settings and are critical to maintaining resident well-being. Arts-based approaches to enhancing meaningful engagement have the potential to empower CNA ownership in the process of improving patient-centered care. We held a series of focus groups with CNAs (n = 14) to adapt arts-based creative caregiving (CCG) techniques for use in long-term care. Iterative revisions focused on CCG techniques, factors influencing implementation, and usability. The Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) manual developed from the adapted CCG describes training guidelines and instructions to facilitate CNA use of creative caregiving techniques in direct care.

Pilot testing the knowledgeable nursing assistants as creative caregivers (KNACC) guide.

Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) was developed to train certified nursing assistants (CNAs) to apply arts-based techniques to enhance care and support to older adults in long-term care (LTC) settings. We piloted (n=8) KNACC techniques for use in LTC and assessed its potential for influence on the CNA outcomes of structural empowerment and job satisfaction. During preliminary implementation, CNAs working in memory care units were more open to applying all techniques. The techniques in KNACC have the potential to improve CNA skills in working with long-term care residents.

Let us progress! Implementing professionally led arts-based programming in senior centers.

The arts offer a cost effective and appealing approach to healthy aging. The purpose of this study is to evaluate the development and implementation of three creative aging pilot programs led by professional teaching artists in multipurpose senior centers. The process of recruitment focused on professional teaching artists, senior center directors, and program participants. Data collection documented attendance, field note observations, participant demographics, self-reported health, and satisfaction. Open-ended interviews detailed individual experience, learning opportunities, dislikes, and both program and instructor feedback. Analysis involved descriptive statistics and apriori pattern coding. Outcomes are reported specific to each program developed, including: 1) readers theatre, 2) choir, and an 3) Improvisation/Movement class. A total of 35 older adults participated in all three programs. The choir had the highest average of regular attendance, while the improvisation/movement class struggled with recruitment. Overall satisfaction was high across all programs, with participants expressing enjoyment with courses that offer a challenge and desired that courses continue. This study emphasizes the importance in collaborating with centers to develop high quality programming and recommends strategies to facilitate program sustainability. Future program development and instruction may be improved through application of lessons learned.

The Development and Validation of a Communication Survey Instrument for Long-term Care Staff.

Information transfers in long-term care (LTC) settings between and among providers, staff, residents, and family caregivers are often fragmented. In order to identify training needs to improve communication, a survey instrument was developed and refined to assess the self-efficacy of LTC staff in communicating with staff, providers, residents, and caregivers. This 11-item survey instrument, based on a literature review, covered four key concepts (mutual respect, recognizing and responding to sensory deficits, limited health literacy, and changes in condition) relevant to communicating health information in LTC settings. Ten content experts evaluated each survey item using a 4-point scale. The content validity of the survey was established by using the content validity index to assess results at the item and scale levels. All items scored 0.90 or greater and were retained. Future work should entail broad-scale validation and testing of this survey across the United States. By assessing the self-efficacy of LTC staff in communicating with the interprofessional team, leadership teams can design personalized interprofessional continuing education activities aimed at improving communication skills. [J Contin Educ Nurs. 2022;53(3):123-130.].

Using ethnodrama to support parents in sense-making after prenatal or neonatal diagnosis of a child's disabling condition.

BACKGROUND/AIMS: This study describes the process of developing video vignettes to meet the parent-expressed need for balanced, meaningful messages about what life may be like for parents who have a child with a disability. Each vignette teaches a general audience salient concepts derived from a grounded theory of the parental process of Rescuing Hope after a child's diagnosis with a developmental disability. METHODS: Using ethnodrama methodology, we completed a secondary analysis of 21 interviews with parents who learned of their child's diagnosis of Down syndrome. RESULTS: Understanding the grounded theory of Rescuing Hope has the potential to help parents construct meaning and purpose as they adapt to parenting a child with a disability. DISCUSSION: The short dramatic vignettes may be placed across platforms, settings and partnerships, with relevance for teachers, clinicians, family members, caregivers. Designed for wide distribution, video vignettes may reach the people who most need sense-making support.

Live hospice discharge: Experiences of families, and hospice staff.

OBJECTIVE: To examine live hospice discharge prevalence and experiences of families and hospice staff. Hospice eligibility is based on a cancer model where decline and death are predicable. Decline is less predictable for diagnoses such as dementia, frequently resulting in involuntary live hospice discharge. METHODS: A mixed-method integration of hospice 2013-17 admission/discharge data, 5 family interviews, hospice discipline-specific focus groups (3 aides, 2 nurses, 1 administrator interview) and a discipline-combined focus group (all 6 staff; each staff participant engaged in two data collection experiences). RESULTS: 5648 hospice admissions occurred between 2013-17; 795 patients experienced live discharge. The most prevalent admitting diagnosis was cancer, the most prevalent live discharge diagnosis was dementia. Family caregiver themes were Attitude and experience with hospice, Discharge experience, and Continued need/desire for hospice following discharge. Staff themes were Discharge circumstances, Regulatory guidelines, and Changing practice to meet regulatory guidelines. CONCLUSION: Involuntary live hospice discharge precludes patient-centered care due to policy constraints, especially for those with noncancer diagnoses. Families and staff noted the paradox of beneficial hospice care, yet this care resulted in ineligibility for continued hospice services. PRACTICE IMPLICATIONS: Transparent, patient-family-staff communication (including CNAs) facilitates hospice live discharge planning. Hospice service eligibility policy changes are needed.

Certified nursing assistants as agents of creative caregiving in long-term care.

AIM: Certified nursing assistants (CNAs) provide most of the direct care for long-term care (LTC) residents, yet there are few CNA-led interventions aimed at improving quality of care. In our preliminary work developing a CNA art-based intervention, we describe CNA definitions and perceptions of creativity in relation to care of LTC residents. METHODS: Data from six sequential focus groups with CNAs (n = 14) in two LTC facilities were analysed to describe the concept of creativity in relation to LTC caregiving and its meaning to CNAs working in LTC. RESULTS: Certified nursing assistants defined creativity as formal art-making, yet they also described creative approaches to engaging residents in order to build relationships and reduce challenging behaviour. While most linked creativity with discerning and responding to resident needs, creativity was also foundational to time management, teamwork and navigating challenges. CONCLUSION: Developing CNA-centred interventions to promote creative caregiving may enhance both person-centred LTC and CNA empowerment, improving resident care. IMPLICATIONS FOR PRACTICE: CNA creativity should be viewed as a skill with the potential to enhance care and increase CNA empowerment. Interventions should be developed, in partnership with CNAs, to promote creative caregiving.

Portrait of a Caregiver: Ethnodrama Development and Its Influence on Caregiver Well-Being.

BACKGROUND AND OBJECTIVES: The majority of long-term care needs are placed upon family members who often receive minimal support. In this study, we collaborate with family caregivers to create an ethnodrama about their experience and assess outcomes of participation, including caregiver well-being. METHODS: Participants met over 4 months to discuss their roles as informal caregivers. Discussions were analyzed in a two-phase process and themes were developed into a script. Member checks included script review and revisions, culminating in viewing a professional performance of the play followed by a post-performance discussion and reflection. Data were gathered at six timepoints to assess caregiver well-being and longitudinal analysis was used to assess change during the course of the intervention. RESULTS: Twenty-two caregivers completed intervention activities. Participant reactions to the process evolved overtime, from an initial hesitance about what individuals had to offer leading to an acknowledgement of feeling heard and a desire to help others. Caregivers had high levels of burden and positive perceptions towards caregiving. Those with high levels of self-rated health had the lowest levels of burden and the most positive perceptions of caregiving. DISCUSSION AND IMPLICATIONS: Developing an ethnodrama in partnership with caregivers is a unique and feasible method of caregiver support, mentoring, reflexivity, and meaning making. Promoting caregiver health early in the caregiving trajectory has the potential of reducing burden and elevating positivity towards caregiving.

Development of a Gerontology Graduate Certificate in Post-Acute and Long-Term Care.

Nurse practitioners (NPs) can provide safe, effective, quality care to older adults in post-acute and long-term care (PALTC) settings. However, there is a paucity of exposure to PALTC settings in most NP educational programs. Therefore, the current authors developed an elective graduate certificate in gerontology with an emphasis in PALTC for NP students. The graduate certificate curriculum was developed by faculty with expertise in nursing and gerontology education. The PALTC certificate comprises 15 credit hours of online didactic courses, 80 leadership hours, 200 clinical hours, and a scholarly project dedicated to PALTC. Completion of a graduate certificate in PALTC is a novel model for preparing NP students for practice in PALTC settings. The current article serves as a framework for other programs to reference as they develop individualized graduate certificate PALTC programs in their academic institutions. [Journal of Gerontological Nursing, 45(10), 47-52.].

Navigating the future of gerontology education: curriculum mapping to the AGHE competencies.

The recent adoption of gerontology competencies for undergraduate and graduate education emphasize a need for competency-based education. The purpose of this manuscript is to describe the approach one program took to mapping and aligning courses to the newly adopted Association for Gerontology in Higher Education's (AGHE) competencies in an effort to clarify curriculum needs for a diverse student population, increase the measurability of objectives, and apply for Program of Merit status through AGHE. Assessment of current courses led to mapping objectives to competencies, identifying missing content, and revising courses to reduce knowledge gaps. Barriers and facilitators to this process are examined in an effort to share the implications of one program's competency alignment process.

Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes.

BACKGROUND: Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited. METHODS: In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Trained nurses collected patients' perceptions via structured interview including 9 pain quality indicators, demographic, and clinical variables; these patient experience data were merged with unit and hospital level data. Analyses included geographic mapping; summary statistics and 3-level mixed effects modeling. RESULTS: Hospitals in 45 states and District of Columbia participated. Of 22,293 screened patients, 15,012 were eligible; 82% verbally consented and participated. Pain prevalence was 72%. Participants were 59.4% female; ages ranged from 19 to 90+ (median: 59 y); 27.3% were nonwhite and 6.5% were Hispanic. Pain intensity on average over the past 24 hours was 6.03 (SD=2.45) on a 0-10 scale. 28.5% of patients were in severe pain frequently or constantly. Race (nonwhite), younger age, being female and nonsurgical were associated (P<0.001) with greater pain. Care quality indicators ranking lowest related to discussion of analgesic side effects and use of nonpharmacologic approaches. CONCLUSIONS: Unrelieved pain remains a high-volume problem. Individual factors and unit type were significantly associated with pain outcomes. Hospitals can employ these quality indicators to direct continuous quality improvement targeting pain care quality.

Context Matters for Nurses Leading Pain Improvement in U.S. Hospitals.

BACKGROUND: Pain continues to be a problem in hospitalized patients. Contextual factors contribute to the success of pain quality improvement efforts. AIMS: This paper describes nurse team leaders' perceptions of organizational context and factors perceived to help and hinder the process of leading a unit-based improvement effort focused on pain. DESIGN: Qualitative descriptive design. SETTING: Interviews took place over the telephone. PARTICIPANTS: Nurses from 106 hospitals across the United States. METHODS: Investigators interviewed 125 nurses leading a unit-based pain quality improvement project in partnership with the National Database of Nursing Quality Indicators. Lewin's Field Theory guided a thematic analysis. RESULTS: Key contextual factors related to the amount of change in the health care environment and characteristics of the organization and providers. Helping forces included characteristics of nurses, teamwork, a culture of quality, opportunities for learning, pain management resources, and accountability for pain management. Hindering forces included: barriers to involvement, attitudes and relationships, lack of knowledge, and types of patients. CONCLUSIONS: Overcoming the pervasive barriers of constant change and lack of staff involvement while also capitalizing on the culture of quality and characteristics of the health care team may further enhance and sustain improvement efforts related to pain management of hospitalized patients. New models for influencing quality improvement could be strengthened with involving frontline staff in both planning and implementation of improvement efforts. CLINICAL IMPLICATIONS: Because of the diverse responses, it is recommended that each unit conduct a force-field analysis to guide successful implementation of improvement efforts.

Aging and the Arts Online: Lessons Learned From Course Development and Implementation.

With the recent move toward competency-based gerontology education, incorporating humanities and arts will be necessary for accreditation. This article describes the pedagogical approaches and lessons learned during 5 years of development and implementation of an asynchronous online course in Aging and the Arts. Fifty graduate and undergraduate students participated in the course over five semesters. Discipline diversity increased subsequent to designation as a fine arts general education course. Students expressed appreciation for multimedia resources, an initial fear of creating a wiki, and online redundancy was reduced through increased community engagement that also augmented application in real-world settings. The visual nature of arts and aging lends itself to a compelling and interactive online course experience that can be adapted to synchronous, hybrid, and face-to-face formats. Opportunities for community engaged learning will increase as art programs for older adults become more prevalent.

Altering Nursing Student and Older Adult Attitudes Through a Possible Selves Ethnodrama.

The purpose of this mixed method study is to evaluate the effects of participation in the development and implementation of ethnodrama about possible selves on nursing student attitudes toward older adults and older adult attitudes to aging. Twelve nursing students and 12 older adult long-term care residents collaborated in a transformational learning experience involving interviews on the topic of possible selves culminating in the presentation of an ethnodrama developed from these data. Longitudinal data from student surveys about attitudes toward older adults were analyzed using growth modeling, whereas older adult pre-post data on attitudes toward aging were analyzed with a paired samples t test. Video of group discussions and open-ended feedback on the overall experience were analyzed to provide qualitative understanding of change in student attitudes over time. Although positive overall, student attitudes varied in initial status and rate of change. Students who interacted most frequently with older adults had more neutral attitudes. Older adult attitudes surrounding psychosocial loss improved over the course of the intervention. Normalizing attitudes may be as important as improving attitudes; neutrality may be more representative of realistic perceptions of older adults and late-life potential.

The Development and Validation of the Interprofessional Attitudes Scale: Assessing the Interprofessional Attitudes of Students in the Health Professions.

PURPOSE: No validated tools assess all four competency domains described in the 2011 report Core Competencies for Interprofessional Collaborative Practice (IPEC Report). The purpose of this study was to develop and validate a tool based on the IPEC Report core competency domains that assesses the interprofessional attitudes of students in the health professions. METHOD: In 2012, an interprofessional team of students and two of the authors developed and administered a survey to students from four colleges and schools at the University of Utah Health Sciences Center (Health, Medicine, Nursing, and Pharmacy). The authors randomly split the responses with complete data into two independent subsets: one for exploratory factor analysis (EFA), the other for confirmatory factor analysis (CFA). They performed these analyses to validate the tool, eliminate redundant questions, and identify subscales. Their analyses focused on aligning tool subscales with the IPEC Report core competencies and demonstrating good construct validity and internal consistency reliability. RESULTS: Of 1,549 students invited, 701 (45.3%) responded. The EFA produced a 27-item scale, with five subscales: teamwork, roles, and responsibilities; patient-centeredness; interprofessional biases; diversity and ethics; and community-centeredness (Cronbach alpha coefficients: 0.62 to 0.92). The CFA indicated that the content of the five subscales was consistent with the EFA model. CONCLUSIONS: The Interprofessional Attitudes Scale (IPAS) is a novel tool that, compared with previous assessment instruments, better reflects current thinking about interprofessional competencies. IPAS should prove useful to health sciences institutions committed to training students to work collaboratively in interprofessional teams.

The feasibility of ethnodrama as intervention to highlight late-life potential for nursing students and older adults.

One barrier to the expansion of geriatric health care providers is the limited desire of nursing students to work with older adults. The purpose of this study is to evaluate the feasibility of using ethnodrama as an intervention to highlight late-life potential. Twelve baccalaureate nursing students were paired with 12 residents of an assisted living facility to complete transformative learning activities focused on the topic of late-life potential culminating in a performance of an ethnodrama developed from these data. Transcripts of initial student meetings, self-reflections, the performance, postperformance discussion, and open-ended survey questions were analyzed using in vivo and pattern coding. Older adult participants recognized and emphasized positive late-life potential, whereas students explored potential throughout the life span and reflected on its meaning in their own lives. Increasing discussion about late-life potential may alter the stigma associated with aging.