Patient-centered Care

One of six national priorities identified in the U.S. National Quality Strategy is a focus on patient-centered care. Patient-centered care addresses improvements in patient, family and caregiver experiences related to quality, safety and access across health care settings. By emphasizing a shared decision-making process that includes culturally sensitive and understandable care plans, patient-centered care enables patients, their families and caregivers in effectively navigating, coordinating and managing patients' care.

A Review of Parental Self Efficacy Scales and Scores Among Infants and Toddlers

Authors: Meenakshi Seetharaman, J. McGrath and A.Vance 
Poster number: 8
Presentation date: Monday, April 5, 9:40 a.m.

Parental Self Efficacy (PSE) is a parent’s belief in their ability to successfully parent a child. Current instruments measuring PSE vary in focus, intended population and scoring, making it difficult to compare findings across studies. We compared PSE measures specific to infancy and toddlerhood for similarities in parenting concepts, scoring and research context, and summarized PSE scores from each instrument to further understand the relationship between PSE and outcomes. This scoping review analyzed 25 PSE measures. The most common factor evaluated was parental personal factors, including satisfaction, birth experience, intuition, parenting familiarity and emotions. Our findings suggest personal factors, including emotional bonds formed and satisfaction with being a parent, are the most indicative factor in PSE. A bond with the child is more important in indicating confidence than other environmental and social factors. Future research could assess how to standardize a scoring system to better understand these scores across studies.

To relieve pain or avoid analgesic risk? Changes in parent's analgesic trade-off preferences and decision-making amidst the opioid crisis

Authors: Rachel Lenko, BSN, RN, Ph.D. student; and Terri Voepel-Lewis, Ph.D., RN
Poster number: 9
Presentation date: Monday, April 5, 9:50 a.m.

Analgesic risk-benefit trade-off preferences — which are shaped by personal experience, health care providers and the media —influence medication use. Given recent widespread attention to the opioid crisis, we aimed to determine whether a concurrent shift in analgesic trade-off preferences and decisions has occurred among parents whose children were prescribed opioids. Our secondary analysis of survey data found that parents surveyed later in the crisis were significantly more analgesic risk averse than those surveyed early on. Further, compared to parents who were analgesic benefit-preferent, those who were risk-averse or ambivalent late in the crisis were less likely to give a prescribed opioid to a child in pain. The recent shift in trade-off preference toward risk aversion may influence parental decisions to administer prescribed opioids to children. Although parents’ risk aversion may have a protective intention, reluctance to give prescribed opioids may negatively impact children’s pain.

Examining Differences in Familial Impact Before and After NICU Discharge

Authors: Jessica Hsu and Ashlee Vance, Ph.D., MA, RN, RNC-NIC
Poster number: 10
Presentation date: Monday, April 5, 10 a.m.

The purpose was to examine differences in familial impact during and after a neonatal intensive care unit (NICU) hospitalization. Knowing the differential effects of how family life is impacted before and after discharge may help providers prioritize support and resources at the right time. This cross-sectional study used survey data that was collected from parents of NICU infants who were hospitalized after January 30, 2020. The Impact on Family Scale (IFS) was used to assess the impact of infant illness on families, with higher scores indicating greater impact. The IFS score was found to be significantly higher for parents who still had an infant hospitalized. Our findings suggest that parents may need the most support while their infant is still hospitalized. Further research would need to be done, but if true, this would benefit nurses and other healthcare providers as they would know when parents need the most support.

Contextualizing and understanding intimate partner violence experienced by transgender and non-binary individuals

Authors: Kieran Todd, MPH; Rob Stephenson, MA, MSc, Ph.D.; Kristi E. Gamarel, Ph.D.;  Erin Bonar, Ph.D.; and Sarah M. Peitzmeier, Ph.D.
Poster number: 18
Presentation date: Monday, April 5, 10:10 a.m.

Project Empower is a mixed-methods study that seeks to develop an understanding of intimate partner violence (IPV) experienced by transgender and non-binary individuals and validate a new scale to measure IPV in this population. We conducted 20 in-depth interviews with transgender and non-binary survivors of IPV that collected the narratives and unique harmful/abusive behaviors experienced. Our findings suggest the weaponization of gender is a significant aspect of transgender and non-binary IPV experiences. Additionally, smaller, intertwined LGBTQ communities can function as both support systems and as barriers to accessing care and services, dependent on whether the abusive partner is also a part of the community. These findings indicate a crucial need to correctly define and contextualize IPV specific to transgender communities to refine clinical screening tools, as well as lead to the creation of more accessible transgender-specific IPV services that consider the complexities of LGBTQ community connectedness.

Developing a dyadic HIV intervention for couples in South Africa

Authors: Jayelin Parker, MPH; Rob Stephenson, Ph.D.; and Lynae Darbes, Ph.D.
Poster number: 19
Presentation date: Monday, April 5, 10:20 a.m.

South Africa has the world’s largest HIV epidemic, and rates of transmission are particularly high among heterosexual couples, driven by low levels of engagement in HIV testing and care, including adherence to antiretroviral medication. In this project, we aim to test the efficacy of a dyadic-focused intervention tailored to the unique needs of couples. The intervention consists of three sessions: a couple’s HIV testing and counseling (CHTC) session in which couples learn their HIV status together, followed by two motivational interview-based counseling sessions in which couples work together to develop plans to engage in HIV prevention and care. The two-arm randomized control trial will take place in KwaZulu-Natal, South Africa, and will recruit and randomize 272 couples who will be followed for 24 months. The poster will detail the development and testing of the dyadic HIV prevention and care intervention.

Perspectives from young partnered gay, bisexual and other men who have sex with men on sexual agreements: the catalysts, barriers and events that color these conversations

Authors: Catherine Washington, Kristi Gamarel, Matthew Rosso, Lynae Darbes, Lisa Hightow-Weidman, Kristina Felder Claude, Mona Rai, Patrick Sullivan and Rob Stephenson
Poster number: 24
Presentation date: Monday, April 5, 10:30 a.m.

Research on sexual agreements among gay, bisexual and other men who have sex with men (GBMSM) has historically focused on adults with limited attention on young GBMSM (YGBMSM). As part of an ongoing HIV prevention study called We Prevent, we conducted in-depth interviews with 30 partnered YGBMSM aged 15-19. Qualitative analyses illustrated that sexual agreements were often implied rather than explicit conversations. Explicit conversations often occurred because of development milestone (e.g., prom, college) as a form of relationship confirmation. Desires for monogamous or open relationships were often influenced by developmental and social factors such as long distance and sexual orientation disclosure. The sexual agreements made by YGBMSM are shaped by developmental factors such as first relationships, milestones and navigating the coming out process. HIV prevention intervention research focused on YGBMSM must consider the development context that motivate and deter this priority population from establishing sexual agreements.

Describing Parenting Topics In Parenting Self-Efficacy Scales

Authors: Isabel Hanson, research assistant, and Ashlee Vance, Ph.D., MA, RN, RNC-NIC
Poster number: 28
Presentation date: Monday, April 5, 10:40 a.m.

It is important to know the main topics addressed in parenting self-efficacy (PSE) scales, as they are used by healthcare providers to measure how a parent evaluates their own ability to successfully perform parenting behaviors and tasks [1]. This study quantified and categorized the main topics addressed in a variety of PSE scales in order to evaluate which parenting topics are being covered well by existing PSE scales and which topics are not. The qualitative coding software NVIVO was used to code 28 PSE scales. It was found that the parenting topics which occur most frequently are Skills (n=9), Emotion (n=5), Intuition (n=5) and Perceived Success (n=5). Because the majority of topics are related to the parent’s own characteristics and skills, this indicates that the scales are not covering other aspects of parenting such as social environment, family systems and the child’s characteristics as thoroughly.

Describing the End-of-life Doula Role and Practices of Care: Perspectives from Four Countries

Authors: Merilynne Rush, MSHP, RN, BSN; and Marian Krawczyk, Ph.D.
Poster number: 30
Presentation Date: Monday, April 5, 10:50 a.m.

End-of-life doulas (EOLDs) are emerging as a potentially important new form of lay, community-based caregiving, providing innovative services to address the myriad needs the dying and their caregivers, particularly during the COVID-19 pandemic. This first international study describing the role and practices of this emerging profession is especially important for nurses, who work alongside EOLDs, to help them understand this growing field in the changing world of palliative and hospice care. Our findings present the first detailed taxonomy of the EOLD role and services, situated within literature on the professionalization of caregiving and discussion of jurisdictional considerations as the end-of-life doula movement develops. EOLDs offer a promising way to bridge the current division of health and death care as they develop alongside but separate from formalized institutional health care amidst concerns about health care restructuring, changing social trends ideologies of choice and the desires of individuals and families to demedicalize dying.

Nicotine/tobacco exposure by sex and sexual identity: Results from a national study

Authors: Rebecca J. Evans-Polce, Danielle M. Smith, Philip Veliz, Carol J. Boyd and Sean Esteban McCabe
Poster number: 31
Presentation date: Monday, April 5, 11 a.m.

Sexual minority individuals are more likely to use tobacco compared to heterosexual individuals; these differences vary by sex. We examined whether sexual minority men and women have differential nicotine and tobacco-specific toxicant exposure compared to heterosexual men and women. Using nationally representative survey and biological data from 2013-14, we found that bisexual women had higher levels of cotinine and tobacco-specific toxicants compared to heterosexual women. However, after accounting for the differences in self-reported tobacco use, bisexual women and heterosexual women did not differ in their levels of nicotine and tobacco-specific toxicants. We did not find differences in sexual orientation among men with respect to nicotine and tobacco-specific toxicant exposures. Higher levels of nicotine and other tobacco-related toxicant exposures related to greater use of tobacco products among sexual minority women have important implications for potential disparate long-term tobacco-related health outcomes and clinical implications for tailoring tobacco cessation intervention.

Associations Between Alzheimer's Disease and Related Dementias and Depressive Symptoms of Partner Caregivers

Authors: Melissa L. Harris, Marita G. Titler and Geoffrey J. Hoffman
Poster number: 33
Presentation date: Monday, April 5, 11:10 a.m.

Spouses provide most of the care to people with Alzheimer’s disease or related dementias (progressive, chronic conditions prevalent among older adults that affect cognitive, physical and emotional health), yet the impact of a partner’s ADRD diagnosis on an individual’s emotional status over time is unknown. We examined the association between a partner’s ADRD status, including the recency of an ADRD diagnosis, and depressive symptoms among older (≥ 51 years) spouses. This observational analysis of data from 62,457 respondents in the National Health and Retirement Study from 2000-14 found that clinically meaningful 30% increases in depressive symptoms were observed for older adults following partners' diagnosis of ADRD, with increases that remained elevated over time. Findings illustrate interdependent dimensions of cognitive impairment and mental health among older adult partners and suggest the need for prioritization of spousal health in care planning to better address the dynamic needs of the partnership.

"You can only give people what they’ll accept:” A qualitative study of healthcare decision-making in older adults receiving home-based care during the COVID-19 pandemic

Authors: Jennifer Inloes, BSN, RN; and Sue Anne Bell, Ph.D., FNP-BC, NHDP-BC, FAAN
Poster number: 34
Presentation date: Tuesday, April 6, 10:40 a.m.

The majority of older Americans prefer to remain living in their own homes — or age in place — making it important to understand how public health emergencies impact their safety in the home environment. The purpose of this study was to assess factors driving care-related decisions made by adults receiving home-based care services during the COVID-19 pandemic to better understand the health needs of older adults aging in place. In this qualitative study, we conducted semi-structured telephone interviews with home-based care providers (n=27) from July through September 2020. Our initial results detail themes indicating that fear-driven decision-making processes contributed to negative patient outcomes. Our findings describe how fear of COVID-19 infection motivated patients to make care-related decisions that were incongruent with their health needs. Shared patient-provider decision-making strategies that promote healthy decision-making processes are necessary to support patients receiving home-based care during the COVID-19 pandemic.

Misconceptions of Mental Health Among at-Risk Populations: The Case of Hotel Workers

Authors: Wei Li, BSN honors student; Hannah Ratliff, BSN, RN, Ph.D. student; and Marie-Anne Sanon Rosemberg, Ph.D., MN, RN 
Poster number: 37
Presentation date: Tuesday, April 6, 10:50 a.m.

The term mental illness has often been stigmatized, creating a rift in the understanding of mental health and related care provision. With the myriad of stressors faced by hotel workers, this population is especially at risk for poor mental health, yet we do not know how they perceive this concept. This study aims to understand how hotel workers perceive the term “mental health.” Twenty-three hotel workers participated in focus group interviews and six managers were interviewed individually. The term “mental health” was commonly interpreted with negative connotations such as “being crazy” and viewed as a “feeling” that one should be able to control. These findings suggest that mental health is not widely understood by this worker group. Implications for practice in addressing mental health among hotel workers include the need for education as well as the importance of building trust and better communication with this population.

Nurse Practitioners and Nurse Practitioner Students’ Knowledge, Skills, and Attitudes Towards Screening for Adverse Childhood Experiences

Authors: Alyssa Clark, DNP student, and Heather Jones. DNP, APRN AGPCNP-BC
Poster number: 42
Presentation date: Tuesday, April 6, 11 a.m.

Amongst members of the Michigan Council of Nurse Practitioners, how is screening for Adverse Childhood Experiences (ACEs), compared to not screening, influenced by the perceptions, knowledge and attitudes of nurse practitioners and nurse practitioner students. Adverse Childhood Experiences are known to contribute to chronic comorbidities amongst all populations, however the United States health care system lacks appropriate screening measures to identify those who have experienced such trauma. For this cross-sectional survey study, descriptive statistics will be calculated to summarize reported knowledge, attitudes and current practices for screening. Comparative statistics will be used to determine associations between attitudes and demographics and practice description. The survey will be a valuable resource to guide future implementations to prevent trauma-associated comorbidities and make communication regarding trauma easier and normal. The end goal is to get data regarding current practice to lead to future implementation of ACE education and screening processes.

Feedback from Assisted Living Residents on a Proposed Intervention to Reduce Sedentary Behavior

Authors: Katelyn Webster, BSN, RN, Ph.D. candidate; and Janet L. Larson, Ph.D., RN, FAAN
Poster number: 46
Presentation date: Tuesday, April 6, 11:10 a.m.

Older adults in assisted living tend to be highly sedentary, but replacing sedentary behavior with light physical activity could have important implications for maintenance of functional abilities and prevention of frailty. We gathered feedback from assisted living residents on the Active for Life intervention, a physical activity-specific, self-efficacy-enhancing intervention designed to promote light physical activity and reduce sedentary behavior. This qualitative study conducted with 20 residents from four assisted living facilities found that most assisted living residents were interested in participating in the proposed Active for Life intervention. Their suggestions included modifying the intervention by shortening each session to one hour, shortening the length of the intervention from 16 to 12 weeks and including exercises that are highly modifiable for residents with varying levels of ability. The residents provided useful feedback for refining the Active for Life intervention before future feasibility and acceptability testing.

Social Support in Young Black Men (Philadelphia) Recovering from Violent Injury

Authors: Grace Bontrager; Terry Richmond, Ph.D, RN, FAAN; and Sarah Jacoby, MPH, MSN, Ph.D.
Poster number: 51
Presentation Date: Tuesday, April 6, 11:20 a.m.

This research addresses recovery concerns in the context of support seeking by 52 young Black men violently injured in the Philadelphia area to better inform continuity of care for violently injured patients. Care of these patients often ends when injuries are healed, and young Black men make up a particularly vulnerable subsection of this population. This qualitative study shows the most common concerns one year post-injury included financial security for self and family and physical changes. It identified that patients of this cohort experience difficulty seeking social support most commonly due to provider distrust, perceptions of masculinity and stigma related to seeking help. Findings suggest that young urban Black men have a unique set of needs following violent injuries that must be assessed for and addressed in the context of support-seeking perceptions among this community. Common themes across needs may be found according to the framework of this study.

Cigarette, e-cigarette, and dual use in a national sample of pregnant sexual minority women

Authors: Dana Beck, Ph.D., FNP-BC; Philip T. Veliz, Ph.D.; Sean Esteban McCabe, Ph.D.; Carol J. Boyd, Ph.D.; and Rebecca J. Evans-Polce, Ph.D.
Poster number: 53
Presentation date: Tuesday, April 6, 11:30 a.m.

Sexual minority women (SMW) are more likely to engage in cigarette and e-cigarette use when compared to heterosexual women; however, understanding the extent of use during pregnancy is challenging due to small sample sizes in national U.S. studies. Accordingly, we examined whether pregnant sexual minority women had greater prevalence of current cigarette and e-cigarette use between 2016 and 2019 when compared to pregnant heterosexual women. Using representative survey data from the Behavioral Risk Factor Surveillance System and National Health Interview Survey from 2016-19, we found that pregnant SMW had higher prevalence of current cigarette and e-cigarette use compared to pregnant heterosexual women (21.1% versus 9.5%). Pregnant SMW who engaged in current cigarette/e-cigarette use were less likely than their sexual minority peers to indicate trying to quit using during the past year. Maternal and infant health among U.S. sexual minority women would benefit from clinicians equipped to provide support for FDA approved smoking cessation and accurate information about e-cigarettes/e-products. Research examining perceptions of harm and motivations for e-cigarette/e-product use among pregnant sexual minority women is needed.

The Effects of Communication between Providers on NTSV Cesarean Section Rates

Authors: Jordan Goodrich, BSN honors student; Jill Brown, RN MSN; Katie Moore, MPH; and Lisa Kane Low, Ph.D., CNM for the Obstetrics Initiative
Poster number: 56
Presentation date: Tuesday, April 6, 11:40 a.m.

National maternity care organizations are addressing high cesarean section (CS) rates in low-risk populations. The objective of this study was to consider how maternity unit culture in Michigan hospitals influences CS rates in patients who are Nulliparous at Term having a Singleton Vertex (NTSV) labor. Using a mixed methods design, survey data from the validated Labor Culture Survey and open-ended text responses from maternity care team members across 57 Michigan hospitals were analyzed. Findings reveal for every one point increase in agreement among hospital staff endorsing elements of patient safety there is a 17% decrease in NTSV CS rates. Comments identified nurse/physician communication as a barrier to safety. Communication among providers is an essential factor in reducing unnecessary CS for NTSV patients in Michigan. Enhancing communication between providers as an element of patient safety is an evidence-based intervention to implement to decrease hospital NTSV cesarean rates.

Perinatal Loss: Effective Approach to Grief Counseling

Authors: Madeline Laurencelle and Savannah McCormick
Poster number: 60
Presentation date: Tuesday, April 6, 11:50 a.m.

The strongest evidence for the effectiveness of providing grief counseling to women following a perinatal loss or stillbirth in the acute care setting involves utilizing a bereavement protocol. This clinical issue is important because about 1 pregnancy in 100 is affected by stillbirths and intense perinatal grief occurs in about 25% of women who experience a perinatal loss. After reviewing numerous data sources and articles, the study includes seven articles from 2007 to 2020, which found that hospitals which provide bereavement protocols for nurses to follow resulted in women having increased feelings of being supported while also benefiting the staff due to grief training and promoting collaboration among health care professionals. The findings suggest that the usage of a bereavement protocol utilizing a perinatal grief scale, a checklist and initiating a grief certification/bereavement care education program can alleviate the painful emotions families experience after losing a child.