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Toni Tripp-Reimer

Publications and source records attributed to Toni Tripp-Reimer.

At least 19 recordsLinked to original sources
PubMed2007

"No one else sees the difference: "family members' perceptions of changes in persons with preclinical Huntington disease.

Manifestations of Huntington disease (HD) prior to clinical diagnosis are not well understood. This study documents adult family members' perceptions of changes and their attempts to manage these changes in persons who had received a positive predictive molecular HD test prior to clinical diagnosis. Data were obtained from 19 adult family members in six focus groups in the US and Canada and one individual interview in the US. Changes reported by family members included problems in cognition and behavior, which are consistent with prior reports. In addition, family members observed changes in motor functioning, the ability to complete usual activities at work or at home, and interpersonal relationships with family and friends. Family members attempted to manage these changes by taking on new responsibilities and preparing for future caregiving. Lack of information about preclinical HD, difficulty in understanding changes that may represent early stages of HD, and efforts to maintain secrecy of the preclinical HD situation contribute to compromising the abilities of family members to respond to changes in the person with preclinical HD. Findings provide insights into alterations in cognition, behavior, and functioning observed by the family members prior to clinical diagnosis. Findings further support the need for a more comprehensive assessment and management of early HD symptoms as well as support for family members.

Adult↗
PubMed2006

An empirically derived taxonomy of factors affecting physicians' willingness to disclose medical errors.

BACKGROUND: Physician disclosure of medical errors to institutions, patients, and colleagues is important for patient safety, patient care, and professional education. However, the variables that may facilitate or impede disclosure are diverse and lack conceptual organization. OBJECTIVE: To develop an empirically derived, comprehensive taxonomy of factors that affects voluntary disclosure of errors by physicians. DESIGN: A mixed-methods study using qualitative data collection (structured literature search and exploratory focus groups), quantitative data transformation (sorting and hierarchical cluster analysis), and validation procedures (confirmatory focus groups and expert review). RESULTS: Full-text review of 316 articles identified 91 impeding or facilitating factors affecting physicians' willingness to disclose errors. Exploratory focus groups identified an additional 27 factors. Sorting and hierarchical cluster analysis organized factors into 8 domains. Confirmatory focus groups and expert review relocated 6 factors, removed 2 factors, and modified 4 domain names. The final taxonomy contained 4 domains of facilitating factors (responsibility to patient, responsibility to self, responsibility to profession, responsibility to community), and 4 domains of impeding factors (attitudinal barriers, uncertainties, helplessness, fears and anxieties). CONCLUSIONS: A taxonomy of facilitating and impeding factors provides a conceptual framework for a complex field of variables that affects physicians' willingness to disclose errors to institutions, patients, and colleagues. This taxonomy can be used to guide the design of studies to measure the impact of different factors on disclosure, to assist in the design of error-reporting systems, and to inform educational interventions to promote the disclosure of errors to patients.

Attitude of Health Personnel↗
PubMed2006

Research as spiritual covenant.

Conducting research with Native American communities poses special challenges from misunderstandings that may arise from the interface of differing cultural worldviews held by the scientific and the Native communities. Although the community-based participatory research approach shows promise for conducting research that can maximize benefits and minimize the risks of harm to Native American people, there is little information related to the practical implementation of culturally appropriate research practices when working with Native American communities. Drawing on the authors' research with three Native American communities in the Northwest, this article describes culturally appropriate processes for engaging Native American communities. The first section identifies and describes the principles that provide the foundation for the authors' research activity as a spiritual covenant and guides the authors' research with the three communities. The second section describes the project phase matrix that was used to organize the approaches employed in this work.

Aged↗
PubMed2005

Exploration of the psychometric properties of an Inventory of Voice Experiences.

The aim of the study was to identify psychometric properties of an inventory of voice-hearing experiences (IVE) [corrected] One hundred fifteen psychiatric nurses rated the language content represented on two forms of the IVE and the Brief Psychiatric Rating Scale (BPRS) [corrected] while viewing a videotaped assessment of an experienced voice hearer. Findings revealed modest to moderate support for internal consistency and concordance of the language represented on the measures as well as moderate support for convergent validity of IVE Forms A and B and modest support for their convergence with the BPRS. Nurse ratings of the IVE [corrected] explained 14 to 15 percent [corrected] of the variation in the same nurses' ratings of the hallucinated symptom item on the BPRS measure. Other [corrected] findings from the study [corrected]augment the position that not all hallucinated voices are indicative of clinical pathology, providing an additional basis on which to further refine and test the two measures [corrected]

Attitude of Health Personnel↗
PubMed2004

VA QUERI informatics paper: information technology for clinical guideline implementation: perceptions of multidisciplinary stakeholders.

OBJECTIVE: This multisite study compared the perceptions of three stakeholder groups regarding information technologies as barriers to and facilitators of clinical practice guidelines (CPGs). DESIGN: The study settings were 18 U.S. Veterans Affairs Medical Centers. A purposive sample of 322 individuals participated in 50 focus groups segmented by profession and included administrators, physicians, and nurses. Focus group participants were selected based on their knowledge of practice guidelines and involvement in facility-wide guideline implementation. MEASUREMENTS: Descriptive content analysis of 1,500 pages of focus group transcripts. RESULTS: Eighteen themes clustered into four domains. Stakeholders were similar in discussing themes in the computer function domain most frequently but divergent in other domains, with workplace factors more often discussed by administrators, system design issues discussed most by nurses, and personal concerns discussed by physicians and nurses. Physicians and nurses most often discussed barriers, whereas administrators focused most often on facilitation. Facilitators included guideline maintenance and charting formats. Barriers included resources, attitudes, time and workload, computer glitches, computer complaints, data retrieval, and order entry. Themes with dual designations included documentation, patient records, decision support, performance evaluation, CPG implementation, computer literacy, essential data, and computer accessibility. CONCLUSION: Stakeholders share many concerns regarding the relationships between information technologies and clinical guideline use. However, administrators, physicians, and nurses hold different opinions about specific facilitators and barriers. Health professionals' disparate perceptions could undermine guideline initiatives. Implementation plans should specifically incorporate actions to address these barriers and enhance the facilitative aspects of information technologies in clinical practice guideline use.

Adult↗
PubMed2004

Gender disparities in common sense models of illness among myocardial infarction victims.

Symptom attributions were contrasted between male and female myocardial infarction victims (N = 157) who were comparable on age, cardiac risk status, medical history, symptom presentation, and other variables. Women were less likely than men to attribute their prehospital symptoms to cardiac causes. In the context of hearing symptom attributions or advice from support persons, women were less likely than men to report receiving a cardiac attribution or advice to seek medical attention. Results have implications for how victim gender influences the lay interpretation of cardiac symptoms.

Adult↗
PubMed2004

Qualitative perspectives in translational research.

The rapid uptake of qualitative approaches in translational research can be best understood in the context of recent innovations in health services research, as well as an overarching concern with improving the quality of health care. Qualitative approaches highlight the human dimension in health care by foregrounding the perceptions, experiences, and behaviors of both consumers and providers of care. As such, these methods are particularly useful for addressing the complex issues related to improving health care quality and implementing system change. This overview traces a brief history of the factors contributing to the recent and rapid growth of qualitative methods in health research in general and translational research in particular; describes the varieties of qualitative approaches employed in this research; and illustrates the utility of these approaches for variable identification, instrument development, description/explanation of patient/provider perceptions and behaviors, individual/organizational change, and theory refinement.

Attitude of Health Personnel↗
PubMed2004

Nurse judgments of hallucinated voice descriptions: relevance for intervention.

The aim of the research was to explore the importance of 58 items of descriptive content represented on two parallel forms of an Inventory of Voice Experiences (IVE). A convenience sample of 317 well-educated psychiatric nurses rated descriptions of IVE item content three times over a period of six months according to how the content might relate to the selection of interventions for the management of verbal auditory hallucinations. Cronbach's alpha, Cohen's kappa, Pearson's r, and Bartko's intra-class correlation coefficients were used to measure the internal consistency of the nurses' judgments as well as the concordance of the judgments with a pre-selected standard. Findings from the study revealed modest-to-moderate support for internal consistency and overall equivalence of parallel item content represented on both forms of the IVE within and across three waves of data collection. Also revealed was a relative lack of concordance of the nurses' judgments with the pre-selected standard, and modest-but-consistent concordance of the nurses' original and subsequent judgments. Eight parallel items represented on the IVE demonstrated potential to serve as important cues for making decisions about intervention. This information shall be used to standardize the language and response categories of items tied to the IVE to permit more-definitive decisions about the management of verbal auditory hallucinations.

Attitude of Health Personnel↗
PubMed2003

Clinical profile of acute confusion in the long-term care setting.

Aspects of acute confusion (AC) including risk factors, behavior patterns, and outcomes are not well documented in long-term care (LTC) residents. The purpose of this prospective study was to describe the clinical profile of AC in LTC including risk factors, behavior patterns, etiologies, and 3-month outcomes. Seventy-four elderly LTC residents were assessed for AC, depression, and global cognitive impairment. Risk factors associated with AC included hearing deficits, depression, pulmonary disorders, and abnormal serum sodium or potassium levels. Behavior patterns of acutely confused residents included hyperactive (n = 9, 31%), hypoactive (n = 8, 28%), and mixed (n = 7, 24%). In the majority of the AC cases, the etiology was multIfactorial infections and dehydration were the most common causes. Residents with AC had very poor 3-month outcomes. Thirty-four percent (n = 10) of the residents with AC died within 3 months of the evaluation. This study highlights the complexity and serious nature of AC in this frail population.

Acute Disease↗
PubMed2003

Imminent concerns of filial caregivers reporting recent experiences of crisis.

The purpose of this descriptive study was to generate information about imminent concerns of adult children that could serve as initial context for development of a meaningful framework for coping with an ongoing parent care situation. Ninety-two adult children pre-selected for self-reports of crisis were interviewed about their concerns and goals for caregiving and asked to discuss experiences of crisis in the previous six months of caregiving. Key issues pertaining to their experiences were extracted from notes of the interviews and classified according to their common properties. Cohen's kappa for interrater reliability of the classifications was .79 while percentage agreement was 98 percent. The results of the study point to the presence of multiple issues pertaining to significant life and death events, relational burdens, early experiences with the family of origin, and focal patterns of distress and coping. Synthesis of the findings reveals overriding concerns for making improvements in one's family of origin, created family of adulthood, and middle-aged self. Findings have implications for experiential adult education in the area of filial maturity and caregiving.

Activities of Daily Living↗
PubMed2002

A pilot study of immune and mood outcomes of a community-based intervention for dementia caregivers: the PLST intervention.

Providing care to a family member with dementia is conceptualized as a chronic stressor with adverse psychological and physical effects. The purpose of this pilot study was to evaluate mood and immune outcomes of caregivers exposed to a community-based psychoeducational nursing intervention based on the progressively lowered stress threshold (PLST) model. The PLST intervention is designed to strengthen the psychological resources of dementia caregivers by teaching methods of preventing and/or managing behavioral problems exhibited by the person with dementia. Mood and immune outcomes were compared between caregivers randomly assigned to receive either the PLST or a comparison intervention. Results of this pilot study suggest that caregivers who received the PLST intervention showed significantly stronger T-cell proliferative responses to both PHA and ConA, indicating an improvement in T-cell immune function immediately after the in-home intervention (T2) and again after 6 months of telephone support for application of the PLST model (T3). Findings do not support the hypothesis that the PLST intervention had a significant effect on total mood disturbance or natural killer cell cytotoxicity over the course of the study.

Aged↗
PubMed2002

Benchmarking Veterans Affairs Medical Centers in the delivery of preventive health services: comparison of methods.

OBJECTIVE: To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expected. METHODS: The 1998 Veterans Health Survey assessed the self-reported delivery of evidence-based clinical preventive services in a stratified national sample of 450 ambulatory care patients seen at each VAMC. Proportions appropriately receiving each service within the recommended time interval were calculated for 138 VAMCs. Percentile ranks for each outcome were assigned. Two approaches were used for benchmarking performance. First, a scaled score for each facility was calculated across the set of 12 measures. Second, facilities were ranked based on the sum of the percentile ranks over a range of specific high cutoffs (eg, 70-80%) and above a range of lower cutoffs (eg, 40-50%). Ranking was validated by comparing with deciles of ranks on chart audit (External Peer Review Program, EPRP) data using Kendall's tau-b and chi2 quality-of-fit test. Differences between consistently high adherence (CHA) and low adherence (CLA) facilities were compared using the Wilcoxon rank sum test on 14 VHS and 11 EPRP outcomes. RESULTS: Data from 39,939 patients (67% response rate) were examined. In combination, cutoffs of greater than 50th percentile and greater than 75th percentile rank yielded 12 of 14 VHS and 6 of 11 EPRP measures different between CHA and CLA facilities. The scaled-score approach resulted in 20 CHA and 14 CLA facilities. The sum of outcomes ranked above 50th percentile and over 75th percentile for CHA facilities (n = 17) was 15 or more. The sum of outcomes ranked above the same cutoffs for CLA facilities (n = 16) was 3 or less. EPRP and 1998 VHS data demonstrated that the survey measures and benchmarking approaches were both reliable and valid. Both approaches resulted in multiple differences between CHA and CLA facilities; differences were greater using the percentile rank approach. CONCLUSIONS: The VA has successfully encouraged adoption of evidence-based clinical preventive services throughout its health care system. However, facilities show wide variation in their levels of delivery and can be distinguished on the basis of their consistently high or low levels of adherence. Examining service delivery across multiple performance indicators allows identification of opportunities to improve clinical practice guideline implementation and the delivery of preventive services. This approach identifies model institutions where focused investigation of factors associated with consistent performance may be particularly fruitful.

Adult↗
PubMed2002

Organizational predictors of adherence to ambulatory care screening guidelines.

OBJECTIVE: The purpose of this study was to identify hospital organizational characteristics consistently associated with adherence to multiple clinical practice guidelines (CPGs). We examined the relationship between organizational and patient population characteristics and adherence to three screening CPGs implemented throughout the Veterans Health Administration (VHA). MATERIALS AND METHODS: The study included 114 acute care facilities. Three sources of data were used: 1998 American Hospital Association data, VHA External Peer Review Program data for 1998 and 1999, and the 1999 Veterans Satisfaction Survey. Organizational characteristics likely to affect adherence with the CPGs were classified into five conceptual domains (clinical emphasis, operational capacity, patient population, professionalism, and urbanicity). Organizational characteristics were ranked, based on their standardized beta coefficients in bivariate logistic regressions predicting the likelihood of adherence. Within-domain multivariable logistic analyses assessed the robustness of individual predictors of CPG adherence, controlling for other organizational factors within the same domain. RESULTS: Overall, 46 of 48 relationships in the bivariate logistic analyses were significant, and 43 of these remained significant in the within-domain multivariate analyses. The relative rankings of the variables as predictors of CPG adherence within conceptual domains were also quite consistent. CONCLUSIONS: Strong evidence was found for the importance of specific organizational factors, including mission, capacity, professionalism, and patient population characteristics that influence CPG adherence in a large multi-institutional sample involving multiple provider practices. Research and programs to improve adherence to CPGs and other quality improvement activities in hospitals should incorporate these organizational factors.

Alcoholism↗
PubMed2002

Barriers and facilitators in nursing home intervention research.

Conducting intervention research in nursing home (NH) settings is particularly challenging because of the advanced age and frailty of the participants and the characteristics of the setting itself. The purpose of this project was to better understand the barriers and facilitators to the research process in NHs. Three primary data sources were used: investigator field notes, guided interviews with the research team and NH staff members, and research assistant (RA) e-mail communications. Data were analyzed using qualitative content and matrix analytic techniques. Barriers to the research process were largely congruent with previously identified NH staff characteristics, such as lack of communication between NH staff and the research team ineffective nursing leadership, decreased staff-to-resident ratios, and high turnover of NH staff. Research facilitators emerged in two overlapping areas, intraresearch team issues such as the flexibility and compatibility of the RAs, effective NH staff-to-research team communication, and the presence of an effective nurse leader in the NH.

Clinical Nursing Research↗
PubMed2002

Cross-cultural health education: materials on the World Wide Web.

Language differences between health providers and consumers create a central barrier to the delivery of health education. This article presents the results of an analysis of more than 75 bi/multilingual health sites available on the Internet. The review criteria and a summary of the key features of the best sites are presented. Limitations common to most sites are identified. Recommendations and caveats in the use of bilingual health information sites are introduced.

Computer User Training↗