Both audiologists and hearing instrument specialists (HIS) can assess hearing loss and fit hearing aids; consumers interested in purchasing hearing aids can choose the type of hearing professional they see. However, there are vast differences in required training and scope of practice for each professional and advanced test batteries, such as those associated with vestibular assessment and tinnitus management, may distinguish the two professional groups more thoroughly than standard hearing testing and hearing aid fitting. This study aimed to determine the knowledge and opinions the average individual possesses regarding differences between these two types of hearing professionals in order to identify areas in which audiologists can more effectively differentiate themselves from hearing instrument specialists. A one-time survey was administered at 3 locations to a total of 47 English-speaking participants over the age of 18. Locations included the 2018 Remote Area Medical event in Gray, TN; the Johnson City Senior Center, and the Bristol Public Library. The survey consisted of 8 demographic questions with 3 additional questions if the participant wore hearing aids, followed by 18 questions that covered “Diagnostics,” “Intervention,” and “Interpersonal Patient Interactions.” Responses were analyzed for trends in overall data as well as in sub-categories for gender, household income, education level, age, and hearing aid use. Overall, participants tended to believe audiologists were most likely to perform tasks in the “Diagnostic” category, while a majority of participants believed both professionals could perform tasks in the “Intervention” category. There was no clear trend within the “Interpersonal Patient Interactions” category. Most participants believed that either both professional groups, or only audiologists, could perform most tasks adequately, indicating subjects likely do understand differences between the two professionals. In analyzing results, two issues emerged. The first was that the majority of participants believed that they would not be likely to pay a reasonable price for hearing aids when visiting either professional. One reason may be that only a few hearing aid companies produce most of the world’s hearing aids, leaving little room for low-cost competition. The “bundled” method which most hearing healthcare providers use for selling hearing aids along with services might also exert an influence on the perception of hearing aid pricing and may not be clear to patients who try to understand the actual cost of devices and services. Another issue identified in this survey was access. A significant number of respondents believed it was difficult to make and attend appointments with either professional, signifying a possible deficit in this area in access to hearing healthcare. The barriers to access included income, availability of transportation, inconvenient provider hours, and lack of insurance coverage. The results suggested that audiologists and HISs face challenges when recommending personal hearing devices to support rehabilitative efforts. Additionally, the provision of services that utilize advanced diagnostic batteries, such as balance assessment and tinnitus services, may offer audiologists an opportunity to distinguish their practices from those managed by HISs.

Introduction: Cardiovascular diseases (CVD) remain the leading cause of death in the United States (U.S.), accounting for one in three deaths annually. Within the U.S., disparities in CVD outcomes and risk factors exist across demographic groups and geographic areas, such as the Central Appalachian region where the burden is higher than state and national rates. Patient-centered care (PCC), is a model of health care delivery that has been shown to improves disease outcomes and quality of life, and is critical in addressing disparities in health care. However, little is known about how high-risk Central Appalachian populations understand or perceive such a model. As such, the objective of this study was to examine the perceptions of PCC among community-dwelling CVD patients/caregivers in the region. Methods: A qualitative study design applying thematic analysis was utilized for data collection and analysis. Seven focus group discussions across six states in Central Appalachia were conducted, and comprised of 78 middle-aged participants selected through purposive sampling. Sessions were guided by standardized instrument regarding current efforts in their communities concerning CVD; challenges and needs; appropriate approaches to their cardiovascular issues; understanding and views about patient-centeredness; and related priorities. The discussions were audio-recorded, transcribed, and then coded for thematic analysis using NVivo qualitative data analysis software. Dependability of data analysis was achieved through an audit trail tracking the NVivo process. Results: Data analysis identified interpersonal relationships with health care providers (HCPs) as the most important aspect of PCC among participants. When asked what PCC meant to them, each group discussed the interpersonal relationship they wanted from HCPs, barriers that kept them from achieving this relationship, and how it impacted their care. Within this theme, two overarching subthemes emerged: (1) developing long-term relationships with HCPs, and (2) developing partnerships with HCPs. The first theme had subthemes that included: turnover of HCPs in their geographical location, the disappearance of family physicians, and preferences related to seeing a physician versus a physician’s assistant or nurse practitioner. The second theme’s subthemes included: communication, feeling cared for as an individual, and input into care. Conclusion: Patients/caregivers stressed the importance of interpersonal relationships with providers in the delivery of PCC. However, patients recognized when PCC was not being provided, provided examples of interactions that were not conducive to providing PCC, and reported feeling disempowered as a person and a patient. The results of this research can be utilized to understand patient/caregiver perceptions of PCC, and indicates the need for further research to reconcile these viewpoints with those of providers to improve the delivery of care, and health outcomes.

Master of Public Health - MPH / Background: HIV remains a global concern. Consequently, global institutions such as the World Health Organisation (WHO) and United Nations Programme on HIV and AIDS (UNAIDS) continue to work towards ending HIV/AIDS by facilitating innovative strategies to improve service delivery of antiretroviral therapy (ART). In 2016 WHO issued the ‘test and treat’ policy recommendation in line with the UNAIDS 2020, 90-90-90 target of reaching 90% people to know their HIV status, get 90% of these on ART treatment and to have 90% of those on treatment virally suppressed. Differentiated Care Models (DCMs) has been put in place for all stakeholders, from global, institutes, government departments and civil society to improve patient access to treatment and retention in care. While various evaluation studies have shown that DCMs improve the retention in care and adherence to medication behaviours of patients on ART, little is known about the patients’ experiences and preferences. The aim of the current study was to explore and compare the experiences of patients in three DCMs (Facility Adherence Clubs [FAC], Community Adherence Club [CAC] and Quick Pharmacy Pick-up [QPUP]) in a community health care facility in a township in Cape Town, South Africa. Methods: An exploratory qualitative study design was used. Data were collected through semi-structured interviews (12) and focus group discussions (6) with purposively selected participants from six DCMs. Thematic analysis was done using Atlas.ti version 8.0. Results: Patients found DCMs easily accessible and convenient and presented positive experiences in relation to the National Health Services (NHS) patients experience principles. FACs and CAC presented attributes of patient-centeredness as prescribed by the NHI. We found that the QPUP model fell short on attributes of patient-centeredness such as coordination and integration of care, information sharing, communication and education, and emotional/psychological support. Conclusions: The principles of DCMs acknowledge the diversity and preference of PLHIV in addressing the barriers they face in accessing ART while empowering these patients to self-manage their disease. Understanding the experiences of patients using DCMs could improve our understanding of how DCMs promote self-management among PLHIV (or not) and some of the challenges faced by the patients using these care models. This understanding could inform strategies to tailor ART delivery services that suit the patients’ needs and enhance their abilities to achieve optimal retention in care and viral suppression.

Introduktion: Endometrios är en kronisk sjukdom som drabbar ungefär 10 procent av flickor ochkvinnor i fertil ålder. Tidigare forskning tyder på att hälso- och sjukvården saknar adekvat kunskapvilket i kombination med sjukdomens många olika symtom försvårar diagnostisering ochbehandling. Detta kan resultera i ett bemötande från vårdpersonal som leder till nedsatthälsorelaterad livskvalitet och välbefinnande för kvinnorna. Syftet: var att beskriva hur kvinnor med endometrios upplever bemötandet inom hälso- ochsjukvården. Metodbeskrivning: En empirisk studie med enkät som metod. Deskriptiv statistik ochinnehållsanalys användes för att sammanställa och analysera insamlad data. Resultat: Totalt 34 kvinnor ingick i studien. Följande fem kategorier framkom: Vårdpersonalensförhållningssätt; Vårdpersonalens kommunikation; Vårdpersonalens kunskap; Vårdmötet; Tid är enfaktor för patientdelaktighet. Resultatet visar både positiva och negativa aspekter gällande hurkvinnor med endometrios upplevde bemötandet inom hälso- och sjukvården. Slutsats: Studien synliggjorde förbättrings- och utvecklingsmöjligheter för vårdpersonal gällandebemötandet av kvinnor med endometrios. Likvärdig kunskap och bättre kommunikation mellanvårdpersonal har betydelse för bemötandet. Hänsyn behöver tas till kvinnors subjektiva upplevelserav sjukdomen, behandling och smärtlindring. Tid är avgörande för kvinnornas delaktighet i denegna vården. / Introduction: Endometriosis is a chronic disease that affects about 10 percent of women of childbearing age. Prior research suggests that healthcare services lack adequate knowledge of thedisease, which, in combination with the wide range of symptoms of the disease, makes diagnosisand treatment difficult. This can result in a response from healthcare professional that may lead toreduced quality of life and wellbeing for women. Aim: The aim was to describe how women with endometriosis perceive how women diagnosedwith endometriosis experience their encount with healthcare. Methods: An empirical study facilitated through the questionnaire method. Descriptive statisticsand content analysis were used to compile and analyze collected data. Results: A total of 34 women participated. Five categories emerged, including: Attitude ofhealthcare professionals; Communication of healthcare professionals; Knowledge of healthcareprofessionals; Encounters with healthcare professionals; Time as a factor of patient participation.The results show both positive and negative aspects regarding how women with endometriosisexperienced their encount with healthcare. Conclusion: The study highlighted opportunities forimprovement and development for healthcare professional regarding the encounting of women withendometriosis. Equivalent knowledge and better communication between healthcare professionalare important for the encounting. Women's subjective experiences of the disease, treatment and painrelief need to be taken into account. Time is crucial for women's participation in their own care.

Many scholars have written about the role of spirituality in health care. One mechanism for incorporating spirituality into the care of patients is to integrate clinically trained chaplains into hospital care teams. We examined in a mixed-methods fashion, the effects of this type of integrated care team within a teaching hospital setting. The quality and impact of chaplain involvement were studied from patient and physician-in-training perspectives, using data from more than 200 patients and physicians in training. Findings clearly show that clinically trained chaplains can contribute meaningful expertise and real value to the quality and comprehensiveness of patient and physician experiences.

When families use a listening and spoken language communication modality to communicate with their child, access to a rich linguistic environment through an intact auditory system is essential. In children with hearing loss, optimal auditory access is achieved through the consistent use of appropriately fitted hearing devices or other assistive hearing technology, allowing these children access to an ample language environment. Parents or caregivers of children with hearing loss or hearing concerns play a large role in facilitating their child’s use of hearing device, as well as supporting their child’s speech and language development, a potentially overwhelming experience for these families. The aim of this study was to continue a similar, previously completed project within the Audiology and Speech Language Pathology program at ETSU. The purpose of both studies was to improve parent self-efficacy, i.e., their confidence in their ability to optimize their child’s amplification use and linguistic exposure, increase family knowledge on language outcomes, and increase consistent use of amplification/treatment options by providing an educational workshop to families with children identified with hearing loss and/or hearing concerns. The current study was adapted based on caregiver feedback from the previous study. The hypothesis of this study was to see an enhancement of self-efficacy skills in parent participants. An educational workshop encompassing 1. the impact of hearing loss and/or hearing concerns on language development; 2. the importance of language exposure; 3. use and care of amplification/treatment options, and 4. empowerment to establish consistent device use in families that utilize amplification or other technology was delivered through a virtual meeting with participants. The participants’ self-efficacy skills regarding their child’s device use and language development were assessed and measured through a pre- and post-survey, the Scale of Parent Involvement and Self-Efficacy-Revised (SPISE-R). The SPISE-R surveys caregivers about their child’s device use as well as their perceptions of their own beliefs, knowledge, confidence, and actions pertaining to supporting their child’s auditory access and spoken language development. The assessment and workshop incorporated in this study were modeled after Ambrose et al. (J Early Hear Detect Interv, 2020) who developed the SPISE-R as a promising tool for use in early intervention to better understand and further support parent’s strengths and needs concerning their young child’s auditory access and spoken language development. Participants were recruited via email from an Early Intervention Specialist. A total of three pre-surveys were completed. Four parents attended the virtual workshop but none of them completed a post-survey. Therefore, data analysis was based on a comparison between the pre-surveys completed in the previous study (n=3) and in the current project. The results revealed that the participants from the current study rated themselves as having lower self-efficacy in supporting their child’s device use and language development than the participants of the previous project. Based on these results, future studies should consider: 1. recruiting from a larger pool of parents 2. hosting the workshops in-person instead of virtually 3. offering workshops multiple times to better accommodate parent schedules, and 4. shortening the survey.

To improve patient safety a major change in health care reduced medical resident work hours to limit provider fatigue, in 2002 (Philibert, Friedmann, Williams, & Hours, 2002). This resulted in mid-level practitioners filling this provider void in health care teams, including critical care units (Buchanan, 1996; Christmas et al., 2005; Hoffman, Tasota, Scharfenberg, Zullo, & Donahoe, 2003; Hoffman, Tasota, Zullo, Scharfenberg, & Donahoe, 2005; Hooker & McCaig, 1996, 2001; Kaups, Parks, & Morris, 1998; Miller, Riehl, Napier, Barber, & Dabideen, 1998; Yeager, Shaw, Casavant, & Burns, 2006). In order to make appropriate clinical decisions for patients in critical care settings, mid-level practitioners are required to interpret data from multiple sources and to assimilate this information in a timely manner (Bernard, Corwin, & MacIntyre, 2000). Although these practitioners are actively involved in decision making individually and among interdisciplinary teams in critical care units, their decision making has not been described in the literature to date (Shortell et al., 1994). Therefore, the purpose of this qualitative study was to describe how critical care mid-level practitioners (N= 17) make decisions within an interdisciplinary team, undergirded by the cognitive continuum theory. A qualitative research design using focus groups guided by naturalistic inquiry enabled data collection. An interview guide, developed from the literature review and undergirded by the cognitive continuum theory, was used to structure discussion in the focus groups. Additionally, a demographic questionnaire and vignette were used to aid in description of findings. Data was managed by note based analysis and summarized on a Microsoft Excel document. Qualitative description was used to illustrate the findings. Prior to this study, there was a paucity of empirical literature describing the clinical decision making of critical care mid-level practitioners. The findings revealed a web of complexity in mid-level practitioner decision making on an interdisciplinary team. This included an overarching theme of quality of care, with central overlapping themes of judgment, resources, and negotiation interwoven with sub-themes of trust, communication, experience, and team structure. This study’s findings have direct implications for mid-level practitioner training courses, mid-level training, critical care orientation programs, theory development, and health policy.

The educational medium GetWellNetWork (GWNW) in a large magnet teaching facility offered few educational videos specific to vascular patients with a focus on leg elevation after lower extremity bypass surgery. Supplying patient-specific education has the potential for providing cost-effective nursing care to vascular patients and improving hospital reimbursement. Guided by the interactive care model, a storyboard was developed using best-practice evidence for vascular postoperative patients that could lead to the development of a video to address the educational needs of vascular patients upon discharge. The practice focused question asked if a video addressing the importance of leg elevation would improve patients’ use of in-house educational videos and stakeholder satisfaction. A vascular physician (n = 1) and nursing staff (n = 9) provided feedback on the appropriateness of the evidence-based educational content for the storyboard by completing a 9-item, open-ended survey. Survey results supported development of the video and revealed positive feedback on storyboard content and that staff with 1–3 years’ experience or 15+ years’ experience had an increased understanding of the importance of evidence-based guidelines for leg elevation for vascular patients. The feedback will be used to develop a vascular-patient-specific educational video. Encouraging patients to view the video on leg elevation has the potential to improve cost effectiveness of patient care and hospital reimbursement, prevent hospital readmission that could lead to patient and caregiver hardships associated with readmission, and improve the health outcomes for postoperative vascular patients.

Chronic diseases impose heavy burdens on the United States health care system, particularly among some ethnic/racial groups such as American Indian and Alaska Natives who experience higher incidence of these diseases than non-Native population. In an effort to improve the health status of its patients, the Ukudigaunal Wellness Center (UWC) partnered with the Improving Patient Care (IPC) Collaborative to implement changes designed to improve chronic disease care for Native Alaskans through intensive monitoring of screening for chronic disease and selected chronic disease outcomes. For this program evaluation, the units of analysis were the changes in health service delivery and the resulting patient clinical outcomes. The data source was the Registration and Patient Management System (RPMS), repository for the data collected over the 14 months of the collaborative. The findings showed that the process measures that met IPC goals were due to improvements in service delivery by UWC. Goals for other services, such as diagnostic screenings, were not met because these clinical components had to be coordinated with facilities outside UWC. Outcome measures for BP and HgbA1c control were not met as these depended on the patients' abilities to self-manage the required procedures. The implications for social change included: (a) Positive outcome in managing chronic diseases is possible by combining chronic care models with Deming's model for improvement; (b) Increased patient awareness of chronic conditions and their long term consequences tended to support more responsible and successful patient self-management; (c) Use of external medical resources should be considered when patient privacy and confidentiality are concerns.

Background: SARS-coronavirus-2 is the virus that was discovered in december, 2019. Covid-19 gave rise to diffuse symptoms and continuously changing routines and guidelines have posed a challenge for health care. The nurse is responsible for helping patients maintain, gain or improve their own health and well-being. During the pandemic, patients have not been sufficiently informed and as a result have experienced a feeling of confusion and a fear of the disease and its treatment. Aim: The aim of this study was to describe nurses' experiences of caring for patients with covid-19. Method: A literature review with a qualitative approach that included 12 original articles. The articles were analyzed with Braun and Clarkes thematic analysis. Results: The result is presented as five themes that emerged during the analysis process: Caring for patients during overload, Caring for isolated patients with a newly discovered virus, Difficulty caring for with protective equipment, Fear of becoming infected and spreading the virus and Positive experiences of caring for patients with covid-19. Conclusions: Nurses have experienced that the challenges posed by the covid-19 pandemic have affected the physical and psychosocial environment as well as their ability to achieve good communication with patients. / Bakgrund: SARS-coronavirus-2 är viruset som upptäcktes i december, 2019. Covid-19 gav upphov till diffusa symtom och kontinuerligt förändrade rutiner och riktlinjer har inneburit en utmaning för hälso- och sjukvården. Sjuksköterskan ansvarar för att hjälpa patienter att upprätthålla, få eller förbättra sin egen hälsa och välbefinnande. Under pandemin har patienterna inte blivit tillräckligt informerade och därav upplevt en känsla av förvirring och enrädsla för sjukdomen och dess behandling. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda patienter med covid-19. Metod: En litteraturstudie med kvalitativ ansats som inkluderar 12 originalartiklar. Artiklarna analyserades med Braun och Clarkes tematiska analys. Resultat: Resultatet presenteras i fem teman som framkom under analysprocessen: Att vårda patienter under överbelastning, Att vårda isolerade patienter med ett nyupptäckt virus, Svårigheter att vårda med skyddsutrustning, Rädsla att bli smittad och sprida viruset vidare och Positiva erfarenheter av att vårda patienter med covid-19. Slutsats: Sjuksköterskor har upplevt att de utmaningar som covid-19 pandemin har inneburit har påverkat den fysiska och psykosociala miljön samt deras möjlighet att uppnå god kommunikation med patienter.