Vision Care Access and Interdisciplinary Impact on Quality of Life in Nursing Home Residents

Vision Care Access and Interdisciplinary Impact on Quality of Life in Nursing Home Residents

Abstracts / Journal of Interprofessional Education & Practice 1 (2015) 48e77 modules address concepts relating to communicating with patients, famili...

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Abstracts / Journal of Interprofessional Education & Practice 1 (2015) 48e77

modules address concepts relating to communicating with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a patient-centered, team-based approach to the maintenance of health and the treatment of disease.

Design The four modules address IPEC Core Competencies: a) values and ethics for interprofessional practice; b) roles and responsibilities; c) teams and teamwork; and d) interprofessional communication. Each module presents an unfolding patient case using a series of video vignettes to illustrate the effects of teamwork and communication on care providers, patients, and their support networks. Through these illustrations and other interactive activities, learners are able to reflect on how strategies for interprofessional collaboration and practice can be applied to facilitate quality, patient-centered care. An instructor's resource guide provides suggestions for debriefing and discussion topics. After initial rapid prototyping and ‘alpha' development, the modules were distributed to reviewers for qualitative feedback guided by a worksheet. After incorporating feedback from these reviewers, additional formative evaluation and faculty acceptance testing will be conducted.

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Methods Clinicians and staff at both sites completed a health literacy assessment tool from AHQR's Health Literacy Universal Precautions Toolkit, assessing baseline health literacy levels in four domains: spoken communications, written communications, self management/empowerment and supportive systems. Deficiencies were identified. Assisted by brief instruction, faculty guidance and a Concise Improvement Manual (Cheren) with QI worksheets, students worked on several QI projects. Students completed QI knowledge based questions, pre and post learning experience and self rating QI confidence scales. A QI Scoring Rubric was utilized to evaluate the learners. Faculty evaluated student demonstration of ability to do improvement planning, write an aim statement and conduct a Plan-Do-Act-Cycle using a scoring rubric. Several QI projects were performed by the team of learners. The first project consisted of selection of REALM-R among three health literacy screening instruments for implementation. Of the seventy-one initially screened, 46 percent scored 6 or less indicating a high risk for health literacy. Other projects included creation of a pharmacy resource tool for identifying best access for diabetic medications and supplies as well as providing patients with pill boxes. The nursing students established group visits for diabetic patients. Results The study group of students showed improvement in knowledge of what PDSA stands for but, there was no improvement in the control group. Neither group improved in ability to write an aim statement. Post assessment results of QI knowledge, confidence and skills are pending.

Findings

Discussion/Conclusions

Qualitative reviews (n¼8) collected in the ‘alpha’ phase of development resulted in many constructive comments and suggestions for improving instructional content, organization, assessment questions, interactive activities, and activity feedback presented in the modules. Early formative evaluation efforts have yielded stronger alignment of learning objectives with presented content and assessment items. These revisions were incorporated prior to beginning faculty acceptance testing with nursing faculty volunteers enrolled in the New York City Nursing Education Consortium in Technology (NYCNECT), a faculty development program for teaching and learning with technology.

Teaching interprofessional students in a PCMH clinical environment provides the opportunity for both clinical and educational change. We anticipate improvements in clinical care related to health literacy: in spoken communications due to implementation of routine health literacy screening, improvement in patient self management due to group visits and use of pill boxes and systemic efforts to assist patients with medication adherence. We anticipate improvement in student knowledge of skills in QI.

William A. Monaco OD, MSEd, PhD, FAAO (Dipl), DPNAP.

Next Steps A formative evaluation survey to assess faculty acceptance of these resources has been distributed to nursing faculty enrolled in the NYCNECT faculty development program. Data collection from faculty volunteer reviewers will conclude in February 2015. In March 2015, respondents will be invited to participate in an online focus group to provide additional qualitative feedback on how the resources can be improved. Results from this phase will be reported. QUALITY IMPROVEMENT IN HEALTH INTERPROFESSIONAL TEAM OF LEARNERS

VISION CARE ACCESS AND INTERDISCIPLINARY IMPACT ON QUALITY OF LIFE IN NURSING HOME RESIDENTS

LITERACY

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Background Access to eye care for seniors in nursing homes is a nationwide problem. Visual impairment is a leading cause of disability in the United States. Currently, there are 18,000 nursing homes nationwide with 1.9 million beds and 84% occupancy. The provision of eye care services at these facilities varies from state to state. Most facilities do not have a plan for eye care services for their residents.

Purpose Angela McLean MD, Mary T. Coleman MD, PhD, Khaleehah Hasan RN, Lakeisha Williams Pharm D, Ellen Lee.

Background Two Academic clinical sites from Internal Medicine and Faculty multidisciplinary primary care seek, transformation into a patient centered medical home (PCMH). The sites have established a longitudinal sixteen week experience of interprofessional student care management teams for patients with uncontrolled diabetes. After refection on practice and learning as part of applying the Exemplary care and learning site model, teams identified health literacy as a focus for improvement. This project introduces quality improvement (QI) into clinical practice/learning, focusing on health literacy. Seven interprofessional faculty (nursing, medicine, pharmacy, social work) twenty-five interprofessional learners and forty diabetic patients are participating in the project.

Nursing homes have minimal responsibility for the provision of eye care to residents suffering glaucoma and diabetes. Patients with hypertension, stroke and other systemic ailments have no guidelines assuring patient protection from asymptomatic, high risk catastrophic vision loss. There is financial, resource, and societal “cost” associated with not addressing vision care needs of the elderly e particularly in nursing homes. Those costs include falls and injury, reduced effectiveness of other interventions, as well as cognitive decline. There is a high percentage of people with dementia, and vision impairment only exacerbates those cognitive problems (Elliott 2009). Appropriate and timely vision care results in added benefits to the institution. It has been estimated that 80% or more of all nursing home residents received no eye care after admission into the nursing facility. The creation of a proactive and cooperative inter-professional team approach to senior eye care will optimize quality of life. Results Vision impairment in nursing facilities is 13-15 times more common among institutionalized elderly than non-institutionalized elderly. Therefore, early ocular

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Abstracts / Journal of Interprofessional Education & Practice 1 (2015) 48e77

intervention strategies are crucial and must be supported by facility administrators and families. Family members responsible for medical decision making, physicians, and other health care professionals are not familiar with strategies of establishing eye exam guidelines. It is incumbent upon eye care professionals to partner with health care providers to set eye exam guidelines, and encourage family members to provide active support for the resident to overcome these barriers to personalized healthcare. (Eye Care Data from actual nursing home practice included).

Conclusions The benefits of inter-professional communication and cooperation in the delivery of health care to nursing home residents are obvious. Currently, a major limiting factor preventing access and delivery of eye care to residents are lack of policies that mandate that eye care services be delivered to all residents. If policies are established, a vehicle for inter-professional cooperation would be created that does not currently exist. It is imperative that we establish and enact policies to provide nursing-home residents (including those with cognitive impairments) with regular eye exams and ensure their access to appropriate corrective measures. Better patient care is possible through the creation and implementation of a health care team approach. There is also the added benefit of environmental engineering impacting the person and environment interfacedthat is, better use of contrast (wall and floor colors), reduction of glare, slip hazards, might be proposed to improve function and prevent injury. Better vision might help to avoid the medical errors that occur when people cannot see the medication bottles. THE IMPACT OF COLLABORATIVE SIMULATION ON COMMUNICATION, ROLE PERCEPTION, STUDENT CONFIDENCE, AND TEACHING EFFECTIVENESS Virginia C. Muckler DNP, CRNA.

was used to detect the individual differences for each of the items on the questionnaires. Statistical significance was indicated with a p-value of  0.05. Themes from open-ended survey questions were identified, analyzed, and described that offered insight to research questions.

Results/Findings All participants were enrolled in Duke University programs. Twelve students completed the questionnaires in Fall 2013 simulations (3 male, 9 female, mean age 28 years; students per program represented: 5 SRNA, 4 ABSN, 2 PT, 1 NP; Student degrees held: 10 BSN and 2 MSN). All students wrote reflective comments on the post-simulation questionnaire.

Conclusion/Lessons Learned These findings support existing research that demonstrates interdisciplinary collaborative simulation improves communication, enhances role perception, and increases confidence. Students also perceive the ICS experience to be an effective teaching tool. Thematic analysis further supported these findings. More confident students who better understand their roles as part of a healthcare team and more effectively communicate within that team may lead to improved patient-care team dynamics. Future research is needed to determine if interdisciplinary collaborative simulation benefits students beyond educational experiences into their professional roles. Additional research is also needed to determine how these experiences relate to patient outcomes. A TRAIN THE TRAINER APPROACH TO IPE FACULTY DEVELOPMENT IN APPALACHIA G.L. NarsavageSON/IPE, R. AbrahamSPH, C. DeBiaseSOD, M. StamatakisSOP, S. CottrellSOM, R. UtzmanPT, A. BurtOT, D. Wilks, C. Coole.

Background/Introduction Interdisciplinary collaboration and communication among healthcare providers is essential to safe and effective patient care, yet the majority of provider education remains segregated by discipline, giving students few opportunities to develop necessary teamwork skills. Teamwork skills are often defined in the literature to include the dimensions of respect, coordination, and communication (Valentine, Nembhard, & Edmondson, 2012). One grand example is the team training simulation method technique taught by The American Heart Association for use in cardiopulmonary resuscitation and emergency cardiovascular care (CPR/ECC) (AHA, 2010). The AHA (2010) states that effective communication is a primary objective for resuscitation teams. Simulation training to improve communication has been shown to greatly improve team performance and confidence during a mega-code (Gonzalez et al., 2009; King & Reising, 2011; Wayne et al., 2005). Despite the proven successes of simulation including its success as a teaching method, many healthcare fields appear reluctant to commit to widespread and regular adoption of this technique in interdisciplinary training. Investigators hope to show that early adoption of interdisciplinary collaborative simulation (ICS) during the healthcare education process can support the goals of the IOM and improve patient-care team dynamics.

Purpose (Objectives) The primary aim of this study is to evaluate whether ICS improves clinical communication skills with students in health professions and if participation improves students' understanding of interdisciplinary roles. The secondary aim is to determine whether students who participate in ICS have improved confidence levels and whether they perceive ICS to be a beneficial teaching strategy. Methods/Design A pre-test post-test mixed methods design was used with questionnaires pre and post simulation. Emerging themes were analyzed from simulation post-test questions. A paired-samples t-test using SPSS version 21.0 (SPSS Inc., Chicago, Illinois)

Background The “InterProfessional Education (IPE) in Appalachia Faculty Workshop” was presented on April 30th at West Virginia University (WVU), partially funded by the Josiah Macy, Jr. Foundation ($10,000) with matching funds obtained from the WV Rural Health Institute and the Wes and Natalie Bush IPE foundation endowment. Faculty from a tri-state area attended this workshop to develop interprofessional education curricular activities using a train-theetrainer approach with active participation. The workshop's hands-on format was very much appreciated by the participants and provided an opportunity for our “early-adopter” faculty to be workshop leaders (as train-the trainers) and showcase what they had been developing for IPE. The three speakers, Dr. Barbara Brandt, Dr. Christine Arenson, and Ms. Martha Conrad provided national and regional perspectives on what is working in IPE education. Dr. Arenson and Ms. Conrad's participation in workshops enhanced networking for the future.

Purpose The Workshop objectives were to: Identify methods being used for InterProfessional Education presented by national experts, List different approaches to InterProfessional Education, Discuss the Core Competencies for IPE, Describe methods to enhance IPE, Plan teaching activities for IPE to use with students.

Methods/Design Twenty-three (23) WVU faculty conducted workshops in eight (8) areas to showcase current work on IPE and 6 administrators provided a panel discussion on IPE to showcase current initiatives. The workshop was video-streamed, including presentations by 3 IPE national leaders and can now be seen at http://home.hsc.wvu. edu/interprofessional-education/news/2014/may/video-interprofessionaleducation-(ipe)-in-appalachia-a-faculty-workshop.