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2015 PhD Dissertations

Dr. Linda Kim successful defense was held June 18, 2014

Title:  The Effects of Simulation-based TeamSTEPPS Interprofessional Communication and Teamwork Training on Patient and Provider Outcomes 

Committee Members: Drs. Linda Searle Leach, Courtney Lyder, Donna McNeese-Smith, Jack Needleman

Abstract: Background: Recent research studies that have applied interprofessional TeamSTEPPS program reported improvements in communication and teamwork between healthcare providers, as well as their perceptions of patient safety culture. Nevertheless, literature on impacts on both provider and patient outcomes remains limited, especially as it relates to the impact of interprofessional simulation-based TeamSTEPPS program in the medical/ surgical setting.

Purpose: To evaluate the effects of simulation-based TeamSTEPPS interdisciplinary communication and teamwork training on provider outcomes (perceptions of communication, teamwork, and patient safety culture) and patient safety outcomes (patient falls and hospital acquired pressure ulcers). A secondary purpose was to investigate associations between provider characteristics (age, gender, ethnicity, primary language, English proficiency, educational level, country of pre-licensure nursing/ MD education, years of U.S. work experience) and provider outcomes.

Methods: A quasi-experimental, pretest-posttest repeated measures study design was used for this pilot study. The study was carried out on two medical/ surgical units in two comparable hospitals located in Los Angeles County and involved a final convenience sample of 61 nurse and physician participants. Repeated measures multivariate analysis of variance (MANOVA) was used to evaluate the differences between and within- sample groups and effects over time. Multiple regression analysis was performed to identify provider characteristics associated with significant variances in the communication, teamwork, and patient safety culture perception scores.

Results: For the first part of the study, positive trends were noted in patient and provider outcomes following the TeamSTEPPS study; however, the results were not statistically significant. In the second part of the study, nurse characteristics including race/ culture, gender, age, years of practice in the U.S., years of employment in the current unit, primary language, and English proficiency had significant effects on nurse perceptions of communication and teamwork.

Conclusion: On-going research identifying effective interventions and strategies to improve interprofessional communication, teamwork, and a culture of patient safety will continue to be of great importance as the U.S. faces the growth of a population with increased chronic conditions, requiring the provision of a mix of services over time and across settings. Lessons learned from this pilot study may facilitate future implementation of a stronger simulation-based TeamSTEPPS training at this and other healthcare organizations, as a strategy to improve provider and patient outcomes.

Dr. Cynthia Albarran abstract, successful defense was held on February 26, 2015

Title: Expanding Perspectives and Gaining Leverage: How Migrant Farmworker Women Navigate HIV Risk in Their Close, Long-Term Relationships 
Committee Members: (from left) Drs. Adey Nyamamthi, Deborah Koniak-Griffin, MarySue Heileman and Cyndi Albaran from the School of Nursing; Dr. Maylei Blackwell from Chicana/o Studies

Abstract:     Women around the world are at risk for HIV when they are in close, long-term relationships with a male partner who is unfaithful, abusive, and/or uses alcohol or illicit drugs.  HIV risk is particularly high among couples that migrate across international borders and experience extended periods of separation. In the US, HIV incidence among farmworker communities is as high as 15 times that of the general population. This study used Constructivist Grounded Theory methodology to explore migrant women's perceptions of and experiences with partner-related HIV risk among a community sample of migrant farmworkers in southern California.  Twenty women with a history of a close, long-term risky relationship participated in one or two in-depth interviews in Spanish.  Interviews were transcribed, translated into English and coded.  After initial coding, focused coding identified the most significant areas of interest and categories were formed.  Theoretical sampling helped to fill the gaps and detail how participants navigated and responded to risk in their relationships.  A Community Advisory Board comprised of stakeholders and farmworker women from the target community offered advice regarding research design, assisted in referring individuals for possible recruitment, and provided insight into preliminary data interpretations and developing categories.

     Results are presented in a theory grounded in women's words, consisting of two simultaneous, overlapping processes.  The first is a process of expanding perspective. While explaining their perceptions of partner risk, women repeatedly used metaphors of eyesight and "seeing" risk over a fluid five-phase process that included being blinded by vulnerabilities, making the discovery, weighing priorities, adopting a risk perspective, and assessing the consequences.  While expanding their views of what HIV risk meant to them, women were also simultaneously and actively pushing back against the actions of their abusive, unfaithful, and/or addicted long-term male partners.  In this second process of gaining leverage, participants did not feel that they had overcome the danger of their risky relationships.  Instead, they felt they were gaining leverage over risk in small but important ways through the use of three specific categories of action: fighting the bad (pushing back against a partner's actions using their own resources), finding the good (navigating complex outside resources while avoiding additional harm), and fortifying the self (helping themselves emotionally and physically get through risky relationships with the goal of "moving forward").

     Future interventions should focus on the ways in which migrant women cognitively, socially and emotional navigate their perceptions of risky relationships, as well as the ways in which they are already taking action to gain leverage.  In this way, healthcare providers can capitalize on women's strengths and plan culturally appropriate public health programs to reduce HIV in migrant communities.

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