Celebrating National Nurses Week May 6-12 2022
Volume 5 | Issue 5
Inside This Issue
May Edition 2022
Using Virtual Reality to Bridge Gaps in Nursing By Lindsey Hendrix
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Dell Children’s, UT Health Austin Launch First Pediatric Abdominal Transplant Center in Central Texas See pg. 10
INDEX Legal Matters....................... pg.3 Oncology Research......... pg.4 Healthy Heart....................... pg.8 Hospital News...................... pg.9 Age Well, Live Well.......... pg.12
The Power of Optimism in Older Age See pg. 11
efore nursing students at Texas A&M University ever enter a clinic, even before they engage in face-to-face clinical scenarios with people acting as patients, they already have hours of experience interacting with patients. They’re accomplishing this through new, innovative virtual reality (VR) simulations developed by their professors. Since early 2020 (in the pre-pandemic days), a team at the Texas A&M College of Nursing has been working on integrating VR simulations into their curriculum to help bridge the gap between classroom and clinic. They have launched two simulations so far that provide immersive experiences for students to hone their skills before working with real patients. “VR simulation is in that area that we call a ‘safe container,’” said Elizabeth Wells-Beede, PhD, RN, C-EFM, CHSE-A, CNE , clinical assistant professor at the College of Nursing. “We’re all human and mistakes are going to be made. This is a place that we hope to create that psychologically safe environment for mistakes to be made, where we as the experts can help walk the students through the processes, and then they take that experience into practice and not make the mistake with a real-life patient.” Clinical simulation is not new.
It has been used in nursing education for many years and allows students to apply the theory they’ve learned from books and skills they’ve learned in labs
Through Cutting-Edge Technology, Texas A&M Nursing Students Gain Clin ical Ex per ience Before Working Directly with Patients (such as checking vital signs, inserting IVs and conducting evaluations) to patient scenarios that they could encounter in a clinical setting. In a traditional simulation, a student is presented with a standardized patient (or trained actor), a mannequin or a computer-based program, to name a few. The student must work through the case presented to them by reading the patient’s chart, interviewing the patient and conducting an examination to decide what action to take. Virtual reality is a new, emerging form of clinical simulation that provides more accessible and immersive experiences that don’t
require learners to travel to clinical settings, helping with the increasing burden on clinical practice partners to place learners. The technology used at Texas A&M is being developed in close collaboration with Jinsil Hwaryoung Seo, PhD, associate professor and director of the Institute for Applied Creativity at the Texas A&M College of Architecture. Nursing faculty write the clinical scenarios and then work with Seo and her students to turn those scenarios into immersive, virtual reality experiences. To access the simulated world, nursing students put on VR headsets that transport them into a virtual setting that can be a clinic, home or school. There, they meet with a virtual patient and work through their case to make a decision while their instructor observes and provides feedback. “I am convinced VR is the future of simulation,” said Cindy Weston, DNP, APRN, FNP-BC, CHSE, associate dean for clinical and outreach affairs at the College of Nursing. “This is an immersive platform that’s deeper than what we’ve been able to do in the past with simulation in the other variety of forms it takes. Student learners feel see VR...page 14
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Legal Matters ACGME Is Instituting New Mandatory Medical, Parental and Caregiver Leave Requirements for Residency and Fellowship Programs: Are You Ready?
By Lori Oliver, JD & Laura Little, JD Polsinelli, PC
O
rganizations overseeing physician training (like ABMS and ACGME) have recently demonstrated a renewed commitment to supporting physicians’ holistic development by adopting new mandatory leave requirements for physicians-in-training (Residents and Fellows). These changes come at a time when the U.S. is reacting to a post COVID-19 pandemic vision of work: long gone are the days when personal identities and commitments are expected to drop at the workplace door. Rather, employers are being asked to see their personnel
as whole people, with conflicting personal and professional priorities. In Medicine, residency and fellowship training programs are finding a similar need to accommodate their trainees’ personal lives—particularly in family planning and wellness. Residency and Fellowship years collide with prime family development years. Recognizing this, the ABMS and ACGME have adopted new minimum leave requirements to standardize medical, parental, and caregiver leave rights across training programs nationwide. Specifically, last year, the ABMS adopted new leave policies expressly calling for its programs to offer medical, parental and caregiver leave to all Residents/Fellows. Now, beginning on July 1, 2022, the ACGME will require all ACGME-accredited Programs to offer six (6) weeks of paid leave to all Residents/Fellows for medical, parental and caregiver leave, with the right to take such leave kicking-in on the individual’s very first day in the
Program. The new requirements apply to Sponsoring Institutions (the institutions that administer ACGME-accredited Programs) and call for them to take key steps prior to July 1, 2022 to be in compliance with the new core institutional requirements. The ACGME recently clarified that the ACGME Institutional Review Committee will not take enforcement actions against Sponsoring Institutions pertaining to the new requirements until after July 1, 2023. However, the requirements go into effect on July 1, 2022, making now the time for Sponsoring Institutions to develop and implement new leave policies and align their existing leave framework with the new requirements. The following checklist describes
activities Sponsoring Institutions should consider now to ensure their teaching program remains compliant with ACGME accreditation requirements: • Recruitment Materials: Ensure interview processes for Residents/ Fellows include information regarding institutional policies for vacation and leaves of absence, including paid benefits during such absences. • Appointment/Employment Agreements: Amend all Appointment Agreements and Employment Agreements entered with Residents/Fellows (and associated templates for future agreements) to describe the new see Legal Matters...page 14
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Oncology Research 5 Tips To Reduce Stress As A Cancer Patient By Kelsey Espinosa, LMSW, Texas Oncology–Austin Lakeway, Bastrop, South Austin
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hat’s going to happen to me? How can I manage all these appointments? How can I keep up with so many medications? Your mind is racing with questions, and facing all of the unknowns that come with cancer is understandably stressful. From diagnosis to prognosis, cancer patients experience a whirlwind of emotions and face an overwhelming number of decisions regarding their treatment journey. Adding to the stress, cancer patients often worry more about the wellbeing of their loved ones than themselves. In time, mental stress can negatively impact a patient’s physical health.
While excessive stress is detrimental to everyone, it presents additional challenges for those who are immunocompromised, such as cancer patients. So how can patients make themselves a top priority and reduce stress while battling cancer? Here are five ways to help reduce stress as a cancer patient. Lean on others. You are not alone in your cancer journey. Asking for and receiving help will benefit you as well as your inner circle of friends and family who want to support you. Indeed, the entire cancer community is committed to patient support. Whether they are fellow cancer patients, survivors, or healthcare workers, a community of support is available to you in your fight to beat cancer. Seek out a support group. Research patient advocacy organizations to join. You will discover that not only do these groups provide you a safe space, but you are also likely to find a lifelong friend in the process of getting involved.
Take it easy. Taking it easy is not always easy, especially for people who are used to caring for others. However, it is not impossible. Keep things simple and take your schedule day by day or week by week. Avoid added stressors by sticking with your top priorities to create a routine that best resembles your new version of ‘normal.’ Enjoy the freedom of editing out unnecessary activities and commitments. The internet is not your physician. It’s no surprise the first thing patients want to do is start searching the web for more information, but take care to avoid going down internet rabbit holes that lead to more fear and
added stress. Rely on your cancer care team to answer any questions you may have. They will be straightforward and honest, and will provide you with expert advice rooted in science and medicine and balanced by experience – not algorithms that don’t take the individual into account. Breathe. Stretch. Walk. Meditate. Sometimes worrying about the big things can make patients forget the little things when it comes to health, even when their bodies are fighting an epic battle. The simplest activities – including deep breathing, stretching, walking, and meditating see Oncology ...page 13
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Nine Tips for Telehealth Clinical Documentation By Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager The Doctors Company
A
s the course of the pandemic continues to unfold and threats from new variants appear, many practices and patients are once again considering telehealth options—a trend that may continue even after the pandemic runs its course. Regardless of whether the care is delivered in person or through telehealth, the required levels of skill and expertise and the standard of care are the same. Clinical documentation plays a significant role in demonstrating regulatory compliance, establishing medical necessity for billing, and defending the provider in the event of a licensing board complaint or professional liability claim. Due to the unique differences between an in-person patient visit and telehealth, documentation plays an essential role in proving that the standard of care has been met. The practice of telehealth
office.” 3. Informed consent: Obtain informed consent for telehealth visits. Advise patients about the risks of a telehealth visit, including the potential for technical difficulties, information security concerns, and that it may be necessary to convert the visit to an in-office visit depending on patient needs. In the progress note, summarize the discussion, the questions asked and answered, and the patient’s decision. Include a copy of the signed consent form. Find our sample “Telehealth Informed Consent” form on our Informed Consent Sample Forms page. 4. Identity: Confirm patient identity to reduce the risk of billing fraud and medical identity theft. Ask new patients to hold a photo ID close to the camera. Document confirmation of patient identity. Patients also have the right to ask for provider identification. 5. Appropriateness: Determine quickly if the patient and environmental conditions are appropriate for a
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creates additional and specific documentation requirements. Consider the following nine tips for documenting telehealth care: 1. Modality: Specify clearly in the patient’s record the telehealth modality used. Examples include “secure interactive audio-video session using [name of] telehealth platform,” “telephone medication management consultation,” or “asynchronous diagnostic test follow-up by portal/text/ email.” 2. Geography: Note the patient’s physical location and geography. For example, including “at her home in Tennessee” is necessary for billing purposes and determining venue in the event of regulatory or professional liability action. Also document the provider’s location as “in the clinic,” “from the hospital,” or “from the home
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telehealth visit. Some patients may not be appropriate candidates for telehealth visits based on their cognitive status. If the patient cannot answer questions or provide an accurate history and no support person is available, the visit may need to be rescheduled. Documentation in this situation might include “the visit was rescheduled at the patient’s request because her husband could not be available.” Evaluate and address distractions in the environment. Document patient assessment, environmental conditions, actions taken, and recommendations made. For more information on addressing patient distractions, see our article “Telehealth’s Newest Safety Risk: Distracted Patients.” 6. Others present: Include see Telehealth...page 13
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Healthy Heart
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Austin’s American Heart Association’s EmPOWERED to Serve Ambassador Program Tackling Health Equity in Central Texas By The American Heart Association
U
nder-resourced communities often face higher risks for heart disease, stroke and other major health problems because of social determinants such as limited access to safe housing, healthy food and quality health care. These communities need localized solutions that will help individuals and families escalate beyond poverty and achieve improved life outcomes. No one knows the changes needed in a community as well as the members themselves, leading the Austin American Heart Association to launch the EmPOWERED to Serve Ambassador Program in Central Texas.
where, for example, the Rosewood area in East Austin has a life expectancy of about 72 years whereas the life expectancy is 11 years longer 5 miles away in West Austin on the other side of I-35 (Austin American Statesman, 2019). Mt. Zion Baptist Church in the Rosewood area has a long history serving the Black community of Austin and surrounding areas. The AMEN (African American Mental Health and Wellness) Program run by the UT School of Nursing and UT Division of Diversity and Community Engagement (DDCE), is a well-established initiative developed to support the mental and physical health of Black residents. With the
EmPOWERED members discuss change through health justice and education.
Nationally, EmPOWERED to Serve is a platform inspired by American Heart Association volunteers around the country who are passionate about driving change through health justice and empowerment in their communities. Locally, EmPOWERED to Serve Ambassadors are emboldened to drive change through health justice and education in Central Texas communities with support from the AHA and community partner, Live Oak. The 1928 Master Plan of the City of Austin was the comprehensive city plan where racial segregation was institutionalized by using East Avenue, now known as IH-35, as a dividing line between Black and Latino communities and White communities. This is still seen today
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support of the Central Texas American Heart Association staff, the AMEN staff implemented a Screen, Educate and Refer initiative to further their mission to reduce health disparity gaps through a comprehensive community-based programs. AHA supplied AMEN with 100 validated blood pressure monitors to provide ongoing high blood pressure self-management support for the 1200 members at Mt. Zion Baptist and Rehoboth Baptist Churches and surrounding community. In addition, sixty community members were enrolled into a culturally tailored, technology-based, mobile health research study to test innovative ways to support and sustain blood pressure
see Healthy Heart...page 13
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Hospital News Heart Hospital of Austin Executive Earns Prestigious Recognition From Texas Tech University
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eart Hospital of Austin Chief Executive Officer, David Laird, was recently honored by Texas Tech University with the esteemed Professor John and Starr Blair Award for Excellence in Health Organization Management. Laird, who graduated from Texas Tech University with a degree in business administration and finance, received the award during a luncheon on March 24. He also gave a keynote address as part of the John A. Buesseler Distinguished Lecture Series. The award is sponsored by the endowment from the John Aure Buesseler and Cathryn Anne Hansen Buesseler Foundation and is presented each spring. The endowment, which also supports
the lecture series and was established in 2000, encourages and promotes excellence at all levels of teaching, research, learning, and service in health organization management. Dr. John A. Buesseler was the emeritus founding dean of the Texas Tech University Health Sciences Center School of Medicine and emeritus founding vice president for health sciences. “I am so grateful for this incredible recognition,” Laird said. “The legacy and generosity of Dr. Buesseler, one of the most innovative health professionals in West Texas history, serve as excellent examples to the next generation.” Laird also serves on the Texas Tech University Rawls College of Business advisory board.
Laird has spent twenty-four years at Heart Hospital of Austin, including the last sixteen as chief executive officer. With his leadership, Heart Hospital of Austin has received numerous accolades for high-quality care, exceptional patient satisfaction, and for being a
Ascension Texas Becomes Largest Provider of Orthopedic and Sports Medicine Services in The Region with New Acquisition Ascension Texas Adds Nine Locations, 19 Doctors and More Than 100 Staff to Serve the Orthopedic/Sports Medicine Needs of Central Texas Close to Home
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scension Texas announced today the acquisition of Orthopedic Associates of Central Texas. The acquisition will add nine new locations, 19 doctors, more than 20 physician assistants and physical therapists and more than 100 staff total to the program. The acquisition will expand the Ascension Texas footprint in providing personalized care for bone and muscle injuries, joint pain and orthopedic diseases. The Ascension Texas multi-specialty orthopedic and sports medicine capabilities include treatments such as medication therapy, minimally invasive outpatient surgery, non-surgical injections and orthobiologics, orthopedic surgery including total and partial joint replacement, rehabilitation, exercise physiology and sports performance.
“We are excited to welcome these new additions to our orthopedic and sports medicine program,” said Andy Davis, President and CEO of Ascension Texas. “This acquisition and expansion fulfills our mission to provide convenient care close to home as Ascension Texas continues to expand with the growth of our population.” “These experienced doctors and staff bring a range of subspecialties including spine, shoulder, sports medicine, trauma, joint replacement, physiatry, podiatry, hand and foot/ankle care,” said Adam Bauman, Vice President, Orthopedics and Sports Performance, Ascension. “We look forward to serving the orthopedic and sports medicine needs of Central Texas in an even bigger way.”
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great place to work. Those accolades include IBM Watson Health’s 50 Top Cardiovascular Hospitals award, which the hospital has received twelve times, and Healthgrades ranking Heart Hospital of Austin as the No. 1 cardiac program in Texas for six consecutive years.
Orthopedic Associates of Central Texas will be renamed Ascension Medical Group Seton Orthopedics, and the new locations include:
• East Round Rock – 4112 Links Lane, Round Rock • Cedar Park – 1401 Medical Parkway Building 2, Suite 150, Cedar Park • Round Rock – 16020 Park Valley Drive, Suite 100, Round Rock • North Austin – 12309 North MoPac Expressway Suite 150, Austin • Southwest Austin – 5625 Eiger Road, Suite 175, Austin • 2nd Street – 3707 South 2nd Street Suite 100, Austin • La Grange – 657 East Travis Street, Suite C, Austin • Central Austin – 3200 Red River Street, Suite 201, Austin • Bastrop – opening in August
May 2022
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Dell Children’s, UT Health Austin Launch First Pediatric Abdominal Transplant Center in Central Texas
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T Health Austin and Dell Children’s Medical Center announce the opening of the Pediatric Abdominal Transplant Center on April 5th, the first and only program of its kind in Central Texas, offering exceptional care to children ranging from newborns to young adults living with end-stage renal disease (ESRD) or kidney failure. The Pediatric Abdominal Transplant Center is a collaboration between Dell Children’s and UT Health Austin, the clinical practice of Dell Medical School at The University of Texas at Austin. “With the launch of our Pediatric Abdominal Transplant Center,
for Disease Control and Prevention (CDC). Housed at Dell Children’s Medical Center, the Pediatric Abdominal Transplant Center diagnoses, treats and manages the care of infants, children and young adults in need of a kidney transplant. Distinguishing program elements include: Coordination of patient care between referring physicians and team members to ensure each child receives the highest level of specialized care in Central Texas. • A team of medical experts comprising leaders in pediatric abdominal care and highly
children and young adults in Central Texas will no longer have to leave their homes, families or communities for kidney transplant care,” said Nicole Turgeon, M.D., transplant director for the Adult and Pediatric Abdominal Transplant Centers and professor in the Department of Surgery and Perioperative Care. “The new program represents a unique strategic collaboration across Dell Children’s Medical Center, Dell Seton Medical Center at The University of Texas and UT Health Austin, building on the Adult Abdominal Transplant Center to provide seamless kidney transplant care for patients of all ages, from newborns to adults.” More than 9,800 children and adolescents in the United States have ESRD or kidney failure and they rely on life saving dialysis or a kidney transplant, according to the Centers
specialized pediatric transplant providers who work with young patients and their families to develop personalized treatment plans. • Leveraging of the latest research-proven methodologies to successfully treat pediatric patients in need of an organ transplant, using both donated kidneys and working with living kidney donors. The Pediatric Abdominal Transplant Center follows the November 2021 establishment of the Adult Abdominal Transplant Center, a program of Dell Seton Medical Center at The University of Texas, which diagnoses, treats and manages care for patients 18 years or older in need of a kidney, as well as those willing to be a living kidney donor.
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The Power of Optimism in Older Age A Recent Study Finds That Optimism Can Help Older Adults Decrease Negative Effects of Physical Limitations on Their Life Satisfaction By Lauren Rouse
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s a person ages, activity limitations can affect their ability to live independently. According to the Centers for Disease Control and Prevention, adults 80 years and older are 43 percent more likely to have physical limitations than their younger counterparts aged 50-59. In turn, functional limitations and barriers to living independently can impact life satisfaction—attitudes and beliefs about quality of life. While previous studies have focused on the association between activity limitations and life satisfaction, few studies have examined how optimism can decrease the effects of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) on life satisfaction.
Matthew Lee Smith, PhD, MPH, associate professor in Environmental & Occupational Health at the Texas A&M University School of Public Health, along with Kent Jason Go Cheng, PhD, from Syracuse University, and Darcy Jones (DJ) McMaughan, PhD, from Oklahoma State University, recently published a study examining the relationship between activity limitations and life satisfaction in the Journal of Applied Gerontology. Using data from the 2008-2018 Health and Retirement Study Leave Behind Survey waves, the team examined if activity limitations were negatively associated with life satisfaction, if optimism was positively associated with life satisfaction, and if optimism lessened
the impact of activity limitations on life satisfaction among middle-aged and older adults over time. The average age of the sample was 68.5 years, and the majority of respondents were white, married women who were not in the labor force and had moderate-to-high levels of optimism, life satisfaction and functional ability. “Mean-centered age was positively associated with life satisfaction, suggesting a slight increase in life satisfaction for
every additional year lived,” Smith said. “Race, Hispanic origin, marital status, and self-rated health appeared to have strong associations with life satisfaction. As activity limitations increased, life satisfaction statistically significantly decreased; however, an increase in optimism was related to an increase in life satisfaction.” “This current study shows that optimism can positively influence see Optimism...page 13
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Age Well, Live Well
•
Celebrating Older Americans Month in May By Camden Frost
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ay is Older Americans Month, and this year’s theme, “Age My Way!” highlights aging-in-place and how older adults can live independently in communities for as long as possible. The Older Americans Act (OAA), passed in 1965, was created to support older adults wanting to live independently and age-in-place. This landmark legislation is carried out through State Units on Aging and local area agencies on aging (AAA) to provide essential community social supports. More than 345 Texas residents reach age 65 daily. Texas added one million people over the age of 65 to the population between 2000–2014. By 2030, the older adult population in Texas will reach nearly six million (Texas Demographic Center, 2016). By 2060, there will be 41 citizens over age 65 to every 100 working-age adults in the United States (U.S. Census Bureau). The Texas Health and Human Services Commission administers an array of programs and supports to help older Texans live healthy lives, stay connected to their communities and
age-in-place. These include: • Aging Texas Well, a strategic planning effort that reviews policies impacting older Texans, assesses local and state readiness to meet the needs of older adults and helps communities build their service capacity. The Aging Texas Well strategic plan uses the OAA impact areas as a foundation to plan for aging needs and identifies aging specific priorities for the state. • Age Well Live Well, a statewide healthy aging campaign, promotes easy pathways to available resources and emphasizes how to make healthy changes using three core message areas: Be Healthy, Be Connected and Be Informed. • • Texercise, a health promotions initiative, provides free physical activity and nutrition resources to educate, motivate and engage adults 45 and older in
•
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healthy behaviors. AAAs serve adults 60 and older, their families and caregivers with multiple programs designed to support independence. Typical programs include benefits counseling, home and congregate meals, support for caregivers, transportation resources and assistance navigating Medicare and Medicaid. Aging and Disability Resources Centers serve as the information and referral hub for older adults and people with disabilities. Trained system navigators are the “front doors” for accessing social supports. Program of All-inclusive Care for the Elderly assists adults 55 and older, who qualify for nursing home care, with receiving in-home services, allowing them age-in-place. Services
can include medical care, personal care, social connection, medication, rehabilitation, transportation and more. • Eldercare Locator, a free national service provided by the U.S. Administration on Aging, helps older adults find local resources, including legal, financial, home repair, caregiving and transportation resources. Military families can use the Guide to Long-term Care for Veterans to obtain beneficial resources and multiple caregiving tools that provide veterans with a range of available services to assist with aging-in-place. This May, celebrate the older Texans in your life and learn more about the programs and resources that promote aging independently.
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Oncology
Continued from page 4 – are beneficial as stress relievers and improve overall physical health. Even if you’re too exhausted to do much beyond getting out of bed, simply taking one to five minutes to quietly observe the cadence and depth of your own breath, the sound of wind through the trees, or the pattern of light through the clouds can serve as a moment to release tension and not let stress get the best of you.
Realize remission. Some patients may be in disbelief when hearing they are in remission. Rather than embracing the positive, a fear of recurrence or other worst-case scenarios can cause stress and anxiety. You may be surprised to suddenly find yourself experiencing negative emotions when the news is good. Some feel guilty, because they can’t help but think of others who don’t
have a similar outcome. Others have been holding in so many emotions that come flooding out once the treatment is concluded. After the ordeal of treatment, some patients simply have difficulty accepting their new reality and feel that somehow remission is toogood-to-be-true. Fortunately, there are tools available to patients to learn to cope with being in remission, including
Acceptance and Commitment Therapy (ACT), designed to help patients reduce the severity of their fear of recurrence. Cancer patients in remission have reason to celebrate and realize their outcome for what it is – hope for the future.
provide instructions to patients if they will be performing tasks during the examination. With preparation, patients may be able to measure and report their weight, vital signs, and home point-of-care testing results. Document results and specify “patient provided.” When patients assist in various aspects of physical examination, document the details as “patient assisted.” For more information on patient-assisted assessment, see our article “Strategies for Effective Patient-Assisted Telehealth Assessments.” 8. Safety concerns: Scan the patient’s environment for possible safety concerns. As the volume of telehealth visits increased during the
pandemic, clinicians were afforded a window into patients’ homes and lives that would not otherwise have been possible. This opportunity was both a blessing and a challenge. Visualizing the patient’s surroundings facilitates patient safety activities such as fall reduction, environmental allergy assessment, and brown bag medication checks. In some cases, however, providers may see conditions that require intervention that are not directly related to the visit. Examples include evidence of hoarding, unsanitary conditions, abuse, and potential human trafficking. Objectively document observations, discussions with the patient, recommendations, and follow-up plans.
9. Quality improvement: Consider revising electronic health record templates to include some of these documentation recommendations as checkboxes, dropdowns, or text macros. Periodically evaluate telehealth visit documentation to ensure compliance with the recommendations. Following these nine tips can help you ensure that your telehealth documentation is patient-centered, comprehensive, and effective. You can also benefit from familiarizing yourself with the regulatory and payer requirements specific to your practice location(s).
Locally, ambassadors are recruited to act upon localized solutions to help under-resourced communities attain better life outcomes. AMEN and AHA continue to work together to create an effective plan to disseminate
information in under-resourced communities, with the ultimate goal of expanding into additional churches and community organizations while engaging additional volunteers. Through the implementation of this
initiative, AHA and AMEN is driving heart health awareness, education, and control to ensure all Central Texans have the chance at a longer, healthier life.
satisfaction/optimism, the research team notes that further research is needed to explore how optimism training (guided exercises that urge individuals to focus on positive life experiences) could impact older adults’ life satisfaction.
“This study reinforces that not every adult with difficulties performing ADLs or IADLs has low levels of life satisfaction. Strategies to improve optimism and other positive perceptions may have promise to increase life satisfaction
and protect middle-aged and older adults from the negative effects of functional limitations.”
Telehealth
Continued from page 6 documentation of all participants. Others may be present at the patient’s location and may assist with or affect the quality of the visit. Document in the progress note the name and relationship of all individuals present on the patient’s side of the interaction. For example, document “visit conducted with child sitting on mother’s lap.” On the provider’s side, document the names of assistants who are present and their purpose. For example, a medical assistant may serve as a chaperone during remote sensitive visual examinations. In addition, document the use of interpreters who assist from a third location by video or telephone. 7. Assisted assessment: Plan for and
Healthy Heart
Continued from page 8 self-management. AMEN is the focus of the AHA Central Texas Market’s EmPOWERED to Serve Ambassador Program and benefits from local events such as the Austin Heart Ball.
Optimism
Continued from page 11 life satisfaction, and optimism can attenuate the negative effects of activity limitations on life satisfaction,” Smith added. Although the study was one of few looking at the relationship between activity limitations and life
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VR
Continued from page 1 like they’re in the environment, and it’s a safe space for them to hone and develop skills with faculty guidance and feedback.” Better care for vulnerable patients Currently, the College of Nursing has applied VR simulation in two areas: Screening, Brief Intervention and Referral to Treatment (SBIRT), and forensic nursing. SBIRT is an approach that health care providers use to quickly recognize when a patient uses drugs and/or alcohol in risky ways so that they can provide brief intervention and refer them to specialty care if more extensive treatment is needed. Forensic nurses are professionally trained to treat victims of violence through patient-centered, trauma-informed care. Both SBIRT and forensic nursing involve patients in vulnerable situations that require highly competent, compassionate and experienced care providers. “We know that when confidence is high, nurses’ performance, retention, and their ability to perform the skill is high,” Weston said. “VR simulation builds their confidence and then we’re able to assess their competence before they head into the clinical setting.” The SBIRT VR simulation has been in use for about a year. It is currently instructor-guided, meaning that when students are interacting with the patient inside the virtual world, an instructor monitoring the simulation from the outside answers on behalf of the patient. The team is working on taking this to the next level and is currently developing an artificial intelligence capability for the platform.
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Texas A&M nursing students take part in a virtual SBIRT simulation in Round Rock, Texas, while Elizabeth Wells-Beede facilitates the simulation from a computer.
The first forensic nursing VR simulation, which launched last month, is self-contained. In it, nurses complete a number of tasks to learn how to conduct a sexual assault examination. The goal is to help them become comfortable performing the exam before working with a live standardized patient. “We have had an overwhelming excitement with all of it,” said Stacey Mitchell, DNP, MBA, MEd, RN, SANE- FAAN, clinical professor and director of the Texas A&M Health Center of Excellence in Forensic Nursing. “Most of the students, every time they put on the VR headset, they say, ‘Oh my gosh, this is so amazing!’ They are thrilled and excited that we’re bringing this to them.” Bridging gaps in rural areas The VR simulations are not only designed to bridge gaps inside nursing school. As part of three Health Resources and Services
Administration (HRSA) grants, they are helping to bridge gaps in rural and medically underserved areas as well. Specific areas of focus include mental health, chronic disease management, medication management, postpartum care, and forensic nursing. “We’re trying to meet the need for those areas, and that’s really not where the big VR companies are. They’re looking at the acute care setting, not the ambulatory care setting where we are,” Wells-Beede said. “Although this whole VR world is building up around us, we are doing something in between that’s going to meet the need for rurally underserved areas. This is where I feel our niche is; we are a land-grant institution and we’re giving back to our community by doing these simulations that can actually be brought into the community setting.”
is also important to ensure these rights align with and are properly integrated with other leave policies, such as federally-required family and medical leave rights under FMLA.) GMEC Oversight: Ensure the Sponsoring Institution’s Graduate Medical Education Committee (“GMEC”) is charged with oversight of leave policies and actually reviews implementation of all institutional policies governing vacation and leaves of absence (including this new leave requirement) no less than annually. Your institution may need to revise policies and/or processes to assure this requirement is met. Resident/Fellow Program
Progression: Ensure that each ACGME-accredited program provides Residents/Fellows with information about the impact of taking extended leaves on their completion of the program and their eligibility to participate in certifying board exams. Support Well-Being: Ensure each ACGME-accredited program dedicates institutional resources to, and adopts processes to, make resources available to Residents/ Fellows to support their overall well-being and education and to minimize how leave of absences impact clinical assignments.
Legal Matters Continued from page 3 • •
medical, parental and caregiver leave policies. Institutional Policies: Adopt institutional policies and procedures describing the new leave rights and how to apply for the leave. (This may be a new policy or modification of an existing policy, but it must be clear on when the leave entitlement arises, address the additional one week paid leave right during applicable years, and clearly provide for continuation of certain insurance policies during the leave period. It
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