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Building the Future: Rejecting, Rethinking, Redoing, Rejuvenating

Mon, 06/16/2014 - 1:57pm

Objectives: Traditional library work is spiraling downward. Health sciences librarians are taking on new roles such as embedded librarians or research data informationists. Simultaneously, institutionally mandated budget cuts force the question, "How do we maintain mission-critical work within our budget?" Survival means rejecting old service models, rethinking our roles, redoing our professional identity, and rejuvenating ourselves and our libraries.

Methods: The Library Fellows Program at the University of Massachusetts (UMass) Medical School is one response to the challenges we are facing. The fellows program, designed to foster the next generation of medical librarians, provides a two-year experience for newly graduated library science students, emphasizing hands-on learning and research into topics of information management and medical librarianship. This innovative curriculum incorporates training, professional development, mentorship, and research with the library as the learning laboratory. Curriculum components focus on medical librarianship foundations as well as rotations within core library functional areas. This paper serves as a project description and evaluation. It discusses organizational changes that necessitated and facilitated the structural changes surrounding this program and the resulting effect on staff and operations. The midpoint success of the program is determined and reported, with recommendations and future considerations.

Results/Conclusions: In early 2013, management at Lamar Soutter Library (LSL) planned organizational changes necessary to meet strategic initiatives and continue supporting the medical school's mission in the face of severe budget constraints. The final plan resulted in discontinuation of many traditional library activities, elimination of staff that supported those activities, and, ultimately, the development of the FELLOWS PROGRAM. In September 2013, three task forces were created to develop an implementation plan. A search committee was formed to begin the process of hiring three fellows. The Curriculum Task Force was charged with structuring the two-year fellowship program. The curriculum developed includes rotations through library departments, in-depth reference experience, expert searching training, structured projects, and performing research. The Reference Services Task Force was charged with developing a new reference model to replace the current triage and pager model. The Research Task Force was charged with laying the groundwork for creating a research environment in the library. With outside consultation, LSL developed a detailed evaluation plan. The program is in its eighth month. Modifications and refinements are being made as the first cohort experiences the program. The program has led to a redefinition of librarianship and a new professional identity based on a culture of achievement, research, and reflection.

Electronic Bedside Documentation and Nurse-Patient Communication: A Dissertation

Mon, 06/16/2014 - 1:41pm

Nurses are often the first members of the health care team with whom patients interact. The initial impression of the nurses’ receptiveness to the patients’ needs influences the patients’ views of their overall care. Researchers have suggested that understanding communication between individuals can provide the human link, or social element, to the successful implementation and use of electronic health records, including documentation (Lanham, Leykum, & McDaniel, 2012). Zadvinskis, Chipps, and Yen (2014) identified that the helpful features of bedside documentation systems were offset by the mismatch between the system and nurse’s workflow. The purpose of this micro-ethnography study was to explore the culture of nurse-patient interaction associated with electronic documentation at the bedside. Data were collected through passive participant observation, audio-taping of the nurse-patient interactions, and informal and semi-structured interviews with the nurses. A total of twenty-six observations were conducted on three nursing units at an urban healthcare facility in New England. These three units were occupied by similar patient populations and all patients required cardiac monitoring. Three themes consistently emerged from qualitative data analysis: the nurses paused during verbal communication, the nurses played a game of tag between the patient and the computer, and the nurses performed automatic or machine-like actions. The participants described these themes in the informal and semi-structured interviews. The nurses’ actions were observed during passive participant observation, and the audio-taped interactions supported these themes. Understanding the adaptation of caregiving necessitated by bedside electronic documentation will have a positive impact on developing systems that interface seamlessly with the nurses’ workflow and encourage patients’ active participation in their care.

Examining Change in Symptoms of Depression, Anxiety, and Stress in Adults after Treatment of Chronic Cough: A Dissertation

Mon, 06/16/2014 - 1:40pm

Background: Chronic cough is a common health problem with variable success rates to standardized treatment. Psychologic symptoms of depression, anxiety, and stress have been reported in association with chronic cough. The purpose of this study was to examine changes in the psychologic symptoms of depression, anxiety, and stress in adults with chronic cough 3 months after management using the ACCP cough treatment guidelines.

Methods: This study used a descriptive longitudinal observation design. The major tenets associated with the Theory of Unpleasant Symptoms were examined. Intervention fidelity to the study components was measured.

Results: A sample of 80 consecutive patients with chronic cough of greater than 8 weeks duration was recruited from one cough specialty clinic. Mean age of subjects was 58.54 years; 68.7% were female; 98.7% were white, and 97.5% were non-smokers. Mean cough duration was 85.99 months and mean cough severity was 6.11 (possible 0 –10; higher scores equal greater cough severity). Cough severity improved post treatment (n=65, M=2.32, (SE =.291), t (64) =7.98, p=.000); cough-specific quality-of-life also improved (n=65, M=9.17, (SE=1.30), t (64) =7.02, p=.000). Physiologic (urge-to-cough r=.360, ability to speak r=.469) and psychologic factors (depression r=.512, anxiety r=.507, stress r=.484) were significantly related to cough-specific quality-of-life and to cough severity (urge-to-cough r=.643, ability to speak r=.674 and depression r=.356, anxiety r=.419, stress r=.323) (all r, p=.01); social support and number of diagnoses were not related to either variable. Those experiencing greater financial strain had worse cough severity. Women, those experiencing financial strain, and those taking self-prescribed therapy had worse cough-specific quality-of-life. Intervention fidelity to the study plan was rated as high according to observation, participant receipt, and patient/physician concordance. Qualitative review identified potential areas of variability with intervention fidelity.

Conclusions: By measuring the factors related to the major tenets of the Theory of Unpleasant Symptoms, this theory has helped to explain why those with chronic cough may have symptoms of depression, anxiety, and stress and why these symptoms improve as cough severity and cough-specific quality-of-life improve. Moreover, by measuring intervention fidelity, it may be possible to determine why cough guidelines may not be yielding consistently favorable results.