College of Health Professions
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Item A Focus Group Study of Perceptions of Quality of Care Among Nurses in Nursing Homes(2010-09) Burke, George C.; Adams, Carmen AnnA research team conducted a focus group study of central Texas nurses over a period of several weeks during September and October of 2009, at four different long-term care facilities. The total number of respondents was 15. We sought insight into the experience of nurses in quality of care, the nurses' perceptions of management competence, and we sought the nurses' perceptions of their roles as contrasted with the roles of certified nursing assistants (CNAs). Basing our set of questions on those from a 2001 study of CNAs, we found that nurses view quality in a holistic manner - - meeting the physical, emotional and spiritual needs of the resident to the greatest degree possible. We found that nurses in one of the four facilities had made progress in cultural change. Nurses and families saw management competence as the effectiveness and speed in which managers responded to questions or complaints. The study found nurses to be motivated by the job itself, seeing it as a ministry to the elderly. Several managerial implications are included in the study, including management's role in quality, motivation, and cultural change.Item A Practitioner's Guide to Culturally Sensitive Practice for Death and Dying(2002-04) Cohoe, Merri; Contreras, Sue Ellen; Sparks, DebraThe purpose of this manual is to educate health care professionals in all areas of practice regarding religious and cultural beliefs in reference to end of life issues. This information is imperative to the helping process, and when utilized, will allow practitioners to provide the best possible service to clients. The following information is to be used as a general guideline and should not be considered definitive with respect to an individual's personal, religious, or cultural beliefs and perceptions. This manual is a collaboration of materials collected with the purpose of assisting practitioners in facilitating culturally and religiously sensitive service at this extremely fragile time in the helping process. In many circumstances, a lack of awareness or information deters professional engagement in times of grief and loss. This disengagement may be misconstrued as a lack of compassion, when in fact, the practitioner may lack the knowledge and cultural understanding required to serve diverse populations. This resource manual has been designed to enhance the multicultural perspective to include the traditions and beliefs of varied religions, denominations, and institutions concerning death and dying as a valuable component of practice applicable to diverse settings and professions. We encourage health care professions to utilize this tool, and when in doubt, to consult with the client. It is vital to remember that diversity exists not only between religions, but also within.Item A Profile of Nursing Assistants Employed in Central Texas Nursing Homes(1994-12) Ransom, Sandy; Fox, NancyNo abstract prepared.Item A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses(Multidisciplinary Digital Publishing Institute, 2020-04) Fulton, Lawrence V.; Beauvais, Bradley; Brooks, Matthew; Kruse, Clemens S.; Lee, KimberlyA major consideration for consumers and the residential construction industry is the cost–benefit and break-even of various sustainable construction options. This research provides a publicly available simulation that allows users to compare baseline construction options versus sustainable options and evaluates both break-even costs as well as environmental effects. This R Shiny Monte Carlo simulation uses common pseudo-random number streams for replicability and includes options for solar, rainwater harvesting, wells, Icynene foam, engineered lumber, Energy Star windows and doors, low flow fixtures, aerobic/non-aerobic/city waste treatment, electric versus gasoline vehicles, and many other options. This is the first simulation to quantify multiple sustainable construction options, associated break-even points, and environmental considerations for public use.Using user default parameters, coupled with a 100% solar solution for a baseline 3000 square foot/279square meter house with 2 occupants results in a break-even of 9 years. Results show that many of the sustainable options are both green for the environment and green for the pocketbook.Item A Publicly Available Simulation of Battery Electric, Hybrid Electric, and Gas-Powered Vehicles(Multidisciplinary Digital Publishing Institute, 2020-05) Fulton, Lawrence V.Volatility in energy markets has made the purchase of battery electric vehicles (BEV) or hybrid vehicles (HEVs) attractive versus internal combustion engine vehicles (ICEVs). However, the total cost of ownership (TCO) and true environmental effects, are difficult to assess. This study provides a publicly available, user-driven simulation that estimates the consumer and environmental costs for various vehicle purchase options, supporting policymaker, producer, and consumer information requirements. It appears to be the first to provide a publicly available, user interactive simulation that compares two purchase options simultaneously. It is likely that the first paper to simulate the effects of solar recharging of electric vehicles (EV) on both cost-benefit for the consumer and environmental benefit (e.g., carbon dioxide, oxides of nitrogen, non-methane organic gasses, particulate matter, and formaldehyde) simultaneously, demonstrating how, as an example, solar-based charging of BEVs and HEVs reduces carbon emissions over grid-based charging. Two specific scenarios are explicated, and the results of show early break-even for both BEV and Plug-in HEV (PHEV) options over ICEV (13 months, and 12 months, respectively) with CO2 emissions about 1/2 that of the gasoline option (including production emissions.) The results of these simulations are congruent with previous research that identified quick break-even for HEVs versus ICEV.Item A Report Card on Prevention Efforts of COVID-19 Deaths in US(Multidisciplinary Digital Publishing Institute, 2021-09) Shanmugam, Ramalingam; Fulton, Lawrence V.; Ramamonjiarivelo, Zo; Betancourt, Jose; Beauvais, Bradley; Kruse, Clemens S.; Brooks, MatthewCOVID-19 (otherwise known as coronavirus disease 2019) is a life-threatening pandemic that has been combatted in various ways by the government, public health officials, and health care providers. These interventions have been met with varying levels of success. Ultimately, we question if the preventive efforts have reduced COVID-19 deaths in the United States. To address this question, we analyze data pertaining to COVID-19 deaths drawn from the Centers for Disease Control and Prevention (CDC). For this purpose, we employ incidence rate restricted Poisson (IRRP) as an underlying analysis methodology and evaluate all preventive efforts utilized to attempt to reduce COVID-19 deaths. Interpretations of analytic results and graphical visualizations are used to emphasize our various findings. Much needed modifications of the public health policies with respect to dealing with any future pandemics are compiled, critically assessed, and discussed.Item A Simulation of Rainwater Harvesting Design and Demand-Side Controls for Large Hospitals(Multidisciplinary Digital Publishing Institute, 2018-05) Fulton, Lawrence V.Inpatient health buildings in the United States are the most intensive users of water among large commercial buildings. Large facilities (greater than 1 million square feet) consume an average of 90 million gallons per building per year. The distribution and treatment of water imposes a significant electrical power demand, which may be the single largest energy requirement for various states. Supply and demand-side solutions are needed, particularly in arid and semi-arid regions where water is scarce. This study uses continuous simulations based on 71 years of historical data to estimate how rainwater harvesting systems and demand-side interventions (e.g., low-flow devices, xeriscaping) would offset the demand for externally-provided water sources in a semi-arid region. Simulations from time series models are used to generate alternative rainfall models to account for potential non-stationarity and volatility. Results demonstrate that hospital external water consumption might be reduced by approximately 25% using conservative assumptions and depending on the design of experiment parameters associated with rainfall capture area, building size, holding tank specifications, and conservation efforts.Item A Unique Way of Delivering Aerosolized medications to Adults: A Translational Research with High Flow Nasal Cannula(2019-02) Ari, Arzu; Alcoforado, Luciana; Dornelas, ArmeleHigh flow nasal cannula (HFNC) has been developed to promote oxygenation and positive airway pressure in critically ill patients with respiratory failure. Although HFNC was not designed for aerosol drug delivery, we developed a unique way of delivering aerosolized medications to adults using a mesh nebulizer with HFNC.Item Accounting with “LIFO” vs. “FIFO”: The devil is in the details(Medical Group Management Association, 2015-04) Lieneck, Cristian H.The ongoing collaboration between the International Financial Reporting Standards (IFRS) and Federal Accounting Standards Board (FASB) has tax-related implications for medical group practices. One of the goals of this collaboration — harmonization of accounting standards across countries — has been pursued since post-World War II economic integration. Generally accepted accounting principle (GAAP) negotiations involve increased global transparency and similarity of accounting standard.Item Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?(Multidisciplinary Digital Publishing Institute, 2021-07) Brooks, Matthew; Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Mileski, Michael; Ramamonjiarivelo, Zo; Shanmugam, Ramalingam; Lieneck, Cristian H.The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.Item Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?(Multidisciplinary Digital Publishing Institute, 2021-07) Brooks, Matthew; Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Mileski, Michael; Ramamonjiarivelo, Zo; Shanmugam, Ramalingam; Lieneck, Cristian H.The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.Item Adaptive Music/Dance Therapy: An Activity to Improve Quality of Life in Long Term Care Settings(2010-05) Nauert, RickAs a result of medical advances and improved self-care, people are living longer. By 2050 government forecasts call for 86.7 million individuals aged 65 or older -- encompassing 20.6 percent of the total population. For many, advanced age is accompanied by reduction in mental capabilities and ambulatory capabilities necessitating a need for medical care and/or assistance to perform everyday activities. For the older, old (> 85 years), one of the fastest growing population segments, this often means living in an assisted living or long-term care facility. Although sadness and depression are not a normal characteristic of aging, nursing home residents are often depressed as a host of risk factors accompany aging and residency in a long-term care facility. Interventions to provide mental stimulation, overcome loneliness, foster social support, aid functional capabilities, and improve perception of care are needed for this special population cohort. In an effort to address these issues we initiated a pilot study of an intervention that blended active music therapy and modified danced therapy. Twenty-two residents from two senior facilities (19 skilled residents and 3 from an Assisted Living setting) were assessed. All skilled residents were wheel chair bound while assisted living residents were ambulatory. Three residents dropped from the study. Twice a week, 45-60 minute activity sessions were performed for 8 weeks. Pre-and post-study assessment of cognitive status, depression symptoms, and functional abilities were performed. Regression analysis discovered mild improvements in mental status and cognitive abilities and a significant improvement in depression scores (p = .000).Item Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review(JMIR Publications, 2017-10) Mileski, Michael; Kruse, Clemens S.; Catalani, Justin; Haderer, TaraBackground: Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. Objective: A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Methods: Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results: Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. Conclusions: This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of hypertension.Item Adoption and Utilization of Electronic Health Record Systems by Long-Term Care Facilities in Texas(American Health Information Management Association, 2012-05) Wang, Tiankai; Biedermann, SueLong-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities.Item Adoption Factors Associated with Electronic Health Record Among Long-Term Care Facilities: A Systematic Review(BMJ Publishing Group, 2015-01) Kruse, Clemens S.; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, ArianaObjectives: The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting: We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants: Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions: Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and Secondary Outcome Measures: Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results: Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions: Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs.Item Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review(Multidisciplinary Digital Publishing Institute, 2019-03) Mileski, Michael; Brooks, Matthew; Topinka, Joseph B.; Hamilton, Guy; Land, Cleatus; Mitchell, Traci; Mosely, Brandy; McClay, RebeccaPerceptions against the use of alarming devices persist in long-term care environments as they are seen as annoying, costly, and a waste of time to the staff involved. Ascertaining whether these perceptions are true or false via the literature was a focus of this study. Proper information to educate staff and to work past these perceptions can be a positive effector for resident safety. Many facilitators for the use of alarming devices were found, as well as many barriers to their use as well. New technology is changing the perceptions regarding these types of devices as time passes. Education is a key component for staff, residents, and families. There are “traditional” issues with the use of alarms such as alarm fatigue by caregivers, high costs of implementation, and issues with proper implementation of alarms. Alarms are perceived as intrusive and the noise from them can be a potential cause of falls. However, alarming devices can be a key intervention in the safety of those residents who are prone to falls. This requires proper implementation and education for all parties involved, and proper oversight surrounding use of the devices.Item An Analysis of a Statewide Survey and the Assessment of Needs within the Long Term Care Delivery System in the State of Texas(1995-09) Upchurch, Marian; Knox, BethThis needs assessment study addressed the needs of various components of the nursing home industry in Texas - those involved in management of long term care facilities, those involved in direct care of long tern care residents, owners of long term care facilities, those involved in regulatory aspects of long term care, and those involved consumers - direct and indirect - of services in long term care facilities. The assessment addressed structural, process, and educational needs of nursing homes. Ten key items were identified via several pretests and utilized in the final survey through a closed format Lilcert-type instrument and a narrative component which also allowed for an open-ended expression of ideas or concerns. The ten key items utilized in the final survey were: (1) Management training for all supervisors, (2) More geriatric nursing skills, (3) Increased physician involvement, (4) Greater consistency in the survey process, (5) Requirement for improved nurse aide to resident ratio, (6) More sensitivity by staff to resident needs, (7) Improvement in food quality and the dining environment, (8) Greater family involvement, (9) More homelike environment, and (10) More educational requirements in long term care for initial licensure as a nursing home administrator. Subjects were asked to rank these ten key items as well as to indicate how much should be done to address each item. In addition to the ten items included in the instrument, subjects were also given an opportunity to identify one additional specific concern in long term care. These comments were assembled and presented in the final report. Respondents gave an overall rating to the quality of care in nursing homes at 5.37 on a ten point scale. Consumers ranked care with a low of 2.6, while administrators recorded the highest rating of 6.8. The highest priority ranked item by the survey respondents was more sensitivity by staff to resident needs. The highest priority items were also grouped as structural, process, and educational needs, and analyzed with the following results. The structural item ranked highest in importance by the survey group was the requirement for improved nurse aide to resident ratio. The highest priority ranked process item was more sensitivity by staff to resident needs. Two educational needs emerged with highest priority rankings: the highest ranked was that of more geriatric nursing skills. Management training for all supervisors was ranked slightly lower. When the importance of the ranking of the ten items was contrasted with the desire to take action on each of the ten items, these same items appeared as the major four items to be addressed. The results varied when the rankings of the ten key items were analyzed by region of Texas or by position of the respondent. Consumers, regulators, and directors of nurses agreed that the highest priority of concern was the requirement for improved nurse aide to resident ratio. Owners and administrators believed the highest priority issue to be greater consistency in the survey process. An analysis of the highest ranked issues by region of Texas indicated that the east and west regions agreed that the highest ranked item was more geriatric nursing skills; central and south regions of Texas rated more sensitivity by staff to resident needs at the top rank; and the metropolitan areas of Texas indicated the requirement for improved nurse aide to resident ratio as the highest ranked item.Item An Evaluation of Alternatives for Providing Care to Veterans(Multidisciplinary Digital Publishing Institute, 2018-08) Fulton, Lawrence V.; Brooks, MatthewIn 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing and more than 10 thousand open or pending prosthetic/sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans during the phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be a viable consideration. Results suggest that TRICARE patient perceptions of quality are superior to VHA and non-VHA/non-DoD, that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance and that the cost per beneficiary of a TRICARE solution ($6.5 K/beneficiary) is far better than a VHA-only solution ($14.0 K/beneficiary), the CMS central payer solution ($12.2 K/beneficiary), or the status quo (between $12.2 K and $14.0 K/beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within or outside of the VHA.Item An Investigation of Quality Improvement Initiatives in Decreasing the Rate of Avoidable 30-day, Skilled Nursing Facility-to-Hospital Readmissions: A Systematic Review(Dove Press, 2017-01) Mileski, Michael; Topinka, Joseph B.; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, JennaObjectives: The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion: These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.Item Analysis of a Global Futures Trend-Following Strategy(Multidisciplinary Digital Publishing Institute, 2019-06) Nokes, Derek; Fulton, Lawrence V.Systematic traders employ algorithmic strategies to manage their investments. As a result of the deterministic nature of such strategies, it is possible to determine their exact responses to any conceivable set of market conditions. Consequently, sensitivity analysis can be conducted to systematically uncover undesirable strategy behavior and enhance strategy robustness by adding controls to reduce exposure during periods of poor performance/unfavorable market conditions, or to increase exposure during periods of strong performance/favorable market conditions. In this study, we formulate both a simple systematic trend-following strategy (i.e., trading model) to simulate investment decisions and a market model to simulate the evolution of instrument prices. We then map the relationship between market model parameters under various conditions and strategy performance. We focus, in particular, on identifying the performance impact of changes in both serial dependence in price variability and changes in the trend. The long-range serial dependence of the true range worsens performance of the simple classic trend-following strategy. During periods of strong performance, the dispersion of trading outcomes increases significantly as long-range serial dependence increases.