Black Americans, hospitalization, and advance care planning: Structural vulnerability in Home Health Value-Based Purchasing.

Skilled home health (HH) is the largest long-term care setting and the fastest-growing site of healthcare in the United States (U.S.). Home Health Value-Based Purchasing (HHVBP) is a structure of Medicare that penalizes U.S. HH agencies for high hospitalization rates. Prior studies have shown inconsistent evidence about associations of race with hospitalization rates in HH. Evidence supports that Black or African Americans are less likely to participate in advance care planning (ACP), or to complete written advance directives, which could affect their potential for hospitalization when nearing end of life. In this quasi-experimental study, we used Medicare administrative datasets, the Weighted Acute Care Services Use Rates (WACSUR) score, and the Advance Care Planning Protocol (ACPP) score to determine whether the proportion of Black HH patients in the U.S. was correlated with acute care use rates and the robustness of agency protocols on ACP. We used primary and secondary data from the U.S. from 2016-2020. We included Medicare-certified HH agencies. Spearman's correlation coefficient was used. We found a statistical trend showing that the greater proportion of Black patients enrolled in a HH agency, the greater tendency to have a high hospitalization rate. Our findings suggest that HHVBP may encourage patient selection and exacerbate health disparities. Our findings support recommendations for alternative measures of quality in HH to include measures of goal-concordant care coordination when patients are denied admission to HH.

Preparing faculty to lead doctor of nursing practice projects: A faculty development pilot project.

Faculty expressed a need to improve knowledge and skills related to leading Doctor of Nursing Practice projects. A mentoring program was designed to provide faculty the skills to increase confidence when leading Doctor of Nursing Practice projects. The program included an assessment of confidence of six key skills. The intervention included didactic and individual experiential learning that coincided with student progression through project courses. Participants' self-identified areas of need included understanding application of translation science, methods, statistical choices, and all phases of analysis. Four of the six elements were improved from baseline, with two statistically significant, Project Analysis (M = 2.05, SD =0.88, p < .041) and Project Dissemination (M = 2.25, SD = 0.89, p < .046). The pilot project was a first step in assessing strategies for educating and mentoring faculty leading Doctor of Nursing Practice projects.

A Qualitative Exploration of Perspectives of Strength among Trauma-Exposed Women Living within Homelessness.

The purpose of this study was to facilitate self-discovery of strengths of women who were homeless and trauma-exposed. Using an emancipatory feminist and existential phenomenological qualitative research design, seventeen women participated in facilitative dialogs exploring perceptions of strength. The dialogue focused on three aspects of strength: characteristics, strategies, and barriers. The participants' words were represented within global themes of strength: balance, protection, and dangerous environments. Results suggest women who are houseless and abused find ways to remain strong as evidenced in their stories. Findings support strength-based discovery, patient engagement, and partnering as a health intervention with vulnerable women.

Improving SBIRT in a nurse-managed clinic serving homeless patients with substance use disorder.

A nurse-managed clinic in Northeast Tennessee that mainly serves unstably housed patients launched a process improvement project to evaluate Screening, Brief Intervention, and Referral to Treatment (SBIRT) implementation and use. These findings could guide future SBIRT efforts among vulnerable groups.

Development of guidelines for improving oral health in individuals with Parkinson's disease.

OBJECTIVE: The purpose of this project was to develop evidence-based clinical practice guidelines (CPGs) for the management of oral health (OH) for patients with Parkinson's disease (PD). BACKGROUND: Individuals with PD have significantly poorer OH than the general population. Poor OH is a risk factor for systemic diseases, including cardiovascular disease, diabetes, and respiratory infections. MATERIALS AND METHODS: After an extensive literature review was completed, available evidence was evaluated for inclusion in the initial draft of the guidelines. The draft was then reviewed for content validity by experts in the areas of dentistry, dental hygiene and neurology using the Delphi method. After consensus among the content experts, final guidelines were completed. The final CPG was presented to individuals with PD and their caregivers at a support group. Participants were asked to review the information in the guidelines for 2 weeks and then submit a survey regarding the usefulness of the CPG. The CPG was also evaluated by practicing nurse practitioners (NPs) and dental hygienists using the AGREE II tool. RESULTS: Twenty people from the PD support group participated in the educational intervention, and surveys were received from 14 participants. Overall, participants agreed or strongly agreed with each statement related to the applicability and usefulness of the guidelines. The CPG was evaluated using the AGREE II tool, and scores were >80% in all domains with an overall score of 97.1%. CONCLUSION: Development of these guidelines represent an initial step in improving the oral health and overall health of individuals with PD.

Confidence of Nursing Personnel in Their Understanding Of the Psychosocial Impact of Prostate Cancer.

Nurses must be equipped with skills to support men diagnosed with prostate cancer. Implementation of a unit-specific, evidence-based education program had significant, positive effects on the confidence of nurses who care for veterans who experience a psychosocial impact of prostate cancer treatment.