WorldWideScience

Sample records for veterans administration nursing

  1. Building capacity for the conduct of nursing research at a Veterans Administration hospital.

    Science.gov (United States)

    Phelan, Cynthia H; Schumacher, Sandra; Roiland, Rachel; Royer, Heather; Roberts, Tonya

    2015-05-01

    Evidence is the bedrock of nursing practice, and nursing research is the key source for this evidence. In this article, we draw distinctions between the use and the conduct of nursing research and provide a perspective for how the conduct of nursing research in a Veterans Administration hospital can build an organization's capacity for nursing research.

  2. Veterans Health Administration

    Science.gov (United States)

    ... code here VA » Veterans Health Administration Veterans Health Administration Veterans – Here's how to Avoid Getting the Flu ... Read more » VA Medical Centers The Veterans Health Administration is home to the United States’ largest integrated ...

  3. The Clinical Nurse Leader: impact on practice outcomes in the Veterans Health Administration.

    Science.gov (United States)

    Ott, Karen M; Haddock, K Sue; Fox, Sandra E; Shinn, Julie K; Walters, Sandra E; Hardin, James W; Durand, Kerri; Harris, James L

    2009-01-01

    The Clinical Nurse Leader (CNL) role was designed to meet an identified need for expert clinical leadership at the point of care. The Veterans Health Administration (VHA) became early adopters of the CNL role, foreseeing the value of this pivotal clinical leader at the point of care to meet the complex health care needs of America's veterans and shape health care delivery. Impact data were collected and assimilated from seven Veterans Administration Medical Centers to support how CNLs impact the delivery of quality and safe patient care and how practice changes could be sustained. Data collection and analyses resulted in many lessons learned. The new CNL role was implemented in a variety of settings in the VHA system. Integration of the CNL role in all areas of practice in every care setting has the promise of streamlining coordination of care for veterans across all spectrums in the provision of care.

  4. Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration.

    Science.gov (United States)

    Miller, Edward Alan; Gidmark, Stefanie; Gadbois, Emily; Rudolph, James L; Intrator, Orna

    2017-06-21

    Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA). Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs). VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans' homes and families was a major factor in NH choice. Other key considerations included Veterans' specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making. Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.

  5. A prism of excellence: The Charleston Veterans Administration Nursing Academic Partnership.

    Science.gov (United States)

    Coxe, D Nicole; Conner, Brian T; Lauerer, Joy; Skipper, Janice; York, Janet; Fraggos, Mary; Stuart, Gail W

    2016-01-01

    The Veterans Administration (VA) has been committed to academic affiliate training partnerships for nearly 70 years in efforts to enhance veteran-centric health care. One such effort, the VA Nursing Academy (VANA) program, was developed in 2007 in response to the nationwide nursing shortage and began as a five-year pilot with funding competitively awarded to 15 partnerships between local VA medical centers and schools of nursing. The VANA program evolved into the VA Nursing Academic Partnership (VANAP) program following the initial pilot. This article describes the development and evolution of the Charleston VANAP, which includes the Ralph H Johnson VA Medical Center (RHJ VAMC) and the Medical University of South Carolina College of Nursing (MUSC CON). The VA Office of Academic Affiliations (OAA) funded a large portion of the initial five years of the Charleston VANAP. Once the national funding source ceased, the RHJ VAMC and the MUSC CON entered into a Memorandum of Understanding (MOU) to offer in-kind contributions to the partnership. The Charleston VANAP is the only program in the nation to offer three different nurse trainee programs and this article highlights some of the more notable achievements from each program. The Charleston VANAP is a comprehensive partnership between the RHJ VAMC and the MUSC CON that truly demonstrates a commitment to assure that the very best care be provided to Veterans, our Nation's heroes. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Reflections of the Veterans Administration Puget Sound Health Care System Regional Nurse Practitioner Residency Forum.

    Science.gov (United States)

    Brown, Kameka; Poppe, Anne; Kaminetzky, Catherine P; Wipf, Joyce A; Woods, Nancy Fugate

    2016-01-01

    There is a proliferation of advanced practice residency programs. However, there is no uniform model of developing and evaluating program success. An information forum was convened by Veterans Health Administration Puget Sound Health Care System's Center for Primary Care Education on September 17, 2013, in Seattle, Washington, to explore critical aspects of residency models. The three objectives of this forum were to develop a shared understanding of key elements needed to support nurse practitioner residencies; define the unique needs of nurse practitioner trainees who are interested in applying for a residency; and examine the viability of designing a replicable nurse practitioner residency model benchmarking stakeholder best practices. This article describes the organization of the forum and summarizes the presentations during the program. The companion article explores key recommendations from the forum related to future development of residency "toolkits" to aid in future evaluation and accreditation. As nurse practitioner residencies continue to develop and evolve, more is needed in the area of structure and alignment. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

  7. Veterans Administration Databases

    Science.gov (United States)

    The Veterans Administration Information Resource Center provides database and informatics experts, customer service, expert advice, information products, and web technology to VA researchers and others.

  8. Veterans Health Administration (VHA)

    Data.gov (United States)

    Social Security Administration — The purpose of this agreement is for SSA to verify SSNs and other identifying information for the Department of Veterans Affairs, VHA. DVA will use the information...

  9. The Department of Veterans Health Administration Office of Nursing Service, "transforming nursing in a national healthcare system: an example of transformation in action".

    Science.gov (United States)

    Wertenberger, Sydney; Chapman, Kathleen M; Wright-Brown, Salena

    2011-01-01

    The Department of Veterans Health Administration Office of Nursing Service has embarked on a multiyear transformational process, an example of which is the development of an organization-wide nursing handbook. The development of this handbook offered the opportunity to improve collaboration, redefine expectations and behavior, as well as prepare for the future of Nursing within the Veterans Health Administration. The lessons learned from this process have revolved around the themes of leadership skills for managing high-level change often in a virtual environment; constant collaboration; that the practice of nursing will continue to evolve on the basis of new evidence, technology, customer expectations, and resources; and that the process to accomplish this goal is powerful.

  10. Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

    Science.gov (United States)

    Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

    2011-01-01

    Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123

  11. Executive Competencies of Nurses within the Veterans Health Administration: Comparison of Current and Future Nurse Executive Views

    National Research Council Canada - National Science Library

    Sutto, Natalie B

    2006-01-01

    ...). Using the Delphi method for executive decision-making, 144 current nurse executives, as well as 168 nurses identified for potential selection to this position, judged the relative importance of SKAs...

  12. VA Pipeline for Future Nurse Leaders: an Exploration of Current Nurse Leadership Development in the Veteran’s Health Administration

    Science.gov (United States)

    2016-06-10

    Administration Mentor, and David Austin, VA Learning University. This thesis is dedicated to my wonderful daughters , Sheila Marie and Sarah Jane, whose love has...and best friend, Stephanie, thank you all for your support with all the challenges along the way. Thanks to you for being there for my daughters ...as life happened, when I couldn’t be while I attended CGSC at Fort Leavenworth in Kansas. Thank you to my earthly fathers , Douglas and Rudy, for their

  13. 78 FR 59769 - Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2013-09-27

    ... AFFAIRS Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...) of 1995 (44 U.S.C. 3501-21), this notice announces that the Veterans Benefits Administration (VBA...-0782.'' SUPPLEMENTARY INFORMATION: Title: Veterans Benefits Administration (VBA) Voice of the Veteran...

  14. 76 FR 20823 - Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2011-04-13

    ... AFFAIRS Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV... U.S.C. 3501-21), this notice announces that the Veterans Benefits Administration (VBA), Department... INFORMATION: Title: Veterans Benefits Administration (VBA) Voice of the Veteran (VOV) Pilot Surveys. a...

  15. 76 FR 4152 - Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2011-01-24

    ... AFFAIRS Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV... Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of... application and servicing processes for the VBA Compensation and Pension (C&P) Service, Education (EDU...

  16. 78 FR 37278 - Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2013-06-20

    ... AFFAIRS Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV... Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of... application and servicing processes for the VBA Compensation Service (CS), Pension Service (P&F), Education...

  17. 32 CFR 644.405 - Transfers to Veterans Administration.

    Science.gov (United States)

    2010-07-01

    ... Transfers to Veterans Administration. 38 U.S.C. 5003 authorizes the Secretaries of the military departments to transfer, without reimbursement, to the Veterans Administration, facilities, supplies, equipment... 32 National Defense 4 2010-07-01 2010-07-01 true Transfers to Veterans Administration. 644.405...

  18. Veterans Health Administration: Actions Needed to Better Recruit and Retain Clinical and Administrative Staff

    Science.gov (United States)

    2017-03-22

    VETERANS HEALTH ADMINISTRATION Actions Needed to Better Recruit and Retain Clinical and Administrative Staff Statement of...the Subcommittee on Health, Committee on Veterans’ Affairs, House of Representatives. March 22, 2017 VETERANS HEALTH ADMINISTRATION Actions...Needed to Better Recruit and Retain Clinical and Administrative Staff What GAO Found Challenges in recruiting and retaining both clinical and human

  19. Innovating Traditional Nursing Administration Challenges.

    Science.gov (United States)

    Joseph, M Lindell; Fowler, Debra

    2016-03-01

    The evolving and complex practice environment calls for new mindsets among nurse leaders, academics, and nurse innovators to envision innovative ways to manage and optimize traditional tasks and processes in nursing administration. The purpose of this article is to present 3 case studies that used linear programming and simulation to innovate staffing enterprises, financial management of healthcare systems, and curricula development.

  20. Distance to Veterans Administration Medical Centers as a Barrier to Specialty Care for Homeless Women Veterans.

    Science.gov (United States)

    Gawron, Lori M; Pettey, Warren B P; Redd, Andrew M; Suo, Ying; Gundlapalli, Adi V

    2017-01-01

    Homeless women Veterans have a high prevalence of chronic mental and physical conditions that necessitate frequent healthcare visits, but travel burdens to specialty services may be overwhelming to navigate for this population, especially for those in rural settings. Access to specialty care is a key priority in the Veterans Health Administration (VHA) and understanding the geographic distribution and rural designation of this population in relation to medical centers (VAMC) can assist in care coordination. We identified 41,747 women Veterans age 18-44y with administrative evidence of homelessness in the VHA anytime during 2002-2015. We found 7% live in rural settings and 29% live >40miles from a VAMC. The mean travel distance for homeless women Veterans with a rural designation to a VAMC specialty center was 107 miles. Developing interventions to overcome this travel burden and engage vulnerable Veterans in necessary care can improve overall health outcomes for this high-risk population.

  1. Organization of nursing and quality of care for veterans at the end of life.

    Science.gov (United States)

    Kutney-Lee, Ann; Brennan, Caitlin W; Meterko, Mark; Ersek, Mary

    2015-03-01

    The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. To examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities. Secondary analysis of linked data from the Bereaved Family Survey (BFS), electronic medical record, administrative data, and the VA Nursing Outcomes Database. The sample included 4908 veterans who died in one of 116 VA acute care facilities nationally between October 2010 and September 2011. Unadjusted and adjusted generalized estimating equations were used to examine associations between nursing and BFS outcomes. BFS respondents were 17% more likely to give an excellent overall rating of the quality of EOL care received by the veteran in facilities with better nurse work environments (P ≤ 0.05). The nurse work environment also was a significant predictor of providers listening to concerns and providing desired treatments. Nurse staffing was significantly associated with an excellent overall rating, alerting of the family before death, attention to personal care needs, and the provision of emotional support after the patient's death. Improvement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL. Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.

  2. Gender disparities in Veterans Health Administration care: importance of accounting for veteran status.

    Science.gov (United States)

    Frayne, Susan M; Yano, Elizabeth M; Nguyen, Vu Q; Yu, Wei; Ananth, Lakshmi; Chiu, Victor Y; Phibbs, Ciaran S

    2008-05-01

    In an effort to assess and reduce gender-related quality gaps, the Veterans Health Administration (VHA) has promoted gender-based research. Historically, such appraisals have often relied on secondary databases, with little attention to methodological implications of the fact that VHA provides care to some nonveteran patients. To determine whether conclusions about gender differences in utilization and cost of VHA care change after accounting for veteran status. Cross-sectional. All users of VHA in 2002 (N = 4,429,414). Veteran status, outpatient/inpatient utilization and cost, from centralized 2002 administrative files. Nonveterans accounted for 50.7% of women (the majority employees) but only 3.0% of men. Among all users, outpatient and inpatient utilization and cost were far lower in women than in men, but in the veteran subgroup these differences decreased substantially or, in the case of use and cost of outpatient care, reversed. Utilization and cost were very low among women employees; women spouses of fully disabled veterans had utilization and costs similar to those of women veterans. By gender, nonveterans represent a higher proportion of women than of men in VHA, and some large nonveteran groups have low utilization and costs; therefore, conclusions about gender disparities change substantially when veteran status is taken into account. Researchers seeking to characterize gender disparities in VHA care should address this methodological issue, to minimize risk of underestimating health care needs of women veterans and other women eligible for primary care services.

  3. A Core Course on Veterans' Health in an Online RN to BSN Program: Preparing Nurses to Work with Veterans

    Science.gov (United States)

    Keavney, Elaine C.

    2015-01-01

    The Joining Forces Initiative challenges nursing programs throughout the country to develop curriculum that addresses the unique healthcare issues facing veterans. It is imperative that Bachelor of Science in Nursing (BSN) students acquire the knowledge that will help them to care for veterans in all areas of nursing practice. This article…

  4. Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan veterans.

    Science.gov (United States)

    Blackstock, Oni J; Haskell, Sally G; Brandt, Cynthia A; Desai, Rani A

    2012-04-01

    Female Veterans comprise 12% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the largest proportion of women to serve of any prior cohort. We sought to determine the sex-specific risk of using a Veterans Health Administration (VHA) homeless program among OEF/OIF Veterans and to identify factors associated with increased risk of program use for women compared with men. We included OEF/OIF Veterans with at least 1 VHA clinical visit between October 1, 2001, and September 30, 2009. The study's outcome was the time to first use of a VHA homeless program. Cox proportional-hazards regression was used to estimate the relative risk of using a homeless program by sex, adjusting for relevant sociodemographic and clinical variables. Exploratory analyses examined interactions between sex and all covariates. Of 445,319 Veterans, 7431 (1.7%) used a VHA homeless program, of which 961 were females (1.8%), and 6470 were males (1.7%) during a median follow-up period of 3.20 years. Women were as likely as men to use a homeless program (adjusted hazard ratio, 1.02; 95% confidence interval, 0.95-1.09); median time to first use was similar for female and male Veterans (1.88 vs. 1.88 y, respectively, P=0.53). In exploratory analyses, we found increased risk of program use for women compared with men for the following subgroups: ages 26-35 years, 100% service-connected disability rating, posttraumatic stress disorder diagnosis, and northeast location. Overall, there was no substantial difference in the sex-specific risk of using a VHA homeless program. In light of this finding, VHA homeless programs must be prepared to recognize and address the unique needs of female OEF/OIF Veterans.

  5. Veterans health administration vocational services for operation iraqi freedom/operation enduring freedom veterans with mental health conditions

    OpenAIRE

    Elizabeth W. Twamley, PhD; Dewleen G. Baker, MD; Sonya B. Norman, PhD; James O. E. Pittman, MSW; James B. Lohr, MD; Sandra G. Resnick, PhD

    2013-01-01

    High rates of mental health conditions and unemployment are significant problems facing Veterans of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). We examined two national Veterans Health Administration (VHA) databases from fiscal years 2008–2009: a larger database (n = 75,607) of OIF/OEF Veterans with posttraumatic stress disorder, depression, substance use disorder, or traumatic brain injury (TBI) and a smaller subset (n = 1,010) of those Veterans whose employment was tracked...

  6. Modeling veterans healthcare administration disclosure processes :

    Energy Technology Data Exchange (ETDEWEB)

    Beyeler, Walter E; DeMenno, Mercy B.; Finley, Patrick D.

    2013-09-01

    As with other large healthcare organizations, medical adverse events at the Department of Veterans Affairs (VA) facilities can expose patients to unforeseen negative risks. VHA leadership recognizes that properly handled disclosure of adverse events can minimize potential harm to patients and negative consequences for the effective functioning of the organization. The work documented here seeks to help improve the disclosure process by situating it within the broader theoretical framework of issues management, and to identify opportunities for process improvement through modeling disclosure and reactions to disclosure. The computational model will allow a variety of disclosure actions to be tested across a range of incident scenarios. Our conceptual model will be refined in collaboration with domain experts, especially by continuing to draw on insights from VA Study of the Communication of Adverse Large-Scale Events (SCALE) project researchers.

  7. Evaluating the Veterans Health Administration's Staffing Methodology Model: A Reliable Approach.

    Science.gov (United States)

    Taylor, Beth; Yankey, Nicholas; Robinson, Claire; Annis, Ann; Haddock, Kathleen S; Alt-White, Anna; Krein, Sarah L; Sales, Anne

    2015-01-01

    All Veterans Health Administration facilities have been mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel. A multi-step process was designed to lead to projection of full-time equivalent employees required for safe and effective care across all inpatient units. These projections were intended to develop appropriate budgets for each facility. While staffing levels can be increased, even in facilities subject to budget and personnel caps, doing so requires considerable commitment at all levels of the facility. This commitment must come from front-line nursing personnel to senior leadership, not only in nursing and patient care services, but throughout the hospital. Learning to interpret and rely on data requires a considerable shift in thinking for many facilities, which have relied on historical levels to budget for staffing, but which does not take into account the dynamic character of nursing units and patient need.

  8. Barriers and facilitators to Veterans Administration collaboration with community providers: the Lodge Project for homeless veterans.

    Science.gov (United States)

    Cretzmeyer, Margaret; Moeckli, Jane; Liu, William Ming

    2014-01-01

    Since 2009, the U.S. Veterans Administration has made concentrated efforts to end homelessness among veterans. As part of these efforts, the Iowa City, Iowa, VA Health Care System in collaboration with local community providers deployed a supportive housing program aimed at homeless veterans. Called the Lodge program, it is intended to serve a Mid-Western mid-size city and its surrounding rural communities. This article presents qualitative findings from a mixed-method, two-year formative evaluation of the Lodge's implementation. Primary barriers to the effectiveness of the Lodge program were regulations hindering cooperation between service programs, followed by problems regarding information sharing and client substance abuse. Facilitators included personal communication and cooperation between individuals within and among service groups. The feasibility of implementing a Lodge program in a more rural community than Iowa City was also discussed.

  9. National Cemetery Administration Summary of Veteran and Non-Veteran Interments: FY2000 to FY2012

    Data.gov (United States)

    Department of Veterans Affairs — Total Veteran and Non-Veteran Interments at National Cemetery, and shown by Interment Type of Casket or Cremain, FY2000 to FY2012. Non-Veteran includes dependents,...

  10. Quality control circles in the Veterans Administration hospital.

    Science.gov (United States)

    Canel, Cem; Kadipasaoglu, Sukran

    2002-01-01

    In response to residents' reports of inefficiencies in the Veterans Administration (VA) system, a temporary task force of quality control circles was implemented at a VA hospital. A total of 25 internal medicine residents, on rotation at the VA, were subdivided into four groups. Each group was presented with a different problem, given the components and constraints of the problem, and asked to identify possible solutions. Program results were submitted to the hospital administration. Efforts are now being made to improve the working environment for medical residents.

  11. Community Nursing Home (CNH)

    Data.gov (United States)

    Department of Veterans Affairs — The Community Nursing Home (CNH) database contains a list of all Community Nursing Home facilities under local contract to Veterans Health Administration (VHA). CNH...

  12. 77 FR 64386 - Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State...

    Science.gov (United States)

    2012-10-19

    ... AFFAIRS Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes) Under OMB Review AGENCY: Veterans Health... day health services care to Veterans. VA requires facilities providing nursing home and adult day...

  13. 78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2013-07-31

    ... AFFAIRS Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes): Comment Request AGENCY: Veterans Health... home and adult day health services care to Veterans. VA requires facilities providing nursing home and...

  14. 78 FR 48543 - Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per...

    Science.gov (United States)

    2013-08-08

    ... AFFAIRS Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per... continue to deliver services to the homeless Special Need veteran population as outlined in their FY 2009.... Quarles, Director, VA's Homeless Providers GPD Program, Department of Veterans Affairs, 10770 N. 46th...

  15. Comparison between Heads of Nursing and Nursing Administration Students in the Sultanate of Oman regarding Education for Nurse Administrators

    OpenAIRE

    Gillian White

    2012-01-01

    Objective: To explore the future of nursing administration in preparation for a major review of the current curriculum in the one-year diploma in nursing administration at the Oman Specialized Nursing Institute (OSNI). Methods: A two-part study explored 1) requisite roles, skills and competencies of the nurse administrator, 2) a leadership profile with two convenience samples: heads of nursing and nursing administration students. Each part was analysed separately; the two groups were then com...

  16. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Science.gov (United States)

    2010-07-01

    ... projection of demand for nursing home and domiciliary care by veterans who at such time are 65 years of age... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Maximum number of nursing... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans...

  17. Universal screening for homelessness and risk for homelessness in the Veterans Health Administration.

    Science.gov (United States)

    Montgomery, Ann Elizabeth; Fargo, Jamison D; Byrne, Thomas H; Kane, Vincent R; Culhane, Dennis P

    2013-12-01

    We examined data for all veterans who completed the Veterans Health Administration's national homelessness screening instrument between October 1, 2012, and January 10, 2013. Among veterans who were not engaged with the US Department of Veterans Affairs homeless system and presented for primary care services, the prevalence of recent housing instability or homelessness was 0.9% and homelessness risk was 1.2%. Future research will refine outreach strategies, targeting of prevention resources, and development of novel interventions.

  18. Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care.

    Science.gov (United States)

    Kimerling, Rachel; Iverson, Katherine M; Dichter, Melissa E; Rodriguez, Allison L; Wong, Ava; Pavao, Joanne

    2016-08-01

    The objectives of this study were to identify the prevalence of past-year intimate partner violence (IPV) among women Veterans utilizing Veterans Health Administration (VHA) primary care, and to document associated demographic, military, and primary care characteristics. This was a retrospective cohort design, where participants completed a telephone survey in 2012 (84% participation rate); responses were linked to VHA administrative data for utilization in the year prior to the survey. A national stratified random sample of 6,287 women Veteran VHA primary care users participated in the study. Past-year IPV was assessed using the HARK screening tool. Self-report items and scales assessed demographic and military characteristics. Primary care characteristics were assessed via self-report and VHA administrative data. The prevalence of past-year IPV among women Veterans was 18.5% (se = 0.5%), with higher rates (22.2% - 25.5%) among women up to age 55. Other demographic correlates included indicators of economic hardship, lesbian or bisexual orientation, and being a parent/guardian of a child less than 18 years old. Military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of Military Sexual Trauma (MST). Most (77.3%, se = 1.2%) women who experienced IPV identified a VHA provider as their usual provider. Compared with women who did not report past-year IPV, women who reported IPV had more primary care visits, yet experienced lower continuity of care across providers. The high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VHA as a source of health care, reinforces the importance of screening all women for IPV in VHA primary care settings. Key considerations for service implementation include sensitivity with respect to sexual orientation, race/ethnicity, and other aspects of diversity, as well as care coordination and linkages with social

  19. The effect of health information technology implementation in Veterans Health Administration hospitals on patient outcomes.

    Science.gov (United States)

    Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

    2014-03-01

    The impact of health information technology (HIT) in hospitals is dependent in large part on how it is used by nurses. This study examines the impact of HIT on the quality of care in hospitals in the Veterans Health Administration (VA), focusing on nurse-sensitive outcomes from 1995 to 2005. Data were obtained from VA databases and original data collection. Fixed-effects Poisson regression was used, with the dependent variables measured using the Agency for Healthcare Research and Quality Inpatient Quality Indicators and Patient Safety Indicators software. Dummy variables indicated when each facility began and completed implementation of each type of HIT. Other explanatory variables included hospital volume, patient characteristics, nurse characteristics, and a quadratic time trend. The start of computerized patient record implementation was associated with significantly lower mortality for two diagnoses but significantly higher pressure ulcer rates, and full implementation was associated with significantly more hospital-acquired infections. The start of bar-code medication administration implementation was linked to significantly lower mortality for one diagnosis, but full implementation was not linked to any change in patient outcomes. The commencement of HIT implementation had mixed effects on patient outcomes, and the completion of implementation had little or no effect on outcomes. This longitudinal study provides little support for the perception of VA staff and leaders that HIT has improved mortality rates or nurse-sensitive patient outcomes. Future research should examine patient outcomes associated with specific care processes affected by HIT. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Ensuring Appropriate Care for LGBT Veterans in the Veterans Health Administration.

    Science.gov (United States)

    Sharpe, Virginia Ashby; Uchendu, Uchenna S

    2014-09-01

    Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same-sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of "spouse," "parent," or "family." Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the "Don't Ask, Don't Tell" policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long-standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging. The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that "[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation." To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. © 2014 by The Hastings Center.

  1. Mapping the literature of nursing administration.

    Science.gov (United States)

    Galganski, Carol J

    2006-04-01

    As part of Phase I of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies the core literature cited in nursing administration and the indexing services that provide access to the core journals. The results of this study will assist librarians and end users searching for information related to this nursing discipline, as well as database producers who might consider adding specific titles to their indexing services. Using the common methodology described in the overview article, five source journals for nursing administration were identified and selected for citation analysis over a three-year period, 1996 to 1998, to identify the most frequently cited titles according to Bradford's Law of Scattering. From this core of most productive journal titles, the bibliographic databases that provide the best access to these titles were identified. Results reveal that nursing administration literature relies most heavily on journal articles and on those titles identified as core nursing administrative titles. When the indexing coverage of nine services is compared, PubMed/MEDLINE and CINAHL provide the most comprehensive coverage of this nursing discipline. No one indexing service adequately covers this nursing discipline. Researchers needing comprehensive coverage in this area must search more than one database to effectively research their projects. While PubMed/MEDLINE and CINAHL provide more coverage for this discipline than the other indexing services, none is sufficiently broad in scope to provide indexing of nursing, health care management, and medical literature in a single file. Nurse administrators using the literature to research current work issues need to review not only the nursing titles covered by CINAHL but should also include the major weekly medical titles, core titles in health care administration, and general business sources if they wish to

  2. Mapping the literature of nursing administration

    OpenAIRE

    Galganski, Carol J.

    2006-01-01

    Objectives: As part of Phase I of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies the core literature cited in nursing administration and the indexing services that provide access to the core journals. The results of this study will assist librarians and end users searching for information related to this nursing discipline, as well as database producers who might consider adding...

  3. Comparison between heads of nursing and Nursing Administration students in the Sultanate of Oman regarding education for nurse administrators.

    Science.gov (United States)

    White, Gillian

    2012-08-01

    To explore the future of nursing administration in preparation for a major review of the current curriculum in the one-year diploma in nursing administration at the Oman Specialized Nursing Institute (OSNI). A two-part study explored 1) requisite roles, skills and competencies of the nurse administrator, 2) a leadership profile with two convenience samples: heads of nursing and nursing administration students. Each part was analysed separately; the two groups were then compared with the latter revealing similarities and differences. Heads of nursing were more likely to describe roles and be task-oriented, emphasising problem solving, whereas students focused on functions and processes. Both groups wanted nursing to be known for its code of professional conduct, and have an empowered nursing association. Leadership profile comparisons indicated heads of nursing were mature and practical whereas students were idealistic, with risk-taking tendencies. There was overall agreement that preparation for the nursing administration specialty should be at master's level; however, all nurses should undertake a leadership and management course during their progression to senior positions. The vision of those preparing to enter and those already in leadership positions is for empowerment of the nursing profession in Oman. Thus there is a need for highly educated nurse leaders and managers in nursing administration to provide the driving force for change and sustained motivation. The current Nursing Administration Programme (NAP) needs to be upgraded and delivered at the master's level for nurses specialising in nursing administration.

  4. Leadership Tenets of Military Veterans Working as School Administrators

    Science.gov (United States)

    Bolles, Elliot; Patrizio, Kami

    2016-01-01

    This study investigates the leadership tenets informing veterans' work as school leaders. Drawing on 15 interviews and surveys with military veterans working as educational leaders, the study relies on Stake's (2006) case study method to substantiate assertions that veterans: 1) come into education without the support of a transitional program, 2)…

  5. Nationwide dissemination of contingency management: the Veterans Administration initiative.

    Science.gov (United States)

    Petry, Nancy M; DePhilippis, Dominick; Rash, Carla J; Drapkin, Michelle; McKay, James R

    2014-01-01

    Contingency management (CM) is an empirically validated intervention but one not often applied in practice settings in the US. The aim of this article is to describe the Veterans Administration (VA) nationwide implementation of CM treatment. In 2011, the VA called for integration of CM in its intensive outpatient substance abuse treatment clinics. As part of this initiative, the VA funded training and ongoing implementation support, and it provided direct funds for reinforcers and other intervention costs. Over 100 clinics received this funding in 2011, and CM has been implemented in over 70 substance abuse treatment clinics since August 2011. This training and implementation experience has been highly successful and represents the largest scale training in evidence-based treatments for substance use disorders in the VA health care system to date. This program may serve as a model for training in evidence-based treatments. © American Academy of Addiction Psychiatry.

  6. 20 CFR 404.1362 - Treatment of social security benefits or payments where Veterans Administration pension or...

    Science.gov (United States)

    2010-04-01

    ... payments where Veterans Administration pension or compensation payable. 404.1362 Section 404.1362 Employees... Administration pension or compensation payable. (a) Before we receive notice from the Veterans Administration. If... status provisions in § 404.1350 before we receive notice from the Veterans Administration that a pension...

  7. Burnout among psychiatrists in the Veterans Health Administration

    Directory of Open Access Journals (Sweden)

    Hector A. Garcia

    2015-12-01

    Full Text Available Research suggests that mental health workers are at high risk for burnout, and that burnout can increase staff turnover and reduce quality of care. The Veterans Administration (VA employs over 3000 psychiatrists across the United States, but little is known about burnout in this population. This study was conducted to examine predictors of burnout and intent to leave the VA among a national sample of VA psychiatrists. Participants (N = 125 responded to an anonymous online survey. Regression analyses were used to examine relationships between workplace variables, patient characteristics, and burnout as measured by the Maslach Burnout Inventory-General Survey – which includes sub-scales for cynicism, exhaustion, and professional efficacy – as well as intent to leave the VA. Based on established cut-off scores, 90% of the sample reported high cynicism, 86% reported high exhaustion, and 74% reported high professional efficacy. High cynicism predicted the intent to leave the VA (p = .004. Not feeling part of a coherent team predicted greater cynicism (p = .01, and patient characteristics such as suspected malingering showed a positive trend with cynicism (p = .05. Workplace characteristics such as unfair treatment by supervisors (p = .03 and insufficient resources (p = .001 predicted greater exhaustion. The current findings suggest that burnout is prevalent in the VA psychiatry workforce. Specific administrative measures to reduce burnout may have potential to improve the emotional health of that workforce and ensure high quality of care for the veteran population it serves. The size of both the VA psychiatry workforce and patient population underscores the importance of greater understanding of burnout as it occurs in the VA.

  8. Educating nurses to care for military veterans in civilian hospitals: An integrated literature review.

    Science.gov (United States)

    Cooper, Linda; Andrew, Sharon; Fossey, Matt

    2016-12-01

    In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. The search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Opportunities, hurdles, solutions, and approaches to transition military veterans into professional nursing programs.

    Science.gov (United States)

    Allen, Patricia E; Armstrong, Myrna L; Saladiner, Jason E; Hamilton, Mary Jane; Conard, Patricia L

    2014-01-01

    Capitalizing on the almost 2.2 million service members returning from Operation Iraqi Freedom and New Dawn (OIF) in Iraq, and Operation Enduring Freedom (OEF) in Afghanistan, baccalaureate educators are encouraged to create realistic, applicable nursing transitional programs for the health and health-related oriented military veterans. Opportunities, hurdles, and solutions related to the veteran's unique socio-economic circumstances of education, finances, and advisement are provided so the potential veteran student is successful within the university's milieu. Transitional nursing educational interventions related to assessment, didactic, and clinical used by two baccalaureate nursing curriculums, including the eLineMilitary* (ELM) Program, provide approaches of how to propel the veteran's journey toward graduation in a professional nursing program. These interventions include modular didactic, competency based education, as well as the concentrated, collegial time within the Faculty/Clinical Coach triad for essential role modeling, care, and skills. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Connecting the dots: interprofessional health education and delivery system redesign at the Veterans Health Administration.

    Science.gov (United States)

    Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm

    2014-08-01

    Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

  11. Psychological safety and error reporting within Veterans Health Administration hospitals.

    Science.gov (United States)

    Derickson, Ryan; Fishman, Jonathan; Osatuke, Katerine; Teclaw, Robert; Ramsel, Dee

    2015-03-01

    In psychologically safe workplaces, employees feel comfortable taking interpersonal risks, such as pointing out errors. Previous research suggested that psychologically safe climate optimizes organizational outcomes. We evaluated psychological safety levels in Veterans Health Administration (VHA) hospitals and assessed their relationship to employee willingness of reporting medical errors. We conducted an ANOVA on psychological safety scores from a VHA employees census survey (n = 185,879), assessing variability of means across racial and supervisory levels. We examined organizational climate assessment interviews (n = 374) evaluating how many employees asserted willingness to report errors (or not) and their stated reasons. Finally, based on survey data, we identified 2 (psychologically safe versus unsafe) hospitals and compared their number of employees who would be willing/unwilling to report an error. Psychological safety increased with supervisory level (P report an error; retaliation fear was the most commonly mentioned deterrent. Furthermore, employees at the psychologically unsafe hospital (71% would report, 13% would not) were less willing to report an error than at the psychologically safe hospital (91% would, 0% would not). A substantial minority would not report an error and were willing to admit so in a private interview setting. Their stated reasons as well as higher psychological safety means for supervisory employees both suggest power as an important determinant. Intentions to report were associated with psychological safety, strongly suggesting this climate aspect as instrumental to improving patient safety and reducing costs.

  12. Communication and psychological safety in veterans health administration work environments.

    Science.gov (United States)

    Yanchus, Nancy J; Derickson, Ryan; Moore, Scott C; Bologna, Daniele; Osatuke, Katerine

    2014-01-01

    The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism--Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers' direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

  13. 77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2012-08-01

    ... Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care... solicits comments on information needed to ensure that nursing home and adult day health care facilities... services care to Veterans. VA requires facilities providing nursing home and adult day health care to...

  14. How Veterans Health Administration Suicide Prevention Coordinators Assess Suicide Risk.

    Science.gov (United States)

    Pease, James L; Forster, Jeri E; Davidson, Collin L; Holliman, Brooke Dorsey; Genco, Emma; Brenner, Lisa A

    2017-03-01

    This cross-sectional study was designed to examine the suicide risk assessment practices of Suicide Prevention Coordinators (SPCs) within the Veterans Health Administration. Specifically, this study sought to (1) identify factors SPCs consider most important in assessing risk and patient priority; (2) measure the level of consistency and agreement between SPCs in assessing suicide risk and prioritizing cases; and (3) measure individual SPC consistency between cases. SPCs (n = 63) responded to online survey questions about imminent and prolonged risk for suicide in response to 30 fictional vignettes. Combinations of 12 acute and chronic suicide risk factors were systematically distributed throughout the 30 vignettes using the Fedorov () procedure. The SPCs were also asked to identify the level of priority for further assessment both disregarding and assuming current caseloads. Data were analysed using clinical judgement analysis. Suicidal plan, β = 1.64; 95% CI (1.45, 1.82), and preparatory behaviour, β = 1.40; 95% CI (1.23, 1.57), were considered the most important acute or imminent risk factors by the SPCs. There was less variability across clinicians in the assessment of risk when alcohol use (p = 0.02) and hopelessness (p = 0.03) were present. When considering acute or imminent risk factors, there was considerable variability between clinicians on a vignette-by-vignette basis, median SD = 0.86 (range = 0.47, 1.13), and within individual clinicians across vignettes, median R2  = 0.80 (0.49, 0.95). These findings provide insight into how this group of providers think about acute and chronic risk factors contributing to imminent suicide risk in Veterans. Copyright © 2016 John Wiley & Sons, Ltd. Identifies factors that practitioners consider most important in suicide risk assessment Discusses how to distinguish between chronic and acute risk for suicide Identifies factors that lead to more consistent clinical judgments. Copyright

  15. Caring with Honor: A Grounded Theory of Caring for Veterans within the Veterans Health Administration

    Directory of Open Access Journals (Sweden)

    Alvita K. Nathaniel

    2017-06-01

    Full Text Available Veterans comprise a unique culture. Through their military experience, Veterans become ingrained with shared values, beliefs and attitudes that characterize their everyday existence. Health care providers must take into consideration that culture impacts health care seeking behaviors. The theory of Caring with Honor is emerging through the classic GT method. A team of investigators within the VA health care system gathered data from 19 health care professionals via one-on-one interviews. The emerging theory, Caring with Honor, represents an amplifying process whereby health care professionals engage with Veterans through a process of enculturating, witnessing, connecting, honoring, and caring with purpose.

  16. Caring with Honor: A Grounded Theory of Caring for Veterans within the Veterans Health Administration

    OpenAIRE

    Alvita K. Nathaniel; Lisa Hardman

    2017-01-01

    Veterans comprise a unique culture. Through their military experience, Veterans become ingrained with shared values, beliefs and attitudes that characterize their everyday existence. Health care providers must take into consideration that culture impacts health care seeking behaviors. The theory of Caring with Honor is emerging through the classic GT method. A team of investigators within the VA health care system gathered data from 19 health care professionals via one-on-one interviews. T...

  17. Characterizing Primary Care Visit Activities at Veterans Health Administration Clinics.

    Science.gov (United States)

    Gutierrez, Jennifer C; Terwiesch, Christian; Pelak, Mary; Pettit, Amy R; Marcus, Steven C

    2015-01-01

    Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better under stand how primary care providers (PCPs) currently spend visit time and to provide insight into potential opportunities for revision or redistribution of healthcare tasks. We videotaped 27 PCPs during office visits with 121 patients at four Veterans Health Administration medical centers. Based on patterns emerging from the data, we identified a taxonomy of 12 provider activity categories that enabled us to quantify the frequency and duration of activities occurring during routine primary care visits. We conducted descriptive and multivariate analyses to examine associations between visit characteristics and provider and clinic characteristics. We found that PCPs spent the greatest percentage of their visit time discussing existing conditions (20%), discussing new conditions (18%), record keeping (13%), and examining patients (13%). Providers spent the smallest percentage of time on preventive care and coordination of care. Mean visit length was 22.9 minutes (range 7.9-58.0 minutes). Site-level ratings of medical home implementation were not associated with differences in how visit time was spent. These data provide a window into how PCPs are spending face-to-face time with patients. The methodology and taxonomy presented here may prove useful for future quality improvement and research endeavors, particularly those focused on opportunities to increase nonappointment care and to ensure that team members work at the top of their skill level.

  18. Partnership to improve quality care for veterans: the VA Nursing Academy.

    Science.gov (United States)

    Harper, Doreen C; Selleck, Cynthia S; Eagerton, Gregory; Froelich, Kimberly

    2015-01-01

    More than 22 million living veterans reside in the United States. In fact, understanding military culture and the experiences of these veterans is important to their ongoing health care and the unique challenges faced by many. The Veterans Affairs (VA) Nursing Academy began in 2007 to fund pilot partnerships between schools of nursing and local VA health care facilities to better serve our veteran population. Fifteen academic/service partnerships were selected for funding between 2007 and 2009 with the goals of expanding faculty and professional development, increasing nursing student enrollment, providing opportunities for educational and practice innovations, and increasing the recruitment and retention of VA nurses. This article details critical components of the partnership developed between the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing, a VA Nursing Academy partnership funded in the 2009 cohort. Site-specific goals of the partnership are described along with a discussion of the framework used to develop the Birmingham VA Nursing Academy, which includes relationship building, engagement, governance, evaluation of outcomes, and sustainability. The logic model developed for the partnership is included, and the interim outputs and outcomes of this practice-academic partnership are detailed, a number of which can be replicated by VAs and schools of nursing across the country. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Hospice nurses' views on single nurse administration of controlled drugs.

    Science.gov (United States)

    Taylor, Vanessa; Middleton-Green, Laura; Carding, Sally; Perkins, Paul

    2015-07-01

    The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants' views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. Data was obtained through semi-structured interviews. Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers.

  20. Suicide Mortality Following Nursing Home Discharge in the Department of Veterans Affairs Health System

    Science.gov (United States)

    Szymanski, Benjamin R.; Karlin, Bradley E.; Katz, Ira R.

    2013-01-01

    Objectives. We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. Methods. In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. Results. Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. Conclusions. Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up. PMID:24134359

  1. Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program.

    Science.gov (United States)

    Finlay, Andrea K; Stimmel, Matthew; Blue-Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid; Smelson, David; Harris, Alex H S; Frayne, Susan M; Bowe, Tom; Timko, Christine

    2017-03-01

    The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.

  2. Pain research using Veterans Health Administration electronic and administrative data sources.

    Science.gov (United States)

    Abel, Erica A; Brandt, Cynthia A; Czlapinski, Rebecca; Goulet, Joseph L

    2016-01-01

    Health services researchers are using Veterans Health Administration (VHA) electronic health record (EHR) data sources to examine the prevalence, treatment, and outcomes of pain among Veterans in VHA care. Little guidance currently exists on using these data; thus, findings may vary depending on the methods, data sources, and definitions used. We sought to identify current practices in order to provide guidance to future pain researchers. We conducted an anonymous survey of VHA-affiliated researchers participating in a monthly national pain research teleconference. Thirty-two researchers (89%) responded: 75% conducted pain-focused research, 78% used pain intensity numeric rating screening scale (NRS) scores to identify pain, 41% used International Classification of Diseases-9th Revision codes, and 57% distinguished between chronic and acute pain using either NRS scores or pharmacy data. The NRS and pharmacy data were rated as the most valid pain data sources. Of respondents, 48% reported the EHR data sources were adequate for pain research, while 45% had published peer-reviewed articles based on the data. Despite limitations, VHA researchers are increasingly using EHR data for pain research, and several common methods were identified. More information on the performance characteristics of these data sources and definitions is needed.

  3. Implementation of Lung Cancer Screening in the Veterans Health Administration.

    Science.gov (United States)

    Kinsinger, Linda S; Anderson, Charles; Kim, Jane; Larson, Martha; Chan, Stephanie H; King, Heather A; Rice, Kathryn L; Slatore, Christopher G; Tanner, Nichole T; Pittman, Kathleen; Monte, Robert J; McNeil, Rebecca B; Grubber, Janet M; Kelley, Michael J; Provenzale, Dawn; Datta, Santanu K; Sperber, Nina S; Barnes, Lottie K; Abbott, David H; Sims, Kellie J; Whitley, Richard L; Wu, R Ryanne; Jackson, George L

    2017-03-01

    The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is little published experience regarding implementing this recommendation in clinical practice. To describe organizational- and patient-level experiences with implementing an LCS program in selected Veterans Health Administration (VHA) hospitals and to estimate the number of VHA patients who may be candidates for LCS. This clinical demonstration project was conducted at 8 academic VHA hospitals among 93 033 primary care patients who were assessed on screening criteria; 2106 patients underwent LCS between July 1, 2013, and June 30, 2015. Implementation Guide and support, full-time LCS coordinators, electronic tools, tracking database, patient education materials, and radiologic and nodule follow-up guidelines. Description of implementation processes; percentages of patients who agreed to undergo LCS, had positive findings on results of low-dose computed tomographic scans (nodules to be tracked or suspicious findings), were found to have lung cancer, or had incidental findings; and estimated number of VHA patients who met the criteria for LCS. Of the 4246 patients who met the criteria for LCS, 2452 (57.7%) agreed to undergo screening and 2106 (2028 men and 78 women; mean [SD] age, 64.9 [5.1] years) underwent LCS. Wide variation in processes and patient experiences occurred among the 8 sites. Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer. A variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, were noted on the scans of 857 patients (40.7%). It is estimated that nearly 900 000 of a population of 6.7 million VHA patients met the criteria for LCS. Implementation of

  4. Social work in the Veterans Health Administration (VA) System: rewards, challenges, roles and interventions.

    Science.gov (United States)

    Beder, Joan; Postiglione, Paul

    2013-01-01

    For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained.

  5. A study to reduce readmissions after surgery in the Veterans Health Administration: design and methodology.

    Science.gov (United States)

    Copeland, Laurel A; Graham, Laura A; Richman, Joshua S; Rosen, Amy K; Mull, Hillary J; Burns, Edith A; Whittle, Jeff; Itani, Kamal M F; Hawn, Mary T

    2017-03-14

    Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital are multiple with some being better targets for intervention than others. To understand risk factors for surgical readmission and their incremental contribution to current Veterans Health Administration (VA) surgical quality assessment, the study, Improving Surgical Quality: Readmission (ISQ-R), is being conducted to develop a readmission risk prediction tool, explore predisposing and enabling factors, and identify and rank reasons for readmission in terms of salience and mutability. Harnessing the rich VA enterprise data, predictive readmission models are being developed in data from patients who underwent surgical procedures within the VA 2007-2012. Prospective assessment of psychosocial determinants of readmission including patient self-efficacy, cognitive, affective and caregiver status are being obtained from a cohort having colorectal, thoracic or vascular procedures at four VA hospitals in 2015-2017. Using these two data sources, ISQ-R will develop readmission categories and validate the readmission risk prediction model. A modified Delphi process will convene surgeons, non-surgeon clinicians and quality improvement nurses to rank proposed readmission categories vis-à-vis potential preventability. ISQ-R will identify promising avenues for interventions to facilitate improvements in surgical quality, informing specifications for surgical workflow managers seeking to improve care and reduce cost. ISQ-R will work with Veterans Affairs Surgical Quality Improvement Program (VASQIP) to recommend potential new elements VASQIP might collect to monitor surgical complications and readmissions which might be preventable and ultimately improve surgical care.

  6. Physical and Mental Health and Access to Care among Nonmetropolitan Veterans Health Administration Patients Younger than 65 Years

    Science.gov (United States)

    West, Alan; Weeks, William B.

    2006-01-01

    Context: The 4.5 million military veterans treated by the Veterans Health Administration (VA) are believed to experience poorer physical and mental health than nonveterans. Furthermore, nonmetropolitan residents have less access to medical services, whether or not they are veterans in VA care. A direct comparison of metropolitan and…

  7. Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

    Science.gov (United States)

    Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

    2017-09-01

    Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

  8. Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes

    Directory of Open Access Journals (Sweden)

    Jia H

    2017-03-01

    Full Text Available Huanguang Jia,1 Qinglin Pei,1 Charles T Sullivan,1 Diane C Cowper Ripley,1 Samuel S Wu,1 W Bruce Vogel,1 Xinping Wang,1 Douglas E Bidelspach,2 Jennifer L Hale-Gallardo,1 Barbara E Bates3 1Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 2Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC, 3Aleda E. Lutz VA Medical Center, Saginaw, MI, USA Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA places veterans needing post-acute institutional care in private community nursing homes (CNHs. These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim: The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods: This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation

  9. Outcome by Gender in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere Weight Management Program.

    Science.gov (United States)

    Batch, Bryan C; Goldstein, Karen; Yancy, William S; Sanders, Linda L; Danus, Susanne; Grambow, Steven C; Bosworth, Hayden B

    2017-07-21

    Few evaluations of the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (MOVE!) weight management program have assessed 6-month weight change or factors associated with weight change by gender. Analysis of administrative data from a national sample of veterans in the VA MOVE! A total of 62,882 participants were included, 14.6% were women. Compared with men, women were younger (49.6 years [standard deviation, SD, 10.8] vs. 59.3 years [SD, 9.8], p stress disorder (26.0% vs. 22.4%, p women was lower than men (5.6 [SD, 5.3] vs. 6.0 [SD, 5.9], p Women, compared with men, reported lower rates of being able to rely on family or friends (35.7% vs. 40.8%, p women was -1.5% (SD, 5.2) and for men was -1.9% (SD, 4.8, p women (body-mass index [BMI] >25 kg/m(2)) compared with men (BMI >25 kg/m(2); odds ratio, 1.05 [95% confidence interval, 0.99-1.11; p = 0.13]). Women veterans lost less weight overall compared with men. There was no difference in the odds of achieving clinically significant weight loss by gender. The majority of women and men enrolled lost <5% weight despite being enrolled in a lifestyle intervention. Future studies should focus on identifying program- and participant-level barriers to weight loss.

  10. Courage to care for our United States veterans: A constructivist way of teaching and learning for future nurses.

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    Magpantay-Monroe, Edna R

    2017-10-20

    The knowledge and skills in providing veteran centered care is essential. The purpose of this retrospective evaluation is to examine a faculty's reflections on a BSN psychiatric mental health curriculum initiative that provides knowledge and skills regarding veterans care through several avenues to senior nursing students. This qualitative study use self-reflections through a constructivist view of teaching and learning as the framework. Open discussions in didactic about the unique psychological health issues of veterans formed a foundational knowledge for the students. The seminar time was used to discuss real veteran case situations. Simulation provided opportunities to address veteran resources. Problem based projects use available evidence to solve veteran health issues. The educators show their commitment to the compassionate and caring ideals of our profession by fostering an educational environment where future nurses can truly learn about veteran centered care. Copyright © 2017. Published by Elsevier Ltd.

  11. Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

    Science.gov (United States)

    Render, Marta L; Freyberg, Ron W; Hasselbeck, Rachael; Hofer, Timothy P; Sales, Anne E; Deddens, James; Levesque, Odette; Almenoff, Peter L

    2011-06-01

    BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices. Leaders prioritise measures based on quality improvement objectives. The electronic extraction is validated manually against the medical record, selecting hospitals whose data elements and measures fall at the extremes (10th, 90th percentile). results are depicted in graphic, narrative and tabular reports benchmarked by type and complexity of ICU. RESULTS The VA admits 103 689±1156 ICU patients/year. Variation in electronic business practices, data location and normal range of some laboratory tests affects data quality. A data management website captures data elements important to ICU performance and not available electronically. A dashboard manages the data overload (quarterly reports ranged 106-299 pages). More than 85% of ICU directors and nurse managers review their reports. Leadership interest is sustained by including ICU targets in executive performance contracts, identification of local improvement opportunities with analytic software, and focused reviews. CONCLUSION Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard.

  12. How well trained are nursing home administrators?

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    Singh, D A; Shi, L; Samuels, M E; Amidon, R L

    1997-01-01

    Nursing home administrators represent wide variations in academic training. General education levels do not seem to affect administrative preparation in key domains of practice--specific academic fields of study are more relevant. Hence, sole emphasis on higher educational requirements for licensure appears to be a misdirected strategy for improving quality of care and enhancing management efficiencies in nursing homes. Educational paradigms studied have strengths and weakness in furnishing various job skills. These results are helpful in defining strategic actions for addressing both current deficiencies and future training needs. A specialized long-term care model that incorporates appropriate clinical and business skills is recommended. The roles of continuing education and executive educational offerings also need streamlining. These initiatives would require a joint effort from policymakers, academicians, and practitioners.

  13. Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration.

    Science.gov (United States)

    Hunt, Christine M; Beste, Lauren A; Lowy, Elliott; Suzuki, Ayako; Moylan, Cynthia A; Tillmann, Hans L; Ioannou, George N; Lim, Joseph K; Kelley, Michael J; Provenzale, Dawn

    2016-05-21

    To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement. We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ(2) test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group. Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628

  14. Measuring sustainability within the Veterans Administration Mental Health System Redesign initiative.

    Science.gov (United States)

    Ford, James H; Krahn, Dean; Wise, Meg; Oliver, Karen Anderson

    2011-01-01

    To examine how attributes affecting sustainability differ across Veterans Health Administration organizational components and by staff characteristics. Surveys of 870 change team members and 50 staff interviews within the Veterans Affairs' Mental Health System Redesign initiative. A 1-way ANOVA with a Tukey post hoc test examined differences in sustainability by Veteran Integrated Service Networks, job classification, and tenure from staff survey data of the Sustainability Index. Qualitative interviews used an iterative process to identify "a priori" and "in vivo" themes. A simple stepwise linear regression explored predictors of sustainability. Sustainability differed across Veteran Integrated Service Networks and staff tenure. Job classification differences existed for the following: (1) benefits and credibility of the change and (2) staff involvement and attitudes toward change. Sustainability barriers were staff and institutional resistance and nonsupportive leadership. Facilitators were commitment to veterans, strong leadership, and use of quality improvement tools. Sustainability predictors were outcomes tracking, regular reporting, and use of Plan, Do, Study, Adjust cycles. Creating homogeneous implementation and sustainability processes across a national health system is difficult. Despite the Veterans Affairs' best evidence-based implementation efforts, there was significant variance. Locally tailored interventions might better support sustainability than "one-size-fits-all" approaches. Further research is needed to understand how participation in a quality improvement collaborative affects sustainability.

  15. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

    Science.gov (United States)

    Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

    2015-01-01

    Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

  16. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

    Directory of Open Access Journals (Sweden)

    Rachel Peterson

    Full Text Available Researchers at the U.S. Department of Veterans Affairs (VA have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012 of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services, plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%. Adding allied V60 codes increased that to 31,260 (rate 3.3%. While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

  17. Processes and outcomes of the veterans health administration safe patient handling program: study protocol.

    Science.gov (United States)

    Rugs, Deborah; Toyinbo, Peter; Patel, Nitin; Powell-Cope, Gail; Hahm, Bridget; Elnitsky, Christine; Besterman-Dahan, Karen; Campbell, Robert; Sutton, Bryce

    2013-11-18

    Health care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move patients, are consistently listed in the top professions for musculoskeletal injuries (MSIs) by the Bureau of Labor Statistics. These MSIs are typically caused by high-risk patient caregiving activities. In 2008, a safe patient handling (SPH) program was implemented in all 153 Veterans Administration Medical Centers (VAMCs) throughout the United States to reduce patient handling injuries. The goal of the present study is to evaluate the effects associated with the national implementation of a comprehensive SPH program. The primary objectives of the research were to determine the effectiveness of the SPH program in improving direct care nursing outcomes and to provide a context for understanding variations in program results across sites over time. Secondary objectives of the present research were to evaluate the effectiveness of the program in reducing direct and indirect costs associated with patient handling, to explore the potential mediating and moderating mechanisms, and to identify unintended consequences of implementing the program. This 3-year longitudinal study used mixed methods of data collection at 6- to 9-month intervals. The analyses will include data from surveys, administrative databases, individual and focus group interviews, and nonparticipant observations. For this study, a 3-tiered measurement plan was used. For Tier 1, the unit of analysis was the facility, the data source was the facility coordinator or administrative data, and all 153 VAMCs participated. For Tier 2, frontline caregivers and program peer leaders at 17 facilities each completed different surveys. For Tier 3, six facilities completed qualitative site visits, which included individual interviews, focus groups, and nonparticipant observations. Multiple regression models were proposed to test the effects of SPH components on nursing outcomes related to patient handling. Content analysis

  18. Medication Administration: Measuring Associate Degree Nursing Student Knowledge

    Science.gov (United States)

    Crowell, Debra L.

    2016-01-01

    The American Nurse Association's (ANA) provisions outline the commitment expected of nurses to protect the community from harm. Medication administration coincides with patient safety as a compelling obligation in nursing practice. The study's purpose was to examine retention of medication safety knowledge among first year nursing students, after…

  19. Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study.

    Science.gov (United States)

    Brown, George R; Jones, Kenneth T

    2016-04-01

    There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status. Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population. In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups. This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

  20. Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration.

    Science.gov (United States)

    Manhapra, Ajay; Quinones, Lantie; Rosenheck, Robert

    2016-03-01

    The advent of buprenorphine as an alternative to methadone has dramatically shifted the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is limited US national level data describing thedifferences between patients who are prescribed these two OAT options. From veterans with OUD diagnosis who used Veterans Health Administration services in 2012, we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n=5,670); (2) methadone only (n=6,252); or (3) both buprenorphine and methadone in the same year (n=2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d) forcharacteristics that differentiated these groups. Logistic regression analysis was then used to identify factors independently differentiating the groups. Ten year increment in age (OR 0.67; 95% CI 0.64-0.70), urban residence (OR 0.26; 95% CI 0.25-0.33), and black race (OR 0.39; 95% CI 0.35-0.43) were strongly and negatively associated with odds of receiving buprenorphine compared to methadone, while medical and psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate substantial differences between groups. Differences between veterans receiving buprenorphine or methadone based OAT seems to be largely shaped by demographic characteristics rather than medical or psychiatric or service use characteristics. A clearer understanding of the reasons for racial differences could be helpful in assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that is their preference. Published by Elsevier Ireland Ltd.

  1. Factors affecting the use of patient survey data for quality improvement in the Veterans Health Administration

    Directory of Open Access Journals (Sweden)

    Davies Elizabeth A

    2011-12-01

    Full Text Available Abstract Background Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities. Methods We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use. Results Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance. Conclusions Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.

  2. The patient-centered medical home in the Veterans Health Administration.

    Science.gov (United States)

    Rosland, Ann-Marie; Nelson, Karin; Sun, Haili; Dolan, Emily D; Maynard, Charles; Bryson, Christopher; Stark, Richard; Shear, Joanne M; Kerr, Eve; Fihn, Stephan D; Schectman, Gordon

    2013-07-01

    The Veterans Health Administration (VHA) is the largest integrated US health system to implement the patient-centered medical home. The Patient Aligned Care Team (PACT) initiative (implemented 2010-2014) aims to achieve team based care, improved access, and care management for more than 5 million primary care patients nationwide. To describe PACT and evaluate interim changes in PACT-related care processes. Data from the VHA Corporate Data Warehouse were obtained from April 2009 (pre- PACT) to September 2012. All patients assigned to a primary care provider (PCP) at all VHA facilities were included. Nonparametric tests of trend across time points. VHA increased primary care staff levels from April 2010 to December 2011 (2.3 to 3.0 staff per PCP full-time equivalent). In-person PCP visit rates slightly decreased from April 2009 to April 2012 (53 to 43 per 100 patients per calendar quarter; P < .01), while in-person nurse encounter rates remained steady. Large increases were seen in phone encounters (2.7 to 28.8 per 100 patients per quarter; P < .01), enhanced personal health record use (3% to 13% of patients enrolled), and electronic messaging to providers (0.01% to 2.3% of patients per quarter). Post hospitalization follow-up improved (6.6% to 61% of VA hospital discharges), but home telemonitoring (0.8% to 1.4% of patients) and group visits (0.2 to 0.65 per 100 patients per quarter; P < .01) grew slowly. Thirty months into PACT, primary care staff levels and phone and electronic encounters have greatly increased; other changes have been positive but slower.

  3. Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

    Science.gov (United States)

    True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

    2014-07-01

    The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

  4. Nurses' attitude and intention of medication administration error reporting.

    Science.gov (United States)

    Hung, Chang-Chiao; Chu, Tsui-Ping; Lee, Bih-O; Hsiao, Chia-Chi

    2016-02-01

    The Aims of this study were to explore the effects of nurses' attitudes and intentions regarding medication administration error reporting on actual reporting behaviours. Underreporting of medication errors is still a common occurrence. Whether attitude and intention towards medication administration error reporting connect to actual reporting behaviours remain unclear. This study used a cross-sectional design with self-administered questionnaires, and the theory of planned behaviour was used as the framework for this study. A total of 596 staff nurses who worked in general wards and intensive care units in a hospital were invited to participate in this study. The researchers used the instruments measuring nurses' attitude, nurse managers' and co-workers' attitude, report control, and nurses' intention to predict nurses' actual reporting behaviours. Data were collected from September-November 2013. Path analyses were used to examine the hypothesized model. Of the 596 nurses invited to participate, 548 (92%) completed and returned a valid questionnaire. The findings indicated that nurse managers' and co-workers' attitudes are predictors for nurses' attitudes towards medication administration error reporting. Nurses' attitudes also influenced their intention to report medication administration errors; however, no connection was found between intention and actual reporting behaviour. The findings reflected links among colleague perspectives, nurses' attitudes, and intention to report medication administration errors. The researchers suggest that hospitals should increase nurses' awareness and recognition of error occurrence. Regardless of nurse managers' and co-workers' attitudes towards medication administration error reporting, nurses are likely to report medication administration errors if they detect them. Management of medication administration errors should focus on increasing nurses' awareness and recognition of error occurrence. © 2015 John Wiley & Sons Ltd.

  5. Correlates of major depressive disorder with and without comorbid alcohol use disorder nationally in the veterans health administration.

    Science.gov (United States)

    Yoon, Gihyun; Petrakis, Ismene L; Rosenheck, Robert A

    2015-08-01

    This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone. Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups. Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization. Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders. © American Academy of Addiction Psychiatry.

  6. Shared meanings for military nurse veterans: follow up survey of nurse veterans from WWII, Korea, Vietnam, and Operation Desert Storm.

    Science.gov (United States)

    Stanton-Bandiero, M P

    1998-01-01

    This study is an extension of a qualitative study involving military nurses in World War II, Korea, Vietnam and Operation Desert Storm. Common themes and shared meanings identified in the previous qualitative study were investigated using a broad sample of military nurses who had served at various times and different branches of the service. The present investigation used a survey to gather data, and results tended to validate results of the earlier study that the experiences of military nurses in times of war tend to transcend many factors including time and branch of service.

  7. Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?

    Directory of Open Access Journals (Sweden)

    Brezinski Paul R

    2006-10-01

    Full Text Available Abstract Background Millions of veterans are eligible to use the Veterans Health Administration (VHA and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk. Methods Data on 1,566 self-responding men (weighted N = 1,522 from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression. Results 96 (11% of the veterans were classified as dual users. 766 men (50.3% had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p Conclusion An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

  8. Taking charge. The role of nursing administrators in removing restraints.

    Science.gov (United States)

    Dunbar, J M; Neufeld, R R; Libow, L S; Cohen, C E; Foley, W J

    1997-03-01

    The leadership and commitment of nursing administrators play a pivotal role in minimizing the use of restraints and maintaining a restraint-free environment. This article describes the role of nursing administrators in reducing the use of physical restraints as part of a 2-year, national nursing home restraint-reduction project. It reviews important information about restraint-free care the benefits of restraint-free care, and strategies to reduce the use of restraints in nursing homes, much of which is applicable to settings other than nursing homes.

  9. Nursing Faculty Shortage Nurses' Perceptions as a Key to Administrative Solutions

    Science.gov (United States)

    Klocke, Evelyn M.

    2009-01-01

    The nursing faculty shortage is well documented. Higher education administrators turn away qualified student applicants because of the lack of qualified nursing faculty. Furthermore, they find recruitment and retention of qualified nursing faculty a challenge. The purpose of this study was to explore perceptions of the nursing faculty role, causes…

  10. Administrator Leadership Styles and Their Impact on School Nursing.

    Science.gov (United States)

    Davis, Charles R

    2018-01-01

    In comparison to other professional staff in an educational based setting, the registered professional school nurse has unique roles, responsibilities, education, training, and scope of practice. In carrying out this unique and specialized role, school nurses operate under a building administrator, the leader of the building and often the immediate supervisor of the school nurse. In addition, many school nurses in small districts are the only registered professional nurse employed by the school. The building administrator's leadership style not only sets the tone for the day-to-day operations in the school but also impacts the school nurse functioning and program implementation. This article reviews the three most common types of leadership styles as defined by Kurt Lewin-laissez-faire, democratic, and coercive/authoritarian-and their potential impact on school nursing practice. In addition, the article provides recommendations for school nurses for successful practice with regard to supervisor leadership styles.

  11. Screening for Food Insecurity in Six Veterans Administration Clinics for the Homeless, June-December 2015.

    Science.gov (United States)

    O'Toole, Thomas P; Roberts, Christopher B; Johnson, Erin E

    2017-01-12

    We assessed findings from a food-insecurity screening of a national sample of Veterans Administration clinics for homeless and formerly homeless veterans. We reviewed results from initial screenings administered at 6 Veterans Administration primary care clinics for the homeless and responses from clinic staff members interviewed about the screening program. A total of 270 patients were screened. The average age was 53 years, and most were male (93.1%). Screening showed a high prevalence of food insecurity. Of the 270, 48.5% reported they experienced food insecurity in the previous 3 months, 55.0% reported averaging 2 meals a day, and 27.3% averaged 1 meal a day. Eighty-seven percent prepared their own meals, relying on food they bought (54.2%), help from friends and family (19.1%), and soup kitchens and food pantries (22%); 47.3% received Supplemental Nutrition Assistance Program benefits (food stamps). Additionally, of those who screened positive for food insecurity 19.8% had diabetes or prediabetes, and 43.5% reported hypoglycemia symptoms when without food. Clinic staff members responded positively to the screening program and described it as a good rapport builder with patients. Integrating screening for food insecurity among patients in clinical settings was well received by both patients and health care providers. Addressing these positive findings of food insecurity requires a multidisciplinary health care approach.

  12. Sustainability in primary care and Mental Health Integration projects in Veterans Health Administration.

    Science.gov (United States)

    Ford, James H; Krahn, Dean; Oliver, Karen Anderson; Kirchner, JoAnn

    2012-01-01

    To explore staff perceptions about sustainability, commitment to change, participation in change process, and information received about the change project within the Veterans Administration Primary Care and Mental Health Integration (PC-MHI) initiative and to examine differences from the Veterans Health Administration Mental Health Systems Redesign (MHSR) initiative. Surveys of change team members involved in the Veterans Affairs PC-MHI and MHSR initiatives. One-way analysis of variance examined the relationship between commitment, participation and information, and sustainability. Differences in PC-MHI sustainability were explored by location and job classification. Staff sustainability perceptions were compared with MHSR results. Sustainability differed by staff discipline. Difference between MHSR and PC-MHI existed by job function and perceptions about the change benefits. Participation in the change process and information received about the change process were positively correlated with sustainability. Staff commitment to change was positively associated with staff perceptions about the benefits of change and staff attitudes toward change. Sustainability is an important part of organizational change efforts. Change complexity seems to influence perception about sustainability and impacts staff perceptions about the benefits of change. These perceptions seem to be driven by the information received and opportunities to participate in the change process. Further research is needed to understand how information and participation influence sustainability and affect employee commitment to change.

  13. Hurricanes Katrina and Rita and the Department of Veterans Affairs: a conceptual model for understanding the evacuation of nursing homes.

    Science.gov (United States)

    Dobalian, Aram; Claver, Maria; Fickel, Jacqueline J

    2010-01-01

    Hurricanes Katrina and Rita exposed significant flaws in US preparedness for catastrophic events and the nation's capacity to respond to them. These flaws were especially evident in the affected disaster areas' nursing homes, which house a particularly vulnerable population of frail older adults. Although evacuation of a healthcare facility is a key preparedness activity, there is limited research on factors that lead to effective evacuation. Our review of the literature on evacuation is focused on developing a conceptual framework to study future evacuations rather than as a comprehensive assessment of prior work. This paper summarizes what is known thus far about disaster response activities of nursing homes following natural and human-caused disasters, describes a conceptual model to guide future inquiry regarding this topic, and suggests future areas of research to further understand the decision-making process of nursing home facilitators regarding evacuating nursing home residents. To demonstrate the utility of the conceptual model and to provide guidance about effective practices and procedures, this paper focuses on the responses of Veterans Health Administration (VHA) nursing homes to the 2 hurricanes. Quarantelli's conceptual framework, as modified by Perry and Mushkatel, is useful in guiding the development of central hypotheses related to the decision-making that occurred in VA nursing homes and other healthcare facilities following Hurricanes Katrina and Rita. However, we define evacuation somewhat differently to account for the fact that evacuation may, in some instances, be permanent. Thus, we propose modifying this framework to improve its applicability beyond preventive evacuation. We need to better understand how disaster plans can be adapted to meet the needs of frail elders and other residents in nursing homes. Moreover, we must address identified gaps in the scientific literature with respect to health outcomes by tracking outcomes over time

  14. Primary Care Tasks Associated with Provider Burnout: Findings from a Veterans Health Administration Survey.

    Science.gov (United States)

    Kim, Linda Y; Rose, Danielle E; Soban, Lynn M; Stockdale, Susan E; Meredith, Lisa S; Edwards, Samuel T; Helfrich, Christian D; Rubenstein, Lisa V

    2017-09-25

    The patient-centered medical home (PCMH) is a primary care delivery model predicated on shared responsibility for patient care among members of an interprofessional team. Effective task sharing may reduce burnout among primary care providers (PCPs). However, little is known about the extent to which PCPs share these responsibilities, and which, if any, of the primary care tasks performed independently by the PCPs (vs. shared with the team) are particularly associated with PCP burnout. A better understanding of the relationship between these tasks and their effects on PCP burnout may help guide focused efforts aimed at reducing burnout. To investigate (1) the extent to which PCPs share responsibility for 14 discrete primary care tasks with other team members, and (2) which, if any, of the primary care tasks performed by the PCPs (without reliance on team members) are associated with PCP burnout. Secondary data analysis of Veterans Health Administration (VHA) survey data from two time periods. 327 providers from 23 VA primary care practices within one VHA regional network. The dependent variable was PCP report of burnout. Independent variables included PCP report of the extent to which they performed 14 discrete primary care tasks without reliance on team members; team functioning; and PCP-, clinic-, and system-level variables. In adjusted models, PCP reports of intervening on patient lifestyle factors and educating patients about disease-specific self-care activities, without reliance on their teams, were significantly associated with burnout (intervening on lifestyle: b = 4.11, 95% CI = 0.39, 7.83, p = 0.03; educating patients: b = 3.83, 95% CI = 0.33, 7.32, p = 0.03). Performing behavioral counseling and self-management education tasks without relying on other team members for assistance was associated with PCP burnout. Expanding the roles of nurses and other healthcare professionals to assume responsibility for these tasks may ease PCP burden and

  15. Health Programs for Veterans

    Science.gov (United States)

    ... Health Administration » Health Programs for Veterans Veterans Health Administration Health Programs for Veterans Beyond the doctors and ... families of patients receiving medical care at major military and VA medical centers Geriatrics & Extended Care Geriatric ...

  16. Medication administration by enrolled nurses: opinions of nurses in an Australian healthcare organization.

    Science.gov (United States)

    Kerr, Debra; Lu, Sai; Mill, Douglas; McKinlay, Louise

    2012-01-01

    This study examined the opinions of nurses about the introduction of enrolled nurse medication administration and analyzed its impact on the medication error rate. Data were collected using a survey and examination of incident reports regarding nursing medication errors. Nurses (registered nurse, enrolled nurse with medication endorsement, enrolled nurse) responded to survey items regarding the introduction of enrolled nurse medication administration. Data analysis included descriptive statistics, Fischer's exact test, and chi-square analysis where appropriate. The majority of nurses (75.2%) supported enrolled nurse medication administration. However, differences in opinion were observed between registered nurse (RN) and enrolled nurse with medication endorsement (ENME) regarding clear understanding of responsibility and accountability (RN: 47.2% vs. ENME: 77.8%; p =.033), and whether suitable education was provided (RN: 34.7% vs. ENME: 73.7%; p =.012). Moreover, less than one-third of RNs agreed that the assessment process for EN medication endorsement clearly identified the competence of the ENME to administer medications. Nonetheless, nursing medication errors did not increase in the 12-month period after the introduction of enrolled nurse medication administration (pre: 314, post: 302). The findings of this study suggest areas that should be addressed in the future, including assessment of competence and focused education about accountability and responsibility. © 2012 Wiley Periodicals, Inc.

  17. Quality management and federal workers' compensation: the Veterans Health Administration workers' compensation program model.

    Science.gov (United States)

    Hodgson, Michael J; Mohr, David C; Lipkowitz-Eaton, Jennifer; Rodrigues, Dianne; Moreau, Sarah; McPhaul, Kate

    2015-03-01

    The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes. A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases. Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance. Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.

  18. Treatment of Veterans with depression who died by suicide: timing and quality of care at last Veterans Health Administration visit.

    Science.gov (United States)

    Smith, Eric G; Craig, Thomas J; Ganoczy, Dara; Walters, Heather M; Valenstein, Marcia

    2011-05-01

    To examine the recency and quality of the last Veterans Health Administration (VHA) visit for patients with depression who died by suicide. We obtained services and pharmacy data for all 1,843 VHA patients with diagnosed depressive disorders (DSM-IV criteria) who died by suicide from April 1999 through September 2004. We ascertained the location and timing of their final VHA visit. For visits occurring within 30 days of suicide, we examined 3 quality indicators: (1) evidence that mental illness was a focus of the final visit, (2) adequacy of antidepressant dosage, and (3) recent receipt of mental health services. Just over half of the patients (51%) with depression diagnoses had a VHA visit within 30 days of suicide. A minority of these patients (43%) died by suicide within 30 days of a final visit with mental health services, although 64% had received such services within 91 days of their suicide. Among the 57% of patients who died by suicide within 30 days and who were seen in non-mental health settings for their final visit, only 34% had a mental health condition coded at the final visit, and only 41% were receiving adequate dosages of antidepressant (versus 55% for those last seen by mental health services) (P Health Administration patients with depression who died by suicide within 30 days of their final visit received relatively high rates of mental health services, but most final visits still occurred in non-mental health settings. Increased referrals to mental health services, attention to mental health issues in non-mental health settings, and focus on antidepressant treatment adequacy by all providers might have reduced suicide risks for these patients. © Copyright 2011 Physicians Postgraduate Press, Inc.

  19. Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes.

    Science.gov (United States)

    Washington, Donna L; Steers, W Neil; Huynh, Alexis K; Frayne, Susan M; Uchendu, Uchenna S; Riopelle, Deborah; Yano, Elizabeth M; Saechao, Fay S; Hoggatt, Katherine J

    2017-06-01

    Patient-centered medical homes are widely promoted as a primary care delivery model that achieves better patient outcomes. It is unknown if their benefits extend equally to all racial/ethnic groups. In 2010 the Veterans Health Administration, part of the Department of Veterans Affairs (VA), began implementing patient-centered medical homes nationwide. In 2009 significant disparities in hypertension or diabetes control were present for most racial/ethnic groups, compared with whites. In 2014 hypertension disparities were similar for blacks, had become smaller but remained significant for Hispanics, and were no longer significant for multiracial veterans, whereas disparities had become significant for American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders. By contrast, in 2014 diabetes disparities were similar for American Indians/Alaska Natives, blacks, and Hispanics, and were no longer significant for Native Hawaiians/other Pacific Islanders. We found that the modest benefits of the VA's implementation of patient-centered medical homes were offset by competing multifactorial external, health system, provider, and patient factors, such as increased patient volume. To promote health equity, health care innovations such as patient-centered medical homes should incorporate tailored strategies that account for determinants of racial/ethnic variations. Evaluations of patient-centered medical homes should monitor outcomes for racial/ethnic groups. Project HOPE—The People-to-People Health Foundation, Inc.

  20. The transformation experience of the Veterans Health Administration and its relevance to Canada.

    Science.gov (United States)

    Fooks, Cathy; Decter, Michael

    2005-01-01

    Over the past few years, there has been a steady stream of visitors to Canada from the US Veterans Health Administration (VA). Led by the former Under Secretary for Health in the Department of Veterans Affairs, Dr. Ken Kizer, they come to tell the remarkable story of how the VA transformed itself from a hospital-based bureaucracy described as "dangerous, dirty and scandal-ridden" to a healthcare system for veterans recognized for its high-quality, patient-centred care. It is a fascinating story of how a publicly funded healthcare service changed its entire approach to patient care with a quality improvement lens at its core. Fifteen years ago, critics of the VA called for its complete privatization as the only solution to fixing its problems. A team of quality champions set out to prove otherwise. Canada has some lessons to learn. The VA is a compelling role model for Canadian reformers, in large measure, due to its public sector character.

  1. Reduction in patient enrollment in the Veterans Health Administration after media coverage of adverse medical events.

    Science.gov (United States)

    Weeks, William B; Mills, Peter D

    2003-12-01

    Health care organizations may experience costs associated with preventable adverse events in the form of poor brand image and subsequent patient disenrollment. A retrospective cohort design was used to determine whether media coverage of adverse events that occurred in Veterans Health Administration (VHA) hospitals was associated with subsequent veteran disenrollment. Twenty-four newspaper reports of medical adverse events that occurred between 1994 and 1999 within the VHA system were identified. Regionally adjusted changes in enrollment rates for VHA facilities that had reported adverse events were compared with those that had not one year before and one and three years after publication of the newspaper reports. Facilities that had published reports of adverse events had lower enrollment rates after publication of the report for two groups of veterans. Within the VHA system, health care organizations involved in adverse events that generated publicity suffered a greater rate of patient disenrollment. If safe patient care practices can reduce adverse publicity, they may enhance corporate value by maintaining enrollment of the patient population.

  2. Suicide Mortality Among Patients Treated by the Veterans Health Administration From 2000 to 2007

    Science.gov (United States)

    Bohnert, Amy S. B.; Ilgen, Mark A.; Ignacio, Rosalinda; McCarthy, John F.; Valenstein, Marcia M.; Knox, Kerry L.

    2012-01-01

    Objectives. We sought to examine rates of suicide among individuals receiving health care services in Veterans Health Administration (VHA) facilities over an 8-year period. Methods. We included annual cohorts of all individuals who received VHA health care services from fiscal year (FY) 2000 through FY 2007 (October 1, 1999–September 30, 2007; N = 8 855 655). Vital status and cause of death were obtained from the National Death Index. Results. Suicide was more common among VHA patients than members of the general US population. The overall rates of suicide among VHA patients decreased slightly but significantly from 2000 to 2007 (P < .001). Male veterans between the ages of 30 and 64 years were at the highest risk of suicide. Conclusions. VHA health care system patients are at elevated risk for suicide and are appropriate for suicide reduction services, although the rate of suicide has decreased in recent years for this group. Comprehensive approaches to suicide prevention in the VHA focus not only on recent returnees from Iraq and Afghanistan but also on middle-aged and older Veterans. PMID:22390612

  3. A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.

    Science.gov (United States)

    Funk, L M; Gunnar, W; Dominitz, J A; Eisenberg, D; Frayne, S; Maggard-Gibbons, M; Kalarchian, M A; Livingston, E; Sanchez, V; Smith, B R; Weidenbacher, H; Maciejewski, Matthew L

    2017-04-01

    In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

  4. Supervising medication administration by undergraduate nursing students: influencing factors.

    Science.gov (United States)

    Reid-Searl, Kerry; Moxham, Lorna; Walker, Sandra; Happell, Brenda

    2010-03-01

    The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required. The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting. A grounded theory approach was used with constant comparative analysis to identify categories from the data. The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia. Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time. The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment. The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented.

  5. Nursing students and the supervision of medication administration.

    Science.gov (United States)

    Reid-Seari, Kerry; Happell, Brenda; Burke, Karena J; Gaskin, Cadeyrn J

    2013-01-01

    Up to one in five medication administrations in Australian hospitals involve an error. As registered nurses (RNs) are at the forefront of medication administration, they have been the focus of attempts to reduce errors. Given that nursing students have reported errors or experiences of near misses, their practices, as well as the supervision they receive from RNs, also deserves investigation. The aim of this study was to investigate student nurses' experiences of supervision while administering medications. Students (N= 45) completed a questionnaire on their supervision experiences while administering medications. The findings revealed that 88% of students agreed that they had been directly supervised during the entirety of administration procedures. Although 7% of students reported not receiving supervision throughout medication administration, higher percentages of students indicated that they received lower levels of supervision when wards were busy (66%), when they felt under pressure to comply with the wishes of RNs (40%), when students had been in clinical settings for extended periods of time (51%), and when the RNs trusted the student nurses (37%). Approximately one third (29%) of student nurses disagreed that RNs followed the six rights when administering medications. These findings suggest that student nurses are not always adequately supervised and are at times administering medications outside the parameters of the law. Healthcare organisations need to adapt their policies and practices to ensure that the legal requirements surrounding student nurse administration of medications are being met, as well as the educational and welfare needs of neophyte nurses.

  6. Student’s opinion about adult nursing assistance administration discipline

    OpenAIRE

    Brandão Chaves, Enaura Helena; Cristina Echer, Isabel

    2008-01-01

    This article describes the student`s opinion about the discipline Administration of Adult Nursing Assistance, developed in the 7th term of nursing graduation course in UFRGS Nursing School. The aspects evaluated were: organization, objectives, theoretical framework, subjects relevance, teaching strategies, field of practice learning and supervision. It`s a qualitative study, the instrument used is a questionary with open questions, which allows the students write their points of view about th...

  7. Medication Administration and Knowledge Retention in Baccalaureate Nursing Students

    OpenAIRE

    Pamela Treister; Donna Darcy

    2016-01-01

    A quality improvement project was undertaken in order to assist the undergraduate baccalaureate nursing students in knowledge retention for medication administration during their senior semester in nursing school. Two specific changes in curriculum were implemented in order to assist these undergraduate baccalaureate nursing students at a suburban private university in New York. Simulation and the incorporation of competency by rubrics were implemented in the spring semester of junior year, w...

  8. Nursing academic administration: who will take on the challenge?

    Science.gov (United States)

    Adams, Lavonne

    2007-01-01

    To address the shortage of qualified candidates interested in nursing academic administration, this study explored factors that influence nursing faculty to pursue administrative positions. Nursing academic administrators and full-time faculty from randomly selected accredited nursing programs in private colleges and universities in the United States participated in this study. Administrators completed the Leadership Practices Inventory-Self and a recruitment questionnaire, whereas faculty completed the Leadership Practices Inventory-Observer and a career aspiration questionnaire. Most faculty respondents (63%) indicated that they would not consider a position with greater administrative responsibility. Respondents identified workload and conflict-related issues as factors likely to discourage their pursuit of administration. Respondents identified additional challenge/variety of work, opportunity to influence organizational climate for change, opportunity to facilitate faculty growth and development, and mix of administration with teaching as likely to encourage their pursuit of administration. Faculty interest in a position with greater administrative responsibility was significantly increased for those who had completed additional course work beyond their highest degree. Practice recommendations included making leadership development opportunities available for faculty interested in administration, exploring methods to manage workload and conflict, and exploring methods to maximize factors identified as likely to encourage the pursuit of academic administration.

  9. Human Papillomavirus Testing by Veterans Administration Women's Health Providers: Are They Adhering to Guidelines?

    Science.gov (United States)

    Hallett, Laura D; Gerber, Megan R

    2017-09-08

    Evidence-based guidelines have been created by professional societies, including the United States Preventive Services Task Force (USPSTF) and American Society for Colposcopy and Cervical Pathology (ASCCP), for use of human papillomavirus (HPV) cotesting in cervical cancer screening. We investigated whether Veterans Health Administration (VA) providers at one VA medical center follow these guidelines. Retrospective chart review of women aged 21-65 who had an HPV test ordered with pap testing in fiscal year 2014 at one Veterans Administration (VA) medical center to evaluate concordance of HPV ordering with screening (USPSTF) and management (ASCCP) guidelines. We collected data on patient characteristics and gynecologic history and documented the reason, if given, for HPV testing. Of the 210 eligible HPV tests evaluated, 142 tests (68%) were determined to be guideline discordant. Of the 142 guideline-discordant tests, 90 had no documented reason for HPV testing in the chart. Site of care was not significant. This study demonstrates potential overuse of HPV testing among women's health providers at one VA medical center. This may indicate that VA providers lack an understanding of HPV cotesting guidelines. Further studies are needed to characterize VA provider adherence to HPV testing guidelines nationally. Implementation of educational interventions and decision aids may improve VA providers' adherence to guidelines.

  10. Gender-specific mental health care needs of women veterans treated for psychiatric disorders in a Veterans Administration Women's Health Clinic.

    Science.gov (United States)

    Miller, Laura J; Ghadiali, Nafisa Y

    2015-04-01

    This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women's Health Clinic (WHC). Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women's Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans' sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.

  11. The Veterans Affairs's Corporate Data Warehouse: Uses and Implications for Nursing Research and Practice.

    Science.gov (United States)

    Price, Lauren E; Shea, Kimberly; Gephart, Sheila

    2015-01-01

    The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA's Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA's transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

  12. Identification of rheumatoid arthritis patients using an administrative database: a Veterans Affairs study.

    Science.gov (United States)

    Ng, Bernard; Aslam, Fawad; Petersen, Nancy J; Yu, Hong-Jen; Suarez-Almazor, Maria E

    2012-10-01

    The accuracy of the diagnosis is vital when administrative databases are used for pharmacoepidemiologic and outcome studies. Data pertaining to the utility of databases for rheumatoid arthritis (RA) are sparse and variable. We assessed the utility of various diagnostic algorithms to identify RA patients within the Veterans Health Administration (VHA) databases. Using the International Classification of Diseases, Ninth Revision code for RA at 2 visits at least 6 months apart, we identified 1,779 patients between October 1, 1998 and September 30, 2009 in our local Veterans Affairs Medical Center (VAMC) administrative database. Disease-modifying antirheumatic drug (DMARD) use was ascertained from the pharmacy database. Cases were analyzed based on DMARD therapy and RA codes at clinic visits. A total of 543 patients' medical records, selected by stratification and random selection on the basis of their visits, were reviewed to ascertain the clinicians' diagnoses and clinical criteria documentation. Positive predictive values (PPVs) were calculated for various database case identification algorithms using diagnosis of RA by medical record review as the gold standard. The PPV for identification of RA with 2 RA codes 6 months apart was 30.9%. Addition of DMARD therapy increased the PPV to 60.4%. The PPV further increased to 91.4% when having an RA code at the last VAMC rheumatology clinic visit criterion was added. An algorithm using only 2 administrative RA codes 6 months apart had a low PPV for correctly identifying patients with RA in the VHA database. Including DMARD therapy and requiring an RA code at the last visit with a rheumatologist increased the performance of the data extraction algorithm. Copyright © 2012 by the American College of Rheumatology.

  13. Genomic Competencies for Nursing Practice: Implications for Nursing Leadership.

    Science.gov (United States)

    Boyd, Andrea M; Alt-White, Anna C; Anderson, Gwen; Schaa, Kendra L; Kasper, Christine E

    2017-01-01

    Nurses must have appropriate knowledge and skills to provide safe and effective nursing care in recognition of evolving science. Knowledge of genomics is required to ensure appropriate referral and education of patients who would benefit from genetic services. This article describes the process the Veterans Healthcare Administration's (VHA's) Office of Nursing Services used to determine the nursing genomic competencies appropriate for VHA nurses and identify available resources for educating nurses on these nursing competencies and a strategic plan for long-term implementation.

  14. Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study.

    Science.gov (United States)

    Weems, Shelley; Heller, Pamela; Fenton, Susan H

    2015-01-01

    The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: 1. Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity. 2. Coder training and type of record (inpatient versus outpatient) affect coding productivity. 3. Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity.

  15. Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study

    Science.gov (United States)

    Weems, Shelley; Heller, Pamela; Fenton, Susan H.

    2015-01-01

    The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity.Coder training and type of record (inpatient versus outpatient) affect coding productivity.Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity. PMID:26396553

  16. Using a framework for spread: The case of patient access in the Veterans Health Administration.

    Science.gov (United States)

    Nolan, Kevin; Schall, Marie W; Erb, Fabiane; Nolan, Thomas

    2005-06-01

    Experience indicates that an effective operational system will spread much more slowly than, for example, a new antinausea drug. The Veterans Health Administration (VHA) used a Framework for Spread to spread improvements in access to more than 1800 outpatient clinics between April 2001 and December 2003. The framework identifies strategies and methods for planning and guiding the spread of new ideas or new operational systems, including the responsibilities of leadership, packaging the new ideas, communication, strengthening the social system, measurement and feedback, and knowledge management. APPLYING THE FRAMEWORK FOR SPREAD: Following a collaborative for reducing waiting times for patients without the large-scale addition of resources, each of the participating 22 Veterans Integrated Service Networks (VISNs) used the framework to expand improvements in access to care to six additional targeted clinics (for example, primary care, eye care, cardiology). During the VHAs spread initiative, waiting time for a primary care appointment decreased from 60.4 days at the end of fiscal year (FY) 2000 to 28.4 at the end of FY 2002. Results were sustained. Waiting time was <25 days at the end of FY 2004. The Framework for Spread suggests areas that organizations should consider when developing and executing a strategy for a spread initiative. Further study is needed to determine the specific activities that should be emphasized to accelerate spread.

  17. Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus.

    Science.gov (United States)

    Morgan, Perri; Everett, Christine M; Smith, Valerie A; Woolson, Sandra; Edelman, David; Hendrix, Cristina C; Berkowitz, Theodore S Z; White, Brandolyn; Jackson, George L

    2017-01-01

    Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.

  18. Activities Carried Out Under the Veterans' Administration Medical School Assistance and Health Manpower Training Act of 1972 (Public Law 92-541), An Annual Report Prepared by the Veterans' Administration.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    The third annual report (fiscal year 1979) of the activities carried out under the Veterans' Administration Medical School Assistance and Health Manpower Training Act of 1972 (Public Law 92-541) is presented. Under this special authority grants have been made to assist in the establishment of new state medical schools, to existing medical schools,…

  19. Mental Health Productivity Monitoring in the Veterans Health Administration: Challenges and Lessons Learned.

    Science.gov (United States)

    Kearney, Lisa K; Smith, Clifford; Kivlahan, Daniel R; Gresen, Robert C; Moran, Eileen; Schohn, Mary; Trafton, Jodie; Zeiss, Antonette M

    2017-07-17

    Achieving quality outcomes and cost efficiency within mental health are overarching objectives of the Veterans Health Administration (VHA). The mental health care workforce has long been oriented toward the goal of high quality outcomes; however, cost efficiency has only recently been elevated into this important value equation. With increased demand for access to mental health services within the VHA, leadership sought to advance methods of determining and improving mental health provider productivity. Monitoring of productivity data may also provide data signaling the potential need for additional staffing to keep up with demand for services. This article outlines VHA's development and specification of mental health productivity policy, implementation strategies, and a discussion of challenges and lessons learned for other systems to consider in implementing productivity monitoring. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Relationship of hospital organizational culture to patient safety climate in the Veterans Health Administration.

    Science.gov (United States)

    Hartmann, Christine W; Meterko, Mark; Rosen, Amy K; Shibei Zhao; Shokeen, Priti; Singer, Sara; Gaba, David M

    2009-06-01

    Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.

  1. Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

    Science.gov (United States)

    True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M

    2013-04-01

    The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

  2. Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration.

    Science.gov (United States)

    Safford, Monika M; Barasch, Andrei; Curtis, Jeffrey R; Outman, Ryan; Saag, Kenneth

    2014-10-01

    Subtrochanteric femoral shaft fractures after little or no trauma have been reported in long-term users of bisphosphonates, but risks relative to hip fracture protective effects and among men are not clear. We examined associations between bisphosphonate use and nontraumatic subtrochanteric (NTST) femoral fractures and hip fractures in the Veterans Health Administration. This retrospective cohort study was conducted using 1998-2007 Veterans Health Administration electronic medical records data on 78,155 individuals who had a fragility fracture at age 45 years or older. Time-to-event analysis examined associations of bisphosphonates with risk of NTST femoral fracture and, separately, hip fracture, controlling for sociodemographics, medications, and comorbid medical conditions. The cohort had a mean age 66.5 years (32.5% were ≥75 years old) at the time of their first fracture, and 69.3% were observed for 6 or more years; only 11.8% were prescribed bisphosphonates during observation. During follow-up, 408 had an NTST femoral second fracture, and 1584 had a hip second fracture. Compared with those never on bisphosphonates, the adjusted hazard ratio for NTST femoral second fracture among patients on 4 years of therapy or longer was 0.40 (95% confidence interval, 0.16-0.97) and for hip second fracture was 0.38 (95% confidence interval, 0.24-0.61). Bisphosphonate treatment in this high-risk cohort was infrequent with few long-term users, limiting power to assess long-term effects. Nontraumatic subtrochanteric femoral fractures were uncommon, and longer bisphosphonate use was associated with lower (not higher) risk. In men, risks of NTST femoral fractures associated with bisphosphonate treatment may be low in contrast to substantial protective benefits for hip fracture.

  3. The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration.

    Science.gov (United States)

    Reddy, Shivani M; Rose, Danielle E; Burgess, James F; Charns, Martin P; Yano, Elizabeth M

    Increasing numbers of women veterans present an organizational challenge to a health care system that historically has served men. Women veterans require comprehensive women's health services traditionally not provided by the Veterans Health Administration. Examine the association of organizational factors and adoption of comprehensive women's health care. Cross-sectional analysis of the 2007 Veterans Health Administration National Survey of Women Veterans Health Programs and Practices. Dependent measures included a) model of women's health care: separate women's health clinic (WHC), designated women's health provider in primary care (DWHP), both (WHC+DWHP), or neither and b) the availability of five women's health services: cervical cancer screening and evaluation and management of vaginitis, menstrual disorders, contraception, and menopause. Exposure variables were organizational factors drawn from the Greenhalgh model of diffusion of innovations including measures of structure, absorptive capacity, and system readiness for innovation. The organizational factors of a gynecology clinic, an academic affiliation with a medical school, a women's health representative on one or more high-impact committees, and a greater caseload of women veterans were more common at sites with WHCs and WHC+DWHPs, compared with sites relying on general primary care with or without a DWHP. Academic affiliation and high-impact committee involvement remained significant in multivariable analysis. Sites with WHCs or WHC+DWHPs were more likely to offer all five women's health services. Facilities with greater apparent absorptive capacity (academic affiliation and women's health representation on high-impact committees) are more likely to adopt WHCs. Facilities with separate WHCs are more likely to deliver a package of women's health services, promoting comprehensive care for women veterans. Copyright © 2016 Jacobs Institute of Women's Health. All rights reserved.

  4. The Veterans Health Administration’s Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans

    Science.gov (United States)

    2012-02-01

    mitigate effects of unrepresentative samples may not be wholly successful. Because of those factors, the samples analyzed may either understate or...VHA’s Health Care Provided to OCO Polytrauma Patients 22D-1. Sample Sizes 38D-2. Alternative Calculation of Average Costs for All of VHA’s Health Care...and the subgroups they sample . The percentage of OCO veterans whom VHA clinicians have diagnosed with PTSD (26 percent) is at the top of the range

  5. A marketing approach to nursing administration--Part 2.

    Science.gov (United States)

    Alward, R R

    1983-04-01

    Marketing has been defined as effectively managing exchange relationships with an organization's markets or constituencies[1]. To apply a marketing approach to nursing administration, an awareness of all divisional relationships that involve the exchange of values must be developed. The interactions of the nursing division with the larger health care organization, patient population, medical staff, community, and other markets are very complex. Identifying markets with similar needs, preferences, perceptions, attitudes, and behaviors is essential because each segment requires different marketing strategies, tactics, and goals. After defining present and potential markets, the nurse administrator must ask what is valued and exchanged by each segment. A marketing information and research program can provide the data necessary to analyze the needs and preferences of the nursing markets as well as the nursing organization's capabilities and deficits. Part 1 concluded with a description of the qualitative and quantitative phases of a marketing information program. Part 2 explores the management phase, in which research information is translated into strategies and tactics designed to meet the needs of identified market segments. Potential problems the nursing administrator may face in implementing a marketing approach are discussed.

  6. [Subcutaneous medication administration: agreement or controverse for nursing?].

    Science.gov (United States)

    Reichembach, Mitsy Tânnia; Meier, Marineli Joaquim; Aschidamini, lone Maria

    2005-01-01

    The correct and safe medication administration, independently of the form, is under the responsibility of the nursing team. To this team it is necessary specific knowledge and abilities, as well as continuous update of the processes that involve such care. This article has as objective to make some considerations about this subject, adjusting them to the common nursing practice. For this, we present a literature review that approaches the main application methods used for subcutaneous medication. After that, we argue some aspects for professional improvement, so that the medication administration be satisfactory and safe in the caring process.

  7. Root cause analysis of serious adverse events among older patients in the Veterans Health Administration.

    Science.gov (United States)

    Lee, Alexandra; Mills, Peter D; Neily, Julia; Hemphill, Robin R

    2014-06-01

    Preventable adverse events are more likely to occur among older patients because of the clinical complexity of their care. The Veterans Health Administration (VHA) National Center for Patient Safety (NCPS) stores data about serious adverse events when a root cause analysis (RCA) has been performed. A primary objective of this study was to describe the types of adverse events occurring among older patients (age > or = 65 years) in Department of Veterans Affairs (VA) hospitals. Secondary objectives were to determine the underlying reasons for the occurrence of these events and report on effective action plans that have been implemented in VA hospitals. In a retrospective, cross-sectional review, RCA reports were reviewed and outcomes reported using descriptive statistics for all VA hospitals that conducted an RCA for a serious geriatric adverse event from January 2010 to January 2011 that resulted in sustained injury or death. The search produced 325 RCA reports on VA patients (age > or = 65 years). Falls (34.8%), delays in diagnosis and/or treatment (11.7%), unexpected death (9.9%), and medication errors (9.0%) were the most commonly reported adverse events among older VA patients. Communication was the most common underlying reason for these events, representing 43.9% of reported root causes. Approximately 40% of implemented action plans were judged by local staff to be effective. The RCA process identified falls and communication as important themes in serious adverse events. Concrete actions, such as process standardization and changes to communication, were reported by teams to yield some improvement. However, fewer than half of the action plans were reported to be effective. Further research is needed to guide development and implementation of effective action plans.

  8. Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation.

    Science.gov (United States)

    Stevenson, Lauren; Ball, Sherry; Haverhals, Leah M; Aron, David C; Lowery, Julie

    2016-11-30

    The Consolidated Framework for Implementation Research was used to evaluate implementation facilitators and barriers of Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based programme where specialist teams train and mentor remotely-located primary care providers in providing routine speciality care for common chronic illnesses. The goal of SCAN-ECHO was to improve access to speciality care for Veterans. The aim of this study was to provide guidance and support for the implementation and spread of SCAN-ECHO. Semi-structured telephone interviews with 55 key informants (primary care providers, specialists and support staff) were conducted post-implementation with nine sites and analysed using Consolidated Framework for Implementation Research constructs. Data were analysed to distinguish sites based on level of implementation measured by the numbers of SCAN-ECHO sessions. Surveys with all SCAN-ECHO sites further explored implementation information. Analysis of the interviews revealed three of 14 Consolidated Framework for Implementation Research constructs that distinguished between low and high implementation sites: design quality and packaging; compatibility; and reflecting and evaluating. The survey data generally supported these findings, while also revealing a fourth distinguishing construct - leadership engagement. All sites expressed positive attitudes toward SCAN-ECHO, despite struggling with the complexity of programme implementation. Recommendations based on the findings include: (a) expend more effort in developing and distributing educational materials; (b) restructure the delivery process to improve programme compatibility; (c) establish an audit and feedback mechanism for monitoring and improving the programme; (d) engage in more upfront planning to reduce complexity; and (e) obtain local leadership support for providing primary care

  9. Chikungunya Fever Cases Identified in the Veterans Health Administration System, 2014.

    Science.gov (United States)

    Perti, Tara; Lucero-Obusan, Cynthia A; Schirmer, Patricia L; Winters, Mark A; Holodniy, Mark

    2016-05-01

    During December 2013, the first locally transmitted chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. Although CHIKV infection is rarely fatal, risk for severe disease increases with age and medical comorbidities. Herein we describe characteristics of Veterans Health Administration (VHA) patients with CHIKV infection and, among those with infections diagnosed in Puerto Rico, investigated risk factors for hospitalization. We queried VHA's national electronic medical records to identify patients with CHIKV testing during 2014. Demographics, clinical history, laboratory results, and outcomes were abstracted. We investigated risk factors for hospitalization among patients with laboratory-confirmed CHIKV infection in Puerto Rico. We identified 180 laboratory-confirmed CHIKV infections; 148 (82.2%) were diagnosed in Puerto Rico, and 32 (17.8%) were diagnosed among returning travelers elsewhere in the United States. In Puerto Rico, where more patients were hospitalized (55.4% versus 20.0%) and died (4.1% versus 0%), risk for hospitalization increased with age (relative risk [RR]/each 10-year increase, 1.19; 95% confidence interval [CI], 1.06-1.32) and, adjusted for age, increased among patients with congestive heart failure (RR, 1.58; 95% CI, 1.25-1.99), chronic kidney disease (RR, 1.52; 95% CI, 1.19-1.94), diabetes mellitus (RR, 1.39; 95% CI, 1.06-1.84), or chronic lung disease (RR, 1.37; 95% CI, 1.03-1.82). CHIKV infection is an emerging problem among Veterans residing in or visiting areas with CHIKV transmission. Although overall mortality rates are low, clinicians in affected areas should be aware that older patients and patients with comorbidities may be at increased risk for severe disease.

  10. Veterans Affairs Suicide Prevention Synthetic Dataset

    Data.gov (United States)

    Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...

  11. Extracting a stroke phenotype risk factor from Veteran Health Administration clinical reports: an information content analysis.

    Science.gov (United States)

    Mowery, Danielle L; Chapman, Brian E; Conway, Mike; South, Brett R; Madden, Erin; Keyhani, Salomeh; Chapman, Wendy W

    2016-01-01

    In the United States, 795,000 people suffer strokes each year; 10-15 % of these strokes can be attributed to stenosis caused by plaque in the carotid artery, a major stroke phenotype risk factor. Studies comparing treatments for the management of asymptomatic carotid stenosis are challenging for at least two reasons: 1) administrative billing codes (i.e., Current Procedural Terminology (CPT) codes) that identify carotid images do not denote which neurovascular arteries are affected and 2) the majority of the image reports are negative for carotid stenosis. Studies that rely on manual chart abstraction can be labor-intensive, expensive, and time-consuming. Natural Language Processing (NLP) can expedite the process of manual chart abstraction by automatically filtering reports with no/insignificant carotid stenosis findings and flagging reports with significant carotid stenosis findings; thus, potentially reducing effort, costs, and time. In this pilot study, we conducted an information content analysis of carotid stenosis mentions in terms of their report location (Sections), report formats (structures) and linguistic descriptions (expressions) from Veteran Health Administration free-text reports. We assessed an NLP algorithm, pyConText's, ability to discern reports with significant carotid stenosis findings from reports with no/insignificant carotid stenosis findings given these three document composition factors for two report types: radiology (RAD) and text integration utility (TIU) notes. We observed that most carotid mentions are recorded in prose using categorical expressions, within the Findings and Impression sections for RAD reports and within neither of these designated sections for TIU notes. For RAD reports, pyConText performed with high sensitivity (88 %), specificity (84 %), and negative predictive value (95 %) and reasonable positive predictive value (70 %). For TIU notes, pyConText performed with high specificity (87 %) and negative predictive

  12. Rural and urban supported employment programs in the Veterans Health Administration: Comparison of barriers and facilitators to vocational achievement for veterans experiencing mental illnesses.

    Science.gov (United States)

    Kukla, Marina; McGuire, Alan B; Salyers, Michelle P

    2016-06-01

    The purpose of this mixed-methods study was to compare urban and rural supported employment programs on barriers and facilitators with employment for veterans experiencing mental illnesses. A national sample of 114 supported employment staff, supervisors, and upper level managers employed by the Veteran's Health Administration were recruited. Participants completed an online survey of work barriers and facilitators, including open-ended questions regarding additional factors that impact the work success of veterans. Survey responses were compared between participants from rural (n = 28) and urban (n = 86) programs using independent groups t tests. Open-ended questions were analyzed using content analysis. Supported employment personnel from rural programs perceived significantly more barriers to work success compared with urban personnel, particularly in the areas of access to services and a range of job-related factors, including job match and interpersonal relationships at the work site. In contrast, participants from urban programs reported greater facilitators in the domain of mental health services. Qualitative findings add depth to the quantitative findings and highlight challenges in rural supported employment programs impacting job development and job fit. Both urban and rural programs experienced unique barriers related to geography and transportation. Findings from this nationwide mixed-methods survey provide a comprehensive picture of the obstacles to employment success for veterans living with mental illnesses and receiving supported employment services in rural areas. Suggestions for changes in policy related to services and resource allocation are presented to address these unique barriers, particularly in rural areas. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  13. Lessons from Initiating the First Veterans Health Administration (VA) Women's Health Practice-based Research Network (WH-PBRN) Study.

    Science.gov (United States)

    Pomernacki, Alyssa; Carney, Diane V; Kimerling, Rachel; Nazarian, Deborah; Blakeney, Jill; Martin, Brittany D; Strehlow, Holly; Yosef, Julia; Goldstein, Karen M; Sadler, Anne G; Bean-Mayberry, Bevanne A; Bastian, Lori A; Bucossi, Meggan M; McLean, Caitlin; Sonnicksen, Shannan; Klap, Ruth; Yano, Elizabeth M; Frayne, Susan M

    2015-01-01

    The Veterans Health Administration (VA) Women's Health Practice-Based Research Network (WH-PBRN) was created to foster innovations for the health care of women veterans. The inaugural study by the WH-PBRN was designed to identify women veterans' own priorities and preferences for mental health services and to inform refinements to WH-PBRN operational procedures. Addressing the latter, this article reports lessons learned from the inaugural study. WH-PBRN site coordinators at the 4 participating sites convened weekly with the study coordinator and the WH-PBRN program manager to address logistical issues and identify lessons learned. Findings were categorized into a matrix of challenges and facilitators related to key study elements. Challenges to the conduct of PBRN-based research included tracking of regulatory documents; cross-site variability in some regulatory processes; and troubleshooting logistics of clinic-based recruitment. Facilitators included a central institutional review board, strong relationships between WH-PBRN research teams and women's health clinic teams, and the perception that women want to help other women veterans. Our experience with the inaugural WH-PBRN study demonstrated the feasibility of establishing productive relationships between local clinicians and researchers, and of recruiting a special population (women veterans) in diverse sites within an integrated health care system. This identified strengths of a PBRN approach. © Copyright 2015 by the American Board of Family Medicine.

  14. Nursing knowledge and practices regarding subcutaneous fluid administration

    OpenAIRE

    Gomes, Nathália Silva; Silva, Andrea Mara Bernardes da; Zago, Luana Barbosa; Silva, Érica Carneiro de Lima e; Barichello, Elizabeth

    2017-01-01

    ABSTRACT Objective: To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. Method: Integrative review of the literature using the descriptors “nursing”, “hypodermoclysis”, “drug administration routes”, “adult health,” and “knowledge,” in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. Results: A predominance of i...

  15. Medication administration via enteral tubes: a survey of nurses' practices.

    Science.gov (United States)

    Phillips, Nicole Margaret; Endacott, Ruth

    2011-12-01

    This article is a report of a study examining the practices of acute care nurses when administering medication via enteral tubes. Administering medication via enteral tubes is predominantly a nursing responsibility across countries. It is important to establish what nurses actually do when giving enteral medication to inform policy and continuing education development. In 2007, a survey was conducted using a random sample of acute care nurses at two large metropolitan hospitals in Melbourne, Australia. There were 181 Registered Nurses who participated in the study; 92 (50.8%) practised in intensive care units, 52 (28.7%) in surgical areas, 30 (16.6%) in medical areas and 7 (3.9%) were from combined medical-surgical areas. The questionnaire was developed by the researchers and a pilot study was conducted in August 2006 to test reliability, face validity and user-friendliness of the tool. Nurses reported using a range of methods to verify enteral tube position prior to administering enteral medication; some were unreliable methods. A majority reported administering enteric-coated and slow or extended release forms of medication, and giving solid forms of medication when liquid form was available. Nearly all (96%) reported flushing a tube after giving medication, 28% before, and 12% always flushed between each medication. Enteral medication administration practices are inconsistent. Some nurses are using unsafe practices and may therefore compromise patient care. © 2011 Blackwell Publishing Ltd.

  16. Adapting a weight management tool for Latina women: a usability study of the Veteran Health Administration's MOVE!23 tool.

    Science.gov (United States)

    Perez, Hector R; Nick, Michael W; Mateo, Katrina F; Squires, Allison; Sherman, Scott E; Kalet, Adina; Jay, Melanie

    2016-10-05

    Obesity disproportionately affects Latina women, but few targeted, technology-assisted interventions that incorporate tailored health information exist for this population. The Veterans Health Administration (VHA) uses an online weight management tool (MOVE!23) which is publicly available, but was not designed for use in non-VHA populations. We conducted a qualitative study to determine how interactions between the tool and other contextual elements impacted task performance when the target Latina users interacted with MOVE!23. We sought to identify and classify specific facilitators and barriers that might inform design changes to the tool and its context of use, and in turn promote usability. Six English-speaking, adult Latinas were recruited from an inner city primary care clinic and a nursing program at a local university in the United States to engage in a "Think-Aloud" protocol while using MOVE!23. Sessions were recorded, transcribed, and coded to identify interactions between four factors that contribute to usability (Tool, Task, User, Context). Five themes influencing usability were identified: Technical Ability and Technology Preferences; Language Confusion and Ambiguity; Supportive Tool Design and Facilitator Guidance; Relevant Examples; and Personal Experience. Features of the tool, task, and other contextual factors failed to fully support participants at times, impeding task completion. Participants interacted with the tool more readily when its language was familiar and content was personally relevant. When faced with ambiguity and uncertainty, they relied on the tool's visual cues and examples, actively sought relevant personal experiences, and/or requested facilitator support. The ability of our participants to successfully use the tool was influenced by the interaction of individual characteristics with those of the tool and other contextual factors. We identified both tool-specific and context-related changes that could overcome barriers to the

  17. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... listen? see more videos from Veterans Health Administration 1 Act see more videos from Veterans Health Administration ... videos from Veterans Health Administration The Power of 1 PSA see more videos from Veterans Health Administration ...

  18. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... listen? see more videos from Veterans Health Administration 1 Act see more videos from Veterans Health Administration ... from Veterans Health Administration Lost: The Power of One Connection see more videos from Veterans Health Administration ...

  19. The Temperament Types of Nursing Administrators in Hospital Nursing Service.

    Science.gov (United States)

    1984-05-01

    INTJ 3 1.56 ENFP 9 4.68 ENFJ 8 4.16 ENTP 5 2.60 ISFJ 7 3.64 ESTP 1 0.52 I SFP 1 0.52 a.INTP 0 0.00 ESFP 0 0.00 INFP 0 0.00 ISTP 0 0.00...Stated Administrative Position* Type 1 2 3 4 5 6 7 8 ESTJ 30 12 12 1 6 2 2 1 ISTJ 6 4 6 1 1 2 ENTJ 6 2 5 1 1 ESFJ 1 5 6 * INFJ I INTJ 1 1 ENFP 4 1 3 1...others develop. INTJ - Logical, critical, decisive innovator of ideas; . A serious, intent, highly independent, concerned with organization, determined and

  20. Enhancing marketing recruitment strategies: administrator tenure and nursing expenditures.

    Science.gov (United States)

    Gunby, Norris White

    2005-01-01

    When recruiting nurses, long-term care facilities require an ability to identify salient organizational characteristics that are attractive to potential nursing services candidates vis-à-vis their competitors. The findings of this study suggest that information on administrative tenure can be utilized to attract applicants by appealing to criteria within their high-involvement job search activities. High-involvement applicants proactively seek recruitment content that provides essential job attributes that match their needs and skills and are more apt to be a higher quality candidate. Based upon the study's findings, managers are offered marketing strategy recommendations for tailoring recruiting messages that appeal to high-involvement job seekers.

  1. Emergency management program operational responses to weapons of mass destruction: Veterans Health Administration, 2001-2004.

    Science.gov (United States)

    Hodgson, Michael J; Bierenbaum, Arnold; Mather, Susan; Brown, Mark A; Beatty, John; Scott, Margie; Brewster, Peter

    2004-11-01

    Despite the recognition of chemical emergencies, terrorist events, and ongoing threats, little practical guidance exists for healthcare facilities. An approach and materials developed by the Veterans Health Administration in a five-element program over the last 2 years to enhance the existing emergency management program is outlined. Nine steps to the development of a comprehensive all-hazards, emergency plan and program, with auditing and improvement tools are offered. Cognitive aids for clinical use are available on-line and in hard copy. A hazard assessment modeled patients as emission sources documenting the operations strategies under which level C personal protective equipment will protect healthcare workers. The development of this response program appears to support a broader, long-standing VHA approach to problem solving. This involves bringing together individual talented field staff, representing specific skills, geographic regions, and work styles; investing in face-to-face consensus development; and developing programs with extensive internal peer-review ("field-based," "bottom-up and top-down," and external reviews). Comprehensive and effective programs can be constructed at low cost with reasonable speed within large systems with a public mandate, leading to responsible use of public funds internally, and as models for private sector programs. It is the long-term operational cost implications, under budget constraints in health care, which often present the true challenge. Copyright 2004 Wiley-Liss, Inc.

  2. Health Hazard Evaluation Report HETA 91-395-2244, Veterans Administration Medical Center, Los Angeles, California

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, J.E.; Miller, A.

    1992-08-01

    In response to a request from an employee of the Veterans Administration Medical Center (SIC-8062), Los Angeles, California, an investigation was undertaken of exposures to chemicals in the laboratory department, excessive heat and humidity in the kitchen area of the dietetics department, and carbon-monoxide (630080) exposures inside the building. In three of five personal breathing zone samples taken in the histopathology laboratory, formaldehyde (50000) was detected at concentrations up to 0.17 part per million (ppm) and it was also present in all four of the area air samples at concentrations up to 1.1ppm. The predominant symptoms associated with work in the laboratory included occasional headaches and nose/throat irritation. Mild episodes of dermal irritation and rash were also reported. All carbon-monoxide levels were less than 5ppm. In the kitchens, relative humidity levels were below the recommended range. Temperatures were above the range of temperatures recommended for a medium level of work. The authors conclude that a potential carcinogenic risk existed for workers in laboratories which use formaldehyde. The authors recommend specific measures to lower the risk of formaldehyde exposures in the laboratory.

  3. Experience of the Veterans Health Administration in Massachusetts after state health care reform.

    Science.gov (United States)

    Chan, Stephanie H; Burgess, James F; Clark, Jack A; Mayo-Smith, Michael F

    2014-11-01

    Starting in 2006, Massachusetts enacted a series of health insurance reforms that successfully led to 96.6% of its population being covered by 2011. As the rest of the nation undertakes similar reforms, it is unknown how the Veterans Health Administration (VHA), one of many important Federal health care programs, will be affected. Our state-level study approach assessed the effects of health reform on utilization of VHA services in Massachusetts from 2005 to 2011. Models were adjusted for state-level demographic and economic characteristics, including health insurance rates, unemployment rates, median household income, poverty rates, and percent of population 65 years and older. No statistically significant associative change was observed in Massachusetts relative to other states over this time period. The findings raise important questions about the continuing role of VHA in American health care as health insurance coverage is one of many factors that influence decisions on where to seek health care. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  4. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    Science.gov (United States)

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-01-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. © The Author(s) 2014.

  5. State of affairs of emergency medicine in the Veterans Health Administration.

    Science.gov (United States)

    Kessler, Chad; Chen, Jennifer; Dill, Curt; Tyndall, Gary; Olszyk, Mark D

    2010-10-01

    The Veterans Health Administration (VHA) has reformed its emergency medical services. This study updates an overview of emergency medicine within VHA. This is a cross-sectional survey of VHA medical facilities offering emergency medical care. Sixty-eight percent (95/140) of facilities had emergency departments (EDs) only, 12% (16/140) had both ED and urgent care centers (UCCs), and 16% (23/140) had only UCCs. The mean (SD) ED/UCC census was 13 371 (7664). A mean (SD) of 53% (27%) of facility admissions were admitted through ED/UCCs. The median of all ED/UCC admissions admitted to intensive care unit level care was 11% (interquartile range, 7-16). Of physicians with any board certification, 16% (209/1331) of physicians had emergency medicine board certification. Emergency medical care is now available at most VHA facilities. The specialty of emergency medicine has an important but minority presence within clinical emergency medical care at VHA. Published by Elsevier Inc.

  6. Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities.

    Science.gov (United States)

    Goetz, Matthew Bidwell; Hoang, Tuyen; Knapp, Herschel; Burgess, Jane; Fletcher, Michael D; Gifford, Allen L; Asch, Steven M

    2013-10-01

    Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown. To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support. Three arm, quasi-experimental implementation research study. Veterans Health Administration (VHA) facilities. Persons receiving primary care between June 2009 and September 2011 INTERVENTION: A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II). The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.

  7. Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration.

    Science.gov (United States)

    Sayuk, G S; Kanuri, N; Gyawali, C P; Gott, B M; Nix, B D; Rosenheck, R A

    2018-03-01

    While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit. To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role. Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups. A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use. Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk. © 2018 John Wiley & Sons Ltd.

  8. Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients.

    Science.gov (United States)

    Zedler, Barbara; Xie, Lin; Wang, Li; Joyce, Andrew; Vick, Catherine; Kariburyo, Furaha; Rajan, Pradeep; Baser, Onur; Murrelle, Lenn

    2014-11-01

    Prescription opioid use and deaths related to serious toxicity, including overdose, have increased dramatically in the United States since 1999. However, factors associated with serious opioid-related respiratory or central nervous system (CNS) depression or overdose in medical users are not well characterized. The objective of this study was to examine the factors associated with serious toxicity in medical users of prescription opioids. Retrospective, nested, case-control analysis of Veterans Health Administration (VHA) medical, pharmacy, and health care resource utilization administrative data. Patients dispensed an opioid by VHA between October 1, 2010 and September 30, 2012 (N=8,987). Cases (N=817) experienced life-threatening opioid-related respiratory/CNS depression or overdose. Ten controls were randomly assigned to each case (N=8,170). Logistic regression was used to examine associations with the outcome. The strongest associations were maximum prescribed daily morphine equivalent dose (MED)≥ 100 mg (odds ratio [OR]=4.1, 95% confidence interval [CI], 2.6-6.5), history of opioid dependence (OR=3.9, 95% CI, 2.6-5.8), and hospitalization during the 6 months before the serious toxicity or overdose event (OR=2.9, 95% CI, 2.3-3.6). Liver disease, extended-release or long-acting opioids, and daily MED of 20 mg or more were also significantly associated. Substantial risk for serious opioid-related toxicity and overdose exists at even relatively low maximum prescribed daily MED, especially in patients already vulnerable due to underlying demographic factors, comorbid conditions, and concomitant use of CNS depressant medications or substances. Screening patients for risk, providing education, and coprescribing naloxone for those at elevated risk may be effective at reducing serious opioid-related respiratory/CNS depression and overdose in medical users of prescription opioids. Wiley Periodicals, Inc.

  9. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration?s ?Homeless Patient Aligned Care Team? Program

    OpenAIRE

    O?Toole, Thomas P.; Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a ?homeless medical home? initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical ho...

  10. CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record.

    Science.gov (United States)

    Patel, Thakor G; Pogach, Leonard M; Barth, Robert H

    2009-03-01

    At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed.

  11. Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map.

    Science.gov (United States)

    Peterson, Kim; Anderson, Johanna; Boundy, Erin; Ferguson, Lauren; McCleery, Ellen; Waldrip, Kallie

    2018-03-01

    Continued racial/ethnic health disparities were recently described as "the most serious and shameful health care issue of our time." Although the 2014 US Affordable Care Act-mandated national insurance coverage expansion has led to significant improvements in health care coverage and access, its effects on life expectancy are not yet known. The Veterans Health Administration (VHA), the largest US integrated health care system, has a sustained commitment to health equity that addresses all 3 stages of health disparities research: detection, understanding determinants, and reduction or elimination. Despite this, racial disparities still exist in the VHA across a wide range of clinical areas and service types. To inform the health equity research agenda, we synthesized evidence on racial/ethnic mortality disparities in the VHA. Our research librarian searched MEDLINE and Cochrane Central Registry of Controlled Trials from October 2006 through February 2017 using terms for racial groups and disparities. We included studies if they compared mortality between any racial/ethnic minority and nonminority veteran groups or between different minority groups in the VHA (PROSPERO# CRD42015015974). We made study selection decisions on the basis of prespecified eligibility criteria. They were first made by 1 reviewer and checked by a second and disagreements were resolved by consensus (sequential review). Two reviewers sequentially abstracted data on prespecified population, outcome, setting, and study design characteristics. Two reviewers sequentially graded the strength of evidence using prespecified criteria on the basis of 5 key domains: study limitations (study design and internal validity), consistency, directness, precision of the evidence, and reporting biases. We synthesized the evidence qualitatively by grouping studies first by racial/ethnic minority group and then by clinical area. For areas with multiple studies in the same population and outcome, we pooled their

  12. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... from Veterans Health Administration Be There: Help Save a Life see more videos from Veterans Health Administration ... more videos from Veterans Health Administration I am A Veteran Family/Friend Active Duty/Reserve and Guard ...

  13. Opioid pain medication prescriptions obtained through emergency medical visits in the Veterans Health Administration.

    Science.gov (United States)

    Grasso, Michael A; Dezman, Zachary D W; Grasso, Clare T; Jerrard, David A

    This study sought to characterize national patterns for opioid pain medication (OPM) prescriptions received during emergency medical encounters in the Veterans Health Administration (VA). The authors conducted a retrospective study of all emergency department (ED) visits by adults in the VA between January 2009 and June 2015. We examined demographics, comorbidities, utilization measures, diagnoses, and prescriptions. The percentage of ED visits that culminated in the receipt of a prescription for an OPM. There were 6,721,134 emergency medical visits by 1,708,545 individuals during the study period. An OPM was prescribed during 913,872 visits (13.6 percent), and 407,408 individuals (27.5 percent) received at least one OPM prescription. Prescriptions for OPMs peaked in 2011 at 14.5 percent, declining to 12.3 percent in 2015. The percentage of prescriptions limited to 12 pills increased from 25.0 to 32.4 percent. The heaviest users (top 1.5 percent, n = 7,247) received an average 602.5 total doses, and had at least 10 ED visits during the study period. The most frequently prescribed OPMs were acetaminophen/hydrocodone, followed by tramadol and acetaminophen/oxycodone. Receiving a prescription was associated with younger patients, musculoskeletal diagnoses, higher pain scores, a history of chronic pain, a history of mental illness, a history of substance abuse, prior heavy prescription OPM use, and lower participation in outpatient services. The writing of OPM prescriptions after an ED visit is on the decline in the VA. Compliance with prescribing guidelines is increasing, but is not yet at goal.

  14. Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration's national program.

    Science.gov (United States)

    Oliva, Elizabeth M; Christopher, Melissa L D; Wells, Daina; Bounthavong, Mark; Harvey, Michael; Himstreet, Julianne; Emmendorfer, Thomas; Valentino, Michael; Franchi, Mariano; Goodman, Francine; Trafton, Jodie A

    To prevent opioid-related mortality, the Veterans Health Administration (VHA) developed a national Opioid Overdose Education and Naloxone Distribution (OEND) program. VHA's OEND program sought national implementation of OEND across all medical facilities (n = 142). This paper describes VHA's efforts to facilitate nationwide health care system-based OEND implementation, including the critical roles of VHA's national pharmacy services and academic detailing services. VHA is the first large health care system in the United States to implement OEND nationwide. Launching the national program required VHA to translate a primarily community-based public health approach to OEND into a health care system-based approach that distributed naloxone to patients with opioid use disorders as well as to patients prescribed opioid analgesics. Key innovations included developing steps to implement OEND, pharmacy developing standard naloxone rescue kits, adding those kits to the VHA National Formulary, centralizing kit distribution, developing clinical guidance for issuing naloxone kits, and supporting OEND as a focal campaign of academic detailing. Other innovations included the development of patient and provider education resources (e.g., brochures, videos, accredited training) and implementation and evaluation resources (e.g., technical assistance, clinical decision support tools). Clinical decision support tools that leverage VHA national data are available to clinical staff with appropriate permissions. These tools allow staff and leaders to evaluate OEND implementation and provide actionable next steps to help them identify patients who could benefit from OEND. Through fiscal year 2016, VHA dispensed 45,178 naloxone prescriptions written by 5693 prescribers to 39,328 patients who were primarily prescribed opioids or had opioid use disorder. As of February 2, 2016, there were 172 spontaneously reported opioid overdose reversals with the use of VHA naloxone prescriptions. VHA

  15. Nursing delegation and medication administration in assisted living.

    Science.gov (United States)

    Mitty, Ethel; Resnick, Barbara; Allen, Josh; Bakerjian, Debra; Hertz, Judith; Gardner, Wendi; Rapp, Mary Pat; Reinhard, Susan; Young, Heather; Mezey, Mathy

    2010-01-01

    Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

  16. Observational Comparative Effectiveness of Pharmaceutical Treatments for Obesity within the Veterans Health Administration.

    Science.gov (United States)

    Grabarczyk, Ted R

    2018-01-01

    To compare the effectiveness of weight-management medications used to assist with weight loss in real-world clinical practice in the Veterans Health Administration (VHA). Retrospective, multicenter, observational cohort study. National VA Corporate Data Warehouse. A total of 66,035 VA patients aged 18 years or older with a body mass index of 25 kg/m 2 or greater who had an initial fill for a study medication (orlistat [6153 patients], phentermine [304 patients], lorcaserin [298 patients], or phentermine-topiramate extended release [233 patients]) or participation in the VA's MOVE! weight-management program with at least three total visits in a clinic coded as a MOVE clinic in the subsequent 24 weeks (59,047 patients) between January 1, 2012, and July 1, 2016. The primary outcome was the percentage change in weight from baseline to at least 20 weeks or later (i.e., closest weight to 6 months). Secondary outcomes were difference in the percentage of weight loss at 12 and 36 weeks; changes in blood pressure, hemoglobin A 1c , high-density and low-density lipoprotein cholesterol and triglyceride levels; and percentage of patients who achieved at least a 5% and 10% weight loss at 6 months from baseline in each group after at least 20 weeks. For the primary outcome, the percentage decrease in weight from baseline after at least 20 weeks in the lorcaserin, phentermine-topiramate, phentermine, orlistat, and MOVE! groups were 3.6%, 4.1%, 3.6%, 2.1%, and 1.6%, respectively (phentermine-topiramate group vs. MOVE! group, pweight loss after at least 20 weeks differed significantly among groups, ranging from 26.2% for the MOVE! Program only group to 40.3% for patients in the phentermine-topiramate group. In the VA population, the effectiveness of four available weight-management medications was similar. Patients receiving phentermine-topiramate had a greater proportion of weight loss after at least 20 weeks compared with those solely enrolled in the VA's MOVE! weight

  17. Evaluating current automatic de-identification methods with Veteran's health administration clinical documents.

    Science.gov (United States)

    Ferrández, Oscar; South, Brett R; Shen, Shuying; Friedlin, F Jeffrey; Samore, Matthew H; Meystre, Stéphane M

    2012-07-27

    The increased use and adoption of Electronic Health Records (EHR) causes a tremendous growth in digital information useful for clinicians, researchers and many other operational purposes. However, this information is rich in Protected Health Information (PHI), which severely restricts its access and possible uses. A number of investigators have developed methods for automatically de-identifying EHR documents by removing PHI, as specified in the Health Insurance Portability and Accountability Act "Safe Harbor" method.This study focuses on the evaluation of existing automated text de-identification methods and tools, as applied to Veterans Health Administration (VHA) clinical documents, to assess which methods perform better with each category of PHI found in our clinical notes; and when new methods are needed to improve performance. We installed and evaluated five text de-identification systems "out-of-the-box" using a corpus of VHA clinical documents. The systems based on machine learning methods were trained with the 2006 i2b2 de-identification corpora and evaluated with our VHA corpus, and also evaluated with a ten-fold cross-validation experiment using our VHA corpus. We counted exact, partial, and fully contained matches with reference annotations, considering each PHI type separately, or only one unique 'PHI' category. Performance of the systems was assessed using recall (equivalent to sensitivity) and precision (equivalent to positive predictive value) metrics, as well as the F(2)-measure. Overall, systems based on rules and pattern matching achieved better recall, and precision was always better with systems based on machine learning approaches. The highest "out-of-the-box" F(2)-measure was 67% for partial matches; the best precision and recall were 95% and 78%, respectively. Finally, the ten-fold cross validation experiment allowed for an increase of the F(2)-measure to 79% with partial matches. The "out-of-the-box" evaluation of text de

  18. Partnering to improve care: the case of the Veterans' Health Administration's Quality Enhancement Research Initiative.

    Science.gov (United States)

    Bergman, Alicia A; Delevan, Deborah M; Miake-Lye, Isomi M; Rubenstein, Lisa V; Ganz, David A

    2017-01-01

    Background Within many large health care organizations, researchers and operations partners (i.e., policymakers, managers, clinical leaders) join to conduct studies to improve the quality of patient care. Yet optimal approaches to conducting partnership research and evaluation are only beginning to be clearly defined. The Veterans' Health Administration (VA) Quality Enhancement Research Initiative (QUERI), funded by operations leaders and administered by the VA's research service, now has nearly two decades of experience in fostering research-operations partnerships for improving quality of VA care. The work reported here is part of a national evaluation of QUERI. Because individuals in research and operations often have differing backgrounds and perspectives, we aim to identify the main sources of tension in research-operations partnerships and strategies for maximizing partnership success, through the eyes of QUERI participants. Methods We conducted semi-structured interviews with 116 researchers and operations partners chosen randomly from within pre-identified key participant groups. We conducted inductive qualitative analysis of verbatim interview transcripts, limited to the 89 interviews of individuals reporting at least some familiarity with QUERI. Results Tensions in research-operations partnerships were primarily related to diverging incentives and to differing values placed on scientific rigor or integrity versus quick timelines. To alleviate these tensions, operations' partners highlighted the importance of 'perspective-taking' (i.e., putting themselves into the shoes of the researchers) to ensure a mutually beneficial and attractive partnership, whereas researchers identified the importance of overcoming the need for recognition to be apportioned between either research or operations for achieved results. Both researchers and operations participants identified jointly designing each partnership from the beginning, minimizing research bureaucracy burdens

  19. Developing a practical suicide risk prediction model for targeting high-risk patients in the Veterans health Administration.

    Science.gov (United States)

    Kessler, Ronald C; Hwang, Irving; Hoffmire, Claire A; McCarthy, John F; Petukhova, Maria V; Rosellini, Anthony J; Sampson, Nancy A; Schneider, Alexandra L; Bradley, Paul A; Katz, Ira R; Thompson, Caitlin; Bossarte, Robert M

    2017-09-01

    The US Veterans Health Administration (VHA) has begun using predictive modeling to identify Veterans at high suicide risk to target care. Initial analyses are reported here. A penalized logistic regression model was compared with an earlier proof-of-concept logistic model. Exploratory analyses then considered commonly-used machine learning algorithms. Analyses were based on electronic medical records for all 6,360 individuals classified in the National Death Index as having died by suicide in fiscal years 2009-2011 who used VHA services the year of their death or prior year and a 1% probability sample of time-matched VHA service users alive at the index date (n = 2,112,008). A penalized logistic model with 61 predictors had sensitivity comparable to the proof-of-concept model (which had 381 predictors) at target thresholds. The machine learning algorithms had relatively similar sensitivities, the highest being for Bayesian additive regression trees, with 10.7% of suicides occurred among the 1.0% of Veterans with highest predicted risk and 28.1% among the 5.0% of with highest predicted risk. Based on these results, VHA is using penalized logistic regression in initial intervention implementation. The paper concludes with a discussion of other practical issues that might be explored to increase model performance. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Principals Learning from Veteran Teachers Serving Impoverished Students: Social Justice Implications for Professors of Educational Administration

    Science.gov (United States)

    Rosine, Dale

    2013-01-01

    This qualitative study of ten elementary veteran teachers used Hargrove's single, double, and triple-loop thinking to understand their perceptions regarding knowledge new principals need to be social justice leaders working in impoverished schools. Findings in three categories revealed the importance of principals learning to identify their…

  1. A hospital experiment in teamwork among students, nurses, and administrators.

    Science.gov (United States)

    Weeks, L; Calderon, E; Chappell, J A; Caver, P E

    1986-09-01

    The adversarial relationships existing in 1982 among medical students, nurses, and hospital staff members were recognized at Hermann Hospital, a private, nonprofit teaching hospital in Houston, Texas, to be potentially detrimental to patient care. A joint communications committee--composed of medical students, faculty members, and hospital and nursing administrators--was developed to identify ways to improve relations between medical students and hospital personnel. The results of the committee's efforts have been an orientation program offered to medical students by the hospital prior to their third-year clerkships; elective workshops for second-year students on skills such as venipuncture, ventilatory management, and physiologic monitoring taught by practicing nurses and other health care personnel; and roundtable seminars for all medical students. Three years after its inception, the committee continues to offer and refine the orientation program and skills workshops. In the authors' opinion, the success of the committee can be attributed to the fact that medical students have been instrumental in directing and evaluating the programs.

  2. Innovative approaches to reducing nurses' distractions during medication administration.

    Science.gov (United States)

    Pape, Tess M; Guerra, Denise M; Muzquiz, Marguerite; Bryant, John B; Ingram, Michelle; Schranner, Bonnie; Alcala, Armando; Sharp, Johanna; Bishop, Dawn; Carreno, Estella; Welker, Jesusita

    2005-01-01

    Contributing factors to medication errors include distractions, lack of focus, and failure to follow standard operating procedures. The nursing unit is vulnerable to a multitude of interruptions and distractions that affect the working memory and the ability to focus during critical times. Methods that prevent these environmental effects on nurses can help avert medication errors. A process improvement study examined the effects of standard protocols and visible signage within a hospital setting. The project was patterned after another study using similar techniques. Rapid Cycle Testing was used as one of the strategies for this process improvement project. Rapid Cycle Tests have become a part of the newly adopted Define, Measure, Analyze, Improve, and Control steps at this particular hospital. As a result, a medication administration check-list improved focus and standardized practice. Visible signage also reduced nurses' distractions and improved focus. The results provide evidence that protocol checklists and signage can be used as reminders to reduce distractions, and are simple, inexpensive tools for medication safety.

  3. Assessment of the Nurse Medication Administration Workflow Process

    Directory of Open Access Journals (Sweden)

    Nathan Huynh

    2016-01-01

    Full Text Available This paper presents findings of an observational study of the Registered Nurse (RN Medication Administration Process (MAP conducted on two comparable medical units in a large urban tertiary care medical center in Columbia, South Carolina. A total of 305 individual MAP observations were recorded over a 6-week period with an average of 5 MAP observations per RN participant for both clinical units. A key MAP variation was identified in terms of unbundled versus bundled MAP performance. In the unbundled workflow, an RN engages in the MAP by performing only MAP tasks during a care episode. In the bundled workflow, an RN completes medication administration along with other patient care responsibilities during the care episode. Using a discrete-event simulation model, this paper addresses the difference between unbundled and bundled workflow and their effects on simulated redesign interventions.

  4. Honoring our Nation's Veterans

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Today is Armistice Day, renamed Veterans Day in 1954, to honor our Nation's Veterans. In Washington the rhetoric from both the political right and left supports our Veterans. My cynical side reminds me that this might have something to do with Veterans voting in a higher percentage than the population as a whole, but let me give the politicians this one. Serving our Country in the military is something that deserves to be honored. I was proud to serve our Veterans over 30 years at the four Department of Veterans Affairs (VA hospitals. However, the VA has had a very bad year. First, in Washington there were the resignations of the Secretary of Veterans Affairs, Eric Shinseki; the undersecretary for the Veterans Health Administration, Robert Petzel; and the undersecretary for the Veterans Benefits Administration, Allison Hickey. Locally, in the light of the VA wait scandal there were the firing of ...

  5. Nurses' clinical reasoning practices that support safe medication administration: An integrative review of the literature.

    Science.gov (United States)

    Rohde, Emily; Domm, Elizabeth

    2017-09-19

    To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that

  6. Emotional exhaustion and medication administration work-arounds: the moderating role of nurse satisfaction with medication administration.

    Science.gov (United States)

    Halbesleben, Jonathon R B; Rathert, Cheryl; Williams, Eric S

    2013-01-01

    Burnout is very common and has significant negative outcomes for both nurses and patients. However, this literature has only recently begun to address the processes that explain why health care provider burnout leads to negative patient outcomes. This article extends that literature by examining how satisfaction with work processes impacts the link between nurse burnout and work-arounds. The purpose of this study was to examine the relationships between emotional exhaustion and potentially unsafe work practices (work-arounds) in the context of nursing administration of medication. The data were collected using online survey software and pencil-and-paper surveys returned directly to the researchers. The study was conducted among nurses in 2 acute care hospitals in the Midwestern United States. For one of the samples, data on work-arounds were provided by the nurses' supervisors. For the other sample, data were collected at a 6-month interval. The survey included measures of emotional exhaustion (the Maslach Burnout Inventory), work-arounds, and nurse satisfaction with medication administration processes. We found that exhaustion was associated with greater use of work-arounds of medication administration processes. We also found that when nurses were more satisfied with the medication administration process, exhausted nurses were less likely to engage in work-arounds. The findings suggest that although exhaustion in nurses can lead to potentially unsafe practices, satisfaction with the work process can either exacerbate or reduce the problem.

  7. Beyond the Iron Triangle: Implications for the Veterans Health Administration in an Uncertain Policy Environment

    Science.gov (United States)

    2014-12-04

    System, August 26, 2014, accessed August 27, 2014, http://www.va.gov/oig/pubs/VAOIG-14-02603-267. pdf . 2 Sloan D. Gibson, “Remarks of Acting Secretary...89 Impersonal groups with anonymous memberships traditionally afford their members few opportunities for entrepreneurship or grass roots action90...republicans.veterans.house.gov/files/documents/FINAL%20113th %20Congress%20Oversight%20Agenda%2001152013. pdf . 116 Ibid. 27

  8. Iranian Nurses' Experiences on Obstacles of Safe Drug Administration: A Qualitative Study

    National Research Council Canada - National Science Library

    Soltanian, Mitra; Molazem, Zahra; Mohammadi, Eesa; Sharif, Farkhondeh; Rakhshan, Mahnaz

    2016-01-01

    .... In this study, the qualitative approach and content analysis method were used. Twenty pediatric nurses involved in medication administration were selected for participation using purposive sampling...

  9. Knowledge of licensed practical nurses and nursing technicians as to medication preparation and administration

    Directory of Open Access Journals (Sweden)

    Cris Renata Grou

    2004-09-01

    Full Text Available Objective: The objective of this study was to identify, categorizeand analyze questions raised by licensed practical nurses andnursing technicians regarding medication preparation andadministration, as well as to propose educational strategies basedon the data collected. Methods: Three clinics of a public hospitalwere randomly selected and the nurses were requested to writedown all the questions that they were asked with regards tomedication administration during one month. After approval by theResearch Ethics Committee, data collection was initiated. Results:The questions (n = 103 were identified and categorized as: Patient’sconditions (21: medication administration in fasting patients withhyperthermia, hypotension and other alterations. General knowledge(19: medication knowledge, mathematical questions andprescription symbols. Dilution (17: type and amount of diluent usedin certain medications. Preparation/Formulation (14: medicationwith a different formulation from that prescribed. Drug interaction(10: administration of two or more drugs at the same time and bythe same route. Administration Route (09: form of application ofcertain drugs. Dose (07: dose presented and dose to beadministered. Generic and Brand names (06: equivalence betweenbrand and generic names in the prescription. Conclusions:Continuous supervision and improvement as well as developmentand implementation of protocols are required for medicationadministration actions.

  10. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... Administration I'm Good. But are you ready to listen? see more videos from Veterans Health Administration ... videos from Veterans Health Administration Vet Centers: Here to Help see more videos from Veterans Health Administration ...

  11. Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression.

    Science.gov (United States)

    Smith, Eric G; Kim, Hyungjin Myra; Ganoczy, Dara; Stano, Claire; Pfeiffer, Paul N; Valenstein, Marcia

    2013-03-01

    To examine the quality of suicide risk assessment provided to veterans with a history of depression who died by suicide between 1999 and 2004. We conducted a case-control study of suicide risk assessment information recorded in 488 medical charts of veterans previously diagnosed with major depression, depression not otherwise specified, dysthymia, or other, less common ICD-9-CM depression codes. Patients dying by suicide from April 1999 through September 2004 or comparison patients (n = 244 pairs) were matched for age, sex, entry year, and region. Seventy-four percent of patients with a history of depression received a documented assessment of suicidal ideation within the past year, and 59% received more than 1 assessment. However, 70% of those who died of suicide did not have a documented assessment for suicidal ideation at their final Veterans Health Administration (VHA) visit, even if that visit occurred within 0 through 7 days prior to suicide death. Most patients dying by suicide denied suicidal ideation when assessed (85%; 95% CI, 75%-92%), even just 0 through 7 days prior to suicide death (73%; 95% CI, 39%-94%). Suicidal ideation was assessed more frequently during outpatient final visits with mental health providers (60%) than during outpatient final visits with primary care (13%) or other non-mental health providers (10%, P risk assessment within the past year, but suicide risk assessments were infrequently administered at the final visit of patients who eventually died by suicide. Among patients who had assessments, denial of suicidal ideation appeared to be of limited value. Practice changes are needed to improve suicide risk assessment among patients with histories of depression, including the development of assessment and prevention strategies that are less dependent on the presence or disclosure of suicidal ideation at scheduled medical visits. © Copyright 2013 Physicians Postgraduate Press, Inc.

  12. Nursing knowledge and practices regarding subcutaneous fluid administration.

    Science.gov (United States)

    Gomes, Nathália Silva; Silva, Andrea Mara Bernardes da; Zago, Luana Barbosa; Silva, Érica Carneiro de Lima E; Barichello, Elizabeth

    2017-01-01

    To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. Integrative review of the literature using the descriptors "nursing", "hypodermoclysis", "drug administration routes", "adult health," and "knowledge," in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. A predominance of international journals (75%) with more than five years of publication (62.5%). The analysis of the methodological characteristics showed a predominance of literature reviews (25%), quantitative studies (62.5%), cross-sectional studies (50%), and non-experimental studies (50%). Although it is an old technique with proven efficacy, hypodermoclysis is still little used, a puzzling fact due to its advantages and indications for any age. descrever as evidências, na literatura, sobre os conhecimentos e as práticas da equipe de enfermagem na administração de medicamentos e de fluidos por via subcutânea no adulto. revisão integrativa da literatura utilizando os descritores enfermagem, hipodermóclise, vias de administração de medicamentos, saúde do adulto e conhecimento; nos idiomas inglês, espanhol e português, sem data limite de publicação. Dos 569 artigos encontrados, oito compuseram a amostra. predomínio de revistas internacionais (75%) e com mais de cinco anos de publicação (62,5%). Ao analisarem-se as características metodológicas, predominaram: revisões de literatura (25%), estudos quantitativos (62,5%), estudos transversais (50%) e não-experimentais (50%). apesar de se tratar de uma técnica antiga com eficácia comprovada, a hipodermóclise ainda é pouco utilizada, fato incoerente pelas suas vantagens e suas indicações para qualquer idade.

  13. Collaborations in leadership: the nurse case management and nursing administration connection.

    Science.gov (United States)

    Carr, Dana Deravin

    2009-01-01

    With a multiple decade's long surge in managed care and the growth of case management as a profession, there is increasing recognition of the leadership role that case managers employ daily as they coordinate and facilitate patient-centered initiatives. Now, more than ever, case managers are being called upon to further expand their leadership capabilities and take a more active role in professional partnering to ensure the continued attainment of clinical, fiscal, and quality outcomes. All settings, particularly acute care hospitals and integrated delivery systems. The collaboration between nurse case managers and nursing administration provides a framework for the establishment of a collegial and supportive working relationship: one that is built on the strength of mutual goals, shared leadership abilities, respect, and professional loyalty.

  14. Patient care and administrative activities of nurses in clinical/surgical units

    Directory of Open Access Journals (Sweden)

    Marilia Moura Luvisotto

    2010-06-01

    Full Text Available Objectives: To identify the administrative and nursing care activities most performed by nurses in clinical/surgical units and to determine which are most and least pleasant to them. Methods: A descriptive-exploratory field study, with a quantitative approach and with a sample made up of 40 nurses working in clinical/surgical units who answered a three-part questionnaire composed of identification data and characterization of the professional; a list of nursing and administrative activities for the nurse to grade according to the numbers: “0 = I do not perform it”, “1 = I perform it occasionally”, “2 = I perform it often”, “3 = I perform it daily”; two open-ended questions, in which the nurse listed the activities he/she enjoyed the most and the least. Results: The administrative activities most performed by the nurses were: changing work shifts, preparing employee daily task charts and managing tests; the most performed nursing care activities were related to the stages of the Nursing Care Systematization and the interaction with the multi-professional team; the most enjoyable activities were direct patient care, patient evaluation and implementation of the systematization; the least enjoyable activities were administrative and bureaucratic routines, justification of complaints/problem-solving and preparation of employee task charts. Conclusion: Compared to administrative activities, nursing activities were performed most during the daily routine of the nurse, and the most enjoyable activities were those related to patient care, according to the opinions of the professionals.

  15. Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans' Health Administration Patients.

    Science.gov (United States)

    Zedler, Barbara; Xie, Lin; Wang, Li; Joyce, Andrew; Vick, Catherine; Brigham, Janet; Kariburyo, Furaha; Baser, Onur; Murrelle, Lenn

    2015-08-01

    Develop a risk index to estimate the likelihood of life-threatening respiratory depression or overdose among medical users of prescription opioids. A case-control analysis of administrative health care data from the Veterans' Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid-induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution. Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C-statistic was 0.88 and Hosmer-Lemeshow goodness-of-fit statistic 10.8 (P > 0.05). RIOSORD performed well in identifying medical users of prescription opioids within the Veterans' Health Administration at elevated risk of overdose or life-threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated. © 2015 The Authors Pain Medicine published by Wiley Periodicals, Inc. on behalf of American Academy of Pain Medicine.

  16. Implementing the MOVE! weight-management program in the Veterans Health Administration, 2007-2010: a qualitative study.

    Science.gov (United States)

    Weiner, Bryan J; Haynes-Maslow, Lindsey; Kahwati, Leila C; Kinsinger, Linda S; Campbell, Marci K

    2012-01-01

    One-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities. Using a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays. Organizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale. Policy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation.

  17. Disparities in initial presentation and treatment outcomes of diabetic foot ulcers in a public, private, and Veterans Administration hospital.

    Science.gov (United States)

    Blumberg, Sheila N; Warren, Stephen M

    2014-01-01

    Disparities in diabetic foot ulcer (DFU) treatment outcomes are well described, although few studies identify risk factors contributing to disparate healing and amputation rates. In a unique academic center serving urban public, private, and veteran patients, we investigated amputation and healing rates and specific risk factors for disparate treatment outcomes. A retrospective chart review of diabetic patients with a new diagnosis of a foot ulcer at geographically adjacent, but independent public, private, and Veterans Administration (VA) hospitals was conducted. Healing and lower extremity amputation outcomes were assessed. Across the three hospitals, 234 patients met the inclusion criteria. Patients at the VA hospital were older (mean 72.5 years; P race (OR 2.42; P = 0.004) increased the risk of amputation on multivariate analysis. Osteomyelitis (P = 0.0371) and gangrene (P < 0.001) are independent risk factors for amputation. Across all three hospitals, 42.3% of patients were treated by amputation (6.8% private, 12% public and 23.5% VA; P < 0.001). In a single triumvirate health care system where the patient population is stratified primarily by insurance, VA patients have significantly higher amputation rates compared with patients at adjacent private and public hospitals. The VA patients are largely racial minorities with advanced DFU progression to gangrenous ulcers. © 2013 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  18. State policies regarding nursing delegation and medication administration in child care settings: a case study.

    Science.gov (United States)

    Heschel, Rhonda T; Crowley, Angela A; Cohen, Sally S

    2005-05-01

    Medication administration is an essential component of quality child care, and nurses play a central role in assuring high-quality training of child care providers. Through key informant interviews and review of public documents, this case study explored the development of state statutes and regulations for medication administration training of child care providers in the state of Connecticut, nursing liability issues related to the definition of this activity, and the role of the Connecticut State Board of Examiners for Nursing. This article also examines the interpretation of the nursing role within this context as delegation versus professional activity and the impact of such designation on nursing practice, child care providers' access to medication administration training by nurses, and children's health status in child care settings. As a result of this case study, the Connecticut State Board of Examiners for Nursing revised its policies, demonstrating an exemplar linkage among research, practice, and policy.

  19. Deconstructing Clinical Workflow: Identifying Teaching-Learning Principles for Barcode Electronic Medication Administration With Nursing Students.

    Science.gov (United States)

    Booth, Richard G; Sinclair, Barbara; Strudwick, Gillian; Brennan, Laura; Morgan, Lisa; Collings, Stephanie; Johnston, Jessica; Loggie, Brittany; Tong, James; Singh, Chantal

    The purpose of this quality improvement project was to better understand how to teach medication administration underpinned by an electronic medication administration record (eMAR) system used in simulated, prelicensure nursing education. Methods included a workflow and integration analysis and a detailed process mapping of both an oral and a sublingual medication administration. Procedural and curriculum development considerations related to medication administration using eMAR technology are presented for nurse educators.

  20. Barcode medication administration work-arounds: a systematic review and implications for nurse executives.

    Science.gov (United States)

    Voshall, Barbara; Piscotty, Ronald; Lawrence, Jeanette; Targosz, Mary

    2013-10-01

    Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety.

  1. Higher Education Military and Veteran Student Program Success: A Qualitative Study of Program Administration Best Practice Application

    Science.gov (United States)

    Murillo, Rose L.

    2017-01-01

    Purpose: The purpose of this study was to determine how Southern California community colleges have implemented best practices based on the 8 Keys to Veterans' Success as identified by the U.S. Departments of Education, Defense, and Veterans Affairs to effectively support and retain military and veteran students in higher education programs. The…

  2. Evaluation of Drug Administrations via Enteral Tube of Intensive Care Nurses

    OpenAIRE

    sevim celik

    2014-01-01

    Aim: The aim of this study was to analyze drug administrations via enteral tube of nurses working intensive care unit Material and Method: Cross-sectional descriptive study was realized with 91 intensive care nurses between 19 March and 9 April, 2012. Data were collected by a survey form. Data were evaluated by number, mean, standart deviation, percentages, chi-square and Fisher's exact tests. Results: Before drug administration via enteral tube, it was determined that 70.3% of nurses ...

  3. Type 2 diabetes mellitus is associated with increased risk of pancreatic cancer: A veteran administration registry study.

    Science.gov (United States)

    Makhoul, Issam; Yacoub, Abdulraheem; Siegel, Eric

    2016-01-01

    The etiology of pancreatic cancer remains elusive. Several studies have suggested a role for diabetes mellitus, but the magnitude of its contribution remains controversial. Utilizing a large administrative database, this retrospective cohort study was designed to investigate the relationship between type 2 diabetes mellitus and pancreatic cancer. Using the Veterans Integrated Services Network 16 database, 322,614 subjects were enrolled in the study, including 110,919 with type 2 diabetes mellitus and 211,695 diabetes-free controls matched by gender, year of birth and healthcare facility. A significantly higher incidence of pancreatic cancer was observed in patients with type 2 diabetes mellitus, with an adjusted hazard ratio (95% confidence interval) of 2.17 (1.70-2.77) for type 2 diabetes mellitus compared to controls (p type 2 diabetes mellitus and pancreatic cancer was statistically significant and may, in part, explain the rising incidence of pancreatic cancer.

  4. The Necessity and Desirability of Including Recipients of Federal Grants Other Than from the Veterans Administration in the 85-15 Ratio Computation. (Prepared in Compliance With Section 305, Public Law 95-202). House Committee Print No. 168.

    Science.gov (United States)

    Veterans Administration, Washington, DC.

    This report presents the findings and recommendations of a study by the Veterans Administration concerning the necessity for including in the computation of the 85-15 ratio those students in receipt of grants from federal agencies other than the Veterans Administration. The problems incurred by educational institutions in the implementation of the…

  5. Organizational factors: impact on administration violations in rural nursing.

    Science.gov (United States)

    McKeon, Christine M; Fogarty, Gerard J; Hegney, Desley G

    2006-07-01

    This paper reports a study investigating organizational factors contributing to procedural violations by nurses during medication administration. Health care is not as safe as it could be, with research indicating that errors involving medications are a leading cause of unintended harm to patients. In the safety literature, strong claims are made about the connection between violation of procedures and adverse occurrences but, in the healthcare field in particular, there is limited empirical evidence that can serve as a basis for understanding why workers deviate from established procedures. Quantitative and qualitative data were collected by questionnaire in 2002 to 627 nurses working in rural and remote areas in Queensland, Australia. The response rate was 31%. The data were used to build a model that shows how organizational variables can produce conditions that improve work practices that fall short of best practice standards. The statistical model accounted for a reliable 19% of the variance in self-reported violations. A higher level of knowledge was found to be associated with lower levels of violations. Conversely, higher workloads and higher expectations by doctors were associated with a higher incidence of violations. Qualitative comments tended to support the conclusions drawn from the model and helped to explain the observed associations. Attempts to deal with deviations from work procedures through interventions such as retraining or disciplinary action are likely to be ineffective unless they take a more holistic management approach aimed at the individual, the team, the task, the workplace, and the institution as a whole and are directed at the weaker points in the system. These interventions may take the form of training programmes, systems redesign, or the injection of resources. The costs of providing adequate resources to a healthcare system are likely to be offset by savings gained through worker productivity, and better patient outcomes.

  6. Overcoming resistance to culture change: nursing home administrators' use of education, training, and communication.

    Science.gov (United States)

    Tyler, Denise A; Lepore, Michael; Shield, Renee R; Looze, Jessica; Miller, Susan C

    2014-01-01

    Nursing home culture change is becoming more prevalent, and research has demonstrated its benefits for nursing home residents and staff-but little is known about the role of nursing home administrators in culture change implementation. The purpose of this study was to determine what barriers nursing home administrators face in implementing culture change practices, and to identify the strategies used to overcome them. The authors conducted in-depth individual interviews with 64 administrators identified through a nationally representative survey. Results showed that a key barrier to culture change implementation reported by administrators was staff, resident, and family member resistance to change. Most nursing home administrators stressed the importance of using communication, education and training to overcome this resistance. Themes emerging around the concepts of communication and education indicate that these efforts should be ongoing, communication should be reciprocal, and that all stakeholders should be included.

  7. Nurses' attitudes and perceived barriers to the reporting of medication administration errors.

    Science.gov (United States)

    Yung, Hai-Peng; Yu, Shu; Chu, Chi; Hou, I-Ching; Tang, Fu-In

    2016-07-01

    (1) To explore the attitudes and perceived barriers to reporting medication administration errors and (2) to understand the characteristics of - and nurses' feelings - about error reports. Under-reporting of medication administration errors is a global concern related to the safety of patient care. Understanding nurses' attitudes and perceived barriers to error reporting is the initial step to increasing the reporting rate. A cross-sectional, descriptive survey with a self-administered questionnaire was completed by the nurses of a medical centre hospital in Taiwan. A total of 306 nurses participated in the study. Nurses' attitudes towards medication administration error reporting were inclined towards positive. The major perceived barrier was fear of the consequences after reporting. The results demonstrated that 88.9% of medication administration errors were reported orally, whereas 19.0% were reported through the hospital internet system. Self-recrimination was the common feeling of nurses after the commission of an medication administration error. Even if hospital management encourages errors to be reported without recrimination, nurses' attitudes toward medication administration error reporting are not very positive and fear is the most prominent barrier contributing to underreporting. Nursing managers should establish anonymous reporting systems and counselling classes to create a secure atmosphere to reduce nurses' fear and provide incentives to encourage reporting. © 2016 John Wiley & Sons Ltd.

  8. Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration.

    Science.gov (United States)

    Bachhuber, Marcus A; Roberts, Christopher B; Metraux, Stephen; Montgomery, Ann Elizabeth

    2015-01-01

    To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. Addiction treatment programs operated by the US Department of Veterans Affairs (VA). All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA's national homelessness screener. Self-reported homelessness or imminent risk of homelessness. The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively). The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

  9. Overburdened Systems and Dealing With Disaster: Nursing Administrators' Experiences and Nursing Leadership Recommendations From a State-Level Perspective.

    Science.gov (United States)

    Millet, Clair P; Porche, Demetrius J

    Hurricane Katrina made landfall on the Louisiana coast on August 29, 2005. Since 2005, there has been a dramatic increase in natural, infectious, and man-made disasters. It is more evident that nursing leaders and administrators need to be prepared for all hazards. The purpose of this article is to provide nursing administrators with a perspective of state-level leadership during a natural disaster and to suggest recommendations based on lessons learned during Hurricanes Katrina, Rita, Gustav, and Ike in 2005. These come from a state governmental public health and a state nursing school within an academic health sciences center.

  10. Prevalence of Post-Traumatic Stress Disorder in Aging Vietnam-Era Veterans: Veterans Administration Cooperative Study 569: Course and Consequences of Post-Traumatic Stress Disorder in Vietnam-Era Veteran Twins.

    Science.gov (United States)

    Goldberg, Jack; Magruder, Kathryn M; Forsberg, Christopher W; Friedman, Matthew J; Litz, Brett T; Vaccarino, Viola; Heagerty, Patrick J; Gleason, Theresa C; Huang, Grant D; Smith, Nicholas L

    2016-03-01

    The prevalence of post-traumatic stress disorder (PTSD) among aging Vietnam-era veterans is not well characterized. In a cross-sectional study, 5,598 male Vietnam-era veterans and members of the Vietnam Era Twin Registry were assessed for PTSD using the Composite International Diagnostic Interview. Current symptoms were measured with the PTSD Checklist (PCL). PTSD was estimated according to age (aged at least 60 years was 16.9% (95% CI: 13.9%-20.5%) and higher than the 5.5% (95% CI: 4.3%-7.0%) among nontheater veterans. Among veterans younger than 60 years, the comparable prevalence was 22.0% for theater (95% CI: 16.7%-28.4%) and 15.7% for nontheater (95% CI: 13.4%-18.2%) veterans. Similar results were found for theater service and current PTSD prevalence (past 12 months). PCL scores were significantly higher in theater compared with nontheater veterans in both younger and older cohorts. In both the younger and older cohorts significant differences in lifetime and current PTSD prevalence and PCL scores persisted in theater service discordant twin pairs. Vietnam service is related to elevated PTSD prevalence and current symptom burden in aging veterans. More than 30 years after the end of the Vietnam conflict, many veterans continue to suffer from PTSD, which highlights the need for continuing outreach throughout the life course. Copyright © 2016 American Association for Geriatric Psychiatry. All rights reserved.

  11. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... listen? see more videos from Veterans Health Administration 1 Act see more videos from Veterans Health Administration Lost: The Power of One Connection see more videos from Veterans Health Administration ...

  12. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... videos about getting help. Be There: Help Save a Life see more videos from Veterans Health Administration ... listen? see more videos from Veterans Health Administration 1 Act see more videos from Veterans Health Administration ...

  13. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... Help see more videos from Veterans Health Administration Suicide Prevention PSA for Military Families see more videos ... About About the Veterans Crisis Line FAQs Veteran Suicide The Veterans Crisis Line text-messaging service does ...

  14. Administrative stressors and nursing job outcomes in Australian public and non-profit health care organisations.

    Science.gov (United States)

    Teo, Stephen T T; Yeung, Melissa; Chang, Esther

    2012-05-01

    The main aim of this study is to develop a path model to examine the effect of administrative stressors on nursing work outcomes in a sample of Australian public and non-profit nurses. The implementation of managerial reform initiatives has negative consequences on work outcomes. However, less is known about the effects of these stressors in public and non-profit health care organisations. An online, self-completion questionnaire was sent to a random sample of nurses, employed in nursing-related occupations. Useable surveys were received from 251 nurses. The path model was analysed using SmartPLS software (SmartPLS, Hamburg, Germany). Public and non-profit nurses experienced time and resource administrative-related stressors (such as resource shortage and pay not as good as other people doing similar work). They relied on work-related social support to reduce the negative consequences. Resource stressors led to job dissatisfaction while time stressors led to psychological strain. Nursing staff who reported better psychological health reported higher job satisfaction and higher level of commitment towards their organisations. Context-specific administrative stressors have a negative impact on the work outcomes of public and non-profit nurses. Work-related social support mechanisms were found to mediate the negative consequences of administrative resourcing stressors on nursing job satisfaction. Nursing managers have to be sympathetic and care for the negative experiences of nursing staff, especially when there is an increasing level of administrative expectations during organisational change. Senior management should take note of the stressors caused by the lack of resources such as information, staffing and resources, as these were found to lead to an increase in nurses seeking work-related social support from their peers and supervisors. Effective implementation of these strategies would lead to a nursing workforce, which has higher level of psychological health

  15. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration.

    Science.gov (United States)

    Solimeo, Samantha L; Ono, Sarah S; Lampman, Michelle A M; Paez, Monica B W; Stewart, Gregory L

    2015-01-01

    In this paper we present results of a mixed methods study conducted to identify barriers to team function among staff implementing patient aligned care teams - the Department of Veterans Affairs' patient centered medical home (PCMH) model. Using a convergent mixed methods design, we administered a standardized survey measure (Team and Individual Role Perception Survey) to assess work role challenge and engagement; and conducted discussion groups to gather context pertaining to role change. We found that the role of primary care providers is highly challenging and did not become less difficult over the initial year of implementation. Unexpectedly over the course of the first year nurse care managers reported a decrease in their perceptions of empowerment and clerical associates reported less skill variety. Qualitative data suggest that more skilled team members fail to delegate and share tasks within their teams. We characterize this interprofessional knowledge factor as an empowerment paradox where team members find it difficult to share tasks in ways that are counter to traditionally structured hierarchical roles. Health care systems seeking to implement PCMH should dedicate resources to facilitating within-team role knowledge and negotiation.

  16. The role of the community mental health nurse in the administration of depot neuroleptic medication: 'not just the needle nurse!'.

    Science.gov (United States)

    Muir-Cochrane, E C

    1998-12-01

    An ethnographic study explored the nature of community mental health nurses' involvement with clients during appointments for the administration of depot neuroleptic medication. Little has been written about this aspect of community mental health nursing practice. Findings illustrate how community mental health nurses attempt to engage clients in meaningful interactions when they attend appointments for their injections. Promoting an atmosphere of normalcy and minimising the distress of having neuroleptic medication by injection were key elements in approaches employed by nurses in this study. Results support current discussions in nursing literature concerned with the need for community mental health nurses to have well-developed interpersonal skills to enable them to capitalise therapeutically from the depot injection encounter.

  17. Disclosing large scale adverse events in the US Veterans Health Administration: lessons from media responses.

    Science.gov (United States)

    Maguire, E M; Bokhour, B G; Asch, S M; Wagner, T H; Gifford, A L; Gallagher, T H; Durfee, J M; Martinello, R A; Elwy, A R

    2016-06-01

    We examined print, broadcast and social media reports about health care systems' disclosures of large scale adverse events to develop future effective messaging. Directed content analysis. We systematically searched four communication databases, YouTube and Really Simple Syndication (RSS) feeds relating to six disclosures of lapses in infection control practices in the Department of Veterans Affairs occurring between 2009 and 2012. We assessed these with a coding frame derived from effective crisis and risk communication models. We identified 148 unique media reports. Some components of effective communication (discussion of cause, reassurance, self-efficacy) were more present than others (apology, lessons learned). Media about 'promoting secrecy' and 'slow response' appeared in reports when time from event discovery to patient notification was over 75 days. Elected officials' quotes (n = 115) were often negative (83%). Hospital officials' comments (n = 165) were predominantly neutral (92%), and focused on information sharing. Health care systems should work to ensure that they develop clear messages focused on what is not well covered by the media, including authentic apologies, remedial actions taken, and shorten the timeframe between event identification and disclosure to patients. Published by Elsevier Ltd.

  18. Cognitive-behavioral treatments for criminogenic thinking: Barriers and facilitators to implementation within the Veterans Health Administration.

    Science.gov (United States)

    Blonigen, Daniel M; Rodriguez, Allison L; Manfredi, Luisa; Nevedal, Andrea; Rosenthal, Joel; McGuire, James F; Smelson, David; Timko, Christine

    2018-02-01

    Cognitive-behavioral treatments for criminogenic thinking (i.e., antisocial cognitions, attitudes, and traits) are regarded as best practices for reducing criminal recidivism among justice-involved adults. However, the barriers and facilitators to implementation of these treatments within large health care systems such as the Veterans Health Administration (VHA) are largely unknown. To address this gap, we conducted qualitative interviews with 22 Specialists from the VHA's Veterans Justice Programs who had been trained in a cognitive-behavioral treatment for criminogenic thinking (i.e., Moral Reconation Therapy [MRT], Thinking for a Change [T4C]). The time-intensiveness of these treatments emerged as a barrier to implementation. Potential solutions identified were patient incentives for treatment engagement, streamlining the curriculum, and implementing the treatments within long-term/residential programs. At the program level, providers' stigma/bias toward patients with antisocial tendencies was seen as a barrier to implementation, as were time/resource constraints on providers. To address the latter, use of peer providers to deliver the treatments and partnerships between justice programs and behavioral health services were suggested. At the system level, lack of recognition of criminogenic treatments as evidence based, and uncertainty of sustained funds to support ongoing costs of these treatments emerged as implementation barriers. To address the latter, a train-the-trainers model was suggested. Our findings serve as a guide for implementation of criminogenic treatments for providers and policymakers in VHA and other large health care systems, which are increasingly called upon to provide care to justice-involved adults in the community. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  19. The oppressive nature of work in healthcare: predictors of aggression against nurses and administrative staff.

    Science.gov (United States)

    Rodwell, John; Demir, Defne; Flower, Rebecca L

    2013-09-01

    To assess the antecedents of workplace aggression (bullying and violence) among nurses and administration staff. As a result of power structures within the healthcare industry, nurses and administration staff may be more vulnerable to workplace aggression. Environmental and individual characteristics have been linked to the occurrence of such aggression among other groups. However, most research focuses on bullying, rarely extending these ideas to violence or nurses and administration staff specifically. Surveys were distributed to nurses and administration staff employed by an Australian healthcare organisation. Aggression types (bullying and violence), as well as environmental (demands, control and support) and individual (negative affectivity, NA) characteristics were measured. External emotional abuse was most frequently reported for nurses (29%) and bullying for administration staff (27%). Demands, support and NA were associated with different aggression types in nurses, whereas for administration staff, control, support and NA were linked. Low support and high NA are particularly important to nurses and administration staff and their experiences of aggression. Appropriate training for managers in providing support and acknowledging individual factors associated with aggression is essential. Further, managers should monitor aggression risk from patients and their associations towards staff in busy times. © 2013 John Wiley & Sons Ltd.

  20. VBA SSA Acc To Fed Rec Online (SAFRO) - Also known as Veterans Benefit Administration Query (VBAQ).

    Data.gov (United States)

    Social Security Administration — The purpose of this query is to provide SSA field office personnel with real-time access to military discharge data from the VA BIRLS database. This information is...

  1. A Qualitative Evaluation of Web-Based Cancer Care Quality Improvement Toolkit Use in the Veterans Health Administration.

    Science.gov (United States)

    Bowman, Candice; Luck, Jeff; Gale, Randall C; Smith, Nina; York, Laura S; Asch, Steven

    2015-01-01

    Disease severity, complexity, and patient burden highlight cancer care as a target for quality improvement (QI) interventions. The Veterans Health Administration (VHA) implemented a series of disease-specific online cancer care QI toolkits. To describe characteristics of the toolkits, target users, and VHA cancer care facilities that influenced toolkit access and use and assess whether such resources were beneficial for users. Deductive content analysis of detailed notes from 94 telephone interviews with individuals from 48 VHA facilities. We evaluated toolkit access and use across cancer types, participation in learning collaboratives, and affiliation with VHA cancer care facilities. The presence of champions was identified as a strong facilitator of toolkit use, and learning collaboratives were important for spreading information about toolkit availability. Identified barriers included lack of personnel and financial resources and complicated approval processes to support tool use. Online cancer care toolkits are well received across cancer specialties and provider types. Clinicians, administrators, and QI staff may benefit from the availability of toolkits as they become more reliant on rapid access to strategies that support comprehensive delivery of evidence-based care. Toolkits should be considered as a complement to other QI approaches.

  2. Clinical information seeking in traumatic brain injury: a survey of Veterans Health Administration polytrauma care team members.

    Science.gov (United States)

    Hogan, Timothy; Martinez, Rachael; Evans, Charlesnika; Saban, Karen; Proescher, Eric; Steiner, Monica; Smith, Bridget

    2017-12-12

    The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult. To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information. Cross-sectional online survey of 236 VHA polytrauma care team members. Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers. Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform. Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit-pronged approach to time and financial constraints. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  3. Reasons for underuse of recommended therapies for colorectal and lung cancer in the Veterans Health Administration.

    Science.gov (United States)

    Landrum, Mary Beth; Keating, Nancy L; Lamont, Elizabeth B; Bozeman, Samuel R; McNeil, Barbara J

    2012-07-01

    Many studies have documented low rates of effective cancer therapies, particularly in older or minority populations. However, little is known about why effective therapies are underused in these populations. The authors examined medical records of 584 patients with cancer diagnosed or treated in Department of Veterans Affairs facilities to assess reasons for lack of 1) surgery for stage I/II nonsmall cell lung cancer, 2) surgery for stage I/II/III rectal cancer, 3) adjuvant radiation therapy for stage II/III rectal cancer, and 4) adjuvant chemotherapy for stage III colon cancer. They also assessed differences in reasons for underuse by patient age and race. Across the 4 guideline-recommended treatments, 92% to 99% of eligible patients were referred to the appropriate cancer specialist; however, therapy was recommended in only 74% to 92% of eligible cases. Poor health was cited in the medical record as the reason for lack of therapy in 15% to 61% of underuse cases; patient refusal explained 26% to 58% of underuse cases. African American patients were more likely to refuse surgery. Older patients were more likely to refuse treatments. Recommendation against therapy was a primary factor in underuse of effective therapies in older and sicker patients. Patients' refusal of therapy contributed to age and racial disparities in care. Improved data on the effectiveness of cancer therapies in community populations and interventions aimed at improved communication of known risks and benefits of therapy to cancer patients could be effective tools to reduce underuse and lingering disparities in care. Copyright © 2011 American Cancer Society.

  4. Fulfilment of administrative and professional organisational obligations and nurses' customer-oriented behaviours.

    Science.gov (United States)

    Trybou, Jeroen; Gemmel, Paul

    2016-07-01

    The aim of the study was to examine the relationship between the perceived quality of organisational exchange and nurses' customer-oriented behaviours. Hospitals face increasing competitive market conditions. Registered nurses interact closely with patients and therefore play an important front-office role towards patients. A cross-sectional study was conducted. Registered nurses (n = 151) of a Belgian hospital received a questionnaire to assess the fulfilment of administrative and professional organisational obligations and their customer-oriented behaviours. We found a positive relationship between psychological contract fulfilment and nurses' customer-oriented behaviours. More precisely administrative and professional psychological contract fulfilment relates significantly to nurses' service delivery and external representation. In case of internal influence only administrative psychological contract fulfilment was significantly related. Nurses' perceptions of the fulfilment of administrative and professional obligations are important to their customer-oriented behaviours. Nurse managers must be aware of the impact of fulfilling both administrative and professional obligations of registered nurses in order to optimise their customer-oriented behaviours. © 2016 John Wiley & Sons Ltd.

  5. Reporting of medication administration errors by nurses in South Korean hospitals.

    Science.gov (United States)

    Lee, Eunjoo

    2017-10-01

    To identify differences in what nurses consider as medication administration errors, to examine their willingness to report these errors and to identify barriers to reporting medication errors by hospital type. Cross-sectional, descriptive design. The questionnaire comprised six medication administration error scenarios and items related to the reasons for not reporting medication errors. Two tertiary and three general hospitals in a metropolitan area, and five general hospitals in K province, in South Korea. Registered nurses working at tertiary and general hospitals in South Korea (n = 467). Consideration of medication administration errors, intention to report medication errors and reasoning for not file an incident report. There were no significant differences in what nurses considered as medication administration errors between nurses working different in hospital types. The rate of incident reporting was very low; it ranged from 6.3% to 29.9%, regardless of hospital type. Korean nurses were more likely to report an error to a physician than file an incident report. The primary reason for not reporting medication errors was fear of the negative consequences of reporting the error and subsequent legal action. The rate of filing an incident report among nurses was very low, regardless of hospital type or whether nurses perceived the incident as a medication administration error. These results may have significant implications for improving medication safety in hospitals, and more efforts are needed at the organizational level to improve incident reporting by nurses.

  6. Collaboration of nursing faculty and college administration in creating organizational change.

    Science.gov (United States)

    Schriner, Cheryl; Deckelman, Susan; Kubat, Mary Anne; Lenkay, Jennifer; Nims, Liz; Sullivan, Debbie

    2010-01-01

    At schools of nursing nationwide, surging enrollments in the early 2000s necessitated changes in administrative structures and departmental organization. The authors describe a collaboration between faculty and administrators at their midwestern liberal arts college that aided a reorganization of the school of nursing. Kurt Lewin's 1951 change theory provided the framework for the restructuring, from the initial phases of data collection through implementation of the new administrative structure. The reorganization has resulted in a more efficient use of resources in the school of nursing.

  7. Comparison of Administrators' and School Nurses' Perception of the School Nurse Role

    Science.gov (United States)

    Green, Rebecca; Reffel, Jim

    2009-01-01

    The current tenuous status of public education funding requires that school nurses be proactive in advocacy efforts on behalf of their school nursing programs. Advocating for nursing practice within an educational setting presents unique challenges. Lack of state or national consensus for support of school nurse services creates an opportunity for…

  8. The role of clinical pharmacist to improve medication administration through enteral feeding tubes by nurses.

    Science.gov (United States)

    Dashti-Khavidaki, Simin; Badri, Shirinsadat; Eftekharzadeh, Seyedeh-Zahra; Keshtkar, Abbasali; Khalili, Hossein

    2012-10-01

    As a common practice, medications are given in addition to nutrients through enteral catheters especially in critically ill patients. Nurses are primarily responsible to administer medications in this manner. The correct drug delivery via enteral tubes requires special skills. This study was designed to evaluate effectiveness of clinical pharmacist-led educational program in progressing nurses' knowledge and practice regarding medications delivery via enteral catheters. This study has been performed in two teaching hospital affiliated to Tehran University of Medical Sciences. This is a case-control, interventional study. At first, a knowledge and practice questionnaire regarding drug administration trough enteral feeding tube by intensivist nurses was prepared. This questionnaire was filled by each nurse at pre-intervention phase of the study. Then, the clinical pharmacists provided educational programs including preparing evidence-based booklet and classes for case group nurses. Nurses in case and control groups were evaluated again after 3 months. At pre- and post-intervention phases nurses were observed regarding their practice to administer drugs via enteral tubes as well. Mean scores of knowledge and practice questions as well as percent of nurses with correct answers were compared between pre- and post-intervention phases in case and control groups. The mean scores of knowledge and practice questions significantly increased in the case group but decreased or remained unchanged in the control group. In contrast to control group, the percent of nurses with correct answers to each domain of knowledge and practice questions increased significantly in the case group. This study showed that nurses did not have sufficient baseline knowledge about rules of drug administration via enteral feeding tubes; however, integrated educational program by clinical pharmacists that focus on promoting correct administration of drugs via enteral feeding catheters significantly

  9. Patient handling in the veterans health administration: facilitating change in the health care industry.

    Science.gov (United States)

    Hodgson, Michael J; Matz, Mary W; Nelson, Audrey

    2013-10-01

    To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership. Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data. Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors. Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.

  10. Role-taking abilities of nursing education administrators and their perceived leadership effectiveness.

    Science.gov (United States)

    Mansen, T J

    1993-01-01

    This article examines the relationship between role-taking abilities of nursing education administrators and their perceived leadership effectiveness as rated by their faculty. Thirty nursing education administrators and their respective faculty members (n = 176) participated in this cross-sectional survey study. All participants filled out a demographic questionnaire, nursing education administrators also filled out the Davis Interpersonal Reactivity Index, which measured their role-taking abilities, and faculty also filled out selected subscales of the Leadership Behavior Description Questionnaire-XII (LBDQ-XII), which measured their perception of their nursing education administrators' leadership effectiveness. Correlation coefficients were calculated for these data, and they were also subjected to multiple regression analysis. Initial analysis of the data indicated that 26 of the 30 administrators were perceived to be effective leaders. Statistical analysis determined that there was a significant positive relationship between the role-taking abilities of the nursing education administrators and the consideration subscale of the LBDQ-XII. Multiple regression analysis found that certain organizational variables--formalization, centralization, and job satisfaction--affected the perception of leadership effectiveness. Further analysis of these three organizational characteristics according to large and small organizations found inverse relationships between job satisfaction and the faculty's perception of formalization and centralization. The results of this study support role-taking abilities among nursing education administrators as a way of enhancing their leadership effectiveness.

  11. The Relation between Nursing Administration's Self-Confidence and the Staff's Vocational Satisfaction.

    Science.gov (United States)

    Farzianpour, Fereshteh; Hosseini, Seyyed Mostafa; Movahed Kor, Elham; Hosseini, Shayan; Amerzadeh, Mohamad; Ahmadi, Batul

    2013-01-01

    Self-confidence is a glorious feature of an effective administrator. Their main goal is the organizational success. Therefore, we approached this idea by evaluating the self-confidence of nursing Administration in Tehran University of Medical Sciences (TUMS) Teaching Hospitals and its relation to vocational satisfaction of the staff. In a cross-sectional study, we interviewed 200 nursing administrators and 200 staff in different departments of the TUMS Teaching Hospitals using a standardized questionnaire to assess the self-confidence among nursing administrators and staff satisfaction. Data were entered in SPSS (17.0) and analyzed using this software and STATA (11.0) using non-parametric tests and Spearman's correlation of coefficient. The significant level was set as Pself-confidence score for the nursing administrators was 134.9 ± 19.8. Among the staff 68 (34%) were male and 132 (66%) were female. The mean ± SD of the vocational satisfaction for staff was 89.12 ± 18.3. After considering the effect of departments in a regression model, the correlation between nursing administration's self-confidence and the staff's vocational satisfaction was found not significant (P=0.055). Gender and years of employment were the only factors affecting self-confidence and vocational satisfaction between the nursing administration and staff respectively, which not significantly correlated after adjustment.

  12. Supervising nursing students in a technology-driven medication administration process in a hospital setting

    DEFF Research Database (Denmark)

    Gaard, Mette; Orbæk, Janne

    2016-01-01

    REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify, describe and synthesize the experiences of nurse supervisors and the factors that influence the supervision of pre-graduate nursing students in undertaking technology-driven medication administration in hospital settings...

  13. [Managment in nursing and the administration of third sector organizations].

    Science.gov (United States)

    Ruthes, Rosa Maria; Cunha, Isabel Cristina Kowal Olm

    2006-01-01

    In this article of bibliographical revision it was aimed at verifying the evolution of the third sector and the relations between nursing management in that organizations. It is observed a growing of this sector in health area, bringing a market anplification in the work of the nurse. Thus, it is considered the need for warning the nurses to be prepared for the management in these organizations, seeking for development in hospital management. Third sector is being valued as a form of social promotion in the health, education, social assistance and others segments, congregating individuals and institutions in a participative form.

  14. Criminal liability research in vaccine administration by public health nurse: a case study of the Nantou vaccine administration case.

    Science.gov (United States)

    Lin, Jui-Chu; Wang, Triumph

    2008-03-01

    Immunization is recognized as a powerful public health tool in disease control and eradication. Registered nurses (RNs) are the principal health professionals responsible for administering vaccines, not only in terms of childhood immunization but also increasingly in administering travel vaccines and annual influenza vaccinations. The RN often provides leadership in developing and maintaining a high quality program. The legal position of nurses when administering a vaccine conflicts with their role as care providers, and nurses must be aware of their legal position when administering a vaccine that has not been individually prescribed by a doctor. A recent case involving a baby who died after receiving a vaccine administered by a public health nurse without a doctor's prescription resulted in the prosecutor initiating a prosecution against the nurse and chief of Health Bureau for a violation of Article 28 of the Physician's Act and the criminal law. Although the nurse and Bureau Chief were judged not guilty, the first trial court pointed out that the behavior of this nurse still violated Article 28. This reflects the conflict that exists between empirical practice and legal regulations. In order to guarantee that prophylactic inoculation is implemented properly under legitimate and effective conditions (specially in remote districts), in May 23, 2006, Legislative Yuan passed an amendment to Article 4 of the Communicable Disease Control Act, which specified that no public health nurse can be prosecuted for violations of Article 28 of the Physician's Act as a result of vaccine administration. In the future, nurses in clinics located in remote districts may conduct prophylactic inoculation work without fear of the terms of Article 28 and focus on implementing public prophylactic inoculation responsibilities. However, a public health nurse can still be liable for the malpractice in criminal law during the vaccination. Therefore, following procedure is still necessary

  15. Validity of code based algorithms to identify primary open angle glaucoma (POAG) in Veterans Affairs (VA) administrative databases.

    Science.gov (United States)

    Biggerstaff, K S; Frankfort, B J; Orengo-Nania, S; Garcia, J; Chiao, E; Kramer, J R; White, D

    2017-09-25

    The validity of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9) code for primary open angle glaucoma (POAG) in the Department of Veterans Affairs (VA) electronic medical record has not been examined. We determined the accuracy of the ICD-9 code for POAG and developed diagnostic algorithms for the detection of POAG. We conducted a retrospective study of abstracted data from the Michael E. DeBakey VA Medical Center's medical records of 334 unique patients with at least one visit to the Eye Clinic between 1999 and 2013. Algorithms were developed to validly identify POAG using ICD-9 codes and pharmacy data. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and percent agreement of the various algorithms were calculated. For the ICD-9 code 365.1x, the PPV was 65.9%, NPV was 95.2%, sensitivity was 100%, specificity was 82.6%, and percent agreement was 87.8%. The algorithm with the highest PPV was 76.3%, using pharmacy data in conjunction with two or more ICD-9 codes for POAG, but this algorithm also had the lowest NPV at 88.2%. Various algorithms for identifying POAG in the VA administrative databases have variable validity. Depending on the type of research being done, the ICD-9 code 365.1x can be used for epidemiologic or health services database research.

  16. Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12.

    Science.gov (United States)

    Hebert, Paul L; Liu, Chuan-Fen; Wong, Edwin S; Hernandez, Susan E; Batten, Adam; Lo, Sophie; Lemon, Jaclyn M; Conrad, Douglas A; Grembowski, David; Nelson, Karin; Fihn, Stephan D

    2014-06-01

    In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. We analyzed data for fiscal years 2003-12 to assess how trends in health care use and costs changed after the implementation of PACT. We found that PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care-sensitive conditions and outpatient visits with mental health specialists. We estimated that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA. Project HOPE—The People-to-People Health Foundation, Inc.

  17. Type 2 diabetes mellitus is associated with increased risk of pancreatic cancer: A veteran administration registry study

    Directory of Open Access Journals (Sweden)

    Issam Makhoul

    2016-12-01

    Full Text Available Background: The etiology of pancreatic cancer remains elusive. Several studies have suggested a role for diabetes mellitus, but the magnitude of its contribution remains controversial. Objectives: Utilizing a large administrative database, this retrospective cohort study was designed to investigate the relationship between type 2 diabetes mellitus and pancreatic cancer. Patients and design: Using the Veterans Integrated Services Network 16 database, 322,614 subjects were enrolled in the study, including 110,919 with type 2 diabetes mellitus and 211,695 diabetes-free controls matched by gender, year of birth and healthcare facility. Results: A significantly higher incidence of pancreatic cancer was observed in patients with type 2 diabetes mellitus, with an adjusted hazard ratio (95% confidence interval of 2.17 (1.70–2.77 for type 2 diabetes mellitus compared to controls (p < 10−9 after controlling for the matching factors. Conclusion: The association between type 2 diabetes mellitus and pancreatic cancer was statistically significant and may, in part, explain the rising incidence of pancreatic cancer.

  18. Nurses' attitudes toward the use of the bar-coding medication administration system.

    Science.gov (United States)

    Marini, Sana Daya; Hasman, Arie; Huijer, Huda Abu-Saad; Dimassi, Hani

    2010-01-01

    This study determines nurses' attitudes toward bar-coding medication administration system use. Some of the factors underlying the successful use of bar-coding medication administration systems that are viewed as a connotative indicator of users' attitudes were used to gather data that describe the attitudinal basis for system adoption and use decisions in terms of subjective satisfaction. Only 67 nurses in the United States had the chance to respond to the e-questionnaire posted on the CARING list server for the months of June and July 2007. Participants rated their satisfaction with bar-coding medication administration system use based on system functionality, usability, and its positive/negative impact on the nursing practice. Results showed, to some extent, positive attitude, but the image profile draws attention to nurses' concerns for improving certain system characteristics. The high bar-coding medication administration system skills revealed a more negative perception of the system by the nursing staff. The reasons underlying dissatisfaction with bar-coding medication administration use by skillful users are an important source of knowledge that can be helpful for system development as well as system deployment. As a result, strengthening bar-coding medication administration system usability by magnifying its ability to eliminate medication errors and the contributing factors, maximizing system functionality by ascertaining its power as an extra eye in the medication administration process, and impacting the clinical nursing practice positively by being helpful to nurses, speeding up the medication administration process, and being user-friendly can offer a congenial settings for establishing positive attitude toward system use, which in turn leads to successful bar-coding medication administration system use.

  19. The practice and effect of combined duty of administrative management, medical treatment and nursing

    Directory of Open Access Journals (Sweden)

    Min HU

    2014-09-01

    Full Text Available Objective: To explore the effect of combined duty mode on discovery and control of medical nursing hidden trouble. Method: In order to make sure that patients are in the first place, we should take the mode of combined duty of administrative management, medical treatment and nursing. Results:The incidence of nursing errors and defects reduced, and patients’ satisfaction improved. the differences were statistically significant (P<0.01 or P<0.05.Results: Combined duty can the reduce medical nursing defects, improve the efficiency of quality health care services and the management efficiency.

  20. Implementing electronic clinical reminders for lipid management in patients with ischemic heart disease in the veterans health administration: QUERI Series

    Directory of Open Access Journals (Sweden)

    Plomondon Mary E

    2008-05-01

    Full Text Available Abstract Background Ischemic heart disease (IHD affects at least 150,000 veterans annually in the United States. Lowering serum cholesterol has been shown to reduce coronary events, cardiac death, and total mortality among high risk patients. Electronic clinical reminders available at the point of care delivery have been developed to improve lipid measurement and management in the Veterans Health Administration (VHA. Our objective was to report on a hospital-level intervention to implement and encourage use of the electronic clinical reminders. Methods The implementation used a quasi-experimental design with a comparison group of hospitals. In the intervention hospitals (N = 3, we used a multi-faceted intervention to encourage use of the electronic clinical reminders. We evaluated the degree of reminder use and how patient-level outcomes varied at the intervention and comparison sites (N = 3, with and without adjusting for self-reported reminder use. Results The national electronic clinical reminders were implemented in all of the intervention sites during the intervention period. A total of 5,438 patients with prior diagnosis of ischemic heart disease received care in the six hospitals (3 intervention and 3 comparison throughout the 12-month intervention. The process evaluation showed variation in use of reminders at each site. Without controlling for provider self-report of use of the reminders, there appeared to be a significant improvement in lipid measurement in the intervention sites (OR 1.96, 95% CI 1.34, 2.88. Controlling for use of reminders, the amount of improvement in lipid measurement in the intervention sites was even greater (OR 2.35, CI 1.96, 2.81. Adjusting for reminder use demonstrated that only one of the intervention hospitals had a significant effect of the intervention. There was no significant change in management of hyperlipidemia associated with the intervention. Conclusion There may be some benefit to focused effort to

  1. The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015

    Directory of Open Access Journals (Sweden)

    Michael A. Grasso

    2016-06-01

    Full Text Available Introduction: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance. Methods: We conducted a retrospective cohort study of emergency department (ED visits within the Veterans Health Administration (VA between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions. Results: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits. The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits, and declined to 35,031 (5.6% during the first half of 2015 (r=‒0.99, p<0.001. The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949 in 2009 to 31% (11,026 in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192‒3.205], a musculoskeletal (OR 1.622, CI [1.615‒1.630] or soft tissue (OR 1.656, CI [1.649‒1.664] diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271‒1.293] and total outpatient ICD 9 codes (OR 1.843, CI [1.833‒1.853]. Conclusion: Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal. [West J Emerg Med. 2016;17(4:396-403.

  2. Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration

    Directory of Open Access Journals (Sweden)

    Hagedorn Hildi

    2006-10-01

    Full Text Available Abstract Background Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system – the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs. Methods A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis. Findings Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use

  3. Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration.

    Science.gov (United States)

    Stetler, Cheryl B; Legro, Marcia W; Rycroft-Malone, Joanne; Bowman, Candice; Curran, Geoffrey; Guihan, Marylou; Hagedorn, Hildi; Pineros, Sandra; Wallace, Carolyn M

    2006-10-18

    Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system - the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs. A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis. Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other implementation interventions, while

  4. Evaluation of Drug Administrations via Enteral Tube of Intensive Care Nurses

    Directory of Open Access Journals (Sweden)

    sevim celik

    2014-03-01

    Results: Before drug administration via enteral tube, it was determined that 70.3% of nurses were always checked the location of enteral tube, provided clarity of the tube with tap water (58.2%, washed their hands (96.6%, wore of gloves (95.5%. During drug administration, it was found that the nurses were controlled pharmaceutic form of drug (94.5%, applied as a bolus of drug (87.9%, immediately passed nutritional after applying medication (56%. It was determined that there was statistical significant difference between applications of nurses and nurses's work years, education, training (p<0.05 Conclusion: It was determined that nurses were made errors on the drug applications via enteral tube. [J Contemp Med 2014; 4(1.000: 18-25

  5. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... Call see more videos from Veterans Health Administration I'm Good. But are you ready to listen? ... PSA see more videos from Veterans Health Administration I am A Veteran Family/Friend Active Duty/Reserve ...

  6. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... videos about getting help. Be There: Help Save a Life see more videos from Veterans Health Administration ... more videos from Veterans Health Administration I am A Veteran Family/Friend Active Duty/Reserve and Guard ...

  7. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... After the Call see more videos from Veterans Health Administration I'm Good. But are you ready to listen? see more videos from Veterans Health Administration 1 Act see more videos from Veterans ...

  8. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... from Veterans Health Administration Suicide Prevention PSA for Military Families see more videos from Blue Star Families These ... from Veterans Health Administration I am A ... Veterans Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us ...

  9. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... in crisis, find a facility near you. Spread the Word Download logos, Web ads, and materials and ... from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from Veterans Health Administration ...

  10. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... for help. Bittersweet More Videos from Veterans Health Administration Watch additional videos about getting help. Be There: ... a Life see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more ...

  11. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... out for help. Bittersweet More Videos from Veterans Health Administration Watch additional videos about getting help. Be ... Save a Life see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see ...

  12. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... More Videos from Veterans Health Administration Watch additional videos about getting help. Be There: Help Save a Life see more videos from Veterans Health Administration Veterans Crisis Line -- After ...

  13. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available ... more videos from Veterans Health Administration Lost: The Power of One Connection see more videos from Veterans Health Administration The Power of 1 PSA see more videos from Veterans ...

  14. High-Fidelity Simulation: A New Method for Improving Medication Administration Skills of Undergraduate Nursing Students in Jordan

    Science.gov (United States)

    Mohammad, Anas Ahmad Ali

    2017-01-01

    Although administering medicines is one of the core nursing actions, errors surrounding this task are prevalent amongst nurses and nursing students. Continued dependence on traditional teaching methods and greater demand and competition for clinical placements are some barriers to expanding medication administration practices for nursing students.…

  15. Is technology the best medicine? Three practice theoretical perspectives on medication administration technologies in nursing.

    Science.gov (United States)

    Boonen, Marcel Jmh; Vosman, Frans Jh; Niemeijer, Alistair R

    2016-06-01

    Even though it is often presumed that the use of technology like medication administration technology is both safer and more effective, the importance of nurses' know-how is not to be underestimated. In this article, we accordingly try to argue that nurses' labor, including their different forms of knowledge, must play a crucial role in the development, implementation and use of medication administration technology. Using three different theoretical perspectives ('heuristic lenses') and integrating this with our own ethnographic research, we will explore how nursing practices change through the use of medication technology. Ultimately, we will argue that ignoring (institutional) complexity and the various types of important knowledge that nurses have, will seriously complicate the implementation of medication administration technology. © 2015 John Wiley & Sons Ltd.

  16. First civil service examination for nurses at the Administrative Department of Public Service.

    Science.gov (United States)

    Brasileiro, Danilo Fernandes; Sanna, Maria Cristina

    2015-01-01

    to describe the results of the first national public service examination for nurses conducted by the Administrative Department of Public Service between 1941 and 1942. historical-documentary research with a quantitative approach. 155 candidates registered, aged between 21 and 35 years old, 141 (91%) of whom were female. A total of 120 candidates passed the practical exam. Of these, 116 took the written qualification exam. In the end, 107 were approved, 74 (69.1%) of whom were temporary public nurses, 59 (55.1%) Anna Nery Nursing School alumni, and 10 among the first 20 twenty became involved with the Brazilian Association of Nursing later. although the exam legitimized the meritbased culture in the staff selection in the area of Brazilian nursing, egalitarian criteria were mitigated, especially regarding the grades applied to different kinds of exams. This resulted in a significant number of temporary nurses approved.

  17. Long-term changes of information environments and computer anxiety of nurse administrators in Japan.

    Science.gov (United States)

    Majima, Yukie; Izumi, Takako

    2013-01-01

    In Japan, medical information systems, including electronic medical records, are being introduced increasingly at medical and nursing fields. Nurse administrators, who are involved in the introduction of medical information systems and who must make proper judgment, are particularly required to have at least minimal knowledge of computers and networks and the ability to think about easy-to-use medical information systems. However, few of the current generation of nurse administrators studied information science subjects in their basic education curriculum. It can be said that information education for nurse administrators has become a pressing issue. Consequently, in this study, we conducted a survey of participants taking the first level program of the education course for Japanese certified nurse administrators to ascertain the actual conditions, such as the information environments that nurse administrators are in, their anxiety attitude to computers. Comparisons over the seven years since 2004 revealed that although introduction of electronic medical records in hospitals was progressing, little change in attributes of participants taking the course was observed, such as computer anxiety.

  18. A nursing bioethics program.

    Science.gov (United States)

    Albrizio, M A; Ozuna, J; Mattheis, R; Saunders, J

    1992-01-01

    In 1985 the Seattle Veterans' Administration Medical Center nursing service implemented a nursing program for bioethics with three goals: (1) to expand the nurse's knowledge of bioethical principles, (2) to develop the nurse's ability and confidence in analyzing bioethical dilemmas, and (3) to increase bioethical application at the bedside. Two psychosocial clinical nurse specialists (CNSs) led this highly successful nursing program that prepared nurses to more actively and responsibly participate in bioethical decision making within the medical center. The program offers an annual workshop for new members, holds a monthly discussion group, conducts a yearly enrichment program, and completes an annual evaluation report. This article describes nursing service bioethics program from planning through evaluation and the role of the CNS as program coordinator, facilitator, and educator in the expanding field of bioethics.

  19. Factors associated with medication administration errors and why nurses fail to report them.

    Science.gov (United States)

    Hammoudi, Baraa M; Ismaile, Samantha; Abu Yahya, Omar

    2017-11-22

    Patient safety is a significant challenge facing healthcare systems. The administration of medication is pivotal to patient safety, and errors in drug administration are associated with mortality and morbidity. In this study, we assessed the factors contributing to the occurrence and reporting of medication errors from the nurse's perspective. In this descriptive cross-sectional study, we distributed a validated questionnaire to 367 nurses at a large public hospital and obtained a response rate of 73.4%. The questionnaire comprised 65 questions, including 29 on the causes of medication errors, 16 on the reasons why medication errors are not reported and 20 that estimated the percentages of the different medication errors actually reported. Informed consent was obtained from all participants, and the anonymity and confidentiality of participants' information were preserved throughout the process. This study received institutional review board approval. Descriptive statistics were used for data analysis. The main factors associated with medication errors by nurses were related to medication packaging, nurse-physician communication, pharmacy processes, nurse staffing and transcribing issues. The main barriers to the reporting of errors by nurses were related to the administrative response, fear of reporting and disagreements regarding the definitions of errors. Medication errors by nurses are related to medication packaging, poor communication, unclear medication orders, workload and staff rotation. To prevent medication errors, teamwork must be improved. All healthcare settings should emphasise awareness of the culture of safety, provide support and guidance to nurses and improve communication skills. We also recommend the use of integrated health informatics, including computerised drug administration systems. The limitations of this study include the potential for nonresponse bias associated with the sampling method. Further research is required to explore the

  20. The relationship of education level to the job tenure of nursing home administrators and directors of nursing.

    Science.gov (United States)

    Decker, Frederic H; Castle, Nicholas G

    2009-01-01

    Research indicates that the length of time a nursing home administrator (NHA) or director of nursing (DON) has worked in a nursing home may have a positive relationship to quality of care. Few studies, however, have focused on factors associated with the job tenure of NHAs and DONs. One important factor may be education level. This study used a nationally representative sample of nursing homes to examine the influence of education level on the current job tenure of NHAs and DONs. The data sources were the 2004 National Nursing Home Survey and the Area Resource File. Control variables for facility characteristics (e.g., ownership type), market characteristics (e.g., unemployment rate), and career experience were included. Data on NHAs, DONs, and nursing facility characteristics came from the National Nursing Home Survey. Market characteristics came from the Area Resource File. The analysis on NHA tenure included 1,082 cases with usable data from the 1,174 sampled facilities in the National Nursing Home Survey. The analysis on DON tenure included 1,048 cases. Job tenure was measured in number of months. Regression models on NHA and DON tenure were analyzed. Among NHAs, and to a lesser extent among DONs, higher education was significantly associated with shorter tenure rather than longer tenure. Ownership status was a notable predictor. For owners of nursing homes, our findings may raise a hiring dilemma. Hiring the best educated NHA and DON may be advantageous, but the retention for these same top managers may be the shortest. Initiatives to hire NHAs and DONs with better educational training may need to be coupled with initiatives designed to promote greater retention.

  1. Regional variations in fluoroquinolone non-susceptibility among Escherichia coli bloodstream infections within the Veterans Healthcare Administration

    Directory of Open Access Journals (Sweden)

    Daniel J. Livorsi

    2016-10-01

    Full Text Available Abstract Objectives We sought to define regional variations in fluoroquinolone non-susceptibility (FQ-NS among bloodstream isolates of Escherichia coli across the Veterans Health Administration (VHA in the United States. Methods We analyzed a retrospective cohort of patients managed at 136 VHA hospitals who had a blood culture positive for E.coli between 2003 and 2013. Hospitals were classified based on US Census Divisions, and regional variations in FQ-NS were analyzed. Results Twenty-four thousand five hundred twenty-three unique E.coli bloodstream infections (BSIs were identified between 2003 and 2013. 53.9 % of these were community-acquired, 30.7 % were healthcare-associated, and 15.4 % were hospital-onset BSIs. The proportion of E.coli BSIs with FQ-NS significantly varied across US Census Divisions (p < 0.001. During 2003–2013, the proportion of E.coli BSIs with FQ-NS was highest in the West South-Central Division (32.7 % and lowest in the Mountain Division (20.0 %. Multivariable analysis showed that there were universal secular trends towards higher FQ-NS rates (p < 0.001 with significant variability of slopes across US Census Divisions (p < 0.001. Conclusion There has been a universal increase in FQ-NS among E.coli BSIs within VHA, but the rate of increase has significantly varied across Census Divisions. The reasons for this variability are unclear. These findings reinforce the importance of using local data to develop and update local antibiograms and antibiotic-prescribing guidelines.

  2. From profession-based leadership to service line management in the Veterans Health Administration: impact on mental health care.

    Science.gov (United States)

    Greenberg, Greg A; Rosenheck, Robert A; Charns, Martin P

    2003-09-01

    To investigate the impact of implementing service line organization on the delivery of mental health services. Survey data on the implementation of service lines and facility-level administrative data on the delivery of mental health services at 139 Department of Veterans Affairs medical centers (VAMCs), over a 6-year period, were used to examine the relationship between service line implementation and subsequent performance in 4 areas: 1) continuity of care (COC), 2) readmission after inpatient discharge, 3) emphasis on community-based mental health care (as contrasted with inpatient care), and 4) maintenance of proportionate funding for mental health care. Models were analyzed using hierarchical linear modeling techniques to control for potential autocorrelation. Of 6 COC measures, 1 strongly improved in all years following service line implementation, and 3 of the 5 other measures demonstrated improvement in the first year. One of 2 readmission measures showed a decline in the first year after service line implementation. Service line implementation was associated with only 1 indicator of increased emphasis on community-based mental health care (and only in the first year), whereas 3 of the 4 other measures suggested a decline in such emphasis. Lastly, although there were increases in per capita mental health expenditures 3 or more years after service line implementation, 2 related measures indicated that service line implementation was associated with a decline in mental health expenditures relative to nonmental health services. Service line implementation was associated with significant, although predominantly short-term, improvement in patient level variables such as continuity of care and hospital readmission, but less so with regard to institutional measures addressing emphasis on outpatient care and maintaining proportionate funding of mental health services.

  3. Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes.

    Science.gov (United States)

    Gransjön Craftman, Åsa; Grape, Charlotte; Ringnell, Katarina; Westerbotn, Margareta

    2016-11-01

    The aim was to describe registered nurses' experience in the context of delegating the administration of medication to unlicensed personnel in residential care homes. The residents in residential care homes have a need for extensive care and nursing, and large amounts of medicines are common practice. Registered nurses' workload and difficulties in fulfilling their duties, such as administration of medicines, have led to frequent delegation of this task between the registered nurses and unlicensed assisting personnel. It is, of course, a great responsibility to ensure that the care of the older people remains safe while maintaining quality in the prevailing situation. A qualitative inductive descriptive study. Data were collected using audio-recorded semistructured interviews with a purposive sample of 18 registered nurses and interpreted using manifest content analysis. The study was approved by the ethical research committee. Registered nurses found the organisation unsupportive with regard to nursing interventions. The delegation context was experienced as a grey zone; the rules and regulations were not in line with the unspoken expectation to delegate the administration of medicine to unlicensed personnel, in order to be able to manage their daily work. The slimmed organisation of residential care homes relies upon registered nurses' use of delegation of medicine administration to unlicensed assistant personnel. It becomes an inevitable assignment entailing a challenging responsibility for patient safety and the quality of care. The results of this study may contribute to a better understanding of the complexity of caring for older people in residential care homes and to improving the work environment of all healthcare personnel. © 2016 John Wiley & Sons Ltd.

  4. Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs).

    Science.gov (United States)

    Edwards, Samuel T; Helfrich, Christian D; Grembowski, David; Hulen, Elizabeth; Clinton, Walter L; Wood, Gordon B; Kim, Linda; Rose, Danielle E; Stewart, Greg

    2018-01-01

    Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5). Task delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses. © Copyright 2018 by the American Board of Family Medicine.

  5. A study of occupational stress and smoking among hospital nurses

    OpenAIRE

    Gunther, Angela Price

    1994-01-01

    Three-hundred and thirty-three surveys were distributed to male and female nurses employed at the Veterans Administration Medical Center in Salem, Virginia. The survey was designed to determine if nurses who smoke perceive more stress from their jobs. Of the 124 nurses who responded to the survey, there were no significant differences in ratings of perceived stress between nurses who reported that they were current smokers and those who reported that they were non-smokers. Over...

  6. Information technology for medication administration: assessing bedside readiness among nurses in Lebanon.

    Science.gov (United States)

    Marini, Sana Daya; Hasman, Arie; Huijer, Huda Abu-Saad

    2009-03-01

    Medication errors continue to be of great concern to hospitals. The use of Information technology (IT) for medication administration was recommended to assist nurses to administer medications safely, decrease the chance of medication errors, and contribute to patient safety. Such IT will be operational soon in some Lebanese hospitals. Users' readiness and acceptance to use such an IT application is crucial as it is a prerequisite for successful system implementation. This descriptive study used the Technology Acceptance Model to determine the level of nurses' readiness to use IT for medication administration in Lebanon. The sample included nurses working in three different major hospitals in Beirut. Data were collected on nurses' demographics, attitudes, perceived usefulness and ease of use of IT for medication administration. During the first 2 weeks of July, 2007, nurses manually or electronically were asked to voluntarily complete the questionnaire. Results showed that the users' attitude towards the use of the proposed IT is correlated with their perceptions on system usefulness and ease of use. Many showed a positive attitude towards system use and scored high on both perceptions. Yet around 20% of the nurses in the sample showed a negative attitude towards the use of the proposed system. © 2009 The Authors. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

  7. Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration.

    Science.gov (United States)

    Hayes, Carolyn; Jackson, Debra; Davidson, Patricia M; Daly, John; Power, Tamara

    2017-12-01

    To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration. Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions. A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis. Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice." Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation. © 2017 John Wiley & Sons Ltd.

  8. Medication administration and interruptions in nursing homes: A qualitative observational study.

    Science.gov (United States)

    Odberg, Kristian Ringsby; Saetre Hansen, Britt; Aase, Karina; Wangensteen, Sigrid

    2017-10-27

    To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? Medication administration is a vital process across health care settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. A qualitative observational study design was applied. Data were collected using partial participant observations. An inductive content analysis was performed. Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation, and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterized as passive (e.g., alarm and background noises), active (e.g., discussions), or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. A process of normalization has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimize interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration.

    Science.gov (United States)

    Bidassie, Balmatee; Williams, Linda S; Woodward-Hagg, Heather; Matthias, Marianne S; Damush, Teresa M

    2015-05-14

    Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement. We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators. The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach's role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not

  10. Recruitment and Retention of Hispanic Nursing Students: Through the Lens of Associate Degree Nursing Program Administrators and Hispanic Nursing Students

    Science.gov (United States)

    Handlos DeVoe, Debra Jean

    2016-01-01

    The Hispanic population in the United States is changing and will constitute 30% of the population in 2050; however, the Hispanic registered nurse population is less than 3%. Cultural differences between patients and nurses may cause harm and a mistrust that can affect patient outcomes. A mixed methods convergent research study was done by an…

  11. LEADERSHIP PERFORMANCE OF NURSING SUPERVISORS AT TWO ORGANIZATIONAL LEVELS.

    Science.gov (United States)

    BLOOD, MILTON R.; NEALEY, STANLEY M.

    THE RELATIONS OF LEADERSHIP STYLE AND BEHAVIOR TO WORK GROUP PERFORMANCE AND SUBORDINATE JOB SATISFACTION HAVE BEEN INVESTIGATED FOR 22 FIRST-LEVEL AND EIGHT SECOND-LEVEL NURSING SUPERVISORS IN A 1680 BED VETERANS ADMINISTRATION HOSPITAL. NURSING ASSISTANTS SUPERVISED BY TASK-ORIENTED LEADERS RECEIVED HIGHER PERFORMANCE RATINGS AT THE FIRST LEVEL…

  12. Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.

    Science.gov (United States)

    Burkhart, Lisa; Sohn, Min-Woong; Jordan, Neil; Tarlov, Elizabeth; Gampetro, Pamela; LaVela, Sherri L

    2016-01-01

    The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

  13. The Use of Computers in Nursing Education, Practice and Administration.

    Science.gov (United States)

    Yucha, Carolyn; Reigeluth, Charles M.

    1983-01-01

    Educational applications include computer programs to individualize instruction and create clinical simulations; computer use to extend classrooms to rural areas, provide continuing education, and individualized testing; and courses in computer applications in health care. Applications in practice and administration include directing and recording…

  14. Concepts applied in daily practice in administration of medicines via nasogastric tube by the nursing team

    Directory of Open Access Journals (Sweden)

    Ingra Monique Duarte Lopes

    2017-08-01

    Full Text Available The study aimed to assess the current situation of medication administration via nasogastric tube (VNGT and identify weaknesses in the process. As a tool, the application of questionnaires to the professionals of the nursing service was used. The questionnaire contained questions and each of them, during the correction, was assigned a specific score. The participant could according to the evaluation system get a grade of 0 to 100 points. Among the participants, 66.7% stated that they had already received some guidance on medication administration via the tube, and after correction and assignment of the notes, the averages obtained were: 47.3 points by the nurses; 38.7 points by nursing technicians; 34.5 points for resident nurses; and 37.0 points by the nursing assistants. The findings of the study indicate that there is a difference between the usual practice and the recommended practice in the literature and the professionals knowledge about administration of medication VNGT is still limited. The insertion of the pharmacist in the multidisciplinary team and disseminating knowledge on incompatibilities, interactions and reactions are of great importance for the improvement of this scenario.

  15. 78 FR 65452 - Proposed Information Collection (Veterans, Researchers, and IRB Members Experiences With...

    Science.gov (United States)

    2013-10-31

    ... understand Veterans' preferences on research recruitment methods. The data will be published in peer-review... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS... Recruitment Restrictions); Comment Request AGENCY: Veterans Health Administration, Department of Veterans...

  16. Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes.

    Science.gov (United States)

    Haverhals, Leah M; Manheim, Chelsea E; Gilman, Carrie V; Jones, Jacqueline; Levy, Cari

    2016-01-01

    The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.

  17. Medication errors in chemotherapy preparation and administration: a survey conducted among oncology nurses in Turkey.

    Science.gov (United States)

    Ulas, Arife; Silay, Kamile; Akinci, Sema; Dede, Didem Sener; Akinci, Muhammed Bulent; Sendur, Mehmet Ali Nahit; Cubukcu, Erdem; Coskun, Hasan Senol; Degirmenci, Mustafa; Utkan, Gungor; Ozdemir, Nuriye; Isikdogan, Abdurrahman; Buyukcelik, Abdullah; Inanc, Mevlude; Bilici, Ahmet; Odabasi, Hatice; Cihan, Sener; Avci, Nilufer; Yalcin, Bulent

    2015-01-01

    Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures

  18. Intralesional Therapy: Consensus Statements for Best Practices in Administration From the Melanoma Nursing Initiative
.

    Science.gov (United States)

    Seery, Virginia

    2017-08-01

    Talimogene laherparepvec (T-VEC) is the first intralesional therapy for melanoma approved by the U.S. Food and Drug Administration. This oncolytic viral immunotherapy has improved outcomes for patients with locoregional recurrent melanoma and is showing promise in combination with systemic therapies. 
. This article aims to provide oncology nurses with expert guidance on best practices in incorporating intralesional therapy for patients diagnosed with melanoma in practice. 
. Members of the Melanoma Nursing Initiative explored issues related to administration of T-VEC in melanoma. The current literature and clinical experiences were reviewed. 
. The author offers a care step pathway (CSP) and commentary detailing best practices in infection control, drug storage, pharmacy interface, patient flow, space/staff allocation, patient education, and adverse event management with T-VEC. The CSP will help nurses improve patient outcomes and streamline the workflow with this novel therapeutic approach.

  19. Veterans Crisis Line: Videos About Reaching out for Help

    Science.gov (United States)

    Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from ...

  20. Leadership Styles of Nursing Home Administrators and Their Association with Staff Turnover

    Science.gov (United States)

    Donoghue, Christopher; Castle, Nicholas G.

    2009-01-01

    Purpose: The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover. Design and Methods: We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certification and Reporting database and the Area Resource File were utilized to extract…

  1. Information technology for medication administration: assessing bedside readiness among nurses in Lebanon

    NARCIS (Netherlands)

    Marini, Sana Daya; Hasman, Arie; Huijer, Huda Abu-Saad

    2009-01-01

    Medication errors continue to be of great concern to hospitals. The use of Information technology (IT) for medication administration was recommended to assist nurses to administer medications safely, decrease the chance of medication errors, and contribute to patient safety. Such IT will be

  2. The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers.

    Science.gov (United States)

    Torre, Carolyn T; Crowley, Angela A

    2011-08-01

    Safe medication administration is an essential component of high-quality child care. Its achievement in New Jersey was impeded by a controversy over whether teaching child care providers medication administration involves registered nurses in the process of nursing delegation. Through the theoretical framework of the Diffusion of Innovation, this paper examines how the interpretation of regulatory policy related to nursing practice in New Jersey was adjusted by the Board of Nursing following a similar interpretation of regulatory policy by the Board of Nursing in Connecticut. This adjustment enabled New Jersey nurses to continue medication administration training for child care providers. National data supporting the need for training child care providers in medication administration is presented, the Diffusion of Innovation paradigm is described; the Connecticut case and the New Jersey dilemma are discussed; the diffusion process between the two states is analyzed and an assessment of the need for further change is made.

  3. Families, nurses and organisations contributing factors to medication administration error in paediatrics: a literature review

    Directory of Open Access Journals (Sweden)

    Albara Alomari

    2015-05-01

    Full Text Available Background: Medication error is the most common adverse event for hospitalised children and can lead to significant harm. Despite decades of research and implementation of a number of initiatives, the error rates continue to rise, particularly those associated with administration. Objectives: The objective of this literature review is to explore the factors involving nurses, families and healthcare systems that impact on medication administration errors in paediatric patients. Design: A review was undertaken of studies that reported on factors that contribute to a rise or fall in medication administration errors, from family, nurse and organisational perspectives. The following databases were searched: Medline, Embase, CINAHL and the Cochrane library. The title, abstract and full article were reviewed for relevance. Articles were excluded if they were not research studies, they related to medications and not medication administration errors or they referred to medical errors rather than medication errors. Results: A total of 15 studies met the inclusion criteria. The factors contributing to medication administration errors are communication failure between the parents and healthcare professionals, nurse workload, failure to adhere to policy and guidelines, interruptions, inexperience and insufficient nurse education from organisations. Strategies that were reported to reduce errors were doublechecking by two nurses, implementing educational sessions, use of computerised prescribing and barcoding administration systems. Yet despite such interventions, errors persist. The review highlighted families that have a central role in caring for the child and therefore are key to the administration process, but have largely been ignored in research studies relating to medication administration. Conclusions: While there is a consensus about the factors that contribute to errors, sustainable and effective solutions remain elusive. To date, families have not

  4. Veterans Benefits: Burial Benefits and National Cemeteries

    Science.gov (United States)

    2010-10-18

    hospital, nursing home, or domiciliary care facility; and (2) a plot allowance for a veteran eligible for burial in a national cemetery who is not... domiciliary care . The VA was permitted to enter into contracts to provide the burial and funeral services for veterans who died in VA facilities...Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility rules; benefits include hospital and medical care

  5. Evaluating the Effect of a Clostridium difficile Infection Prevention Initiative in Veterans Health Administration Long-Term Care Facilities.

    Science.gov (United States)

    Singh, Maninder B; Evans, Martin E; Simbartl, Loretta A; Kralovic, Stephen M; Roselle, Gary A

    2018-03-01

    We evaluated rates of clinically confirmed long-term-care facility-onset Clostridium difficile infections from April 2014 through December 2016 in 132 Veterans Affairs facilities after the implementation of a prevention initiative. The quarterly pooled rate decreased 36.1% from the baseline (P<.0009 for trend) by the end of the analysis period. Infect Control Hosp Epidemiol 2018;39:343-345.

  6. The development of an ergonomics training program to identify, evaluate, and control musculoskeletal disorders among nursing assistants at a state-run veterans' home.

    Science.gov (United States)

    Peterson, Erica L; McGlothlin, James D; Blue, Carolyn L

    2004-01-01

    Nursing assistants (NAs) who work in nursing and personal care facilities are twice and five times more likely, respectively, to suffer a musculoskeletal disorder compared to service industries and other health care facilities, respectively. The purpose of this study was to develop an ergonomics training program for selected NAs at a state-run veterans' home to decrease musculoskeletal disorders by 1) developing questionnaires to assess musculoskeletal stress, 2) evaluating the work environment, 3) developing and using a training package, and 4) determining the application of the information from the training package by NAs on the floor. Results show two new risk factors not previously identified for nursing personnel in the peer-reviewed literature. Quizzes given to the nursing personnel before and after training indicated a significant improvement in understanding the principles of ergonomics and patient-handling techniques. Statistical analysis comparing the pre-training and post-training questionnaires indicated no significant decrease in musculoskeletal risk factors and no significant reduction in pain or discomfort or overall mental or physical health.

  7. Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators.

    Science.gov (United States)

    Benin, Andrea L; Borgstrom, Christopher P; Jenq, Grace Y; Roumanis, Sarah A; Horwitz, Leora I

    2012-05-01

    The objective of this study was to qualitatively describe the impact of a Rapid Response Team (RRT) at a 944-bed, university-affiliated hospital. We analysed 49 open-ended interviews with administrators, primary team attending physicians, trainees, RRT attending hospitalists, staff nurses, nurses and respiratory technicians. Themes elicited were categorised into the domains of (1) morale and teamwork, (2) education, (3) workload, (4) patient care, and (5) hospital administration. Positive implications beyond improved care for acutely ill patients were: increased morale and empowerment among nurses, real-time redistribution of workload for nurses (reducing neglect of non-acutely ill patients during emergencies), and immediate access to expert help. Negative implications were: increased tensions between nurses and physician teams, a burden on hospitalist RRT members, and reduced autonomy for trainees. The RRT provides advantages that extend well beyond a reduction in rates of transfers to intensive care units or codes but are balanced by certain disadvantages. The potential impact from these multiple sources should be evaluated to understand the utility of any RRT programme.

  8. Republished: Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators.

    Science.gov (United States)

    Benin, Andrea L; Borgstrom, Christopher P; Jenq, Grace Y; Roumanis, Sarah A; Horwitz, Leora I

    2012-10-01

    The objective of this study was to qualitatively describe the impact of a Rapid Response Team (RRT) at a 944-bed, university-affiliated hospital. We analysed 49 open-ended interviews with administrators, primary team attending physicians, trainees, RRT attending hospitalists, staff nurses, nurses and respiratory technicians. Themes elicited were categorised into the domains of (1) morale and teamwork, (2) education, (3) workload, (4) patient care, and (5) hospital administration. Positive implications beyond improved care for acutely ill patients were: increased morale and empowerment among nurses, real-time redistribution of workload for nurses (reducing neglect of non-acutely ill patients during emergencies), and immediate access to expert help. Negative implications were: increased tensions between nurses and physician teams, a burden on hospitalist RRT members, and reduced autonomy for trainees. The RRT provides advantages that extend well beyond a reduction in rates of transfers to intensive care units or codes but are balanced by certain disadvantages. The potential impact from these multiple sources should be evaluated to understand the utility of any RRT programme.

  9. The budget process in schools of nursing: a primer for the novice administrator.

    Science.gov (United States)

    Starck, P L; Bailes, B

    1996-01-01

    All administrators are expected to be competent in budget and financial management. Novice administrators of schools of nursing are expected to know about the budgetary process, budgeting techniques, and the various types of budgets that can be used, such as the open-ended budget, incremental budget, alternate-level budget, quota budget, formula budget, intramural budget, zero-based budget, and cost center budget. In addition, administrators are expected to know what key questions need to be asked about how the budget is structured and revenue sources and how to manage and evaluate their budgets.

  10. 75 FR 78807 - Agency Information Collection (Notice to Department of Veterans Affairs of Veteran or Beneficiary...

    Science.gov (United States)

    2010-12-16

    ... Incarcerated in Penal Institution) Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In compliance with the Paperwork Reduction Act (PRA... Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution, VA Form 21-4193. OMB Control...

  11. Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping.

    Science.gov (United States)

    Veenema, Tener Goodwin; Deruggiero, Katherine; Losinski, Sarah; Barnett, Daniel

    Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.

  12. Nursing administration of medication via enteral tubes in adults: a systematic review.

    Science.gov (United States)

    Phillips, Nicole M; Nay, Rhonda

    2007-09-01

    Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included

  13. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.

    Science.gov (United States)

    Nelson, Karin M; Helfrich, Christian; Sun, Haili; Hebert, Paul L; Liu, Chuan-Fen; Dolan, Emily; Taylor, Leslie; Wong, Edwin; Maynard, Charles; Hernandez, Susan E; Sanders, William; Randall, Ian; Curtis, Idamay; Schectman, Gordon; Stark, Richard; Fihn, Stephan D

    2014-08-01

    In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P burnout (Maslach Burnout Inventory emotional exhaustion subscale, 2.29 vs 2.80; P = .02), lower hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P emergency department use (188 vs 245 visits per 1000 patients; P < .001). The extent of PCMH implementation, as

  14. Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol.

    Science.gov (United States)

    Sales, Anne E; Ersek, Mary; Intrator, Orna K; Levy, Cari; Carpenter, Joan G; Hogikyan, Robert; Kales, Helen C; Landis-Lewis, Zach; Olsan, Tobie; Miller, Susan C; Montagnini, Marcos; Periyakoil, Vyjeyanthi S; Reder, Sheri

    2016-09-29

    The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments. These treatments include cardiac resuscitation, mechanical ventilation, and other forms of life support. However, veteran preferences for care go beyond whether or not they receive life-sustaining treatments to include issues such as whether or not they want to be hospitalized if they are acutely ill, and what kinds of comfort care they would like to receive. Three projects, all focused on improving the provision of veteran-centered care, are proposed. The projects will be conducted in Community Living Centers (VA-owned nursing homes) and VA Home-Based Primary Care programs in five regional networks in the Veterans Health Administration. In all the projects, we will use data from context and barrier and facilitator assessments to design feedback reports for staff to help them understand how well they are meeting the requirement to have conversations with veterans about their preferences and to document them appropriately. We will also use learning collaboratives-meetings in which staff teams come together and problem-solve issues they encounter in how to get veterans' preferences expressed and documented, and acted on-to support action planning to improve performance. We will use data over time to track implementation success, measured as the proportions of veterans in Community Living Centers (CLCs) and Home-Based Primary Care (HBPC) who have a documented goals of care conversation soon after admission. We will work with

  15. Nurses' perspectives on how an e-message system supports cross-sectoral communication in relation to medication administration

    DEFF Research Database (Denmark)

    Foged, Signe; Nørholm, Vibeke; Andersen, Ove

    2018-01-01

    AIMS AND OBJECTIVES: The aim was to describe nurses' perspectives on how an e-message system supports communication between hospital and home care nurses in relation to medication administration. BACKGROUND: Medication administration is a complex process involving a high risk of error. Unclear...... communication and lack of updated information about medication have been identified as the leading cause of medication errors during care transitions. E-message systems are progressively being used to improve information exchange across sectors, yet little is known about their usage for exchange of medication......: The e-message system did not provide the information needed by the home care nurses to ensure safe medication administration after discharge due to (a) limitations of the system, (b) hospital nurses' lack of knowledge about home care nurses' information needs, and (c) hospital nurses' lack of access...

  16. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program.

    Science.gov (United States)

    O'Toole, Thomas P; Johnson, Erin E; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-03-31

    Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a "homeless medical home" initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans.

  17. Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: therapist and patient outcomes.

    Science.gov (United States)

    Walser, Robyn D; Karlin, Bradley E; Trockel, Mickey; Mazina, Barbara; Barr Taylor, C

    2013-09-01

    The U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D. Therapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745). Three-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = -20.3, p < 0.001. Quality of life scores also increased. Training in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes. Published by Elsevier Ltd.

  18. Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period.

    Science.gov (United States)

    Yin, Hai-Hui; Tse, Mimi M Y; Wong, Frances K Y

    2015-10-01

    To provide an overview of the administration of opioid analgesics by nurses when prescription is on an "as-needed" basis for postoperative pain, and to identify the important factors that determine the decisions of nurses, by using the framework of predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation. Multiple databases were searched for the period from 2000-2012. Out of a total of 1755 citations and 148 abstracts retrieved, 39 studies met the criteria for inclusion. Studies were considered eligible for review if they focused on situations or factors influencing a nurse's performance in pain assessment and the administration of opioid analgesics in postoperative pain management. The topics of the descriptive and qualitative studies presented four themes: (i) nurses' knowledge and attitudes about pain management; (ii) the situation of nurses' work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses' work practices; and (iv) perceived barriers to effective pain management from the nurse's perspective. The experimental studies investigated the effects of different approaches in nurses' pain management practices in postoperative settings and their outcomes for patients. A knowledge deficit was observed to be the reason in most cases for a nurse's failure to administrate adequate analgesics for postoperative pain relief. Pain-related education for nurses is the cornerstone to improve pain management. The integration of enabling and reinforcing factors will help nurses to develop the ability to make the decision to engage in a comprehensive intervention to improve pain management and patient outcomes. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  19. How a better understanding of transformational leadership can help improve your practice as a nurse administrator.

    Science.gov (United States)

    Skelton-Green, J M

    1995-01-01

    Nursing administrators of today find themselves practising in an environment of permanent whitewater--an environment of chaotic change. Not only is the environment changing, so too are our employees: their needs, motives and priorities are vastly different than those we knew 20 years ago. The challenges of permanent whitewater cannot be overcome without effective leadership. Theorists agree that most North American organizations are currently overmanaged and underled. Certainly the leadership record of Canadian health care institutions has not been impressive. This paper will examine a selected set of concepts which the author believes are essential for nursing administrators who wish to provide real leadership to their departments and organizations: transformational (as compared to transactional) leadership; feminine (as compared to masculine) leadership; and empowerment. The literature review draws out both theory and practical applications.

  20. Leadership styles of nursing home administrators and their association with staff turnover.

    Science.gov (United States)

    Donoghue, Christopher; Castle, Nicholas G

    2009-04-01

    The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover. We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certification and Reporting database and the Area Resource File were utilized to extract organizational and local economic characteristics of the facilities. A general linear model (GLM) was used to estimate the effects of NHA leadership style, organizational characteristics, and local economic characteristics on nursing home staff turnover for registered nurses (RNs), licensed practical nurses (LPNs), and nurse's aides (NAs). The complete model estimates indicate that NHAs who are consensus managers (leaders who solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. Shareholder managers (leaders who neither solicit input when making a decision nor provide their staffs with relevant information for making decisions on their own) are associated with the highest turnover levels, 32% for RNs, 56% for LPNs, and 168% for NAs. The findings indicate that NHA leadership style is associated with staff turnover, even when the effects of organizational and local economic conditions are held constant. Because leadership strategies are amenable to change, the findings of this study may be used to develop policies for lowering staff turnover.

  1. Information Literacy: Instrument Development to Measure Competencies and Knowledge Among Nursing Educators, Nursing Administrators, and Nursing Clinicians: A Pilot Study

    Science.gov (United States)

    Pierce, Susan; Pravikoff, Diane; Tanner, Annelle

    2003-01-01

    This poster describes a pilot study conducted to establish validity and reliability of an instrument that will be used in a nationwide needs assessment, implemented to identify gaps in Information Literacy skills, competencies, and knowledge among key nursing groups nationally. Data and information gathered using the tool will guide the profession in developing appropriate education and continuing education programs to close identified gaps and enhance nurses’ readiness for Evidence-Based Practice (EBP). PMID:14728475

  2. Improving Bar Code Medication Administration Compliance in a Community Hospital Through a Nursing Leadership Initiative.

    Science.gov (United States)

    Van Ornum, Michael

    2018-01-09

    Achieving optimal compliance for bar code medication administration (BCMA) in mature medication use systems is challenging due to the iterative system refinements over time. A nursing leadership initiative increased BCMA compliance, measured as a composite across all hospital units, from 95% to 98%, discovering unanticipated benefits and unintended consequences in the process. The methodology used provides valuable insight into effective strategies for BCMA optimization with applicability for other, similar quality improvement initiatives.

  3. Using problem-based learning to redesign nursing administration masters programs.

    Science.gov (United States)

    Baker, C M

    2000-01-01

    Problem-based learning (PBL) is offered as an appropriate pedagogy to prepare nurse managers for the uncertainties of future administrative practice. It is a student-centered, experiential learning strategy aimed at developing clinical reasoning, structuring knowledge in real-life contexts, motivating learning, and developing self-learning skills. Health professions and business schools report positive feedback from their stakeholders after adopting this new learning paradigm.

  4. The importance of “patient-nurse-physician-pharmacist” collaboration on drug administrations

    OpenAIRE

    Gülşah Köse; Ümran Subaşı; Sevgi Hatipoğlu; Hatice Lenk; Engin Gönül

    2012-01-01

    he exact definition of the roles of the participants of the health team and their collaboration with each other and their patients leads to safe administration of medicine and ensures a high quality pharmaceutical care of the patients for it may reduce or prevent drug related adverse effects. Thus, it will enable a better thearapeutic outcome of the treatment. In this review, the importance of collaboration between “patient-nurse-physician-pharmacist” is emphasized in regard with the the Join...

  5. Veterans' Education Benefits: Enhanced Guidance and Collaboration Could Improve Administration of the Post-9/11 GI Bill Program. GAO-11-356R

    Science.gov (United States)

    Scott, George A.

    2011-01-01

    With the passage of the Post-9/11 Veterans Educational Assistance Act of 2008 (Post- 9/11 GI Bill), Congress created a comprehensive education benefit program for veterans, service members, and their dependents pursuing postsecondary education. Since implementation, the Department of Veterans Affairs (VA) has provided just over $5.7 billion for…

  6. Assisted living nursing practice: medication management: part 2 supervision and monitoring of medication administration by unlicensed assistive personnel.

    Science.gov (United States)

    Mitty, Ethel; Flores, Sandi

    2007-01-01

    More than half the states permit assistance with or administration of medications by unlicensed assistive personnel or med techs. Authorization of this nursing activity (or task) is more likely because of state assisted living regulation than by support and approval of the state Board of Nursing. In many states, the definition of "assistance with" reads exactly like "administration of" thereby raising concern with regard to delegation, accountability, and liability for practice. It is, as well, a hazardous path for the assisted living nurse who must monitor and evaluate the performance of the individual performing this nursing task. This article, the second in a series on medication management, addresses delegation, standards of practice of medication administration, types of medication errors, the components of a performance evaluation tool, and a culture of safety. Maintaining professional standards of assisted living nursing practice courses throughout the suggested recommendations.

  7. Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills.

    Science.gov (United States)

    Sowan, Azizeh K; Idhail, Jamila Abu

    2014-08-01

    Nursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students' response to an interactive web-based course using streaming video technology tailored to students' needs and the course objectives of the fundamentals of nursing skills clinical course. A mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students' grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined. Students were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45-0.49, p streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students' efforts. Published by Elsevier Ireland Ltd.

  8. Improving medication administration in nursing home residents with swallowing difficulties: sustainability of the effect of a multifaceted medication safety programme

    NARCIS (Netherlands)

    Stuijt, Clementine C. M.; Klopotowska, Joanna E.; Kluft-van Driel, Chantal; Le, Nhut; Binnekade, Jan; van der Kleij, Bea; van der Schors, Tjalling; van den Bemt, Patricia; Lie-A-Huen, Loraine

    2013-01-01

    Crushing solid oral dosage forms is an important risk factor for medication administration errors (MAEs) in patients with swallowing difficulties. Nursing home (NH) residents, especially those on psychogeriatric wards, have a high prevalence of such difficulties. Six different psychogeriatric wards

  9. Clinical supervision for nurses in administrative and leadership positions: a systematic literature review of the studies focusing on administrative clinical supervision.

    Science.gov (United States)

    Sirola-Karvinen, Pirjo; Hyrkäs, Kristiina

    2006-11-01

    The aim of this systematic literature review was to describe administrative clinical supervision from the nursing leaders', directors' and administrators' perspective. Administrative clinical supervision is a timely and important topic as organizational structures in health care and nursing leadership are changing in addition to the increasing number of complex challenges present in health care. The material in this review was drawn from national and international databases including doctoral dissertations, distinguished thesis and peer-reviewed articles. The material was analysed by means of content analysis. The theoretical framework for the analysis was based on the three main functions of clinical supervision: administrative, educational and supportive. The findings demonstrated that the experiences of the administrative clinical supervision and its supportiveness were varying. The intervention was seen to provide versatility of learning experiences and support in challenging work experiences. Administrative clinical supervision effects and assures the quality of care. The effects as a means of development were explained through its resemblance to a leading specialist community. The findings support earlier perceptions concerning the importance and significance of administrative clinical supervision for nursing managers and administrators. However, more research is needed to develop administrative clinical supervision and to increase understanding of theoretical assumptions and relationships of the concepts on the background.

  10. Evaluation of intensivist-nurses' knowledge concerning medication administration through nasogastric and enteral tubes.

    Science.gov (United States)

    Mota, Maria Lurdemiler Sabóia; Barbosa, Islene Victor; Studart, Rita Mônica Borges; Melo, Elizabeth Mesquita; Lima, Francisca Elisângela Teixeira; Mariano, Fabíola Amaro

    2010-01-01

    This study evaluates the knowledge of nurses working in intensive care units concerning recommendations for the proper administration of medication through nasogastric and enteral tubes. This exploratory-descriptive study with a quantitative approach was carried out with 49 nurses in an intensive care unit of a tertiary hospital in Fortaleza, CE, Brazil. A total of 36.7% of nurses reported they disregard the dosage forms provided by the pharmacy at the time of administering the medication through tubes. Metal, wood, or a plastic mortar is the method most frequently reported (42.86%) for crushing prescribed solid forms; 32.65% leave the drugs in 20 ml of water until dissolved; 65.3% place the responsibility for choosing the pharmaceutical formulation and its correlation with the tube site, either into the stomach or into the intestine, on the physician. The results indicate there is a gap between specific literature on medication administered through tubes and knowledge of nurses on the subject.

  11. Multimedia applications in nursing curriculum: the process of producing streaming videos for medication administration skills.

    Science.gov (United States)

    Sowan, Azizeh K

    2014-07-01

    Streaming videos (SVs) are commonly used multimedia applications in clinical health education. However, there are several negative aspects related to the production and delivery of SVs. Only a few published studies have included sufficient descriptions of the videos and the production process and design innovations. This paper describes the production of innovative SVs for medication administration skills for undergraduate nursing students at a public university in Jordan and focuses on the ethical and cultural issues in producing this type of learning resource. The curriculum development committee approved the modification of educational techniques for medication administration procedures to include SVs within an interactive web-based learning environment. The production process of the videos adhered to established principles for "protecting patients' rights when filming and recording" and included: preproduction, production and postproduction phases. Medication administration skills were videotaped in a skills laboratory where they are usually taught to students and also in a hospital setting with real patients. The lab videos included critical points and Do's and Don'ts and the hospital videos fostered real-world practices. The range of time of the videos was reasonable to eliminate technical difficulty in access. Eight SVs were produced that covered different types of the medication administration skills. The production of SVs required the collaborative efforts of experts in IT, multimedia, nursing and informatics educators, and nursing care providers. Results showed that the videos were well-perceived by students, and the instructors who taught the course. The process of producing the videos in this project can be used as a valuable framework for schools considering utilizing multimedia applications in teaching. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Paediatric nurses' adherence to the double-checking process during medication administration in a children's hospital: an observational study.

    Science.gov (United States)

    Alsulami, Zayed; Choonara, Imti; Conroy, Sharon

    2014-06-01

    To evaluate how closely double-checking policies are followed by nurses in paediatric areas and also to identify the types, frequency and rates of medication administration errors that occur despite the double-checking process. Double-checking by two nurses is an intervention used in many UK hospitals to prevent or reduce medication administration errors. There is, however, insufficient evidence to either support or refute the practice of double-checking in terms of medication error risk reduction. Prospective observational study. This was a prospective observational study of paediatric nurses' adherence to the double-checking process for medication administration from April-July 2012. Drug dose administration events (n = 2000) were observed. Independent drug dose calculation, rate of administering intravenous bolus drugs and labelling of flush syringes were the steps with lowest adherence rates. Drug dose calculation was only double-checked independently in 591 (30%) drug administrations. There was a statistically significant difference in nurses' adherence rate to the double-checking steps between weekdays and weekends in nine of the 15 evaluated steps. Medication administration errors (n = 191) or deviations from policy were observed, at a rate of 9·6% of drug administrations. These included 64 drug doses, which were left for parents to administer without nurse observation. There was variation between paediatric nurses' adherence to double-checking steps during medication administration. The most frequent type of administration errors or deviation from policy involved the medicine being given to the parents to administer to the child when the nurse was not present. © 2013 John Wiley & Sons Ltd.

  13. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... out for help. Bittersweet More Videos from Veterans Health Administration Watch additional videos about getting help. Behind the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see ...

  14. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... for help. Bittersweet More Videos from Veterans Health Administration Embedded YouTube video: https://www.youtube.com/v/ ... the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see more ...

  15. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... for help. Bittersweet More Videos from Veterans Health Administration Watch additional videos about getting help. Behind the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see more ...

  16. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... out for help. Bittersweet More Videos from Veterans Health Administration Embedded YouTube video: https://www.youtube.com/ ... Behind the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see ...

  17. Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

    Science.gov (United States)

    McGuire, Alan B; Salyers, Michelle P; White, Dominique A; Gilbride, Daniel J; White, Laura M; Kean, Jacob; Kukla, Marina

    2015-12-01

    Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (c) 2015 APA, all rights reserved).

  18. Risk Factors and Predictive Model Development of Thirty-Day Post-Operative Surgical Site Infection in the Veterans Administration Surgical Population.

    Science.gov (United States)

    Li, Xinli; Nylander, William; Smith, Tracy; Han, Soonhee; Gunnar, William

    2018-02-01

    Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population. In a retrospective observation study, surgical patients who underwent surgery from October 2013 to September 2016 from 136 VA hospitals were included. The Veteran Affairs Surgical Quality Improvement Program (VASQIP) database was used for the pre-operative demographic and clinical characteristics, intra-operative characteristics, and 30-day post-operative outcomes. The study population represents 11 surgical specialties: neurosurgery, urology, podiatry, otolaryngology, general, orthopedic, plastic, thoracic, vascular, cardiac coronary artery bypass graft (CABG), and cardiac valve/other surgery. Multivariable logistic regression models were developed for the 30-day post-operative SSIs. Among 354,528 surgical procedures, 6,538 (1.8%) had SSIs within 30 days. Surgical site infection rates varied among surgical specialty (0.7%-3.0%). Surgical site infection rates were higher in emergency procedures, procedures with long operative duration, greater complexity, and higher relative value units. Other factors associated with increased SSI risk were high level of American Society of Anesthesiologists (ASA) classification (level 4 and 5), dyspnea, open wound/infection, wound classification, ascites, bleeding disorder, chemotherapy, smoking, history of severe chronic obstructive pulmonary disease (COPD), radiotherapy, steroid use for chronic conditions, and weight loss. Each surgical specialty had a distinct combination of risk factors. Accurate SSI risk-predictive surgery specialty

  19. Nurses' opinions on appropriate administration of PRN range opioid analgesic orders for acute pain.

    Science.gov (United States)

    Gordon, Debra B; Pellino, Teresa A; Higgins, Gerry Ann; Pasero, Chris; Murphy-Ende, Kathleen

    2008-09-01

    The use of "as needed" or "pro re nata" (PRN) range opioid analgesic orders is a common clinical practice in the management of acute pain, designed to provide flexibility in dosing to meet an individual's unique needs. Range orders enable necessary adjustments in doses based on individual response to treatment. However, PRN range opioid orders have recently come under scrutiny as a source of confusion and as a medication management safety issue. How nurses administer range orders may vary based on their interpretation of the intent of an order, inadequate knowledge of analgesic titration, or exaggerated concerns about opioid safety. The purpose of this study was to investigate nurses' opinions of the appropriate implementation of range orders. Six hundred two nurses from one large academic medical center and one multihospital system completed an online survey using theoretic clinical vignettes to examine their opinions of appropriate analgesic administration practices. The majority of participants chose appropriate responses to the vignettes; however, there was a great deal of variability in responses. Those who had attended pain management courses were more likely to have a higher percentage of appropriate responses than those who had not attended courses. Years in practice and educational level were not significantly related to percentage of appropriate responses; however, there was a trend for nurses with a master's degree to have a higher percentage than nurses with other educational preparation. Consideration of opioid pharmacokinetics can provide logic to develop a new paradigm where range orders are replaced with orders that provide more explicit instructions to titrate an opioid to the most effective dose.

  20. Elements of the Veterans Health Administration Patient-Centered Medical Home are Associated with Greater Adherence to Oral Hypoglycemic Agents in Patients with Diabetes.

    Science.gov (United States)

    Meo, Nicholas; Wong, Edwin; Sun, Haili; Curtis, Idamay; Batten, Adam; Fihn, Stephan D; Nelson, Karin

    2017-07-05

    In 2010, Veterans Health Administration (VHA) primary care clinics adopted a patient-centered medical home (PCMH) model. This study sought to examine the association between the organizational features related to adoption of PCMH and the level of adherence to oral hypoglycemic agents (OHAs) among patients with diabetes. This retrospective cohort study involved 757 VA clinics that provide primary care to 440,971 patients with diabetes who were taking OHAs in fiscal year 2012. One-year refill-based medication possession ratios (MPRs) were calculated at the patient level. Clinic-level adherence was defined as the proportion of clinics with MPR ≥80%. Risk adjustment of adherence was performed using logistic regression to account for differences in patient populations at clinics. Eight domains of the PCMH model (ie, access, continuity, coordination, teamwork, comprehensive care, self-management, communication, shared decision making) were assessed using items from a previously validated index. Multivariate linear regression was applied to identify PCMH components associated with clinic-level adherence. Patients with diabetes per clinic ranged from 100 to 5011. The average level of adherence to OHAs among clinics ranged from 52.8% to 61.9% (interquartile range = 57.9% to 59.4%). In multivariate analysis, organizational features associated with higher clinic-level adherence included access to routine care (standardized beta [Sβ] = .21, P = .004), having a respectful office staff (Sβ = 0.21, P = .002), and utilization of telephone encounters (Sβ = 0.23, P < .001). Among a national cohort of veterans with diabetes, overall PCMH implementation did not significantly increase adherence to oral hypoglycemic agents, although aspects of implementation were associated with increased adherence. Measures of access to care appear the most significant.

  1. Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration.

    Science.gov (United States)

    Atkins, David; Kilbourne, Amy M; Shulkin, David

    2017-03-20

    The Veterans Health Administration is unique, functioning as an integrated health care system that provides care to more than six million veterans annually and as a home to an established scientific enterprise that conducts more than $1 billion of research each year. The presence of research, spanning the continuum from basic health services to translational research, has helped the Department of Veterans Affairs (VA) realize the potential of a learning health care system and has contributed to significant improvements in clinical quality over the past two decades. It has also illustrated distinct pathways by which research influences clinical care and policy and has provided lessons on challenges in translating research into practice on a national scale. These lessons are increasingly relevant to other health care systems, as the issues confronting the VA-the need to provide timely access, coordination of care, and consistent high quality across a diverse system-mirror those of the larger US health care system.

  2. Learning the organization: a model for health system analysis for new nurse administrators.

    Science.gov (United States)

    Clark, Mary Jo

    2004-01-01

    Health systems are large and complex organizations in which multiple components and processes influence system outcomes. In order to effectively position themselves in such organizations, nurse administrators new to a system must gain a rapid understanding of overall system operation. Such understanding is facilitated by use of a model for system analysis. The model presented here examines the dynamic interrelationships between and among internal and external elements as they affect system performance. External elements to be analyzed include environmental factors and characteristics of system clientele. Internal elements flow from the mission and goals of the system and include system culture, services, resources, and outcomes.

  3. Applying Technology to Enhance Nursing Education in the Psychological Health and Traumatic Brain Injury Needs of Veterans and their Families

    Science.gov (United States)

    2012-10-01

    functioning and satisfaction . 3. Objective 3.1.1 Given the presence of one or more positive responses to PTSD screening questions, the nurse selects...evaluation at an eating disorder clinic. b. Individual psychotherapy at the mental health clinic. c. Marital counseling at the family services center...and depression, stating, Its nothing I can t handle . The nurse puts her pen down and talks directly to Jeff, expressing empathy for how

  4. Administrative Data Repository (ADR)

    Data.gov (United States)

    Department of Veterans Affairs — The Administrative Data Repository (ADR) was established to provide support for the administrative data elements relative to multiple categories of a person entity...

  5. Assessment of Service Members Knowledge and Trust of the Department of Veterans Affairs

    Science.gov (United States)

    2015-06-12

    OIF Operation Iraqi Freedom VA Department of Veterans Affairs VA OIG Department of Veterans Affairs Office of Inspector General VBA Veterans Benefits...reorganization into the three administrations: Veterans Health Administration (VHA), Veterans Benefits Administration ( VBA ) and National Cemetery...features. VBA also implemented a similar program in coordination with DoD called eBenefits which allows Veterans, Service Members and their families to

  6. Perioperative use of anti-rheumatic agents does not increase early postoperative infection risks: a Veteran Affairs' administrative database study.

    Science.gov (United States)

    Abou Zahr, Zaki; Spiegelman, Andrew; Cantu, Maria; Ng, Bernard

    2015-02-01

    The aim of this study was to validate a novel technique that predicts stopping of disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents (BA) from the Veterans Affairs (VA) database and compare infection risks of rheumatoid arthritis patients who stopped versus continued DMARDs/BA perioperatively. We identified 6,024 patients on 1 DMARD or BA in the perioperative period between 1999 and 2009. Time gap between medication stop date and the next start date predicted drug stoppage (X). Time gap between surgery date and stop date predicted whether stoppage was before surgery (Y). Chart review from Houston VA was used for validation. ROC analyses were performed on chart review data to obtain X and Y cutoffs. The primary endpoints were wound infections and other infections within 30 days. ROC analyses found X ≥ 33 (AUC = 0.954) and Y ≥ -11 (AUC = 0.846). Risk of postoperative infections was not different when stopping and continuing DMARDs/BA preoperatively. Stopping BA after surgery was associated with higher odds of postoperative wound (OR 14.15, 95 % CI 1.76-113.76) and general infection (OR 9.2, 95 % CI 1.99-42.60) compared to not stopping. Stopping DMARDs after surgery was associated with increased risk of postoperative general infection (OR 1.84, 95 % CI 1.07-3.16) compared with not stopping. There was positive association between stopping DMARDs after surgery and postoperative wound infection but failed to achieve statistical significance (OR 1.67, 95 % CI 0.96-2.91). There was no significant difference in postoperative infection risk when stopping or continuing DMARD/BA. Our new validated method can be utilized in the VA and other databases to predict drug stoppage.

  7. Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses' Medication Administration Processes and Systems (the MAPS Study.

    Directory of Open Access Journals (Sweden)

    Monsey McLeod

    Full Text Available Research has documented the problem of medication administration errors and their causes. However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety.To identify system factors that facilitate and/or hinder successful medication administration focused on three inter-related areas: nurse practices and workarounds, workflow, and interruptions and distractions.We used a mixed-methods ethnographic approach involving observational fieldwork, field notes, participant narratives, photographs, and spaghetti diagrams to identify system factors that facilitate and/or hinder successful medication administration in three inpatient wards, each from a different English NHS trust. We supplemented this with quantitative data on interruptions and distractions among other established medication safety measures.Overall, 43 nurses on 56 drug rounds were observed. We identified a median of 5.5 interruptions and 9.6 distractions per hour. We identified three interlinked themes that facilitated successful medication administration in some situations but which also acted as barriers in others: (1 system configurations and features, (2 behaviour types among nurses, and (3 patient interactions. Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'. The former contributed to a more streamlined workflow with fewer interruptions while the latter seemed to empower patients to act as a defence barrier against medication errors by being: (1 an active resource of information, (2 a passive information resource, and/or (3 a 'double-checker'.We have identified practical

  8. Veterans Crisis Line: Videos About Reaching out for Help

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    Full Text Available Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There Show You ... more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from Veterans ...

  9. Safety criteria for contrast administration in computed tomography cardiac angiography: perception of nursing

    Directory of Open Access Journals (Sweden)

    Laura Vargas Acauan

    2015-09-01

    Full Text Available Objective: to understand the perception of the nursing team about the safety criteria adopted in the use and administration of iodinated contrast media on computed tomography cardiac angiography. Methods: a descriptive study with a qualitative approach. The data were produced using the semi-structured interview with twelve participants from two diagnostic imaging centers. Results: two thematic categories emerged from the analysis: safe practices in the use and administration of iodinated contrast media and use of light technologies for safe care in the use of iodinated contrast media. Conclusion: it was surmised that safety criteria linked by light and hard technologies are used, but not standardized. To promote effective and quality care focused on patient safety, protocols and guidelines should be established to overcome possible barriers unsafe.

  10. Administration of medication to use when needed and the care of psychiatric nursing

    Directory of Open Access Journals (Sweden)

    Kelly da Silva Rocha Estrela

    2014-07-01

    Full Text Available This qualitative study aimed to analyze the clinical criteria used for the administration of prescribed medications for use when needed (SOS; and discuss the implication of the findings in this research to clinical psychiatric nursing. The records of female patients admitted to a psychiatric institution in the city of Rio de Janeiro, in the time frame from May to June 2009, were analyzed. In the 38 patient records, 16 prescriptions for medications SOS were found. The mean age of patients was around 45-55 years with a clinical diagnosis of Bipolar Mood Disorder. The medication category most prescribed as SOS was of benzodiazepines, followed by antipsychotics. It was noticed a tendency to not valuing the administration of medication in SOS notes. The study points out the importance to establish clinical criteria to indicate the need, or not, to administer prescribed SOS medications.

  11. [Is smoking cessation part of the basic nursing education curriculum in Quebec? A survey of the program administrators].

    Science.gov (United States)

    Lepage, Mario; Dumas, Louise; Saint-Pierre, Chantal

    2014-01-01

    Basic nursing education has a major impact on the future professional practices of nurses. Nurses must be adequately trained to perform health promotion activities, such as smoking cessation. However, nurses play only a minor role in this field. The objective of this research was to describe the smoking cessation content in basic nursing programmes in Quebec. A simple descriptive mixed design (quantitative and qualitative) study was conducted among nursing programme administrators in Quebec, using a validated online questionnaire. On average, the time devoted to smoking cessation was reported to be less than one hour per year, essentially concerning the physiological and pathophysiological factors of tobacco consumption, while nursing professional assessment and counselling in smoking cessation were almost non-existent. The results confirm the need to increase and improve the time and content devoted to smoking cessation in the basic nursing education curriculum. It is also important to structure basic training courses so to improve knowledge, attitudes, and skills of future nurses in order to influence their role in smoking cessation in their future professional practice.

  12. Personal, Medical, and Healthcare Utilization Among Homeless Veterans Served by Metropolitan and Nonmetropolitan Veteran Facilities

    OpenAIRE

    Gordon, Adam J.; Haas, Gretchen L.; Luther, James F.; Hilton, Michael T.; Goldstein, Gerald

    2010-01-01

    This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of...

  13. Diabetes guidelines: a summary and comparison of the recommendations of the American Diabetes Association, Veterans Health Administration, and American Association of Clinical Endocrinologists.

    Science.gov (United States)

    Clark, M J; Sterrett, J J; Carson, D S

    2000-08-01

    This paper summarizes and compares 3 major organizations' guidelines for the management of diabetes mellitus. Diabetes mellitus is a chronic disease that affects >16 million Americans. A decrease in adverse events has been demonstrated when hyperglycemia and comorbid conditions such as hypertension and dyslipidemia are controlled in patients with diabetes. Although each patient with diabetes is unique and medical care should be tailored to his or her individual needs, clinical evidence and expert opinion have established a baseline level of care for all patients with diabetes. Guidelines have been created to guide practitioners in selecting appropriate care, but their length and complexity may serve as barriers to their use. The diabetes management guidelines of the American Diabetes Association (ADA), Veterans Health Administration (VA), and American Association of Clinical Endocrinologists (AACE) are summarized and compared in both text and tabular form. Although the guidelines published by the ADA, VA, and AACE vary slightly, all of them can be used to ensure that patients with diabetes receive appropriate care.

  14. Evaluation of the Veterans Health Administration's Specialty Care Transformational Initiatives to Promote Patient-Centered Delivery of Specialty Care: A Mixed-Methods Approach.

    Science.gov (United States)

    Williams, Katherine M; Kirsh, Susan; Aron, David; Au, David; Helfrich, Christian; Lambert-Kerzner, Anne; Lowery, Julie; Battaglia, Catherine; Graham, Glenn D; Doukas, Michael; Jain, Rajiv; Ho, P Michael

    2017-07-01

    Veteran's Affairs Office of Specialty Care (OSC) launched four national initiatives (Electronic-Consults [e-Consults], Specialty Care Access Networks-Extension for Community Healthcare Outcomes [SCAN-ECHO], Mini-Residencies, and Specialty Care Neighborhood) to improve specialty care delivery and funded a center to evaluate the initiatives. The evaluation, guided by two implementation frameworks, provides formative (administrator/provider interviews and surveys) and summative data (quantitative data on patterns of use) about the initiatives to OSC. Evaluation of initiative implementation is assessed through CFIR (Consolidated Framework for Implementation Research)-grounded qualitative interviews to identify barriers/facilitators. Depending on high or low implementation, factors such as receiving workload credit, protected time, existing workflow/systems compatibility, leadership engagement, and access to information/resources were considered implementation barriers or facilitators. Findings were shared with OSC and used to further refine implementation at additional sites. Evaluation of other initiatives is ongoing. The mixed-methods approach has provided timely information to OSC about initiative effect and impacted OSC policies on implementation at additional sites.

  15. 77 FR 20886 - Agency Information Collection (Conversion From Servicemembers' Group Life Insurance to Veterans...

    Science.gov (United States)

    2012-04-06

    ... AFFAIRS Agency Information Collection (Conversion From Servicemembers' Group Life Insurance to Veterans' Group Life Insurance); Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department of... Evaluation of the Conversion Privilege from Servicemembers' Group Life Insurance (SGLI) to Veterans' Group...

  16. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes.

    Science.gov (United States)

    Pineles, Lisa; Morgan, Daniel J; Lydecker, Alison; Johnson, J Kristie; Sorkin, John D; Langenberg, Patricia; Blanco, Natalia; Lesse, Alan; Sellick, John; Gupta, Kalpana; Leykum, Luci; Cadena, Jose; Lepcha, Nickie; Roghmann, Mary-Claire

    2017-09-01

    This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies. Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA. There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P  1.0, P < .05) for gown contamination included changing dressings (eg, wound), dressing, providing hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR < 1.0, P < .05 or no transmission) for gown contamination included glucose monitoring, giving medications, and feeding. MRSA transmission from colonized residents to gloves was higher than transmission to gowns. Transmission to gloves varies by type of care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environment. Published by Elsevier Inc.

  17. Military Sexual Trauma Among Homeless Veterans

    OpenAIRE

    Pavao, Joanne; Turchik, Jessica A.; Hyun, Jenny K.; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel

    2013-01-01

    ABSTRACT BACKGROUND Military sexual trauma (MST) is the Veteran Health Administration?s (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. OBJECTIVE To estimate the prevale...

  18. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA).

    Science.gov (United States)

    Damschroder, Laura J; Reardon, Caitlin M; AuYoung, Mona; Moin, Tannaz; Datta, Santanu K; Sparks, Jordan B; Maciejewski, Matthew L; Steinle, Nanette I; Weinreb, Jane E; Hughes, Maria; Pinault, Lillian F; Xiang, Xinran M; Billington, Charles; Richardson, Caroline R

    2017-07-26

    The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA). A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m2 (or BMI ≥ 25 kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7-6.5% or fasting plasma glucose (FPG) 100-125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed. Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session. Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for

  19. Attitudes towards the administration of long-acting antipsychotics: a survey of physicians and nurses

    Science.gov (United States)

    2013-01-01

    Background Discontinuation of antipsychotic treatment for schizophrenia can interrupt improvement and exacerbate the illness. Reasons for discontinuing treatment are multifactorial and include adherence, efficacy and tolerability issues. Poor adherence may be addressed through non-pharmacological approaches as well as through pharmacological ones, ie ensured delivery of medication, such as that achieved with long-acting injectable (LAI) antipsychotics. However, attitudes of healthcare professionals (HCPs) towards LAI antipsychotics may influence their prescribing decisions and may influence medication choices offered to patients. We therefore conducted a survey to investigate factors driving LAI use as well as physician and nurse attitudes to LAI antipsychotics and to different injection sites. Methods An independent market research agency conducted the survey of HCPs across Europe. Participants were recruited by telephone and completed the survey online. Using conjoint analyses (a multivariate statistical technique analysing preferences on the basis of ranking a limited number of attributes which are presented repetitively), attitudes to oral versus LAI medication and gluteal versus deltoid injection routes were assessed. Results A total of 891 HCPs across Europe were surveyed. Of these, 40% would choose LAI antipsychotics for first episode patients whereas 90% would select LAI antipsychotics for chronic patients with two to five psychotic episodes. Dominant elements in antipsychotic choice were low sedation but no tardive dyskinesia, no or mild pain at injection and low risk of embarrassment or impact upon therapeutic alliance. Eighty-six per cent of respondents considered that having the choice of a deltoid as well as gluteal administration site was beneficial over not having that choice. Two thirds of respondents said they agreed that medication administration via the deltoid muscle may reduce social embarrassment associated with LAI antipsychotics and most

  20. Provider practices in the primary care behavioral health (PCBH) model: an initial examination in the Veterans Health Administration and United States Air Force.

    Science.gov (United States)

    Funderburk, Jennifer S; Dobmeyer, Anne C; Hunter, Christopher L; Walsh, Christine O; Maisto, Stephen A

    2013-12-01

    The goals of this study were to identify characteristics of both behavioral health providers (BHPs) and the patients seen in a primary care behavioral health (PCBH) model of service delivery using prospective data obtained from BHPs. A secondary objective was to explore similarities and differences between these variables within the Veterans Health Administration (VHA) and United States Air Force (USAF) primary care clinics. A total of 159 VHA and 23 USAF BHPs, representing almost every state in the United States, completed the study, yielding data from 403 patient appointments. BHPs completed a web-based questionnaire that assessed BHP and setting characteristics, and a separate questionnaire after each patient seen on one day of clinical service. Data demonstrated that there are many similarities between the VHA and USAF BHPs and practices. Both systems tend to use well-trained psychologists as BHPs, had systems that support the BHP being in close proximity to the primary care providers, and have seamless operational elements (i.e., shared record, one waiting room, same-day appointments, and administrative support for BHPs). Comorbid anxiety and depression was the most common presenting problem in both systems, but overall rates were higher in VHA clinics, and patients were significantly more likely to meet diagnostic criteria for mental health conditions. This study provides the first systematic, prospective examination of BHPs and practices within a PCBH model of service delivery in two large health systems with well over 5 years of experience with behavioral health integration. Many elements of the PCBH model were implemented in a manner consistent with the model, although some variability exists within both settings. These data can help guide future implementation and training efforts.

  1. Tenure, certification, and education of nursing home administrators, medical directors, and directors of nursing in for-profit and not-for-profit nursing homes: United States 2004.

    Science.gov (United States)

    Resnick, Helaine E; Manard, Barbara; Stone, Robyn I; Castle, Nicholas G

    2009-07-01

    To understand key characteristics of the leadership team, and to examine if differences in these factors exist between for-profit (FP) and not-for-profit (NFP) nursing homes (NHs). Cross sectional. US nursing homes. A nationally representative sample of 1174 US NHs conducted in 2004. N/A. Reported data on tenure, education, and certification of NH administrators (NHAs), medical directors (MeDs), and directors of nursing (DoNs) at FP and NFP facilities. NHAs, MeDs, and DoNs at NFP facilities all had significantly greater tenure at their current facilities compared with their FP counterparts. NHAs and MeDs at NFP facilities were also more likely to have more years of accumulated experience in those roles. MeD certifications differed substantially by specialty, with 23.3%, 37.6%, and 43.5% of MeDs having certification in geriatric, internal, and family medicine, respectively, and about 42% of MeDs were certified by AMDA. However, no differences in MeD certification were observed by facility ownership. Although 68% of all US nursing homes had a MeD who spent 4 or fewer days per month in the facility and only 14% spent 11 days or more per month in the facility, nearly twice as many NFP MeDs spent 11 days or more onsite in the facility compared with FP MeDs. Facility ownership was strongly associated with NHA educational attainment, with a significantly higher proportion of NFP NHAs having master's degrees or higher (41.4% versus 26.6%, P NFP NHAs having a bachelor's degree or less. In 2004, members of the leadership teams of NFP NHs had more favorable profiles for several characteristics related to education and tenure compared with their FP counterparts. More research is needed to understand how variation in leadership skills and capacity affects quality of care and quality of work life outcomes, including the role of FP/NFP differences in explaining differential quality outcomes.

  2. Medication administration error reporting and associated factors among nurses working at the University of Gondar referral hospital, Northwest Ethiopia, 2015.

    Science.gov (United States)

    Bifftu, Berhanu Boru; Dachew, Berihun Assefa; Tiruneh, Bewket Tadesse; Beshah, Debrework Tesgera

    2016-01-01

    Medication administration is the final step/phase of medication process in which its error directly affects the patient health. Due to the central role of nurses in medication administration, whether they are the source of an error, a contributor, or an observer they have the professional, legal and ethical responsibility to recognize and report. The aim of this study was to assess the prevalence of medication administration error reporting and associated factors among nurses working at The University of Gondar Referral Hospital, Northwest Ethiopia. Institution based quantitative cross - sectional study was conducted among 282 Nurses. Data were collected using semi-structured, self-administered questionnaire of the Medication Administration Errors Reporting (MAERs). Binary logistic regression with 95 % confidence interval was used to identify factors associated with medication administration errors reporting. The estimated medication administration error reporting was found to be 29.1 %. The perceived rates of medication administration errors reporting for non-intravenous related medications were ranged from 16.8 to 28.6 % and for intravenous-related from 20.6 to 33.4 %. Education status (AOR =1.38, 95 % CI: 4.009, 11.128), disagreement over time - error definition (AOR = 0.44, 95 % CI: 0.468, 0.990), administrative reason (AOR = 0.35, 95 % CI: 0.168, 0.710) and fear (AOR = 0.39, 95 % CI: 0.257, 0.838) were factors statistically significant for the refusal of reporting medication administration errors at p-value definition, administrative reason and fear were factors statistically significant for the refusal of errors reporting at p-value definition of reportable errors and strengthen the educational status of nurses by the health care organization.

  3. Automation and adaptation: Nurses' problem-solving behavior following the implementation of bar coded medication administration technology.

    Science.gov (United States)

    Holden, Richard J; Rivera-Rodriguez, A Joy; Faye, Héléne; Scanlon, Matthew C; Karsh, Ben-Tzion

    2013-08-01

    The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses' operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA's impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians' work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign.

  4. Rework and workarounds in nurse medication administration process: implications for work processes and patient safety.

    Science.gov (United States)

    Halbesleben, Jonathon R B; Savage, Grant T; Wakefield, Douglas S; Wakefield, Bonnie J

    2010-01-01

    Health care organizations have redesigned existing and implemented new work processes intended to improve patient safety. As a consequence of these process changes, there are now intentionally designed "blocks" or barriers that limit how specific work actions, such as ordering and administering medication, are to be carried out. Health care professionals encountering these designed barriers can choose to either follow the new process, engage in workarounds to get past the block, or potentially repeat work (rework). Unfortunately, these workarounds and rework may lead to other safety concerns. The aim of this study was to examine rework and workarounds in hospital medication administration processes. Observations and semistructured interviews were conducted with 58 nurses from four hospital intensive care units focusing on the medication administration process. Using the constant comparative method, we analyzed the observation and interview data to develop themes regarding rework and workarounds. From this analysis, we developed an integrated process map of the medication administration process depicting blocks. A total of 12 blocks were reported by the participants. Based on the analysis, we categorized them as related to information exchange, information entry, and internal supply chain issues. Whereas information exchange and entry blocks tended to lead to rework, internal supply chain issues were more likely to lead to workarounds. A decentralized pharmacist on the unit may reduce work flow blocks (and, thus, workarounds and rework). Work process redesign may further address the problems of workarounds and rework.

  5. A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data.

    Science.gov (United States)

    Aiken, Alice B; Mahar, Alyson L; Kurdyak, Paul; Whitehead, Marlo; Groome, Patti A

    2016-08-04

    Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1-83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0-61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2-41.5) went to the emergency department in that same time period and 9.9 % (9.5-10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.

  6. Veterans' homecomings

    DEFF Research Database (Denmark)

    Sørensen, Birgitte Refslund

    2015-01-01

    social identity and find a meaningful life in the civilian world. When doing so, they need to navigate an ambiguous political environment and emergent public imaginaries of the veteran while also wrestling with their own military socialization and personal experiences of war. The certainty previously...... experiences, present conditions, and future ambitions are embedded in webs of concealment, disclosure, exposure, deception, lying, silence, and so forth, only partially controlled by the veterans themselves. The intricacies and anxieties associated with secrecy work are discussed in relation to three veteran...

  7. First-line nurse administrators in academe: how are they prepared, what do they do, and will they stay in their jobs?

    Science.gov (United States)

    Princeton, J C; Gaspar, T M

    1991-01-01

    This article examines the role characteristics, responsibilities, and anticipated career patterns of first-line nurse administrators employed in university-based nursing education programs throughout the nation. First-line administration is the first level on the administrative ladder, and these administrators are most frequently entitled department chairpersons; division, program, and level directors; or coordinators. This was an exploratory and descriptive research project, and the questions addressed were (1) How are first-line nurse administrators in academe formally educated and informally prepared for their administrative role? (2) What are the administrative competencies important for this administrative role? (3) What strains, conflicts, and work overload are associated with the first-line administrative role, and what strategies are used to cope? (4) What do these administrators anticipate as a career pattern in administration based on their experiences as first-line administrators? Fifty-six first-line nurse administrators were interviewed from 42 schools of nursing that offer both bachelor's degree and graduate nursing programs. Data indicated that one third of the study participants completed graduate level courses in administration, and the majority had worked with administrative mentors. They ranked having character and integrity as their most important competency, which was defined as being trusted by faculty, other administrators, and students. Settling priorities for their administrative work caused them their greatest strain, and work overload was most predominant. Role conflict was present consistently as they attempted to meet the traditional triad of faculty responsibilities (research and scholarship, teaching, service) plus administrative duties. Numerous time-management strategies were used to cope, but nonetheless, one half will not continue in an administration career pathway. Implications for academic nurse administrators are cited.

  8. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program

    National Research Council Canada - National Science Library

    O'Toole, Thomas P; Johnson, Erin E; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    .... We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute...

  9. 76 FR 78732 - FY 2011 Discretionary Funding Opportunity; Section 5309 Bus and Bus Facilities Veterans...

    Science.gov (United States)

    2011-12-19

    ... Administration's priority of supporting America's veterans and military families, as well as the objectives of... Federal Transit Administration FY 2011 Discretionary Funding Opportunity; Section 5309 Bus and Bus Facilities Veterans Transportation and Community Living Initiative AGENCY: Federal Transit Administration...

  10. Access to Care Among Nonelderly Veterans.

    Science.gov (United States)

    Bernard, Didem M; Selden, Thomas M

    2016-03-01

    Veteran access to care is an important policy issue that has not previously been examined with population-based survey data. This study compares access to care for nonelderly adult Veterans versus comparable non-Veterans, overall and within subgroups defined by simulated eligibility for health care from the Veterans Health Administration and by insurance status. We use household survey data from the Medical Expenditure Panel Survey from 2006 to 2011. We use iterative proportional fitting to standardize (control for) differences in age, sex, income, medical conditions, disability, Census region, and Metropolitan Statistical Area. Nonelderly Veterans and comparable non-Veterans. For medical, dental, and prescription medicine treatments, we use 4 access measures: delaying care, inability to obtain care, perceiving delay as a big problem, and perceiving inability to obtain care as a big problem. We also examine having a usual source of care. Frequencies of access barriers are similar for nonelderly Veterans and comparable non-Veterans for dental and prescription medicine treatments. For medical treatment, we find that Veterans eligible for VA health care and Veterans with VA use who are uninsured report fewer access problems than the comparable non-Veteran populations for 2 measures: inability to obtain care and reporting inability to obtain care as a big problem. Our results show that uninsured Veterans, the most policy-relevant group, have better access to care than comparable non-Veterans. Our results highlight the importance of adjusting Veteran and non-Veteran comparisons to account for the higher than average health care needs of Veterans.

  11. Effect of bar-code-assisted medication administration on nurses' activities in an intensive care unit: a time-motion study.

    Science.gov (United States)

    Dwibedi, Nilanjana; Sansgiry, Sujit S; Frost, Craig P; Dasgupta, Anandaroop; Jacob, Sheeba M; Tipton, Joyce A; Shippy, Angela A

    2011-06-01

    The effect of bar-code-assisted medication administration (BCMA) on nurses' activities in an intensive care unit was evaluated. A prospective, observational, time-motion study was conducted by considering two approaches to medication administration in an intensive care unit: paper-based medication administration (PBMA) and BCMA. The time spent on nursing activities was measured using a prevalidated time-motion observation instrument and categorized based on workflow factors such as direct patient care, indirect patient care, administration, and miscellaneous or other. A descriptive analysis was conducted with the amount of time spent on each of the nursing activities. A multivariate analysis of covariance was conducted to assess the difference between the two approaches for the amount of time spent on various categorized nursing activities. Covariates included in the analysis were patient characteristics, medication administration characteristics, and number of nurses involved in medication administration. A total of 101 PBMAs and 151 BCMAs were reviewed. The mean duration of total medication administration time was higher in the BCMA phase compared with the PBMA phase, as was the mean time spent on direct patient care activity. However, nurses spent less time on administration activity during BCMA. Statistical analysis revealed that the medication administration approach (BCMA versus PBMA) had a significant effect on time spent on direct patient care and medication administration activities. The implementation of BCMA led to a reduction in the time spent by nurses on medication administration activities and increased the time spent on direct patient care activities.

  12. Women Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report summarizes the history of women Veterans in the military and as Veterans. It profiles the characteristics of women Veterans in 2015, and illustrates how...

  13. Mortality patterns among women Vietnam-era veterans: results of a retrospective cohort study.

    Science.gov (United States)

    Cypel, Yasmin; Kang, Han

    2008-03-01

    This research compiled and analyzed the data of two cohorts of women veterans who either served in Vietnam ("Vietnam veteran" cohort, n = 4586) or served elsewhere during the Vietnam War ("non-Vietnam veteran" cohort, n = 5325). All cause and cause-specific mortality were compared between Vietnam and non-Vietnam veteran cohorts, to the U.S. population, and to earlier research. Similar analyses were performed for nurses only. Vital status was determined through December 31, 2004, using primarily the U.S. Department of Veterans Affairs beneficiary file and the Social Security Administration Death Master File. Selected data were submitted to the National Center for Health Statistics for merging with the National Death Index to obtain cause of death. Cox proportional hazard analysis modeling was used to obtain adjusted relative risks (ARR). SEER( *)Stat software was used to compute standardized mortality ratios (SMR) for comparisons to the U.S. population. Women Vietnam veterans showed a significant deficit (ARR = 0.78, 95% confidence interval [CI] 0.62-0.98) in circulatory system disease relative to non-Vietnam veterans, but significant deficits also were observed when the Vietnam and non-Vietnam cohorts were each compared with women in the U.S. population (SMR = 0.65, 95% CI 0.54-0.77; SMR=0.82, 95% CI 0.73-0.93, respectively). Vietnam veterans had significantly lower mortality than women in the U.S. population for all causes (SMR = 0.87, 95% CI 0.80-0.94). Vietnam veterans were at significantly greater risk of mortality from motor vehicle accidents than non-Vietnam veterans (ARR = 2.60, 95% CI 1.22-5.55) and this appeared to be specific to service in Vietnam based on comparisons to the U.S. population. Patterns did not differ greatly for the analysis on nurse veterans or to earlier mortality studies of these cohorts. Mortality from motor vehicle accidents was significantly associated with service in Vietnam. Mortality patterns generally resembled those reported on

  14. Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

    Science.gov (United States)

    Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V

    2017-02-01

    There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  15. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging.

    Science.gov (United States)

    Shimada, Stephanie L; Petrakis, Beth Ann; Rothendler, James A; Zirkle, Maryan; Zhao, Shibei; Feng, Hua; Fix, Gemmae M; Ozkaynak, Mustafa; Martin, Tracey; Johnson, Sharon A; Tulu, Bengisu; Gordon, Howard S; Simon, Steven R; Woods, Susan S

    2017-09-01

    We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. We coded 1000 threads of SM communication sampled from 40 primary care teams. Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.

  16. Development and applications of the Veterans Health Administration's Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

    Science.gov (United States)

    Oliva, Elizabeth M; Bowe, Thomas; Tavakoli, Sara; Martins, Susana; Lewis, Eleanor T; Paik, Meenah; Wiechers, Ilse; Henderson, Patricia; Harvey, Michael; Avoundjian, Tigran; Medhanie, Amanuel; Trafton, Jodie A

    2017-02-01

    Concerns about opioid-related adverse events, including overdose, prompted the Veterans Health Administration (VHA) to launch an Opioid Safety Initiative and Overdose Education and Naloxone Distribution program. To mitigate risks associated with opioid prescribing, a holistic approach that takes into consideration both risk factors (e.g., dose, substance use disorders) and risk mitigation interventions (e.g., urine drug screening, psychosocial treatment) is needed. This article describes the Stratification Tool for Opioid Risk Mitigation (STORM), a tool developed in VHA that reflects this holistic approach and facilitates patient identification and monitoring. STORM prioritizes patients for review and intervention according to their modeled risk for overdose/suicide-related events and displays risk factors and risk mitigation interventions obtained from VHA electronic medical record (EMR)-data extracts. Patients' estimated risk is based on a predictive risk model developed using fiscal year 2010 (FY2010: 10/1/2009-9/30/2010) EMR-data extracts and mortality data among 1,135,601 VHA patients prescribed opioid analgesics to predict risk for an overdose/suicide-related event in FY2011 (2.1% experienced an event). Cross-validation was used to validate the model, with receiver operating characteristic curves for the training and test data sets performing well (>.80 area under the curve). The predictive risk model distinguished patients based on risk for overdose/suicide-related adverse events, allowing for identification of high-risk patients and enrichment of target populations of patients with greater safety concerns for proactive monitoring and application of risk mitigation interventions. Results suggest that clinical informatics can leverage EMR-extracted data to identify patients at-risk for overdose/suicide-related events and provide clinicians with actionable information to mitigate risk. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  17. Consistency of Self-Reported Neurocognitive Symptoms, Post-Traumatic Stress Disorder Symptoms, and Concussive Events From End of First Deployment to Veteran Health Administration Comprehensive Traumatic Brain Injury Evaluation by Operations Enduring Freedom/Iraqi Freedom/New Dawn Veterans.

    Science.gov (United States)

    Russo, Arthur C; Fingerhut, Esther C

    2017-03-01

    This study examined the consistency of self-reported symptoms and concussive events in combat veterans who reported experiencing concussive events. One hundred and forty, single deployed, Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn combat veterans with Veteran Health Administration (VHA) Comprehensive Traumatic Brain Injury Evaluations (CTBIE) and no post-deployment head injury were examined to assess consistency of self-reported (a) traumatic brain injury (TBI)-related symptoms, (b) post-traumatic stress disorder (PTSD)-related symptoms, and (c) TBI-related concussive events from soon after deployment to time of VHA CTBIE. Compared to their self-report of symptoms and traumatic events at the time of their Post-Deployment Health Assessment, at the time of their comprehensive VHA evaluation, subjects reported significantly greater impairment in concentration, decision making, memory, headache, and sleep. In addition, although half the subjects denied any PTSD symptoms post-deployment, approximately three quarters reported experiencing all four PTSD screening symptoms near the time of the VHA CTBIEs. At the latter time, subjects also reported significantly more TBI-related concussive events, as well as more post-concussive sequelae such as loss of consciousness immediately following these concussive events. Finally, although 84% reported a level of impairment so severe as to render all but the simplest activity doable, the vast majority simultaneously reported working and/or attending college. These findings raise questions regarding the accuracy of veteran self-report of both near and distant traumatic events, and argue for the inclusion of contemporaneous Department of Defense (DOD) records in veteran assessment and treatment planning.

  18. Nurses' Perceptions of the Impact of Work Systems and Technology on Patient Safety during the Medication Administration Process

    Science.gov (United States)

    Gallagher Gordon, Mary

    2012-01-01

    This dissertation examines nurses' perceptions of the impacts of systems and technology utilized during the medication administration process on patient safety and the culture of medication error reporting. This exploratory research study was grounded in a model of patient safety based on Patricia Benner's Novice to Expert Skill Acquisition model,…

  19. Veterans and Homelessness

    Science.gov (United States)

    2013-11-29

    health care and rehabilitation services for homeless veterans (the Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans...Health Care for Homeless Veterans ................................................................................... 19 Domiciliary Care for Homeless...for Homeless Veterans (HCHV), Domiciliary Care for Homeless Veterans (DCHV), the Compensated Work Therapy/Therapeutic Residences Program, and the

  20. A Survey of Educational Programs for Provisionally Licensed Nursing Home Administrators.

    Science.gov (United States)

    Mowrer, John L.

    Continuing education for health service professionals operating nursing homes is the subject of this report. Reasons for the growth and development of nursing homes are discussed, and licensure is defined. Methodologies and techniques employed in Missouri and other states are identified, after a background report on the Missouri Nursing Home…

  1. The Influence of Emerging Nursing Administrative and Leadership Researchers: An Interview With Dr Lesly Kelly.

    Science.gov (United States)

    Adams, Jeffrey M

    2017-02-01

    This department highlights emerging nursing leaders who have demonstrated leadership in advancing innovation and patient care in practice, policy, research, education, and theory. This interview profiles Lesly Kelly, PhD, RN, Assistant Professor at the Arizona State University College of Nursing and Health Innovation and Nursing and Clinical Research Program Director at Banner-University Medical Center Phoenix.

  2. Foreign-born care givers in Washington State nursing homes: characteristics, associations with quality of care, and views of administrators.

    Science.gov (United States)

    Acker, Katherine; Pletz, Anna Maria; Katz, Aaron; Hagopian, Amy

    2015-06-01

    Following national trends, Washington State relies heavily on foreign-born workers to provide long-term care. Our study assesses state nursing facility characteristics, quality ratings, and the views of facility administrators about the implications of an increasing number of foreign-born employees. We used independently available data to supplement a survey of nursing home administrators. Nearly half of the administrators reported difficulty hiring U.S.-born job applicants. Three in four administrators reported problems related to language differences, and just more than a third reported challenges related to cultural and/or religious differences. Nonetheless, the proportion of foreign-born employees was positively associated with independent facility quality ratings. Almost half of the administrators reported discrimination by patients/clients toward their foreign-born workers. Quality ratings were negatively associated with for-profit, chain, or multi-ownership status. The proportion of foreign-born employees in nursing facilities may be associated with improved performance. © The Author(s) 2014.

  3. End-of-life opioid administration on neonatal and pediatric intensive care units: nurses' attitudes and practice.

    Science.gov (United States)

    Garten, Lars; Daehmlow, Steffen; Reindl, Tobias; Wendt, Anke; Münch, Annette; Bührer, Christoph

    2011-10-01

    (1) To compare caregivers attitudes on the use of end-of-life opioid analgesia in neonatal (NICU) and pediatric (PICU) intensive care units. (2) To investigate actual opioid administration to DR (delivery room), NICU and PICU patients in various end-of-life situations. (1) Administration of an anonymous self-report questionnaire survey to nurses of 2 level III NICUs and 3 PICUs, presenting 5 hypothetical NICU and PICU patients in end-of-life situations. (2) Retrospective chart review of all deaths at the above mentioned DRs (served by NICU staff), NICUs and PICUs during the years 2008-2009. There was no difference between NICU and PICU nurses in self-proclaimed opioid administration in dying NICU or PICU patients with signs of pain (about 80%) or distress (about 65%). 35.0% of NICU and 44.5% of PICU nurses favoured opioid administration with the implicit aim of active intentional ending of life. Shortening of life as an adverse effect of end-of-life opioid analgesia was acceptable for the majority of PICU (94.5%) and NICU (87.0%) nurses. The rate of dying infants who actually had received opioids was similar in NICUs (41/74, 55.4%) and PICUs (40/68, 58.8%). In contrast, none of the neonates (n=24) who died under primary comfort care in the DR received opioids. End-of-life opioid administration to primary comfort care patients in the DR differs fundamentally from NICU or PICU handling of dying patients. Once patients are admitted to an intensive care unit, practice and attitudes towards end-of-life opioid administration are similar in NICUs and PICUs. Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  4. Use of Electronic Medication Administration Records to Reduce Perceived Stress and Risk of Medication Errors in Nursing Homes.

    Science.gov (United States)

    Alenius, Malin; Graf, Peter

    2016-07-01

    Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P electronic medication administration records will reduce many of the concerns regarding the medication administration process.

  5. 38 CFR 52.130 - Nursing services.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing services. 52.130... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.130 Nursing services. The program management must provide an organized nursing service with a sufficient number of qualified nursing personnel...

  6. [Do nursing homes with higher quality ratings provide a better quality of care? : Empirical study based on administrative data].

    Science.gov (United States)

    Przylog, Adam; Stroka, Magdalena A; Engel, Susanne; Linder, Roland

    2016-06-01

    In 2009 a new system for the objective evaluation of nursing homes was introduced in Germany. The so-called nursing transparency agreement (Pflege-Transparenzvereinbarungen) was introduced to provide a reliable tool for an objective comparison of inpatient (PTVS) and outpatient (PTVA) care; however, the new regulations have been the subject of a broad discussion regarding reliability, efficiency and objectivity. To overcome the lack of objective health outcomes, this study used administrative data from Germany's largest health insurance fund, the Techniker Krankenkasse, in order to analyze the association between the quality ratings and objective quality measures on an individual level. This is the first study that provides empirical evidence on this topic using administrative data. The administrative dataset contained information on several individual characteristics as well as data on injuries, poisoning and other extrinsic effects on care-dependent individuals over the age of 64 years who were living in a nursing home in 2009. Based on these data an objective measure was constructed to test whether higher quality ratings of nursing homes led to a better quality of care of the respective patients using non-linear regression models. The results of the estimated models showed no significant evidence of such a relationship, neither considering the probability nor the number of injuries, poisoning and other extrinsic effects. Significant effects were only observed for gender and specific diseases. The results of this study support the argument that the current rating procedure for nursing homes has to be refined. Using quality indicators in combination with the administrative data could possibly contribute to such an enhancement.

  7. Service Members in School: Military Veterans’ Experiences Using the Post-9/11 GI Bill and Pursuing Postsecondary Education

    Science.gov (United States)

    2010-11-01

    Afghanistan Veterans of America (IAVA); Brian Hawthorne, legisla- tive director of the Student Veterans of America ( SVA ); Derek Blumke, president of SVA ...Veterans of America ( SVA ), a national student veterans’ organization; the National Association of Veterans’ Program Administrators (NAVPA), a

  8. Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

    Science.gov (United States)

    Levy, Cari; Whitfield, Emily A

    2016-12-01

    To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. Descriptive, unmatched study. VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs). Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011. Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment. Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs. MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  9. Military sexual trauma among homeless veterans.

    Science.gov (United States)

    Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel

    2013-07-01

    Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless

  10. A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center.

    Science.gov (United States)

    Broyles, Lauren Matukaitis; Rodriguez, Keri L; Kraemer, Kevin L; Sevick, Mary Ann; Price, Patrice A; Gordon, Adam J

    2012-05-02

    Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills, communication, and collaboration

  11. O ensino da administração em enfermagem: percepção diante da vivência profissional Teaching nursing administration: the nurse's comprehension

    Directory of Open Access Journals (Sweden)

    Raquel Rapone Gaidzinski

    1998-04-01

    Full Text Available Este estudo teve por objetivo desvelar a compreensão de um grupo de enfermeiras egressas da Escola de Enfermagem da USP, quanto disciplina Administração aplicada à Enfermagem ministrada no Curso de Graduação em Enfermagem da Escola de Enfermagem da Universidade de São Paulo. Para tanto buscou-se como trajetória metodológica a fenomenologia, tendo MARTINS;BICUDO como autores básicos e eixo principal da pesquisa. Guiadas por este referencial, realizou-se o estudo junto a oito enfermeiras, fazendo a descrição e a compreensão dos seus discursos e buscando trazer o significado que foi percebido do fenômeno estudado. Da análise fenomenológica dos relatos das enfermeiras emergiram possibilidades e limites do ensino da referida disciplina.The purpose of this study was to disclose the nurses comprehension about the Nursing Administration discipline taught in the Nursing graduation course of the Nursing School of São Paulo University. We have followed the phenomenology as the methodological way, and MARTINS; BICUDO were taken as the basic authors and main axis of the research. Being guided by this referencial, we have done this study together with eight nurses and we could do a description and comprehension speeches trying to bring out the meaning of what was understood about their phenomenon studied. From the phenomenological analysis of the nurses'reports appeared the possibilities an limits of the teaching of this discipline.

  12. Veterans Education Outreach Program. Exemplary Projects.

    Science.gov (United States)

    Amon, Ronald D.

    As a result of a review of performance reports submitted by almost 400 colleges and universities receiving Veterans Education Outreach Program (VEOP) grants, 37 exemplary programs were identified by a panel of 5 professionals in veterans' education and government administration. The exemplary programs selected showed consistency in staff efforts…

  13. Defining "Rural" for Veterans' Health Care Planning

    Science.gov (United States)

    West, Alan N.; Lee, Richard E.; Shambaugh-Miller, Michael D.; Bair, Byron D.; Mueller, Keith J.; Lilly, Ryan S.; Kaboli, Peter J.; Hawthorne, Kara

    2010-01-01

    Purpose: The Veterans Health Administration (VHA) devised an algorithm to classify veterans as Urban, Rural, or Highly Rural residents. To understand the policy implications of the VHA scheme, we compared its categories to 3 Office of Management and Budget (OMB) and 4 Rural-Urban Commuting Area (RUCA) geographical categories. Method: Using…

  14. Administration

    DEFF Research Database (Denmark)

    Bogen handler om den praksis, vi kalder administration. Vi er i den offentlige sektor i Danmark hos kontorfolkene med deres sagsmapper, computere, telefoner,, lovsamlinger,, retningslinier og regneark. I bogen udfoldes en mangfoldighed af konkrete historier om det administrative arbejde fra...... forskellige områder i den offentlige sektor. Hensigten er at forstå den praksis og faglighed der knytter sig til det administrative arbejde...

  15. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from ...

  16. Developing and Implementing a Simulated Electronic Medication Administration Record for Undergraduate Nursing Education: Using Sociotechnical Systems Theory to Inform Practice and Curricula.

    Science.gov (United States)

    Booth, Richard G; Sinclair, Barbara; Brennan, Laura; Strudwick, Gillian

    2017-03-01

    Knowledge and skills related to medication administration are a fundamental element of nursing education. With the increased use of electronic medication administration technology in practice settings where nurses work, nursing educators need to consider how best to implement these forms of technology into clinical simulation. This article describes the development of a simulated electronic medication administration system, including the use of sociotechnical systems theory to inform elements of the design, implementation, and testing of the system. Given the differences in the medication administration process and workflow generated by electronic medication administration technology, nursing educators should explore sociotechnical theory as a potentially informative lens from which to plan and build curricula related to simulation activities involving clinical technology.

  17. Risk factors for homelessness among women veterans.

    Science.gov (United States)

    Washington, Donna L; Yano, Elizabeth M; McGuire, James; Hines, Vivian; Lee, Martin; Gelberg, Lillian

    2010-02-01

    Women veterans are three to four times more likely than non-veteran women to become homeless. However, their risk factors for homelessness have not been defined. Case-control study of non-institutionalized homeless women veterans (n533) and age-matched housed women veterans (n=165). Health, health care, and factors associated with homelessness were assessed using multiple logistic regression with a Monte Carlo algorithm to estimate exact standard errors of the model coefficients and p-values. Characteristics associated with homelessness were sexual assault during military service, being unemployed, being disabled, having worse overall health, and screening positive for an anxiety disorder or post-traumatic stress disorder. Protective factors were being a college graduate or married. Efforts to assess housed women veterans' risk factors for homelessness should be integrated into clinical care programs within and outside the Veterans Administration. Programs that work to ameliorate risk factors may prevent these women's living situations from deteriorating over time.

  18. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy.

    Science.gov (United States)

    Neuss, Michael N; Polovich, Martha; McNiff, Kristen; Esper, Peg; Gilmore, Terry R; LeFebvre, Kristine B; Schulmeister, Lisa; Jacobson, Joseph O

    2013-05-01

    In 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.

  19. Administration

    OpenAIRE

    2009-01-01

    Cet imposant volume constitue un registre des cours magistraux tenus par l’auteur à l’École supérieure allemande des sciences administratives de Spire, enrichis des résultats de travaux scientifiques menés principalement à l'Institut Allemand de Recherche en Administration Publique (Deutsches Forschungsinstitut für öffentliche Verwaltung Speyer, FÖV). Il s’agit donc d’une entreprise au long cours, destinée à apporter un nouvel éclairage (quasi ?) exhaustif sur l’administration publique : son ...

  20. Documentation of chemotherapy administration by nursing staff in inpatient and outpatient oncology/hematology settings: a best practice implementation project.

    Science.gov (United States)

    Turner, Allison; Stephenson, Matthew

    2015-10-01

    Documentation of chemotherapy administration by nursing staff is undertaken in a written and electronic form at the Canberra Hospital and has been identified as requiring improvement in both inpatient and outpatient settings. Safe prescribing, dispensing, administration and documentation are essential to patient safety, outcomes and quality of care, and to staff safety. Due to the limited available research and evidence on this topic, recommended safety standards for the safe administration of chemotherapy formed the framework for audit criteria and documentation requirements. The aim of this evidence implementation project was to improve documentation of chemotherapy administration by nursing staff in inpatient and outpatient oncology/hematology units, thereby improving patient care and safety, as well as meeting the legal and educational responsibilities of the nursing staff. This evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit was conducted to assess current practice and identify areas requiring improvement, followed by reflection on results and design, and implementation of strategies for documentation improvement. Lastly, a follow-up audit was conducted to assess compliance and practice improvement. The baseline audit results highlighted areas of good current practice, areas requiring improvement and barriers to data collection and practice improvement. Strategies based on raising awareness of best practice guidelines, education and useful tools were developed and implemented. It was evident that the electronic documentation prompts used in the outpatient setting, compared to paper-based documentation in the inpatient setting, contributed to better compliance to documentation guidelines. The follow-up audit demonstrated improved practices across both the inpatient and outpatient settings. The aim of improving documentation after

  1. Veterans Crisis Line

    Data.gov (United States)

    Department of Veterans Affairs — The caring responders at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances. Some of the responders are...

  2. Patient safety and technology-driven medication e A qualitative study on how graduate nursing students navigate through complex medication administration

    DEFF Research Database (Denmark)

    Orbæk, Janne; Gaard, Mette; Fabricius, Pia

    2014-01-01

    Background: The technology-driven medication process is complex, involving advanced technologies, patient participation and increased safety measures. Medication administration errors are frequently reported, with nurses implicated in 26e38% of in-hospital cases. This points to the need for new...... and confidence in using technology, but were fearful of committing serious medication errors. From the nursing students' perspective, experienced nurses deviate from existing guidelines, leaving them feeling isolated in practical learning situations. Conclusion: Having an unclear nursing role model...... for the technology-driven medication process, nursing students face difficulties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient...

  3. Oncology nurses' perceptions about involving patients in the prevention of chemotherapy administration errors.

    Science.gov (United States)

    Schwappach, David L B; Hochreutener, Marc-Anton; Wernli, Martin

    2010-03-01

    To explore oncology nurses' perceptions and experiences with patient involvement in chemotherapy error prevention. Qualitative descriptive study. In- and outpatient oncology units of a community hospital in Switzerland. 11 actively practicing oncology nurses working in an ambulatory infusion unit or on wards. Oncology nurses participated in two focus groups on two occasions. Participants discussed their personal experiences with patients intervening to intercept errors, attitudes toward patient involvement in error prevention, and changes in relationships with patients. A content-analysis framework was applied to the transcripts and analytical categories were generated. Perceptions about patient involvement in error prevention. Participants shared affirmative attitudes and overwhelmingly reported positive experiences with engaging patients in safety behaviors, although engaging patients was described as a challenge. Nurses intuitively chose among a set of strategies and patterns of language to engage patients and switch between participative and authoritative models of education. Patient involvement in error prevention was perceived to be compatible with trustful relationships. Efforts to get patients involved have the potential for frustration if preventable errors reach patients. Considerable differences exist among organizational barriers encountered by nurses. Nurses acknowledged the diverse needs of patients and deliberately used different strategies to involve patients in safety. Patient participation in safety is perceived as a complex learning process that requires cultural change. Oncology nurses perceive patient education in safety as a core element of their professional role and are receptive to advancing their expertise in this area.

  4. Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014.

    Science.gov (United States)

    Goto, Michihiko; Schweizer, Marin L; Vaughan-Sarrazin, Mary S; Perencevich, Eli N; Livorsi, Daniel J; Diekema, Daniel J; Richardson, Kelly K; Beck, Brice F; Alexander, Bruce; Ohl, Michael E

    2017-10-01

    Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes. Evidence indicates that specific care processes are associated with improved outcomes for patients with S aureus bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, and consultation with infectious diseases (ID) specialists. Whether use of these care processes has increased in routine care for S aureus bacteremia or whether use of these processes has led to large-scale improvements in survival is unknown. To examine the association of evidence-based care processes in routine care for S aureus bacteremia with mortality. This retrospective observational cohort study examined all patients admitted to Veterans Health Administration (VHA) acute care hospitals who had a first episode of S aureus bacteremia from January 1, 2003, through December 31, 2014. Use of appropriate antibiotic therapy, echocardiography, and ID consultation. Thirty-day all-cause mortality. Analyses included 36 868 patients in 124 hospitals (mean [SD] age, 66.4 [12.5] years; 36 036 [97.7%] male), including 19 325 (52.4%) with infection due to methicillin-resistant S aureus and 17 543 (47.6%) with infection due to methicillin-susceptible S aureus. Risk-adjusted mortality decreased from 23.5% (95% CI, 23.3%-23.8%) in 2003 to 18.2% (95% CI, 17.9%-18.5%) in 2014. Rates of appropriate antibiotic prescribing increased from 2467 (66.4%) to 1991 (78.9%), echocardiography from 1256 (33.8%) to 1837 (72.8%), and ID consultation from 1390 (37.4%) to 1717 (68.0%). After adjustment for patient characteristics, cohort year, and other care processes, receipt of care processes was associated with lower mortality, with adjusted odds ratios of 0.74 (95% CI, 0.68-0.79) for appropriate antibiotics, 0.73 (95% CI, 0.68-0.78) for echocardiography, and 0.61 (95% CI, 0.56-0.65) for ID consultation. Mortality decreased progressively as the number of care processes that a

  5. 20 CFR 404.1311 - Ninety-day active service requirement for World War II veterans.

    Science.gov (United States)

    2010-04-01

    ... World War II veterans. 404.1311 Section 404.1311 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Uniformed Services World War II Veterans § 404.1311 Ninety-day active service requirement for World War II veterans. (a) The 90 days of active service required for World War II veterans do not have to be...

  6. 38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

    Science.gov (United States)

    2010-07-01

    ...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

  7. A Comparison of Nurses’ Activities Under Two Models of Administration

    Science.gov (United States)

    1985-08-01

    Unit Manager." Hospital Management 101 (June 1966): 30-36. Brodt, Dagmar. "The Service Manager : Innovation for Nursing and Health Organizations... Service Manager 13 (December 1980): 3-6. Regan, Patrick A. "Measuring the Effectiveness of a Unit Management Program." Hospital Program 50 (December...Approach." Health Service Manager 12 (January 1979): 6-8. Rotkovitch, Rachel. "The Head Nurse as a First Line Manager." The Health Care Supervisor 1 (July

  8. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology.

    Science.gov (United States)

    Neuss, Michael N; Gilmore, Terry R; Belderson, Kristin M; Billett, Amy L; Conti-Kalchik, Tara; Harvey, Brittany E; Hendricks, Carolyn; LeFebvre, Kristine B; Mangu, Pamela B; McNiff, Kristen; Olsen, MiKaela; Schulmeister, Lisa; Von Gehr, Ann; Polovich, Martha

    2016-12-01

    Purpose To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards .

  9. Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences

    Directory of Open Access Journals (Sweden)

    Dale B

    2013-10-01

    Full Text Available Bjørg Dale,1 Sigrun Hvalvik21Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 2Centre for Caring Research – Southern Norway, Faculty of Health and Social Studies, Telemark University College, Porsgrunn, NorwayBackground: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes.Methods: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach.Results: Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional

  10. A Study of Veterans Administration/Department of Defense Health Care Resources Sharing at Keller Army Community Hospital West Point, New York 10996

    Science.gov (United States)

    1984-04-01

    inventory FEAR Fear Inventory FES Family Environment Scale PDS 163 MEDH Medical History PAIN Pain Questionnaire PROB Problem List SEXH Sexual Experiences...Comnmunity Health Nursing (1) Nurse Anesthetists (2) Inhalation Therapy IPPB Treatments Humidity Aerosol Chest Physiotherapy Arterial Blood Samples OB...find its wyto VA ficilte a mokre often the rlta of political pressure from. individual Sth Pain ethafuconierted action by the VA. In truth,~ tratic

  11. Theory of Planned Behavior Constructs Associated with Nurses' Pain Assessment and Pro Re Nata (PRN) Opioid Analgesic Administration: A Cross-sectional Study.

    Science.gov (United States)

    Youngcharoen, Phichpraorn; Vincent, Catherine; Park, Chang G

    2017-06-01

    Little theory-based research has been performed to better understand nurses' perceptions of pain management. Framed by the theory of planned behavior, the aims of the study were to describe nurses' beliefs (behavioral, normative, and control) about pain management for hospitalized elderly patients with postoperative pain; to present an item analysis for beliefs, attitudes, perceived norms, perceived behavioral control, intentions, and behaviors (measured in case study vignettes) for nurses (a) with different durations of nursing experience, (b) working in university, public health, and military hospitals, and (c) who either had or had not received pain management training in the past six months; and to compare differences in the constructs across these three groups. A comparative descriptive cross-sectional design was used with a convenience sample of 140 Thai nurses working in three Bangkok hospitals. Participants responded to pain assessment and management questionnaires. Most nurses expressed fairly strong beliefs about pain assessment and pro re nata (PRN) opioid analgesic administration. Nurses with more than 10 years of experience had the highest scores for attitudes toward pain assessment and perceptions of others' expectations about PRN opioid analgesic administration. Responses of nurses working in different types of hospitals indicated significantly different pain assessment and PRN opioid analgesic administration behaviors. No significant differences were found for nurses who did and did not receive pain management training. The study highlighted the need for improved pain management education for nurses to enhance the quality of patient care. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  12. Center for Women Veterans

    Science.gov (United States)

    ... various organizations and individuals are doing to challenge perceptions about women Veterans. Learn more » #VeteranOfTheDay - Nominate a Veteran Today! Veteran of the Day has been a tradition on VA’s social media pages for more than two years now. This ...

  13. Will Veterans Answer Sexual Orientation and Gender Identity Questions?

    Science.gov (United States)

    Ruben, Mollie A; Blosnich, John R; Dichter, Melissa E; Luscri, Lorry; Shipherd, Jillian C

    2017-09-01

    The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of sexual or gender minority identities among active duty personnel, Veterans may be reluctant to respond to SOGI questions. This population-based study assesses item nonresponse to SOGI questions by Veteran status. This is a secondary analysis of data from a population-based sample of adults in 20 US states that elected to administer a SOGI module in the 2014 Behavioral Risk Factor Surveillance System survey. Prevalence of SOGI refusals and responses of "don't know" were compared for Veterans and non-Veterans. Veterans (n=22,587) and non-Veterans (n=146,475) were surveyed. Nearly all Veteran respondents (≥98%) completed the SOGI questions, with 95.4% identifying as heterosexual, 1.2% as gay or lesbian, 1.2% as bisexual, and 0.59% as transgender. A significantly lower proportion of Veterans than non-Veterans refuse to answer sexual orientation (1.5% vs. 1.9%). There was no difference between Veterans and non-Veterans in responses for gender identity. Veterans are just as likely as non-Veterans to complete SOGI items in survey research. Asking Veterans about SOGI is unlikely to yield significant nonresponse. These data suggest that future research should investigate Veterans' perspectives on being asked about SOGI in research settings and as part of routine clinical care.

  14. Bachelors of Science in Nursing Students and a Qualitative Analysis of Their Medication Administration Experiences

    Science.gov (United States)

    Betts, Kelly J.

    2016-01-01

    Lack of medication knowledge and skills is detrimental to the safety and welfare of patients. Lack of pharmacology knowledge and skills is detrimental to the safety and welfare of patients. In a southern baccalaureate nursing program, students demonstrated deficiencies in their medication knowledge and skill proficiency. This qualitative study…

  15. Perceptions of Nursing Education Administrators Regarding the Relationship of Admission Criteria to Student Graduation

    Science.gov (United States)

    Cline, Joy F.

    2013-01-01

    This research investigated admission criteria of baccalaureate nursing students related to their success in a multi-state sample of peer universities in the United States. The researcher used mixed methods to collect data that were analyzed using descriptive and phenomenological approaches. The sample of the study was chairpersons from peer…

  16. Identifying US veterans who access services from health care for the homeless clinics.

    Science.gov (United States)

    Knopf-Amelung, Sarah M; Jenkins, Darlene M

    2013-12-01

    Research on veterans experiencing homelessness is predominantly focused on the US Department of Veterans Affairs setting, despite the fact that substantial numbers receive services from Health Care for the Homeless (HCH) clinics. We explored how HCH clinics identified veteran patients through a survey of administrators (49% response rate). The majority (98%) identified veterans but used varied language and approaches. Implementing a streamlined, culturally competent identification process is vital to collecting accurate data, connecting veterans with benefits, and informing treatment plans.

  17. A systematic review of nursing administration of medication via enteral tubes in adults.

    Science.gov (United States)

    Phillips, Nicole M; Nay, Rhonda

    2008-09-01

    This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown. Systematic review. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a

  18. 2007 Veterans Employability Research Survey

    Data.gov (United States)

    Department of Veterans Affairs — The 2007 Veterans Employability Research Survey (VERS) was conducted to determine the factors that impact veterans' employability resulting from participation in the...

  19. Mental health consultation in a nursing home.

    Science.gov (United States)

    Kennedy, B; Covington, K; Evans, T; Williams, C A

    2000-11-01

    As the world's population ages, increasing numbers of people can anticipate spending their latter years in long-term care settings. Many of these nursing home residents will also present psychiatric illnesses as primary or secondary diagnoses. The resulting behavioral problems may present challenges to nursing staff that they are ill-prepared to meet. This article illustrates the application of the Blake and Mouton consultation model to a Veterans Administration (VA) nursing home situation by a team of psychiatric mental health nurse specialists. The consultation is described and interpreted in terms of the Blake and Mouton model. The focal conflicts addressed in the consultation included issues of morale/cohesion, power/authority, and norms/standards. Interventions used were acceptant, prescriptive, confrontation, and theories/principles. The model provided a useful structure for conceptualizing and organizing assessment and intervention in the consultation situation.

  20. US veterans and their unique issues: enhancing health care professional awareness

    Directory of Open Access Journals (Sweden)

    Olenick M

    2015-12-01

    Full Text Available Maria Olenick,1 Monica Flowers,1 Valerie J Diaz1,21Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami, FL, USA; 2Operational Health Support Unit Jacksonville, United States Navy Nurse Corps, Jacksonville, FL, USAAbstract: United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies

  1. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... in crisis, find a facility near you. Spread the Word Download logos, Web ads, and materials and ... Administration Watch additional videos about getting help. Behind the Scenes see more videos from Veterans Health Administration ...

  2. Online video in clinical skills education of oral medication administration for undergraduate student nurses: a mixed methods, prospective cohort study.

    Science.gov (United States)

    Holland, Agi; Smith, Fiona; McCrossan, Gill; Adamson, Elizabeth; Watt, Susan; Penny, Kay

    2013-06-01

    Improvements in the safety of the prescribing, dispensing and administration of medicines are identified as a priority across international healthcare systems. It is therefore essential that higher education institutions play their part in helping to meet this patient safety objective. New developments in clinical skills education which are aligned to emerging educational theory are available, but evaluations and supportive evidence are limited. To evaluate the use of an online best practice exemplar as an adjunct to the clinical skills teaching of oral medication administration to undergraduate student nurses. Mixed-methods prospective cohort design. Two intakes of undergraduate nursing students (n=168, n=154) undertaking a first year clinical skills based module at a British university. The Control group received standard teaching using lectures and skills classes facilitated by experienced clinical skills lecturers. The Intervention group received the standard teaching and unlimited access to an online video clip of medication administration. Performance and satisfaction were measured using module assessment results and a satisfaction questionnaire. Qualitative data were gathered using focus groups (n=16, n=20). The Intervention group was significantly (p=0.021) more likely to pass the assessment and rate their satisfaction with the teaching significantly higher (pskill was enhanced. An online video of a best practice exemplar as an adjunct to taught clinical skills sessions improves student assessment results and satisfaction ratings. The video was also reported to positively influence all themes identified in Classroom Learning and was perceived to promote the Transfer to Practice of teaching input. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Treatment-seeking veterans of Iraq and Afghanistan: comparison with veterans of previous wars.

    Science.gov (United States)

    Fontana, Alan; Rosenheck, Robert

    2008-07-01

    Differences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission. A series of analyses of covariance was used hierachically to control for program site and age. In analyses of contemporaneous veterans uncontrolled for age, Iraq/Afghanistan veterans differed most notably from Vietnam veterans by being younger, more likely to be female, less likely to be either married or separated/divorced, more often working, less likely to have ever been incarcerated, and less likely to report exposure to atrocities in the military. Regarding clinical status, Iraq/Afghanistan veterans were less often diagnosed with substance abuse disorders, manifested more violent behavior, and had lower rates of VA disability compensation because of PTSD. Differences are more muted in comparisons with Persian Gulf veterans, particularly in those involving noncontemporaneous samples, or those that controlled for age differences. Among recent war veterans with PTSD, social functioning has largely been left intact. There is a window of opportunity, therefore, for developing and focusing on treatment interventions that emphasize the preservation of these social assets.

  4. Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Brandyn D Lau

    Full Text Available Venous thromboembolism (VTE is a common cause of preventable harm in hospitalized patients. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. The purpose of this trial was to evaluate the effectiveness of nurse education on medication administration practice.This was a double-blinded, cluster randomized trial in 21 medical or surgical floors of 933 nurses at The Johns Hopkins Hospital, an academic medical center, from April 1, 2014 -March 31, 2015. Nurses were cluster-randomized by hospital floor to receive either a linear static education (Static module with voiceover or an interactive learner-centric dynamic scenario-based education (Dynamic module. The primary and secondary outcomes were non-administration of prescribed VTE prophylaxis medication and nurse-reported satisfaction with education modules, respectively.Overall, non-administration improved significantly following education (12.4% vs. 11.1%, conditional OR: 0.87, 95% CI: 0.80-0.95, p = 0.002 achieving our primary objective. The reduction in non-administration was greater for those randomized to the Dynamic arm (10.8% vs. 9.2%, conditional OR: 0.83, 95% CI: 0.72-0.95 versus the Static arm (14.5% vs. 13.5%, conditional OR: 0.92, 95% CI: 0.81-1.03, although the difference between arms was not statistically significant (p = 0.26. Satisfaction scores were significantly higher (p<0.05 for all survey items for nurses in the Dynamic arm.Education for nurses significantly improves medication administration practice. Dynamic learner-centered education is more effective at engaging nurses. These findings suggest that education should be tailored to the learner.ClinicalTrials.gov NCT02301793.

  5. Nurses' attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature.

    Science.gov (United States)

    Bryon, E; de Casterlé, B Dierckx; Gastmans, C

    2008-06-01

    Although nurses have an important role in the care process surrounding artificial food or fluid administration in patients with dementia or in terminally ill patients, little is known about their attitudes towards this issue. The purpose of this study was to thoroughly examine nurses' attitudes by means of a literature review. An extensive systematic search of the electronic databases PubMed, Cinahl, PsycINFO, The Cochrane Library, FRANCIS, Philosopher's Index and Social Sciences Citation Index was conducted to identify pertinent articles published from January 1990 to January 2007. Nurses' arguments for or against could be categorised as ethical-legal, clinical or social-professional. The most important arguments explicitly for artificial food and fluid administration in patients with dementia or in terminally ill patients were sanctity of life, considering artificial food and fluid administration as basic nursing care, and giving reliable nutrition, hydration or medication. An explicit counter-argument was the high cost of treatment. Arguments used by opponents and proponents were quality of life and dignified death. The arguments were not strikingly different for the two patient populations. It turned out that the nurses' ethical arguments remarkably reflected the current ethical debate. But some of their clinical presuppositions contradicted current clinical evidence. The interaction between clinical facts and ethical reflections makes the findings of this review extremely relevant for clinical ethics. A large need exists to clearly communicate to nurses the latest clinical evidence and the main results of ongoing ethical debates.

  6. Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

    Science.gov (United States)

    Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

    2017-01-25

    From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of

  7. 75 FR 7648 - Privacy Act of 1974, as Amended; Computer Matching Program (SSA/Department of Veterans Affairs...

    Science.gov (United States)

    2010-02-22

    .../Veterans Benefits Administration (VA/ VBA))--Match Number 1309 AGENCY: Social Security Administration (SSA... announces a renewal of an existing computer matching program that we are currently conducting with VA/VBA... Matching Program, SSA With the Department of Veterans Affairs/Veterans Benefits Administration (VA/VBA) A...

  8. Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study Conducted at Chicago Area Veterans Health Administration Sites.

    Science.gov (United States)

    Binns-Calvey, Amy E; Malhiot, Alex; Kostovich, Carol T; LaVela, Sherri L; Stroupe, Kevin; Gerber, Ben S; Burkhart, Lisa; Weiner, Saul J; Weaver, Frances M

    2017-09-01

    "Patient context" indicates patient circumstances and characteristics or states that are essential to address when planning patient care. Specific patient "contextual factors," if overlooked, result in an inappropriate plan of care, a medical error termed a "contextual error." The myriad contextual factors that constitute patient context have been grouped into broad domains to create a taxonomy of challenges to consider when planning care. This study sought to validate a previously identified list of contextual domains. This qualitative study used directed content analysis. In 2014, 19 Department of Veterans Affairs (VA) providers (84% female) and 49 patients (86% male) from two VA medical centers and four outpatient clinics in the Chicago area participated in semistructured interviews and focus groups. Topics included patient-specific, community, and resource-related factors that affect patients' abilities to manage their care. Transcripts were analyzed with a previously identified list of contextual domains as a framework. Analysis of responses revealed that patients and providers identified the same 10 domains previously published, plus 3 additional ones. Based on comments made by patients and providers, the authors created a revised list of 12 domains from themes that emerged. Six pertain to patient circumstances such as access to care and financial situation, and 6 to patient characteristics/states including skills, abilities, and knowledge. Contextual factors in patients' lives may be essential to address for effective care planning. The rubric developed can serve as a "contextual differential" for clinicians to consider when addressing challenges patients face when planning their care.

  9. Veterans and Homelessness

    National Research Council Canada - National Science Library

    Perl, Libby

    2007-01-01

    .... The Department of Veterans Affairs (VA) estimates that it has served approximately 300 returning veterans in its homeless programs and has identified over 1,000 more as being at risk of homelessness...

  10. For Homeless Veterans

    Science.gov (United States)

    ... for VA health care services and are experiencing homelessness. VA case managers may connect these Veterans with ... Veterans who have experienced long-term or repeated homelessness. As of Sept. 30, 2015, HUD had allocated ...

  11. Minority Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

  12. Minority Veteran Report 2014

    Data.gov (United States)

    Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

  13. Paralyzed Veterans of America

    Science.gov (United States)

    ... Clothing Donate a Vehicle Matching Gifts Buy PVA Gear Donate Donate Now Give Monthly Planned Giving View ... PVA1946 National Veterans Wheelchair Games App Download Now TOP Contact Us Paralyzed Veterans of America 801 Eighteenth ...

  14. Master Veteran Index (MVI)

    Data.gov (United States)

    Department of Veterans Affairs — As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA,...

  15. Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

    Science.gov (United States)

    Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W

    2016-05-01

    In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Homeless and Unemployed Veterans. Hearing before the Subcommittee on Education, Training and Employment of the Committee on Veterans' Affairs. House of Representatives, Ninety-Ninth Congress, Second Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    This congressional report contains the testimony that was presented at a hearing to examine the needs of homeless and unemployed veterans. Testimony was provided by representatives of the following agencies and organizations: the Vietnam Veterans Ensemble; the National Coalition for the Homeless; the various Veterans' Administration (VA)…

  17. Attitudes and Usage of the Food and Drug Administration Adverse Event Reporting System Among Gastroenterology Nurse Practitioners and Physician Assistants.

    Science.gov (United States)

    Salk, Allison; Ehrenpreis, Eli D

    2016-01-01

    The Food and Drug Administration Adverse Event Reporting System (FAERS) is used for postmarketing pharmacovigilance. Our study sought to assess attitudes and usage of the FAERS among gastroenterology nurse practitioners (NPs) and physician assistants (PAs). A survey was administered at the August 2012 Principles of Gastroenterology for the Nurse Practitioner and Physician Assistant course, held in Chicago, IL. Of the 128 respondents, 123 (96%) reported a specialty in gastroenterology or hepatology and were included in analysis. Eighty-nine participants were NPs and 32 PAs, whereas 2 did not report their profession. Although 119 (98%) agreed or strongly agreed with the statement that accurately reporting adverse drug reactions is an important process to optimize patient safety, the majority of participants (54% NPs and 81% PAs) were unfamiliar with the FAERS. In addition, only 20% of NPs and 9% of PAs reported learning about the FAERS in NP or PA schooling. Our study shows enthusiasm among gastroenterology NPs and PAs for the reporting of adverse drug reactions, coupled with a lack of familiarity with the FAERS. This presents an opportunity for enhanced education about reporting of adverse drug reactions for gastroenterology NPs and PAs.

  18. Blended learning on medication administration for new nurses: integration of e-learning and face-to-face instruction in the classroom.

    Science.gov (United States)

    Sung, Young Hee; Kwon, In Gak; Ryu, Eunjung

    2008-11-01

    This study analyzed the effects of a blended learning program on medication administration by new nurses using a non-equivalent groups design. A medication education program using blended learning (including e-learning) was administered to 26 new nurses, while face-to-face instruction in the classroom was given to 24 new nurses. The following dependent variables were compared: degree of knowledge of medication, self-efficacy of medication administration, medication-administration ability, and satisfaction with the learning program. The experimental, blended learning group showed a significantly higher level of knowledge of medication and satisfaction with the comprehensiveness of their medication learning, but the self-efficacy of medication administration, medication-administration ability, and other items related to their learning satisfaction did not differ significantly from that in the control group. These results suggest that blended learning integrating e-learning and face-to-face instruction in the classroom is useful for enhancing medication knowledge. An e-learning program can reduce the lecturing time and cost of repeated topics such as medication, suggesting that it can be an effective component in nurse education programs.

  19. 76 FR 55570 - Per Diem Payments for the Care Provided to Eligible Veterans Evacuated From a State Home as a...

    Science.gov (United States)

    2011-09-08

    ... veteran receiving nursing home care, domiciliary care, and adult day health care in State home facilities... AFFAIRS 38 CFR Parts 17 and 51 RIN 2900-AN63 Per Diem Payments for the Care Provided to Eligible Veterans... for providing a specified level of care to eligible veterans in a facility that is officially...

  20. Status limbo: analysis of nurse faculty member reports of administrator response to workplace bullying complaints.

    Science.gov (United States)

    Dzurec, Laura Cox

    2013-01-01

    Increasing concern about bullying among adults in workplaces is notable internationally. Unlike blatant physical bullying, workplace bullying often involves bullies' dismissive, demeaning, and typically surreptitious, one-on-one communications with their intended victims. These communications challenge recognition when they are examined beyond the interpersonal margins of the bully-victim dyad. Thus, they tend to elude formal, administrative reproach, despite the negative, long-term outcomes they herald for workplace employees--those immediately involved as victims and those who are bystanders--and for employing organizations and the consumers they serve. This article offers a hermeneutic analysis of workplace bullying victims' narrative reports of administrator responses to their complaints of having been bullied at work. Analysis demonstrated respondent perceptions of the variability and unevenness of administrative responses to their reports and, more broadly, respondents' collective sense of administrative abandonment. That sense is characterized in this report as status limbo, a term employed by Facebook users to represent a state of perceived neglect and oblivion. © 2013 Elsevier Inc. All rights reserved.

  1. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Hands PSA see more videos from Veterans Health Administration I am A Veteran Family/Friend Active Duty/Reserve and Guard Signs of Crisis Identifying Take a Self-Check Quiz Resources Spread the Word Videos Homeless Resources Additional Information ...

  2. 77 FR 7244 - Advisory Committee on Women Veterans, Notice of Meeting

    Science.gov (United States)

    2012-02-10

    ... such programs and activities. The agenda will include overviews of the Veterans Health Administration..., military sexual trauma, the claims process, and homeless initiatives for women Veterans. No time will be... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS...

  3. 77 FR 69551 - Advisory Committee on Women Veterans; Notice of Meeting

    Science.gov (United States)

    2012-11-19

    ... such programs and activities. The agenda will include overviews of the Veterans Health Administration..., the claims process, and homeless initiatives for women Veterans. No time will be allocated at this... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS...

  4. Higher Education Benefits for Post-9/11 Military Service Members and Veterans. Testimony. CT-428

    Science.gov (United States)

    Gonzalez, Gabriella C.; Miller, Laura L.; Buryk, Peter; Wenger, Jennie W.

    2015-01-01

    This testimony was presented before the House Veterans' Affairs Committee, Subcommittee on Economic Opportunity on March 17, 2015. To inform the Subcommittee hearing on the Department of Veterans Affairs' administration of its education programs, and the educational and training needs of post-9/11 veterans, the presenters offered the statement in…

  5. 38 CFR 3.108 - State Department as agent of Department of Veterans Affairs.

    Science.gov (United States)

    2010-07-01

    ... Administrative § 3.108 State Department as agent of Department of Veterans Affairs. Diplomatic and consular officers of the Department of State are authorized to act as agents of the Department of Veterans Affairs... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false State Department as agent...

  6. 5 CFR 335.106 - Special selection procedures for certain veterans under merit promotion.

    Science.gov (United States)

    2010-01-01

    ... veterans under merit promotion. 335.106 Section 335.106 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROMOTION AND INTERNAL PLACEMENT General Provisions § 335.106 Special selection procedures for certain veterans under merit promotion. Preference eligibles or veterans who have...

  7. 76 FR 16354 - Per Diem Payments for the Care Provided to Eligible Veterans Evacuated From a State Home as a...

    Science.gov (United States)

    2011-03-23

    ... veteran receiving nursing home care, domiciliary care, and adult day health care in State home facilities... governing domiciliary care. We have carefully crafted proposed Sec. 51.59 to fit within such a possible... proposed rule would apply for per diem payments for veterans receiving domiciliary care as well as nursing...

  8. 38 CFR 19.50 - Nature and form of administrative appeal.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nature and form of administrative appeal. 19.50 Section 19.50 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) BOARD OF VETERANS' APPEALS: APPEALS REGULATIONS Administrative Appeals § 19.50 Nature and form of...

  9. The association between higher nurse staffing standards in the fee schedules and the geographic distribution of hospital nurses: A cross-sectional study using nationwide administrative data.

    Science.gov (United States)

    Morioka, Noriko; Tomio, Jun; Seto, Toshikazu; Kobayashi, Yasuki

    2017-01-01

    In Japan, the revision of the fee schedules in 2006 introduced a new category of general care ward for more advanced care, with a higher staffing standard, a patient-to-nurse ratio of 7:1. Previous studies have suggested that these changes worsened inequalities in the geographic distribution of nurses, but there have been few quantitative studies evaluating this effect. This study aimed to investigate the association between the distribution of 7:1 beds and the geographic distribution of hospital nursing staffs. We conducted a secondary data analysis of hospital reimbursement reports in 2012 in Japan. The study units were secondary medical areas (SMAs) in Japan, which are roughly comparable to hospital service areas in the United States. The outcome variable was the nurse density per 100,000 population in each SMA. The 7:1 bed density per 100,000 population was the main independent variable. To investigate the association between the nurse density and 7:1 bed density, adjusting for other variables, we applied a multiple linear regression model, with nurse density as an outcome variable, and the bed densities by functional category of inpatient ward as independent variables, adding other variables related to socio-economic status and nurse workforce. To investigate whether 7:1 bed density made the largest contribution to the nurse density, compared to other bed densities, we estimated the standardized regression coefficients. There were 344 SMAs in the study period, of which 343 were used because of data availability. There were approximately 553,600 full time equivalent nurses working in inpatient wards in hospitals. The mean (standard deviation) of the full time equivalent nurse density was 426.4 (147.5) and for 7:1 bed density, the figures were 271.9 (185.9). The 7:1 bed density ranged from 0.0 to 1,295.5. After adjusting for the possible confounders, there were more hospital nurses in the areas with higher densities of 7:1 beds (standardized regression

  10. Women Veterans’ Healthcare Delivery Preferences and Use by Military Service Era: Findings from the National Survey of Women Veterans

    National Research Council Canada - National Science Library

    Washington, Donna L; Bean-Mayberry, Bevanne; Hamilton, Alison B; Cordasco, Kristina M; Yano, Elizabeth M

    2013-01-01

    The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns...

  11. Arthritis, comorbidities, and care utilization in veterans of operations enduring and Iraqi Freedom.

    Science.gov (United States)

    Rivera, Jessica C; Amuan, Megan E; Morris, Ruth M; Johnson, Anthony E; Pugh, Mary Jo

    2017-03-01

    Veteran populations are known to have frequencies of arthritis higher than civilian populations. The aim of this study is to define the prevalence of arthritis among a cohort of veterans from ongoing U.S. military operations. A retrospective cohort study using Veterans Administration data sources for service connected disability, comorbidities, clinic utilization, and pharmacy utilization was conducted including veterans who deployed in service to operations in Afghanistan or Iraq, comparing veterans with a diagnosis of arthritis, arthritis plus back pain, and veterans with no pain diagnoses. The frequency of arthritis was 11.8%. Veterans with arthritis and arthritis plus back pain had greater frequencies of diabetes, hyperlipidemia, hypertension, and obesity compare to veterans with no pain diagnosis. Veterans with arthritis plus back pain had the highest pain clinic utilization and prescription use of opioids and anti-inflammatories. Veterans with no pain diagnosis had higher frequencies of diagnosis and clinic utilization for mental health disorders. Arthritis is prevalent among the latest generation of combat veterans and is associated with diabetes, obesity, and cardiovascular comorbidities. The need for arthritis care and associated comorbidities is expected to increase as the Veterans Administration and the civilian health care sector assumes care of these veterans. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:682-687, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Understanding the health of veterans who are homeless: A review of the literature.

    Science.gov (United States)

    Weber, Jillian; Lee, Rebecca C; Martsolf, Donna

    2017-09-01

    The United States Department of Housing and Urban Development estimates that almost 50,000 veterans are homeless on any given night. Homeless veterans are at greater risk of health disparities than their housed counterparts due to the multifactorial nature of their health and social needs. The Department of Veterans Affairs, in collaboration with more than a dozen other federal agencies, has concentrated efforts to improve the health of this vulnerable population while enacting a plan to eliminate veteran homelessness within the near future. Understanding the unique health needs of veterans who are homeless allows the profession of nursing to better support these efforts. The purpose of this literature review was to provide comprehensive knowledge to nurses about the health of homeless veterans for their use in clinical practice, research, and in contributing to the positive health outcomes for this vulnerable population. © 2017 Wiley Periodicals, Inc.

  13. National Coalition for Homeless Veterans

    Science.gov (United States)

    ... Continues Support of National Campaign to End Veteran Homelessness Nov. 14, 2017 This Veterans Day, Harbor Freight ... support of the national campaign to end veteran homelessness through generous contributions to the National Coalition for ...

  14. Korean War Veterans by State

    Data.gov (United States)

    Department of Veterans Affairs — The spreadsheet of Korean War Veterans by State includes the total Korean War Veteran population for each state and broken out by age and gender. It also includes...

  15. 77 FR 41472 - Interagency Task Force on Veterans Small Business Development

    Science.gov (United States)

    2012-07-13

    ...-disabled veterans (SDVOSB'S). Moreover, the Task Force shall coordinate administrative and regulatory... President and emailed prior to the meeting for inclusion in the public record, verbal presentations; however...

  16. Gerontological Nursing

    OpenAIRE

    Tyra J. Withers

    2017-01-01

    The core idea of this literature is to explain a summarized point of view regarding the gerontological nursing and its present condition in our society. The literature will explain the clear definition and at the same time will point out the core ideas that can help the administrators to increase the interest of nursing students in gerontological nursing

  17. Veterans Medical Care: FY2010 Appropriations

    Science.gov (United States)

    2010-01-21

    construction of state- owned nursing homes and domiciliary facilities and collaborates with the Department of Defense (DOD) in sharing health care ... domiciliary care , or travel for family members of veterans receiving mental health services from the VA except for such travel performed beyond a 100-mile...institutional respite care , geriatric evaluation, adult day healthcare - $15 per day; domiciliary care - $5 per day) Priority Group 1 (service

  18. [Safety issues of chemo drug administration handling by nurses from an occupational exposure viewpoint-through visualization with contrast media for ophthalmic vasculature].

    Science.gov (United States)

    Terui, Kentaro; Nagayama, Katsuko; Okajima, Hiroko; Kato, Sosuke; Nakajima, Yasuaki

    2010-10-01

    A number of studies on health effects of exposure to antineoplastic agents by health professionals have been reported recently. The health effects suggested are mutagenic, teratogenic and/or carcinogenic effects. In the United States or in EU countries cancer chemotherapy nursing guidelines have been already established, whereas in Japan the management of chemotherapy agents is left to each facility and the drug is administered based on the standard of each facility. We used a chemical in this study during preparation and administrations of antineoplastic agents to visualize spills that could be generated during the procedures so that we can sort out safety issues of chemo drug handling by nurses from an occupational exposure point of view. The result showed spills all over in the procedures by nurses in the study: specifically splash to environment around the drug preparation area, contamination of needles which were used for drug preparations, contamination of environment as the result of priming with chemo agents and spills at the exchange of IV bottle or at removal of the IV line from the patient without rinsing with normal saline. For future protective measures from exposure to antineoplastic agents, it is considered that the current administration method must be reviewed, and new methods to avoid the current safe handling issues must be developed and evaluated. Furthermore, strict conformity to chemo drug administration procedures based on the authorized guideline is very important in addition to the standard of the administration procedures in each facility. Hence, the work to prepare for the upcoming Japanese guideline is expected beyond the work to translate the US chemotherapy administration guideline by the Oncology Nursing Society (ONS) into the Japanese language.

  19. Nurse perceptions of workplace environment: differences across shifts.

    Science.gov (United States)

    Teclaw, Robert; Osatuke, Katerine

    2015-11-01

    To evaluate whether nurse work shift affected workplace perceptions. Although the importance of work schedule in shaping work attitudes, generally (and specifically for nurses) is well accepted, much work remains in characterising how and why nurses' perceptions might differ across shifts. Using an exploratory study of observational data, we examined whether shift influenced non-supervisory nurses' job perceptions in the Veterans Health Administration All Employee Survey (n = 14057; years 2008, 2010, 2012). The size of differences in item means (95% C.I.) across shifts was evaluated graphically. Using ordinal logistic regression, we accounted for the ordinal outcome variables and controlled for the demographic and survey year effects. Nurses' perceptions of workplace climate differed across shifts. Items with the greatest differences, consistent across years and analytic methods, involved supervisors and fairness. Night and weekend shift nurse ratings were more negative than for weekday shift nurses. Off-shift nurses are less satisfied with work/life balance, their supervisors and especially fairness. Overall satisfaction and turnover intention are not affected to the same extent. These results indicate several specific areas that nurse managers can address through workforce support and communication. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  20. A multi-centre comparison of nursing staff time required for the preparation and administration of liposomal amphotericin B and amphotericin B deoxycholate vs. voriconazole.

    Science.gov (United States)

    Flynn, Elizabeth; Marciniak, Anne; Barbabietola, Giuliana; Oppenheim, Beryl A; Roberts, Craig; Barker, Kenneth

    2009-04-01

    To compare the nursing time and cost required for preparation and administration of liposomal amphotericin B, amphotericin B deoxycholate and voriconazole. Cost comparison study. Nurse activities associated with the preparation and administration of the three study drugs were divided into 11 tasks and timed by observers at five hospitals. Target tasks were defined as those likely to be affected by the differences between drugs and excluded those tasks likely to differ owing to site-specific factors. Mean times for administration of a single day of therapy for each study drug were compared. Costs of preparation and administration of a 14-day regimen were estimated. Sixty-nine patients were observed receiving a total of 256 doses of study medications. Labour times were 20, 16, 14 and 3 minutes per day for liposomal amphotericin B, amphotericin B deoxycholate, intravenous voriconazole and oral voriconazole, respectively. Administration time was significantly lower for intravenous voriconazole compared with liposomal amphotericin B (p B than for the other drugs by 3-5 minutes. Average non-drug costs associated with preparation and administration of a 14-day regimen were greatest in the amphotericin B deoxycholate arm at US$ 335, followed by liposomal amphotericin B (US$ 310) and voriconazole (US$ 180). Intravenous voriconazole required less time to prepare and administer on a daily basis than liposomal amphotericin B, and was similar to amphotericin B deoxycholate. Measurements of intravenous vs. oral voriconazole administration suggest the opportunity to save 10-17 minutes per day with the oral formulation. Oral voriconazole may provide significant savings in terms of nursing time compared with intravenous antifungal drugs.

  1. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... see more videos from Blue Star Families These Hands PSA see more videos from Veterans Health Administration ... Line text-messaging service does not store mobile phone numbers of users who access information via text ...

  2. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... in crisis, find a facility near you. Spread the Word Download logos, Web ads, and materials and ... Videos from Veterans Health Administration Watch additional videos about getting help. Be There: Help Save a Life ...

  3. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... in crisis, find a facility near you. Spread the Word Download logos, Web ads, and materials and ... videos about getting help. Be There: Help Save a Life see more videos from Veterans Health Administration ...

  4. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Involved Crisis Centers About Be There Show You Care Find Resources Graphic Generator Toolkit Signs of Crisis ... out for help. Bittersweet More Videos from Veterans Health Administration Watch additional videos about getting help. Be ...

  5. 77 FR 4471 - Tribal Veterans Cemetery Grants

    Science.gov (United States)

    2012-01-30

    ... Code, and the 2002 edition of the National Electrical Code, NFPA 70, may be obtained from the National... Frank Salvas, Director of Veterans Cemetery Grants Service, National Cemetery Administration (41E... cemetery grants under the authority of title 38 Code of Federal Regulations (CFR) Part 39.'' Further, on...

  6. 38 CFR 17.57 - Use of community nursing homes.

    Science.gov (United States)

    2010-07-01

    ... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Use of community nursing...

  7. Research on rural veterans: an analysis of the literature.

    Science.gov (United States)

    Weeks, William B; Wallace, Amy E; West, Alan N; Heady, Hilda R; Hawthorne, Kara

    2008-01-01

    The Veterans Health Administration (VA) provides comprehensive health care services to veterans across the United States. Recently, the VA established an Office of Rural Health to address the health care needs of rural veterans. To review the literature on rural veterans' health care needs in order to identify areas for future research. We conducted a literature review of articles listed in the Medline, CINAHL, and BIOSIS datasets since 1950. We reviewed and summarized the findings of 50 articles that specifically examined rural veterans. The literature on rural veterans included 4 articles examining access to care, 7 evaluating distance technology, 4 examining new models of care delivery, 11 studying rural veterans' patient characteristics, 10 evaluating programs provided in a rural setting, 6 examining rural health care settings, and 8 exploring rural veterans' health services utilization patterns. Most studies were small, based on data obtained before 2000, and consisted of uncontrolled, retrospective, descriptive studies of health care provided in rural VA settings. Definitions of rural were inconsistent, and in 20% of the articles examined the rural aspect of the setting was incidental to the study. The literature on rural veterans' health care needs warrants expansion and investment so that policy makers can make informed decisions in an environment of limited resources and competing interests.

  8. Arthritis and Veterans

    Centers for Disease Control (CDC) Podcasts

    2015-11-09

    One in three veterans has arthritis. This podcast provides information on how veterans can improve their quality of life with physical activity and other arthritis management strategies.  Created: 11/9/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 11/9/2015.

  9. Transcriptomic identification of ADH1B as a novel candidate gene for obesity and insulin resistance in human adipose tissue in Mexican Americans from the Veterans Administration Genetic Epidemiology Study (VAGES.

    Directory of Open Access Journals (Sweden)

    Deidre A Winnier

    Full Text Available Type 2 diabetes (T2D is a complex metabolic disease that is more prevalent in ethnic groups such as Mexican Americans, and is strongly associated with the risk factors obesity and insulin resistance. The goal of this study was to perform whole genome gene expression profiling in adipose tissue to detect common patterns of gene regulation associated with obesity and insulin resistance. We used phenotypic and genotypic data from 308 Mexican American participants from the Veterans Administration Genetic Epidemiology Study (VAGES. Basal fasting RNA was extracted from adipose tissue biopsies from a subset of 75 unrelated individuals, and gene expression data generated on the Illumina BeadArray platform. The number of gene probes with significant expression above baseline was approximately 31,000. We performed multiple regression analysis of all probes with 15 metabolic traits. Adipose tissue had 3,012 genes significantly associated with the traits of interest (false discovery rate, FDR ≤ 0.05. The significance of gene expression changes was used to select 52 genes with significant (FDR ≤ 10(-4 gene expression changes across multiple traits. Gene sets/Pathways analysis identified one gene, alcohol dehydrogenase 1B (ADH1B that was significantly enriched (P < 10(-60 as a prime candidate for involvement in multiple relevant metabolic pathways. Illumina BeadChip derived ADH1B expression data was consistent with quantitative real time PCR data. We observed significant inverse correlations with waist circumference (2.8 x 10(-9, BMI (5.4 x 10(-6, and fasting plasma insulin (P < 0.001. These findings are consistent with a central role for ADH1B in obesity and insulin resistance and provide evidence for a novel genetic regulatory mechanism for human metabolic diseases related to these traits.

  10. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  11. 76 FR 70076 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

    Science.gov (United States)

    2011-11-10

    ... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... diem from VA for providing nursing home care to veterans. The proposed rule would require State nursing... Required Assessment Tool for State Nursing Homes Receiving Per Diem Payments From VA.'' Copies of comments...

  12. Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin M; Sullivan, J Cherry; Bertrand, Christina; Kinney, Rebecca L; Sherman, Michelle D; Gustason, Carolyn

    2015-06-01

    Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

  13. Nurses and opioids: results of a bi-national survey on mental models regarding opioid administration in hospitals.

    Science.gov (United States)

    Guest, Charlotte; Sobotka, Fabian; Karavasopoulou, Athina; Ward, Stephen; Bantel, Carsten

    2017-01-01

    Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses' mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors. A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses' mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580) and one German (n=799) hospital between September 2014 and February 2015. A total of 511 (37.1%) questionnaires were returned. Mean (standard deviation) age of participants were 37 (11) years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87% did not regard opioids as drugs to help patients die, and 72% did not view them as drugs of abuse. More English (41%) than German (28%) nurses were afraid of criminal investigations and were constantly aware of side effects (UK, 94%; Germany, 38%) when using opioids. Four latent variables were identified which likely influence nurses' mental models: "conscious decision-making"; "medication-related fears"; "practice-based observations"; and "risk assessment". They were predicted by strength of religious beliefs and indicators of informal learning such as experience but not by indicators of formal learning such as conference attendance. Nurses in both countries employ analytical and affective mental models when administering the opioids and seem to learn from experience

  14. What Is Nursing Informatics?

    Science.gov (United States)

    McGonigle, D.; And Others

    Information technology has developed to the point of providing a means to manage nursing and related health-care data effectively for nursing administrators, educators, practitioners, and researchers. Therefore, the newly recognized area of nursing informatics is important to the nursing profession as a whole. Nursing informatics is defined as the…

  15. Migration by Veterans Who Received Homeless Services From the Department of Veterans Affairs.

    Science.gov (United States)

    Metraux, Stephen; Treglia, Dan; O'Toole, Thomas P

    2016-10-01

    We examined migration patterns among 113,400 homeless veterans, focusing on the prevalence and the basic geographic patterns of this migration. Data were for all veterans who initiated use of Veterans Affairs homeless services in 2011 or 2012; and we followed them using Veterans Affairs administrative records for up to 2 years following this initial contact. Results showed that 15.3% of the veterans migrated across regions while homeless. Those who were homeless for longer periods were more likely to migrate, and migration, were it to occur, was most likely earlier on in veterans' homelessness episodes. There were no clear geographic correlates that explained the dynamics of this migration as, overall, in-migration tended to roughly balance out-migration in a region. These findings suggest that concerns about the extent of migration and its impact on localities are exaggerated, but also sets forth an agenda for more in-depth study of these data to gain a deeper and more expansive understanding of this phenomenon. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  16. Veterans Health Administration Readmissions and Deaths Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of VHA hospitals with data on readmissions and deaths. These data show how often patients who are hospitalized for certain conditions experience serious...

  17. Veterans Health Administration Behavioral Health Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of VHA hospitals with behavioral health measure data. VHA reports data on a set of core performance measures for Hospital-Based Inpatient Psychiatric Services...

  18. Veterans Health Administration Patient Safety Indicators Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of VHA hospitals with data on the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs). These indicators provide information on...

  19. Sexual health and quality of life among male veterans with intestinal ostomies.

    Science.gov (United States)

    Symms, Michelle R; Rawl, Susan M; Grant, Marcia; Wendel, Christopher S; Coons, Stephen Joel; Hickey, Sara; Baldwin, Carol M; Krouse, Robert S

    2008-01-01

    This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma. Three Veterans Health Administration sites. Four hundred eighty-one male veterans. Case-control, mixed-methods design; cases were those who had ostomies for at least 2 months, and controls had a similar major intestinal surgical procedure that did not result in an ostomy. Quantitative and qualitative data on sexual functioning, relationships, and other dimensions of HR-QOL were collected using the modified City of Hope Quality of Life-Ostomy questionnaire. The overall response rate was 49%. Prevalence of erectile dysfunction was significantly higher among ostomates compared with controls (P ostomies reported being sexually active before surgery compared with controls (P sexual activity after surgery is significantly lower among the ostomy group (P = .015). Compared with veterans with ostomies who did not resume sexual activity after surgery, those who were sexually active reported a higher total HR-QOL score and higher scores on all 4 modified City of Hope Quality of Life-Ostomy dimensions (psychological, social, physical, and spiritual well-being). Veterans with ostomies who had resumed sexual activity after their ostomy also reported that their ostomy had caused significantly less interference with social activities, less isolation, less interference with their personal relationships, and less interference with their ability to be intimate. These men also reported less difficulty adjusting to the ostomy. Results of qualitative analyses showed that problems with intimacy and sexual function are among the greatest challenges faced by ostomates. Presence of an ostomy was associated with lower rates

  20. Mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination to assess their competence in medicine administration.

    Science.gov (United States)

    Hemingway, Steve; Stephenson, John; Roberts, Bronwyn; McCann, Terence

    2014-08-01

    The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.

  1. [Development of a scale measuring the competences of public health nurses in public health policy in Japanese administrative agencies].

    Science.gov (United States)

    Suzuki, Yuriko; Tadaka, Etsuko

    2014-01-01

    There is an urgent need to build healthy communities and increase the public health nursing capacity to solve the complex and diverse health problems in modern society. The purpose of this study was to develop a scale called the Competences of Public health nurses in Public health policy (hereinafter referred to as the CPP scale), and to test the reliability and validity of the scale. A literature review, individual qualitative interviews with five expert public health nurses, and surveys of all public health nurses in the local governments in one ordinance-designated city in Japan (n=460) were conducted. A factor analysis of the results showed that the CPP scale contained two factors and 16 items: the first factor was "Community Partnership," and the second factor was "Community Nursing Diagnosis Cycle." Confirmatory factor analysis for the CPP scale demonstrated high fit indices (GFI=.889, AGFI=.847, CFI=.956, RMSEA=.068). The Cronbach's α coefficient of the scale was 0.93, and the scale scores were significantly correlated with the standardized scale, the Competency Measurement of Creativity (r=0.52, Pscale had sufficient reliability and validity to assess the competency of public health nurses in forging public health policy.

  2. Multimorbidity and Persistent Depression among Veterans with Diabetes, Heart Disease, and Hypertension

    Science.gov (United States)

    Findley, Patricia; Shen, Chan; Sambamoorthi, Usha

    2011-01-01

    This study investigated the association between multimorbidity and persistent depression among cohorts of veterans with diabetes, heart disease, or hypertension. The retrospective longitudinal analysis used national administrative data on around 1.38 million Veteran Health Administration clinic users merged with Medicare claims data.…

  3. Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans.

    Science.gov (United States)

    Hussey, Peter S; Ringel, Jeanne S; Ahluwalia, Sangeeta; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W; Lovejoy, Susan L; Martsolf, Grant R; Rudin, Robert S; Schultz, Dana; Sloss, Elizabeth M; Watkins, Katherine E; Waxman, Daniel; Bauman, Melissa; Briscombe, Brian; Broyles, James R; Burns, Rachel M; Chen, Emily K; DeSantis, Amy Soo Jin; Ecola, Liisa; Fischer, Shira H; Friedberg, Mark W; Gidengil, Courtney A; Ginsburg, Paul B; Gulden, Timothy; Gutierrez, Carlos Ignacio; Hirshman, Samuel; Huang, Christina Y; Kandrack, Ryan; Kress, Amii; Leuschner, Kristin J; MacCarthy, Sarah; Maksabedian, Ervant J; Mann, Sean; Matthews, Luke Joseph; May, Linnea Warren; Mishra, Nishtha; Miyashiro, Lisa; Muchow, Ashley N; Nelson, Jason; Naranjo, Diana; O'Hanlon, Claire E; Pillemer, Francesca; Predmore, Zachary; Ross, Rachel; Ruder, Teague; Rutter, Carolyn M; Uscher-Pines, Lori; Vaiana, Mary E; Vesely, Joseph V; Hosek, Susan D; Farmer, Carrie M

    2016-05-09

    The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.

  4. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Science.gov (United States)

    2010-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

  5. Veterans Choice Program

    Data.gov (United States)

    Department of Veterans Affairs — If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community. Using this program does NOT impact your...

  6. Characteristics and Health Needs of Veterans in Jails and Prisons: What We Know and Do Not Know about Incarcerated Women Veterans.

    Science.gov (United States)

    McCall, Janice D; Tsai, Jack

    2017-12-04

    The majority of U.S. veterans in prisons and local jails are men, but incarcerated women veterans remain an important and understudied group. This study reported differences in sociodemographic, health, and criminal justice characteristics using Veterans Affairs (VA) administrative data on a national sample of 30,964 incarcerated veterans (30,440 men and 524 women) who received outreach from the VA Health Care for Reentry Veterans program between 2007 and 2011. Descriptive statistics and multivariable logistic regressions determined gender and racial differences in this population. Compared with incarcerated veterans who were men, incarcerated women veterans were younger (d = 0.68), had significantly lower lifetime arrests (AOR, 0.65; p problems, hypertension, chronic obstructive pulmonary disease, and seizure disorder, and were more likely to receive a preliminary diagnosis of mood disorder than men. Women were more likely to have received VA benefits, used VA health care before, and be willing to use VA services after release. A few important differences emerged when stratified by race. These findings suggest that incarcerated women veterans are interested in VA health care services, but there is lack of information about women's health needs through the Health Care for Reentry Veterans program. The inclusion of Health Care for Reentry Veterans screening questions about women's health issues may support the VA's interests to better engage women veterans in care. Published by Elsevier Inc.

  7. Validation of self-reported veteran status among two sheltered homeless populations.

    Science.gov (United States)

    Metraux, Stephen; Stino, Magdi; Culhane, Dennis P

    2014-01-01

    We assessed the accuracy of self-reported veteran status among sheltered homeless adults to assess the reliability of using self-report to determine the number of veterans in homeless populations and examine whether there are demographic correlates to inaccurate reporting of veteran status. Records on 5,860 sheltered adults from Columbus, Ohio, and 16,346 sheltered adults from New York City (NYC) were matched with U.S. Department of Veterans Affairs (VA) records. We analyzed the agreement between veteran self-reporting and official records using descriptive measures, diagnostic tests, and logistic regression. The degree of concordance was moderate. Using VA records rather than self-report data to determine veteran status increased homeless veteran prevalence rates by 27% in Columbus and 39% in NYC. Veterans with discordant veteran status (i.e., false positive or false negative) showed lower levels of services use in the VA (both cities) and in the municipal shelter system (NYC only). Younger veterans and women were at higher risk of not being identified as veterans. Administrative records can help to more accurately identify homeless veterans and to connect them to available services and benefits.

  8. Military and Veteran Support: DOD and VA Programs That Address the Effects of Combat and Transition to Civilian Life

    Science.gov (United States)

    2014-11-01

    transfer their benefits to dependents. VA – Veterans Benefit Administration ( VBA ) Spinal Cord Injury and Disorders Centers Disability; Physical...who are temporarily residing in a home owned by a family member to help adapt the home to meet his or her special needs. VA - VBA Yellow Ribbon...member and Veteran X X Allowance for Aid and Attendance for Housebound Veterans VA/ VBA Veteran X X X Appendix III

  9. Mathematical calculation skills required for drug administration in undergraduate nursing students to ensure patient safety: A descriptive study: Drug calculation skills in nursing students.

    Science.gov (United States)

    Bagnasco, Annamaria; Galaverna, Lucia; Aleo, Giuseppe; Grugnetti, Anna Maria; Rosa, Francesca; Sasso, Loredana

    2016-01-01

    In the literature we found many studies that confirmed our concerns about nursing students' poor maths skills that directly impact on their ability to correctly calculate drug dosages with very serious consequences for patient safety. The aim of our study was to explore where students had most difficulty and identify appropriate educational interventions to bridge their mathematical knowledge gaps. This was a quali-quantitative descriptive study that included a sample of 726 undergraduate nursing students. We identified exactly where students had most difficulty and identified appropriate educational interventions to bridge their mathematical knowledge gaps. We found that the undergraduate nursing students mainly had difficulty with basic maths principles. Specific learning interventions are needed to improve their basic maths skills and their dosage calculation skills. For this purpose, we identified safeMedicate and eDose (Authentic World Ltd.), only that they are only available in English. In the near future we hope to set up a partnership to work together on the Italian version of these tools. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study

    Directory of Open Access Journals (Sweden)

    Chelsea Leonard

    2017-10-01

    Full Text Available Abstract Background Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA rural transitions nurse program (TNP is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. Methods This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance. We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. Discussion The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources

  11. Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study.

    Science.gov (United States)

    Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert

    2017-10-23

    Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a

  12. Organizational factors associated with Health Care Provider (HCP) influenza campaigns in the Veterans health care system: a qualitative study

    National Research Council Canada - National Science Library

    Razouki, Zayd; Knighton, Troy; Martinello, Richard A; Hirsch, Pamela R; McPhaul, Kathleen M; Rose, Adam J; McCullough, Megan

    2016-01-01

    .... We sought to characterize organizational factors and practices that were associated with vaccination campaign success among six sites within the Veterans Health Administration, where receipt of flu...

  13. Student veterans' construction and enactment of resilience: A constructivist grounded theory study.

    Science.gov (United States)

    Reyes, A T; Kearney, C A; Isla, K; Bryant, R

    2018-02-01

    WHAT IS KNOWN ON THE SUBJECT?: Resilience is an ability and a process that allows an individual to develop positive adaptation despite challenges and adversities. Many military veterans returning to college after their military service have difficulty transitioning to civilian life. Although some research exists that explores factors related to the resilience of college student veterans, limited theoretical descriptions exist that explain how student veterans construct resilience, and how resilience is enacted and enhanced in their academic and personal (non-academic) lives. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The resilience of student veterans involves a complex process of transitioning from military to civilian life and an iterative journey between positive adaptation and transient perturbations. Student veterans' resilience is a result of integrating and resolving various aspects of their academic and personal challenges. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can apply this grounded theory as a practical framework for equipping student veterans with effective strategies to develop and enhance resilience. Nurses can employ a holistic approach of care in their interactions with military veterans and student veterans that includes fostering psychological resilience, helping to manage their multiple non-academic responsibilities and supporting their academic success. Introduction Adjusting to college life is one of the most difficult experiences in a military veteran's transition to civilian life. Many military veterans returning to college not only encounter academic challenges, but also deal with physical and psychiatric disabilities, loss of military camaraderie and social disconnect. These often negatively affect their personal and academic lives. Hence, it is important to explore resilience to best support student veterans as they transition from military to civilian life. Aim The aim of this study was to explore how student veterans

  14. Engagement in the Hepatitis C Care Cascade Among Homeless Veterans, 2015.

    Science.gov (United States)

    Noska, Amanda J; Belperio, Pamela S; Loomis, Timothy P; O'Toole, Thomas P; Backus, Lisa I

    The Veterans Health Administration (VHA) is the largest provider of hepatitis C virus (HCV) care nationally and provides health care to >200 000 homeless veterans each year. We used the VHA's Corporate Data Warehouse and HCV Clinical Case Registry to evaluate engagement in the HCV care cascade among homeless and nonhomeless veterans in VHA care in 2015. We estimated that, among 242 740 homeless veterans in care and 5 424 712 nonhomeless veterans in care, 144 964 (13.4%) and 188 156 (3.5%), respectively, had chronic HCV infection. Compared with nonhomeless veterans, homeless veterans were more likely to be diagnosed with chronic HCV infection and linked to HCV care but less likely to have received antiviral therapy despite comparable sustained virologic response rates. Homelessness should not necessarily preclude HCV treatment eligibility with available all-oral antiviral regimens.

  15. Deserving Veterans' Disability Compensation: A Qualitative Study of Veterans' Perceptions.

    Science.gov (United States)

    MacGregor, Casey; Heilemann, MarySue V

    2017-05-01

    Veterans recently returned from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience many health and mental health problems after deployment. These OEF/OIF veterans are applying and appealing for veterans' disability compensation (VDC) at rapidly increasing rates, often for "invisible conditions" such as posttraumatic stress disorder. Little is known about how veterans experience the process of applying and receiving VDC. In-depth qualitative interviews were conducted with OEF/OIF veterans ages 35 and younger (N = 18). This article addresses how veterans perceive themselves, and other veterans, of being deserving and undeserving of VDC. Veterans' rationales can be categorized into four primary areas: (1) risking and suffering, (2) the cause of the condition, (3) intentions to become self-sufficient, and (4) putting VDC to "good use." © 2017 National Association of Social Workers.

  16. Designing a Curriculum Model to Include Sexuality and a Procedure for its Administration. Human Sexuality-Nursing 50383.

    Science.gov (United States)

    Hoffman, Elise; And Others

    In order to design and implement a plan to integrate human sexuality into the curriculum for associate degree nursing students at Alvin Community College (Texas), levels of knowledge, attitudes and skills necessary in promoting sexual health were defined. Of the four levels in the Mims and Swenson Sexual Health Model (life experiences, basic,…

  17. The Impact of an Electronic Medication Administration Record (eMAR) and Computerized Physician Order Entry (CPOE) on Nurse Extender and Unit Clerk Staffing.

    Science.gov (United States)

    Robinson, Edmondo J; Bergey, Meredith R; Brady, Elizabeth; Mapp, Alexandra M; Goldsack, Jennifer C

    2017-12-01

    The aim of this study is to describe the impact of the introduction of health information technology (HIT) on the utilization and payroll costs of nurse extenders and unit clerks in medicine and surgery units in a large regional health system. Long-term policy goals of HIT implementation are reported to include system-level reductions in labor costs, achieved through improved efficiency. Using a retrospective cohort model, we analyzed how hours worked per patient day and staffing costs per patient day varied with the implementation of HIT over time at 2 different hospitals within a health system. Implementation of electronic medication administration records was not associated with significant changes in staffing or labor costs. Both labor hours and costs associated with nurse extenders and unit clerks were significantly reduced after the subsequent addition of computerized provider order entry. Simultaneously, units that did not implement any HIT experienced a significant increase in both labor hours and costs. Health information technology implementation in the inpatient setting is associated with significant savings in labor hours and costs in non-registered nursing roles.

  18. Rural Veterans by State (2014)

    Data.gov (United States)

    Department of Veterans Affairs — This speadsheet contains data from the 2014 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...

  19. The Veteran Population Projection 2014

    Data.gov (United States)

    Department of Veterans Affairs — VetPop2014 is an actuarial projection model developed by the Office of the Actuary (OACT) for Veteran population projection from Fiscal Year FY2014 to FY2043. Using...

  20. Veteran Religious Affiliation by State

    Data.gov (United States)

    Department of Veterans Affairs — This dataset provide a count of Veteran by their religious affiliation and state of residence. The dataset set covers all 50 states, District of Columbia and other...

  1. Rural Veterans by State (2015)

    Data.gov (United States)

    Department of Veterans Affairs — This spreadsheet contains data from the 2015 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...

  2. VA Is Here for the People Who Support Our Veterans

    Science.gov (United States)

    ... Expect Resource Locator Veterans Live Chat Veterans Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of ... word about the Veterans Crisis Line. Access confidential Homeless Veterans Chat and see resources for homeless Veterans . Network ...

  3. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Expect Resource Locator Veterans Live Chat Veterans Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of ... Expect Resource Locator Veterans Live Chat Veterans Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of ...

  4. Psychosocial Equine Program for Veterans.

    Science.gov (United States)

    Ferruolo, David M

    2016-01-01

    Nearly half of all combat veterans suffer from serious psychological disorders and reintegration issues. Veterans shy away from typical talk therapy and are seeking alternative treatments. Equine-facilitated mental health therapy has shown promise in treating veterans with depressive and anxiety disorders and reintegration issues. This article reports on an institutional review board-approved pilot program designed to address the mental health needs of veterans. Furthermore, this article discusses future directions for evolving development of equine treatment programming.

  5. Nurses and opioids: results of a bi-national survey on mental models regarding opioid administration in hospitals

    Directory of Open Access Journals (Sweden)

    Guest C

    2017-03-01

    Full Text Available Charlotte Guest,1 Fabian Sobotka,2 Athina Karavasopoulou,3 Stephen Ward,3 Carsten Bantel4,5 1Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 2Division of Epidemiology and Biometry, Department of Health Services Research, Faculty 6, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany; 3Pain Service, Barts Health, St Bartholomew’s Hospital, London, UK; 4Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Oldenburg University, Klinikum Oldenburg Campus, Oldenburg, Germany; 5Department of Surgery and Cancer, Anaesthetics Section, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK Objective: Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses’ mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors. Material and methods: A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses’ mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580 and one German (n=799 hospital between September 2014 and February 2015. Results: A total of 511 (37.1% questionnaires were returned. Mean (standard deviation age of participants were 37 (11 years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87

  6. Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

    Science.gov (United States)

    Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P

    2016-03-01

    We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.

  7. Homeless female U.S. veterans in a national supported housing program: comparison of individual characteristics and outcomes with male veterans.

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A; Kane, Vincent

    2014-08-01

    As more women serve in the U.S. military, the proportion of females among homeless veterans is increasing. The current study compares the individual characteristics and 1-year outcomes of homeless female and male veterans in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program nationally. Administrative data on 43,853 veterans (10.69% females; 89.31% males) referred to HUD-VASH were analyzed for gender differences at baseline and over a 1-year period. Homeless female veterans were younger, had shorter homeless and incarceration histories, and were less likely to have substance use disorders than men. However, despite being less likely to report combat exposure, female veterans were more likely to have posttraumatic stress disorder. Homeless female veterans were also much more likely to have dependent children with them and to plan to live with family members in supported housing. Once admitted to HUD-VASH, there were no gender differences in attrition or main housing outcomes. Case managers were faster to admit female veterans to the program, reported better working alliances, and provided more services related to employment and income than male veterans. These findings suggest homeless female veterans may have certain strengths, including being younger, less involved in the criminal justice system, and more adept at relating to professional and natural supports; but special attention to noncombat trauma and family-oriented services may be needed.

  8. Comparisons of self-ratings on managerial competencies, research capability, time management, executive power, workload and work stress among nurse administrators.

    Science.gov (United States)

    Kang, Chun-Mei; Chiu, Hsiao-Ting; Hu, Yi-Chun; Chen, Hsiao-Lien; Lee, Pi-Hsia; Chang, Wen-Yin

    2012-10-01

    To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Although NAs require multifaceted managerial competencies, research related to NAs' managerial competencies is limited. A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. The present study provides recommendations for future administrative training programmes to increase NAs' managerial competency in fulfilling their management roles and functions. The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently. © 2012 Blackwell Publishing Ltd.

  9. 78 FR 70088 - Advisory Committee on Veterans Business Affairs

    Science.gov (United States)

    2013-11-22

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION... Business Affairs. The meeting will be open to the public. DATES: December 5, 2013 from 9 a.m. to 3 p.m...

  10. Training Veterans to Provide Peer Support in a Weight-Management Program: MOVE!

    OpenAIRE

    Allicock, Marlyn; Haynes-Maslow, Lindsey; Carr, Carol; Orr, Melinda; Kahwati, Leila C; Weiner, Bryan J.; Kinsinger, Linda

    2013-01-01

    Introduction The Veterans Health Administration (VHA) has implemented MOVE!, a weight-management program for veterans designed to address the increasing proportion of overweight and obese veterans. The objective of our study was to determine whether peer support employing motivational interviewing (MI) could positively influence lifestyle changes, thus expanding the reach of the MOVE! program. We describe the initial evaluation of the peer training program. Methods We developed an MI peer cou...

  11. A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR, China

    Directory of Open Access Journals (Sweden)

    Judith M. Parker

    2017-04-01

    Full Text Available This paper provides an overview of Advanced Practice Nursing (APN in the USA, Canada, Australia and Hong Kong. It is based upon documents presented to the China Medical Board (CMB China Nursing Network (CNN as background for discussions held by the CNN in Shanghai. It discusses the APN role in these countries and regions according to topics identified by the CNN. These are APN educational preparation; role legitimacy; capacity requirements; scope of practice, domains of activities and limited rights for prescription and referral; professional promotion ladder; accreditation system; and, performance evaluation system. Both Canada and Australia have adapted many aspects of the USA model of APN to fit their specific legislative requirements and local conditions. Hong Kong has taken a different path which may be of interest in the Chinese context.

  12. The war veteran identity

    Directory of Open Access Journals (Sweden)

    Marković-Savić Olivera S.

    2015-01-01

    Full Text Available The paper discusses how war veterans perceive themselves and how they answer the question 'Who am I?'. War veterans face many challenges in the process of re-socialization from a state of war and war traumatization to a peacetime society. There are several reasons why their re-socialization is a slow process: the first one is that a war engagement is in itself a highly stressful situation which carries traumas of different degrees, the other reason is the changed system of values in relation to war engagement. Namely, at the time they went to war, they had a strong social support, but at the time of their return and today this support is lost to the point of judgment. And the third reason which limits their re-socialization is the situation of social transition they found on their return from war, which specifically means that a large percentage of the population in general, and thus the war veterans after returning from the war, lost their jobs, creating a large social group of 'transition losers'. Such a condition often generates an identity crisis. This set of socio-cultural circumstances together with the ontological insecurity carried by war trauma generate an identity crisis, which is manifested among the respondents in nihilistic answers when responding to questions about their own personality. Studying the identity of war veterans, it was found that a strong attachment to the veteran identity is dominant. In fact, this paper discusses the different ways in which this attachment is refracted in the personality and identity of subjects, from negative attitudes to the pride in belonging to a group of war veterans and personal fulfillment in the activism in associations of war participants.

  13. 77 FR 26183 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

    Science.gov (United States)

    2012-05-03

    ... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... State homes that receive per diem from VA for providing nursing home care to veterans. It requires State nursing homes receiving per diem from VA to use the most recent version of the Centers for Medicare and...

  14. Nursing's Image on Campus.

    Science.gov (United States)

    Woolley, Alma S.

    1981-01-01

    In studying the nurse's image at a liberal arts college, it was found that faculty and administrators view nurses as long-suffering drones. On the whole, the image of nursing was positive, with those who had the most contact with the nursing program having a more enlightened image. (CT)

  15. The Veterans Choice Act: A Qualitative Examination of Rapid Policy Implementation in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin M; Mengeling, Michelle; Sadler, Anne; Baldor, Rebecca; Bastian, Lori

    2017-07-01

    Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 [Veterans Choice Act (VCA)] to improve access to timely, high-quality health care for Veterans. Although Congress mandated that VCA must begin within 90 days of passage of the legislation, no guidelines were provided in the legislation to ensure that Veterans had access to an adequate number of community providers across different specialties of care or distinct geographic areas, including rural areas of the country. To examine VCA policy implementation across a sampling of Veterans Health Administration (VHA) Medical Centers. We conducted a qualitative study of 43 VHA staff and providers by conducting in-person interviews at 5 VA medical centers in the West, South, and Midwest United States. Interview questions focused on perceptions and experiences with VCA and challenges related to implementation for VHA staff and providers. We identified 3 major themes to guide description of choice implementation: (1) VCA implemented too rapidly with inadequate preparation; (2) community provider networks insufficiently developed; and (3) communication and scheduling problems with subcontractors may lead to further delays in care. Our evaluation suggests that VCA was implemented far too rapidly, with little consideration given to the adequacy of community provider networks available to provide care to Veterans. Given the challenges we have highlighted in VCA implementation, it is imperative that the VHA continue to develop care coordination systems that will allow the Veterans to receive seamless care in the community.

  16. O papel da enfermagem na administração do ferro por via parenteral The role of nurses in parenteral iron administration

    Directory of Open Access Journals (Sweden)

    Ana Elizabeth P. L. Figueiredo

    2010-06-01

    Full Text Available Este artigo tem como objetivo descrever os cuidados de enfermagem na administração de ferro parenteral intramuscular e endovenoso. A escolha da apresentação de ferro a ser usada depende da tolerabilidade do paciente. A administração de um medicamento por via intramuscular ou endovenosa envolve mais do que a injeção de uma solução no interior da massa muscular ou veia, mas também uma avaliação sobre a melhor região e músculo a ser selecionado. Tal procedimento deve ser realizado por pessoas que possuam conhecimentos sobre os aspectos fundamentais de sua execução, ou seja, a equipe de enfermagem. Isso requer conhecimentos de farmacologia relacionados ao tipo da droga, mecanismos de ação, excreção, atuação nos sistemas orgânicos, além de conhecimentos de semiologia e semiotécnica, e avaliação clínica do estado de saúde do paciente.This article aims at describing nursing care with the intramuscular and intravenous administration of parenteral iron. The choice of the type of iron to be used depends on the tolerability of the patient. The intramuscular or intravenous administration of a medicine involves more than just the injection of a solution inside the muscle mass or vein, an evaluation of the best site for the injection must also be considered. This procedure must be carried out by a professional with knowledge on the basic aspects of administration, that is, the nursing team. It requires knowledge of the pharmacology of the drug type, mechanisms of action, excretion and performance in organic systems, as well as knowledge of the clinical evaluation of the patient's state of health.

  17. Female Veterans of Iraq and Afghanistan seeking care from VA specialized PTSD Programs: comparison with male veterans and female war zone veterans of previous eras.

    Science.gov (United States)

    Fontana, Alan; Rosenheck, Robert; Desai, Rani

    2010-04-01

    Differences in the characteristics and mental health needs of female veterans of the Iraq/Afghanistan war compared with those of veterans of other wars may have useful implications for VA program and treatment planning. Female veterans reporting service in the Iraq/Afghanistan war were compared with women reporting service in the Persian Gulf and Vietnam wars and to men reporting service in the Iraq/Afghanistan war. Subjects were drawn from VA administrative data on veterans who sought outpatient treatment from specialized posttraumatic stress disorder (PTSD) treatment programs. A series of analyses of covariance (ANCOVA) was used to control for program site and age. In general, Iraq/Afghanistan and Persian Gulf women had less severe psychopathology and more social supports than did Vietnam women. In turn, Iraq/Afghanistan women had less severe psychopathology than Persian Gulf women and were exposed to less sexual and noncombat nonsexual trauma than their Persian Gulf counterparts. Notable differences were also found between female and male veterans of the Iraq/Afghanistan war. Women had fewer interpersonal and economic supports, had greater exposure to different types of trauma, and had different levels of diverse types of pathology than their male counterparts. There appear to be sufficient differences within women reporting service in different war eras and between women and men receiving treatment in VA specialized treatment programs for PTSD that consideration should be given to program planning and design efforts that address these differences in every program treating female veterans reporting war zone service.

  18. Ergonomics and nursing in hospital environments.

    Science.gov (United States)

    Rogers, Bonnie; Buckheit, Kathleen; Ostendorf, Judith

    2013-10-01

    This study describes workplace conditions, the environment, and activities that may contribute to musculoskeletal injuries among nurses, as well as identifies solutions to decrease these risks and improve work-related conditions. The study used a mixed-methods design. Participants included nurses and stakeholders from five hospitals. Several focus groups were held with nurses, walk-throughs of clinical units were conducted, and stakeholder interviews with key occupational health and safety personnel were conducted in each of the five hospitals, as well as with representatives from the American Nurses Association, Veterans Health Administration hospital, and National Institute for Occupational Safety and Health. Several key contributing factors, including the physical environment (e.g., layout and organization of work stations), work organization and culture (e.g., heavy workload, inadequate staffing, lack of education), and work activities (e.g., manual lifting of patients, lack of assistive devices), were identified. Recommendations included the need for a multifaceted and comprehensive approach to developing a sound ergonomics program. Copyright 2013, SLACK Incorporated.

  19. 20 CFR 408.216 - Are you a World War II veteran?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Are you a World War II veteran? 408.216 Section 408.216 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and Entitlement Military Service § 408.216 Are you a World War II...

  20. Plastic surgery within the Veterans Affairs Medical System: proposed modified indications for operative procedures.

    Science.gov (United States)

    Erdmann, Detlev; Pradka, Sarah P; Similie, Ernest; Marcus, Jeffrey R; Moyer, Kurtis E; Shelburne, John D; Tyler, Douglas S; Levin, Scott L

    2009-07-01

    Many plastic surgery procedures span the divide between aesthetic ("cosmetic") and reconstructive surgery. However, definitions and guidelines may be inconsistent, which may decrease patients' access to legitimate procedures. The article aims to assist Veterans' Health Administration-affiliated plastic surgeons in continuing to provide optimal care to the Nation's Veterans and family members, and should be regarded as an open discussion.

  1. Mortality and Revascularization following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

    Science.gov (United States)

    Abrams, Thad E.; Vaughan-Sarrazin, Mary; Kaboli, Peter J.

    2010-01-01

    Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified…

  2. Revisions to the 2009 American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards: expanding the scope to include inpatient settings.

    Science.gov (United States)

    Jacobson, Joseph O; Polovich, Martha; Gilmore, Terry R; Schulmeister, Lisa; Esper, Peg; Lefebvre, Kristine B; Neuss, Michael N

    2012-01-01

    In November 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) jointly published a set of 31 voluntary chemotherapy safety standards for adult patients with cancer, as the end result of a highly structured, multistakeholder process. The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. In January 2011, a workgroup consisting of ASCO and ONS members was convened to review feedback received since publication of the standards, to address interim changes in practice, and to modify the standards as needed. The most significant change to the standards is to extend their scope to the inpatient setting. This change reflects the conviction that the same standards for chemotherapy administration safety should apply in all settings. The proposed set of standards has been approved by the Board of Directors for both ASCO and ONS and has been posted for public comment. Comments were used as the basis for final editing of the revised standards. The workgroup recognizes that the safety of oral chemotherapy usage, nononcology medication reconciliation, and home chemotherapy administration are not adequately addressed in the original or revised standards. A separate process, cosponsored by ASCO and ONS, will address the development of safety standards for these areas.

  3. Nurse manager perspective of staff participation in unit level shared governance.

    Science.gov (United States)

    Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J

    2017-11-01

    To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.

  4. Helping War Veterans with Posttraumatic Stress Disorder: Incarcerated Individuals' Role in Therapeutic Animal Programs.

    Science.gov (United States)

    Furst, Gennifer

    2016-05-01

    A grassroots movement of nonprofit, nongovernmental organizations is creating programs in which incarcerated individuals train rescued shelter dogs as therapeutic canines for Veterans with posttraumatic stress disorder (PTSD). Driven in part by reports of Veterans not receiving adequate treatment for PTSD, the programs are the latest iteration of prison-based animal programs and are founded on the principles of animal therapy and healing powers of animals. The far-reaching and deleterious collateral consequences of PTSD create social and economic burdens on the country; providing beneficial interventions for Veterans is a pressing social problem. Without oversight, a patchwork of agencies has developed that provides Veterans with dogs with varying levels of training and differing abilities. To best serve the needs of Veterans, the programs need regulation and standardized methods of training. [Journal of Psychosocial Nursing and Mental Health Services, 54(5), 49-57.]. Copyright 2016, SLACK Incorporated.

  5. Growing Use of Mental and General Health Care Services Among Older Veterans With Mental Illness.

    Science.gov (United States)

    Wiechers, Ilse R; Karel, Michele J; Hoff, Rani; Karlin, Bradley E

    2015-11-01

    National data from Veterans Health Administration (VHA) electronic medical records were used to examine rates of mental illness and service use among older veterans since mental health care transformation efforts were implemented in 2005. Data were extracted from VHA electronic medical records for each fiscal year from 2005 through 2013 for veterans ages 65 and older. Among those receiving any health care services, the number and proportion treated for a confirmed mental illness and the utilization of non-mental health care services were identified. In 2013, 2.6 million older veterans utilized services in VHA, 14% of whom had a confirmed mental illness, which was a 57% increase from 2005. Older veterans with confirmed mental illness accounted for a sizable and growing proportion of non-mental health service utilization. Preparing the workforce to address the mental health needs of older veterans and nonveterans is essential.

  6. Homelessness in a national sample of incarcerated veterans in state and federal prisons.

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A; Kasprow, Wesley J; McGuire, James F

    2014-05-01

    The Veterans Health Administration (VHA) has been increasing efforts to reach out to assist incarcerated veterans. While previous studies have shown strong associations between incarceration and homelessness, few studies have examined distinctive characteristics of incarcerated homeless and non-homeless veterans. National administrative data on 30,348 incarcerated veterans served by the Health Care for Re-entry Veterans (HCRV) program were analyzed. Incarcerated veterans were classified into four groups based on their history of past homelessness: not homeless, transiently homeless, episodically homeless, and chronically homeless. Multinomial logistic regression was used to compare groups on sociodemographic characteristics, criminal justice status, clinical status, and their interest in using VHA services. Of the sample, 70 % were classified as not homeless, 8 % as transiently homeless, 11 % as episodically homeless, and 11 % as chronically homeless. Thus, 30 % of the sample had a homeless history, which is five times the 6 % rate of past homelessness among adult men in the general population. Compared to non-homeless incarcerated veterans, all three homeless groups reported significantly more mental health problems, more substance abuse, more times arrested in their lifetime, more likely to be incarcerated for a non-violent offense, and were more interested in receiving VHA services after release from prison. Together, these findings suggest re-entry programs, like HCRV, can address relevant mental health-related service needs, especially among formerly homeless veterans and veterans in need of services are receptive to the offer of assistance.

  7. Long-acting Reversible Contraception Among Homeless Women Veterans With Chronic Health Conditions: A Retrospective Cohort Study.

    Science.gov (United States)

    Gawron, Lori M; Redd, Andrew; Suo, Ying; Pettey, Warren; Turok, David K; Gundlapalli, Adi V

    2017-09-01

    US women Veterans are at increased risk of homelessness and chronic health conditions associated with unintended pregnancy. Veterans Health Administration (VHA) provision of long-acting reversible contraception (LARC) can assist in healthy pregnancy planning. To evaluate perinatal risk factors and LARC exposure in ever-homeless women Veterans. A retrospective cohort study of women Veterans using VHA administrative data from fiscal years 2002-2015. We included 41,747 ever-homeless women Veterans age 18-44 years and 46,391 housed women Veterans matched by military service period. A subgroup of 7773 ever-homeless and 8674 matched housed women Veterans deployed in Iraq and Afghanistan [Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND)] conflicts comprised a second analytic cohort. Descriptive statistics compared demographic, military, health conditions, and LARC exposure in ever-homeless versus housed women Veterans. Multivariable logistic regression explored factors associated with LARC exposure in the OEF/OIF/OND subgroup. All health conditions were significantly higher in ever-homeless versus housed Veterans: mental health disorder in 84.5% versus 48.7% (Phomeless women Veterans and providing LARC access. The prevalence of perinatal risk factors in ever-homeless women Veterans highlights a need for further programmatic enhancements to improve reproductive planning.

  8. Alcohol and drug misuse, abuse, and dependence in women veterans.

    Science.gov (United States)

    Hoggatt, Katherine J; Jamison, Andrea L; Lehavot, Keren; Cucciare, Michael A; Timko, Christine; Simpson, Tracy L

    2015-01-01

    We conducted a systematic literature review on substance misuse, abuse, and dependence in women veterans, including National Guard/reserve members. We identified 837 articles published between 1980 and 2013. Of 56 included studies, 32 reported rates of alcohol misuse, binge drinking, or other unhealthy alcohol use not meeting diagnostic criteria for abuse or dependence, and 33 reported rates of drug misuse or diagnosed alcohol or drug use disorders. Rates ranged from 4% to 37% for alcohol misuse and from 7% to 25% for binge drinking; among Veterans Health Administration (VA) health-care system outpatients, rates ranged from 3% to 16% for substance use disorder. Studies comparing women veterans and civilians reported no clear differences in binge or heavy drinking. Substance misuse rates were generally lower among women veterans than men veterans. Substance misuse was associated with higher rates of trauma, psychiatric and medical conditions, and increased mortality and suicide rates. Most studies included only VA patients, and many used only VA medical record data; therefore, the reported substance misuse rates likely do not reflect true prevalence. Rates also varied by assessment method, source of data, and the subgroups studied. Further efforts to develop epidemiologically valid prevalence estimates are needed to capture the true health burden of substance misuse in women veterans, particularly those not using VA care. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  9. 2001 National Survey of Veterans (NSV)

    Data.gov (United States)

    Department of Veterans Affairs — The 2001 National Survey of Veterans (NSV) is the fifth in a series of comprehensivenationwide surveys designed to help the Department of Veterans Affairs (VA) plan...

  10. Profile of Vietnam War Veterans (2015).

    Data.gov (United States)

    Department of Veterans Affairs — The Profile of Vietnam War Veterans uses the 2015 ACS to provide a view into the demographic characteristics and socioeconomic conditions of the Vietnam War Veteran...

  11. 2015 Veteran Economic Opportunity Report

    Science.gov (United States)

    2015-01-01

    and data analysis to the VBA and stakeholders. PA&I developed the VBA Enterprise Data Warehouse to enable the generation of recurring and ad hoc...reports in response to VBA decision-making and business needs. PA&I will be a primary source of information on Veteran education, vocational...Servicemembers UI Unemployment Insurance URL Uniform Resource Locator USB Under Secretary for Benefits VA Department of Veterans Affairs VBA Veterans

  12. Transgender Veterans' Satisfaction With Care and Unmet Health Needs.

    Science.gov (United States)

    Lehavot, Keren; Katon, Jodie G; Simpson, Tracy L; Shipherd, Jillian C

    2017-09-01

    Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. We used data from transgender Veterans collected in 2014 through an online, national survey. In total, 298 transgender Veterans living in the United States. We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.

  13. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... About About the Veterans Crisis Line FAQs Veteran Suicide Spread the Word Videos Homeless Resources Additional Information ... About About the Veterans Crisis Line FAQs Veteran Suicide The Veterans Crisis Line text-messaging service does ...

  14. Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers.

    Science.gov (United States)

    Ball, Sherry L; Stevenson, Lauren D; Ladebue, Amy C; McCreight, Marina S; Lawrence, Emily C; Oestreich, Taryn; Lambert-Kerzner, Anne C

    2017-07-01

    The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects. The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS. This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.

  15. 77 FR 1548 - Interagency Task Force on Veterans Small Business Development

    Science.gov (United States)

    2012-01-10

    ... service-disabled veterans (SDVOSBs). Moreover, the Task Force shall coordinate administrative and... ``six focus areas'' of the Task Force and emailed prior to the meeting for inclusion in the public...

  16. 76 FR 56863 - Interagency Task Force on Veterans Small Business Development

    Science.gov (United States)

    2011-09-14

    ... service-disabled veterans (SDVOSB'S). Moreover, the Task Force shall coordinate administrative and...'' of the Task Force and emailed prior to the meeting for inclusion in the public record, verbal...

  17. 78 FR 7849 - Interagency Task Force on Veterans Small Business Development

    Science.gov (United States)

    2013-02-04

    ...-disabled veterans (SDVOSB's). Moreover, the Task Force shall coordinate administrative and regulatory... ``six focus areas'' of the Task Force and emailed prior to the meeting for inclusion in the public...

  18. 76 FR 21090 - Interagency Task Force on Veterans Small Business Development

    Science.gov (United States)

    2011-04-14

    ...-disabled veterans (SDVOSB'S). Moreover, the Task Force shall coordinate administrative and regulatory... applicable to the ``six focus areas'' of the Task Force and emailed prior to the meeting for inclusion in the...

  19. 75 FR 75187 - Interagency Task Force on Veterans Small Business Development Meeting Notice

    Science.gov (United States)

    2010-12-02

    ... service-disabled veterans (SDVOSB'S). Moreover, the Task Force shall coordinate administrative and...'' of the Task Force and e-mailed prior to the meeting for inclusion in the public record; verbal...

  20. 75 FR 62611 - Interagency Task Force on Veterans Small Business Development

    Science.gov (United States)

    2010-10-12

    ... service-disabled veterans (SDVOSB'S). Moreover, the Task Force shall coordinate administrative and... to the ``six focus areas'' of the Task Force and emailed prior to the meeting for inclusion in the...