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1.
Nurs Clin North Am ; 55(1): 81-95, 2020 03.
Article in English | MEDLINE | ID: mdl-32005368

ABSTRACT

The Veterans Health Administration Home Based Primary Care (VHA-HBPC) program serves Veterans with complex, chronic conditions. Emergency management is a concern for VHA-HBPC programs. Geographic information system (GIS) mapping has been implemented for local program operations in 30 locations. An evaluation assessed GIS mapping as a tool in emergency management, including frontline nurses' and nurse leaders' experiences. Nurses' roles included making and using maps for preparedness and response. Maps provided valuable information, including locations of vulnerable patients (eg, ventilator dependent), community emergency resources, and environmental threats (eg, hurricane). Nurses' willingness to embrace this new technology and skill set was notable.


Subject(s)
Emergency Medical Services/organization & administration , Emergency Nursing/organization & administration , Geographic Information Systems , Home Care Services/organization & administration , Military Medicine/organization & administration , Nurse's Role , Veterans , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Primary Health Care/organization & administration , United States
2.
Geriatr Nurs ; 41(3): 282-289, 2020.
Article in English | MEDLINE | ID: mdl-31757414

ABSTRACT

The Veteran's Health Administration (VHA) Home Based Primary Care (HBPC) program provides comprehensive in-home primary care services to elderly Veterans with complex chronic medical conditions. Nurses have prominent roles in HBPC including as program leaders, primary care providers and nurses who make home visits. Delivery of primary care services to patients in their homes can be challenging due to travel distances, difficult terrain, traffic, and adverse weather. Mapmaking with geographic information systems (GIS) can support optimization of resource utilization, travel efficiency, program capacity, and management during normal operations, and patient safety during disasters. This paper reports on the feasibility, acceptability and outcomes of an initiative to implement GIS mapmaking in VHA HBPC programs. A mixed method evaluation assessed extent of adoption and identified facilitators and barriers to uptake. Results indicate that GIS mapping in VHA HBPC is feasible and can increase effectiveness and efficiency of VHA HBPC nurses.


Subject(s)
Geographic Information Systems , Health Personnel/organization & administration , Home Care Services/organization & administration , Primary Health Care/organization & administration , Quality Improvement , Aged , Chronic Disease/therapy , Feasibility Studies , Female , Health Personnel/trends , Humans , Interviews as Topic , Program Evaluation , United States , United States Department of Veterans Affairs , Veterans/psychology
3.
Transl Behav Med ; 8(3): 419-428, 2018 05 23.
Article in English | MEDLINE | ID: mdl-29800406

ABSTRACT

Coordinating care between Veterans Health Administration (VA) and community providers is essential for providing high-quality comprehensive maternity care to women veterans, particularly those with chronic medical or mental health issues. We iteratively developed and assessed feasibility, as well as facilitators and barriers, of implementing the VA Maternity Care Coordinator Telephone Care Program, and identified specific health needs of pregnant women Veterans served by the program. We used three Plan-Do-Study-Act cycles. The final program consisted of materials supporting seven structured phone calls spanning initiation of pregnancy care through six weeks postpartum. We used logs to measure veteran uptake and surveys and field notes to capture care-coordinator perceptions about potential program value and facilitators and barriers to implementing it. We conducted a medical record review assessing pregnant veterans' need for coordination of services for physical and mental health problems and health behaviors. Veterans' uptake was 60%. Implementation facilitators included conducting training sessions for program coordinators and tailoring materials to address differences across VA facilities. Implementation barriers included limited information and communication technology tools to support the program and lack of coordinator time for delivering the telephone care. Among 244 pregnant veterans, 41% had pre-pregnancy chronic physical problem(s); 34% mental health problem(s); 18% actively or recently smoked. Implementation of a telephone-based care coordination program for pregnant veterans was feasible. Effective program spread required tailoring for local variations in resources and processes, investing in information and communication technology tools and allocating coordinator time to deliver care. Pregnant women veterans have a substantial burden of physical health, mental health, and risky health behaviors needing care coordination.


Subject(s)
Maternal Health Services , Telemedicine/methods , Veterans , Attitude of Health Personnel , Female , Humans , Pregnancy , Pregnancy Complications/therapy , Telephone , United States , United States Department of Veterans Affairs
4.
Nurs Adm Q ; 41(2): 112-117, 2017.
Article in English | MEDLINE | ID: mdl-28263268

ABSTRACT

This article provides an update on the progress of the "Call to Action: Nurses as Leaders in Disaster Preparedness and Response." A steering committee, initiated, directed, and supported by the Veterans Emergency Management Evaluation Center of the US Department of Veterans Affairs, has undertaken the work of bringing together subject matter experts to develop a vision for the future of disaster nursing. The ultimate goal is to ensure that every nurse is a prepared nurse. As one result of this work, the Society for the Advancement of Disaster Nursing has held its inaugural meeting in December 2016.


Subject(s)
Civil Defense/standards , Disaster Planning/standards , Guidelines as Topic , Leadership , Nurse's Role , Public Health Nursing/organization & administration , Cooperative Behavior , Delphi Technique , Humans , Pilot Projects , United States , United States Department of Veterans Affairs
5.
Subst Use Misuse ; 44(14): 2114-37, 2009.
Article in English | MEDLINE | ID: mdl-20001698

ABSTRACT

We designed a patient-centered smoking cessation program for women in 2004/2005, incorporating women's preferences and expert opinion. Our four-step process included: (1) concept-development focus groups; (2) an expert panel; (3) concept-testing focus groups, and (4) a pilot study. Data analyses occurred in 2004-2007. The new program offered options: the traditional Veterans Health Administration (VA) male-dominated program was the least selected option in the pilot study. Patients can be effectively involved in program development. The study's implications and limitations are noted. This research (conducted in Los Angeles, California) was funded by the American Legacy Foundation with additional VA support.


Subject(s)
Expert Testimony , Health Promotion/methods , Patient Preference , Program Development/methods , Smoking Cessation/methods , Women's Health Services , Female , Focus Groups , Humans , Patient Education as Topic , Pilot Projects , United States , United States Department of Veterans Affairs , Veterans
6.
Subst Use Misuse ; 43(8-9): 1240-59, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18649241

ABSTRACT

We used a consumer-driven approach to develop a model smoking-cessation program for women. Four focus groups (N = 23 [5-7/group]), each lasting 2 hours, were led by a professional moderator and audiotaped in 2004. Researchers reviewed transcripts; key themes were identified using scrutiny techniques (Ryan and Bernard, 2003). Necessary elements of a smoking-cessation program for women included support and choice (i.e., control over the program components), suggesting the need for an individualized program. Identifying appropriate components is a critical step in the development of efficacious programs that target substance-abusing populations; focus group methodology is useful in this endeavor. The study's implications and limitations are noted.


Subject(s)
Community Participation/methods , Focus Groups/methods , Program Development/methods , Smoking Cessation/methods , Smoking Prevention , Women's Health , Adult , Aged , Ambulatory Care/methods , Female , Health Promotion/methods , Humans , Middle Aged , Motivation , Sex Factors , Smoking/epidemiology , Smoking/psychology , Social Support , Tape Recording , United States/epidemiology , United States Department of Veterans Affairs/organization & administration , Veterans/psychology
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