Programs and Communities
The collection collates collections by schools, centers, programs, and research groups.
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- All Subjects: Mediterranean Region
- All Subjects: Advance Care Planning
- All Subjects: Vaccination
ContributorsSoto-Berelov, Mariela (Author) / Fall, Patricia L. (Author) / Barton, C. Michael (Author) / Falconer, Steven E. (Author) / Sarjoughian, Hessam S. (Author) / Arrowsmith, J. Ramon (Author)
Created2007
ContributorsMayer, Gary R. (Author) / Sarjoughian, Hessam S. (Author)
Created2007
Description
Background: The COVID-19 pandemic has been causing high rates of hospitalization and death among the marginalized Asian American Pacific Islander (AAPI) community. Disaggregated data revealed low COVID-19 vaccine uptake among Korean Americans/Immigrants (KA/I) due to vaccine-related fears unaddressed by cultural and linguistic barriers. Prior evidence demonstrates that digital storytelling (DST) is an effective medium to improve recommended vaccine intent and uptake among AAPIs. Objective: This DNP project aimed to assess the effect of DST intervention on improving KA/I’s COVID-19-related vaccine hesitancy, intent, and uptake. Methods: A quasi-experimental design was conducted, with participants (n=4) self-identifying as KA/I adults with English or Korean fluency residing in the U.S. Participants were recruited online via convenience sampling from CARE (Collaborative Approach for AAPI Research and Education). Individuals who had already received COVID-19 vaccines were excluded. The intervention included two first-person audiovisual stories documenting the personal experience of receiving the COVID-19 vaccine. Outcomes were measured via a pre-post-1-month-follow-up survey utilizing a modified Vaccine Hesitancy Scale (? = 0.72) and Narrative Quality Assessment Tool (? = 0.78-0.81). Results: DST intervention had a marginally significant effect on lowering post-COVID-19 vaccine hesitancy scores (p = 0.068). Participants (n=2) who rated the DST videos with a higher score indicated vaccine uptake at one-month follow-up. Conclusion: This cost-effective, sustainable, and scalable DST evidence-based project has the potential to promote COVID-19 vaccination among KA/I and other AAPI groups with appropriate modification.
ContributorsYoon, Paula (Author) / Chen, Angela (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-01
Description
Background: Advance Care Planning (ACP) conversations are discussions between patients, providers, and loved ones addressing key care decisions in the event of incapacity. Nearly twothirds of US adults have not completed an Advance Directive (AD), yet ACP conversations rarely occur in practice. The objective of this quality improvement project was to implement workflow changes with a reminder system to facilitate ACP conversations during Medicare Wellness Visits (MWV).
Method: Social Cognitive Theory describes the complex relationship between variables that can influence an individual’s decision to address ACP. Providers in a primary care office in the Southwestern United States participated in an ACP education session and confidence survey. Patients presenting for the MWV were screened for ACP, and visual reminders were attached outside the exam room for provider review. Aggregate data were used to evaluate provider surveys. Descriptive statistics were used to evaluate patient characteristics and the Chi-square Test of Independence, and Fisher’s test was used to compare the pre-and post-intervention advance directive documentation.
Results: Qualitative feedback from the survey indicates reminders and easily accessible resources may help facilitate ACP conversations. Of the 251 MWVs, 21 (8%) had an AD documented, significantly less than the nationally reported rate of 37.7% (p < 0.05, z = -2.39).
Conclusions: Healthcare providers face multiple barriers preventing or delaying ACP conversations in practice. System-level changes and provider education can improve the rate of ACP conversations and impact patients’ care at the end of life.
ContributorsSmith, E. Elizabeth (Author) / Reifsnider, Elizabeth (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical services of a patient’s wishes. Internal evidence found that many providers are unfamiliar with the Physician Order for Life-Sustaining Treatment form. The Theory of Planned Behavior was used to guide the project.
Objectives: To improve advanced care planning processes in a healthcare organization.
Design: A quality improvement project was performed at a medical center with outpatient provider groups. Virtual training was provided by the Arizona Hospital and Healthcare Association on the Physician Order for Life-Sustaining Treatment. Participants completed a three-part survey to measure skills for advance care planning after a training event.
Setting/Subjects: Five (n=5) American palliative and primary care providers at a medical center.
Measurements: The East Midlands Evaluation Toolkit is a validated survey tool that measures confidence and competence in advance care planning after training.
Results: Descriptive statistics, Friedman’s test, and the Kruskal-Wallis test were used for data analysis. Results provided evidence to the healthcare facility that there is a significant need to train their healthcare professionals on advance care planning.
Conclusions: Recommendations are made to focus research on larger studies looking at the types of advance care planning, and differences in disciplines and specialties.
ContributorsPate, A. Shurine (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each year in the United States (US) from vaccine-preventable diseases, and nine billion dollars are spent on associated healthcare costs and lost productivity (ADHS, 2015; Wilson et al., 2019). To improve adult vaccination rates, the National Vaccine Advisory Committee recommends the Standards for Adult Immunization Practices, including regular assessment, recommendation, delivery or referral, and documentation during follow-up on vaccination (Orenstein et al., 2014; CDC, 2016).
Local problem: A free clinic in Arizona serving uninsured, undocumented Latin American immigrants had low vaccination rates and a deficiency in vaccination documentation in electronic medical records.
Methods: An evidence-based quality improvement project was conducted to address low vaccination rates and provider practices using a multi-component intervention. The effect and usage were evaluated through chart audits and pre- post-intervention surveys.
Interventions: A vaccination questionnaire was administered at all in-person primary care visits. Brief educational videos were provided to providers and office staff before the intervention addressing the questionnaire's use, purpose, and goals. Adult immunization schedule printouts were made available in all patient rooms and provider charting areas. Additionally, a resource sheet on local free immunization programs was created for providers and patients.
Results: The intervention's effect was unable to be determined due to a breakdown in the protocol after the second week of implementation. However, 92% of completed questionnaires reviewed indicated the patient needed one or more vaccination. Sixty-five percent of electronic medical records reviewed had no vaccination documentation historically for assessment, recommendation, referral, follow-up, or scanned vaccination records. No charts reviewed had these areas documented regularly.
Conclusion: Vaccination rates and the Standards of Adult Immunization Practices are low at the free clinic. Further quality improvement measures are indicated addressing barriers present.
ContributorsDukes, Alyssa (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-27
Description
As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.
King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.
ContributorsMorrison, Melissa (Author) / Baker, Laurie (Thesis advisor)
Created2016-05-07
Description
Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could receive unwanted treatment. Providers can utilize advance care planning (ACP) to educate patients and support them in forming a medical power of attorney (MPOA) and AD. Evidence suggests that having ACP conversations can engage a patient to form an AD. The purpose of this project was to see if ACP discussions with older patients encouraged them to complete an AD and MPOA.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
ContributorsKrasowski, Maria (Author) / Rauton, Monica (Thesis advisor)
Created2018-05-01
ContributorsUllah, Isaac I. T., 1979- (Author) / Barton, C. Michael (Author)
Created2007
Description
PowerPoint presentation to the Santa Fe Institute, October 2004.
ContributorsBarton, C. Michael (Author)
Created2004