0401. Changes to School Nurse Attitudes to the Adoption of Bleeding Control Curriculum for School Staff
Author(s): Megan Gallant Mentor(s): Dr. Patricia Poirier
Abstract: Context and Objective. During mass casualty events or trauma, the single most important factor to victim survival is the rapid identification and control of life-threatening bleeding. While many schools across the country have mandated the adoption of bleeding control curriculum for staff, some schools in southeastern Connecticut have not incorporated this training into annual staff education. Will school nurses in the Ledyard, Connecticut school district be willing to include this training for staff in the interest of improving response to trauma and mass casualty events?
Methods. School nurses were provided a 2-hour training session using the Stop the Bleed curriculum. Following the training, all nurses were eligible to register as Stop the Bleed instructors. Nurses were provided pre- and post-training surveys to determine knowledge level and attitudes toward adoption of the curriculum into annual school trainings. Nurses will receive an additional survey a week post-training to determine the percentage of nurses who completed the Stop the Bleed Instructor Registration.
Results and Conclusion. Nurses surveyed showed improvement in knowledge related to both the skills necessary to identify and stop life-threatening bleeding and the process of adopting and incorporating the curriculum into the annual staff trainings required by the Connecticut State Department of Education. At the 1-week point, trained nurses will be contacted to determine the number of participants who completed the registration process.
0402. Screening Women for Late-Life Depression: The Primary Care Family Nurse Practitioner’s Role
Author(s): Elissa Tremblay Mentor(s): Eileen Owen-Williams
Abstract: Depression is the most common mental health condition treated by primary care providers in the United States (U.S.). Maine is one of the states with the highest prevalence of depression for adult women. Over 479,800 women in Maine (35.7%) report a depression diagnosis compared to the 24% national average. The yearly U.S. economic burden of major depression is estimated to be greater than $210.5 billion. If undetected in the older woman, depression later in life has been shown to have serious consequences on quality of life, medical outcomes, health care utilization, morbidity, and mortality. Risk factors for depression include a prior depressive episode, being female, a family history of depression, childhood trauma, lower income, stressful life events, poor social support, medical comorbidities, dementia, substance use disorder, advancing age, residing in a rural area, and living alone. Screening for depression in older women in primary care has been shown to be effective in connecting women to treatment and improving quality of life. The CDC and USPSTF recommend screening as routine primary care with use of the PHQ-2 tool for screening and the PHQ-9 as appropriate. The Family Nurse Practitioner (FNP) is in a prime position to screen for and effectively treat older women suffering from depression. More than 80% of patients with a depression diagnosis can successfully be treated making it crucial for the FNP to screen all older women for depression in the primary care setting utilizing a standardized method and begin timely intervention.
0403. Does Providing Education Reduce Vaccine Hesitancy?
Author(s): Stephanie Massey, Kyle D. Massey Mentor(s): Patricia Poirier
Abstract: Background: The pace of COVID-19 vaccine development has been rapid. Significant public interest and the modern speed of information has created the paradoxical potential for under-informing and misinforming. Providing education from local experts may improve public perceptions and decrease vaccine hesitancy Method: This is a retrospective analysis of prospectively gathered anonymous survey data obtained before and after receipt of vaccine education as part of quality improvement. Due to software limitations, results were not paired. The survey employed six questions to assess three domains assessing: overall understanding, and understanding of safety, efficacy, mechanism of action, and side effects; and willingness to receive the vaccine. Responses were on a 5-point Likert scale and a free text comment was allowed. The primary outcome was impact of education on willingness to receive the vaccine. Likert scale results were summarized using descriptive statistics. A two-tailed Student’s t-test with an alpha-level set to 0.05 was used to test significance. Free text comments were grouped into relevant categories at the author’s discretion. Results: For the primary outcome, median scores at baseline were 5(IQR 4,5). No significant difference in survey responses were noted (-0.06, 95% CI[-0.41,0.30]). For secondary outcomes median scores at baseline were 3 (IQR 3,4) and similar across questions. Scores increased significantly after education (0.95, 95% CI[0.84,1.07]) Conclusion: Willingness to receive the COVID-19 vaccine was high at baseline, and education did not make a significant impact on survey results, but improved vaccine understanding.
0404. Level II Neonatal Intensive Care Unit (NICU) Nursing Curriculum
Author(s): Erin Voisine Mentor(s): Patricia Poirier
Abstract: Level II Neonatal Intensive Care Unit (NICU) nurses provide skillful and dynamic postnatal care to neonates needing resuscitation and stabilization, as well as ongoing supportive care to neonates ≥32 weeks gestation and weighing ≥ 1500 grams who remain physiologically stable. To develop the knowledge, skills, and attitudes (KSAs) required to provide this care, a multilayered educational approach utilizing active learning strategies to increase critical thinking and clinical judgment is required. Ultimately, this will improve nurse competency, resulting in optimal, consistent, and evidence-based care to this vulnerable population. The identification of the KSAs that a Level II nurse must possess creates the foundation for this Level II NICU orientation. Topics within those KSAs have been developed into learning modules that include summaries and supplemental modalities such as policy reviews. Each learning module concludes with an exercise, such as an unfolding case study or multiple choice quiz, to develop critical thinking and clinical judgment using evidence-based strategies, such as priority setting, recognizing abnormals, or identifying risk factors. The literature supports the use of an organized, multilayered, and adult learner focused approach in the development of an orientation program. In addition, literature calls for facilitating lifelong learning in the nursing profession. To support the healthcare facility’s need to formalize the orientation to provide dynamic postnatal care in the Level II NICU, a robust competency based orientation was developed.
0405. An Assessment of Stress in Undergraduate Nursing Students
Author(s): Amy Barnes Mentor(s): Patricia Poirier
Abstract: Nursing students are enrolled in a rigorous curriculum involving didactic, lab and clinical courses. NUR 202 students are concurrently enrolled in their first Med/Surg lab and clinical rotation. This initial combination of course work can be overwhelming and cause increased stress. The mental health of students is a vital component to a successful nursing program. The purpose of this study is to measure and understand the level of personal stress that second semester undergraduate nursing students are currently experiencing in their laboratory course (NUR 202). They will be asked to participate in a voluntary, anonymous survey via Qualtrics about their own perceived stress. The Perceived Stress Scale (PSS) consists of ten items that will measure how students perceive their reaction to situations over the last month. Nursing students acknowledge that feeling incompetent and lack of professional nursing skills and knowledge, exposure to clinical practice, and heavy academic workloads are the origins of depression and anxiety. The negative effects of depression, anxiety and stress demonstrate the importance of treating their incidence among nursing students. Survey responses will be reviewed and data will be evaluated to establish a baseline level of stress. Nursing students can not avoid the multiple stressors associated with their clinical coursework and must utilize coping strategies to successfully manage their stress levels. Faculty will be able to use survey data to identify needs and implement interventions to improve support of the nursing students’ mental health throughout their progression in the nursing program.
0406. Implementation of a S.K.I.N Response Team as a Multidisciplinary Approach to Pressure Injury Care and Prevention
Author(s): Shannon Jagger Mentor(s): Patricia Poirier
Abstract: Implementation of a S.K.I.N. Response Team as a Multidisciplinary Approach to Pressure Injury Care and Prevention Shannon Jagger BSN, RN-BC, NE-BC, CPPS, University of Maine, Orono, ME Hospital acquired pressure injuries (HAPIs) are on the list of serious reportable events (SRE) otherwise known as ‘never events’ according to the National Quality Forum (2021). Nevertheless, more than 2.5 million people develop HAPIs in the United States every year with 60,000 dying from associated complications (Agency for Healthcare Research and Quality, 2014). Like pressure injury rates across the nation, HAPI rates at the hospital involved in this study were at an alarming level. S.K.I.N. Response Team was developed and trialed on two (2) units with the highest HAPI rates within the organization. This team consists of the bedside nurse, nurse leader, provider, risk management, nutrition, wound nurse, clinical informaticists, and executive leader. The response brings the multidisciplinary team to the bedside within 20 minutes to assist with identification, interventions, and care planning for any identified skin concern. After a 90-day trial period S.K.I.N. Response went live across all in-patient units as a permanent fixture within the organization. Through this work we have identified and targeted specific areas for improvement, uncovered opportunities within our electronic medical record, involve the patient and family in pressure injury prevention, developed relationships among the multidisciplinary team, decreasing cost of care to the patient, increased productivity, and seen a reduction in HAPI rates from 33 sentinel events quarter one of FY 2020 to 7 sentinel events quarter one of FY 2021 – a reduction of over 75%. This approach to pressure injury prevention served as the catalyst for a culture change around skin care and pressure injury prevention within the organization.
0407. In Women of Childbearing Age with Cervical Ectopy (Cervical Erosion), How Does Cryotherapy Compared to Vaccination Affect the Incidence of Human Papillomavirus (HPV)?
Author(s): Elena Kolesnikova, Emilienne Soucy, Kaylin Le, Madison Bibbo Mentor(s): Valerie Herbert
Abstract: Purpose: Cervical ectopy is a physiological process commonly found in women of reproductive age. The endocervical columnar mucosal layer everts towards the outside of the cervix. Cervical ectopy can be symptomatic (pelvic pain, bleeding, or vaginal discharge) or asymptomatic (silent). Additionally, this condition has a strong significance in the prognosis of Human Papillomavirus (HPV). Cervical cancer is the second most common cancer in women worldwide, and HPV is the main causative agent and is detected in 99% of cervical cancers. The traditional prophylactic intervention for HPV in the United States is immunization. Cryotherapy has been shown to be effective in the treatment of symptomatic cervical ectopy in other countries and can serve as a preventive measure for HPV as well. The purpose of this literature review was to compare the effectiveness of these two interventions on the incidence of HPV in women of childbearing age with cervical ectopy.
Method: PubMed and CINAHL databases were searched for any scholarly articles related to the topic and published between 2010 and 2021. The following keywords were used: cervical ectopy, cervical ectropion, cervical erosion, cervical eversion; HPV, Human Papillomavirus; vaccination, immunization; cryotherapy, cryocauterization, and cold therapy. Out of 25 relevant articles found, 14 matched the criteria.
Conclusion: Upon review of the literature, the implementation of cryotherapy and vaccination can help reduce the incidence of HPV. Further research is needed to evaluate which method of prevention would be most effective in women with cervical ectopy.
0408. STATIN USE AND DEMENTIA INCIDENCE
Author(s): Mariana Day Mentor(s): Eva Quirion
Abstract: There is a positive correlation between dementia and high cholesterol in midlife individuals, which has been indicated through research. In the analysis, it is stated that even though there is a possibility that statins could potentially prevent dementia, there are some safety concerns regarding the adverse effects of statins (Zhang et al., 2018). Purpose: This aims to clarify the effects of statins with relation to dementia and whether statins can prevent or reverse the disease (Flodgren & Berg, 2016). Due to safety concerns for users of statin medication, this will also clarify whether statins could lead to dementia (Zhang et al., 2018). Data Sources: Information was acquired from a review of literature from 2008 to 2019. Conclusion: Clinical trials show that prolonged statin usage in patients who have Alzheimer’s Disease (AD) does not change the disease’s pathology. Midlife dyslipidemia seems to play an essential role in the development of AD. Studies continue to show mixed results; however, the highest-quality studies display that statins have a protective effect in preventing dementia if taken during midlife. Based on the abovementioned research, memory loss and confusion are associated with statin use within one or multiple years from beginning treatment. However, statins were not associated with dementia or even with significant cognitive decline, and the symptoms tend to resolve once the medications were discontinued. The providers need to take into consideration the patient’s benefits as compared to associated risks and apply shared decision making before the medication is discontinued.
0409. Communication with Patients on End of Life
Author(s): Danielle Fabian Mentor(s): Patricia Poirier
Abstract: Life expectancy is increasing along with rates of chronic disease due to advancements in therapies. These advancements to prolong life, necessitate the need for early end of life (EOL) discussions, starting with advanced care planning. Early discussions with patients, lead to better patient satisfaction, better quality of life, and less stress for the family. Purpose: This paper will discuss the patient and provider barriers to approaching EOL discussion along with facilitators that improve communication. Other topics discussed will be how EOL care is evolving and the nursing implications on EOL. Data Base: Information was obtained through a review of literature between 2016 through 2020. Data bases used were CINAHL, Google Scholar, and OneSearch. Conclusion: Improved patient outcomes and satisfaction in the context of end of life (EOL) care, is having early discussions. Literature shows that introducing advanced care planning in a timely manner allows the patient and family time to process and plan for their last wishes. Barriers are identified on both the patient side and provider side for advanced care planning. Implications for Practice: Literature shows a lack of formal education in medical training on advanced care planning and how to effectively communicate with patients on EOL discussions. Incorporating advanced care planning and EOL discussions within school curriculum could predictably prepare providers to feel better prepared. Continuing education within employment will help maintain skills in communicating difficult material to patients and their families.
0410. Opioid Use Disorder Treatment Availability During the COVID-19 Pandemic
Author(s): Claire Collins, Ashley Oullette, Abigail Danforth, Jane Stevens Mentor(s): Valerie Herbert
Abstract: The US has been experiencing an opioid epidemic over the past decade, that has “continued to surge substantially, realizing 300–400% increases among some populations” (Cochran et al., 2020). Our focus was, in adult patients with opioid use disorder (OUD), how has the treatment availability been affected by COVID-19, compared to treatment availability prior to the pandemic? The pandemic has drastically increased the demand for remote care models involved in the access to medications for OUD. Methods Information was collected using the CINAHL database, PubMed database and Google Scholar. We searched these databases for evidence based practice articles related to OUD and treatment availability, before and after the COVID-19 pandemic. Keywords used in our search included: OUD, treatment availability, and COVID-19 pandemic. A total of 773 articles were found and 12 were used. Outcomes of the Project After review of the literature, certain interventions such as prescribing patients more take-home medication, shortening medication refill windows, or eliminating the need for face-to-face refill requirements, may increase treatment availability to pre-pandemic levels for OUD patients. The literature also recommends that in addition to psychiatrists being able to prescribe these treatments, pharmacists should be able to as well. Lastly, it is recommended to initiate peer-to-peer and telehealth meetings to prevent overdoses. Interventions should be implemented in various healthcare facilities and out-patient clinical settings which can minimize the impact of decreased in-person care.
0411. Effect of Remote Mental Health Services on Anxiety and Depression Rates During the COVID-19 Pandemic
Author(s): Stephanie Nichols, Jennifer Turner, Miranda McKim Mentor(s): Valerie Herbert
Abstract: Focus The COVID-19 Pandemic has created isolation, fear, and stress on a global scale. This tumultuous environment has left devastating effects on mental health, specifically anxiety, depression, and insomnia. Additionally, safety and distancing guidelines have greatly limited the access to in person mental health treatment. The purpose of this literature review is to analyze the benefits of remote mental health services and determine if these services decrease rates of anxiety, depression, and stress disorders in adults when compared to in-person services during the COVID-19 pandemic. Methods The databases consulted for this literature review were PubMed and CINAHL. The search was conducted using the following keywords: ‘COVID-19’, ‘pandemic’, ‘disaster management’, ‘emergency’, ‘emotional distress’, ‘mental health’, ‘depression’, ‘telehealth’, and ‘telemedicine’. A total of 22 articles were examined for usability and 13 articles were incorporated into this literature review. Outcomes The literature has shown that the COVID-19 pandemic has led to significantly increased rates of anxiety, depression, and stress disorders. The literature also points to the efficacy of telehealth in managing mental health disorders. After review of the literature, it is evident that telehealth services are a viable solution for the reduction of anxiety, depression, and stress disorders among adults affected by the COVID-19 pandemic.
0412. The Effects of Nurse Patient Ratios on Geriatric Patient Outcomes
Author(s): Deanna Kolenovic, Emma Moulton, Taylor Jackson, Victoria Shepardson Mentor(s): Valerie Herbert
Abstract: PICO Question: In hospitalized geriatric patients (age 65 and older), how do higher nurse to patient ratios compared to lower nurse to patient ratios affect patient outcomes in the last five years?
Topic and Purpose
The level of patient safety and outcomes accomplished depends on the quality of care provided. This study examines how nurse staffing contributes to patient outcomes among hospitalized geriatric patients. The purpose of this study is to identify potential areas of improvement for patient safety and outcomes.
The researchers examined the CINAHL Database on the University of Maine’s Fogler Library website using keywords including nurse-to-patient ratio, geriatric patient outcomes, quality indicators, nurse staffing, and adverse effects. We used all evidenced based and peer reviewed articles published within the last 10 years for our research. Twelve evidence based, peer reviewed articles published within the last ten years were found and three were chosen to be analyzed for the study. The researchers organized data into a table to analyze patient outcomes related to nurse-to-patient ratios.
Upon review of the literature, increasing nurse patient ratios may positively impact patient outcomes in hospitalized geriatric patients. The data suggests increasing nurse patient ratios should be implemented in all hospital units with geriatric patient populations. This intervention should decrease mortality, shock, medication errors, ulcers, restraint use, unplanned extubation, patient falls,infections, pneumonia and patient length of stay. Further research is required to determine recommendations for optimal nurse patient ratios on geriatric units.
0413. A Quality Improvement Approach to Reducing Hospital Readmission Rates in Heart Failure Patients
Author(s): Anna Cresse, Natalia Budri, Eliza Palow, Reilley Joyce Mentor(s): Valerie Herbert
Abstract: PICO Question:
In heart failure patients over 50, would implementing discharge education, interdisciplinary collaboration and medication management lead to improved treatment outcomes and decreased readmission rates within 30 days?
Topic and Purpose:
Heart failure is a leading cause for readmission in elderly patients, leading to increased healthcare costs, patient mortality and decreased quality of life. Hospital readmissions related to heart failure are associated with a lack of interprofessional collaboration, non-compliance to treatment regimens, and knowledge deficits regarding the disease process. The purpose of this review is to identify interventions to reduce 30-day readmission rates of patients with heart failure.
Using the CINHAL database on the University of Maine Fogler library website, fifteen articles were initially found regarding heart failure readmissions, the impact on health outcomes and different interventions that can be used to decrease readmission rates. Key words such as heart failure, readmissions, teach-back method, interdisciplinary collaboration and medication management were utilized. Ten articles were used to research the PICO question. Evidence-based and peer reviewed articles published within the last five years were used.
Upon review of the literature, several effective interventions were identified. These included using the teach-back method during patient education, collaborating with other healthcare team members and individualized patient care. These resulted in improved patient satisfaction, improved health outcomes and reduced readmission rates. The outcomes will be put into a table and further analyzed. These interventions should be implemented during the initial admission within the interdisciplinary care team. Further analysis will be needed to determine the most effective interventions in specific populations
0414. The Effect of Group Activities on Cognitive Decline in Those Diagnosed with Dementia
Author(s): Hannah Nadeau, Gabbi Kaczynski, Katie Swanson, Megan Sobiech Mentor(s): Valerie Herbert
Abstract: PICO In elderly patients with dementia, how does participating in group activities compared to not participating in group activities affect the decline in cognitive functioning within one year? Background Over 50 million people worldwide have been diagnosed with dementia. The purpose of this study was to determine the importance of and if participation in activities such as listening to music, or exercising, could affect the cognitive decline of those with dementia. Methods We conducted a literature review using peer reviewed studies from CINAHL and Google Scholar databases that had been published within the last 5 years. A total of 16 articles were found, but only 12 studies were used. Through using the key words dementia, cognitive decline, and group activities, our research team narrowed the search to include studies looking specifically at the impact of group activities on cognitive decline. Outcomes Group activities do not conclusively delay the cognitive decline of elderly adults with dementia. These activities did have a significant impact on quality of life. This being that group activities such as exercise helped clients meet their intellectual, social and emotional needs, while also helping prevent physical decline and serious events such as falls. Lastly, the research found that older adults who had consistent intellectual, social, and emotional stimulation decreased their risk for a diagnosis of dementia later in life. Further research is still needed to determine what activities increase quality of life in those with dementia, and what frequency of activities can help prevent cognitive decline.
0415. Benefits of Female External Urinary Catheters
Author(s): Mary Chamberlin, Andrea Bresnah, Jamers Cramer, Sierra Harmon Mentor(s): Dr. Valerie Herbert
Abstract: Catheter associated urinary tract infections (CAUTI) are the leading cause of healthcare associated infection in the United States. It is essential to consider ways to reduce these infections as many patients require some form of bladder drainage during their hospital stay. The purpose of this review is to examine whether female external urinary catheters (FEUCs), a non invasive alternative to indwelling bladder catheters, reduce rates of infection and skin breakdown in these patients. Methods and Results Using CINAHL and other scholarly databases connected to the University of Maine System, ten evidence-based, peer-reviewed articles related to the efficacy of various catheter types were selected from approximately 15 relevant articles, and subsequently studied. The articles, published within the last five years, were related to evidence-based practice and care. Articles were found using search phrases such as: “external catheter efficacy,” “harm reduction with FEUCs,” and “benefits and risks associated with external/indwelling catheters.” The conclusion of the study and information regarding indwelling catheters versus FEUCs were summarized. Conclusion After reviewing the literature, the study concluded that the incidence of CAUTIs decreases with the use of FEUCs. Decreased CAUTI rates were especially high in intensive care units. FEUCs also prevent skin breakdown. FEUCs should become part of the protocol for decreasing infections and skin breakdown obtained in hospital settings. More research is needed to develop best practices for incorporating these devices into everyday use.
0416. Effects of Volunteering on the Health of Older Adults in a Caregiving Role
Author(s): Rachel Coleman, Jennifer Crittenden Mentor(s): Jennifer Crittenden
Abstract: Caregiving for a dependent and increases in age are both associated with declines in health and wellbeing, though this may be mitigated through the physical and mental health benefits associated with volunteer participation. To explore the impact of volunteer involvement on the health of those who are both older adult caregivers and volunteers, demographic and activity data from a longitudinal sample of caregivers aged 55 and older from the National Survey on Caregivers (NSOC) was analysed to identify significant health changes for those who were not volunteering in round II (2015) and then began volunteering in round III (2017) (n=56). NSOC is supplemental to the National Health and Aging Trends Study (NHATS) survey of people who are 65 or older and receive Medicare benefits.
Caregivers’ general health was provided through self-assessment on a Likert scale of 5 (excellent) to 1 (poor). A paired t-test revealed significant correlations between round II (m=3.52) and round III (m=3.57) caregiver self-reported general health but no significant difference between means. Base weights provided by NSOC were then applied to the data (round II N=534,149, round III N=867,614). An unpaired two-tailed t-test of this weighted data revealed a statistically significant difference (p<0.0001) between the round II mean general health score of 3.51 (SD=1.011) and the round III mean general health score of 3.56 (SD=1.024), indicating that volunteer participation for the month prior to assessment improved general health self-assessment.
0417. Frontline Leadership Nursing Program
Author(s): Sarah Hanscome, Lori Fiandaca Mentor(s): Patricia Poirier
Abstract: The Future of Nursing: Leading Change, Advancing Health recommends that nurses should be prepared and enabled to lead change to advance healthcare in the United States. Often time, frontline nurses are placed in leadership positions without the proper training to meet the evolving healthcare system challenges. Providing thorough educational training to frontline nurses is key to providing patient-centered care that is based on safe practices, regulatory guidelines, and professional standards of practice. An electronic search of the literature was conducted using the following keywords: Frontline leader, charge nurse, and leadership skills. The literature supported the use of formalized training to improve nurses’ knowledge, skills, abilities, and attitudes in an array of leadership competencies. However, the literature showed a lack of formalized leadership training and education for frontline nursing leaders around the country. Due to the evolving and increasingly complex healthcare system, the need for formalized Frontline Nursing Leadership Programs is critical for providing safe and efficient care. With the support of hospital administration, a year-long leadership program will be developed for frontline leaders. The initial part of the project requires curriculum development and nurse leader approval. Once approved, the education will be provided monthly. An evaluation will be done pre-and post-program using a five-point Likert Scale. The evaluations will be compared to assess for improvement and program success. The goal of the Frontline Nurse Leader Program is for nurses to acquire skills that will improve their practice, knowledge, and confidence in an array of leadership skills.
0418. Program Profile Project: How RSVPs Support Older Adult Volunteers Who are Working and Caregiving
Author(s): Abbie Hartford Mentor(s): Jennifer Crittenden
Abstract: Older adults are a key group of volunteers for the nonprofit sector and research by the Corporation for National and Community Service (CNCS) in 2015 revealed more than 21 million older adults volunteered over 3.3 billion hours of service in their communities. Despite this, the rate of formal volunteering is decreasing as rates of participation in other roles are increasing. Recruiting and retaining volunteers is a complex task with a variety of supports tailored to volunteer needs in order to ensure ongoing volunteer participation. With such complexities further research is needed to better support volunteer organizations and their volunteers as they seek to recruit and support volunteers over the long-term. The Retired and Senior Volunteer Program (RSVP) is a national program that trains and places older adult volunteers. This Phase 3 of a multi-phase study focusing on older adult volunteers examined strategies RSVP sites have implemented that support volunteers who are holding multiple life roles such as working and/or caregiving. This poster presentation will review findings from semi-structured qualitative interviews conducted with eleven RSVP sites across the United States. Participating RSVPs ranged in size from 50 volunteers to 650 volunteers. Interview analysis revealed six main category themes including onboarding practices that are sensitive to the needs of older workers and caregivers and offering one-time and flexible volunteer opportunities. This presentation will examine all six thematic categories. This research will culminate in the creation of a program that will instruct other volunteer programs in implementing similar best practices to better support volunteers.
0419. Healing the Cycle of Intergenerational Trauma: The Family Nurse Practitioner’s Role
Author(s): Jessica Alicea-Santiago Mentor(s): Dr. Patricia Poirier and Dr. Owen-Williams
Abstract: The Family Nurse Practitioner provides care to individuals across the lifespan including members of families–often the entire family–with exposure to Adverse Childhood Experiences (ACEs). With the rising prevalence of ACEs since original research was conducted over two decades ago, current literature is calling for increased screening of ACEs in primary care, transforming delivery of care to a trauma-informed approach, and–ideally–primary prevention of trauma. An intergenerational cycle of abuse is common and includes physical, emotional, and sexual abuse; physical and emotional neglect; witnessing domestic violence; having a family member with mental illness, substance abuse, or incarceration; and losing a parent due to separation or divorce. Increased exposure to ACEs increases risk of cognitive-social-emotional dysfunction which leads to risk for chronic disease and premature mortality. Attention to the prevalence and implications of ACEs is further magnified by the concurrent phenomenon of America’s rapidly aging population. Aging, itself, is a risk factor for accruing lifetime trauma and is implicated in challenging end of life experiences. Further research is needed to examine the implications of providing end of life care to one’s parents in the setting of ACE exposure and intergenerational trauma. Review of the literature reveals the extensive scope of ACE impact, challenges of the aging population in regards to caregiving, and the role of the Family Nurse Practitioner in trauma prevention strategies, universal screening practices, implementation of trauma informed care, and incorporating intergenerational storytelling to promote resilience and empowerment of the entire family throughout the life continuum.
0421. Making Aging in Place Possible for Maine Seniors
Author(s): Briann Andrews Mentor(s): Kelley Strout
Abstract: This paper is a systematic review of literature about the population shift that is occurring worldwide with the potential implications it has on the future care for older adults and their ability to “age in place” in Maine. There were a total of 23 sources included in this review. The period of time covered in the review ranged from 2008-2021. It is proven that Maine is the oldest state in the nation per capita of total population. Advancing age results in functional changes that can affect a person’s ability to provide proper care for themselves. A large proportion of adults are wishing to age in the community, and they desire to stay within their homes. When early identification and interventions are implemented, Family Nurse Practitioners (FNP) are in a position to develop and assist in the execution of a comprehensive and coordinated plan while developing a close provider-patient relationship to help preserve the individual’s ability to age in place without having to enter a care facility. The FNP can use a comprehensive geriatric assessment to identify functional needs and potential deficits in care; they can also have conversations at the beginning of their relationship to identify the patient’s goals of care. They can assist in the collaboration of other professions, like occupational therapy, to make recommendations for necessary home adjustments to ensure safety and success while staying in their home and community as they age. Long-term care placement in Maine has limited capacity and has had documented negative psychological effects on individuals. Many make every attempt to avoid this placement and with the early intervention facilitated by the FNP there is a greater chance of people successfully aging in place.
0423. Early Home Visiting Programs: A Key Component of Maternal and Infant Health in Maine
Author(s): Rebecca Bolduc Mentor(s): Dr. Patricia Poirier
Abstract: Early home visiting (EHV) programs have received widespread support from healthcare providers and policy makers as an effective public health approach to improving the perinatal health of moms and babies. Recent literature supports that EHV programs improve birth outcomes, prevent and reduce child abuse and neglect, improve family relationships, advance school readiness, reduce preventable diseases, and ultimately reduce healthcare costs. The Center for Disease Control and Prevention supports that these resources available to families in the perinatal period directly correlates with the rise and fall in infant mortality rate. Maine utilizes three early home visiting programs: Maine Families, Public Health Nursing, and Early Head Start. These programs are state and federally funded, some serve target populations and some are universally offered. However, despite steady efforts to provide early home visiting services across the state, only a small percentage of families are served. Knowledge gleaned from the literature and expert interviews helps identify some of the barriers to program expansion in Maine. Possibly the most common barrier identified is the lack of program awareness by health providers. Nurse practitioners play a pivotal role in overcoming this barrier. As one of the fasting growing careers in the nation and as a profession that practices in a diverse array of healthcare settings, Maine nurse practitioners should be knowledgeable of the programs available, advocate for policy change, and make the referral when appropriate. Ultimately, more families would have home visitation and maternal and infant health in Maine would unquestionably improve.
0424. Education and Nursing Interventions of the Spinal for Injury Patient
Author(s): Amanda Cowan Mentor(s): Patricia Poirier
Abstract: Focus: Educating nursing staff on the various clinical responsibilities required in the holistic care of a spinal cord injury (SCI) is immense. It requires the nurse to be thoroughly educated, and in turn, well equipped for critically thinking regarding all aspects of bodily functions of the individual SCI patient.
Method or Process:
A systematic approach of evidence based literature, combined with an immersion experience of acute, intermediate, and chronic care of the SCI patients, is the foundation of the education being presented. A visual poster presentation, verbal explanation and printed educational handouts will be given to the audience and an informal Q&A will be allotted.
Outcomes of the Project:
In every stage of the SCI progression, there are key educational objectives that require correlated nursing inventions that are pertinent in the continuum of care. Dedicated education focused on each stage of SCI progression will contribute to increased patient outcomes and long term qualilty of living.
0425. Motivations and Experiences of Older Adult Volunteers: An Exploration of a Telehealth Simulation Experience
Author(s): Kayla Thompson Mentor(s): Jennifer Crittenden
Abstract: This presentation will explore Retired Senior and Volunteer Program (RSVP) participants’ experiences and motivations in regard to recruitment and participation in a telehealth nursing simulation. The UMaine School of Nursing partnered with the RSVP program to engage older adult volunteers as mock patients in a telehealth simulation training for nurse practitioner students. Volunteers were offered pre-simulation training to prepare for their role play assignment. The study encompasses three debriefing interviews following each volunteer’s participation in the virtual simulation. Following the debriefing interviews, transcripts were created and reviewed for accuracy. Transcripts were coded for recurring themes to determine the motivations and experiences regarding the participants’ volunteer simulation. Initial findings of the qualitative analysis determined that previous educational and volunteer experiences or personal experiences with healthcare were strong motivators to sign up for the simulation. Additionally, having an existing connection with the university was noted by volunteers. Other positive motivators identified include feeling helpful in teaching students. Volunteers reported an ease with the use of Zoom and noted that the telehealth platform facilitated their ability to engage in the role play s, citing being able to discreetly use “cheat sheets” and personalize the script. Lastly, volunteers identified that thorough training was essential to a positive role play experience. This summary presentation represents feedback gathered from debriefing interviews. It is anticipated that findings will accumulate over time to further solidify themes and guide future research efforts.
0426. Older Adult Nutrition Innovation Pilot: Partner Interviews
Author(s): Jennifer Jain Mentor(s): David Wihry
Abstract: In-home supports and proper nutrition are critical to post-acute recovery and long-term health management for adults 60 and older. Such supports are often difficult to deploy in rural settings. To address these challenges, a unique multi-sector consortium was formed between a local Area Agency on Aging, a healthcare system, a health technology company, and the University of Maine’s Center on Aging to conduct a clinical trial of a novel in-home health technology program paired with customized chronic care nutrition support. Early stage clinical trial development required coordination across health and community-based organizations to develop a pathway for older adults to access the in-home project supports. At the conclusion of the year one, six project partners were interviewed using a semi-structured interview protocol examining the strengths of early project design and challenges inherent in the early phases of a community-based clinical trial. Thematic analysis uncovered six themes instructive in formulating efficacious clinical trial methodologies: 1) Logistical challenges related to the pandemic, including reduced patient numbers and the curtailing of in-hospital recruitment; 2) Partner collaboration as essential to designing preferred project modifications; 3) The challenge of converting project referrals into project enrollees; 4)A new appreciation among community partners regarding institutional review board requirements; 5) Recommendations for addressing emerging staffing challenges; and 6) The overriding importance of engaging older adults in their own care and health promotion post-discharge. Results will inform construction of a replicable model for establishing novel research partnerships that span healthcare, social services, the business sector, and higher education.
0427. Operationalizing Person-centered Care in Long Term Care Settings: Initial Literature Review Findings
Author(s): Rocky Coastlines Mentor(s): Jennifer Crittenden
Abstract: Person centered care has been recognized as the gold standard in healthcare (Kitwood, 1998) for decades. But what exactly is person-centered care, what does it entail, and how can it be operationalized for long term care settings? At the University of Maine Center on Aging, the Mayer-Rothschild Designation of Excellence in Person-Centered Care Project has set out to explore this question in partnership with The Cedars, a person-centered retirement community in Portland, Maine. In this presentation, I will describe the first month of work completed on the project’s literature review and its initial findings. Through using the US Preventative Services literature review methodology, a database of relevant articles was compiled through searches using two different sets of inclusion/exclusion criteria: one for definitions of person centered care generally, and another specific to person-centered care in long term care settings. From the 152 academic articles compiled, 14 domains of person centered care as they relate to long term care were identified. We organized these into 4 overarching categories (me and my wishes and feelings; my family, friends, and community; my personal space and spared spaces; and my care providers) and applied ecosystem theory (micro, mezzo, and macro) and the Donabelian model (structure, process, outcome) to the compiled definitions and domains. The literature review team then engaged in free association as a research method (Randolph, 2015) to look at gaps in the existing literature and brainstorm new possible domains (justice and racial inequity, risk-taking, identity, and social isolation and loneliness). We have been able to apply these initial literature review research findings to inform the development of a survey, message board activity, and focus group, which will further contribute to creating a designation for person-centered care in long term care settings.