Medicine and Health Sciences Commons^™

The Perceived Benefits And Effectiveness Of Patient Feedback Systems In Strengthening Patient-Provider Relationships In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Introduction

Patient feedback system (PFS) forms an important entry point for the medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on the PFS in rural primary healthcare settings appears limited.

Objective

The paper examines the perceived role and efectiveness of PFS in improving therapeutic relationships building on the recent research on patient-provider relationships in rural Tanzania.

Methods

The paper examines the fndings of qualitative descriptive research conducted in the Shinyanga Region which employed a human-centred design (HCD) …

Interventions Co-Designed By Healthcare Providers And Clients For Improving Therapeutic Relationships In Maternal And Child Healthcare: A Pilot Study Using Human Centered Design In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Background

Research shows that poor provider–client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems.

Objective The study’s objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach.

Methods A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough …

Association Between Chronic Disease And Substance Use Among Older Adults In Tennessee, Manik Ahuja, Jessica Stamey, Johanna Cimilluca, Kawther Al Skir, Mary K. Herndon, Kathleen Baggett, Thiveya Sathiyasaleen, Praveen Fernandopulle

ETSU Faculty Works

Background:

Design and methods:

Improving Nursing Education Curriculum As A Tool For Strengthening The Nurse–Client Relationships In Maternal And Child Healthcare: Insights From A Human-Centered Design Study In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Background. There are growing evidence of poor nurse–client relationships in maternal and child health (MCH). The nursing curriculum forms an important entry point for strengthening such relationships, consequently improving client satisfaction with nurses' competencies, confidence in the formal healthcare system, healthcare-seeking practices, continuity with care, and MCH outcomes.

Objective. MCH nurses and clients were invited to design an intervention package (prototype) to improve nurse–client relationships using a human-centered design (HCD) approach.

Methods. A multi-step HCD approach was employed to first examine the contributors of poor nurse–client relationships using nine focus group discussions with nurses and clients and 12 key informant …

Telehealth Acceptance Among Appalachian Respondents During Covid 19: A Secondary Data Analysis, Victoria Hood-Wells, Florence M. Weierbach, Amy Wahlquist, Janet M. Keener, Manik Ahuja, Hadii M. Mamudu

ETSU Faculty Works

Purpose: The purpose of this study is to examine the relationship between telehealth use, telehealth satisfaction, and chronic medical conditions among residents living in Appalachian and non-Appalachian communities.

Sample: A COVID-19 public health survey was distributed via social media and healthcare clinics in the tri-state region of central Appalachia. Survey responses were limited to adults aged ≥18 years who consented to participate in the survey that self-identified as an individual with one or more chronic medical conditions (n=195).

Method: Simple descriptive statistics including frequencies, percentages, means, and standard deviations (SDs) were calculated for variables of interest both overall and by …

Design, Development, And Testing Of Best4baby, An Mhealth Technology To Support Exclusive Breastfeeding In India: Pilot Study., Tony Ma, Katie Chang, Amal Alyusuf, Elina Bajracharya, Yukiko Washio, Patricia J Kelly, Roopa M Bellad, Niranjana S Mahantashetti, Umesh Charantimath, Vanessa Short, Parth Lalakia, Frances J. Jaeger, Shivaprasad Goudar, Richard Derman

Department of Pediatrics Faculty Papers

Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries.

Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices.

Methods: A …

Factors Shaping Good And Poor Nurse-Client Relationships In Maternal And Child Care: A Qualitative Study In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Columba Mbekenga, Eunice Ndirangu, Constance Shumba

School of Nursing & Midwifery, East Africa

Background: Evidence indicates that poor nurse‐client relationships within maternal and child health (MCH) continues to impact trust in formal healthcare systems, service uptake, continuity with care and MCH outcomes. This necessitates contextualized innovative solutions that places both nurses and clients at the forefront as agents of change in optimizing intervention designs and implementation. This study explored nurses and clients’ perspectives on the factors shaping nurse‐client relationships in MCH care to generate evidence to guide subsequent steps of human centered design (HCD) that involve designing effective strategies for improving therapeutic relationships in Shinyanga, Tanzania.

Methods: Qualitative descriptive design was …

Healthcare Providers' Experiences With A Clinical Mentorship Intervention To Improve Reproductive, Maternal And Newborn Care In Mwanza, Tanzania, Kahabi Isangula, Columba Mbekenga, Tumbwene Mwansisya, Loveluck Mwasha, Lucy Kisaka, Edna Selestine, David Siso, Thomas Rutachunzibwa, Secilia Mrema, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Introduction: There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources—friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania.

Materials and Methods: A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) …

An Integrative Review: Best Practices In Advanced Practice Registered Nurse (Aprn) Telehealth Services To Improve Outcomes For Children With Chronic Health Conditions, Tamara Sue Moyer

Doctoral Dissertations and Projects

Telehealth is a rapidly growing field that affords individuals the opportunity to receive access to specialty providers, reduce expenses and travel, break down geographic barriers, deliver equality of care, and improve patient outcomes. Equality of healthcare for pediatric patients with chronic health conditions in rural areas face geographic barriers to delivery of care, resulting in poor patient outcomes, and increased costs. An integrative review was completed to identify and describe research findings in an attempt to answer the clinical questions proposed and identify areas in research that can lead to improved patient outcomes. The need to receive access to specialty …

Collaborating With Rural Practice Partners To Address The Need For Registered Nurses In Primary Care, Robin Brown, Heidi Mennenga, Alham Abuatiq, Linda Burdette, Christiana Plemmons

College of Nursing Faculty Publications

Purpose: Primary care in rural areas of the U.S. urgently need competent healthcare providers, especially registered nurses (RNs). Registered nurses are ideal team members to help meet the primary care needs in rural communities, yet RNs are underutilized in primary care settings and rarely practice to the full scope of their license in these settings. The purpose of the project was to conduct a needs assessment with rural primary care practice partners to address the need for RNs in primary care.
Sample: A needs assessment was sent to nurse leaders at 13 rural primary care facilities via an online survey …

Determining The Effectiveness Of System-Based Solutions To Improve Fragmented Care For Oncology Patients Living In Rural And Remote Regions: An Integrative Review, Andrea Nicole Fulmer

Doctoral Dissertations and Projects

The purpose of this integrative review is to review, critique, and synthesize the current literature to determine the state of the science related to the established systems approach for improving healthcare management and care coordination of the oncology patient population in rural and remote regions. The oncology patient population with co-existing chronic disease living in rural and remote regions experience fragmented health care. New cancer diagnoses take precedence over other existing comorbidities and require focused and specialized care for lengthy periods of time. Research is significantly limited for the current state of science for the identified patient population living in …

Implementing A Health Promotion Physical Activity Program For Middle School Youth In A Rural, Faith-Based Organization, Karmin Maher-Hasse

Doctor of Nursing Practice Projects

Problem: Childhood obesity is more prevalent in rural areas, and these areas have fewer resources to address it. Geographic distance to available resources, health care provider shortages, parental obesity, and poverty contribute to higher prevalence of obesity in rural children compared to urban children.

Rationale: Obesity prevention and treatment often requires long-term healthy lifestyle behavior changes including nutrition counseling and physical activity (PA). It is likely an obese pre-adolescent will have obesity as an adult, and the likelihood increases if obesity continues into adolescence. Pre-adolescence provides a window of opportunity to influence healthier PA habits to prevent overweight (OW) and …

Barriers To The Implementation Of Telehealth In Rural Communities And Potential Solutions, Mariana Barreiro, Ashley Coles, Caris Conradt, Emma Hales, Elizabeth Zellmer

Nursing Undergraduate Work

Telehealth is an ever-growing health care system, providing health services from a distance. Telehealth provides medical care through teletechnologies and two-way video and audio communication to connect doctors to patients. A detailed review was created to show the barriers and interventions of implementing a telehealth program in a rural area. The overall purpose of the systematic review was to find and explore relevant research and answer the question, “What are commonly encountered barriers to implementing telehealth in rural areas and what interventions can nurses implement to overcome these barriers?” The approach used to obtain quality data and research was convenience …

Rural Definition Consistency Among U.S. Veteran Studies: A Rapid Review Of The Literature, Jed Hansen, Abbey Klein, Christine Eisenhauer, Marcia Shade

Posters and Presentations: College of Nursing

No abstract provided.

Enhancing Access To Parenting Services Using Digital Technology Supported Practices, Elaine Bennett, Wendy Simpson, Cathrine Fowler, Ailsa Munns, Jane Kohlhoff

Nursing Papers and Journal Articles

Background: Early parenting services (EPS) in Australia provide a range of expanding and rapidly changing services, including innovative digital technologies to improve service access for metropolitan and rural families.

Aim: This research aims to provide comprehensive information required for the planning, implementation and evaluation of the use of digital technologies for service delivery with parenting/child and family services in Australia and New Zealand in metropolitan and rural settings.

Methods: An interpretive descriptive approach was applied using semi-structured interviews from 23 EPS practitioners and managers in five sites.

Findings: These are presented as five main themes – preparing the way, practitioner …

Querying Rural Content Experts Using An Online Questionnaire, Marilyn A. Swan, Barbara B. Hobbs

College of Nursing Faculty Publications

Purpose: Obtaining feedback from rural content experts is critical in developing valid and reliable instruments to advance the science of rural health. However, traditional methods, i.e., focus groups are impractical due to location and distance. Using an online questionnaire combined with telephone and email contacts to obtain content experts’ feedback is discussed. Item statement analysis and efficiency and effectiveness of the process are presented.
Methods: The process included the development of an online questionnaire, asking experts to rate 51 item statement for their relevancy, sufficiency of description, and clarity and readability. To increase the response rate, a series of four …

Evidence-Based Guidelines And Protocol Implementation In A Primary Care Clinic To Improve Chronic Asthma Care, Jo E. Cote

Doctor of Nursing Practice Projects

The aim of this project was to pilot the implementation of evidence-based guidelines and protocols for chronic asthma care in a rural primary care clinic system. Asthma is under-diagnosed and under-treated, resulting in significant burden of disease. Achieving asthma control requires collaborative care between the patient and healthcare clinicians. Education on evidence-based guidelines was provided to healthcare clinicians. Effectiveness of education and integration of altered workflow was measured. Integration of evidence-based guidelines and protocols was demonstrated by clinicians. The results support expanding the project to the remaining five clinics in the clinic system.

The Effectiveness Of Mi Smart: A Nurse Practitioner Led Technology Intervention For Multiple Chronic Conditions In Primary Care, Jennifer A. Mallow Phd, Laurie Theeke, Elliott Theeke, Brain K. Mallow

Faculty & Staff Scholarship

Aims: Used as integrated tools, technology may improve access and outcomes of care. A new inter- vention that integrates multiple technologies called mI SMART has been developed, implemented, and evaluated by Nurse Practitioners. The aim of this paper is to present the initial effectiveness of a web- based, structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural, chronically ill patients by using technology.

Methods: The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults. Adults with at least one chronic condition, a minimum of …

Prevalence And Factors Associated With Underutilization Of Antenatal Care Services In Nigeria: A Comparative Study Of Rural And Urban Residences Based On The 2013 Nigeria Demographic And Health Survey, Emmanuel O. Adewuyi, Asa Auta, Vishnu Khanal, Olasunkanmi D. Bamidele, Cynthia P. Akuoko, Kazeem Adefemi, Samson J. Tapshak, Yun Zhao

Research outputs 2014 to 2021

Introduction Antenatal care (ANC) is a major public health intervention aimed at ensuring safe pregnancy outcomes. In Nigeria, the recommended minimum of four times ANC attendance is underutilized. This study investigates the prevalence and factors associated with underutilization of ANC services with a focus on the differences between rural and urban residences in Nigeria. Methods We analyzed the 2013 Nigeria Demographic and Health Survey dataset with adjustment for the sampling weight and the cluster design of the survey. The prevalence of underutilization of ANC was assessed using frequency tabulation while associated factors were examined using Chi-Square test and multivariable logistic …

Rural Emergency Nurses’ Suggestions For Improving End-Of-Life Care, Renea L. Beckstrand, Kelly E. Smith, Karlen E. (Bethy) Luthy, Janelle L. B. Macintosh

Faculty Publications

Introduction: Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments.

Methods: A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify …

The Nursing Community Apgar Questionnaire In Rural Australia: An Evidence Based Approach To Recruiting And Retaining Nurses, Molly Prengaman, Daniel R. Terry, David Schmitz, Ed Baker

Nursing Faculty Publications and Presentations

Purpose: To date, the Nursing Community Apgar Questionnaire (NCAQ) has been effectivly utlized to quantify resources and capabilities of a rural Idaho communities to recruit and retain nurses. As such, the NCAQ was used in a rural Australian context to examine its efficacy as an evidence-based tool to better inform nursing recruitment and retention.

Sample: The sample included nursing administrators, senior nurses and other nurses from six health facilities who were familiar with the community and knowledgeable with health facility recruitment and retention history. Participants were registered nurses and/or directly involved in nursing recruitment.

Method: The 50 factor NCAQ was …

Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences: Stories From The Last Frontier, Renea L. Beckstrand, Jonathan Rohwer, Karlen E. Luthy, Janelle L. B. Macintosh, Ryan J. Rasmussen

Faculty Publications

Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles.

Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting.

Results: The lack of an ideal death (eg, the nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians.

Discussion: Rural emergency nurses often provide …

Examining Factors Influencing Colorectal Cancer Screening Of Rural Nebraskans Using Data From Clinics Participating In An Accountable Care Organization: A Study Protocol., Lufei Young, Jungyoon Kim, Hongmei Wang, Li-Wu Chen

Journal Articles: College of Nursing

BACKGROUND: Although mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. Understanding and eliminating barriers to cancer screening will decrease cancer burden and lead to substantial gains in quality and quantity of life for rural populations. However, existing studies have shown inconsistent findings and fail to address how contextual and provider-level factors impact CRC screening in addition to individual-level factors.

PURPOSE: The purpose of the study is to examine multi-level factors related to CRC screening, and providers' perception of barriers and facilitators of …

Rural Characteristics Tool, Heidi A. Mennenga, Laurie Johansen, Becka Foerster, Lori Hendrickx

College of Nursing Faculty Publications

This tool examines current knowledge and confidence in teaching rural characteristics.

Safe Motherhood Training For Rural Health Care Workers In Odukpani Local Government Area Of Cross River State, Nigeria, Josephine Etowa, Ekaete Asuquo, Ani Etokidem

School of Nursing & Midwifery, East Africa

Maternal mortality remains a challenge in developing countries which bear 99% of global maternal deaths (WHO, 2014). Nigeria, India, Pakistan, Afghanistan and Ethiopia carry more than 50% of the global burden of maternal mortality. According to the UNDP Human Development Report (2014), Nigeria’s maternal mortality ratio of 630 per 100,000 live births ranks among the highest in Africa. Two countries accounted for one third of all global maternal deaths: India at 17% (50 000) and Nigeria at 14% (40 000) (WHO, 2014).. Archibong and Aghan (2010) found that hospital based maternal mortality ratio in Cross River state was 1,513.4per 100,000 …

Menopause, Rurality, And Obesity In Rural African American Women, Colleen Kilgore

FIU Electronic Theses and Dissertations

In the US, one in every eight deaths is due to an obesity-related chronic health condition (ORCHC). More than half of African American women (AAW) 20 years old or older are obese or morbidly obese, as are 63% of menopausal AAW. Many have ORCHC that increase their morbidity and mortality and increase health care costs. In 2013, 42.6 percent of AAs living in South Carolina (SC) were obese. The purpose of this cross-sectional study was to identify the cognitive, behavioral, biological, and demographic factors that influence health outcomes (BMI, and ORCHC) of AAW living in rural SC. A sample of …

Recruitment And Retention Of Rural Nursing Students: A Retrospective Study, J. Bigbee, D. Mixon

Nursing Faculty Publications and Presentations

Introduction: The shortage of registered nurses is an issue globally, but particularly in rural and remote areas. Previous research in medicine suggests that recruiting students from rural backgrounds is an effective strategy to enhance the supply of rural healthcare providers. This strategy has not been widely adopted or evaluated in nursing. The purpose of this study was to compare rural and urban nursing students in relation to application, admission, and retention/graduation trends at a metropolitan state university in the Pacific Northwest area of the USA.
Methods: A retrospective longitudinal descriptive design was used, analyzing existing data from 2005 to …

Differences And Similarities In Rural Residents’ Health And Cardiac Risk Factors, Florence M. Weierbach, Bernice Yates, Melody Hertzog, Bunny Pozehl

ETSU Faculty Works

Purpose: The current U.S. population exceeds three hundred million with approximately 20% living in non-urban rural areas. A higher percentage of rural residents have diagnosed heart disease and report poorer health compared to non-rural residents; however, it is not known whether risk factor modification for heart disease and health status differ based on degree of rurality. The purposes of this study were: 1) to compare differences in health status and cardiac risk factors between cardiac patients living in large and small/isolated rural areas, and 2) to compare the health status of rural cardiac patients with a national sample. Method: A …

The Influence Of Cognitive-Perceptual Variables On Patterns Of Change Over Time In Rural Midlife And Older Women's Healthy Eating., Bernice C, Yates, Carol H. Pullen, Jonathan Bruce Santo, Linda Boeckner, Patricia A. Hageman, Paul J. Dizona, Susan Noble Walker

Journal Articles: College of Nursing

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = …

The Last Frontier: Rural Emergency Nurses’ Perceptions Of End-Of-Life Care Obstacles, Renea L. Beckstrand, Virginia C. Giles, Karlen E. (Beth) Luthy, Lynn C. Callister, Sondra Heaston

Faculty Publications

Introduction: Caring for dying patients is part of working in a rural emergency department. Rural emergency nurses are prepared to provide life-saving treatments but find there are barriers or obstacles to providing end-of-life (EOL) care. This study was completed to discover the size, frequency, and magnitude of obstacles in providing EOL care in rural emergency departments as perceived by rural emergency nurses.

Methods: A 57-item questionnaire was sent to 52 rural hospitals in Idaho, Wyoming, Utah, Nevada, and Alaska. Respondents were asked to rate items on size and frequency of perceived obstacles to providing EOL care in rural emergency departments. …