Purpose: The purpose of this project was to increase early identification of patients with cognitive impairment through use of the mini-cog screening tool.
Method: A literature review compared different screening tools for cognitive impairment. The mini-cog was noted to be a highly reliable, efficient, and evidence-based method for measuring cognitive decline. Collaborative effort between nursing, social work, and neuropsychology disciplines in the North Florida/South Georgia (NFSG) Veterans Health System occurred to develop the process. Nurses can screen, perform, and document during a routine visit with veterans. Primary care RNs and LPNs can complete these tasks, as well as enter a consult to the social worker, if warranted for further testing. The social worker will provide recommendations to the primary care provider. The provider will consult neuropsychology, as indicated, for a comprehensive assessment.
Findings: Phase 1: Four RNs at The Villages VA Outpatient Clinic (TVOPC) piloted the mini-cog in their respective teams. Out of a total of 2,366 veterans, 104 (4%) were screened, results: 30 (29%) failed testing; 13 were seen by the neuropsychologist and 8 (27%) were diagnosed with some form of dementia. Phase 2: During the COVID-19 pandemic the project was implemented clinic-wide and 8,338 veteran visits were seen, results: 15 (0.1%) were screened with the mini-cog, 11 (73%) failed the screening, three of the 11 were assessed by neuropsychology and all three, or 27% were diagnosed with a cognitive deficit.
Discussion: A keynote in improving these outcomes is early recognition of dementia. Educating primary care clinicians on the implementation of the mini-cog will reduce negative outcomes related to cognitive decline. TVOPC has improved the process of cognitive screening by promoting awareness to the clinical staff and patients of the symptoms of cognitive deficits. Early diagnosis of cognitive deficits can lead to early access to resources, medication and treatment, and decision-making for life planning and involvement in healthcare decisions. Implementation of the mini-cog screening tool has proven to be of value in identifying patients with cognitive impairment. Subsequently plans are underway to deploy use of this screening tool throughout the NFSG primary care clinics to enhance health outcomes in this patient population.
Purpose: The study purpose is to recruit and educate baccalaureate nursing students to practice to the full scope of their licensure in community-based primary care settings.
Background/significance: Baccalaureate registered nurses (RNs) are in pivotal positions to expand their practice role in primary care settings. Baccalaureate nursing programs are well positioned to integrate primary care and preventative services in their communities. Primary care nursing is a comprehensive continuum of collaborative care, coordinated sustained relationships, and access and navigation of health services and resources for patients, families, and communities. Thus, the advancing community oriented registered nursing (ACORN) program was proposed to recruit and educate baccalaureate nursing students to practice to the full scope of their licensure in community-based primary care settings.
Methods: The ACORN program was funded through a health resources and services administration grant and launched in July 2018 with select faculty, a community leadership advisory board, and research collaborations. In partnership with the veterans’ administration (VA) in San Antonio, students were placed in their primary care clinics throughout the city. Evaluative measures were focus group interviews, demographic and observational data collection, pre- and post-clinical experience comparisons, preceptor RN surveys, and reflective journaling. An external consultant assisted with the evaluative process.
Results: Three information sessions were held to recruit nursing students who were in their last year of nursing school. A rigorous interview process took place that ensured systematic objectivity and inter-rater reliability. A cohort of 5 nursing students was selected for year 1, 6 for year 2, and 7 for year 3. Students were provided with essential competencies and skill sets in population health, chronic disease prevention and management, team-based leadership and management, clinical judgment and reasoning, and culturally inclusive care coordination. Findings revealed students’ perspectives about primary care and preceptor insights about teaching. The VA served as the foundation for the ACORN program by hiring new graduates to work in their primary care settings.
Conclusions/implications: The ACORN program is an innovative model with a successful pathway for students to renew primary care nursing by generating educated RNs to deliver accessible healthcare services, supporting equity, diversity, and inclusivity for all.
Purpose: Traditionally, bachelor of science in nursing (BSN) curricula provide clinical experiences within the community setting, but not specifically in primary care. At a midwestern university, a 150-hour, two-year, longitudinal primary care clinical experience was added to the curriculum. Funding from the health resources and services administration nurse education, practice, quality, and retention registered nurses in primary care grant supported this rotation. The purpose of this presentation is to discuss BSN students’ reflections regarding the benefits of a primary care clinical immersion experience.
Description: Students were placed in rural, primary care settings and paired with registered nurse (RN) preceptors to perform all aspects of care including telehealth, health education, case management, chronic disease management, care of acute illness, and health promotion. Focus group data was obtained from students each semester. To promote unbiased student responses, participation in the focus groups was voluntary and anonymous, a person unrelated to the clinical experience conducted the focus groups, and no rewards were offered for focus group involvement. Standardized questions regarding the primary care clinical experience were asked. This presentation will focus on the students’ perceived benefits of the primary care experience.
Evaluation/outcome: Several themes emerged regarding the students’ perception of the clinical experience benefits. Students felt there is a big disconnect between primary care and acute care. They identified gaps that frequently occur in healthcare and the potential consequences such as hospitalizations and adverse patient outcomes. Additionally, experience in the primary care setting facilitated student understanding of preventative measures and health promotion education, and its impact on decreasing hospital stays and improving patient outcomes. Relationship building between patients and the healthcare team was another perceived benefit. Students enjoyed observing the invested, caring, long-term relationships between patients and the primary care team, which contrast the brief episodic care provided in the acute setting. Students also gained an appreciation of the RN’s knowledge base and scope of practice in the primary care setting. Furthermore, they reported surprise with the amount of critical thinking that primary care, especially telehealth, requires and felt the experience greatly improved their critical-thinking abilities. Students also enjoyed learning new skill sets and were exposed to many unique primary care experiences. Because of the immersion experience, many students have indicated they would consider pursuing a career in ambulatory care post-graduation. In addition to the recognized benefits of the clinical experience, students also provided valuable, constructive feedback which was utilized to revise and improve the primary care clinical immersion.
Background: Research on engagement has been primarily reported in the business literature, and a single definition for what engagement looks like remains allusive. This lack of a single definition for engagement makes it difficult to measure. We found many definitions and methods of measurement in our review of the literature. However, it is unclear if these studies are truly measuring engagement or if they are capturing some other associated variable, such as work satisfaction or happiness. In addition, while there may be other forms of engagement, such as professional engagement, little has been written or reported on this engagement variation.
Purpose: Thus, the purpose of this project was to develop two new engagement scales (Professional Engagement Behavior Scale [PEBS] and Organizational Engagement Behavior Scale [OEBS]) that attempt to quantify engagement behaviors and explore what engaged nurses look like, rather than what makes nurses satisfied or happy with their career and employment.
Methods: We developed two, single-item scoring tools to calculate a score for professional and organizational engagement behaviors. The engagement behaviors were developed from a review of the literature.
The total number of activities or behaviors in each scale are tabulated and higher scores indicate higher levels of engagement behaviors. Scores are standardized, converting total scores to a t-score (mean = 50, SD = 10) to make comparisons easier.
The Professional Engagement Behavior Scale: We define professional engagement behaviors as acts of independently and autonomously improving ones’ skills and knowledge and sharing this with others through professional service and networking. Thus for this study, professional engagement behaviors include evidence of formal education, professional certification, and networking with peers and experts through membership in a professional organization and attendance at a professional conference, presentations, and publications.
The Organizational Engagement Behavior Scale: We defined organizational engagement behaviors as the act of actively contributing to the betterment of the organization to the best of one’s ability through leadership and participation in organizational activities. Thus for this study, organizational engagement behaviors consisted of accepting a leadership roles in nursing (manager, assistant manager, charge nurse, patient educator, clinical educator, and advanced practice nurse), participating in shared governance (as a committee member, as a project or council chair), attending unit meetings, leading quality improvement or evidence-based projects, and participating on organizational committees.
Findings: Content validity was confirmed by sending out the list of behaviors to four nurses who are actively engaged in clinical practice, and calculating a CVI based upon their assessment. Two revisions were made to achieve a CVI of greater than 0.80. Factor analysis identified only a single component for each of the scale. Preliminary analysis suggests that satisfaction with nursing as a career is highly correlated (r > 0.50) with professional engagement behaviors, and linear regression suggests that professional engagement predicts organizational engagement. Thus, organizations that facilitate nurses’ ability to advance professionally may reap the benefits in the form of more organizational engagement.
Recommendations: We recommend continued testing of these two scales.
Introduction: COPD is one of the leading chronic conditions that result in hospital readmissions (Mihailoff et al., 2017). Evidence suggests that shared medical appointments (SMAs) have potential benefits for improved clinical outcomes and healthcare cost reductions (Kirsh et al., 2017). Telemedicine has value to patients, providers, and organizations for improved care of chronic conditions (AMA, 2020). Implementing SMAs with telemedicine in the format of virtual shared medical appointments (VSMAs) combines these evidenced-based interventions.
Research methodology: A review of the literature was conducted for scholarly peer-reviewed current articles for telemedicine and shared medical visits as healthcare treatment venues for patients with COPD. The literature chosen from reputable databases for this Integrative Review was narrowed to include evidence-based content for motivational interviewing (MI) and health coaching to promote treatment adherence for the prevention of exacerbations. The DNP student search included the databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, EBSCOhost Health Policy Reference Center, PubMed, PubMed Central, ProQuest Central Medline, and Medline complete which resulted in 21,249 articles. Keywords included in the search were telemedicine, shared medical appointments, group medical visits, virtual shared medical appointments, motivational interviewing, health coaching, self-management, social networking, and health-related quality of life using “AND” with Boolean phrases. The Johns Hopkins Research Appraisal Tool was used to appraise articles for the final determination of 15 articles with evidence-based findings for inclusion into this Integrative Review (Dang & Dearholt, 2017).
Results and discussion: VSMAs have positive benefits for convenient patient access, revenue-producing for the organization, self-management skills in group settings for treatment adherence, social networking, and prevention of exacerbations with opportunities for nurse facilitation.
Conclusions: Telemedicine is an effective modality for healthcare delivery. SMAs are an effective intervention of healthcare delivery for chronic diseases. Combining telemedicine with SMAs in the format of VSMAs is an evidence-based intervention for the care of patients with COPD.
Further recommendations: MI is recommended as a tool to implement with VSMAs. MI has been found to promote treatment adherence in patients with COPD (Naderloo et al., 2018). MI implemented within VSMAs, could sustain the prevention of exacerbations requiring ED visits.
References
1) American Medical Association. (2020). Telehealth Implementation Playbook. Retrieved February 12, 2021.from https://www.ama-assn.org/syste...
2) Dang, D., & Dearholt, S. (2018). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (3rd ed.). Sigma Theta Tau International.
3) Kirsh, S. R., Aron, D. C., Johnson, K. D., Santurri, L. E., Stevenson, L. D., Jones, K. R., &Jagosh, J. (2017). A realist review of shared medical appointments: How, for whom, and under what circumstances do they work? BioMed Central Health Services Research, 17(1), 1-13.
4) Mihailoff, M., Deb, S., Lee, J. A., & Lynn, J. (2017). The effects of multiple chronic conditions on adult patient readmissions and hospital finances: a management case study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 54, 0046958017729597.
5) Naderloo, H., Vafadar, Z., Eslaminejad, A., & Ebadi, A. (2018). Effects of Motivational Interviewing on Treatment Adherence among Patients with Chronic Obstructive Pulmonary Disease: a Randomized Controlled Clinical Trial. Tanaffos, 17(4), 241.
Objectives: Discuss the advancement of the CT-guided biopsy of spinal lesions and evaluate the literature and implications for advance practice providers.
Robert and Ball were the first to describe percutaneous biopsy of the spine in 1935. Since that time, the CT-guided biopsy has advanced into an extremely effective procedure. The open surgical method is less favorable due to operative complications, risk of leakage, and contamination to nearby organs and tissues. Spinal lesion is often close to vital organs or can be deeply positioned; therefore, the risk of a biopsy is concerning. Nonetheless, with advances in imaging, especially the CT scan, biopsies once considered in difficulty locations are guided by needle placement using the CT.
The CT-guided biopsy of the spine or vertebra has been found to be a safe, accurate, and efficient procedure for obtaining spinal and paraspinal tissue samples. Another advantage of the CT-guided biopsy is that it is a minimally invasive outpatient procedure with a high-yield tissue diagnosis and it is the best option to an open biopsy. It is also used for the evaluation and management of spinal infections, primary and metastatic lesions of the spine.
Literature review: Katappuram et. al. completed a retrospective reviewed of 75 patients who underwent percutaneous spinal or paraspinal soft tissue biopsies from 1980-1987. Information obtained from the record was based on biopsy location, age, sex, location of the lesion, type of needle used, and imaging modality. Twenty 22/75 of the biopsies were metastatic disease; infection and primary neoplasm make up the additional. The study found a 69/75 accuracy base on needle biopsy and 96% accuracy based on diagnostic category. Metastatic disease had the highest diagnostic yield (96%), and benign, primary and fracture (82%). Females were found to have a better biopsy result than males: 97% vs. 86%. A larger biopsy needle vs. a smaller needle was found to yield a better result: 97% vs. 80 %. Radicular symptoms were the only complication reported in this study, but overall, the complication rate for CT-guided biopsy of the spine is low. In summary, percutaneous need biopsy was found to be safe, accurate, inexpensive, quick, and reliable procedure of diagnosing a variety of spinal lesions (1991).
Implications for the advanced practice provider: With an increase demand for minimally invasive procedure in the outpatient and hospital setting, the role of the interventional radiologist (IR) has increased significantly over the past ten years. This rapid growth, along with challenges in filling IR fellowships, has caused a demand for IR MD. According to Taylor et. al. (2012), this provided an opportunity for allied health professionals including nurse practitioners (NP) and physician assistants (PA) to answer the call of this complex specialty. Since the consultation to IR comes from different services, nurse practitioner s who are not directly employed in the IR can also play a role by coordinating referrals and educating patients on the reason for the procedure, which will promote patient satisfaction and enhance a positive clinic outcome.